ABSTRACT
The Symptom Check-List-90-R (SCL-90-R) is a widely used psychological status symptom inventory. The properties of the German SCL-90-R version were studied in two clinical samples: psychosomatic outpatients and primary care patients. The data were compared with a German community sample. The internal consistency, measured by Cronbach's alpha coefficients, was found to be high, for the global scale and all original subscales. Mokken scale analysis indicated hierarchical structure for most of the subscales. Concurrent validity, evaluated by studying the relationship between the SCL-90-R subscales and the Inventory of Interpersonal Problems (IIP-C) and the General Health Questionnaire (GHQ-12) was also high. On the basis of receiver operating characteristic (ROC) analyses, it was found that the SCL-90-R was able to differentiate between subjects known to have a given psychological disorder and those who do not. Results of exploratory and confirmatory factor analysis failed to support the original nine factor model and two subsequent factor models. The strong interdependence of the original subscales and the strong first unrotated factor of the exploratory factor analyses raised concern regarding the multi-dimensionality of the SCL-90-R subscales. We concluded that the SCL-90-R is a useful tool for measuring psychological status, measuring change in outcome studies, or screening for mental disorders.
Subject(s)
Mental Disorders/diagnosis , Psychiatric Status Rating Scales , Adult , Area Under Curve , Factor Analysis, Statistical , Female , Germany , Humans , Male , Mass Screening , Predictive Value of Tests , Psychometrics , Quality of Life , Reproducibility of Results , Self Disclosure , Sensitivity and SpecificityABSTRACT
Social requirements of shortness and efficiency influence the psychotherapeutical Situation in many ways. Based on this background the author first deals with the concept of time which showed mythic features in Sigmund Freud's writings while today we assume linear processes. This has a direct effect in dealing with therapy time where currently short-time therapies dominate. An understanding of therapy time as a setting variable enables a structuring procedure in both out-patient and in-patient therapies where the end of therapy is included early. The article ends with some remarks on how the therapist handles his time.
ABSTRACT
Until now psychoanalytic training and literature have hardly considered the transference love of homosexual patients. We summarized the scarce literature and related it to the background of our knowledge of heterosexual transference love. The discussion leaves no doubt that, like the heterosexual, homosexual transference love must be read on all levels of psychosexual development instead of reading it on only one and definitely not on an amorphous "preoedipal" level. This is particularly true for the level of the adult homosexual patient, as the case history demonstrates.
Subject(s)
Countertransference , Homosexuality, Female/psychology , Homosexuality, Male/psychology , Psychoanalytic Theory , Psychoanalytic Therapy , Transference, Psychology , Adult , Dreams , Female , Humans , Male , Psychoanalytic Interpretation , Psychosexual DevelopmentABSTRACT
207 individuals were selected from a random sample of the adult urban population of Mannheim according to the criterion of medium psychogenic impairment (high-risk population) and investigated three times between 1979 and 1991 with regard to prevalence and severity of psychogenic disorders. In contrast to clinical investigations, the present data render statements on the spontaneous course of psychogenic disorders in the general population. The existing psychogenic impairment was determined by means of various operationalizations (symptomatology, ICD-diagnoses, severity of impairment). The available data indicate a high stability of psychogenic impairment in the spontaneous course. Group statistically the severity of impairment even increases in the long term course. However, different subtypes of course in the investigated high-risk population can be identified by a cluster analysis.
Subject(s)
Psychophysiologic Disorders/epidemiology , Somatoform Disorders/epidemiology , Adult , Cohort Studies , Female , Follow-Up Studies , Germany/epidemiology , Humans , Incidence , Male , Middle Aged , Prevalence , Psychophysiologic Disorders/diagnosis , Psychophysiologic Disorders/psychology , Psychotherapy , Somatoform Disorders/diagnosis , Somatoform Disorders/psychology , Treatment OutcomeABSTRACT
Practical and organizational reasons, e.g. problems of timing, and strain factors in private or professional life are cited predominantly when probands spontaneously utter their motives for the non-acceptance of an offer of psychotherapy. In the second place, a lack of insight into the necessity of this kind of treatment is indicated as motive for the rejection of a therapy offer. An exploration of the probands leads to a change in the frequently distribution of the motives uttered to refuse psychotherapeutic treatment. Basically, the differentiation of the answers increases (indication of more than one category of motives). A negative attitude to or fear of psychotherapy was indicated considerably more often, especially by women. Those--mostly male--probands, who had pointed out that a lack of insight into the necessity of psychotherapeutic treatment was the decisive factor for their non-acceptance of the therapy offer, adhered most consistently to their argumentation also after exploration. The statistical analysis of possible determinants for the different styles in which probands state the motives for their rejection revealed significant sex differences. These findings suggest that the uptake of psychotherapeutic treatment is also guided by sex role sterotypes.
