[Disseminated tuberculosis during induction chemotherapy in acute myeloid leukemia]. / Disseminierte Tuberkulose unter Induktionschemotherapie bei akuter myeloischer Leukämie.

A patient with acute myeloid leukemia developed disseminated tuberculosis with cerebral involvement in the early phase of induction chemotherapy before allogenic stem cell transplantation. He presented with persisting fever of unknown origin, and initially misinterpreted organ lesions in CT scans.

Psychosomatic factors in borderline hypertensive subjects and offspring of hypertensive parents.

Psychosomatic factors, sympathoneural and sympathoadrenal as well as cardiovascular mechanisms, were studied in 24 patients 18-24 years of age with borderline hypertension, 50 age-matched normotensive offspring of hypertensive parents, and 49 controls with no family history of hypertension. They were compared by projective and questionnaire-based psychological tests and their circulatory and neurohormonal reactivity to mental (Stroop color-word conflict test and arithmetic test) and physical stressors (orthostasis and bicycle ergometry test) were measured. Borderline hypertensive subjects externalized aggression less (p less than 0.05) but internalized it more (p less than 0.05) and were more submissive (p less than 0.05) when compared with controls. Offspring of hypertensive parents showed a similar but weaker pattern. Both risk groups reported more positive interactions with their parents (genetic risk subjects versus controls, p less than 0.05; borderline hypertensive patients versus controls, p = 0.08) and had higher state-anxiety levels (p less than 0.05). There were more subjective symptoms of beta-adrenergic receptor-mediated functions (e.g., tachycardia, tremor) in borderline hypertensive subjects and offspring of hypertensive parents, elevated heart rates (analysis of repeated measures, p less than 0.001), and enhanced plasma norepinephrine concentrations (p less than 0.05) when compared with controls. These findings in subjects at risk for the development of hypertension suggest that psychosomatic factors and sympathetic overactivity are involved in the early phase of hypertension.

[Sick behavior of patients with rheumatic diseases]. / Krankheitsverhalten bei Patienten mit Weichteilrheumatismus.

The illness behavior of 119 patients with rheumatic disorders (predominantly nonarticular rheumatism) has been studied. The behavior differed in relation to the rheumatological diagnosis, the personality and the previous stress situations.

Apparent and hidden changes in group members according to the different phases of group psychotherapy.

On a psychological-motivational-vertical axis, the more or less covert experiences of members of a therapeutic group are determining factors, whereas on a sociological-interactional-horizontal axis, the system approach, or the network of preponderantly apparent interactions, is the object of therapeutic interventions. The psychological view is directed toward the individual members, whereas the sociological approach means grasping the group as a whole. In group treatment a shifting resultant is mostly observed, at times stressing the individual-psychological approach and at other times the systemic-interactional approach. Five phases of group psychotherapy are discussed in which childhood conflicts and deficiency experiences are activated, and insight and social learning are furthered; the psychodynamics and interactions between the members go on in the described phases on individually different levels, apparent or hidden.

Defense and coping in the antinomy between self-maintenance and adaptation.

After definitions of the terms defense and coping, the disturbances of both linked to narcissistic personality disorders, borderline personality disorders, and major depressions are described. All three are characterized by deficient narcissism. In narcissistic personality disorders, defense and coping are hindered mainly because of a lack of narcissistic investment of the ego, in borderline personality disorders preponderantly because of a fragmentation-prone ego with its rigid defenses, and in major depressions primarily because narcissistic emptiness or depletion breaks down interest of the ego to get along with the environment or leads to an extreme overinvestment of the remaining narcissism in the objects. Finally, the three levels of object relations--the narcissistic--fusionary one, the level of active ego performances, and the level of free decisions--and their functioning with respect to coping in the three disorders mentioned are discussed.

[Crisis intervention in suicidal subjects]. / Krisenintervention bei Suizidalen.

By the term crisis intervention in connection with suicidal behavior the author understands a therapeutic intervention which should help the concerned individual to cope alone, with the situation which led to the suicidal attempt or to the acute suicidal behavior. With the help of his relatives, of a therapeutic or of a self help group according to the experiences within the psychiatric consultation service at the emergency station at the general hospital in Basel the multidisciplinary approach by a psychiatrist, a psychiatric nurse and, if necessary, a social worker, is indicated. Among the 848 patients who were seen in the years 1985 to 1989 for a psychiatric crisis intervention because of suicidal attempts, the age distribution showed that there is a peak in the age group of 20 to 24 (p less than 0.01). If, however, men and women are taken separately, a much broader age peak is visible in men: 20 to 34 (p less than 0.05). With respect to the diagnosis patients with psychogenic reactions and development included neuroses and borderline personality disorders are overrepresented (p less than 0.01). Also alcohol- and drug-dependents show a significant higher representation (p less than 0.01). The fact that only 17.2 to 24.5% of these patients had to be hospitalized during crises shows that in general the crisis intervention belongs to the ambulatory psychiatric services. A suicidal crisis does not mean that the concerned patients would definitely like to die, but rather to set a signal for the environment that they had not received enough human attention.(ABSTRACT TRUNCATED AT 250 WORDS)

[Holistic medicine--away from the separation of mind and body]. / Ganzheitsmedizin--weg von der Trennung in Psyche und Soma.

