[Trends in Adolescents' Satisfaction with Their Inpatient Psychiatric Treatment: A Panel Analysis over 7 Years]. / Trends in der Zufriedenheit von Jugendlichen mit ihrer stationären psychiatrischen Behandlung: Eine Verlaufsanalyse über 7 Jahre.

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.

[Diagnostic Performance and Validity of the German Version of the BDI-II - A Secondary Analysis with Data from Clinical and Nonclinical Samples]. / Diagnostische Performanz und Validität des deutschsprachigen BDI-II ­ Eine Sekundäranalyse mit Daten aus klinischen und nichtklinischen Stichproben.

OBJECTIVES: Study of the diagnostic performance and validity of the German Beck Depression Inventory (BDI-II) in a large data set from multiple adult samples. METHODS: The BDI-II was assessed together with the SCID-I as external criterion in 638 individuals (385 currently or remitted depressed individuals, 253 controls). The screening performance of the BDI-II was calculated for suggested cut-offs from the BDI-II manual and for optimal cut-offs derived from ROC-analyses. RESULTS: The internal consistency of the BDI-II was high (> 0,90) and it showed plausible associations with construct-related scales. Optimal cut-off scores of 16+ resulted for MDE (Youden's J = 0.838) and of 14+ for DD (J = 0.814). CONCLUSIONS: The German BDI-II is a reliable und valid screening tool for detecting depressive episodes and depressive disorders in the adult population. Depending on prioritized goals different cut-off-values can be used.

[Development of Mental Health Problems of Girls and Boys in Residential Care Between 2008 and 2020]. / Entwicklung von psychischen Auffälligkeiten bei Mädchen und Jungen in stationären Jugendhilfeeinrichtungen zwischen den Jahren 2008 und 2020.

Development of Mental Health Problems of Girls and Boys in Residential Care Between 2008 and 2020 Abstract. Objective: Studies show a high prevalence of mental health problems in children and adolescents in youth-welfare facilities compared to the general population. However, to date, studies on this development over time are lacking. The present study examines the development of mental health problems and psychosocial functioning in the years 2008 to 2020. Method: Mental health problems were assessed with the CBCL, psychosocial functioning with Axis VI of the MAS. In total, data from 3,269 children and adolescents from residential-care facilities located throughout Germany were included in the analysis. Results: a decrease in externalizing behaviour was observed regarding the frequency of mental health problem in children and adolescents in youth-welfare facilities from 2008 to 2020. Particularly boys aged 12 and older show less deviant behavior. Older girls show high internalizing behavior problem scores over time, but there is no consistent trend. More than a quarter of the institutionalized children in youth-welfare institutions show severely impaired psychosocial functioning at a consistent level over time. Conclusions: In light of the age and gender effects associated with the development of mental health problems over time, there is a need to regard the care situation in youth-welfare institutions.

Adverse childhood experiences are associated with a higher risk for increased depressive symptoms during Covid-19 pandemic - a cross-sectional study in Germany.

BACKGROUND: Covid-19 pandemic has been profoundly affecting people around the world. While contact restrictions, school closures and economic shutdown were effective to reduce infection rates, these measures go along with high stress for many individuals. Persons who have experienced adverse childhood experiences (ACEs) have an increased risk for mental health problems already under normal conditions. As ACEs can be associated with a higher vulnerability to stress we aimed to assess the role of ACEs on depressive symptoms during the Covid-19 pandemic. METHODS: In a cross-sectional online survey, 1399 participants above the age of 18 years were included during the first lockdown in Germany. Via two-way repeated measures ANOVA, differences in depressive symptoms before (retrospectively assessed) and during the pandemic were analyzed. Linear regression analyses were performed in order to identify predictors for increase of depressive symptoms. RESULTS: Compared to prior to the Covid-19 pandemic, depressive symptoms increased among all participants. Participants with ACEs and income loss reported about a stronger increase of depressive symptoms. Other predictors for increased depressive symptoms were young age and a lack of social support. CONCLUSIONS: Based on these results, ACEs are a significant predictor for an increase in depressive symptoms during the pandemic, indicating that personss with ACEs may be a risk group for mental health problems during the current and potential later pandemics. These findings underline the relevance of support for persons who have experienced ACEs and may help to provide more targeted support in possible scenarios due to the current or possible other pandemics. Besides, economic stability seems to be of prior importance for mental health.

