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Conditioned blocking (CB) is the undermining of conditioning to a stimulus by conjoint exposure to a stimulus already associated with the unconditioned stimulus. CB is one of several tests of "learned inattention" in which performance has been found to depend on certain features of personality and on monoamine activity recorded in animals performing CB. Methods: In part 1, the performance of 25 healthy young adults (mean age 21.6 years) on a new test form for demonstrating CB is described ("mouse-in-house"). The personality inventories used included the Hamburger neuroticism/extroversion scale (HANES) and the short version of the Minnesota multiphasic personality inventory (MMPI). From 24h urine samples collected at the time of testing the levels of four monoamine and three of their metabolites were measured as an indicator of the overall level of neurotransmitter activity. In part 2, the development of CB was studied across children and adolescents clustered into 4 age groups (means 10, 14, 17 and 22 years of age). Results: Part 1 demonstrated CB in normal healthy young adults and the expression of CB correlated with extroversion and increased catecholamine utilisation (turnover). Part 2 showed CB was least marked prepubertally, but developed across adolescence independent of IQ. Although performance did not correlate with developing personality features, like the adults, CB was positively correlated with dopamine activity. Unlike adults CB was inversely correlated with noradrenaline activity. We show the development of increasing CB across the 4 age-groups and correlations with monoamine activity: also we illustrate how the measures of the 3 monoamines, their metabolites and their activity (turnover) develops across age-groups, with a separate pattern for each transmitter. Conclusions: The maturation of attention related information processing was discussed in terms of the development and maturation of structures in the limbic part of the central nervous system and, in particular, the separate function of dopamine in switching between and noradrenaline in tuning in/out stimulus features during selection processes.

The interdisciplinary care of children and adolescents with mental disorders requires services from various German codes of social law and-within the medical care system-enclosing inpatient and outpatient services. The increasing demand, the increase in severity of disorders, and the general shortage of staff in social services put pressure on the structures of the interdisciplinary service networks resulting in long waiting periods, long distances, and regionally insufficient care. The medical field of child and adolescent psychiatry and psychotherapy (CAPP) plays the central and coordinating role within the cooperative care for children and adolescents with mental disorders. The CAPP is in clear need of reforms; however, these are markedly different from the reform needs of the German somatic medical care system and differ substantially from those of the (adult) psychiatry, psychotherapy, and psychosomatics disciplines. This discussion paper describes the reform requirements, the specifics of the CAPP structures, and suggestions to overcome sectors of service provision, enhance networking, intensify telemedicine, and develop evidence-based prevention and early recognition of child mental disorders., (© 2024. The Author(s).)

Trends in Adolescents' Satisfaction with Their Inpatient Psychiatric Treatment: A Panel Analysis over 7 Years Abstract. Because the German legislature is increasingly enabling adolescents' participation in their psychiatric treatment, we traced changes in satisfaction of 6,893 patients at the end of their stay in 10 hospitals using BEST-J. The treatments resulted in a fair overall satisfaction without any improvement over the 7 years studied. In seven hospitals, we calculated deviation from the overall satisfaction based on annual surveys. Satisfaction with the psychotherapeutic relationship was good from the beginning, whereas the relationship with caregivers improved during the sample period. When new legal standards were introduced, we measured an improvement in some items concerning patient participation (coercive measures information, goals of treatment discussed). Patients were less satisfied with the information about their illness than with medication information. Initially poor satisfaction with leave regulations significantly improved over time. Respect for privacy also improved. Satisfaction with the environment and service organization scored substantially worse than the other items. Peer relations within the ward were rated close to overall satisfaction. The results point to benefits from training in psychotherapy and a growing awareness of closeness-distance issues and patients' rights. Nevertheless, psychoeducation and leave regulations require improvement. Furthermore, patients stated unmet needs for refurbishing and renovating buildings.

