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Biomedical subjects

W Böker

Publications and source records attributed to W Böker.

At least 19 recordsLinked to original sources
PubMed2005

[Etiological concepts of chronification in schizophrenia].

Kraepelin and Eugen Bleuler understood the chronicity of schizophrenia as a typical expression of its natural course. Although they erred in this pessimistic assessment, some 30-35 % of all schizophrenia patients do suffer from chronic residual symptoms after years of having the disease, despite sociopsychiatric reform efforts that led to open hospitals and greater patient autonomy. According to the vulnerability conception, schizophrenia is regarded as a vulnerability that causes decompensation leading to psychotic episodes under the influence of internal and/or external stressors. The vulnerability threshold can be increased or lowered by influencing variables. In addition to factors immanent to the disease, some of these variables are related directly or indirectly to chronicity of the disease.

Chronic Disease↗
PubMed2001

[Psychotherapy for schizophrenia].

Based on different theoretical concepts, psychotherapeutic methods in the treatment of schizophrenia reach from clinical pragmatism, psychoanalysis, learning theory, cognition and communication psychology to concepts of systems-theory. Both the German (DGPPN) and the American (APA) practice guidelines for the treatment of schizophrenic patients don't separate psychotherapy, social and rehabilitation measures strictly. So a specific psychotherapy for psychotic patients seems to be missing. A better relationship between patient and expert is fundamental for building up a ??? therapeutic liaison. For that purpose, the disease concepts of both sides must be carefully explained and integrated ("Basic psychotherapy").

Guidelines as Topic↗
PubMed1999

[Perception and insight of illness in schizophrenic patients].

A review of prevalence and causes of low insight in schizophrenic patient as well as of possible interventions. Low insight was found in 20-80% of cases. The complex phenomenon 'lack of insight' is caused by a common pathway of different psychopathological and adaptive processes: psychotic reality distortion, psychotic resistance ('denial') and the expression of neurobiological deficits ('anosognosia'), respectively. Step by step, the subjective awareness and the individual causal model of the patient have to be adopted to the medical disorder model ('vulnerability-stress-coping concept') to achieve a functional understanding of the disorder that is optional for good cooperation between patient, relatives and professional carers. Thereby, a strengthening of the negative self-image and of the weakened autonomy should be given special attention to prevent hopeless-suicidal developments.

Humans↗
PubMed1992

[Neuroleptic therapy and suicide--review of the literature and personal results].

The majority of schizophrenic patients receive neuroleptics (NL) and a relatively high number of them commit suicide. Is there a relationship between the two variables? Long-term observations failed to demonstrate an interdependence between a large-scale introduction of NL in the therapeutic practice and suicide rates. There is a relationship between depression and suicide and depressive syndroms are frequent in schizophrenic patients. Depressions due to an exclusive use of NL probably do occur, but quite seldom so. Also, possible relationships between other NL side effects (akathisia, dysphoric reaction to NL) and suicidal behavior are not sufficiently supported by the clinical data. Direct comparisons in controlled studies (the own study included) between NL therapy of suicide and control subjects yielded no consistent results. Suicide promoting effect of NL cannot be postulated on the basis of the available data, however, it also cannot be fully excluded in individual cases.

Antipsychotic Agents↗
PubMed1991

[Disorders of pain perception in schizophrenia].

Starting from a case of marked pain insensitivity in a patient suffering from catatonic schizophrenia we state in this paper that analgesia seems to be an ubiquitous phenomenon which is not only caused by physical disorders of the central nervous system. Different models of interpretation as to be found in scientific literature are reviewed. On the basis of today's physiological knowledge, five hypotheses on causal explanation of pain insensitivity in schizophrenics are discussed: Hypalgesia and analgesia are an expression of motorial inability to react; a consequence of a disorder of consciousness; an analgetic effect of neuroleptic drugs; a basic deficit in schizophrenia and; a result of a disturbed psycho-physiological development.

Humans↗
PubMed1991

[Development of a therapeutic partnership understanding of schizophrenia as a sequela of recent concepts of etiology and changes in psychiatric contemporary theory].

