[Show abstract][Hide abstract] ABSTRACT: Die Zwangsstög ist die vierthäufigste psychiatrische Erkrankung. Unbehandelt nimmt sie einen chronischen Verlauf. Vor allem durch die Weiterentwicklung verhaltenstherapeutischer und pharmakotherapeutischer Behandlungsstrategien hat sich das prognostische Bild um vieles verbessert. Die Verhaltenstherapie gilt heute als Therapie der Wahl, sowohl hinsichtlich einer Symptomtherapie als auch hinsichtlich einer Ursachentherapie. Anwendung findet Verhaltenstherapie im Gruppen- und im Einzelsetting. Eine zusätzliche Pharmakotherapie sollte im Einzelfall überlegt werden.
[Show abstract][Hide abstract] ABSTRACT: The present study evaluates a central hypothesis of synergetic psychotherapy research according to which a marked instability in the psychotherapeutic process is associated with high response rates.
14 patients with obsessive-compulsive disorder (OCD) completed an eight-week in-patient course of multimodal behavior therapy with exposure exercises. The instability during the course of the therapy was recorded by daily selfassessment by the patient using the Synergetic Navigation System (SNS), an Internet-based real-time monitoring procedure.
There was a negative correlation between the degree of the instability and the percentage reduction in the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) (r = -0.395; P = 0.199), the "Global Severity Index" (GSI) of the symptom check-list (SCL-90-R) (r = -0.718; P = 0.013), the scale value for obsessive-compulsiveness in the SCL-90-R (r = -0.782; P = 0.004) and the remaining sub-scales of this data-gathering instrument.
An unstable progress of the psychotherapy causes a smaller reduction in symptoms than a stable one. The contradiction relative to the study hypothesis is possibly based on the special features of OCD, with a high level of patient insecurity when anticipating new, non-obsessive-compulsive ways of thought and behavior. The relationships between instability and reduction in symptoms appear to be diagnosisspecific.
No preview · Article · Apr 2012 · Neuropsychiatrie: Klinik, Diagnostik, Therapie und Rehabilitation: Organ der Gesellschaft Österreichischer Nervenärzte und Psychiater
[Show abstract][Hide abstract] ABSTRACT: Several electronically assisted monitoring and feedback systems have been developed in the context of psychotherapy research. The purpose of this paper is to present three methods that differ mainly in their ways of observing the progress of therapy at closely-spaced time intervals, in their scope of functionalities and in their theoretical background: the handheld-based Outcome Questionnaire-45 (OQ-45) completed weekly is presented first. Of all the available monitoring and feedback systems, this is the one whose effectiveness has been studied and published most comprehensively. The most important results of these studies are explained and discussed with regard to their positive effects on the outcome of the psychotherapy and on the duration of therapy. Next the Internet-based Synergetic Navigation System (SNS) is examined, taking as an example a Therapy Process Questionnaire (TPQ) which is based on the theory of synergetics, the self-organization of non-linear systems, and evaluates the progress of therapy daily via the patient's self-assessment. The extensive time series analyses available through the use of the SNS are presented. In conclusion, information is given about those points that currently still stand in the way of implementing monitoring and feedback systems in routine psychotherapeutic care, and future research strategies are also indicated.
No preview · Article · Dec 2010 · Psychotherapie Forum
[Show abstract][Hide abstract] ABSTRACT: 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 räumliche Ordnung herstellen oder halten zu können. Eine eindeutige diagnostische Zuordnung ist bis jetzt nicht möglich. Je nach Ausprägungsgrad und Leidensdruck kommen verschiedene therapeutische Maßnahmen zur Anwendung: Hilfestellung, Coaching, Selbsthilfegruppen, Psychotherapie (kognitive Verhaltenstherapie) und medikamentöse Therapie (selektive Serotonin-Wiederaufnahmehemmer).
[Show abstract][Hide abstract] ABSTRACT: This article discusses diagnostic features of social phobia, social skills and (anxious) avoidant personality disorder, and gives an overview on principles of cognitive behaviour therapy strategies used in social anxiety patients. Motivation to change and the therapeutic relationship are important issues to be worked on at the beginning and throughout therapy. Functional analysis focuses on interactional and systemic features. Three specific programmes dealing with anxiety management, social skills training and relaxation techniques are presented (Gruppentraining sozialer Kompetenzen, Hinsch und Pfingsten (2007); Soziale Phobien, ein kognitiv-verhaltenstherapeutisches Behandlungsmanual, Stangier et al. (2003) und Soziales Kompetenztraining, Gruppentherapie bei sozialen Angsten und Defiziten, Alsleben und Hand (2006)).
