Tratamiento de adolescentes con trastorno límite en un hospital de día mediante técnicas de la psicoterapia focalizada en la transferencia (TFP) / Day clinic treatment of adolescent borderline patients using the techniques of the transference-focused psychotherapy (TFP) for adolescents / Estudi de prevalença de possible trastorn per dèficit d’atenció i hiperactivitat en nens preescolars

En este artículo se presenta un programa especializado de tratamiento en hospitales de día del Departamento de Psiquiatría Infantil y Juvenil de la Universidad de Colonia de adolescentes con trastorno límite basado en la terapia focalizada en la transferencia (TFP) de Kernberg. Este tratamiento se basa en la definición e interpretación de las díadas de relaciones de objeto del paciente que se dan en la transferencia con el terapeuta, que constituyen la base de sus dificultades y síntomas. Una modificación del tratamiento con los jóvenes es la implicación de los padres, así como las particularidades incluidas en los acuerdos contractuales. Junto con consideraciones conceptuales, se debaten las primeras experiencias acumuladas en el tratamiento en hospitales de día

This paper introduces a specialized day-treatment program for borderline adolescents offered by the child and adolescent psychiatry department of the university clinic of Cologne, based on O. Kernberg‘s concept of transference-focused psychotherapy (TFP). TFP focuses on defining and interpreting the central object relation dyads of the adolescent that appear through transference on the therapist. These dyads are the basis of difficulties and symptoms in these juvenile borderline patients. Including the parents in treatment is one modification of TFP for youth that is presented, along with other modifications in the treatment contract. Conceptual considerations are discussed, and first experiences of the day clinic treatment are described

El nostre ob­jectiu és realitzar un estudi pilot clínic i epidemiològic de trastorn per dèficit d’atenció i hiperactivitat (TDAH) en la població escolar. El mètode emprat ha estat un estudi poblacional multicèntric. Vam avaluar 1.171 preescolars, el 4,1% dels quals corresponien a un possible cas de TDAH. Els possibles factors associats a una presència de sospita de TDAH han estat an­tecedents familiars de TDAH, consum de tabac en l’embaràs i antecedents de dificultats en el desenvolupament psicomotor. És important realitzar una detecció precoç del TDAH en l’època preescolar per iniciar de manera primerenca intervencions efectives

[Effectiveness of psychodynamic psychotherapy in children and juveniles - results of a pilot study]. / Tiefenpsychologisch fundierte Psychotherapie bei Kindern und Jugendlichen.

QUESTION: The effectiveness of psychodynamic psychotherapy for children and adolescents has yet to be studied sufficiently in Germany. Because psychodynamic psychotherapy aims to reduce symptoms in both the short and long term - besides achieving other long-term goals - in this paper we present results focusing on whether symptoms and problem behavior can be improved within 25 h of outpatient psychodynamic psychotherapy taking place in a practice. Moreover, it addresses whether a positive change of life quality can be achieved in the same timeframe. METHOD: Thirty children and juveniles with emotional, behavioral, and adjustment disorders who had received 25 h of psychodynamic psychotherapy were investigated. Parental reports on the Child Behavior Checklist and parental and expert opinions on the DISYPS-KJ were compared before and after therapy. RESULTS: We found significant improvement on almost all measured CBCL scales, but not on the syndrome scales measured with the DISYPS. Predominantly medium-size effects were calculated. But parents did not report an improvement of general life quality of their children during the course of psychotherapy. CONCLUSIONS: Our results indicate that there is an effective reduction of childhood emotional and behavioral symptoms following psychodynamic psychotherapy. The measured timeframe, however, seems to be too short to ensure significant improvements in specific childhood disorders from both parental and expert perspectives.

Factor structure of the Hare Psychopathy Checklist: Youth Version (PCL:YV) in adolescent females.

