[Post-traumatic and psychotic symptoms in severely traumatised patients]. / Posttraumatische und psychotische Symptome bei schwer traumatisierten Patienten.

BACKGROUND: Severely traumatised patients may show a variety of impairments, including psychotic symptoms. The therapist's specific professional background (e. g., trauma-focussed psychotherapy or general psychiatry) may impede adequate diagnosis and treatment of these patients. METHODS: Three case reports show the development and change of post-traumatic and psychotic symptoms over time and the influence of specific interventions. CONCLUSIONS: It is important not to jump to conclusions and interpret perceptual disturbances (flashbacks, dissociative or psychotic ones) too quickly in an one-sided way. Further scientific investigations are mandatory in order to understand and treat patients in an adequate way.

Who benefits from inpatient short-term psychotherapy in the long run? Patients' evaluations, outpatient after-care and determinants of outcome.

BACKGROUND: Little work has been published on short-term inpatient treatments combining the virtues of inpatient treatments and short-term psychotherapy. The purposes of this study are to (a) determine the outcomes of short-term psychodynamic inpatient psychotherapy from patients' and therapists' perspectives, (b) assess the stability of changes, and (c) identify predictors of long-term outcome. METHODS: 83 consecutive inpatients (76% of those eligible) were assessed at intake, discharge, and 1 year follow-up by standardized questionnaires regarding symptoms (SCL-90R), interpersonal problems (IIP), object relationships (IPO), and the therapeutic relationship (HAQ). Diagnoses and functioning (GAF) were assessed by the therapists. RESULTS: Psychological distress (effect size S = 1.14) and physical complaints (ES = 1.03) decreased strongly from intake to discharge, the majority of patients moving from the pathological to the normal range of the global severity index GSI (SCL-90R). At follow-up, average distress remained at a low level, and the majority of patients, and their therapists and physicians, regarded their well-being as improved. In a multivariate approach, a substantial proportion of variance of the distress at follow-up (42%) was explained by an infantile object relationship pattern (IPO), social avoidance (IIP), negative vocational changes, and a lack of a confidant at follow-up. A delayed start of subsequent ambulatory psychotherapy was another negative outcome predictor. CONCLUSIONS: Attention should be given to maladaptive interpersonal relationship patterns, to vocational reintegration, and a confiding relationship as potential predictors of long-term outcome. Also, patterns of ambulatory after-care following inpatient treatment need further scrutiny.