[Stalking: unwelcome company. The psychopathology of a modern phenomenon]. / Stalking: Psychopathologie eines modernen Phänomens. Schatten, die nicht weichen.

The term stalking describes a pattern of behavior in which the victim is pursued, pestered and threatened. In many cases, the stalker resorts to physical violence, and may even commit murder. In the German-speaking areas, the phenomenon is to date not much discussed in the psychiatric and psychological literature, despite the fact that it is a widespread occurrence. While stalkers are diagnosed as suffering from schizophrenia and/or narcissistic as well as borderline disorders, victims have no typical "victim personality". They do, however, respond to stalking with anxiety, depression and post-traumatic stress disorders, which need to be recognized and treated.

[Not Available]. / Differente Perspektiven auf den Prozeß in stationärer Psychotherapie/ Different perspectives on the process ofinpatient psychotherapy.

Inpatient psychotherapy is characterized by a combination of different therapeutic approaches. Research on psychotherapeutic processes in inpatient psychotherapy uses often only a single observer's perspective, based on the assumption that there exists a unitary process underlying the total process of inpatient psychotherapy. This assumption is investigated in the present study of two single psychotherapy cases. The process is documented by means of Intrex-questionnaire of both therapist and patient, and by the SASB-coded videotaped and transcribed interactions. The results show a marked incongruence of the process as seen from the perspective of independent raters and from the questionnaire based self-report of therapist and patient. These findings put the commonly described process models of inpatient psychotherapy into question.

[Not Available]. / Qualitativ-inhaltsanalytische Studie zu pychosomatischen Aspekten der Endometriose/ Qualitative Research on Psychosomatic Aspects of Endometriosis.

Endometriosis is one of the most frequent gynecological disorders in the reproductive age. Discrepancies between clinical findings and subjective Symptoms cause the question of the determing factors for the subjective experience. In the present study an hermeneutic, sense-orientated approach was employed by using qualitative methods of research. Eleven interviews with endometriosis patients were recorded on tape and transcribed, followed by an individual-case and a comparative analysis in partly deductively and inductively defined categories. The psychosexual development has been found as negatively influenced. Endometriosis patients show conflicting concepts of their sex-specific role. A found aggression conflict manifests itself in the pain Sensation, at an intrapsychic land an interpersonnel level: it influences the relations with other persons, in particular, the doctor-patient relationship. Changes of sense in the doctor-patient-relationship and recent concepts of psychosomatic disorders are discussed.

Small-molecule solar cells-status and perspectives.

In this paper we focus on the current status of organic solar cells based on small molecules. Since their discovery, much progress has been made, and the main steps are highlighted that led to the current state-of-the-art devices. However, organic solar cells still need to be improved further, and the main strategies for improving the power conversion efficiency, namely raising the open circuit voltage V(oc) and increasing the short circuit current density J(sc), are discussed. In theory, power conversion efficiencies of around 15% should be possible with a single heterojunction; for higher efficiencies, stacked solar cell concepts have to be employed.

[Inpatient psychoanalytic treatment of sever personality disorders]. / Die stationäre psychoanalytische Behandlung bei schweren Störungen der Persönlichkeit.

Highlighting the development of in-patient psychoanalytical therapy the insufficiency of traditional therapeutical conceptions ("out-patient psychoanalysis in the hospital", "bipolar model of in-patient psychotherapy") in view of increasing numbers of patients with ego-structural disorders in psychosomatoses and borderline pathologies become clear. Their manifold splitting tendencies toward any conceptual distinction of the psychoanalytical session with its transferential processes on the one hand and the "actual" milieu of the ward on the other hand. This fact will be taken into account only by the integrative inpatient psychoanalytical therapy which contrasts the group of patients with the therapeutical team. Only this theoretical constellation may grasp the dynamic processes which the individual patient as well as the whole group of patients but also the individual therapist and his team are undergoing. On this basis interventions will become particularly effective. - The method is illustrated by a description of the setting and a casuistry. A necessary broadening in view of the patients' environment outside the ward and of the bounds of the procedure are described. - Summing up we can say that the integrative inpatient psychoanalytical treatment for the first time provides an approach to the group of severe personality disorders which up to now could not be treated and at best were exposed to an expert rating.