Incidence of inpatient cases with mental disorders due to use of cannabinoids in Germany: a nationwide evaluation.

BACKGROUND: Quantitative (e.g. increasing recreational cannabinoid use) and qualitative (e.g. increasing availability and use of synthetic cannabinoids and cannabis preparations with increased tetrahydrocannabinol content) changes in cannabinoid use may be associated with changes in the prevalence of cannabinoid-related mental and behavioural disorders and, accordingly, changes in the need for medical care. We aimed to investigate if there are changes in the number of inpatient cases (ICs) due to cannabinoid-related disorders in Germany. METHODS: Data were obtained from the Federal Statistical Office of Germany (Destatis) and comprised type and number of hospital main diagnoses (according to ICD-10) of all ICs in Germany in the period 2000-18. Linear trend analysis of absolute and relative annual frequencies (AFs) of ICs with diagnoses related to the use of cannabinoids (DRUCs), and, as controls, alcohol-related psychiatric disorders and schizophrenia-spectrum disorders was performed. RESULTS: Absolute AFs of ICs with DRUCs increased statistically significantly (P<0.0001, trend analysis) in Germany between 2000 and 2018 and corresponding relative AFs increased considerably (4.8-fold increase when comparing 2000 and 2018). Specifically, absolute AFs of ICs with cannabinoid intoxications (P<0.0001), harmful use (P=0.0005), dependence syndrome (P< 0.0001), withdrawal state (P<0.0001), psychotic disorders (P< 0.0001) and residual and late-onset psychotic disorder (P<0.0001) statistically significantly increased. Absolute AFs of schizophrenia-spectrum disorders slightly, but statistically significantly decreased (P=0.008), and alcohol dependence did not statistically significantly change (P=0.844). CONCLUSIONS: Our evaluation demonstrates increasing numbers of ICs with mental and behavioural disorders due to use of cannabinoids in Germany and emphasizes the need for adequate prevention of such disorders.

Malignant catatonia: Severity, treatment and outcome - a systematic case series analysis.

Objectives: Malignant catatonia (MC) is a rare, yet potentially life-threatening neuropsychiatric condition. Evidence on its therapy is weak, treatment recommendations are scarce and predominantly unprecise. The aim of this study was to compare the effectiveness of different MC treatment approaches regarding outcome and severity of MC.Methods: We conducted systematic searches for MC case reports in biomedical databases and the psychiatric archive of University Hospital Ulm. Treatments were compared considering MC severity and temporal aspects.Results: A total of 117 cases were included. Treatment had a significant influence on outcome: treatment with both benzodiazepines and electroconvulsive therapy (ECT) entailed the most favourable, purely supportive therapy the least favourable outcome. Earlier application of benzodiazepines was significantly associated with a favourable outcome. A classification of MC severity was developed. Patients with severe MC were significantly more often subject to intensive care treatment and had a 78% higher risk of dying than in moderate MC.Conclusions: This is the first study to introduce a severity classification for MC, and the largest to compare outcomes of MC treatments with clear distinction from neuroleptic malignant syndrome (NMS). Preferable MC treatment should include early initiation of benzodiazepines and ECT. MC severity could serve as a prognostic instrument.

The Association Between Test Anxiety, Self-Efficacy, and Mental Images Among University Students: Results From an Online Survey.

