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Zusammenfassung: Das Jugendalter stellt eine wichtige Phase in der Entwicklung der Verarbeitungsgeschwindigkeit, der Aufmerksamkeit, des Gedächtnisses und der exekutiven Funktionen dar. Im Rahmen einer Normierungsstudie der kognitiven Basistestung (COGBAT) für das Jugendalter wurden Testwerte bei n = 269 Jugendlichen im Alter von 12 bis 15 Jahren erhoben und mit den Normen der Altersgruppe der 16- bis 30-Jährigen verglichen. Zusätzlich wurde überprüft, inwiefern sich diese Testergebnisse in der subjektiven Einschätzung zur Leistungsfähigkeit (FLei) und Psychopathologie (SDQ) abbilden lassen. Im Jugendalter zeigte sich ein starker Zuwachs in der kognitiven Flexibilität, der Verarbeitungs- und Reaktionsgeschwindigkeit sowie der Inhibitions- und Planungsfähigkeit. Ein bedeutsamer Geschlechtsunterschied fand sich in der Inhibition, mit stärkeren Leistungen bei Mädchen als bei Jungen. Zwischen den Testergebnissen und den subjektiven Einschätzungen zeigten sich keine Zusammenhänge.

European Union, FP7 [HEALTH-F2-2009-223091]; Projekt DEAL, Lustig S, Kaess M, Schnyder N, Michel C, Brunner R, Tubiana A, Kahn JP, Sarchiapone M, Hoven CW, Barzilay S, Apter A, Balazs J, Bobes J, Saiz PA, Cozman D, Cotter P, Kereszteny A, Podlogar T, Postuvan V, Värnik A, Resch F, Carli V, Wasserman D

The ability to regulate one's emotions (emotion regulation, ER) with regard to individual short- and long-term goals presents one of the most central human skills. A disrupted development of ER skills is associated with psychopathological outcomes. Non-suicidal self-injury (NSSI) presents a frequent and impairing phenomenon among young individuals. Disruptions regarding various aspects of ER are involved in the development and maintenance of NSSI. In the present study, we examined ER from a multidimensional perspective, including a sample of female adolescents meeting DSM-5 criteria for NSSI disorder (N = 30) and a psychologically healthy control group (N = 30). In line with results from previous studies, female adolescents with NSSI exhibited considerable difficulties regarding all aspects of ER investigated. Furthermore, various aspects of ER were distinctly linked with depressive and BPD symptomatology. Differences in NSSI frequency between participants largely went back to difficulties regarding specific aspects of ER, in combination with the self-rated severity of exposure to early life maltreatment. With regard to clinical practice, the use of interventions to improve particular aspects of ER, under simultaneous consideration of the individual developmental history and psychopathological impairment, might provide an efficient approach to mediate long-lasting change in the treatment of deliberate self-harm.Zusammenfassung The ability to regulate one’s emotions (emotion regulation, ER) with regard to individual short- and long-term goals presents one of the most central human skills. A disrupted development of ER skills is associated with psychopathological outcomes. Non-suicidal self-injury (NSSI) presents a frequent and impairing phenomenon among young individuals. Disruptions regarding various aspects of ER are involved in the development and maintenance of NSSI. In the present study, we examined ER from a multidimensional perspective, including a sample of female adolescents meeting DSM-5 criteria for NSSI disorder (N = 30) and a psychologically healthy control group (N = 30). In line with results from previous studies, female adolescents with NSSI exhibited considerable difficulties regarding all aspects of ER investigated. Furthermore, various aspects of ER were distinctly linked with depressive and BPD symptomatology. Differences in NSSI frequency between participants largely went back to difficulties regarding specific aspects of ER, in combination with the self-rated severity of exposure to early life maltreatment. With regard to clinical practice, the use of interventions to improve particular aspects of ER, under simultaneous consideration of the individual developmental history and psychopathological impairment, might provide an efficient approach to mediate long-lasting change in the treatment of deliberate self-harm.

Bullying is a common and significant risk factor for mental and physical health problems. The aim of the outlined study was to evaluate the German version of the Olweus Bullying Prevention Program (OBPP) and to investigate potential moderators of its effectiveness. 23 schools started with the implementation and all students were invited to complete the Olweus Bullying Questionnaire annually. For our analyses, the data from grades 5 to 9 were used (t0: n = 5759; t1: n = 5416; t2: n = 4894). 16 out of the 23 schools completed the 18-months implementation period. The effectiveness of the program statistically depended on its complete implementation (χ2(2) = 7.62, p = 0.022). In the group of non-completers, the prevalence of victimization did not change during the observation period of 2 years (χ2(2) = 4.64, p = 0.099). In the group of the completer schools, a significant decrease in bullying between t0 and t1 was found for victims (t0: 9.14%; t1: 6.87%; OR = 0.74; 95% CI 0.62–0.88; p = 0.001) and perpetrators (t0: 6.16%; t1: 4.42%; OR = 0.70; 95% CI 0.55–0.89; p = 0.004). After 24 months (t2), this decrease could be retained (victims: t2: 6.83%; OR = 0.73; 95%CI = 0.61–0.88; p = 0.001; perpetrators: t2: 4.63%; OR = 0.72; 95% CI 0.57–0.92; p = 0.009). Furthermore, we found the following moderators of program effectiveness in the completer schools: (1) gender (with a stronger decrease among victimized girls; p = 0.004) and (2) school grade (with a stronger decrease of victimization among grades 5–7; p = 0.028). The German version of the OBPP significantly reduced the bullying prevalence in the completer schools. Effective prevention needs time and resources: fulfilling the 18-months implementation period was the basis for positive results.

