Psychometric properties of the German version of the pregnancy-related anxiety questionnaire-revised 2 (PRAQ-R2) in the third trimester of pregnancy.

BACKGROUND: Pregnancy-related anxiety (PrA) has been identified as a construct distinct from general stress and anxiety with a negative impact on birth and child outcomes. Validated instruments with good psychometric properties to assess pregnancy-related anxiety in German-speaking expectant mothers are still lacking. The Pregnancy-Related Anxiety Questionnaire revised for its use independent of parity (PRAQ-R2) assesses fear of giving birth (FoGB), worries of bearing a physically or mentally handicapped child (WaHC) and concerns about own appearance (CoA). The aim of this study was to investigate the psychometric properties of the PRAQ-R2 in a German sample of pregnant women in their third pregnancy trimester. METHODS: The PRAQ-R2 and several questionnaires measuring different forms of anxiety as well as depressive symptoms and perceived general self-efficacy were administered cross-sectionally in a sample of nulliparous and parous women (N = 360) in the third trimester of pregnancy. RESULTS: Reliability was satisfactory to excellent for the PRAQ-R2 total scale (Cronbach's α = .85) and the subscales (α = .77 to .90). Confirmatory and exploratory factor analysis confirmed the three-factorial structure of the instrument. The three factors together explained 68% of variance. Construct validity was confirmed by positive low- to moderate-sized correlations of the PRAQ-R2 total score and the subscales with measurements of anxiety and depression and by negative low correlations with general self-efficacy. CONCLUSIONS: The German version of the PRAQ-R2 is a valid and feasible measurement for pregnancy-related anxiety for research and clinical practice.

Early detection and integrated care for adolescents and young adults with psychotic disorders: the ACCESS III study.

OBJECTIVE: The objective of the study was to investigate whether a combined intervention composed of early detection plus integrated care (EDIC) enhances outcomes in patients with early psychosis compared to standard care (SC). METHODS: ACCESS III is a prospective non-randomized historical control design 1-year study examining the efficacy of EDIC (n = 120) vs. SC (n = 105) in patients aged 12-29 years. Primary outcome was the rate of ≥6 months combined symptomatic and functional remission. Additional outcomes comprised the reduction of DUP and course of psychopathology, functioning, quality of life, and satisfaction with care. RESULTS: In observed cases, 48.9% in the EDIC and 15.2% in the SC group reached the primary endpoint. Remission was predicted by EDIC (OR = 6.8, CI: 3.15-14.53, P < 0.001); younger age predicted non-remission (OR = 1.1, CI: 1.01-1.19, P = 0.038). Linear regressions indicated a reduction of DUP in EDIC (P < 0.001), but not in SC (P = 0.41). MMRMs showed significantly larger improvements in PANSS positive (P < 0.001) and GAF (P < 0.01) scores in EDIC vs. SC, and in EDIC over time in CGI-Severity (P < 0.001) and numerically in Q-LES-Q-18 (P = 0.052). CONCLUSIONS: EDIC lead to significantly higher proportions of patients achieving combined remission. Moderating variables included a reduction of DUP and EDIC, offering psychotherapeutic interventions.

Mental Health Care Use in Children of Parents with Mental Health Problems: Results of the BELLA Study.

Whether parental mental health problems facilitate or hinder the use of mental health care of the parents´ children is still unclear. The present cross sectional study examined mental health care use and potential predictors in a population based sample. Children of parents with mental health problems (CPM) were nearly 5 times more likely to use mental health care compared to children of parents without mental health problems. A multiple regression analysis revealed that the most important predictors of mental health care use for CPM were active family life (OR = 2.67) and children´s own mental health problems (OR = 1.18 self-report, 1.17 parent-report). Additionally, parental strain showed a tendency to predict mental health care use (OR = 2.45). This study demonstrates that parental mental health problems are associated with mental health care use in their children and that improving certain family factors may support children´s mental health care use.

