C. Mundt

Prevalence, onset and comorbidity of postpartum anxiety and depressive disorders

Objective:  The study presents data on the 3‐month prevalences of postpartum anxiety disorders (PAD) and postpartum depressive disorders (PDD) and their comorbidity in a German community sample. Associations with sociodemographic variables and previous history of psychopathology were analysed.

ZEITERLEBEN UND ZEITSCHATZUNG DEPRESSIVER PATIENTEN

ZusammenfassungIn einer Studie an 20 endogen, 20 neurotisch Depressiven und 15 gesunden Kontrollprobanden wurden das subjektive Zeiterleben und die objektive Zeitschätzung untersucht. Sowohl endogen wie neurotisch depressive zeigten Zeitdehnungserlebnisse gegenüber Gesunden. Unterschiede der objektiven Zeitschätzung ergeben sich zwischen der depressiven Gesamtgruppe und den Gesunden für relativ längere, nicht für sehr kurze Zeitspannen, ebenfalls im Sinne einer Zeitdehnung bei den Depressiven. Die Abweichungen sind im Verlauf des stationären Aufenthaltes rückläufig. Sie korrelieren stärker mit Depressivität als mit dem Ausmaß der Retardierung. Die Befunde stützen die Hypothesen der anthropologischen Phänomenologie einer Entfremdung des Zeitgefühls. Motivationale und Elemente der seelischen Ausrichtung und Erwartung scheinen gegenüber instrumentellen neuropsychologischen Störungen für die Zeitdehnungseffekte Vorrang zu haben. Die ausgeprägtere Minderung des Zeitdehnungseffekts bei gleichzeitiger Besserung der Befindlichkeit in intentional gegliederter gegenüber leerer Zeit legt psychotherapeutische Folgerungen nahe im Sinne des Aktivierungstrainings nach Lewinsohn.SummarySubjective time-experience and objective time-estimation were examined in 20 endogenous, 20 neurotic depressives, and 15 healthy volunteers. Subjective experience of past and anticipated future time was more extended in both depressive groups than in healthy controls. Objective time estimation differed between depressives and controls concerning relatively long time spans whereas very short time spans were correctly estimated also by depressives. There were no significant differences between endogenous and neurotic depressives. The perception of extended time normalized during treatment. The depressives’ time perception, differences correlated with the extent of depressive psychopathological symptoms and – to a lesser degree – with retardation. The findings support the hypotheses of anthropological phenomenology concerning disturbed time perception and estimation in depressives. Amelioration of experienced time-extension in intentionally structured time spans compared to empty time spans suggests psychotherapeutic consequences in the sense of Lewinsohn.

Dimensions of the Typus melancholicus personality type.

AbstractThe Typus melancholicus personality type (TMP) is characterised by orderliness, conscientiousness and interpersonal dependence. Several standardised instruments have been developed for the assessment of the Typus melancholicus personality. To date there has been no systematic comparison of these instruments and in particular it has been unclear whether TMP represents a single trait or a personality trait constellation. The aim of this study was the comparison of four TMP questionnaires and the investigation of the dimensionality of the personality as revealed by these questionnaires. The factorial validity of four TMP questionnaires was examined based on a sample of n = 264 psychiatric inpatients and normal controls. In a factor analysis of the items of the TMP questionnaires, four dimensions could be differentiated: Dependence, Intolerance of Ambiguity, Norm–Orientation, and Perfectionism. Psychometric evaluation showed good values for the individual items and the new TMP scales. The four subscales had a differential correlation profile in relation to the dimensions of the five–factor model of personality. The TMP scales could distinguish a group of depressed patients from a group of normal controls. The results show that TMP personality is not a single trait but consists of four related but separate traits. These can be clearly distinguished from those of the five–factor model of personality. The analysis of the TM concept therefore also represents a theoretical perspective for the integration of the personality characteristics which are relevant for depression. Based on this analysis, we constructed a multidimensional TMP inventory which forms the basis for the investigation of the effect of TM personality on clinical outcome and on psychotherapeutic treatment.

