Familienfunktionalität und Therapieerfolg

Background

Even though it is a treatment standard of child psychotherapy to involve the parents, hardly any research has been carried out about the impact of family functioning on treatment outcome. Aims of the present study were to investigate the change in and the prognostic power of family functioning on treatment outcome of short-term psychodynamic psychotherapy in children and adolescents.

Patients and methods

The sample consisted of 54 children and adolescents undergoing outpatient short-term psychodynamic psychotherapy. To assess family functioning, their parents were asked to complete the Family Assessment Measure (FAM).

Results

Patients from families with high levels of functioning in task accomplishment, communication and affective expression were more often treated successfully. Improvement in levels of functioning in role performance, emotionality and control were only found in the group of successfully treated patients.

Conclusion

Family functioning is a decisive factor in the differential indication of psychotherapeutic treatment in children and adolescents.     

Psychotherapeutische Behandlung von depressiven Kindern und Jugendlichen

Background

Depression is a psychiatric disorder with debilitating symptoms (e.g. suicidal behavior) with a high prevalence rate even in children and adolescents and the disorder shows a chronic course in many cases. According to psychiatric guidelines, cognitive behavioral therapy and interpersonal therapy are the psychotherapeutic methods of choice.

Aim

This article gives an overview of the current studies on cognitive behavioral and interpersonal group therapy programs for the treatment of depression in children and adolescents as well as a short illustration of the most prevalent therapy programs.

Material and methods

A literature research (PsycInfo, Psyndex, Pubmed) revealed 280 hits. After a review of all titles and abstracts 25 studies were included in this study.

Results

Efficacy studies mainly exist for cognitive behavioral group therapy programs (effect sizes ranged from 0.02 to 1.34) from English-speaking countries. There are only a few German programs available. With respect to interpersonal group therapies there are only few articles published in English and to the best of our knowledge none in German.

Conclusion

There is a great need for further studies that investigate the efficacy of group therapies for the treatment of depression in children and adolescents especially in German-speaking countries.     

PALME

Background

Single mothers and their children are exposed to increased psychosocial burdens and risks. Nevertheless, in Germany offers of help especially designed for the needs of this group are lacking.

Method

An emotion-oriented parental training program (PALME, http://www.palme-elterntraining.de) based on the attachment theory was developed particularly for single mothers with preschool children. The training is guided by trained kindergarten nurses. The effectiveness of the parental training program on the measure of maternal psychological impairment, emotional competence and child problem behavior was investigated within a randomized, controlled study with 61 single mothers suffering from medium grade psychosocial impairment.

Results

Analyses of variance revealed significant group×time interaction effects in favor of the intervention group compared to controls. After the training the mothers showed improvement in their psychological impairment, depression and emotional competence. In addition, evidence suggests that behavioral problems of the children were reduced.

Conclusion

In view of the benefits of this parental training and its low costs it should be recommended as a regular offer of support for single mothers within community settings.     

Psychopathy as Predictor and Moderator of Multisystemic Therapy Outcomes among Adolescents Treated for Antisocial Behavior

Objective

The aim of the present study was to determine whether psychopathic traits act as a predictor and/or moderator of the effectiveness of Multisystemic Therapy (MST).

Method

The sample included N?=?256 adolescents (188 boys and 68 girls) referred for conduct problems, randomized to MST or Treatment As Usual (TAU). The mean age was 16 years (SD?=?1.31). Assessments were carried out before and immediately after treatment (6 months later). Three psychopathic traits (callous/unemotional traits, narcissism, and impulsiveness) were assessed with parent reports. Adolescents and parents were informants on externalizing problems.

Results

MST was more effective than TAU in decreasing externalizing problems for the “lower callous/unemotional” and “lower narcissism” group, but not for the “high callous/unemotional” and “high narcissism” group (moderators). Impulsiveness was found to predict more post-treatment externalizing problems rated by adolescents (predictor), but not more post-treatment externalizing problems rated by parents.

