Gender dysphoria in adolescence: examining the rapid-onset hypothesis.

The sharp rise in the number of predominantly natal female adolescents experiencing gender dysphoria and seeking treatment in specialized clinics has sparked a contentious and polarized debate among both the scientific community and the public sphere. Few explanations have been offered for these recent developments. One proposal that has generated considerable attention is the notion of "rapid-onset" gender dysphoria, which is assumed to apply to a subset of adolescents and young adults. First introduced by Lisa Littman in a 2018 study of parental reports, it describes a subset of youth, primarily natal females, with no childhood indicators of gender dysphoria but with a sudden emergence of gender dysphoria symptoms during puberty or after its completion. For them, identifying as transgender is assumed to serve as a maladaptive coping mechanism for underlying mental health issues and is linked to social influences from peer groups and through social media. The purpose of this article is to analyze this theory and its associated hypotheses against the existing evidence base and to discuss its potential implications for future research and the advancement of treatment paradigms.

Treatment of psychiatric comorbidities and interaction patterns in Coffin-Siris syndrome: A case report of a 4-year-old girl.

Coffin-Siris syndrome (CSS) is a rare genetic disorder and often co-occurs with attention-deficit hyperactivity disorder (ADHD) and autism spectrum (ASD). The present case study illustrates possible therapeutic interventions of these common psychiatric comorbidities taking into account the family interaction patterns. This can contribute to improve holistic management and overall level of functionality.

Unresolved attachment and identity diffusion in adolescence.

This study examined the severity of unresolved attachment underlying adolescent identity diffusion. Our sample consisted of 180 inpatient adolescents aged 14 to 18 years (77% female, M age = 15.13, SD = 1.35; 23% male, M age = 14.85, SD = 1.41) and 84 age-matched non-clinical adolescents (52% female, M age = 16.14, SD = 1.21; 48% males, M age = 15.98, SD = 1.07). We used the Adult Attachment Projective Picture System (AAP) interview to assess attachment representations and the Assessment of Identity Development in Adolescence (AIDA) questionnaire to evaluate the severity of identity diffusion. Our results demonstrate a higher amount of unresolved attachment and identity diffusion in the patient sample than in the control sample. Furthermore, patients with an unresolved attachment status scored higher on identity diffusion than those with no unresolved attachment pattern. Interestingly, this was not found in the control group. Furthermore, patients with a greater severity of unresolved attachment showed the highest maladaptive identity development scores. Psychotherapeutic interventions integrating attachment-related aspects might be useful to treat young people with identity diffusion.

Personality Disorders and Attachment Trauma in Adolescent Patients with Psychiatric Disorders.

This study examined how personality disorders (PD) differ with respect to gender, attachment status and traumatic childhood experiences in adolescent psychiatric inpatients. In particular, we investigated attachment-related traumatic material underlying adolescent PD. Our sample consisted of 175 inpatient adolescents aged 14 to 18 years (77% female, Mage = 15.13, SD = 1.35; 23% male, Mage =14.85, SD = 1.41). Thirty-nine patients (22%) fulfilled the diagnostic criteria for a PD according to the SCID-II PD: 51% avoidant, 13% obsessive-compulsive, 13% antisocial, 19% borderline, 2% paranoid and 2% histrionic. In the total sample, eighty-three (47%) of our inpatients were classified with an unresolved attachment status using the Adult Attachment Projective Picture System (AAP). We did not find any significant gender differences for patients with and without a PD. Our results revealed a higher percentage of unresolved attachment status in patients with a PD. The in-depth analysis of the total sample showed that patients with a PD demonstrated more traumatic material in their attachment interviews indicating a greater severity of attachment trauma. Furthermore, patients with a PD reported higher scores on emotional and physical neglect. Intervention strategies targeting traumatic attachment-related themes might be useful to treat adolescents with PD.

[Effects of the COVID-19-Pandemic on the AffectiveWell-Being of Preschool Children]. / Einfluss der COVID-19-Pandemie auf das affektive Wohlbefinden von Kindergartenkindern.

