[The image of God in old age]. / Gottesvorstellungen älterer Menschen.

The image of God in old age was explored in a group of 32 probands over 65 years (18 women, 14 men; mean age 71.4) and a control group of youths between 20 and 29 years (15 women, 16 men; mean age 20.6) using different questionnaires -- the God concept, personal relationship to God and emotional inclinations and feelings towards God as well as 3 scales for the determination of mental health status. The findings show a tight relationship between the concepts (images) of an emotional, protecting God and feelings of being sheltered and being near to God. Also there was a highly positive correlation between self reflection, life affirmation and stable emotionality and the concepts of a guiding, shelter giving God, whose nearness can be directly experienced. The image of God of the older probands showed special characteristics like "a God who guides", "an empathetic God", and "a God, whose nearness can be experienced", but also "a strict and punishing God" and "a God who created everything". An interesting gender difference in the image of God was found dominantly in the old aged: while the old men stressed a strict law and order God, the old women emphasized the aspects of emotionality, care, and nearness. The results of this study show the necessity of emphasizing an age- and gender-specific pastoral health care, so that the religious dimension could be a constructive coping strategy for successful aging.

Importance of mental health assessment in HIV-infected outpatients.

HIV infection, even when well controlled, may be associated with important mental health problems. We sought to investigate anxiety, depression, and health-related quality of life using screening measurements in patients with HIV infection and to examine their dependency on biosocial parameters relating to HIV. Prospective clinical, virologic, and immunologic data were obtained in a cross-sectional study within the Swiss HIV Cohort Study. Four self-reported questionnaires were used in 397 HIV-infected individuals. The scores for anxiety and depression were high as measured by the Hospital Anxiety and Depression Scale (HADS) and the State Trait Anxiety Inventory (STAI). Half the population scored <75 on a visual analog scale (VAS) Patients were also affected in their quality of life as measured by the HIV Medical Outcome Study (HIV-MOS). Almost all scores were significantly worse for intravenous drug users compared with other transmission groups. People who were employed, with a higher education or with higher CD4 count tended to score better, whereas those who had been hospitalized within the last 6 months, infected for a longer time, with higher viral load, or loss of weight scored significantly worse. A multivariate analysis showed higher education, being employed, low viral load, female gender, and shorter HIV disease duration to be associated with better scores. This study highlights the importance of mental health assessment regardless of HIV-disease parameters.

The Frontal Lobe Score: part I: construction of a mental status of frontal systems.

OBJECTIVE: To develop a bedside mental status examination to assess the behavioural effects of damage to the frontal lobes. DESIGN: A prospective clinical comparison of patients with cerebral lesions of different locations. SUBJECTS: A total of 118 subjects were examined: 27 patients with cerebral lesions confined to the frontal lobes, 25 patients with cerebral lesions without involvement of the frontal lobes, 18 patients with mixed frontal/nonfrontal lesions, and 48 normal control subjects. MEASURES: Twenty-three mental status tests, clinical examinations and rating scales that had been reported as indicative of frontal lobe function were brought together. By statistical analysis, 12 tests and a neurobehavioural rating scale were selected. These constitute the Frontal Lobe Score (FLS). RESULTS: The FLS detected pure frontal lesions with a sensitivity of 77.7%. It discriminated patients with frontal lesions from normal control subjects with a specificity of 100%. Differentiation from patients with nonfrontal lesions was obtained with a specificity of 84%. CONCLUSION: The Frontal Lobe Score is a useful screening instrument for the clinical detection of effects of frontal lobe damage.

[Results of long-term follow-up of transsexual patients]. / Resultate einer Langzeitkatamnese von Transsexuellen.

From 69 transsexual patients (48 men, 21 women) having consulted the Basel University Psychiatric Outpatient-Department between 1970 and 1990, 13 men-to-woman- and 4 woman-to-man-transsexuals could be examined in a follow-up (5-20 years after the operation). The social conditions and the quality of life of the 13 men-to-woman-transsexuals had significantly deteriorated: 9 of the 13 depend on life annuity or on social welfare assistance. The patients live socially very isolated. Eight of them report almost not being able to experience sexual pleasure, 10 suffer from anxieties, depression or addictions. Three regret having demanded the operation and two have passed a second operation for restoration of the original state. The 4 woman-to-man-transsexuals showed slightly better results: 2 of them are fully professionally active and live in constant personal relationships of several years of duration. The 2 others, however, suffer from depression and problems of addiction and give the impression of affective lability. The results lead to the following conclusions: 1. the criteria of indication for the operation of the transsexuals should be observed thoroughly, especially the psychotherapeutic accompaniment before the operation during at least 1 year; 2. the question of emotional stability, of frustration tolerance and of the danger of an outbreak of psychosis are to be examined carefully; 3. the professional and social integration before and after the operation is of central importance.

