Thomas Stompe

Magnetic resonance imaging in patients with obsessive–compulsive disorder with good versus poor insight

The DSM-IV provides two subtypes of obsessive-compulsive disorder (OCD), labelled as OCD with insight and OCD with poor insight. For the latter, patients generally fail to recognize that the obsessions or compulsions are excessive or unreasonable. Several studies have shown significant brain abnormalities in OCD patients. However, at present, it remains unclear whether a specific pattern of structural brain abnormalities is related to poor insight in OCD. In the present study, magnetic resonance imaging (MRI) findings were compared in OCD patients with insight versus those with poor insight. Outpatients with diagnoses of OCD according to DSM-IV (300.30) and ICD-10 (F42) (n = 84; mean age 38+/-13; 35 females, 49 males) were dichotomized into the two subtypes. All subjects underwent an MRI examination. MRI findings were rated as MRI abnormality and normal MRI. In our sample, 48% of the patients had MRI abnormalities. There was a highly significant difference between the two groups according to frequencies of MRI abnormalities, with 83% of the patients with poor insight showing MRI abnormalities compared with only 21% of the patients with insight. The specifier poor insight helps to identify a subgroup of OCD with a higher frequency of brain abnormalities of various types. This distinction should be taken into account in future studies concerning the course and therapeutic outcome of OCD.

Das Cotard-Syndrom bei schizophrenen Erkrankungen

BACKGROUNDnThe Cotard-Syndrome (CS), the belief of being dead, was described for the first time in 1880. Since then it met the interest not only of psychopathologists but also of philosophers. With a few exceptions, the literature is mainly restricted to case reports of anxious-depressive, demented or paranoid patients. It was the aim of our study to investigate the prevalence and the psychopathological context of the CS.nnnMETHODSnWe analyzed the Austrian data (N = 346) of the International Study of Psychotic Symptoms in Schizophrenia.nnnRESULTSnA CS could be diagnosed in three cases (0.87%). In all of them, CS developed on the basis of nihilistic-hypochondriac delusions and a progressive loss of energy. Two patients bridged the logical inconsistencies between obviously being alive and the belief of being dead by visual illusions, the third patient, however, by locating himself in an intermediate region between this world and the afterworld.nnnCONCLUSIONSnOn the one hand the CS can be considered as a special manifestation of the topic of death in schizophrenic delusions, on the other as a nihilistic delusional identity. Without doubt, this uncommon and bizarre psychotic phenomenon will be an object of interest for general psychopathology as well as for the philosophy of mind also in future.ZusammenfassungGrundlagenDas Cotard Syndrom (CS), die Überzeugung tot zu sein, wurde erstmals 1880 beschrieben und fand seither immer wieder das Interesse von Psychopathologen, aber auch von Philosophen. In der Fachliteratur findet es sich vorwiegend in Kausuistiken über ängstlich-depressive, demente oder paranoide Patienten. Die vorliegende Arbeit versucht, die Prävalenz sowie den psychopathologischen Kontext des CS bei schizophrenen Erkrankungen zu erfassen.MethodikAusgewertet wurden die Daten des österreichischen Samples (Nu2009=u2009346) der International Study on Psychotic Symptoms in Schizophrenia.ErgebnisseEin CS fand sich in drei Fällen (0,87xa0%). Bei allen drei Patienten entwickelte es sich aus einem nihilistisch-hypochondrischen Wahn und einem seit längerer Zeit bestehenden progredienten Energieverlust. Die logischen Brüche der Wahnerzählung wurden in zwei Fällen durch illusionäre Verkennungen, im dritten Fall durch eine wahnhafte Situierung in einem Zwischenreich zwischen Diesseits und Jenseits überbrückt.SchlussfolgerungenDas CS kann einerseits als eine besondere Form der Verarbeitung der Todesthematik im Wahn, andererseits als eine nihilistische Wahnidentität aufgefasst werden. Dieses seltene, jedoch überaus faszinierende und bizarre psychotische Phänomen wird wohl noch länger Gegenstand des Interesses sowohl der allgemeinen Psychopathologie als auch der Philosophie des Geistes sein.SummaryBackgroundThe Cotard-Syndrome (CS), the belief of being dead, was described for the first time in 1880. Since then it met the interest not only of psychopathologists but also of philosophers. With a few exceptions, the literature is mainly restricted to case reports of anxious-depressive, demented or paranoid patients. It was the aim of our study to investigate the prevalence and the psychopathological context of the CS.MethodsWe analyzed the Austrian data (Nu2009=u2009346) of the International Study of Psychotic Symptoms in Schizophrenia.ResultsA CS could be diagnosed in three cases (0.87xa0%). In all of them, CS developed on the basis of nihilistic-hypochondriac delusions and a progressive loss of energy. Two patients bridged the logical inconsistencies between obviously being alive and the belief of being dead by visual illusions, the third patient, however, by locating himself in an intermediate region between this world and the afterworld.ConclusionsOn the one hand the CS can be considered as a special manifestation of the topic of death in schizophrenic delusions, on the other as a nihilistic delusional identity. Without doubt, this uncommon and bizarre psychotic phenomenon will be an object of interest for general psychopathology as well as for the philosophy of mind also in future.

