Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) im Jugendalter

Attention deficit–hyperactivity disorder (ADHD) in children and adolescents is a common and severe psychiatric disorder with a prevalence between 2 and 6%. In a high percentage of cases, there is a positive family history. In almost all sufferers, persistent functional limitations that impact everyday life are observed. The prognosis for untreated ADHD is very poor, being associated with social decline, drug addiction, and delinquency. Diagnosis is complex. Typical symptoms are often “hidden”. They are age specific and are mainly associated with inattention, impulsiveness associated with aggression and delinquency, and dangerous risk-taking behavior. More than half of patients also have additional comorbid disorders. The treatment concept always includes nonpharmacological interventions, which are often supplemented with drugs.     

„Psychopathy“ im Kindes- und Jugendalter

The term psychopathy is defined as a severe personality pathology, which is characterized by extreme aggressive, antisocial and violent behavior as well as affective and interpersonal deficits. In recent years, research into the construct of psychopathy has often focused on the incidence and detection of such pathologies in children and adolescents. In this context, a point of interest is to explore the course and stability of psychopathic personality dimensions throughout youth. Results demonstrate clear evidence for the occurrence of personality traits characteristic for psychopathy in early childhood and adulthood, which facilitates early detection with the aid of age-specific diagnostic instruments.The distinct correlation between psychopathy and severe, repeated and largely treatment refractory violence, which results in substantial public damage, calls for further research in children and adolescents in order to define the construct of psychopathy more precisely, to further illuminate underlying pathologies and consequently develop more specific typologies and effective treatment strategies. To that end, it is of particular importance to correctly capture dimensional factors of psychopathy in youth and to examine their stability throughout stages of adolescent development.     

Depressive Störungen im Kindes- und Jugendalter

Unipolar depressive disorders in adolescence are common, lead to serious impairments and are often associated with comorbid disorders and a high risk for suicide. Thus, recognition and early treatment of depressive disorders are important. International and national treatment guidelines show that effective treatment approaches for prevention and acute therapy of depressive disorders are available. Based on current evidence and consensus-based guidelines, such as the Association of the Scientific Medical Societies in Germany (AWMF) S3 treatment guidelines for unipolar depressive disorders in children and adolescents, state of the art diagnostic procedures and treatment recommendations are proposed. Diagnostic procedures and differential diagnoses as well as differential indications and treatment planning are reported in detail. In the treatment section the focus is on cognitive behavioral therapy (CBT), which is currently the best evaluated psychological treatment form for depressive disorders in children and adolescents.     

Stationäre oder teilstationäre Psychotherapie?

In a pilot study we compared two groups, one of inpatients and one of day clinic patients who were treated between January 1999 and December 2001 at the Department of Psychosomatics and Psychotherapeutic Medicine in Freiburg/Germany. Both settings offer a similar, multimodal and intensive psychotherapy program on a psychodynamic background. In a first explorative data analysis (sociodemographic data, SCL-90-R, IIP-C) we studied differences in severity of initial symptomatology and differences in outcome (prae/post). Patients with anorexia nervosa and a very low weight were preferentially treated in the inpatient setting. In addition the inpatient group of patients with a somatoform disorder showed higher degrees of somatization, as compared to patients with a somatoform disorder in the day clinic. Therapeutic change with respect to psychopathology however did not differ between the two settings: both groups showed a significant improvement during the course of therapy.     

Aktuelle Entwicklungslinien in der Pers?nlichkeitsforschung im Jugendalter

Personality disorders in juveniles are still a controversially discussed topic. The aim of this paper is to describe the recent trend in personality research in adolescence and to outline perspectives in research and assessment. Recent study results have pointed out that personality disorders in juveniles can be reliably assessed with diagnostic instruments that have been developed for adults. At the same time there is a lack of specific instruments that can represent the characteristics during adolescence and that can differentiate personality disorders from youth crises. As some personality disorder dimensions also describe unstable developmental criteria we will focus separately on this differential diagnosis and meaning of stable versus transient personality characteristics in youth. The prevalence of personality disorders seems to be higher in adolescence than in adulthood. The stability, however, is comparable in adolescence and adulthood. Psychopathy as a subtype of the antisocial personality disorder ?C that can also be assessed in juveniles ?C will be discussed regarding its core and behavioral dimensions as well as primary and secondary subtypes. Furthermore, we discuss forensic issues when assessing personality disorders with respect to criminal responsibility. Overall we can show that more diagnostic longitudinal studies are essential in order to clarify under which conditions personality disorders develop, which factors influence its course and which interventions can change them.     

Angststörungen und Phobien im Kindes- und Jugendalter

Anxiety disorders belong to the most frequent mental disorders in childhood and adolescence. They cause severe impairment, show poor long-term outcome and they are often not recognized as a mental disorder. For a reliable and valid diagnosis and treatment outcome evaluation a multi-informant approach is essential including information from the child and the parents. Methods of choice are structured clinical interviews and questionnaires filled out by the child and the parents. Meta-analyses showed that only cognitive-behavioral treatment can be considered as a sufficiently evidence-based treatment. No differences in outcome were found between individual and group treatments or child and family focused treatments. Medication treatment with selective serotonin reuptake inhibitor (SSRI) showed short-term efficacy. Major evidence-based interventions are psycho-education, exposure techniques and cognitive restructuring strategies.     

