Background: Bipolar disorders (BD) are among the most severe mental disorders with first clinical signs and symptoms frequently appearing in adolescence and early adulthood. The long latency in clinical diagnosis (and subsequent adequate treatment) adversely affects the course of disease, effectiveness of interventions and health-related quality of life, and increases the economic burden of BD. Despite uncertainties about risk constellations and symptomatology in the early stages of potentially developing BD, many adolescents and young adults seek help, and most of them suffer substantially from symptoms already leading to impairments in psychosocial functioning in school, training, at work and in their social relationships. We aimed to identify subjects at risk of developing BD and investigate the efficacy and safety of early specific cognitive-behavioural psychotherapy (CBT) in this subpopulation. Methods/Design: EarlyCBT is a randomised controlled multi-centre clinical trial to evaluate the efficacy and safety of early specific CBT, including stress management and problem solving strategies, with elements of mindfulness-based therapy (MBT) versus unstructured group meetings for 14 weeks each and follow-up until week 78. Participants are recruited at seven university hospitals throughout Germany, which provide in- and outpatient care (including early recognition centres) for psychiatric patients. Subjects at high risk must be 15 to 30 years old and meet the combination of specified affective symptomatology, reduction of psychosocial functioning, and family history for (schizo)affective disorders. Primary efficacy endpoints are differences in psychosocial functioning and defined affective symptomatology at 14 weeks between groups. Secondary endpoints include the above mentioned endpoints at 7, 24, 52 and 78 weeks and the change within groups compared to baseline; perception of, reaction to and coping with stress; and conversion to full BD. Discussion: To our knowledge, this is the first study to evaluate early specific CBT in subjects at high risk for BD. Structured diagnostic interviews are used to map the risk status and development of disease. With our study, the level of evidence for the treatment of those young patients will be significantly raised.

Background: Bipolar disorders (BD) are among the most severe mental disorders with first clinical signs and symptoms frequently appearing in adolescence and early adulthood. The long latency in clinical diagnosis (and subsequent adequate treatment) adversely affects the course of disease, effectiveness of interventions and health-related quality of life, and increases the economic burden of BD. Despite uncertainties about risk constellations and symptomatology in the early stages of potentially developing BD, many adolescents and young adults seek help, and most of them suffer substantially from symptoms already leading to impairments in psychosocial functioning in school, training, at work and in their social relationships. We aimed to identify subjects at risk of developing BD and investigate the efficacy and safety of early specific cognitive-behavioural psychotherapy (CBT) in this subpopulation. Methods/Design: EarlyCBT is a randomised controlled multi-centre clinical trial to evaluate the efficacy and safety of early specific CBT, including stress management and problem solving strategies, with elements of mindfulness-based therapy (MBT) versus unstructured group meetings for 14 weeks each and follow-up until week 78. Participants are recruited at seven university hospitals throughout Germany, which provide in- and outpatient care (including early recognition centres) for psychiatric patients. Subjects at high risk must be 15 to 30 years old and meet the combination of specified affective symptomatology, reduction of psychosocial functioning, and family history for (schizo)affective disorders. Primary efficacy endpoints are differences in psychosocial functioning and defined affective symptomatology at 14 weeks between groups. Secondary endpoints include the above mentioned endpoints at 7, 24, 52 and 78 weeks and the change within groups compared to baseline; perception of, reaction to and coping with stress; and conversion to full BD. Discussion: To our knowledge, this is the first study to evaluate early specific CBT in subjects at high risk for BD. Structured diagnostic interviews are used to map the risk status and development of disease. With our study, the level of evidence for the treatment of those young patients will be significantly raised.

