prof. dr. med. em. dr. h.c. luc ciompi berne / switzerland ix. symposium „early intervention in...
DESCRIPTION
3 1. Historical rootsTRANSCRIPT
Prof. Dr. med. em. Dr. h.c. Luc CiompiProf. Dr. med. em. Dr. h.c. Luc Ciompi
Berne / Switzerland Berne / Switzerland
IX. Symposium „Early intervention in psychiatry“IX. Symposium „Early intervention in psychiatry“Cordoba, March 24-26Cordoba, March 24-26thth, 2011, 2011
Soteria Berne 1984-2011Basic concepts, practical realisation, results
2
Plan of lecturePlan of lecture
1.1. Historical rootsHistorical roots2.2.Basic conceptsBasic concepts3.3.Practical realisationPractical realisation4.4.Therapeutic resultsTherapeutic results5.5.Hypotheses and open questionsHypotheses and open questions
4
3
1.1. Historical rootsHistorical roots
43
76
8
Long-term outcomeLong-term outcome
Full recovery 20-30 %Full recovery 20-30 %
Minor residuals 30-40 %Minor residuals 30-40 %
Severe chronicity 30-35 %Severe chronicity 30-35 %
7
9
Three phase model Three phase model of the long-term evolution of schizophreniaof the long-term evolution of schizophrenia
biological factors biological factors ⇆⇆ pychosocial factors pychosocial factors
↘↘↘↘↘↘ ↙↙↙↙↙↙premorbid vulnerabilitypremorbid vulnerability
↓↓↓↓↓↓
stressfull life-eventsstressfull life-events ↓↓↓↓↓↓
acute psychotic decompensation(s)acute psychotic decompensation(s)
↓↓↓↓↓↓ long-term evolutionlong-term evolution
↙↙↙↙↙↙ ↓↓↓↓↓↓ ↘↘↘↘↘↘ full recovery minor residuals severe chronicityfull recovery minor residuals severe chronicity
7
10
2. Basic concepts2. Basic concepts
Basic principle:Basic principle:
Do Do everything which lowers the emotional everything which lowers the emotional tension!tension!
Avoid everything which increases it!Avoid everything which increases it!
12
Eight basic therapeutic Eight basic therapeutic principlesprinciples
10
1.1. Small, open, „normal“ family-like settingSmall, open, „normal“ family-like setting2.2. Relaxing therapeutic approachRelaxing therapeutic approach3.3. Specially selected staffSpecially selected staff4.4. Same information for patients, family, staffSame information for patients, family, staff5.5. Therapeutic alliance with familyTherapeutic alliance with family6.6. Elaboration of realistic goals and expectationsElaboration of realistic goals and expectations7.7. Low medication strategiesLow medication strategies8.8. Systematic post-care and relapse preventionSystematic post-care and relapse prevention
13
3. Practical realisation3. Practical realisation
26
29
Four phases of treatment
• Calming down (soft room)• Reinsertion into everyday reality• Reinsertion into external reality • Post-care
30
4. Results4. Results
31
global outcome = n.s. relapse rate = n.s.global outcome = n.s. relapse rate = n.s.
2-years global outcome and relapse-rates2-years global outcome and relapse-ratesfirst column = Soteria second column = controlsfirst column = Soteria second column = controls
blue = favorable blue = favorable lila = unfavorablelila = unfavorable
38
Soteria has neuroleptica-like effectsSoteria has neuroleptica-like effects
– – but without undesirable side-effects!but without undesirable side-effects!
39
5. Working hypothesis and open 5. Working hypothesis and open questionsquestions
★ Soteria acts by naturally induced sustained emotional relaxation
★ lack of long-term follow-ups
★ lack of large scale comparisions
★ lack of formal verifications of the working hypothesis
40
¡ Muchas gracias¡ Muchas gracias por su atenciòn ! por su atenciòn !