Ideas and concepts of the essence and nature of mental diseases have always been rooted in the current zeitgeist that usually regarded the psychotic patient as a helpless victim of demoniacal influences, degenerative processes, organic (endogenous) diseases or the dynamics of familial determinants, all of which seemingly destroyed or paralysed the autonomy of the person who became a schizophrenic. In consequence of these concepts the doctor-patient relationship (active expert-passive object of treatment) has largely been asymetrical, whereas at the same time the doctors' attitude towards the relatives was either indifferent or in the manner of a defence reaction, or of a corrective nature. Recent theories such as the concept of vulnerability and stress-coping stimulated new and fruitful forms of cooperation between doctor, patient and relatives. The schizophrenic patient is now being credited with a greater measure of possibilities to influence the prodromata, the course and the consequences of his psychosis. His relatives can help him in doing so, and in fact they should. Clearly formulated and easily appreciated information on this concept, as well as common attention to and assistance of self-protective and compensatory efforts to cope with psychological basic deficiencies, managing of stressors, early symptoms and handicaps. could promote a "treatment partnership" that is also effective as a preventive measure. The idea of a partnership therapy, too, is linked to current trends in research theory and practice that are characterised by the systemic paradigm while aiming at partially restoring the mental patients' capacity and right to act.

Adaptation, Psychological↗
PubMed1987

On autoprotective efforts of schizophrenics, neurotics and controls.

Autoprotective efforts of schizophrenics have hardly been systematically investigated until now, although the role of coping processes in regard to numerous psychic disorders is increasingly recognized. The investigation of autoprotective efforts, however, is of special significance in view of the different current formulations of the vulnerability stress concept of schizophrenia. Thus the cognitive disorders in the sense of information processing deficits among schizophrenics deserve our special attention, since they are described consistently as vulnerability characteristics and as cause of a heightened susceptibility to stress, and since they can be considered an explanatory basis for a wide range of subjectively experienced basic disorders of schizophrenia. In the present study the two disorder dimensions and the corresponding autoprotective efforts were investigated among 60 schizophrenic patients, 30 neurotic patients and 30 healthy controls. The schizophrenic patients had both significantly more experimental psychologically operationalized dysfunctions in information processing and subjectively experienced basic disorders. However, we found no correlation between the two levels of investigation. This may mainly be attributed to the fact that on the level of subjective experience the primary disorder, the perception of the disorder and the individual response to the disorder cannot be differentiated unequivocally. All of the schizophrenic patients reported consciously performed autoprotective efforts in regard to basic disorders. In this connection it is of interest that the schizophrenic patients had a significantly higher percentage of problem solving oriented attempts in comparison with the two non-schizophrenic comparison groups, and that this percentage even increased by a progressive amount of disorders. The schizophrenic patients experienced basic disorders with much more emotional tension and existential, ego-threatening anxiety. They were interpreted by the schizophrenic patients as danger signals, by the neurotic patients, however, predominantly as concomitant symptoms of their neurosis, whereas healthy persons comprehended them within the framework of ordinary psychological explanatory models. The relevance of these results in regard to further research in autoprotective efforts of schizophrenic patients and in their possible therapeutic implications is discussed.

Adaptation, Psychological↗
PubMed1986

Self-help attempts of depressive patients.

The paper, based on the theoretical analysis of the problem and a review of the pertinent literature, focuses on the following questions: Which behaviour patterns can be understood as self-healing attempts in depressive disorders? Are there any scientific findings with regard to the efficacy of such self-healing attempts? In which phase of a depression are such attempts being applied? Are self-healing techniques teachable and learnable? The label 'depressive disorders' covers not only brief and mild affective disturbances but also persistent severe depressions.

Cognition↗
PubMed1986

[Steps in the recovery from severe depression. On the psychosomatic aspects of a convalescent process].