Subject(s)
Psychophysiologic Disorders/psychology , Psychotherapy , Stereotyping , Treatment Refusal , Adult , Female , Humans , Internal-External Control , Male , Middle Aged , Motivation , Personality Assessment , Psychophysiologic Disorders/therapyABSTRACT
The author reports on the prevalence and stability of the course of neurologically relevant psychogenic symptoms as well as their dependence on age and sex. Altogether 240 probands from the Mannheim Cohort Study on the epidemiology of psychogenic disorders were examined for psychogenic impairment over a 10-year period during three investigation periods. On the whole, seven neurologically relevant groups of symptoms (headache, lumbar and cervical vertebral complaints, non-systematic vertigo, functional hyperkinesia, functional paresis, sleep disturbances, concentration disturbances) differ clearly in frequency, characteristics of the course and clinical relevance.
Subject(s)
Psychophysiologic Disorders/epidemiology , Somatoform Disorders/epidemiology , Adult , Cohort Studies , Cross-Sectional Studies , Female , Follow-Up Studies , Germany/epidemiology , Humans , Incidence , Male , Middle Aged , Personality Inventory , Prospective Studies , Psychophysiologic Disorders/diagnosis , Psychophysiologic Disorders/psychology , Sick Role , Social Environment , Somatoform Disorders/diagnosis , Somatoform Disorders/psychologyABSTRACT
In a subgroup of patients with bronchial asthma, irrational fears of cortisone medication can be observed beyond justified worries about side-effects. A cortisone image which involves overemphasizing the threatening aspects of cortisone, often underlies noncompliant illness behaviour. In the present study, cortisone image and subjectively experienced emotional support by a key figure was investigated in 62 patients, all of whom had participated in the Düsseldorf Asthma treatment and teaching programme (ATTP). The data show that patients having a supportive relationship with their key figures are less likely to experience threatening aspects of cortisone. The findings are discussed in light of psychoanalytic object relations theory.
Subject(s)
Adaptation, Psychological , Arousal/drug effects , Asthma/drug therapy , Cortisone/adverse effects , Sick Role , Social Support , Adaptation, Psychological/drug effects , Adult , Asthma/psychology , Cortisone/administration & dosage , Female , Humans , Male , Middle Aged , Patient Compliance/psychologyABSTRACT
Within the limits of an epidemiological longitudinal field survey on prevalence and course of psychogenic disorders a high-risk-population suffering from medical psychogenic impairment was investigated. The study was conducted in order to verify an etiological multi-level-model of psychogenic disorders in relation to the socialempiric variables "critical life events" and "social support" as well as the depth psychological oriented construct "personality". Besides other instruments a self rating scale based on Vallant's hierarchical model of defense, i.e. the german adaptation of the DSQ (Defense Style Questionnaire) of Bond and coworkers, was used for the accurate measurement of relevant personality parameters. Although defense processes predominantly work unconscious, manifestations of defense mechanisms could be measured indirectly by means of the rating scale. Its essential dimensions separated clinical patients from a group of healthy controls. Furthermore an immature organisation of defense was found to be related to psychogenic impairment. Concerning self- and expert-rating a significant correlation between "immature defense" and the defense mechanisms "schizoid phantasy", "projection" and "acting out" was proved.
