Early detection and integrated care for adolescents and young adults with severe psychotic disorders: rationales and design of the Integrated Care in Early Psychosis Study (ACCESS III).

AIM: The Integrated Care in Early Psychosis (ACCESS III) Study examined the efficacy and cost-effectiveness of a combined intervention consisting of strategies to improve early detection and quality of care (integrated care including therapeutic assertive community treatment) in adolescents and young adults in the early phase of a severe psychotic disorder from 2011 to 2014. METHODS: This is a prospective, single-centre, 1-year cohort study comparing an intervention condition (early detection plus integrated care, n = 120) to the historical control condition (standard care, SC, n = 105) for adolescents and young adults aged 12-29 years suffering from a severe, early-phase psychotic disorder (i.e. within 2 years of treatment). RESULTS: Primary outcome is the rate of combined symptomatic (i.e. Positive and Negative Syndrome Scale (PANSS) criteria) and functional (i.e. Global Assessment of Functioning scale (GAF) ≥ 60 points criterion) remission over at least 6 months at study endpoint. Secondary outcome comprises the comparison of the reduction in the duration of untreated psychosis within the 4-year study duration between integrated care and SC, course of psychopathology, functioning, quality of life, satisfaction with care, cost and quality-adjusted life years (QALYs) in comparison to a historical control group. CONCLUSION: To the authors' knowledge, this is the first study assessing the efficacy and cost-effectiveness of a combined intervention consisting of early detection strategies and strategies to improve quality of care in both adolescents and young adults with early-phase psychosis. The results will be published in 2016.

[Early Detection and Integrated Care in Adolescents and Young Adults with Severe Psychotic Illnesses]. / Früherkennung und integrierte Versorgung von Jugendlichen und jungen Erwachsenen mit schweren psychotischen Erkrankungen.

This is a prospective 1-year follow-up study comparing a combined intervention consisting of multidimensional early detection strategies with age- and interdisciplinary integrated care (intervention group, n = 120) with standard care (historical control group, n = 105) in adolescents and young adults within the early phase of psychosis. Data at study entry indicate a high complexity and severity of illness. Primary outcome is the 6-month rate of combined symptomatic and functional remission at study endpoint.

Rationale and content of psychenet: the Hamburg Network for Mental Health.

With the public-funded research and development project psychenet: the Hamburg Network for Mental Health (2011-2014), the Federal Ministry of Education and Research contributes to strengthening healthcare regions in Germany by establishing new trans-sectoral cooperations and implement and evaluate selected innovations. More than 60 partners from research, health care, health industry and government in the Free and Hanseatic City of Hamburg are promoting innovative measures to improve the treatment for mental disorders. The main objective is to implement integrated healthcare networks based on evidence for effective treatment methods, deriving from high-quality research throughout five indications such as psychosis, depression, somatoform and functional syndromes, anorexia and bulimia and addiction illnesses in adolescence. Those networks are accompanied by additional measures, for example, for improving information and education, addressing occupational health or strengthening the participation of patients and their families suffering from mental illness.

[Support for families with a parent diagnosed with cancer and children under the age of five--delineation of a counselling concept]. / Unterstützung von Familien mit einem an Krebs erkrankten Elternteil und Kindern unter fünf Jahren--Darstellung eines Beratungskonzeptes.

Parents of infants and young children, who have been diagnosed with cancer wish to protect their child from the emotional strains of their illness. They wonder, what the child can understand about the illness and how it is able to process or assimilate the experience of the illness. In fact, infants and young children are particularly sensitive to the degree of emotional burden and the mental state of their parents and will experience varying degrees of insecurity due to even small changes in their relationship with their parents. On the basis of psychological development parameters specific to this age group as well as scientific findings on risk and protection factors an integrated interaction based counseling approach was developed. Within this approach, support for the communication between parent and child in view of the specific strains of their illness, both non-verbal and in the child's early stages of verbal communication, is central. In the present article the counselling concept is described and illustrated by case studies. Application and limits are discussed.

[Psychosocial care of children with a parent having cancer--an appraisal of specific care services in Germany]. / Psychosoziale Versorgung von Kindern mit einem an Krebs erkrankten Elternteil--Eine Bestandsaufnahme spezifischer Versorgungsangebote in Deutschland.

