Anamnese und Semiologie geben oft wegweisende Hinweise auf das Vorliegen dissoziativer Anfälle. Offenheit und Wachsamkeit des behandelnden Arztes, an dissoziative Anfälle frühzeitig zu denken, sind essenziell. Eine Video-Elektroenzephalographie-basierte Analyse der Ereignisse ist in der Regel entscheidend zur korrekten Diagnosestellung, insbesondere bei komplexeren Fällen. Der Beziehungsgestaltung ist bereits im diagnostischen Prozess ein hoher Stellenwert zuzuordnen, um Patienten für eine psychotherapeutische Behandlung zu gewinnen. Psychische Komorbidität und weitere somatische Beschwerden müssen im Diagnoseprozess erfasst werden. Aktuelle Änderungen in den gängigen Diagnosemanualen, einschließlich der ICD-11, spiegeln das lebhafte Interesse und die kontroverse Diskussion um die lange bekannte Krankheitsentität wider.

Patient history taking and semiology provide seminal clues to the diagnosis of dissociative seizures. Openness and alertness of the treating physician are essential. Video-electroencephalogram(EEG)-based analyses of the events are crucial to establish the correct diagnosis, particularly in complex cases. The patient-doctor relationship is of particular importance in order to successfully motivate the patient for psychotherapeutic treatment. Coexisting psychiatric morbidity as well as other functional somatic symptoms must be actively explored. Current changes in the established diagnostic manuals, including ICD-11, reflect the ongoing vivid interest and controversial discussions in the field of dissociative disorders.

Consecutive admissions to the psychosomatic departments of 5 hospital units in southwest Germany registered between October 2012 and October 2013 were asked to participate in a study investigating the treatment selection process for psychosomatic rehabilitation. 527 patients were included in the study, 269 outpatients and 258 inpatients at the end of their inpatient treatment. 52 patients (10.1%) received the recommendation for rehabilitation. 47 (90.4%) could be followed up 3 months later. 22 patients had applied for a rehabilitation treatment, 11 (50%) had obtained an approval for their rehabilitation, 5 had still no answer and for 6 patients the request was refused. 4 of the latter had objected their refusal and were still waiting for an answer. Only one patient was already admitted to a rehabilitation center. Possible reasons for the low permeability at the interface between hospital care and rehabilitation are discussed.

Migraine is one of the problems that has debilitating pain, and effects on all aspects of life, including the function of the academic, social and family life of patients. Smith (1996), also, has been shown the effects of migraine on family members such as patient's relationships with spouse, children and other family members. In addition migraineurs tend to have high levels of depression and anxiety, and migraine headaches have a profoundly negative impact on sufferers' quality of life (Johari Fard, 2011). In this research we investigated the regressions of cognitive, personality and family variables with migraine headache, to find predictor variables of migraine. In this study, we used these questionnaires: For migraine: six-item Headache Impact Test (HIT-6;Kosinski et al, 2003), Specific Quality of Life Questionnaire; Christine et al, 2012). For cognitive variables: Irrational Beliefs Test; (Jones, 1968) and Dysfunctional Attitudes Scale; (Beck et al, 1991),for personality variables: NEO inventory (Mccrae & Costa, 1985) for family variables: Family Assessment Device (Epstein et al,1983). This project was on 58 women with migraine headache, diagnosed by neurologist. The findings show that, there is significant regression between cognitive, personality and family variables and HIT-6. In cognitive variables: frustration reactivity, anxious overconcern, in personality variables, extraversion trait and in family variables, affective involvement are significant. Also, there is significant regression between cognitive, personality and family variables and MSQ.In cognitive variables: frustration reactivity, anxious overconcern, and helplessness, in personality variables, agreeableness and consciousness and in family variables, affective involvement and general functioning are significant.

Objective: The purpose of this study was to examine the influence of attachment, social support and the quality of the current partnership on the outcome of bereavement after perinatal loss.Methods: In a prospective cohort design 33 women after perinatal loss were approached on admission to hospital and reassessed four weeks, four months and nine months later. The initial assessment included the Adult Attachment Interview and self-report questionnaires for social support and quality of the current partnership. Bereavement outcome was assessed using measures of grief (MTS), depression and anxiety (HADS), psychological distress (BSI), somatisation (BSI-SOM) and symptoms of PTSD (PDS).Results: All measures of outcome showed a significant improvement over time. Standardized effect sizes between the initial assessment and nine month follow-up ranged between .36 for anxiety (HADS) and 1.02 for grief (MTS). Social support, quality of the partnership and secure attachment correlated inversely, and insecure preoccupied attachment correlated positively with the outcome measures. Preoccupied attachment was included as a predictor in two multivariate statistical models of non-linear regression analysis, one with somatisation (adjusted R-2=.698. P=.016), the other with posttraumatic stress symptoms at nine month follow-up (adjusted R-2=.416, P=.002) as target variable. Initial assessment scores of psychological distress predicted the course of the respective measure during follow-up (adjusted R-2=.432, P=.014).Conclusion: Attachment, social support and the quality of the current partnership have an impact on the course of bereavement after perinatal loss. Secondary prevention after the event may focus on these factors in order to offer specific counselling and support. (C) 2012 Elsevier Inc. All rights reserved.

