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In Germany, cognitive-behavioral therapy, psychodynamic therapy, and systemic therapy are scientifically and legally approved as suitable procedures for treating mental disorders. While all methods have provided empirical evidence of their effectiveness in adults according to defined criteria of the "Scientific Advisory Board for Psychotherapy" (in German: "Wissenschaftlicher Beirat Psychotherapie"), i. e., the official board which decides upon the formal scientific approval of psychotherapeutic approaches in Germany, an evaluation is lacking for the psychodynamic methods in children and adolescents. Against this background, we evaluated the available empirical data for psychodynamic therapy in children and adolescents based on the methods paper of the "Scientific Advisory Board for Psychotherapy" (2019; version 2.9). Published reviews served as the basis for identifying relevant studies, supplemented by a systematic literature search. We identified 91 potentially relevant studies but could not consider the majority of these due to formal exclusion criteria (mainly not disorder-specific, no control group). Up to 26 of the remaining studies provide evidence of efficacy as defined by the "Scientific Advisory Board for Psychotherapy". These cover 10 of the 18 areas of application as defined by the "Scientific Advisory Board for Psychotherapy". According to our evaluation, the reviewed studies provide empirical evidence for the three most relevant areas of application (i. e., affective disorders; anxiety disorders and obsessive-compulsive disorders; hyperkinetic disorders and conduct disorders). Thus, the available evidence supports the suitability of psychodynamic therapy as a method for the treatment of children and adolescents.

In Germany, cognitive-behavioral therapy, psychodynamic therapy, and systemic therapy are scientifically and legally approved as suitable procedures for treating mental disorders. While all methods have provided empirical evidence of their effectiveness in adults according to defined criteria of the "Scientific Advisory Board for Psychotherapy" (in German: "Wissenschaftlicher Beirat Psychotherapie"), i. e., the official board which decides upon the formal scientific approval of psychotherapeutic approaches in Germany, an evaluation is lacking for the psychodynamic methods in children and adolescents. Against this background, we evaluated the available empirical data for psychodynamic therapy in children and adolescents based on the methods paper of the "Scientific Advisory Board for Psychotherapy" (2019; version 2.9). Published reviews served as the basis for identifying relevant studies, supplemented by a systematic literature search. We identified 91 potentially relevant studies but could not consider the majority of these due to formal exclusion criteria (mainly not disorder-specific, no control group). Up to 26 of the remaining studies provide evidence of efficacy as defined by the "Scientific Advisory Board for Psychotherapy". These cover 10 of the 18 areas of application as defined by the "Scientific Advisory Board for Psychotherapy". According to our evaluation, the reviewed studies provide empirical evidence for the three most relevant areas of application (i. e., affective disorders; anxiety disorders and obsessive-compulsive disorders; hyperkinetic disorders and conduct disorders). Thus, the available evidence supports the suitability of psychodynamic therapy as a method for the treatment of children and adolescents.Zusammenfassung In Deutschland sind Verhaltenstherapie, psychoanalytisch begründete Verfahren und systemische Therapie wissenschaftlich und sozialrechtlich als geeignete Verfahren zur Behandlung von psychischen Störungen anerkannt. Während alle Verfahren den empirischen Nachweis ihrer Wirksamkeit bei Erwachsenen gemäß definierter Kriterien des „Wissenschaftlichen Beirats Psychotherapie“ als dem offiziellen Gremium, das über die formale wissenschaftliche Anerkennung von psychotherapeutischen Verfahren in Deutschland entscheidet, erbracht haben, fehlt ein entsprechender Nachweis bei Kindern und Jugendlichen für die psychoanalytisch begründeten Verfahren. Vor diesem Hintergrund wurde die empirische Datenlage für psychoanalytisch begründete Verfahren bei Kindern und Jugendlichen auf der Grundlage des Methodenpapiers des „Wissenschaftlichen Beirats Psychotherapie“ (2019; Version 2.9) evaluiert. Als Grundlage zur Identifikation relevanter Studien dienten veröffentlichte Übersichtsarbeiten, die durch eine systematische Literaturrecherche ergänzt wurden. Insgesamt wurden 91 potenziell relevante Studien überprüft, von denen der Großteil jedoch aufgrund formaler Ausschlusskriterien (v. a. nicht störungsspezifisch, keine Kontrollgruppe) nicht weiter berücksichtigt werden konnte. Von den verbliebenen Studien konnten bis zu 26 als Wirksamkeitsnachweise im Sinne des Wissenschaftlichen Beirats Psychotherapie klassifiziert werden. Diese verteilen sich auf 10 der 18 vom Wissenschaftlichen Beirat Psychotherapie definierten Anwendungsbereiche. Gemäß der vorliegenden Evaluation liefert die vorhandene empirische Studienlage hinreichend Evidenz für die drei versorgungsrelevantesten Anwendungsbereiche (Affektive Störungen; Angststörungen und Zwangsstörungen; Hyperkinetische Störungen und Störungen des Sozialverhaltens und der Emotionen) und belegt damit zugleich die Eignung psychoanalytisch begründeter Verfahren für die Behandlung von Kindern und Jugendlichen.

Background: Children of mentally ill parents have a three to seven times higher risk of developing mental disorders compared to the general population. For this high-risk group, specialized prevention and intervention programs have already been developed. However, there has been insufficient sytematic evaluation to date. Moreover, effectiveness and the cost-effectiveness data of the respective programs until today is very scarce and at the same time constitutes the pre-condition for the program's implementation into regular health care.Methods: The study consists of a two-group randomized controlled multicenter trial conducted at seven study sites throughout Germany and Switzerland. Participants are families with mentally ill parents and their children aged from 3 to 19 years. The intervention comprises 6 to 8 semi-structured sessions over a period of about 6 months. Topics discussed in the intervention include parental mental illness, coping, family relations and social support. Families in the control condition will receive treatment as usual. The children's mental health, assessed using the K-SADS-PL by blinded external raters will constitute the primary efficacy outcome. Further outcomes will be assessed from the parents' as well as from the children's perspectives. Participants are investigated at baseline, 6, 12, and 18 months after baseline assessment. In addition to the assessment of various psychosocial outcomes, a comprehensive health-economic evaluation will be performed.Discussion: This paper describes the evaluation of a family-based intervention program for children of mentally ill parents (CHIMPs) in the regular health care system in Germany and Switzerland. A methodically sophisticated study design has been developed to reflect the complexity of the actual health care situation. This trial will contribute to the regular health care for the high-risk group of children of mentally ill parents.Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT02308462; German Clinical Trials Register: DRKS00006806.

Zusammenfassung Hintergrund Ziel war die Analyse direkter Kosten sozialer Angststörung (SAD) bei Jugendlichen und der Kosteneffektivität von CBT bzw. PDT. Methoden Multizentrische randomisierte Studie mit N = 103 Patienten. Krankheitskosten wurden zur Baseline und Kosteneffektivität nach der Behandlung analysiert. Ergebnisse Direkte 6-Monats-Kosten zu Baseline lagen bei 809 €. Während die inkrementelle Kosten-Effektivitäts-Relation von CBT im Vergleich zur Warteliste bei 18 824 €/QALY lag, war PDT nicht kosteneffektiv. Zusammenfassung SAD verursacht hohe direkte Kosten. CBT ist wahrscheinlich kosteneffektiv.