Conclusions

These findings point out the clinical relevance of adequately assessing psychopathic traits in adolescents referred for treatment of antisocial behaviour, and identifying those adolescents who show high levels of these traits. It is important to tailor MST specifically to meet the needs of juveniles with high levels of callous/unemotional traits and high levels of narcissism to obtain the same level of effectiveness as with juveniles scoring lower on these traits.     

„Rocken statt Ritzen“

Background

Non-suicidal self-injury (NSSI) starts in adolescence and decreases during young adulthood. Despite a high prevalence among adolescents only a few therapeutic interventions directly addressing adolescents exist.

Aim

By connecting music therapy with elements from behavioral therapy an attempt was made to create a therapeutic program which is attractive to adolescents.

Material and methods

A pilot trial of the program “Stop cutting - rock!” was conducted with 12 adolescent females with a mean age of 15.15 years (standard deviation SD ±1.34). The study aimed to compare the frequency of NSSI throughout the treatment phase as well as a pre-post comparison of depression scores.

Results

The results showed a trend towards a decreasing frequency of NSSI. Depression scores decreased significantly between the assessment before therapy and at a 3-month follow-up after the end of the therapy.

Conclusion

The positive feedback concerning music therapeutic elements points to the attractiveness of the approach. By integrating multimodal therapeutic strategies it seems possible to create an individually tailored intervention for adolescents with NSSI.     

Alexithymie bei Neurodermitis

Background

The study shows correlations between atopic dermatitis (AD) and alexithymia. Furthermore it examines their influences on skin-related quality of life.

Patients and methods

A total of 62 adult AD patients were compared with a control group (n=62) of skin healthy persons. Alexithymia (Toronto Alexithymia Scale-20, TAS-20) and impairment of the skin-related quality of life (Dermatology Life Quality Index, DLQI) were assessed as well as duration, severity [patients?? self-evaluation based on scoring of atopic dermatitis (SCORAD)] and onset of AD.

Results

The prevalence of alexithymia (TAS-20 ??61) in AD patients was 22.6% (control group 4.9%). Problems with identifying feelings (TAS-20 scale) and also the severity of AD were significant predictors for the impairment of skin-related quality of life.

Conclusions

Atopic dermatitis patients showed a prevalence of alexithymia (22.6%) similar to diseases found in the field of psychosomatic and psychiatric patients (Leweke & Bausch 2009). From a psychotherapeutic point of view the study may provide a further reason for the observance of mental features in AD treatment. A possible indication for a specific psychotherapy in atopic dermatitis is discussed.     

Individuelle Therapiezielerreichung nach Gruppentherapie „SAVE“

Background

Adolescents with attention deficit hyperactivity disorder (ADHD) are severely impaired in routine daily activities in the same way as adults. Therapy programs focus on improving everyday behavior. Goal attainment scaling (GAS) has already proven to be a suitable instrument for assessing treatment success with adult ADHD patients.

Material and methods

Goal attainment scaling was used in addition to standardized self-evaluation of core symptoms of ADHD in 49 adolescents aged 12-18 years old with a mean age of 14.14 years (standard deviation SD±1.59 years) with ADHD to operationalize treatment success of the cognitive behavior group therapy program SAVE. Behavior-oriented aims and criteria for target achievement were set. To examine treatment success changes were assessed at different time points (10 weeks before treatment, process evaluation during treatment and after treatment).

Results

The adolescents in this study were able to define relevant goals together with the therapists. They focused on goals concerning organization of everyday life, attention, distraction and power of endurance. Goals were reached from the beginning of the study to post-evaluation, even before SAVE started, with great effects (d?=?1.85). Adolescents evaluated changes in symptoms during the course of the SAVE program in general (d?=?0.47) and attention deficits (d?=?0.45) as having significant effects. The reduction in symptoms (attention) was only moderately correlated with the target achievement.

Conclusion

The GAS method has been proven to be a practical instrument to assess treatment success for adolescents with ADHD. Further studies in a controlled design should focus on assessment of the influence of GAS as an intervention method.     

