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ZusammenfassungWährend intensive, aufsuchende Behandlungsformen in der Kinder- und Jugendpsychiatrie in vielen Ländern bereits erfolgreich evaluiert und etabliert wurden, ist die Entwicklung in diesem Bereich in Österreich am Beginn stehend. Im Zuge des sogenannten home-treatments erfolgt eine Behandlung von Patientinnen und Patienten, die aufgrund der Schwere ihrer Erkrankung ansonsten im stationären Setting behandelt werden würden durch ein multiprofessionelles Team im eigenen Haushalt. Das erlaubt unter anderem eine bessere Generalisierbarkeit therapeutischer Fortschritte und eine intensive Zusammenarbeit mit dem Familiensystem. Stationsersetzende Maßnahmen wie das home-treatment haben das Potenzial unabhängig von baulichen Strukturen eine intensive therapeutische Option darzustellen. Ein Ausbau dieser Behandlungsform basierend auf evaluierten Modellprojekten ist auch im österreichischen Gesundheitssystem wünschenswert.

Background Conspiracy beliefs have become widespread throughout the COVID-19 pandemic. Previous studies have shown that endorsing conspiracy beliefs leads to lower protective guideline adherence (i.e., wearing face masks), posing a threat to public health measures. The current study expands this research across the lifespan, i.e., in a sample of adolescents with mental health problems. Here, we investigated the association between conspiracy beliefs and guideline adherence while also exploring the predictors of conspiracy beliefs. Methods N = 93 adolescent psychiatric outpatients (57% female, mean age: 15.8) were assessed using anonymous paper–pencil questionnaires. Endorsement of generic and COVID-19 conspiracy beliefs was assessed, in addition to items measuring adherence to protective guidelines and mental health (stress, depressive symptoms, emotional/behavioral problems, and adverse childhood experiences). Multiple regressions and supervised machine learning (conditional random forests) were used for analyses. Results Fourteen percent of our sample fully endorsed at least one COVID-19 conspiracy theory, while protective guidelines adherence was relatively high (M = 4.92, on a scale from 1 to 7). The endorsement of COVID-19 conspiracy beliefs—but not of generic conspiracy beliefs—was associated with lower guideline adherence (β = − 0.32, 95% CI − 0.53 to − 0.11, p Conclusion While a significant proportion of our sample of adolescents in psychiatric treatment endorsed conspiracy beliefs, the majority did not. Furthermore, and to some degree, contrary to public perception, we found that adolescents show relatively good adherence to public health measures—even while experiencing a high degree of mental distress. The predictive value of adverse childhood experiences and peer/conduct problems for conspiracy beliefs might be explained by compensatory mechanisms to ensure the safety, structure, and inclusion that conspiracies provide.

Made available in DSpace on 2022-04-28T19:40:08Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-07-01 Background: The COVID-19 pandemic is having profound mental health consequences for many people. Concerns have been expressed that, at their most extreme, these consequences could manifest as increased suicide rates. We aimed to assess the early effect of the COVID-19 pandemic on suicide rates around the world. Methods: We sourced real-time suicide data from countries or areas within countries through a systematic internet search and recourse to our networks and the published literature. Between Sept 1 and Nov 1, 2020, we searched the official websites of these countries’ ministries of health, police agencies, and government-run statistics agencies or equivalents, using the translated search terms “suicide” and “cause of death”, before broadening the search in an attempt to identify data through other public sources. Data were included from a given country or area if they came from an official government source and were available at a monthly level from at least Jan 1, 2019, to July 31, 2020. Our internet searches were restricted to countries with more than 3 million residents for pragmatic reasons, but we relaxed this rule for countries identified through the literature and our networks. Areas within countries could also be included with populations of less than 3 million. We used an interrupted time-series analysis to model the trend in monthly suicides before COVID-19 (from at least Jan 1, 2019, to March 31, 2020) in each country or area within a country, comparing the expected number of suicides derived from the model with the observed number of suicides in the early months of the pandemic (from April 1 to July 31, 2020, in the primary analysis). Findings: We sourced data from 21 countries (16 high-income and five upper-middle-income countries), including whole-country data in ten countries and data for various areas in 11 countries). Rate ratios (RRs) and 95% CIs based on the observed versus expected numbers of suicides showed no evidence of a significant increase in risk of suicide since the pandemic began in any country or area. There was statistical evidence of a decrease in suicide compared with the expected number in 12 countries or areas: New South Wales, Australia (RR 0·81 [95% CI 0·72–0·91]); Alberta, Canada (0·80 [0·68–0·93]); British Columbia, Canada (0·76 [0·66–0·87]); Chile (0·85 [0·78–0·94]); Leipzig, Germany (0·49 [0·32–0·74]); Japan (0·94 [0·91–0·96]); New Zealand (0·79 [0·68–0·91]); South Korea (0·94 [0·92–0·97]); California, USA (0·90 [0·85–0·95]); Illinois (Cook County), USA (0·79 [0·67–0·93]); Texas (four counties), USA (0·82 [0·68–0·98]); and Ecuador (0·74 [0·67–0·82]). Interpretation: This is the first study to examine suicides occurring in the context of the COVID-19 pandemic in multiple countries. In high-income and upper-middle-income countries, suicide numbers have remained largely unchanged or declined in the early months of the pandemic compared with the expected levels based on the pre-pandemic period. We need to remain vigilant and be poised to respond if the situation changes as the longer-term mental health and economic effects of the pandemic unfold. Funding: None. Centre for Mental Health Melbourne School of Population and Global Health University of Melbourne Swansea University Medical School Translational Health Research Institute Western Sydney University Ministry of Public Health Department of Health Promotion National Confidential Inquiry into Suicide and Safety in Mental Health University of Manchester Centre for Mental Health and Safety and National Institute for Health Research Patient Safety Translational Research Centre University of Manchester School of Public Health National Suicide Research Foundation University College Cork Australian Institute for Suicide Research and Prevention School of Applied Psychology Griffith University Institute for Life Course Health Research Department of Global Health Stellenbosch University Working Group on Prevention of Suicide and Depression at Public Health Council Department of Psychiatry Blekinge Hospital Botucatu Medical School Universidade Estadual Paulista Instituto Nacional de Psiquiatría Ramon de la Fuente Muñiz University of Rochester Medical Center Region Friuli Venezia Giulia Central Health Directorate Outpatient and Inpatient Care Service Department of Medicine University of Udine Institute of Health Behaviors and Community Sciences College of Public Health National Taiwan University Thames Valley Local Criminal Justice Board Department of Psychiatry Psychotherapy and Psychosomatics Medical University of Innsbruck Center for Outcomes Research and Evaluation Yale School of Medicine Coroners Court of Victoria Danish Research Institute for Suicide Prevention Department of Mental Health Johns Hopkins School of Public Health Centre for Mental Health Research Australian National University Brigham and Women's Hospital Department of Emergency Medicine School of Population Health University of Auckland Magistrates Court of Tasmania (Coronial Division) Bureau of Vital Records and Statistics Louisiana Office of Public Health Ministry of Public Health Undersecretary of Health Services Research Department, 113 Suicide Prevention Departments of Psychiatry and Epidemiology Columbia University Medical Center/New York State Psychiatric Institute Centre for Suicide Research University of Oxford Louisiana Department of Health Greater Manchester Mental Health NHS Foundation Trust Department of Psychiatry Aga Khan University KU Leuven Center for Contextual Psychiatry Population Health Sciences Bristol Medical School University of Bristol South Asian Clinical Toxicology Research Collaboration Faculty of Medicine University of Peradeniya World Health Organization Country Office for Nepal Karolinska Institutet Bekhterev National Medical Research Center of Psychiatry and Neurology Pavlov First Saint Petersburg State Medical University Unit Suicide Research and Mental Health Promotion Department of Social and Preventive Medicine Center for Public Health Medical University of Vienna Department of Child and Adolescent Psychiatry Medical University of Vienna School of Psychology University of Nottingham Self-Harm Research Group School of Psychology University of Nottingham Mental Health Centre Copenhagen Department of Psychiatry and Psychotherapy Klinikum Klagenfurt am Wörthersee Suicidal Behaviour Research Lab University of Glasgow Preventing Deaths from Poisoning Research Group University of Edinburgh Usher Institute University of Edinburgh Suicide Research and Prevention Center Shanghai Mental Health Center Shanghai Jiao Tong University School of Medicine Departments of Psychiatry and Epidemiology Columbia University Department of Child and Adolescent Psychiatry and Psychotherapy University of Ulm Psychosocial Services in Vienna National Centre for Suicide Research and Prevention Institute of Clinical Medicine University of Oslo Department of Child and Adolescent Psychiatry Psychotherapy and Psychosomatics University Hospital Leipzig Department of Psychiatry and Psychotherapeutic Medicine Landeskrankenhaus Villach Department of Psychiatry Psychosomatic Medicine and Psychotherapy University Hospital Frankfurt Department of Borderline Disorders and Psychotherapy Bekhterev National Medical Research Center of Psychiatry and Neurology Saint Petersburg State University Department of Psychiatry Health Authority Frankfurt am Main Department of Addictive Disorders Psychiatry and Psychotherapy LVR-Klinik Köln Department of Psychiatry Psychosomatic Medicine and Psychotherapy Goethe-University Organizational-Scientific Department Bekhterev National Medical Research Center of Psychiatry and Neurology Department of Psychiatry University of Toronto Department of Psychiatry Sunnybrook Health Sciences Centre Waseda University Faculty of Political Science and Economics Sneha—Suicide Prevention Centre Voluntary Health Services Department of Community Medicine Faculty of Medicine and Allied Sciences Rajarata University of Sri Lanka Department of Psychiatry Sackler School of Medicine Tel Aviv University and Geha Mental Health Center Division of Molecular Imaging and Neuropathology New York State Psychiatric Institute and Department of Psychiatry Columbia University National Institute of Health Research Biomedical Research Centre University Hospitals Bristol and Weston NHS Foundation Trust University of Bristol Department for Psychiatry University Psychiatric Hospital Vrapče School of Medicine University of Zagreb Botucatu Medical School Universidade Estadual Paulista

