Godemann F, Schuller J, Uhlemann H, Budde A, Heinz A, Ströhle A, Hauth I
Center for Neurology, Psychiatry and Psychotherapy, St. Joseph Hospital, Berlin, Germany.
Psychopathology. 2009;42(2):99-107. doi: 10.1159/000203342. Epub 2009 Feb 19.
In our 2-year prospective study of 80 patients admitted consecutively to our clinic with an episode of acute vestibular neuritis, a total of 8 patients later developed a panic disorder according to DSM-III-R criteria. The goal of our analysis was to determine whether certain conflict patterns (e.g. in the area of autonomy vs. dependence) or deficient psychological structure could predict later panic disorder, as might be expected based on psychodynamic theory.
Between 4 and 8 weeks after the acute vestibular episode, we evaluated all patients using operationalized psychodynamic diagnostics (OPD). With the different axes of the OPD system, we were able to assess patients' experience of illness (Axis I), potential conflicts (Axis III), and psychological structure (Axis IV) in a semiquantitative manner.
Poor psychosocial integration, a lack of social support, a high burden of suffering, and moderate to severe impairment of self-experience were able to account for 32.1% (Nagelkerkes R(2)=0.321) of variance in the development of panic disorder over the course of 2 years. However, contrary to what might have been expected based on psychodynamic theory, patients who later developed a panic disorder did not exhibit any differences in their Axis III or IV scores compared to patients who remained psychologically healthy.
在我们对连续入住我院的80例急性前庭神经炎患者进行的为期2年的前瞻性研究中，共有8例患者后来根据《精神疾病诊断与统计手册》第三版修订版（DSM-III-R）标准患上了惊恐障碍。我们分析的目的是确定某些冲突模式（例如在自主与依赖领域）或心理结构缺陷是否能够预测后来的惊恐障碍，正如基于精神动力学理论所预期的那样。
在急性前庭发作后的4至8周内，我们使用操作性精神动力学诊断（OPD）对所有患者进行了评估。借助OPD系统的不同轴，我们能够以半定量的方式评估患者的疾病体验（第一轴）、潜在冲突（第三轴）和心理结构（第四轴）。
心理社会整合不良、缺乏社会支持、高痛苦负担以及自我体验的中度至重度受损能够解释2年内惊恐障碍发生过程中方差的32.1%（Nagelkerkes R² = 0.321）。然而，与基于精神动力学理论可能预期的情况相反，后来患上惊恐障碍的患者与保持心理健康的患者相比，在第三轴或第四轴得分上没有表现出任何差异。