Background and Objectives: A substantial portion of students report test anxiety, and those reporting low levels of self-efficacy seem to be especially affected. Previous research has indicated the relevance of mental images in the maintenance of anxiety disorders, however, no data are available with respect to test anxiety. In order to close this gap, the present study investigates the association between test anxiety, self-efficacy and mental images. Method: One hundred sixty-three university students completed an online survey. Test anxiety (PAF), general self-efficacy (WIRKALL-r), study-related self-efficacy (WIRK_STUD), intrusiveness of mental images (IFES), spontaneous use of imagery (SUIS) and vividness of imagery (VVIQ) were examined. Results: Test-related mental images were frequently reported among the surveyed students. Test anxiety showed a positive correlation with IFES and a negative correlation with self-efficacy. Mediation analyses showed that about one fifth of the influence of self-efficacy on test anxiety is mediated by IFES. Discussion: The present study gives first indication about an association between test anxiety, self-efficacy and mental images, even though the results are limited with respect to generalizability. Further investigations with respect to the impact of test-related mental images on the self-efficacy/test-anxiety linkage are needed.

Satisfaction with in-patient child and adolescent psychiatric treatment: development and psychometric properties of the BEST questionnaires for adolescents and for parents.

BACKGROUND: Interest in the assessment of patient satisfaction with in-patient psychiatric treatment has steadily increased and several measurement tools are available for the quantification of patients' experience. However, they are often uni-dimensional or focus mainly on therapeutic relationship and environment, and neglect other important issues such as information about treatment and participation. The BEST questionnaires were developed as comprehensive instruments that include items on all of the mentioned topics. The present study evaluates the psychometric properties of the BEST in a version for adolescents and for parents. Furthermore, the dimensionality of the satisfaction ratings is analyzed. METHOD: Descriptive statistics were applied to data of 1582 adolescents (mean age = 15.0 years, SD = 1.65; 62.4% female) and 1998 parents/guardians assessed in seven in-patient units across Germany. The factorial structure of the BEST questionnaires was determined by exploratory and confirmatory factor analyses, including a bifactor model. RESULTS: The psychometric quality of the scales was strong. Correlations with another assessment instrument of patient satisfaction were good to high, indicating good convergent validity. Exploratory factor analyses revealed three factors in adolescents that were labelled as: Therapeutic relationship, environment, and general satisfaction and treatment success. For parents, the same three factors could be distinguished. Confirmatory bifactor models suggested that the vast majority of variance was accounted for by the general factor; the three specific factors provided some additional information. Agreement between the subscales of adolescents and their parents was only moderate. Parents were usually more satisfied. CONCLUSIONS: The BEST questionnaires can be considered as reliable and valid instruments to not only assess the "classical" aspects of patient satisfaction, but to also assess newer fundamental topics such as children's rights and treatment participation. For scientific usage, the total score seems superior because of the high explained variance by the general factor, but the subscale scores provide further information. The use of single items seems advantageous for quality management purposes.

[Violence in intimate partnerships and mental problems in children and adolescents]. / Gewalt in intimen Partnerschaften und psychische Probleme bei Kindern und Jugendlichen: Online-Survey während der COVID-19-Pandemie.

Background: The coronavirus disease 2019 (COVID-19) pandemic has changed the lives of families in an unprecedented way. During the first lockdown, extrafamilial contact was significantly reduced. Many parents had to look after their children and work from home while the economic pressure increased. Objective: The aim of the present study was to investigate the association between intimate partner violence (IPV) and mental health problems in children and adolescents before and during the COVID-19 pandemic. Material and methods: In a cross-sectional online survey 687 parents of underaged children in Germany were included. Demographic and psychosocial predictors for IPV and associations with mental health problems of children before and during the first lockdown due to the COVID-19 pandemic were assessed. The survey ran from 18 May 2020 to 21 July 2020 and the lockdown in Germany began on 23 March 2020 and ended via a gradual relaxation. The first schools reopened on 22 April and the opening of schools, kindergartens and daycare centers extended to the end of June 2020. Results: Lower household incomes and the experience of own adverse childhood experiences increased the risk of participants reporting violence in their relationship. According to the participating parents, children and adolescents living in families in which violence was reported by intimate partners were more likely to have higher levels of externalizing problems before and during the pandemic. There were no significant differences with respect to emotional problems. Conclusion: Adverse childhood experiences increase the risk of intimate partner violence, which in turn increases the risk of mental health problems in the children. Therefore, in the psychotherapeutic practice questions should also be systematically asked about corresponding experiences and appropriate treatment offers should be recommended.