Background The COVID-19 pandemic results in disproportional consequences for psychiatric patients. Due to restraints in physical contacts, providers switched from face-to-face contacts to teletherapy, but prior experiences were mostly limited. The study aimed at assessing symptom dynamics, potentially increased adversities and factors influencing a successful transition into teletherapy in adolescent psychiatric outpatients during the COVID-19 pandemic. Method Thirty adolescent psychiatric outpatients participated in an interview-based study. The differential impact of the COVID-19 pandemic was measured by integrating patients' and psychiatrists' judgements. Results Patients who reported deteriorated symptoms and patients who showed (partial) improvement of symptomatology could be separated by feelings of isolation (specific to deterioration) and perceived reduction in school-associated stress (unique to improvement). Patients with worsening symptomatology showed a significantly higher degree of psychosocial disability before lockdown and at the first interview. Patients who deteriorated in their level of psychosocial functioning also reported negatively on teletherapy. These patients were verbally less differentiated concerning emotions and affect, reported introspection and rumination, and stated distinctly lower levels of perceived social support. Concerning adversities, no clear trend could be identified, but some patients reported increased domestic violence and neglect. Conclusions Patients with a higher degree of psychosocial disability suffer disproportionally from the crisis, so that an assessment of functioning should serve as a triage tool. Also, a screening of the perceived level of social support should be established before offering teletherapy. Additionally, the provision of strategies to enhance verbalisation and differentiation of emotions and affect might be beneficial.

Background The use of distance-based interventions (DBIs) to reduce suicidal ideation and behaviours are an increasingly relevant form of intervention. DBIs are more affordable, scalable and available than traditional face-to-face interventions, helping to narrow the gap between needed and provided care. Aims To evaluate the overall effectiveness of DBIs against suicidal ideation and behaviours. Method We systematically searched Web of Science, Scopus and PubMed for all DBIs primarily aimed at reducing suicidal ideation and behaviours. Data were analysed with a robust variance estimation corrected, multi-level meta-analysis. Results We found 38 studies, reporting 110 outcomes. Effectiveness in reducing suicidal ideation was low (standardised mean difference −0.174, 95% CI −0.238 to −0.110). DBIs were significantly less effective against suicidal behaviours than against suicidal ideation, although still effective (standardised mean difference −0.059, 95% CI −0.087 to −0.032). Human involvement had no significant effect on effectiveness. Conclusions Despite low effectiveness, DBIs might play a role in large-scale prevention efforts against suicidal ideation within a stepped care approach. Further, DBIs may be helpful in expanding mental health services in low- and middle-income countries with otherwise limited access to mental healthcare. Although the evidence for DBIs efficacy is well grounded, the technical and scientific evaluation of DBIs regarding their set up, functionality and components needs to be addressed in future studies.

BACKGROUND Sertraline is a selective serotonin reuptake inhibitor with specific indications in child and adolescent psychiatry. Notwithstanding its frequent use and clinical benefits, the relationship between pharmacokinetics, pharmacodynamics, efficacy, and tolerability of sertraline across indications, particularly in non-adult patients, is not fully understood. METHOD This naturalistic therapeutic drug monitoring (TDM) study was conducted in a transdiagnostic sample of children and adolescents treated with sertraline (n��=��78; mean age, 14.22������2.39; range, 7-18��years) within the prospective multicenter "TDM-VIGIL" project. Associations between dose, serum concentration, and medication-specific therapeutic and side effects based on the Clinical Global Impression scale were examined. Tolerability was measured qualitatively with the 56-item Pediatric Adverse Event Rating Scale. RESULTS A strong linear positive dose-serum concentration relationship (with dose explaining 45% of the variance in concentration) and significant effects of weight and co-medication were found. Neither dose nor serum concentration were associated with side effects. An overall mild-to-moderate tolerability profile of sertraline was observed. In contrast with the transdiagnostic analysis that did not indicate an effect of concentration, when split into depression (MDD) and obsessive-compulsive disorder (OCD) diagnoses, the probability of clinical improvement significantly increased as both dose and concentration increased for OCD, but not for MDD. CONCLUSIONS This TDM-flexible-dose study revealed a significant diagnosis-specific effect between sertraline serum concentration and clinical efficacy for pediatric OCD. While TDM already guides clinical decision-making regarding compliance, dose calibration, and drug-drug interactions, combining TDM with other methods, such as pharmacogenetics, may facilitate a personalized medicine approach in psychiatry.

BackgroundGiven the widespread nature and clinical consequences of self-harm and suicidal ideation among adolescents, establishing the efficacy of developmentally appropriate treatments that reduce both self-harm and suicidal ideation in the context of broader adolescent psychopathology is critical.MethodsWe conducted a systematic review and meta-analysis of the Dialectical Behaviour Therapy for Adolescents (DBT-A) literature on treating self-injury in adolescents (12–19 years). We searched for eligible trials and treatment evaluations published prior to July 2020 in MEDLINE/PubMed, Scopus, Google Scholar, EMBASE, and the Cochrane Library databases for clinical trials. Twenty-one studies were identified [five randomized-controlled trials (RCTs), three controlled clinical trials (CCTs), and 13 pre-post evaluations]. We extracted data for predefined primary (self-harm, suicidal ideation) and secondary outcomes (borderline personality symptoms; BPD) and calculated treatment effects for RCTs/CCTs and pre-post evaluations. This meta-analysis was pre-registered with OSF: osf.io/v83e7.ResultsOverall, the studies comprised 1673 adolescents. Compared to control groups, DBT-A showed small to moderate effects for reducing self-harm (g = −0.44; 95% CI −0.81 to −0.07) and suicidal ideation (g = −0.31, 95% CI −0.52 to −0.09). Pre-post evaluations suggested large effects for all outcomes (self-harm: g = −0.98, 95% CI −1.15 to −0.81; suicidal ideation: g = −1.16, 95% CI −1.51 to −0.80; BPD symptoms: g = −0.97, 95% CI −1.31 to −0.63).ConclusionsDBT-A appears to be a valuable treatment in reducing both adolescent self-harm and suicidal ideation. However, evidence that DBT-A reduces BPD symptoms was only found in pre-post evaluations.

Objectives: Symptoms of distress and dysfunctional posttraumatic cognitions (PTCs) have been frequently described in parents of children and adolescents with posttraumatic stress symptoms (PTSS), e...

Vaccination is essential to control the COVID-19 pandemic. High vaccination willingness is a key for successful vaccination programs. This study assessed attitudes toward vaccination in Austrian adolescents and determined whether there are differences in vaccination readiness regarding education status, gender and migration background. Two cross-sectional online surveys were conducted from March to July 2021 in apprentices and high school students. Willingness to receive COVID-19 vaccination was rated on a 5-point scale. In total, n = 2006 (n = 1442 apprentices and n = 564 high school students) completed the survey. Willingness to receive COVID-19 vaccination was higher in students compared to apprentices (p

Zusammenfassung. Kinder und Jugendliche mit Migrations- und Fluchthintergrund unterliegen einerseits diversen gesundheitlichen, psychosozialen, soziokulturellen sowie ökonomischen Belastungen, die Prävalenz, Manifestation, Verlauf und Behandlung sowie die Prognose von psychiatrischen Erkrankungen beeinflussen können, und sind andererseits in der Inanspruchnahme und Behandlung durch zahlreiche Zugangsbarrieren im Vergleich zu Einheimischen deutlich benachteiligt. Die Transitionslücke verschärft die Situation. Zur Verbesserung der Versorgungssituation werden in Analogie zur Situation bei jungen Erwachsenen auch für Kinder und Jugendliche mit Migrations- und Fluchthintergrund Forderungen aufgestellt. So werden im stationären Rahmen bei ihrer unzureichenden Versorgung die Etablierung sogenannter Adoleszentenstationen unter kinder- und jugend- und erwachsenenpsychiatrisch-psychotherapeutischer Leitung und mit entsprechender pflegerischer und therapeutischer Personalausstattung sowie in Anlehnung an ein Entlassmanagement ein sog. „Transitionsmanagement“ im klinischen Alltag sowie der Erwerb von interkultureller Kompetenz empfohlen.

