Depresija yra vienas iš dažniausių psichikos sveikatos sutrikimų, ir neretai sergantiesiems depresija tuo pat metu pasireiškia ir nerimo sutrikimai. Psichologinis atsparumas yra susijęs su bendra psichinės sveikatos būkle - asmenys su psichikos sutrikimais turi žemesnį atsparumą. Atsparumas yra kintantis ir gali būti pagerintas gydymu. Psichoterapijos dienos stacionaras apima intensyvią, bet trumpalaikę psichoterapinę ar kombinuotą pagalbą ir yra ypatinga, tarpinė tarp hospitalizacijos ir ambulatorinio gydymo grandis. Šiame darbe siekėme išsiaiškinti psichoterapijos dienos stacionaro pacientų su neuroziniais ir afektiniais sutrikimais gydymo efektyvumą ir sociodemografinių veiksnių, psichopatologinių simptomų, psichologinio distreso, motyvacijos psichoterapiniam gydymuisi ir psichologinio atsparumo ryšius bei pokyčius laikui bėgant. Buvo tirti psichoterapijos dienos stacionare besigydantys pacientai su afektiniais ir neuroziniais sutrikimais. Atliktas longitudinis trijų etapų tyrimas. Rezultatai parodė, kad gydymo metu ir po jo psichopatologinių simptomų, distreso, motyvacijos psichoterapiniam gydymuisi ir psichologinio atsparumo išreikštumas statistiškai reikšmingai kito; nustatyti reikšmingi skirtumai tarp pacientų su afektiniais ir neuroziniais sutrikimais bei tarp psichoterapiniu ir kombinuotu būdu gydytų pacientų. / Depression is one of the most common mental health disorders, and patients who suffer from depression at the same time often also experience symptoms of anxiety disorders. It was found that individuals who developed psychopathological symptoms were characterized by significantly lower resilience. Resilience was changeable and could be improved by treatment. Treatment in a Psychotherapy Day-Care Centre included an intensive but short-term psychotherapy or combined help, and was a special, partial hospitalization programme, in-between hospitalization and outpatient treatment. Aim of the study was to estimate the effectiveness of the treatment for patients with neurotic and affective disorders at the Psychotherapy Day Care Centre, and establish the relationships and changes over time of sociodemographic factors, psychopathological symptoms, psychological distress, motivation for psychotherapeutic treatment and psychological resilience. The patients with Neurotic and Mood (affective) disorders who were receiving treatment in Psychotherapy Day Care Centre were tested. The study was longitudinal – it consisted of three evaluative stages. We found out that the expression of the psychopathological symptoms, distress, motivation and resilience significantly changed during and after the treatment. Significant differences were established between the patients with affective and neurotic disorders and between the patients treated by psychotherapy and combined treatment.