Background: Although social anxiety disorder (SAD) has an early onset and is frequently found in adolescence, evidence for psychotherapeutic treatments of SAD in adolescents is rather scarce. Within the Social Phobia Psychotherapy Research Network (SOPHO-NET), we examined the efficacy of cognitive-behavioral (CBT) and psychodynamic therapy (PDT) compared to a waiting list (WL) in these patients. Methods: In a multicenter randomized controlled superiority trial, 107 patients, aged 14–20 years, were randomized to CBT (n = 34), PDT (n = 34), or WL (n = 39). Assessments were made at baseline, at the end of treatment, and 6 and 12 months after termination. The Liebowitz Social Anxiety Scale for Children and Adolescents (LSAS-CA) applied by raters masked to the treatment condition was used as the primary outcome. As secondary outcomes, rates of response and remission and the Social Phobia Anxiety Inventory (SPAI) were used. Results: Both treatments were superior to WL in the LSAS-CA (CBT: p = 0.0112, d = 0.61, 95% CI 0.14–1.08; PDT: p = 0.0261, d = 0.53, 95% CI 0.06–1.00). At the end of treatment, response rates were 66, 54, and 20% for CBT, PDT, and WL. The corresponding remission rates were 47, 34, and 6%, respectively. CBT and PDT were significantly superior to WL regarding remission (CBT: p = 0.0009, h = 1.0; PDT: p = 0.0135, h = 0.74), response (CBT: p = 0.0004, h = 0.97; PDT: p = 0.0056, h = 0.72), and the SPAI (CBT: p = 0.0021, d = 0.75, 95% CI 0.27–1.22; PDT: p = 0.0060, d = 0.66, 95% CI 0.19–1.13). Treatment effects were stable at 6- and 12-month follow-ups. Conclusions: These results are comparable to the large SOPHO-NET trial in adults (n = 495). Early treatments for social anxiety are needed in order to prevent chronic manifestation of SAD.

Zusammenfassung Ziel der Studie Psychische Belastungen bei Arbeitssuchenden sind häufig und können bei den Betroffenen zu Beeinträchtigungen in unterschiedlichen Lebensbereichen führen. Programme zur Unterstützung Betroffener, v. a. von Langzeitarbeitslosen, erfahren in jüngster Zeit zunehmend Beachtung. Vorbehalte sowie strukturelle Barrieren stellen jedoch Hindernisse für deren Inanspruchnahme dar. Im Folgenden wird ein Kooperationsprojekt zwischen einem Jobcenter und einer psychiatrischen Klinik mit dem Ziel der niedrigschwelligen Begleitung und etwaigen Weitervermittlung psychisch belasteter Langzeitarbeitsloser vorgestellt und die Evaluation des Projektes beschrieben. Methodik Darstellung des methodischen und klinischen Vorgehens sowie der Evaluation der Pilotphase. Ergebnisse In den ersten 12 Monaten konnten insgesamt 57 Arbeitslosengeld-II (ALG-II) Empfänger im Rahmen des Projektes begleitet werden. Die psychische Belastung der Teilnehmenden war hoch und entspricht der bisherigen Datenlage. Die niedrigschwellige Begleitung wurde gut angenommen und führte bei einem Großteil der Teilnehmenden (n=37) zu einer Weitervermittlung in das Gesundheitssystem. Schlussfolgerung Psychische Belastungen bei Arbeitssuchenden sind häufig und können bei den Betroffenen zu erheblichen Einschränkungen in unterschiedlichen Lebensbereichen führen. Bestehende Angebote der Gesundheitsversorgung zielen bisher zu wenig auf diese Gruppe und erreichen die Betroffenen nicht. Niedrigschwellige Unterstützungs- und Beratungsangebote sind gut geeignet, um möglichen Barrieren der Inanspruchnahme auf Seite der Betroffenen und des Versorgungsystems entgegenzuwirken und Betroffenen die Aufnahme einer bedarfsgerechten, psychosozialen Versorgung zu ermöglichen.

ZusammenfassungDie Bezeichnung Low-Intensity Cognitive Behavioral Therapie (LI-CBT) (in der Übersetzung etwa „niedrigintensive kognitive Verhaltenstherapie“) beschreibt Versorgungsangebote, die das Ziel verfolgen, den Zugang zu evidenzbasierten psychologischen Therapien zu verbessern. Dies wird erreicht indem (1) die Kontaktzeit zwischen Therapeut und Patient reduziert wird, (2) Fachkräfte mit speziellem Training aber ohne langjährige psychotherapeutische Qualifikation und (3) Interventionen mit variabler Intensität eingesetzt werden. Gestufte (Stepped-care) und berufsgruppen-vernetzende (Collaborative-care) Versorgungsstrukturen bilden den strukturellen Rahmen für eine erfolgreiche Umsetzung von LI-CBT. Während sich international großangelegte Forschungs- und Praxisprojekte diesem Thema widmen, liegt die Entwicklung in Deutschland deutlich zurück. Gerade vor dem Hintergrund wachsender Bedarfe und Inanspruchnahmen sowie der Zielsetzung von politischer Seite, neue Versorgungsformen zu entwickeln, stellte das Konzept LI-CBT daher einen vielversprechenden Ansatz dar.

Despite being recommended for use in clinical trials, the consensus remission criteria were found to leave patients with persisting symptoms, relevant areas of functional impairment and a decreased sense of wellbeing. Therefore, to evaluate the appropriateness of the schizophrenia consensus criteria, a definition of remission based on the Clinical Global Impression Scale (CGI) was developed and remitter subgroups were compared.239 patients with a schizophrenia spectrum disorder were evaluated regarding their remission status after inpatient treatment. Remission in schizophrenia was defined according to the symptom-severity component of the consensus criteria by Andreasen et al. and a CGI based definition was calculated using sensitivity and specificity using receiver operating curves (asymptomatic remitter). Both remitter groups (schizophrenia consensus versus asymptomatic remitters) were compared regarding different clinical variables at discharge as well as the likelihood to relapse within a 1-year follow-up period. Both schizophrenia remitter subgroups were compared to remitters in major depression as a reference value.Following the consensus criteria, 63% of the schizophrenia patients were in remission compared to only 18% following the asymptomatic criterion. The schizophrenia consensus remitters were less likely to be concurrent treatment responders (p 0.0001), had a significantly greater illness severity (p 0.0001) and less functioning (p = 0.0358) as well as a significantly greater risk to relapse (p = 0.0174) compared to the schizophrenia asymptomatic remitters as well as the depressed remitters.It should be critically re-evaluated if the currently proposed consensus criteria are adequate to measure what is traditionally understood to be remission.

"Nicht von schlechten Eltern - NischE": A Family Orientated Collaborative Care Approach to Support Children in Families with Mentally Ill Parents The present work describes the setting- and multi-professional offer "NischE" in Gutersloh, a systemic approach for the care of children and their mentally ill parents. Children of mentally ill parents are a special risk group for developing their own mental illness. The aim of the collaborative care model between child and adolescent psychiatry, youth services and adult psychiatry is to enable affected families in terms of family-focused practice a low threshold access to different services. For this purpose, two positions have been created to advise the affected families and support access to the help system in the sense of a systemic case management in a project. The article describes the background and the need for the development of the offer, the current scientific knowledge base on the subject and illustrates the procedure using a case study from practice.

