Reading the self-other drama of the clinical encounter: The role of literary reading and writing as a challenge for psychiatrists.

OBJECTIVE: The purpose of this article is to suggest ways in which literary practices such as reading of fiction and creative writing may be beneficial for psychiatrists in their clinical practice. METHODS: Concepts from literary theory, phenomenology, and psychodynamic thinking will be used to move the therapeutic thinking of the medical paradigm beyond the dichotomic body-mind model. The ability to listen and respond to subjective and intersubjective processes, and the understanding of the dynamics and structure of the verbalized qualia will be emphasized. We will draw on our personal experiences from a pilot project applying literary techniques for psychiatrists and psychologists to improve their clinical practice. RESULTS: In our analysis, we suggest a framing of the clinical encounter as a hermeneutic situation with a gradually growing scenic and poetic understanding of the texts enunciated in the therapeutic actions and of the texts being produced by the patient's mind. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: This theoretical study suggests two ways in which literary practices and concepts are highly valuable for the clinical practice of psychologists and psychiatrists. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

[Short-term psychodynamic psychotherapy].

There are different types of psychotherapy for anxiety, depression, and personality disorders with comparable effect. This review describes the theory, methods, and evidence of psychodynamic short-term therapy. After a description of nuances in the dominant tendencies, the common elements of the therapy are summarised. The therapeutic question is which treatment works best for which patient under which circumstances. In this context, psychodynamic short-term therapy must be part of a continuum of treatment options, adapted to the patients' personal characteristics, needs, and wishes.

Perfectionism, Shame, and Aggression in Depressive Patients With Narcissistic Personality Disorder.

Depressive symptoms are known to co-occur in patients with narcissistic personality disorder (NPD). From a psychodynamic perspective, perfectionism, shame, and aggression are regarded as prominent in depressed patients. The authors investigated the occurrence of perfectionism, shame, and aggression in patients with NPD, and whether shame is a mediating or a moderating factor for aggression. Two groups of patients with depression, 61 diagnosed with NPD and no other personality disorders (PD) were compared with 56 without any PD, using the SCID screening questionnaire and a semistructured interview. All participants were administered the Multidimensional Perfectionism Scale, the Internalized Shame Scale, and the Buss-Perry Aggression Questionnaire. The NPD group showed significantly higher scores for self-oriented and socially prescribed perfectionism, shame, and aggression (i.e., physical, verbal, anger, and hostility). Shame was found to act as a mediating factor, reducing levels of aggression in patients with perfectionistic traits.

[Functional motor disorders can be treated successfully].

Functional neurological disorders involve motor disorders associated with psychological stressful experiences. This case report describes an 18-year-old woman, who had tumbled severely doing gymnastics and had been through physical rehabilitation. Later, she was referred to a liaison psychiatric clinic and after treatment of a comorbid depression admitted to a specialised department of neurology. The treatment consisted of a combination of physiotherapy and psychological intervention. The first days she was lifted to the pool but after three weeks she walked and rode the bicycle normally. At control three months later, she was still free of symptoms.

Characterological depression in patients with narcissistic personality disorder.

Background: Depressive symptoms often occur in patients with personality disorders. Along the lines of the precious concepts of reactive and melancholic forms of depression, two different patterns of depressive symptoms can be identified. Reactive forms of depression is considered to be related to dysfunction of emotional regulation and social functioning, and to personality disorders. This study aimed at exploring the pattern of depressive symptoms in patients with Narcissistic Personality Disorder (NPD) compared to a group of depressed patients without Personality Disorder (PD). The Newcastle Diagnostic Depression Scale (NDDS) is a clinical instrument designed to differentiate reactive depression from melancholic depression. Method: The study investigated patterns of depressive symptoms in 117 out-patients, divided into two groups. One group containing 56 patients with depressive symptoms by no PD and the other group comprised of 61 patients with depressive symptoms and NPD. The participants were interviewed using the Newcastle Diagnostic Depression Scale. Results: There was a significant difference between the groups, as the NPD group suffered from reactive forms of depression. The NPD group showed a pattern of depressive symptoms characterized by fluctuation of the depressive state, without time demarcation of depressive episode, ruminations preoccupied with hostility and accusatory feelings towards other, but not self-accusatory feelings, fluctuation suicidal ideation triggered by external events accompanied by parasuicidal behavior, lack of neuro-vegetative symptoms such as insomnia with early wakening, loss of appetite and weight loss. The No PD group showed the opposite pattern. Conclusion: Based on these results NDDS is considered to be an applicable instrument for identifying personality pathology in patients with depressive symptoms, by recognizing the specific pattern. This is thought to be important for adequate treatment planning.

