Posttraumatische Störungen bei Patienten mit Erkrankungen aus dem schizophrenen Formenkreis

Background. The findings of internation- al studies suggest high rates of interperson- al violence and posttraumatic stress disorder (PTSD) among patients with schizophrenia spectrum disorders. Only few studies, how- ever, have so far been conducted in the Ger- man-speaking countries. Objectives. The aim of our study was to determine the prevalence of lifetime experi- ences of interpersonal violence and comor- bid PTSD among inpatients in a German uni- versity hospital. Method. In N=145 consecutively admitted patients with schizophrenia spectrum disor- ders (67% male) the structured trauma in- terview (STI) was used to assess experiences of interpersonal violence and the structured clinical interview for DSM-IV (SCID) to assess comorbid PTSD. Results. Sexual violence under the age of 16 years was reported by 17% of the patients (women 27%, men 12%). Approximately one third (32%) reported physical violence by pa- rental figures (women 38%, men 29%). At least one form of early violence (sexual or physical) was reported by half of the women (48%) and one third of the men (34%). Neg- ative sexual experiences later in life were re- ported by 17%, physical violence by 38% and at least one of these forms by 48% of the pa- tients. In total two thirds of all patients (66%) reported experiences of violence during their lifetime. The prevalence of acute PTSD was 12%. Another 9% of patients had a subsyn- dromal PTSD. Conclusion. The present study confirmed the high rates of experiences of interperson- al violence and comorbid PTSD in a German sample of patients with schizophrenia spec- trum disorders. Violence and it's consequenc- es should therefore be routinely assessed and the full spectrum of trauma-specific therapies should be integrated into the treatment of this group of patients

Open Dialogue services around the world: a scoping survey exploring organizational characteristics in the implementation of the Open Dialogue approach in mental health services

ObjectiveThis cross-sectional study investigates the characteristics and practices of mental health care services implementing Open Dialogue (OD) globally.MethodsA structured questionnaire including a self-assessment scale to measure teams’ adherence to Open Dialogue principles was developed. Data were collected from OD teams in various countries. Confirmatory Composite Analysis was employed to assess the validity and reliability of the OD self-assessment measurement. Partial Least Square multiple regression analysis was used to explore characteristics and practices which represent facilitating and hindering factors in OD implementation.ResultsThe survey revealed steady growth in the number of OD services worldwide, with 142 teams across 24 countries by 2022, primarily located in Europe. Referrals predominantly came from general practitioners, hospitals, and self-referrals. A wide range of diagnostic profiles was treated with OD, with psychotic disorders being the most common. OD teams comprised professionals from diverse backgrounds with varying levels of OD training. Factors positively associated with OD self-assessment included a high percentage of staff with OD training, periodic supervisions, research capacity, multi-professional teams, self-referrals, outpatient services, younger client groups, and the involvement of experts by experience in periodic supervision.ConclusionThe findings provide valuable insights into the characteristics and practices of OD teams globally, highlighting the need for increased training opportunities, supervision, and research engagement. Future research should follow the development of OD implementation over time, complement self-assessment with rigorous observations and external evaluations, focus on involving different stakeholders in the OD-self-assessment and investigate the long-term outcomes of OD in different contexts

