Asklepios Fachklinikum Tiefenbrunn

The current study examined whether personality domains have nonmonotonic relationships with functional outcomes, specifically in relation to quality of life and impairment. Four samples were utilized, which were drawn from the United States and Germany. Personality trait domains were measured via the IPIP-NEO and PID-5; quality of life (QoL) was measured with the WHOQOL-BREF, and impairment was measured using the WHODAS-2.0. The PID-5 was analyzed in all four samples. Two-line testing, which fits two spline regression lines separated at a break point, was conducted to evaluate potential nonmonotonicity of the relationship between personality traits and quality of life. Overall, results demonstrated little support for nonmonotonic relationships in the PID-5 and IPIP-NEO dimensions. Rather, our results indicate that there is one clear pathological pole of major domains of personality that is associated with lower quality of life and increased impairment. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Reliability and validity of the OPD-conflict-questionnaire in an inpatient treatment sample Objectives: Unconscious conflicts are a major part of psychodynamic diagnostics. Benecke et al. (2018) developed the OPD-conflict-questionnaire (OPD-CQ) to assess unconscious conflicts according to the Operationalized Psychodynamic Diagnostics (OPD) via self-report. We inspected its reliability and validity in a large inpatient sample with a focus on correlations with symptomatic burden, interpersonal problems, and structural level. Methods: N = 2083 patients completed questionnaires at the beginning of their inpatient stay in the Fachklinikum Tiefenbrunn between 2017 and 2020. We calculated internal consistencies of the OPD-CQ scales and (partial-)correlations of the OPD-CQ scales with different instruments. Results: Internal consistencies were only partly satisfying (for eight of 13 scales). We found significant (partial-)correlations of the conflicts with symptom severity and interpersonal problems which were in line with expectations. However, structural level correlated with more conflicts than we expected. Conclusions: Due to the low internal consistencies of some scales, we recommend a revision of the OPD-CQ. Still, the found correlations show the potential of the OPD-CQ as a screening instrument for patients in inpatient treatment.

Objectives: The relationship between patients' attachment strategies and the effectiveness of psychotherapy is empirically well established. However, studies on outcome measures other than symptomatic change are mostly lacking. The present study investigates if attachment anxiety and avoidance predict changes in personality functioning at the end of inpatient psychotherapy. Method: In two independent samples (the first sample consisting of N = 967 diagnostically heterogeneous patients, Fachklinikum Tiefenbrunn, and the second sample comprising N = 344 patients with personality impairments, Rehaklinik Bad Grönenbach), personality functioning was assessed by means of the short version of the OPD structure questionnaire OPD-SQS (OPD-Strukturfragebogen 12-Item-Screeningversion, OPD-SFK) at admission and discharge in a naturalistic study design. Data on the Brief Symptom Inventory (BSI) and the Inventory of Interpersonal Problems (IIP-32) were evaluated as additional outcome measures in the first sample. Patients' attachment strategies were assessed at admission using the German short version of the Experiences in Close Relationships (ECR-RD 12). Results: Attachment avoidance at baseline was inversely associated with improvements in personality functioning, psychopathology, and interpersonal problems. In the sample of patients diagnosed with personality disorders (sample 2), we found a negative association between attachment anxiety and improvements in the ability to make contact with others. Conclusions: Considering the limitations, our results underline the relevance of attachment for the treatment outcome of inpatient psychotherapy. The assessment of patient's attachment strategy as part of standardized diagnostics can be helpful in clinical practice regarding prognosis, therapy planning as well as the adjustment of the therapeutic relationship while treating patients suffering from impairments in personality functioning.

