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SummaryPoverty is a risk factor for mental health problems during childhood and adolescence in general. The economic crisis (2007–2013) seemed to have intensified poverty in families within the most affected countries, esp. in the southern countries of Europe. Within a selective literature review, existing data on the risk of poverty, mental disorders in parents and further risk factors on mental health of children are analyzed. Direct effects like limited access to mental health care system may exist, but are not proved in general. From a developmental perspective, effects of the crisis seem more indirectly mediated by well-known risk factors for psychiatric disorders of children and adolescents: substance abuse in families, mental disorders of parents and loss of perspectives within families are risk factors both on mental health of a child but also for a low educational level which would be a resilience factor. There is evidence that an increase of child abuse and neglect (adverse childhood experiences, ACE) was linked to the economic crisis. Long-term effects e.g. due to ACE may be observed in later times, when children are grown-up.

ZusammenfassungDie Verbesserung von Teilhabe ist zentraler Bestandteil sowohl der UN-Behindertenrechtskonvention als auch der UN-Kinderrechtskonvention. Zentrale Aspekte für Inklusion und Teilhabe sind die Lebensbereiche von Kindern, wie Schule, Einbindung in Freundesbeziehungen und Familie. Derzeit sind in Deutschland die Anspruchsgrundlagen für Maßnahmen zur Reduzierung der Teilhabebeeinträchtigung in den Sozialgesetzbüchern niedergelegt. Dies führt zu Problemen in der Praxis, da Kinder oft mehrfachbehindert sind, und kann für Familien bei der Erlangung von Hilfen schwierig sein. Es wird eine gesetzliche Veränderung diskutiert, die alle Leistungen für alle behinderten Kinder und Jugendlichen unter dem Dach der Jugendhilfegesetzgebung vereint. Die Teilhabebeeinträchtigung muss umfassend strukturiert, aber auch wissenschaftlich evaluiert erfasst werden. Im Beitrag werden einige verwendete Instrumente vorgestellt.

ZusammenfassungDie Diagnostik und Therapie aggressiv-oppositioneller Verhaltensstörungen bei Kindern und Jugendlichen stellt eine besondere Herausforderung für die Praxis dar, weil diese Störungen sehr häufig auftreten, meist einen chronischen Verlauf haben und insgesamt schwer zu behandeln sind. Um eine gute klinische Praxis in jedem Einzelfall gewährleisten zu können, sollte die Diagnostik dem Konzept einer evidenzbasierten multimodalen Verhaltens- und Psychodiagnostik folgen, die auf reliablen und validen Verfahren basiert. Zur Behandlung von oppositionell-aggressiven Störungen sollte ebenfalls ein evidenzbasiertes multimodales Vorgehen gewählt werden, bei dem patienten-, familien-, kindergarten- bzw. schulzentrierte und, wenn nötig, auch gleichaltrigenzentrierte Interventionen als Methoden der ersten Wahl integriert werden, das in seltenen Fällen bei entsprechender Indikation auch mit Pharmakotherapie kombiniert werden kann. Evaluierte deutschsprachige diagnostische Verfahren sowie Therapiemanuale werden vorgestellt.

Children of mentally ill parents are exposed to a multitude of burdens due to the diseases of their parents. Age-related preventive measures and interventions are needed to minimize the risk for the development of psychiatric disorders by the children themselves.The aim of the study was the documentation of preventive options on a national and international level for children of different age groups between 3 and 14 years with parents with depressive or anxiety disorders.A systematic literature search was conducted to identify current evidence-based preventive interventions measures for these target groups and analyzed with respect to age-specific aspects and evidence.From screening 107,573 publications 43 interventions could be found. After examining the evidence of the interventions 25 projects could be included in the analysis For each of the different age groups the intervention with the best evidence is presented in this article.Many interventions were found but most of them were not sufficiently evaluated or psychometrically defined; however, the few well-evaluated evidence-based projects for children mostly addressed the age-specific needs. Projects for preschool age children mostly worked with the parents and referred to elements of parental training. For schoolchildren there were various preventive projects that especially worked with increasing the self-esteem and the development of coping strategies. Projects for adolescents worked with psychoeducation and increasing social connectedness. Across all age groups there was no comprehensive and cross-system networking between the interventions.