[Reflections on the cause and consequences of exposure to violent presentations in children]. / Uberlegungen zu den Ursachen und Wirkmechanismen des Konsums von Gewaltdarstellungen bei Kindern und Jugendlichen.

The article deals with the questions why children and adolescents nowadays have an intensive use of violent videos and which are the consequences of this use. The motives of the use are compensation and flight of daily problems and of inner psychic emptiness, identification with grandiose heroes, the experience of anxiety-joy, protest against the parents' generation and the test of courage to obtain a social status in the peer group. The consequences of violent presentations can be understood by different psychological concepts as social cognitive learning theory, suggestion hypothesis, justification hypothesis, habituation hypothesis, catharsis theory, priming effect, arousal theory. These findings lead to the following consequences: Media critical lectures at school, governmental protection of children against harmful products, solution of the underlying social problems which lead to resignation and hopelessness in children and adolescent.

[Significance of concepts about illness attribution and treatment expectations in the initial treatment phase]. / Die Bedeutung der Konzepte zu Krankheitsursachen und Behandlungserwartungen in der ersten Behandlungsphase.

To evaluate the influence and the consequences of subjective concepts about attribution and treatment expectations of patients and therapists 56 patients of two psychiatric outpatient departments were examined with the inventory for concepts about illness and the Giessen-Test. In addition biographic data and information of the present problems as well the judgment of the therapists were registered. The results show that the subjective concepts of problem attribution and treatment expectations correlate with patient variables as personality, social economic states, social network, anamnestic data, present problems, previous therapeutic experience and vocational situation. Some concepts (e.g. psychologically oriented concepts) and the conformity of therapists and patients are important predictors of indication, prognosis and outcome of therapy. Therapists are especially motivated to work with patients who have similar concepts and a similar social background as themselves. The concepts of the patients assimilate of those of the therapists already after a short period of therapy.

[Counseling male adolescents with homosexual orientation and their parents]. / Zur Beratung männlicher Adoleszenten mit homosexueller Orientierung und ihrer Eltern.

In counseling of adolescents with a homosexual orientation and their parents we are not only confronted with the typical conflicts of this developmental phase as those between autonomy and dependence. Moreover we are concerned with specific problems which--because of the coming out--result for the adolescent himself as well as for the whole family system. It is important in such counseling that the following three questions are considered: the characteristic tendencies of separation of the adolescent and the parental reactions to it, the parental acceptance of the homosexual orientation of their son, and the coming out process for the adolescent and the family as a whole.

[Validity of the Narcissism Inventory (Denecke and Hilgenstock)]. / Zur Validität des Narzissmusinventars (Denecke u. Hilgenstock).

For investigating the validity of the Narzissmusinventar 27 somatic and psychic healthy men aged between 30 and 45 were tested with the Narzissmusinventar, the Fragebogen zur Erfassung von Aggressivitätsfaktoren, the State-Trait-Angstinventar and the Fragebogen zur Messung der Kontrollambitionen. Moreover a structured interview for the evaluation of type A behavior was administered. Correlative statistical analyses showed in the sense of construct validity that the dimension of the "bedrohtes Selbst" ("threatened self") is characterized by anxiety, feelings of insufficiency and aggression. The other subscales of the Narzissmusinventar correlate only with a few variables of the other tests and the speaking behavior. These subscales evaluate the narcissistic personality traits which the other instruments we used in our investigation are not able to reflect.

[Psychotherapy with dyssocial patients]. / Psychotherapie mit dissozialen Patienten.