Die Entwicklung der künstlichen sozial-emotionalen Intelligenz wird intensiv beforscht und finanziell gefördert. Sozial und emotional intelligente Roboter sind noch „science fiction“, allerdings finden Hilfsroboter in sozialen Bereichen wie in der Pflege sowie künstliche Intelligenz in Form von maschinellem Lernen auch in der Psychiatrie bereits ihren Einsatz. Welche Implikationen leiten sich daraus für die Kinder- und Jugendpsychiatrie ab? Der Nutzen der vereinzelt eingesetzten „sozialer“ Roboter in der Kinder- und Jugendpsychiatrie sollte aus inhaltlicher, ethischer und politischer Sicht intensiv untersucht und kritisch hinterfragt werden. Maschinelles Lernen für die Entwicklung von Apps zur psychischen Gesundheit und therapeutischen Chatbots ist weltweit im Einsatz und aus dem digitalen Bereich der „mental health“-Versorgung nicht mehr wegzudenken. Hier kann die künstliche Intelligenz hilfreich und unterstützend sein, um Hilfsbedürftigen, die anderweitig keinen Zugang zu einer psychiatrischen Versorgung bekämen, zu erreichen. Sie kann in Form von Screenings massenhaft Daten verarbeiten und so gefährdete Menschen identifizieren und eine Unterstützung durch das Helfersystem ermöglichen. Für eine derartige Nutzung sollte sich die psychiatrische Fachgemeinschaft intensiv einbringen, um qualitative, ethische und rechtliche Standards zu erarbeiten. Künstliche Intelligenz sei es in Form von Robotik oder maschninellem Lernen kann immer nur als Werkzeug niemals als Ersatz fungieren., Heidelberger Jahrbücher Online, Bd. 6 (2021): Intelligenz – Theoretische Grundlagen und praktische Anwendungen

IMPORTANCE The ENIGMA clinical high risk (CHR) for psychosis initiative, the largest pooled neuroimaging sample of individuals at CHR to date, aims to discover robust neurobiological markers of psychosis risk.OBJECTIVE To investigate baseline structural neuroimaging differences between individuals at CHR and healthy controls as well as between participants at CHR who later developed a psychotic disorder (CHR-PS+) and those who did not (CHR-PS-).DESIGN, SETTING, AND PARTICIPANTS In this case-control study, baseline T1-weighted magnetic resonance imaging (MRI) data were pooled from 31 international sites participating in the ENIGMA Clinical High Risk for Psychosis Working Group. CHR status was assessed using the Comprehensive Assessment of At-Risk Mental States or Structured Interview for Prodromal Syndromes. MRI scans were processed using harmonized protocols and analyzed within a mega-analysis and meta-analysis framework from January to October 2020.MAIN OUTCOMES AND MEASURES Measures of regional cortical thickness (CT), surface area, and subcortical volumes were extracted from T1-weighted MRI scans. Independent variables were group (CHR group vs control group) and conversion status (CHR-PS+ group vs CHR-PS- group vs control group).RESULTS Of the 3169 included participants, 1428 (45.1%) were female, and the mean (SD; range) age was 21.1 (4.9; 9.5-39.9) years. This study included 1792 individuals at CHR and 1377 healthy controls. Using longitudinal clinical information, 253 in the CHR-PS+ group, 1234 in the CHR-PS- group, and 305 at CHR without follow-up data were identified. Compared with healthy controls, individuals at CHR exhibited widespread lower CT measures (mean [range] Cohen d = -0.13 [-0.17 to -0.09]), but not surface area or subcortical volume. Lower CT measures in the fusiform, superior temporal, and paracentral regions were associated with psychosis conversion (mean Cohen d = -0.22; 95% CI, -0.35 to 0.10). Among healthy controls, compared with those in the CHR-PS+ group, age showed a stronger negative association with left fusiform CT measures (F = 9.8; P < .001; q < .001) and left paracentral CT measures (F = 5.9; P = .005; q = .02). Effect sizes representing lower CT associated with psychosis conversion resembled patterns of CT differences observed in ENIGMA studies of schizophrenia (rho = 0.35; 95% CI, 0.12 to 0.55; P = .004) and individuals with 22q11.2 microdeletion syndrome and a psychotic disorder diagnosis (rho = 0.43; 95% CI, 0.20 to 0.61; P = .001).CONCLUSIONS AND RELEVANCE This study provides evidence for widespread subtle, lower CT measures in individuals at CHR. The pattern of CT measure differences in those in the CHR-PS+ group was similar to those reported in other large-scale investigations of psychosis. Additionally, a subset of these regions displayed abnormal age associations. Widespread disruptions in CT coupled with abnormal age associations in those at CHR may point to disruptions in postnatal brain developmental processes.Question How are brain morphometric features associated with later psychosis conversion in individuals at clinical high risk (CHR) for developing psychosis?Findings In this case-control study including 3169 participants, lower cortical thickness, but not cortical surface area or subcortical volume, was more pronounced in individuals at CHR in a manner highly consistent with thinner cortex in individuals with established psychosis. Regions that displayed lower cortical thickness in individuals at CHR who later developed a psychotic disorder additionally displayed abnormal associations with age.Meaning In this study, CHR status and later transition to psychosis was robustly associated with lower cortical thickness; abnormal age associations and specificity to cortical thickness may point to aberrant postnatal brain development in individuals at CHR, including pruning and myelination.This case-control study investigates baseline structural magnetic resonance imaging (MRI) differences between individuals at clinical high risk and healthy controls as well as between participants at clinical high risk who later developed a psychotic disorder and those who did not.