Zusammenfassung. Im Rahmen der Task-Force Transitionspsychiatrie der Deutschen Gesellschaft für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie e. V. (DGKJP) und der Deutschen Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN) wurde die Bedeutung der Lebensphase der Adoleszenz für die Versorgung von Borderline-Persönlichkeitsstörungen (BPS) in Deutschland durch eine Gruppe von Expertinnen und Experten näher beleuchtet. Besondere Lücken und Probleme wurden in den folgenden Bereichen identifiziert: Früherkennung der BPS; Zugang zu spezifischer, ambulanter Psychotherapie; langwierige, stationäre Behandlungen und Polypharmazie. Die Autorinnen und Autoren beschreiben in der Folge einige Empfehlungen und Forderungen betreffend der Generierung und Dissemination von Wissen zur BPS bei Adoleszenten sowie zu möglichen Anpassungen im deutschen Gesundheitssystem.

BackgroundLockdown during the pandemic has had significant impacts on public mental health. Previous studies suggest an increase in self-harm and suicide in children and adolescents. There has been little research on the roles of stringent lockdown.AimsTo investigate the mediating and predictive roles of lockdown policy stringency measures in self-harm and emergency psychiatric presentations.MethodThis was a retrospective cohort study. We analysed data of 2073 psychiatric emergency presentations of children and adolescents from 23 hospital catchment areas in ten countries, in March to April 2019 and 2020.ResultsLockdown measure stringency mediated the reduction in psychiatric emergency presentations (incidence rate ratio of the natural indirect effect [IRRNIE] = 0.41, 95% CI [0.35, 0.48]) and self-harm presentations (IRRNIE = 0.49, 95% CI [0.39, 0.60]) in 2020 compared with 2019. Self-harm presentations among male and looked after children were likely to increase in parallel with lockdown stringency. Self-harm presentations precipitated by social isolation increased with stringency, whereas school pressure and rows with a friend became less likely precipitants. Children from more deprived neighbourhoods were less likely to present to emergency departments when lockdown became more stringent,ConclusionsLockdown may produce differential effects among children and adolescents who self-harm. Development in community or remote mental health services is crucial to offset potential barriers to access to emergency psychiatric care, especially for the most deprived youths. Governments should aim to reduce unnecessary fear of help-seeking and keep lockdown as short as possible. Underlying mediation mechanisms of stringent measures and potential psychosocial inequalities warrant further research.

Although self-injurious thoughts and behaviors are a global health concern, little is known about suicidal threat/gesture(s) where a person leads others to believe they want to end their lives when they have no intention to do so. This study assessed the lifetime prevalence of self-injurious thoughts and behaviors among both community adolescents (n = 1117) and in clinical youth (n = 191). Suicide threats/gestures were common among youth; 12.2% of community adolescents and 18.0% of clinical youth reporting having made a suicide threat/gesture, most commonly in the context of other self-injurious thoughts and behaviors. Across both samples, suicide threats/gestures were not uniquely associated with suicide attempts, and youth who reported suicide threats/gestures in the context of a history of self-harm or suicide plan(s) were no more likely to report a history of suicide attempt(s). Suicide threats/gestures were distinguished from suicide attempts in that they primarily fulfilled positive social functions, rather than autonomic functions. Findings suggest that suicidal threats/gestures are common in both community and clinical youth, and are not uniquely associated with suicide attempts, but rather function to communicate distress to others.

There has been an increase in stress in adolescents since the beginning of the COVID-19 pandemic. Social distancing and home-schooling are just two of many stress factors for this age group. The aim of this study was to assess stress in high-school students after a semester of home-schooling. A cross-sectional online survey (February 3rd to 28th 2021) was performed, measuring stress with the Perceived Stress Scale (PSS-10) in Austria. In total, N = 2884 students (age: M = 16.47 (SD = 1.44); 70.4% females) completed the survey. Mean PSS-10 score was M = 23.50 (SD = 7.47) [females: M = 24.69 (SD = 6.80); males: M = 20.11 (SD = 7.93); p < 0.001]. 11.0% reported low stress (females: 7.2%; males 20.9%), 52.5% moderate stress (females: 51.5%; males: 57.3%), and 36.5% high stress (females: 41.3%; males 21.8%); p

Zusammenfassung Einleitung Belastende Kindheitserlebnisse treten oft gehäuft auf. Je mehr Formen von Kindheitsbelastungen erlebt werden, desto höher sind die psychischen und physischen Beeinträchtigungen im Erwachsenenalter. Die vorliegende Studie untersucht daher, inwieweit das Erleben der elterlichen Trennung mit dem Risiko für andere Formen von Kindheitsbelastungen zusammenhängt und inwieweit die Kumulation von Belastungen in der Kindheit mit Beeinträchtigungen im Erwachsenenalter zusammenhängt. Methoden Es erfolgte eine querschnittliche Analyse einer repräsentativen Stichprobe der deutschen Bevölkerung ab dem 18. Lebensjahr (N=2466; mittleres Alter=49,5 Jahre (18–93); f: 1368 (55,5%); m: 1098 (44,5%)). Die Erfassung der demografischen Daten erfolgte durch ein Interview, die restlichen Daten wurden mittels Fragebögen erhoben. Die Einschätzung der depressiven und ängstlichen Symptome und der selbsteingeschätzten somatischen Gesundheit bezog sich auf den Untersuchungszeitpunkt, belastende Kindheitserfahrungen wurden retrospektiv mit dem Adverse Childhood Experiences (ACE)-Fragebogen erfasst. Ergebnisse Kindesmisshandlung sowie psychische Erkrankung von Haushaltsmitgliedern, Substanzmittelabusus von Haushaltsmitgliedern und Gefängnisaufenthalt von Haushaltmitgliedern sowie Gewalt gegen die Mutter waren häufiger, wenn die Teilnehmenden von der Trennung der Eltern berichteten. Die Trennung der Eltern war nicht mit einer erhöhten Rate psychischer Beeinträchtigungen und bei Frauen auch für körperliche Beeinträchtigungen assoziiert, wenn keine anderen Formen von Kindheitsbelastungen vorlagen. Schlussfolgerung Kinder und Jugendliche, deren Eltern sich getrennt haben, erleben häufiger auch weitere Formen von Kindheitsbelastungen als Altersgenossen. Gerade diese Kumulation von belastenden Kindheitserlebnissen scheint es zu sein, die mit Beeinträchtigungen im Erwachsenenalter zusammenhängen.

An altered processing of negative salient stimuli has been suggested to play a central role in the pathophysiology of major depression (MD). Besides negative affective and social stimuli, physical pain as a subtype of negative sensory stimulation has been investigated in this context. However, the few neuroimaging studies on unpleasant sensory stimulation or pain processing in MD report heterogeneous findings. Here, we investigated 47 young females, 22 with MD and 25 healthy controls (HC) using fMRI (3.0 T). Four levels of increasingly unpleasant electrical stimulation were applied. Ratings of stimulus intensity were assessed by a visual analogue scale. fMRI-data were analyzed using a 2 × 4 ANOVA. Behavioral results revealed no group differences regarding accuracy of unpleasant stimulation level ratings and sensitivity to stimulation. Regarding neural activation related to increasing levels of unpleasant stimulation, we observed increasing activation of brain regions related to the pain and salient stimulus processing corresponding to increasingly unpleasant stimulation in controls. This modulation was significantly smaller in MD compared to controls, particularly in the dorsal anterior cingulate cortex, the somatosensory cortex, and the posterior insula. Overall, brain regions associated with the processing of unpleasant sensory stimulation, but also associated with the salience network, were highly reactive but less modulated in female patients with MD. These results support and extent findings on altered processing of salience and of negative sensory stimuli even of a non-painful quality in female patients with MD. Electronic supplementary material The online version of this article (10.1007/s00406-020-01123-0) contains supplementary material, which is available to authorized users.