Psychotherapy of dissocial personalities is, even by psychotherapists, often judged sceptically. As obstacles are most of all mentioned the lack of motivation and the excessive acting out of these patients. Because of the development of the personality of dissocial people motivation in the ordinary sense can not be expected. But this does not mean that therapy is impossible. These patients are often rejected by therapists because they feel injured by the patients' rejection and by their devaluation of the therapeutic attention. We find the same dynamics concerning the excessive acting out or these patients. Problems in countertransference also arise because therapists must reduce their therapeutic ambitions and must be satisfied with improvements which-in their eyes-are negligible.

[Heroin addicts in substitution programs]. / Heroinabhängige in Substitutionsprogrammen.

40 heroin addicts of whom 20 were undergoing maintenance therapy with hydrocodone (Dicodid) and another 20 with methadone have been questioned by standardized interview regarding their previous history and present situation. With data on the history we examined how well heroin addicts succeed in getting away from criminality and prostitution and look for employment while undergoing drug maintenance therapy. We were also interested to learn whether reaching the aim depended on the maintenance medication, i.e. if hydrocodone is as appropriate as methadone for maintenance therapy. The inquiry showed a significant reduction of criminality and prostitution. The rate of employment was quite stable. The therapeutic successes, measured by employment, prostitution and criminality did not differ with medication by hydrocodone or methadone. Although the more reliable patients received hydrocodone and the less reliable methadone, they did not differ either in past history or in therapeutic success. We conclude that hydrocodone can be recommended for maintenance therapy of relatively reliable heroin addicts.

[Assessment of patients with narcissistic neuroses using the Deneke Narcissism Inventory]. / Untersuchung von Patienten mit narzisstischen Neurosen mittels des Denekeschen Narzissmusinventars.

In the following paper Deneke's Narzissmusinventar (1989) was used for examining 32 (17 men, 15 women) patients who, after a first interview were diagnosed having a narcissistic personality disorder respectively neurosis. We compared our results with the results Deneke found in patients with borderline personality disorders, narcissistic personality disorders and healthy persons. Our results correspond with the results Deneke found in patients with narcissistic personality disorders. Deneke's Narzissmusinventar is qualified to confirm the diagnosis of a narcissistic personality disorder respectively neurosis.

Psychosomatic factors in borderline hypertensive subjects and offspring of hypertensive parents.

Psychosomatic factors, sympathoneural and sympathoadrenal as well as cardiovascular mechanisms, were studied in 24 patients 18-24 years of age with borderline hypertension, 50 age-matched normotensive offspring of hypertensive parents, and 49 controls with no family history of hypertension. They were compared by projective and questionnaire-based psychological tests and their circulatory and neurohormonal reactivity to mental (Stroop color-word conflict test and arithmetic test) and physical stressors (orthostasis and bicycle ergometry test) were measured. Borderline hypertensive subjects externalized aggression less (p less than 0.05) but internalized it more (p less than 0.05) and were more submissive (p less than 0.05) when compared with controls. Offspring of hypertensive parents showed a similar but weaker pattern. Both risk groups reported more positive interactions with their parents (genetic risk subjects versus controls, p less than 0.05; borderline hypertensive patients versus controls, p = 0.08) and had higher state-anxiety levels (p less than 0.05). There were more subjective symptoms of beta-adrenergic receptor-mediated functions (e.g., tachycardia, tremor) in borderline hypertensive subjects and offspring of hypertensive parents, elevated heart rates (analysis of repeated measures, p less than 0.001), and enhanced plasma norepinephrine concentrations (p less than 0.05) when compared with controls. These findings in subjects at risk for the development of hypertension suggest that psychosomatic factors and sympathetic overactivity are involved in the early phase of hypertension.

[Psychoanalytic observations on musical creativity]. / Psychoanalytische Betrachtungen zur musikalischen Kreativität.

The author applies concepts of creativity, developed in regard to literature and graphic arts, to the field of music. He refers to Sterba's concept of "regressive self passage" as an explanation of musical creativity. Modern theories of narcissism as well as composers' personal accounts are incorporated into the argument.

[Coping with drinking--how do females and males relate to their alcoholic partners?]. / "Coping with Drinking"--Wie gehen Frauen bzw. Männer mit ihren alkoholabhängigen Partnern um?

