Trauma Informed Interventions to Reduce Seclusion, Restraint and Restrictive Practices Amongst Staff Caring for Children and Adolescents with Challenging Behaviours: A Systematic Review

Engaging with children and adolescents in mental health settings who are exhibiting behaviours that challenge can often result in the use of seclusion, restraint and coercive practices. It is recognised that more therapeutic ways to engage this population are needed, adopting trauma informed interventions may provide a solution. The aim of this systematic review is to synthesize the evidence in relation to the effect of trauma-informed interventions on coercive practices in child and adolescent residential settings. The review is guided by elements of the Cochrane Handbook for Systematic Reviews of Interventions and reported using the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist. Results were synthesized and reported narratively. Nine studies met the eligibility criteria for this review. There was a lack of homogeneity amongst the studies. The trauma-informed interventions used were typically multi-faceted, underpinned by a variety of approaches and sought to bring about changes to clinical practice. Most studies (n = 8) reported significant reductions in the use of restrictive practices following the implementation of a trauma informed approach. The use of a trauma-informed approach, underpinned by an organisational change or implementation strategy, have the potential to reduce coercive practices with children and adolescents. However, the included interventions were insufficiently described to draw strong conclusions.

Mental health literacy among primary healthcare workers in South Africa and Zambia

BACKGROUND

In developing countries, mental health literacy (MHL) still needs to be improved due to the high prevalence of mental disorders. It is widely recognized that MHL can improve health outcomes for both individuals and populations. Healthcare professionals' development in MHL is crucial to the prevention of mental disorders. The aim of this study was to assess MHL of primary healthcare (PHC) workers in South Africa (SA) and Zambia and determinants thereof. Limited evidence is available on the levels of MHL among PHC workers in the sub-Saharan Africa region, which faces a large burden of mental disorders.

METHODS

The study population for this cross-sectional survey comprised PHC workers (n = 250) in five provinces of SA and Zambia. MHL was measured with the Mental Health Literacy Scale (MHLS). We conducted a multivariate analysis to explore determinants of MHL.

RESULTS

Results showed moderate MHL among PHC professionals, but with a wide range from low to high MHL. Knowledge-related items had a greater dispersion than other attributes of MHL. PHC workers with more education showed a greater ability to recognize mental health-related disorders. Those who had experience in the use of mental health-related assessment scales or screening tools reported a higher total MHL. The results confirmed strong internal consistency for the MHLS.

CONCLUSION

The results highlighted varying mental health perceptions and knowledge in PHC. Implementation of specifically developed formal training programs and interventions to improve MHL in PHC workers to strengthen their competence may help bridge the treatment gap.

Development of a Mobile Application for Detection of Adolescent Mental Health Problems and Feasibility Assessment with Primary Health Care Workers

Introduction: There has been a sharp increase in the use of digital health interventions in global health, particularly mobile health applications, in recent years. The extreme shortage of health care providers trained in mental health screening and intervention in low- and middle-income countries raises questions about the applicability of mobile applications to deliver these services due to their accessibility and availability. This exploratory paper describes the development and feasibility assessment of a mobile screening application for the detection of mental disorders among adolescents in Zambia and South Africa. Methods: Eighty-two health care workers (HCW) working in primary care evaluated the acceptability and practicality of the mobile screening application after receiving brief training. The evaluation included questions from the Mobile Application Rating Scale (MARS) as well as open-ended questions. Results: The acceptability of the screening app was high and study participants were positive about using the app in routine care. Problems with internet connectivity, and time and staff constraints were perceived as the main barriers to regular use. Conclusion: HCW in primary care were able and willing to use a mobile screening app for the detection of mental health problems among treatment-seeking adolescents. Implementation in clinical practice needs to be further evaluated.

Mental Health of University Students in Southeastern Asia: A Systematic Review

Mental health in young people is a public health challenge worldwide, with around one-fifth of university students suffering from a 12-month mental disorder. In low- and middle-income countries (LMICs) of Southeastern Asia, resources for mental health are limited and counseling services are not regularly established at universities. This review aims to determine the prevalence of mental health problems among university students in six ASEAN (Association of Southeast Asian Nations) countries (Cambodia, Laos, Malaysia, Myanmar, Thailand, and Vietnam) and to identify the determinants of mental health. A systematic database search (PubMed, CINAHL, PsycINFO, PubPsych, and Scopus) for peer-reviewed, English language articles, published 2010-2020, reporting prevalence data based on standardized screening instruments resulted in 335 articles; 108 were eligible for full-text analysis, of which 34 could be included in the review. Median point prevalence was 29.4% for depression, 42.4% for anxiety, 16.4% for stress, and 13.9% for disordered eating. Current suicidality was present in 7% to 8% of students. There was a high rate of psychiatric comorbidity. Despite the high prevalence of mental health problems, the willingness to seek professional help was comparatively low. Implications for mental health promotion and prevention in university settings are discussed.

