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Possibilities for Suicide Prevention Through Architecture in Child and Adolescent Psychiatry Abstract. In Germany, departments of Child and Adolescent Psychiatry are responsible for the treatment of young people with acute suicidal tendencies. Therefore, it is important to consider means of preventing suicide already during the construction and business operations of these institutions. Approaches to structural suicide prevention can be divided into restrictive and atmospheric-therapeutic measures. The latter includes ways to create an antisuicidal environment and to establish a setting amenable to close support and care by mental-health professionals. Restrictive measures comprise security measures and means of avoiding potential hazards, for example, through life-threatening jumps (e. g., staircases) or intentional strangulation (e. g., employing materials with predetermined breaking points). In addition to security issues, architectural and creative aspects must be incorporated to enable a suicide-preventive atmosphere, that is, satisfying protective needs, creating positive distractions (panoramic views, activities, occupational therapy opportunities), and using positive physiological and natural influences (such as colors and light). Secure access to a pleasant and protected external area as well as exercise spaces is also essential. Architects and construction managers should work closely with the institution's health personnel (e. g., doctors, therapists, and psychiatric nursing staff) during the planning stages for Departments of Child and Adolescent Psychiatry in order to come up with solutions that comprise appropriate, practical, and functional requirements and safety-restrictive measures. Thus, an inviting and atmospherically pleasant space can be created that simultaneously provides suicide prevention and protection, where adolescents with psychiatric disorders can be treated by mental-health professionals.Zusammenfassung. Da in Kliniken für Kinder- und Jugendpsychiatrie auch Jugendliche mit akuter Suizidalität behandelt werden, sind beim Bau und Unterhalt solcher Kliniken suizidpräventive Maßnahmen zu berücksichtigen. Die Ansätze der baulichen Suizidprävention lassen sich in restriktive und atmosphärisch-therapeutische Maßnahmen unterteilen. Letztere umfassen Maßnahmen zur Schaffung eines antisuizidalen Milieus und zur engen Begleitung der Patienten und Patientinnen durch die Mitarbeiter. Unter restriktiven Maßnahmen sind die Sicherung von potenziellen Sprung- sowie die Reduzierung von Strangulationsmöglichkeiten, zum Beispiel durch die Verwendung von Materialien mit Sollbruchstellen, zu verstehen. Neben suizidpräventiver sichernder Gestaltung sind zur Schaffung einer solchen suizidpräventiven Atmosphäre architektonisch-gestalterische Aspekte zu berücksichtigen, wie zum Beispiel Befriedigung des Schutzbedürfnisses, Schaffung positiver Ablenkung (Blick in Natur, Beschäftigungsmöglichkeiten) und die Nutzung positiver physiologischer Wirkung (durch Licht, Farben). Ein gesicherter Zugang zu einem ansprechenden und gleichzeitig geschützten Außenbereich sowie zu Bewegungsräumen ist ebenfalls zu berücksichtigen. Bereits in der Planung einer kinder- und jugendpsychiatrischen Klinik sollten sich Architekten und Bauplaner eng mit Ärzten, Therapeuten und Mitarbeitern des Pflege- und Erziehungsdienstes austauschen und restriktive Maßnahmen hinsichtlich Praktikabilität und funktionellen Abläufen abstimmen. So kann kooperativ ein suizidpräventiver, ebenso sichernder wie atmosphärisch ansprechender altersgerechter Ort entstehen, an dem Jugendliche mit psychischen Störungen mit therapeutischer Unterstützung und fachpflegerisch-pädagogischer Begleitung behandelt werden können.

The medium- and long-term effects and side effects of inpatient treatment of patients with anorexia nervosa is still a matter of debate. The German S3-guidelines underline the importance of providing specialized and competent treatment. In this article we focus on the inpatient service structure in German child and adolescent psychiatric clinics with regard to their diagnostic and therapeutic concepts.A self-devised questionnaire was sent to 163 German child and adolescent psychiatric clinics. The questionnaire focused on the characteristics of the respective clinic as well as its diagnostic and therapeutic strategies.All clinics with an inpatient service for patients with anorexia nervosa (N = 84) provide single-therapy, family-based interventions and psychoeducation. A target weight is defined in nearly all clinics, and the mean intended weight gain per week is 486 g (range: 200 g to 700 g/week; SD = 117). Certain diagnostic tests and therapeutic interventions are used heterogeneously.This is the first study investigating the inpatient service structure for patients with anorexia nervosa in German clinics. Despite the provision of guideline-based therapy in all clinics, heterogeneous approaches were apparent with respect to specific diagnostic and therapeutic concepts.

