[Diagnostics and initial estimation of refugee minors]. / Diagnostik und Ersteinschätzung bei minderjährigen Flüchtlingen.

The number of underage refugees arriving in Germany has rapidly increased since 2015. Many of these children and adolescents have been and still are, exposed to a large number of stressful circumstances. The group of those helping refugee minors is heterogeneous with both volunteers and professional workers from the fields of child welfare and healthcare services. Easily applicable instruments to assess both burdens and resources are needed in order to plan appropriate interventions. This paper focuses on instruments for assessing the circumstances of refugee minors and includes pilot data of an online-based screening instrument to assess burdens and resources (providing online resource and trauma assessment for refugees, PORTA). Field application was tested by the staff of a clearing and preclearing institution with 33 cases and good practical feasibility was reported. Applying a simple to use screening instrument for refugee minors and their helpers, which is available in several languages creates the possibility of a shared definition of problems and solutions and is beneficial to helpers (e.g. volunteers, youth welfare services and medical doctors) as well as refugee minors.

Cost-effectiveness of intensive home treatment enhanced by inpatient treatment elements in child and adolescent psychiatry in Germany: A randomised trial.

BACKGROUND: Admission rate to child and adolescent mental health inpatient units in Germany is high (54,467 admissions in 2013), resources for providing necessary beds are scarce. Alternative pathways to care are needed. Objective of this study was to assess the cost-effectiveness of inpatient treatment versus Hot-BITs-treatment (Hometreatment brings inpatient-treatment outside), a new supported discharge service offering an early discharge followed by 12 weeks of intensive support. METHODS: Of 164 consecutively recruited children and adolescents, living within families and being in need of inpatient mental health care, 100 patients consented to participate and were randomised via a computer-list into intervention (n=54) and control groups (n=46). Follow-up data were available for 76 patients. Primary outcome was cost-effectiveness. Effectiveness was gathered by therapist-ratings on the Children's Global Assessment Scale (CGAS) at baseline (T1), treatment completion (T2) and an 8-month-follow-up (T3). Cost of service use (health care costs and non-health care costs) was calculated on an intention-to-treat basis at T2 and T3. RESULTS: Significant treatment effects were observed for both groups between T1/T2 and T1/T3 (P<0.001). The Hot-BITs treatment, however, was associated with significantly lower costs at T2 (difference: -6900.47€, P=0.013) and T3 (difference: -8584.10€, P=0.007). Bootstrap cost-effectiveness ratio indicated that Hot-BITs was less costly and tended to be more effective at T2 and T3. CONCLUSIONS: Hot-BITs may be a feasible cost-effective alternative to long inpatient stays in child and adolescent psychiatry. Further rigorous evaluations of the model are required. ( REGISTRATION NUMBER: ISRCTN02672532, part 1, Current Controlled Trials Ltd, URL: http://www.controlled-trials.com).

[Patients of immigrant origin in inpatient psychiatric facilities. Differences between first and second generation: nationwide questionnaire of the Psychiatry and Migration Working Group of the German Federal Conference of Psychiatric Hospital Directors]. / Patienten mit Migrationshintergrund in stationär-psychiatrischen Einrichtungen. Unterschiede zwischen erster und zweiter Generation: Bundesweite Umfrage der Arbeitsgruppe "Psychiatrie und Migration" der Bundesdirektorenkonferenz.

In a representative nationwide survey, the Psychiatry and Migration Working Group of the German Federal Conference of Psychiatric Hospital Directors examined the use of inpatient psychiatric and psychotherapeutic services in Germany by patients of immigrant origin. Questionnaires were sent to a total of 350 general hospital psychiatric clinics throughout Germany and 131 responded by the specified deadline (19 July 2006). In our study, persons of immigrant origin comprised 17% of patients in the responding facilities, which confirmed the results of the pilot study in 2004 of 17.4%. This indicates that the percentage of inpatient psychiatric services used by patients of immigrant origin is almost proportionate to these patients' percentage of the general population (18.6%, Microcensus 2005). In this main study patients of immigrant origin were significantly more likely to receive an ICD-10 F2 diagnosis, and it was precisely patients with this diagnosis who were observed to experience difficulties in communication with caregivers. With reference to the F2 diagnoses there were no noticeable differences between first generation of inpatients with migration history and second generation of inpatients with migration history. There were however more first generation of inpatients with migration history diagnosed with affective disorders whereas more second generation of inpatients with migration history were diagnosed with personality and behavioural disorders. Such differences were not found in the group of patients without immigrant origin. Whilst first generation of inpatients with migration history demonstrated higher educational levels, second generation of inpatients with migration history showed fewer linguistic difficulties.

Patients of immigrant origin in inpatient psychiatric facilities. A representative national survey by the Psychiatry and Migration Working Group of the German Federal Conference of Psychiatric Hospital Directors.