Psychotherapie der postpartalen Depression: Mutter-Kind-Interaktion im Blickpunkt

ZusammenfassungDie Mutter-Kind-Interaktion nimmt im Rahmen der ambulanten und stationären Behandlung postpartal depressiver Mütter eine zentrale Stellung ein. Es ist bekannt, dass Säuglinge äußerst sensibel auf den emotionalen Zustand ihrer Mutter und anderer Bezugspersonen reagieren. Diese Sensitivität in den ersten Lebensmonaten ist grundlegend für das Verständnis des Einflusses mütterlicher psychiatrischer Erkrankungen auf die kindliche Entwicklung. Der postpartalen Depression kommt als der häufigsten psychischen Störung junger Mütter dabei eine zentrale Bedeutung zu. Die besondere Lebenssituation der jungen Mütter erfordert eine Anpassung des therapeutischen Angebotes an die Bedürfnisse der Patientinnen. Ansätze zur Behandlung der Mutter-Kind-Beziehung sowie Evaluationsstudien werden vorgestellt. Abschließend wird ein von der Heidelberger Projektgruppe entwickeltes psychotherapeutisches Behandlungsmodell für die postpartale Depression unter Einschluss Mutter-Kind-zentrierter Interventionen vorgestellt.SummaryIn the treatment of mothers with postpartum depression, mother-infant interaction plays a central role. It is well known that babies are very sensitive to their mothers’ emotional state. This sensitivity during the first months of life is fundamental to understanding the influence of maternal psychiatric disorders and especially of postpartum depression, as the most frequent, on children’s development. The specific situation of young mothers requires adaptation of psychotherapeutic approaches to their needs. In connection with an overview of these issues, models of mother-infant treatment as well as evaluation studies are discussed. Finally, an integrated treatment approach for postpartum depression including mother-infant-centered interventions is presented.

Psychotherapie der postpartalen Depression

ZusammenfassungDie Mutter-Kind-Interaktion nimmt im Rahmen der ambulanten und stationären Behandlung postpartal depressiver Mütter eine zentrale Stellung ein. Es ist bekannt, dass Säuglinge äußerst sensibel auf den emotionalen Zustand ihrer Mutter und anderer Bezugspersonen reagieren. Diese Sensitivität in den ersten Lebensmonaten ist grundlegend für das Verständnis des Einflusses mütterlicher psychiatrischer Erkrankungen auf die kindliche Entwicklung. Der postpartalen Depression kommt als der häufigsten psychischen Störung junger Mütter dabei eine zentrale Bedeutung zu. Die besondere Lebenssituation der jungen Mütter erfordert eine Anpassung des therapeutischen Angebotes an die Bedürfnisse der Patientinnen. Ansätze zur Behandlung der Mutter-Kind-Beziehung sowie Evaluationsstudien werden vorgestellt. Abschließend wird ein von der Heidelberger Projektgruppe entwickeltes psychotherapeutisches Behandlungsmodell für die postpartale Depression unter Einschluss Mutter-Kind-zentrierter Interventionen vorgestellt.SummaryIn the treatment of mothers with postpartum depression, mother-infant interaction plays a central role. It is well known that babies are very sensitive to their mothers’ emotional state. This sensitivity during the first months of life is fundamental to understanding the influence of maternal psychiatric disorders and especially of postpartum depression, as the most frequent, on children’s development. The specific situation of young mothers requires adaptation of psychotherapeutic approaches to their needs. In connection with an overview of these issues, models of mother-infant treatment as well as evaluation studies are discussed. Finally, an integrated treatment approach for postpartum depression including mother-infant-centered interventions is presented.

Psychotic Continuum or Distinct Entities: Perspectives from Psychopathology

The pursuit of clear-cut and theoretically convincing classifications of the idiopathic psychoses by means of operationalized psychopathology was instigated 30 years ago in order to carry out epidemiological studies, studies of the long-term-course, and studies of treatment efficacy. Today, the revitalized genetics need sound categorical classification. However, one has to bear in mind that this is but one reason for typing psychiatric patients. A psychotherapist who wants to address coping behavior, or avoidance of precipitating life events, or training methods for deficits will have quite different diagnostic demands; again other aspects of typing may serve the pharmacologist, such as the Kielholz design, which in the meantime is questioned. Thus, the following considerations will leave aside pragmatic aspects of classification, e.g., for treatment, but instead refer to classical nosological research, the principles of which were outlined by Kraepelin (1903) and, in the English scientific world, by Cullen in 1803 (see Berrios and Beer 1992) as follows:

Psychodynamische Therapieansätze bei depressiven Störungen Pathogenesemodelle und empirische Grundlagen