ZusammenfassungBei entsprechender Indikation für eine medikamentöse Behandlung wird im Rahmen der psychopharmakologischen Behandlung von Kindern und Jugendlichen auf wenige zugelassene Substanzen zurückgegriffen. Um den aktuellen Zulassungsstand der in Österreich verfügbaren Psychopharmaka für die Altersgruppe der unter 18-Jährigen zu erfassen, und damit einen Baustein für eine informierte Aufklärung bereitzustellen, wurde das Arzneispezialitätenregister des österreichischen Bundesamts für Sicherheit im Gesundheitswesen systematisch durchsucht. Die entsprechenden Detailtabellen sind abgebildet.

Zusammenfassung. Einleitung: Ziel dieses Reviews war es, einen Überblick über verfügbare empirisch untersuchte internetbasierte kognitiv-behaviorale Interventionen (iCBT) für Kinder und Jugendliche und/oder deren Eltern zu verschaffen und diese anhand von vorläufig definierten Qualitätskriterien hinsichtlich des Einsatzes im Gesundheitssystem zu beurteilen. Methodik: Die vorliegende Übersichtsarbeit wurde anhand der PRISMA-Leitlinien durchgeführt und die wissenschaftliche Literatur bezogen auf iCBT evaluiert. Es wurde eine umfassende Literaturrecherche über PubMed, PsychINFO, PsychARTICLES, PsychNDEX und Science Direct unter Nutzung relevanter Suchbegriffe durchgeführt. Die Studien wurden anhand von vorläufig definierten 10 Qualitätskriterien bewertet. Ergebnisse: Insgesamt wurden 4479 Artikel gescreent; 62 Studien wurden in die weitere Auswertung eingeschlossen. Davon wurden 24 internationale iCBT-Programme mit 50 randomisiert kontrollierten Studien (RCTs) identifiziert und evaluiert, die M = 7.25 (SD = 1.07) Qualitätskriterien erfüllen würden. Für 11 internationale iCBT-Programme liegen bereits 13 Studien zur Beurteilung der präliminieren Wirksamkeit vor. Sie würden M = 7.45 (SD = .82) Qualitätskriterien erfüllen. Es gab keinen signifikanten Unterschied zwischen Programmen mit und ohne RCT-Studiendesign (t[33] = –.56; p = .58. Schlussfolgerungen: Unsere Ergebnisse weisen darauf hin, dass es international bereits eine Vielzahl an Programmen gibt. Da die Wartezeiten auf eine psychotherapeutische oder psychiatrische Behandlung immer noch ca. fünf Monate in Deutschland betragen, haben iCBT-Programme das Potenzial, diese Versorgungslücke zu verkleinern.

Introduction Despite the growing evidence base for psychotropic drug treatment in pediatric patients, knowledge about the benefit-risk ratio in clinical practice remains limited. The ‘Therapeutic Drug Monitoring (TDM)-VIGIL’ study aimed to evaluate serious adverse drug reactions (ADRs) in children and adolescents treated with antidepressants and/or antipsychotics in approved (‘on-label’), and off-label use in clinical practice. Methods Psychiatric pediatric patients aged 6-18 years treated with antidepressants and/or antipsychotics either on-label or off-label were prospectively followed between October 2014 and December 2018 within a multicenter trial. Follow-up included standardized assessments of response, serious ADRs and therapeutic drug monitoring. Results 710 youth (age=14.6±2.2 years, female=66.6%) were observed for 5.5 months on average; 76.3% received antidepressants, 47.5% antipsychotics, and 25.2% both. Altogether, 55.2% of the treatment episodes with antidepressants and 80.7% with antipsychotics were off-label. Serious ADRs occurred in 8.3% (95%CI=6.4–10.6%) of patients, mainly being psychiatric adverse reactions (77.4%), predominantly suicidal ideation and behavior. The risk of serious ADRs was not significantly different between patients using psychotropics off-label and on-label (antidepressants: 8.1% vs. 11.3%, p=0.16; antipsychotics: 8.7% vs 7.5%, p=0.67). Serious ADRs occurred in 16.6% of patients who were suicidal at enrollment versus 5.6% of patients who were not suicidal (relative risk 3.0, 95%CI=1.9-4.9). Conclusion Off-label use of antidepressants and antipsychotics in youth was not a risk factor for the occurrence of serious ADRs in a closely monitored clinical setting. Results from large naturalistic trials like ours can contribute to bridging the gap between knowledge from randomized controlled trials and real-world clinical settings.

Suicide is the second leading cause of death among adolescents worldwide, yet adequate mental health services for children and adolescents are lacking across the globe. Likewise, youth who engage in non-suicidal self-injury (NSSI) are at heightened risk for suicide, but few pediatric settings have established protocols for screening and responding to youth who engage in NSSI and/or endorse thoughts of suicide. In this article, we highlight similarities and differences of managing suicide and NSSI across cultures, including persisting stigma associated with youth at risk for self-harm. We summarize current guidelines for screening youth at risk for suicide and NSSI across services, consider the use of online and telehealth services, and offer recommendations for a multidisciplinary approach to treating youth who engage in self-harming behaviors as well as how healthcare professionals can communicate with each other using common, non-stigmatizing language. We conclude with a discussion of future policy recommendations and areas for research.

Child maltreatment is a risk factor for a range of mental disorders later in life, including dangerous self-harm and suicide attempts. A better understanding of the mechanisms underlying this association can inform prevention and intervention.To investigate personality functioning as a potential mediator of the association of childhood abuse and neglect and self-harm and suicide attempts in the general population.Data were drawn from a representative German population sample (N = 2510).Participants filled out the Childhood Trauma Questionnaire (CTQ), OPD Structure Questionnaire (OPD-SQS), and items of the Self-Injurious Thoughts and Behaviors Interview (SITBI). In structural equation models, we operationalized impaired personality functioning as the mediator between childhood abuse and neglect and self-harm.Individuals with a history of self-harm (combining suicide attempts, N = 47, and non-suicidal self-injury, N = 83) reported more childhood abuse and neglect (d = 1.39, p .001) and greater impairments in personality functioning (d = 1.64, p .001) than the rest of the population. The indirect effect via personality functioning accounted for 48.8 % of the total effect of childhood abuse and neglect on self-harm. In more differentiated analyses, emotional abuse showed the strongest association with self-harm. Only physical and sexual abuse had direct effects.The results specify the relationship between child maltreatment and self-harm by demonstrating that it is partly mediated by basic functions of personality assessed using a dimensional measure. These abilities constitute modifiable risk factors that can be addressed by psychotherapy.

Background: Social–emotional difficulties are a core symptom of autism spectrum disorder (ASD). Accordingly, individuals with ASD have problems with social cognition such as recognizing emotions from other peoples' faces. Various results from functional magnetic resonance imaging and electroencephalography studies as well as eye-tracking data reveal a neurophysiological basis of these deficits by linking them to abnormal brain activity. Thus, an intervention targeting the neural origin of ASD impairments seems warranted. A safe method able to influence neural activity is transcranial direct current stimulation (tDCS). This non-invasive brain stimulation method has already demonstrated promising results in several neuropsychiatric disorders in adults and children. The aim of this project is to investigate the effects of tDCS on ASD symptoms and their neural correlates in children and adolescents with ASD. Method: This study is designed as a double-blind, randomized, and sham-controlled trial with a target sample size of 20 male participants (aged 12–17 years) diagnosed with ASD. Before randomization, the participants will be stratified into comorbid depression, comorbid ADHS/conduct disorder, or no-comorbidity groups. The intervention phase comprises 10 sessions of anodal or sham tDCS applied over the left prefrontal cortex within 2 consecutive weeks. To engage the targeted brain regions, participants will perform a social cognition training during the stimulation. TDCS-induced effects on ASD symptoms and involved neural circuits will be investigated through psychological, neurophysiological, imaging, and behavioral data at pre- and post-measurements. Tolerability will be evaluated using a standardized questionnaire. Follow-up assessments 1 and 6 months after the intervention will examine long-lasting effects. Discussion: The results of this study will provide insights into the changeability of social impairments in ASD by investigating social and emotional abilities on different modalities following repeated sessions of anodal tDCS with an intra-simulation training. Furthermore, this trial will elucidate the tolerability and the potential of tDCS as a new treatment approach for ASD in adolescents. Clinical Trial Registration: The study is ongoing and has been registered in the German Registry of Clinical Trials (DRKS00017505) on 02/07/2019., publishedVersion

Gold standard treatments for anxiety- and trauma-related disorders focus on exposure therapy promoting extinction learning and extinction retention. However, its efficacy is limited. Preclinical and particularly animal research has been able to demonstrate that homozygosity for the fatty acid amide hydrolase (FAAH) C385A allele, similar to FAAH inhibition, is associated with elevated concentrations of anandamide (AEA) and facilitates extinction learning and extinction recall. However, in humans, the underlying neurobiological processes are less well understood, and further knowledge might enhance the development of more effective therapies. In this functional magnetic resonance imaging (fMRI) study, a fear conditioning, fear extinction and extinction recall paradigm was conducted with 55 healthy male adults. They were genotyped for the FAAH single-nucleotide polymorphism (SNP) rs324420 to investigate differences related to extinction recall in neural activation and State–Trait Anxiety Inventory (STAI) ratings between AC heterozygotes and CC homozygotes (FAAH C385A SNP). Differential brain activation upon an unextinguished relative to an extinguished stimulus, was greater in AC heterozygotes as compared to CC homozygotes in core neural structures previously related to extinction recall, such as the medial superior frontal gyrus, the dorsal anterior cingulate and the anterior and middle insular cortex. Furthermore, AC heterozygotes displayed higher AEA levels and lower STAI-state ratings. Our data can be interpreted in line with previous suggestions of more successful extinction recall in A-allele carriers with elevated AEA levels. Data corroborate the hypothesis that the endocannabinoid system, particularly AEA, plays a modulatory role in the extinction of aversive memory.