Shame and guilt are vital in borderline personality disorder (BPD), and previous research using explicit measures has consistently found elevated levels of these self-conscious emotions (SCE) in those with BPD. However, these measures cannot elucidate implicit processes that are equally important, as they guide the perceptions of the self and influence behavioral responses. Thus, we aimed to extend the research on SCE in BPD utilizing an indirect latency-based measure. A total of 29 female inpatients with BPD and 21 healthy women were assessed with a shame and a guilt self-concept Implicit Association Test (IAT). These two tasks use reaction time measurements to determine the relative strengths of associations between the self versus others and shame versus pride and guilt versus innocence. In addition, participants completed questionnaires capturing shame, guilt, and BPD symptoms. Women with BPD displayed significantly more shame- and guilt-prone implicit self-concepts than the control group (d = 1.2 and d = 0.7, respectively). They also scored significantly higher on explicit measures of shame and guilt. Although explicitly and implicitly assessed shame and guilt were strongly associated with borderline pathology, multivariate models indicated that solely self-reported, but not implicitly measured, guilt was consistently related to all BPD outcomes. Shame was only associated with the number of BPD criteria. This study extends previous findings on SCE in BPD, in that women with BPD do not only explicitly conceive themselves as more shame- and guilt-prone but also exhibit implicitly more shame and guilt self-concepts than healthy controls. Our results may hold clinical and therapeutic implications. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Introduction: From both a clinical and research perspective, it is important to determine what constitutes a perceivable change in commonly used outcome measures. Objective: We aimed to do so for the Symptom Checklist-90-Revised (SCL-90-R). Methods: Patients from a large real-world sample treated with inpatient psychotherapy (n = 4,791) rated improvements in symptoms on a global 5-point Likert scale at discharge. These ratings were related to pre-post changes in the Global Severity Index (GSI) of the SCL-90-R by use of equipercentile linking. Results: A patient rating of 5 (“clearly improved”) was found to be equivalent to an absolute pre-post difference in the GSI of 0.67 or to a percentage improvement of 54%, with the latter corresponding to the common definition of response as a 50% reduction in symptoms. A rating of 1 (“clearly worse”) was equivalent to an increase in the GSI >0.50 and to a percentage worsening >55%. “Slightly improved” or “slightly worse” (ratings of 4 or 2) corresponded to pre-post changes in the GSI of 0.07 and 0.50. For severely disordered patients, larger changes were required for ratings of improvement, and for less severely disordered patients, larger changes were required for ratings of worsening. Results for depressive, anxiety, and personality disorders were widely consistent with those of the total sample. Conclusions: This study is the first to link patient ratings of improvement or worsening to changes in the SCL-90-R. Results are relevant to both the interpretation of changes in individual patients and of effect sizes in outcome research. Results require replication.

Im Abschnitt "Medikamentöse Strategie" des veröffentlichten Beitrags kam es zu einem Umrechnungsfehler. Bitte beachten Sie den korrigierten Text: Es liegt gute Evidenz dafür vor, dass – insbesondere beim opioidgewöhnten Patienten – intraoperativ die Gabe von niedrigdosiertem Ketamin (0,5 mg/kgKG in

BackgroundAt present, the flexible endoscopic evaluation of swallowing (FEES) is one of the most commonly used methods for the objective assessment of swallowing. This multicenter trial prospectively collected data on the safety of FEES and also assessed the impact of this procedure on clinical dysphagia management.MethodsPatients were recruited in 23 hospitals in Germany and Switzerland from September 2014 to May 2017. Patient characteristics, professional affiliation of the FEES examiners (physicians or speech and language therapists), side-effects and cardiorespiratory parameters, severity of dysphagia and clinical consequences of FEES were documented.Results2401 patients, mean age 69.8 (14.6) years, 42.3% women, were included in the FEES-registry. The most common main diagnosis was stroke (61%), followed by Parkinson’s disease (6.5%). FEES was well tolerated by patients. Complications were reported in 2% of examinations, were all self-limited and resolved without sequelae and showed no correlation to the endoscopist’s previous experience. In more than 50% of investigations FEES led to changes of feeding strategies, in the majority of cases an upgrade of oral diet was possible.DiscussionThis study confirmed that FEES, even when performed by less experienced clinicians is a safe and well tolerated procedure and significantly impacts on the patients’ clinical course. Implementation of a FEES-service in different clinical settings may improve dysphagia care.Trial registrationClinicalTrials.gov NCT03037762, registered January 31st 2017.

Schizophrenia is a devastating disease that arises on the background of genetic predisposition and environmental risk factors, such as early life stress (ELS). In this study, we show that ELS-induced schizophrenia-like phenotypes in mice correlate with a widespread increase of histone-deacetylase 1 (Hdac1) expression that is linked to altered DNA methylation. Hdac1 overexpression in neurons of the medial prefrontal cortex, but not in the dorsal or ventral hippocampus, mimics schizophrenia-like phenotypes induced by ELS. Systemic administration of an HDAC inhibitor rescues the detrimental effects of ELS when applied after the manifestation of disease phenotypes. In addition to the hippocampus and prefrontal cortex, mice subjected to ELS exhibit increased Hdac1 expression in blood. Moreover, Hdac1 levels are increased in blood samples from patients with schizophrenia who had encountered ELS, compared with patients without ELS experience. Our data suggest that HDAC1 inhibition should be considered as a therapeutic approach to treat schizophrenia.

At the beginning of modern psychopathology the notion of the will had ahigh significance. Thus, the works of Eugen Bleuler, Emil Krapelin and Karl Jaspers show an intensive study of disorders of the will, such as abulia, ambivalence or disorders of impulse control. Retrospectively, changes of the scientific paradigms in psychology could be one of the reasons for abreak, which led to giving up the concept of the will in psychopathology. With increasing interest in issues of agency and free will, however, areactivation of this central concept could close agap in psychopathology as well as in therapeutic practice. Methodologically, apsychopathology of the will may be founded on adifferential typological phenomenology. To this purpose, the article first proposes aclassification along the structural components of conation, suspension and volition, then gives atemporal analysis of the predecisional, the decisional and the postdecisional phases. The aim of the article is to help identify different disorders of the will, thus also furthering apsychotherapy of will, which can be connected with both cognitive behavioral and psychodynamic approaches.