Specificity concepts reflected by psychoanalytic epidemiology.

The issue of whether there are specific constellations of intrapsychic conflicts, personality structures and symptom patterns within the general population is investigated by means of a representative epidemiological field cohort study. Out of a population of 600 adults three groups are compared: probands who are suffering from functional cardiac symptoms, those who are suffering from headaches and a sample of 'healthy' probands. The interview protocols of these probands were examined to identify typical conflict patterns. Finally the raters had to give a 'blind' overall diagnosis. Six criteria differentiating the 3 samples were identified and the 'blind' overall ratings were compared with the actual diagnosis. The results are discussed with regard to a hypothesis from the literature.

[Inpatient psychoanalytic treatment of patients with structural ego disorders]. / Die stationäre psychoanalytische Behandlung von Patienten mit strukturellen Ich-Störungen.

Psychoneurotic and psychosomatic patients with severe personality disorders suffer from structural defects of their ego-functions and are in need of specific treatment techniques which can be supplied by the differentiated strategies of inpatient psychoanalysis. The experiences of a specific inpatient ward of the Psychosomatic department at the Central Institute of Mental Health in Mannheim are summarized whereby the use of the inward setting to initiate long term psychotherapeutic processes is emphasized. According to an integrative treatment concept various verbal and non-verbal modalities of experience and working through represented by different members of the therapeutic team co-operate within their well defined functions. The main task of the team is to identify the various splitting mechanisms of the patients with personality disorders and to combine all the walled off ways of experiencing and social behavior into a complete picture of his person. To this end close attention is payed to the dynamics within the group of the patients as well as with the group of the therapists. As a precondition the setting of the ward and its rules of conduct for inpatient group life have closely to be watched and the respective behavior of the patients and the team has to be monitored. We describe our setting, the time phases of treatment, the tasks of the different therapists, and explicitely emphasize sociotherapeutic aspects for the final therapy phase. At last, we mention special emotional difficulties waiting for therapists who work in this setting.

[Psychosomatic medicine between natural science and psychological science--tertium non datur?]. / Psychosomatische Medizin zwischen Naturwissenschaft und Geisteswissenschaft--tertium non datur?

Psyche and soma are open to scientific-causal analysis for biomedicine as well as for social-empirical studies. Both are furthermore accessible to the ideographic discourse of subjective meanings and intentional acts. The German language marks this difference with the terms of "Körper" (body) and "Leib" (embodied soul--spirited body). The Bieri-trilemma demonstrates the resulting epistemological calamity. Neither the so-called behavioral medicine as variation of an ontologic-methodological materialism nor pure phenomenology of the sick subject lead the way out of such inconsistencies. Attempts of systemtheoretical mediation usually only prove their poor reviewing of traditional discussion. This paper outlines some of the currently interesting positions towards the so-called body-soul-problem in the field of psychosomatic medicine, at the same time warning against hasty expectations. We discuss the intentional-biographic approach, the biomedical approach (including the simultaneity correlation (Schultz-Hencke) as well as the brain-soul-correlationism (Kurthen and Linke). As our result we maintain the complementarity of a double discourse for psychosomatic medicine, namely the complementarity of hermeneutic analysis of meaningful processes and of bio-psycho-social casualties. The complementary discourse levels occasionally find their counterparts on an intersubjective-objective time-space-axis. For this we suggest the concept of socialempiric and biomedical markers. Attempts of mediation, be it from systemic-emergence-theoretical or from hermeneutic perspective of interaction forms and their interaction engrams corresponding to their central nervous substratum, turn out to be mystifications of actual incompatibilities, namely of the inevitably double discourse. For this the theory of absolute processes (W. Sellars) promises mediation, but so far no more.(ABSTRACT TRUNCATED AT 250 WORDS)

[Love and partnership in adulthood: a continuation or correction of early childhood experiences? A review of theoretical concepts]. / Liebe und Partnerschaft im Erwachsenenalter: Fortbestehen oder Korrektur frühkindlicher Erfahrungen?

