Patterns and correlates of expressed emotion, perceived criticism, and rearing style in first admitted early-onset schizophrenia spectrum disorders.

The aim of this study was to assess patterns and correlates of family variables in 31 adolescents treated for their first episode of a schizophrenia spectrum disorder (early-onset schizophrenia [EOS]). Expressed emotion, perceived criticism, and rearing style were assessed. Potential correlates were patient psychopathology, premorbid adjustment, illness duration, quality of life (QoL), sociodemographic variables, patient and caregiver "illness concept," and caregiver personality traits and support. Families were rated as critical more frequently by patients than raters (55% vs. 13%). Perceived criticism was associated with worse QoL in relationship with parents and peers. An adverse rearing style was associated with a negative illness concept in patients, particularly with less trust in their physician. Future research should examine perceived criticism as a predictor of relapse and indicator of adolescents with EOS who need extended support and treatment. Rearing style should be carefully observed because of its link with patients' illness concept and, potentially, to service engagement and medication adherence.

Basic symptoms in the general population and in psychotic and non-psychotic psychiatric adolescents.

OBJECTIVE: Cognitive-perceptive 'basic symptoms' are used complementary to ultra-high-risk criteria in order to predict onset of psychosis in the pre-psychotic phase. The aim was to investigate the prevalence of a broad selection of 'basic symptoms' in a representative general adolescent population sample (GPS; N=96) and to compare it with adolescents first admitted for early onset psychosis (EOP; N=87) or non-psychotic psychiatric disorders (NP; N=137). METHODS: Subjects were assessed with the Bonn Scale for the Assessment of Basic Symptoms (BSABS). Prevalence of at least one 'basic symptom' and mean numbers were compared across the three groups. Logistic regression was used to predict group membership by BSABS subscales; risk ratios were calculated to identify 'basic symptoms' which best discriminated between groups. RESULTS: The prevalence of at least any one 'basic symptom' was 30.2% in GPS compared to 81% in NP and 96.5% in EOP. Correct classification of EOP when compared to GPS was high (94.0%) and lower when compared to NP (78.6%). Cognitive symptoms discriminated best between EOP and NP. CONCLUSION: Alike other prodromal- and psychotic-like experiences, 'basic symptoms' are prevalent in the general adolescent population, yet at a lower rate compared to EOP and NP. The usage of 'at least one basic symptom' as a screening criterion for youth at risk of developing a psychotic disorder is not recommended in the general population or in unselected psychiatrically ill adolescents. However, particularly cognitive 'basic symptoms' may be a valuable criteria to be included in future 'at risk' studies in adolescents.

[The function of team-meetings for treatment teams on child and adolescent psychiatric wards]. / Die Funktion von Besprechungen für multi- disziplinäre Behandlungsteams kinder- und jugendpsychiatrischer Stationen.

In the daily work of multidisciplinary teams on child and adolescent psychiatric wards team-meetings play a central role to coordinate various treatment activities. In medical literature studies on the topic are lacking, and only few articles were found. The authors explore by a descriptive-hermeneutic analysis the numerous functions of meetings for the treatment team. To them belong catharsis, containment, reflection, regulation and integration. Psychodynamic, group dynamical and institutional factors will be described regarding their influence on the therapy management. Issues of power in institutions will be comprised in the discussion. The dialectical tension between professionalism and emotionality in the work with patients especially from the borderline-spectrum as well as between unity and diversity within the treatment team in regard to the different roles of each and everyone team member will be presented. Hints at how to manage these tensions will be given to preserve the therapeutical milieu on the ward.

[Dilemma of early drug intervention in prepsychotic illnesses of adolescence]. / Zum Dilemma der medikamentösen Frühintervention bei präpsychotischen Zuständen in der Adoleszenz.

It will be largely supposed that early intervention in schizophrenia improves the outcome of the illness. The paper summarizes the up today significant knowledge about the early recognition and treatment of schizophrenic psychosis in the adolescence. It will be pointed at the diagnostic difficulties and peculiarities in this age group. A comprehensive repeated assessment is necessary if prodromal symptoms of schizophrenia respectively psychotic states have to be taken in account. It will be pleaded for a early low dosis therapy with atypical neuroleptics to prevent the "psychotic catastrophe", that means the full outbreak of the disease. The pharmacotherapy should be a part of an intensive multimodal treatment program. The longstanding continuity of the relations to one and the same treatment setting and therapist responsible for it seems to influence the outcome positively.

[Indications for inpatient child and adolescent treatment]. / Zur Indikation einer stationären jugendpsychiatrischen Behandlung.

When the demand for inpatient treatment in acute psychiatric crisis of adolescents rises, it is not always recommended to admit a patient to the hospital. The limited number of hospital beds forces medical professionals to use their resources cautiously. This leads to the need to activate the intrapersonal and intrafamilial resources. The motivation for change emerging out of a crisis is to be used for clarification of the indication of inpatient treatment and of the order of treatment, a patient (and/or his legal representative) gives to the hospital representatives. A clarification of the aims of a hospitalisation prior to the admission to the ward rises the efficacy of the invested time.

[Should an adolescent psychiatric clinic be managed as an open setting? Initial evaluation of 7 years experiences]. / Soll eine Jugendpsychiatrische Klinik offen geführt werden?--Erste Auswertung von sieben Jahren Erfahrung.

After a controversial discussion, the adolescent department of the child and adolescent psychiatry clinic of the university of Basle (KJUP) opened seven years ago as an open ward for the treatment of acute psychiatric breakdowns in adolescents. Meanwhile more than 22.000 days of care have been provided. The patients suffered from the whole range of psychiatric illnesses. The lack of possibilities to engage in an examination of security measures lead to an increased involvement in relationships between patients and his/her parents and the staff. Yet there are limits in treating psychiatric patients in an open ward. A conditio sine qua non is the possibility to hospitalize patients in peaks of crisis in the locked ward of the adult department of the university clinic. In the first seven years, 13 patients had to be transferred to the locked ward for a total of 0.05@1000 of the days of care, 6 of whom returned to the adolescent department after a short while (2.6 days in average). In the rest of the time, the advantages of an open setting could be used to the full extent.