Police Officers' Ability in Recognizing Relevant Mental Health Conditions

The recognition of certain mental health conditions is important as this requires police officers to communicate and behave in an adjusted manner with affected individuals. The objective of the present study was to test police officers’ knowledge about mental health symptoms as a component of their mental health literacy (MHL) and to examine if police officers’ perceived knowledge corresponds with their actual knowledge. A questionnaire was used to assess for MHL representing mental health conditions which occur frequently in police requests (schizophrenia, bipolar disorder, depression, post-traumatic stress disorders, and emotionally unstable personality disorder). Furthermore, the questionnaire assessed the frequency of police requests, the officers’ perceived knowledge regarding mental disorders and their sense of feeling sufficiently trained to deal with these kinds of requests. Eighty-two police officers participated in the study. Police officers’ actual knowledge about mental health conditions did not correspond with their perceived knowledge. Participants revealed a moderately high level of overall knowledge which differed with regard to symptoms of each of the five mental health conditions. The mental status of a paranoid schizophrenia was best identified by the police officers and the majority correctly allocated the symptoms. Post-traumatic stress disorders and manic episodes were only identified by a minority of police offers. Police training geared to prepare for requests involving individuals with mental disorders should expand this limited knowledge transfer and focus on a broader variety of mental health conditions that police officers frequently encounter in requests.

Psychometric Properties of the German Version of the Perception of Interprofessional Collaboration Model-Questionnaire (PINCOM-Q)

OBJECTIVE

The Perception of Interprofessional Collaboration-Model Questionnaire (PINCOM-Q) measures professionals' perceptions of interprofessional collaboration in the field of child and youth mental health. The aim of this study was to validate the PINCOM-Q in a sample of German child welfare and child and youth mental health professionals.

METHODS

The PINCOM-Q was translated into German and its underlying factor structure was examined using exploratory and confirmatory factor analysis.

RESULTS AND DISCUSSION

Findings from this study suggest four factors (Interprofessional Climate, Conflict, Role Expectancy and Shared Goals, and Motivation) capture the concept of perceptions of interprofessional collaboration between child welfare and child and adolescent psychiatry.

CONCLUSION

The use of PINCOM-Q (German) can be recommended as a research tool, investigating professional groups working with children and young people with multiple and complex needs.

[A Police Perspective on the Interaction with Individuals with Mental Disorders]

OBJECTIVE

Police officers often come in contact with individuals suffering from behavior disturbances. The present study examined the subjective experience of these interactions from a police perspective to detect further needs in police trainings to make these interactions safer.

METHODS

N = 958 police officers filled out a questionnaire regarding their subjective experience. The questionnaire assessed the frequency of contact with individuals with behavior disturbances, specific challenges in regard to the interaction and associated subjective anxiety or stress as well as knowledge about behavior disturbances.

RESULTS

Police staff experience individuals suffering from behavior disturbances often as unpredictable, verbally and physically aggressive. 27.9 % report anxiety in these interactions and 76 % report a lack of specific knowledge.

CONCLUSION

Police training programs should focus on increasing mental health literacy, specific communication skills and anti-stigma interventions.

Design and Development Process of a Youth Depression Screening m-Health Application for Primary Health Care Workers in South Africa and Zambia: An Overview of the MEGA Project

Literature indicates a high prevalence and burden of mental illness in youths world-wide, which may be even higher in low- and middle-income countries (LMIC), such as South Africa and Zambia. Additionally, there is a lack of knowledge regarding youth depression amongst many primary health care (PHC) practitioners. The principal goal of the MEGA project is to provide youth with better access to mental health services and appropriate care, by developing a mental health screening mobile application tool to be used in PHC settings in South Africa and Zambia. In this study, we will use a mixed methods multi-center study design. In phase one, we will investigate the mental health literacy of PHC practitioners to identify areas in need of development. Based on the needs identified, we will develop and test a mobile health application to screen for common youth mental health problems in phase two. In phase three, we will implement and evaluate a tiered education and training program in the use of the m-health application. In the final phase, we will evaluate the acceptability and feasibility of the m-health application in PHC centres across South Africa and Zambia. Evidence suggests that PHC practitioners should routinely consider mental illness when assessing youth. However, common psychiatric disorders remain largely undetected and untreated in PHC settings. By identifying limitations in PHC workers knowledge with regard to youth mental health, we aspire to improve the depression care provided to youth in Southern Africa and Zambia by developing and implementing a locally relevant m-health application.

