Swiss Archives of Neurology, Psychiatry and Psychotherapy

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Open AccessBook Review

Serge Frisch, Robert D. Hinshelwood, Jean-Marie Gauthier, editors: Psychoanalysis and Psychotherapy. The Controversies and the Future

by EMH Swiss Medical Publishers Ltd.

Swiss Arch. Neurol. Psychiatry Psychother. 2003, 154(1), 44; https://doi.org/10.4414/sanp.2003.01339 - 1 Jan 2003

Abstract

Dies ist ein wahrhaft europäisches Buch; das Vorwort aber stammt von einem Amerikaner – und das unterstreicht noch die spezielle Problematik, die im Buch auf eindrucksvolle Art ausgebreitet und beleuchtet wird [...] Full article

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Open AccessBook Review

H. Kind, H.-J. Haug: Psychiatrische Untersuchung. Ein Leitfaden für Studierende und Ärzte in Praxis und Klinik

by EMH Swiss Medical Publishers Ltd.

Swiss Arch. Neurol. Psychiatry Psychother. 2003, 154(1), 44; https://doi.org/10.4414/sanp.2003.01338 - 1 Jan 2003

Abstract

Dieses aus der Praxis und Lehre erwachsene und in mehreren Auflagen gewachsene für die Ausbildung aller in der Psychiatrie arbeitenden Berufe so nützliche und bewährte Buch ist nun in Koautorschaft von Kind und Haug in der 6 [...] Full article

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Open AccessBook Review

David Healy: The Creation of Psychopharmacology

by Redaktion Buchbesprechungen

Swiss Arch. Neurol. Psychiatry Psychother. 2003, 154(1), 43; https://doi.org/10.4414/sanp.2003.01337 - 1 Jan 2003

Cited by 1

Abstract

David Healy, der als Direktor des North Wales Department of Psycholocigal Medicine wirkt, ist einer der Gründer der Geschichte der Psychopharmakologie [...] Full article

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Open AccessBook Review

Daniel Hell, Christian Scharfetter, Arnulf Möller (Hrsg.): Eugen Bleuler - Leben und Werk

by EMH Swiss Medical Publishers Ltd.

Swiss Arch. Neurol. Psychiatry Psychother. 2003, 154(1), 43-44; https://doi.org/10.4414/sanp.2003.01336 - 1 Jan 2003

Abstract

Eine grosse, empfindliche Lücke klafft in der Geschichtsschreibung der Schweizer Psychiatrie. Es gibt bis heute weder eine Werkausgabe noch eine Biographie von Eugen Bleuler [...] Full article

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Open AccessNews

Aktualitäten

by Karl Studer

Swiss Arch. Neurol. Psychiatry Psychother. 2003, 154(1), 42; https://doi.org/10.4414/sanp.2003.01335 - 1 Jan 2003

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Abstract

Arbeitsrehabilitation versus geschützte Arbeitsplätze [...] Full article

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Open AccessStudy Protocol

Psychisches Trauma und Trauerprozess beim Kind

by Barbara Steck

Swiss Arch. Neurol. Psychiatry Psychother. 2003, 154(1), 37-41; https://doi.org/10.4414/sanp.2003.01334 - 1 Jan 2003

Cited by 1 | Viewed by 32

Abstract

In this inaugural lecture for child and adolescent psychiatry, children’s emotional experience and their creative ways of coping (expressed in drawings and statements) are addressed. Psychobiological aspects of early childhood psychological trauma, causes and stress effects, as well as specific characteristics and cycles [...] Read more.

In this inaugural lecture for child and adolescent psychiatry, children’s emotional experience and their creative ways of coping (expressed in drawings and statements) are addressed. Psychobiological aspects of early childhood psychological trauma, causes and stress effects, as well as specific characteristics and cycles of coping with psychological trauma are presented. The importance to grieve the losses experienced through traumatisation is discussed and the specific mourning process of children. Full article

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Open AccessReview

Development of a competence scale for brief psychodynamic investigation: a pilot study

by Milos Tadic, M. Drapeau, S. Solai, Y. de Roten and J.-N. Despland

Swiss Arch. Neurol. Psychiatry Psychother. 2003, 154(1), 28-36; https://doi.org/10.4414/sanp.2003.01333 - 1 Jan 2003

Cited by 14 | Viewed by 29

Abstract

Background: The Brief Psychodynamic Investigation (BPI) is an ultra-brief psychodynamic psychotherapy used at the time of intake interviews in order to investigate a patient’s difficulties. Inspired by the brief psychodynamic psychotherapy tradition, BPI focuses mainly on the patient’s initial request for treatment, which [...] Read more.

