Psychotherapeutischer Einfluss auf Einsicht und Therapie-Compliance

Insight is a complex phenomenon comprising an awareness of illness and its psychosocial consequences, awareness of signs and symptoms and their attribution to illness and an awareness of need for treatment. An insightful patient can be treated better, yet a lack of illness insight is a relatively frequent phenomenon. Lack of insight increases the probability of illness relapse and rehospitalisation. Insight, however, can obviously improve spontaneously in the course of the illness. Psychopathological, neurobiological and psychological models have attempted to explain insight. Generally, there is a negative correlation between insight and its components on the one hand and the extent of psychopathology on the other hand: the more ill the patient, the less insightful he or she is. Nevertheless, psychopathology does not explain the lack of insight.There exist no convincing correlations between illness insight and morphological brain findings, and also, the relationship between insight and cognitive achievements appears equivocal. Insightful patients do not feel better, and patients without insight were found to be less depressed. The lack of insight could therefore perhaps protect from negative emotions and be used as a defence mechanism (unconsciously by definition). Insight can make it easier for the patient to cope with his or her illness and it can favourably influence the therapy.Generally, insight goes hand in hand with better prognosis. In contrast, identification of an individual insightful patient with his or her illness can lead to demoralisation and worsen the prognosis. Thus, it is not illness insight as such which is of the utmost importance, but the individual handling of insight and what the patient makes of it. Therapy noncompliance, partial compliance or insufficient adherence to therapy is also frequent and again, it is not a constant variable, but fluctuates over time. On the whole, patients without insight have worse adherence to therapy. Improvement of insight and therapy adherence belongs to the important therapeutic goals. Patients with mental disorders are able to learn and to get information. In spite of this fact it can prove problematic to increase insight and ameliorate therapy adherence psychotherapeutically. Repeated bi-directional information exchange and participative decision making on the basis of openness, reliability and mutual respect are necessary. Keywords: insight; compliance; adherence; psychopathology; psychotherap

Different Traumatic Experiences are Associated with Different Pathologies

We tested the hypothesis that different traumatic experiences will contribute in variable degree to different mental pathologies. A total of 223 young adult non-patients were assessed with the help of self-reports. The role of six different trauma experiences (broken home, dysfunctional family, family violence, child sexual abuse, child severe sexual abuse and adult sexual abuse) in six different conditions/pathologies (alexithymia, depression, somatization, borderline, overall physical health and overall mental health) was tested in a series of multivariate analyses of variance and of Roy-Bargmann stepdown analyses. The hypothesis was confirmed: Individual traumatic experiences were indeed associated with different pathologies. Specifically, sexual abuse predicted borderline pathology, severe child sexual abuse somatization, and dysfunctional or broken family depression. Family violence was associated with worse overall mental health and alexithymia, whereas no trauma variable could be identified to be associated with overall physical health. Most of these individual relationships were reported in the literature, based on results obtained in different clinical samples. Our results were won in a sample of young non-patients controlling for overlap between pathologie

Completed suicide and criminality: lack of a direct relationship

A comparison was made of the crime rate among 181 suicides and 181 controls, representing an unselected sample of the population matched with the suicides for sex, age, marital status, place of residence and occupational level. Sixteen per cent of the suicides and 11% of the controls had a criminal record, a statistically insignificant difference. In addition, no significant differences were found in the proportion of recidivists and of violent offenders, or in the number of their offences and convictions. A significant difference was found regarding the distribution of the offences by particular laws: more than a half of the offences committed by criminal suicides concerned violations of the road traffic laws, this being in agreement with the hypothesis that risky, accident-prone behaviour is a suicidal behaviour equivalen

Two types of classification in female alcoholism

Two types of alcoholism with distinct clinical features and mode of inheritance have been identified in male alcoholics. The relevant studies, however, have given consistent results in men but not in women. The current study tested the hypothesis that the type I and II classification is also valid in women. A sample of 103 hospitalised alcohol-dependent women were given face-to-face structured interviews considering four different classification criteria sets devised for differentiation of alcoholism type I and II and type A and B along with SCID I and II. The two types of classification could be replicated with three of the four criteria sets, 73 women being allocated to the larger cluster C1, and 30 women to a smaller cluster C2. Comparing the patients from both clusters with each other, eight variables were identified which excellently discriminate between the groups. The two types of classification for alcoholism could also be found in a female sample. A type II of female alcohol-dependent patient was identified, characterized by parental alcoholism and paternal and patient's tendency for violent behavior. Type I lacks these characteristics. Early identification of the type II female alcoholic may be clinically importan

