Petra Dykierek’s research while affiliated with University Medical Center Freiburg and other places

Die Interpersonelle Psychotherapie (IPT) ist eine evidenzbasierte, semistrukturierte Kurzeittherapie zur Behandlung von Depressionen, für die auch eine Modifikation für ältere Depressive zur Verfügung steht. Anhand einer Kasuistik wird das therapeutische Vorgehen in den drei Behandlungsphasen erläutert; typische Problemfelder älterer depressiver Menschen (z. B. medizinische Begleiterkrankungen, überwertige Sorgen und Ängste) finden dabei eine besondere Berücksichtigung.

Der demografische Wandel rückt die Gesundheitsversorgung älterer Menschen immer weiter in den Fokus. Auch in der Psychotherapie ist es notwendig, bestehende Konzepte an Ältere anzupassen, um deren spezifischen Bedürfnissen gerecht zu werden. Gerade für die häufige Komorbidität von Depression und Substanzmissbrauch im Alter existieren bislang keine einheitlichen Therapiekonzepte, und auch die Psychotherapieforschung auf diesem Gebiet bietet noch wenig Anhaltspunkte. In diesem Kapitel wird sowohl die aktuelle Forschungslage zusammengefasst sowie – abgeleitet aus der Interpersonellen Psychotherapie – ein möglicher Behandlungsansatz für Depression und komorbiden Substanzmissbrauch bei Älteren für das stationäre sowie das ambulante Setting beschrieben.

Background Hashimoto’s encephalopathy (HE) is a rare immunological neuropsychiatric disorder characterized by increased antithyroid antibodies and mixed neurological and psychiatric symptoms. HE has been previously discussed as a differential diagnosis for rapid progressive dementia. However, most of these patients suffered from additional neurological symptoms, like ataxia or seizures. Case presentation Here, we present the case of a 59-year-old female patient suffering rapid onset dementia with salient frontal executive dysfunction. She developed rapid onset symptoms, including apathy, verbal depletion up to a stuporous state, severe working memory deficits, evidence of primitive reflexes, disturbed Luria’s three-step test, and micturition disorder. Analysis of her cerebrospinal fluid was normal. The serum analyses showed increased antithyroid (antithyroid peroxidase and antithyroglobulin) antibodies. In the cerebral magnetic resonance imaging, supratentorial deep and peripheral white matter lesions were found; the electroencephalography showed intermittent slowing, and the [¹⁸F]fluorodeoxyglucose positron emission tomography (FDG-PET) depicted medial and superior dorsolateral frontal hypometabolism. Several different psychopharmacological therapeutic approaches with various neuroleptics, antidepressants, and high doses of lorazepam were unsuccessful. Due to the organic alterations, including increased antithyroid antibodies, HE was suspected. Against expectations, treatment with high-dose corticosteroids proved to be ineffective and was associated with worsening symptoms. However, escalated treatment with plasmapheresis over 5 days led to significant improvement in all reported symptoms and in psychometric testing. The neuropsychological improvement was stable over a 6-month follow-up period, and the FDG-PET normalized. Conclusion This case report reveals that (1) HE can mimic rapid onset dementia with predominantly frontal dysfunction; (2) this syndrome can be successfully treated in the context of HE; and (3) plasmapheresis can be effective in such a disease constellation. The detection of the immunological causes of rapid onset dementia and other psychiatric syndromes is important because it opens opportunities for new, innovative immunosuppressive treatment options.

Background: This article focusses on the possibilities, varieties, indications, and benefits of psychotherapy with elderly patients. Objective: Which basic principles can be differentiated, what theoretical rationales are helpful for psychotherapy with the elderly and what kind and forms of psychotherapy are available? Material and methods: Based on relevant references and research, clinically relevant and evidence-based psychotherapies are described, to understand the theoretical rationale, the goals, the procedure and main strategies. Results: Cognitive behavior therapy, problem solving therapy, life review therapy, interpersonal psychotherapy, and psychodynamic psychotherapy are available to treat various psychological and somatic problems in elderly patients. In particular, cognitive behavior therapy, problem solving therapy, and life review therapy are evidence-based and empirically validated. Evidence for interpersonal psychotherapy is mixed and for psychodynamic psychotherapy is missing. Conclusion: Psychotherapy with old and very old patients is possible, well received, and successful. Age per se is no longer considered to be a relevant variable for indications of psychotherapy.