The aim of this study was to determine the predictive value of corona-specific variables and post-traumatic stress symptoms associated with the COVID-19-pandemic, considering sociodemographic data and health-related quality of life, on the affective well-being of preschool children and to identify predictors of positive and negative affect. A secondary analysis of third-party assessment data by parents of three- to six-year-old preschool children from the Tyrolean COVID-19 Children's Study at two measurement time points (123 records at t1 in summer 2020; 467 records at t2 in winter 2020/21) was conducted. To answer the research question hierarchical multiple regression analyses were performed.The largest part of the variance explanation of affective well-being was explained by health-related quality of life: while self-esteem and psychological well-being were measurement-time-independent, effects of physical well-being, preschool, family, and friends were only significant in winter. Coronaspecific variables caused additional variance explanation due to subjective threat experience in winter; post-traumatic stress symptoms had an effect at both measurement-times. In times of crisis children's self-esteem, psychological well-being, and post-traumatic stress symptoms should be considered.Measurement-time-dependent results suggest that the pandemic course plays a decisive role regarding the influence on children's affective well-being. Everyday life and routines must be redefined accordingly and communicated to the children.

Comparative study of children's mental health outcomes in Tyrol, Austria, and South Tyrol, Italy, during the COVID-19 pandemic.

PURPOSE: This study aimed to compare the mental health outcomes of children in North Tyrol, Austria, and South Tyrol, Italy, during the coronavirus disease 2019 (COVID-19) pandemic, considering the sociocultural and contextual differences between the two regions. METHODS: The Tyrolean COVID-19 Children's Study (TCCS: n = 401; June 2021 to July 2021) and the Corona and Psyche in South Tyrol 2021 Study (COP­S; n = 3402; May 2021 to June 2021) were used for data analyses. Both studies employed cross-sectional designs and collected data through online questionnaires completed by children aged 7-13 years and their parents. Various psychosocial assessment tools including the Child and Adolescent Trauma Screening, Children Anxiety Test, Child Behavior Check List, Screen for Child Anxiety Related Emotional Disorders, and Health Behaviour in School-Aged Children were used in the surveys. RESULTS: The comparison between North Tyrol and South Tyrol revealed no significant differences in perceived threats, trauma, or anxiety among children. Similarly, there were no substantial disparities in psychosomatic complaints, indicating similar manifestations of emotional distress across the two regions. CONCLUSION: The comparative analysis of children's mental health outcomes in North Tyrol and South Tyrol during the COVID-19 pandemic confirmed the analogous influence of sociocultural and contextual factors on their wellbeing. Despite presumable variations in pandemic events, management strategies, and healthcare systems, the study suggests comparable resilience among children and highlights the importance of sociocultural factors in shaping their wellbeing. The findings emphasize the need for comprehensive understanding and targeted interventions to support children's mental health during challenging times.

[Transitional psychiatric needs and identity development of adolescents in Tyrol]. / Transitionspsychiatrische Bedürfnisse und Identitätsentwicklung von Adoleszenten in Tirol.

BACKGROUND: Due to the structural separation of child and adolescent psychiatric treatment and adult psychiatric treatment, a switch between these two systems upon the age of 18 is necessary. Considering the importance of an organized transition, patients from an age of 17 were asked about their transition needs and aspects of their identity development. Thus future improvements in the treatment structures in this sensitive phase should derive. METHODS: With the help of the Transition Readiness and Appropriateness Measure (TRAM), the transition-specific needs of 17 to 24-year-old patients (N = 42) at the Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy in Hall in Tirol were surveyed. In addition, the connection between identity development and transition was examined using the Assessment of Identity Development in Adolescence (AIDA). RESULTS: Almost 80% of the patients stated that they needed further care. 'Patient-related factors' and 'family support' were described as barriers to the willingness to transition. A significant connection was found between identity development and the willingness or need for transition (r = 0.431, p < 0.01), although this was more pronounced in relation to the need for transition (r = 0.821 p < 0.01). In addition, those affected stated that they were frequently and severely burdened by stress, 45% reported self-injurious behavior, 48% suicidal thoughts or behavior in the last six months. In terms of psychopathology, anxiety and depression were among the most common symptoms. In terms of functional impairment, the 'relationships' area was the most affected. CONCLUSIONS: The study provides initial insights into the transition-specific characteristics and needs of patients in transition age. The integration of standardized measuring instruments in institutional care systems, which individually record the transition-related needs, the willingness and need of young people in transition age, can facilitate targeted and needs-based treatment or transition. Interdisciplinary cooperation between child and adolescent psychiatry and adult psychiatry as well as a continuous transfer of the therapeutic relationships in the transition process should also be guaranteed.