Die gruppentherapeutische Intervention „Gesund bleiben im Beruf“ zur Wiedererlangung der Arbeitsfähigkeit

Zusammenfassung. Theoretischer Hintergrund: In der psychotherapeutischen Forschung und Versorgung wurde die Wiedererlangung der Arbeitsfähigkeit bislang nur unzureichend berücksichtigt. Einige Studien weisen jedoch auf die Wirksamkeit arbeitsbezogener kognitiv-verhaltenstherapeutischer Therapieansätze hin. Fragestellung: Die vorliegende Pilotstudie soll ein neues Gruppentherapiekonzept mit dem Ziel der Verbesserung der Arbeitsfähigkeit evaluieren. Methoden: Es wurden Daten von N = 17 Teilnehmenden mit depressiven Störungen erhoben. Dafür wurden die Arbeitsfähigkeit, Arbeitsmotivation, generelle Symptombelastung und Depressivität zu drei Messzeitpunkten erfasst. Ergebnisse: Die Arbeitsfähigkeit verbesserte sich tendenziell. Teilnehmende wiesen kurz- und mittelfristig eine geringere Symptombelastung und geringere Depressivität auf. Die Aktivität und Partizipation erhöhten sich kurz- und mittelfristig. Schlussfolgerungen: Die Intervention scheint die psychische Gesundheit zu verbessern, allerdings müssen diese ersten Ergebnisse in einer randomisierten-kontrollierten Studie verifiziert werden.

Successful group psychotherapy of depression in adolescents alters fronto-limbic resting-state connectivity

BACKGROUND

Current resting state imaging findings support suggestions that the neural signature of depression and therefore also its therapy should be conceptualized as a network disorder rather than a dysfunction of specific brain regions. In this study, we compared neural connectivity of adolescent patients with depression (PAT) and matched healthy controls (HC) and analysed pre-to-post changes of seed-based network connectivities in PAT after participation in a cognitive behavioral group psychotherapy (CBT).

METHODS

38 adolescents (30 female; 19 patients; 13-18 years) underwent an eyes-closed resting-state scan. PAT were scanned before (pre) and after (post) five sessions of CBT. Resting-state functional connectivity was analysed in a seed-based approach for right-sided amygdala and subgenual anterior cingulate cortex (sgACC). Symptom severity was assessed using the Beck Depression Inventory Revision (BDI-II).

RESULTS

Prior to group CBT, between groups amygdala and sgACC connectivity with regions of the default mode network was stronger in the patients group relative to controls. Within the PAT group, a similar pattern significantly decreased after successful CBT. Conversely, seed-based connectivity with affective regions and regions processing cognition and salient stimuli was stronger in HC relative to PAT before CBT. Within the PAT group, a similar pattern changed with CBT. Changes in connectivity correlated with the significant pre-to-post symptom improvement, and pre-treatment amygdala connectivity predicted treatment response in depressed adolescents.

LIMITATIONS

Sample size and missing long-term follow-up limit the interpretability.

CONCLUSIONS

Successful group psychotherapy of depression in adolescents involved connectivity changes in resting state networks to that of healthy controls.

An der Schnittstelle von stationärer Kinder- und Jugendhilfe und psychiatrisch- psychotherapeutischer Gesundheitsversorgung

Im Rahmen des EU-Projektes RESME wurden in einer explorativen, qualitativen Studie Fachkräfte der stationären Jugendhilfe und der Kinder- und Jugendpsychiatrie zur gegenseitigen Kooperation befragt. Mit Hilfe umfassender leitfadengestützter Interviews wurden exemplarische Erfahrungen und Einschätzungen gesammelt, um die besonderen Herausforderungen in der Zusammenarbeit besser zu verstehen, Bedingungen und Beispiele für gelungene Kooperation zusammen zu tragen und Ansätze für Verbesserungen zu finden. Zentrale Ergebnisse der Interviews mit Sozialarbeitern und -pädagogen, Kinder- und Jugendpsychiatern und Psychologen werden zusammenfassend dargestellt. Es zeigen sich verschiedene Ansatzpunkte zur Verbesserung der systemübergreifenden und interdisziplinären Zusammenarbeit. Als wesentlich für eine gelungene Kooperation werden neben Fachlichkeit und Wissen, individuelle Einstellungen und Werte, Aspekte der persönlichen Kontakt- und Beziehungsgestaltung sowie organisatorische Rahmenbedingungen und Entwicklungen erachtet. Die Ergebnisse werden zur Entwicklung eines Curriculums genutzt, das sich zur Förderung der Zusammenarbeit gleichzeitig an Mitarbeiter psychiatrisch-psychotherapeutischer Einrichtungen und der Jugendhilfe richtet.

[Cognitive behavior therapy for depression in children and adolescents - procedure, effects, and developments]

Cognitive behavior therapy offers a theoretically and empirically valid therapeutic approach for children and adolescents suffering from depression. It can be recommended according to present guidelines and efficacy studies. Further research and conceptual development, however, is necessary especially regarding the small to moderate effect sizes as well as the lack of long-term efficacy and effect factors. This article gives a short overview of the basics and contents of cognitive behavior therapy for depressive children and adolescents. It furthermore presents the latest findings and an assessment of its efficacy and relevant developments and perspectives.

