Use of magnetic ear beads –

Treatment of the „almost Untreatable“

EURO-NADA, September 20 – 21, Graz

Christian Döring

• use of magnetic ear beads as an additional option are frequently favored

• good experiences with “untreatable” patients - severe personality disorders or complex trauma, severe addiction problems

• beginning in individualized sessions

Center of Substance Dependence

„Heavy User“

„Almost Untreatable“

„Untreatable“

Heroin and Kokain, PTSD and Psychosis, HIV and HCV

Antoinette *1962

Center of Substance Dependence

Treatment of the „almost Untreatable“:

• Biological, psychological and/or social situation are frequently decompensated in terms of acute mental crisis, escalating family conflicts, cognitive performance limitations and/or physical impairments

• Challenges: - high degree of aggressiveness, impulsiveness and lack of social integration - suicidal tendency - delinquency and substance use - manipulation and disturbance

• The treatment of the "untreatable" patient-revisited World J Gastroenterol. 2003 May;9(5):885-7 Kirsner JB Section of Gastroenterology, Department of Medicine, University of Chicago, USA, gpence@medicine.bsd.uchicago.edu

Abstract• The limits of medicine have not yet been reached. Numerous human

illnesses initially thought to be incurable are reversible under unique and unpredictable individual circumstances. This paper, and the preceding companion publication, describes instances of the successful treatment of patients previously labeled as untreatable, including instances of severe ulcerative colitis and Crohn's disease.

The Almost Untreatable Narcissistic PatientOtto F. Kernberg

New York Hospital Cornell Medical Center Westchester Division 21 Bloomingdale Road White Plains, NY 10605, okernber@med.cornell.edu

Abstract• Clinical experience in the Personality Disorders Institute at Weill Cornell

Medical College suggests that patients with borderline personality organization and a narcissistic personality disorder have a more serious prognosis than all other personality disorders functioning at the borderline level, and that those who in addition present significant antisocial behavior have an even worse prognosis (Clarkin, Yeomans, and Kernberg 1999; Stone 1990). This negative trend culminates in a group of practically untreatable patients with antisocial personality disorder, who represent the most severe cases of pathological narcissism. There are also patients with severe narcissistic personality disorder, functioning at an overt borderline level with significant antisocial features, but not presenting an antisocial personality disorder proper, who at times respond to treatment, while others do not. These patients are explored here, with a focus on particular psychotherapeutic techniques that have proven helpful, as well as on the limits of these technical approaches.

• NICE Guideline NICE • Nice Guideline

PSYCHOSIS WITH COEXISTING SUBSTANCE MISUSE (2011)

When working with adults and young people with known or suspectedpsychosis and coexisting substance misuse, take time to engage theperson from the start, and build a respectful, trusting, non-judgementalrelationship in an atmosphere of hope and optimism. Be direct in yourcommunications, use a flexible and motivational approach, and take intoaccount that:

• stigma and discrimination are associated with both psychosis and substance misuse• some people will try to conceal either one or both of their conditions• many people with psychosis and coexisting substance misuse fear being detained or imprisoned, being given psychiatric medication forcibly or having their children taken into care, and some fear that they may be ‘mad’.

The End

Thanks for your attention