Die Spuren der Gewalt

BACKGROUNDnSuicide and homicide rates are the ultimate expressions of violence. The rates are globally almost distributed mirror-reverted. Rich, modern democratic countries with a functioning legal system have high suicide and low homicide rates, traditional states with a weak central government high homicide and low suicide rates. Exceptions are some Eastern European countries, in which both, the rates of homicide and suicide are very high. These states are located on the territory of the former Bloodlands (Snyder, Bloodlands: Europa zwischen Hitler und Stalin, 2011), where between 1930 and 1945 14 million people were civilian victims of the Soviets and the National Socialists. We addressed the question of whether these eight countries (Poland, Lithuania, Estonia, Latvia, Moldova, Belarus, Russia and Ukraine) differ from the other European countries of the former East bloc, from the Asian countries of the former USSR and the Western European countries in social, economic and psychosocial factors.nnnMETHODSnThe data used for analyses were taken of various data sets from the WHO, the UN and the CIA. The statistical comparison of the four regions was carried out by nonparametric tests.nnnRESULTSnThe States on the grounds of the former Bloodlands and the other European countries of the former East bloc are comparable concerning important social and economic parameters such as level of modernization, Democracy-index and Rule of Law-Index. Statistically significant differences were found only in the annual alcohol consumption per capita and the divorce rates.nnnCONCLUSIONSnWe hypothesize that the high suicide and homicide rates in some Eastern European countries may be the result of the traumatic experience of extreme violence of nearly the entire population between 1930 and 1945. Possible paths of the transgenerational transmission as well as conceivable chains of causality between the trauma in the first generation and suicidal or homicidal behavior in the following generations are presented.

Psychische Gesundheit, Akkulturation und Religiosität bei jüdischen Migranten aus der ehemaligen Sowjetunion in Österreich