Background There is a lack of studies examining psychosocial functioning in patients with non-suicidal self-injury (NSSI), especially in adolescents, and rates of impaired functioning in existing literature vary considerably. These variations may be attributable to further risk factors that influence psychosocial functioning. Thus, the aim of the study was to examine whether adolescent NSSI patients with childhood maltreatment (CM), a known risk factor for lower psychosocial functioning, may differ from adolescent NSSI patients without CM, and whether these differences may be explained by the severity of comorbid disorders. Specifically, we examined whether severity of borderline personality disorder (BPD), depression and posttraumatic stress disorder may explain differences in psychosocial functioning in NSSI patients with and without CM. Methods Data of 368 adolescents with NSSI disorder from an outpatient clinic were analyzed using structural equation modeling. Clinicans’ rating of the Global Assessment of Functioning Scale (GAF) was collected, in addition to clinical interviews. Results Results indicate that GAF scores were lower among NSSI patients with CM and that the difference in psychosocial functioning between these groups was explained by BPD and depression severity. Conclusions Psychosocial functioning in NSSI patients varies depending on whether they have experienced CM or not. Specifically, these differences seem to be attributable to higher BPD and depression severity in adolescent NSSI patients with CM. Clinicians should ensure to assess CM and focus on BPD and depression severity in this population. Treatment of BPD and depression may notably reduce psychosocial impairment in NSSI patients with CM.

Zusammenfassung Stress und Anstrengung sind unvermeidlicher Teil unseres Lebens. Die Bewältigung fällt leichter, wenn ein Gefühl der Kontrolle über die Stressoren gewonnen werden kann. Kinder können jedoch sehr oft nicht kontrollieren, welche Stressoren in welchem Umfang auf ihr Leben einwirken. Mit Beginn der Schwangerschaft sind sie – über das endokrine System der Mutter – Stressoren ausgeliefert, von normalem Schwangerschaftsstress bis hin zu Misshandlung, Flucht oder Folter. Dieser Artikel trägt Forschungsergebnisse der letzten zwei Dekaden zusammen, da der Einfluss von Stress auf das wachsende Gehirn in dieser Zeit intensiv untersucht wurde. Sowohl Tier- als auch Menschenstudien tragen dazu bei, das Verständnis der Auswirkungen von Stress auf das junge Kind bis ins Erwachsenenalter hinein zu erhöhen. Die hier zusammengestellten Ergebnisse unterstreichen die Notwendigkeit von stressmindernden und resilienzfördernden Programmen für Kinder und vor allem auch ihre Eltern. Auch und vor allem die Schwangerschaft als hochsensibler Zeitraum sollte in Präventionsansätzen Berücksichtigung finden.

Following Dr. Harms´ case report, the identity development of adolescence and emergent adulthood is viewed through a postmodern environmental framework. The holding function of the therapeu...

ZusammenfassungDie Adoleszenz ist aufgrund des Hirnreifungsprozesses und vor allem bei zusätzlichen Belastungsfaktoren ein besonders vulnerables Alter für die Erstmanifestation von Psychosen mit negativen psychosozialen Konsequenzen für die Betroffenen und ihre Angehörigen. Die Nachteile eines frühen Erkrankungsalters können teilweise durch eine hochqualitative Früherkennung und Frühbehandlung unter einer Berücksichtigung transitionsmedizinischer Versorgungsansätze ausgeglichen werden. Für die Förderung einer erfolgreichen Transition heranwachsender PatientInnen mit Psychosen bestehen praxisbezogene Empfehlungen zum Aufbau populationsbezogener, flexibler und nachgehender Früherkennungs- und Behandlungsnetzwerke, in denen MitarbeiterInnen diagnose-, alters- und fachübergreifend settingübergreifend zusammenarbeiten und eine erfolgreiche Transition strukturiert, flächendeckend, patientenorientiert und flexibel ermöglichen.

