Guilt and Shame in Patients with Obsessive-Compulsive Disorders.

INTRODUCTION: Obsessive-compulsive disorder (OCD) is a tremendous psychiatric illness with a variety of severe symptoms. Feelings of shame and guilt are universal social emotions that fundamentally shape the way people interact with each other. Mental illness is therefore often related to pronounced feelings of shame and guilt in a maladaptive form. METHODS: A total of 62 participants (38 women and 24 men) were clinically and psychometrically investigated. RESULTS: The OCD patients (n = 31) showed a maladaptive guilt and shame profile, characterized by increased interpersonal feelings of guilt accompanied by a stronger tendency to self-criticism and increased punitive sense of guilt with a simultaneous prevailing tendency to perfectionism, as well as an increased concern for the suffering of others. The proneness to profuse shame in OCD patients seems to be in the context of the violation of inner values and a negative self-image with persistent self-criticism. CONCLUSION: Although there are limitations with a small sample size in this monocentric approach, our study underlines the importance of an individual consideration of the leading obsessive-compulsive symptomatology, especially in the context of very personal feelings of guilt and shame. Further multidimensional studies on guilt and shame could contribute to their implementation more strongly in individualized psychotherapy.

[Virtual reality in teaching using mentally ill patient avatars]. / Virtuelle Realität in der Lehre mit psychisch kranken Patientenavataren.

BACKGROUND: Medical interaction and exploration techniques are the most important tools that medical students have to acquire in the subject of psychiatry and psychotherapy. The new digital technologies currently available, such as virtual reality (VR), as important supplements can contribute to a significant improvement in the teaching of psychiatric-psychopathological learning content as well as, in particular, the technique of ascertaining the psychiatric history and diagnosis. OBJECTIVE: Evaluation of the Bochum Avatar Exploration Project (AVEX) as part of the curricular course in medical studies at the Ruhr University Bochum for its possibilities to convey learning content and techniques of anamnesis and diagnosis in the subject of psychiatry and psychotherapy. METHODS: In AVEX, a total of 87 medical students in the clinical study section have so far been able to enter into a dialogue with "mentally ill" avatars and gain experience with VR technology as a learning and teaching method in the subject of psychiatry and psychotherapy. RESULTS: Despite the limited possibilities for interaction with the digital avatars, it is possible to achieve a substantial transfer of learning content in psychiatry; however, the students must be well supported by the lecturers. CONCLUSION: The AVEX project already shows promising possibilities for supplementing the teaching of medical students, even if the fit of questions and replies in dialogue with the virtual avatars still needs to be improved. As advances in the linguistic communication of emotions and the visual effects of the avatar representation can be predicted, the significance of this technology will continue to increase.

Embitterment and metacognition in obsessive-compulsive disorder.

OBJECTIVE: Embitterment is a persistent emotion that is known to everybody in reaction to injustice and being let down, associated with feelings of helplessness and hopelessness. People with psychiatric disorders can develop bitterness, which is to be understood as a form of reactive embitterment to the illness. The aim of this explorative study was to investigate the occurrence of embitterment in obsessive-compulsive patients compared to healthy volunteers and in the context of their metacognitions and other biographical and clinical characteristics. METHOD: Following a semi-structured diagnostic interview, a number of measures were administered to 31 patients with obsessive-compulsive disorder (OCD) [ICD-10 F42.X: mean age 35.2 (SD = 10.7) years] and 31 healthy volunteers [mean age 39.1 (SD = 15.0) years]. These measures included the Post-Traumatic Embitterment Disorder questionaire (PTEDq) for measuring embitterment, the Yale-Brown Obsessive-Compulsive Scale, the Metacognition Questionnaire and other psychometric questionnaires such as the Beck Depression Inventory and the State-Trait Anxiety Inventory. RESULTS: Patients with OCD scored more than three times higher (mean = 2.0, SD = 1.1) than the healthy participants in the PTEDq (mean = 0.6, SD = 0.8; p < 0.001), but the cut-off of < 2.5 for a clinically relevant embitterment disorder was not reached. Dysfunctionally distorted metacognition (MCQ-30), which is a consistent finding in OCD, as well as a generally high degree of clinical impairment were significantly cor related to the degree of embitterment. CONCLUSION: Our findings suggest that embitterment as measured by PTEDq is important in patients with OCD, who are characterized by metacognitive distortions with an injustice of fate as well as a mortification of their self-image. In future, it would be necessary to screen patients with OCD not only for depressive symptoms but also specifically for feelings of embitterment in order to be able to initiate appropriate psychotherapeutic measures at an early stage.

