Inanspruchnahme eines psychoedukativen Gruppenangebotes für Angehörige von Patienten mit affektiven Störungen

The relevance of family interactions in the course of affective disorders has been well described. In contrast to the situation regarding schizophrenic disorders, there are few systematic concepts for involvement of the relatives of patients with affective disorders in treatment. The goal of this study was the development and evaluation of a standardised psychoeducational treatment programme. We determined the number and characteristics of relatives accepting the offer of such a group. Relatives of almost half of 55 patients with major depression and a bipolar disorder participated in the group. Relatives of male patients were more likely to take part than relatives of female patients. Relatives of patients with a bipolar disorder were more likely to take part than relatives of patients with unipolar depression. The patients whose relatives attended the group showed a more favourable understanding of the illness and more knowledge about affective disorders, but on the other hand, felt themselves to be more strongly criticised by their relatives and had less social support than the other patients. These results emphasise the importance of differential family-focused treatment modalities in affective disorders.     

Psychotherapeutische Ans?tze für Patienten mit somatoformen St?rungen

Patients with somatoform symptoms are considered to be difficult to treat. Clinical studies on treatment of this condition are underrepresented compared to other mental and psychosomatic disorders. Cognitive-behavioral treatment for patients with somatoform symptoms was found to have a significant effect; additionally, some evidence of recently published findings supports psychodynamic therapy. This report provides information on how to effectively deal with those patients. Furthermore it describes transtherapeutic targets and explains three therapeutic phases: establishing a therapeutic relationship, developing a model of the disorder and establishing coping strategies. As a last point a cognitive-behavioral treatment study, a psychodynamically-oriented study, a group intervention study and a new approach, a combination of cognitive-behavioral therapy and emotion regulation training, are presented.     

Interaktionales Therapieprogramm für Mütter mit postpartalen psychischen Störungen

BACKGROUND: The period around delivery frequently causes psychiatric diseases that may disturb maternal competence and influence bonding behaviour with the child. Until now only a few possibilities have existed for inpatient treatment and therapy for these problems. The therapy program developed in Wiesloch, Germany, is especially well suited to such patients. METHODS: Fifty-three mothers with postpartum disorders (33 depressive, 20 psychotic) were examined before and after therapy. Psychopathologic severity, psychosocial level of functioning, and parameters of the mother-child interaction were assessed and compared. RESULTS: Overall the results showed clear improvements in the assessed parameters at the end of treatment for both psychotic mothers and those with affective disorders. CONCLUSION: The interactional treatment program for postpartum mental disorders leads to a significant reduction in psychic/psychiatric severity and the associated psychosocial impairment and disturbed mother-child interaction. Considerations of the effects of therapy were not possible due to the study design.     

Psychotherapie bei bipolaren affektiven Störungen

Mood stabilisers show convincing evidence of relapse prevention in patients suffering from bipolar affective disorder. However, despite continuous medication the majority of patients suffer from relapses. It seems logical to apply principles of psychological intervention to bipolar patients. Elements of psychotherapy are: psychoeducation about symptoms, prodromal states, and course of illness; symptom monitoring; and influencing cognitive and behavioural strategies to improve symptomatology, social functioning, compliance, and relapse prevention. The goal of this review is to summarise the current status of controlled studies including psychological approaches to bipolar patients, to describe the efficacy of psychotherapy, and to address lack of knowledge and future trends in this clinical field. We located 461 reports about psychological interventions with bipolar patients but identified only 28 controlled and methodologically sound studies. In those studies 2294 patients were treated. Almost all (over 90%) fulfilled bipolar I criteria. All psychotherapies include psychoeducation and information about bipolar affective disorders and ask patients to self-monitor daily symptoms and other daily events. The majority of psychotherapies are cognitive-behaviorally oriented and treat patients in a one-to-one setting, but family oriented approaches and group settings were also prevalent. Studies show evidence that psychotherapy in combination with mood stabilizers improved depressive (to less extent manic) symptoms (d=0.39) and almost doubled the period of time between two episodes (d=0.71). Open questions are: indicators and predictors of successful outcome, length and intensity of treatment, essential elements of helpful intervention, long-term follow-up, and prevention of bipolar disorders in high-risk groups.     

