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Sertraline is a selective serotonin reuptake inhibitor with specific indications in child and adolescent psychiatry. Notwithstanding its frequent use and clinical benefits, the relationship between pharmacokinetics, pharmacodynamics, efficacy, and tolerability of sertraline across indications, particularly in non-adult patients, is not fully understood. This naturalistic therapeutic drug monitoring (TDM) study was conducted in a transdiagnostic sample of children and adolescents treated with sertraline (n = 78; mean age, 14.22 ± 2.39; range, 7–18 years) within the prospective multicenter "TDM-VIGIL" project. Associations between dose, serum concentration, and medication-specific therapeutic and side effects based on the Clinical Global Impression scale were examined. Tolerability was measured qualitatively with the 56-item Pediatric Adverse Event Rating Scale. A strong linear positive dose–serum concentration relationship (with dose explaining 45% of the variance in concentration) and significant effects of weight and co-medication were found. Neither dose nor serum concentration were associated with side effects. An overall mild-to-moderate tolerability profile of sertraline was observed. In contrast with the transdiagnostic analysis that did not indicate an effect of concentration, when split into depression (MDD) and obsessive-compulsive disorder (OCD) diagnoses, the probability of clinical improvement significantly increased as both dose and concentration increased for OCD, but not for MDD. This TDM–flexible-dose study revealed a significant diagnosis-specific effect between sertraline serum concentration and clinical efficacy for pediatric OCD. While TDM already guides clinical decision-making regarding compliance, dose calibration, and drug–drug interactions, combining TDM with other methods, such as pharmacogenetics, may facilitate a personalized medicine approach in psychiatry. • The dose-, concentration- and age-related effects of SSRIs are not well understood. • The study was conducted in patients aged 7–18 treated with sertraline (25–250 mg/day). • Dose explained 45% of the variance in serum drug concentration across indications. • Clinical improvement was associated with dose and concentration in OCD, but not MDD. • Therapeutic drug monitoring is a promising tool in OCD research and therapy. [ABSTRACT FROM AUTHOR]

Non-suicidal Self-injury (NSSI) is a relevant clinical problem with high prevalence rates in adolescence. Despite the high numbers of individuals with NSSI, the neurobiological background is still poorly understood. This review aims to present an overview from different fields of neurobiological research. Results from neuroimaging studies, as well as from studies on neurotransmitters, point to an insufficient stress response. Analgesia and hypalgesia are often reported from individuals with repetitive NSSI, supporting neurobiological alterations. Therefore NSSI can be understood as a coping strategy that serves to down-regulate high experienced emotions. [ABSTRACT FROM AUTHOR]

Non-suicidal Self-injury (NSSI) is a relevant clinical problem with high prevalence rates in adolescence. Despite the high numbers of individuals with NSSI, the neurobiological background is still poorly understood. This review aims to present an overview from different fields of neurobiological research. Results from neuroimaging studies, as well as from studies on neurotransmitters, point to an insufficient stress response. Analgesia and hypalgesia are often reported from individuals with repetitive NSSI, supporting neurobiological alterations. Therefore NSSI can be understood as a coping strategy that serves to down-regulate high experienced emotions. [ABSTRACT FROM AUTHOR]

The aim of the current study was the examination of exhaled breath carbon monoxide levels as a predictor for heaviness of smoking. In this regard, nicotine dependence was assessed among a representative sample of 1,870 Austrian male military conscripts in a cross-sectional setting. Participants completed the Heaviness of Smoking Index (a brief questionnaire for assessment of nicotine dependence), and their expired breath carbon monoxide levels were measured. The performance of carbon monoxide as a predictor of dependence levels was examined by means of Receiver-Operating-Characteristic Curve Analysis. Area Under the Curve, as well as sensitivity and specificity, were reported for each carbon monoxide cut-off level. The authors demonstrate that exhaled carbon monoxide levels serve as a satisfactory means to discriminate between smokers and non-smokers, yielding optimal discrimination at a cut-off level ≥ 5.5 parts per million (ppm), with a sensitivity of 95% and a specificity of 83%. However, the results indicate that carbon monoxide levels do not discriminate adequately between different levels of severity of nicotine dependence. The study demonstrates exhaled carbon monoxide as a useful marker of smoking status but not of nicotine dependence. [ABSTRACT FROM AUTHOR]