[Do Children and Adolescents with Different Reasons for Admission Equally Benefit from Institutional Care?] / Profitieren Kinder und Jugendliche mit unterschiedlichen Aufnahmegründen gleichermaßen von einer Heimunterbringung?

Do Children and Adolescents with Different Reasons for Admission Equally Benefit from Institutional Care? Currently, almost 150.000 children and adolescents are placed in institutional care in Germany with the aim to improve their living conditions. Various studies showed positive effects concerning the development of those institutionalized children and adolescents. Within the present study, 500 children and adolescents in institutional care were examined regarding the improvement of quality of life and social competencies during their care placement depending on the respective reason for admission (group A: admission due to mental health and behavior problems; group S: problems in the context of the school; group O: no mental health problems, but other reasons). Furthermore, differences in the development of children and adolescents who initiated the placement by themselves and those who did not were examined. Results show that over a period of 18-24 months, all three groups developed effectively equally. Group A had a lower initial level regarding quality of life and social competencies compared to group S and group O and therefore reached lower outcomes within the investigation period. Development was irrespective of whether or not children and adolescents initiated the institutional placement by themselves. The results demonstrate that all three groups were able to benefit from institutional care, although children and adolescents with mental health problems had a notable potential for further development.

Long-term trajectories of anxiety and depression in patients with stable coronary heart disease and risk of subsequent cardiovascular events.

BACKGROUND: Anxiety and depression seem to be under-recognized in their importance and are often not incorporated in subsequent prevention strategies in routine clinical care of coronary heart disease. METHODS: The KAROLA cohort included coronary heart disease patients participating in an in-patient rehabilitation program (years 1999/2000) and followed after 1, 3, 6, 8, 10, 13, and 15 years. We identified anxiety and depression trajectories based on the hospital anxiety and depression scale subdomains using joint latent class mixture time-to-event models. We included cardiovascular (CV) events and non-CV mortality as competing endpoints. RESULTS: We included 1,109 patients (15.4% female; mean age, 59.4 (standard deviation [SD] = 8.0) years) with baseline covariate data. Over a median follow-up of 14.8 years, participants experienced 324 subsequent CV events. We identified four anxiety and depression trajectory classes, a low-stable class (52.2% and 69.6% of patients for anxiety and depression, respectively), moderate-stable class (37.6% and 23.8%), increasing class (2.3% and 3.3%), and high-stable/high-decreasing class (7.9% and 3.3%). The hazard ratio (HR) for subsequent CV events for the increasing anxiety class was 2.13 (95% confidence interval [CI], 0.61; 7.45) compared with the low-stable class after covariate adjustment. Patients following the high-decreasing anxiety trajectory showed an HR of 1.72 (95% CI, 1.11; 2.68) and patients following the high-stable depression trajectory an HR of 2.47 (95% CI, 1.35; 4.54). CONCLUSIONS: Chronic high anxiety and depression trajectory classes were associated with increased risk of subsequent CV events. Assessments of both symptoms of anxiety and depression during long-term routine medical care are recommended to identify patients who would benefit from appropriate interventions.

Factor Structure and Measurement Invariance Across Gender of the Beck Depression Inventory-II in Adolescent Psychiatric Patients.