Social anxiety disorder is one of the most prevalent mental disorders and often manifests in youth or adolescence. Our aim was to determine direct costs of adolescents with social anxiety disorder and the cost-effectiveness of cognitive-behavioral therapy (CBT) and psychodynamic therapy (PDT) compared to waiting list (WL).Baseline data (n = 103) of a randomized controlled trial was used to determine direct costs. Cost-effectiveness of CBT and PDT compared to WL was analyzed using quality-adjusted life years (QALYs) based on the EQ-5D index as measure of health effects.Total six-month direct costs were 809 € (SE 508 €). Especially costs of outpatient physician treatment (325 €; SE 301 €) and psychiatric hospital stays (377 €; SE 258 €) were high. The incremental cost-effectiveness ratio (ICER) of CBT compared to WL was 18,824 €/QALY, with a probability of 63 % for the ICER being below 50,000 €/QALY. PDT did not prove to be cost-effective.Direct costs were mainly caused by psychiatric hospital stays and outpatient physician treatments. CBT is likely to be cost-effective compared to WL, whereas PDT is unlikely to be cost-effective.Ziel war die Analyse direkter Kosten sozialer Angststörung (SAD) bei Jugendlichen und der Kosteneffektivität von CBT bzw. PDT.Multizentrische randomisierte Studie mit N = 103 Patienten. Krankheitskosten wurden zur Baseline und Kosteneffektivität nach der Behandlung analysiert.Direkte 6-Monats-Kosten zu Baseline lagen bei 809 €. Während die inkrementelle Kosten-Effektivitäts-Relation von CBT im Vergleich zur Warteliste bei 18 824 €/QALY lag, war PDT nicht kosteneffektiv.SAD verursacht hohe direkte Kosten. CBT ist wahrscheinlich kosteneffektiv.

The present article gives an overview of the Heidelberg Study on the evaluation of psychodynamic psychotherapy for children and adolescents. The study design is described and instruments for the assessment of structural characteristics and the psychotherapeutic process developed and evaluated in the project are presented. Also, results regarding treatment outcome are reported. The aim of the study was to examine the efficacy of short-term psychodynamic psychotherapy in an RCT-trial as well to assess the effectiveness of long-term psychoanalysis in a naturalistic study design. 71 patients aged 6-18 with internalizing and externalizing disorders were treated with an average of 82 therapy sessions. For several variables, a significant statistical superiority of the therapy group compared to the waiting control group could be shown. Considerably higher effect sizes were found for long-term treatment than for short-term psychotherapy. The results demonstrate that short-term psychodynamic psychotherapy and long-term psychoanalysis are highly effective treatments for children and adolescents with mental disorders.

Ziel der Studie: Darstellung der Evaluation eines Kooperationsprojektes fur ein niedrigschwelliges, anonymes Beratungsangebot zwischen psychiatrischer Versorgung und dem Handlungsfeld der Kinder- und Jugendhilfe fur Familien mit Kindern und psychisch erkrankten Eltern. Methodik: Auswertung der Leistungsdaten und der durch die Eltern beantworteten Evaluationsbogen zum Projekt. Ergebnisse: Im Zeitraum von 2011 bis 2014 haben 150 Familien im Rahmen des Projektes ein familienorientiertes Beratungsangebot mit bis zu 10 Gesprachsterminen erhalten. Die Ergebnisse der Befragung belegen eine hohe Zufriedenheit mit den Leistungen des Kooperationsprojektes. Der uberwiegende Teil der Befragten wurde das Angebot weiterempfehlen bzw. erneut in Anspruch nehmen. Schlussfolgerung: Eine Kooperation der Leistungserbringer aus den Bereichen Psychiatrie und Kinder- und Jugendhilfe und ein daraus hervorgehendes Bruckenangebot mit gemeinsamer familienmedizinischer Perspektive stellt im Hinblick auf die Versorgung von Familien mit einem psychisch erkrankten Elternteil ein zukunftsweisendes Modell dar.

Psychological problems are highly prevalent in unemployed people and can lead to impairments in several areas of life. Programs to support and assist those affected, especially the long-term unemployed, are scarce. Reservations by those affected present an additional barrier with respect to health care utilisation. The authors designed a collaborative care cooperation project between a local job center and a psychiatric clinic with the aims of counselling unemployed people with psychological distress as well as offering continuing psychosocial care if required.This paper presents the methodological design, clinical procedure as well as a preliminary evaluation of the pilot phase.Within the first 12 months of the pilot phase, 57 long-term unemployed were enrolled in the project. Subjective psychological distress in the sample was comparable with other studies reporting high rates of psychological problems in the unemployed. The psychosocial intervention was well accepted not only by the unemployed but also by case managers and led to high re-assignment rates (n=37) to complementary services within the psychosocial health care system.Unemployment and psychological distress should be addressed together within collaborative care projects that can positively affect the negative interaction between unemployment and psychological distress. Low-intensity psychological interventions are well suited to address barriers that hinder health care utilization and to offer person-centered, psychological assistance.Psychische Belastungen bei Arbeitssuchenden sind häufig und können bei den Betroffenen zu Beeinträchtigungen in unterschiedlichen Lebensbereichen führen. Programme zur Unterstützung Betroffener, v. a. von Langzeitarbeitslosen, erfahren in jüngster Zeit zunehmend Beachtung. Vorbehalte sowie strukturelle Barrieren stellen jedoch Hindernisse für deren Inanspruchnahme dar. Im Folgenden wird ein Kooperationsprojekt zwischen einem Jobcenter und einer psychiatrischen Klinik mit dem Ziel der niedrigschwelligen Begleitung und etwaigen Weitervermittlung psychisch belasteter Langzeitarbeitsloser vorgestellt und die Evaluation des Projektes beschrieben.Darstellung des methodischen und klinischen Vorgehens sowie der Evaluation der Pilotphase.In den ersten 12 Monaten konnten insgesamt 57 Arbeitslosengeld-II (ALG-II) Empfänger im Rahmen des Projektes begleitet werden. Die psychische Belastung der Teilnehmenden war hoch und entspricht der bisherigen Datenlage. Die niedrigschwellige Begleitung wurde gut angenommen und führte bei einem Großteil der Teilnehmenden (n=37) zu einer Weitervermittlung in das Gesundheitssystem.Psychische Belastungen bei Arbeitssuchenden sind häufig und können bei den Betroffenen zu erheblichen Einschränkungen in unterschiedlichen Lebensbereichen führen. Bestehende Angebote der Gesundheitsversorgung zielen bisher zu wenig auf diese Gruppe und erreichen die Betroffenen nicht. Niedrigschwellige Unterstützungs- und Beratungsangebote sind gut geeignet, um möglichen Barrieren der Inanspruchnahme auf Seite der Betroffenen und des Versorgungsystems entgegenzuwirken und Betroffenen die Aufnahme einer bedarfsgerechten, psychosozialen Versorgung zu ermöglichen.