Relationship Between (Pathological) Internet Use and Sleep Problems in a Longitudinal Study Excessive or pathological Internet use has already been associated with sleep disorders, but the direction of the connection remains still uncertain. The relationship between (pathological) Internet use and sleep problems in adolescence was investigated by a representative longitudinal survey of data from a sample of 1,060 students from Heidelberg and the surrounding area (SEYLE study). The students, on average 15 years old, responded at a baseline and after one year to a survey on sleep and Internet use. In addition to the number of hours of Internet use, pathological Internet use was assessed using the Young Diagnostic Questionnaire (YDQ). Sleep duration and sleep problems were surveyed by self-assessment. The prevalence of adolescents with pathological Internet use was 3.71 % in the follow-up survey. Furthermore, 20.48 % of adolescents reported sleep problems. Pathological and excessive Internet use were predictors of sleep problems over the course of one year. Adolescents who met the criteria for Internet addiction to the baseline had a 3.6 times greater risk of developing sleep problems in the course of one year. Whereas sleep problems to the baseline increased the YDQ symptoms only by 0.22. Sleep problems often occur as a result of pathological Internet use and could have an addiction-enhancing effect as well as mediating further psychiatric comorbidities. Thus, sleep problems should be targeted for early intervention and therapeutic measures.

ZUSAMMENFASSUNG Gegenstand und Ziel Mobbing ist häufig unter Kindern und Jugendlichen; es besteht ein kausaler Zusammenhang zwischen Mobbingerfahrungen und der Ausbildung zahlreicher psychischer und physischer Störungen. Der negative Einfluss von Mobbing betrifft viele Lebensbereiche der Opfer: psychologisch, sozial und ökonomisch. Im Kontext Schule kann und sollte Mobbing effektiv entgegengewirkt werden. Insbesondere präventive Programme für die gesamte Schule, wie das hier vorgestellte „Olweus Präventions-Programm gegen Mobbing und antisoziales Verhalten“, erscheinen vielversprechend. Schlussfolgerungen Mobbing hat weitreichende Konsequenzen für die betroffenen Opfer sowie für die ganze Gesellschaft. Es braucht verstärkte Anstrengungen in der Entwicklung, Erforschung und Dissemination von präventiven Ansätzen. Klinische Relevanz Angesichts der klinischen Folgen von Mobbing kann davon ausgegangen werden, dass Betroffene häufiger mit dem Gesundheitssystem in Kontakt kommen als nicht gemobbte Gleichaltrige. Eine erhöhte Sensibilisierung bezüglich der Wichtigkeit der Beziehung zu Gleichaltrigen hat das Potenzial, betroffene Kinder in diesem Kontext effektiver zu erkennen und zu behandeln.

Early life maltreatment can have severe and long-lasting consequences for the directly affected individual as well as for the next generation. Data from our research including mother-child dyads from Heidelberg and Berlin show that early life maltreatment is associated with behavioral and neural changes including personality traits and attachment style of the affected mothers that negatively affect their relationship with their child. The children of these mothers affected by early life maltreatment have an elevated risk to be maltreated and to develop mental disorders. They also show a heightened cortisol concentration and a reduced inhibition control. It seems to be of importance whether the mother has experienced early life maltreatment but is resilient, meaning that she has not developed a mental disorder (up to the time of examination) or whether in addition to the early life maltreatment she has developed a mental disorder later in life. Children of mothers with early life maltreatment and a lifetime mental disorder seem to be especially exposed to stress and show the greatest impairments and risks. Based on the existing data from our research practical and clinical implications are discussed and one possible intervention in the form of a training of mentalization competencies for parents is presented.

Introduction: The aim of this study was to examine whether (a) cyberbullying has unique associations with mental health problems, risk-taking, and self-harm behavior in victims and perpetrators when compared to school bullying and (b) if cyberbullying is associated with an additional burden for students already involved in school bullying. Methods: Data were collected from 6,561 students across 23 schools in Germany (grades 5–13). The sample was divided into the following four groups: cyber-only involvement (victims = 1.9%, perpetrators = 0.6%), school-only involvement (victims = 17.2%, perpetrators = 11.9%), dual involvement (victims = 5.7%, perpetrators = 2.9%), and noninvolvement (victims = 75.3%, perpetrators = 84.6%). Multilevel mixed-effects regression analysis was conducted to examine group differences in mental health (Strengths and Difficulties Questionnaire, KIDSCREEN-10), risk-taking, and self-harm behavior (e.g., substance use, suicide attempts). Results: Cyber-only bullying had unique associations with mental health problems and risk-taking behavior in victims (lower levels of peer relationship problems: p < 0.001, greater substance use: p < 0.05) and perpetrators (higher levels of peer relationship problems: p < 0.05) when compared to school-only bullying. Dual victims and perpetrators reported significantly more mental health problems (victims: χ2(5) = 221.58, p < 0.001; perpetrators: χ2(5) = 116.40, p < 0.001) and were more likely to report risk-taking and self-harm behavior (victims: χ2(7) = 115.15, p < 0.001; perpetrators: χ2(7) = 38.79, p < 0.001) than students involved in school-only bullying. Conclusion: Cyber-only bullying appears to be related to specific mental health issues beyond those associated with school-only bullying. Cyberbullying and school bullying go along with additive mental health problems, risk-taking, and self-harm behavior in both victims and perpetrators. Thus, bullying prevention and intervention programs should also target cyberbullying.