Früh- und Basisintervention bei Patienten mit schizophrenen Störungen

THEORETICAL BACKGROUND: Of all outpatients with a diagnosis of schizophrenia, 30-40% refuse a psychiatrist's care. For this group of patients the general practitioner holds a key position for such different tasks as detection of prodromal schizophrenia or early warning signs of relapse and identification of risk variables for deteriorating outcome, gatekeeping (referral to specialists or other services), integration, and counseling of key relatives. Fifty percent of GPs are interested in disease-specific medical education programs. STUDY DESIGN AND METHODS: A control trial examined the changes that participating GPs intended to make in three main topics of the curriculum: (1) changing attitudes (pessimistic outcome expectation, low self-esteem), (2) enhancement of detection skills (prodromal schizophrenia, early warning signs of relapse, and risk factors for poor social and vocational integration), and (3) enhancement of management skills (dosing schemes, motivational interviewing). RESULTS: In the assessment 2 weeks after the training session, we found significant changes in favor of the trained group in detection and management skills and also improved self-confidence of GPs. CONCLUSIONS: Problem-oriented and case-based learning strategies should be preferred to lectures in training programs for psychiatric skills in primary care.     

Hirnstrukturelle Veränderungen bei bipolaren affektiven Störungen

The neurobiological basis of bipolar affective disorders is unknown. However, neuroanatomic circuits of mood regulation have been hypothesized. Neuroimaging revealed volumetric changes of specific brain structures in these circuits. The most prominent abnormality is enlargement of the amygdala. In addition there might be structural changes in the frontal lobe, cerebellum, and pituitary. The findings in bipolar disorder differ from those in unipolar depression and schizophrenia. For further identification of the neurobiological basis of bipolar disorders, structural neuroimaging combined with functional neuroimaging such as magnetic resonance spectroscopy, neuroendocrinological studies, and genetical analyses are required to subgroup patients with bipolar disorder by diagnostic, prognostic, and therapeutic criteria.     

Subjektives Erleben eines computergestützten kognitiven Trainings durch Patienten mit Schizophrenien

Zusammenfassung Die Behandlung kognitiver Störungen ist ein wichtiges Ziel der Schizophrenietherapie. Allerdings sind PC-gestützte kognitive Trainingsverfahren noch nicht sehr verbreitet, und es gibt Vorbehalte gegen den therapeutischen Einsatz von Computern. In einer multizentrischen Untersuchung wurde das subjektive Erleben eines computergestützten kognitiven Trainings durch 64 Patienten mit Schizophrenien erhoben. Vor und nach einem durchschnittlich 5-wöchigen Training mit dem Programm Cogpack erfolgten je ein semistrukturiertes Interview und eine Selbstbeurteilung von subjektivem Wohlbefinden (SWN) und Computerangst (CARS). Die Patienten beurteilten die Therapie auch im Vergleich zu allen anderen Behandlungsmaßnahmen sehr positiv. Ihre Erwartungen bezüglich möglicher Therapieeffekte wurden überwiegend erfüllt. Sie berichteten nicht nur über eine Verbesserung ihrer kognitiven Fertigkeiten (primärer Effekt), sondern auch über Spaß, Zunahme von Selbstvertrauen und Belastbarkeit sowie Fortschritte im Umgang mit dem Computer (sekundäre Effekte). Im Therapieverlauf kam es zur signifikanten Zunahme des subjektiven Wohlbefindens und signifikanten Abnahme der Computerangst; auch vor dem Training war diese nicht höher als in der Allgemeinbevölkerung.Folgende Kliniken bzw. Kolleginnen und Kollegen haben an der Studie mitgearbeitet:Rheinische Kliniken Bonn, Bonn (Prof. Dr. T. Held, G. Prehn)Marienhospital, Duisburg (Dr. Dr. W. Krebs, Dr. Ch. Schoppmann)Rheinische Kliniken Essen/Klinik für Psychiatrie und Psychotherapie der Universität Duisburg-Essen (Prof. Dr. M. Gastpar, Dr. S. Bender, Dr. A. Dittmann-Balcar, R. Thienel)St.-Elisabeth-Krankenhaus Niederwenigern, Hattingen (Priv.-Doz. Dr. T. Zeit, K. Heiden)Hans-Prinzhorn-Klinik, Hemer (Prof. Dr. U. Trenckmann, T. Mohr)St.-Alexius-Krankenhaus, Neuss (Prof. Dr. H. Stuckstedte, Dr. H. Steingrüber)Fliedner-Krankenhaus, Ratingen (Dr. M. Schifferdecker, Dr. G. Tymister)     