For children and adolescents in need of psychiatric and psychotherapeutic care, outpatient, day patient, and inpatient facilities are provided. A new development is called "inpatient equivalent treatment" that consists of home visits by a multiprofessional team. This paper depicts the landscape of Child and Adolescent Psychiatry (CAP) Services, covering its historical development and the structural, care policy, and financing backgrounds. Until 2014, there was free choice of private practice locations in the outpatient sector, leaving rural areas and marginalized neighborhoods partially undersupplied until today.The number of beds in the hospital sector decreased significantly between 1991 and 2004. It later rose again in favor of improved regional access and smaller units, with an additional 50% of day patient places. Inpatient equivalent treatments are equally effective, but not yet established nationwide; only a few innovative models have been negotiated. Regional networks of all social support systems, aiming for child psychiatric supply networks, are limited due to the pillarization of the social system. In conclusion, an imperative cooperation between all services of the Social Security Code and enabling true cross-sectoral services would benefit CAP patients., (© 2023. The Author(s).)

COVID-19 and Psychiatric Disorders in Minors: Changes in Inpatient Treatment According to Hospital Statistics Abstract: Increased rates of psychiatric disorders and psychiatric emergencies in children and adolescents stemming from the COVID-19 pandemic have been reported, with more children and adolescents suffering from internalizing disorders. This study analyzes whether the increased rates led to increased rates of inpatient treatment in child and adolescent psychiatric and pediatric hospitals in Germany as well as a change in diagnoses of the treated patients. We analyzed routine hospital data ("InEK" data, § 21 KHG data files) from a prepandemic (2019) and a pandemic (2021) half-year regarding changes in the number of cases, diagnoses, and length of stay (LoS) in child and adolescent psychiatry and pediatrics. We also investigated the development of psychiatric emergencies in minors. We found an increase in internalizing problems (depression, anorexia nervosa, trauma-related disorders) and a decrease in externalizing problems among the admitted psychiatric inpatients. Further, we observed a halving of cases treated for alcohol intoxication. However, we discovered no change for the frequency of psychiatric emergency treatments nationwide. A more detailed analysis revealed that, in areas with a low number of child and adolescent psychiatry inpatient beds, emergency care was prioritized and LoS decreased, whereas in areas with a fair bed-to-inhabitant ratio among minors, there was a trend toward increased LoS, also in pediatric departments. We recommend continued monitoring of inpatient care after the pandemic, with special attention paid to underprivileged children and adolescents such as those with externalizing problems.

Background: Admission rates to child and adolescent mental health inpatient units in Germany are substantial (58.831 admissions in 2019). Historically, different treatment pathways have not been available. The evidence suggests that home treatment could be an alternative. The objective of this study was to assess the long-term stability of treatment gains among children and adolescents treated for serious mental health problems with home treatment (HT) as compared with inpatient treatment-as-usual (TAU)., Methods: Hundred patients were enrolled and randomized into an intervention (HT n = 54) and control group (TAU n = 46). Follow-up data were available after 8.4 months (n = 78) (T3) and after 4.3 years (n = 51) (T4). The primary outcome measured was overall level of functioning, for which the Children's Global Assessment Scale (CGAS) was used. Secondary outcomes included severity of patient impairment and parental competency in dealing with their child's symptoms, measured using the Health of the Nation Outcome Scales (HoNOSCA). A qualitative interview with parents was performed at T3 and T4., Results: Treatment effects remained stable for both groups at T3 and T4 (p < .001). After 4.3 years 70% of the parents in the intervention group stated satisfaction with the treatment received, while only 36.8% of the parents within the control group rated themselves as satisfied. 43.7% of parents in the home treatment group reported that the most helpful aspect of this pathway was the prompt and intensive professional help and advice they received as primary caregivers at home., Conclusions: Home treatment may be considered a viable alternative to inpatient care., (© 2021 The Authors. Child and Adolescent Mental Health published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.)