Despite substantial evidence for the fit of the 3- and 4-factor models of Psychopathy Checklist-based ratings of psychopathy in adult males and adolescents, evidence is less consistent in adolescent females. However, prior studies used samples much smaller than recommended for examining model fit. To address this issue, we conducted a confirmatory factor analysis of 646 adolescent females to test the fit of the 3- and 4-factor models. We also investigated the fit of these models in more homogeneous subsets of the full sample to examine whether fit was invariant across geographical region and setting. Analyses indicated adequate fit for both models in the full sample and was generally acceptable for both models in North American and European subsamples and for participants in less restrictive (probation/detention/clinic) settings. However, in the incarcerated subsample, the 4-factor model achieved acceptable fit on only two of four indices. Although model fit was not invariant across continent or setting, invariance could be achieved in most cases by simply allowing factor loadings on a single Psychopathy Checklist: Youth Version (Forth, Kosson, & Hare, 2003) item to vary across groups. In summary, in contrast to prior studies with small samples, current findings show that both the 3- and 4-factor models fit adequately in a large sample of adolescent females, and the factor loadings are largely similar for North American and European samples and for long-term incarcerated and shorter-term incarcerated/probation/clinic samples.

[Epidemiological data on personality dimensions in the psychopathy of adolescent boys and girls - results of the Cologne GAP study]. / Epidemiologische Daten zu Persönlichkeitsdimensionen der Psychopathy bei Jungen und Mädchen.

OBJECTIVE: This paper evaluates epidemiological data on psychopathy dimensions among adolescents. METHOD: The Psychopathy Checklist Youth Version (PCL:YV) was administered to a forensic sample of 169 boys and 172 girls, to a clinical sample of 30 boys and 63 girls, and to a community sample of 119 male and 116 female pupils. Analysis was based on three different conceptualizations of psychopathy. In total 669 youths between 14 to 19 years were included in the study. RESULTS: Depending on the cutoff used, we found a psychopathy prevalence between 27 % and 63 % among the incarcerated boys, and from 7 % and 24 % among the incarcerated girls. The clinical and the community samples showed higher scores on the behavior and lower scores on the core personality dimensions. All samples indicated significantly more psychopathy dimensions in boys than in girls. CONCLUSIONS: Varying rates of prevalence are found when using different models for analyzing the PCL:YV. The extent of age-typical adolescent and antisocial behavioral dimensions represented by the Lifestyle and the Antisocial Factor inflates the total PCL:YV score without presenting increased scores in the psychopathy core dimensions. Prospectively, the two core personality dimensions of psychopathy should be studied more closely.

[The differentiation between identity crisis and identity diffusion and its impact on treatment]. / Differenzierung zwischen Identitätskrise und Identitätsdiffusion und ihre Bedeutung für die Behandlung.

The differentiation between an identity crisis, a transient phenomenon that usually results (after resolution) in a well-integrated identity with flexible and adaptive functioning, and an identity diffusion that is viewed as a basis for subsequent personality pathology, has a major impact on the selection of a treatment method. A new treatment method (Adolescent Identity Treatment, AIT), a modification of Transference Focused Psychotherapy, was developed to treat adolescents with identity diffusion in order to improve their relationships with friends, parents, and teachers and to help them acquire positive self-esteem, clarify life goals and establish a stable identity. In a case study we describe the basic approaches of AIT in assessment and treatment.

[Psychopathy, temperament and antisocial behaviour in girls]. / Psychopathy-, Temperaments- und Charakterdimensionen bei inhaftierten Mädchen.

OBJECTIVE: This study addresses the question whether temperament and character differ between antisocial incarcerated girls with and without psychopathy. Furthermore, it enquires whether this model discriminates between groups with varied psychopathy symptoms. METHOD: 170 incarcerated girls aged 14 to 17 years were examined using the German version of the Junior Temperament and Character Inventory (JTCI 12-18) and the Psychopathy Checklist Youth Version (PCL:YV). On the basis of the PCL:YV scores the girls were divided into three high-scoring psychopathy groups and compared to a group without psychopathy. RESULTS: Three-quarters of the juvenile criminals did not show psychopathy; the percentage of those scoring high on the psychopathy core dimensions was only 7%. With the aid of Cloninger's model of personality, differences in the psychopathy groups as compared to the nonpsychopathy group were identified regarding the dimensions novelty seeking, reward dependence, cooperativeness and self-transcendence. However, specific relationships between individual psychopathy dimensions and the JTCI-factors could not be identified. CONCLUSIONS: The results confirm the existence of the psychopathy construct in female delinquents, though the percentage of girls with core psychopathy dimensions is very small. The differentiating temperament factors found among girls scoring high on psychopathy dimensions as opposed to girls without psychopathy indicate that psychopathy is a valid construct that can identify a specific subgroup of antisocial girls with core psychopathy symptoms.