Psychological stress is a major risk factor for cardiovascular diseases. While the relevance of early life stress, such as that which is due to child maltreatment (CM), is well known to impact individual stress responses in the long-term, and data on the interplay between CM and stressful events in adulthood on cardiovascular health are sparse. Here, we aimed to assess how stressful life events in adulthood are associated with cardiovascular health infarction in later life and whether this association is independent of CM. In a cross-sectional design, a probability sample of the German population above the age of 14 was drawn using different sampling steps. The final sample included 2510 persons (53.3% women, mean age: 48.4 years). Participants were asked about sociodemographic factors, adult life events, CM, and health conditions in adulthood. Results indicate that the number of experienced adverse life events in adulthood is associated with significantly increased odds for obesity (Odds Ration (OR)women = 1.6 [1.3; 2.0], ORmen = 1.4 [1.1; 1.9]), diabetes (ORwomen = 1.5 [1.1; 2.1], ORmen = 1.5 [1.1; 2.3]) and myocardial infarction (ORwomen = 2.1 [1.0; 4.3], ORmen = 1.8 [1.1; 2.8]). This association is not moderated by the experience of CM, which is associated with cardiovascular problems independently. Taken together, adult stressful life events and CM are significantly and independently associated with cardiovascular health in men and women in the German population in a dose-dependent manner. General practitioners, cardiologists and health policy-makers should be aware of this association between psychosocial stressors during childhood and adulthood and cardiovascular health. [ABSTRACT FROM AUTHOR]

Background: Influence of architectural features in child and adolescent psychiatric wards on coercive measure use has not been investigated so far. We aimed to assess the effect of altering the physical environment of an adolescent psychiatric inpatient unit on the proportion and frequency of adolescents experiencing mechanical coercive measures. Method: In a naturalistic observational design, coercive measures were compared before and after an architectural intervention facilitated by rebuilding a child and adolescent psychiatric department in October 2020. Age, gender, length of stay, main psychiatric diagnosis and indices of coercion in n = 782 admissions to inpatient child and adolescent psychiatry from April 2019 to April 2022 were extracted. Group comparisons were performed using chi‐squared tests for categorical and Mann–Whitney U‐tests for numerical variables. Results: After structural modernization which included amplifying space and with the newly introduced availability of seclusion rooms, significantly fewer patients were affected by mechanical restraint (8.1% vs. 13.7%, p =.013). Rate of seclusion increased to 5.0% (vs. 0%, p <.001). Rate of seclusion and/or restraint decreased from 13.7% to 11.8% (p =.425). The median cumulative duration of all coercive measures per affected case decreased significantly (2.8 vs. 5.4 h, p =.005), as well as its proportion to length of stay (0.8% vs. 2.8%, p =.006). Conclusions: Modernisation and restructuring of buildings hosting psychiatric departments can contribute to a reduction of coercive measures in child and adolescent psychiatric units. [ABSTRACT FROM AUTHOR]

Background: Nonsuicidal self-injury (NSSI) is highly prevalent in adolescents and young adults worldwide. It is linked to a broad variety of mental disorders and an increased suicide risk. Despite its high prevalence, research on the underlying mechanisms and on potential risk and resilience factors for maintaining or quitting NSSI remains scarce. This manuscript presents an overview of the "Self-injury: Treatment-Assessment-Recovery" (STAR) collaboration, which aimed to address these gaps. Methods: We investigated the natural course of NSSI as well as its social, psychological, and neurobiological predictors (observational study; OS). OS data collection occurred at four timepoints (baseline [T0], 4 [post, T1], 12 [follow-up (FU), T2], and 18 [FU, T3] months after baseline) for the NSSI group, which was compared to a healthy control (HC) group at T0 only. Online self-report was used at all timepoints, while semi-structured interviews (face-to-face (f2f)) were conducted at T0 and T3. At T0 only, we conducted ecological momentary assessment and neurobiological investigations. Here, we present the general methodology and sample characteristics of the completed OS including the f2f subprojects, while other subprojects are not within the scope of this paper. Sample description: The OS sample consists of 343 participants at T0 (180 NSSI, 163 HC). Mean age in the NSSI group (T0) was 18.1 years (SD = 2.09, range: 15–25), gender-related data is available for 166: 156 = female, 7 = male, 3 = transgender, 10 = not disclosed). In the HC group, mean age (T0) was 19.1 years (SD = 2.35, range: 15–25) (142 = female, 21 = male). At T1, 128 (71.11%) of the NSSI participants completed the questionnaires, at T2 125 (69.44%) and at T3 104 (57.78%). In the fMRI subproject, 126 adolescents participated (NSSI = 66, HC = 60, 100% female; mean age (T0): NSSI = 18.10 years, SD = 2.21; HC = 19.08, SD = 2.36). Conclusion: Understanding predictors is of utmost importance for adequate diagnosis and intervention for NSSI. Our OS applied a multimodal investigation of social, psychological, and neurobiological parameters and is the largest sample of adolescents with NSSI to date including follow-up assessments. As health care providers require specific knowledge to develop new treatments, we believe that our in-depth assessments can potentially enhance care for youths engaging in NSSI. [ABSTRACT FROM AUTHOR]

