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194 patients who were referred to adolescent psychiatry inpatient unit (98) and a drug rehabilitation unit (96) in 1999 and 2000 were compared as to sociodemographic variables, comorbidity and course of treatment. Female patients were overrepresented in the psychiatry unit, whereas in the rehab unit more immigrants or referrals from juvenile detention were treated. Most psychiatry patients were comorbid with at least one, a quarter with more than one additional diagnosis and had less polysubstance dependence (69%). Due to a drop out rate of 71% in the patients with a criminal justice status, rehab patients did not complete treatment as often as psychiatry patients. Three years after their first dismissal and, in some cases, after several new admissions, 60% of rehabilitation clients completed the program. Both settings have their own right in the system because comorbid patients need highly individualized therapy, and rehab patients need programs able to address school-based, family-related, and gender-specific issues.

Purpose of this study is to identify predictors of the length of stay (LOS) in child and adolescent psychiatry (CAP) and the success of inpatient treatment. All child and adolescent inpatients that had been dismissed over a year's time from a non-university hospital after a medium-length-treatment were rated by their therapists (crisis interventions for < 2 weeks excluded). The group featured a low drop-out-rate (9.8%) and a high percentage of "problematic patients". The ICD-10 diagnoses were irrelevant for the prediction of LOS and success of treatment. The Global Assessment of Function scale (axis VI) correlated significantly with LOS, and functioning in all areas improved with a longer LOS. By the degree of initial psychopathology therapeutic success as well as LOS could be predicted fairly well. Concerning adolescents, motivation for treatment and the degree of cooperation both correlated with LOS and improvement, which implies the importance of their participation. For children under 12, cumulated psychosocial adversities (axis V) predicted a less positive outcome, cooperation of parents and patients raised the chance of success. Shortened lengths of stay will not lead to comparable success. As a system like DRGs for reimbursement of hospitalization in CAP will not prove to be efficient, other variables deserve more attention in future health economy planning. More intervening variables, such as psychosocial adversities, motivation, and cooperation have to be considered.

In family interviews with 77 families migrated from Turkey, reasons for the low rate of attendance in psychiatric institutions were investigated. The reasons that came up were a preference for intra-family solutions in cases of behavior disorders as well as a lack of information, but not a preponderance of traditional magical approaches. A comparison of families attending a mother-tongue outpatient service with non-attendants failed to demonstrate more intra-family resources in the latter. Families proposed to spread information via ethnic communities and to establish mother-tongue facilities. Since the beginning of such a service a systematic increase in attendance rates was recorded.

Handouts in their mother tongue might be helpful in informing patients who do not speak German about medications that are prescribed. A survey among 97 producers of CNS active drugs used in neurology and psychiatry showed that only two patient information leaflets on preparations and nine on specific disorders are available in Germany. The producers who answered were mostly open-minded and mentioned causes like the legal situation and logistic problems.

After defining social work in child and adolescent psychiatry as social therapy, we present the development of our own concept and our experiences, referring to the Psych-PV's professional provisions (Psych-PV being a law ruling the staff: patient ratios in FRG). Social work in the multiprofessional team contributes independently to therapy, and it unquestionably adds to the institutional perspectives.

A psychoeducational approach of the nursing staff's work with parents is presented. By offering a family visit to the unit prior to admission, systematic preparation of the admission process, reflected interactions with parents during their visits, by parents' evenings and parents' weekends, the nursing team makes a distinct contribution to the families' treatments. Pros and cons are dealt with, concerning issues of professional self-image, goal planning of the team as a whole, structures of team conferences, and supervision. As to evaluation, some parameters (incidence of dismissals for reasons of discipline, withdrawal of children against medical advice, patients referred to care of public authorities after treatment) are discussed for their usefulness.

This paper deals with the problem of overlapping clinical effects of neurotropic agents in treating children with complex comorbidity. An 8-year-old boy suffering from a complexity of symptoms such as chronic motor tics, compulsions, phobias, anxious inhibition, and stuttering displayed the totality of Tourette's syndrome while taking imipramine. Sulpiride also enhanced motor and vocal tics. In the discussion, a review on the neurometabolic mechanisms in tic disease actually known is given, and on drugs proven to precipitate tics, which is the case in a number of neurotropic agents. Psychodynamics and famility dynamics are another issue to be regarded independently.

In recent years factitious disorders have gained increasing significance in all medical specialties although in child psychiatry publications on this topic are rare. In this article these and other somatoform disorders are discussed with reference to a case report on a 14-year-old girl. Psychodynamic aspects of this syndrome are presented and differentiated from simulation. Conversion syndromes and hysterical neurosis and comparisons are made with other publications on this topic. Treatment of these patients, who repeatedly succeed in subjecting themselves to invasive and sophisticated diagnostic procedures is difficult because of minimal compliance. The prognosis is affected by the extent to which changes in personality structure and development of alternative problem-solving mechanisms can be achieved.

The question of pathologic roots of achievement patterns in girls and boys suffering from anorectic disorders is investigated by empirical and theoretical means. Records of 59 inpatients were reviewed with special emphasis on premorbid school achievement and its development during therapy. 44 completed a catamnestic questionnaire or interview. 10 students performed better, 10 worse. The latter differed in severity of clinical symptoms, duration of stay and continuing therapy, improvement in aggressiveness, recurring menstruation and changes in family interactions. Results are discussed regarding psychodynamic issues.

The study reports experiences with two therapeutic apartments (12 residents) accommodating 30 young adults over a 5-year period. For this age group this kind of aftercare poses special problems: Contrary to previous evidence, patients suffering from psychotic or borderline disorders achieved a much lower level of autonomy than those with neurotic or psychosomatic disturbances and also did significantly worse regarding vocational integration and social contacts. Social contact behavior outside the group was the strongest predictor of the level of autonomy achieved. As the rehospitalization rate was high (50% of all residents), no economizing on inpatient capacities could be expected from this program. However, improvements in the number of staff and in the program itself did lead to a significant decrease in the length of rehospitalizations. Program-related factors that may increase the vulnerability of young people with psychosis are discussed in the context of the general state of psychiatric care.