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Variations of the µ-opioid receptor gene OPRM1 have been shown to modulate pain perception with some evidence pointing towards a modulation of not only physical but also "psychological pain". In line with suggestions of a common neural network involved in the processing of physical pain and negative and distressing stimuli, like social rejection as a psychologically harmful event, we examined the influence of the A118G polymorphism on the neural processing of physical and non-physical pain. Using fMRI, we investigated a sample of 23 females with the more frequent AA genotype, and eight females with the relatively rare but more pain-sensitive AG genotype during electrical stimulation to the dorsum of the non-dominant hand. Non-physical pain was investigated using Cyberball, a virtual ball-tossing game, to induce experiences of non-self-dependent social rejection. A Go/NoGo task with an increased risk of self-dependent erroneous performance was used as a control task to investigate the effects of negative feedback as a more cognitive form of distress. Relative to A118G homozygous A-allele carriers, G-allele carriers showed significantly increased activation of the supplementary motor area/superior frontal gyrus and the precentral gyrus during electrical stimulation. Increased activation of the secondary sensorimotor cortex (SII) was found during social exclusion and during negative feedback. We demonstrate that brain regions particularly related to the somatosensory component of pain processing are modulated by variations in OPRM1. Influences were evident for both physical and psychological pain processing supporting the assumption of shared neural pathways.

Patients often bring transitional objects (TO) to inpatient units. The authors quantified the frequency of TO possession in an inpatient psychiatric setting and assessed whether TO use is specific to a personality disorder (PD) diagnosis, focusing on borderline PD (BPD). TO possession was assessed using the Transitional Objects Questionnaire, and PD diagnosis was established using standard DSM-IV clinical interviews. Of the 104 female patients assessed, 57.7% showed TO use; 84% of BPD patients, 71% of BPD-trait patients, 65% of patients with PD traits (other than BPD), and 56% of PD patients (other than BPD) displayed TO use, whereas 30.6% of patients without PD showed TO use. Patients with TOs were significantly younger and had significantly longer hospital stays. The specificity and sensitivity for TO use in the BPD group were 0.506 and 0.84, respectively. The authors conclude that TO use is closely related to PD diagnosis, but is not specific to BPD.

ZusammenfassungDie aktuellen Daten aus der KiGGS-Studie zeigen keine Zunahme an psychischen-und Verhaltensstörungen im Kindes-und Jugendalter in der Allgemeinbevölkerung, während eine Zunahme von psychopharmakologischer Behandlung zu verzeichnen ist. Diese Arbeit analysiert die Häufigkeit der Vergabe von Diagnosen des Kapitels F der ICD-10 in der stationären Behandlung bei Kindern bis zum 15. Lebensjahr in den Jahren 2003 bis 2012. Eine signifikante Zunahme in fast allen Bereichen war nachweisbar. Lediglich in den Bereichen organische, einschließlich symptomatischer psychischer Störungen (F0), Schizophrenie, schizotype und wahnhafte Störungen (F2), Persönlichkeits-und Verhaltensstörungen (F6) und Intelligenzstörung (F7) zeigte sich im untersuchten 10-Jahres-Zeitraum ein stabiles Niveau bzw. eine Abnahme der Diagnosehäufigkeit.

Research in adults has identified an association between bipolar disorder and suicidal behavior. This relationship, however, has been insufficiently investigated in adolescents to date.1,117 adolescents from 13 German schools (mean age = 14.83, SD = .63; 52.7% females) completed an extended German version of the Center for Epidemiological Studies Depression Scale (CES-D), which assesses depressive and manic symptoms during the last week, as well as the Self-Harm Behavior Questionnaire (SHBQ) for the assessment of lifetime suicidal behavior.In the present sample 39.4% of the girls and 23.1% of the boys reported lifetime suicidal thoughts and 7.1% of the girls as well as 3.9% of the boys a lifetime history of suicide attempts. 18.7% of the adolescent sample revealed elevated symptoms of depression and 9% elevated levels of mania symptoms. Elevated sum scores of depression and mania were associated with a higher number of suicidal ideations and suicide attempts. A block-wise regression analysis revealed that sum scores of depression and mania predicted suicidal ideations best. Concerning suicide attempts, the best predictors were age as well as depression and mania sum scores.Suicidal behavior was reported more often when adolescents demonstrate symptoms of mania as well as symptoms of depression than when they demonstrate only depressive symptoms. The presence of bipolar symptoms in adolescents should alert clinicians to the heightened possibility of suicidal behavior.Fragestellung: Studien bei Erwachsenen konnten einen Zusammenhang zwischen bipolarer Störung und Suizidalität feststellen. Dieser Zusammenhang wurde bei Jugendlichen bisher nur unzureichend untersucht. Methodik: 1117 Jugendliche aus 13 deutschen Schulen (M = 14,83 Jahre; SD = .63; 52.7 % Mädchen) füllten die Allgemeine Depressionsskala und ihre Erweiterung um manische Symptome (ADMS), welche depressive und manische Symptome während der letzten Woche erfasst, sowie den Self-Harm behavior Questionnaire (SHBQ), zur Erfassung von Suizidalität über die Lebensspanne hinweg, aus. Ergebnisse: In der vorliegenden Studie berichteten 39,4% der Mädchen und 23,1% der Jungen von Suizidgedanken und 7.1 % der Mädchen sowie 3.9 % der Jungen von einem Suizidversuch in der Vorgeschichte. Erhöhte Depressionswerte wurden von 18.7 % berichtet, 9 % berichteten von erhöhten Maniewerten. Es zeigten sich signifikant höhere Depressions- und Maniewerte bei denjenigen Teilnehmern mit suizidalem Verhalten. Mittels hierarchischer Regressionsanalyse konnte gezeigt werden, dass Suizidgedanken am besten durch die Summenwerte der Depressions- und Manie- Items vorhergesagt werden, Suizidversuche am besten durch das Alter, sowie von Depressions- und Manie- Werten. Schlussfolgerungen: Suizidalität tritt bei Jugendlichen häufiger auf, die sowohl depressive als auch manische Symptome aufweisen im Vergleich zu Jugendlichen, die lediglich depressive Symptome aufweisen. Kliniker sollten bei Jugendlichen mit bipolaren Erkrankungen besonders wachsam hinsichtlich einer erhöhten Suizidalität sein.