Background: Non-binary identities are increasingly recognized within the spectrum of gender diversity, yet there is a dearth of research exploring the mental health challenges specific to this population. Therefore, this systematic review and meta-analysis aimed to comprehensively assess the mental health outcomes of non-binary youth in comparison to their transgender and cisgender peers. Methods: A systematic search was conducted to identify relevant studies across three electronic databases (PubMed, Scopus, Web of Science) covering the period from inception to October 2023. The meta-analysis was performed employing a random-effects model. Inclusion criteria encompassed studies comparing non-binary youth with transgender or cisgender youth, providing data on mental health outcomes such as general mental health, depressive and anxiety symptoms, self-harm and suicidality. Results: Twenty-one studies, meeting the inclusion criteria and originating from six different countries, were included in the analysis. The sample encompassed 16,114 non-binary, 11,925 transgender, and 283,278 cisgender youth, with ages ranging from 11 to 25 years. Our meta-analysis revealed that non-binary youth exhibit significantly poorer general mental health compared to both transgender (d = 0.24, 95% CI, 0.05–0.43, p =.013) and cisgender youth (d = 0.48, 95% CI, 0.35–0.61, p <.001), indicating a more impaired general mental health in non-binary youth. Regarding depressive symptoms, when comparing non-binary and cisgender individuals, a moderate and significant effect was observed (d = 0.52, 95% CI, 0.41–0.63, p <.001). For anxiety symptoms, a small but significant effect was observed in the comparison with cisgender individuals (d = 0.44, 95% CI, 0.19–0.68, p =.001). Furthermore, non-binary individuals exhibited lower rates of past-year suicidal ideation than transgender peers (OR = 0.79, 95% CI, 0.65–0.97, p =.023) and higher rates of lifetime suicidal ideation than cisgender youth (OR = 2.14, 95% CI, 1.46–3.13, p <.001). Conclusion: Non-binary youth face distinct mental health challenges, with poorer general mental health, elevated depressive and anxiety symptoms compared to cisgender, and similar rates of self-harm and suicidal behavior compared to transgender individuals. These findings underscore the urgent need for targeted interventions, including gender-affirming mental health support, to address the specific needs of non-binary youth. [ABSTRACT FROM AUTHOR]

Suicide is a global health challenge. One prevention strategy is teaching individuals how to detect and respond to suicidality. These training have increasingly been delivered online. We searched WoS, Scopus, and PubMed from inception until the 20 September 2023 to evaluate e-learning efficacy as standardized mean changes and standardized mean differences. We synthesized main results using multilevel meta-analyses and subgroups using random-effects meta-analyses. Robins-I, RoB-II and trim-and-fill were used to assess the risk of bias. Of the 6516 initially screened articles, 26 were included. Overall, e-learning increased suicide prevention skills. Subgroups reported differing results: e-learning affected knowledge and self-efficacy more than behavior and attitudes. Efficacy, short duration, and low-cost suggest that e-learning may be feasible in teaching basic suicide prevention skills to lay people. However, current evidence suggests that health care professionals should not rely on e-learning as a training modality, except when no other form of training is available. Preregisteration: CRD42020218978. [ABSTRACT FROM AUTHOR]