Differences in perceived threat and trauma in children during the COVID-19 pandemic.

BACKGROUND: The past 2 years of the COVID-19 pandemic were stressful for most children and adolescents; some children may have experienced a high level of stress and trauma. To date, no study has examined self-reported stress and trauma levels due to COVID-19 in children. This study aimed to assess perceived threat, exposure and trauma symptoms in children aged 7-13 years. In addition, we explored whether parent-reported factors could predict a higher risk of COVID-19 vulnerability in their children. METHOD: Cross-sectional data were collected from 752 children to assess COVID-19 threat, exposure and trauma symptoms using the self- and parent-reported Child and Adolescent Trauma Screening Self-Report (CATS) Trauma questionnaire. We used exploratory analyses (factor analysis of mixed data and hierarchical clustering) to identify subgroups (i.e., clusters) of children sharing similar characteristics in the dataset. Linear regression modeling was applied to determine the likelihood of higher threat and vulnerability in children with parent-reported COVID-19 threat, exposure, CATS trauma symptoms, behaviors on the Child Behavior Checklist (CBCL), and posttraumatic growth (PTG). RESULTS: We identified a high-risk group of children reporting clinically relevant trauma symptoms and COVID-19-related fears. Parents' reports of trauma could be used to identify children at high risk. CONCLUSIONS: Approximately 25% of children reported moderate to clinically relevant levels of trauma symptom. It is especially important to offer adequate support to these children to ease the trauma and prevent their symptoms from developing into psychopathology.

Attachment Trauma Is Associated with White Matter Fiber Microstructural Alterations in Adolescents with Anorexia Nervosa before and after Exposure to Psychotherapeutic and Nutritional Treatment.

In the present study, we explore the role of attachment for microstructural white matter (WM) changes in adolescents with anorexia nervosa (AN) before and after exposure to short-term and nutritional treatment. The case sample consisted of 22 female adolescent inpatients with AN (mean age: 15.2 ± 1.2 years) and the control sample were 18 gender-matched healthy adolescents (mean age: 16.8 ± 0.9 years). We performed a 3T MRI in the patient group during the acute state of AN and after weight restoration (duration: 2.6 ± 1 months) and compared the data to a healthy control group. To classify attachment patterns, we used the Adult Attachment Projective Picture System. In the patient sample, over 50% were classified with an attachment trauma/unresolved attachment status. Prior to treatment exposure, fractional anisotropy (FA) reductions and concordant mean diffusivity (MD) increases were evident in the fornix, the corpus callosum and WM regions of the thalamus, which normalized in the corpus callosum and the fornix post-therapy in the total patient sample (p < 0.002). In the acute state, patients with an attachment trauma demonstrated significant FA decreases compared to healthy controls, but no MD increases, in the corpus callosum and cingulum bilaterally, which remained decreased after therapy. Attachment patterns seem to be associated with region-specific changes of WM alterations in AN.

Evaluation of visual food stimuli paradigms on healthy adolescents for future use in fMRI studies in anorexia nervosa.