Low-intensity cognitive behavioural therapy (LI-CBT) depicts interventions that aim at increasing access to evidence-based psychological therapies. This is achieved by (1) reducing the amount of time in which the practitioner is in contact with individual patients, (2) using practitioners that have been specifically trained to deliver low intensity interventions and without any prior formal health professional qualifications and (3) use of interventions with varying intensity. Stepped care and collaborative care constitute the organizational frame to deliver low-intensity interventions. Whereas large-scale research and health service projects abroad are focussing on LI-CBT, research in German is lagging far behind. Particularly in the light of the growing demands and utilization of mental health care as well as governmental claims to develop and evaluate new forms of providing mental health services, LI-CBT represents a promising approach.Die Bezeichnung Low-Intensity Cognitive Behavioral Therapie (LI-CBT) (in der Übersetzung etwa „niedrigintensive kognitive Verhaltenstherapie“) beschreibt Versorgungsangebote, die das Ziel verfolgen, den Zugang zu evidenzbasierten psychologischen Therapien zu verbessern. Dies wird erreicht indem (1) die Kontaktzeit zwischen Therapeut und Patient reduziert wird, (2) Fachkräfte mit speziellem Training aber ohne langjährige psychotherapeutische Qualifikation und (3) Interventionen mit variabler Intensität eingesetzt werden. Gestufte (Stepped-care) und berufsgruppen-vernetzende (Collaborative-care) Versorgungsstrukturen bilden den strukturellen Rahmen für eine erfolgreiche Umsetzung von LI-CBT. Während sich international großangelegte Forschungs- und Praxisprojekte diesem Thema widmen, liegt die Entwicklung in Deutschland deutlich zurück. Gerade vor dem Hintergrund wachsender Bedarfe und Inanspruchnahmen sowie der Zielsetzung von politischer Seite, neue Versorgungsformen zu entwickeln, stellte das Konzept LI-CBT daher einen vielversprechenden Ansatz dar.

Subtyping depression is important in order to further delineate biological causes of depressive syndromes. The aim of this study was to evaluate clinical and outcome characteristics of distinct subtypes of depression and to assess proportion and features of patients fulfilling criteria for more than one subtype. Melancholic, atypical and anxious subtypes of depression were assessed in a naturalistic sample of 833 inpatients using DSM-IV specifiers based on operationalized criteria. Baseline characteristics and outcome criteria at discharge were compared between distinct subtypes and their overlap. A substantial proportion of patients (16%) were classified with more than one subtype of depression, 28% were of the distinct anxious, 7% of the distinct atypical and 5% of the distinct melancholic subtype. Distinct melancholic patients had shortest duration of episode, highest baseline depression severity, but were more often early improvers; distinct anxious patients had higher NEO-Five Factor Inventory (NEO-FFI) neuroticism scores compared with patients with unspecific subtype. Melancholic patients with overlap of anxious features had worse treatment outcome compared to distinct melancholic and distinct anxious subtype. Distinct subtypes differed in only few variables and patients with overlap of depression subtypes may have independent clinical and outcome characteristics. Studies investigating biological causes of subtypes of depression should take influence of features of other subtypes into account.

Background: Treatment algorithms are considered as key to improve outcomes by enhancing the quality of care. This is the first randomized controlled study to evaluate the clinical effect of algorithm-guided treatment in inpatients with major depressive disorder. Methods: Inpatients, aged 18 to 70 years with major depressive disorder from 10 German psychiatric departments were randomized to 5 different treatment arms (from 2000 to 2005), 3 of which were standardized stepwise drug treatment algorithms (ALGO). The fourth arm proposed medications and provided less specific recommendations based on a computerized documentation and expert system (CDES), the fifth arm received treatment as usual (TAU). ALGO included 3 different second-step strategies: lithium augmentation (ALGO LA), antidepressant dose-escalation (ALGO DE), and switch to a different antidepressant (ALGO SW). Time to remission (21-item Hamilton Depression Rating Scale

Background: Self-generated coping strategies and the enhancement of coping strategies are effective in the treatment of psychotic symptoms. Evaluating these strategies can be of clinical interest to develop better coping enhancement therapies. Cognitive models consider delusions as multidimensional phenomena. Using a psychometric approach, the relationship between coping and the dimensions of delusion were examined. Methods: Thirty schizophrenia spectrum patients with delusions and 29 patients with affective disorder with psychotic symptoms were interviewed using the Heidelberg Coping Scales for Delusions and the Heidelberg Profile of Delusional Experience. Analyses of variance were conducted to investigate differences between the groups, and Spearman's rank-based correlations were used to examine the correlations between coping factors and the dimensions of delusion. Results: Schizophrenia spectrum patients used more medical care and symptomatic coping, whereas patients with affective disorder engaged in more depressive coping. In the schizophrenia spectrum sample, the action-oriented, the cognitive, and the emotional dimensions of delusion were related to coping factors. In patients with affective disorder, only the action-oriented dimension was related to coping factors. Conclusion: Patients with schizophrenia and affective disorder cope differently with delusions. The dimensions of delusion are related to coping and should be regarded when using cognitive therapy approaches to enhance coping strategies.

Hintergrund Empirische Studien zeigen einen Zusammenhang zwischen familiaren Faktoren und essgestortem Verhalten. Ebenso ist ein erhohtes Schamempfinden mit einer starkeren Auspragung von Essstorungssymptomen und mit als dysfunktional wahrgenommenen Familienbeziehungen assoziiert. Scham kommt somit als Mediator der Beziehung zwischen dysfunktionalen Familienbeziehungen und Essstorungssymptome in Betracht.

Summary Interrater-Reliability of the OPD-CA, the Axes Conflict and Structure The reliability of the meanwhile widely used Operationalized Psychodynamic Diagnostics in childhood and adolescence (OPD-CA) is only rarely examined. By means of audiovisual recordings of OPD-CA-interviews with 39 adolescents in the context of a randomized-controlled psychotherapy study for the treatment female adolescents with bulimia nervosa and atypical bulimia nervosa the reliability of the axis conflict and the axis structure were examined. This was carried out by the calculation of Intraklassen-correlations of three raters. The rater agreements ranged from good to excellent, except for impulse control in the axis structure, where the results were satisfactory. The relevance of the results for clinical practice is discussed.

"Nicht von schlechten Eltern - NischE": A Family Orientated Collaborative Care Approach to Support Children in Families with Mentally Ill Parents The present work describes the setting- and multi-professional offer "NischE" in Gütersloh, a systemic approach for the care of children and their mentally ill parents. Children of mentally ill parents are a special risk group for developing their own mental illness. The aim of the collaborative care model between child and adolescent psychiatry, youth services and adult psychiatry is to enable affected families in terms of family-focused practice a low threshold access to different services. For this purpose, two positions have been created to advise the affected families and support access to the help system in the sense of a systemic case management in a project. The article describes the background and the need for the development of the offer, the current scientific knowledge base on the subject and illustrates the procedure using a case study from practice.