No preview · Article · Dec 2009 · Psychiatria Danubina
[Show abstract][Hide abstract] ABSTRACT: In dem vorliegenden Einzelfallbericht wird eine internetbasierte Methode des Monitorings psychotherapeutischer Veränderungsprozesse,
das Synergetic Navigation System (SNS), an einem 23-jährigen männlichen Patienten mit der Diagnose einer Zwangsstörung untersucht,
der im Rahmen einer siebenwöchigen stationären Verhaltenstherapie täglich einen 46-Items umfassenden Fragebogen mittels SNS
ausgefüllt hat. Es kann aufgezeigt werden, dass durch die SNS-Zeitreihenanalyse der gesamte Therapieverlauf online gut abgebildet
werden kann und Phasen erfasst werden können (Phasen kritischer Instabilität), welche die Voraussetzung für eine langfristige
The present case report examines an Internet-based therapy process monitoring method, the Synergetic Navigation System (SNS),
in the case of a 23-year-old male patient diagnosed as having an obsessive-compulsive disorder, subtype washing/contamination
fear, who used the SNS to complete a questionnaire comprising 46 items daily during a seven-week in-patient behavioural therapy.
It could be shown that using the time-series analysis methods implemented in the SNS enables a good portrayal of the entire
therapy process online, and it is possible to record the phases (phases of critical instability) which are in the long term
a pre-condition for a positive outcome of the therapy with a reduced symptom burden.
No preview · Article · Oct 2009 · Psychiatrie und Psychotherapie
[Show abstract][Hide abstract] ABSTRACT: Der Begriff „Messie-Syndrom“ hat in den letzten Jahren zunehmende Verbreitung erfahren. Der zwanghafte Charakter des „Messie-Syndroms“
hat dazu geführt, dass das Syndrom schon früh mit Zwangssymptomen in Verbindung gebracht wurde. An der Spezialambulanz für
Zwangsstörungen an der Universitätsklinik für Psychiatrie und Psychotherapie der Medizinischen Universität Wien haben sich
in den letzten Jahren daher zunehmend Menschen mit Sammelzwängen vorgestellt, die unter einem „Messie-Syndrom“ leiden. Das
„Messie-Syndrom“ ist aber sicher nicht zur Gänze als Zwangsstörung zu verstehen. Eine Reihe von psychiatrischen Erkrankungen
können dem „Messie-Syndrom“ zugrunde liegen, die sich über beinahe das gesamte Diagnosenspektrum des ICD-10 (WHO 1994) erstrecken
(Tabelle 1). Für den Therapeuten ist die Diagnostik der entsprechenden Grunderkrankung notwendig, um die geeigneten therapeutischen
Schritte einleiten zu können. Der „Sammlertrieb“ kann als „Urtrieb“ der Jäger und Sammler verstanden werden. Im Sammeln steckt
ein Dominanzbedürfnis („Besitzen wollen“, „Beherrschen wollen“), aber auch ein Ausweichverhalten mit Rückzug und Beschäftigung
mit Gegenständen. Sammeln kann eine Kompensation unerfüllter sozialer Wünsche nach Anerkennung oder Bewunderung sein. Auch
als „Ersatzbefriedigung“ zur Kompensation unerfüllter sexueller Wünsche kann es dienen.
[Show abstract][Hide abstract] ABSTRACT: Numerous findings indicate alterations in brain serotonin systems in obsessive-compulsive disorder (OCD). We investigated the in vivo availability of thalamus-hypothalamus serotonin transporters (SERT) in patients with DSM-IV OCD who displayed prominent behavioral checking compulsions (OC-checkers). Four hours after injection of [(123)I]-2beta-carbomethoxy-3beta-(4-iodophenyl)tropane ([(123)I]-beta-CIT), single photon emission computed tomography (SPECT) scans were performed in 24 medication-free non-depressed OC-checkers and 24 age- and gender-matched healthy controls. For quantification of brain serotonin transporter availability, a ratio of specific to non-displaceable [(123)I]-beta-CIT brain binding was used (V''(3)=(thalamus and hypothalamus-cerebellum)/cerebellum). Drug-free non-depressed OC-checkers showed an 18% reduced brain serotonin transporter availability in the thalamus and hypothalamus, as compared with healthy control subjects (1.38+/-0.19 vs 1.69+/-0.21; p<0.001). There was a strong negative correlation between severity of OC symptomatology (Y-BOCS scores) and SERT availability (r=-0.80; p<0.001). Moreover, we found a significant positive correlation between illness duration and serotonin transporter availability (r=0.43; p<0.05). This first report of significantly reduced [(123)I]-beta-CIT binding in the thalamus-hypothalamus region in OC-checkers suggests reduced brain serotonin transporter availability, which is more pronounced with increased severity of OC symptomatology and short duration of illness. The results provide direct evidence for an involvement of the serotonergic system in the pathophysiology of OCD.