Nonsuicidal Self-Injury (NSSI) in adolescence is highly prevalent and seems to be on the rise. To deliver evidence-based treatments to a large and growing number of adolescents, it is crucial to provide scaleable, manualized interventions that have the potential to fit into a stepped-care approach. The work by Kaess et al. (2019) was able to show a reduction of NSSI both by the brief intervention "Cutting Down", as well as by regular psychotherapeutic treatment. Future treatment strategies for NSSI should tailor treatment approaches to fit adolescents´ needs.

Authoritarianism becomes respectable in Germany: A risk factor for condoning physical violence toward children? Abstract. Objective: Authoritarianism denotes aggressive behavior toward subordinates, submission to authorities, and conventionalism. Authoritarianism is assumed to be a central factor in the emergence of right-wing extremist ideology. Horkheimer described a close relationship between authoritarianism and the use of physical violence as a disciplinary method. Against the background of the current increase in right-wing extremist ideologies in Germany, which manifests itself in both social and political realms, this study examines the association between authoritarian and right-wing extremist ideology and the affirmation of corporal punishment as a disciplinary method. Method: We performed a cross-sectional study on a representative sample of the German population (N = 2,524). Results: 44.5 % of the participants supported corporal punishment. When respondents reported authoritarian and right-wing extremist attitudes, we discovered an increased affirmation of physical violence as a disciplinary method. Regarding party preference, participants who stated that they preferred the right-wing Alternative for Germany Party (AfD) showed the highest rate of supporting corporal punishment. Conclusions: The results presented indicate that the condoning of corporal punishment is still very widespread in Germany, and that the children of parents with authoritarian and right-wing extremist attitudes comprise a risk group for physical violence. Increased social awareness of these risks is necessary in light of the current increase of right-wing ideologies.

Background: Investigating adolescents and young adults may provide a unique opportunity to understand developmental aspects of the neurobiology of depression. During adolescence, a considerable physiologic reorganization of both grey and white matter of the brain takes place, and it has been suggested that differences in grey-matter volumes during adolescence may reflect different maturational processes. Methods: We investigated grey-matter volumes in a comparatively large sample (n = 103) of adolescents and young adults (aged 12 to 27 years), 60 of them with a diagnosis of current depression. Results: Replicating previous studies, we found a clear whole-brain effect of age: the older the participants, the lower their global grey-matter volumes, particularly in the paracingulate and prefrontal cortices. Contrasting depressed and healthy youth in a whole-brain approach, we found greater grey-matter volumes in the dorsolateral prefrontal cortex of those with depression. Furthermore, a region-of-interest analysis indicated lower grey-matter volumes in the hippocampus in participants with depression compared with healthy controls. Limitations: The present study was limited because of a skewed sex distribution, its cross-sectional design and the fact that some participants were taking an antidepressant. Conclusion: During adolescence, restructuring of the brain is characterized by marked decreases in prefrontal grey-matter volumes, interpreted as a correlate of brain maturation. Findings of greater volumes in the prefrontal cortex, particularly in younger adolescents with depression, may suggest that these participants were more prone to delayed brain maturation or increased neuroplasticity. This finding may represent a risk factor for depression or constitute an effect of developing depression.

Zusammenfassung. Hintergrund: Die gleichzeitige Einnahme verschiedener Arzneimittel erhöht die Wahrscheinlichkeit von Wechselwirkungen und unerwünschten Arzneimittelwirkungen (UAWs). In der Kinder- und Jugendpsychiatrie wird versucht, Polypharmazie zu vermeiden, wobei allerdings kaum Daten zur Häufigkeit vorliegen. Ziel der Studie war die Untersuchung der Häufigkeit von Polypharmazie bei der Behandlung mit verschiedenen Antidepressiva und Antipsychotika sowie der fraglichen Assoziation mit einem erhöhten Auftreten von UAWs im Vergleich zur Monotherapie. Methodik: 940 Datensätze von Kindern und Jugendlichen unter Psychopharmakotherapie aus 10 Studien zum Therapeutischen Drug Monitoring (TDM) in Deutschland wurden retrospektiv-deskriptiv ausgewertet. Ergebnis: Polypharmazie war in bis zu 72.1 % der Fälle bei primärer Therapie mit Olanzapin und in bis zu 45.6 % der Fälle bei Escitalopram zu beobachten. In bis zu 17.4 % der Fälle wurden vier und mehr Neuro-/Psychopharmaka gleichzeitig eingesetzt. Bei Antipsychotika wurde keine erhöhte Häufigkeit von UAWs unter Polypharmazie dokumentiert. Bei den Antidepressiva wurden bei Sertralin signifikant mehr UAWs unter Polypharmazie beobachtet. Diskussion und Fazit: Polypharmazie wird relativ häufig angewandt. Rückschlüsse zum UAW-Risiko sollten aufgrund der geringen Fallgröße der untersuchten Subpopulationen, der Limitationen naturalistischer Studien sowie möglicher Doppelauswertungen unter Vorbehalt gezogen werden. Weiterführende Studien mit größeren und im Hinblick auf z. B. Alter und komorbide Störungen homogeneren Gruppen sind notwendig.

Background Current research on treatment predictors and long-term effects of trauma-focused interventions for (unaccompanied) refugee minors is limited. This secondary analysis of a recent randomised controlled trial (RCT), evaluating the trauma-focused group intervention “Mein Weg” (English “My Way”) compared to usual care, investigated several refugee-specific factors such as treatment predictors and sustainability of treatment gains. Methods In total N = 50 participants (Mage = 17.00, 94% male) were included in this analysis. Evaluation of 3-month follow-up data included: posttraumatic stress symptoms [(PTSS) CATS-Self, CATS-Care], depression (PHQ-8), and dysfunctional posttraumatic cognitions (CPTCI-S). Baseline symptom severity of the above-mentioned measures, trauma load and socio-demographic factors were investigated as the treatment predictors. Results Intention-to-treat-analyses (ITT) revealed the sustainability of treatment effects in self-reported PTSS (pre to post change: 6.48 ± 1.60, d = 0.62, p d = 0.11, p = 0.47) and depression (pre to post change: 7.82 ± 2.09, d = 0.64, p d = 0.05, p = 0.54). Country of origin alone was a significant predictor of the change in PTSS (b = − 8.22 ± 3.53, t(30) = − 2.33, p = 0.027), and baseline levels of depression were a significant predictor of the change in depression (b = 0.83 ± 0.19, t(33) = 4.46, p Conclusion This group intervention can serve as a valuable component in a stepped care approach with promising long-term effects for young refugees. Trial registration DRKS, #DRKS00010915. Registered 15 September 2016, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00010915

Person-centered approaches are considered promising methods for a deeper understanding of the causes and consequences of maltreatment. So far, only few studies have employed such approaches in the study of maltreatment. The aim of the present study was to examine the impact of maltreatment-related variables on trajectories after maltreatment. Growth mixture modelling (GMM) was used to examine different trajectories of functioning in 206 children and adolescents (M = 9.8 years) with a history of child maltreatment. Trajectories were analyzed in regards to maltreatment characteristics and revictimization using multinomial logistic regression. The participants were followed up over a 12 months period including three assessments. Four trajectories were identified: resilient (22.9%), worsening (15.1%), recovering (32.2%), chronic (29.8%). Revictimization (OR: 2.6–5.5), a longer period between first and last reported incident of maltreatment (OR: 0.033 – 0.038) and consequently the age at first (OR: 0.039 – 0.054) and age at last reported incident (OR: 20.3–26.9) were significant predictors of a worsening functioning trajectory. Having experienced neglect predicted a worsening trajectory in contrast to a chronic and resilient trajectory (OR = 4.8–5.2). Findings suggest that a clinical follow-up of children with a history of maltreatment is crucial as this population represents a high risk sample. A worsening trajectory was closely associated with revictimization. Functioning trajectories seem to be directly linked to chronicity and timing of maltreatment. Implications are discussed.