ZusammenfassungJugendliche und Heranwachsende nehmen aufgrund ihres jungen Alters eine besondere Stellung im deutschen Strafrechtssystem ein. Vor allem im Maßregelvollzug muss die spezielle Behandlungsbedürftigkeit der Jugendlichen beachtet werden. Ob die Therapie erfolgreich war lässt sich unter anderem durch eine Analyse des Legalbewährungsverlaufs nach Entlassung überprüfen. In der Klinik für Forensische Psychiatrie Rostock, in der Patienten nach § 64 StGB untergebracht sind, wurde zu diesem Zweck eine umfangreiche Rückfalluntersuchung initiiert. Im Folgenden wurden Bundeszentralregisterauszüge für 76 Jugendliche und Heranwachsende im Alter von 15 bis 21 Jahren analysiert, die zwischen 2001 und 2012 entlassen wurden. Die allgemeine Rückfallquote lag bei 65,8%, wobei 38% aller rückfällig gewordenen Patienten innerhalb der ersten sechs Monate nach Entlassung die Tat begingen. Junge Patienten, deren Behandlung nicht erfolgreich abgeschlossen wurde, stellen zudem eine besondere Risikogruppe dar. In der Gruppe der 15-bis 21-Jährigen wurden Therapieabbrecher signifikant häufiger rückfällig als regulär entlassene Patienten. Diese Unterschiede konnten in keiner anderen Altersgruppe beobachtet werden.

Severe mental illness in parents increases the risk of neglect, physical and sexual abuse (adverse childhood experiences, ACE) of children.Presentation of the current situation of child protection issues in psychiatric care in Germany and the derivation of needs and potential solution strategies.Based on a selective literature search, the needs and the current situation in Germany are presented and potential solution strategies are pointed out. The analysis is supplemented by a descriptive evaluation of specific consultation requests to the medical child protection hotline, which were descriptively evaluated and served as a starting point for the selective literature search.Despite the well-known comprehensive influence of mental illnesses of parents on their children, psychiatric patients have not yet been systematically registered regarding whether they have to care for underage children. There is a lack of systematic and comprehensive support for families at risk. Of all calls to the project medical child protection hotline, calls from the field of adult psychiatry and psychosomatics make up by far the highest proportion from the field of adult medicine.An increased awareness of child protection issues is necessary in the field of adult psychiatric treatment. Systematic counselling services for acute cases and also networking and structured cooperation with other medical fields, such as child and youth psychiatry, pediatrics and child and youth welfare should be addressed.

This article is an abridged version of a report by an advisory council to the German government on the psychosocial problems facing refugee families from war zones who have settled in Germany. It omits the detailed information contained in the report about matters that are specific to the German health system and asylum laws, and includes just those insights and strategies that may be applicable to assisting refugees in other host countries as well. The focus is on understanding the developmental risks faced by refugee children when they or family members are suffering from trauma-related psychological disorders, and on identifying measures that can be taken to address these risks. The following recommendations are made: recognizing the high level of psychosocial problems present in these families, providing family-friendly living accommodations, teaching positive parenting skills, initiating culture-sensitive interventions, establishing training programs to support those who work with refugees, expanding the availability of trained interpreters, facilitating access to education and health care, and identifying intervention requirements through screening and other measures. published

ZusammenfassungKinder in der Heimerziehung und in Pflegefamilien entwickeln oft eine posttraumatische Belastungsstörung (PTBS) aufgrund des häufigen Erlebens traumatischer Ereignisse. Ziel dieser Arbeit war es, die globale Prävalenz von Trauma und PTBS in der Heim- und Pflegepopulation unter Berücksichtigung von Risiko- und Schutzfaktoren zu untersuchen. Dafür wurde eine systematische Literaturanalyse der Originalarbeiten aus den Datenbanken Web of Science, PubMed, PsyInfo, PubPsych, Psyndex, CSA, FIS und PILOTS von 2003 bis 2014 durchgeführt. Die Analyse deutete auf höhere Prävalenzen von Trauma und PTBS in der Heim- und Pflegepopulation im Vergleich zu der Allgemeinbevölkerung hin. Während keine Geschlechtseffekte auf diese Prävalenzen beobachtet wurden, konnten geschlechtsspezifische Traumaprofile bezüglich des sexuellen Missbrauchs, der körperlichen Misshandlung und lebensbedrohlicher Unfälle identifiziert werden. Es wurden mehrere Risikofaktoren für eine PTBS untersucht. Analysiert wurde jedoch nur ein protektiver Faktor: die soziale Unterstützung. Die Ergebnisse betonen die Notwendigkeit von Psychotherapeuten in den stationären Settings der Jugendhilfe.