Die rationale Therapie mit Arzneimitteln stellt eine Herausforderung in der Kinder- und Jugendpsychiatrie dar. Steigende Verordnungszahlen stehen im Kontrast zu erheblichen Unsicherheiten in Bezug auf die Arzneimittelsicherheit und Wirksamkeit. Der Mangel an (Zulassungs-)Studien führt häufig zu einem nicht altersspezifischen Gebrauch der Medikamente. Junge Patienten weisen jedoch besondere Stoffwechselbedingungen sowie eine höhere Vulnerabilität für unerwünschte Arzneimittelwirkungen (UAW) auf. Es ist daher notwendig, eigene Daten zur Pharmakokinetik, Wirkung und Sicherheit von Psychopharmaka bei Minderjährigen zu generieren. Auch die Gesetzgebung hat diese Situation erkannt und auf nationaler sowie europäischer Ebene entsprechende Vorschriften sowie wissenschaftliche Programme eingeführt. Ziel der unter dem Begriff der Pharmakovigilanz zusammengefassten Maßnahmen ist es, das Nutzen-Risiko-Verhältnis eines Arzneimittels kontinuierlich zu evaluieren, UAWs so schnell wie möglich zu entdecken und deren Risiken durch geeignete Maßnahmen, z. B. konsequentes Therapeutisches Drug Monitoring (TDM), zu minimieren. Der folgende Artikel erläutert die Notwendigkeit sowie Grundlagen der Pharmakovigilanz in der Kinder- und Jugendpsychiatrie und stellt ein vom Bundesministerium für Arzneimittel und Medizinprodukte (BfArM) gefördertes multizentrisches epidemiologisches Forschungsprojekt («TDM-VIGIL») vor, an dem zahlreiche kinder- und jugendpsychiatrische Zentren sowie Facharztpraxen aus dem deutschsprachigen Raum beteiligt sind. Ziel ist die systematischen Erfassung von Informationen zum Verordnungsverhalten und der Sicherheit von Psychopharmaka im Kindes- und Jugendalter mittels eines internetbasierten Patientenregisters.

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.A total of 2,413 subjects, aged 18-94 years, participated in this population-based, representative study based on self-reports.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.DMDD symptoms seem to show a chronic course and go hand in hand with elevated psychiatric symptoms and impaired socioeconomic and demographic status.

Child maltreatment represents a major risk factor for the development of emotional and behavioral problems, especially posttraumatic stress disorder (PTSD). While effective trauma-focused treatments are available, little is known about the usual mental healthcare for abused youths in Germany. The present study compared the utilization of mental healthcare in abused youths who had developed a PTSD (N = 95) with a group presenting other mental disorders (N = 146). Semistructured interviews were used to assess maltreatment histories, current mental health, and healthcare utilization. In addition, potential child factors associated with access to mental healthcare (age and level of functioning) were examined. Results showed that 65 % of both diagnostic groups currently fail to use any mental healthcare service. Of the participants with PTSD, 43 (45 %) had never received any mental healthcare intervention. Investigations on potential barriers are necessary to close the huge gap between clinical services and evidence-based, trauma-focused interventions.

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

Introduction Non-suicidal self-injury (NSSI) is a symptom of borderline personality disorder (BPD). However, NSSI often occurs independently of BPD. Altered neural processing of social exclusion has been shown in adolescents with NSSI and adults with BPD with additional alterations during social inclusion in BPD patients. Aims of this study were to investigate differences in neural processing of social inclusion and exclusion situations between adolescents with NSSI and young adults with BPD and NSSI. Methods Using fMRI, neural processing of positive and negative social situations (paradigm: “Cyberball”) was explored. Participants were 14 adolescents with NSSI, but without BPD (Mage = 15.4; SD = 1.9), 15 adults with BPD and NSSI (Mage = 23.3; SD = 4.1), as well as 15 healthy adolescents (Mage = 14.5; SD = 1.7), and 16 healthy adults (Mage = 23.2; SD = 4.4). Results Behavioral results showed enhanced feelings of social exclusion in both patient groups as compared to healthy controls but only the NSSI group showed enhanced activation during social exclusion versus inclusion compared to the other groups. While both NSSI and BPD groups showed enhanced activation in the ventral anterior cingulate cortex during social exclusion as compared to their age-matched controls, enhanced activation during social inclusion as compared to a passive watching condition was mainly observed in the BPD group in the dorsolateral and dorsomedial prefrontal cortex, and the anterior insula. Discussion While neural processing of social exclusion was pronounced in adolescents with NSSI, BPD patients also showed increased activity in a per se positive social situation. These results might point toward a higher responsiveness to social exclusion in adolescents with NSSI, which might then develop into a generalized increased sensitivity to all kinds of social situations in adults with BPD.

Background Child maltreatment and its consequences are considered a major public health problem. So far, there is only one study from Germany reporting prevalence rates on different types of maltreatment. Methods A representative sample of the German general population was examined for experiences of child maltreatment using the Childhood Trauma Questionnaire (CTQ) between September and November 2016. A total of 2510 (53.3% female) participants between 14 and 94 years (M = 48.8 years) were enrolled. Besides the CTQ, a range of sociodemographic information was collected. The interrelatedness of different types of maltreatment was examined using configuration analysis and predictors for maltreatment were identified by performing binary logistic regression analyses. Results Overall, 2.6% (f: 3.9%, m: 1.2%) of all participants reported severe emotional abuse, 3.3% (f: 3.4%, m: 3.3%) severe physical abuse, 2.3% (f: 3.7%, m: 0.7%) severe sexual abuse, 7.1% (f: 8.1%, m: 5.9%) severe emotional neglect and 9% (f: 9.2%, m: 8.9%) severe physical neglect. Women were more likely to report at least moderate sexual and emotional abuse than men. The largest difference between age groups was reported for physical neglect, with participants aged over 70 years reporting the highest rates. Participants who reported childhood maltreatment were more likely to be unemployed or have lower educational outcomes. The most common combination of maltreatment types were physical and emotional neglect, all five types of maltreatment combined and physical and emotional neglect and physical abuse combined. Conclusions Child maltreatment, especially physical neglect is common in the German population. Women seem to be at greater risk for sexual and emotional abuse than men. Knowledge about different types of maltreatment based on the Childhood Trauma Questionnaire (CTQ) can help to put findings of future studies into an epidemiological and societal context.