Zusammenfassung. Kindesmisshandlung stellt einen bedeutenden Risikofaktor für die Entwicklung dar. Einzelne Formen von Kindesmisshandlung treten häufig nicht isoliert auf, sondern das gemeinsame Auftreten verschiedener Formen von Kindesmisshandlung stellt eher die Regel als die Ausnahme dar. Neben den langfristigen und vielfältigen individuellen Folgen führt Kindesmisshandlung jährlich zu einer hohen gesamtgesellschaftlichen Belastung. Die WHO hat Kindesmisshandlung als großes Public Health Problem identifiziert und die Vereinten Nationen haben den Kampf gegen Kindesmisshandlung zum Ziel in ihrer Agenda für nachhaltige Entwicklung gemacht. In dem vorliegenden Beitrag werden die Häufigkeit sowie das gemeinsame Auftreten unterschiedlicher Formen von Kindesmisshandlung sowie deren Assoziation mit psychischen und somatischen Folgen auf Basis einer bevölkerungsrepräsentativen Stichprobe untersucht und dargestellt. Die Ergebnisse verdeutlichen den Zusammenhang zwischen der Kumulation verschiedener Formen von Misshandlung und negativen Folgen für die Betroffenen. So ist das Risiko für negative Konsequenzen beim Erleben von vier oder mehr Formen von Misshandlung um das bis zu 10-fache erhöht. Viel zu selten werden die kumulativen Effekte von mehreren Belastungen berücksichtigt. Gerade weil die Wirkweisen über die Misshandlung, die Gesundheit beeinflusst, zunehmend gut untersucht sind, muss dieses Wissen im Gesundheitswesen stärker bei der Konzeption von Präventions- und Interventionsmaßnahmen berücksichtigt werden.

Zusammenfassung. Belastende Kindheitserlebnisse (adverse childhood experiences; ACE) wie Misshandlung, aber auch das Erleben von Gewalt in der Paarbeziehung der Eltern (häusliche Gewalt) in der Kindheit, können das Leben auf vielfältige Weise beeinträchtigen. Obwohl bekannt ist, dass ACEs häufig gemeinsam auftreten, gibt es kaum Untersuchungen zu der Bedeutung von Kindesmisshandlung bei häuslicher Gewalt und deren Langzeitfolgen. Daher haben wir das Auftreten von Kindesmisshandlung in Abhängigkeit zu dem Erleben von häuslicher Gewalt in einer repräsentativen Stichprobe der deutschen Bevölkerung ( N = 2531) untersucht. Die Ergebnisse zeigen ein deutlich erhöhtes Risiko für alle Formen von Kindesmisshandlung, wenn häusliche Gewalt gegen die Mutter berichtet wurde (Odds Ratios je nach Form der Kindesmisshandlung 4.4 bis 10.3). Für weibliche Teilnehmende stieg das Risiko für sexuellen Missbrauch, körperliche Misshandlung und körperliche Vernachlässigung stärker an als bei männlichen. Der Zusammenhang von häuslicher Gewalt gegen die Mutter mit einer niedrigeren Lebenszufriedenheit im Erwachsenenalter wurde partiell durch Kindesmisshandlung vermittelt, das erhöhte Risiko für eine schlechtere Gesundheit im Erwachsenenalter sogar vollständig. Kindesmisshandlung vermittelt somit einen großen Ateil des Zusammenhanges von schlechterer Gesundheit und geringerer Zufriedenheit bei Erwachsenen, die in der Kindheit häusliche Gewalt erlebt haben. Vor diesem Hintergrund sind ein größeres Bewusstsein für die erhöhten Risiken von Kindern, die in Haushalten mit häuslicher Gewalt aufwachsen, und Unterstützungsangebote, in denen der Kinderschutz eine zentrale Rolle spielt, zu empfehlen.

Background: Suicide is the second leading cause on death in young people and self-harm is one of the strongest predictors of death by suicide. Little is known about the impact of covid-19 lockdown on hospital presentations with self-harm. Method: We used electronic patient records from 23 hospital emergency departments in 10 countries to examine differences in hospital emergency psychiatric presentations for self-harm of youths through age 18 in March and April 2020 compared with the same period in 2019. To compare the number of hospital presentations a negative binomial model was used. For other variables, individual participant data (IPD) meta-analyses were carried out. Findings: The total number of emergency psychiatric hospital presentations decreased from 1,239 in 2019 to 834 in 2020, IRR 0·67, 95% CI 0·62-0·73. The proportion of youths presenting with self-harm increased from 50% in 2019 to 57% in 2020, OR 1·33, 95% CI 1·07-1·64, but there was no difference in the proportion presenting with severe self-harm. Within self-harm presentations, the proportion of youths with emotional disorders increased from 58% to 66%, OR 1·58, 95% CI 1·06-2·36. The proportion of youths admitted to an observation ward also decreased from 13% to 9% in 2020, OR 0·52, 95% CI 0·28 to 0·96. There were no differences in other outcomes and no evidence that youths from deprived areas or from ethnic minorities were disproportionally affected. Interpretation: During lockdowns, there are likely to be fewer hospital emergency psychiatric presentations. Many children and adolescents with psychiatric emergencies might not receive any service. Developing intensive community care services with outreach capabilities should be prioritised. Funding Statement: None. Declaration of Interests: In the last three years Dr. Carucci had collaborations within projects from the European Union (7th Framework Program) and as sub-investigator in sponsored clinical trials by Shire Pharmaceutical Company, Lundbeck, Otsuka, Janssen Cilag and Angelini. Travel support from Fidia Farmaceutici. PLP has received research funding from the German Federal Ministry of Education and Research (BMBF), the German Federal Institute for Drugs and Medical devices (BfARM), the Baden Wuerttemberg state foundation, eh Volkswagen foundation, Lundbeck and Servier. He received a speaker´s honorarium from Shire. All remaining authors have no competing interests to declare. Ethics Approval Statement: This study is based on the data from the NCDR obtained under licence from the UK Medicines and Healthcare products Regulatory Agency. The study was approved by the King’s College London/South London and Maudsley NHS Foundation Trust service evaluation and clinical audit committee Ref no: AP1312/05/2020.

Alleviating the multiple problems of children with autism spectrum disorder (ASD) and its comorbid conditions presents major challenges for the affected children, parents, and therapists. Because of a complex psychopathology, structured therapy and parent training are not always sufficient, especially for those patients with intellectual disability (ID) and multiple comorbidities. Moreover, structured therapy is not available for a large number of patients, and pharmacological support is often needed, especially in those children with additional attention deficit/hyperactivity and oppositional defiant, conduct, and sleep disorders.Die Linderung der vielfältigen Probleme von Kindern mit Autismus-Spektrum-Störung (ASS) und ihrer Begleiterkrankungen stellt für die betroffenen Kinder, Eltern und Therapeuten eine große Herausforderung dar. Aufgrund einer komplexen Psychopathologie reichen strukturierte Therapie und Elterntraining nicht immer aus, insbesondere bei Menschen mit geistiger Behinderung (GB) und multiplen Komorbiditäten. Darüber hinaus steht für viele Patienten keine strukturierte Therapie zur Verfügung, und häufig ist pharmakologische Unterstützung erforderlich, insbesondere bei Kindern, bei denen eine Aufmerksamkeitsdefizit‑/Hyperaktivitätsstörung und oppositionelle Trotz‑, Verhaltens- oder Schlafstörungen hinzukommen.

Background Post-traumatic stress disorder (PTSD) is a debilitating disorder that is often accompanied by alterations in the hypothalamic-pituitary (HPA) axis. While there is abundant evidence for the efficacy of psychological therapies in reducing post-traumatic stress symptoms, barely anything is known about pharmacological interventions. Given the role of the HPA axis in the pathophysiology of PTSD, the aim of this study was to provide the first meta-analysis of Hydrocortisone as a potential treatment for this condition. Method A systematic review of randomized-controlled trials (RCTs) was conducted to investigate the efficacy of hydrocortisone in the prevention and curative treatment of post-traumatic stress symptoms. This study was pre-registered with the OSF (doi:10.17605/OSF.IO/GJAZF). Findings Eight studies (9 effect sizes) covering 362 participants met our inclusion criteria. We found that Hydrocortisone as compared to placebo significantly reduced PTSD symptoms (d = 0.96, 95% Cl 0.22–1.69 p = 0.011) and PTSD incidence (logRR = 0.85, 95% CI 1.12–1.59, p = 0.023). Subgroup analyses revealed a significant effect of Hydrocortisone when it was administered in a preventative context (d = 1.50; 95%CI 0.30–2.69, p = 0.014), but not when it was administered in a curative context (d = 0.28; 95%CI −0.11 to 0.66, p = 0.161). Conclusion Hydrocortisone appears to be a promising and efficient low-cost medication for the prevention of PTSD. However, the small number of included studies and their limited methodological quality emphasize the need for further rigorous studies in this field.

