Body, Mind & Spirit Articles and Latest News

Drawing on psychoanalytic pedagogy: the influence of August Aichhorn on the psychotherapy of adolescents.

Psychoanal Q. 2009 Oct;78(4):1091-108

Authors: Houssier F, Marty F

The authors locate August Aichhorn’s pioneering ideas about the psychodynamics and psychotherapy of adolescents in the context of psychoanalytic pedagogy in Europe in the 1920s and ’30s. Strongly influenced by Freud’s discoveries and theory, Aichhorn was himself a major influence on the work of Anna Freud and of many other child and adolescent psychoanalytic theoreticians, including Spitz, Mahler, Eissler, Erikson, and Blos. His technique drew heavily on the element of surprise and on the adolescent patient’s identification with the analyst, as well as on the use of humor and empathy in treatment. The authors utilize brief vignettes from Aichhorn’s descriptions of his practice to illustrate his unique clinical style.

PMID: 19928439 [PubMed - in process]

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Metabolic Alterations in the Amygdala in Borderline Personality Disorder: A Proton Magnetic Resonance Spectroscopy Study.

Biol Psychiatry. 2009 Nov 20;

Authors: Hoerst M, Weber-Fahr W, Tunc-Skarka N, Ruf M, Bohus M, Schmahl C, Ende G

BACKGROUND: Emotional dysfunction in a frontolimbic network has been implicated in the pathophysiology of borderline personality disorder (BPD). The amygdala is a key region of the limbic system and plays an important role in impulsivity, affect regulation, and emotional information processing and thus is likely related to BPD symptoms. Alterations of the metabolism in the amygdala might be of interest for understanding the pathophysiology of BPD. However, the amygdala is a difficult region from which to acquire magnetic resonance spectra. We implemented a method for proton magnetic resonance spectroscopy ((1)H MRS) at 3.0 T in which we acquire data within only the small amygdala. The purpose of this study was to determine alterations of the metabolism in the amygdala in BPD patients. METHODS: Twenty-one unmedicated BPD patients and 20 age-matched healthy control participants underwent (1)H MRS to determine neurometabolite concentrations in the left amygdala. All participants underwent psychometric assessments. RESULTS: Significantly reduced total N-acetylaspartate (tNAA) and total creatine (tCr) concentrations in the left amygdala of patients with BPD were found. BPD patients with comorbid posttraumatic stress disorder (PTSD) showed lower levels of tCr compared with BPD patients without PTSD and healthy control subjects. No significant correlations between neurochemical concentrations and psychometric measures were found. CONCLUSIONS: Decreased tNAA and tCr might indicate disturbed affect regulation and emotional information processing in the amygdala of BPD patients. These findings are consistent with many functional and structural neuroimaging studies and may help to explain the greater emotional reactivity of BPD patients.

PMID: 19931853 [PubMed - as supplied by publisher]

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Trait anxiety in children and adolescents with anorexia nervosa.

Eat Weight Disord. 2009 Jun-Sep;14(2-3):e163-8

Authors: Schulze UM, Calame S, Keller F, Mehler-Wex C

In this study of trait anxiety in children and adolescents with anorexia nervosa, a consecutive series of 23 newly admitted children and adolescents with anorexia nervosa was studied by use of the State-Trait-Anxiety-Inventory, the Eating Disorders Inventory (EDI), the Social Phobia and Anxiety Inventory for Children (SPAI-C), and a structured psychiatric interview (DIPS: Diagnostisches Interview bei psychischen Störungen). In addition, clinical diagnoses were taken from the files. Trait anxiety was significantly increased at the time of admission and social phobia was present in a large proportion of the patients. Specific eating disorder psychopathology as measured by the EDI was significantly associated with trait anxiety. There were no clinical diagnoses (according to the International Classification of Diseases - Tenth Revision) of anxiety disorders. Features of anxiety are very common in young patients with anorexia nervosa and closely linked to specific psychopathology. Anxiety disorders need careful evaluation in these patients.

PMID: 19934633 [PubMed - in process]

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Inside and outside: autumn reflections.

J Psychiatr Pract. 2009 Nov;15(6):467-9

Authors: Clemens NA

The concepts of “inner” and “outer” interact with each other in myriad ways, both in the way we view mental life and in the practice of psychotherapy, within a therapeutic frame and in relation to the larger environment. This dichotomy pervades the relationship between the therapist and the patient, and the boundary between the therapy and the outside world. Through personal impressions, the author reflects on the dynamically shifting emotional and mental life of the therapist in his or her own life cycle and in today’s world. (Journal of Psychiatric Practice 2009;15:467-469).

PMID: 19934722 [PubMed - in process]

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Olanzapine for the treatment of acquired neurogenic stuttering.

J Psychiatr Pract. 2009 Nov;15(6):484-8

Authors: Catalano G, Robben DL, Catalano MC, Kahn DA

Stuttering is a vocal phenomenon, which manifests itself as disturbances in speech fluency. While stuttering is most commonly treated with speech therapy and psychotherapy, a number of antipsychotic agents have been investigated as possible treatments. We present the case of a 37-year-old man who developed a post-concussive syndrome with psychosis and associated stuttering after his second exposure to a blast from an improvised explosive device (IED). After treatment with olanzapine, both his psychosis and his stuttering showed significant improvement. We also discuss stuttering and review previous studies that have investigated antipsychotic use in stuttering. (Journal of Psychiatric Practice 2009;15:484-488).

PMID: 19934725 [PubMed - in process]

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Social Anxiety Disorder: Epidemiology, Biology and Treatment.