Induction of rat hepatic and intestinal glutathione s-transferases and glutathione by dietary naturally-occurring anticarcinogens

Effects of dietary naturally occurring anticarcinogens; quercetin, flavone, ellagic acid, ferulic acid, tannic acid, curcumin, coumarin, alpha-angelicalactone, fumaric acid and Brussels sprouts on male Wistar rat hepatic and intestinal (i) glutathione S-transferases (GST) enzyme activity, (ii) GST isozyme levels and (iii) glutathione (GSH) content were investigated. GST enzyme activity was significantly increased by all anticarcinogens tested, except fumaric acid, at least at one of the five sites investigated: proximal, middle, distal small intestine, large intestine and liver. Only alpha-angelicalactone gave an enhanced GST enzyme activity at all five sites. Large intestinal GST enzyme activity was increased only by quercetin (175%) and alpha-angelicalactone (138%). Concomitant changes in GST isozyme levels occurred. Class alpha GSTs were induced in 50% of the cases, especially in liver and upper parts of the intestine by quercetin, flavone, coumarin and alpha-angelicalactone. GST class pi levels were enhanced only at one site by quercetin, coumarin and alpha-angelicalactone. GST class mu changed in 14% of the cases, most profoundly in proximal and middle small intestine by flavone, coumarin and alpha-angelicalactone. Tannic acid and fumaric acid gave a significant raise in class alpha GSTs at almost all sites, whereas overall GST enzyme activity hardly changed. GSH was increased at various sites in 14% of the cases by Brussels sprouts, quercetin, flavone and alpha-angelicalactone. These data demonstrate that most anticarcinogens, in particular flavone, coumarin and alpha-angelicalactone, enhance GST activity in liver and intestine, mainly by induction of class alpha and mu isozymes.

Evaluation eines deutschsprachigen Instrumentes zur Erfassung positiver und negativer automatischer Gedanken bei Kindern und Jugendlichen

Zusammenfassung. Theoretischer Hintergrund: Negative automatische Gedanken stellen nach Beck eine wichtige Ursache für depressive Störungen dar. Fragestellung: Überprüfung der psychometrischen Gütekriterien des deutschen „Fragebogens für negative und positive automatische Gedanken” (FAG) bei Kindern und Jugendlichen. Methode: Der Fragebogen wurde an einer unselektierten Stichprobe aus der Allgemeinbevölkerung (n = 952) zwischen 11 und 16 Jahren untersucht. Die Stichprobe wurde in die beiden Gruppen ≤13 Jahre und >13 Jahre aufgeteilt. Ergebnisse: In der Gruppe ≤13 Jahre wurden die Skalen „negative Selbstaussagen” und „positive Selbstaussagen”, in der Gruppe >13 Jahre die Skalen „negative Selbstaussagen”, „Selbstvertrauen” und „Wohlbefinden” faktorenanalytisch extrahiert. Die internen Konsistenzen der FAG-Skalen lagen zwischen .75 und .89. Alle Skalen wiesen signifikante Zusammenhänge mit Depressivität auf und differenzierten zwischen höher und niedriger depressiven Teilnehmern. Schlussfolgerung: Insgesamt bestätigen die Ergebnisse die Reliabilität und Validität des FAG bei Kindern und Jugendlichen.

Was wirkt in der Therapie von Depression bei Kindern und Jugendlichen wirklich?

Vor allem die kognitiv-verhaltenstherapeutische Behandlung depressiver Kinder und Jugendlicher gilt als recht gut untersucht und wirksam. Die Ergebnisse und Erkenntnisse aktueller Metaanalysen und Übersichtsarbeiten werden diskutiert. Bisher belegen keine Ergebnisse stichhaltig die Überlegenheit einer Therapierichtung über die andere. Es stellt sich die Frage, ob neben spezifischen, theoretisch begründeten Interventionen einzelner Therapieschulen nicht vielmehr unspezifische, allgemeine Wirkfaktoren die Effektivität psychotherapeutischer Behandlungen begründen. Vergleichende Therapiestudien sind nötig. Allgemeine Wirkfaktoren müssen in Forschung und Therapie stärker berücksichtigt werden.

Sciatica and the sacroiliac joint: a forgotten concept

The definition of sciatica is restricted to the pattern and localization of pain, although much emphasis is given to root compression as causative factor. Other sources of similar pain patterns are generally neglected. Despite absence of obligatory neurological signs in radicular syndromes, a number of patients are subjected to extensive, but redundant screenings. In this report, three patients are presented with presumed radicular pain syndromes, whose symptoms finally could be linked to the sacroiliac (SI) joint either via CT and MRI scans or via pain relief by intra-articular injection with local anaesthetics. Possible mechanisms of SI joint-related pain and difficulties in diagnostic specificity of signs and symptoms are discussed.

Response inhibition in borderline personality disorder: event-related potentials in a Go/Nogo task

Borderline personality disorder (BPD) has been related to a dysfunction of anterior cingulate cortex, amygdala, and prefrontal cortex and has been associated clinically with impulsivity, affective instability, and significant interpersonal distress. We examined 17 patients with BPD and 17 age-, sex-, and education matched control participants with no history of Axis I or II psychopathology using event-related potentials (ERPs). Participants performed a hybrid flanker-Go/Nogo task while multichannel EEG was recorded. Our study focused on two ERP components: the Nogo-N2 and the Nogo-P3, which have been discussed in the context of response inhibition and response conflict. ERPs were computed on correct Go trials (button press) and correct Nogo trials (no button press), separately. Groups did not differ with regard to the Nogo-N2. However, BPD patients showed reduced Nogo-P3 amplitudes. For the entire group (n = 34) we found a negative correlation with the Barratt Impulsiveness Scale (BIS-10) and Becks's depression inventory (BDI). The present study is the first to examine Nogo-N2 and Nogo-P3 in BPD and provides further evidence for impaired response inhibition in BPD patients.