Nonsuicidal self-injury (NSSI) is a frequent, clinically relevant phenomenon occurring in adolescence, which can be observed parallel to various mental disorders. Within Europe, Germany has one of the highest prevalence rates in youths, with the lifetime prevalence ranging between 25–35 %. To date a guideline on the treatment of self-injury and stereotypic motoric disorders has been available, the last having been updated in 2006 and expired in 2011.The guideline development group consisted of members of 11 medical, psychological, or psychotherapeutic professional associations and two members from patient and prevention groups. The guideline was developed in two meetings followed up by consecutive literature searches; it was adopted in a final consensus conference. The algorithm on the treatment of NSSI was approved in three rounds of a Delphi process.Although there is solid evidence of NSSI from the fields of epidemiology and diagnostics, few studies report data on the longitudinal course as well as on the psychotherapeutic and adjuvant psychopharmacological treatment of NSSI in adolescence. The stepped care regimens in cases demanding somatic treatment were addressed interdisciplinarily.In accordance with the heterogeneous evidence, important points for the treatment of NSSI in adolescence were determined in a consensus conference. There is still a lack of knowledge on prevention as well as clinical interventions, both of which need to be addressed by further research.

Due to the clinical relevance of suicidal risks, suicide attempts, and suicides in adolescence consensus-based guidelines with clinical recommendations were updated and summarized in this article. It should be considered that each indication has to be taken serious. Suicidality is an essential component of the psychopathological report and should be explored for the short- and long term risk. The clinical assessment of the acute suicidality results from a trustful anamnestic conversation, assessment of risk factors, mental disorders, and the use of alcohol and drugs. Acute suicidality is an indication for an inpatient treatment that for the protection of the patient has to be implemented also against his will. An adequate documentation is inevitable. After a suicide attempt, in addition to the initial medical treatment it has to be paid attention that the patient cannot harm himself any further and a rapid consultation in the responsible clinic takes place. First therapeutic goal is the reduction of suicidality and if necessary the re-achievement of the ability to negotiate a non-suicide agreement. For recurrent suicide thoughts an emergency plan has to be created. In addition to offer conversations, for a further relief a temporary sedated psychopharmacology can be necessary. In case of a suicide in a clinic, recommendations should be present that regulates responsibilities and procedures. Effective prevention methods are multiplier training, public education, restricted access to methods, and complying with media guidelines.

Postvention is the term used to describe a package of interventions designed for people affected by suicide. Inpatient suicides in Departments of Child and Adolescent Psychiatry are rare, but nevertheless constitute an immense burden to family members, friends, and fellow patients, as well as to medical staff members. Besides including an effective management of the acute crisis situation with well-defined communication rules, appropriate interaction with the bereaved, and prevention of copycat suicides in other patients, reliable guidelines for dealing with inpatient suicide must also contain a precise procedure on how to handle mental stress in physicians, psychotherapists, and other staff members. Furthermore, postvention should be an important part of the professional training of physicians as well as psychotherapists who work in child and adolescent psychiatry departments or outpatient clinics.

The Autism Diagnostic Observation Schedule, Second Edition (ADOS-2) is a revision of the standardized assessment for individuals with suspected autism spectrum disorders (ASD). The study examines the diagnostic accuracy of the original and revised algorithms for Modules 1 through 3.In a large clinical sample of children and adolescents (N = 1080, age 1.7 to 20.5), the differentiation of ASD from relevant differential diagnoses was investigated. As studies on the diagnostic accuracy for girls are sparse, comparisons concerning the diagnostic accuracy for gender subgroups were undertaken.The revised algorithms exhibit an improvement in sensitivity (84.9 %) and a slight reduction in specificity (85.7 %). The improvements in the ADOS-2 pertain especially to cases with core autism and girls. Including the repetitive behavior domain in the algorithm contributes to a correct clinical ASD classification in modules 2 and 3. This was not found for younger children examined with module 1. Results also suggest less effective diagnostic differentiation for children and adolescents with internalizing disorders and conduct disorder.Good diagnostic accuracy was found for children in the average range of cognitive abilities. Results suggest good diagnostic utility for the ADOS-2 in clinical settings, provided that thorough diagnostics are given by experienced examiners.

