Swiss Archives of Neurology, Psychiatry and Psychotherapy

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Aktualitäten

by Karl Studer

Swiss Arch. Neurol. Psychiatry Psychother. 2010, 161(5), 187-189; https://doi.org/10.4414/sanp.2010.02169 - 1 Jan 2010

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Berufliche Eingliederung von psychisch Kranken Eine deutsche Expertenkommission «Zukunft der betrieblichen Gesundheitspolitik» hat auf die zunehmende Verunsicherung als Folge beobachtbarer gesellschaftlicher Entwicklungen hingewiesen [...] Full article

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Neurologist-in-training

by Anne-Chantal Héritier Barras

Swiss Arch. Neurol. Psychiatry Psychother. 2010, 161(5), 185-186; https://doi.org/10.4414/sanp.2010.02170 - 1 Jan 2010

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Case vignette A 23-year-old woman, with no medical history, had an uncomplicated episode of gastroenteritis with fever, which resolved spontaneously [...] Full article

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Open AccessCase Report

Dix ans de psychothérapie infantile

by Jacqueline Mégevand

Swiss Arch. Neurol. Psychiatry Psychother. 2010, 161(5), 178-184; https://doi.org/10.4414/sanp.2010.02167 - 1 Jan 2010

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Motifs de consultation Les parents ont demandé une consultation car leur fils présentait des difficultés scolaires, supportait mal les frustrations, préférait son monde imaginaire à la réalité et souffrait d’une énurésie nocturne primaire [...] Full article

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Heart rate variability and “Antrieb” (drive, impulse) Association between a psychopathological sign and the autonomic nervous system’s state in depressive patients

by Felix Hohl-Radke, Conny Lundershausen and Wolfgang Kaiser

Swiss Arch. Neurol. Psychiatry Psychother. 2010, 161(5), 173-177; https://doi.org/10.4414/sanp.2010.02168 - 1 Jan 2010

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Abstract

German psychopathology uses a rather broad definition of the term “Antrieb” (drive, impulse). In our opinion, this psychopathological symptom should be subdivided into three more differentiated components. Of these three, the most bodily sign, “basal Antrieb”, is a very subjectively sensed variable, which [...] Read more.

German psychopathology uses a rather broad definition of the term “Antrieb” (drive, impulse). In our opinion, this psychopathological symptom should be subdivided into three more differentiated components. Of these three, the most bodily sign, “basal Antrieb”, is a very subjectively sensed variable, which hypothetically may influence, or be influenced by, the autonomic nervous system (ANS), particularly as measured by heart rate variability (HRV). In the present study we investigate a possible relationship using visual analogue scales and HRV measurements. We recorded the HRV spectral analysis component “total power” in 93 psychiatric inpatients (50 women, 43 men) suffering from affective (N = 43) or schizophrenia (N = 50) spectrum disorders. The psychopathological sign “basal Antrieb” was investigated using a selfrating and a clinicianrated visual analogue scale. Clinicians’ ratings showed higher values for depressive patients, while patient ratings showed a tendency to feel lazy and lack energy. Selfratings and clinicians’ ratings correlated only for the depressive patients. Only for the depressive patients did a significant correlation exist between selfratings and the HRV measurements. The clinicians’ ratings correlated on a 6% significance level with power, and the direction of the correlation was inverse. The tendency in the clinicians’ ratings to assign higher VAS values to depressive patients than to the schizophrenics may be ascribed to a clinicians’ misjudgement caused by the influence of autistic aspects in schizophrenic patients. The missing correlation between selfand clinicians’ ratings in our schizophrenic patients may be due to the fact that insight into illness is much less pronounced in schizophrenic patients than in depressive patients. For the first time we were able to depict our assumed association between ‘Antrieb’ as a statedependent psychopathological sign and the ANS’s functional state as measured by HRV in a subgroup of depressive patients. Full article

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Prozessanalyse des Abklärungs- und Behandlungskonzeptes für Patienten mit Transitorischer Ischämischer Attacke im Universitätsspital Basel

by Florian Weisskopf, Felix Fluri, Margareth Amort, Mira Katan, Roland Bingisser, Stefan T. Engelter and Philippe Lyrer

Swiss Arch. Neurol. Psychiatry Psychother. 2010, 161(5), 166-172; https://doi.org/10.4414/sanp.2010.02166 - 1 Jan 2010

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Background and goal: A well structured TIA concept reduces the stroke rate. It is unclear whether this also applies if a general stroke unit concept already exists. Hence we analyzed systematically the effects and the functionality of a newly implemented TIA concept in [...] Read more.

Background and goal: A well structured TIA concept reduces the stroke rate. It is unclear whether this also applies if a general stroke unit concept already exists. Hence we analyzed systematically the effects and the functionality of a newly implemented TIA concept in a Swiss University stroke center with an existing stroke unit concept. Methods: 118 consecutive TIA patients were recruited before (n = 41) and after (n = 77) introduction of the TIA concept. Before the introduction, the TIA patients were treated according to the general stroke unit concept. We carried out a “before-after“ comparison and analysed the following variables: Frequency and timing of diagnostic investigations, distribution of the TIA etiology, and frequency of stroke within 90 days. Patients with “TIA mimics” or “possible TIA” were excluded. Results: Both groups did not differ in baseline characteristics. After implementation of the TIA concept the number of cerebral magnet resonance tomographies (cMRT) increased from 73.2 to 83.1% (p = 0.2) whereas the number of cerebral computer tomographies (cCT) dropped from 82.9 to 71.4% (p = 0.17). Neurosonography was performed more often: 94.8% instead of 90.2% (p = 0.35). The timing of the diagnostic investigations met international requirements. The rate of adherence to the concept with regard to treatment as inpatient versus outpatient increased from 63.4% to 67.5% (p = 0.65). The frequency of undetermined etiologies (TOAST classification) dropped by 8% (p = 0.4) while the rate of cardioembolism and large-artery atherosclerosis increased. The 90-days stroke risk decreased from 9.8% to 3.9% (p = 0.24). Summary: The implementation of a specific TIA concept in addition to an already existent stroke unit concept resulted in moderate improvements with regard to the number of determined etiologies and the use of diagnostic tools. More importantly, a reduction of the stroke rate at 3 months was achieved, possibly by the higher adherence rate to the TIA concept. However these changes have been achieved without any statistical significance due to a small number of patients included. Full article