Anorexia nervosa und unipolare Affektive Störungen stellen häufige und schwerwiegende kinder- und jugendpsychiatrische Störungsbilder dar, deren Pathogenese bislang nicht vollständig entschlüsselt ist. Verschiedene Studien zeigen bei erwachsenen Patienten gravierende Auffälligkeiten in den kognitiven Funktionen. Dahingegen scheinen bei adoleszenten Patienten lediglich leichtere Einschränkungen in den kognitiven Funktionen vorzuliegen. Die Prävalenz der Anorexia nervosa und unipolaren Affektiven Störung ist mit Beginn der Adoleszenz deutlich erhöht. Es ist anzunehmen, dass kognitive Dysfunktionen, die sich bereits in diesem Alter abzeichnen, den weiteren Krankheitsverlauf bis in das Erwachsenenalter, die Behandlungsergebnisse und die Prognose maßgeblich beeinträchtigen könnten. Zudem ist von einem höheren Chronifizierungsrisiko auszugehen. In der vorliegenden Arbeit wurden daher kognitive Funktionen bei adoleszenten Patientinnen mit Anorexia nervosa sowie Patienten mit unipolaren Affektiven Störungen untersucht. Die Überprüfung der kognitiven Funktionen bei Patientinnen mit Anorexia nervosa erfolgte vor und nach Gewichtszunahme. Weiterhin wurden zugrundeliegende biologische Mechanismen überprüft. Zudem wurde die Spezifität kognitiver Dysfunktionen für beide Störungsbilder untersucht und bei Patienten mit unipolaren Affektiven Störungen geschlechtsbezogene Unterschiede exploriert. Insgesamt gingen 47 Patientinnen mit Anorexia nervosa (mittleres Alter 16,3 + 1,6 Jahre), 39 Patienten mit unipolaren Affektiven Störungen (mittleres Alter 15,5 + 1,3 Jahre) sowie 78 Kontrollprobanden (mittleres Alter 16,5 + 1,3 Jahre) in die Untersuchung ein. Sämtliche Studienteilnehmer durchliefen eine neuropsychologische Testbatterie, bestehend aus Verfahren zur Überprüfung der kognitiven Flexibilität sowie visuellen und psychomotorischen Verarbeitungsgeschwindigkeit. Neben einem Intelligenzscreening wurden zudem das Ausmaß der depressiven Symptomatik sowie die allgemeine psychische Belastung erfasst. Die Ergebnisse legen nahe, dass bei adoleszenten Patientinnen mit Anorexia nervosa, sowohl im akut untergewichtigen Zustand als auch nach Gewichtszunahme, lediglich milde Beeinträchtigungen in den kognitiven Funktionen vorliegen. Im akut untergewichtigen Zustand offenbarten sich deutliche Zusammenhänge zwischen dem appetitregulierenden Peptid Agouti-related Protein und kognitiver Flexibilität, nicht jedoch zwischen Agouti-related Protein und visueller oder psychomotorischer Verarbeitungsgeschwindigkeit. Bei dem Vergleich von Anorexia nervosa und unipolaren Affektiven Störungen prädizierte die Zugehörigkeit zu der Patientengruppe Anorexia nervosa ein Risiko für das Vorliegen kognitiver Dysfunktionen. Es zeigte sich zudem, dass adoleszente Patienten mit unipolaren Affektiven Störungen lediglich in der psychomotorischen Verarbeitungsgeschwindigkeit tendenziell schwächere Leistungen offenbarten als gesunde Kontrollprobanden. Es ergab sich jedoch ein genereller geschlechtsbezogener Vorteil für weibliche Probanden in der visuellen und psychomotorischen Verarbeitungsgeschwindigkeit. Die vorliegenden Befunde unterstreichen die Notwendigkeit der Überprüfung kognitiver Funktionen bei adoleszenten Patienten mit Anorexia nervosa sowie unipolaren Affektiven Störungen in der klinischen Routinediagnostik. Die Patienten könnten von spezifischen Therapieprogrammen profitieren, die Beeinträchtigungen in den kognitiven Funktionen mildern bzw. präventiv behandeln. / Anorexia nervosa and unipolar affective disorders are common and severe psychiatric disorders whose pathogenesis is not fully understood so far. Several studies have revealed serious impairments in cognitive functions among adult patients whereas recent research in adolescent patients shows only subtle cognitive dysfunctions. The prevalence in both disorders increases with the beginning of adolescence. Cognitive impairments that occur during adolescence may exacerbate the course of disease. Early cognitive deficits may also hinder treatment efforts and prognosis to a greater extent than during adulthood. Moreover, there is a higher risk for chronification. In the present study cognitive functions in adolescent patients with anorexia nervosa and unipolar affective disorders were examined. Cognitive functions in patients with anorexia nervosa were assessed before and after weight gain. Furthermore, the underlying biological mechanisms were explored. Moreover, the specificity for these psychiatric diagnoses as well as gender differences in patients with unipolar affective disorders were investigated. 