The purpose of liaison-psychiatry is to sensitize the colleagues for the aspect of the patient as a whole. The German expression 'wie er leibt und lebt' (as he exists in and with his body, and lives) is expressing this holistic view and says that the human being is living and experiencing himself in his corporal being and subjectivity. The body simultaneously is a somatic process and experience. If the physician wants to understand the human being, consulting him as an undivided entity, he has to be able to grasp the organ language as posture, as expression of the patient's subjectivity and of his self-esteem. He has to consider that the 'organ choice' shows, besides hereditary, culture and individual factors, the role which an organ plays within a family and an individual. The organ language can also be a significant expression of a basic drive problem. In the encounter with the patient it is further important to notice that he often is only the 'presented symptom' of the family. The vulnerability of a human being, genetically and life-historically caused, is different according to age. The cultural background out of which a human being originates decides on a more somatic or a more verbal mode of expression, whereby in our cultural background prejudices are existing against the emotional expression in the body language. In therapy, unconditional understanding may be expected of the physician.(ABSTRACT TRUNCATED AT 250 WORDS)

[Anxiety, a basic human experience]. / Angst, eine menschliche Grundbefindlichkeit.

Anxiety, unlike fear, which is strongly object-related, accompanies man all his life. This anxious condition appears especially then, when danger is imminent, also in the case of being severely ill. Anxiety and hope, even in people severely ill, do not exclude each other. Human life for many and perhaps for all is a race with time. The anxiety not being able to realize enough in a given time often is the reason for a busy and restless activity. Man often suffers from anxiety of other human beings. As ever an individual may live, it always owes something to others. Accordingly, the doctor or other helpers never are able to behave totally in the way as the patient expects and the patient cannot act as the helper truly would like it. Man experiences anxiety, however, also then, when he recognizes to remain in debts towards himself and, in the view of religion, towards a task given by God. Yet, man suffers anxiety not only because of his confrontation with death but also with life and the responsibilities which he has to take over when growing up in society. The struggle for existence described by Darwin, a result of anxiety, seems to be lost for the patient knowing he or she is severely ill, and he/she is therefore upset against a destiny which threatens to exclude him/her from the community of healthy people and perhaps soon from the living persons. Anxiety always turns also around the existence in the group.(ABSTRACT TRUNCATED AT 250 WORDS)

[Confusional states following administration of short-acting benzodiazepines (midazolam/triazolam)]. / Dämmerzustände nach Einnahme von kurzwirkenden Benzodiazepinen (Midazolam/Triazolam).

The authors report about six patients, who after the intake of Midazolam or Triazolam suffered from an oneiroid-confusional state in which they carried out complex acts and for which an anterograde amnesia existed. In addition to these drugs, one female patient was under the influence of alcohol and one male patient of Bromazepam. Two of the patients suffered of emotional conflicts. The possibility of disinhibition of suicide and other impulses is named. The authors recommend caution in prescribing these benzodiazepines of ultrashort action.

[Narcissistic disorders in the light of modern psychoanalysis]. / Narzisstische Störungen im Lichte der modernen Psychoanalyse.

Whereas psychoanalysis in its beginnings was based preponderantly on drive-theory, later on attention was paid essentially on ego-psychology and in the last years on self-psychology. This development is seen in the context of developments in society, especially of the fact of an increasing outer direction of man in the modern world with the danger linked with it of loss of ego and of self. The designed development may be understood as a reactive one. After an overview on the different concepts of the self it is defined as the narcissism which gives to the instances ego, id and super-ego as well as to the body the feeling and the impression, to be an individual capable for feeling and cognitive processes, forming an entity which is experienced continuously and in its continuity. Two different narcissistic disturbances are described: Narcissistic neuroses (= narcissistic personality disorders in the sense of Kohut) with a consistent ego, but a lack in self-representation because of deficiency experiences in early childhood, Borderline-conditions with a severe ego-pathology and, as a consequence of it, rigid defense-mechanisms, extreme fusion tendencies and projective identification, splitting etc. The development of normal narcissism is discussed. At the end the slightly modified psychoanalytic technique in the treatment of patients with narcissistic neuroses and the analytically oriented expressive psychotherapy of borderline-patients which is directed on reality testing is described.