In this survey of literature on the subject, we discuss the question of whether or not and if so to what extent a mature, adult ability to love depends on relevant early experience, or whether it functions as a corrective to unfavorable emotional experience in early childhood. There is no compelling connection between certain disturbances of partner relations and concrete family circumstances in the first years of life. Such disturbances are regarded by traditional psychoanalysis as the result of an unresolved infantile conflict; however, since there is no psychoanalytical interaction theory for the description and explanation of interpersonal phenomena, recent discussions have drawn increasingly on a systematic approach. From a historical point of view, psychoanalytical discussions reflect essential changes in theories about the ability to love. More recent empirical studies point to a possible involvement of corrective and compensatory mechanisms for unfavorable early experiences of a medium degree of seriousness. Nevertheless, warm affection based on needs during the first years of life (at best from loving parents with a partner-oriented relationship) provides a basis for the adult's ability to love and form partnerships.

[Psychosomatic specificity--newly reflected by psychoanalytic epidemiology]. / Psychosomatische Spezifität--neu beleuchtet im Spiegel der tiefenpsychologischen Epidemiologie.

The issue of whether there are specific constellations of intrapsychic conflicts, personality structures and symptom patterns within the general population is investigated by means of a representative epidemiological field cohort study. Out of a population of 600 adults three groups are compared: probands who are suffering from functional cardiac symptoms, those who are suffering from headaches and a sample of 'healthy' probands. The interview protocols of these probands were examined to identify typical conflict patterns. Finally the raters had to give a 'blind' overall diagnosis. Six criteria differentiating the 3 samples were identified and the 'blind' overall ratings were compared with the actual diagnosis. The results are discussed with regard to a hypothesis from the literature.

[Markers of schizophrenic language. A comparative patholinguistic study of dialogues with schizophrenic, manic, depressive and brain-damaged patients]. / Merkmale schizophrener Rede. Eine vergleichende patholinguistische Untersuchung von Dialogen mit Schizophrenen, Manikern, Depressiven und Hirnorganikern.

Transcripts of dialogues with patients showing schizophrenic, manic, depressive or organic syndromes, 15 persons in each group, were analyzed in order to determine their degree of cohesion and coherence. The cohesion of a text is defined by the grammatical and lexical relation between its elements. Coherence, however, means that the sequence of sentences appears reasonable in the context of communicative action. There is a significantly higher incidence of incoherences in dialogues with schizophrenic patients than in dialogues with patients who show manic, depressive or organic syndromes. Schizophrenic language is conceived as a disorder in the implicitly dialogical structure of texts. This can be proven by these patients' inability to find communicative solutions for misunderstandings emerging during the interview.

[The psychological consequences of prognathism (author's transl)]. / Die psychischen Folgen der Progenie.

In a prospective study of 54 prognathic patients the psychological effects of this condition, which occurs typically at puberty, were investigated in postoperative follow-up examinations and the psychological effect of a corrective operation investigated. For this purpose standardized questionnaires and a semistructured psychiatric interview were used. The hypothetically expected personality disturbance of a "dysmorphophobia" was found in only some of our patients. With an inconspicuous premorbid personality they reacted to the psychological trauma of their facial deformity with depressive crises of self-assessment in the occupational and private spheres. Here, convincing postoperative improvements occur beside which the "psychological scars" are still recognizable owing to the earlier deformity.

Predicting extreme patterns of long-term course of psychogenic impairment: a ten-year follow-up.

This longitudinal study identifies predictors of course and etiologically relevant factors of psychogenic disorders. Since 1979, the Mannheim Cohort Project on the Epidemiology of Psychogenic Disorders has investigated neurotic spectrum disorders, personality disorders, stress reactions, and somatoform disorders in the normal population. Using these data, a cohort of probands suffering from moderate psychogenic impairment (N = 240; 121 men, 119 women) based on a representative sample of the urban adult population (N = 600; with cohorts 1935, 1945, 1955; gender distribution 1:1) of Mannheim, an industrial and university town in Germany, was followed up for almost 10 years. The cohort was investigated three times by psychodynamically trained physicians and psychologists. Tests were performed by means of cluster analysis. Different types of course of psychogenic impairment were identified. Both extreme types--the probands with the most positive and the most negative spontaneous long-term course--were investigated with regard to potential course-determining variables. Personality variables and conditions of early childhood development considerably influenced the spontaneous long-term course.