The German Psychiatry Personnel Act, which went into effect in 1990, has led to a decrease in the number of child and adolescent psychiatry inpatient beds, to a decrease in the length of stay, and to an increase in inpatient psychotherapy. Today, this act is outdated~ for a number of reasons, such as changes in the morbidity of the population, the rising number of emergencies, and new professional standards such as documentation. In addition, new legal provisions and conventions (like the UN Convention on the Rights of the Child) necessitate a complete reevaluation. Child and adolescent psychiatry needs a normative act to enable the necessary implementation. Many different rationales are available to support the debate.

Various different questionnaires are available for the screening of autism spectrum disorders (ASD). These screening instruments show high sensitivity and are able to identify a large number of individuals with ASD, but they lack the specificity to differentiate individuals with ASD from those children and adolescents with other complex neurobehavioural disorders (such as attention-deficit/hyperactivity disorder, emotional disorders, and others), especially for those without intellectual disabilities.The present study evaluates the data of 309 individuals (153 with high-functioning ASD, 156 with other psychiatric disorders, IQ70) to find out whether selected items of the ADI-R can be used for an economic and sensitive screening of high-functioning ASD.The results show that 8 items of the ADI-R can be used to discriminate high-functioning ASD and other psychiatric disorders. A cutoff of 5 led to a sensitivity of 0.93 and a cutoff of 6 to a specificity of 0.74.The combination of early onset, serious abnormalities in social contact with stereotyped or compulsive-ritualized behaviour or interests can be detected with few interview questions for screening of ASD. Nevertheless, a more detailed and specific assessment in an expert setting should follow the screening process.

Dissemination of knowledge concerning normal and deviant development as well as child and adolescent psychiatric (CAP) disorders with a focus on diagnosis and treatment should represent an integral part of medical training at every medical school. Furthermore, it is of utmost importance that medical students acquire skills in communication and basic psychiatric assessment of children and adolescents. The article summarizes the current state of affairs of teaching in CAP in German medical schools.All chairs of child and adolescent psychiatry were asked for detailed information on involvement in compulsory and noncompulsory medical training, scope of lectures in CAP, and courses for students of other disciplines.In 25 out of 26 medical schools with a chair for CAP this medical specialty is already part of compulsory medical training. CAP is either taught in independent lectures or is integrated into lectures on psychiatry, pediatrics, and/or psychosomatics. The main lecture of 1.2 semester periods per week on average (range 0.1 to 2, the equivalent of 2 to 28 teaching units per semester) is complemented by numerous additional offers (internships, advanced courses, compulsory elective subjects). The CAP elective tertial of the "practical year" (final year of medical school in Germany) can be completed at all medical faculties with a CAP chair. CAP is often taught students of other disciplines as well, e.g., psychology or education.Given the importance of CAP, the overall goal should be to anchor CAP as a required specialty in all 35 medical schools in Germany.Einleitung: Wissen über kinder- und jugendpsychiatrische Störungen, deren Diagnostik und Therapie, Kenntnisse über Risiken devianter Entwicklungen, sowie das Erlernen von Fertigkeiten im adäquaten Umgang mit Kindern und Jugendlichen gehören in jede Medizinerausbildung. Die vorliegende Arbeit ist eine Bestandsaufnahme der Lehre im Fach Kinder- und Jugendpsychiatrie (KJP) an den medizinischen Fakultäten in Deutschland. Methodik: Es wurden alle Lehrstuhlinhaber für KJP befragt zur Einbindung in die Pflichtlehre, zu den Lehrangeboten für KJP vor Ort und zu Lehrangeboten für andere Fachbereiche. Ergebnisse: An 25 von 26 medizinischen Fakultäten mit Lehrstuhl für KJP ist das Fach KJP bereits in die Pflichtlehre für Mediziner integriert. Die Vorlesung wird entweder als eigenständige KJP-Vorlesung gehalten oder ist in die Vorlesung Psychiatrie, Pädiatrie und/oder Psychosomatik integriert. Die durchschnittlich 1.2 Semesterwochenstunden umfassende Hauptvorlesung (Range von 0.1 bis 2 SWS; entsprechend 2 bis 28 Unterrichtseinheiten KJP pro Semester) wird durch zahlreiche weitere Lehrangebote ergänzt, wie Praktika, vertiefende Veranstaltungen und Wahlpflichtfachangebote. Das KJP-Wahltertial des Praktischen Jahrs kann an allen Orten mit KJP-Lehrstuhl absolviert werden. Oft wird KJP-Lehre auch für andere Fachbereiche angeboten, am häufigsten für Studierende der Psychologie und der Pädagogik. Schlussfolgerung: Ein übergeordnetes Ziel sollte es sein, KJP aufgrund ihrer Bedeutung als Approbationsfach in der ärztlichen Ausbildungsordnung zu verankern und zukünftig an allen 35 Universitäten mit Fachbereich Medizin in Deutschland zu lehren.

