Antidepressants and cognitive-behavioural therapy (CBT) have been reported to decrease severity of psychopathology in PTSD-patients. To date, no study has been carried out which compares psychopharmacolo-gical and psychotherapeutic treatments. In a randomized pilot study, PTSD-patients were treated either with paroxetine or CBT. Diagnoses were made by structured clinical interviews (ADIS, CAPS). The duration of treatment was 3 months; the paroxetine dosage was 10-50 mg; exposure and cognitive restructuring were the main elements in cognitive-behavioural therapy. Twenty-one patients were included. Drop-outs in both groups occurred within the first 2 weeks. Paroxetine and CBT significantly decreased PTSD-symptoms (CAPS) as well as concurrent depression (MADRS) after 3 months treatment. At 6 month follow-up, symptoms of PTSD had slightly increased in the paroxetine group and further decreased in the cognitive-behavioural therapy group. (Int J Psych Clin Pract 2004; 8: 19-23).

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PTSD can be precisely diagnosed and effectively treated when the diagnostic criteria and guideline recommendations are taken into account. Referral for trauma-focused psychotherapy should be considered if the acute symptoms persist for several weeks.

Somatoform disorders, or somatic symptom disorder, as it is denominated in Diagnostic and Statistical Manual of Mental Disorders, fifth edition, are a heterogeneous group of mental health problems that are characterized by enduring bodily complaints and symptoms that are not due to organic dysfunction or disease. These patients perceive a wide range of severe symptoms like pain, gastrointestinal, cardiovascular, sexual, and/or pseudoneurological symptoms, which cause permanent attention, worry, and distress. They excessively seek medical help and reassurance, but have difficulties accepting the nonpathological results in medical examinations. The concept of psychological and psychosocial influences and causes is rejected, and mental health services are usually not attended. Biological, psychological, and psychosocial factors interact as precipitating, triggering, and maintaining factors of psychopathology. The different subtypes (somatization, conversion, pain disorders, hypochondriasis, and dysmorphophobia) are described with their central features: clinical presentation, epidemiology, comorbidity, and course. Current etiological and pathogenic models are introduced as a clinical and theoretical basis for therapeutic interventions. Besides general psychotherapeutic principles more specific interventions addressing the modification of subjective health-beliefs, illness behaviors, and coping skills are described. The clinical significance of somatoform disorders stresses the need for training programs to provide and improve basic diagnostic and therapeutic skills, especially in primary care. Future directions for the management of these disorders are outlined.

Teil II: Wirksamkeit einer stationären psychologischen Frühintervention Hintergrund Psychologische Frühintervention nach akuten TraumenPsychische Folgestörungen nach Extrembelastungen und Traumen -dazu können auch Arbeitsunfälle mit schweren körper-lichen Verletzungen zählen -sind häufig und neigen unbehandelt zur Chronifizierung und sekundären Komplikationen [8,9] ) for information on the study design and the epidemiological results. The interventional part of the study evaluated the short-and long-term effectiveness of a psychological early intervention program for high-risk patients: 103 highrisk patients were screened for severe peritraumatic symptoms, and each was allocated either to a therapy group (five individual sessions of prophylactic cognitive behavioral therapy while still on the surgical ward) or to a control group that received no specific psychotherapeutic support. Analysis of the group as a whole did not show shortterm prophylactic psychotherapy to be superior in either the short or the long term. Only in high-risk patients who had higher risk scores (>7 on the 10-item screening instrument) and more severe symptoms immediately after their accidents was a significant effect of the therapy ascertained. Positive effects of the early intervention treatment were specific for posttraumatic stress disorder, and other psychopathological complaints were not affected. In conclusion, different subtypes of patients are defined within the high-risk group, for which different treatment strategies might be indicated.