Objective The authors compared cognitive-behavioral therapy (CBT) and psychodynamic therapy (PDT) for the treatment of bulimia nervosa (BN) in female adolescents. Method In this randomized controlled trial, 81 female adolescents with BN or partial BN according to the DSM-IV received a mean of 36.6 sessions of manualized disorder−oriented PDT or CBT. Trained psychologists blinded to treatment condition administered the outcome measures at baseline, during treatment, at the end of treatment, and 12 months after treatment. The primary outcome was the rate of remission, defined as a lack of DSM-IV diagnosis for BN or partial BN at the end of therapy. Several secondary outcome measures were evaluated. Results The remission rates for CBT and PDT were 33.3% and 31.0%, respectively, with no significant differences between them (odds ratio [OR] = 0.90, 95% CI = 0.35−2.28, p = .82). The within-group effect sizes were h = 1.22 for CBT and h = 1.18 for PDT. Significant improvements in all secondary outcome measures were found for both CBT ( d = 0.51−0.82) and PDT ( d = 0.24−1.10). The improvements remained stable at the 12-month follow-up in both groups. There were small between-group effect sizes for binge eating ( d = 0.23) and purging ( d = 0.26) in favor of CBT and for eating concern ( d = −0.35) in favor of PDT. Conclusion CBT and PDT were effective in promoting recovery from BN in female adolescents. The rates of remission for both therapies were similar to those in other studies evaluating CBT. This trial identified differences with small effects in binge eating, purging, and eating concern. Clinical trial registration information— Treating Bulimia Nervosa in Female Adolescents With Either Cognitive-Behavioral Therapy (CBT) or Psychodynamic Therapy (PDT). http://isrctn.com/; ISRCTN14806095.

The objective of the present study was the application and comparison of common remission and recovery criteria between patients with the diagnosis of schizophrenia and major depressive disorder (MDD) under inclusion of other outcome parameters. Patients with schizophrenia and MDD who were treated as inpatients at the beginning of the study were examined within two naturalistic follow-up trials from admission to discharge of an inpatient treatment period and the one-year follow-up assessment. PANSS criteria of the Remission in Schizophrenia Working Group (RSWG) for schizophrenia and HAMD criteria of the ACNP Task Force in MDD for depressive patients as well as the Clinical Global Impression-Severity Scale (CGI-S) were applied as symptomatic outcome measures additionally to functional outcome parameters. Data of 153 schizophrenia patients and 231 patients with a MDD episode have been included in the analysis. More depressive than schizophrenia patients reached a threshold score of ≤3 on the CGI-S, indicating symptomatic remission at discharge and at the one-year follow-up. In contrast similar proportions of patients reaching symptomatic remission at discharge from inpatient treatment and at the one-year follow-up in the schizophrenia and in the MDD group were found when disease-related consensus criteria (RSWG vs. ACNP Task Force) were used. Functional remission and recovery rates were significantly lower in schizophrenia than in depressive patients at the one-year follow-up visit. Common outcome criteria for remission and recovery in schizophrenia and major depression were not directly comparable. However, our results indicated a significantly poorer outcome in schizophrenia than in depressive patients according to terms of remission and recovery.

BackgroundSelf-ratings of psychotic experiences might be biased by depressive symptoms.MethodData from a large naturalistic multicentre trial on depressed inpatients (n = 488) who were assessed on a biweekly basis until discharge were analyzed. Self-rated psychotic symptoms as assessed with the 90-Item Symptom Checklist (SCL-90) were correlated with the SCL-90 total score, the SCL-90 depression score, the Beck Depression Inventory (BDI), the Hamilton Depression Rating Scale 21 item (HAMD-21) total score, the Montgomery Åsberg Depression Rating Scale (MADRS) total score and the clinician-rated paranoid-hallucinatory score of the Association for Methodology and Documentation in Psychiatry (AMDP) scale.ResultsAt discharge the SCL-90 psychosis score correlated highest with the SCL-90 depression score (0.78, PPPPPPPP = 0.02).ConclusionsIn depressed patients self-rated psychotic symptoms correlate poorly with clinician-rated psychotic symptoms. Caution is warranted when interpreting results from epidemiological surveys using self-rated psychotic symptom questionnaires as indicators of psychotic symptoms. Depressive symptoms which are highly prevalent in the general population might influence such self-ratings.

Background: Until now few studies have proven that an attachment style can be changed in the course of psychotherapy and that the attachment style has an impact on the therapy outcome. In particular, there is a lack of studies about these relationships in long-term psychoanalytic psychotherapy with children and adolescents. Sampling and Methods: Seventy-one children with mental disorders receiving long-term outpatient psychodynamic psychotherapy were assessed 4 times using the Heidelberg Attachment Style Rating for Children and Adolescents. The measurements were conducted at the beginning of treatment, at the 25th treatment session, at the end of treatment and 1 year after the completion of treatment. Results: The results showed a significant change in attachment style during treatment. The proportion of children and adolescents with a secure attachment style increased from 23% to 63%. There was no significant difference in the attachment style between patients with good and poor treatment outcome, but a significant relationship between secure attachment and the number of treatment sessions could be demonstrated. Conclusions: A reorientation towards a secure main attachment style over the course of psychotherapy is possible. However, attachment style seems to be not a moderator but a mediator for the outcome of psychoanalytic psychotherapy in children and adolescents.

Background: Although the long-term course of depression has been intensively examined, there are only few studies on the long-term development of depressed patients' spousal relationships. The aim of the study was to assess the quality and stability of depressed patients' spousal relationships in the long-term course of depression and to identify predictors of relationship outcome. Methods: In the study, 50 inpatients with Major Depression were followed-up one, two and ten years after discharge from hospital and compared to a healthy control group matched by age and sex. Marital satisfaction was measured by the Terman item. Expressed Emotion (EE) was assessed with the Five-Minute Speech Sample (FMSS) and the Perceived Criticism Index (PC). Results: In the follow-up period of ten years, 26 patients (56.5%) had a recurrence. Ten years after discharge from hospital 8 couples were separated, 11 were unhappy and 26 couples were happy with their spousal relationship. The quality of marital relationship decreased over the follow-up period. In comparison to a healthy control group, patients showed a significantly worse quality of marital relationship at follow-up. Besides age and course of depression, the spousal EE status was a prognostic factor for the quality of the relationship after 10 years. Conclusions: The results confirm the decrease of marital satisfaction over time in the long-term course of depression. Identified interpersonal predictors of the quality of spousal relationship in major depression could be used as indication criteria for couple therapy.

Objective The objective of this study was to explore the prevalence of anxious depression in an inpatient population, to describe its clinical and sociodemographic correlates, and to compare treatment outcomes between patients with anxious and nonanxious depression. Furthermore, the efficacy of algorithm-guided treatment versus treatment as usual in patients with anxious versus nonanxious depression was evaluated. Method Data were collected on 429 inpatients with the diagnosis of a depressive episode (according to ICD-10) and a score of ≥ or = 15 on the 21-item Hamilton Depression Rating Scale (HDRS-21). The German Algorithm Project, phase 3 (GAP3), was conducted between 2000 and 2005 in 10 psychiatric departments throughout Germany. A baseline HDRS-21 anxiety/somatization factor score of ≥ or = 7 was considered indicative of anxious depression. Remission was defined as an HDRS-21 score or ≤ = 9. To evaluate the efficacy of algorithm-guided treatment, patients were randomly assigned into 3 groups: 2 different treatment algorithms or treatment as usual. Results The prevalence of anxious depression was 49%. Patients with anxious depression were more likely than those with nonanxious depression to be older (mean ± SD = 45.3 ± 12.8 vs 42.9 ± 12.0 years, odds ratio [OR] = 1.02 [95% CI, 1.00-1.03], P = .046), retired (70% vs 30%, OR = 3.09 [95% CI, 1.70-5.62], P = .000), without school qualification (74% vs 26%, OR = 3.11 [95% CI, 1.09-8.83], P = .035), more severely depressed (mean ± SD HDRS-21 score = 20.1 ± 5.0 vs 18.5 ± 4.4, OR = 1.08 [95% CI, 1.03-1.12], P = .001), and more likely to have a longer duration of the current episode (mean ± SD = 20.9 ± 26.2 vs 13.7 ± 14.3 weeks, OR = 1.02 [95% CI, 1.01-1.03], P = .011). Patients with anxious depression were more likely to display a variety of melancholic features. In patients with anxious depression compared to those with nonanxious depression, remission was less likely to be achieved (48.6% vs 61.5%, OR = 0.63 [95% CI, 0.42-0.92], P = .018) and took longer to occur (mean ± SD = 44 ± 3.4 vs 30 ± 2.8 days, HR = 0.65 [95% CI, 0.50-0.85], P = .001). There was no significant interaction with the treatment mode with regard to remission (Wald = 0.20, P = .890). Conclusions Anxious depression is common in patients diagnosed with depression. The poorer treatment outcome in patients with anxious depression demonstrates the need to address the issue of specific treatment strategies for this subgroup. However, anxious depression has no moderating effect on the efficacy of algorithm-guided treatment. Trial registration http://www.germanctr.de/ Identifier: DRKS00000161.