[Integrated care for patients with first and multiple episodes of severe psychotic illnesses: 3-year results of the Hamburg model]. / Integrierte Versorgung für erst- und mehrfacherkrankte Patienten mit schweren psychotischen Erkrankungen : 3-Jahres-Ergebnisse des Hamburger Modells.

BACKGROUND: The so-called "Hamburg model" is a designated integrated care model according to § 140 of the Social Code Book (SGB) V for psychosis patients fulfilling the definition of severe mental illness (SMI). OBJECTIVES: Description of the model and evaluation of efficacy of all patients being treated for ≥ 3 years. MATERIALS AND METHODS: Service entry illness status, course of illness, and interventions were assessed within a continuous quality assurance study. One hundred and fifty-eight patients who fulfilled the criterion of being treated for ≥ 3 years were analyzed. RESULTS: At service entry, SMI were among others mirrored by a high level of psychopathology (Brief Psychiatric Rating Scale [BPRS]: 80.3) and severity of illness (Clinical Global Impression Severity [CGI-S]/Clinical Global Impression Bipolar scales [CGI-BP]: 5.8), low functioning level (Global Assessment of Functioning scale [GAF]: 35.9), and high rates of comorbid psychiatric (94.3 %) and somatic (81.6 %) disorders. Only 8 patients (5.1 %) disengaged from the service within the 3-year treatment period. The course of the illness over 3 years showed significant and stable improvements in psychopathology (BPRS: p < 0.001), the severity of illness (CGI-S/CGI-BP: p < 0.001), functioning (GAF: p < 0.001), quality of life (Quality of Life Enjoyment and Satisfaction Questionnaire [Q-LES-Q-18]: p < 0.001), and satisfaction with care (Client Satisfaction Questionnaire [CSQ-8]: 2.0 to 3.3; p = 0.164; nonsignificant because of early improvements). Further, compulsory admissions were reduced and medication adherence in addition to working ability improved (all p < 0.001). Data on interventions showed a continuously high frequency of outpatient interventions over time (on average 112.0 per year), a high percentage of patients in psychotherapy (67 %), and a nearly 90 % reduction in inpatient treatment days from year 1 to year 3. CONCLUSION: Integrated care in severely ill patients with psychotic disorders leads to multidimensional illness improvement and stabilization by offering intensive outpatient care.

[Mental health of children, adolescents and young adults--part 1: prevalence, illness persistence, adversities, service use, treatment delay and consequences]. / Die psychische Gesundheit von Kindern, Jugendlichen und jungen Erwachsenen--Teil 1: Häufigkeit, Störungspersistenz, Belastungsfaktoren, Service-Inanspruchnahme und Behandlungsverzögerung mit Konsequenzen.

Numerous birth-control studies, epidemiological studies, and observational studies have investigated mental health and health care in childhood, adolescence and early adulthood, including prevalence, age at onset, adversities, illness persistence, service use, treatment delay and course of illness. Moreover, the impact of the burden of illness, of deficits of present health care systems, and the efficacy and effectiveness of early intervention services on mental health were evaluated. According to these data, most mental disorders start during childhood, adolescence and early adulthood. Many children, adolescents and young adults are exposed to single or multiple adversities, which increase the risk for (early) manifestations of mental diseases as well as for their chronicity. Early-onset mental disorders often persist into adulthood. Service use by children, adolescents and young adults is low, even lower than for adult patients. Moreover, there is often a long delay between onset of illness and first adequate treatment with a variety of linked consequences for a poorer psychosocial prognosis. This leads to a large burden of illness with respect to disability and costs. As a consequence several countries have implemented so-called "early intervention services" at the interface of child and adolescent and adult psychiatry. Emerging studies show that these health-care structures are effective and efficient. Part 1 of the present review summarises the current state of mental health in childhood, adolescence and early adulthood, including prevalence, age at onset, adversities, illness persistence, service use, and treatment delay with consequences.