No preview · Article · Aug 2007 · Neuropsychopharmacology
[Show abstract][Hide abstract] ABSTRACT: The DSM-IV provides two subtypes of obsessive-compulsive disorder (OCD), labelled as OCD with insight and OCD with poor insight. For the latter, patients generally fail to recognize that the obsessions or compulsions are excessive or unreasonable. Several studies have shown significant brain abnormalities in OCD patients. However, at present, it remains unclear whether a specific pattern of structural brain abnormalities is related to poor insight in OCD. In the present study, magnetic resonance imaging (MRI) findings were compared in OCD patients with insight versus those with poor insight. Outpatients with diagnoses of OCD according to DSM-IV (300.30) and ICD-10 (F42) (n = 84; mean age 38+/-13; 35 females, 49 males) were dichotomized into the two subtypes. All subjects underwent an MRI examination. MRI findings were rated as "MRI abnormality" and "normal MRI." In our sample, 48% of the patients had MRI abnormalities. There was a highly significant difference between the two groups according to frequencies of MRI abnormalities, with 83% of the patients with poor insight showing MRI abnormalities compared with only 21% of the patients with insight. The specifier "poor insight" helps to identify a subgroup of OCD with a higher frequency of brain abnormalities of various types. This distinction should be taken into account in future studies concerning the course and therapeutic outcome of OCD.
No preview · Article · Dec 2005 · Psychiatry Research
[Show abstract][Hide abstract] ABSTRACT: Behavioural Group Therapy for Obsessive-Compulsive DisorderIntroduction: The effectiveness of a behavioural group therapy programme over 10 double sessions for patients with obsessive-compulsive disorder (OCD) is evaluated. This out-patient group treatment programme provides education about OCD, instruction in a cognitive behavioural approach to self-treatment, guided behavioural treatment and additional multiple family groups. The group therapy (GRU) is compared with a pure medical treatment (MED) and a combined treatment (GRU/MED). Patients and Methods: For evaluation 155 patients (GRU: 45; MED: 55; GRU/MED: 5) were investigated pre (t1) and post (t2) treatment. The groups did not differ significantly pre-treatment regarding Y-BOCS scores and the duration of disorder. The groups differed according to age, depressive symptoms (Beck Depression Inventory) and psychosocial disability regarding work. Results: All groups showed a significant improvement of clinical pathology (Y-BOCS t1: 25.8 ± 4.9; t2 19,3 ± 7,8; p < 0.001), especially patients who received the group therapy or the combined treatment improved well (GRU t1: 25 ± 5.4; t2: 16.7 ± 8.9; GRU/MED t1: 25.6 ± 5.3, t2: 16.7 ± 7.09) compared to the purely medically treated group (MED t1: 26.4 ± 4; t2: 23.5 ± 5.9). Discussion: Results show that behavioural group therapy with multiple family groups is an effective therapy option for patients with OCD.
No preview · Article · Apr 2004 · Verhaltenstherapie
[Show abstract][Hide abstract] ABSTRACT: Embarrassability refers to an individual's general susceptibility to becoming embarrassed and is closely linked to another personality characteristic known as fear of negative evaluation. To find out if panic disorder patients with and without agoraphobia differ in terms of embarrassability and fear of negative evaluation 100 patients with a DSM-III-R diagnosis of panic disorder with agoraphobia, 30 patients with a DSM-III-R diagnosis of uncomplicated panic disorder and 80 controls were administered the Embarrassability Scale and the 12-item version of the Fear of Negative Evaluation Scale. Depressive mood in the clinical group was assessed with the help of the Beck Depression Inventory. Comparisons between these three groups, between patients with mild, moderate, and severe phobic avoidance and between male and female subjects were carried out. Patients with agoraphobic avoidance showed significantly higher scores on both scales than patients with uncomplicated panic disorder and controls and women generally showed higher embarrassability scores than men. We conclude that heightened embarrassability is an important characteristic of patients suffering from panic disorder with agoraphobia.
No preview · Article · Sep 2003 · Journal of Behavior Therapy and Experimental Psychiatry
[Show abstract][Hide abstract] ABSTRACT: Neuropsychological testing provides increasing evidence that certain memory deficits might play an essential role in the emergence of doubts and, as a result, in perpetuating checkers' rituals. Another account of doubting implicates meta-cognitive factors, such as confidence in memory. The present study examined mnestic functioning and self-perception of memory ability in a group of 27 nondepressed patients with obsessive-compulsive disorder (OCD) and 27 normal controls. All patients met DSM-IV and ICD-10 criteria for OCD, displayed prominent behavioral checking rituals and had to show a score on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) of at least 16. Significant deficits in intermediate (Lern- und Gedächtnistest; LGT-3) and immediate (Corsi Block-Tapping Test) nonverbal memory were identified in the patients with OCD compared to normal controls. Contrary to predictions, OCD patients also showed a significant deficit in general memory and verbal memory (LGT-3). With respect to meta-cognition, OCD patients reported less confidence in their memories than controls. These findings suggest that obsessional doubt reflects a deficit in memory as well as a deficit in memory confidence. Depending on which dysfunction predominates, different therapeutic procedures seem to be required.