[Psychodynamic psychotherapy of patients with schizophrenia spectrum psychosis].

This Danish review is a description of the relevance and importance of psychodynamic psychotherapy in the understanding and treatment of patients with schizophrenia spectrum psychosis. Previous research is included, and the results of a recently published, large-scale, prospective comparative study showing good results of adding psychodynamic psychotherapy to treatment as usual are summarised. Concrete examples are given to demonstrate the specificity of the dynamics and the supportive characteristics of the effective interventions in the relationship between patient and therapist.

[Evidence of the effect of psychodynamic psychotherapy].

Evidence of the effect of psychodynamic psychotherapy (PDT) has been called into question. Thus, an updated review of the effect of short-term and long-term PDT (STPP and LTPP) for anxiety, depression and personality disorders seems necessary. A systematic search of randomized controlled studies of PDT published from January 2000 to May 2016 was conducted, and we found 57 single studies and 13 meta-analyses fulfilling the criteria for inclusion. The studies show that PDT has therapeutic efficacy and effectiveness matching other forms of psychotherapy. LTPP shows better effect than STPP in the treatment of complex psychiatric disorders and long-term depression.

Transdiagnostic group CBT for anxiety disorders: the unified protocol in mental health services.

Comorbidity among the anxiety disorders is common and may negatively impact treatment outcome. Potentially, transdiagnostic cognitive-behavioral treatments (CBT) deal more effectively with comorbidity than standard CBT. The present study tested the effectiveness of The Unified Protocol (UP) applied to Mental Health Services. Pre-post-treatment effects were examined for psychiatric outpatients with anxiety disorders receiving UP treatment in groups. Forty-seven patients (mean-age = 34.1 (SD = 9.92), 77% females) with a principal diagnosis of anxiety were included. We found significant and clinically meaningful changes in the primary outcomes Clinical Global Impression Severity Scale (CGI-S; d = 1.36), Hamilton Anxiety Scale (HARS; d = .71), and WHO-5 Well-being Index (WHO-5; d = .54). Also, comorbid depressive symptoms and levels of positive and negative affect changed significantly after treatment. Patients with high levels of comorbidity profited as much as patients with less comorbidity; however, these patients had higher scores after treatment due to higher symptom burden at onset. Patients with comorbid depression profited more from treatment than patients without comorbid depression. The treatment effects found in the present study correspond to treatment effects of other TCBT studies, other UP group studies, and effectiveness studies on standard CBT for outpatients. The results indicate that the UP can be successfully applied to a MHS group setting, demonstrating positive effects on anxiety and depressive symptoms for even highly comorbid cases.

The DiaS trial: dialectical behavior therapy versus collaborative assessment and management of suicidality on self-harm in patients with a recent suicide attempt and borderline personality disorder traits - study protocol for a randomized controlled trial.

