Diagnostik depressiver Störungen

Zusammenfassung: Es gibt heute eine Vielzahl an reliablen (zuverlässigen) und validen (gültigen) Instrumenten zur Diagnostik depressiver Störungen. Neben dem Screening bei Verdacht auf Vorliegen einer depressiven Störung sind vor allem auch die exakte Diagnosestellung nach einem international akzeptierten Klassifikationssystem wie ICD-10 oder DSM-IV sowie auch die differenzierte Schweregradbeurteilung der Symptomatik im Hinblick auf die Therapieplanung und -evaluation von großer Bedeutung. Ziel des vorliegenden Beitrages ist es, die auf diesen Ebenen im deutschsprachigen Raum eingesetzten und bewährten Instrumente/Verfahren (Selbstund Fremdbeurteilungsverfahren) in einem Überblick vorzustelle

Therapy-relevant factors in adult ADHD from a cognitive behavioural perspective

Adult individuals with attention-deficit hyperactivity disorder (ADHD) have been suffering from this neurobiological and highly heritable disorder chronically since childhood. Resulting from their longstanding neuropsychological impairments, such as attentional problems, emotional instability, and disinhibition, they are familiar to a multiplicity of negative life outcomes and underachievement. Furthermore, a large part of this population suffers from psychiatric comorbidity. This accumulation of negative experiences has an impact on therapy-relevant factors such as the individual's self-esteem, self-efficacy, development of core beliefs/schemas, and coping strategies. Based on negative beliefs about the self, individuals confronted with difficult situations develop maladaptive coping strategies, for instance avoidance and procrastination. These strategies lead to maintenance and reinforcement of maladaptive beliefs, and as such they acquit themselves as schema-confirming. Captured in this vicious cycle, the individual sees her negative view of the self confirmed. The purpose of this paper is to illuminate these interactive factors that influence the aforementioned cycle in order to emphasize the cognitive behavioural interventions tailored to those factors on the basis of latest research. Furthermore, the authors want to attract notice to the resources people with ADHD are said to have, namely creativity and resilience. These postulated resources could be therapy-relevant by creating positive beliefs about the self, hence improving coping skills and breaking the vicious circle of negative appraisal. Taking into account personal resources and their fostering may be an important fundament for the treatment plan of adult ADHD. Information on the current state of research and theoretical approaches concerning the below-mentioned key words was gathered through MEDLINE, PsycINFO, PSYNDEXplus, and PubMed database

Definition und Erfassung psychischer Störungen: Bestandsaufnahme

Zusammenfassung: Die Entwicklung von Klassifikationssystemen für psychische Störungen hat eine lange Tradition und wird von einer unverändert anhaltenden Diskussion zu grundlegenden Fragen begleitet. Dies betrifft v.a. die allgemeine Frage, wann überhaupt eine Störung vorliegt, sowie daran anschließend die Frage, welche und wie viele Störungen sinnvoll und notwendig sind. Im vorliegenden Beitrag wird ein Überblick über die mit den bisherigen Systemen Diagnostisches und Statistisches Handbuch Psychischer Störungen, 4.Aufl. (DSM-IV) und Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme, 10.Ausgabe (ICD-10) verbundenen Paradigmen und Klassifikationsmethoden gegeben. Entgegen den ursprünglichen Erwartungen ist es nicht gelungen, auch nur eine der existierenden Diagnosen wissenschaftlich hinreichend zu validieren. Ebenso ist keine Alternative zum bisherigen deskriptiv-phänomenologischen Ansatz in Sicht. Die bevorstehenden Revisionen DSM-5 und ICD-11 werden keine konzeptuellen Neuerungen bringen, sondern lediglich einige neue Diagnosen einführen und die Kriterien einiger anderer Diagnosen modifizieren. Am Beispiel der Entwicklung von DSM-5 werden sowohl grundlegende Überlegungen als auch ausgewählte bevorstehende Änderungen kritisch diskutiert. Zudem werden Vorschläge für eine rationalere Entwicklung von Klassifikationssystemen vorgestell

Symptom overlap and screening for symptoms of attention-deficit/hyperactivity disorder and psychosis risk in help-seeking psychiatric patients

Symptoms of attention-deficit/hyperactivity disorder (ADHD) and psychosis risk share features which might represent an early vulnerability marker for schizophrenia. Early detection of individuals with this symptomatic overlap is relevant and may assist clinicians in their decision making for diagnosis and treatment. This study sought to analyze the capability of different instruments in the screening of patients for ADHD symptoms or at psychosis risk, assess their classification accuracy, and describe the extent of symptoms overlap between them. 243 adult patients completed one instrument screening for ADHD and two instruments screening for psychosis risk symptoms [Adult ADHD Self-Report Scale Symptom Checklist (ASRS-v1.1); Prodromal Questionnaire Brief Version (PQ-16); Self-Screen Prodrome (SPro)]. The ability of these instruments to distinguish between the symptomaticity of these patients appears modest. The most satisfactory scale to identify subjects at psychosis risk was SPro with its subscale psychosis risk. ASRS-v1.1 showed good reliability in assessing individuals as not having ADHD symptoms and had higher probability to achieve its own and the cut-off of another questionnaire. Subjects having symptoms of psychosis risk and ADHD showed elevated symptomatology. Reliable instruments capable of separating ADHD symptoms from those of psychosis risk are needed to better identify the symptomatic overlap of this two conditions

Is emotional dysregulation part of the psychopathology of ADHD in adults?