Background: Delusional experience is a fundamental symptom of psychotic illness. Over recent years, a multidimensional perspective has become increasingly important regarding this phenomenon. Several instruments to measure different dimensions of delusions have been constructed. The aims of this study were to examine the reliability and validity of a German version of the Dimensions of Delusional Experience Scale (DDE). Methods: Two hundred inpatients with a schizophrenic spectrum disorder or an affective disorder with delusions were examined with the DDE, the Positive and Negative Syndrome Scale (PANSS) and other rating scales for delusional experiences. Results: The scale was found to have good reliability and excellent inter-rater reliability. The 2 factors, delusional involvement and delusional construct, found by Kendler et al. [Am J Psychiatry 1983;140:466–469] could be replicated. The convergent and differential validity of the scale was supported. Besides the content-related aspect ‘bizarreness’, the DDE mainly assesses cognitive aspects, emotional and behavioral aspects are not incorporated. Conclusions: The results support the value of a multidimensional perspective of delusional experiences. The German version of the DDE is a reliable and valid assessment tool for different dimensions of delusions, and an economical instrument for research and clinical practice. Further research is needed to reveal the dimensional structure underlying delusional experience.

Background: Research suggests delusions may be better viewed as multidimensional rather than dichotomous phenomena. The aim of this study was to assess the reliability and validity of a German version of the Characteristics of Delusions Rating Scale (CDRS) as an expert rating scale. Method: 200 inpatients with schizophrenic spectrum and affective disorders with delusions were assessed with the CDRS and other delusion rating scales. Factorial validity was analysed, and differences between diagnostic groups on the CDRS subscales as well as on the total score were examined. Results: The CDRS was found to have good inter-rater reliability and internal consistency as an expert rating. Factor analysis yielded an interpretable structure with 3 factors – cognition, emotion and bizarreness – accounting for 70% of the variance. The convergent and differential validity of the scales was supported. Compared to other scales, the CDRS measures all dimensions of delusional experience that have been suggested to date with the exception of behavioural aspects. Conclusions: The results support the view of delusions as multidimensional phenomena. The CDRS as an expert rating is a reliable and valid assessment tool for dimensions of delusional experience and an economical instrument for research and clinical practice. Further research is needed to examine the dimensional structure underlying delusional phenomena and the relationship of the dimensions to neurobiological and psychotherapeutic processes.

Shame and guilt feelings play a pivotal role in the aetiology and maintenance of a number of psychological disorders as well as in the development and regulation of moral behaviour. Despite intensive theoretical treatments of this topic, there have been few empirical studies to date, chiefly because of the lack of appropriate measuring instruments. The purpose of this study was the psychometric evaluation of the German version of the Test of Self-Conscious Affect for Children and Adolescents (TOSCA-C/A). The psychometric properties of this instrument were evaluated using a non-clinical sample of N = 505 children and adolescents aged between 8 and 18 years and a clinical sample of N = 50 children and adolescents. The individual scales proved reliable. There were many indications of the validity of the scales. We conclude that the German version of the TOSCA-C/A is the basis for the further investigation of self-conscious affects such as guilt and shame in children and adolescents.

Outcome studies of patients suffering from depression indicate a high relapse rate and a tendency towards chronicity. A family atmosphere characterised by expressed emotion (EE) and perceived criticism (PC) was reported to be a robust predictor of outcome in affective disorders. The aim of the study was to analyze the association between EE, PC and long-term outcome of depression. Fifty inpatients with major depression were followed up 1, 2 and 10 years after discharge from the hospital. After 10 years, 26 patients (56.5%) had at least one recurrence. Spousal EE, assessed with the Five-Minute Speech Sample (FMSS), and the Perceived Criticism Index (PCI) were not significant prognostic factors for depression outcome. The significance of EE and PC for the long-term course of depression has to be questioned. The findings indicate a need to examine factors that may partly mediate the effect of EE and PC on the outcome of depression.

In several studies, the association between attachment style and psychotherapy outcome has been shown for adults. The aim of the present study was to examine the association between attachment style and outcome of short-term psychodynamic psychotherapy for children and adolescents. 71 children and adolescents with a mental disorder receiving out-patient short-term psychodynamic psychotherapy were studied. Attachment style was assessed with the Heidelberg Attachment Style Rating for Children and Adolescents (HASR-CA). Therapy outcome was measured using the Severity of Impairment Score for Children and Adolescents (SIS-CA). It could be shown that good outcome in therapy is significantly more frequently associated with a secure attachment style than with an insecure attachment style. No significant changes in attachment security were observed during treatment. Thus, attachment style is a good predictor of a successful short-term psychodynamic psychotherapy for children and adolescents and therefore is an important criterion for the differential indication for psychodynamic therapies.

Background: For affective disorders, imparting information about the illness has become standard treatment. Despite the great clinical relevance of knowledge about depression, few empirical studies on this subject have been carried out. The aim of the study was to identify the prognostic value of knowledge about affective disorders for the two year outcome of depression. Methods: 62 first-hospitalised patients with major depression were recruited and tested with the Knowledge about Depression and Mania Inventory (KDMI). The patients were followed-up after 1 and 2 years. Results: In the 2-year follow-up period, 28 patients (45.2%) had a recurrent or chronic course of depression. Patients with stable remission had significantly more knowledge about affective disorders compared to patients with recurrence or chronic depression. Knowledge about treatment was prognostically relevant whereas knowledge about symptoms and knowledge about coping were not. Conclusions: The results show that knowledge about affective disorders and especially knowledge about treatment is a predictor for the outcome of depression. This indicates the necessity of multidimensional assessment of knowledge about disorder. Future studies should examine the mechanisms underlying the prognostic effect in order to improve treatment of depression. © 2007 Elsevier B.V. All rights reserved.