Nachsorge nach station?rer Psychotherapie f��r Essst?rungen

Background

Despite high relapse rates there is a lack of feasible, effective and efficient interventions to provide aftercare support to patients who complete treatment for an eating disorder. A program based on the short message service (SMS) and text messaging has been developed in order to provide such additional support to patients who undergo inpatient treatment for an eating disorder.

Materials and methods

A total of 165 patients with bulimia nervosa or an eating disorder not otherwise specified were randomly assigned either to the intervention group (n?=?82) with access to the text messaging intervention for 4 months following discharge from hospital or to the control group (n?=?83). The efficacy of the intervention was determined via the three eating disorder related subscales of the Eating Disorder Inventory (EDI-2) at 4 and 8 months follow-up and via the frequency of self-reported binge eating and compensatory behaviors (vomiting and abuse of laxatives) in the Short Evaluation of Eating Disorders (SEED) at 8 months follow-up.

Results

Participants in the intervention group reported significantly lower impairment on the EDI scales drive for thinness and body dissatisfaction both at 4 and 8 months follow-up. They also reported significantly fewer episodes of binge eating and vomiting. No differences were found for the EDI subscale bulimia and for the frequency of the use of laxatives.

Conclusion

The intervention based on text messaging proved efficacious in the aftercare treatment of patients with eating disorders. Chances and limitations concerning its use in the clinical routine as part of a stepped care model are discussed.     

Scham und Familienbeziehungen bei Bulimie

Background

Empirical studies show a relationship between family factors and disturbed eating behavior. Feelings of shame are associated with a higher level of eating disorder symptoms and with family relations perceived as being dysfunctional. Thus shame can be understood as a mediator of the relationship between dysfunctional family relations and eating disorder symptoms.

Material and methods

For 69 female patients, including 55 with bulimia nervosa and 14 with eating disorder not otherwise specified (EDNOS) between 14 and 22 years of age, who participated in a comparative study of psychotherapy outcome, eating disorder symptoms (EDI, EDE-Q), general psychiatric symptoms severity (SCL-90R), level of shame (TESE-KJ) and perceived family relations (FB-A) were measured at the beginning of psychotherapy.

Results

The higher the feeling of shame the more dysfunctional the perceived family relationships were and the more the eating disorders and general symptoms severity were reported. Shame was a partial mediator of the relationship between family functionality and symptoms.

Discussion

Feelings of shame could originate in dysfunctional family relationships but could also evoke more negative perceptions of interpersonal relationships. The direction of causality could not be proven in the correlative design; nevertheless, shame contributes to an understanding of the mechanisms between dysfunctional family relationships and eating disorder symptoms.     

Schizophrene Patienten der forensischen Psychiatrie im Vergleich zu schizophrenen Patienten der Allgemeinpsychiatrie

Background

The number of schizophrenic patients admitted to forensic hospitals according to section 63 of the German Criminal Code has increased continuously over the past years. Some researchers assume that these forensic patients form a group of patients with very complex mental disorders, a number of risk factors and insufficient pretreatment in general psychiatry. This study aimed to identify differences regarding the history of treatment of forensic and general psychiatric patients diagnosed with schizophrenia.

Method

The matched samples included 72 male patients from forensic wards and 72 male patients from general psychiatric institutions diagnosed with schizophrenia. The history of psychiatric treatment was reconstructed by interviewing the patients as well as outpatient psychiatrists and patients’ legal custodians and by analyzing patient medical records.

Results

In contrast to the general psychiatric patients, prior to admission forensic patients were less integrated into psychiatric care and showed a lower rate of treatment compliance. They also showed a higher rate of previous compulsory treatment because of aggressive behavior towards other persons as well as higher rates of treatment difficulties and violent behavior during previous inpatient treatment. Furthermore, forensic patients had a higher number of previous criminal convictions and had been convicted more often for violent offences. With regard to other relevant risk factors (e.g. comorbid substance abuse disorder, age, education, conduct disorder, antisocial personality disorder, previous exposure to violent and abusive behavior) the two patient groups were, however, comparable.