[Social support in suicide forums]

Suicide forums--interactive forums on the Internet--are attractive to suicidal youth. The question if participation in these forums might be dangerous (because of imitation and contagion) or if it should be considered as helpful (being a chance to talk openly with others) is still discussed controversely. Mutual social support seems to be an important factor. By means of an online survey in German suicide forums and a content analysis of forum postings, we gathered information about this subject. Selected results from our study are presented in this paper. Social support in suicide forums is rated as high as support from friends and higher than support from family. Social support is higher in suicide forums where discussion of suicide methods does not occur. Higher social support in suicide forums correlates with participants' ratings of reduction of suicidality. Furthermore, some information about the contents of communication in suicide forums will be given, based on the results of the content analysis. Results are discussed regarding the potential risks of these forums.

Influence of general self-efficacy on the effects of a school-based universal primary prevention program of depressive symptoms in adolescents: a randomized and controlled follow-up study

BACKGROUND

Depressive disorders in adolescents are a widespread and increasing problem. Prevention seems a promising and feasible approach.

METHODS

We designed a cognitive-behavioral school-based universal primary prevention program and followed 347 eighth-grade students participating in a randomized controlled trial for three months.

RESULTS

In line with our hypothesis, participants in the prevention program remained on a low level of depressive symptoms, having strong social networks. The control group showed increasing depressive symptoms and a reduced social network. Contrary to our expectations, students low in self-efficacy benefited more from the program than high self-efficient students. Social network did not mediate the relationship between participation in the prevention program and changes in depressive symptoms.

CONCLUSIONS

Our results show that the prevention program had favorable effects. Further research is needed to explore the impact of self-efficacy on the effects of prevention programs.

Depressive Störungen im Jugendalter:

Zusammenfassung. Theoretischer Hintergrund: Depressionen treten häufig im Jugendalter auf. Epidemiologische Längsschnittstudien ermöglichen repräsentative Aussagen zum Verlauf depressiver Störungen. Fragestellung: Die Persistenz depressiver Diagnosen über zwei Messzeitpunkte und prospektive Verlaufsprädiktoren sollen bestimmt werden. Methode: In einer epidemiologischen Längsschnittstudie mit Jugendlichen (12-17 Jahre; N = 1035) und einer Follow-Up-Erhebung nach 16 Monaten wurden DSM-IV-Diagnosen depressiver und anderer psychischer Störungen mit Hilfe eines hochstandardisierten Interviews ermittelt. Ergebnisse: Bei knapp 25% der Jugendlichen mit ursprünglicher Depressionsdiagnose zeigte sich eine persistierende Depression. Die Persistenz der Depression konnte vor allem durch das Vorliegen komorbider Störungen und bestimmte Depressionssymptome vorhergesagt werden. Schlussfolgerung: Die Befunde verdeutlichen das hohe spezifische Verlaufsrisiko depressiver Jugendlicher und können zu verbesserten Prognosestellungen beitragen.

School-based prevention of depressive symptoms in adolescents: a 6-month follow-up

OBJECTIVE

Depressive disorders in adolescents are a widespread problem with extensive psychosocial consequences. The authors designed a school-based program to prevent the increase in depressive symptoms. The authors expect the program to reduce dysfunctional automatic thoughts and improve social skills and thus prevent the increase in depressive symptoms.

METHOD

The design includes a training group and a nontreatment control group with pre- and post-measurement and 3- and 6-month follow-up. The authors followed up 324 eighth graders in both groups. School classes were randomly assigned to one of the two groups. The prevention program, LISA-T, is based on cognitive-behavioral therapy concepts and targets of cognitive and social aspects. It comprises 10 meetings of 1.5 hours in a regular school setting.

RESULTS

Increases in depressive symptoms in nondepressed adolescents in the training group were prevented over a 6-month period. Furthermore, adolescents with subsyndromal depression in the training group reported fewer symptoms, whereas depressive symptoms within the control group did not change. However, the groups did not differ with regard to social skills, frequency of negative automatic thoughts, and depressive symptoms before the prevention program.

CONCLUSIONS

LISA-T is an effective school-based prevention program for eighth graders with minimal to mild depressive symptoms, but further research is needed.