BACKGROUNDnResearch on migration provides controversial findings regarding the links between mental health and migration as well as the factors influencing the mental health of migrants. Even though there is evidence for differences between migrant groups from different countries of origin, almost no empirical studies about individual migrant groups in Austria have been undertaken so far.nnnMETHODSnIn the present population-based study we compared depression and anxiety of 96xa0ex-Soviet Jews to axa0sample of 101 Austrians matched by age and sex. Furthermore, we investigated the impact of acculturation attitude and religiosity on the psychological condition of the migrants. Depression and anxiety were measured with Beck-Depression-Inventory (BDI), State-Trait-Anxiety-Inventory (STAI) and Brief Symptom Inventory (BSI). Acculturation attitude was assessed with Vancouver Index of Acculturation (VIA) and religiosity with axa0self-developed scale.nnnRESULTSnEx-Soviet Jews were significantly more depressed and more anxious than native Austrians but not more likely to be affected by clinical depression. Integration (i.e. interest in both the original and the receiving societys culture) as an acculturation strategy was associated with the lowest mental health burden. Religiosity had axa0protective effect against depression but not against anxiety.nnnCONCLUSIONnThe present study allows initial insights into the mental health of axa0migrant group which has hardly been subject to research, and it indicates axa0need for axa0greater opening of the Austrian majority population to migrants.ZusammenfassungGrundlagenDie Migrationsforschung ergibt kontroverse Befunde über den Zusammenhang zwischen psychischer Gesundheit und Migration sowie zu den Faktoren, die die psychische Gesundheit von Migranten beeinflussen. Es gibt zwar Hinweise auf Unterschiede zwischen Migrantengruppen aus verschiedenen Herkunftsländern, allerdings wurden bisher fast keine empirischen Studien über einzelne Migrantengruppen in Österreich unternommen.MethodikIn der vorliegenden populationsbasierten Untersuchung wurden Depressivität und Ängstlichkeit von 96xa0jüdischen Migranten aus der ehemaligen UdSSR mit einem nach Alter und Geschlecht gematchten Sample mit 101 Österreichern verglichen. Weiters wurde der Einfluss von Akkulturationseinstellung und Religiosität auf die psychische Verfassung der Migranten untersucht. Depressivität und Ängstlichkeit wurden mit dem Beck-Depression-Inventory (BDI), dem State-Trait-Anxiety-Inventory (STAI) und dem Brief Symptom Inventory (BSI) erhoben. Die Akkulturationseinstellung wurde mit dem Vancouver Index of Acculturation (VIA) gemessen, die Religiosität mit einer selbstentwickelten Skala erfasst.ErgebnisseDie Juden aus der ehemaligen Sowjetunion waren signifikant depressiver und ängstlicher als die gebürtigen Österreicher, jedoch nicht häufiger von klinischen Depressionen betroffen. Integration als Akkulturationsstrategie (d.u202fh. Interesse sowohl an der Herkunfts- als auch an der Aufnahmekultur) ging mit der niedrigsten psychischen Belastung einher. Die Religiosität wirkte sich protektiv auf Depressivität, nicht jedoch auf Ängstlichkeit aus.SchlussfolgerungenDie vorliegende Untersuchung erlaubt erste Rückschlüsse auf die psychische Gesundheit einer bis dato kaum untersuchten Migrantengruppe und weist auf einen Bedarf nach größerer Öffnung der österreichischen Mehrheitsgesellschaft den Migranten gegenüber hin.SummaryBackgroundResearch on migration provides controversial findings regarding the links between mental health and migration as well as the factors influencing the mental health of migrants. Even though there is evidence for differences between migrant groups from different countries of origin, almost no empirical studies about individual migrant groups in Austria have been undertaken so far.MethodsIn the present population-based study we compared depression and anxiety of 96xa0ex-Soviet Jews to axa0sample of 101 Austrians matched by age and sex. Furthermore, we investigated the impact of acculturation attitude and religiosity on the psychological condition of the migrants. Depression and anxiety were measured with Beck-Depression-Inventory (BDI), State-Trait-Anxiety-Inventory (STAI) and Brief Symptom Inventory (BSI). Acculturation attitude was assessed with Vancouver Index of Acculturation (VIA) and religiosity with axa0self-developed scale.ResultsEx-Soviet Jews were significantly more depressed and more anxious than native Austrians but not more likely to be affected by clinical depression. Integration (i.e. interest in both the original and the receiving society’s culture) as an acculturation strategy was associated with the lowest mental health burden. Religiosity had axa0protective effect against depression but not against anxiety.ConclusionThe present study allows initial insights into the mental health of axa0migrant group which has hardly been subject to research, and it indicates axa0need for axa0greater opening of the Austrian majority population to migrants.