Conclusions

Regarding schizophrenic patients with comorbid substance abuse disorders, previous violent delinquency and violent behavior during previous inpatient treatment, an intensive outpatient aftercare should be arranged before they are discharged from general psychiatric institutions.     

Patienten- und Elternzufriedenheit bei intensiver,klinikvernetzter Zu-Hause-Behandlung

Background

Due to the increasing importance of effective, patient-oriented treatment options for mentally ill children and adolescents, new alternatives to established inpatient and outpatient care in child and adolescent psychiatry have to be found. Intensive cross-sectoral treatment settings may be an alternative but have not yet been evaluated or implemented in routine care.

Aim

The objective of this randomized study was to compare and assess satisfaction with a new model of care within the underlying BeZuHG (“behandelt zu Hause gesund werden”, treated at home become healthy) study with regular inpatient care (TAU). Patients in BeZuHG received early discharge from inpatient care followed by 3 months of intensive home treatment enhanced by clinical elements.

Material and methods

Youths and parents were asked to fill in a patient satisfaction questionnaire (BesT) at completion of treatment. Participants in the study were evaluated between April 2012 and January 2013.

Results

Neither BeZuHG nor inpatient care was clearly superior. Youths in the control group stated a higher satisfaction with the overall treatment than youths in the BeZuHG group (p?=?0.031), while youths in the BeZuHG group named a significantly higher satisfaction with the home treatment component than with the inpatient component of treatment (p?=?0.007).

Conclusion

Patient satisfaction could be shown for inpatient and BeZuHG treatment at discharge. Data may change at follow-up. A long-term follow-up should be implemented to confirm these results or to allow other conclusions.     

Stabilität posttraumatischer Intrusionen bei Polizeibeamten

Objectives

This prospective study examined the course of posttraumatic symptoms of police officers across a time span of 12 months (T1: directly, T2: 6 months and T3: 12 months) after confrontation with an event of potentially traumatic nature while on duty.

Method

A total of 50 police officers were diagnosed 6 months after the event (T2) using a structured interview (SCID-I and SCID-II). The global functioning was operationalized at T1 and T2 by the Global Assessment of Functioning Scale (GAF) and the degree of impairment by the Impairment Score (IS). Furthermore, the intensity of posttraumatic symptoms was assessed at T1 and T2 by the Impact of Event Scale - Revised (IES-R). After 12 months (T3) the intensity of posttraumatic symptoms of 40 police officers was assessed again by a mail enquiry.

Results

Of the police officers 14 (28%) received the diagnosis of post-traumatic stress disorder (PTSD) after 6 months. In the PTSD group a significant drop in the level of functioning and a significant increase in the degree of psychiatric impairment could be found. Concerning the stability of the intensity of posttraumatic intrusions (IES-R subscale intrusions) the PTSD group showed in comparison to the non-PTSD group a slower decrease of symptoms over the period of 12 months (ordinal interaction) and no such strong amelioration of the symptoms as for avoidance and hyperarousal could be found.

Conclusions

Although the police force are, due to pre-employment screening and the professional training, both mentally and physically healthy in comparison with the general population, the results point at the risk potential of exceptional events for police officers. Due to the fact that the intensity of posttraumatic intrusions remained on a relatively stable level it seems indispensable to render these police officers further professional support.     

Evaluation des Screeninginstruments „Autism Mental Status Examination“

Background

Diagnostic procedures for autism spectrum disorders (ASD) include a thorough patient history, a clinical evaluation and the use of specific assessment tools, such as the autism diagnostic observation schedule (ADOS). For initial screening other instruments, such as questionnaires addressing the parents as well as affected children also exist. The autism mental status examination (AMSE) was developed to provide clinicians with a short, structured instrument to collate impressions after a clinical exploration. First studies from the USA showed a sensitivity and specificity which were satisfactory for a screening instrument with a cut-off score of 5.