Universelle, schulbasierte Prävention der Depression im Jugendalter: Ergebnisse einer Follow-Up-Studie

Zusammenfassung. Es werden Evaluationsergebnisse für eine universelle, schulische Präventionsmaßnahme zur Vorbeugung depressiver Symptome im Jugendalter vorgestellt. Bei der Präventionsmaßnahme handelt es sich um das in Tübingen entwickelte kognitiv-verhaltenstherapeutische Trainingsprogramm “Lust an realistischer Sicht & Leichtigkeit im sozialen Alltag“ (LARS & LISA; Pössel, Horn, Seemann & Hautzinger, in Druck ). In der evaluierten Version umfasste das Programm neun Sitzungen à 90 Minuten und wurde mit insgesamt 179 Schülern und Schülerinnen durchgeführt. Effekte wurden im Rahmen einer kontrollierten Studie mit einer Prä- und Post-Erhebung sowie einem Elf-Monats-Follow-Up überprüft. Als Ergebnis zeigen sich noch keine bedeutsamen Effekte auf die Depressionssymptomatik, jedoch bereits verschiedene positive Auswirkungen vor allem im Hinblick auf selbstwert-relevante kognitive Faktoren, als ein wichtiges Präventionsziel. Diese Effekte könnten wiederum präventiv auf eine spätere depressive Entwicklung wirken. Weiterhin ergab sich ein Trend für eine vorbeugende Wirkung des Programms auf aggressives Verhalten.

Validität und Reliabilität der SCL-90-R: Ergebnisse der Bremer Jugendstudie

Zusammenfassung: Die Symptomcheckliste SCL-90-R ( Derogatis, 1977 ; Franke, 1995 ) quantifiziert die aktuelle Belastung durch allgemeine klinisch-psychologische Symptome. Sie findet Anwendung in unterschiedlichen Bereichen von Wissenschaft und Praxis. Im englischen Sprachraum hat sich der Einsatz der SCL-90-R auch bei Jugendlichen bewährt. Für die deutschsprachige Version fehlen bisher Daten zur Reliabilität und Validität für die Verwendung bei Jugendlichen. Im Rahmen dieser Arbeit werden verschiedene Gütekriterien und die Anwendbarkeit der SCL-90-R bei Jugendlichen anhand der Ergebnisse einer Subpopulation der Bremer Jugendstudie (N = 852) überprüft. In Vergleichen mit den Diagnosen des standardisierten diagnostischen Interviews M-CIDI (Münchener Version des Composite International Diagnostic Interview) kann eine hohe generelle Übereinstimmung zwischen erhöhten Werten der Symptomcheckliste und verschiedenen Störungsdiagnosen nach den Kriterien des DSM-IV festgestellt werden. Es zeigt sich weiterhin ein Zusammenhang zwischen der psychosozialen Beeinträchtigung der Jugendlichen sowie der Inanspruchnahme professioneller Hilfe und der mit Hilfe der SCL-90-R ermittelten Symptombelastung. Zusammenfassend zeigen die ermittelten Ergebnisse eine hohe Reliabilität und generelle Validität des Fragebogens und sprechen für die Verwendung der SCL-90-R bei Jugendlichen zur Erfassung einer allgemeinen Symptombelastung.

[Frequency, comorbidity and psychosocial correlates of attention-deficit/hyperactivity disorder. Results of a Bremen adolescent study]

Using data from the first wave of the Bremen Adolescent Study, this article presents findings on the frequency, comorbidity and correlates of Attention-Deficit/Hyperactivity Disorder (ADHD). ADHD ist the least common disorder examined in our study, with only two out of 1009 adolescents (0.2%) meeting the full DSM-IV criteria for ADHD. On the symptom level, our data show that 159 adolescents (15.8%) report at least six symptoms of inattention and/or six symptoms of hyperactivity-impulsivity. When considering those with this ADHD syndrome, our data show that about half of them have problems in school and at home, and 69.8% of them have at least one comorbid disorder. Compared to adolescents without any disorder and to those with other disorders, adolescents with only ADHD syndrome score significantly lower on control orientation (behavior conduct), perceived competence (academic, behavior, friendship subscales), and show lower emotional attachment to parents and peers. The results are discussed in terms of their implication for classification and intervention.

Komorbidität, Risikofaktoren und Verlauf aggressiven Verhaltens

Zusammenfassung. Es werden Ergebnisse aus der Bremer Jugendstudie (N=1035) zur Komorbidität, Risikofaktoren sowie zum Verlauf der Störung des Sozialverhaltens und der Störung mit Oppositionellem Trotzverhalten dargestellt. 49 Jugendliche (4,7%) erfüllten die DSM-IV-Kriterien der Störung des Sozialverhaltens, 26 (2-5%) erhielten die Diagnose einer Störung mit Oppositionellem Trotzverhalten. Von den Jugendlichen mit einer Störung des Sozialverhaltens wiesen 89,8% den Typus mit Beginn in der Adoleszenz auf. Es waren signifikant mehr Jungen als Mädchen von einer Störung des Sozialverhaltens betroffen. Jugendliche mit dieser Störung waren im Vergleich mit Altersgenossen ohne eine Störung des Sozialverhaltens einer signifikant höheren Anzahl von Lebensereignissen und Bedingungen ausgesetzt, ihre Bindung zu den Eltern sowie ihre Kontrollüberzegung war geringer, das familiäre Umfeld war signifikant häufiger dysfunktional. Fast 40% der Jugendlichen, bei denen zu T1 eine Störung des Sozialverhaltens festgestellt wurde, erfüllten auch 15 Monate später die Kriterien für die Diagnose dieser Störung. Zu den Faktoren, die mit der Stabilität der Störung zusammenhängen, gehört ein früher Beginn. Der Artikel schließt mit einer Diskussion der Implikationen der vorliegenden Ergebnisse für Prävention und Intervention.