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

Vaccination is essential to control the COVID-19 pandemic. High vaccination willingness is a key for successful vaccination programs. This study assessed attitudes toward vaccination in Austrian adolescents and determined whether there are differences in vaccination readiness regarding education status, gender and migration background. Two cross-sectional online surveys were conducted from March to July 2021 in apprentices and high school students. Willingness to receive COVID-19 vaccination was rated on a 5-point scale. In total, n = 2006 (n = 1442 apprentices and n = 564 high school students) completed the survey. Willingness to receive COVID-19 vaccination was higher in students compared to apprentices (p < 0.001). Furthermore, migration background (p = 0.023) and female gender (p = 0.001) were associated with lower vaccination willingness. In conclusion, more efforts are required to improve confidence and willingness to vaccinate adolescents with lower educational levels, those with migrant backgrounds and females. [ABSTRACT FROM AUTHOR]

Background: Psychotic-like experiences (PLE) are reported in the general population, characterizing a non-clinical psychosis phenotype. Although those who report PLE have a higher probability of transitioning to psychosis, PLE are usually a transitory state, and most individuals will not transition to psychosis. However, PLE samples may experience symptoms such as social withdrawal, social anxiety, or social anhedonia. These symptoms may lead individuals with PLE to choose online gaming as a preferred means of social interaction. Objective: This study aims to examine the relation between PLE and problematic online gaming. Methods: An online questionnaire was posted in online game forums, on online fan-pages with German-speaking domains and in social media groups. Data from adolescents and young adults (14 to 30 years old; 55.4% males) from Austria and Germany (N=280) was analyzed. Measures: PLE were assessed with the Early Recognition Inventory based on the Interview for the Retrospective Assessment of the Onset of Schizophrenia (ERIraos); problematic gaming behavior was assessed with the Compulsive Internet Use Scale (CIUS) adapted for online gaming; social anxiety was assessed with the Mini-Social Phobia Inventory (Mini-SPIN); preference for online social interactions was assessed with the Preference for Online Social Interaction scale (POSI). Analyses: Problematic gaming behavior was divided into two groups based on the suggested cut-off point of ≥18 on the CIUS (i.e., ≥18 gaming disorder vs. ˂18 no gaming disorder). Multivariable logistic regression analyses were performed and adjusted for sex, age, gaming hours, POSI, and social anxiety. Results: A total of 63 individuals reached the cutoff for a gaming disorder, while 217 did not reach the cutoff. The majority of subjects in the gaming disorder group were males, young adults (19–24 years old, M=23.1, SD=3.7), single, or had less than high school diploma. Individuals who experienced an increased amount of PLE had a higher probability of reaching the cut-off for a gaming disorder (AOR=1.35 [95% CI 1.19–1.53]). Males were three times as likely as females to have a gaming disorder. Discussion: Results implicate a close relation between the phenomena of PLE and continued problematic gaming behavior. [ABSTRACT FROM AUTHOR]

Recent revelations of the extent of sexual abuse in the Roman Catholic Church in Germany and the United States have once more triggered the debate about sexual abuse. Those inquiries identify cases that are known to authorities or have been recorded in these institutions. However, to assess the full magnitude of the problem, data beyond recorded or known cases are needed, as it can be assumed that a vast number of cases are not reported and are hence not included in such file reviews. Therefore, representative surveys are needed. The aim of the present study was to examine the prevalence of sexual abuse by priests and in different contexts in the German population based on a representative sample. A total of 2,510 participants (54.3% female, M = 48 years) were retrospectively asked about different experiences, offenders, contexts, and so on, of child sexual abuse using questions that were used to assess child sexual abuse in prior surveys and the Childhood Trauma Questionnaire (CTQ). In sum, 0.21% (n = 7) of the participants reported child sexual abuse by a priest or pastor. 0.16% reported child sexual abuse in an institution of the Roman Catholic Church. Results also indicated that victims of sexual abuse by priests and pastors reported rather severe types of sexual abuse based on the CTQ in comparison with other contexts, such as schools. Extrapolating the data for the population, it can be assumed that the estimated number of victims is much higher than those identified by research based on recorded cases. [ABSTRACT FROM AUTHOR]

