Aussagen der Seelsorgestudie aus pastoralpsychologischer Sicht

Die Seelsorgestudie (2012–2014) wurde angelegt als Befragung der pastoralen MitarbeiterInnen innahezu allen Bistümern in Deutschland. Von den etwa 21.000 Angeschriebenen antworteten ungefähr8.500 Personen, davon 4.200 Priester. Zentrale Variablen waren die Lebenszufriedenheit, die psychischeGesundheit, das Engagement im Dienst und die Spiritualität. Ziele dieser Arbeit sind, 1. einenÜberblick über die bis heute aus der Studie publizierten Manuskripte zu geben, 2. kritisch die Repräsentativität,die Instrumente und die Methoden der Studie zu diskutieren im Hinblick auf 3. die gezogenenSchlussfolgerungen. Abschließend wird in Erinnerung gerufen, dass das II. Vaticanum die dyadischeDynamik zwischen der Institution Kirche und den pastoralen MitarbeiterInnen auf eine triadischePerspektive hin geöffnet hat, die alle Gläubigen der katholischen Kirche und letztlich alle Menschenumfasst.The German Pastoral Ministry Study (2012–2014) conducted a survey among about 8.500 persons –4.200 of them being priests – on life satisfaction, psychic health, work engagement, relationships andspirituality. Aim of this paper is 1. to give an overview of all published manuscripts till now, 2. to discussthe representativity, instruments and methods of the study critically with regard 3. to the conclusions.Finally, it is mentioned that the II. Vaticanum opened the dyadic dynamic between the “institutionChurch” and the “Pastoral Workers” to a triadic perspective including all believers of the CatholicChurch and all men

Reliability and validity of the German version of the Structured Interview of Personality Organization (STIPO)

Background: The assessment of personality organization and its observable behavioral manifestations, i.e. personality functioning, has a long tradition in psychodynamic psychiatry. Recently, the DSM-5 Levels of Personality Functioning Scale has moved it into the focus of psychiatric diagnostics. Based on Kernberg's concept of personality organization the Structured Interview of Personality Organization (STIPO) was developed for diagnosing personality functioning. The STIPO covers seven dimensions: (1) identity, (2) object relations, (3) primitive defenses, (4) coping/rigidity, (5) aggression, (6) moral values, and (7) reality testing and perceptual distortions. The English version of the STIPO has previously revealed satisfying psychometric properties. Methods: Validity and reliability of the German version of the 100-item instrument have been evaluated in 122 psychiatric patients. All patients were diagnosed according to the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV) and were assessed by means of the STIPO. Moreover, all patients completed eight questionnaires that served as criteria for external validity of the STIPO. Results: Interrater reliability varied between intraclass correlations of .89 and 1.0, Crohnbach's a for the seven dimensions was .69 to .93. All a priori selected questionnaire scales correlated significantly with the corresponding STIPO dimensions. Patients with personality disorder (PD) revealed significantly higher STIPO scores (i.e. worse personality functioning) than patients without PD; patients cluster B PD showed significantly higher STIPO scores than patients with cluster C PD. Conclusions: Interrater reliability, Crohnbach's a, concurrent validity, and differential validity of the STIPO are satisfying. The STIPO represents an appropriate instrument for the assessment of personality functioning in clinical and research settings

Reliability and validity of the German version of the Structured Interview of Personality Organization (STIPO)

Background: The assessment of personality organization and its observable behavioral manifestations, i.e. personality functioning, has a long tradition in psychodynamic psychiatry. Recently, the DSM-5 Levels of Personality Functioning Scale has moved it into the focus of psychiatric diagnostics. Based on Kernberg's concept of personality organization the Structured Interview of Personality Organization (STIPO) was developed for diagnosing personality functioning. The STIPO covers seven dimensions: (1) identity, (2) object relations, (3) primitive defenses, (4) coping/rigidity, (5) aggression, (6) moral values, and (7) reality testing and perceptual distortions. The English version of the STIPO has previously revealed satisfying psychometric properties. Methods: Validity and reliability of the German version of the 100-item instrument have been evaluated in 122 psychiatric patients. All patients were diagnosed according to the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV) and were assessed by means of the STIPO. Moreover, all patients completed eight questionnaires that served as criteria for external validity of the STIPO. Results: Interrater reliability varied between intraclass correlations of .89 and 1.0, Crohnbach's a for the seven dimensions was .69 to .93. All a priori selected questionnaire scales correlated significantly with the corresponding STIPO dimensions. Patients with personality disorder (PD) revealed significantly higher STIPO scores (i.e. worse personality functioning) than patients without PD; patients cluster B PD showed significantly higher STIPO scores than patients with cluster C PD. Conclusions: Interrater reliability, Crohnbach's a, concurrent validity, and differential validity of the STIPO are satisfying. The STIPO represents an appropriate instrument for the assessment of personality functioning in clinical and research settings

