Search

Although adolescents in juvenile residential facilities are at high risk for mental disorders, not all of these adolescents develop psychiatric symptoms. The aim of our study was to define traits protecting these adolescents. A total of 314 adolescents of 20 juvenile residential facilities were examined using standardized assessment instruments (Child Behavior Checklist (CBCL), Junior Temperament and Character Inventory (JTCI)). Educators of the facilities filled out a sociodemographic questionnaire for each participant. Adolescents were divided into two groups (resilient vs. mental problems) by CBCL-Cut-off-Scores. Analyses were based on these two groups. Resilient youth differed from youth with psychiatric symptoms in temperament- and character-traits (e. g. self-directedness F = 28.4, p < .001, d = 0.64) with small to moderate effect sizes (d = 0.36 to 0.64). Resilient adolescents lived in larger facilities (U = 9080, p = .025). No associations were found between gender and resilience, as well as age at placement in the facility and duration of the stay in the facility and resilience. Significant differences in temperament- and character-traits between resilient adolescents and adolescents with mental problems were identified. Especially character-traits could be a basis for developing strategies for promoting mental health and further resilience factors, as social support.

Purpose: Non-suicidal self-injury (NSSI) has been recognized as a significant mental health problem in adolescence with high prevalence rates. To date, there are few studies that compare rates of adolescent NSSI between different countries. Thus far no prevalence rates of adolescent NSSI have been reported for Austrian or Swiss community samples., Methods: This study aimed to assess and compare rates of adolescent NSSI in school samples from Austria, Germany and Switzerland using the same assessment instrument (Ottawa Self-Injury Inventory; OSI)., Results: Within these countries, 6-month prevalence rates between 7.6 and 14.6% were found, with rates showing significant differences between countries (χ² = 16.54, p = 0.02)., Conclusions: These results demonstrate with some variability the significant rates of NSSI in youth in a cross-country study.

Depending on symptom severity, psychopharmacological treatment can be a valuable option in the treatment of depressive disorders in childhood and adolescence. This review provides recommendations for clinical treatment, focusing on suicidality and treatment-resistant patients. The quality of studies regarding the psychopharmacological therapy of depressive disorders in childhood and adolescence has improved since the «black box» warning of the FDA concerning the occurrence of suicidality under treatment with selective serotonin reuptake inhibitors (SSRIs). In Germany, there is proof for a trend toward a more evidence-based psychopharmacological treatment approach within recent years.

Emotion-regulation difficulties have been identified as one of the core components in Non-suicidal self-injury (NSSI), a behaviour often beginning in adolescence. This pilot study evaluated differences in emotion processing between 18 female adolescents with and without NSSI by using verbal responses and functional magnetic resonance imaging (fMRI). Responses to pictures taken from the International Affective Picture System and slides with reference to NSSI were recorded both by verbal rating of valence and arousal and by fMRI. The NSSI group rated pictures with self-injurious reference as significantly more arousing than controls. For emotional pictures, the NSSI group showed a significantly stronger brain response in the amygdala, hippocampus and anterior cingulate cortex bilaterally. Depression explained differences between groups in the limbic area. Furthermore, the NSSI group also showed increased activity in the middle orbitofrontal cortex, and inferior and middle frontal cortex when viewing NSSI picture material. Participants with NSSI showed decreased activity in correlation to arousal in the occipital cortex and to valence in inferior frontal cortex when watching emotional pictures. The fMRI data support the notion that individuals with NSSI show an altered neural pattern for emotional and NSSI pictures. Behavioural data highlight proneness to excitement regarding NSSI topics. This fMRI study provides evidence for emotion-regulation deficits in the developing brain of adolescents with NSSI., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Background: The behaviours of non-suicidal self-injury (NSSI) and deliberate self-harm (DSH) are prevalent among adolescents, and an increase of rates in recent years has been postulated. There is a lack of studies to support this postulation, and comparing prevalence across studies and nations is complicated due to substantial differences in the methodology and nomenclature of existing research., Methods: We conducted a systematic review of current (2005 - 2011) empirical studies reporting on the prevalence of NSSI and DSH in adolescent samples across the globe., Results: Fifty-two studies fulfilling the inclusion criteria were obtained for analysis. No statistically significant differences were found between NSSI (18.0% SD = 7.3) and DSH (16.1% SD = 11.6) studies. Assessment using single item questions led to lower prevalence rates than assessment with specific behaviour checklists. Mean prevalence rates have not increased in the past five years, suggesting stabilization., Conclusion: NSSI and DSH have a comparable prevalence in studies with adolescents from different countries. The field would benefit from adopting a common approach to assessment to aide cross-cultural study and comparisons.