Two types of classification for male opioid dependence: Identification of an opioid addict with depressive features

Objective : There are similarities between alcoholics and opioid addicts and an overlap between both diagnostic groups. We tested the hypothesis that the type I and II classification, well established in male alcoholism, could also be relevant in a population of male opioid addicts. Methods : A sample of 100 hospitalized adult opioid dependent men were studied with the help of an extended semi-structured clinical interview, considering four classification criteria sets devised by Cloninger et al. (1981, 1982), von Knorring et al. (1985, 1987), Buydens-Branchey et al. (1989) and Babor et al. (1992). Results : The two types of classification could be confirmed with all four criteria sets. In at least three of four analyses, 52 patients were allocated to the same larger cluster C1, and 25 patients to a smaller cluster C2. These two groups were compared with each other with the help of the stepwise discriminant analysis. Seven variables were identified which excellently discriminate between the groups: The C2 patient is younger, has a history of therapy because of depression and a history of severe suicide attempts, also abuses benzodiazepines and becomes violent while intoxicated. His father suffers from alcoholism and received treatment because of depression. The C1 patient lacks these characteristics. Conclusions : The hypothesis was confirmed, showing that the two types of classification for male opioid addicts is feasible. A depressive type of male opioid dependent patient was identified. Early identification of patients of this type is clinically importan

Un procès pour hérésie à Strasbourg en 1400

Au cours du printemps de l’année 1400, la ville de Strasbourg fut la scène d’un procès pour hérésie, dont nous avons réédité et analysé les actes. Cette affaire est connue par l’historiographie spécialisée depuis le milieu du XIXe siècle déjà, sans pourtant avoir reçu toute l’attention qu’elle mérite. Cette constatation apparemment paradoxale s’explique par le fait que les actes, conservés aux Archives de la Ville et de la Communauté urbaine de Strasbourg sous la cote VI 699/1, ont fait l’obj..

Le gentleman, la sorcière et le diable : Reginald Scot, un anthropologue social avant la lettre ?

Cette contribution analyse la figure de la sorcière ainsi que celle du diable et du sabbat telles qu'elles ont été représentées par Reginald Scot dans son traité sceptique The Discoverie of Witchcraft (1584). Dans un second temps, elle s'interroge sur l'héritage de Scot dans l'historiographie moderne de la sorcellerie.The Gentleman, the Witch and the Devil : Reginald Scot, an Early Modern Social Anthropologist ? This paper analyses the way witches, as well as the devil and the witches' Sabbath are represented in Reginald Scot's sceptical treatise The Discoverie of Witchcraft of 1584. In a second step, Scot's heritage in modern historiography of witchcraft is explored

Un procès pour hérésie à Strasbourg en 1400

Au cours du printemps de l’année 1400, la ville de Strasbourg fut la scène d’un procès pour hérésie, dont nous avons réédité et analysé les actes. Cette affaire est connue par l’historiographie spécialisée depuis le milieu du XIXe siècle déjà, sans pourtant avoir reçu toute l’attention qu’elle mérite. Cette constatation apparemment paradoxale s’explique par le fait que les actes, conservés aux Archives de la Ville et de la Communauté urbaine de Strasbourg sous la cote VI 699/1, ont fait l’obj..

Use of potentially abusive psychotropic substances in psychiatric inpatients

A series of 417 consecutively admitted psychiatric inpatients were studied with regard to their use of potentially abusive psychotropic substances in the last 3 months preceding admission. In all patients face-to-face interviews were performed; in 354 of them urine specimens could also be tested. Alcohol and benzodiazepines belonged to the most frequently used substances followed by cannabis, opiates and cocaine. Barbiturates, hallucinogens and amphetamine derivatives were only exceptionally reported. The most important finding of the study is that every fifth patient regularly used "hard” drugs (opiates and/or cocaine), every fourth patient illegal drugs and every third patient alcohol. Substances were found in 54% of all urine specimens; methadone, opiates and cocaine were hardly found alone. For the latter substances excellent agreement was found between interview reports and urine exams. Excluding patients diagnosed as substanceuse disorders, there were no statistically significant differences between schizophrenic, affective, neurotic/stress/ somatoform and other disorders with regard to the use of "hard” drugs and illegal drugs. Regular substance use correlated with much worse psychosocial adjustment. Substance use has to be explored and considered in every individual psychiatric inpatien