Psychiatr Danub. 2009 Dec;21(4):533-542

Authors: Fink M, Akimova E, Spindelegger C, Hahn A, Lanzenberger R, Kasper S

Social anxiety disorder (SAD) is considered to be one of the most common anxiety disorders. Despite its high prevalence, the disorder is still considerably underdiagnosed and undertreated. SAD shows a typically early onset in childhood or early adolescence and generally becomes chronic. The disease places a massive burden on patients lives, affecting not only their social interactions but also their educational and professional activities, thereby constituting a severe disability. Although substantial progress in the study of the etiology of SAD has been made, no commonly accepted model has emerged yet. Data from genetic and neuroimaging studies point towards a contribution of several neurotransmitter systems (i.e. norepinephrine, dopamine and serotonin) to the pathophysiology of this disorder. Functional magnetic resonance imaging studies have repeatedly emphasized the central role of the amygdalae and insula in the neural circuitry of the disorder. Selective serotonin reuptake inhibitors (SSRI) are commonly accepted as first line therapy, however other substance classes like serotonin norepineprine reuptake inhibitors (SNRI), monoamine oxidase inhibitors (MAOI), benzodiazepines and several other agents have also proved effective. There is still a substantial lack of data on therapeutic options in cases of non-responsive SAD as well as on add-on therapy. A combined treatment-approach including psychotherapy (e.g. cognitive behavioural therapy) may prove useful.

PMID: 19935490 [PubMed - as supplied by publisher]

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The TEACCH Program in the Era of Evidence-Based Practice.

J Autism Dev Disord. 2009 Nov 24;

Authors: Mesibov GB, Shea V

‘Evidence-based practice’ as initially defined in medicine and adult psychotherapy had limited applicability to autism interventions, but recent elaborations of the concept by the American Psychological Association (Am Psychol 61: 271-285, 2006) and Kazdin (Am Psychol 63(1):146-159, 2008) have increased its relevance to our field. This article discusses the TEACCH program (of which the first author is director) as an example of an evidence-based practice in light of recent formulations of that concept.

PMID: 19937103 [PubMed - as supplied by publisher]

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Keeping psychotherapy notes separate from the patient record.

Clin Psychol Psychother. 2009 Nov 23;

Authors: Delettre JL, Sobell LC

Doctoral level psychologists (N = 464) who were members of the American Psychological Association and who identified themselves as clinical practitioners were surveyed about their knowledge and utilization of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule that allows practitioners to keep their psychotherapy notes separate from their patients’ records if they involve electronic submissions. Although 79% of those surveyed said they were aware of the HIPAA privacy rule allowing for a separate set of notes, slightly less than half (46%) reported currently using such notes even though half (49%) felt that patients benefit most from the use of a separate set of psychotherapy notes. Surprisingly, 21% said they had never heard of the HIPAA provision allowing for a separate set of notes. Considering that when this provision was introduced it was heralded as a major benefit for mental health practitioners, its low utilization is surprising. Perhaps clinical practitioners would benefit from continuing education about the benefits of such notes. Copyright (c) 2009 John Wiley & Sons, Ltd.Key Practitioner Message: There can be some value to keeping psychotherapy notes apart from the patient’s record.Seventy-nine per cent of psychologists in the USA who were surveyed were aware that they could keep a separate set of notes.Less than half (46%) of those who were aware of this provision actually kept a second set of notes.When asked, half said the benefit of keeping such a set of notes was for their patients.

PMID: 19937717 [PubMed - as supplied by publisher]

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Association of trait emotional intelligence and individual fMRI-activation patterns during the perception of social signals from voice and face.

Hum Brain Mapp. 2009 Nov 23;

Authors: Kreifelts B, Ethofer T, Huberle E, Grodd W, Wildgruber D

Multimodal integration of nonverbal social signals is essential for successful social interaction. Previous studies have implicated the posterior superior temporal sulcus (pSTS) in the perception of social signals such as nonverbal emotional signals as well as in social cognitive functions like mentalizing/theory of mind. In the present study, we evaluated the relationships between trait emotional intelligence (EI) and fMRI activation patterns in individual subjects during the multimodal perception of nonverbal emotional signals from voice and face. Trait EI was linked to hemodynamic responses in the right pSTS, an area which also exhibits a distinct sensitivity to human voices and faces. Within all other regions known to subserve the perceptual audiovisual integration of human social signals (i.e., amygdala, fusiform gyrus, thalamus), no such linked responses were observed. This functional difference in the network for the audiovisual perception of human social signals indicates a specific contribution of the pSTS as a possible interface between the perception of social information and social cognition. Hum Brain Mapp, 2010. (c) 2009 Wiley-Liss, Inc.

PMID: 19937724 [PubMed - as supplied by publisher]

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Adolescent eating disorders: treatment and response in a naturalistic study.

J Clin Psychol. 2009 Nov 24;

Authors: Thompson-Brenner H, Boisseau CL, Satir DA

This naturalistic study investigated the treatment and outcome of adolescents with eating disorders (EDs) in the community. Clinicians from a practice-research network provided data on ED symptoms, global functioning, comorbidity, treatment, and outcome for 120 adolescents with EDs. ED “not otherwise specified” was the most common ED diagnosed. After an average of 8 months of treatment, about one third of patients had recovered, with patients with anorexia nervosa showing the most improvement. Clinicians utilized a range of psychotherapy interventions and two thirds of the patients had received adjunct psychoactive medication. Although CBT showed the strongest association with outcome in a subsample characterized by poor relational/personality functioning, dynamic therapy was associated with better global outcome in the overall sample. (c) 2009 Wiley Periodicals, Inc. J Clin Psychol 66: 1-25, 2010.

PMID: 19938166 [PubMed - as supplied by publisher]

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