[Obsessive Doubting as a Philosophical-Psychopathological Phenomenon]. / Zwanghaftes Zweifeln als philosophisch-psychopathologisches Phänomen.

Obsessive doubting (OD) is a rather forgotten and underestimated psychopathological phenomenon, although clinically it seems to exist in many patients with e. g. obsessive-compulsive disorder. The few primary psychoanalytic and cognitive-scientific studies in the literature concerning OD do not explain the phenomenon completely, nor do they offer treatment perspectives. Here, another way is proposed. Doubting whether one's perception of objects, other people and one's own self is correct, which is part of human nature, can reach pathological dimensions as in OD. Doubting is regarded as an existential problem of human beings, and is one of the major questions of philosophy from very early times, but is especially central to scepticism. If grounds against such doubting can be found, mental solution strategies within the framework of theoretical depth psychotherapy including cognitive training approaches can be established for treatment of patients with OD.

Death Anxiety in Obsessive-Compulsive Disorders.

Objective: Death anxiety has long been attributed a role as a psychopathologically decisive factor in the development of mental illnesses such as obsessive-compulsive disorder (OCD). For example, patients with washing compulsions associate their behavior with a fear of life-threatening diseases or patients with control compulsions report that the constant checking is driven by the fear of fatal or deadly consequences for the occupants.Method: The Bochum Questionnaire to Assess Death Anxiety and Attitudes Towards Death (BOFRETTA) was administered to 31 patients with OCD and 31 healthy volunteers within a semi-structured interview using broad psychometry.Results: OCD patients showed increased death anxiety and negative attitute to death in comparison to healthy volunteers. A significant correlation was found between BOFRETTA-anxiety and the currently present religious obsessive thoughts.Conclusions: Our investigation provides further findings on the role of death anxiety and the problematic attitude towards death in OCD patients.

Death Anxiety in the Context of Religion, Personality and Life Meanings.

Previous studies on the context between death anxiety and religion do not provide any clear evidence regarding "anxiety buffer" function. In this explorative study, death anxiety and attitude to death were determined in the context of mood, personality and meaning of life among groups of Muslims (n = 60) and Christian Protestants (n = 60). Death anxiety and attitude to death were assessed using the Bochum questionnaire for recording death anxiety and attitudes to death. Death anxiety was mild to moderate in our healthy Participants of Muslim and Christian faith. Attitude towards death was therefore much more pronounced among Muslim members than Christians. The influence of religious beliefs on the fear of death does not appear to be direct and linear. Sources that provide meaning in life and emotional stability can contribute to a reduction in death anxiety and a less problematic attitude towards death.

P300 and delay-discounting in obsessive-compulsive disorder.