BACKGROUND: Mostly, visual food stimuli paradigms for functional Magnetic Resonance Imaging are used in studies of eating disorders. However, the optimal contrasts and presentation modes are still under discussion. Therefore, we aimed to create and analyse a visual stimulation paradigm with defined contrast. METHODS: In this prospective study, a block-design fMRI paradigm with conditions of randomly altering blocks of high- and low-calorie food images and images of fixation cross was established. Food pictures were rated in advance by a group of patients diagnosed with anorexia nervosa to address the dedicated perception of patients with eating disorders. To optimize the scanning procedure and fMRI contrasts we have analysed neural activity differences between high-calorie stimuli versus baseline (H vs. X), low-calorie stimuli versus baseline (L vs. X) and high- versus low-calorie stimuli (H vs. L). RESULTS: By employing the developed paradigm, we were able to obtain results comparable to other studies and analysed them with different contrasts. Implementation of the contrast H versus X led to increased blood-oxygen-level-dependent signal (BOLD) mainly in unspecific areas, such as the visual cortex, the Broca´s area, bilaterally in the premotor cortex and the supplementary motor area, but also in thalami, insulae, the right dorsolateral prefrontal cortex, the left amygdala, the left putamen (p < .05). When applying the contrast L versus X, an enhancement of the BOLD signal was detected similarly within the visual area, the right temporal pole, the right precentral gyrus, Broca´s area, left insula, left hippocampus, the left parahippocampal gyrus, bilaterally premotor cortex and thalami (p < .05). Comparison of brain reactions regarding visual stimuli (high- versus low-calorie food), assumed to be more relevant in eating disorders, resulted in bilateral enhancement of the BOLD signal in primary, secondary and associative visual cortex (including fusiform gyri), as well as angular gyri (p < .05). CONCLUSIONS: A carefully designed paradigm, based on the subject's characteristics, can increase the reliability of the fMRI study, and may reveal specific brain activations elicited by this custom-built stimuli. However, a putative disadvantage of implementing the contrast of high- versus low-calorie stimuli might be the omission of some interesting outcomes due to lower statistical power. Trial registration NCT02980120.

Although the relationship with food is crucial for living, its underlying mechanisms (e.g., neurological, cognitive, physiological) are still not fully discovered. The development of functional magnetic resonance imaging made it possible to explore brain's responses to images of food. However, a proper methodological analysis of the research paradigm is still lacking. Here, we present the optimization of visual food stimuli paradigms achieved by comparison of neural activations of 20 female healthy adolescents after applying particular contrasts (i.e., high- versus low-calorie food images, high-calorie food images versus baseline, low-calorie food images versus baseline). Application of the contrast high- versus low-calorie food images resulted in stronger neural activation in visual cortex (including fusiform gyri) and angular gyri. This study highlights the importance of choosing a proper contrast regarding the study hypothesis, as it may induce more specific results. However, it may lead to loss of some outcomes, due to lower statistical power. Additionally, we have performed an evaluation of visual food stimuli chosen by patients diagnosed with anorexia nervosa. They have selected images of the most and the least willingly eaten meals. Although they didn't know the exact calorie content, they chose intuitively photos later classified as extremely high- or low-caloric.

[Inpatient care capacities in child and adolescent psychiatry-increase in emergency admissions during the COVID-19 pandemic?] / Stationäre Versorgungskapazitäten in der Kinder- und Jugendpsychiatrie ­ Zunahme der Akutaufnahmen während der COVID-19 Pandemie?

The COVID-19 pandemic and the accompanying containment measures have had a fundamental impact on the mental health of children and adolescents. In the present study, the emergency admissions of the first two Corona years (2020/21) at the Department for Child and Adolescent Psychiatry Hall i. T./Innsbruck were retrospectively analysed and compared with the two years before the COVID-19 pandemic (2018/19). There was no change in the total number of emergency admissions in 2020 compared to 2019 before Corona, but in 2021 emergency admissions increased by 40.1%. The pre-Corona (2018/19) gender ratio of 65.4% girls to 34.6% boys did not change in 2020. In 2021, the proportion of girls increased to 74.4%. In the COVID-19 pandemic, acute suicidality increased (+48.3%) while aggression decreased (-51.0%). Acute intoxications increased in the first Corona year and decreased again in 2021. The present study results show that the mental health needs of children and adolescents increased significantly in the course of the COVID-19 pandemic and that this was also reflected in child and adolescent psychiatry. The increased demands must now be met with appropriate care and prevention measures as well as sufficient child and adolescent psychiatric bed capacities in order to mitigate the longer-term psychosocial effects of the COVID-19 pandemic as best as possible.

[Forensic adolescent psychiatry: the care situation in Austria]. / Forensische Kinder- und Jugendpsychiatrie: Versorgungssituation in Österreich.