Background: 25–35% of adolescents in random samples drawn from German schools have been found to have manifested at least one episode of nonsuicidal self-injury (NSSI). The prevalence in samples from child and adolescent psychiatric clinics is approximately 50%. NSSI can arise as a symptom in the setting of various types of mental illness. Methods: This review is based on a selective literature search carried out in the PubMed, PsycINFO, and Cochrane Library databases, with special consideration of regional study samples. Results: NSSI is usually resorted to as a dysfunctional coping strategy for emotional regulation. The main risk factors for NSSI include bullying, accompanying mental illnesses, and a history of abuse and neglect in childhood. Neurobiological studies have shown abnormal stress processing in persons with NSSI and an elevated pain threshold in persons with repetitive NSSI. Psychotherapeutic interventions of various kinds lessen the frequency of NSSI; to date, no particular type of psychotherapy has been found to be clearly superior to the others. Randomized controlled trials have revealed small to moderate effects from dialectic-behavioral therapy and mentalization-based therapy in adolescent patients. No psychoactive drug has yet been found to possess specific efficacy against NSSI in adolescents. Conclusion: The first ever German-language clinical guidelines for the treatment of NSSI have now been issued. Psychotherapy is the treatment of first choice. More research is needed so that subgroups with different disease courses can be more clearly defined.

Children and adolescents are a vulnerable group to develop post-traumatic stress symptoms after natural or man-made disasters. In the light of increasing numbers of refugees under the age of 18 years worldwide, there is a significant need for effective treatments. This meta-analytic review investigates specific psychosocial treatments for children and adolescents after man-made and natural disasters. In a systematic literature search using MEDLINE, EMBASE and PsycINFO, as well as hand-searching existing reviews and contacting professional associations, 36 studies were identified. Random- and mixed-effects models were applied to test for average effect sizes and moderating variables. Overall, treatments showed high effect sizes in pre–post comparisons (Hedges' g = 1.34) and medium effect sizes as compared with control conditions (Hedges' g = 0.43). Treatments investigated by at least two studies were cognitive–behavioural therapy (CBT), eye movement desensitization and reprocessing (EMDR), narrative exposure therapy for children (KIDNET) and classroom-based interventions, which showed similar effect sizes. However, studies were very heterogenic with regard to their outcomes. Effects were moderated by type of profession (higher level of training leading to higher effect sizes). A number of effective psychosocial treatments for child and adolescent survivors of disasters exist. CBT, EMDR, KIDNET and classroom-based interventions can be equally recommended. Although disasters require immediate reactions and improvisation, future studies with larger sample sizes and rigorous methodology are needed.

A number of neuroimaging studies have identified altered regional cerebral blood flow (rCBF) related to major depressive disorder (MDD) in adult samples, particularly in the lateral prefrontal, cingular and temporal regions. In contrast, neuroimaging investigations in adolescents with MDD are rare, although investigating young patients during a significant period of brain maturation might offer valuable insights into the neural mechanisms of MDD. We acquired perfusion images obtained with continuous arterial spin labelling in 21 medication-naive adolescents with MDD before and after a five-session cognitive behavioural group therapy (group CBT). A control group included medication-naive patients under treatment as usual while waiting for the psychotherapy. We found relatively increased rCBF in the right dorsolateral prefrontal cortex (DLPFC; BA 46), the right caudate nucleus and the left inferior parietal lobe (BA 40) after CBT compared with before CBT. Relatively increased rCBF in the right DLPFC postgroup CBT was confirmed by time (post vs. pre)×group (intervention/waiting list) interaction analyses. In the waiting group, relatively increased rCBF was found in the thalamus and the anterior cingulate cortex (BA 24). The relatively small number of patients included in this pilot study has to be considered. Our findings indicate that noninvasive resting perfusion scanning is suitable to identify CBT-related changes in adolescents with MDD. rCBF increase in the DLPFC following a significant reduction in MDD symptoms in adolescents might represent the core neural correlate of changes in 'top-down' cognitive processing, a possible correlate of improved self-regulation and cognitive control.

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

Purpose of Review Non-suicidal self-injury (NSSI) is a common mental health threat among adolescents. This review aims to present the current literature on epidemiology, etiology, and therapeutic approaches with a focus on the period of adolescence. Recent Findings NSSI is widespread among adolescents both in community as well as in clinical settings with lifetime prevalence rates between 17 and 60% in recent studies. It is influenced by multiple factors including social contagion, interpersonal stressors, neurobiological background, as well as emotional dysregulation and adverse experiences in childhood. Summary There is still a lack of studies regarding the psychotherapeutic as well as the psychopharmacological treatment of NSSI in adolescence. Furthermore, sufficient evidence for prevention programs is missing.

Nonsuicidal self-injury (NSSI) and suicidality are common among adolescents. School staff are often the first adults to be confronted with those behaviors. However, previous studies have shown a lack of knowledge and confidence in dealing with self-harming behaviors. Objectives of this study were to evaluate a workshop on NSSI and suicidality in adolescence for teachers, school social workers and school psychologists. In total, N = 267 school staff participated in 1 of 16 two-day workshops, which were offered in different cities in southern Germany. Pre-, post- and 6-month follow-up assessments were conducted concerning attitudes, confidence in own skills, perceived knowledge, and knowledge on NSSI and suicidality. Satisfaction with the workshop was evaluated directly after the workshop; changes in handling situations involving youth with self-harm were evaluated at follow-up. Overall, participants were very satisfied with the workshop. Few negative attitudes regarding NSSI and suicidality were prevalent before and after the workshop. Large effect sizes were found for improvement in confidence, perceived knowledge, and knowledge at postassessment, which were still present at 6-month follow-up. There were significant differences between professions, with teachers seemingly benefitting the most from the workshop. At follow-up, participants reported more changes in their own behavior than having been able to implement changes on a school level. A 2-day workshop seems to be effective in changing knowledge and confidence in school staff regarding NSSI and suicidality. Workshops catered to different professions (i.e., teachers and school psychologists) might be feasible. (PsycINFO Database Record

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.