The number of underage refugees arriving in Germany has rapidly increased since 2015. Many of these children and adolescents have been and still are, exposed to a large number of stressful circumstances. The group of those helping refugee minors is heterogeneous with both volunteers and professional workers from the fields of child welfare and healthcare services. Easily applicable instruments to assess both burdens and resources are needed in order to plan appropriate interventions. This paper focuses on instruments for assessing the circumstances of refugee minors and includes pilot data of an online-based screening instrument to assess burdens and resources (providing online resource and trauma assessment for refugees, PORTA). Field application was tested by the staff of a clearing and preclearing institution with 33 cases and good practical feasibility was reported. Applying a simple to use screening instrument for refugee minors and their helpers, which is available in several languages creates the possibility of a shared definition of problems and solutions and is beneficial to helpers (e.g. volunteers, youth welfare services and medical doctors) as well as refugee minors.

ZusammenfassungBeeinträchtigte individuelle Lebensqualität und die zunehmende ökonomische Bedeutung psychischer Erkrankungen machen eine genuin entwicklungspsychiatrische Diskussion über Prävention und Frühintervention bei psychischen Erkrankungen unabdingbar. Allerdings scheint sich die medizinisch psychiatrische Kompetenz hierbei primär auf die kurative Seite zu beschränken oder beschränken zu lassen. In Europa existieren zahlreiche Präventionsprogramme. Die einzelnen Akteure sind jedoch oft unkoordiniert, Maßnahmen nicht abgestimmt und häufig nicht empirisch evaluiert. Wachsende Erkenntnisse über molekulare Entstehungsprozesse psychischer Erkrankungen lassen Therapieoptionen, die bereits in der Krankheitsentstehung ansetzen, zukünftig möglich erscheinen. Die Rolle von Surrogat-Markern und die Rahmenbedingungen für die Erforschung indizierter Präventions- und Frühinterventionsansätze müssen jedoch definiert werden. Die psychiatrischen Fächer könnten mit ihrer Expertise in der Evaluation von Interventionen und ihrem Wissen um protektive Faktoren und Entwicklungsverläufe wichtige Beiträge für eine empirischfundierte wirksame Prävention psychischer Störungen in der Lebensspanne leisten.

ZusammenfassungComputer- und Videospiele (vor allem „Ego-Shooter”) werden häufig als kausaler Faktor im Zusammenhang mit „Amokläufen” an Schulen genannt. Diese Übersichtsarbeit beschäftigt sich mit dem Computerspielkonsum, der Debatte über Computerspiele und aggressives-Verhalten und dem Zusammenhang zwischen Computerspielen und „School shootings”.Während die Literatur zu Computerspielen und aggressivem Verhalten gemischte Resultate zeigt, lässt sich in Hinblick auf School shootings kein kausaler Zusammenhang herstellen. Andere Einflussfaktoren wie der private Waffenbesitz und die mediale Berichterstattung über „Amokläufe” verdienen eine detailliertere Beachtung in der gegenwärtigen Diskussion.

ZusammenfassungDie Bedeutung von (Cyber-)Bullying als Motiv oder Auslöser von Amokläufen in der Schule wird in der Forschung kontrovers diskutiert. Ca. 5 bis 10% aller Schüler werden regelmäßig in der realen oder virtuellen Welt viktimisiert, das Vorkommen der Problematik wird von Bezugspersonen meist unterschätzt. (Cyber-)Bullying kann zu vielfältigen psychosozialen Schwierigkeiten (internalisierende Verhaltensauffälligkeiten bis in seltenen Fällen hin zu schweren Gewaltformen) führen, da dadurch die Entwicklung sozio-kognitiver Kompetenzen und sozialer Ressourcen beeinträchtigt sein kann. Verschiedene Schutzfaktoren und günstige Coping-Strategien werden vorgestellt. Die Stärkung der Persönlichkeitsentwicklung von Kindern/Jugendlichen und die Förderung günstiger Umgebungsfaktoren kann das Risiko für das Auftreten von extremer Gewalt wie sie bei Amokläufen deutlich wird, präventiv reduzieren.

