RESUMEN
Using a reinforcement-oriented model of depression, we applied a multimodal approach of behavior therapy in clinical setting. We modified the self-control-group-therapy of psychoreactive depression, developed by Fuchs und Rehm (1977) in order to reach applicability for inpatients of psychiatric hospital. Operant techniques, social skills training, self-control-techniques, and the cognitive techniques developed by Beck (1979) were used. In contrast to Becks cognitive therapy we emphasized both the motivational aspect of depression and the aspect of self-regulation and self-modification too. There was not only the therapist trying to change behavior, thinking, and feeling of the patient by cognitive techniques. The patient himself tried to develop cognitive and behavior coping strategies. The treatment of patients with severe depression in an early stage was controlled by the therapist, later on they learned to control themselves. A central point of the concept of self-modification is teaching well founded knowledge of behavior analyses to the patient. Self-modification is not very efficient without, and the patient's motivation to work on his own therapy is elevated significantly. In some cases we continue this form of therapy after the patient's leaving the hospital up to three months.
Asunto(s)
Terapia Conductista/métodos , Trastorno Depresivo/terapia , Adulto , Anciano , Trastornos del Conocimiento/psicología , Condicionamiento Operante , Trastorno Depresivo/psicología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Psicoterapia de Grupo , Tratamiento DomiciliarioRESUMEN
This study is concerned with the diagnostic process of psychiatrists. Two concepts are investigated; the internalized nosological theory and the psychiatric diagnostic scheme. If patients or diseases are judged on predefined lists of symptoms (e.g. AMDP-list), we assume that judgments are based on the first one. If the psychiatrist, however, is free in the choice of relevant attributes in judging patients or diseases, we assume that his judgments are based on his individual diagnostic scheme. Results show high agreement in internalized nosological theories, but strong individual differences in diagnostic schemes. Interindividual agreement in internalized nosological theories is still greater than intraindividual agreement between diagnostic scheme and nosological theory. This proves that distinguishing the two concepts is meaningful. Structural components of both concepts, e.g., their dimensions, pregnant structures, and their metric, were analyzed by multidimensional scaling. We assume that the psychiatric diagnostic scheme determines the clinical diagnosis in everyday practice, whereas the internalized nosological theory is of importance mainly in research. The differences between both concepts suggest that lists of symptoms are not very helpful in analyzing clinical diagnosis. Thus, in order to achieve greater agreement in diagnosis, further and detailed analysis of individual "implicit" theories which determine the greater part of diagnostic schemes is necessary.
Asunto(s)
Trastornos Mentales/diagnóstico , Alcoholismo/diagnóstico , Trastornos de Ansiedad/diagnóstico , Trastorno Depresivo/diagnóstico , Trastorno Depresivo Mayor/diagnóstico , Diagnóstico Diferencial , Humanos , Histeria/diagnóstico , Trastornos Mentales/psicología , Trastornos del Humor/diagnóstico , Psiquiatría , Teoría Psicológica , Esquizofrenia Hebefrénica/diagnóstico , Esquizofrenia Paranoide/diagnósticoRESUMEN
Diagnostic schemes of psychiatrists are explained by two components, a general explicit nosological theory and an individual implicit theory. An experimental study is devoted to the analysis of diagnostic schemes in three groups with different degrees of internalization of explicit nosological theory: (1) a non-psychiatrist group without nosological knowledge (2) a non-psychiatrist group, who obtained nosological knowledge in a 40-min session, and (3) a group of psychiatrists. Four structural components of diagnostic schemes were analyzed: stability, complexity, relevance for therapy of the individual diagnostic scheme, and interindividual homogeneity within groups. The diagnostic schemes of psychiatrists showed no more stability and relevance for therapy than those of group (2), whereas interindividual homogeneity as well as complexity were higher. Results indicate that the diagnostic schemes of psychiatrists are determined to a great extent by individual implicit theories.
Asunto(s)
Trastornos Mentales/diagnóstico , Trastorno Depresivo/diagnóstico , Diagnóstico Diferencial , Humanos , Trastornos Mentales/terapia , Trastornos Neuróticos/diagnóstico , Psiquiatría/educación , Teoría Psicológica , Trastornos Psicofisiológicos/diagnóstico , Trastornos Psicóticos/diagnóstico , Esquizofrenia/diagnósticoRESUMEN
A factor analytic study of the Psychopathology Scale and the Somatic Symptoms Scale of the AMDP System in reported. The random sample was comprised of 1166 psychiatric inpatients, and the resulting factors are compared with other factor analytic studies based on the AMDP System. The study concluded that the AMDP scales have a stable factorial structure, but more exact comparative methods of factorial structure should be applied in future studies.