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Die emotionale Qualität der therapeutischen Arbeitsbeziehung und ihre Auswirkung auf Prozess und Outcome nach dem ersten Jahr ambulanter Psychotherapien

by Nicole Häring, Puspa Agarwalla, Eva Müller and Joachim Küchenhoff

Swiss Arch. Neurol. Psychiatry Psychother. 2010, 161(5), 154-165; https://doi.org/10.4414/sanp.2010.02171 - 1 Jan 2010

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Aims: Emotional processes are of crucial importance in psychotherapeutic processes. The main objective of the present study is to improve our understanding of the role played by the emotional quality of therapeutic processes and its relation to different change measures, e.g., symptom reduction [...] Read more.

Aims: Emotional processes are of crucial importance in psychotherapeutic processes. The main objective of the present study is to improve our understanding of the role played by the emotional quality of therapeutic processes and its relation to different change measures, e.g., symptom reduction and improvement of interpersonal behaviour or per-sonality structure. Our aim is also to understand whether diagnosis or personality struc-ture are influential in shaping the therapeutic alliance. Methods: A multi-perspective mul-timodal design was chosen. The study is both naturalistic and prospective. Outpatient therapies of different intensity and patients with different levels of personality organisa-tion were compared, and data were collected five times during the first year of psycho-therapy. The main approach was completion of standardised questionnaires by both pa-tients and therapists. However, the therapists’ main task was to write protocols on differ-ent aspects of the treatment, e.g., the therapeutic relationship. In the present study proto-cols referring to the therapeutic alliance and process are evaluated by external raters with respect to the emotional quality of the process on a five-point scale. Additionally, external researchers conduct videotaped interviews with the patients every six months (beginning of therapy and every six months thereafter) which are analysed according to “operation-alised psychodynamic diagnostics”. Results: The emotional quality of the therapeutic al-liance is a significant predictor of symptom change in various symptomatic measures, and in this it apparently does better than the individual alliance ratings of therapist and pa-tient. The better the emotional quality, the more pronounced are the changes in the differ-ent symptom areas. However, no relationship becomes evident between emotional quality and patients‘ structural possibilities in dealing with central difficulties. Full article

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General features of motor fatigue – a review

by Olivier Scheidegger, Christian W. Hess and Kai M. Rösler

Swiss Arch. Neurol. Psychiatry Psychother. 2010, 161(5), 150-153; https://doi.org/10.4414/sanp.2010.02165 - 1 Jan 2010

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Abstract

Fatigue is an ubiquitous phenomenon that has many definitions, and it is always multidimensional comprising physiological and psychological aspects. It ranges from a chronic symptom in somatic and psychiatric disorders to time-related physiological alterations of primary cortical areas, and to efferent and afferent [...] Read more.

Fatigue is an ubiquitous phenomenon that has many definitions, and it is always multidimensional comprising physiological and psychological aspects. It ranges from a chronic symptom in somatic and psychiatric disorders to time-related physiological alterations of primary cortical areas, and to efferent and afferent pathways of the central and peripheral nervous system (CNS, PNS) in healthy exercise physiology. Thus, it is necessary to define the context when referring to fatigue. Fatigue can generally be defined as a difficulty in initiating or sustaining a voluntary activity, the latter also being named fatigability in a more strict sense of nomenclature. Fatigue in a clinical setting is best quantified by means of self-reported questionnaires, for example the Fatigue Severity Scale (FSS). The discrimination of accounts of depression, sleepiness, weakness, exercise intolerance and exhaustion relies however on a focused interview, clinical signs, and on the use of additional para-clinical investigations. Time-related physiological alterations during fatiguing tasks can occur at spinal and supraspinal sites, termed central fatigue, as well as at the neuro-muscular junction and in muscle fibres, termed peripheral fatigue. In exercise physiology, both central and peripheral fatigue can be assessed by electrophysiological techniques (e.g., transcranial magnetic stimulation, peripheral nerve stimulation, electromyography), pharmacological intervention, functional magnetic resonance imaging and laboratory tests. In the myriad of neurological disorders that cause fatigue, ranging from chronic fatigue syndrome and multiple sclerosis to neuro-muscular disorders and myopathy, different sites of pathological alterations are involved, all yielding to a patient complaining about excessive fatigue. This links the different aspects of fatigue, thus always calling for a multidimensional assessment of this intriguing phenomenon. Full article

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Open AccessEditorial

Psychotherapeutische Tätigkeit in der Praxis

by Karl Studer and Iris-Katharina Penner

Swiss Arch. Neurol. Psychiatry Psychother. 2010, 161(5), 149; https://doi.org/10.4414/sanp.2010.02164 - 1 Jan 2010

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Im vorliegenden Heft sind drei Arbeiten der psychotherapeutischen Tätigkeit gewidmet [...] Full article

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Swiss Arch. Neurol. Psychiatry Psychother., Volume 161, Issue 5 (01 2010) – 8 articles , Pages 149-189

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