Background: The Brief Psychodynamic Investigation (BPI) is an ultra-brief psychodynamic psychotherapy used at the time of intake interviews in order to investigate a patient’s difficulties. Inspired by the brief psychodynamic psychotherapy tradition, BPI focuses mainly on the patient’s initial request for treatment, which is then explored for a maximum of four sessions. A therapist’s competence in using proper techniques, which refers to the level of skill shown by the therapist in delivering the treatment, is one among multiple variables that may influence the psychotherapeutic process in BPI. In order to assess this variable, we have developed an instrument: the brief psychodynamic Investigation Competence Scale (ICS), composed of 33 items divided into 5 subscales.The first two subscales refer to the therapist’s general and psychoanalytic attitude, whereas the other three subscales refer to his competence in investigating and interpreting, the BPI’s specific techniques and the therapist’s global competence. The aim of this study was to validate the ICS by testing its (a) inter-rater reliability, (b) internal consistency, (c) content validity and (d) construct validity. Method: A pilot study was done on 16 BPIs, half of which were done in consensus sessions. The interviews used in this study were taken from a larger project on the development of early alliance during BPIs (Lausanne Early Alliance Project, LEAR). All interviews had been video or audio recorded.The subjects were chosen amongst adults requesting an appointment with a therapist from the Lausanne University Adult Psychiatry Department’s outpatient clinic. The patients had been diagnosed as presenting anxiety, mood disorders or personality disorders.Seven therapists participated in this study: 4 therapists were considered to be experts in BPI while the other 3 were considered to be junior therapists.Two raters participated in assessing the 16 available BPIs according to a rating manual.The raters were blinded to the outcome of the therapeutic intervention. Results: Inter-rater reliability was assessed using intra-class correlations (ICC). ICCs ranged from 0.54 to 0.84 with an average of 0.71: these scores are in the range of scores obtained in other studies on adherence and competence scales. Significant scores are also obtained for the internal consistency of the scale. The content of the ICS was found significant by 4 independent expert therapists and the author of BPI. Finally, using the ICS permitted to discriminate between senior (>5 years of experience in BPI) and junior (<5 years experience) therapists. Conclusions: Initial results concerning the psychometric properties of the ICS are promising.The instrument reflects four basic aspects of psychodynamic investigation: (1) the general attitude in receiving the patient, (2) the psychoanalytic attitude during the investigation, (3) the exploration of conflicts and repetitions and, (4) the meaning given to the patient’s conflicts in an initial interpretation. The limits of this pilot study must be pointed out, regarding mainly: (1) the relatively small size of the sample, (2) the fact that the raters sometimes knew the therapists and how much clinical experience they had, and (3) a limitation related to the necessity to give clear explanations on how to use the instrument. Full article

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Open AccessReview

Verlauf und Einflussfaktoren der Öffnungszeiten von teiloffen geführten psychiatrischen Akutstationen

by Martin Neuenschwander, P. C. Meyer and D. Hell

Swiss Arch. Neurol. Psychiatry Psychother. 2003, 154(1), 20-27; https://doi.org/10.4414/sanp.2003.01332 - 1 Jan 2003

Cited by 6 | Viewed by 31

Abstract

During the last decades a major international trend in psychiatric care has been the deinstitutionalisation of the care providing system. The open-door policy as an alternative style of treatment was developed in Great Britain in the fifties of the last century with a [...] Read more.

