Selbst und Körper in der Depression: Herausforderungen an die Therapie

Abstract

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 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 operationalised subjective psychological characteristics and prefrontal cortical activation patterns during emotional-motor stimulation, explored by 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 operationalised 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 psychopatho-logical 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. Furthermore, 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.