47 patients with anorexia nervosa (mean age 16.3 + 1.6), 39 patients with unipolar affective disorders (mean age 15.5 + 1.3) and 78 healthy adolescents (mean age 16.5 + 1.3) participated in this study. Each of them completed a battery of neuropsychological tests for cognitive functions including tests for assessing cognitive flexibility as well as visual and psychomotor processing speed. Moreover, intelligence, depressive symptoms and psychological stress were explored. The findings revealed only subtle cognitive impairments in adolescent patients with anorexia nervosa, both in underweight condition and after weight gain. Besides, the results showed an association between cognitive flexibility and plasma agouti-related protein levels in female adolescent patients with acute anorexia nervosa, but not for visual or psychomotor speed and plasma agouti-related protein levels. Comparing anorexia nervosa and unipolar affective disorders, the results suggested a higher risk for cognitive dysfunctions when belonging to the anorexia nervosa group. Furthermore, the results only revealed a slightly weaker performance in psychomotor processing speed in adolescent patients with unipolar affective disorders compared to healthy adolescents. Moreover, female subjects generally displayed a better performance in visual and psychomotor processing speed. The present findings underlie the necessity of exploring cognitive functions in adolescent patients with anorexia nervosa and unipolar affective disorders within routine clinical diagnostic. Patients may benefit from specific therapy programs to reduce or prevent cognitive dysfunctions.

Thesis (M.Soc.Sc. Psychology)--University of Waikato, 2007. / Title from PDF cover (viewed April 8, 2008) Includes bibliographical references (p. 70-76)

Thesis (M.S.W.)--Smith College School for Social Work, Northampton, Mass., 2009. / Includes bibliographical references (p. 53-55).

Bipolar disorders and recurrent depressions are two common psychiatric disorders with a life time prevalence of approximately 1% and 8%, respectively. Despite treatment these patients suffer from affective symptoms up to 50% of the time, resulting in lower well-being. The average life length is also reduced with 10-15 years, mainly attributable to suicide and cardiovascular disease. Increased stress is one of many factors that have been shown to be linked to an increased risk for developing affective disorders and some comorbid somatic conditions such as metabolic disturbances and cardiovascular disease. An increased stress level is known to cause hyperactivity of the hypothalamic-pituitary-adrenal-axis (HPA-axis) with increased cortisol secretion. Hyperactivity of the HPA-axis (or hypercortisolism) is one of the most replicated neurobiological finding in depression. In other stress related disorders it has however been shown that prolonged stress over long periods of time can lead to a state of low HPA-axis activity, hypocortisolism. Since persons with recurrent affective disorders such as bipolar disorder and recurrent depression are exposed to a high degree of recurrent and chronic stress it could be expected that in addition to hypercortisolism, a state of hypocortisolism could also develop in these disorders, potentially exerting an influence upon the psychological and somatic wellbeing among these patients. The major aim of this thesis was to evaluate whether hypocortisolism is related to relevant psychiatric and somatic phenotypes in recurrent affective disorders. In bipolar disorder, individuals with hypocortisolism exhibited a higher degree of depression and low quality of life compared to patients with normal HPA-axis activity. In recurrent depression, individuals with hypocortisolism exhibited shorter leukocyte telomere length than patients with normal or high HPA-axis activity, which is an indication of an accelerated aging process. In a sample of both bipolar and recurrent depression patients, hypocortisolism was associated with an increased proportion of obesity, dyslipidemia and metabolic syndrome compared with patients with normal or high HPA-axis activity. Patients with recurrent depression showed a higher occurrence of hypocortisolism than the control sample representative of the general population. Patients with bipolar disorder showed a similar occurrence of hypocortisolism as the control sample. Among bipolar disorder patients with a low degree of lifetime with lithium prophylaxis, there was an inverse correlation between age and HPA-axis activity. In contrast, among patients with a higher degree of lifetime with lithium prophylaxis as well as among the controls, there was no correlation between age and HPA-axis activity. Accordingly, hypocortisolism was most common among older patients with a low degree of lifetime with lithium prophylaxis. In conclusion, hypocortisolism in both recurrent depression and bipolar disorder was associated with multiple clinically-relevant phenotypes. Additionally it was shown for bipolar disorder patients that increasing age was a risk factor for hypocortisolism and that prophylactic lithium treatment was a protective factor. It is argued that the protective effect of lithium towards the HPA-axis is attributable to its mood-stabilizing effect, which in turn reduces the chronic stress level. These results provide new insight into the role of hypocortisolism and chronic stress in recurrent affective disorders warranting further studies and hopefully providing clues to improved treatment strategies.