In Austria there is a lack of registered experts in the field of forensic child and adolescent psychiatry. Their tasks include the assessment of young people in various legal issues, but there is also a lack of child and adolescent psychiatrists for treatment and care for mentally ill adolescents in prison. This lack means that child psychiatric questions are often answered by psychologists or adult psychiatrists.In the group of incarcerated young people, there is an increased proportion of mental illnesses. However, it is also known that young people with-primarily externalizing-mental illnesses also show a significantly increased risk of becoming delinquent. Specialized youth psychiatric treatment can also have a (relapse) preventive effect.To ascertain the exact requirement in Austria, the figures are lacking. These numbers should be collected urgently.Furthermore, a structured training for forensic child and adolescent psychiatrists should be expanded and a platform for exchange and supervision of child psychiatrists working in forensic topics would be desirable. If it is possible to cover the need in this area, the goal that children and adolescents are only examined by specially trained child and adolescent psychiatrists, can be achieved.

[Inpatient care in child and adolescent psychiatry-Who gets treatment?] / Stationäre Versorgung in der Kinder- und Jugendpsychiatrie ­ wer hat Platz?

BACKGROUND AND RESEARCH QUESTION: This article presents and analyses the landscape for inpatient child and adolescent psychiatric care in Austria and examines current data from June 2022. METHOD: In June 2022, the authors surveyed the current status of child and adolescent psychiatric primary care in Austria. Both systemised beds and day hospital beds as well as the number of specialists and assistant doctors were taken into account. RESULTS: A bed index of 0.05 beds/1000 inhabitants (as of 6/2022) was calculated, which is below the guideline for beds needed and does not correspond with the need depicted for sufficient provision of care ("Österreichischer Strukturplan Gesundheit"). Moreover, in June 2022, 40 beds had to be closed due to staff shortages and 26.5 training positions were vacant across Austria. DISCUSSION AND CONCLUSIONS: Even though the training ratio was raised to 1:2 as of 07.02.2022 within the framework of the "Mangelfachverordnung" for a limited period of time until 31.05.2027, it is hardly possible to guarantee sufficient mental health care according to the increased demand for child and adolescent psychiatry, especially in times of the pandemic. Measures need to be urgently taken to improve child and adolescent psychiatric treatment options. In order to ensure adequate care for the increasing number of mentally ill children and adolescents (a) the number of beds must be increased, (b) structural deficits have to improve, and (c) innovative treatment options in the sense of inpatient-equivalent treatment (home treatment) has to be considered.

[A three-country comparison of mental health and treatment options of children and adolescents with mental health problems in times after the COVID-19 pandemic]. / Die psychische Gesundheit unserer Kinder und Jugendlichen und deren Behandlungsmöglichkeiten im Drei-Länder-Vergleich (Ö, D, CH) unter Berücksichtigung der Veränderungen durch die COVID-19-Pandemie.

BACKGROUND AND RESEARCH QUESTION: The Austrian Society for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy (ÖGKJP) is publishing a series of articles in a special issue of Neuropsychiatrie dealing with the current provision of care in child and adolescent psychiatry. Aim of this article is to give an overview of provision of care for children and adolescents with mental health problems in Austria, Germany, and Switzerland and then draw conclusions for the Austrian child and adolescent psychiatric care landscape. METHOD: First, epidemiologic data as well as different traditions and treatment philosophies and their effect for provision of care in child and adolescent psychiatry in Austria, Germany and Switzerland are presented. Subsequently, data of provided child and adolescent psychiatric care in Austria and Germany are presented and related to each other. RESULTS AND CONCLUSIONS: On the basis of the data presented, the current deterioration of mental health in children and adolescents due to the pandemic as well as the deficit of available inpatient beds (0.03-0.09) there is an urgent need for action in Austrian provision of child and adolescent psychiatric care. An improvement of the structural deficits in the child and adolescent psychiatric research and care landscape, a significant increase of capacities for inpatient treatment, day-care as well as outpatient treatment with establishment of modern treatment options such as home treatment is necessary.