Background: Coping is of substantial relevance in the treatment and course of psychiatric disorders. Standardized instruments to assess coping with psychotic symptoms, particularly delusions, are rare. The aim of this study was to develop and evaluate the psychometric properties of a new instrument to assess coping strategies in the context of delusional experiences: the Heidelberg Coping Scales for Delusions (HCSD). Methods: Two hundred and twelve inpatients with schizophrenia spectrum disorders and affective disorders currently experiencing delusions were interviewed with the HCSD and other coping assessment instruments. Psychometric properties and factor structure were analyzed. Results: The HCSD showed good inter-rater reliability and convergent validity. Factor analysis yielded an interpretable structure with five factors: resource-oriented coping, medical care, distraction, cognitive coping, and depressive coping. Symptomatic behavior, due to its particular characteristics, was considered apart. Conclusion: The HCSD is a reliable and valid instrument for the assessment of coping strategies in patients with delusions. Further research is needed to evaluate coping changes over time and their influence on treatment and clinical outcomes.

The relevance of family interactions in the course of affective disorders has been well described. In contrast to the situation regarding schizophrenic disorders, there are few systematic concepts for involvement of the relatives of patients with affective disorders in treatment. The goal of this study was the development and evaluation of a standardised psychoeducational treatment programme. We determined the number and characteristics of relatives accepting the offer of such a group. Relatives of almost half of 55 patients with major depression and a bipolar disorder participated in the group. Relatives of male patients were more likely to take part than relatives of female patients. Relatives of patients with a bipolar disorder were more likely to take part than relatives of patients with unipolar depression. The patients whose relatives attended the group showed a more favourable understanding of the illness and more knowledge about affective disorders, but on the other hand, felt themselves to be more strongly criticised by their relatives and had less social support than the other patients. These results emphasise the importance of differential family-focused treatment modalities in affective disorders.

One aim of the present study was the psychometric evaluation of the German version of the questionnaire TEMPS-A of Akiskal, Mundt, Maier and Angst , which explores five affective temperaments. Another aim was to create a short version of the questionnaire. For that purpose the TEMPS-A was filled in by n = 62 in-patients who suffered from Major Depression. Then the relation between the five types of temperament and the big five personality factors was examined. The intercorrelations of the five temperament scales of the TEMPS-A showed mainly moderate associations. The correlations with the big five personality factors resulted in significant associations of all temperaments with neuroticism. By factor analyses, conducted for each scale of the TEMPS-A, we developed a short form of the TEMPS-A with 30 items. The evaluation of the TEMPS-A is just beginning. The TEMPS-A is an important basis for the further examination of the relationship between temperament and psychiatric disorders.

Background: Increasing importance is attributed to the knowledge that patients have concerning their illness. For psychiatric disorders, imparting information about the illness has become a standard part of treatment. Despite the great clinical relevance of knowledge about depression, only few empirical studies on this subject have been carried out. This study aimed to identify psychosocial factors associated with greater or lesser knowledge about affective disorders. Methods: Sixty-one in-patients with depression were recruited and tested with the Knowledge about Depression and Mania Inventory. Results: Almost all patients sought specific information about their disorder prior to admission to hospital. There were large differences in patients’ knowledge about the disorder and their choice of information source. Older and less educated patients had less knowledge about affective disorders. Patients with less illness knowledge also have a less favourable illness concept, poorer interpersonal relationships and more passive coping strategies. Conclusions: The results show that knowledge about affective disorders is a central illness characteristic that has numerous implications for the ability to cope with the disorder, as well as for psychotherapeutic management. The results contribute to a clarification of the relationship between psychoeducation and psychotherapy.

Background: Milder forms of depression are highly prevalent in the clinical setting as well as in primary care. However, it is still unclear whether there are distinguishable groups among the various subthreshold syndromes and to what extent they are associated with impairment, thus requiring treatment. Therefore, the study aimed at comparing the degree of impairment in 2 groups of subthreshold depressive patients (nonspecific and minor depressive) with nondepressive patients and with major depressive patients. Another aim of the study was to evaluate the spectrum hypothesis of depressive syndromes. Sampling and methods: A sample of 619 primary care patients was studied using the self-administered Patient Health Questionnaire (PHQ). After defining subthreshold depressive syndromes on a criterion basis, frequencies, sociodemographic factors, and impairment of nondepressive, subthreshold depressive, and major depressive patients were compared. Results: Nonspecific depressive symptoms (NDS) were diagnosed in 9.1% of the study subjects and minor depression in 6.2%. Subjects with subthreshold depressive disorders did not differ from each other or from subjects with major depression regarding sociodemographic risk factors such as age, sex, or marital status. Yet, a continually increasing impairment from NDS to minor depression to major depression could be found. Moreover, the investigated groups differed with regard to the severity index. Conclusions: The results of the study are in accordance with the spectrum hypothesis of depressive syndromes ranging from NDS to minor depression to major depression. Patients with subsyndromal depression showed significant functional impairment to the extent that at least some of these patients probably had a disorder requiring treatment.

Zusammenfassung: Nachdem der depressiven Persönlichkeitsstörung lange Zeit nur eine historische Bedeutung zukam, gewann sie in letzter Zeit im Zusammenhang mit der Differenzierung leichterer und chronisch verlaufender Formen der Depression wieder an Bedeutung. Dies drückt sich auch in der Aufnahme des Konzeptes in die Forschungskriterien des DSM-IV aus. Zu den Hauptmerkmalen der depressiven Persönlichkeitsstörung zählen negative, pessimistische Vorstellungen über die eigene Person und andere Menschen. Ziel der vorliegenden Untersuchung war die psychometrische Evaluation einer deutschsprachigen Version des Diagnostischen Interviews für die Depressive Persönlichkeit (DID) ( Gunderson, Phillips, Triebwasser & Hirschfeld, 1994 ). Die Untersuchung wurde an N = 96 stationär behandelten Patienten, die an einer Major Depression gemäß DSM-IV litten, durchgeführt. Es fand sich eine Interraterreliabilität für den DID-Gesamtwert von 0.90, für die Subskalen zwischen 0.83 und 0.90. Die Übereinstimmung darin, ob eine depressive Persönlichkeitsstörung vorliegt oder nicht, ergab ein κ von 0.77. Die interne Konsistenz für die DID-Skalen lag zwischen Cronbachs α von 0.53 und 0.84. Bezüglich der Validität zeigte sich eine hohe Korrelation zwischen dem DID und dem Strukturierten Klinischen Interview für DSM-IV, Achse II (SKID-II). Eine Faktorenanalyse mit allen Persönlichkeitsstörungen des DSM-IV zeigte, dass die depressive Persönlichkeitsstörung in den Cluster C eingeordnet werden kann. Zudem ist die depressive Persönlichkeitsstörung die Persönlichkeitsstörung des Clusters C, die den Persönlichkeitsstörungen des Clusters B am nächsten steht. Insgesamt sprechen die Ergebnisse für eine gute Reliabilität und Validität des DID als einem Instrument zur mehrdimensionalen Erfassung der depressiven Persönlichkeitsstörung.

Lately the concept of the depressive personality disorder has been regarded more often again in the context of chronic and subthreshold forms of depression. The purpose of the present study was the psychometric evaluation of a German version of the "Depressive Personality Disorder Inventory" (DPDI), which is a questionnaire for the exploration of the depressive personality disorder. A total of 138 depressive patients and controls were included in the study. The inter-rater-reliability as well as the internal consistency and the test-retest-reliability of the DPDI revealed satisfactory and good results. A short version of the DPDI was developed by means of a factor analysis. Medium correlations were found between the DPDI and two interviews for the depressive personality disorder. These results are discussed and it is concluded that the DPDI as well as its short version are reliable, valid and economic self-rating instruments for the exploration of the depressive personality disorder.