[Mental health of children, adolescents and young adults--part 2: burden of illness, deficits of the German health care system and efficacy and effectiveness of early intervention services]. / Die psychische Gesundheit von Kindern, Jugendlichen und jungen Erwachsenen--Teil 2: Krankheitslast, Defizite des deutschen Versorgungssystems, Effektivität und Effizienz von "Early Intervention Services"

Numerous birth-control studies, epidemiological studies, and observational studies investigated mental health and health care in childhood, adolescence and early adulthood, including prevalence, age at onset, adversities, illness persistence, service use, treatment delay and course of illness. Moreover, the impact of the burden of illness, of deficits of present health care systems, and the efficacy and effectiveness of early intervention services on mental health were evaluated. According to these data, most mental disorders start during childhood, adolescence and early adulthood. Many children, adolescents and young adults are exposed to single or multiple adversities, which increase the risk for (early) manifestations of mental diseases as well as for their chronicity. Early-onset mental disorders often persist into adulthood. Service use of children, adolescents and young adults is low, even lower than in adult patients. Moreover, there is often a long delay between onset of illness and first adequate treatment with a variety of linked consequences for poorer psychosocial prognosis. This leads to a large burden of illness with respect to disability and costs. As a consequence several countries have implemented so-called "early intervention services" at the border of child and adolescent and adult psychiatry. Emerging studies show that these health care structures are effective and efficient. Part 2 of the present review focuses on illness burden including disability and costs, deficits of the present health care system in Germany, and efficacy and efficiency of early intervention services.

[Psychological comorbidity in children and adolescents with chronic somatic diseases]. / Psychische Komorbidität bei chronisch somatischen Erkrankungen im Kindes- und Jugendalter.

This article analyzes emotional and behavioral problems in children and adolescents with chronic somatic disorders. Within the German Health Interview and Examination Survey for Children and Adolescents (Kinder- und Jugendgesundheitssurvey, KIGGS), chronic somatic conditions and obesity were assessed in 11,529 children and adolescents aged 7-17 years old. Special health care needs (CSHCN), emotional and behavioral problems (SDQ), as well as personal, familial, and social resources were surveyed. About 10.8% of the respondents displayed special health care needs and declared a chronic somatic disorder. Of these cases, 20.6% were classified as abnormal in the SDQ (non-somatic conditions: 6.4%). In a logistic regression analysis, male gender (OR=2.0), low socioeconomic status (Winkler index; OR=2.6), family structure (OR>1), and deficits in familial (OR=2.4) and personal (OR=2.1) resources were found to be significantly associated with psychological comorbidity in chronic somatic conditions. The results confirmed previous findings. Especially socioeconomic, structural, and functional aspects of a family have to be considered in the development and prevention of psychological comorbidity in chronic somatic conditions in childhood and adolescence.

[Diffusion tensor imaging (DTI) and its importance for exploration of normal or pathological brain development]. / Diffusion Tensor Imaging (DTI) und seine entwicklungspsychiatrische Bedeutung.

Diffusion tensor MR imaging (DTI) can provide in vivo unique information on integrity of white matter structures (anisotropy) and connectivity (fiber tracking) in the human brain. This is made possible by means of non-invasive MR-based technique. The purpose of this article is to review the method and the current applications of diffusion tensor MR imaging. Studies of the past decade featuring relevant neuropsychiatric disorders as well as disorders in child psychiatry are reviewed. Furthermore, this report offers a summary of DTI-studies in children and adolescents showing alterations in brain or CNS structures including neurological, traumatological and oncological investigations. In particular, it focuses on the importance of this method with respect to exploration of normal and pathological brain development.

[AWMF-guideline: cocaine-, amphetamine-, ecstasy- and hallucinogen-related disorders]. / AWMF-Behandlungsleitlinie: Psychische und Verhaltensstörungen durch Kokain, Amphetamine, Ecstasy und Halluzinogene.

