Guido Flatten

The neurofunctional mechanisms of traumatic and non-traumatic memory in patients with acute PTSD following accident trauma

Neurofunctional alterations in acute posttraumatic stress disorder (PTSD) and changes thereof during the course of the disease are not well investigated. We used functional magnetic resonance imaging to assess the functional neuroanatomy of emotional memory in surgical patients with acute PTSD. Traumatic (relative to non-traumatic) memories increased neural activity in the amygdala, hippocampus, lateral temporal, retrosplenial, and anterior cingulate cortices. These regions are all implicated in memory and emotion. A comparison of findings with data on chronic PTSD suggests that brain circuits affected by the acute disorder are extended and unstable while chronic disease is characterized by circumscribed and stable neurofunctional abnormalities.

Psychotraumatologie in der Unfallmedizin – Zum Stand der psychischen Versorgung von Unfallopfern in Deutschland

ZusammenfassungUnfalltraumatisierungen verursachen in klinisch relevanter Häufigkeit unfallreaktive psychische Störungsbilder. Studien zum Outcome und zur Lebensqualität nach Polytrauma belegen die Bedeutung einer frühzeitigen Erkennung und Behandlung psychotraumatologischer Störungen. In einer bundesweiten Untersuchung wurden alle unfallchirurgischen und verbrennungschirurgischen Abteilungen zum Stand der psychischen Versorgung von Unfallopfern in Deutschland befragt. Die Ergebnisse belegen eine hohe Sensibilität der chirurgischen Behandler für die Wahrnehmung komorbider psychischer Symptomatik und eine weitgehend gute Kenntnis psychotraumatologisch relevanter Störungsbilder. Defizite bestehen bei den strukturellen Möglichkeiten zur psychischen Diagnostik und Behandlung sowie in der tatsächlichen Inanspruchnahme. Nur wenige Abteilungen verfügen über abteilungszugehörige psychotherapeutisch kompetente Mitarbeiter. Nur ein geringer Teil der Unfallpatienten erfährt eine fachgerechte psychische Mitbetreuung. Auf dem Hintergrund der bekannten Prävalenzzahlen unfallreaktiver psychischer Störungsbilder werden Überlegungen zum psychotraumatologischen Betreuungsbedarf und die Möglichkeiten einer kooperativen Versorgung entsprechend dem Modell einer Integrativen Posttraumatischen Akutversorgung diskutiert.AbstractA clinically significant amount of accident victims display psychological disorders as a reaction to the trauma. Outcome studies on multiple trauma emphasize that life quality following severe accidental injury is influenced by early diagnosis and treatment of psychic co-morbidity. In a nationwide survey concerning the state of the art in in-patient treatment of injury patients conducted in Germany, every surgical ward was contacted and physicians were asked about their standard procedures of detecting and treating psychotraumatic complications. The results of the survey indicate that surgeons pay close attention to signs of psychological co-morbidity and have good basic knowledge of psychotraumatic disorders. Nevertheless, there are structural deficiencies caused by the fact that only a few wards have staff specially trained in psychotraumatological care. Only a minority of patients is treated for psychotraumatic symptoms. In view of the high prevalence rates for psychotraumatic disorders in the aftermath of severe accidental injuries, the article discusses the need for psychic diagnosis and support as well as the necessary cooperative structures required in the model of Integrative Posttraumatic Acute Care.

Effect of group leaders on doctors’ learning in Balint groups

Objective Although effective Balint leadership is viewed as essential for good Balint practice, nearly no quantitative research is available regarding the importance of the person of the group leader in Balint group outcome. This study aims to identify Balint group leaders’ impact on “typical Balint” learning processes in Balint groups. Method A total of 1460 medical doctors in 352 Balint groups in Germany, Austria, and Switzerland were investigated. Based on the three learning dimensions of the Balint Group Session Questionnaire, statistical analyses were conducted to identify differential effectiveness in Balint leadership. Results On the basis of the mean scores of the Balint Group Session Questionnaire items across all group participants of each group leader, the 80 certified Balint group leaders were clustered into two groups of more and less effective leaders by a hierarchichal cluster analysis. Mixed model analyses revealed that the effectiveness of the person of the Balint group leader was the most predictive factor for learning effects. Conclusions Training for Balint group leaders should take into account that effective learning processes in Balint groups are strongly related not only to the method itself but also to the person of the group leader.