In a representative nationwide survey, the Psychiatry and Migration Working Group of the German Federal Conference of Psychiatric Hospital Directors (Bundesdirektorenkonferenz) examined the use of inpatient psychiatric and psychotherapeutic services in Germany by patients of immigrant origin. Questionnaires were sent to a total of 350 general hospital psychiatric clinics throughout Germany, and 131 clinics responded. As shown by the 2005 Microcensus [22], almost one-fifth (18.6%) of the German population is of immigrant origin. In our study, persons of immigrant origin comprised 17% of patients in the responding facilities. This indicates that the percentage of inpatient psychiatric services used by patients of immigrant origin is almost proportionate to these patients' percentage of the general population. The largest group of immigrant patients in our study were those of Russian heritage, followed by patients of Turkish, Arabic, or other origin. Almost two-thirds of the immigrant patients were born in Germany, and a considerably larger percentage were German citizens (74%). Sixty-two per cent of all patients of immigrant origin spoke a language other than German (e.g. Russian, Turkish, Polish) at home. Patients of immigrant origin were significantly more likely to receive an ICD-10 F2 diagnosis, and it was precisely patients with this diagnosis who were observed to experience difficulties in communication with caregivers.

[Outcome predictors of intermediate-term treatments in inpatient child and adolescent psychiatry]. / Verlaufsprädiktoren mittelfristiger Behandlungen in der stationären Kinder- und Jugendpsychiatrie.

Purpose of this study is to identify predictors of the length of stay (LOS) in child and adolescent psychiatry (CAP) and the success of inpatient treatment. All child and adolescent inpatients that had been dismissed over a year's time from a non-university hospital after a medium-length-treatment were rated by their therapists (crisis interventions for < 2 weeks excluded). The group featured a low drop-out-rate (9.8%) and a high percentage of "problematic patients". The ICD-10 diagnoses were irrelevant for the prediction of LOS and success of treatment. The Global Assessment of Function scale (axis VI) correlated significantly with LOS, and functioning in all areas improved with a longer LOS. By the degree of initial psychopathology therapeutic success as well as LOS could be predicted fairly well. Concerning adolescents, motivation for treatment and the degree of cooperation both correlated with LOS and improvement, which implies the importance of their participation. For children under 12, cumulated psychosocial adversities (axis V) predicted a less positive outcome, cooperation of parents and patients raised the chance of success. Shortened lengths of stay will not lead to comparable success. As a system like DRGs for reimbursement of hospitalization in CAP will not prove to be efficient, other variables deserve more attention in future health economy planning. More intervening variables, such as psychosocial adversities, motivation, and cooperation have to be considered.

[Help in explaining to Turkish-speaking patients about the central affects of pharmaceuticals. Fact or fiction?]. / Hilfen bei der Aufklärung türkischsprachiger Patienten über zentral wirksame Pharmaka. Fact or Fiction?

Handouts in their mother tongue might be helpful in informing patients who do not speak German about medications that are prescribed. A survey among 97 producers of CNS active drugs used in neurology and psychiatry showed that only two patient information leaflets on preparations and nine on specific disorders are available in Germany. The producers who answered were mostly open-minded and mentioned causes like the legal situation and logistic problems.

[Significant barriers to attendance of outpatient psychosocial care facilities for Turkish migrant families from their own point of view]. / Inanspruchnahmebarrieren in der ambulanten psychosozialen Versorgung von türkeistämmigen Migrantenfamilien aus der Sicht der Betroffenen.

In family interviews with 77 families migrated from Turkey, reasons for the low rate of attendance in psychiatric institutions were investigated. The reasons that came up were a preference for intra-family solutions in cases of behavior disorders as well as a lack of information, but not a preponderance of traditional magical approaches. A comparison of families attending a mother-tongue outpatient service with non-attendants failed to demonstrate more intra-family resources in the latter. Families proposed to spread information via ethnic communities and to establish mother-tongue facilities. Since the beginning of such a service a systematic increase in attendance rates was recorded.

Auditory event-related potentials (ERPs) and mismatch negativity (MMN) in healthy children and those with attention-deficit or tourette/tic symptoms.

The study compares 5 auditory event-related potential (ERP) components (P1 to P3) after 3 tones differing in pitch and rarity, and contrasts the mismatch negativity (MMN) between them in 12 children with attention-deficit hyperactivity disorder (ADHD; mean 10.2 years of age), 12 healthy controls pairwise matched for age (controls), and 10 with Chronic Tic or Tourette Syndrome (TS). Topographic recordings were derived from 19 scalp electrodes. Four major effects are reported. (a) Shorter latencies in ADHD patients were evident as early as 100 ms. (b) Both ADHD and TS groups showed very large P2 components where the maxima were shifted anteriorly. The differences in the later potentials were of a topographical nature. (c) Frontal MMN was non-significantly larger in the ADHD group but normalized data showed a left rather than a right frontal bias as in control subjects. Maxima for TS were usually posterior. (d) ADHD patients did not show the usual right-biased P3 asymmetry nor the frontal versus parietal P3 latency difference. From these results it is suggested that ADHD patients process perceptual information faster from an early stage (N1). Further, along with the TS group, ADHD patients showed an unusually marked inhibitory phase in processing (P2), interpreted as a reduction of the normal controls on further processing. Later indices of stimulus processing (N2-P3) showed a frontal impairment in TS and a right hemisphere impairment in ADHD patients. These are interpreted in terms of the difficulties in sustaining attention experienced by both ADHD and TS patients.