Zusammenfassunglm Rahmen der Glaubhaftigkeitsbegutachtung steht dem Sachverständigen die Methodik der kriterienorientierten Aussageanalyse zur Verfugung, welche in Deutschland auch von Seiten derJustizals richtungweisend angesehen wurde (BGH1 StR 618/98). Fur den Umgang mit psychisch oder psychiatrisch auffälligen, kognitiv beeinträchtigten bzw. jüngeren Opferzeugen lassen sich hieraus jedoch kei-ne hinreichenden methodischen Kriterien ableiten. Dervorliegende Beitrag gibt einen Oberblick über die klassische Methodik der Glaubhaftigkeitsbegutachtung und zeigt damit verbundene Probleme in der Praxis auf. Es wird auf ers-te Eindrücke einer umfangreichen Aktenanalyse Bezug genommen. Die Autoren sprechen sich für eine auf klinischem Wissen basierende Integration individueller Voraussetzungen von Opferzeugen und weitergehende Forschung auf diesem Gebiet aus.

Recent reports and recommendations from national and international health care regulatory authorities have informed us that serotonin reuptake inhibitors (SSRI) are contraindicated as new treatment for those under 18 years of age with depressive illness. They conclude that SSRI carry the risk of increased suicide-related behavior; although there was no completed suicide. The European Medicine Agency (EMEA) and German regulatory agency (BfArM) advise that these components generally should not be used in this age group except in their other, approved indications. However, it is acknowledged that they may sometimes be chosen, depending on individual clinical needs. Based on these data, the Commission for Child and Adolescent Developmental Psychopharmacology of the German Scientific Society for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy is trying to give recommendations for the use of SSRI in clinical practice. Recent studies demonstrate that combining SSRI with psychological treatment such as cognitive behavioral therapy may reduce the risk of suicidal behavior in depressed children and adolescents.

Sexual harassment among adolescents has long been neglected in Germany though it is frequent and leads to significant strain for the victims. In international studies, the prevalence of sexual harassment ranges from 10 to 80 % among students. For the development of sexual harassment individual as well as school based factors play a role. Different pathways lead to this problematic behaviour. The effect of new media in the development of sexual harassment cannot be estimated so far. Frequent consequences of sexual harassment in addition to school associated difficulties are unspecific somatic complaints. General practitioners and pediatricians are frequently consulted tn the first place. Recommendations for consultation and interventions are presented.

The article provides an overview of the research on sexual abuse and the current political developments in Germany. First, the terminology of sexual child abuse is discussed, followed by the presentation of epidemiological data. The section on diagnostics and therapy shows that--because of mostly nonspecific indicators--the diagnosis of child sexual abuse is very difficult to define. Child sexual abuse is discussed as a traumatic experience for children and adolescents with different psychiatric and physical diseases. Current studies have shown that especially cognitive behavioral therapeutic-oriented approaches are effective in curing posttraumatic stress disorders. Based on the new German Child Protection Act, the focus lies on the clarification of confidentiality for medical professionals and their right to consulting services for child protection. In conclusion, guidelines and minimum standards for a child prevention and protection model are presented as well as institutional recommendations addressed to all institutions (also clinical) that take care of or treat children and adolescents.