Attention-deficit hyperactivity disorder is a common condition in adulthood. The disorder is characterized by symptoms of inattention, hyperactivity, and impulsivity. Alongside these symptoms, it is discussed whether symptoms of emotional dysregulation could add additional and better description of the psychopathology of ADHD. Neither the current ICD-10 and DSM-IV nor the upcoming DSM-5 includes symptoms of emotional dysregulation as a core aspect of ADHD. Several authors (e.g., Wender 1995) describe adult ADHD in a more differentiated way and propose concepts of the disorder that consider the subjective experiences of the adult patient by introducing the symptomatology of emotional symptoms. Empirical studies attest this dimension sufficient reliability and validity. Symptoms of emotional dysregulation are definable and seem to be distinct factors of the psychopathology of adult ADHD. Pharmacological and psychotherapeutic interventions help to alleviate this type of symptoms. This review attests a decisive role to the emotional symptoms in the ADHD symptomatology, which should be taken in serious consideration by future researc

Functional Neuroimaging Correlates of Aggression in Psychosis: A Systematic Review With Recommendations for Future Research

Background and methods: Aggression in psychosis is clinically important. We systematically compiled the evidence on functional correlates of aggression in psychosis searching PubMed, EMBASE, ScienceDirect, and PsycINFO until September 2017. We included studies reporting functional brain imaging correlates of aggression comparing: (1) affective or non-affective psychosis groups with a history of violence or with aggression operationalized using questionnaires, (2) affective or non-affective psychosis groups with a history of violence or with aggression operationalized using questionnaires to controls, (3) affective or non-affective psychosis groups with a history of violence or with aggression operationalized using questionnaires to controls with diagnoses other than affective or non-affective psychoses. We applied no language restriction and required patients to have a DSM or ICD diagnosis of affective or non-affective psychosis.Results: Our sample consisted of 12 studies with 334 patients and 113 controls. During n-back tasks, violent (VS) as opposed to non-violent persons with schizophrenia (NVS) hypoactivated their inferior parietal lobe. When anticipating shock, VS vs. NVS hyperactivated their medial prefrontal gyrus, cuneus, middle temporal gyrus, and middle occipital gyrus. When viewing negative emotional pictures, VS vs. NVS hyperactivated the middle frontal gyrus, inferior frontal gyrus, anterior cingulate, lingual gyrus, precentral gyrus, globus pallidus, mid-cingulate, and precuneus.Limitations: Due to the small number of available studies, sample overlap, and insufficient reporting of relevant moderators we could not conduct a meta-analysis.Conclusions: We found non-systematic functional correlates of aggression in schizophrenia. Only few studies using varied paradigms and often overlapping samples have been conducted. There have been no attempts to replicate any of the observed findings in the published literature. Focusing on future directions, we recommend that authors adhere to clear definitions of aggression, measurements of psychopathology, comorbidities, and medication. In particular, replication studies would allow for a better synthesis of the findings.PROSPERO Registration Number: CRD4201604857

Diagnostic validity of the Basler Vegetative State Assessment - BAVESTA

Introduction: Clinical assessments should meet the general psychometric properties of reliability and validity. Furthermore there are requirements in matters of diagnostic validity and usability. In regards to patients with severe brain damage, both issues can mainly be implemented by detecting and assessing returning abilities as early as possible, in order to use them for treatment planning. Main aim of this article is to investigate whether the newly developed and validated interprofessional Basel Vegetative State Assessment (BAVESTA) meets these practice criteria. Method: Data were collected as part of validity assessment of BAVESTA. Using the Glasgow Coma Scale as a reference, predictive parameters and measures of effect are calculated. Moreover, expert users were interviewed and results are presented in a descriptive way. Results: With a sensitivity of 0.84 and a specificity of 0.85, the BAVESTA can be regarded as suitable in differentiating between vegetative state and further states of remission such as the minimally conscious state. Expert users regard BAVESTA as eligible for mapping rehabilitative process of patients with severely impaired consciousness. They agree upon the fact that all relevant areas are covered by BAVESTA. Discussion: The BAVESTA displays high levels of differentiation, in regards to both sensitivity and specificity. However, measures of effect ought generally to be regarded with caution, as reference standards have not been developed for the area of rehabilitation. Considering time expenditure, BAVESTA is rated as only marginally feasible by expert users. It should be continued to investigate BAVESTA in regards to its diagnostic quality, integrating electrophysical diagnostic tools as reference standards

A Comparison of Cognitive-Behavioral Therapy and Pharmacotherapy vs. Pharmacotherapy Alone in Adults With Attention-Deficit/Hyperactivity Disorder (ADHD)—A Randomized Controlled Trial

In the treatment of adult attention-deficit/hyperactivity disorder (ADHD) the importance of psychological interventions in combination with pharmacotherapy is widely accepted in contemporary clinical routine. The natural course of the disorder seems to justify additional psychological interventions because even in patients who are highly compliant to pharmacotherapy full remission is not always achieved. The aim of the present study was to analyze the contribution of psychotherapy to the treatment of adult ADHD patients. In a randomized controlled study, the efficacy of a combined treatment of psychotherapy with pharmacotherapy is compared to pharmacological intervention alone. After initiation and stabilization of treatment with methylphenidate (MPH) in all subjects randomization to the two different treatment conditions was done. Afterwards both groups underwent treatment for about 10–12 weeks, the experimental group receiving sessions of cognitive-behavioral therapy (CBT) whereas the control group only received medication and standard clinical management (SCM). ADHD symptoms differed statistically during time but not between the two different treatment conditions. This result was the same for the single ADHD symptoms—inattention, hyperactivity, impulsivity, and emotional symptoms—and also for impairment. Individual standardized ADHD specific CBT program was not able to outperform SCM