Fragestellung: Ist bei älteren Menschen mit komplizierter Trauer trauerspezifische Psychotherapie (Complicated Grief Treatment, CGT) wirksamer als interpersonelle Psychotherapie (IPT)?Hintergrund: Verwitwung oder der Verlust von engen Bindungspersonen erhöht das Risiko von „komplizierter Trauer“, einem Muster psychischer Folgebeschwerden, die das psychosoziale Funktionsniveau und die physische Gesundheit der Betroffenen gravierend beeinträchtigen sowie das Suizidrisiko erhöhen. Bei Personen mittleren Alters wurde gezeigt, dass Trauersymptome weniger gut auf IPT ansprechen und eine Kombination aus Expositionsverfahren, IPT und motivierender Gesprächsführung erfolgversprechender ist. Eine Replikation dieser Ergebnisse wäre für den geriatrischen Bereich sehr interessant, da gegenüber Expositionstechniken im Alter Vorbehalte bestehen oder diese wegen der häufigen depressiven Symptomatik nicht erwogen werden.Patienten und Methodik: Im Rahmen einer randomiserten kontrollierten Studie wurden ...

Das Wissen um ToM-Leistungen bei Depressionen ist als begrenzt einzuschätzen, da sich die Forschung bisher auf psychiatrische Krankheitsbilder konzentrierte, die mit erheblichen Störungen der Person-Umwelt-Interaktion einhergehen (wie z. B. schizophrene Erkrankungen, Autismus). In der Literatur finden sich nur wenige Publikationen, die sich mit ToM bei affektiven Störungen befassen – und wenn, dann mit eingeschränkter methodischer Qualität. In Anbetracht der Phänomenologie der Depression ist dies erstaunlich. Das Hauptsymptom einer major depression besteht in depressiver Verstimmung und/oder im Verlust von Interesse oder Spaß an nahezu allen Tätigkeiten, die dem Betroffenen sonst Freude bereitet hätten. Hinzu kommt eine Vielzahl von Symptomen auf anderen Ebenen, z. B.

Discrepancies between scores on the Hamilton Depression Rating Scale (HAMD) and the Beck Depression Inventory (BDI), as well as differences regarding their sensitivity to detect change, have been reported. This study investigates discrepancies and their potential prediction on the basis of demographic, personality, and clinical factors in depressed inpatients and analyzes the sensitivity to change. The HAMD and the BDI were administered to 105 inpatients with major depressive disorder randomized to 5weeks of either interpersonal psychotherapy or clinical management. Personality was assessed with the NEO Five-Factor Inventory. Low extraversion and high neuroticism were associated with relatively higher endorsement of depressive symptoms on the BDI compared with the HAMD. The HAMD presented a greater reduction of symptom scores than the BDI. Patients with high BDI scores, high HAMD scores or both revealed the greatest change, possibly due to a statistical effect of regression to the mean. Restricted by sample size, analyses were not differentiated by treatment condition. Regression to the mean cannot be tested directly, but it might be considered as a possible explanation. The HAMD and the BDI should be regarded as two complementary rather than redundant or competing instruments as the discrepancy is associated with personality characteristics. Attributing large effect sizes solely to effective treatment and a sensitive measure may be misleading.

Background: There is a lack of research about the extent to which common factors influence the effectiveness of psychotherapies in the treatment of chronic depression: Which common factors differentiate between successful and less-successful psychotherapies in chronically depressed patients? Patients and Methods: Using the Bern Post Session Report (BPSR) for patients and therapists, the common factors in the treatment of 29 chronically depressed patients have been evaluated during the 16- week treatment with either the Cognitive Behavioral Analysis System of Psychotherapy (CBASP) or with Interpersonal Psychotherapy (IPT). The primary efficacy outcome measure was the score on the 24-item Hamilton Rating Scale for Depression (HRSD-24). Results: Significant differences were found on the patient-rated subscales ‘clarification’ (p = 0.02) and ‘mastery’ (p = 0.01) when comparing successful with less-successful (response defined as a 50% reduction in HRSD-24 score) therapies. However, analysis of variance showed no significant difference in common factors between CBASP and IPT therapies. Discussion: Independent of the therapeutic approach, the impact of the common efficacy factors clarification and mastery for successful treatment of chronically depressed patients has been confirmed.