Aim

The specificity and sensitivity of the German-speaking version of the AMSE for detection of ASD were investigated in a psychiatry cohort of children and adolescents.

Material and methods

This article reports the findings of a pilot study on the first use of the German version of the AMSE in 21 children who were evaluated for ASDs.

Results

The findings show a promising overlap with the ADOS and a satisfactory statistically significant correlation of 0.43.

Conclusion

The German version of the AMSE seems to be a promising screening instrument for ASDs; however, it cannot replace specific diagnostic tools.     

Bindungsrepräsentation bei stationär behandelten chronisch-depressiven Patientinnen

Background

Studies on the association between attachment and chronic depression are scarce.

Aim

This study was carried out to investigate attachment representations in chronically depressed female inpatients.

Material and methods

A total of 20 female inpatients with major depression were assessed with the adult attachment interview. Attachment representations were assessed following the method of Main et al. Furthermore, a dimensional evaluation of attachment representations according to Waters was compiled and related to symptom severity.

Results

The analysis of attachment resulted in a distribution of 5?% securely attached patients, 30?% with insecure-avoidant attachment, 15?% insecure-preoccupied attachment and 50?% disorganised attachment representation. For the dimensional approach along the secure-insecure dimension, attachment security was correlated with global assessment of functioning (GAF) and reflective functioning and insecurity was correlated with unresolved loss. For the dimension avoidance-preoccupation a relationship was found between avoidance and GAF.

Conclusion

In comparison to non-clinical samples the results demonstrate a high proportion of insecure and disorganised attachment in this sample of severely depressed female inpatients with high chronicity (mean course of illness 11.7?±?7.6 years) and high symptom load (Beck depression inventory BDI =?36.6?±?8.7 points). This result underlines the importance of psychotherapeutic interventions for depressed patients with unresolved loss experiences.     

Cognitive-behavioral treatment of childhood obsessive-compulsive disorder in community-based clinical practice: clinical significance and benchmarking against efficacy

Objective

To evaluate the feasibility and outcomes of evidence-based (EB) manualized, cognitive-behavioral treatment (CBT) for childhood obsessive-compulsive disorder (OCD), when delivered in an outpatient community-based specialist clinic.

Method

This study, conducted in an outpatient private clinic in South-East Queensland Australia, involved thirty-three children and adolescents with OCD. Children were assessed at pre- and post-treatment, by means of diagnostic interviews, symptom severity interviews, and self-report. Treatment involved 12 sessions CBT delivered either individually or in small groups and included parental involvement.

Results

Manualized CBT could be transported to the community setting effectively, with 63% of the current sample responding positively, based on post-treatment diagnosis. Significant change was evident across a wide-range of outcomes; including, diagnostic severity, symptom severity, child reported depression and anxiety, and both child and parent reported OCD functional impairment.

Conclusions

This study provides evidence for the transportability of manualized CBT in clinical community practice for pediatric OCD. The next important step is larger community based dissemination and effectiveness studies to advance both research and clinical practice outcomes.     

Youth’s Negative Self-Statements as Related to Social Self-Efficacy Among Differing Relationships

Background

Cognitive variables are often neglected in child and adolescent populations despite their roles in the development and maintenance of psychopathology. Furthermore, the importance of examining these variables contextually is underestimated.

Objective

The present study aimed to examine the relationship between two theoretically related cognitive variables in a contextually relevant fashion by proposing several models demonstrating the association between negative self-statements and social self-efficacy holistically and among differing relationships (i.e., peers, adults, strangers) using Structural Equation Modeling (SEM) techniques.

Method

As part of a larger study, 126 participants (ages from 11 to 14 years) were recruited for participation from the middle school grades. Participants’ parents were contacted for informed consent, and subsequently, participants were asked to fill out a set of measures in assembly format.