Previous research showed that dysfunctions of fronto-striatal neural networks are implicated in the pathophysiology of obsessive-compulsive disorder (OCD). Accordingly, patients with OCD showed altered performances during decision-making tasks. As P300, evoked by oddball paradigms, is suggested to be related to attentional and cognitive processes and generated in the medial temporal lobe and orbitofrontal and cingulate cortices, it is of special interest in OCD research. Therefore, this study aimed to investigate P300 in OCD and its associations with brain activity during decision-making: P300, evoked by an auditory oddball paradigm, was analysed in 19 OCD patients and 19 healthy controls regarding peak latency, amplitude and source density power in parietal cortex areas by sLORETA. Afterwards, using a fMRI paradigm, Blood-oxygen-level-dependent (BOLD) contrast imaging was conducted during a delay-discounting paradigm. We hypothesised differences between groups regarding P300 characteristics and associations with frontal activity during delay-discounting. The P300 did not differ between groups, however, the P300 latency over the P4 electrode correlated negatively with the NEO-FFI score openness to experience in patients with OCD. In healthy controls, P300 source density power correlated with activity in frontal regions when processing rewards, a finding which was absent in OCD patients. To conclude, associations of P300 with frontal brain activation during delay-discounting were found, suggesting a contribution of attentional or context updating processes. Since this association was absent in patients with OCD, the findings could be interpreted as being indeed related to dysfunctions of fronto-striatal neural networks in patients with OCD.

Relationship between Psychopathology and Sources of Meaning in Psychotherapeutically Treated Patients: A Naturalistic Cross-Sectional Analysis.

INTRODUCTION: The experience of meaning seems to be crucial for psychic well-being. In the literature, there are reports of relationships between personality, illness, and life meanings. The objective of this study was to investigate types of experiences of meaning (meaningfulness, crisis of meaning, existential indifference) and their associations with some psychopathological categories in a clinical population. METHODS: In a naturalistic and cross-sectional design, 56 German patients in outpatient psychotherapy (29 women, 27 men; mean age = 42.8 years, standard deviation = 13.8) were assessed by the Sources of Meaning and Meaning in Life Questionnaire (SoMe) Questionnaire (meaning of life, hedonism, eudaemonia). Psychopathology (Beck Depression Inventory (BDI), Clinical Global Impression scale, Symptom Checklist (SCL)-90), self-esteem (Rosenberg scale), neuroticism (NEO-Five-Factor Inventory), and suicidality (Suicide Behaviors Questionnaire Revised (SBQ-R)). RESULTS: Three distinct groups concerning the experience of meaning emerged: meaningfulness (33.9%), crisis of meaning (21.4%), and, as the largest group, existential indifference (42.9%). Eudaemonia as well as the hedonistic SoMe variables of fun and wellness were shown to be inversely related to psychopathology such as suicide risk (SBQ-R), general symptom distress (SCL-90), and depressive symptomatology (BDI-II). CONCLUSION: This study highlights the importance of a differential consideration of existential factors, sources of meaning and life orientations for psychopathology in mental health, which should be more considered in standard psychotherapeutic situations.

[Disturbances of time experience in mental disorders]. / Störungen der Erfahrung von Zeit bei psychischen Erkrankungen.

Experience of time is a field of only little research in psychiatry which is and was often induced by philosophers interested in the human existence in time. This review article underlines the importance to differentiate between several forms of time experience. With respect to current knowledge, there are disturbances of time experience in the sense of knowledge about basal temporal relations only in organic brain disorders, while objective time perception was found to be changed in patients with schizophrenia, but less in those with depression. In contrast, the subjective time feeling seems to be disturbed in several psychiatric diseases. Up to now, however, it is still unclear how especially the subjective time feeling as a psychopathological alteration could be best scientifically investigated, without focusing only on the phenomenological single case level. Therefore, time experience should be studied at different levels of time perception and time feeling in mental disorders combined also with modern neurobiological methods, such as EEG and fMRI, in order to clarify in which specific way changed time experience is present in mentally ill patients and how this could be relevant for the pathophysiology of these illnesses.

[Virtual reality in teaching of psychiatry and psychotherapy at medical school]. / Virtuelle Realität in der Lehre im Fach Psychiatrie und Psychotherapie.