Education of children and child protection was improved in all three European German-speaking countries, Austria, Germany, and Switzerland, up to the late 1960s/1970s as a continuing process. More and more research on the prevalence of child sexual abuse in institutions and prevention and intervention strategies has been developed since then. Awareness and consciousness of child sexual abuse in institutions has led to outrage in the public since 2010. Reappraisal processes of child sexual abuse in institutions in the past have been implemented by political/governmental bodies and the Roman Catholic Church in different ways in the three countries, dependent on their federal structure. Results of these research programs showed a high prevalence of abuse and neglect in institutions. Research projects financed by politics or the Roman Catholic Church helped us to understand that the structures of institutions – and not the organizational background (like the Roman Catholic Church) – have influenced the occurrence of the abuse. Even if controlled for familial risk factors, child sexual abuse has an important influence on the development of psychiatric problems. Being heard, taken seriously, and helped are protective factors for survivors of child sexual abuse that can prevent long-lasting psychosocial consequences. Historical studies conducted in Switzerland have explained the influence of society on the appearance of child sexual abuse in institutions in the past. Current studies still show a high risk of child sexual abuse in institutions today. These studies point to a high prevalence of peer-to-peer victimization that has to be considered in the future. Prevention and intervention strategies and direction of research are discussed at the end.

In this chapter, we describe the development of research about child sexual abuse in religiously affiliated and secular institutions in Germany that has been neglected for a long time. In 2010, the so-called abuse affair in Germany ignited a political debate over the extent of abuse committed by professional educators. At around the same time, the German government and the Roman Catholic Church in Germany each set up a contact point to gather information on child sexual abuse that had taken place within the church and secular institutions. In one of our analyses, we looked at a subset of the data, in order to compare the nature of abuse experienced in three types of institutions: Roman Catholic, Protestant, and secular. The results suggest that child sexual abuse in institutions is attributable to the nature of institutional structures more than to the attitudes towards sexuality of a specific religion. In another analysis, we compared data about sexual abuse in the Roman Catholic Church that has been collected through a church and through a government contact point. Some differences were found. These differences highlight the need for an effective complaint management system to offer not just one but complementary channels of communication. In addition, the findings confirm the feasibility and value of a critical incident reporting system (CIRS) approach and the use of so-called citizen science in politically driven review processes. Finally, we draft developments in politics, society and institutions concerning prevention and intervention strategies.

Fragestellung: Vorhergehende Studien zeigen eine hohe Übereinstimmung von Selbst- und Klinikerurteil bei der Erfassung von Depressivität. Die Übereinstimmung auf Summen-, Subskalen- und Einzelitemebene wurde aber bisher nicht bei einer psychiatrischen jugendlichen Stichprobe untersucht. Der Einfluss von Drittvariablen, wie Alter, Geschlecht, IQ und Behandlungssetting wurde bei Jugendlichen bisher unzureichend überprüft. Methodik: Untersucht wurden 105 depressive Jugendliche (mittleres Alter = 15.94) bei welchen innerhalb einer Woche das BDI-II und CDRS-R durchgeführt wurde. Korrelationsanalysen erfolgten auf Ebene der Summenwerte, Subskalen und Einzelitems. Ergebnisse: Es zeigte sich eine hohe Korrelation zwischen Selbst- und Klinikerurteil (r = .67). Auf Subskalen-Ebene zeigten Items, die somatische Inhalte erfassen, keine höhere Konkordanz als Subskalen, die kognitive oder affektive Inhalte messen. Auf Symptom-Ebene zeigte sich die höchste Übereinstimmung bei dem Item Selbstmordgedanken. Drittvariablen hatten keinen signifikanten Einfluss auf die Höhe der Korrelation aber Jugendliche mit einem eher hohen IQ und ambulant Behandelte neigten zur relativen Überschätzung ihrer Symptomatik. Schlussfolgerungen: Die Gesamtkorrelation war hoch und unterschied sich nicht von Ergebnissen vergleichbarer Korrelationsstudien. Die höchste Übereinstimmung bei dem Item «Selbstmordgedanken» spricht für die gute Erfassbarkeit von Suizidalität auch im Klinikerurteil. Der Fragebogen kann somit deutliche Hinweise auf das Vorliegen einer Depression liefern, jedoch sollte trotz hoher Korrelationen nicht ein Verfahren durch ein anderes ersetzt werden.

Nonsuicidal self-injury (NSSI) has a high prevalence among the general undergraduate population, but as yet, no study has investigated the rate of NSSI among medical students despite the high levels of depression and suicidal ideation found in this population. Our study aimed to estimate the prevalence of NSSI and suicide attempts in German medical students and explore the associations between these behaviors and the five major personality traits. Seven hundred fourteen medical students (67% women; age range, 18-35 years; mean age, 23.1 years) participated in an online survey. We report a lifetime prevalence of 14.3% for NSSI and 1.5% for suicide attempt. The students with NSSI showed higher levels of neuroticism and openness to experience but lower levels of conscientiousness and extraversion on the NEO Five-Factor Inventory. Our results are in line with previous research from other countries regarding the prevalence of NSSI among students and its association with personality.