Introduction: Aggressive behavior in reaction to threats, frustration, or provocation is prevalent in borderline personality disorder (BPD). This study investigated aggressive behavior and its biological correlates in adolescents with BPD. Methods: Twenty-one female adolescents with a DSM-IV BPD diagnosis and 25 sex- and age-matched healthy controls participated in the Taylor Aggression Paradigm (TAP), a laboratory-based experiment measuring aggressive behavior in the interpersonal context. Heart rate was measured and saliva samples were taken throughout the experiment. Results: Multilevel mixed-effects linear regression analyses revealed no significant group difference in aggressive behavior induced by the TAP. Additionally, the two groups did not differ in cortisol, testosterone, and heart rate responses to the aggression induction. The BPD group showed a significant cortisol increase in the time preceding the start of the TAP in contrast to the healthy control group, in whom a significant heart rate increase from baseline to the first block of the TAP was observed. Discussion: There was no evidence, either at the phenomenological or the biological level, of increased task-induced aggression in adolescents with BPD. The results may indicate that adolescents with BPD experienced fearful stress in anticipation of the experimental task in contrast to healthy controls who showed an adaptive response of the autonomic nervous system necessary to deal with the upcoming demand.

Prompt access to appropriate professional care for adolescents with self-harm thoughts and respective behaviors (suicidal behavior and non-suicidal self-injury [NSSI]) is crucial as both are associated with an increased risk of suicide in later life. The present study aimed to describe the duration from initial onset of thoughts and incidents of self-harm until first clinical presentation in children and adolescents and to identify factors affecting help-seeking duration. Onset of self-harm thoughts and behaviors, time of first clinical presentation, and psychiatric and demographic variables were obtained from n = 672 adolescents (11–19 years) from the Germany-based AtR!Sk (Ambulanz fur Risikoverhalten & Selbstschadigung) cohort-study at an outpatient clinic for risk-taking and self-harm behaviors. In 22% of overall cases, the first self-harm thoughts and behaviors occurred after contact to professional care was already established. Focusing on actual help-seeking delay only, it took between M = 0.99 years (after first suicide attempt) and M = 1.98 years (after first thoughts of NSSI) until participants sought professional help. Overall, help-seeking duration and help-seeking delay were longer for participants with more severe psychopathology (i.e., BPD, depressive symptoms, general symptom severity). The findings revealed a substantial delay of receiving appropriate professional care in adolescents with self-harm thoughts and behavior. The correlation between treatment latency and higher psychopathology may emphasize the need of prompt treatment. A better understanding of barriers and facilitators to professional help will contribute to enhance measures of tailored support for young patients in their help-seeking process.

Research has shown associations between adverse parenting experiences and (borderline) personality disorder ([B]PD). A biopsychosocial model suggests that child characteristics and the environment interact in the development of symptoms. However, prospective data in this aspect are limited. This study focused on maternal bonding impairment (MBI; 2 weeks postpartum) and its interactions with child temperament (age 5) and child sex as predictors of BPD symptoms and general personality dysfunction in adolescence. Participants were 64 mother-child dyads from a community sample who took part in a 14-year longitudinal study. Higher MBI was a significant predictor of general personality dysfunction as defined in Criterion A of the alternative model for PD of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Interactions showed that the effect of MBI on general personality dysfunction was decreased for children higher in harm avoidance and increased for children higher in novelty seeking. There was also a negative main effect of harm avoidance on (B)PD features. Regarding BPD symptoms, the MBI × Child Sex interaction indicated differential susceptibility. Girls' but not boys' BPD symptoms were dependent on maternal bonding. Our results indicate that children at risk of developing personality pathology can be identified early in life. They stress the importance of early relationship disturbances in the development of personality pathology and refine the understanding of differential susceptibility factors in the context of MBI and PD symptom development. Our findings can be applied to target at-risk dyads for selective early prevention based on temperament and maternal bonding. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