Early Affective Processing in Patients with Acute Posttraumatic Stress Disorder: Magnetoencephalographic Correlates

Background: In chronic PTSD, a preattentive neural alarm system responds rapidly to emotional information, leading to increased prefrontal cortex (PFC) activation at early processing stages (<100 ms). Enhanced PFC responses are followed by a reduction in occipito-temporal activity during later processing stages. However, it remains unknown if this neuronal pattern is a result of a long lasting mental disorder or if it represents changes in brain function as direct consequences of severe trauma.Methodology: The present study investigates early fear network activity in acutely traumatized patients with PTSD. It focuses on the question whether dysfunctions previously observed in chronic PTSD patients are already present shortly after trauma exposure. We recorded neuromagnetic activity towards emotional pictures in seven acutely traumatized PTSD patients between one and seven weeks after trauma exposure and compared brain responses to a balanced healthy control sample. Inverse modelling served for mapping sources of differential activation in the brain.Principal Findings: Compared to the control group, acutely traumatized PTSD patients showed an enhanced PFC response to high-arousing pictures between 60 to 80 ms. This rapid prefrontal hypervigilance towards arousing pictorial stimuli was sustained during 120–300 ms, where it was accompanied by a reduced affective modulation of occipito-temporal neural processing.Conclusions: Our findings indicate that the hypervigilance-avoidance pattern seen in chronic PTSD is not necessarily a product of an endured mental disorder, but arises as an almost immediate result of severe traumatisation. Thus, traumatic experiences can influence emotion processing strongly, leading to long-lasting changes in trauma network activation and expediting a chronic manifestation of maladaptive cognitive and behavioral symptoms

Sex Differences in Itch Perception and Modulation by Distraction – an fMRI Pilot Study in Healthy Volunteers

Background: Even though itch is a common syndrome of many diseases there is only little knowledge about sex and gender differences in pruritus, especially in central itch perception and modulation. To our knowledge, this is the first fMRI study examining sex differences in perception and its modulation by distraction. Methods: Experimental itch was induced by application of histamine (0.1 mM) via microdialysis fibers twice at the left forearm and twice at the left lower leg in 33 healthy volunteers (17 females, 16 males). The brain activation patterns were assessed by fMRI during itch without and with distraction (Stroop task). Between the various conditions, subjects were asked to rate itch intensity, desire to scratch and pain intensity. In a second experiment in 10 of the 33 volunteers histamine was replaced by saline solution to serve as control for the ‘Stroop’ condition. Results: Women generally presented higher itch intensities compared to men during itch over the course of the experiment. A more specific analysis revealed higher itch intensities and desire to scratch in women during experimental induced itch that can be reduced by distraction at the lower legs when itch is followed by ‘Stroop’. In contrast, men depicted significant reduction of ‘itch’ by ‘Stroop’ at the forearms. Women depicted higher brain activation of structures responsible for integration of sensory, affective information and motor integration/planning during ‘itch’ and ‘Stroop’ condition when compared to men. No sex differences were seen in the saline control condition. Conclusion: Women and men exhibited localisation dependent differences in their itch perception with women presenting higher itch intensities and desire to scratch. Our findings parallel clinical observations of women reporting higher itch intensities depending on itch localisation and suffering more from itch as compared to men

Do the elderly and those with comorbid chronic physical conditions have improved access to outpatient psychotherapy post structural reforms in Germany? Results of the ES-RiP study

BackgroundIn 2017, a reform of the German outpatient psychotherapy guideline was carried out, aiming to reduce waiting times and facilitate low-threshold access. This study analyzes the extent to which the implementation of the two new service elements ‘psychotherapeutic consultation times’ and ‘acute short-term psychotherapeutic interventions’ improved psychotherapeutic care for patients with mental disorders and chronic physical conditions (cMPs), for patients with mental disorders without chronic physical conditions (MnoP), and elderly patients.MethodsIn a quantitative secondary analysis, we analyzed health insurance data of patients with psychotherapy billing codes obtained from the National Association of Statutory Health Insurance Physicians (KBV) for the years 2015-2019, evaluating descriptive statistical parameters for specific patient groups and care services.ResultsBetween 2015 and 2019, the number of mentally ill receiving psychotherapy at least once in the corresponding year increased by 30.7%. Among these, the proportion of cMPs-patients increased from 26.8% to 28.2% (+1.4%), while that of MnoP-patients decreased from 68.3% to 66.4% (-1.9%). The number of elderly people receiving treatment also increased.ConclusionSince increases and decreases in the percentage shares occur evenly over the years investigated, it is questionable whether the reform in 2017 has had a direct influence on these changes.Study registrationID DRKS00020344, URL: https://www.bfarm.de/DE/Das-BfArM/Aufgaben/Deutsches-Register-Klinischer-Studien/_node.html