BACKGROUND: In Denmark 8,000 to 10,000 people will attempt suicide each year. The Centre of Excellence in Suicide Prevention in the Capital Region of Denmark is treating patients with suicidal behavior, and a recent survey has shown that 30% of the patients are suffering from borderline personality disorder. The majority of patients (70% to 75%) with borderline personality disorder have a history of deliberate self-harm and 10% have a lifetime risk to die by suicide. The DiaS trial is comparing dialectical behavior therapy with collaborative assessment and management of suicidality-informed supportive psychotherapy, for the risk of repetition of deliberate self-harm in patients with a recent suicide attempt and personality traits within the spectrum of borderline personality disorder. Both treatments have previously shown effects in this group of patients on suicide ideation and self-harm compared with treatment as usual. METHODS/DESIGN: The trial is designed as a single-center, two-armed, parallel-group observer-blinded randomized clinical superiority trial. We will recruit 160 participants with a recent suicide attempt and at least two traits of the borderline personality disorder from the Centre of Excellence in Suicide Prevention, Capital Region of Denmark. Randomization will be performed though a centralized and computer-generated approach that conceals the randomization sequence. The interventions that are offered are a modified version of a dialectical behavior therapy program lasting 16 weeks versus collaborative assessment and management of suicidality-informed supportive psychotherapy, where the duration treatment will vary in accordance with established methods up to 16 weeks. The primary outcome measure is the ratio of deliberate self-harming acts including suicide attempts measured at week 28. Other exploratory outcomes are included such as severity of symptoms, suicide intention and ideation, depression, hopelessness, self-esteem, impulsivity, anger, and duration of respective treatments. TRIAL REGISTRATION: Clinical Trial.gov: NCT01512602.

Five-year follow-up of supportive psychodynamic psychotherapy in first-episode psychosis: long-term outcome in social functioning.

OBJECTIVES: The long-term outcomes of several approaches to intervention targeting social functioning in schizophrenia are not well documented. Contemporary supportive psychodynamic psychotherapy (SPP) aims to improve social functioning. The aim of the present study was to investigate the long-term outcome of SPP in a prospective, longitudinal, comparative, multicenter investigation of successively referred patients diagnosed with first-episode schizophrenia spectrum disorder. METHOD: Manualized SPP for up to 3 years as a supplement to standard treatment (ST) were compared to ST alone and followed up for 5 years (N = 269). The SPP targeted interpersonal relationships, emotion regulation, social cognition, and self-coherence. RESULTS: Significant between-group effects in favor of SPP+ST on social functioning, overall symptoms, and positive psychotic symptoms were found during the period of active SPP intervention. These differential effects, however, were not sustained after end of additional SPP at 5-year follow-up. CONCLUSION: The findings are in line with results from other approaches targeting social functioning in schizophrenia and support SPP as a valuable treatment. Further research into the curative elements of SPP is needed.

A psicanálise na China: evolução e desafios / Psychoanalysis in China: developments and challenges / El psicoanálisis en China: evolución y desafíos

A China é um país em rápido desenvolvimento, que apresenta necessidade crescente de atendimento psiquiátrico e psicoterapêutico devido a um aumento do sofrimento mental ligado tanto a mudanças na sociedade como a condições traumáticas do passado. O entendimento psicanalítico e as terapias psicanalíticas, cada vez mais, vêm atraindo o interesse dos profissionais e da sociedade. Neste artigo, descrevemos o desenvolvimento da psicanálise na China, e alguns dos desafios envolvidos no ensino da psicanálise e na formação de profissionais em psicanálise e psicoterapia psicanalítica. O conhecimento das diferenças culturais existentes entre a China e o Ocidente é enfatizado.

China is a fast developing country with growing need for psychiatric and psychotherapeutic services due to increase in mental suffering connected changes in society but also with traumatizing conditions in the past. Psychoanalytic understanding and psychoanalytic therapies has had growing interest among professionals and in the public. In this article we describe the development of psychoanalysis in China and some of the challenges involved in teaching psychoanalysis and training professionals in psychoanalysis and psychoanalytic psychotherapy. Awareness of cultural differences between China and the West are underlined.

