Josef Hättenschwiler

Comparison of four groups of substance-abusing in-patients with different psychiatric comorbidity.

Objective:  Comparisons of different groups of dual patients are rare, yet potential differences could have therapeutic implications. In this study, four groups of psychiatric in‐patients with substance use disorder were compared to each other: patients with no psychiatric comorbidity, patients with comorbid schizophrenia and patients with affective and personality disorder.

Effectiveness of Inpatient Drug Detoxification: Links between Process and Outcome Variables

The Psychiatric University Hospital of Zürich offers a 2-week residential detoxification treatment program for patients abusing illegal drugs. 96 out of 160 patients were interviewed at three intervals: upon admission, on the 10th day of treatment, and about 1 month after leaving the clinic. Approximately 17% of the patients were completely abstinent 1 month after treatment. About 50% of the patients could give up the consumption of particular drugs. For around one third of the dependents, the drug consumption remained the same or had increased. The analysis of the predictors of drug consumption after treatment stresses the importance of the social integration of the dependents before detoxification as well as of characteristics of the treatment process (relapse, dropping out of treatment, and referral to a follow-up program).

The fear of being laughed at as additional diagnostic criterion in social anxiety disorder and avoidant personality disorder

Social anxiety disorder (SAD) is the most common anxiety disorder and has considerable negative impact on social functioning, quality of life, and career progression of those affected. Gelotophobia (the fear of being laughed at) shares many similarities and has therefore been proposed as a subtype of SAD. This hypothesis has, however, never been tested in a clinical sample. Thus, the relationship between gelotophobia, SAD and avoidant personality disorder (APD) was investigated by examining a sample of 133 participants (64 psychiatric patients and 69 healthy controls matched for age and sex) using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders (4th edition) and an established rating instrument for gelotophobia (GELOPH<15>). As expected, gelotophobia scores and the number of gelotophobic individuals were significantly higher among patients with SAD (n = 22) and APD (n = 12) compared to healthy controls and other psychiatric patients. Furthermore, gelotophobia scores were highest in patients suffering from both SAD and APD. In fact, all patients suffering from both disorders were also suffering from gelotophobia. As explained in the discussion, the observed data did not suggest that gelotophobia is a subtype of SAD. The findings rather imply that the fear of being laughed at is a symptom characteristic for both SAD and APD. Based on that, gelotophobia may prove to be a valuable additional diagnostic criterion for SAD and APD and the present results also contribute to the ongoing debate on the relationship between SAD and APD.

Der Begriff der Therapieresistenz bei unipolaren depressiven Störungen aus medizinischer und aus rechtlicher Sicht – eine Standortbestimmung im Nachgang zu BGE 9C_13/2016

Der Beitrag befasst sich mit der bundesgerichtlichen Rechtsprechung zur allfalligen invalidisierenden Wirkung bestimmter depressiver Storungen. Dabei steht fur das Bundesgericht im Zentrum, ob die betreffende Einschrankung therapieresistent ist. Das Bundesgericht legt dar, dass es sich um seltene Konstellationen handle, in denen bei Depressionen leichter oder mittelgradiger Natur eine Therapieresistenz bestehe. Im Beitrag wird aus medizinischer Sicht eine Definition der chronischen depressiven Storung und der therapieresistenten Depression gegeben. Dabei wird genau untersucht, wann eine Therapieresistenz angenommen werden muss. Bei chronischen Verlaufen mit einer z.T. mehrjahrigen Krankheitsdauer kann aus medizinischer Sicht nicht mehr mehrheitlich von einer gunstigen Prognose ausgegangen werden. Mindestens in 40% dieser chronifizierten Falle besteht eine echte Therapieresistenz.

Traitement d’entretien et prévention des récidives des troubles dépressifs unipolaires

Ces recommandations de traitement de la Societe suisse des troubles anxieux et de la depression et de la Societe suisse de psychiatrie biologique ont ete elaborees conjointement avec la Societe suisse de psychiatrie et psychotherapie suivant les lignes directrices de la «World Federation of Societies of Biological Psychiatry» et de la «Deutsche Gesellschaft fur Psychiatrie, Psychotherapie und Nervenheilkunde».

Umgang mit dem suizidalen Patienten in der ambulanten Praxis

Appropriate handling of suicidal tendencies is for certain one of the most important duties within ambulant treatment. As various examples show, occurrence of a suicidal tendency can be chronical as well as acute. Well-known risk factors including current psychopathology and psychodynamics help to identify and assess a suicidal tendency and to take necessary therapeutic options. Some of these can be applied in general, others have to be tailored specifically with respect to the mental disorder in question. Suicide often occurs in an interpersonal context. This fact underlines on one hand the importance and the therapeutic potential of the relationship between the patient and the therapist, on the other hand it results in many cases in a highly stressful situation for the therapist. Significant attention has to be paid to counter transference and its control. Development of an emergency plan and challenges of a „non-suicidal-contract“ are discussed. We recommend an agreement with the patient to contact the therapist in case of not feeling able to control his/her own actions. This agreement includes our guarantee of permanent reachability.