Objective Recent literature suggests an association between type 1 diabetes (T1D) and depression. So far, most studies explored this link in adult populations, with few data being available on diabetes and depression from minors and young adults. This study aimed to look for associations between symptoms of depression/antidepressant treatment and metabolic outcomes of T1D. Methods We conducted an observational study using the German diabetes database (Diabetes-Patienten-Verlaufsdokumentation – DPV) and searched for patients up to the age of 25 yr, with depressive symptoms and/or receiving antidepressant medication. Results Of 53 986 T1D patients below the age of 25 yr, antidepressant medication and/or depressive symptoms were reported in 419 (0.78%). After adjustment for age, gender, diabetes duration and center heterogeneity, minors and young adults with depressive symptoms showed worse outcome parameters such as a higher rate of severe hypoglycemia (0.56 vs. 0.20/patient year, p = 0.005) and more episodes of diabetic ketoacidosis (0.20 vs. 0.07/patient year, p < 0.001). Hemoglobin A1c (HbA1c) was higher in the depression group (74.50 vs. 67.58 mmol/mol, p < 0.001) and young patients with T1D and depression showed longer duration of inpatient treatment (7.04 vs. 3.10 hospital days/patient year, p < 0.001) and more frequent admissions to hospital care (0.63 vs. 0.32/patient year, p < 0.001). Antidepressant medication was recorded in 52.3% of the depressed patients, with selective serotonin reuptake inhibitors (SSRIs) being the most widely described class of antidepressants (29.1%). Conclusions Our findings demonstrate an adverse treatment outcome for young patients with T1D and comorbid depressive symptoms underlining an urgent need for collaborative mental and somatic health care for patients with T1D and depression.

Zusammenfassung Obwohl Jugendliche in stationaren Jugendhilfeeinrichtungen eine Hochrisikopopulation fur psychische Storungen darstellen, zeigen nicht alle Jugendlichen psychische Auffalligkeiten. Ziel dieser Studie ist, protektive Merkmale bei diesen Jugendlichen zu bestimmen. 314 Jugendliche aus 20 stationaren Jugendhilfeeinrichtungen wurden mittels standardisierter Instrumente (Child Behavior Checklist (CBCL), Junior Temperament and Character Inventory (JTCI)) untersucht. Sozidemografische Daten wurden durch Befragung der Betreuer in den Einrichtungen erhoben. Auf Grundlage der Daten wurden anhand von Wertebereichen in der CBCL zwei Gruppen (resiliente vs. psychisch auffallige) gebildet, mit denen die Analysen erfolgten. Resiliente Jugendliche und Jugendliche mit psychischen Auffalligkeiten unterschieden sich in Temperaments- und Charaktereigenschaften (z. B. Selbstlenkungsfahigkeit F = 28.4, p.001, d = 0.64) mit kleinen bis mittleren Effektstarken (d = 0.36 bis 0.64). Resiliente Jugendliche lebten zud...

Nicht-suizidales selbstverletzendes Verhalten (NSSV) und die Suizidale Verhaltensstörung (SVS) wurden in der 5. Auflage des «Diagnostic and Statistical Manual» (DSM-5) der amerikanischen psychiatrischen Gesellschaft (APA) in der «Sektion 3» erstmals als diagnostische Kategorien aufgenommen. Damit werden diese beiden Störungsbilder zwar nicht als formale Diagnosen im neuen Klassifikationssystem anerkannt, jedoch erstmals eindeutig im Rahmen eines Klassifikationssystems definiert. Dies soll weitere Forschungsarbeiten in diesem Bereich in Zukunft vereinheitlichen und erleichtern. Die vorliegende Arbeit stellt diese beiden neuen Störungsbilder vor und bietet anhand eines selektiven Literaturreviews einen Überblick über die Diskussion über NSSV und SVS als eigenständige Störungsbilder. Erste vorliegende Arbeiten, die auf diese Definitionen zurückgreifen, werden vorgestellt. In Deutschland dürfte die Ein-Jahres Prävalenz von NSSV im Jugendalter ca. 4 % betragen, für SVS ca. 9 %. Es kann davon ausgegangen werden, dass die neuen Definitionen zur besseren Vergleichbarkeit von künftigen Studienergebnissen führen werden.

Nicht-suizidales selbstverletzendes Verhalten (NSSV) tritt im Jugendalter mit Prävalenzraten von weltweit ca. 19 % relativ häufig auf. NSSV kann dabei ohne weitere psychopathologische Auffälligkeiten, aber auch sehr häufig komorbid zu verschiedenen psychischen Störungen auftreten. NSSV stellt einen zudem einen Risikofaktor für suizidales Verhalten dar, was eine spezifische Diagnostik unerlässlich macht. Die vorliegende Arbeit soll einen Überblick über Instrumente im deutschen Sprachraum und eine praktische Handreichung geben. Standardisierte Instrumente zur Erfassung selbstverletzenden Verhaltens wurden primär für die wissenschaftliche Forschung konstruiert. Sie eignen sich jedoch auch im klinischen Alltag zur differenzierten Diagnostik, Verlaufskontrolle und Therapieevaluation. Dazu liegen im deutschen Sprachraum verschiedene evaluierte Fragebögen und ein Interview vor.

Background Self-harm is highly prevalent in adolescence, often serving an emotion regulation function. Social stressors such as bullying are associated with self-harm. The neurobiological background of the relationship between social stressors and self-harm needs to be further understood to inform prevention and therapy. Methods Participants were members of an epidemiological cohort study. 130 female participants underwent the Trier Social Stress Test (TSST) at age 19. Of them, 21 reported a history of self-harm as assessed by the Youth Self Report. Psychiatric diagnoses were recorded. Results Participants with a history of self-harm showed significantly lower blood cortisol levels throughout the TSST. Early psychosocial adversity did not significantly differ between groups with and without self-harm, with self-harming participants reporting more childhood adversities. Conclusion These results add to the limited field of studies showing an altered HPA axis activity in females with self-harm. Future studies need to address the causal mechanisms behind this association.