The revised version of the Beck Depression Inventory (BDI-II) is one of the most frequently applied questionnaires not only in adults, but also in adolescents. To date, attempts to identify a replicable factor structure of the BDI-II have mainly been undertaken in adult populations. Moreover, most of the studies which included minors and were split by gender lacked confirmatory factor analyses and were generally conducted in healthy adolescents. The present study therefore aimed to determine the goodness of fit of various factor models proposed in the literature in an adolescent clinical sample, to evaluate alternative solutions for the factor structure and to explore potential gender differences in factor loadings. The focus was on testing bifactor models and subsequently on calculating bifactor statistical indices to help clarify whether a uni- or a multidimensional construct is more appropriate, and on testing the best-fitting factor model for measurement invariance according to gender. The sample comprised 835 adolescent girls and boys aged 13-18 years in out- and inpatient setting. Several factor models proposed in the literature provided a good fit when applied to the adolescent clinical sample, and differences in goodness of fit were small. Exploratory factor analyses were used to develop and test a bifactor model that consisted of a general factor and two specific factors, termed cognitive and somatic. The bifactor model confirmed the existence of a strong general factor on which all items load, and the bifactor statistical indices suggest that the BDI-II should be seen as a unidimensional scale. Concerning measurement invariance across gender, there were differences in loadings on item 21 (Loss of interest in sex) on the general factor and on items 1 (Sadness), 4 (Loss of pleasure), and 9 (Suicidal Thoughts) on the specific factors. Thus, partial measurement invariance can be assumed and differences are negligible. It can be concluded that the total score of the BDI-II can be used to measure depression severity in adolescent clinical samples.

[Quality of Life and Behavioral Problems of Unaccompanied Minor Refugees in Child Care Facilities]. / Lebensqualität und Verhaltensauffälligkeiten bei unbegleiteten minderjährigen Flüchtlingen in Einrichtungen der Jugendhilfe.

Quality of Life and Behavioral Problems of Unaccompanied Minor Refugees in Child Care Facilities Unaccompanied minor refugees (UMR) who arrive in Germany are generally placed in institutional child care facilities. UMR are a very burdened group, however other children and adolescents in institutional care are burdened as well, and their quality of life is often reduced. The aim of the current study was thus to compare quality of life and behavioral problems of UMR in child care facilities with those of other resident adolescents. For a total of 50 UMR, data regarding behavioral problems was available, for 41 UMR ratings on quality of life, both from external assessments. Two parallel comparison samples of other adolescents in the same institutional care facilities were drawn with adolescents with and without a migration background. Results show that in general, UMR show fewer behavioral problems than the other two groups, especially in externalizing behavior. For internalizing behavior, no differences were evident. For quality of life, no differences could be found between the three groups of inhabitants in institutional care. This indicates that the same factors determining quality of life are present in all three groups, but that the underlying mental problems are different in UMR than in other adolescents. Thus, staff in institutional care should possibly work differently with these group of adolescents than with other inhabitants and should be educated respectively.

Longitudinal Associations Between Dysfunctional Maltreatment-Related Cognitions and Psychopathology in Children and Adolescents.