ImportanceThe ENIGMA clinical high risk for psychosis (CHR) initiative, the largest pooled CHR-neuroimaging sample to date, aims to discover robust neurobiological markers of psychosis risk in a sample with known heterogeneous outcomes.ObjectiveWe investigated baseline structural neuroimaging differences between CHR subjects and healthy controls (HC), and between CHR participants who later developed a psychotic disorder (CHR-PS+) and those who did not (CHR-PS-). We assessed associations with age by group and conversion status, and similarities between the patterns of effect size maps for psychosis conversion and those found in other large-scale psychosis studies.Design, Setting, and ParticipantsBaseline T1-weighted MRI data were pooled from 31 international sites participating in the ENIGMA CHR Working Group. MRI scans were processed using harmonized protocols and analyzed within a mega- and meta-analysis framework from January-October 2020.Main Outcome(s) and Measure(s)Measures of regional cortical thickness (CT), surface area (SA), and subcortical volumes were extracted from T1-weighted MRI scans. Independent variables were group (CHR, HC) and conversion status (CHR-PS+, CHR-PS-, HC).ResultsThe final dataset consisted of 3,169 participants (CHR=1,792, HC=1,377, age range: 9.5 to 39.8 years, 45% female). Using longitudinal clinical information, we identified CHR-PS+ (N=253) and CHR-PS- (N=1,234). CHR exhibited widespread thinner cortex compared to HC (average d=-0.125, range: -0.09 to -0.17), but not SA or subcortical volume. Thinner cortex in the fusiform, superior temporal, and paracentral regions was associated with psychosis conversion (average d=-0.22). Age showed a stronger negative association with left fusiform and left paracentral CT in HC, compared to CHR-PS+. Regional CT psychosis conversion effect sizes resembled patterns of CT alterations observed in other ENIGMA studies of psychosis.Conclusions and RelevanceWe provide evidence for widespread subtle CT reductions in CHR. The pattern of regions displaying greater CT alterations in CHR-PS+ were similar to those reported in other large-scale investigations of psychosis. Additionally, a subset of these regions displayed abnormal age associations. Widespread CT disruptions coupled with abnormal age associations in CHR may point to disruptions in postnatal brain developmental processes.Key PointsQuestionHow do baseline brain morphometric features relate to later psychosis conversion in individuals at clinical high risk (CHR)?FindingsIn the largest coordinated international analysis to date, reduced baseline cortical thickness, but not cortical surface area or subcortical volume, was more pronounced in CHR, in a manner highly consistent with thinner cortex in established psychosis. Regions that displayed greater cortical thinning in future psychosis converters additionally displayed abnormal associations with age.MeaningCHR status and later transition to psychosis is robustly associated with reduced cortical thickness. Abnormal age associations and specificity to cortical thickness may point to aberrant postnatal brain development in CHR, including pruning and myelination.

Objectives Behavioral disturbances in adolescence are potentially linked to aberrant functioning of the thyroid gland. Accordingly, alterations of the hypothalamic-pituitary-thyroid (HPT) axis might impact psychopathological development. Yet corresponding research in adolescents with nonsuicidal self-injury (NSSI) and comorbid mental disorders is scarce. Methods The present study examined HPT axis functioning in adolescents with NSSI compared to healthy controls (HC) using blood-based assays of thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), and the ratio of these hormones (fT3/fT4 ratio). Cortisol was additionally examined to contrast HPT axis functioning with a well-established biomarker of stress responsivity. Moreover, associations between clinical characteristics, HPT axis and HPA axis functioning were investigated. Female adolescents meeting NSSI criteria according to DSM-5 criteria (n = 117) were compared to adolescent HC (n = 41). Standardized serum-based endocrinological assays and interview- and questionnaire-based psychiatric assessments were used. Smoking status was included as covariate for all analyses. Results NSSI patients displayed altered HPT axis functioning as fT3/fT4 ratio values were blunted in comparison to HC. Negative correlations were further present between fT3, fT3/fT4 ratio and severity of BPD symptoms, depression scores and symptomatic distress. TSH correlated negatively with severity of BPD symptoms and symptomatic distress exclusively. Cortisol values differed neither significantly between experimental groups nor correlated significantly with clinical characteristics. Conclusions Longitudinal examinations, assessing links between psychopathology and endocrinological alterations, are warranted to address potential clinical implications of thyroid markers in child and adolescent psychiatry.

If one has described the risk behaviors and psychopathological symptoms in detail, they need to be differentiated in their context (How do the patients suffer? In which way are the symptoms linked to each other and to the environment?). The next question that usually arises is the cause (Where do symptoms and behaviors come from? What are the causal conditions and antecedents of certain behaviors?). Many neurobiological and socio-theoretical models attempt to describe clinical symptoms as a result of cerebral disorders and/or social constraints. The therapeutic steps based on these models are causally oriented and try to influence the causal conditions—e.g. a suspected lack of serotoninergic processes through medication or in the psychotherapeutic field through the processing of biographical trauma—so that the clinical symptoms may decrease. However, these models assume that symptoms follow their causes almost reflexively or seem to be unconditionally driven by them. This is rarely the case and the therapeutic attempts may in many cases remain unsuccessful. We want to take a different view on symptoms and risk behaviors, which assumes that they always have an adaptive function and are embedded in their psychosocial contexts. Symptoms and behaviors always pursue inner goals and endowments, symptoms and behaviors aim at purposes (what for?).

The book is based on the idea that epidemiologically increasing juvenile risk behaviors—like substance abuse, non-suicidal self-injury (NSSI), antisocial or suicidal behavior—serve the adolescent’s self to fulfill developmental tasks like identity-formation and regulation of self-worth. Three questions are addressed

Background There is a well-established link between maternal depression and child mental health. Similar effects have been found for maternal history of early life maltreatment (ELM). However, studies investigating the relationship of children's quality of life and maternal depression are scarce and none have been conducted for the association with maternal ELM. The aim of the present study was to investigate the effects of maternal history of ELM and depression on children's health-related quality of life and to identify mediating factors accounting for these effects. Methods Our study involved 194 mothers with and without history of depression and/or ELM and their children between five and 12 years. Children's health-related quality of life was assessed by maternal proxy- and child self-ratings using the KIDSCREEN. We considered maternal sensitivity and maternal parenting stress as potential mediators. Results We found an effect of maternal history of depression but not of maternal history of ELM on health-related quality of life. Maternal stress and sensitivity mediated the effects of maternal depression on child global health-related quality of life, as well as on the dimensions Autonomy & Parent Relation, School Environment (maternal and child rating), and Physical Wellbeing (child rating). Limitation Due to the cross-sectional design of the study, causal interpretations must be made with caution. Some scales yielded low internal consistency. Conclusions Maternal impairments in areas of parenting which possibly developed during acute depression persist even after remission of acute affective symptoms. Interventions should target parenting stress and sensitivity in parents with prior depression.