In Germany, cognitive-behavioral therapy, psychodynamic therapy, and systemic therapy are scientifically and legally approved as suitable procedures for treating mental disorders. While all methods have provided empirical evidence of their effectiveness in adults according to defined criteria of the "Scientific Advisory Board for Psychotherapy" (in German: "Wissenschaftlicher Beirat Psychotherapie"), i. e., the official board which decides upon the formal scientific approval of psychotherapeutic approaches in Germany, an evaluation is lacking for the psychodynamic methods in children and adolescents. Against this background, we evaluated the available empirical data for psychodynamic therapy in children and adolescents based on the methods paper of the "Scientific Advisory Board for Psychotherapy" (2019; version 2.9). Published reviews served as the basis for identifying relevant studies, supplemented by a systematic literature search. We identified 91 potentially relevant studies but could not consider the majority of these due to formal exclusion criteria (mainly not disorder-specific, no control group). Up to 26 of the remaining studies provide evidence of efficacy as defined by the "Scientific Advisory Board for Psychotherapy". These cover 10 of the 18 areas of application as defined by the "Scientific Advisory Board for Psychotherapy". According to our evaluation, the reviewed studies provide empirical evidence for the three most relevant areas of application (i. e., affective disorders; anxiety disorders and obsessive-compulsive disorders; hyperkinetic disorders and conduct disorders). Thus, the available evidence supports the suitability of psychodynamic therapy as a method for the treatment of children and adolescents.

After initial reluctance masks have emerged as an important means of restricting the spread of SARS-CoV‑2, the new coronavirus causing COVID-19. Other simple measures are keeping a distance of at least 1 ½ m from other persons and observing hygiene recommendations, including washing or even disinfecting the hands, coughing into the crook of the arm and remaining at home when sick. Combining the initial letters of the German words for the three measures ( Abstand-Hygiene-Alltagsmaske, distance-hygiene-face mask) the acronym AHA was formed, a colloquial German word meaning that the speaker understood the information presented. This acronym was later extended by the letter "L", initial letter of "Lüften" meaning air ventilation for indoor rooms and arriving at AHA‑L, recommended by the federal German Health Institute the Robert Koch Institute. In fact, masks including surgical masks and face coverings can form an effective barrier against the spread of the virus: protecting other people from droplets expelled from the throat of the speaker wearing a mask and even in part protecting the wearer from inhaling droplets emanating from other peoples' throats. Studies to find out if wearing masks might impose risks did not find essential problems: alterations of respiratory parameters due to an increased airway resistance remained within normal limits in healthy adults and even in asthmatics whose disease was well controlled; however, many adults expressed their unease with masks describing them as cumbersome and inconvenient. Emotional resistance against masks made it increasingly more difficult for them to use a mask. Efficient application of masks requires, in addition to a logical explanation of its effect, the evocation of empathy for vulnerable people who can be protected from catching a possibly deadly disease. In children there are very few data on adverse effects of wearing a mask although there is ample experience in children with serious diseases compromising defense against infectious agents acquired via respiratory mucus membranes; however, when using masks appropriately in children relevant adverse effects have not been reported and are not to be expected. Masks should only be used in children when they are healthy and awake and can remove the masks themselves anytime they like. Children 10 years or older can use masks efficiently when they have been informed beforehand appropriate to their age. Under these conditions they can also be obliged to wear masks in certain situations, for example while walking through the school building to their desk in class. To limit the period of wearing a mask normally they will be allowed to remove the mask when sitting in class and keeping their distance. Children in primary schools may use masks, but they should not be obliged to wear them and children in kindergartens should not use masks. This exemption of younger children does not expose school and kindergarten teachers to additional risks since the infectivity with SARS-CoV‑2 is age-dependent and increases with age reaching adult values only after 12 years of age., (© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2020.)

From home treatment to psychiatric ward-equivalent treatment (StäB) - A systematic review of outpatient treatment in Germany Abstract. Objective: In the past, home treatment was not available in Germany for children and adolescents with mental health problems. However, enactment of the PsychVVG law on 1 January 2017 has changed this, so that intensive home treatment (stationsäquivalente Behandlung, StäB) can now be offered as an alternative to inpatient treatment. This literature review a) analyzes existing German home treatment studies for effectiveness, b) determines from international reviews criteria for effective home treatment, and c) aligns these with the standardized StäB criteria. Method: We performed a systematic literature search in PubMed, Scopus, PsycINFO, and Cochrane Library referencing "hometreatment AND children" as well as "hometreatment AND adolesc*. Results: Flexibility, mobility, multiprofessionality, a wide spectrum of possible interventions, the option of inpatient admission, 24/7 availability as well as daily treatment sessions have been found to be factors for effective home treatment. In German studies, home treatment was shown to enhance psychosocial functioning, parental competences, long-term effectiveness, and acceptance by the families. The highest effect for home treatment was demonstrated in children and adolescents with externalizing disorders. Conclusion: Intensive home treatment (StäB) meets the criteria identified in the literature and is a good addition to existing treatment options for children and adolescents with mental health problems in Germany.

