Wolfgang Schneider

The effects of shift work on physical and mental health

Occupational engagement is a pre-requisite for continuous income opportunities. Among the changing social circumstances work-related conditions play an increasingly eminent role in psychological and mental well-being. The public discusses the question of a possible association between the demands of modern work life and the increases of psychological, psychosomatic and cardiovascular disorders. Given the socioeconomic implications of psychiatric and psychosomatic suffering in the general population, there is a need to further elucidate the causes of their increasing incidence. From a medical point of view, any organization of work disrupting the phased circadian rhythms for bio-psycho-social processes and functioning of the individual are interesting against the background of clock genes and certain biological functions that are organized in a circadian fashion. The authors review the influence of shift work as a form of systematic desynchronization of inner clock systems on the endocrine, the physical, and the mental level. The significance of the findings in the field is discussed along with future directions of conclusive research.

Gender Differences in Dissociation

Considering that epidemiological research on dissociative disorders has suggested a 9 to 1 predominance of female cases, this study investigated the relationship between gender and dissociation using a dimensional approach. A total of 2,153 participants from different diagnostic groups completed the Dissociative Experience Scale. In order to control for the confounding effect of current psychopathology a subgroup 790 subjects additionally completed the SCL-90. We did not find any differences in the general or pathological dissociation scores. Hypothetical gender differences in dissociative psychopathology were not a function of diagnostic categories. There were no significant sex differences in the distribution of high dissociators. Our findings suggest that men and women do not generally differ in dissociative psychopathology. The implications for future investigations on the epidemiology, etiology, and psychobiology of dissociative symptoms are discussed.

Differential effects of childhood abuse and neglect: Mediation by posttraumatic distress in neurotic disorder and negative symptoms in schizophrenia?

Dissociation, though understood as a response to trauma, lacks a proven etiology. The assumption of a dose-response relationship between trauma, dissociation and Schneiderian symptoms led to the proposal of a dissociative subtype of schizophrenia characterized by severe child maltreatment, dissociation and psychosis. Child maltreatment and dissociation are common features of neurotic disorders as well, and the link between trauma, dissociation, and hallucinations is not specific for schizophrenia. This study compares childhood abuse and neglect, posttraumatic distress and adult dissociation in patients with psychotic vs. non-psychotic disorder. Thirty-five participants with non-psychotic disorder and twenty-five with schizophrenia were analyzed using the Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS), the Montgomery-Åsberg Depression Rating Scale (MADRS), the Posttraumatic Stress Diagnostic Scale PDS (PDS), the Childhood Trauma Questionnaire (CTO) and the Arbeitsgemeinschaft Methodik und Dokumentation in der Psychiatrie (AMDP)-module on dissociation. Trauma and clinical syndromes were compared by means of T-testing and logistic regression between 1) the diagnoses and 2) groups with and without post-traumatic stress disorder (PTSD), marked dissociation and psychotic symptoms. While non-psychotic disorder was related to abuse, schizophrenia showed an association with neglect. Childhood trauma predicted posttraumatic symptomatology and negative symptoms. Childhood abuse and neglect may effectuate different outcomes in neurotic and psychotic disorder. The underlying mechanisms, including dissociation, dovetail with cognitive, emotional and behavioural changes involved in depression, posttraumatic distress and chronic schizophrenia symptoms rather than being directly linked to trauma.

Frequency, Clinical and Demographic Correlates of Pathological Dissociation in Europe

ABSTRACT Although pathological dissociation (PD) has received increasing scientific attention in Anglo-American countries, European research on the frequency, clinical and demographic correlates of this discontinuous construct are lacking. An 8-item subscale of the Dissociative Experiences Scale, called the DES-Taxon, was administered to five samples comprising a non-clinical population, students, unselected psychiatric inpatients, eating-disordered inpatients and psychosomatic outpatients with a total of 1,759 adult participants. In the two non-clinical samples, the frequency of PD ranged between 0.3 and 1.8%. Its prevalence was highest in the psychiatric inpatients (5.4%) followed by the eating disorders (4.8%) and the psychosomatic outpatients (2.2%). PD was seen in all diagnostic groups and it was associated with more psychopathological distress and younger age. PD is frequently found in clinical populations in European countries, too. However, methodological problems relating to its empirical determination might obscure the clinical and scientific value of the construct.