To reduce coercion in acute inpatient child and adolescent psychiatric units, a better understanding of individuals at risk for seclusion and/or restraint (S/R) is needed. We report data on the proportion of patients secluded/restrained and factors associated with higher risk of S/R. Identifying preventative mechanisms through risk stratification upon inpatient admission can aid the training of mental health professionals, and support shaping specific workflows for at-risk populations for example by joint crisis plans or post-coercion review sessions. Methods: A case-control study included all admissions (n = 782) to a department of child and adolescent psychiatry within 36 months between 2019 and 2022. Data on age, sex, out of home care, primary and comorbid ICD-10 diagnoses, length of stay, prior/multiple admissions were compared between admissions with and without S/R using chi square tests for categorical and t-tests for continuous variables. Uni- and multivariate binary logistic regression models were computed. Results: The overall proportion of S/R was 12.8% (n = 100). Females (p = 0.001), patients in out of home care (p < 0.001), with prior admission (p < 0.001), Post-traumatic stress disorder (PTSD; p < 0.001) and Borderline personality disorder (BPD; p < 0.001) were at a significantly higher risk of S/R. Length of stay in days (OR 1.01), out of home care (OR 3.85), PTSD (OR 6.20), BPD (OR 15.17), Attention deficit hyperactivity disorder (ADHD)/conduct disorder (OR 4.29), and manic episode/bipolar disorder (OR 36.41) were significantly associated with S/R in multivariate regression. Conclusions: Child and adolescent psychiatric staff should consider risk factors when using coercive measures. Patients with PTSD and/or BPD are the most vulnerable subgroups. Training of professionals and clinical practice need to be adapted in order to prevent the use of S/R and its potential hazards. [ABSTRACT FROM AUTHOR]

Background: Non-suicidal self-injury (NSSI) is of high clinical relevance due to its high prevalence and negative long-term implications. In 2016, the German consensus-based clinical guidelines for diagnostic, assessment and treatment of NSSI in childhood and adolescence were published. However, research indicates that clinical guidelines are often poorly implemented in clinical practice. One crucial part of this process is the training of healthcare professionals to transfer knowledge and capacities to bring guideline recommendations into clinical practice. Methods: The effect of three different dissemination strategies (printed educational material, e-learning, and blended-learning) on the NSSI guidelines´ recommendations was examined among 671 physicians and psychotherapists via an online-survey. The quasi-experimental study included three measurement points (before the training, after the training, 3-month follow-up) and mixed effects models were used to test for changes in knowledge, competences and attitudes toward NSSI and treatment. Moreover, the transfer of gained competences to practical work and user satisfaction were reviewed. Results: With all three training formats, the intended changes of the outcome variables could be observed. Hereby, the printed educational material condition showed the lowest improvement in the scores for the 'negative attitudes toward NSSI and those who self-injure'. The training effect remained stable throughout the follow-up measurement. The highest application rate of acquired intervention techniques in clinical practice was reported for the blended-learning condition. For all three training strategies, user satisfaction was high and evaluation of training quality was positive, with printed educational material receiving the lowest and blended-learning the highest evaluations. Conclusions: In summary, all three training formats were perceived to be of high quality and seem to be suited to cover the needs of a heterogeneous group of physicians and psychotherapists. The choice of training method could be driven by considering which training goals are desired to be achieved and by the benefit-cost ratio allowing for tailored training approaches. [ABSTRACT FROM AUTHOR]

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

The clinical presentation of major depression (MD) is heterogenous and comprises various affective and cognitive symptoms including an increased sensitivity to errors. Various electrophysiological but only few functional magnetic resonance imaging (fMRI) studies investigated neural error processing in MD with inconsistent findings. Thus, reliable evidence regarding neural signatures of error processing in patients with current MD is limited despite its potential relevance as viable neurobiological marker of psychopathology. We therefore investigated a sample of 16 young adult female patients with current MD and 17 healthy controls (HC). During fMRI, we used an established Erikson-flanker Go/NoGo-paradigm and focused on neural alterations during errors of commission. In the absence of significant differences in rates of errors of commission in MD compared to HC, we observed significantly (p < 0.05, FWE-corrected on cluster level) enhanced neural activations of the dorsal anterior cingulate cortex (dACC) and the pre-supplementary motor area (pre-SMA) in MD relative to HC and thus, in brain regions consistently associated to neural error processing and corresponding behavioral adjustments. Considering comparable task performance, in particular similar commission error rates in MD and HC, our results support the evidence regarding an enhanced responsivity of neural error detection mechanisms in MD as a potential neural signature of increased negative feedback sensitivity as one of the core psychopathological features of this disorder. [ABSTRACT FROM AUTHOR]

