Das Symptom Schwindel im Fokus der Psychiatrie

Das Symptom Schwindel wird in der klinischen Praxis organisch meist regelrecht durch die zuständige Fachrichtung abgeklärt. Ein möglicher psychiatrischer Impact im Symptom Schwindel wird oft übersehen und somit vernachlässigt. Die Folge ist ein Persistieren und Chronifizieren einer Symptomatik, die unter dem Namen phobischer Schwindel bekannt ist. Neuere Begriffe wie die somatische Symptomstörung des DSM‑5 und der heute stigmatisierende Begriff des somatoformen Schwindels werden in diesem Fallbericht klinisch und theoretisch umrissen. Sofern der phobische Schwindel richtig diagnostiziert wird, kann im Rahmen eines Gesamtbehandlungsplanes unter Einbeziehen von Physiotherapie, dem Erlernen von Angstbewältigungsstrategien und adäquater Aufklärung und Information des Betroffenen konkret an Beschwerden gearbeitet werden. Voraussetzung dafür ist ein interdisziplinäres Denken beim behandelnden Arzt. Im Fallbericht geht es um einen älteren Patienten, der neben schwerwiegenden körperlichen Ursachen für Schwindelsymptome letztlich einen phobischen Schwindel bietet, der nach der richtigen Diagnosestellung umfassend behandelt werden kann.     

Fifty Years of Prison Suicide in Austria: Does Legislation Have an Impact?

The absolute and relative frequency of suicides in jails and prisons in Austria over the 50 years from 1947 to 1996 is described. Important legislational changes regarding the criminal justice system are discussed with regard to possible consequences for the incidence of prisoners' suicides. Within the five decades a significant increase in the absolute numbers of jail and prison suicides was evident in spite of the considerable decrease in the total inmate population. Therefore, the suicide rate of inmates of correctional facilities increased significantly. Possible reasons for this phenomenon are discussed in relation to changes of the criminal law.     

Eine erfolgreiche Behandlunsgkette bei Zwangsstörung

Obsessive-compulsive disorder (OCD) belongs to a group of disorders with an estimated lifetime prevalence of 2?%, associated with a high socio-economic burden and the risk of chronification. In the latest version of the DSM-5, OCDs were detached from the chapter of anxiety disorders, similar to the ICD-10. Consequently, the fifth revision of the DSM highlights the fact that scientific results so far, like the overactivation of basal-ganglia thalamocortical circuits, basically support a common model for OCDs. Although in the past, OCDs have been ignored as a diagnostic entity, in the DSM-5, the concept of obsessive–compulsive spectrum disorders according to Hollander was partly realized. The present case report outlines an example of a successful therapeutic chain in the treatment of a severe case of OCD with a 90?% reduction of symptoms throughout a calendar-year, emphazising the importance of efficient treatment chains within psychiatric disorders.     

Applicability of two violence risk assessment tools in a psychiatric prison hospital population

The risk of violent behavior is known to be higher for patients who suffer from a severe mental disorder. However, specific prediction tools for clinical work in prison psychiatry are lacking. In this single-center study, two violence risk assessment tools (Forensic Psychiatry and Violence Tool, “FoVOx,” and Mental Illness and Violence Tool, “OxMIV”) were applied to a prison hospital population with a primary psychotic or bipolar disorder and subsequently compared. The required information on all items of both tools was obtained retrospectively for a total of 339 patients by evaluation of available patient files. We obtained the median and inter-quartile range for both FoVOx and OxMIV, and their rank correlation coefficient along with 95% confidence intervals (CIs)—for the full cohort, as well as for cohort subgroups. The two risk assessment tools were strongly positively correlated (Spearman correlation = 0.83; 95% CI = 0.80–0.86). Such a high correlation was independent of nationality, country of origin, type of detention, schizophrenia-spectrum disorder, previous violent crime and alcohol use disorder, where correlations were above 0.8. A lower correlation was seen with patients who were 30 years old or more, married, with affective disorder and with self-harm behavior, and also in patients without aggressive behavior and without drug use disorder. Both risk assessment tools are applicable as an adjunct to clinical decision making in prison psychiatry.     