The department of ophthalmology at the medical faculty of the University of Ulm provides additionally for interested students in clinical semesters an optional activity. In small groups the students deepen their theoretical knowledge and learn more about ophthalmological diagnostic standard procedures. The "objective structured clinical examination" (OSCE) is known as a useful tool in the assessment of clinical skills. The OSCE is a well-established and valid examination method, but also time-consuming and costly. In form of a trial the OSCE was launched during the optional activity "Look into my eyes, baby"; in the summer semester 2009.By means of four examination areas established diagnostic methods in ophthalmology were tested. During the tests two simulation patients as well as two phantom heads for ophthalmological examinations were assessed. The preparation of the examination materials occurred in close collaboration with the department of ophthalmology and the division exam development of our university. In the assessment of the examinations a high value was set on good communication skills between students and simulation patients as well as on the professional handling of the student tasks. After the examinations the acceptance of the test methods was evaluated using a focused group interview between the students of the optional activity and the participating examiners.We performed two OSCEs involving three students each in the last two semesters. The OSCE was to a great extent time- and resource-consuming, due to the intensive pre- and post-reviewing and the time students needed to pass the various examination areas. Students and examiners as well confirmed the validity of the assessment and acknowledged a positive effect on the students learning behaviour.The teaching staff members are willing to accept the OSCE, especially when the assessment procedures are thoroughly planned and well structured. The acceptance of the students can be achieved by providing valid assessment and reviewed teaching conditions. The high input in personnel and instrumental resources for the assessment and the student's individual supervision should be critically discussed in the light of the efficacy of the additional ongoing hospital and outpatient services and the personnel-relevant education budget assigned to the department of ophthalmology of a university.

Child protection can only be successfully solved by interdisciplinary cooperation and networking. The individual, heterogeneous, and complex needs of families cannot be met sufficiently by one profession alone. To guarantee efficient interdisciplinary cooperation, there should not be any gaps in the network. In addition, each actor in the network should be placed at an optimal position regarding function, responsibilities, and skills. Actors that serve as allocators, such as pediatricians or youth welfare officers, should be in key player positions within the network. Furthermore, successful child protection is preventive and starts early. Social network analysis is an adequate technique to assess network structures and to plan interventions to improve networking. In addition, it is very useful to evaluate the effectiveness of interventions like round tables. We present data from our pilot project which was part of "Guter Start ins Kinderleben" ("a good start into a child's life"). Exemplary network data from one community show that networking is already quite effective with a satisfactory mean density throughout the network. There is potential for improvement in cooperation, especially at the interface between the child welfare and health systems.

Off-label use is an ongoing problem in child and adolescent psychiatry. Except methylphenidate and atomoxetine for attention-deficit/hyperactivity disorder (ADHD), most substances used to treat children and adolescents with psychiatric disorders are prescribed off-label. In additional to aspects of drug safety and efficacy the widespread off-label use raises issues of liability in the case of adverse events. In Germany off-label use also poses problems of reimbursement by the health insurance. In the future we expect, driven by written request of the FDA, numerous new indications for novel antipsychotics in the USA for the treatment of so-called childhood bipolar disorders. Given another diagnostic framework in context in Europe, these so-called bipolar disorders in children are very rarely diagnosed. Anyhow, antipsychotics are widely used in the USA and in Europe to treat impulsivity or aggressiveness in children and adolescents. There is still a lack of European labelling of novel antipsychotics for the treatment of schizophrenia. In clinical practice given the risk of liability and other forensic issues in the treatment of schizophrenic patients, this is still one of the major hindrances in the treatment of young schizophrenic patients in Europe. Whereas these drugs may urgently be needed for treatment of psychotic disorders and of impulsivity or aggressiveness, the indication of bipolar as used in the USA leads to a misconception and does not increase availability of licensed modern antipsychotics for minors.

As a medical discipline Child and Adolescent Psychiatry and Psychotherapy has gained increasing importance within society since given the epidemiological importance of behavioural problems in childhood and adolescence, it has verifiably improved the developmental chances of children at high risk. Child and Adolescent Psychiatry and Psychotherapy therefore should be systematically integrated into the German Medical Curriculum. The bio-psycho-social model provides us with a comprehensive paradigm of psychiatric disorders and has to face the problem of hermeneutics. An equilibrium between Evidence-based Medicine and the individual clinical experience with patients (Experience-based Medicine) must be established within medical teaching, rather than playing one against the other. Ethical dilemmas of medical therapy have to be taken into account.

Infants and toddlers are at high risk of neglect and maltreatment, as they are especially dependent on the care and the safeguard of their parents. Child protection can only succeed if early and preventive support for families at risk and their infants is provided. The project "A good start to life" helps to promote parental sensitive behaviour and care giving competence of parents in precarious life settings and in high risk situations and is aimed to prevent child neglect and abuse at an early age. A relevant prerequisite for child protection is interdisciplinary networking between the involved systems. The main focus of the project is the establishment of collaboration and network structures between the infant and youth welfare system and the health-care system and their services in eight communities in four states in Germany by using so-called round tables as communication platforms. Preliminary results of the round tables are reported in this article together with the results of the evaluation process.