The relationship between attention deficit hyperactivity disorder, conduct disorder, and psychopathy in adolescent male and female detainees.

Although ADHD and CD are apparent risk factors for adult psychopathy, there are three distinct perspectives regarding their relationships to psychopathy: (1) ADHD may contribute uniquely to the development of psychopathy or (2) its contribution may reflect its high comorbidity with CD. Alternatively, (3) the comorbid presence of ADHD and CD may confer unique risk for the development of psychopathy. Although prior adult studies have yielded conflicting findings, no prior studies of adolescents address this issue. We examined these three hypotheses and the possibility of sex differences using cross-sectional analyses in 90 male and 123 female incarcerated adolescents. Among males the influence of ADHD was largely attributable to the overlap between ADHD and CD, whereas among females ADHD contributed independently to psychopathy scores and to scores on several dimensions of psychopathy. In addition, among females, the ADHD x CD interaction was significant for the total score and the antisocial component of psychopathy and in a direction opposite to that predicted by the comorbid subtype hypothesis. These findings indicate that there may be sex-specific pathways to elevations in psychopathic traits and suggest that the comorbid subtype hypothesis is probably not correct for either boys or girls.

Factor structure of the Hare Psychopathy Checklist: youth version in German female and male detainees and community adolescents.

Substantial evidence exists for 3- and 4-factor models of psychopathy underlying patterns of covariation among the items of the Psychopathy Checklist-Revised (PCL-R) in diverse adult samples. Although initial studies conducted with the Psychopathy Checklist: Youth Version (PCL:YV) indicated reasonable fit for these models in incarcerated male adolescents in the United States and the United Kingdom, only one published study has addressed the factor structure of PCL:YV psychopathy in female adolescents, and no prior studies have addressed it outside of these countries. We used confirmatory factor analysis to investigate the factor structure underlying PCL:YV scores in 314 incarcerated (143 male, 171 female) and 193 in-school (99 male, 94 female) adolescents, ages 14 to 19 years. The 2-factor model provided adequate fit only for incarcerated male adolescents and the 4-factor model was problematic in all samples, but the 3-factor solution provided an adequate model in incarcerated and community male adolescents. None of the models provided consistently acceptable fit among female adolescents. Current findings provide evidence for the robustness of the 3-factor model of psychopathy in incarcerated and community male adolescent samples but raise doubts about the applicability of this model to female adolescents. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Examining relations between psychopathology and psychopathy dimensions among adolescent female and male offenders.

AIM: This study was performed to investigate relations between psychopathology and psychopathy in adolescent female and male detainees. METHOD: We examined 91 male and 123 female adolescent detainees (aged 14-19) for psychopathology -using the Youth Self Report, the Overt Aggression Scale-Modified and a Conduct Disorder Self Report Scale- and for psychopathic dimensions using the psychopathy checklist youth version (PCL:YV). Based on a linear regression analysis we compared the specific associations between psychopathology and psychopathy in both male and female delinquent juveniles. RESULTS: Our results revealed higher scores for externalizing behavior and psychopathic dimensions in delinquent males, and higher internalizing problem scores in delinquent females. Furthermore, we found a positive relationship between suicidal behavior and the psychopathy total score as well as the affective, the lifestyle and the antisocial dimension only in girls. No association was found for suicidal behavior in boys. Regarding anxious-depressive behavior, we found a negative relation to the psychopathy total score and to the affective psychopathy factor for the boys. CONCLUSION: Expectedly, the population of incarcerated adolescents exhibited a high prevalence of psychopathology. At the same time our results referred to meaningful gender-related differences with respect to associations with psychopathy. The gender-related differences in psychopathological symptoms could indicate varied subtypes of psychopathy in boys and girls.