Die vorliegende Arbeit untersucht allusives Sprechen in psychotherapeutischen Gesprächen, wobei es um verdeckt angedeutete Kritik am Therapeuten geht. Über Allusionsmarker, die ein Wort oder Wortgruppen bilden, wird innerhalb eines Kontextes auf einen anderen verwiesen. Die vorliegende Arbeit legt den Fokus insbesondere auf beziehungskommentierende Allusionen. Dies sind verdeckt geäußerte Kommentare, die den Rezipienten der Allusion adressieren. In Politik, im Flirten, in Klatschgesprächen oder Bestechungen wird von jener sprachlichen Praktik, deren Ressource Ambiguität ist, Gebrauch gemacht. Dies sind sozial heikle Situationen, in denen das Ansehen des einen vom Urteil des anderen abhängt. Anhand detaillierter Transkripte aus Verhaltenstherapie, tiefenpsychologisch fundierter Psychotherapie und Psychoanalyse wird gezeigt, wie eine verdeckt kritische Kommentierung des Patienten einer frustrierenden Interaktionserfahrung folgt. Die Kommentierung wird anhand eines Narrativs realisiert, welches Allusionsmarker beinhaltet, die auf den aktuellen Kontext verweisen. Die sich daran anschließenden Äußerungen der Therapeuten zeigen, dass jene die beziehungskommentierende Funktion des Narrativs verstehen. Dennoch wird die Bedeutung dessen weiter ambig verhandelt. Mit der aus der Ethnomethodologie, Soziologie und Linguistik stammenden Methode der Konversationsanalyse (KA) wird der Interaktionsverlauf zwischen Patienten und Therapeuten detailliert untersucht, Erkenntnisse abgeleitet und anhand von Transkriptfragmenten dargestellt. Dabei wird deutlich, dass die Interaktionshistorie der Interaktanten in einen Redezug und dessen Interpretation mit einfließt. Wenn psychotherapeutische Theorie und Praxis für solche Phänomene offen sind, können sowohl beziehungsrelevante Äußerungen erkannt werden als auch Äußerungen, die nicht intrasubjektiv, sondern durch die aktuelle Szene der Konversation bestimmt sind, die von den Interaktanten kokonstruiert wird. / This paper examines allusive speaking in psychotherapeutic conversations, with a focus on covertly insinuated criticism of the therapist. Allusion markers, which form a word or groups of words, are used to refer to another context. The present work focuses in particular on allusions that comment on relationships. These are hidden comments that address the recipient of the allusion. In politics, in flirting, in gossip or bribery, the linguistic practice whose resource is ambiguity is used. These are socially delicate situations in which the reputation of one depends on the judgement of the other. Using detailed transcripts from behavioural therapy, psychodynamic psychotherapy (tiefenpsychologisch fundiert is a special modification of psychoanalysis in Germany) and psychoanalysis, the book shows how a covertly critical commentary by the patient follows a frustrating interaction experience. The commentary is realized by means of a narrative that contains allusion markers that refer to the current context. The subsequent statements of the therapists show that they understand the relationship-commenting function of the narrative. Nevertheless, the meaning of the narrative continues to be ambiguously negotiated. With the method of conversation analysis (CA), which originates from ethnomethodology, sociology and linguistics, the course of interaction between patients and therapists is examined in detail, findings are derived and presented using transcript fragments. It becomes clear that the interaction history of the interactants is incorporated into utterances and its interpretation. If psychotherapeutic theory and practice are open to such phenomena can be recognized: Relationship-relevant utterances and utterances that are not intrasubjective but determined by the current scene of the conversation that is co-constructed by the interactants.

The thesis deals with neurotic disorders problems, which can, due to different causes, affect children in the early-school age. The theoretical part defines the basic concepts and their characteristics (neurotical disorder, history of the concept, early-school age, neurotical symptoms of children, disorders such as: sleep, somatic, food-intake, excretion, adaptation and anxiety, obsessional-compulsive, communication and speaking, sadness and depression, suicidal tendencies and behaviour). Further on it describes a number of internal and external factors, which can participate in the originating of child{\crq}s neurotic disorders. The end of this part is dedicated to the treatment by means of psychotherapy, psychopharmacotherapy, eventualy by means of relaxation. These therapeutical procedures end with preventive aspects and advices how to communicate with neurotic children. The practical part contains four briefly case reports of neurotic children, which lead to the understanding of the problem described on concrete example. Simultaneously it refers to the fact, that in many cases the disorders are a result of dysfunctional family environment.