BackgroundSocial media has become increasingly important for communication among young people. It is also often used to communicate suicidal ideation.AimsTo investigate the link between acute suicidality and language use as well as activity on Instagram.MethodA total of 52 participants, aged on average around 16 years, who had posted pictures of non-suicidal self-injury on Instagram, and reported a lifetime history of suicidal ideation, were interviewed using Instagram messenger. Of those participants, 45.5% reported suicidal ideation on the day of the interview (acute suicidal ideation). Qualitative text analysis (software ATLAS.ti 7) was used to investigate experiences with expressions of active suicidal thoughts on Instagram. Quantitative text analysis of language use in the interviews and directly on Instagram (in picture captions) was performed using the Linguistic Inquiry and Word Count software. Language markers in the interviews and in picture captions, as well as activity on Instagram were added to regression analyses, in order to investigate predictors for current suicidal ideation.ResultsMost participants (80%) had come across expressions of active suicidal thoughts on Instagram and 25% had expressed active suicidal thoughts themselves. Participants with acute suicidal ideation used significantly more negative emotion words (Cohen's d = 0.66, 95% CI: 0.088-1.232) and words expressing overall affect (Cohen's d = 0.57, 95% CI: 0.001-1.138) in interviews. However, activity and language use on Instagram did not predict acute suicidality.ConclusionsWhile participants differed with regard to their use of language in interviews, differences in activity and language use on Instagram were not associated with acute suicidality. Other mechanisms of machine learning, like identifying picture content, might be more valuable.

Depression beschreibt eine psychische Storung mit stark beeintrachtigenden Symptomen (z. B. erhohte Suizidalitat), die auch im Kindes- und Jugendalter eine hohe Pravalenzrate aufweist und haufig einen chronischen Verlauf zeigt. Sowohl die kognitive Verhaltenstherapie (KVT) als auch die interpersonelle Therapie stellen derzeit nach diversen Leitlinien die Therapien der ersten Wahl dar. Die aktuelle Studienlage bezuglich kognitiv-verhaltenstherapeutischer und interpersoneller Gruppentherapieverfahren zur Behandlung von Depressionen im Kindes- und Jugendalter sollte dargestellt werden. Die gangigsten Therapieprogramme werden in ubersichtlicher Form erlautert. Die Literaturrecherche (PsycInfo, Psyndex, Pubmed) lieferte 280 Treffer. Nach Durchsicht der Titel und Abstracts konnten 25 Studien in die vorliegende Arbeit aufgenommen werden. Wirksamkeitsnachweise existieren v. a. fur englischsprachige kognitiv-verhaltenstherapeutische Gruppentherapieprogramme (Effektstarken zwischen 0,02 und 1,34) und nur wenige fur die interpersonelle Gruppentherapie. Fur den deutschen Sprachraum liegen wenige Studien zu kognitiv-verhaltenstherapeutischen Gruppentherapien und gemas dem Wissen der Autoren keine zur interpersonellen Gruppentherapie vor. Die Wirksamkeit von Gruppentherapieverfahren zur Behandlung von depressiven Kindern und Jugendlichen sollte v. a. im deutschsprachigen Raum weiterfuhrend untersucht werden.

Suizidales Verhalten erreicht einen ersten Haufigkeitsgipfel in der Adoleszenz. Etwa ein Drittel der Jugendlichen berichtet uber Suizidgedanken, zwischen 6 und 8 % von Suizidversuchen in der Vergangenheit. Es wurde ein systematisches Review der Literatur der letzten 10 Jahre zur psychotherapeutischen Behandlung suizidalen Verhaltens bei Jugendlichen durchgefuhrt. Von 514 gefundenen Arbeiten erfullten 23 Originalarbeiten die Einschlusskriterien (englisch- oder deutschsprachig, Behandlung von mehr als einer Person, Patienten bis zum 18. Lebensjahr). Die Arbeiten beschreiben psychotherapeutische Interventionen bei insgesamt 2582 Individuen. Vor allem verhaltenstherapeutische Masnahmen und Masnahmen mit dem Fokus auf Familieninterventionen finden sich in der Literatur. Interventionen im Bereich suizidalen Verhaltens bei Jugendlichen sind effektiv, allerdings sind die Effekte haufig unspezifisch. Gute Effekte im Sinne der Reduktion suizidalen Verhaltens wurden v. a. fur Interventionen berichtet, bei denen Familienmitglieder der suizidalen Jugendlichen einbezogen werden konnten. Dementsprechend erscheint die Involvierung von Familienmitgliedern bei Interventionen mit suizidalen Jugendlichen klinisch sinnvoll.

Hintergrund Nichtsuizidales selbstverletzendes Verhalten (NSSV) beginnt meist in der Adoleszenz und nimmt im jungen Erwachsenenalter ab. Trotz der hohen Pravalenz in der jugendlichen Allgemeinbevolkerung existieren bislang nur wenige jugendspezifische therapeutische Angebote.

Der Wechsel von der kindespsychiatrischen in die erwachsenenpsychiatrische Behandlung wird durch das Erreichen der Volljährigkeit gemeinhin festgelegt. Diese festgesetzte Altersgrenze wird jedoch den unterschiedlichen Entwicklungsständen und Reifungsgraden von jungen Erwachsenen im Alter von 16 bis 24 Jahren mit psychischen Störungen nicht gerecht. Neurologische Besonderheiten, psychische Störungen und die rechtliche Einordnung dieser distinkten Zeitperiode, derzeitige Bruchstellen im Übergang zwischen den Einrichtungen, sowie verschiedene Transitionsprogramme und Konzepte werden diskutiert.

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 (?² = 16.54 p = 0.02). CONCLUSIONS These results demonstrate with some variability the significant rates of NSSI in youth in a cross country study.

ZusammenfassungDie öffentliche Debatte um Missbrauchsfälle bei Kindern hat zu einer politischen Auseinandersetzung mit dem Thema Kinderschutz geführt, die aktuell ihren Niederschlag im Bundeskinderschutzgesetz gefunden hat. Durch neu geschaffene gesetzliche Grundlagen, ergeben sich für Ärzte neue Handlungsmöglichkeiten, die in der Praxis zu realen Verbesserungen führen können, wie etwa die Möglichkeit einer pseudonymisierten Beratung durch das Jugendamt in Kinderschutzfällen. Das Wissen um die neuen gesetzlichen Bestimmungen muss innerhalb der Ärzteschaft disseminiert werden, wofür unter anderem auch E-Learning-Programme ein hilfreiches Mittel sein können.