Subject(s)
Defense Mechanisms , Personality Assessment/statistics & numerical data , Personality Inventory/statistics & numerical data , Psychophysiologic Disorders/psychology , Adult , Female , Humans , Life Change Events , Male , Middle Aged , Psychometrics , Psychophysiologic Disorders/diagnosis , Reference Values , Sick RoleABSTRACT
Using the data of the Mannheim Cohort Projekt (Schepank, 1987, 1990), the authors investigate possible correlations between psychic symptoms in childhood, risk and protective factors with regard to psychogenic disorders in adulthood. For this, the number of symptoms and the "Impairment-Score" as the degree of psychogenic complaints were related to each other by determining Spearmen's rank correlation coefficient. Additionally, the predictive power of these three variables were investigated by means of discriminance analysis. It could be shown, that the severity of psychogenic illness in adulthood increases with the number of childhood symptoms. There was no evidence for the hypothesis of an increasing predictive power for the assembled variables (number of symptoms, risk factors, and protective factors) in comparison with the single variables. The results found are, however, comparable to the data of two prospective longitudinal studies.
Subject(s)
Personality Development , Psychophysiologic Disorders/rehabilitation , Adaptation, Psychological , Adult , Cohort Studies , Female , Humans , Male , Middle Aged , Personality Assessment , Prognosis , Psychophysiologic Disorders/diagnosis , Psychophysiologic Disorders/psychology , Risk Factors , Sick RoleABSTRACT
The present article deals mainly with problems arising from the motivation of individuals for the participation in an epidemiological field study and their solutions on the basis of psychological-psychiatric findings. Subsequent to a more detailed survey of the research project in question formal and technical aspects of the motivational efforts (home visits, phone contacts) which had to be performed by the research group are mentioned. In the following the authors focus on the scientific concepts and orientations of their motivation work including the specific attention paid to the constellation of transference and countertransference. Particular importance is attributed to the presentation of several case studies which illustrate the influence of different psychoanalytical character traits on the motivational process. Finally the authors concentrate on specific problems regarding the sex of the probands as well as on their experiences with so-called hesitators i.e. individuals who for a longer period of time cannot decide whether to participate in the study or not.
Subject(s)
Countertransference , Motivation , Patient Compliance/psychology , Psychoanalytic Theory , Psychophysiologic Disorders/psychology , Somatoform Disorders/psychology , Transference, Psychology , Adult , Cohort Studies , Female , Humans , Interview, Psychological , Male , Personality Disorders/epidemiology , Personality Disorders/psychology , Professional-Patient Relations , Psychophysiologic Disorders/epidemiology , Somatoform Disorders/epidemiologyABSTRACT
To be able to identify qualitative differences in the results of psychotherapeutic activity and to establish a relationship between those results and the particularities of the treatment process involved, the problems of the patient, the relevant events during therapy, and therapeutic results must be interrelatable both terminologically and theoretically (P-T-O congruence; Strupp et al., 1989). If, therefore, the relevant qualities of the relationships involved in interpersonal transactions during the therapeutic process are to be represented adequately and independently of schools, an appropriate instrument is required for both clinical and research use. This instrument is introduced here in the form of the Structural Analysis of Social Behavior (SASB) after Lorna Smith Benjamin by means of the key question: Who acts how toward whom and how does the latter react to this?
Subject(s)
Personality Tests , Professional-Patient Relations , Psychotherapy/education , Social Behavior , Follow-Up Studies , Humans , Personality Development , Psychometrics , Psychotherapy/methods , ResearchABSTRACT
After discussing social issues of epidemiologic research on neurotic, character and psychosomatic disorders, we outline the main results of a field cohort study on 600 representative adults of Mannheim, a West German industrial city. According to ICD 300-307 (WHO 8th revision) and to a quantitative case definition clinically based on the severity of the symptoms we find an overall case rate of 26% in which females prevail over men by a ratio of approximately 2:1 and the rate of lower social class members over that of higher ones. We then turned to conclusions of our research for matters of primary and secondary prevention. Concerning primary prevention of psychogenic diseases life circumstances during childhood proved to be relevant as predisposing variables and risk factors often indicating poor emotional relationships between the child and its caretakers. Furthermore, we deal with protective factors preserving mental and physical health in spite of heavy burdens during childhood. Turning to secondary prevention we examine risk factors in present life, the importance of the lay system, and the influence of life events as well as the true demand for psychotherapy.