[Social work in the child and adolescent psychiatric clinic--aspects of quality assurance within the scope of the psychiatric personnel regulation]. / Die Sozialarbeit in der kinder- und jugendpsychiatrischen Klinik-- Aspekte der Qualitätssicherung im Lichte der Psychiatrie-Personalverordnung.

After defining social work in child and adolescent psychiatry as social therapy, we present the development of our own concept and our experiences, referring to the Psych-PV's professional provisions (Psych-PV being a law ruling the staff: patient ratios in FRG). Social work in the multiprofessional team contributes independently to therapy, and it unquestionably adds to the institutional perspectives.

[Parent counseling by the patient care and guidance team on a child psychiatry unit]. / Elternarbeit durch das Pflege- und Erziehungsteam auf einer kinderpsychiatrischen Station.

A psychoeducational approach of the nursing staff's work with parents is presented. By offering a family visit to the unit prior to admission, systematic preparation of the admission process, reflected interactions with parents during their visits, by parents' evenings and parents' weekends, the nursing team makes a distinct contribution to the families' treatments. Pros and cons are dealt with, concerning issues of professional self-image, goal planning of the team as a whole, structures of team conferences, and supervision. As to evaluation, some parameters (incidence of dismissals for reasons of discipline, withdrawal of children against medical advice, patients referred to care of public authorities after treatment) are discussed for their usefulness.

Serum gonadal steroid hormones in young schizophrenic patients.

Psychosis is reported to show a later age of onset in women than in men and its nature and course in women may also differ. The purpose of this study was to determine if levels of four steroid hormones at the start of early onset psychosis differ from the levels of other groups of young people and if predicted low levels of estrogen (E2) are a feature of female psychosis. Two blood samples from 22 young psychotic patients were analysed by radioimmunoassay for E2, progesterone (PROG), testosterone (TE), and dehydroepiandrosterone sulphate (DHEAS). Female psychotic patients showed E2 levels lower than matched healthy cycling controls but higher than those on a contraceptive pill; they also showed higher TE levels than controls. Male psychotic patients had higher DHEAS levels than healthy or obsessive compulsive disorder (OCD) subjects. We suggest that illness-related changes of steroids can be measured superimposed on medication-induced changes and that lower E2 levels in psychotic women may increase their vulnerability to psychosis. Changes of TE in female and DHEAS in male psychotics may be more a consequence of the illness.

[Self-manipulated disease and Munchausen syndrome in adolescents. A case report]. / Selbstmanipulierte Erkrankung und Münchhausen-Syndrom bei Jugendlichen. Ein kasuistischer Bericht.

In recent years factitious disorders have gained increasing significance in all medical specialties although in child psychiatry publications on this topic are rare. In this article these and other somatoform disorders are discussed with reference to a case report on a 14-year-old girl. Psychodynamic aspects of this syndrome are presented and differentiated from simulation. Conversion syndromes and hysterical neurosis and comparisons are made with other publications on this topic. Treatment of these patients, who repeatedly succeed in subjecting themselves to invasive and sophisticated diagnostic procedures is difficult because of minimal compliance. The prognosis is affected by the extent to which changes in personality structure and development of alternative problem-solving mechanisms can be achieved.

[The importance of school achievements in adolescents with anorectic disorders]. / Die Bedeutung der Schulleistungen bei Jugendlichen mit anorektischen Störungen.

The question of pathologic roots of achievement patterns in girls and boys suffering from anorectic disorders is investigated by empirical and theoretical means. Records of 59 inpatients were reviewed with special emphasis on premorbid school achievement and its development during therapy. 44 completed a catamnestic questionnaire or interview. 10 students performed better, 10 worse. The latter differed in severity of clinical symptoms, duration of stay and continuing therapy, improvement in aggressiveness, recurring menstruation and changes in family interactions. Results are discussed regarding psychodynamic issues.

[Therapeutic communities for after-care of adolescent psychiatric inpatients]. / Therapeutische Wohngemeinschaften in der Nachsorge stationärer jugendpsychiatrischer Patienten.

The study reports experiences with two therapeutic apartments (12 residents) accommodating 30 young adults over a 5-year period. For this age group this kind of aftercare poses special problems: Contrary to previous evidence, patients suffering from psychotic or borderline disorders achieved a much lower level of autonomy than those with neurotic or psychosomatic disturbances and also did significantly worse regarding vocational integration and social contacts. Social contact behavior outside the group was the strongest predictor of the level of autonomy achieved. As the rehospitalization rate was high (50% of all residents), no economizing on inpatient capacities could be expected from this program. However, improvements in the number of staff and in the program itself did lead to a significant decrease in the length of rehospitalizations. Program-related factors that may increase the vulnerability of young people with psychosis are discussed in the context of the general state of psychiatric care.