[Attention-deficit hyperactivity disorder and personality disorders in treated in-patient and incarcerated adolescents]. / Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung und Persönlichkeitsstörungen bei klinisch behandelten und bei inhaftierten Jugendlichen.

Prevalence and comorbidity of attention-deficit hyperactivity disorder (ADHD) and personality disorders (PD) were studied in a sample of juvenile in-patients (n = 43) and a sample of detained adolescents. The prevalence of ADHD showed no difference between detainees and in-patients, but significantly more incarcerated girls than boys reported ADHD-symptoms. PD and comorbid PDs were significantly more prevalent in the detained sample: whereas the in-patient juveniles fulfilled more often criteria for passive-avoidant and obsessive-compulsive PD, the detainees showed more antisocial PD (ASPD) and narcissistic PD. Incarcerated boys showed more paranoid, narcissistic and antisocial PD, detained girls more borderline PD (BPD). The incarcerated adolescents with BPD reported significantly more ADHD during childhood and current hyperactivity; the detainees with ASPD had more often hyperactivity during childhood. Furthermore, for both genders most and greatest correlations were found for ADHD and psychopathy. Moreover, there were significant relations between BPD and hyperactivity as well as impulsive behaviour. The incarcerated boys showed correlations between ASPD and ADHD and early impulsivity; in detained girls BPD and hyperactivity were associated and PD-dimensions and ADHD. This study indicates that ADHD and PD are often found disorders in juvenile at-risk populations which show on the one hand gender related prevalence differences and on the other hand significant overlap. This result contributes to the ongoing discussion on the conceptual handling of both diagnoses on the basis of current classification systems.

[Transference focused psychotherapy for adolescents: a preliminary communication]. / Ubertragungsfokussierte Psychotherapie für Jugendliche: Der vorläufige Stand.

This article describes transference focused psychotherapy and its treatment strategies for the psychoanalytic treatment of severe personality disorders. The specific modifications proposed for the treatment of adolescent patients with this disorder are discussed. Elaborately, we dwell on the assessment phase for evaluating adolescents with the specific modifications regarding contract setting and inclusion of parents and caregivers in the beginning of und during psychotherapy. Besides the modified treatment strategies the interventions or "treatment tactics" and specific "treatment techniques" are recommended which are essential during the treatment of adolescents with severe personality disorders.

[Treatment of an 11-year-old child with elements of the dialectical behavioral therapy for adolescents]. / Behandlung eines 11-jährigen Kindes mit Elementen der Dialektisch-Behavioralen Therapie für Adoleszente.

When a psychiatric disorder during childhood is on the verge of becoming chronic despite intensive early and guideline-based psychotherapy, the diagnostic classification according to research results ought to be reconsidered. By means of this case review it should be discussed which diagnostic and therapeutic procedure is appropriate, taking into account the stage of development and the pathology of the patient. This paper encourages sharpening the eye towards phenomena that--with respect to some disorders--can easily be ignored and be misinterpreted as typically conflict neurotic.

Early traumatization and psychopathy in female and male juvenile offenders.

Childhood traumatization is expected to have a significant impact on the development of antisocial and aggressive behavior in adulthood. Psychopathy as a syndrome that can predict future violent and aggressive behavior in adults is therefore believed to be associated with early traumatization. The association between early childhood victimization and violence might at least be mediated through psychopathy. The present study examined the relationship between early emotional, physical or sexual trauma and neglect and psychopathy in incarcerated delinquent female and male juveniles using the Childhood Trauma Questionnaire (CTQ) and the Psychopathy Checklist-Youth Version (PCL-YV). A sample of detained adolescents (n=185) was compared to adolescent students (n=98). Also, gender differences were analyzed with respect to the association of trauma and psychopathy. As expected, our analyses revealed higher scores of traumatization in delinquent juveniles compared to school adolescents. Hypothesized relationships between physical traumatization and the PCL-YV total score could be confirmed among criminal boys, but not among delinquent girls. Results, therefore, indicated that an association exists between early physical, but also emotional traumatic experience and psychopathy in detained boys. In girls, however, other family-related variables, such as non-parental living arrangements, seemed to be more influential in developing the psychopathy syndrome than traumatization.

Dimensional assessment of personality pathology in female and male juvenile delinquents.