Actually, guidelines for treatment of substance-related disorders were written under the overall control of the DG-Sucht e. V. and the DGPPN e. V. This appears within the framework of the Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaft (AWMF). The leading objective of these guidelines is the description of the current scientifically proven and evidence-based medicine in addiction to derive recommendations to therapy. In this context, the guideline for treatment of cocaine-, amphetamine-, ecstasy-, and halluzinogen-related disorders is introduced.

[Expressed emotion and the outcome of child and adolescent psychiatric disorders]. / Expressed Emotion im Verlauf kinder- und jugendpsychiatrischer Störungen.

OBJECTIVE: The review discusses empirical research on the association of "Expressed Emotion" (EE) and the outcome of child and adolescent psychiatric disorders. METHOD: A comprehensive search in the databases Medline, PsycINFO and PSYNDEX was performed. Moreover, publications cited in the reference sections were taken into consideration. RESULTS: Empirical data suggest that EE is a predictor of the outcome of depressive and eating disorders in childhood and adolescence, but not of behavioural disorders and ADHD. There are no studies on EE and its influence on anxiety disorders and - surprisingly - only two case studies on EE and schizophrenia in childhood and adolescence. Across psychiatric groups there is an association between behavioural disturbances of the child and parental criticism and an association of child anxiety and parental emotional over involvement. Data suggest that EE is not a stable variable. There is some evidence that a high-EE-status of parents transforms from a state into a trait variable. CONCLUSION: Further studies on the predictive validity of EE for the outcome of child adolescent psychiatric disorders are warranted, as well as studies on variables of the parents and their offspring, which are associated with EE and with the entrenchment of EE with the progress of the disorder. Child and adolescent psychiatrists may contribute to a large research area with studies on the early development of high-EE. The mutual goal is the development of effective early family interventions.

[Risks and resources for mental health of children and adolescents]. / Risiken und Ressourcen für die psychische Gesundheit von Kindern und Jugendlichen.

Children's and adolescents' mental health is an epidemiological outcome of considerable public health relevance. This is based on a comparably high prevalence of mental health problems and disorders in children and adolescents. The supplementary study 'Mental Health', which is a modular part of the Health Survey for Children and Adolescents conducted by the Robert Koch Institute, aims at assessing the prevalence of specific mental health problems and disorders in a representative sample of children and adolescents in Germany. Furthermore, determinants of mental health will be studied in a developmental context. Screening to assess mental health problems will be performed in a representative sub-sample of the National Health Survey for Children and Adolescents. The sub-sample will comprise approximately 4,000 children and adolescents aged 7 to 17 years. Participants are interviewed once to assess the occurrence of risk factors and available assets (protective factors) for mental health, thus providing valuable data for health monitoring and planning (cross-sectional part of the study). A sub-group of this cross-sectional sample as well as an additional clinical sample are repeatedly studied in a longitudinal design. This part of the study is carried out to estimate the effect size of risk and protective factors on mental health, and to analyse their combined effects on the developmental process. From the findings, clues to effective prevention and intervention strategies can be derived.

[Day clinic treatment in child and adolescent psychiatry]. / Die tagesklinische Behandlung in der Kinder- und Jugendpsychiatrie.

OBJECTIVES: The history of day treatment in child and adolescent psychiatry in Germany is brief. Accordingly, day treatment programs deal primarily with programming, outcome studies and indications/contraindications. METHODS: This article reviews the English- and German-language literature between 1960 and 2000 relevant to the outcome of day treatment in child and adolescent psychiatry. Outcome studies are discussed. RESULTS: Outcome studies do not yet allow decisions about for whom day treatment does or does not exactly work. Nonetheless, evidence from the literature suggests that day treatment does work for many different disorders in child and adolescent psychiatry. The predictive value of parental involvement in therapy for outcome is supported by several studies. CONCLUSIONS: In addition to randomized controlled outcome studies, effectiveness studies of single day treatment programs are useful and should deliver the data on the kinds of children, treatment goals and results for which a program in a specific regional mental health care system is effective.

[Trichobezoar in a 16-year old girl. Case report and review of literature]. / Trichobezoar bei einem 16-jährigen Mädchen. Kasuistik und Literaturübersicht.