Germany, in comparison to other countries, provides a good quality of services to distinct groups of patients. But as far as total expenditure for mental health services is concerned, it belongs to the top European states. The differentiation of services since the Expert Commission to the parliament (1975) was associated by fragmentation of the therapeutic alliances and the patient's relations in his or her personal social system. The management of intake to hospital treatment seems to need further improvement. Treatment paths which integrate distinct sectors are clinically tested in other countries and should be hold up as examples for politicians to further improve our mental health services. With the available resources, better and economically sound results could be reached. This is important for the future, a) because of increasing utilization of mental health treatment, b) to guarantee the quality of services for the chronic, severely mentally ill patients., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Intensive outpatient treatment - a therapy option for all patients in child and adolescent psychiatry or just for a few? Abstract. Objective: "Child and adolescent psychiatric ward-equivalent treatment" (= stationsäquivalente Behandlung, StäB) is an intensive daily home treatment that has now become available in Germany. Conditions for StäB services were negotiated were negotiated, authorized and came into force by German healthcare commissioners and hospitals on 1 January 2018. However, to date few hospitals in Germany offer StäB, and its feasibility has been questioned. This study evaluates the first 58 cases of StäB in the Department of Child and Adolescent Psychiatry, ZfP Südwürttemberg (2018-2019). Method: All patients admitted consecutively to StäB from 1 January 2018 to 15 August 2019 were included and evaluated solely using descriptive analyses in SPSS.25. Results: The average length of stay in StäB was 37.95 days (SD 15.35). 86.2 % of the families completed treatment, with 3 patients discontinuing treatment and 5 patients needing inpatient admission. Unlike in the literature, internalising disorders predominated (70.7 %), whereas externalizing disorders were diagnosed in only 27.8 % of the patients. The cost of treatment in StäB was on average 8779.25 €. Conclusions: StäB is a viable and well-accepted new treatment alternative for patients requiring inpatient admission. The multiprofessionality of treatment as well as daily contacts are required. Feasibility under the conditions set is given. The average length of stay is slightly longer, but the costs are lower than those of inpatient treatment.

The transition from child and adolescent to adult mental health services for young people with mental health problems is of international concern. Despite the high prevalence of mental disorders during adolescence and their tendency to continue during adulthood, the majority of young people do not experience continuity of care. The aim of this review paper is to unravel the complexity of transitional mental healthcare to clinicians, policy makers and mental health service managers, and to address challenges to a smooth transition process at all levels.

Process analysis of weekly self- and external assessments of adolescents with substance abuse disorder during long-term psychotherapy Abstract., Objective: Little is known about the course of emotional and motivational states in young patients with substance use disorder (SUD) during long-term treatment., Method: We collected weekly self-reports from N = 42 adolescents, resulting in 853 questionnaires. Additionally, 708 observations were obtained from their key carers. Principal component analysis (PCA) was used to explore the dimensional structure of the questionnaires. Multi-level models were applied to test for group differences and time series models to evaluate dependencies on the person level., Results: PCA yielded four factors: negative mental state, appreciation of the setting, motivation, and addiction dynamics. Correlations between self- and (unidimensional) carer-reports were low to moderate, but differential on the individual level. Scores of all four scales decreased during the course of treatment. The level of appreciation during the initial phase was the only significant predictor for drop-outs of treatment later on: in drop-outs, appreciation decreased, whereas it increased in completers., Conclusion: Appreciation was the most important predictive factor for a regular therapy ending in SUD, whereas motivation showed fluctuations typical for adolescence. Addiction dynamics were of lesser relevance than commonly expected. Therefore, programs in long-term SUD treatment should focus more on improving appreciation than on issues of addiction itself.