L'axe-conflits (axe III) du diagnostic psychodynamique opérationnalisé (DPO)

Die Notwendigkeit einer Operationalisierung psychoanalytischer Konfliktdiagnostik gründet in den zunehmenden Ansprüchen an die Validität und Reliabilität diagnostischer Kriterien. Dies ist für die Planung von Studien, die unter dem Gesichtspunkt einer Evidence Based Medicine (EBM) akzeptiert werden sollen, ebenso relevant wie für die Qualitätssicherung im Rahmen klinischer Versorgung. Neben den sieben repetitiv-dysfunktionalen Konfliktmustern wird das Konzept einer eingeschränkten Konflikt- und Gefühlswahrnehmung entsprechend dem Alexithymie-Konzept und das Konzept des Aktualkonfliktes diskutiert. Es wird auf die Bedeutung der Leitaffekte für ein valides Konfliktrating hingewiesen. Außerdem wird begründet, dass beim Rating der aktiven versus passiven Modalität des führenden Konfliktes der biographisch führende Modus abgebildet werden soll. Zur Erhöhung der Validität wird am Beispiel des Autonomie-Abhängigkeits-Konfliktes und des Versorgungs-Autarkie-Konfliktes jeweils ein differenzierendes Begriffscluster vorgestellt. Da in diesem Jahr die englische Übersetzung der OPD verfügbar sein wird, zeichnet sich die Möglichkeit ab, auch international mit Hilfe der operationalisierten Konzepte wieder ein wissenschaftliches Interesse an psychoanalytischen Inhalten entwickeln zu können.Schlüsselwörter: Operationalisierte Psychodynamisehe Diagnostik, OPD, Konflikt, Struktur, AktualkonfliktConsidering increasing demands with regard to validity and reliability of diagnostic criteria, the necessity arises to operationalize psychoanalytic diagnostics of intrapsychic conflicts. This is an important issue in the planning of studies which should fulfill criteria of Evidence Based Medicine (EBM) and also for quality management in clinical treatment. In addition to the seven repetitive and dysfunctional patterns of intrapsychic conflict, the concept of “limited perception of conflict and feelings", based on the alexithymia concept, and the concept of the "current external conflict" are discussed. The importance of the main emotions for a valid rating of intrapsychic conflict is emphasized. In rating the active vs. passive mode of processing of the most important conflict, the biographically predominating attitude should be represented. In order to increase the OPD’s validity, clusters of terms that lead to further differentiation are introduced exemplary for the conflicts “dependance vs. autonomy” and "desire for care vs. autarchy”. With the English translation of the OPD becoming available this year, operationalized concepts may lead to a renewed international scientific interest with regard to psychoanalytic issues.Keywords: Operationalized Psychodynamic Diagnostics, OPD, Intrapsychic conflict, structure, current external conflictLa nécessité de rendre opérationnel le diagnostic psychanalytique des conflits se fonde sur les exigences croissantes posées à la validité et à la reliabilité des critères diagnostiques. Cet aspect est pertinent par rapport à la planification d’études devant être approuvées sous l’angle d’une Evidence Based Medicine (EBM) comme d’ailleurs au niveau de la gestion de qualité dans le cadre de l’offre clinique. L’article traite d’une part des sept schémas de conflit répétitif-dysfonctionnel, mais aussi du concept du manque d’une perception des conflits et des affects, en fonction du concept de l’alexithymie et de celui du conflit actuel. On souligne l’importance des affects directeurs pour une évaluation valide du conflit. On démontre également qu’au moment d’effectuer un rating de la modalité active ou passive du conflit directeur, c’est le mode dominant au niveau de la biographie qui doit être reflété. Un groupe de concepts permettant une meilleure différenciation et donc une validité accrue sont présentés en utilisant l’exemple des conflits autonomie-dépendance et attachement-autarcie. Selon les expériences faites à ce jour, la validité du rating sur l’axe du DPO des conflits augmente en fonction de la précision avec laquelle on utilise le manuel. De manière paradoxale les «jeunes» collègues disposant d’une certaine expérience clinique au niveau de la perception d’affects directeurs et de la perception scénique (effectuées par le biais du contre-transfert) parviennent à une opérationnalisation plus valide que ceux qui se considèrent comme des psychanalystes expérimentés. Il est de fait que lorsqu’on dispose de nombreuses années d’expérience en psychanalyse, on risque de penser qu’on sait ce que l’on entend par conflit œdipe-sexuel ou par conflit dépendance-autonomie - et qu’on ne vérifie pas les critères dans le manuel. Il s’en suit que les ratings se fondent sur une conception «privée» des différents termes conceptuels, ce qui a des conséquences négatives pour la reliabilité. Il est également à conseiller à des équipes travaillant constamment avec le DPO, pour poser des diagnostics dans un cadre ambulatoire par exemple, d’effectuer à l’occasion des comparaisons avec d’autres groupes, ceci afin de vérifier qu’elles ne sont pas influencées par un éventuel bias interne.Lorsqu’il s’agit de former de jeunes collègues à la psychanalyse, le DPO peut contribuer à leur enseigner assez rapidement les termes et concepts de manière claire, alors qu’on sait que la lecture des textes psychanalytiques de base prend souvent plusieurs années - et ne produit pas le résultat escompté puisqu’en psychanalyse il n’existe pas de métathéorie complète. La formation au DPO qui est offerte à plusieurs endroits sous forme de cours de base ou avancés ne rend toutefois pas l’étude de ces textes superflue, car il demeure indispensable de saisir les concepts actuels en fonction de leur source historique.Entre-temps l’expérience clinique a montré que le diagnostic des conflits peut également apporter une contribution importante à la focalisation du traitement, ce qui ne signifie pas forcément que ce dernier va se concentrer sur le conflit dominant. Le fait que le DPO conceptualise les conflits de manière très claire va également ouvrir de nouveaux champs de recherche intéressants. - Une traduction du DPO en anglais doit être disponible dès cette année, ce qui va permettre de promouvoir l’intérêt scientifique international pour les contenus de la psychanalyse, ceci sur la base de concepts opérationnalisés