ZusammenfassungAnsatzpunkt für die psychodynamische Psychotherapie sind der zentrale Beziehungsmodus, seine Folgen für die Befindlichkeit, das Sozialverhalten und das Selbstbild. Libidotheoretische oder konflikttheoretische Konzepte des Beziehungsmodus werden zunehmend aufgegeben zugunsten des Begriffs der Intersubjektivität, die als Phänomen seelischer Gesundheit die dem Menschen mitgegebene Aufgabe zum Gegenstand hat, sich zum sozialen Anderen in Bezug zu setzen. Die Therapie wirkt über die Veränderung des Beziehungsmodus und seiner Folgen für Befindlichkeit, Sozialverhalten und Selbstbild. Es hat sich eine Umgewichtung des technischen Paradigmas ergeben durch Relativierung des Mediums Einsicht und deklaratives Wissen zugunsten des Mediums unbewusstes prozedurales Lernen und der Repräsentanz der dyadischen Intersubjektivität, wie sie sich im Mutter-Säuglings-Paradigma darstellt. Dieses Paradigma fordert dem Therapeuten intersubjektive Kompetenz jenseits von Abstinenz und Gegenübertragungskontrolle ab, nämlich aktiv mitkonstitutierender, stilgebender Part der zu korrigierenden Dyade zu werden. Evaluationsstudien belegen die Wirksamkeit der psychodynamischen Therapie. Die Effekte sind annähernd mit denen der kognitiven Verhaltenstherapie und der interpersonellen Therapie vergleichbar.SummaryTargets for psychodynamic psychotherapy are the core conflictual relational mode and its consequences for mood, social behaviour, and self image. Libido- and conflict-based concepts of the relational mode are increasingly being replaced by the concept of intersubjectivity, which includes also nonconflictual, healthy modes of relations as a basic human mental task. According to recent mother-infant interaction research, the psychotherapeutic effect on the relational mode can be interpreted in terms of procedural learning rather than insight-oriented discourse. The mother-infant paradigm is a particularly suitable research paradigm to elucidate unconscious procedural acquisition of mental representations of dyadic interactional styles. Procedural learning requires a more active corrective style of interacting on the therapists side, beyond abstinence and control of countertransference. Evaluative studies show that psychodynamic psychotherapy of depression is nearly as effective as cognitive behaviour therapy (CBT) and interpersonal therapy (IPT).

Karl Wilmanns’ theoretische Ansätze und klinische Praxis

Karl Wilmanns (1873-1945) is widely known as the founder of the Heidelberg school of psychopathology. His important contributions to criminology and forensic psychiatry and his encouragement of psychoanalysis in the inpatient setting are less known today. During the First World War, he worked as director of the military hospitals in the German county of Baden and as director of the Reichenau Mental Hospital at Lake Constance. Thus, he was familiar with the needs of everyday psychiatric practice under difficult circumstances. In Heidelberg he dealt intensively with criminology, social psychiatry and psychoanalysis. Wilmanns remained sceptical towards deterministic positions including the biological psychiatry of his days, but he fought for psychiatry open to social and political questions and open to different scientific methods. In 1933, the Nazis expelled him from office. Wilmanns remained as a private practitioner in Germany and died shortly after the liberation in 1945.ZusammenfassungKarl Wilmanns (1873–1945) ist der heutigen Psychiatergeneration wenig bekannt, obgleich er die Heidelberger Schule für Psychopathologie begründete und bahnbrechende Arbeiten in Kriminologie und forensischer Psychiatrie veröffentlichte. Während des Ersten Weltkrieges lernte er als Direktor der badischen Reservelazarette sowie der psychiatrischen Anstalt Reichenau bei Konstanz die Praxis der Versorgungspsychiatrie kennen. In Heidelberg setzte er sich wissenschaftlich mit Kriminologie, Sozialpsychiatrie und Psychoanalyse intensiv auseinander. Wilmanns blieb deterministischen Positionen gegenüber stets skeptisch, beurteilte daher die damalige biologische Psychiatrie eher kritisch und bemühte sich um eine alle Richtungen gelten lassende wissenschaftliche Position der Psychiatrie, die sich auch sozialen und gesellschaftlichen Fragen aktiv zuwendet. 1933 wurde er von den Nationalsozialisten aus dem Amt vertrieben, blieb in Deutschland und starb kurz nach der Befreiung durch die Alliierten im Juli 1945.SummaryKarl Wilmanns (1873–1945) is widely known as the founder of the Heidelberg school of psychopathology. His important contributions to criminology and forensic psychiatry and his encouragement of psychoanalysis in the inpatient setting are less known today. During the First World War, he worked as director of the military hospitals in the German county of Baden and as director of the Reichenau Mental Hospital at Lake Constance. Thus, he was familiar with the needs of everyday psychiatric practice under difficult circumstances. In Heidelberg he dealt intensively with criminology, social psychiatry and psychoanalysis. Wilmanns remained sceptical towards deterministic positions including the biological psychiatry of his days, but he fought for psychiatry open to social and political questions and open to different scientific methods. In 1933, the Nazis expelled him from office. Wilmanns remained as a private practitioner in Germany and died shortly after the liberation in 1945.