Zusammenfassung. Theoretischer Hintergrund: Die therapeutische Beziehung stellt innerhalb der Psychotherapieforschung bei Kindern und Jugendlichen ein weitgehend unerforschtes Gebiet dar. Eine Ursache dieses Forschungsdefizits liegt im Mangel an psychometrisch evaluierten Messinstrumenten. Fragestellung und Methode: In der vorliegenden Untersuchung wurde die ins Deutsche übersetzte Version der Therapeutic Alliance Scales for Children ( Shirk & Saiz, 1992 ) an einer Stichprobe von N = 80 ambulant pychotherapeutisch behandelten Kindern und Jugendlichen und ihrer Therapeuten evaluiert. Ergebnisse: Die Drei-Faktoren-Lösung der amerikanischen Originalversion der Fragebogen konnte repliziert werden. Für die Skalen Arbeitsbeziehung und positive und negative Aspekte der emotionalen Beziehung ergaben sich gute Reliabilitätskennwerte. Der Zusammenhang zwischen Therapeuten- und Patienteneinschätzungen lag vergleichbar dem bei Erwachsenen im mittleren Bereich. Schlussfolgerungen: Der Fragebogen zur Therapeutischen Beziehung für Kinder und Jugendliche (FTB-KJ) bildet eine Grundlage für weitere Prozessstudien in der Kinderpsychotherapieforschung.

Zusammenfassung: Aus unterschiedlichen theoretischen Perspektiven ist die Bedeutung der Emotionen Scham und Schuld für die Entstehung psychischer Störungen kontrovers diskutiert worden. Bislang wurden die unterstellten Zusammenhänge empirisch noch nicht zufrieden stellend untersucht, da derzeit wenige gut evaluierte Erhebungsinstrumente zur Erfassung und Differenzierung von Scham und Schuld vorliegen. Aufgrund dieses Mangels soll in der vorliegenden Arbeit die deutsche Version des “Test of Self-Conscious Affects” (TOSCA) vorgestellt und hinsichtlich der Gütekriterien evaluiert werden. Der TOSCA erfasst typische affektive, kognitive und verhaltensbezogene Aspekte, die mit einer Neigung, mit Schuld bzw. Scham zu reagieren, assoziiert sind. Darüber hinaus werden Stolz sowie emotionsrelevante Attributionsmuster erfasst. Ergebnisse aus Studien mit einer klinischen Stichprobe stationärer psychiatrischer Patienten (N = 127) und einer nicht-klinischen studentischen Stichprobe (N = 194) weisen auf hohe interne Konsistenzen und Retest-Reliabilitäten der Subskalen hin. Die empirische Differenzierbarkeit beider Emotionen bestätigt sich durch das Muster der Skaleninterkorrelation; Hinweise auf die klinische Bedeutung von Scham gegenüber Schuld ergeben sich aus den Zusammenhängen mit störungsrelevanten Persönlichkeitseigenschaften.

Inwieweit Personlichkeitsmerkmalen eine verlaufspradiktive Bedeutung bei schwer depressiv erkrankten Patienten zukommt, wurde in den letzten Jahren kontrovers diskutiert. Im Rahmen der Heidelberger Studie zur Ruckfallpradiktion der Depression wurde die Bedeutung von Personlichkeitsfaktoren fur den 2-Jahres-Verlauf der Depression prospektiv an einer Stichprobe von N=50 Patienten untersucht. Uber die Halfte aller Patienten zeigte in diesem Zeitraum einen Ruckfall. Klassische Verlaufspradiktoren wie die Anzahl der Vorepisoden konnten repliziert werden. Fur die uberpruften Personlichkeitsmerkmale ergaben sich differenzielle Pradiktionseffekte fur die 1- und die 2-Jahres-Katamnese. Personlichkeitstraits wie Neurotizismus erwiesen sich fur das 1. Katamnesejahr als verlaufspradiktiv und pradizieren demnach ein Fruhrezidiv besser als Ruckfalle zu einem spateren Zeitpunkt. Fur den 2-Jahres-Verlauf ging eine Personlichkeitsstruktur im Sinne des Typus melancholicus mit einem gunstigeren Storungsverlauf einher. Die Typus-melancholicus-Personlichkeitsstruktur ist demnach eher zur Vorhersage des mittelfristigen Verlaufes der Depression geeignet. Der Vergleich mit klassischen Pradiktoren ergab, dass Personlichkeitsfaktoren von diesen unabhangig Verlaufsvarianz aufklaren. Implikationen der Ergebisse fur die Ruckfallpravention und die psychotherapeutische Behandlung werden diskutiert.

Personality traits are significant factors in the development and course of depression. Apart from the classical five-factor model of personality, other personality constellations, such as Tellenbach’s Typus melancholicus, have been described in association with depressive disorder. Several instruments have been developed to assess the Typus melancholicus personality (TMP). A systematic comparison of these instruments has not been done to date. The goal of this study was the comparison of four questionnaires used in assessing TMP. Four TMP questionnaires were compared and their relationship to the five-factor model of personality was examined among 264 psychiatric patients and normal controls. It was found that the TMP type represents a trait distinct from those of the five-factor model. TMP inventories had only moderate concurrent validity. The single TMP scales focus on different aspects of the TMP, despite their common core. Both the five-factor personality traits and the TMP scales were able to differentiate a group of depressed patients from control groups. The results show that TMP is not one trait but a personality trait constellation. This leads to the conclusion that a number of dimensions must be taken into consideration in the construction of a TMP inventory. This multidimensionality contributes to the refinement of the TMP concept and differentiates its therapeutic implications.

A manual for a disorder oriented psychodynamic treatment of bulimia nevosa and atypical bulimia nervosa of female adolescents and young adults is presented. This manual is applied in a therapy project, which started in 2007. The work on conflicts and structural dysfunctions is meant to lead to the removal or alleviation of the symptoms and an improvement of eating behavior and body image. The bulimic symptoms are contextualized and focussed according to the conflicts and ego-structural deficits of the patients. Typical patterns of interpersonal relationships, transference, conflict, defence and structural problems as well as therapeutic steps are described. The typical psychosocial situation of female adolescence and young adult age is taken into account. Special emphasis is laid on the limitedness of the therapy to 60 sessions and the active structuring of the final phase of he therapy by the therapist.

The construct of expressed emotion is regarded as one of the most important predictors of the course of schizophrenia and has also proven to be a predictor of the course of depressive disorders, psychosomatic disorders and physical illness. Despite its clinical significance, the utility of the EE-construct has been limited since measurement by interview is time-consuming, and to date only applicable to psychotic illness. Questionnaires as a practicable alternative to the structured interview are also mostly applicable solely to psychotic disorders. One exception is the Family Emotional Involvement and Criticism Scale (FEICS, Shields et al.). This questionnaire allows a general assessment of EE and thus a practical application of EE to the general area of family research. In a sample of n = 202 patients, the German version of this instrument proved to be reliable in our research. The two-factor structure of the original American version was replicated. We found good correlation between the measured factors, and clinical and other diagnostic markers particular to family pathology. This questionnaire is therefore a brief, reliable and valid instrument for measuring EE in many disorders.

Cognitive-Behavioral Psychotherapy with and within Groups – A Treatment Program for Depressed Inpatients Background: Extensive research of cognitive behaviora