Background: Non-suicidal self-injury (NSSI) is a clinically significant behavior affecting approximately 18% of adolescents and young adults worldwide. The importance of NSSI is supported by its association with a broad spectrum of mental disorders. Despite its high relevance, evidence-based, specific, time-, and cost-effective treatment approaches are scarce. Cognitive behavioral therapy (CBT) seems effective in reducing the frequency of NSSI in adolescents and young adults. However, young people are often reluctant to seek professional help and effective interventions adressing NSSI are not sufficiently available across all regions of Germany. Research indicates that the majority of youth with risk behavior (including NSSI) prefer technology-based interventions. To date, effective interventions for adolescents and young adults with NSSI that are deliverd online are not available.Methods: The present project aims to develop and evaluate an online intervention for adolescents and young adults with NSSI based on the content of a recently evaluated face-to-face short-term program that includes elements of CBT and dialectical behavior therapy (DBT): "The Cutting Down Programme" (CDP). The efficacy of the new online CDP intervention will be tested in a randomized controlled trial (RCT) in which n = 700 youths engaging in repetitive NSSI will participate in either an online psychoeducation (n = 350) or online CDP (n = 350). Within a postline assessment four months after baseline (end of treatment; T1), and follow-up evaluations 12 and 18 months after baseline (follow-ups; T2 and T3), NSSI and comorbid symptoms as well as quality of life will be assessed. It is hypothesized that participants receiving online CDP report a greater reduction in the frequency of NSSI within the last three months at T2 (primary endpoint) compared to those receiving online psychoeducation. Exploratory analyses will focus on predictors of treatment outcome.Discussion: We report on the development and evaluation of an online intervention for adolescents and young adults engaging in NSSI based on the CDP. If supported by empirical evidence, an online-based intervention for NSSI might help to overcome the limited availability of adequate interventions for youth.Trial Registration: German Clinical Trials Register, DRKS00014623 . Registered on 22 May 2018. [ABSTRACT FROM AUTHOR]

Background: Current research on treatment predictors and long-term effects of trauma-focused interventions for (unaccompanied) refugee minors is limited. This secondary analysis of a recent randomised controlled trial (RCT), evaluating the trauma-focused group intervention "Mein Weg" (English "My Way") compared to usual care, investigated several refugee-specific factors such as treatment predictors and sustainability of treatment gains. Methods: In total N = 50 participants (Mage = 17.00, 94% male) were included in this analysis. Evaluation of 3-month follow-up data included: posttraumatic stress symptoms [(PTSS) CATS-Self, CATS-Care], depression (PHQ-8), and dysfunctional posttraumatic cognitions (CPTCI-S). Baseline symptom severity of the above-mentioned measures, trauma load and socio-demographic factors were investigated as the treatment predictors. Results: Intention-to-treat-analyses (ITT) revealed the sustainability of treatment effects in self-reported PTSS (pre to post change: 6.48 ± 1.60, d = 0.62, p < 0.001; post to 3-month follow-up change: 1.41 ± 1.96, d = 0.11, p = 0.47) and depression (pre to post change: 7.82 ± 2.09, d = 0.64, p < 0.001; post to 3-month follow-up change: 1.35 ± 2.17, d = 0.05, p = 0.54). Country of origin alone was a significant predictor of the change in PTSS (b = − 8.22 ± 3.53, t(30) = − 2.33, p = 0.027), and baseline levels of depression were a significant predictor of the change in depression (b = 0.83 ± 0.19, t(33) = 4.46, p < 0.001). Conclusion: This group intervention can serve as a valuable component in a stepped care approach with promising long-term effects for young refugees. Trial registration DRKS, #DRKS00010915. Registered 15 September 2016, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00010915 [ABSTRACT FROM AUTHOR]

