Zeitschrift fur Psychosomatische Medizin und Psychoanalyse最新文献

Confusion exists regarding the usage of the two adjectives psychic and psychogenic. Therefore a differentiation of the two words is necessary. We will try to do this with the help of concrete examples. Regarding the pair of terms psychic versus somatic one has to differentiate strictly between (psychic or somatic) causes on the one hand and the forms of manifestation in the psychic or somatic field of observation on the other hand. The discussion about the linguistic ruling of psychic versus psychogenic has important consequences for the responsibilities and care of the different professions: psychiatrist, psychosomatist/psychotherapist, other specialists, general physician.

Oncological diseases often represent a psychic trauma, which leads affected patients into a narcissistic crisis. Starting from the concept of narcissistic regulation system (Deneke, 1989), the origins of the destabilisation of the self are described, and parallels to persecution trauma will be drawn. The longing of the patients for symbiotic relationships are investigated in their double sense. On the one hand they serve the patient to stabilise his self, on the other hand they involve the danger of traumatisation within an object relation. The consequences for the process of mourning and integration will be discussed.

For investigating the validity of the Narzissmusinventar 27 somatic and psychic healthy men aged between 30 and 45 were tested with the Narzissmusinventar, the Fragebogen zur Erfassung von Aggressivitätsfaktoren, the State-Trait-Angstinventar and the Fragebogen zur Messung der Kontrollambitionen. Moreover a structured interview for the evaluation of type A behavior was administered. Correlative statistical analyses showed in the sense of construct validity that the dimension of the "bedrohtes Selbst" ("threatened self") is characterized by anxiety, feelings of insufficiency and aggression. The other subscales of the Narzissmusinventar correlate only with a few variables of the other tests and the speaking behavior. These subscales evaluate the narcissistic personality traits which the other instruments we used in our investigation are not able to reflect.

Concepts of group psychotherapy are standard in contemporary inpatient psychotherapy. The effective treatment combination of both inpatient and outpatient group psychotherapy, however, is less common. The following discussion evaluates the effectiveness of inpatient-outpatient group psychotherapy as a therapeutic method as well as its applicability for standard treatment.

The present 3-year longitudinal study investigated the relationship between causal attribution and coping mechanism. Data were collected in a group of 66 breast cancer patients by self-report questionnaires. Three issues were addressed: 1. How do the patients explain the cause of their illness? 2. Do the subjective causes change over the course of three years? 3. What kind of relationship can be found between the causal attributions and the coping mechanism of the patients? Results showed a predominance of psychological attribution. Only little statistical prove could be found for changes between the four ratings. Analysing the individual data of the patients however revealed changing perceptions for about half the patients. A relationship between psychological attribution and depressive coping and problem solving as well were found.

One of the central tasks of psychodynamic diagnosis, next to determining intrapsychic conflicts, central relational patterns, and subjective forms of experiencing is assessing the psychic structure or the structural disorder. This article develops the structure term from object relationship theoretical, ego-psychological, and self-psychological concepts of psychoanalysis. This "Structure of the self in the relationship to others" thus obtained is described with six structural criteria (self-perception, self-control, defence, object perception, communication, attachment). In order to be able to distinguish the extent and the quality of structural disorders four structure levels of integration based on psychoanalytic experience in the out-patient and the in-patient setting are differentiated. A basis for an operationalization is then made; it is made in the system OPD (Operationalized Psychodynamic Diagnostics). First studies regarding practicalibility and reliability are promising.

Psycho-neuroimmunology depicts a conceptual frame in which possible interactions between psychic and physical processes can be examined. It could be very significant in the field of psychosomatics when the courses of psychic and somatic processes are examined. However, the research results from this field of study are varied and only for a few parameters of immunity is it possible to prove correlations with psychic variables. Many of the studies that have been conducted up to date were construed as cross-section studies and possibly therefore are not very suitable for depicting the probably very complicated forms of interactions between psychic and somatic levels in an adequate manner. In the framework of stationary psychosomatic psychotherapy two single case studies were carried out in order to examine temporal connections between psychic and immunological course parameters. Both single case studies are to be viewed as explorative attempts of examining questions of examination design and organization which are highly resolved regarding time. Furthermore we report several interesting individual results which emphasize in general the correlation between psychic and somatic parameters also in the course of time. However the limits of such studies regarding the significance of the individual immunological parameters, using time serial analytical methods as well as constructing models in the field of psycho-neuroimmunology are discussed.