[Characteristics of the population of a parent-child unit: early interaction-based treatment as a chance in child and adolescent psychiatry]. / Merkmale der Inanspruchnahmepopulation einer Eltern-Kind-Station: Frühe interaktionszentrierte Behandlung als Chance in der Kinder- und Jugendpsychiatrie.

BACKGROUND: In inpatient child psychiatric parent-child treatment, the child is admitted as a patient and the parents as accompanying persons. Due to the importance of parent-child interaction in the development and maintenance of mental disorders in children, parents are integrated more centrally in the treatment of children with emotional or behavioral disorders. In order to further expand this form of treatment in the future and to make it more effective, the characteristics of the previous utilization population of a child psychiatric parent-child unit in Tyrol were examined with regard to child symptomatology and the burden on parents. METHODS: The Child Behavior Checklist 1 ½-5, Child Behavior Checklist 6-18R, and Tröster's (2011) Parent Stress Inventory scores of 96 parent-child pairs were used to examine child symptom expression and parent stress. RESULTS: The 6-10 year old patients had higher T­scores (M = 76.9, SD = 7.1) than the 0-5 year old patients (M = 63.1, SD = 12.4) on the CBCL total scale, t (50) = -3.52, p < 0.001. On the EBI total scale, the 0-5 year old patients and the 6-10 year old patients did not differ in terms of T­scores, t (54) = -0.75, p = 0.459, as well as in the EBI child domain t (54) = -1.75, p = 0.087 and in the EBI parent domain, t (54) = 0.19, p = 0.846. Also, the four diagnostic groups did not differ in the EBI total scale, F (4,58) = 1.34, p = 0.266, nor in the parent domain of the EBI, F (4,58) = 1.44, p = 0.232, nor in the child domain of the EBI, F (4,58) = 2.81, p = 0.033. CONCLUSIONS: Early identification and treatment of behavioral or mental disorders in very young children seems crucial to prevent long-term negative consequences as well as chronicity. Parent-child therapies should generally focus on identifying and changing current dysfunctional patterns of interaction between parent and child.

[Nutritional Therapy in Vegans with Anorexia Nervosa from a Diaetological Point of View]. / Ernährungstherapie bei veganer Ernährung und Anorexia nervosa aus diaetologischer Sicht.

Veganism is a form of nutrition that is becoming increasingly popular. There is also a pandemic-related increase in mental illness, which often manifests itself in the form of an eating disorder among children and adolescents. Particularly challenging in nutritional therapy is anorexia nervosa in combination with veganism.There is consensus that a correctly implemented vegan diet can generally cover the daily nutritional requirements. However, this does not apply to people who are in a growth period. Therefore, this article attempts to highlight the special requirements of a vegan diet along the dietary process development.The basis is provided by a specific anamnesis as well as the elicitation of nutritional status by means of nutrition protocol and bioelectrical impedance analysis. The treatment and goal setting are influenced by the motives behind a vegan diet and further diagnoses such as orthorexia or food intolerance. Regarding the course of action, it must be clarified how an adequate vegan diet can be guaranteed and which conditions are needed to create a space where different diets can be accepted simultaneously. Withing the daily care, nutritional aspects such as the reduction of anorexia-related digestive complaints as well as the selection, quantity and preparation of vegan foods are foregrounded. This is illustrated by nutritional analyses. The objective is to achieve a high level of compliance and to ensure a sufficient nutrient supply in order to make food, as well as vegan food, enjoyable.

[An Inpatient Concept for the Treatment of Eating Disorders - How to Implement a Systemic- Family-Therapeutic Approach]. / Stationäres Konzept zur Behandlung von Essstörungen ­ Wie kann eine systemisch-familientherapeutische Haltung umgesetzt werden?

The ward for the treatment of eating disorders was reconceptualized in the context of the reopening of the Kinder- und Jugendpsychiatrie, Psychotherapie und Psychosomatik in Hall in Tyrol. The focus is on systemic-family-therapeutic approaches, interdisciplinarity and groups offered for adolescents and their families struggling with an eating disorder. In addition, the ward will be expanded for adolescents with obesity who also suffer from a psychological comorbidity. Transparency, personal responsibility and voluntariness are lived in a collaboration with adolescents and their families in a multimodal treatment team.