During the last decades a major international trend in psychiatric care has been the deinstitutionalisation of the care providing system. The open-door policy as an alternative style of treatment was developed in Great Britain in the fifties of the last century with a peak of popularity in the seventies. Nevertheless, there was a rather low acceptance in the German-speaking countries. The process towards a community-oriented psychiatric operating organisation has been associated with expectations to preserve or improve patients’ psychosocial functioning, an improved ward atmosphere, better compliance with psychiatric treatment and acceptance of rehospitalisation. Since 1994 the Psychiatric Hospital of Zurich has a selective open-door policy under which entrance doors to wards are left unlocked except when there is risk of escape, suicide or dangerous behaviour. The present study analyses changes in the rate doors are left unlocked (“open rate”) and factors that influence this rate, and this in six wards. Data concerning opening hours, structure of the wards and various clinical aspects of the inpatients such as diagnosis, suicidal danger and compulsory measures were used.The data was taken from logs of the wards and basic psychiatric statistics respectively. Consequently a questionnaire to gather the data needed was not necessary. We focussed on a period of 27 months from 1995 to 1997. The sample consisted of 4926 recorded days from five general emergency units with compulsory admission (including mentally ill offenders) and one unit specialising in depression and anxiety with a slightly different treatment setting. All five emergency units were on average (partially) open for only 14% of recorded days where the rate for the unit specialising in affective disorders was 94%. So this ward used for control purposes was mostly operated on a fully open-door basis. For the emergency units a significant downward trend in the “open rate” was observed over the course of the study period. Multiple regression was carried out to investigate factors which are relevant to the operating system of the admission units. In addition to time, forced isolation turned out to be an important predictor for the “open rate”. Other variables assumed to be important did not significantly add to the prediction of the dependent variable. Contrary to the hypothesis, there is no relationship between the level of patient turnover or number of diagnoses associated with high-risk situations and the “open rate”. With regard to the available data it is hardly possible to figure out the real potential factors of influence. Without doubt an open-door policy vitally depends on the size and experience of the nursing staff, the turnover of patients, patients’ need for a save place and treatment aspects. If the unit has no option of refusing admission to some patients and if the unit is geared to shortstay treatment, the open-door system is inevitably restricted. Full article

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Open AccessArticle

Eugenisch motiviertes Denken und Handeln im «Burghölzli» am Anfang des 20. Jahrhunderts

by Bernhard Küchenhoff

Swiss Arch. Neurol. Psychiatry Psychother. 2003, 154(1), 11-19; https://doi.org/10.4414/sanp.2003.01331 - 1 Jan 2003

Cited by 3 | Viewed by 41

Abstract

Eugenic theories and practice were widespread in Europe and the United States in the early decades of the 20th century. B.A. Morel’s theories of degeneration, social Darwinism and Galton’s concepts (Galton defined the term “eugenics”) were precursors of eugenics in the 19th century.The [...] Read more.

Eugenic theories and practice were widespread in Europe and the United States in the early decades of the 20th century. B.A. Morel’s theories of degeneration, social Darwinism and Galton’s concepts (Galton defined the term “eugenics”) were precursors of eugenics in the 19th century.The introduction of eugenics led to a biologically biased interpretation of social issues. Psychiatry was used to intervene with eugenic measures in healthcare and social policy issues. Eugenic concepts were important in the Swiss psychiatry of the time as well; it is noteworthy that the first castrations in Europe were carried out in Switzerland. The present article explores this subject concentrating on the Psychiatric University Hospital Zurich, Burghölzli, as an example. It deals in more detail with the dissertation of Emil Oberholzer, who wrote his thesis Castration and sterilisation of mental patients in Switzerland in 1911.This dissertation was submitted to Eugen Bleuler,who was the medical director of the Burghölzli at that time. E. Oberholzer worked as a resident at the Burghölzli from 1908 to 1910; he later became renowned in the international psychoanalytic association. In his thesis, he reports 19 cases: 11 from the Burghölzli and 8 from the asylum of Wil; 15 women and 4 men; diagnoses: mental deficiency (6 cases), moral insanity (3 cases), combination of mental deficiency and moral insanity (4 cases), epilepsy (1 case) and developmental defect (1 case). He uses eugenic arguments as indications for castration or sterilisation, which were performed in most of the cases. A detailed case history of 5 patients are given in this paper. E. Oberholzer’s primary concern was to advance the thinking of birth control for “degenerated”subjects. To generate ill and degenerated children was for him the worst crime and also the greatest misery for the government and race. He therefore stressed the need to prevent such descendants. Oberholzer criticised the extensive bureaucracy and missing legal framework for eugenic measures. He claimed a new law, which would facilitate castrations and sterilisations.While there was no legal framework for eugenic treatments, Oberholzer for example suggested to use other medical indications for sterilisations. This article also examines to which extent sterilisations took place under coercion or under the patients’ informed consent.The patients often had only two alternatives: to agree to sterilisation or castration or to remain in the hospital for the rest of their lives. In order to complete Oberholzer’s material, unpublished medical records and forensic expertises were used. The additional information from Eugen Bleuler and his co-workers allows us to understand the official contemporary policy concerning eugenic practice of the Burghölzli.Eugenic theory and practice was promoted even though there is no evidence for any racial hygiene, with the ultimate goal to prevent any hereditary diseased offspring, as was the case in Germany. Full article