ZusammenfassungDisruptive Mood Dysregulation Disorder (DMDD), übersetzbar als disruptive Störung der Stimmungsregulation, findet sich als neues eigenständiges Krankheitsbild im DSM-5. Im Gegensatz zu anderen disruptiven Störungsbildern wurde DMDD in den Bereich der depressiven Störungen gelegt. Der vorliegende Beitrag soll sich mit den diagnostischen Kriterien, der Prävalenz sowie den Behandlungsoptionen dieses neuen Störungsbildes, basierend auf einer selektiven Literaturübersicht auseinandersetzen. Aus Deutschland liegen keine Studien vor, die aufbauend auf den neuen diagnostischen Kriterien erstellt wurden; eine Prävalenzschätzung ist daher schwierig. Aus den USA wurden Prävalenzraten von ca. 1% aus nicht klinischen Stichproben berichtet. Die spezifischen therapeutischen Optionen zur Behandlung dieses neu geschaffenen Störungsbildes sind in ihrer Evidenz kaum überprüft. Essenziell scheinen die Trennung des Störungsbildes von bipolaren Störungen und die Beachtung von DMDD als möglicher Vorläufer einer depressiven Entwicklung.

ZusammenfassungNeben verschiedenen Behandlungsoptionen für nicht suizidales selbstverletzendes Verhalten (NSSV), stellt sich in der Praxis die Frage nach der Ergänzung durch psychopharmakologische Komponenten. Diese Arbeit will einen Überblick über Studien zur pharmakologischen Behandlung von NSSV bieten und den Kliniker darüber informieren, wann eine solche Option gerechtfertigt erscheint und welche Substanzen dafür in Betracht kommen. Im Rahmen einer systematischen Literaturrecherche der vergangenen 20 Jahre konnten 21 Studien identifiziert werden. Insgesamt ist die Evidenz für die pharmakologische Behandlung von NSSV sehr begrenzt. Je nach begleitendem Symptomcluster finden sich Hinweise für die Wirksamkeit von Sselektiven Serotoninwiederaufnahmehemmern, atypischen Antipsychotika oder Opioidantagonisten. Eine solche Behandlung soll nur in Kombination mit Psychotherapie erfolgen und nicht als Einzeltherapie.

ZusammenfassungDer vorliegende Beitrag gibt einen Überblick über den Stand in der Forschung zu Missbrauch, Misshandlung und Vernachlässigung von Kindern und Jugendlichen in Deutschland. Es werden Definitionen und Grundbegriffe erörtert. Es folgt eine Darstellung der epidemiologischen Daten zur Verbreitung des Phänomens und eine Diskussion zu deren Problemen. Es wird deutlich, dass in Deutschland keine belastbaren national und international vergleichbaren Daten zum Ausmaß von Missbrauch, Misshandlung und Vernachlässigung vorliegen. Auf aktuelle Neuerungen in der Erfassung von Missbrauch, Misshandlung und Vernachlässigung in der Medizin auf Grundlage neuer Kodierrichtlinien des Instituts für das Entgeltsystem im Krankenhaus (InEK) wird eingegangen. Es folgt eine Darstellung der psychischen, physischen und gesellschaftlichen Folgen. Abschließend werden Faktoren, die Missbrauch, Misshandlung und Vernachlässigung begünstigen und Resilienzfaktoren diskutiert und Präventionsmöglichkeiten dargestellt.

ZusammenfassungZur Erfassung von nicht suizidalem selbstverletzendem Verhalten (NSSV) existieren in Klinik und Forschung diagnostische Verfahren. Die Möglichkeit, NSSV und generell Bewältigungsstrategien in epidemiologischen Studien mittels eines Screening-Verfahrens zu erheben, existiert in deutscher Sprache nicht. Im Rahmen einer kanadischen Studie wurde zu diesem Zweck der „How I deal with stress”-Fragebogen entwickelt. Das Ziel der vorliegenden Arbeit ist die Überprüfung einer deutschen Version (WIMSU; „Wie ich mit Stress umgehe”) als qualitativ geeignetes Screening-Instrument, insbesondere für NSSV bei Jugendlichen. Untersucht wurde eine Stichprobe von 266 Schülern im Altersbereich von 13 bis 18 Jahren und mit etwa ausgeglichenem Geschlechterverhältnis. Die mittels WIMSU erhobene NSSV-Prävalenzrate von 19,6% ist mit anderen nationalen und internationalen Daten gut vergleichbar. Eine Faktorenanalyse der WIMSU ergab vier interpretierbare Faktoren, deren interne Konsistenz nur als ausreichend zu bewerten ist. Zusammenfassend eignet sich der WIMSU-Fragebogen aufgrund seiner psychometrischen Eigenschaften als Screening-Instrument zur Erfassung von NSSV und bietet zusätzlich einen Überblick über verschiedene Bewältigungsstrategien bei Stress.

Self-mutilation (SM) not only occurs among patients with schizophrenia, personality disorders or transsexuality but also as a phenomenon induced by psychotropic substances (PS). We intended to find characteristics of patients at risk to perform SM induced by PS (SMIPS), frequent PS within this phenomenon and typical presentations of SMIPS. A systematic review of the literature (including Medline, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials and Scopus) was conducted. On October 2011 we identified 26 cases (23 publications) of SM related to PS. Majority of patients (85%) was male, mean age was 30 years (median 41 years). Seventy-three percent of patients developed SM subsequent to the use of one PS, 27% presented SM after the use of more than one PS. Alcohol (25%), hallucinogens (25%) and amphetamines (22%) were found most frequently among the reported substances. Major impairment was present in 80%. Our findings suggest male sex, young age, a previous history of abuse of PS and the current use of alcohol, hallucinogens or amphetamines to favour SMIPS.