Coordination Theme 1 (Health) of the European Union Seventh Framework Program (FP7) [HEALTH-F2-2009-223091], Kaess, M., Klar, J., Kindler, J., Parzer, P., Brunner, R., Carli, V., Sarchiapone, M., Hoven, C.W., Apter, A., Balazs, J., Barzilay, S., Bobes, J., Cozman, D., Gomboc, V., Haring, C., Kahn, J.-P., Keeley, H., Meszaros, G., Musa, G.J., Postuvan, V., Saiz, P., Sisask, M., Varnik, P., Resch, F., Wasserman, D.

Background Beta-endorphin (BE) has been suggested to play a central role as to why people engage in NSSI. To our knowledge, no study has systematically assessed this potential relationship in adolescents with NSSI. Methods 94 adolescents with NSSI (according to DSM-5 criteria) and 35 healthy controls (HC) were enrolled. All participants received heat pain stimulation, with pain threshold and tolerance measured in °C. Plasma BE levels were assessed. Sociodemographic and clinical characteristics were obtained via semi-structured interviews and self-report questionnaires. Results Adolescents with NSSI showed increased pain thresholds (t(127)=2.071, p=.040), lower pain intensity (t(114)==2.122, p=.036) and lower plasma BE levels (t127==3.182, p=.002) compared to HC. Groups did not differ on pain tolerance (t(127)=0.911, p=.364). Greater pain threshold correlated positively with borderline personality disorder (BPD) symptoms (r=0.182, p=.039), while pain intensity (r=-0.206, p=.033) and BE levels (r=-0.246, p=.007) correlated negatively with depression severity. No significant relationship was found between pain threshold and plasma BE (r=-0.013, p=.882). Limitations Future studies should implement repeated plasma BE measures to assess BE release in association with pain in NSSI. Validity of plasma BE measures compared to central measures should be considered. Assessing the association between pain sensitivity (PS) and BE in a naturalistic setting presents a promising avenue for future research in NSSI. Conclusions Findings support both reduced PS and basal opioid deficiency as independent biological correlates and potential risk-factors for NSSI. Further longitudinal and experimental studies are needed to investigate the role of BE levels and PS as well as their potential association.

In the functional symptom analysis, an attempt is made to combine the control loop model with the concepts of “psychic structures” [142, 236] and Grawe’s principle of consistency to explain mental disorders [221].

The “cognitive revolution” in behavior therapy (second wave) was the result of scientific developments in the last third of the twentieth century. The focus shifted from observable behavior to mental processes, but the scientific paradigm as a methodology of “chains of causal conclusions” remained unchanged from the beginnings of empirical psychology [222]. Now attempts have been made to map intrapsychic processes in non-linear models and more complex explanatory patterns.

Developmental psychopathology ambitiously provides an overview of the unfolding knowledge on mental disorders and the variety of therapeutic approaches available in a new synopsis by integrating clinical developmental psychological knowledge and psychiatric experience into a bio-psycho-social model [129, 130]. Developmental psychopathology is therefore concerned not only with the pathogenesis of mental disorders, but also in particular with the clinical course over the further lifespan. Clinical decisions will be therapeutically enriched through the application of developmental psychological knowledge. The development focus is directed to different areas: on the one hand, the influences of normal development on the genesis and manifestation of psychopathological symptoms in different ages are considered, on the other hand, the influence of psychopathological symptoms on normal development is the subject of the study [129]. In different phases of life children typically have very different ways of reacting to mental irritation. The infant’s forms of expression of distress focus mainly on changes in eating, sleeping, and excretion behavior, and the interactional alarm situation, in which the child uses crying to make the caregiver aware of his or her condition. The different forms of fear, for example, separation anxiety, dark fear, social anxiety or fear of existence are also tied to important cognitive developmental steps of the child and adolescent. We also know that toddlers may not develop delusions as long as they cannot take social perspectives. Delusions need the takeover of another’s focus. We expect social perspectives to be adopted by children from the age of four earliest.

The “New Morbidity in Childhood and Adolescence” is a term for different disorders that have become the focus of public attention in recent decades. Since the serious infectious diseases of childhood through vaccinations and antibiotics have lost their horror and since childhood cancer and congenital metabolic disorders, as well as congenital malformations, could be contained through early detection and treatment, new clinical pictures have occupied the treatment area. According to Schlack and Brockmann [238], these are in the narrower sense emotional and behavioral problems, functional disorders such as developmental disorders of language, problems of cognitive and motor skills, obesity and eating disorders as well as other risk behaviors like substance abuse and addictive behavior. In a broader sense, chronic somatic clinical pictures are also attributed to new morbidity, with the allergic diseases being particularly noteworthy here. The new morbidity has led to a shift in the focus of the disease spectra prevailing in childhood and adolescence since the 1960s [238].