In retrospect, several phases of the healing process are easily distinguishable: Initiated with a terminal inpatient antidepressant therapy, continued by a tranquilizer-hypnotic withdrawal treatment, the psychotherapeutic mastering of the life-crises which provoked the mental disturbance in the first place, then the patient's going back to work, and, finally, the total mental stabilization on a mature level. The psychopathologic and psychosomatic symptoms appearing in the process are interpreted as expressions of spontaneous healing and not to be confounded with symptoms of withdrawal and/or relapse. The transition of the disturbance suffered and vanquished into a new self-image terminates the process of healing and recovery.

Adaptation, Psychological↗
PubMed1985

Homicide in a psychiatric institution.

A unique case of a homicide committed by a young male psychotic inpatient on a fellow-patient is reported and discussed with regard to the special victim-offender relationship, the relationship between suicide and homicide, the phenomenon of aggression and the question of the management of a highly suicidal psychotic patient, including the issue of continuous observation.

Adult↗
PubMed1984

Self-healing strategies among schizophrenics: attempts at compensation for basic disorders.

New experimental findings show that schizophrenics, as well as some of their non-schizophrenic relatives, manifest basic cognitive disorders defined in terms of variables from the field of experimental psychology. These basic disorders can be regarded as markers--if not, indeed, as psychological manifestations--of vulnerability to schizophrenia. They can be associated with subjectively experienced forms of non-clinically manifest impairments in psychological functioning. It was therefore hypothesised that schizophrenics, as well as non-schizophrenic subjects vulnerable to schizophrenia, will, in the course of learning processes, develop compensatory efforts which may be more or less effective. It is assumed that effective efforts of this kind will take on special significance in stress situations which would tend to elicit the occurrence of a schizophrenic episode. Effective efforts at compensation for basic disorders should be able to act as a 'buffer' against negative stressor effects (moderator function), thus reducing the danger of a psychotic breakdown. These compensation efforts were studied in 40 inpatients in remission after an acute schizophrenic episode. It was found that significant correlations exist between the extent of subjectively experienced basic disorders and the number and kind of conscious compensation attempts. Although the findings to date are of a preliminary and purely descriptive nature they would seem to justify further research.

Adaptation, Psychological↗
PubMed1984

[Self healing attempts by schizophrenic patients].

There has effectively been no investigation, at a systematic empirical level, whether schizophrenics possess self-help capability. Clinical observation and self description would seem to make its existence likely. This will first be shown on hand of the pertinent clinical literature. In an own investigation, which was based on a "Model of Vulnerability" (Zubin and Spring, 1977), 40 schizophrenics were questioned in accordance to the formulation provided in the Frankfurt Complaint Questionnaire (Süllwold, 1977) about their compensatory efforts concerning subjectively experienced basic disorders Reaction time measurements served as indicators of schizophrenic vulnerability. All 40 patients reported awareness about compensatory efforts in regard to experienced disorders which they conceived to be danger signals. A clearly greater number of problem solving oriented (active) than non problem solving (passive avoidance) attempts were reported. They can provisionally be classified as "reinterpretation", "restructuring", "reality testing", "action displacement" or "search for action stereotypes".

Adaptation, Psychological↗
PubMed1982

[The future of the psychiatric hospital--dissolution or change?].

A great variety of therapeutic models and alternative ways of taking care of the mentally disturbed have lately made the future of the independent psychiatric hospital rather uncertain. Out-patient and partially in-patient facilities, psychiatric wards within the frame of general hospitals, the transfer of chronic cases to non-psychiatric nursing homes, and redress in cases of misplaced persons, constitute steps and measures entailing a considerable shrinkage in the size and extent of the psychiatric hospital of today, although the alternatives mentioned cannot, of course, entirely replace it. There is in the population an estimated need for 1.1 to 1.6 psychiatric hospital beds for every 1000 of persons. The psychiatric hospital of the future should aim at attending to and satisfy the various needs of the following three categories, i.e. 1. crisis intervention in cases of gravely upset, psychotically agitated or suicidal patients, 2. programs of intensive therapy by specialized nursing teams for average and long-term mentally disturbed patients, and finally, 3. a certain supply of asylums for the comparatively small number of most severely handicapped persons. The experiences drawn from these combined operations will be of great value to the research field, as well as in the basic and continued training of personnel.

Ambulatory Care↗