BACKGROUND: Since the COVID-19 pandemic medical training and teaching have to adapt to the new circumstances, especially as new digital technologies become available. Physician's interaction and exploration techniques are among the most important tools that medical students have to acquire in psychiatry and psychotherapy. OBJECTIVE: Virtual reality (VR) avatars can basically represent all syndromes in varying degrees of severity at any time. MATERIAL AND METHODS: In Bochum's avatar exploration project (AVEX), students enter into dialogues with "mentally ill" avatars and, under guidance and supervision, try to work out the diagnosis, differential diagnoses and treatment recommendations. RESULTS AND DISCUSSION: This allows students to learn about rare or severe psychiatric conditions presented in VR. This review article presents first experiences especially in setting up and development as well as regarding the technological challenges.

[Traumatization and Schizophrenic Disorders - A Multidimensional View]. / Traumatisierung und schizophrene Störungen ­ eine mehrdimensionale Betrachtung.

Prevalence of traumatizing of patients with schizophrenia is higher as in the normal community. Meta analyses show significant relationships between traumatic experiences in childhood and psychotic disorders. Patients with schizophrenia as well as those with posttraumatic stress disorder (PTSD) are characterized by brain morphological changes (mygdala und Hippocampus). In these two patient groups, neuroendocrinological disturbances (cortisol und α-amylase) as well as a worse clinical outcome could be additionally found. In the psychodynamic theoretical discussion, there are only few approaches concerning trauma and psychosis. Specifically here, the name of Frieda Fromm-Reichmann should be noted, who already pointed out the great meaning of child traumatization (especially physical and sexual abuse) for the later manifestation of schizophrenia. She also developed first principles of analytic psychosis therapy with the working on the deep life anxiety caused by the trauma in the here and now of the transference situation. It is assumed that schizophrenic disorders and PTSD have to be understood as trauma consequence diseases, which occur in comorbidty in a so far unknown extent.

[Paranormal Experience and Mental Disorders]. / Paranormales Erleben und psychische Störungen.

Paranormal experiences such as superstition, perception of the supernatural and magical thinking have accompanied human history into the so-called modern world and play a major role in developmental psychology. Yet this area has remained unclear in its terminology, in its phenomenal scope, but also in its relation to reality in literature and everyday practice. The attempt is here undertaken clarify the significance of paranormal experience on a theoretical level in the sense of a "unsure experience of reality", but also to present its importance for diagnostics and therapy of psychiatric conditions in the context of e. g., psychotic, dissociative or OCD-related symptomatology.

[Psychopathology and Theory of Perceptual Disturbances]. / Psychopathologie und Theorie von Wahrnehmungsstörungen.

Current classification systems for psychiatric disorders are primarly based on categorial typologies and describe these as distinct nosological entities. A dimensional perspective allows descriptions of a gradual transition between pathologies as well as between normality and pathologies of psychiatric symptoms. Using acoustic hallucinations as most common form of perception disturbances as example, psychiatric-psychopathological and theoretical pros and cons for a dimensional classification of psychiatric symptomatology are sketched in this article. Although doubts concerning the similarity of real perceptions and acoustic hallucinations which underlie such mental events are controversially discussed, many hints could be found for a continuum of hallucinatoric symptoms from the mentally healthy population up to the group of patients with schizophrenia. Studies which investigate the neurophysiological mechanisms of acoustic hallucinations such as hearing voices in healthy persons in comparison to those in patients with schizophrenia could contribute to further differentiation.

Differences in interactional behaviour in postpartum depression with and without pre-existing mental disorder.