IntroductionEmotion dysregulation is a common challenge pertaining to numerous psychiatric disorders in adolescence and is associated with increased morbidity and mortality. Dialectical Behavior Therapy for Adolescents (DBT®-A) has been shown to be an effective treatment, especially in the reduction of self-harm and suicidality. Measures in relation to the COVID-19 pandemic set strict limits on physical contacts with patients. In order to continuously provide evidence-based specialized care to patients suffering from emotion dysregulation, we offered two online DBT®-A skill groups in a video-group-call format.ObjectiveWe aimed at assessing our online DBT®-A skills groups, collect according up- and downsides, and form a basis for advancement of this form of treatment provision. Also, the impact of the COVID-19 pandemic on patients was assessed.MethodsA physical DBT®-A skill group was switched to a video-group-call format and a second group was initiated de novo online. After five sessions, patients engaged in structured group discussions to reflect experiences. Discussion content was analyzed via Inductive Category Formation within the Framework of Qualitative Content Analysis.ResultsPatients unanimously found the COVID-19 pandemic challenging, but also reported differentially on its impact. Downsides were balanced by subjective “gains” in time and a perceived reduction in stress. Technical problems of the online format were discussed, but did not limit the positive experience of still receiving treatment. Patients of both online DBT®-A skill groups valued the offer, felt connected, and reported benefits from the treatment. The transition group additionally discussed changes in structure and content of the group sessions after the switch to online meetings and reflected differential functions of the group.DiscussionAlthough the sample size is small, and conclusions are drawn from Inductive Qualitative Content Analysis, the presented results are of interest. In our investigation, video-group-calls were both safe and beneficial for patients. This alternative to physical meetings is not only interesting for further waves of the current pandemic but also for service provision in remote areas with limited access to specialized care. Further research is needed to challenge and refine our results and to explore extensions to “basic” video-group-calls, such as “break-out sessions,” blended therapy, or real-time supervision within an online session.

Nonsuicidal Self-Injury (NSSI) and suicidality are common reasons for emergency presentations in child and adolescent psychiatry. Therefore, we focused on reasons for emergency presentations as well as specific characteristics of those presenting with NSSI or suicidality to an emergeny psychiatric service. We analyzed data from a German university hospital regarding emergency presentations during a 78 months' period. NSSI and suicidality were rated according to the Columbia Classification Algorithm of Suicide Assessment (C-CASA). Data from 546 emergency presentations was recorded, of which 347 (63.5%) presented for NSSI or suicidality. Given the high percentage, thorough assessment of sucidality as well as providing adequate treatment in emergency settings to establish further care, is of utmost importance., publishedVersion

Background Self-harm is a clinically relevant and prevalent behaviour which peaks in adolescence. Given the high prevalence of self-harm, the high levels of psychiatric comorbidity, and its role as a risk factor for suicide, delivering evidence-based care is critical. Methods We conducted a systematic review and meta-analysis of the literature on treating self-harm in adolescents (12–19 years) published in the last 20 years, identifying 25 randomised controlled trials. We calculated the effect of treatment interventions relative to active control conditions in reducing self-harm, suicidal ideation and depressive symptoms. Results Overall, treatment interventions fared slightly better than active controls in decreasing self-harm (d = 0.13, 95% CI 0.04–0.22, p = .004), suicidal ideation (d = 0.31, 95% CI 0.12–0.50, p = .001) and depressive symptoms (d = 0.22, 95% CI 0.07–0.38, p = .006). Subgroup analysis of specific therapies revealed moderate effects of DBT-A in reducing self-harm (d = 0.51, 95% CI 0.18–0.85, p = .002) and suicidal ideation (d = 0.48, 95% CI 0.17–0.80, p = .003), as well as moderate effects of family-centred therapy in the treating suicidal ideation (d = 0.58, 95% CI 0.01–1.15, p = .049). Conclusions The findings of our meta-analysis indicate that, overall, currently available treatments are effective in treating self-harm, suicidal ideation, and depressive symptoms in adolescence. Although the treatment intervention conditions showed only small to moderate effects in comparison to active controls, these differences were statistically significant and are clinically important. Further research is needed to understand the reduction in self-harm within active controls, which may arise due to the natural course of self-harm, or the potential efficacy of treatment as usual and enhanced usual care. Given the significant reduction of self-harm in active control conditions, delivering effective care to a large number of adolescents with self-harm may require developing stepped-care models in clinical practice. Expensive and poorly available treatments should be targeted at young people who most need them.

Background The coronavirus disease 2019 (COVID-19) is profoundly affecting life around the globe. Isolation, contact restrictions and economic shutdown impose a complete change to the psychosocial environment in affected countries. These measures have the potential to threaten the mental health of children and adolescents significantly. Even though the current crisis can bring with it opportunities for personal growth and family cohesion, disadvantages may outweigh these benefits. Anxiety, lack of peer contact and reduced opportunities for stress regulation are main concerns. Another main threat is an increased risk for parental mental illness, domestic violence and child maltreatment. Especially for children and adolescents with special needs or disadvantages, such as disabilities, trauma experiences, already existing mental health problems, migrant background and low socioeconomic status, this may be a particularly challenging time. To maintain regular and emergency child and adolescent psychiatric treatment during the pandemic is a major challenge but is necessary for limiting long-term consequences for the mental health of children and adolescents. Urgent research questions comprise understanding the mental health effects of social distancing and economic pressure, identifying risk and resilience factors, and preventing long-term consequences, including—but not restricted to—child maltreatment. The efficacy of telepsychiatry is another highly relevant issue is to evaluate the efficacy of telehealth and perfect its applications to child and adolescent psychiatry. Conclusion There are numerous mental health threats associated with the current pandemic and subsequent restrictions. Child and adolescent psychiatrists must ensure continuity of care during all phases of the pandemic. COVID-19-associated mental health risks will disproportionately hit children and adolescents who are already disadvantaged and marginalized. Research is needed to assess the implications of policies enacted to contain the pandemic on mental health of children and adolescents, and to estimate the risk/benefit ratio of measures such as home schooling, in order to be better prepared for future developments.

Zusammenfassung. Ein- und Durchschlafstörungen sind mit einer Prävalenz von etwa 20 % eine relevante Symptomatik im Kindes- und Jugendalter. Aufgrund des mit Insomnien oftmals verbundenen verminderten psychosozialen Funktionsniveaus und des sich einstellenden Leidensdrucks ist eine suffiziente Behandlung notwendig. Zeigen sich Maßnahmen wie eine angemessene Schlafhygiene und andere nichtmedikamentöse Therapieansätze als nicht ausreichend, wird oftmals eine pharmakotherapeutische Behandlung in Betracht gezogen. Die vorliegende Arbeit bietet eine Literaturübersicht zum Einsatz verschiedener Substanzklassen in hypnotischer Indikation. Der Einsatz von Melatonin bei Kindern und Jugendlichen mit Autismus-Spektrum-Störungen ist zwischenzeitlich gut untersucht und ist mit einem positiven Effekt auf den Schlaf bei dieser Patientengruppe assoziiert. Hinsichtlich der Wirksamkeit und Verträglichkeit anderer Wirkstoffe bei primären Insomnien bzw. Schlafstörungen im Kontext anderer psychiatrischer Erkrankungen bei Minderjährigen besteht bislang eine geringe Evidenz. Daher sind zunächst nichtmedikamentöse Behandlungsstrategien vorzuziehen und eine Pharmakotherapie erst sekundär und nach kritischer Abwägung zu erwägen.