Background Adolescence is a critical time for brain development. Findings from previous studies have been inconsistent, failing to distinguish the influence of pubertal status and aging on brain maturation. The current study sought to address these inconsistencies, addressing the trajectories of pubertal development and aging by longitudinally tracking structural brain development during adolescence. Methods Two cohorts of healthy children were recruited (cohort 1: 9–10 years old; cohort 2: 12–13 years old at baseline). MRI data were acquired for gray matter volume and white matter tract measures. To determine whether age, pubertal status, both or their interaction best modelled longitudinal data, we compared four multi-level linear regression models to the null model (general brain growth indexed by total segmented volume) using Bayesian model selection. Results Data were collected at baseline (n = 116), 12 months (n = 97) and 24 months (n = 84) after baseline. Findings demonstrated that the development of most regional gray matter volume, and white matter tract measures, were best modelled by age. Interestingly, precentral and paracentral regions of the cortex, as well as the accumbens demonstrated significant preference for the pubertal status model. None of the white matter tract measures were better modelled by pubertal status. Limitations: The major limitation of this study is the two-cohort recruitment. Although this allowed a faster coverage of the age span, a complete per person trajectory over 6 years of development (9–15 years) could not be investigated. Conclusions Comparing the impact of age and pubertal status on regional gray matter volume and white matter tract measures, we found age to best predict longitudinal changes. Further longitudinal studies investigating the differential influence of puberty status and age on brain development in more diverse samples are needed to replicate the present results and address mechanisms underlying norm-variants in brain development.

The developmental model that underlies a functional analysis of symptoms in developmental psychopathology is the interactionist development theory [178]. Influences of nature and culture, civilization norms, and expectations of caregivers as well as natural environmental conditions are development incentives and represent developmental tasks that must be mastered by the individual. The peculiarity of the interactionist theory is that it gives the individual an active role in shaping his environment and does not degrade it to the passive place of action of different development influences.

Psychotherapy in adolescents can not only focus on discontinuing and alleviating psychopathological symptoms, but should also consider the cognitive-emotional resources of the person, give importance to affect regulation and life issues, and focus on internal conflicts and interactional problem issues. The psychic structure and the development of the self-concept are of central importance. The role of memory cannot be neglected when considering conscious and unconscious processes. The development of “mentalization” [34] also plays an important role in the development of psychological structures.

Objective: Obstetric complications (OCs) are adverse events during pregnancy, birth, or immediately after birth. Evidence on cumulative OC and longitudinal associations with child psychopathology is sparse. Prospective studies testing mediating pathways such as parenting stress are needed. This study aimed to investigate the impact of OC on child psychopathology in middle childhood and to highlight whether and which type of parenting stress specifically mediates this association. Methods: We investigated n = 54 mother-child dyads from 5 months to 8 years of age. Child psychopathology at 8 years and parenting stress at 12 months were assessed using the Child Behavior Checklist (CBCL) and the Parenting Stress Index. OCs were evaluated by the Steinhausen Questionnaire and through access to official pregnancy records at the 5-month visit. Half of the mothers had experienced early-life maltreatment (ELM), assessed with the Childhood Trauma Questionnaire. Results: There was a significant indirect effect of maternal parenting stress at 12 months mediating the association between OC and child psychopathology at 8 years (�� = 0.26; p < 0.01; 95% [0.35-1.83]). A significant proportion of 35% of CBCL-variance was explained. The significant effect remained even when maternal ELM and maternal psychological distress were controlled for. On the subscale level, only the "Difficult Child" subscale was a significant mediator. Conclusion: Our findings suggest that parenting stress should be targeted to prevent adverse effects of OC on child psychopathology. More research focusing on families subjected to OC is needed to highlight how maternal parenting stress and child regulatory functioning interact to affect child development longitudinally.

Background. Predicting suicide attempts is a challenging task for clinicians and researchers, particularly among high-risk individuals (i.e. adolescents with lifetime suicide attempts). In this study, we examined whether adolescents were able to predict their own risk of attempting suicide in the future and whether borderline personality disorder (BPD) or depressive symptoms impacted the predictive value of self-ratings. Methods. Structured clinical assessments were conducted at baseline and after 12 months in a high-risk sample of treatment-seeking adolescents (n = 134; 12-17y.; 90% female) with at least one lifetime suicide attempt. Results. During the follow-up period, n = 51 participants (38%) attempted suicide at least once. Self-rated risk was a significant predictor for the recurrence of a suicide attempt, whereas BPD and depression were not. While there was no significant interaction between self-rated risk and BPD, a negative interaction emerged between self-rated risk and depression in the prediction of a suicide attempt. Greater depression severity diminished the predictive value of self-ratings. Limitations. Depression severity was measured using a questionnaire, not a clinical interview. The findings may not be applicable to less burdened samples. Conclusions. Asking high-risk adolescents to rate their own risk of attempting suicide appears to be an easy to apply method in improving the prediction of future suicide attempts in the clinical context.