China es un país en rápido desarrollo, que presenta una creciente necesidad de atención psiquiátrica y psicoterapéutica debido al aumento del sufrimiento mental relacionado tanto a los cambios en la sociedad como a las traumáticas del pasado. La atención psicoanalítica y las terapias psicoanalíticas están atrayendo un interés creciente entre los profesionales y la sociedad. En este artículo describimos el desarrollo del psicoanálisis en China y algunos de los retos involucrados en la enseñanza del psicoanálisis y en la formación de profesionales del psicoanálisis y de la psicoterapia psicoanalítica. El conocimiento de las diferencias culturales existentes entre China y Occidente también se destaca en el presente trabajo.

Psychometric evaluation of the Danish and Swedish Satisfaction with Life Scale in first episode psychosis patients.

PURPOSE: To psychometrically evaluate the Satisfaction with Life Scale in two cohorts of first-episode psychosis patients in the Danish National Schizophrenia Project and in the Swedish Parachute Project. METHOD: Four properties of the Satisfaction with Life Scale were examined in the Danish cohort (explorative investigation) and then confirmed in the Swedish cohort: (1) the factor structure; (2) correlations between subscales; (3) internal consistencies of subscales; and (4) main tendencies (arithmetic means) and variations (standard deviations) of subscales. The relations between the Satisfaction with Life Scale and various life conditions were investigated in the Swedish cohort. RESULTS: For both samples, the analysis indicated that the obtained four-dimensional 11-item scale had satisfactory properties. Moderately high scores were obtained in the four subscales: "living," "social relationships," "self and present life" and "work." They correlated positively with each other, the internal consistencies of the subscales were acceptable and the means for the subscales indicated no apparent floor or ceiling effects. The four dimensions obtained seem relevant and presented good face validity. The dimensions were confirmed in the Swedish sample. CONCLUSION: The Satisfaction with Life Scale shows satisfactory psychometric properties and seems valid and useful among first-episode psychosis patients.

Supportive psychodynamic psychotherapy versus treatment as usual for first-episode psychosis: two-year outcome.

During recent decades, the field of treatment of schizophrenia has lacked empirical, systematic outcome studies that support psychodynamic psychotherapy as an evidence-based intervention for patients with schizophrenia. The Danish schizophrenia project (DNS) compared psychodynamic psychotherapy for psychosis with standard treatment in patients with a first-episode schizophrenia spectrum disorder. The study was designed as a prospective, comparative, longitudinal multi-site investigation of consecutively referred patients who were included during two years. The patients were treated with either manualized individual supportive psychodynamic psychotherapy (SPP) in addition to treatment as usual or with treatment as usual alone (TaU). Symptoms and functional outcomes were measured using the Positive and Negative Syndrome Scale (PANSS) and the Global Assessment of Functioning scale (GAF). The study included 269 consecutively admitted patients, age 18-35, of whom 79% remained in the study after two years. The intervention group improved significantly on measures of both PANSS and GAF scores, with large effect sizes at two years follow-up after inclusion. Further, improvement on GAF(function) (p = 0.000) and GAF(symptom) (p = 0.010) significantly favored SPP in combination with TaU over TaU alone. In spite of limitations, this study speaks in favor of including supportive psychodynamic psychotherapy in the treatment for patients with schizophrenic first-episode psychoses.

Rorschach inkblot method data at baseline and after 2 years treatment of consecutively admitted patients with first-episode schizophrenia.

BACKGROUND: The Rorschach Inkblot Method is regarded as an important clinical instrument for detailed diagnostic description of the integrative capacities of individuals in psychotic states and as an instrument for measuring progression in the course of treatment. AIMS: To describe relevant Rorschach variables at baseline in a group of consecutively admitted patients with first-episode schizophrenia. Furthermore, to describe the changes in these variables from baseline to year 2 for the group of patients given psychiatric standard treatment, and to compare these changes with changes in other outcome measures [Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning (GAF), Strauss-Carpenter and socio-demographic variables]. METHODS: In a prospective study, 34 patients consecutively admitted to treatment for a first episode of schizophrenia were tested using Exner's Rorschach Comprehensive System at inclusion and after 2 years. RESULTS: Core variables of the Rorschach, assumed to show changes (e.g. reality testing, perceptual and thought disorders) in patients with a first episode of schizophrenia, all improved but revealed no significant changes after 2 years of treatment, while other measurements (PANSS, GAF) did. Furthermore, discrepancies were found between the Perceptual-Thinking Index (PTI) and PANSS(positive) symptoms of delusions and hallucinations. CONCLUSION: The small sample limits the conclusions, but the Rorschach variables may have problems reflecting major changes in psychotic symptoms and social functioning. With short protocols, PTI seems at risk of being unnecessarily insensitive and PTI may benefit from changes in the scoring procedures.