Die prämenstruelle dysphorische Störung Vorschlag zur Diagnostik eines eigenständigen affektiven Störungsbildes

In the research appendix of the Diagnostic and Statistical Manual of Mental Disorders (fourth edn.), premenstrual dysphoric disorder (PMDS) is classified as a cycle-related affective disorder. The cycle dependency of symptoms is the mean criterion for classifying this syndrome as a distinct etiological entity. These time-related criteria make special demands on diagnostic procedure, which must include retrospective and prospective elements. With our own study, we propose a three-step diagnostic process: (1) telephone screening, (2) retrospective diagnosis by a structured clinical interview, and (3) prospective diagnosis based on daily symptom ratings during two consecutive menstrual cycles. Following this procedure, the disorder could be verified in 4% of the original sample, which replicates the prevalence rate found in the literature.     

Auswirkungen einer moderaten Bewegungseinheit auf die psychische Befindlichkeit bei PatientInnen mit affektiven Störungen in stationär psychiatrischer Behandlung

Objective

To explore the effects of a single bout of exercise on psychological well-being in inpatients with affective disorder.

Methods

Thirty-four participants under hospital treatment because of affective disorder attended a supervised but self-paced 60 min Nordic Walking session. All participants completed a self-report questionnaire on psychological well-being before and after physical activity.

Results

A significant increase was found for calmness, activation and mood whereas the scales thoughtfulness, weakness, depression and arousal decreased.

Conclusions

A self-paced but supervised single Nordic Walking session seems to be effective in improving acute psychological well-being in patients with affective disorder. Positive affective components of exercise should be addressed in clinical trials focusing on anti-depressive effects and exercise maintenance in patients with affective disorders.     

Die Hamburger Schätzskala für Psychische Störungen nach Herzoperationen (HRPD)

Zusammenfassung An einer Stichprobe von 99 herzoperierten Patienten wurde zur Erfassung, Beschreibung und Klassifikation früh-postoperativer psychischer Störungen aus dem psychopathologischen Befundbogen des AMP/AMDP-Systems eine Kurzform (HRPD) entwickelt. Weitgehend mit Hilfe einer klassischen Itemanalyse wurde eine Auswahl von 36 Symptomen vorgenommen.Eine Faktorenanalyse dieser Kurzform ergab 8 Merkmalsfaktoren bzw. Syndromskalen: Desorientierung, Konzentrations-/Denkstörungen, paranoid-halluzinatorische Symptomatik, Angstsymptomatik, gehemmt-depressive Symptomatik, Hostilität, Kontrollverlust sowie Selbstaufgabe.Clusteranalytisch wurden 6 psychopathologisch verschiedene Patientengruppen gefunden: unauffällig, fast unauffällig, leichte psychoorganische Symptomatik mit Affektstörungen, schwere psychoorganische Symptomatik mit Kontrollverlust, Hostilität mit paranoid-halluzinatorischer und psychoorganischer Symptomatik, sowie delirante Symptomatik.Ein Vergleich der Ergebnisse der HRPD mit Syndrombeschreibungen anderer AMP/AMDP-Untersucher ergab zum Teil gute Übereinstimmungen, zum Ted aber auch deutliche Unterschiede, die am ehesten durch die besondere Situation herzoperierter Patienten bedingt sein dürfte.Vorform in englischer Sprache: HRPD = Hamburg Rating Scale for Psychic Disturbances