We present the case of a 16-year-old girl with a 12-year history of trichotillomania and trichotillophagia in combination with mental retardation and early childhood deprivation, all contributing to the growth of a stomach ulcer and an oversized, stomach-shaped trichobezoar which had to be removed by gastrotomy. Included are a discussion of psychodynamic aspects, therapeutic strategies, and significant literature, concluding with a short, historic view on the varieties and therapy of bezoars.

[Brief report of the working group OPD-CA (children and adolescents) Axis I: subjective dimensions, resources, and preconditions for treatment]. / Werkstattbericht der Arbeitsgruppe Achse I: Subjektive Dimensionen, Ressourcen und Behandlungsvoraussetzungen.

The progress of work in adaptation axis I of OPD (operationalized psychodynamic diagnostic) to axis I OPD-CA (children and adolescents) is delineated. The items are now classified as subjective dimensions, resources and preconditions for treatment. Overlapping with the multi-axial classification for children and adolescents as used in Germany (MAS) was eliminated and important items for child and adolescent psychiatric and psychotherapeutic treatment were added. In the field of personal dimensions only subjective impairment will be covered. Resources were accentuated for the benefit of peer relationships. Motivation for treatment is now differentiated between a more global motivation for change and motivation for psychotherapeutic treatment. In order to reduce ambiguity the term of compliance was transformed into ability for therapeutic agreement. The possibility of realization of therapeutic indication was added.

[How can psychodynamic diagnosis in childhood and adolescence be operationalized?]. / Wie ist psychodynamische Diagnostik im Kindes- und Jugendalter operationalisierbar?

Multiaxial diagnostics and classifications in child and adolescent psychiatry based on ICD-10 generally now have been operationalized. Initial procedures to operationalize psychodynamically oriented concepts are currently underway. One of them is the operationalized psychodynamic diagnostics (OPD), which consists of five axes: illness concepts and treatment predispositions, human relationships, intrapsychic conflict, psychic structure, and the ICD-10. A team is currently adapting the adult version of the OPD for use in children and adolescents. Such an OPD-CA would affiliate with the MAS, a well-established system of classification. Central methodological and conceptual topics of the OPD-CA are presented.

[Operationalized psychodynamic diagnosis in childhood and adolescence--a contribution to quality assurance]. / Operationalisierte psychodynamische Diagnostik im Kindes- und Jugendalter--Ein Beitrag zur Qualitätssicherung.

Adopting a therapeutic view on diagnosis in child and adolescent psychiatry a psychodynamic diagnostic manual seems to be necessary, that may provide reliability in the assessment of intrapsychic processes. Multiaxial diagnosis of children's and adolescent's psychiatric disturbances may thus be completed with additional psychodynamic assessment procedures. In adults an operationalized procedure of psychodynamic assessment (OPD) already exists. In child and adolescent psychiatry a working group for psychodynamic diagnostic (OPD-KJ) has been founded. In 4 areas (subjective experiences of disturbances, relationships, intrapsychic conflicts and psychic structure) diagnostic manuals are being worked out. Fundamental questions of developmental psychopathology and diagnostic procedures have to be addressed. The basic proposition takes into account that children should not be psychodynamically compared with adults, but normally have a basic capacity to adapt to environment on a high level of psychic organisation in all developmental stages. Reports of the ongoing work are being given.

[Trichobezoar. A rare cause of recurrent upper abdominal pain]. / Der Trichobezoar. Eine seltene Ursache rezidivierender Oberbauchschmerzen.

Recurrent abdominal pain in a two years old toddler and a sixteen years old girl were caused by huge trichobezoars, which in one case had a weight of 412 g and provoked a gastric ulcus. Removal was possible only by gastrotomy. Deprivation in infancy and childhood in combination with slight mental retardation had led the teenager to trichtillomania and -phagia for years and finally to a bezoar. A short historic survey of the variety and therapy of bezoars is added.