Die forensisch-psychiatrische Begutachtung von Kindern und Jugendlichen mit Migrationshintergrund

Die gegenwartigen grosen Flucht- und Wanderungsbewegungen bringen Menschen in die EU, die haufig schwer traumatisiert sind – darunter viele Kinder und Jugendliche, die mit Gewalt und Krieg aufgewachsen sind. Fur manche davon ist Gewalt zu einer fur sie normalen Uberlebensstrategie geworden, die sie unter Umstanden auch in einem neuen, in vielerlei Hinsicht problematischen Umfeld einsetzen konnten. In der forensisch-psychiatrischen Begutachtung von Kindern und Jugendlichen wird man daher vermehrt auf uns fremde Wertehaltungen stosen. Auch psychiatrische Krankheitsbilder weisen eine mitunter ungewohnte Phanomenologie auf. Es ist daher fur gerichtliche Sachverstandige ein Gebot der Stunde, ausreichende interkulturelle Kompetenzen zu erwerben, um diesen kommenden Herausforderungen gewachsen zu sein.

[The representation of madness in William Shakespeare's characters].

SummaryShakespeare is one of the great creators of human characters of the 16th century. Like for many of his contemporaries madness was a central topic of his work. The first part of this paper discusses the sociocultural environment and the semantic field of madness in the Elizabethan age, which forms the background for Shakespeares characters. In the second part we try to analyze the clinical pictures of the fictive characters of Othello, Hamlet, Lear and Macbeth. While we find melancholy, delusions and hallucinations, other diseases such as schizophrenia are missing entirely. Schizophrenia only appears in the literature more than two hundred years later, in the beginning of modern age.ZusammenfassungShakespeare gilt als der große Menschenbeschreiber am Beginn der Neuzeit. Wie bei vielen seiner Zeitgenossen war der Wahnsinn ein ganz zentrales Thema seines Schaffens. Diese Arbeit geht der Frage des kulturgeschichtlichen und gesellschaftlichen Umfeldes nach, aus dem heraus Shakespeare Figuren entwickelt hat, die aus diesem Kontext weit herausragen. Dabei liegt ein wesentlicher Schwerpunkt auf der historischen Semantik des Wortfelds des Wahnsinns. Danach wird exemplarisch an der Interpretation der Figuren von Othello, Hamlet, Lear und Macbeth dargestellt, welche klinischen Bilder Shakespeare entwickelt. Während sich Darstellungen von Melancholie, Wahn und Halluzinationen finden, fehlen andere auffällige Krankheitsbilder wie die Schizophrenie, die in der Literatur erst mehr als zwei Jahrhunderte später mit Anbruch der Moderne auftaucht.

Die Gestaltungen des Wahnsinns bei William Shakespeare

SummaryShakespeare is one of the great creators of human characters of the 16th century. Like for many of his contemporaries madness was a central topic of his work. The first part of this paper discusses the sociocultural environment and the semantic field of madness in the Elizabethan age, which forms the background for Shakespeares characters. In the second part we try to analyze the clinical pictures of the fictive characters of Othello, Hamlet, Lear and Macbeth. While we find melancholy, delusions and hallucinations, other diseases such as schizophrenia are missing entirely. Schizophrenia only appears in the literature more than two hundred years later, in the beginning of modern age.ZusammenfassungShakespeare gilt als der große Menschenbeschreiber am Beginn der Neuzeit. Wie bei vielen seiner Zeitgenossen war der Wahnsinn ein ganz zentrales Thema seines Schaffens. Diese Arbeit geht der Frage des kulturgeschichtlichen und gesellschaftlichen Umfeldes nach, aus dem heraus Shakespeare Figuren entwickelt hat, die aus diesem Kontext weit herausragen. Dabei liegt ein wesentlicher Schwerpunkt auf der historischen Semantik des Wortfelds des Wahnsinns. Danach wird exemplarisch an der Interpretation der Figuren von Othello, Hamlet, Lear und Macbeth dargestellt, welche klinischen Bilder Shakespeare entwickelt. Während sich Darstellungen von Melancholie, Wahn und Halluzinationen finden, fehlen andere auffällige Krankheitsbilder wie die Schizophrenie, die in der Literatur erst mehr als zwei Jahrhunderte später mit Anbruch der Moderne auftaucht.