Migrant adaptation was studied in children and families of French soldiers and of Greek and Turkish migrant workers in West Berlin. In addition, a German control group was investigated. All four samples were matched with regard to sex and age of the children. Psychiatric morbidity differed significantly between the migrant groups. Disturbed parental behaviour and impaired maternal health clearly correlated with psychiatric disturbance in the children in samples. Cultural rather than socioeconomic factors seemed to be most influential with regard to psychosocial adaptation.

Recent reports and recommendations from national and international health care regulatory authorities have informed us that serotonin reuptake inhibitors (SSRI) are contraindicated as new treatment for those under 18 years of age with depressive illness. They conclude that SSRI carry the risk of increased suicide-related behavior; although there was no completed suicide. The European Medicine Agency (EMEA) and German regulatory agency (BfArM) advise that these components generally should not be used in this age group except in their other, approved indications. However, it is acknowledged that they may sometimes be chosen, depending on individual clinical needs. Based on these data, the Commission for Child and Adolescent Developmental Psychopharmacology of the German Scientific Society for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy is trying to give recommendations for the use of SSRI in clinical practice. Recent studies demonstrate that combining SSRI with psychological treatment such as cognitive behavioral therapy may reduce the risk of suicidal behavior in depressed children and adolescents.

Kinder im Krankenhaus befinden sich in einer spezifischen Stresssituation. Sie erleben haufig zum ersten Mal eine langere Trennung vom Elternhaus und sind gleichzeitig durch den Grund dieser Trennung — meist eine schwere Erkrankung, die Hospitalisierung notwendig macht — in ihren Moglichkeiten der Bewaltigung dieser Belastung eingeschrankt. Viele Kinder wissen zum Zeitpunkt ihrer stationaren Aufnahme wenig uber ihre Rechte und Pflichten als Patienten. Manche haben massiv Angst vor den banalsten medizinischen Eingriffen. Andere versuchen sich sehr tapfer zusammenzunehmen. Dennoch haben alle Kinder im Krankenhaus in der Regel eine neue Situation zu bewaltigen, auf die sie nicht vorbereitet sind. Das ubliche Beziehungsnetz zwischen den Bezugspersonen und den Kindern wird durch das medizinische System, insbesondere durch die Pflegekrafte, Arztinnen und Arzte, verandert. Plotzlich unterhalten sich die Eltern mit dem Arzt vor der Tur, Schwestern ubernehmen Betreuungsaufgaben etc. Aus diesen neuen Beziehungen konnen Rollenkonflikte entstehen, die dann auch zu Komplikationen in der Pflege und medizinischen Versorgung fuhren konnen. Gerade wenn es sich um sehr schwere Erkrankungen mit einer schlechten Prognose handelt, sind Gesprache mit dem Betroffenen haufig eine sehr schwierige Aufgabe fur die Arzte. Die Berucksichtigung von Informations- und Partizipationsrechten in dieser Situation ist nach wie vor eher ein marginales Thema, obwohl z. B. die UN-Kinderrechtskonvention hier ganz klare Vorgaben formuliert.

The present article reviews the specific problems of the off-label use of atypical and typical neuroleptics in the treatment of adolescent patients with schizophrenia. There is a considerable gap in the empirical knowledge of treatment efficacy and long term safety in adult populations as compared to children and adolescents. This means that in most in-patients with early onset schizophrenia some sort of typical or atypical neuroleptic drug is currently used beyond license. From a legal point of view there is no protection for treated children or adolescents and their parents as the manufacturer of these pharmaceutical products does not assume liability for off-label use. Whether the doctor can be held liable in these cases, depends on the quality of the information he provides to his patients and the patients' consent. Legal changes such as the Food and Drug Administration Modernization Act (FDAMA) and Pediatric Rule in the USA have brought forward more research to the benefit of children and adolescents. In 2002 a trend has been noticed in both the European and the German Parliament to improve the general conditions for using drugs that are well-established in adult medicine for the treatment of children.