Health care insurers in Germany fund long-term psychotherapy of up to 240 sessions as well as brief psychotherapeutic interventions of up to 25 sessions. In a former study, it was observed that a substantial proportion of interventions initially designed as brief psychotherapy were changed into long-term therapy. The present study investigated the criteria of such decisions to change treatment plans and is part of a more comprehensive auditing study in outpatient psychotherapy. Twenty-six psychotherapists in private practice participated in the study. During a 12-month recruitment period, 70 patients started with brief psychodynamic psychotherapy. Thirty-six therapies were evaluated according to the study protocol. The results provide evidence that motivation for psychotherapy, satisfaction with the results of therapy, persistence of psychological symptoms at the end of short-term intervention, and aspects of the patient's personality are factors predictive of treatment selection. Patients who changed from short-term to long-term therapy were more motivated towards their therapy (prognostic indication), displayed more severe symptoms, were less satisfied with the results of short-term psychotherapy (adaptive indication), and scored higher on the "structure of personality organization" parameter according to the OPD diagnostic system.

In einer prospektiven, naturalistischen Studie wurde die Indikationsstellung während tiefenpsychologischer Kurzzeitpsychotherapien untersucht. Voruntersuchungen hatten gezeigt, dass ein hoher Prozentsatz tiefenpsychologischer Kurzzeitpsychotherapien in Langzeitbehandlungen umgewandelt wird. In der hier vorgestellten Untersuchung wurden die Entscheidungskriterien überprüft, die der Umwandlung von Kurzzeit- in Langzeitbehandlungen zugrunde liegen.

Zusammenfassung Somatoforme Störungen beinhalten neben einer körperlichen Störung eine grundsätzliche Störung im Erleben und Gestalten von zwischenmenschlichen Beziehungen. Interpersonelle Probleme einschließlich derjenigen, die sich infolge eines spezifischen Krankheitsverhaltens in der Patient-Arzt-Interaktion entwickeln, gehören zu den zentralen behandlungsbedürftigen Aspekten dieser Krankheitsentität (Nickel u. Egle 1999). Aus der Perspektive der Bindungsforschung weisen die Beziehungsschwierigkeiten von Patienten mit somatoformen Störungen auf einen entwicklungsgenetischen Hintergrund des Störungsbilds hin. Im Anschluss an einen kurzen Abriss der Bindungstheorie wird im Zusammenhang mit dem Konzept der Bindungsrepräsentation gesondert auf die entwicklungpsychopathologische Dimension der Repräsentanzenbildung bei somatoformen Störungen eingegangen. Es folgt eine ausführliche Übersicht über den Stand der Theorie und Forschung zur Bindungsentwicklung bei somatoformen Störungen. Schließlich wird auf dieser Basis ein Vulnerabilitätsmodell für somatoforme Störungen skizziert.

Patients with physical symptoms but no detectable organic substrate often present a challenge for the family doctor. The therapeutic approach discussed herein focuses on the development of a psychosomatic model of the problem. In this step-by-step approach, the patient's subjective understanding of, and attitude towards, his illness and its treatment are established, alternative psychosomatic models of disease based on a consideration of psychophysiological interactions are worked out jointly with the patient, and, finally, thought is given to the current complaints within the context of the patient's personality and life situation. The basis for successful treatment is an empathic and sound doctor-patient relationship based on trust that gives the patient the feeling that he and his problem are being taken seriously. The prerequisite for the use of such a program is appropriate training in basic psychosomatic care.

Zusammenfassung Tiefenpsychologische Kurzzeitpsychotherapie und tiefenpsychologisch fundierte Langzeitpsychotherapie sind in den untersuchten Praxen mit insgesamt 54,6% die am häufigsten praktizierten Behandlungsverfahren. Die analytische Psychotherapie stellt mit 32% ebenfalls einen hohen Anteil am Gesamt der untersuchten Behandlungen. Die Anzahl der Therapien, die länger als 2,5 Jahre dauern ist dennoch gering (ca. 15%). Im Behandlungsverlauf kommt es zu eine Reduktion der Arbeitsunfähigkeit, der Verabreichung von Psychopharmaka und der Inanspruchnahme medizinischer Leistungen. Die Ergebnisse werden unter drei Gesichtspunkten diskutiert: der Zugänglichkeit zur ambulanten Fachpsychotherapie, der Differentialindikation für unterschiedliche Psychotherapieverfahren und der Aussagekraft von „Ereignisparametern” zur Verlaufsbeurteilung von Psychotherapien.

Idiopathic spasmodic torticollis (IST) is one of the most frequent dystonic movement disorders. Its classification as a focal dystonia, as well as its treatment with botulinum toxin resulted in groups of patients being regularly seen by neurologic specialists. In a multicentre study, we investigated psychosocial changes, coping and psychopathology, and their interrelations with signs, symptoms and course. 256 patients were included in the study (59.3% women, 40.7% men). The mean age was 49.1 years. Rotating torticollis occurred more often than latero-retrocollis and antero-retrocollis. A family history of IST was seen in 3.1% of the total sample. 34% of the patients had additional dystonic symptoms. Most frequently, these affected the upper extremities (13%), less often the legs. 19.1% of the patients had experienced a period of complete remission. The General Symptom Index of the SCL 90-R in 27% of the patients ranged above the double standard deviation of the normal controls, indicating a clinically significant psychopathology.

A total of 21 patients with psychogenic tremor (PT) were asked to take part in a neurologic and psychosomatic assessment; for 17 patients follow-up information was also recorded. Women out-numbered men in the sample. In the majority of patients the tremor was associated with a variety of other conversion symptoms. The clinical picture of the tremor varied. After beginning exclusively in the extremities, it tended to spread to other parts of the body. Other psychopathology (depression and histrionic personality disorder) existed in almost a third of the sample. Many patients had retired from professional life, or planned to do so in the near future, because of PT. At follow up the initial diagnosis was confirmed in all patients although in some patients additional physical illness had developed during the follow-up period. When neurological and psychiatric/psychosomatic criteria are applied the diagnosis of PT can be established reliably. Studies that have questioned the validity of the conversion concept on the basis of frequent misdiagnoses may indicate problems in the diagnostic procedure rather than an invalid theoretical construct.