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Permanent URL to this publication: http://dx.doi.org/10.5167/uzh-19652

Boeker, H (2009). Selbst und Körper in der Depression: Herausforderungen an die Therapie. Schweizer Archiv für Neurologie und Psychiatrie, 160(5):188-199.

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Ausgehend von klinischen Beobachtungen, die die Bedeutung der Wahrnehmung psychomotorischer Veränderungen bei depressiv Erkrankten im Hinblick auf Diagnostik und Beurteilung des Krankheitsverlaufes unterstreichen, wird in diesem Beitrag der Zusammenhang von Selbst und Körper bei depressiv Erkrankten insbesondere in einer therapeutischen Perspektive beleuchtet. Auf der Grundlage des Modells der Depressionen als Psychosomatosen der Emotionsregulation werden unterschiedliche wissenschaftliche Zugänge
aufgezeigt, die zur Erforschung des Zusammenhangs von Selbstkonzept und somatischen Prozessen der Depression herangezogen werden können. Neben der qualitativen Einzelfallforschung können Untersuchungen zur emotional-kognitiven Interaktion bei depressiv Erkrankten Aufschluss geben über die Hemmungsphänomene bei Depressionen.
Angesichts der Mehrdimensionalität depressiver Erkrankungen erweist sich die Begegnung mit dem psychomotorischen Ausgebremstsein des depressiven Menschen als besondere Herausforderung in der Behandlung. Der Gestaltung der therapeutischen Beziehung kommt dabei – insbesondere unter Berücksichtigung des subjektiven Erlebens – eine besondere Bedeutung zu.
Depression can be considered to be the result of multiple neurobiological, psychological and social factors which are related to one another. Clinical experience underlines the importance of psychomotor symptoms in depression. These are correlated both to subjective experience and to the underlying somatic processes in the course of affective disorders.
The main aim of this article is to analyse the inter-relationship between the self, self concepts and subjective experience of depressed patients and neurobiological processes of depression, particularly from a psychotherapeutical perspective. Reflecting the concept of depression as a psychosomatosis of affect regulation, different empirical approaches are demonstrated focussing on the self-body relationship in depression.
In a series of combined studies, operationalized subjective psychological characteristics and prefrontal cortical activation patterns during emotional-motor stimulation, explored using functional magnetic resonance imaging (fMRI), were investigated. The Repertory Grid Technique, an idiographical procedure, was used to explore the individual features of the depressed patients. In the first study phase, catatonic patients in an acute and post-acute state who also had an underlying affective disorder, were investigated. Subjective operationalized psychological characteristics in both the acute and post-acute state showed a significant lack of contact, decreased self-esteem and reduced emotional arousal (compared to non-catatonic psychiatric and healthy controls). fMRI revealed significant dysfunctional activation patterns in the orbito-frontal cortex and alterations in the medial pre-frontal and pre-motor cortex during negative emotional stimulation.
The results support the hypothesis that emotional arousal plays a central role in depressive stupor and that orbito-frontal cortical dysfunction may be closely related to regression to somatic defence mechanisms as
paradigmatically observed in depressive stupor.
Further results from combined neuropsychological and fMRI- / MRS-investigations of the neurophysiological basis of depressive symptomatology and its therapeutically induced effects are demonstrated. In these studies, a pathological functional interaction between lateral and medial prefrontal cortical regions and a disturbed balance between left and right dorso-lateral prefrontal cortex was found. This emotional-cognitive dysbalance may be correlated with the dominant negative emotions and cognitive deficits in depression. The results of current studies reveal a possible dissociation between cognitive and psychopathological symptoms in the course of depression.
These combined neuropsychological and neuroimaging approaches may contribute to the development of specific neuronal and metabolic “diagnostic markers” for depression and thus to more specific, effective and sustainable treatment.
Further, the therapeutical challenges arising from the multi-dimensionality of depressive disorders (especially the inhibitions reflected in psychomotor symptoms) and the subjective experience of the individual depressive patient are discussed. Finally, the development of a therapeutic relationship is an important precondition in enabling the patient to overcome the vicious circles of depression.



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Item Type:Journal Article, refereed, further contribution
Communities & Collections:04 Faculty of Medicine > Psychiatric University Hospital Zurich > Clinic for Psychiatry, Psychotherapy, and Psychosomatics
Dewey Decimal Classification:610 Medicine & health
Uncontrolled Keywords:Depression, psychotherapy, self, body, emotional-cognitive interaction, therapeutic relationship
Date:June 2009
Deposited On:15 Jul 2009 14:11
Last Modified:05 Apr 2016 13:17
Publisher:EMH Swiss Medical Publishers
Related URLs:http://www.schwabe.ch/navigation/frameset.asp?p1=buttons.html&p2=magazine.html (Publisher)

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