BACKGROUND: Mothers with postpartum depression (PPD) show impaired affects and behaviour patterns in the mother-child interaction, which affects an infant's emotional and cognitive development and the maternal course of disease. However, impairment of the mother-child relationship does not occur in every case of PPD. AIM: The aim of this exploratory-descriptive video-based study was to investigate the possible associations between mother-child interactions and aspects of maternal biography and clinical history, with a focus on pre-existing mental disorder. METHODS: Sixty-two mother-child dyads (31 mothers with PPD and pre-existing mental disorders and 31 mothers with PPD but no further mental disorder) hospitalized at the mother and baby unit (MBU) of the LWL-Hospital Herten were included in this study. The Marcé Clinical Checklist and the "Mannheimer Beurteilungsskala zur Erfassung der Mutter-Kind-Interaktion im Säuglingsalter" (MBS-MKI-S) were used to explore sociodemographic and clinical parameters, and video-based interaction behaviour was examined. RESULTS: Mother-infant interaction behaviour showed a significant group difference on the MBS-MKI-S-Vm subscale (variability in maternal behaviour) before psychiatric treatment (exact Mann-Whitney U test: U = 555, p = 0.023), with higher scores in mothers with a pre-existing mental disorder. Furthermore, significant differences were shown on the MBS-MKI-S-RSm (maternal reactivity/sensitivity) (U = 259, p = 0.019) and MBS-MKI-S-Rc (child's reactivity) subscales at discharge (U = 251, p = 0.021). Among mothers with a pre-existing diagnosis, the MBS-MKI-S-Tm (maternal tenderness) and MBS-MKI-S-Rc (child's reactivity) subscales were significantly correlated after treatment. CONCLUSIONS: Mothers with PPD and a pre-existing mental disorder displayed significantly more behavioural variability than mothers with only PPD. Maternal behaviour seems to influence the child's responsive behaviour; thus, mothers and their children can benefit from inpatient treatment at an MBU. Further investigations with larger samples should be conducted.

Pareidolias and Creativity in Patients with Mental Disorders.

OBJECTIVE: Pareidolias are ilusionary misjudgments and are seen as the result of deliberately or unconsciously caused misinterpretations by the human brain, which tends to complete diffuse and apparently incomplete perceptual images. The psychopathological value of pareidolia in the context of neuropsychiatric diseases has, however, been little researched so far. METHODS: In this pilot study, a total of 25 patients (mean age 43.3 years, SD 16.2) with an affective disorder or schizophrenic disease (ICD-10: F3.X or F2.X) and 25 healthy volunteers (mean age 46.1 years, SD 15.4) were compared for sociodemographic factors and psychometric findings, as well as pareidolias and creativity. RESULTS: We found that the patients identified significantly fewer pareidolias than healthy controls (p = 0.002) and that patients with schizophrenia, in particular, had a significantly lower hit rate (p = 0.005). Across the whole group, there were clear positive correlations between pareidolia and high creativity, as well as personality traits such as impulsiveness/spontaneity, extraversion, and conscientiousness. CONCLUSIONS: Unexpectedly, having less nosology-specific features than individual specific properties such as creativity and extraversion, and especially openness and verbal intelligence, in patients with affective disorder or schizophrenia promotes the recognition of pareidolia as a specific form of illusionary misperception.

[Psychiatric comorbidities in hidradenitis suppurativa/acne inversa]. / Psychiatrische Komorbidität bei Hidradenitis suppurativa/Acne inversa.

BACKGROUND: The findings of most studies suggest that depression and anxiety disorders are the most common psychiatric comorbidities in patients with hidradenitis suppurativa/acne inversa (HS/AI). METHODS: In a prospective study, 51 patients with HS/AI were further examined for psychiatric comorbidity using a standardized interview and questionnaires. RESULTS: In psychiatric examination, 29.4% of HS/AI patients had additional mental symptoms, mainly manifested as depressive disorder. The HS/AI patients were rather young and female, and they showed a high incidence of nicotine and alcohol use, and a positive family history of paternal alcohol dependence. In addition, HS/AI patients experienced more severe psychosocial impairments in the form of lack of partnership and lower school attainment. CONCLUSIONS: Acne inversa is a severe chronic inflammatory skin disease that, like other inflammatory dermatoses, is associated with mental comorbidity and psychosocial impairments. Since especially young patients are affected, a psychiatric-psychotherapeutic cotreatment should be considered already at an early stage.

[Striving for power and aggression - underestimated aspects in the psychotherapy of hysteria]. / Machtstreben und Aggression ­ unterschätzte Aspekte in der psychotherapeutischen Behandlung der Hysterie.