Operationalized psychodynamic diagnosis in planning and evaluating the psychotherapeutic process

The multiaxial system of operational psychodynamic diagnosis (OPD) is based on five axes covering illness experience and prerequites for treatment, interpersonal relations, conflict, structure and symptomatology following ICD-10, Chapter V (F). The new version, OPD-2, has developed from a purely diagnostic system into one including a set of tools and procedures for treatment planning and for measuring change, as well as for determining the appropriate main focuses of treatment and developing appropriate treatment strategies. Focusing on axis I of the system, the concept and content of OPD are introduced and data concerning aspects of reliability and validity are discussed.

Detachment, Compartmentalization, and Schizophrenia: Linking Dissociation and Psychosis by Subtype

To explain the phenomenological overlap between dissociation and schizophrenia, a dissociative subtype of schizophrenia has been proposed as a possibility. Dissociation is often believed to be organized on a continuum, although 2 qualitatively different phenomena can be distinguished in theory, research, and clinical practice: (a) states of separation from self or environment (detachment dissociation) and (b) inaccessibility of normally accessible mental contents (compartmentalization dissociation). This study used the Positive and Negative Syndrome Scale (PANSS) and the Association for Methodology and Documentation in Psychiatry module for the interview assessment of dissociation to investigate the relationships between PANSS subscales, detachment dissociation, and compartmentalization dissociation in a sample of 72 patients with schizophrenia. A confirmatory factor analysis sustained the bipartite model, yielding factors that grouped dissociative items around amnesia and depersonalization/derealization. The latter factor also contained identity disturbances and was therefore not entirely consistent with the theoretical formulations of detachment dissociation. It is important to note that the structure of those factors may be influenced by the symptoms of schizophrenia to which they were specifically linked: The factor containing depersonalization/derealization was connected to the positive symptoms subscale of the PANSS, whereas the factor containing amnesia was associated with the negative subscale. Hence, a dichotomy of dissociation is confirmed inasmuch as its subtypes are as distinguishable as PANSS subscales. This has implications on theoretical and clinical levels.

Results of the ICD-10 Research Criteria Study in German-Speaking Countries in the Field of Psychosomatics and Psychotherapy

Selected results from the section psychotherapy/psychosomatics of the ICD-10 research criteria study are discussed. One hundred thirty diagnosticians from 11 psychosomatics centers took part in this section, assessing 16 video-documented patients in case conferences. The results of the study, which were based on 633 diagnostical assessments, demonstrated sufficient chance-corrected interrater reliability coefficients for the majority of the disorders (kappa ranged from 0.22 to 0.99). System-related problems of the ICD-10 approach were identified concerning depressive and psychosomatic disorders. The results are discussed, following some problematical aspects of the concept of comorbidity and multiaxial approaches. Special reference is given to the work group Operational Psychodynamic Diagnoses which has produced a multiaxial system covering important psychodynamic variables.

Neurotic and psychosomatic disorders (F4, F5). Results from the ICD-10 field trial of the Diagnostic Criteria for Research in German-speaking countries.

The concept of neurotic and psychosomatic disorders in ICD-10, chapter V (F), follows the principle of descriptive diagnosis; therefore the classical approaches with special regard to psychoanalytic terminology were abandoned. These changes were subject of a multicentric field trial in German speaking countries evaluating practicability, acceptability, feasibility, reliability and aspects of validity of the ICD-10 Diagnostic Criteria for Research: Involving 34 psychiatric, child-psychiatric and psychosomatic centres 17 video-documented cases with ICD-10 diagnoses from sections F4 and F5 were assessed independently in case conferences. On the basis of 1,116 ratings, acceptability and practicability were rated as comparatively sufficient. For 3-character diagnostic categories, the chance-corrected interrater reliability coefficients (kappa) showed a range from 0.62 to 0.95. The concordance with the independently assessed expert consensus diagnosis for the different cases showed a range between 87 and 100%.