[Psychogenic illness and social mobility between generations]. / Psychogene Krankheit und soziale Mobilität zwischen den Generationen.

A representative epidemiological survey on psychogenic disorders confirms the often reported result, that these disorders are more common in lower socioeconomic classes. However, in looking for the socioeconomic origin of the subjects (parental class position), it could be shown that "cases" were equally distributed over social classes. Therefore, it seems to be unlikely that low social class as macrosocial factor in its own right has causative influence on the subjects' later mental health or illness. It seems more likely that microsocial aspects of primary and secondary socialization are of decisive importance. After the "breeding-hypothesis" as an explanation of the inverse relationship between social class and mental illness could be ruled out, the rival hypotheses of social stress and social selection (drift-hypothesis) are discussed. A research design which might test these alternatives is outlined.

[Psychogenesis of the course of Sudeck's disease--a case report]. / Zur Psychogenese der Verlaufsgestaltung des Morbus Sudeck--Ein kasuistischer Beitrag.

Several authors have already pointed out the significance of personality, subjectively stressful life events and relevant conflicts for the course of reflex sympathetic dystrophy. Psychodynamic hypotheses are demonstrated by two patients who had psychotherapeutic treatment and were observed over a longer stretch of time. A therapeutic concept which is enriched by this knowledge may obtain the patients' better compliance with orthopaedists, surgeons and physiotherapists and may influence duration of illness and treatment results favorably.

Application of stratum-specific likelihood ratios in mental health screening.

BACKGROUND: The accuracy of a diagnostic procedure is commonly assessed by measuring sensitivity, specificity and positive and negative predictive values. Likelihood ratios provide an alternative method for describing these results, though they are typically reported only for dichotomized outcomes. However, likelihood ratios can also be applied to ordinal or continuous results. METHODS: The present paper discusses the application of stratum-specific likelihood ratios in a primary care setting using the General Health Questionnaire (GHQ-12) and the Symptom Check List 90-R (SCL-90-R). A randomly selected sample (n = 408) of adult outpatients from primary care offices in Düsseldorf was screened using the German versions of the GHQ-12 and the SCL-90-R. RESULTS: Logistic regression analysis indicated that stratum-specific or multilevel likelihood ratios preserve more information than a fixed threshold approach with a single cutoff point. For each test, five clinically useful strata with monotonically increasing stratum-specific likelihood ratios were selected. CONCLUSIONS: Stratum-specific likelihood ratios have enormous practical value, and they are becoming an important way of expressing and comparing the usefulness of different tests. Stratum-specific likelihood ratios reduce the spectrum bias that might arise if only two categories (cases and non-cases) are chosen. Additionally, multilevel likelihood ratios can be used as bedside information to obtain the post-test probability from the pre-test probability of the disorder.

Improving screening for mental disorders in the primary care setting by combining the GHQ-12 and SCL-90-R subscales.

Most of patients with mental disorders are cared for in the primary care sector, rather than in the mental health sector. Self-report questionnaires can be used as screening instruments to identify mental disorders in primary care. The 12-item General Health Questionnaire (GHQ-12) is a widely used screening questionnaire for common mental disorders. Unfortunately, the GHQ-12 generates many false presumptive positives and forces the employer to expend resources on confirmatory testing. Therefore, the aim of the present report was to investigate a two-stage questionnaire screening design in a primary care setting. The GHQ-12 was used as an initial screening test followed by the Symptom Checklist (SCL-90-R). A randomly selected sample of adult outpatients (N = 408) from 18 primary care offices was screened using the two questionnaires. A structured diagnostic interview and an impairment rating were used as standards. Subjects were classified into true-positives and false-positives based on their GHQ-12 score and the clinical interview. Logistic regression and receiver operating characteristic analysis were performed to determine whether the SCL-90-R increased accuracy in screening for mental disorders by discriminating between true-positive and false-positive cases. The SCL-90-R subscales Depression, Obsessive-Compulsive, and Somatization were identified as factors associated with the GHQ-12 classification. Therefore, a significant improvement in screening performance of the GHQ-12 is obtained by combination of the test results. The approach may reduce artifact due to high scoring tendencies not associated with psychological disorder.