Guidelines as recommendations by the medical associations concerning the diagnosis and treatment of certain diseases do not have the character of judicial norms. However, they may have an impact on decision-making in court. Within social security insurance law, and especially in medical malpractice litigation, the medical standard has become a legal term. As far as statements in guidelines render the actual standard as affirmed, the more binding is their character with respect to judicial questions. This article deals with this interplay between medical quality assurance and the legal demands on medical action. As a basis for discussion of this issue the relevant jurisdiction will be represented. Its impact on the guidelines for child and adolescent psychiatry will be pointed out as a concrete example.

Failure of incentive to investigation in infantile pharmaceutical trials has lead to insufficient supply with drugs within pediatrics and child- and adolescent psychiatry in Germany. In practice, drugs that are approved for adults are used to treat minors as a remedy. In many areas such "off label use" has become the medical standard and is therefore owed by the doctor under medical malpractice law. The principle of economy, that rules the law of public health insurance, forbids the prescription of drugs, that are not tested. However, as minors have the right to equal protection, the principle of economy can not prohibit off label use to the determent of minors. By virtue of the European orphan drug direction we can expect an improvement of drug supply in the field of pediatrics and child- and adolescent psychiatry in the long run. But meanwhile it would be unethical and unlawful to deny minors through restrictions on drug prescription a standard treatment, where the medical standard demands off label use of a pharmaceutical product.

Research in the field of the impact of chronic illness is nowadays often based on concepts such as coping and stress adaptation. From the point of view of the family chronic illness influences family functioning, while coping behavior is influenced by the families resources. There is little research done on this interaction. This article focuses on atopic eczema.Qualitative free interviews of more than two hours duration each, had been done with all family members of families with a child suffering from severe chronic atopic eczema until the age of (pre-) puberty. A family interview with all members of the family has also been transcribed. The interpretation of the data is based on the qualitative content analysis and the grounded theory. The results from 5 families (24 interviews) lead to a typology of familial coping. The implications of this typology are discussed.

This article describes experiences of parents of sexual abused children and their evaluations of institutional interventions on sexual child abuse. Results are presented of a study investigating 'individual and institutional reactions on sexual child abuse'. The number of contacted institutions, personnel experiences with these institutions and resulting requirements are described. The results are based on a sample of 47 (82.5%) girls and 10 (17.5%) boys (range 6-18 years) and interviews with their 'non-abusing' parents. 28 (49.1%) of these children were abused by a member of the family, 29 (50.9%) children by non-familiar persons. It could be shown that 70.2% of the children had contacted four or more different institutions soon after the sexual abuse had been revealed. In cases of sexual abuse by a family member the first contacted institution was the Youth-and-Health-Care-System whereas in cases of sexual abuse by non-familiar persons mostly the police was contacted. Nevertheless in most cases both judicial and supporting approach were chosen. Additionally to concrete advices and professional competences the interviewed parents reported that emotional warmth was a very helpful aspect of the professional intervention. Generally the perspective of the parents seems to give some interesting informations about 'consumer satisfaction'.