A developmental perspective implies similar personality pathology dimensions for adolescents and adults. The present study examined the applicability of a dimensional approach in incarcerated delinquent female and male juveniles using the Dimensional Assessment of Personality Pathology-Basic Questionnaire (DAPP-BQ). A sample of detained adolescents (n = 146) was compared to adolescent students (n = 98) and a healthy control group of adults (n = 82). Additionally, psychopathology was assessed in the incarcerated juveniles using the Youth Self Report (YSR). Analyses of variance revealed higher scores on personality disorder traits for juveniles compared to adult controls; the highest scores were observed in criminal juveniles. Hypothesized relationships could be confirmed within the criminal sample between the DAPP factor Emotional Dysregulation and the YSR Internalization syndrome scale, and between the DAPP factor Dissocial Behavior and the YSR Externalization syndrome scale. Moreover, gender differences in the criminal sample are discussed. Results indicate that the DAPP-BQ can assess personality disorder traits in delinquent and nondetained juveniles with sufficient group and criterion validity.

Motives for maternal filicide: results from a study with female forensic patients.

The objective of this study was to examine different motivational factors, leading mothers to commit neonaticidal, infanticidal or filicidal acts. This study was based on data gathered through a retrospective chart review of all filicidal women admitted to the Mid-Hudson Forensic Psychiatric Hospital in New York State (MHFPC) between 1976 and 2000 (n=57). Because our sample was drawn from MHFPC records it excludes filicidal mothers who went directly to prison. Our women were either found not competent to stand trial, or found not guilty by reason of insanity, or were convicted offenders who were seriously mentally ill and were not sent to prison. Fourteen percent committed neonaticide, meaning that they killed their child within the first day of its life; 21% killed the child after the first day but before it reached its first birthday (infanticide); and 65% committed filicide by murdering a child older than one. Two groups of women could be identified as having different motivational profiles: The neonaticidal mothers were mostly troubled by psychosis and social problems while the filicidal women were defined as severely depressed, with a history of self-directed violence and a high rate of suicide attempts following the filicidal offense.

[The psychopathy-concept and its psychometric evaluation in childhood and adolescence]. / Das Psychopathy-Konzept nach Hare als Persönlichkeitsdimension im Jugendalter? Literaturübersicht und Fallbeispiele.

In accordance with Robert Hare's concept, over twenty years the word psychopathy is used to describe a specific combination of affective and interpersonal traits in adults as subtype of antisocial personality disorder. Recently in North America personality traits of psychopathy have also been studied in juveniles (and children). The Psychopathy Checklist: Youth Version (PCL-YV) was developed to take the special conditions of adolescents into account and focuses on assessing personality dimensions from age 12 upwards. In juveniles with a high score, research with the PCL-YV demonstrated for example a lack of empathy, impulsivity and social adjustment disorder. Furthermore, researchers found associations between the number and severity of violent offences, early drug abuse and heightened recidivism. This paper discusses the concept of psychopathy for adolescents on the basis of 3 case reports. Biological determinants, experimental results and diagnostic aspects are described.

[Less severe sexual child abuse and its sequelae: are there different psychic and psychosomatic symptoms in relation to various forms of sexual interaction?]. / Minderschwere sexuelle Kindesmisshandlung und ihre Folgen. Finden sich unterschiedliche psychische und psychosomatische Symptome in Verbindung mit verschiedenen Formen sexueller Interaktion?

A typology of less severe sexual encounters was used to analyze short and long term sequelae of sexual abuse via intimate skin contact. Well known theoretical approaches on the harmful effects of sexual abuse were tested. Do we find different peri- and posttraumatic reactions dependent upon varied forms of sexual interactions with children? A cluster analysis was calculated with symptom variables that were described in 141 child statements taken out of written expert opinions. Afterwards variance analyses of these symptom clusters were conducted in reference to six different abuse constellations. Different symptom profiles were found for these six abuse constellations. Panic symptoms, shame related feelings, avoidant behavior and physical reactions showed significant results. The sequelae to different forms of less severe sexual child abuse differ and depend more upon the situational dynamic than upon the kind of relationship between adult and child.