Zusammenfassung. Fragestellung: Ziel der vorliegenden Pilotstudie war die Erhebung der Ausgangslage zur aktuellen Situation der Transitionspsychiatrie in Österreich sowie zu den spezifischen Fragen, Problemen und Veränderungswünschen des Fachpersonals im Zusammenhang mit dem Übergang psychisch erkrankter Adoleszenter in den Behandlungsbereich der Erwachsenen. Methodik: Im Rahmen einer Online-Fragebogenuntersuchung wurden fachkundige KlinikerInnen (N = 86) der Arbeitsfelder Psychiatrie, Kinder- und Jugendpsychiatrie, Klinische Psychologie und Psychotherapie zu ihren Erfahrungen die Transition von jungen Erwachsenen betreffend befragt. Ergebnisse: Das aktuelle System der Transition wird von 98.8 % der Befragten als ungünstig beurteilt. Ein Großteil (70.9 %) der Stichprobe ist der Meinung, dass der Übergang vom Jugend- zum Erwachsenenbereich von den PatientInnen nicht gut verkraftet werde. Nur 16.3 % geben an, dass an ihrem Arbeitsplatz ein geplantes und geregeltes Prozedere des Überganges vom jugendpsychiatrischen in den Erwachsenenbereich bestehe. 83.7 % plädieren für eine Verbesserung der Zusammenarbeit an der Schnittstelle zwischen der Kinder- und Jugendpsychiatrie und der Erwachsenenpsychiatrie. Schlussfolgerungen: Aus Sicht der hier befragten BehandlerInnen finden sich in Österreich, die Transitionspsychiatrie betreffend, deutliche Defizite. Nicht zuletzt aufgrund der Tatsache, dass gerade im Transitionsalter die Weichenstellung für die psychische Konstellation im weiteren Leben erfolgt, besteht die dringende Notwendigkeit, Strukturen zur geregelten Transition im Bereich der Psychiatrie zu etablieren.

Background Child maltreatment is an identified risk factor for Non-Suicidal Self-Injury (NSSI). The aim of the current study was to investigate effects of different types of maltreatment, and mediating effects of depression and anxiety on NSSI in the general population. Methods A representative sample of the German population, comprising N = 2498 participants (mean age = 48.4 years (SD = 18.2), 53.3% female) participated in this study. Child maltreatment was assessed using the Childhood Trauma Questionnaire (CTQ),NSSI was assessed with a question on lifetime engagement in NSSI, depressive symptoms were assessed by the Patient Health Questionnaire (PHQ-2) and anxiety symptoms by the General Anxiety Disorder questionnaire (GAD-2). Results Lifetime prevalence of NSSI in this sample was 3.3, and 30.8% reported at least one type of child maltreatment. Participants in the NSSI group reported significantly more experiences of child maltreatment. Emotional abuse was endorsed by 72% of all participants with NSSI. A path analytic model demonstrated an unmediated direct effect of emotional neglect, a partially mediated effect of emotional abuse, and a fully mediated effect of sexual abuse and physical neglect by depression and anxiety on NSSI. Conclusions Especially emotional neglect and abuse seem to play a role in the etiology of NSSI above and beyond depression and anxiety, while sexual and physical abuse seem to have a rather indirect effect.

Abstract. Objective: According to DSM-5, Disruptive Mood Dysregulation Disorder (DMDD) is characterized by chronic temper outbursts and irritable moods. So far, little is known about its prevalence rate, course and influence on individual well-being. We assessed the prevalence rates of DMDD symptoms during adulthood and primary school age – the latter retrospectively – and studied their relationship with psychiatric disorders and socioeconomic variables. Methods: A total of 2,413 subjects, aged 18–94 years, participated in this population-based, representative study based on self-reports. Results: 12 (0.50 %) subjects reported elevated DMDD symptoms during adulthood, and 19 (0.79 %) reported elevated DMDD symptoms during primary school age. DMDD symptoms were associated with higher rates of depression and anxiety symptoms. Those reporting elevated DMDD symptoms during adulthood were more often single or divorced, and those reporting elevated DMDD symptoms during primary school age were more often childless and unemployed during adulthood compared to subjects without DMDD symptoms. Conclusions: DMDD symptoms seem to show a chronic course and go hand in hand with elevated psychiatric symptoms and impaired socioeconomic and demographic status.

Zusammenfassung. Hintergrund: Nicht-suizidales selbstverletzendes Verhalten (NSSV) ist ein häufiges, klinisch relevantes Phänomen im Jugendalter, das sich in Zusammenhang mit verschiedenen psychischen Störungen beobachten lässt. Deutschland gehört mit einer Lebenszeitprävalenz von 25–35 % bei Jugendlichen innerhalb Europas zu den Ländern mit den höchsten Prävalenzraten an NSSV. Bislang existierte eine zuletzt im Jahr 2006 überarbeitete AWMF-Leitlinie zu selbstverletzendem Verhalten und stereotypen Bewegungsstörungen, deren Gültigkeit 2011 abgelaufen war. Methoden: Die Leitliniengruppe setzte sich aus elf medizinisch, psychologisch bzw. psychotherapeutischen Fachgesellschaften und zwei Interessensvertretungen aus Angehörigen- bzw. Präventionsprojekten zusammen. Die Leitlinie wurde in zwei Konferenzen, darauf aufbauenden Literaturrecherchen und einer abschließenden Konsensuskonferenz erarbeitet. Der Algorithmus wurde in drei Delphi-Runden verabschiedet. Ergebnisse: Während die Datenlage zur Epidemiologie und zur Diagnostik von NSSV gut ist, sind noch immer wenige Studien zum Langzeitverlauf und zur psychotherapeutischen sowie zum Stellenwert einer psychopharmakologischen, adjuvanten Behandlung von NSSV im Jugendalter verfügbar. Berufsgruppenübergreifend wurde auch das Vorgehen im Falle der Notwendigkeit einer somatischen Versorgung bei NSSV thematisiert. Schlussfolgerungen: In Anbetracht der heterogenen Evidenzlage wurden, um die klinische Anwendbarkeit der Leitlinie zu gewährleisten, die wesentlichen Punkte zur Behandlung von NSSV im Jugendalter in einer Konsensuskonferenz abgestimmt. Forschungsdefizite zeigen sich sowohl im Bereich präventiver als auch klinischer Interventionen.

Zusammenfassung. Aufgrund der klinischen Relevanz von suizidalen Krisen, Suizidversuchen und Suiziden im Jugendalter wurde eine konsensusbasierte Leitlinie als Handlungsempfehlung erstellt. Jede Andeutung in Richtung Suizidalität muss ernst genommen werden. Suizidalität ist ein zentraler Bestandteil des psychopathologischen Befunds und Patienten sollten gezielt auf kurz- und langfristige Suizidgefährdung exploriert werden. Eine klinische Einschätzung des akuten Suizidrisikos ergibt sich aus einem vertrauensvollen anamnestischen Gespräch, der Erhebung von Risikofaktoren und dem Erfassen von psychischen Störungen sowie von Suchtmittelkonsum. Bei akuter Selbstgefährdung besteht eine Indikation zur stationären Behandlung, die zum Schutz des Patienten notfalls auch gegen dessen Willen umgesetzt werden muss. Eine adäquate Dokumentation ist unumgänglich. Nach einem Suizidversuch ist neben der fachärztlichen medizinischen Erstversorgung darauf zu achten, dass der Patient sich nicht schaden kann und rasch ein Konsil in der akutversorgenden Klinik erfolgt. Erstes therapeutisches Ziel ist die Reduktion der Suizidalität und ggf. das Wiedererreichen der Absprachefähigkeit. Für wiederkehrende Suizidgedanken ist ein Notfallplan zu erstellen. Zur Entlastung kann zusätzlich zu Gesprächsangeboten vorübergehend eine sedierende Medikation notwendig werden. Im Falle eines Suizids in einer Klinik sollte ein Handlungsleitfaden vorliegen, der die Zuständigkeiten und Abläufe genau regelt und festhält. Wirksame präventive Maßnahmen sind Schulungen von Multiplikatoren, Aufklärungskampagnen, Einschränkung der Verfügbarkeit von Suizidmethoden und die Einhaltung der Richtlinien zur Suizidberichterstattung.

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 objective of this study was to compare structured case management (CM) to usual care (UC) for helping victims of child abuse and neglect (CAN) with mental disorders access evidence-based treatment (EBT). N = 121 children and adolescents aged 4–17 with a history of CAN and a current mental disorder were recruited in three German states in a multi-center parallel group trial. They were randomly assigned, stratified by study site and level of psychosocial functioning, to receive CM additionally to UC or only UC. CM was delivered by trained professionals and volunteers, most of them affiliated to local child welfare agencies or NGOs. UC comprised child welfare services typically delivered in Germany. The primary outcome was EBT utilization after 6 months. Secondary outcome was the time until commencement of EBT. Outcomes were determined by semi-structured clinical interviews with assessors blinded to group allocation. Predictors of access to EBT and barriers to utilization of treatment were analyzed. The intent to treat analysis showed that after 6 months 23 of 60 participants recruited to CM (38%) and 19 of 61 participants recruited to UC (31%) were using EBT, χ 2 (1, N = 121) = 0.689, p = .261. Female gender, out-of-home placement, and home state were significant predictors of access to EBT. Less than 40% of participants across both groups were successfully referred to EBT. Access to EBT seems to be in part due to system-level barriers, namely lack of implementation of EBT in community settings. Trial Registration: DRKS00003979 German Clinical Trials Register