[Show abstract][Hide abstract] ABSTRACT: Thirty-seven patients with depression and anxiety disorder, who participated in an intensive inpatient cognitive behaviour therapy program for 6 weeks, were interviewed before treatment and 6 weeks after the end of treatment; in addition to other measures, quality of life was assessed with the Berlin Quality of Life Profile. Substantial reduction in subjective quality of life, objective functioning and environmental assets was found at baseline. At follow-up, according to clinical global impression, 13.5% of the patients were very much improved, 45.9% much improved; in 26.3% only slight improvement and in 16.2% no improvement was reported. Quality of life changed for the better in areas like work and education, leisure, housing, social relations, psychological well-being and a global rating of satisfaction with life, but not in marital relations, health in general and in finances.
[Show abstract][Hide abstract] ABSTRACT: Seventy-four patients who met DSM-III-R criteria for obsessive compulsive disorder (OCD) were studied in a prospective follow-up study in order to investigate course and prognosis of OCD with or without comorbid depressive symptomatology. Subjects were examined three times: at admission (baseline), 6 months later (follow-up 1) and 12 months after follow-up 1 (follow-up 2). At admission, 51 (72.9%) OCD patients were assessed as depressive by the Hamilton Depression Scale score. Between admission and follow-up 1, all patients received behavior therapy and a serotonin reuptake inhibitor, between follow-up 1 and follow-up 2 they received different kinds of treatment in order to maximize therapeutic effects. A 25 % Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score reduction from admission to follow-up 2 and in addition, a total Y-BOCS score of below 16 at follow-up 2 was defined as ‘good prognosis course’. The results obtained showed that OCD patients who followed a good prognosis course, showed no significant depressive symptomatology at follow-up 2 (p = 0.001). These results imply that patients with a diagnosis of OCD may present depression at admission and/or follow-up 1; however, if OC symptomatology decreases longitudinally, depressive symptoms disappear too. We may assume that OCD is dominant over depression, and it seems that a comorbid depression does not have any major influence on the prognosis of OCD.
[Show abstract][Hide abstract] ABSTRACT: Seventy-four patients who met DSM-III-R criteria for obsessive compulsive disorder (OCD) were studied in a prospective follow-up study in order to investigate course and prognosis of OCD with or without comorbid depressive symptomatology. Subjects were examined three times: at admission (baseline), 6 months later (follow-up 1) and 12 months after follow-up 1 (follow-up 2). At admission, 51 (72.9%) OCD patients were assessed as depressive by the Hamilton Depression Scale score. Between admission and follow-up 1, all patients received behavior therapy and a serotonin reuptake inhibitor, between follow-up 1 and follow-up 2 they received different kinds of treatment in order to maximize therapeutic effects. A 25% Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score reduction from admission to follow-up 2 and in addition, a total Y-BOCS score of below 16 at follow-up 2 was defined as 'good prognosis course'. The results obtained showed that OCD patients who followed a good prognosis course, showed no significant depressive symptomatology at follow-up 2 (p = 0.001). These results imply that patients with a diagnosis of OCD may present depression at admission and/or follow-up 1; however, if OC symptomatology decreases longitudinally, depressive symptoms disappear too. We may assume that OCD is dominant over depression, and it seems that a comorbid depression does not have any major influence on the prognosis of OCD.
[Show abstract][Hide abstract] ABSTRACT: 1.1. Seventy-four patients who met DSM-III-R criteria for Obsessive Compulsive Disorder received a serotonin reuptake inhibitor and cognitive behavior therapy for 6 months (baseline to follow-up I).2.2. In order to maximize therapeutic effects, different kinds of treatment were applied between followup I and follow-up II (12 months).3.3. Patients were followed-up twice with respect to long-term outcome of obsessive compulsive disorder and depression. Forty % of the sample showed marked improvement at follow-up. No specific variant of treatment could be identified to be significantly more effective.4.4. Cross-sectional investigations showed significant correlations between extent of depressive and obsessive compulsive symptomatology ( admission, follow-up I and II).
No preview · Article · Jul 1996 · Progress in Neuro-Psychopharmacology and Biological Psychiatry