Background Substance abuse is among the leading causes of preventable diseases and premature death but reasons and conditions leading to substance abuse are complex and multifaceted. Different models of abuse and dependence assume an underlying emotional vulnerability. Individual behavioral and emotional reactivity patterns of personality are considered in the concept of temperament but studies linking different types of temperament with substance use are rare. Methods In this study we investigated 1380 inhabitants (59.7% females; 40.3% males) of residential student homes in Austria, using Akiskals TEMPS-M auto-questionnaire. Further, we administered the CAGE- and the HSI-questionnaire and assessed other psychoactive substance use to examine associations between traits of temperament and substance abuse using ordered logistic regression. Results Temperaments follow different distributions in both genders: Women have higher scores on the depressive, cyclothymic, and anxious subscales and lower scores on the hyperthymic scale than men. The cyclothymic and particularly irritable temperament serve as predictors of self-reported nicotine dependence, alcohol abuse and cannabis use. Interestingly, the depressive temperament seems to be protective against self-reported cannabis use. Limitations Substance abuse assessment is based on self-reports only and urine drug and blood tests were not performed. Also, the history of substance abuse is not documented thus temperamental factors could have been influenced by substance abuse if the time of onset was in early adolescence. The study design was cross-sectional, thus limiting causal interpretations. Conclusions It might be important to consider temperamental traits as protective- and risk factors in the etiology, prevention and therapy of substance abuse in future.

Die psychopharmakologische Behandlung kann – je nach Schweregrad- eine wichtige Option in der Therapie depressiver Erkrankungen bei Kindern und Jugendlichen darstellen. Diese Überblicksarbeit gibt klinische Behandlungsempfehlungen mit einem Fokus auf den Umgang mit Suizidalität und therapieresistenten Patienten. Die Studienlage zur medikamentösen Therapie der depressiven Erkrankung im Kindes- und Jugendalter hat sich seit den Warnungen der amerikanischen Zulassungsbehörde zum Auftreten von Suizidalität unter Therapie mit Selektiven Serotonin Wiederaufnahmehemmern (SSRIs) deutlich verbessert. In der Versorgung von depressiven Kindern und Jugendlichen ist in den letzten Jahren in Deutschland ein Trend hin zu einer evidenzbasierten psychopharmakologischen Therapie zu erkennen.

Pharmacotherapeutic interventions are available for most psychiatric disorders in children. Evidence for these interventions varies, depending on the targeted disorders. For attention-deficit/hyperactivity disorder, a sound database on efficacy and safety of medication exists. For other common disorders or psychopathological phenomena like disruptive behavior, anxiety disorders, depressive disorders, or autism, data on efficacy and safety are much scarcer. This selective review aims to provide an overview about current psychopharmacological interventions in child and adolescent psychiatry. The literature indicates either a lower efficacy than other interventions or less beneficial effects compared to possible adverse events in these cases. Most guidelines recommend psychopharmacotherapy in children to be embedded in a psychosocial or therapeutic intervention plan. Decision for medication depends on the severity of symptoms, chronicity, and, most important, impairment of the child in academic performance, family relationships, and everyday life. The high rates of off-label use in the age group of children are often due to a lack of market authorization studies less indicative of low efficacy. As adverse events need to be monitored closely, pharmacotherapy should mainly be restricted to experienced mental health care providers.

Risperidone is a widely used, second-generation antipsychotic approved for treating schizophrenia as well as for treating aggression in children and adolescents with mental retardation. The substance has a well-established risk profile including alterations of body temperature. Apart from hyperthermia with and without full-blown malignant neuroleptic syndrome, low body temperatures (hypothermia) have also been reported anecdotally, usually appearing in the context of comedication. Here, we report a case of hypothermia associated with a low-dose risperidone monotherapy in a child.

Direct self-injurious behaviour (D-SIB) is associated with suicidal behaviour and suicide risk. It is not known if D-SIB cessation reduces these risks. The aim of this study was to explore trajectories of D-SIB and their prospective influence on suicidal thoughts and behaviour during adolescence. Data (n = 506; 62.06 % females, 14.53 years) from the Saving and Empowering Young Lives in Europe study were analysed. D-SIB and suicidal thoughts and behaviour were assessed at baseline (T0), 1- (T1) and 2-year follow-up (T2). Onset and maintenance of D-SIB between T0 and T1 were associated with a two to threefold increased odds ratio for suicidal thoughts and behaviour at T2. Suicidal thoughts and behaviour in those terminating D-SIB before T1 were similar compared to those with no life-time history of D-SIB. Late onset and maintenance of D-SIB prospectively indicate risk for suicidal thoughts and behaviour. This is the first study showing that D-SIB cessation reduces later risk for suicidal thoughts and behaviour in adolescence. Suicide prevention efforts should set one focus on reducing adolescent D-SIB.

Background Current resting state imaging findings support suggestions that the neural signature of depression and therefore also its therapy should be conceptualized as a network disorder rather than a dysfunction of specific brain regions. In this study, we compared neural connectivity of adolescent patients with depression (PAT) and matched healthy controls (HC) and analysed pre-to-post changes of seed-based network connectivities in PAT after participation in a cognitive behavioral group psychotherapy (CBT). Methods 38 adolescents (30 female; 19 patients; 13–18 years) underwent an eyes-closed resting-state scan. PAT were scanned before (pre) and after (post) five sessions of CBT. Resting-state functional connectivity was analysed in a seed-based approach for right-sided amygdala and subgenual anterior cingulate cortex (sgACC). Symptom severity was assessed using the Beck Depression Inventory Revision (BDI-II). Results Prior to group CBT, between groups amygdala and sgACC connectivity with regions of the default mode network was stronger in the patients group relative to controls. Within the PAT group, a similar pattern significantly decreased after successful CBT. Conversely, seed-based connectivity with affective regions and regions processing cognition and salient stimuli was stronger in HC relative to PAT before CBT. Within the PAT group, a similar pattern changed with CBT. Changes in connectivity correlated with the significant pre-to-post symptom improvement, and pre-treatment amygdala connectivity predicted treatment response in depressed adolescents. Limitations Sample size and missing long-term follow-up limit the interpretability. Conclusions Successful group psychotherapy of depression in adolescents involved connectivity changes in resting state networks to that of healthy controls.