In both classificatory systems DSM-IV and ICD-10 self-injury is a symptom of borderline personality disorder (BPD). But it has been shown empirically that self-injury can also occur independent of BPD, for example, as a component of depressive states or even in adolescents without classifiable psychopathology. The scientific discussion about future diagnostic criteria recently led to a proposal to include Non-Suicidal Self-Injury as an independent disorder in the upcoming DSM-5 classification system. Based on recent epidemiological studies of adolescents in Germany, one may assume that approximately 4% of all youths in middle to late adolescence would fulfill the prevalence criterion (criterion A) of the proposed DSM-5 disorder (that is, at least five self-injury incidents within the previous 12 months). A precise classification of Non-Suicidal Self-Injury based on empirical research is needed to further the research, treatment, and prevention of this diagnosis.

Standardized instruments are crucial for a valid assessment of suicidal behavior. In questionnaire assessments the wording of questions can influence the results. In this study we compared the congruence of the Self-Harm Behavior Questionnaire (SHBQ) and the Ottawa Self-Injury Inventory (OSI) as measures of prevalence of suicidal ideation in an adolescent sample (n = 665, mean age: 14.8, SD: 0.66). We found a life-time prevalence of 36.4 % in the SHBQ and a one-year-prevalence of 27.8 % in the OSI. There was good agreement between the two instruments in terms of the prevalence of suicidal ideation and the association with suicide attempts. The observed rates are comparable with other studies in adolescents; differences arise with varying study designs.

Objective: Research on psychopharmacological treatment in children and adolescents is the subject of ongoing ethical discussion, as minors with mental disorders constitute a vulnerable patient group. Considering the important legislative changes in pediatric research over the past decade in both the US and Western Europe, there is a need to review recent developments in this area., Method: Based on a systematic literature review, a hermeneutical analysis focusing the main issues of ethics in child and adolescent psychopharmacology is provided. Legal and regulatory aspects of psychopharmacological research in children are compared between the US and Europe. Relevant issues were informed assent and consent to research participation, minimal risk and burden of research, ethics of pharmacogenetics, research on "me-too" medications, and justice in global research. Additionally, the concern about undue influence of financial interests in research is also addressed., Conclusion: Incentives for the conduct of clinical trials with children comparable to those contained in US legislation are now provided in the EU. Research to develop "me-too" preparations may have no significant benefit for children, but can cause research burden and detract from clinically more important projects by utilizing limited investigator time and patient resources. Thus far, pharmacogenetic studies may bring more individualized treatment approaches into child psychiatry but they remain at present a promise for the future. Finally, the issues of avoiding undue influence from funders and conflicts of interest remain a prominent concern which can be solved by declaring conflicts and publishing all results of studies extensively.

Attention Deficit Hyperactivity Disorder (ADHD) is not only a childhood disorder but symptoms persist into adolescence and adulthood in approximately one third of the patients. Especially inattention and poor concentration impair driving performance in road traffic. Adolescents and young adults with ADHD are twice as likely to be involved in traffic accidents as people of the same age. This review sums up the legal situation in Germany and provides an overview of the current existing experimental studies on driving performance of adolescents and young adults with ADHD. Psychostimulant therapy seems to improve driving performance in ADHD patients. At the same time psychostimulants are prohibited, according to the road traffic act. Atomoxetine as a non-stimulant is not mentioned there. Therefore it could be unproblematically prescribed, however, the evidence for improved driving is not as unequivocal as for methylphenidate. The psychoeducation of adolescents and young adults with ADHD concerning their increased risk in road traffic often seems to be insufficient in clinical practice. Given the high number of traffic deaths in these young age groups consulting regarding this matter should be of high priority.

Neurobiological studies hypothesize a common final pathway of addictive behavior in the mesolimbic dopaminergic system. Nicotine has been shown to sensitize the reward pathway, thereby causing increased drug-seeking behavior. Since there is evidence to suggest that nicotine, alcohol and other psychoactive substances act on the same final pathway and seem to augment their effects in animal subjects, drug intake behavior of humans would likely be reflected in increased substance use of nicotine-dependent persons. We used biological markers of substance use as well as questionnaires to assess the levels of psychoactive substance use among 18-year-old males in a naturalistic cross-sectional setting. We found that increasing levels of nicotine dependence were related to higher levels of alcohol abuse and dependence. Furthermore, higher levels of nicotine dependence were associated with elevated levels of recent cannabinoid use.

"Chemical restraint" (CR) is an important intervention for the management of aggressive behaviour in children and adolescents. The use of CR during in-patient treatment should be based on standardized intervention strategies. The principles of such an approach include transparent agreement with all participants on fast save and staff-independent reduction of aggressive behaviour without inducing retraumatisation. In clinical practice medication that is effective both for tranquilization and prevention of aggressive escalation is recommended. Current data suggest first line treatment using neuroleptics and benzodiazepines. Due to their potential use both for rapid sedation and prevention atypical neuroleptics are of particular importance. Further controlled studies are needed to evaluate pharmacological treatment of aggressive states with potential (self) harming behaviour in children and adolescents.