Mucosal immunoadjuvant activity of liposomes: role of alveolar macrophages

Previously, we have reported on a liposomal adjuvant system for stimulation of both systemic IgG and mucosal s-IgA responses against viral antigens (influenza virus subunit antigen or whole inactivated measles virus) administered intranasally to mice. Immune stimulation is observed with negatively charged, but not with zwitterionic, liposomes and is independent of a physical association of the antigen with the liposomes. Furthermore, liposome-mediated immune stimulation requires deposition of the liposomes and the antigen in the lower respiratory tract. In the present study, it is shown that alveolar macrophages (AM) are the main target cells for negatively charged liposomes administered to the lungs of mice. AM isolated from animals, to which negatively charged liposomes were administered beforehand, showed large intracellular vacuoles, suggestive of massive liposome uptake. Under ex vivo conditions, both AM and RAW 264 cells exhibited a high capacity to take up negatively charged liposomes. The deposition of negatively charged liposomes, but not zwitterionic, liposomes in the lung reduced the phagocytic and migratory behaviour of AM, as assessed on the basis of transport of carbon particles to the draining lymph nodes of the lungs. Depletion of AM in vivo with dichloromethylene diphosphonate, facilitated an enhanced systemic and local antibody response against influenza subunit antigen deposited subsequently to the lower respiratory tract. In conclusion, these data provide support for the hypothesis that uptake of negatively charged liposomes blocks the immunosuppressive activity of AM, thereby facilitating local and systemic antibody responses.

Replacement of dendritic cells in the airways of rat lung allografts

It is unknown whether dendritic cells are able to migrate normally from the recipient into the allogeneic lung graft. Using monoclonal antibodies to major histocompatibility complex class II antigens (OX6 for both donor and recipient types; HIS19 for recipient type), we studied the replacement of donor dendritic cells by recipient type cells in rat lung allografts that are indefinitely accepted with a short course of cyclosporine early after transplantation. The recipient dendritic cells started to migrate into lung allografts early (by 1 wk) after transplantation. Donor dendritic cells in the grafts were replaced by recipient cells during the first 2 months after transplantation. Dendritic cells in the perivascular tissue were replaced quickly, most of them within 1 wk, whereas those in the alveolar septa were replaced slowly. In the lung allograft surviving 2 or more months, the normal phenotypic heterogeneity of dendritic cells was preserved. Recipient dendritic cells accumulated in dense peribronchial aggregates that remained 6 months. The dendritic aggregates were associated with late airway changes in allografted lungs. The abnormal accumulation of dendritic cells peribronchially might be related to an abnormal mucosal immune response or a chronic rejection process.

Late airway changes caused by chronic rejection in rat lung allografts

Airway disease after lung or heart-lung transplantation is one of late major complications, affecting the prognosis of the transplants. Little is known about the causes of airway changes. We performed rat lung transplantation and investigated the late airway changes of the long-term surviving lung grafts: allografts, BN to Lewis; isografts, BN to BN rat. All recipients were treated with CsA. We found airway changes, i.e., mucosal ulceration, granulation, submucosal fibrosis, which was located in the large airways, in four of five allografted lungs. The lung isografts showed no pathological abnormalities. Immunopathological studies disclosed the localized expression of MHC class II antigens on the bronchial epithelium of the large airways where recipient type dendritic cells accumulated in the submucosa and CD4 positive predominant lymphocytes infiltrated. These findings support the idea that the late airway changes in lung transplants are caused by immunologically mediated chronic rejection.

Inactivation of aztreonam by faecal supernatants of healthy volunteers as determined by HPLC

The enzymatic inactivation of aztreonam to its biologically inactive open ring form, by faecal enzyme preparations from 12 volunteers, was investigated. The percentage inactivation was determined by a high-performance liquid chromatography assay at months 0, 6 and 24. Faecal enzyme preparations from five volunteers could inactivate aztreonam by more than 50% within 20 h at one or more of these sampling times. Monitoring of aztreonam inactivation over a shorter period of time (14 days) in three of the volunteers showed that aztreonam inactivation cannot be predicted.

Enzymatic inactivation of aztreonam by faecal enzyme preparations from healthy volunteers

The enzymatic inactivation of aztreonam by the faecal flora was investigated in 25 healthy human volunteers. Ten volunteers received aztreonam orally and 15 volunteers did not receive antibiotic treatment. Residual aztreonam and its inactivated open ring form were simultaneously detected by an HPLC-assay. Independent of aztreonam treatment, beta-lactamase activity was detected in the faecal flora of 20 volunteers. The inactivation of aztreonam by the faecal supernatants was inhibited by clavulanic acid.

