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»I want to grow into the sky, but that could destroy the world.« Psychotherapeutic treatment of a traumatized child in the field of tension between stabilization and structural change This paper describes the therapist's approach with a traumatized and psychologically already prestressed boy and reflects on it based on various theoretical concepts. The structural weaknesses of the patient appeared in the play in the fragility of the symbolization ability and the pretend mode. Strong feelings of anxiety and confusion, perceptible in the countertransference, as well as the presence of defense mechanisms such as splitting, idealization, omnipotence or dissociation, demand to a greater extent the therapist's container function. Therefore, at the beginning of the treatment, an initial phase served to stabilize the patient. Only gradually, after a good working alliance was established, a clearer confrontation with the fears became possible. Instead of being left alone with it, the patient found in therapy a language, images, space. Thus, the patient was able to reduce his omnipotent control and the transformation of stressful fantasies and feelings also developed in the relationship with the therapist. A gradual integration and de-idealization became possible. [ABSTRACT FROM AUTHOR]

Background and objective: The Working Group on Ethics in Anesthesia and Intensive Care Medicine of the Austrian Society for Anesthesiology Resuscitation and Intensive Care Medicine (ÖGARI) already developed documentation tools for the adaption of therapeutic goals 10 years ago. Since then the practical implementation of Comfort Terminal Care in the daily routine in particular has raised numerous questions, which are discussed in this follow-up paper and answered in an evidence-based manner whenever possible. Results: The practical implementation of pain therapy and reduction of anxiety, stress and respiratory distress that are indicated in the context of Comfort Terminal Care are described in more detail. The measures that are not (or no longer) indicated, such as oxygen administration and ventilation as well as the administration of fluids and nutrition, are also commented on. Furthermore, recommendations are given regarding monitoring, (laboratory) findings and drug treatment and the importance of nursing actions in the context of Comfort Terminal Care is mentioned. Finally, the support for the next of kin and the procedure in the time after death are presented. Discussion: A change in treatment goals with a timely switch to Comfort Terminal Care enables good and humane care for seriously ill patients and their relatives at the end of life and the appreciation of their previous life with the possibility of positive experiences until the end. [ABSTRACT FROM AUTHOR]

Background: The coronavirus disease 2019 (COVID-19) pandemic represented a serious challenge for healthcare systems worldwide. Special psychiatric patients represent a vulnerable group and are particularly affected by lockdown interventions. Knowledge on the possible effects for this group of patients in an emergency physician setting is low. Objective: The aim of this paper is to investigate the impact of the first lockdown during the COVID-19 pandemic in 2020 on emergency ambulance services for psychiatric patients in a large German city. Material and methods: A retrospective analysis was conducted on all prehospital psychiatric emergencies in a large German city during the first pandemic-related lockdown from 22 March 2020 to 4 May 2020, with the same period in 2019 serving as a reference. Results: During the first lockdown there was a significant increase in the number of emergency missions with respect to psychiatric cases. A substantial rise in substance-associated deployments was observed. Moreover, there was an increase in the proportion of psychiatric patients who did not meet emergency criteria. Suicidal tendencies and agitation status played a minor role during the lockdown. Conclusion: The lockdown had a notable impact on the frequency and profile of emergency physician calls in the metropolitan area studied. The substantial increase in substance-associated callouts can be interpreted as both a deterioration in access to the healthcare system and an expression of the increased stress faced by the general population and vulnerable groups in particular. [ABSTRACT FROM AUTHOR]

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The article focuses on stress and perceived changes during the COVID-19 pandemic. It mentions that the intensity and importance of the perceived behavior and changes in attitudes should be made with different groups of people differentiated according to experience of nature, times of silence and reflection, social relationship, interest in spirituality, reflection on life and loneliness feel, but also in relation to the general feeling of restriction.