This study is concerned with 35 couples of which one partner is an alcoholic. The afflicted person and corresponding partner have sought assistance either with a psychotherapist or with Alcoholics Anonymous or Al-Anon respectively. The research instrument used is Oxford's Coping-with-Drinking-Questionnaire alongside a partially standardized interview. Using different versions of this questionnaire a record is built up of what coping strategies a partner has used in the past and what types are being used at the time of the interview. The alcoholic also fills out a questionnaire which records how far he or she has perceived the coping strategies used by his or her partner. The study leads to the following results: 1) Partners of alcoholics significantly reduce the coping strategies they utilize, over time. 2) This is particularly true for Al-Anon members. 3) The alcoholics do not fully realize the extent to which their partners are using coping strategies, before they enter a specific treatment. 4) In addition, there are significant differences between A.A.members and those who have sought assistance from other institutions or persons (the latter group remembers less the measures taken by their respective partners.

Effects of psychological and physical covariates on plasma catecholamines in borderline hypertensives and offspring of hypertensive parents.

The interpretation of plasma catecholamine measurements may be influenced by psychological and physical factors. Therefore, catecholamine concentrations were adjusted for between-subject differences by the following possible confounding factors, i.e. body-mass index, individual maximal physical work capacity, urinary sodium excretion rates and anxiety score. Subjects were 24 borderline essential hypertensives, aged 18-24 years, 50 age-matched normotensive offspring of hypertensive parents and 49 controls with no family history of hypertension studied at rest and during mental stressors (Stroop colour-word conflict test, mental arithmetic). Borderline hypertensives had consistently higher adjusted venous noradrenaline concentrations than control subjects (p less than 0.05). Adjusted plasma adrenaline concentrations were higher in borderline hypertensive subjects than in offspring of hypertensive parents during supine rest. Despite its limitations, venous plasma noradrenaline concentrations when adjusted for work capacity, body-mass, sodium excretion and anxiety suggest enhanced sympatho-neural activity in young borderline essential hypertensives.

Hyperadrenergic borderline hypertension is characterized by suppressed aggression.

The effect of suppressed aggression on the reactivity of the sympathetic nervous and cardiovascular systems has been investigated in two groups of 24 subjects each with either borderline hypertension or normal blood pressure and no family history of hypertension. Groups were matched for sex and age (18-24 years). Suppressed aggression was defined by the newly standardized Rosenzweig Picture-Frustration test, a projective method assessing the reaction to everyday stress. Responses of blood pressure, heart rate, and venous plasma catecholamines were measured before and during application of mental stressors, using the Stroop color-word conflict test and mental arithmetic. In an analysis of covariance for repeated measures, which eliminates the influence of anxiety, borderline hypertensive subjects with suppressed aggression had significantly higher heart rates and diastolic blood pressures and a greater noradrenaline reactivity than borderline hypertensive subjects without suppressed aggression or normotensive subjects. Suppressed aggression may lead to a hyperadrenergic form of early borderline hypertension and thereby contribute to higher blood pressure.

[Behavior of delinquents in social conflict situations. A study using the Rosenzweig Picture-Frustration Test (PFT)]. / Zum Verhalten von Delinquenten in sozialen Konfliktsituationen. Eine Untersuchung mit dem Rosenweig Picture-Frustration Test (PFT).

35 delinquents with chronic dissocial developments and 35 neurotics (of equal sex and age) have been investigated with the Rosenzweig Picture Frustration Test (PFT). The results show a number of significant differences: The dissocial personalities are characterized by a denial of their strong latent guilt-feelings. They experience frustrations generally as a blame and try to remove the unbearable conflicts as soon as possible, especially by developing great activity. A modification of the evaluation of the PFT (differentiation between ego- and super-ego-blocking items) leads to the result that only the test-situations where the subjects are confronted with own fault and blame (super-ego-blocking) show clear differences between neurotics and delinquents. Clusteranalysis with super-ego-reactions to super-ego-blocking items show a great homogenity of the delinquent subjects. The other clusteranalyses lead to 2 subgroups which are interpreted as 2 ways of the delinquents to handle their strong latent guilt-feelings: the subjects of one subgroup show a defiant denial of guilt-feelings with a latent passive resignation; the subjects of the other subgroup emphasize the guilt-feelings, but are unable to take full responsibility, and they show a strong tendency to become active in order to get rid of the guilt-feelings.