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Open AccessReview

Hochschulprüfungen: Hürde oder Alptraum? Beratung und Therapie von Prüfungsängsten

by Nina Bakman

Swiss Arch. Neurol. Psychiatry Psychother. 2003, 154(1), 5-10; https://doi.org/10.4414/sanp.2003.01330 - 1 Jan 2003

Cited by 1 | Viewed by 32

Abstract

Exam conditions have become stricter at Swiss universities and test anxiety is increasing. The selection character of examinations is a particular burden for students. In the year 1999, 16% of the clients of the Psychological Counselling Centre for Students of the University and [...] Read more.

Exam conditions have become stricter at Swiss universities and test anxiety is increasing. The selection character of examinations is a particular burden for students. In the year 1999, 16% of the clients of the Psychological Counselling Centre for Students of the University and the Swiss Federal Institute of Technology of Zurich came because of test anxiety; in 2000 they were 17%, in 2001 19%. In this article, based on the experience with students of the Zurich Universities, possibilities of counselling and therapy of test anxiety are discussed and illustrated with individual case reports. Examinations are considered under two aspects: their real, pragmatic aspect and their emotional aspect.They each need a different approach: real anxiety can be dealt with practical methods, such as improving learning strategies, whereas anxiety caused by emotional, subjective factors requires psychotherapy. The distinction between real and neurotic anxiety is important for differential diagnosis and the choice of intervention. Recent empirical studies show that factors like low self-esteem and self-doubts are stressors which impair the capacity to learn and cause anxiety. Additionally, because of their highly emotional meaning, examinations can reactivate unconscious conflicts, e.g. the fear of a punishing authority, and cause an intellectual inhibition. Here Freud’s concept of inhibition (1926) is referred to, according to which an emotional conflict can restrict the functions of the ego or cause a general loss of psychic energy. Later psychoanalytic investigations (Danon-Boileau and Lab, 1962; Danon-Boileau 1984) have explored the clinical manifestations of intellectual inhibitions in children and adolescents. The activity of the mind is particularly vulnerable to interferences, it presupposes a certain autonomy from emotional problems. From a psychoanalytic point of view, intellectual activities are transformations of drive impulses. As such, they are related to unconscious wishes and fantasies that determine the capacity of learning and succeeding or failing at an examination. An often occurring fantasy is that the examiner wants to harm the student. This is masterly represented by Ionesco in his play “The lesson”. In these fantasies, relations to the mother and the father also play an important part, including identification with a good authority. Forms of intervention and treatment of test anxiety depend on the assessment. A recent investigation at the Zurich Institute of Social Psychology about stress and resources among students shows the remarkable result that the strongest resource of students is contact with the peer-group. Preventive measures such as tutoring are appreciated by students. A careful investigation reveals if exam problems are related to an individual’s history and his or her unconscious conflicts. In such cases, a psychoanalytically oriented brief therapy is indicated and can take place during exam preparations.The analysis of attitudes, fantasies and projections has a relieving effect and restores the autonomy of intellectual work from affective problems. Curiosity and the pleasure of learning can be regained. Test anxiety is a complex phenomenon that can be met with a broad range of interventions, reaching from cognitive strategies to psychotherapy. It requires a flexible approach adapted to the individual needs of the students. If the basic problems which restrain or inhibit intellectual activity are explored and understood, students can pursue their development. Full article

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Open AccessEditorial

Das Schweizer Archiv für Neurologie und Psychiatrie in der Beurteilung seiner Leserschaft

by Daniel Hell and François Ferrero

Swiss Arch. Neurol. Psychiatry Psychother. 2003, 154(1), 3-4; https://doi.org/10.4414/sanp.2003.01329 - 1 Jan 2003

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Abstract

Im vergangenen Jahr wurde unsere Zeitschrift zusammen mit anderen Fachzeitschriften von einem unabhängigen Forschungsinstitut auf ihre Akzeptanz unter Schweizer Ärztinnen und Ärzten untersucht [...] Full article

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Swiss Arch. Neurol. Psychiatry Psychother., Volume 154, Issue 1 (01 2003) – 11 articles

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