Results

Results indicated that the structural model was well-fitted to the data. Specifically, the frequency of negative self-statements was found to indicate the amount of social self-efficacy present with more negative self-statements being associated with less social self-efficacy. Further, when examined among differing relationships via path analysis, the frequency of negative self-statements was found to be indicative of the social self-self efficacy with peers and adults, but not with strangers.

Conclusions

These findings provide useful information concerning cognitive trends, which are likely relevant for the enhancement of treatment processes in children and adolescents. Implications and recommendations are discussed.     

Internetbasierte Vorbereitung auf eine station?re psychosomatisch-psychotherapeutische Behandlung

Background

Encouraged by promising results of online aftercare programs, this study adapted the concept of internet-based minimal interventions in order to use the time between referral and actual admission to inpatient treatment. The online intervention includes information about the hospital and the treatment and sections which aim to enhance motivation, provide support and allow contact.

Methods

A comprehensive cohort study was conducted with 379 participants in the randomized subcohort. Primary endpoint was the speed of change of the physical, mental and social impairment and of the psychological well-being in the first 2 weeks of inpatient treatment as well as the rates of reliable change 2 weeks after admission.

Results

Both the control and intervention group of the randomized subcohort showed statistically significant improvements in health status. No significant difference in the rate of change was found. The degree of achieved improvement in the physical impairment was equal to the expected intervention effect. A difference in the rates of change was found for the psychological well-being: the intervention group showed 19% more reliable improvements.

Conclusions

The study design and the contents of the intervention were accepted by the patients. The internet-based intervention can help to prepare for treatment and to shorten the settling-in period.     

Schwere Anorexia nervosa

Background

Psychosomatic support during acute medical treatment of patients with anorexia nervosa is a special need but up to now a rare constellation. These patients can barely accept necessary somatic procedures even if they suffer from severe consequences of the eating disorder. The ambivalence of patients towards treatment is explained by the loss of the right perception of their bodies and the strong obsession with further weight loss.

Methods

This article reports on eight consecutively treated patients on a medical ward who received a liaison psychosomatic, psychotherapeutic visit twice a week. The aim was to maintain better therapy adherence, to support oral food intake and understanding of the disorder as well as to motivate patients for further psychosomatic treatment.

Results

By means of a respectful cooperation between the departments of internal medicine and psychosomatics it was possible to gain psychotherapeutic access to the patients in this highly complicated situation.

Consequence

The psychodynamic aspects of this collaboration are discussed with a focus on the triangulation of the therapeutic process.     

Eltern und Patienten als Subjekt der Behandlung

Background

There are hardly any alternatives to inpatient treatment for children and adolescents in need of intensive psychiatric treatment. In the randomized study BeZuHG (“behandelt zu Hause gesund werden”, treated at home become healthy), equality of treatments could be shown in the outcome parameters when comparing TAU (inpatient treatment) and the new treatment module BeZuHG (early discharge followed by intensive home treatment enhanced by clinical elements). Patient satisfaction with each treatment module was evaluated at follow-up.

Material and methods

In this study 144 parents and patients of the intervention group (n?=?79) and the control-group (n?=?65) were interviewed after an average of 8 months. Information on expectations, experience with BeZuHG, changes in communication and interaction within the family as well as problem solving strategies (and sustainability of the changes), overall satisfaction and treatment suggestions for modification of the BeZuHG treatment were collected in semistructured telephone interviews.

Results

The following aspects in the BeZuHG treatment were rated as important by parents and patients: support and help with transfer problems, single sessions, a trusting therapeutic relationship as well as treatment setting at home. Enhanced problem solving skills as well as improved family communication were noticed. In the intervention group 70?% would prefer the BeZuHG setting to inpatient care and 46?% in the control group.

Conclusion

The BeZuHG concept is a good and functional alternative to inpatient treatment. Continuity in treatment and therapeutic relationships are essential for successful treatment at home. Positive treatment results within the family as well as the patient remain stable at follow-up after 8 months.