Dysfunctional posttraumatic cognitions seem to play an important role in adjustment after traumatic experiences. However, little research has been done on maltreated children and adolescents. Furthermore, possible causal associations between cognitions, posttraumatic stress symptoms, and internalizing and externalizing problems have rarely been investigated. In the current study, 263 maltreated children and adolescents (8-17 years of age) were assessed at baseline and again at time points 6 and either 12 or 18 months later. Cross-lagged panel analyses were used to gain a better understanding of the course of and associations among dysfunctional maltreatment-related cognitions, posttraumatic stress symptoms, and internalizing and externalizing problems. Ratings of all variables significantly decreased over time. Moderate to strong autoregressive paths emerged for all variables, denoting stability. Furthermore, the variables showed moderate to high correlations at every assessment. Posttraumatic stress symptoms moderately predicted dysfunctional maltreatment-related cognitions as well as internalizing and externalizing problems 6 months after baseline. Cross-lagged paths from the cognitions as well as from internalizing and externalizing problems to all other variables were not significant. Age, gender, and maltreatment characteristics did not play a relevant role in these cross-lagged associations when they were included as covariates. Our results underline the cognitive scar model, in which preceding posttraumatic stress symptoms adversely impact cognitions. Posttraumatic stress symptoms appear to be an important target for treatment as their reduction may help decrease internalizing and externalizing problems as well.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Asociaciones Longitudinales Entre Cogniciones Disfuncionales Relacionadas Con Maltrato Y Psicopatología En Niños Y Adolescentes COGNICIONES DISFUNCIONALES RELACIONADAS CON MALTRATATO Las cogniciones postraumáticas disfuncionales parecen jugar un papel importante en la adaptación después de experiencias traumáticas. Sin embargo, se ha realizado poca investigación en niños y adolescentes maltratados. Además, se ha investigado muy poco las posibles asociaciones causales entre cogniciones, síntomas de estrés postraumático y los problemas de internalización y externalización. En este estudio, 263 niños y adolescentes maltratados (de 8 a 17 años de edad) fueron evaluados al inicio y nuevamente en los períodos de 6 y 12 o 18 meses posteriores. Se utilizaron análisis de casos de cruce desfasado para obtener una mejor comprensión del curso y las asociaciones entre las cogniciones relacionadas con el maltrato disfuncional, los síntomas de estrés postraumático y problemas de internalización y externalización. Las calificaciones de todas las variables disminuyeron significativamente en el tiempo. Trayectorias autorregresivos moderadas a fuertes surgieron para todas las variables, denotando estabilidad. Además, las variables mostraron correlaciones moderadas a altas en cada evaluación. Los síntomas de estrés postraumático predijeron moderadamente cogniciones disfuncionales relacionados con maltrato como también los problemas de internalización y externalización 6 meses después de la evaluación inicial. Trayectorias de cruce desfasado de las cogniciones, como de los problemas de internalización y externalización a todas las demás variables no fueron significativas. Las características de edad, género y maltrato no jugaron un papel relevante en estas asociaciones de cruce desfasado cuando se incluyeron como covariables. Nuestros resultados destacan el modelo de cicatriz cognitiva, en el que los síntomas de estrés postraumático precedente afectan negativamente las cogniciones. Los síntomas de estrés postraumático parecen ser una un objetivo importante para el tratamiento, ya que su reducción puede también ayudar a disminuir los problemas de internalización y de externalización.

Common Factors of Psychotherapy in Inpatients With Major Depressive Disorder: A Pilot Study.

Background: Psychotherapeutic interventions share common factors, which might contribute to treatment success independent of the type of psychotherapy. Previous research on common factors of psychotherapy was mostly conducted in outpatients and covered the development of common factors throughout a therapy over months or years. However, the role of common factors for the psychotherapeutic treatment success in inpatients during their hospital stay has not been addressed so far. The present research therefore aimed to explore changes of the common factors within a short-term stay at the psychiatric hospital for inpatients with major depressive disorder (MDD) and their relation to treatment outcome. Method: We developed a standardized manualized individual cognitive-behavioral psychotherapy (SMiCBT) for depression. The SMiCBT treatment lasted 4 weeks with eight therapy sessions. Following each treatment session, patients and therapists separately completed the questionnaire of "Stundenbogen für die Allgemeine und Differentielle Einzel-Psychotherapie" (STEP) to assess common factors from the perspective of the patient and the therapist. Severity of depression was also measured by the German version of the "Beck Depression Inventory" (BDI-II) before and after the treatment (SMiCBT). We conducted multilevel analysis for the longitudinal data for each scale of the STEP. Results: We found an improvement in the severity of depressive symptoms across the treatment period according to BDI-II scores. Regarding the STEP scales, motivational clarification and problem-solving scores increased over the treatment period for both patient and therapist perspectives. This was not the case for the scale therapeutic relationship. Furthermore, baseline levels of motivational clarification and problem solving were related to the treatment response. Limitations: The results have to be interpreted with care because of the small sample with MDD and the lack of a control group for comparison of treatment outcome. Conclusion: Our data demonstrate that common factors improve within a short-term psychotherapy in inpatients with MDD. Most importantly, our research highlights the distinguished role of motivational clarification and problem solving for the improvement of depressive symptoms during short-term psychotherapy in inpatient settings.

The role of attachment characteristics in dialectical behavior therapy for patients with borderline personality disorder.