Cerebral Activation and Catastrophizing During Pain Anticipation in Patients With Fibromyalgia

Objective: Anticipation of pain influences its cerebral processing and dysfunctional cognitive style like catastrophizing correlates with the severity of pain. Patients with fibromyalgia syndrome (FMS) exhibit higher levels of catastrophizing, increased attention to pain, and augmented cerebral pain processing. Therefore, alteration in cerebral processing during anticipation of experimental pain and its relation to catastrophizing are the main focus of the study. Methods: Functional magnetic resonance imaging of the brain was acquired during the time of pain anticipation with announcement of its intensity or not in 12 patients with FMS and 14 healthy controls. Within a two-factorial model (factors group'' and session''), the main effect of group and the interaction effect were tested in a whole-brain analysis. In addition, activation of the periaqueductal gray (PAG) was analyzed in a region-of-interest analysis. Results: Patients with FMS generally displayed greater catastrophizing behavior (p = .003) but not during the anticipation of the experimental pain (p > 9.16). Furthermore, patients showed greater activation of the dorsolateral prefrontal cortex (p = .05), the PAG (p = .04), and the posterior parietal cortex (p = .03) during the anticipation of pain, independent of the pain coping behavior during anticipation. Conclusions: The lack of difference in catastrophizing during the experimental pain suggests independent coping mechanisms during experimental and clinical pain. Regarding the importance of the frontal cortex and the PAG in the descending pain modulation system, it seems reasonable to assume that these functional changes related to the context of stimulus presentation may contribute to central sensitization in FMS

Psychometric properties and normative values of the revised demoralization scale (DS-II) in a representative sample of the German general population

Abstract Background Demoralization is a clinically relevant syndrome in chronic diseases. The demoralization scale (DS-II) was recently developed as an economic screening tool in clinical populations. Main aim of this study was to provide normative data of DS-II scores in the general population. Methods We developed a new German version, the DS-II Münster, and tested internal consistency as well as the previously proposed two-factor structure with confirmatory factor analyses. The DS-II was applied in a household survey of the general population. Associations between DS-II scores and age, gender and other sociodemographic variables were explored. Results The final sample consisted of N = 2471 participants (mean age = 49.8 years, range: 18–96; 50.1% men, 49.8% women). The DS-II Münster showed nearly excellent internal consistency. The model fit indices of the two-factor structure were not superior to those of the one-factor model. Mean scores of the DS-II were as follows. Total score: M = 3.76 (SD = 5.56), Meaning and Purpose subscale: M = 1.65 (SD = 2.77), Distress and Coping Ability subscale: M = 2.11 (SD = 3.02). DS-II scores were increased in women with an effect size of Cohen’s d = 0.19. An age-related increase was specifically found for the Meaning and Purpose subscale (d = 0.21). Conclusions The study provides normative values of the DS-II with respect to age and gender in the general population to facilitate interpretation of DS-II scores in clinical samples. A DS-II total score > 5 is suggested as a cut-off value. The findings further our understanding of significant symptom burden that was previously suggested in young patients with cancer