[Ambulatory treatment of sex offenders with cyproterone acetate (Androcur). A catamnestic study]. / Ambulante Behandlung von Sexualdelinquenten mit Cyproteronacetat (Androcur). Eine katamnestische Untersuchung.

The authors report about the catamnestic inquiry concerning 13 patients with sexual problems treated with cyproterone acetate (CA) of whom 12 relapsed repeatedly in sexual delinquency. Since 1972 the Basle University Psychiatry Outpatient-Department treated 12 of these patients with CA-tablets and psychotherapy. One patient was treated in the same way by a head physician of the Basle University Psychiatry Hospital. Reason for CA-intake: 6 patients took CA because they were obliged by legal order. 4 patients were "voluntarily" ready to take CA for fear of imprisonment. 2 patients who were not accountable for their crimes were treated with CA and one patient desired CA-medication because he suffered from his masochism severely. The mean age of the patients was 34.5 years, the mean daily dosage 115 mg. Result of CA-therapy and psychotherapy: 11 patients (85%) did not relapse under CA treatment which lasted on the average three years. 3 patients succeeded under CA treatment with full social integration. 3 patients showed an improvement of social integration and 3 patients one of whom received Disulfirame (Antabus) reduced alcohol intake. After having ended or interrupted CA-medication two of 7 patients relapsed. 3 patients who did not relapse after stopping the CA-intake were observed for as long as 3 years. As forensic psychiatric consequence it follows that CA in combination with psychotherapy can be considered--in spite of the side-effects linked with it--as a method of choice in the ambulatory treatment of sexual delinquents who have frequently relapsed and whom psychotherapy alone did not help.

[Decreased narcissism in the aged and in suicide]. / Abnahme des Narzissmus im Alter und Suizid.

The elderly have less narcissism (= self-representation, narcissistic information, attention or libido) at their disposal to invest their own ego as well as the environment narcissistically. It therefore becomes more difficult to enlarge one's own self on encountering new persons, new environments and new customs. Some elderly may therefore feel more and more isolated and commit suicide. The rate of suicide attempts in the Canton (state) Basel-city shows a statistically significant decrease with higher age (p < 0.001) up to the age group of 60-69. Men of the age group > 80, however, manifest a significant increase in the rate of suicide attempts. The rate of fatal suicides for Swiss women increases with growing age, though not reaching statistical significance. In Basel-city, the suicide rate for women shows a rising tendency only up to the age group of 50-59 years. For Swiss men from 30-69 there is a steady, but not significant increase, which is still more pronounced from 60-69 to 70-79 (p < 0.05) and from 70-79 to > 80 (p < 0.01). For men of Basel-city the suicide rate shows, however, a clear peak in the age group 30-29 and, after a downwards trend until 40-49, an increase to a peak in the age group 60-69. From there the suicide rate stays level with a slightly decreasing trend. These statistical data seem generally to confirm, at least as a tendency, that suicide rates increase with growing age, i.e. with diminishing narcissism at one's disposal. The exception, the peak of suicides in young adults, is probably due to drug dependents who have taken their own lives. When working with elderly people, it is important to consider this reduction in narcissism and to work with them on an individual psychotherapeutic and eventually psychopharmacological but parallel also on a group basis. The individual psychotherapy should be directed toward supporting their self-confidence. In the supervision of two groups of elderlies, one of which was composed of older people who suffered from paranoid ideas, it was striking that during 75 sessions of working with this group the delusions receded and the patients became more and more communicative and no longer thought of committing suicide. In prevention it is important that the elderly be encouraged to seek participation in some group and/or family activities, though even then the individual freedom of each one not to participate in such events should be respected.

[Assessment of patients with narcissistic neuroses using the Deneke Narcissism Inventory]. / Untersuchung von Patienten mit narzisstischen Neurosen mittels des Denekeschen Narzissmusinventars.

In the following paper Deneke's Narzissmusinventar (1989) was used for examining 32 (17 men, 15 women) patients who, after a first interview were diagnosed having a narcissistic personality disorder respectively neurosis. We compared our results with the results Deneke found in patients with borderline personality disorders, narcissistic personality disorders and healthy persons. Our results correspond with the results Deneke found in patients with narcissistic personality disorders. Deneke's Narzissmusinventar is qualified to confirm the diagnosis of a narcissistic personality disorder respectively neurosis.