Combined size-exclusion and reversed-phase high-performance liquid chromatography of a detergent extract of Sendai virus

Virus envelope proteins obtained by Triton X-100 extraction of Sendai virions were purified to a high degree by a combination of high-performance liquid chromatography (HPLC) methods. Size-exclusion HPLC on a TSK 4000 PW column with several concentrations of acetonitrile or ethanol-1-butanol in 0.1% hydrochloric acid as eluent was used as the first chromatographic step. Peak fractions were diluted in water and further fractionated on reversed-phase columns (TMS-250 or Vydac 218 TP). Size-exclusion HPLC with 45% acetonitrile in 0.1% hydrochloric acid, combined with reversed-phase HPLC on either column, was most suitable for obtaining highly purified F2 protein. Antibodies obtained after injection of this protein were reactive with the intact virus.

Isolation of detergent-extracted Sendai virus proteins by gel-filtration, ion-exchange and reversed-phase high-performance liquid chromatography and the effect on immunological activity

Virus envelope proteins were isolated from Triton X-100 extracts of purified Sendai virions by gel-filtration, ion-exchange and reversed-phase high-performance liquid chromatography (HPLC). The fusion protein F, the matrix protein M and the tetrameric and dimeric form of the HN protein were isolated by gel-filtration HPLC with a solvent containing 0.1% sodium dodecyl sulphate. HN and F were also isolated by ion-exchange HPLC with 0.1% Triton X-100 in the eluent. Reversed-phase HPLC was performed on a C1 column with acetonitrile as the organic solvent. Especially the F1 and F2 component of the fusion protein F were obtained in pure form. The immunological activity of the proteins after HPLC was determined with an enzyme-linked immunosorbent assay (ELISA). After gel-filtration and ion-exchange HPLC, proteins still reacted with antiserum to the intact virus while proteins purified by reversed-phase HPLC did not react.

Isolation of Sendai virus F protein by anion-exchange high-performance liquid chromatography in the presence of Triton X-100

Purified Sendai virions were treated with Triton X-100. The detergent extract containing the fusion protein (F) and the haemagglutinin-neuraminidase protein (HN) was subjected to anion-exchange high-performance liquid chromatography on a Mono Q (Pharmacia) column with 0.1% Triton X-100 in phosphate-buffered saline. HN was not retained by the column while elution with a salt gradient resulted in several peaks containing mainly or only F protein.

Biochemical effects on germ-free mice of association with several strains of anaerobic bacteria

The effects of the following changes throughout the association of germ-free mice with increasing numbers of anaerobic bacteria were studied: (i) elution patterns obtained by gel-filtration chromatography of caecal diffusates; (ii) concentration of beta-aspartylglycine in caecal and faecal contents; (iii) polypeptide patterns obtained by sodium dodecyl sulphate-polyacrylamide gel electrophoresis of caecal supernatants; (iv) free amino acid content of caecal supernatants; (v) faecal bile acids, analysed by gas-liquid chromatography; (vi) colonization-resistance. The results indicate that monitoring the normalization (association) process can be accomplished in several ways, but the level of colonization-resistance is most easily measured by high-voltage paper electrophoresis of faecal supernatants to determine the concentration of beta-aspartylglycine. During association, the concentration of beta-aspartylglycine decreased and became undetectable after association with 40 to 50 different strains of bacteria. There was a good negative correlation between the level of colonization-resistance and the concentration of beta-aspartylglycine.

beta-Aspartylglycine, a substance unique to caecal contents of germ-free and antibiotic-treated mice

The caecal supernatants from germ-free, antibiotic-treated and control mice were compared with respect to their content of low-molecular-weight substances (less than 3500 mol. wt.). The supernatants contained about the same amount of free amino acids. After acid hydrolysis, the caecal supernatants of germ-free and antibiotic-treated mice showed a 2.9-fold increase in free amino acids, whereas a similar treatment of the supernatant from control mice resulted in a 2.6-fold increase. By gel filtration on Sephadex G-25, and high-voltage paper electrophoresis at pH 3.5 of the fractions eluted after the void volume, it was found that the caecal supernatants of germ-free and antibiotic-treated mice contained a substance more acidic than aspartic acid. Preparative high-voltage electrophoresis, dansylation, amino acid analysis and a specific colour reaction showed the substance to be beta-aspartylglycine. After a minimal 36 h of treatment with neomycin and bacitracin, a high concentration of beta-aspartylglycine was found, and no enterococci and aerobic Gram-negative rods could be cultured from the caecal contents. The possibility that in one mouse the appearance of beta-aspartylglycine was related to a decrease in Gram-negative rods was ruled out by selective elimination of aerobic Gram-negative rods by using polymyxin B. This suggests that other bacteria concomitantly eliminated with the enterococci and aerobic Gram-negative rods, directly or indirectly, could play a role in the accumulation of beta-aspartylglycine.