Traitement adapté aux besoins et dialogues ouverts

Das finnische Modell der bedürfnisangepassten Behandlung entstand für die Behandlung psychotischer Ersterkrankungen. Kennzeichnend sind die sofortige und flexible Hilfe, die Einbeziehung der Familien und weiterer Bezugspersonen von Beginn an und möglichst zuhause bei den Patienten durch ein multiprofessionelles therapeutisches Teams und eine möglichst niedrig dosierte selektive Psychopharmakotherapie. Ungefähr die Hälfte der Patienten nimmt zusätzlich längerfristige Einzeltherapie in Anspruch.Unter der Leitung von J. Seikkula wurde innerhalb dieses Behandlungsmodells die systemische Methodik des Offenen Dialoges entwickelt. Sie ist ausgerichtet auf die sozialen Netzwerke der Patienten und fördert in diesem möglichst sicheren Rahmen einen gemeinsamen offenen dialogischen Prozess aller Beteiligten.Die Evaluation durch vergleichende Kohortenstudien zeigte signifikant bessere symptomatische und funktionelle Ergebnisse im Vergleich zur Standardbehandlung, insbesondere eine geringe Hospitalisierungsrate und hohe Integration in bezahlte Arbeit oder Ausbildung.Schlüsselwörter: Bedürfnisangepasste Behandlung, Offener Dialog, Multiprofessionelles Team, Hometreatment, AntipsychotikaThe Finnish model of Need-Adapted Treatment was developed for treating first episode psychosis. It is characterized by immediate and flexible help, involving the family and other attachment persons from the start and when possible in the patient’s home setting with a multi-professional therapeutic team and with the lowest possible dosage of selective psycho-pharmaceutical therapy. Approximately half the patients actually make use of the offer of long-term individual therapy.Under the leadership of J. Seikkula within this treatment framework, a systemic methodology model of open dialogue has been developed. It is directed at the patient’s social networks and facilitates, within this secure framework, a shared open dialogue process with all those involved.Evaluation through comparable cohort studies shows a significant improvement in the symptomatic and functional outcomes in comparison to standard treatment, in particular a reduced rate of hospitalization and a higher integration in paid work or vocational training.Keywords: Need-Adapted Treatment, open dialogue, multi-professional team, Hometreatment, psycho-pharmaceuticalsLe modèle finlandais du ‘traitement adapté aux besoins’ (need-adapted treatment) est appliqué en particulier lorsqu’il s’agit de traiter des psychoses chez des patients qui ne souffraient d’aucun trouble précédemment ; il a été élaboré au cours d’un long processus de développement, est actuellement utilisé dans environ un quart des régions du pays et est également mis en œuvre dans d’autres pays scandinaves. Il est caractérisé par les aspects suivants : un soutien immédiat et flexible est apporté, les familles et d’autres référents participent dès le début à des ‘assemblées thérapeutiques’ – dans la mesure du possible chez les patients ­–, la continuité thérapeutique est assurée par une équipe multi professionnelle et une dose aussi basse que possible de neuroleptiques soigneusement sélectionnés est prescrite. Environ la moitié des patients suit en outre une psychothérapie individuelle de longue durée. Sous la direction de J. Seikkula et inspiré par T. Andersen (Tromsø, Norvège), ce modèle a été complété dans la région de Laponie occidentale par la méthode systémique du dialogue ouvert. Celle-ci utilise les réseaux sociaux des patients, mettant en place des échanges multiples et créant un cadre aussi sécurisé que possible au niveau d’un processus collectif ouvert. La méthode en question implique les principes d’une égalité (aussi grande que possible) entre participants, celui d’une responsabilité collective ainsi que celui du besoin de supporter les moments marqués par l’insécurité tout en évitant les conclusions et les décisions hâtives. La mise en œuvre flexible de la réflexion d’équipe s’est avérée très utile.Une évaluation par le biais d’études comparant des cohortes a montré que les effets au niveau symptomatique et fonctionnel sont bien meilleurs que dans les traitements standards ; cela concerne en particulier le taux d’hospitalisation – qui est moindre – et l’intégration dans le monde du travail ou de la formation.Plusieurs facteurs actifs jouent sans doute un rôle par rapport aux bons résultats des traitements : seuil bas puisque le traitement est mené dès le début chez le patient (Hometreatment), travail avec les familles et les réseaux sociaux utilisant prioritairement les ressources sociales, psychothérapie individuelle lorsque cela est nécessaire, continuité au niveau des traitants et cohérence psychologique des processus thérapeutiques, recherche d’une intégration au monde du travail, doses aussi basses que possible de neuroleptiques ­– ou pas de traitement médicamenteux lorsque cela est possible –, mise en œuvre de tous les modes d’intervention et nombre bas d’interruptions du traitement