Das Messie-Syndrom

Messie ist abgeleitet von mess (englisch für Chaos, Unordnung). Betroffene, die als Messies bezeichnet werden, leiden darunter insbesondere im privaten Bereich keine zeitliche und / oder r?umliche Ordnung herstellen oder halten zu k?nnen. Eine eindeutige diagnostische Zuordnung ist bis jetzt nicht m?glich. Je nach Auspr?gungsgrad und Leidensdruck kommen verschiedene therapeutische Ma?nahmen zur Anwendung: Hilfestellung, Coaching, Selbsthilfegruppen, Psychotherapie (kognitive Verhaltenstherapie) und medikament?se Therapie (selektive Serotonin-Wiederaufnahmehemmer).     

Psychopharmakotherapie der Essstörungen

Es gibt eine Reihe von Studien zur Pharmakotherapie der Essst?rungen. Empfehlungen für die pharmakologische Behandlung von Essst?rungen (Anorexia nervosa (AN), Bulimia nervosa (BN), Binge Eating Disorder (BED)), basierend auf der verfügbaren Literatur, werden vorgestellt: Für AN gibt es Hinweise, dass eine ,,Zinksupplementierung“ oder der Einsatz von atypischen Antipsychotika hilfreich sein kann. Für BN zeigen die Studien positive Ergebnisse hinsichtlich des Einsatzes von Antidepressiva, insbesondere für Fluvoxamin und Fluoxetin. Auch für das Antiepilektum Topiramat gibt es positive Studienergebnisse. Bei BED k?nnen bestimmte Antidepressiva und Antiepileptika erfolgreich eingesetzt werden. Jedoch wird weitere Forschung für die Verbesserung der Behandlung von Essst?rungen ben?tigt. Speziell für Anorexia nervosa besteht ein Bedarf für weitere pharmakologische Behandlungsstrategien.     

Grasping the diagonal: controlling attention to illusory stimuli for action and perception

Since the pioneering work of [Aglioti, S., DeSouza, J. F., & Goodale, M. A. (1995). Size-contrast illusions deceive the eye but not the hand. Current Biology, 5(6), 679-685] visual illusions have been used to provide evidence for the functional division of labour within the visual system-one system for conscious perception and the other system for unconscious guidance of action. However, these studies were criticised for attentional mismatch between action and perception conditions and for the fact that grip size is not determined by the size of an object but also by surrounding obstacles. Stoettinger and Perner [Stoettinger, E., & Perner, J., (2006). Dissociating size representations for action and for conscious judgment: Grasping visual illusions without apparent obstacles. Consciousness and Cognition, 15, 269-284] used the diagonal illusion controlling for the influence of surrounding features on grip size and bimanual grasping to rule out attentional mismatch. Unfortunately, the latter objective was not fully achieved. In the present study, attentional mismatch was avoided by using only the dominant hand for action and for indicating perceived size. Results support the division of labour: Grip aperture follows actual size independent of illusory effects, while finger-thumb span indications of perceived length are clearly influenced by the illusion.     

Theorie und Praxis der Angstbewältigung

Anxiety disorders are among the more common psychological disorders and show a high level of comorbity with other psychiatric disorders. The lifetime prevalence is 15%; women are twice as likely to be effected twice as men. There is a tight correlation between patient age and the type of anxiety disorder. Social phobias arise as early as puberty. Panic disorders are viewed as disorders of late adolescence and early adulthood. It is not uncommon for generalized anxiety disorders to first arise beyond the age of 40. Many patients don’t just have one, but often also an additional phobia. Withdrawal and avoidant behavior play important roles in the chronification of anxiety disorders and reduction in the level of psychosocial functioning. These dysfunctional coping strategies only help patients to reduce their anxiety in the short term; avoidant behavior and the consequent psychological problems serve to increase the level of anxiety in the long term. Outpatient therapy is often inadequate in the case of severe anxiety disorders. However, a hospital stay can be avoided in the therapeutic setting of a day care clinic. The special aspect of a day care clinic is the combination of treatment and everyday life situations. The patient is able to perceive himself in the most divergent therapeutic situations, while simultaneously maintaining contact with family, his social environment, his problems and the demands of life.