Multiple complex developmental disorder (MCDD) is a little-known disorder characterized by disturbances in the regulation of emotions, social interactions and thought disorders. Neither the classification system of ICD-10 nor the DSM-IV lists MCDD as an independent disorder.The study presents an overview on diagnostic criteria, current research and illustration by a case report of a 17-year-old adolescent.MCDD, autistic disorders and schizophrenic disorders partially overlap. A clear classification or differentiation is currently not clearly possible.Many open questions remain, and further research is needed.

When a parent has a serious somatic illness, children suffer grave distress, their risk to develop a mental disorder increases. Sick mothers, in comparison to patients without children, experience additional strain, e. g. because they worry about their children. Although many studies focus on the quality of life of breast cancer patients, little is known about the special situation of young mothers with breast cancer. Currently, a prospective study with four assessment points (pre, post, 3- and 12-months-follow-up) is conducted on a large sample of women taking part in the family-oriented inpatient rehabilitation program "gemeinsam gesund werden'. In this paper a longitudinal sample of 173 women and 153 children, their quality of life and psychological impairment prior to, after and in the course of one year after the rehabilitation is presented. Compared to the general population, the children as well as the mothers are considerably impaired, especially in regard to Psychological Health/Emotional Functioning. These impairments improve markedly within the survey period. One year after the rehabilitation, the children show no more impairment than the reference groups. The mothers improve significantly as well, however, after one year their quality of life scores are still lower than those of the general population. In conclusion, a considerable impairment of the analyzed group of mothers with breast cancer and their children, the necessity of special supportive measures as well as the effectiveness of the model rehabilitation program can be shown.

Considerable debate exists regarding differing prevalence rates of co-morbid bipolar disorder in children and adolescents with ADHD in Germany as compared to the US.Described in this case report are the assessment of and treatment procedure for a 14-year old boy with hyperkinetic conduct disorder and co-morbid hypomanic episode, as well as different possible interpretations of symptoms.Further studies of children and adolescents with ADHD and coexisting impulsive-aggressive behaviour are needed. Important in practice is a precise differentiation of symptoms with regard to co-morbid bipolar disorder.