Diagnosi clinica come costruzione sociale

Zusammenfassung: Diagnosemanuale der zurückliegenden Jahrzehnte bewirkten oder beabsichtigten eine fortschreitende De-Kontextualisierung psychischer Störungen, die mit einer fortschreitenden Biologisierung der Psychiatrie einherging, die letzten Endes eher der Pharmaindustrie als den PatientInnen dient. Dabei ist die Befundlage der biologischen Psychiatrie alles andere als ermutigend, insbesondere auch deshalb, weil die diagnostischen Kategorien zu wenig valide sind. Das neue System der Research Domain Criteria (RDoC), das von funktionellen neuronalen Teilsystemen des gesunden Gehirns ausgeht, könnte die Neurobiologie weiterbringen. Ob dies gelingt, ist nicht absehbar. Klinische Diagnosen dagegen sollten in erster Linie dem Verstehen und der Verständigung dienen. Da sie grundsätzlich Ergebnis eines sozialen Konstruktionsprozesses sind, sollte ein dialogisches Ko-Konstruieren mit den bedeutungsvollen Anderen in der sozialen Welt des Betroffenen im Zentrum stehen. Notwendig und unhintergehbar ist dabei eine innere und äussere Polyphonie dieser Wirklichkeitskonstruktionen. Psychotherapeutisches Expertenwissen ist Teil dieser Polyphonie.Diagnostic manuals of recent decades intended or effected an ongoing de-contextualization of mental disorders, which went hand in hand with the advancing biologizing of psychiatry, that ultimately served the pharmaceutical industry rather than the patients. Moreover, the findings of biological psychiatry are far from encouraging, notably because the diagnostic categories lack validity. The Research Domain Criteria (RDoC) constitutes a new research framework that is based on functional neural subsystems of the healthy brain and may advance neurobiology. It is not foreseeable whether this approach will succeed. The first and foremost objective of clinical diagnoses, on the other hand, should be understanding and communication. Since they are fundamentally the result of a social construction process, the primary focus should be on co-constructing through dialogue with the significant others in the social environment of the person concerned. Accordingly, an inner and outer polyphony of these constructions of reality is necessary and inevitable. Psychotherapeutic expertise also forms a part of this polyphony.I manuali di diagnosi degli ultimi decenni funzionano e propongono una progressiva decontestualizzazione dei disturbi psichici, la quale è andata insieme a una progressiva biologizzazione della psichiatria, che alla fine serve più l’industria farmaceutica dei pazienti. A riguardo la conoscenza scientifica della psichiatria è tutt’altro che incoraggiante, in particolare anche perché le categorie diagnostiche non sono sufficientemente valide. Il nuovo sistema di Research Domain Criteria (RDoC), che deriva dai sottosistemi neuronali funzionali del cervello sano potrebbero far progredire la neurobiologia. Se ciò riesca, è da vedere. Le diagnosi cliniche per contro devono servire prima di tutto alla comprensione e all’informazione. Poiché esse fondamentalmente sono il risultato di un processo di costruzione, al centro di esso dovrebbe trovarsi un dialogo di co-costruzione con gli altri attori significativi nel mondo sociale dei soggetti. È quindi necessaria e inevitabile una polifonia interna ed esterna di costruzioni di verità. Il sapere psicoterapeutico fa parte di questa polifonia

Sexual and physical abuse during childhood and adulthood as predictors of hallucinations, delusions and thought disorder

In light of recent studies indicating a relationship between child abuse and the positive symptoms of schizophrenia, this study investigated the hypotheses that childhood sexual and physical abuse are related to hallucinations, delusions, and thought disorder in adults, and that those relationships are greater in those who have suffered abuse during adulthood as well as childhood. In 200 community mental-health-centre clients, the clinically evaluated symptomatology of the 92 clients whose files documented sexual or physical abuse at some point in their lives was compared with that of the 108 for whom no abuse was documented. In the 60 patients for whom child abuse was documented, hallucinations (including all six subtypes), but not delusions, thought disorder or negative symptoms, were significantly more common than in the non-abused group. Adult sexual assault was related to hallucinations, delusions, and thought disorder. In linear regression analysis, a combination of child abuse and adult abuse predicted hallucinations, delusions, and thought disorder. However, child abuse was a significant predictor of auditory and tactile hallucinations, even in the absence of adult abuse. Possible psychological and neurobiological pathways from abuse to symptoms are discussed, along with research and clinical implications

Posttraumatische Störungen bei Patienten mit Erkrankungen aus dem schizophrenen Formenkreis

Background. The findings of internation- al studies suggest high rates of interperson- al violence and posttraumatic stress disorder (PTSD) among patients with schizophrenia spectrum disorders. Only few studies, how- ever, have so far been conducted in the Ger- man-speaking countries. Objectives. The aim of our study was to determine the prevalence of lifetime experi- ences of interpersonal violence and comor- bid PTSD among inpatients in a German uni- versity hospital. Method. In N=145 consecutively admitted patients with schizophrenia spectrum disor- ders (67% male) the structured trauma in- terview (STI) was used to assess experiences of interpersonal violence and the structured clinical interview for DSM-IV (SCID) to assess comorbid PTSD. Results. Sexual violence under the age of 16 years was reported by 17% of the patients (women 27%, men 12%). Approximately one third (32%) reported physical violence by pa- rental figures (women 38%, men 29%). At least one form of early violence (sexual or physical) was reported by half of the women (48%) and one third of the men (34%). Neg- ative sexual experiences later in life were re- ported by 17%, physical violence by 38% and at least one of these forms by 48% of the pa- tients. In total two thirds of all patients (66%) reported experiences of violence during their lifetime. The prevalence of acute PTSD was 12%. Another 9% of patients had a subsyn- dromal PTSD. Conclusion. The present study confirmed the high rates of experiences of interperson- al violence and comorbid PTSD in a German sample of patients with schizophrenia spec- trum disorders. Violence and it's consequenc- es should therefore be routinely assessed and the full spectrum of trauma-specific therapies should be integrated into the treatment of this group of patients