There is now considerable evidence that both schizophrenia and affective disorders have their origin at least in part in events that occur during early pre- and post-natal development. In the case of schizophrenia, many observations, for example, increased risk for schizophrenia in the offspring of mothers who had influenza A during their second trimester of pregnancy and evidence for abnormal neuronal migration in the cerebral cortex of post mortem tissue from schizophrenic patients, suggest that a second trimester insult may have occurred and that this insult may have increased the risk for the development of schizophrenia in late adolescence or early adulthood. Animal studies have found that rats that undergo excitotxic damage to the ventral hippocampus on postnatal day 7 develop exaggerated sensitivity to dopamine-stimulating drugs or to stressful stimuli that becomes apparent after sexual maturity but not before, providing a neurodevelopmental model of schizophrenia. Similarly, post-weaning social isolation leads to nehanced responses to dopaminergic drgus and to stress that emerges after sexual maturity. These animal models are proving to be valuable tools to study the neurobiological mechanisms mediating the influence of early insults to the nervous system on later behavioural functins. In the case of affective disorders, although the evidence is not as strong, a number of the same observations have been made suggesting that an insult during early ontogeny may lead to the development of affective disorders later in life. For example, retrospective studies of people with affective disorders showed that they were more likely to have attained motor milestones at a later age and to have had poorer academic performance as children. There is a wealth of evidence suggesting hyperfunctioning of the hypothalamic-pituitary-adrenal (HPA) axis in affective disorders. Animal studies have shown that early matenal deprivation can lead to lasting changes in the reactivity of the HPA axis to stressful stimuli, providing another link from early experience to adult psychopathology. Continued studies of the effects of pre- and early post-natal events on the development of the nervous system and the relationships of these events to schizophrenia or affective disorder will provide new insights into the mechanisms underlying these common neuropsychiatric illnesses.

本研究旨在探討以優勢觀點為基礎之社會工作實施場域中，社會工作者與情感性精神疾病個案助人關係歷程、雙向復元因素與意涵，與不同組織政策與文化對雙向復元之影響，進一步形成實務場域中助人關係與雙向復元之建議與策略。 　　本研究運用質性研究深度訪談法與詮釋現象學觀點，採立意與滾雪球抽樣，使用半結構式訪談大綱與研究者於田野之互動與觀察，再現八名受訪者（五名優勢觀點社工、三位情感性精神疾病個案）之生活經驗，回歸現象本質綜觀與探討。 　　本研究主要發現如下： 一、情感性精神疾病的重新詮釋：社會工作者正視個案憂鬱或躁狂發作而產生生理、心理與社會的排除，將疾病常態化、普同化，並經由多面向的宏觀檢視以打破原本負面框架與預設立場，包含：1.給予自殺的生命解套—給予選擇與自我決定；2.賦予反覆訴說的意義—重新詮釋生命的機會。 二、歷經「隧道」、不斷攀升—助人關係發展之歷程：歸納優勢觀點社會工作者與情感性精神疾病個案發展助人關係之歷程，可分為想像期、建立期、考驗期、合作期與復元期五大階段，形塑「穿越生命隧道之旅」般的助人關係意象，並發現差序格局文化下的助人關係連續體之特色。 三、雙向復元的實質意涵：由個案「置身死地而後生」與社會工作者「從助人意義中回觀自我」的復元經驗中，歸納「雙向復元」之實質意義與內涵，是一種助人關係與個人內、外在情境三者交互作用而成的超越狀態與主體終極目標，影響成因包含個人、人際與環境三大層面和七個項目。 四、組織政策與文化對雙向復元之影響：不同組織政策與文化之對雙向復元具有實質之影響，分析受訪社會工作者所屬的機構內部可發現「考驗」與「支持」的態樣，後者不但創造充分的人際支持與成長環境，更能促進社會工作者的復元、提升個案服務品質與績效、穩定社工流動率。 依據上述研究發現，提出以下建議： 一、情感性精神疾病個案之助人關係策略：1.增強個體權能：擱置並轉化問題、充分尊重與信任、著力優勢與能力、累積成功經驗、創造選擇性。2.善用關係影響：借重家庭的影響力、保持助人關係中的接觸與等待、建立分享與互惠的彈性關係、善用權力落差形成改變。3.導入環境資源：地緣與文化的親近性、開放的會談地點與時間、連結資源與網絡合作。 二、正視雙向復元之目標：回歸自身被忽略的正向經驗，賦予生命及工作狀態之意義，個案或社會工作者復元的同時也使對方進一步昇華和復元，像漣漪效應般能擴及旁人，間接影響家庭與社會系統，啟動整體社會文化的善循環。 三、機構推動優勢觀點模式之建議：瞭解如何有效學習並運用優勢觀點模式、適度激勵並給予充分支持、提供合理的保障與實質誘因。 四、未來研究之建議：瞭解情感性精神疾病之特性並有所應變、具備接近田野之管道並增加研究對象的多元性、學習與受訪對象共創新的復元價值。 / The study aimed to explore the process, elements and meanings of mutual recovery for social workers and the clients with mood disorder, the organizational influences on the mutual recovery, and to propose strategies for mutual recovery for social workers. The methodology adopted in this study was hermeneutic phenomenology. Using purposive/ snowball sampling, the researcher interacted, observed, and in-depth interviewed the participants using a semi-structured interview guide. Though this process, the living experiences of the eight interviewees (five strengths-based social workers and three clients with mood disorder) were represented to reveal the nature of the phenomenon of mutual recovery. The major discoveries of this study include: 1.Re-definition of mood disorder: social workers could recognize the consequence of clients being seriously excluded from the society due to their depressive or manic episode; they helped the clients to normalize their disease, as well as to break their own negative assumptions toward the disorder. The tactics that they used were such as like：a) Providing relief to suicide–personal choice and self-determination, b) giving meaning to repetitive narratives– opportunity to redefine life. 2.“Tunnel” process, continuing to rise, the process of helping relationship: the process of strength-based social workers in developing relationship with clients with mood disorder could be categorized into five stages: imagination stage, development stage, challenge stage, cooperation stage, and recovery stage. Hence, the nature of helping relationship was like “going through the life tunnel” . The characteristics of such a relationship reflected the differential association continuum among Chinese culture. 3.Essential meaning of mutual recovery: For the clients, the recovery experiences were as if being brought back to life. For the social workers, they rediscovered of themselves in the meaning of assisting others. The real meaning and essence of mutual recovery could be summed up as the interaction of within a person, internal and external environment, and in turn further shaping the transcendental force to help acquire the life goal. Moreover, those goal were affected by personal, relational and environmental factors. 4.Organizational influences on mutual recovery: by analyzing the effects of organizational policies and cultures on mutual recovery, we found that “supportive surrounding” creates an environment which was better for the development of interpersonal relationship than an “challenging surrounding”. The former could help facilitate the recovery and performance of social workers, as well as decrease the turnover rate of social workers. Based on these findings, we propose: 1.Strategy for forming the helping relationship with clients with mood disorder: 1) empowering individual: letting go and transform problems into respect, trust, and focusing on advantages, capabilities, and successful experiences to create options. 2) Better utilizing the effects of interpersonal relationship: by using the influences from family, maintaining the contacts in interpersonal relationship, building mutual and flexible relationship, and using the power differentiation to facilitate changes. 3) Introducing resources from surrounding: an open location and timing that connect the clients/social workers with their surrounding and culture, and enabling the linkage of resources and networks. 2.Emphasizing mutual recovery: stressing the positive experiences that were over sighted previously and finding meaning to life and work status. The recovery of the clients and social workers will further influence their families and the whole social system, and create a benign cycle accordingly. 3.Suggestions for organizations in promoting the strength-based model: to learn the effective ways of learning and applying strengths-based models, giving adequate encouragement and support, and providing reasonable assurance and incentives. 4.Recommendations for future research: should understand the characteristics of mood disorder and know how to handle the situations, to expand the sources of participants, and to have the intention of creating the new meaning of recovery with participants.