Collaborative assessment and management of suicidality method shows effect.

INTRODUCTION: Previous studies confirm the effect of collaborative assessment and management of suicidality (CAMS) in an experimental setup, but there is a need to test CAMS with regard to its effectiveness and feasibility in a real-life clinical context. The purpose of this study was to investigate CAMS in a Danish population in such a context. MATERIAL AND METHODS: In the present descriptive study, CAMS treatment was administered to a total of 42 patients referred during 1 August 2008 to 30 September 2009 to The Centre of Excellence in Suicide Prevention due to suicidal thoughts or a suicide attempt. Qualitative and quantitative data were obtained before and after CAMS treatment. Five major suicidal markers were regularly assessed. The patients' experiences of the importance of the treatment were studied as endpoints. RESULTS: A total of 81% of the patients completed treatment and 68% hereof completed the final evaluation. 74% from this group judged the sessions to be the main factor in the elimination of their suicidality. A significant decrease was observed in the five suicidal markers recorded for the 42 patients included. One patient attempted suicide and another patient committed suicide. CONCLUSION: CAMS was assessed to be effective and useful in a real-life clinical context. Further studies in larger patient populations are needed as are studies to determine whether the CAMS method may be applied with equal effect to all patient groups. FUNDING: not relevant. TRIAL REGISTRATION: Danish Data Protection Agency.

[Evidence to support psychodynamic psychotherapy]. / Evidens for psykodynamisk psykoterapi.

In general, psychodynamic psychotherapy is not considered evidence-based treatment. This review includes recent meta-analyses and review papers. We conclude that evidence in favour of psychodynamic psychotherapy exists for unipolar depression, panic anxiety with and without agoraphobia, social phobia, generalised anxiety and post-traumatic stress disorder. For complex mental conditions, long-term psychodynamic psychotherapy shows greater effect than no treatment, standard treatment and short-term psychotherapy. Psychodynamic psychotherapy can be recommended for treatment of specific psychiatric disorders.

Early and sustained dynamic intervention in schizophrenia.

This paper is based on the Danish National Schizophrenia Project manual for psychodynamic individual psychotherapy with persons in states of schizophrenia. The methods for engaging with and treating a patient with schizophrenia in a supportive, psychodynamic way are described.

[Dementia in elderly Turkish immigrants]. / Demenslidelser hos aeldre tyrkiske indvandrere.

INTRODUCTION: The health condition in a population of elderly Turkish immigrants is investigated with special focus on dementia conditions. The possibility to use the screening test Mini Mental State Examination (MMSE) in relation to the investigated population is evaluated as well as their future need for a nursing home. MATERIAL AND METHODS: With the help of an interpreter, the Turkish population of elderly (> 60 years old) in the municipality of Ishöj was interviewed about educational-, working- and health conditions. In addition to MMSE and semi-structured interviews, the ICD-10 criteria were used in diagnosing dementia conditions. RESULTS: We found an increased frequency of dementia conditions (13,3%) compared to the expected prevalence of 7% in the Danish population. Furthermore, we found an increased frequency of diabetes type-2. The use of MMSE as a guideline instrument of screening was shown to be applicable only with modifications to persons who were illiterates and without any education, and to those 1st-generation immigrants who were to a limited degree integrated as citizens CONCLUSION: The increased incidence of dementia conditions and diabetes type-2 shows the need for a more assertive approach.