Attachment characteristics play a key role in understanding borderline-specific problems with respect to childhood maltreatment. The aim of this study was to investigate how attachment representations may influence the trajectory of change in a 1-year outpatient dialectical behavior therapy (DBT) for patients with borderline personality disorder (BPD). Attachment representations were assessed in 26 BPD patients and 26 healthy controls (HC) using the Adult Attachment Projective Picture System (AAP) before treatment. Borderline and global symptom severity and interpersonal problems were examined before, during, and after completing the intervention. Analysis of variance and stepwise hierarchical regression analyses were used to explore the course of symptomatology. As expected, BPD patients displayed a predominance of unresolved attachment in the AAP compared with HC, by showing a lack of ability to integrate attachment related trauma. Whereas both resolved and unresolved attachment groups revealed significant improvement in symptom severity during treatment, dimensional AAP scores showed differences. Patients with higher scores in "synchrony" demonstrated more indicators of mutual care in their narratives to dyadic pictures and displayed a significantly stronger decrease of interpersonal problems than patients with lower synchrony scores. Assessing attachment representations prior to DBT might provide a helpful insight into individual attachment related resources or lack of these capacities. Responsiveness and synchrony in dyadic interactions with significant others are crucial for healthy interpersonal relations. A stronger therapeutic focus on the patient's capacity to show synchrony in dyadic attachment situations might improve the patient's interpersonal problems towards sensitive and mutual interaction.

[Process analysis of weekly self- and external assessments of adolescents with substance abuse disorder during long-term psychotherapy]. / Verlaufsanalyse wöchentlicher Selbst- und Fremdeinschätzungen in der Langzeittherapie suchtkranker Jugendlicher.

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.

Emergency Presentations to Child and Adolescent Psychiatry: Nonsuicidal Self-Injury and Suicidality.

Nonsuicidal Self-Injury (NSSI) and suicidality are common reasons for emergency presentations in child and adolescent psychiatry. Therefore, we focused on reasons for emergency presentations as well as specific characteristics of those presenting with NSSI or suicidality to an emergeny psychiatric service. We analyzed data from a German university hospital regarding emergency presentations during a 78 months' period. NSSI and suicidality were rated according to the Columbia Classification Algorithm of Suicide Assessment (C-CASA). Data from 546 emergency presentations was recorded, of which 347 (63.5%) presented for NSSI or suicidality. Given the high percentage, thorough assessment of sucidality as well as providing adequate treatment in emergency settings to establish further care, is of utmost importance.

Treatment expectancy, working alliance, and outcome of Trauma-Focused Cognitive Behavioral Therapy with children and adolescents.

BACKGROUND: It has been shown that positive treatment expectancy (TE) and good working alliance increase psychotherapeutic success in adult patients, either directly or mediated by other common treatment factors like collaboration. However, the effects of TE in psychotherapy with children, adolescents and their caregivers are mostly unknown. Due to characteristics of the disorder such as avoidant behavior, common factors may be especially important in evidence-based treatment of posttraumatic stress symptoms (PTSS), e.g. for the initiation of exposure based techniques. METHODS: TE, collaboration, working alliance and PTSS were assessed in 65 children and adolescents (age M = 12.5; SD = 2.9) and their caregivers. Patients' and caregivers' TE were assessed before initiation of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). Patients' and caregivers' working alliance, as well as patients' collaboration were assessed at mid-treatment, patients' PTSS at pre- and post-treatment. Path analysis tested both direct and indirect effects (by collaboration and working alliance) of pre-treatment TE on post-treatment PTSS, and on PTSS difference scores. RESULTS: Patients' or caregivers' TE did not directly predict PTSS after TF-CBT. Post-treatment PTSS was not predicted by patients' or caregivers' TE via patients' collaboration or patients' or caregivers' working alliance. Caregivers' working alliance with therapists significantly contributed to the reduction of PTSS in children and adolescents (post-treatment PTSS: ß = - 0.553; p < 0.001; PTSS difference score: ß = 0.335; p = 0.031). CONCLUSIONS: TE seems less important than caregivers' working alliance in TF-CBT for decreasing PTSS. Future studies should assess TE and working alliance repeatedly during treatment and from different perspectives to understand their effects on outcome. The inclusion of a supportive caregiver and the formation of a good relationship between therapists and caregivers can be regarded as essential for treatment success in children and adolescents with PTSS.