Sekundäre Demenzen

The majority of dementias are caused by degenerative disorders, followed by dementias with a vascular etiology. A mixed etiology is especially common in the elderly. Dementias associated with other disorders are relatively rare accounting for about 10?% of all cases and result from structural, inflammatory or metabolic disorders of the brain. The spectrum of etiologies covers such different disorders as limbic encephalitis, intracranial malignancies, AIDS, vitamin deficiencies, alcoholism and even normal pressure hydrocephalus. The symptomatic nature of these disorders enables the possibility of a causal treatment in some cases.     

Evolutionäre Psychiatrie

In contrast to mainstream psychiatry which mainly focuses on the proximate causes of human behavior, evolutionary psychiatry tries to elucidate the ultimate causes of the systems involved in generating specific behavioral patterns. Thus, it is in contradiction to the tabula-rasa model commonly used in social sciences. Using this explanatory approach, it is shown that behavioral sciences like human ethology initiated by K. Lorenz and I. Eibl-Eibesfeldt provide an important scientific basis for modern psychiatry.     

Teilstationäre Psychotherapie

Psychotherapeutic day clinics increasingly take over responsibility for the treatment of patients who cannot be cared for satisfactorily, respectively, at all in an inpatient setting. Psychotherapy in a day clinic setting is a treatment in its own right which has progressively established itself between inpatient and outpatient treatment. Empirically raised up to date data prove the efficacy and the efficiency of psychotherapeutic treatment in day clinics. Accordingly, the goal of the present study is to investigate the outcomes of psychotherapeutic treatment in a day clinic with a psychodynamic concept. Since 1996 the psychotherapeutic day clinic Basel empirically assesses the treatment course of all admitted patients. Patients and therapists fill in questionnaires upon admittance, two months into the course of treatment and upon discharge (SCL-90-R, PSKB-Se-R, OPD etc.) Our results indicate that significant improvements of symptoms as well as of socio-communicative competency can be achieved during treatment which remain stable even after discharge (first follow-up three months after discharge). Comparing outcome data of patients treated in full-time inpatient setting and of patients who undergo partial hospitalization we found that outcome was at least equivalent. Additionally we found that the diagnosis of a personality disorder influenced treatment results significantly in some symptom specific spheres.     

Sekundäre Traumatisierung

During the past several years there has been a growing interest in the negative effects that therapy may have on therapists. Of special interest is a phenomenon called secondary traumatization, which can arise while working with traumatized clients. As yet it has not been verified that secondary traumatization consists of posttraumatic symptoms and leads to clinically significant distress. In an exploratory study 21 therapists were interviewed who declared that they had experienced an incident of this form of work-related stress. The presented study reveals that in fact such a ?vicarious“ traumatization can arise, even without direct contact to the original trauma. It consists of post-traumatic stress disorder (PTSD)-like symptoms, but in severe cases it can also manifest itself in symptoms which are far beyond the typical PTSD spectrum. Conditions for the development of secondary traumatization are high empathic ability and dissociative processing of the trauma material by the therapist.     

Stationäre Rehabilitation alkoholabhängiger Patienten

Systemic therapy concepts are widely used in therapy and rehabilitation of alcohol addictive patients. Although very useful in practice, evaluation studies are rare. Adequate evaluation strategies should be developed and implemented. This study was realized in a clinical rehabilitation centre (Hirtenstein, Allgäu/Germany), whose systemic concept is characterized by patient's wideranged possibilities of choice concerning therapy measures and therapy goals, the activation of social and personal resources, the development of an individually appropriate life-style, the training of desired competencies, and an offer for marital and family therapy. The evaluation is based on a repeated measures design without control group. The instruments and constructs of the evaluation are: F-SOZU (perceived social support), IIP (perceived interpersonal problems), MLDL (quality of life), SOC (sense of coherence), and an assessment sheet for personal resources (RI). Patients (n= 44) reported increased personal ressources as well as an increased level of quality of life. Perceived social support and the sense of coherence changed only moderately. Scaling of treatment satisfaction and goal attainment at the end of the rehabilitation program resulted in high positive scores. Patients reported only positive, no negative treatment side effects. The results indicate the usefulness of systemic and resource oriented concepts in the rehabilitation of alcohol addictive patients.     

Endovaskuläre Therapie des akuten ischämischen Schlaganfalls

Endovascular therapy of acute ischemic stroke represents a supplementary or (in cases of contraindications to systemic lysis) alternative therapy option to intravenous thrombolysis for patients with severe clinical deficits and proximal vascular obstruction. Currently, (in cases with no contraindications to systemic lysis) the combination with mechanical thrombectomy in the form of so-called stent retrievers has proven to be effective and safe. Until superiority over intravenous thrombolysis alone has been proven in certain patient groups, patients who have received endovascular therapy should be carefully documented in register-based studies.