Children of a parent having cancer are at greater risk to develop mental health problems. Aim is to investigate specific psychosocial care for children having a parent with cancer, as well as to characterize and assess utilization and needs of affected minor children. Employees of institutions in Germany supplying psychosocial care to families with a parent having cancer were surveyed, using a semi-structured interview (n = 29). Specific psychosocial care for affected children is limited and heterogeneous in Germany. Regarding different distress stages of those families, the situation could be interpreted as eligible. However, this primarily reflects the low quality assurance of care. Results suggest that in addition to preventive care needs of children having a parent with cancer, increased needs exist in specific risk constellations, like in single parent families.

[The function of music in the context of non-suicidal self injury]. / Die Funktion von Musik im Zusammenhang mit selbstverletzendem Verhalten und Suizidalität bei Jugendlichen.

Music and non-suicidal self injury (NSSI) are both of extraordinary importance for adolescents with respect to expressing emotions, and demonstrating protest. Nevertheless, little is known about the interrelation between these phenomena, in particular about the function of music in the context of NSSI. The aim of our study was to investigate the connections between music and auto-aggressive behaviour and suicidality in adolescents. We developed a specific questionnaire for this purpose, which was used together with a self-reporting depression inventory in 40 subjects in a child and adolescent psychiatric clinic. We enrolled inpatients between 13 and 18 years who had presented with NSSI and/or suicidality during the last three months. Music proved to be very important to the patients and seemed to have an emotionally elevating function. Moreover, music was in some cases an integral part of the NSSI-scenario, but also was used to inhibit autoaggressive tendencies. In a qualitative analysis, it could be demonstrated that music and lyrics are associated with affect regulation, anti-dissociation and interpersonal influence. Music seems to fulfil similar self-regulatory functions as have been described for NSSI and can thus be considered, as a substitute to have a protective effect. There were no indications that specific music preferences are directly linked to NSSI or suicidality.

[The status of music therapy in inpatient child and adolescent psychiatry]. / Zur Situation der Musiktherapie in der stationären Kinder- und Jugendpsychiatrie.

OBJECTIVES: Although music therapy is very common in child and adolescent psychiatry, no data are available that describe the working conditions for music therapists or the situation with regard to coverage of the patient population. METHODS: A cross-sectional questionnaire study in all German hospitals of child and adolescent psychiatry with inpatient treatment programmes (n = 134) collected data on the structure and content of the respective music therapy treatment offered. RESULTS: 63.4% of the hospitals provide music therapy as a method of inpatient psychotherapy (77.7% response rate). This article focuses on the duties, setting, and clientele in music therapy, the available equipment and instruments, and the formation and methodological spectrum of music therapists. CONCLUSIONS: In summary, we conclude that music therapists working in child and adolescent psychiatry are well trained and experienced. To strengthen the professional identity of music therapists and to evaluate the efficacy of music therapy further research is needed and professional representation and proofs of efficacy must be emphasized.

Lessons learned in the implementation of an innovative consultation and liaison service for children of cancer patients in various hospital settings.

OBJECTIVE: To evaluate the process of implementing a family-oriented consultation and liaison service in various hospital-based settings, with special regard to problems and obstacles encountered. METHOD: Qualitative content analysis using categorization and sequential, phenomenological analysis of descriptive progress notes during the implementation period. The team members of the liaison service were defined as participant observers. Interpretations of the material were derived in previously defined, sequential steps in team discussions. RESULTS: Despite a consistent concept behind the new service, the degree to which it was able to be integrated into different medical settings varied to a remarkable degree. Obstacles encountered were often linked to a lack of consideration being given to divergent concepts of care. It was necessary to give special attention to providing physicians with practical evidence of the value of the intervention. The new service was most readily utilized by families when physicians personally communicated the referrals as a standard procedure to their patients and when the referrals were not made too quickly after the parent's initial diagnosis. CONCLUSIONS: Hospital-based services for cancer patients with children under the age of 18 should carefully address patients' fears of psychiatric stigmatization. Furthermore, they should include modules for acute crisis intervention. Implications for future implementation activities in this field are discussed.