Gründung des Dachverbandes Deutschsprachiger PsychosenPsychotherapie (DDPP)

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Measuring Emotional Awareness in Patients With Schizophrenia and Schizoaffective Disorders

The ability to mentalize (i.e., to form representations of mental states and processes of oneself and others) is often impaired in people with schizophrenia spectrum disorders. Emotional awareness (EA) represents one aspect of affective mentalizing and can be assessed with the Levels of Emotional Awareness Scale (LEAS), but findings regarding individuals with schizophrenia spectrum disorders are inconsistent. The present study aimed at examining the usability and convergent validity of the LEAS in a sample of N = 130 stabilized outpatients with schizophrenia or schizoaffective disorders. An adequacy rating was added to the conventional LEAS rating to account for distortions of content due to, for example, delusional thinking. Scores of the patient group were compared with those of a matched healthy control sample. Correlation with symptom clusters, a self-report measure of EA, a measure of synthetic metacognition (MAS-A-G), and an expert rating capturing EA from the psychodynamic perspective of psychic structure (OPD-LSIA) were examined. Regarding self-related emotional awareness, patients did not score lower than controls neither in terms of conventional LEAS nor in terms of adequacy. Regarding other-related emotional awareness, however, patients showed a reduced level of adequacy compared to controls whereas no such difference was found for conventional LEAS scores. Higher conventional LEAS scores were associated with fewer negative symptoms, and higher structural integration of self-perceptions measured by the OPD-LSIA. Higher adequacy of responses correlated with fewer symptoms of disorganization as well as excitement, higher scores of self-reflection on the MAS-A-G as well as self- and object-perception and internal and external communication as measured by the subscales of the OPD-LSIA. Findings suggest that the LEAS might not be sensitive enough to detect differences between mildly symptomatic patients with schizophrenia or schizoaffective disorders and healthy controls. However, LEAS ratings are still suitable to track intraindividual changes in EA over time. Observing the adequacy of patients' responses when using the LEAS may be a promising way to increase diagnostical utility and to identify patterns of formal and content-related alterations of mentalizing in this patient group. Methodological indications for future studies are discussed

Levels of Structural Integration Mediate the Impact of Metacognition on Functioning in Non-affective Psychosis: Adding a Psychodynamic Perspective to the Metacognitive Approach

Synthetic metacognition is defined by integrative and contextualizing processes of discrete reflexive moments. These processes are supposed to be needed to meet intrapsychic as well as interpersonal challenges and to meaningfully include psychotic experience in a personal life narrative. A substantial body of evidence has linked this phenomenon to psychosocial functioning and treatment options were developed. The concept of synthetic metacognition, measured with the Metacognition Assessment Scale-Abbreviated (MAS-A), rises hope to bridge gaps between therapeutic orientations and shares valuable parallels to modern psychodynamic constructs, especially the 'levels of structural integration' of the Operationalized Psychodynamic Diagnosis (OPD-2). As theoretical distinctions remain, aim of this study was to compare the predictive value of both constructs with regard to psychosocial functioning of patients with non-affective psychoses, measured with the International Classification of Functioning, Disability and Health (MINI-ICF-APP). It was further explored if levels of structural integration (OPD-LSIA) would mediate the impact of metacognition (MAS-A) on function (MINI-ICF-APP). Expert ratings of synthetic metacognition (MAS-A), the OPD-2 'levels of structural integration' axis (OPD-LSIA), psychosocial functioning (MINI-ICF-APP) and assessments of general cognition and symptoms were applied to 100 individuals with non-affective psychoses. Whereas both, MAS-A and OPD-LSIA, significantly predicted MINI-ICF-APP beyond cognition and symptoms, OPD-LSIA explained a higher share of variance and mediated the impact of MAS-A on MINI-ICF-APP. Levels of structural integration, including the quality of internalized object representations and unconscious interpersonal schemas, might therefore be considered as valuable predictors of social functioning and as one therapeutic focus in patients with non-affective psychoses. Structural integration might go beyond and form the base of a person's actual reflexive and metacognitive capabilities. Psychotherapeutic procedures specific for psychoses may promote and challenge a patient's metacognitive capacities, but should equally take the need for maturing structural skills into account. Modern psychodynamic approaches to psychosis are shortly presented, providing concepts and techniques for the implicit regulation of interpersonal experience and aiming at structural integration in this patient group

Gründung des Dachverbandes Deutschsprachiger PsychosenPsychotherapie (DDPP)

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Entwicklung einer psychoanalytisch begründeten Typologie von psychotischen Erkrankungen

Der Artikel begründet die Notwendigkeit eines genuin psychoanalytischen und gleichsam in der empirischen Psychotherapieforschung anschlussfähigen Beitrags zum Verständnis psychotischer Erkrankungen. Die sequenziell erklärende Mixed-Methods-Studie 'Therapie und Psychodynamik von Patient*innen mit psychotischen Symptomen' (T3PS-Studie) fokussiert auf die Binnendifferenzierung psychotischer Erkrankungen. Hierfür soll eine psychoanalytisch begründete Typologie dieser Patient*innen anhand messender und hermeneutischer Methoden entwickelt und validiert werden. Zur Entwicklung der Typologie sieht das Studiendesign psychodynamische, psychopathologische und weitere diagnostische Interviews mit stationären Patientinnen und Patienten (N= 100) vor. Zusätzlich werden am Ende der Behandlung Beziehungsepisodeninterviews mit Mitgliedern des Behandlungsteams geführt und Fragebogen eingesetzt. Mittels zunächst statistischer Modellierung und anschließender qualitativer Konzeptbildung sollen schließlich Prototypen psychotischer Erkrankungen entlang der in der Operationalisierten Psychodynamischen Diagnostik (OPD) erfassbaren psychoanalytischen Konzepte von Konflikt, Struktur und Beziehungsdynamik identifiziert werden. Die klinische Nützlichkeit dieser Typologie soll durch systematische Untersuchungen einzelner Behandlungsverläufe nach dem Hermeneutic Single-Case Efficacy Design (HSCED) geprüft werden

Die Mixed-Methods-Studie „Therapie und Psychodynamik von Patient*innen mit psychotischen Symptomen“ (T3PS-Studie)

Gefördert im Rahmen des Projekts DEA