Eine schwere korperliche Erkrankung der Eltern stellt fur Kinder eine grose Belastung dar, sie tragen ein erhohtes Risiko psychische Storungen zu entwickeln. Kranke Mutter erfahren im Vergleich zu kinderlosen Patienten zusatzliche Belastungen, da sie sich z. B. um ihre Kinder sorgen. Obwohl uber die Lebensqualitat von Brustkrebspatientinnen viele Studien vorliegen, weis man wenig uber die spezielle Situation junger Mutter mit Brustkrebs. Im Rahmen einer prospektiven Studie mit vier Messzeitpunkten (Pra, Post, 3-, und 12-Monats-Follow-up) zur Evaluation der familienorientierten Modell-Rehabilitationsmasnahme „gemeinsam gesund werden“ werden z. Z. Daten einer grosen Stichprobe erhoben; in der vorliegenden Arbeit wird eine Langsschnittstichprobe von 173 Frauen und 153 Kindern hinsichtlich ihrer Lebensqualitat und psychischen Beeintrachtigung vor der Rehabilitation und im Verlauf eines Jahres vorgestellt. Sowohl Kinder als auch Mutter sind im Vergleich zur Allgemeinbevolkerung vor der Rehabilitation erheblich beeintrachtigt, das betrifft insbesondere die Bereiche Psychische/Emotionale Gesundheit und Funktionsfahigkeit. Diese Beeintrachtigungen verbessern sich im Erhebungszeitraum. Die Kinder sind nach einem Jahr in keinem der erfassten Bereiche auffalliger als Vergleichsgruppen aus der Allgemeinbevolkerung, auch die Mutter verbessern sich deutlich, sind jedoch im Vergleich zur Allgemeinbevolkerung weiterhin eingeschrankt. Durch die Studie kann somit eine erhebliche Beeintrachtigung der untersuchten brustkrebskranken Mutter und ihrer Kinder, die Notwendigkeit spezieller Unterstutzungsangebote sowie die Effektivitat des Modellprojekts aufgezeigt werden Schlagworter Kinder korperlich kranker Eltern – Kind beeintrachtigter Eltern – Brustkrebs – Lebensqualitat – Rehabilitation When a parent has a serious somatic illness, children suffer grave distress, their risk to develop a mental disorder increases. Sick mothers, in comparison to patients without children, experience additional strain, e. g. because they worry about their children. Although many studies focus on the quality of life of breast cancer patients, little is known about the special situation of young mothers with breast cancer. Currently, a prospective study with four assessment points (pre, post, 3- and 12-months-follow-up) is conducted on a large sample of women taking part in the family-oriented inpatient rehabilitation program “gemeinsam gesund werden”. In this paper a longitudinal sample of 173 women and 153 children, their quality of life and psychological impairment prior to, after and in the course of one year after the rehabilitation is presented. Compared to the general population, the children as well as the mothers are considerably impaired, especially in regard to Psychological Health/Emotional Functioning. These impairments improve markedly within the survey period. One year after the rehabilitation, the children show no more impairment than the reference groups. The mothers improve significantly as well, however, after one year their quality of life scores are still lower than those of the general population. In conclusion, a considerable impairment of the analyzed group of mothers with breast cancer and their children, the necessity of special supportive measures as well as the effectiveness of the model rehabilitation program can be shown. Keywords children of somatically ill parents – child of impaired parents – breast cancer – quality of life - rehabilitation

The presence of certain alleles in polymorphisms of the dopamine receptor gene (DRD4) and the dopamine transporter gene (DAT1) increases a child's risk of developing ADHD or another mental disorder. We investigated whether or not the severity of the above-mentioned dopaminergic polymorphisms is associated with regulatory disorders in infancy.The Mannheim Study of Children at Risk interviewed parents of three-month-old children in depth about behavior problems and observed parents and children in various situations as well. The genotyping for DRD4 and DAT1 polymorphisms was carried out in the children by means of standard methods at the age of 15 years. Investigated were 300 children (145 boys, 155 girls) for whom complete datasets existed with regard to the research question.Isolated regulatory problems were observed in 54 boys, respectively in 64 girls (37.2%, respectively 41.3%), while 17 boys, respectively 19 girls (11.7%, respectively 12.3%) exhibited multiple regulatory problems. In boys, the presence of the DRD4-7r allele was significantly associated with the occurrence of multiple regulatory problems (p = .04). No such association was found with regard to isolated regulatory problems, or among girls. There was no association for either gender between the DAT1 genotype (10r/10r vs. rest) and isolated or multiple regulatory problems.The result must be replicated in an independent sample before any conclusions can be drawn.

Infectious diseases represent a continuous and increasing threat to human health and welfare. Due to emerging diseases, increasing resistances, international travelling, and the risk of bioterroristic attacks, infectious diseases concern the whole world and can only be combated by internationally coordinated and interdisciplinary approaches. When assessing the worldwide publication activities on infectious diseases in the years 1994–2004 accessible via the ISI Science Citation Index Expanded ® , an overall increase by 24% can be monitored. Furthermore, it becomes evident that highest research priorities are given to HIV/AIDS, hepatitis C, tuberculosis, respiratory infections, and sepsis. Ten countries – including the USA, the UK, France, Germany, and Japan – contributed to more than 80% of these publications; nation-specific research priorities focusing on the current problems in the respective country can be estimated. Countries with the highest disease burdens are still not given the opportunity to contribute adequately to the scientific field. Based on our data, relatively increasing publication activities include those on respiratory infections, tuberculosis, malaria, hepatitis, and sepsis, whereas decreasing activities were determined for AIDS, diarrhoea, meningitis, schistosomiasis, and other diseases. Accordingly, the prevalence of many infectious diseases occurring in tropical countries is not clearly reflected in the worldwide publication activities.