No description available.

This thesis has examined what long-term psychological and neurological effects that are apparent in children and adults who have experienced parental divorce. It was predicted that significantly more children and adult children from divorced families would have increased symptoms of mental disorders than children and adult children from married homes e.g., anxiety, depression, panic disorder, and generalized anxiety disorder. It was further predicted that parental divorce would negatively affect the neurological system in the offspring. The correlation between children of divorce and negative neurological effects was not found to be true. However, adult children of divorce have significantly lower baseline cortisol levels compared to adult children of marriage. Dysregulated cortisol levels are highly associated with the development of e.g., anxiety, depression, and brain damage. Parental divorce did not only influence how secretion of the hormone cortisol is regulated within adult children of divorce, but how both children and adult children of divorce psychologically adapt postdivorce. Children of divorce have for instance lower general well-being, more symptoms of anxiety and depression, lower self-esteem, and feel more stress than children of marriage. Adult children of divorce are more likely to experience marital discord, getting divorced themselves, anxiety and depression, lower academic performance, and substance abuse, etc. The result of the thesis suggests that children and adult children from divorced families are negatively affected, both psychologically and neurologically, regardless of age. Parental divorce and supplementary effects make it more likely for children and adult children to experience more symptoms of mental disorders.

Background: For optimizing the validity of diagnoses of mental disorders, several sources of information should be used to assess psychopathological symptoms. Among these are relatives of patients with mental illness. The very low number of empirical studies examining the assessment of psychopathology by relatives of adult, nondemented mentally ill patients stands in significant contrast to the clinical importance of this source of information, however. Sampling and Methods: Using the Positive and Negative Syndrome Scale (PANSS), researchers asked 163 relatives of patients with the main clinical ICD-10 diagnosis of schizophrenic, recurrent depressive or bipolar disorders to rate the current symptoms of the patients at the time of outpatient community-oriented treatment. Results: On average, severity of symptoms was rated as absent or minimal, although anxiety, depression and passive/apathetic social as well as emotional withdrawal, motor retardation, poor attention, and disturbance of volition were clearly rated above the PANSS mean total score for all patients. A six-factor structure identified by factor analysis better illustrates the significant differences in the assessments of the three main diagnostic groups than the three established PANSS scales. With the exception of ‘problematic social behavior’, differences among the diagnostic groups appeared in all factors and were particularly pronounced for ‘delusional beliefs’ and ‘motor impairments’. Conclusions: The results of this study showed that the use of standardized instruments such as PANSS for the assessment of psychopathology by relatives is not only practical, but produces adequately reliable results. The use of PANSS for this purpose, however, requires interviewing of relatives by trained experts able to explain technical terms. Because this study did not sufficiently explore the validity of this approach, further research on this specific issue is urgently needed and should, for example, assess the concordance of ratings between professionals and relatives as well as correlation with suitable external criteria. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.