Question: For decades hysteria has been psychodynamically interpreted sexualized as part of a frustrated desire with a depressive core. However, this "victim" side should be faced with the other often hidden aspects of hysteria with aggression and striving for power. Method: The basic hypothesis pursued here is that the hysterical/histrionic person was not primarily "disadvantaged" in his or her development, but that his or her striving for power and thus his or her potential for aggression is to be understood above all as a learned mode of global relationship that the adolescents have learned to respond and assert themselves to an intra-familiar situation of tension and pressure. Results: Any therapy that does not take this sufficiently into account falls short and reinforces the underlying mechanism of the therapeutic relationship dynamics. During treatment the patient must increasingly feel how much destruction and loneliness this global relationship implies. Conclusions: Only if the patient experiences that reduction of dominance and self-reference as well as increase of "true" felt empathy lead to more satisfying relations, the "imprisonment" in hysterical mode can be gradually lifted.

[Postpartum depression and migration]. / Postpartale Depression und Migration.

Psychiatric research and care increasingly explore the connection between mental health and migration; however, it is striking that only a small number of analyses exist on the effect of migration on mental ailments specific to women. For example, even though postpartum depression regularly occurs among women with a migration background, in Germany and internationally there is a lack of knowledge on the epidemiology, particularly with respect to factors causing or contributing to postpartum depression among women with a migration background. Prospectively, culturally specific treatment options for women with a migration background are necessary to prevent chronification and subsequent harm to the mother and other family members. With this aim in mind, psychologists, psychiatrists and gynecologists should be aware of the specific factors contributing to the development of postpartum depression among women with a migration background. This overview article focuses on key aspects of postpartum depression, such as epidemiology, symptoms, risk factors and treatment concepts, while contextualizing them with respect to women's experience of migration.

Kinematic Analysis of Handwriting Movements in Individuals with Intellectual Disabilities with and without Obsessive Compulsive Symptoms.

Theory/calculation: Movement disorders such as disturbances of coordination, clumsiness, and hand-related stereotypies are a frequent phenomenon in individuals with intellectual disabilities (ID). Obsessive-compulsive symptoms are also common in persons with ID. Our aim was to investigate hand motor dysfunction in persons with ID with and without OCD, using a digitizing tablet and the kinematic analysis of handwriting and drawing movements. METHODS: We examinedthe hand motor performance of 23 individuals (12 males, 11 females, 42.6 ± 13.7 years old) with ID of heterogeneous aetiology. All subjects were required to write a sentence and draw circles under various conditions. Kinematic parameters were calculated to quantify hand motion. RESULTS: Individuals with ID exhibit serious hand motor impairments suggestive of bradykinesia, irregularity, and micrographia. More than half of our ID patients (60.9%) displayed obsessive-compulsive symptoms of moderate severity (Y-BOCS total score: 16.6 ± 8.3). Interestingly, the ID patients with OCD displayed smaller amplitudes of hand motor movements than did patients with no obsessive-compulsive symptoms, while differences observed in the writing and drawing concentric circles trials were significant. CONCLUSIONS: The results of this pilot study support the use of kinematic analyses of handwriting movements to evaluate motor abnormalities in patients with ID and comorbid mental illnesses.

Psychiatric comorbidy in Ullrich-Turner syndrome.

OBJECTIVE: Ullrich-Turner Syndrome (UTS; Turner Syndrome (TS)) is a X-chromosomal disorder, which is characterized by a variety and heterogenous clinical conditions. Although it is not typically associated with neuropsychiatric disorders, several case reports describe concomitant TS and neuropsychiatric abnormalities that may represent a pathogenetic link. METHODS: Based on the case representation of woman with TS and co-occurrent schizoaffective disorder we discuss possible relationships and current literature. CONCLUSION: Several current reports about the frequent occurrence of psychotic symptoms in TS suggest a relationship between X-chromosomal aberration and schizophrenic disorders. Regarding to comorbidity, however, a universally valid nosological categorization is required, which would also facilitate further necessary research activity.