Introduction: Mentalization‐based therapy (MBT) and its adapted version for adolescents (MBT‐A) are repeatedly highlighted as promising treatments for reducing self‐harm, particularly in borderline personality disorder (BPD). Despite the availability of publications providing evidence of their efficacy in reducing self‐harm, recent meta‐analyses have yielded mixed results. To inform best‐practice clinical decision‐making, we conducted a systematic review and meta‐analysis. We aimed to disentangle findings for both adolescents and adults on the efficacy of MBT(‐A) in reducing self‐harm (primary outcome) and symptoms of BPD and depression (secondary outcomes). Methods: Web of Science, Scopus, Embase, PubMed/Medline, and Cochrane Review Database were searched for eligible studies published until September 2022. In total, 14 studies were identified, comprising 612 participants from nine MBT studies (six pre–post, three RCTs) and five MBT‐A studies (two pre–post, three RCTs). Aggregated effect sizes were estimated using random‐effects models. Meta‐regressions were conducted to assess the effect of moderator variables (treatment duration, drop‐out rates, and age) on effect sizes. Results: Overall, both MBT and MBT‐A demonstrated promising effects in reducing self‐harm (g = −0.82, 95% CI −1.15 to −0.50), borderline personality disorder (g = −1.08, 95% CI −1.38 to −0.77), and depression (g = −1.1, 95% CI −1.52 to −0.68) symptoms. However, when compared to control interventions (TAU, SCM), MBT(‐A) did not prove to be more efficacious, with the exception of MBT showing superior effects on BPD symptoms in adults (g = −0.56, 95% CI −0.88 to −0.24). Conclusion: Although the pre–post evaluations seem promising, this analysis, including RCTs, showed no superiority of MBT(‐A) to control conditions, so that prioritizing the application of MBT (‐A) for the treatment of self‐harm is not supported. Possible explanations and further implications are discussed. [ABSTRACT FROM AUTHOR]

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

Objectives: Symptoms of distress and dysfunctional posttraumatic cognitions (PTCs) have been frequently described in parents of children and adolescents with posttraumatic stress symptoms (PTSS), especially if the parents had experienced traumatic events themselves. The inclusion of non-offending parents in trauma-focused cognitive-behavioral therapy (TF-CBT) for children and adolescents may, thus, help parents to cope with the traumatic experience of their child. The aim of this study is to investigate the effects of TF-CBT on the parents, while taking their own history of traumatic experiences into account. Methods: Parents (N = 57, 84.2% mothers) of children and adolescents who received TF-CBT completed the Posttraumatic Diagnostic Scale, the Beck Depression Inventory, the State-Trait Anxiety Inventory, and the Posttraumatic Cognitions Inventory. Treatment effects and the sustainability at 6- and 12 months post-treatment were tested via repeated-measures analysis of variance, following the intention-to-treat approach. Results:N = 19 (35.2%) of the parents evaluated their child's trauma as the worst event, 18 (33.3%) rated their own experience as their worst event, and 17 (31.5%) indicated that their own worst traumatic experience was the same type as their child's trauma. Significant improvements (p < 0.001) emerged for parental PTSS [F(2, 837) = 8.27; d = 0.30], depression [F(3, 284) = 14.73; d = 0.41], anxiety symptoms [F(3, 185) = 17.44; d = 0.64], and dysfunctional PTCs [F(2, 465) = 13.58; d = 0.46]. Sustainability of these treatment gains remained at both follow-up time points (p < 0.05). There was no interaction between the time and the reference person of the traumatic index event, reported by parents. Conclusion: These results indicate parental benefits from participation in TF-CBT delivered to their child, until 1-year post-treatment and independently from the parental trauma history. The ongoing tendency of improvement might indicate that TF-CBT furnishes children and their parents with skills to further reduce the impact of their traumatic memories. ClinicalTrials.gov NCT01516827. [ABSTRACT FROM AUTHOR]