Je weniger die moderne neonatologische Intensivtherapie an ihre technischen Grenzen stost, desto mehr beruhrt sie ethische Grundfragen. Der enorme biotechnologische Fortschritt fuhrt zu einem immer ausgepragteren Ungleichgewicht im Kompetenzbzw. Inkompetenzerleben von medizinischen Experten und Eltern. Die behandelnden Arzte konnen Erfolgserlebnisse aus gelungenen Interventionen beziehen. Zufriedenheit entsteht uber die Beherrschung neuer Technik, ja teilweise allein schon uber den Besitz neuer Maschinen. Das Pflegepersonal steht haufig zwischen beiden Extremen. Dennoch kann auch hier primar eine Orientierung hin auf die schwierigen Patienten, welche eine therapeutische Herausforderung darstellen, beobachtet werden. (1984) beschrieb, das Schwestern in der Pflegeroutine auch deutlich mehr Zeit (35%) mit den schwierigsten Patienten verbrachten (vs. 18% bei den „gesunderen“ Fruhgeborenen). Wahrend sich also medizinische Experten durch ihre Problemorientierung beschreiben lassen, versuchen Eltern in der gleichen Situation den Aufbau einer intimen Beziehung zu ihrem Kind. Haufig erleben sie sich ohnmachtig angesichts des Neonlichts, des Piepens der Uberwachungsgerate, der Schlauche, Kabel etc.. Viele Eltern empfinden diese Umwelt als Bedrohung, als noch weitere Entfremdung vom noch fremden Kind. Angst, Orientierungsverlust sind dabei haufig die Folge. Dies fuhrt nicht selten dazu, das Kritiker den technischen Fortschritt generell anprangern. (1988) konstatierte 2 grose Traditionen der Einaugigkeit, die auch die Auseinandersetzungen um den biotechnologischen Fortschritt charakterisieren konnen. Auf der einen Seite wird jede technische Weiterentwicklung als Zugewinn von Moglichkeiten, quasi fraglos als Fortschritt angesehen, auf der anderen Seite werden Weiterentwicklungen als Autonomieverlust, als Unterwerfung des Menschen unter Maschinen unter Diktate des technisch Machbaren konzipiert. In ihrem Band „Welche Gesundheit wollen wir“ spricht Elisabeth Beck-Gernsheim (1995) von einer 3. Perspektive der systemischen Verzahnung von Chancen und Risiken. In der Kinder- und Jugendneuropsychiatrie und Psychotherapie wird immer die Entwicklung jedes einzelnen Kindes eingebettet in seine biologischen und psychosozialen Voraussetzungen betrachtet. Der Aspekt der Familienbeziehungen, des Entstehens von Bindungen spielt dabei eine besondere Rolle. Deshalb sollen hier zunachst die Risiken und Chancen eines fruhen Beziehungsaufbaus, einer Bindungsbeziehung und die Bedeutung der emotionalen Bindung fur die Entwicklung und Fruhforderung von Kindern dargestellt werden. Anschliesend werden individuelle Entwicklungsrisiken fruhgeborener Kinder beschrieben.

Neurobiological research has implicated the dopamine and serotonin system in the pathogenesis of self-injurious behavior. The efficacy of antipsychotic drugs has been questioned. Opened and controlled investigations have shown risperidone is effective for reducing self-injurious behaviour in mentally retardation. We report about 3 mentally retarded patients which were given open-label risperidone for 12 weeks. They participated in a detailed assessment of behaviour symptoms at baseline and the repetitive behaviour was weekly rated with the disability assessment schedule (DAS). All three patients responded.

The progress of work in adaptation axis I of OPD (operationalized psychodynamic diagnostic) to axis I OPD-CA (children and adolescents) is delineated. The items are now classified as subjective dimensions, resources and preconditions for treatment. Overlapping with the multi-axial classification for children and adolescents as used in Germany (MAS) was eliminated and important items for child and adolescent psychiatric and psychotherapeutic treatment were added. In the field of personal dimensions only subjective impairment will be covered. Resources were accentuated for the benefit of peer relationships. Motivation for treatment is now differentiated between a more global motivation for change and motivation for psychotherapeutic treatment. In order to reduce ambiguity the term of compliance was transformed into ability for therapeutic agreement. The possibility of realization of therapeutic indication was added.

Subject of the study is the situation of 12- to 25-year-old girls and women from Berlin with a mental handicap who have experienced sexualised violence. 367 residential institutions of the Behindertenhilfe Berlin (aid for the handicapped) as well as 15 selected advice and consultancy facilities with amongst others a range of offers on problems of sexual violence. The return from the residencies was 68.7%. The gained individual data for the first time show the belonging to a sex for the residents. The group that was relevant for the study--altogether 147 girls and young women--was cared for in 31 institutions. The heads of the institutions provided information about more than 116 of these inhabitants. Every third to fourth resident (32 out of 116) was concerned by sexualised violence. This high extend of experience of sexualised violence in mentally handicapped female residents is directly opposed to an utterly insufficient psychosocial care situation. On one side the access to the questioned advice and consultancy centres is considerably limited for this clientele. Furthermore, heads of institutions of the Behindertenhilfe rather fall back on experts with medical-psychiatric knowledge, but not necessarily with knowledge of the handling of problems of sexual violence. Suggestions for the necessary improvement of the care situation of concerned girls and women with a mental handicap are being made.