The core of negative symptoms in schizophrenia: affect or cognitive deficiency?

The association of negative symptoms on one hand and cognitive failures and language and thought disturbances on the other hand was examined in 25 schizophrenics and 22 neurotics over a 2-month period of intensive therapy. Psychopathological negative symptoms were more pronounced in schizophrenics than in neurotics at the first assessment before intensive therapy. However, cognitive and language performance showed no difference between the groups in both cross-sectional comparisons before and after treatment. Thus, our hypothesis that cognitive deficiencies are the core of negative symptoms could not be confirmed. It is discussed that young schizophrenics at an early stage of the illness may imply more affective components in the psychopathology of their negative syndrome than chronic schizophrenics with more pronounced cognitive deficits.

[Karl Wilmanns' theoretical contributions and his clinical practice. What does it mean for contemporary psychiatry?].

Karl Wilmanns (1873-1945) is widely known as the founder of the Heidelberg school of psychopathology. His important contributions to criminology and forensic psychiatry and his encouragement of psychoanalysis in the inpatient setting are less known today. During the First World War, he worked as director of the military hospitals in the German county of Baden and as director of the Reichenau Mental Hospital at Lake Constance. Thus, he was familiar with the needs of everyday psychiatric practice under difficult circumstances. In Heidelberg he dealt intensively with criminology, social psychiatry and psychoanalysis. Wilmanns remained sceptical towards deterministic positions including the biological psychiatry of his days, but he fought for psychiatry open to social and political questions and open to different scientific methods. In 1933, the Nazis expelled him from office. Wilmanns remained as a private practitioner in Germany and died shortly after the liberation in 1945.ZusammenfassungKarl Wilmanns (1873–1945) ist der heutigen Psychiatergeneration wenig bekannt, obgleich er die Heidelberger Schule für Psychopathologie begründete und bahnbrechende Arbeiten in Kriminologie und forensischer Psychiatrie veröffentlichte. Während des Ersten Weltkrieges lernte er als Direktor der badischen Reservelazarette sowie der psychiatrischen Anstalt Reichenau bei Konstanz die Praxis der Versorgungspsychiatrie kennen. In Heidelberg setzte er sich wissenschaftlich mit Kriminologie, Sozialpsychiatrie und Psychoanalyse intensiv auseinander. Wilmanns blieb deterministischen Positionen gegenüber stets skeptisch, beurteilte daher die damalige biologische Psychiatrie eher kritisch und bemühte sich um eine alle Richtungen gelten lassende wissenschaftliche Position der Psychiatrie, die sich auch sozialen und gesellschaftlichen Fragen aktiv zuwendet. 1933 wurde er von den Nationalsozialisten aus dem Amt vertrieben, blieb in Deutschland und starb kurz nach der Befreiung durch die Alliierten im Juli 1945.SummaryKarl Wilmanns (1873–1945) is widely known as the founder of the Heidelberg school of psychopathology. His important contributions to criminology and forensic psychiatry and his encouragement of psychoanalysis in the inpatient setting are less known today. During the First World War, he worked as director of the military hospitals in the German county of Baden and as director of the Reichenau Mental Hospital at Lake Constance. Thus, he was familiar with the needs of everyday psychiatric practice under difficult circumstances. In Heidelberg he dealt intensively with criminology, social psychiatry and psychoanalysis. Wilmanns remained sceptical towards deterministic positions including the biological psychiatry of his days, but he fought for psychiatry open to social and political questions and open to different scientific methods. In 1933, the Nazis expelled him from office. Wilmanns remained as a private practitioner in Germany and died shortly after the liberation in 1945.