Background: Depressive disorders are among the most prominent health problems in youth. Even with the best available pharmacological and non-pharmacological treatments, remission rates are low. Without early treatment, depression in youth is associated with a high risk of symptom progression, chronicity, co-morbidity, and suicidal behavior. Thus, adolescent depression is a prime candidate for innovation in treatment. In depressive adults, meta-analytic evidence has proven that bright light therapy (BLT) is a potent low-threshold intervention, promising due to easy application, low side effects, and optimized compliance. In adolescents, studies with small samples show promising effects. This randomized controlled trial will examine the effectiveness of BLT in youth inpatients.Methods/design: In this randomized, controlled, double-blind multicenter parallel group trial, morning BLT is applied for four weeks in addition to treatment as usual (TAU) for depressed youth inpatients (daily morning exposure to bright light via light-emitting glasses, 10,000 lx, for 30 min) and will be compared to a control condition (placebo light treatment, red light, identical light glasses). The primary objective is to assess whether BLT reduces symptoms of depression in youth with greater effect compared to placebo light therapy. Secondary objectives are to examine the impact of BLT on responder status, application of antidepressant medication, and further depression-related symptoms (sleep, activity, quality of life, satisfaction with health, general psychopathology, alertness, and circadian function). N = 224 patients will be recruited in a naturalistic inpatient setting. A follow-up will be carried out after three and six months.Discussion: The study aims to discuss and evaluate BLT as an additive method supporting standardized clinical procedures dealing with severe to moderate depressive symptoms in youth.Trial Registration: German Clinical Trials Register, DRKS00013188 . Registered on November 30, 2017. [ABSTRACT FROM AUTHOR]

Background: Child maltreatment of all types is a serious concern for society, and it is important to monitor trends in incidence in order to inform child welfare agencies and policy-makers about emerging issues. In Germany, however, information on such trends is limited: apart from official sources, the only published study is a comparison of surveys conducted in 1992 and 2011 that had focused primarily on sexual abuse. The present study is the first to look at more recent trends and to examine other types of maltreatment as well. Methods: We compared the datasets of two population-based nationwide surveys, one conducted in 2010 (N = 2504) and the other in 2016 (N = 2510). Both had used identical methodology. Participants aged 14 years and older had been selected randomly using the Kish selection grid method, and information about childhood experiences of abuse had been solicited using the Childhood Trauma Questionnaire. Results: The overall percentage of respondents who reported having experienced at least one type of child maltreatment decreased over the 6 years, from 35.3% in 2010 to 31.0% in 2016; however, the percentages who reported multiple types of maltreatment remained stable. The decrease in any type of maltreatment was mainly driven by fewer reports of physical neglect, which was likelier to be reported by older respondents who had experienced privation during the (post-) war years and whose representation was lower in the later survey. There was a significant increase over time in the prevalence of emotional abuse, with respondents aged 26–45 years reporting higher rates of this type of maltreatment. The prevalence rates of other types of maltreatment remained unchanged. All effect sizes were very small. Conclusions: At present, the systems in place in Germany for monitoring the occurrence of child maltreatment are insufficient. While this study contributes to a better understanding, more information is needed, particularly on populations that have been excluded or underrepresented in previous research efforts. As has been done elsewhere, large databases should be set up, using identical methodologies and definitions, in order to accurately assess trends over time in different types of abuse and neglect. [ABSTRACT FROM AUTHOR]

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

The article present a case study of a 32 year old male patient who amputated both of his testicles after consuming alcohol along with his first ever dose of lysergic acid diethylamide. A follow up examination which was conducted on the patient six months after the incident and revealed no psychiatric disorders is discussed.

Child maltreatment is an important risk factor for development. Different types of child maltreatment often do not occur in isolation, but the co-occurrence of different types of child maltreatment is the rule rather than the exception. In addition to the long-term and diverse individual consequences, child maltreatment leads to a high societal burden every year. The WHO has identified child abuse as a major public health problem and the United Nations has made the fight against child maltreatment an aim of its sustainable development agenda. This paper examines and presents the frequency and co-occurrence of different types of child maltreatment and its association with psychological and somatic consequences on the basis of a representative sample. The results illustrate the association between the accumulation of different types of maltreatment and negative consequences for those affected. For example, the risk of negative consequences is up to 10 times higher when four or more types of child maltreatment are experienced. Far too rarely the cumulative effects of multiple stresses are taken into account. Especially, because the effects of maltreatment on health are increasingly well investigated, this knowledge must be taken more into account in the design of prevention and intervention strategies. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented about worldwide research networks for young children and adolescent psychiatrists.