Personality Disorders and Attachment Trauma in Adolescent Patients with Psychiatric Disorders

This study examined how personality disorders (PD) differ with respect to gender, attachment status and traumatic childhood experiences in adolescent psychiatric inpatients. In particular, we investigated attachment-related traumatic material underlying adolescent PD. Our sample consisted of 175 inpatient adolescents aged 14 to 18 years (77% female, Mage = 15.13, SD = 1.35; 23% male, Mage =14.85, SD = 1.41). Thirty-nine patients (22%) fulfilled the diagnostic criteria for a PD according to the SCID-II PD: 51% avoidant, 13% obsessive-compulsive, 13% antisocial, 19% borderline, 2% paranoid and 2% histrionic. In the total sample, eighty-three (47%) of our inpatients were classified with an unresolved attachment status using the Adult Attachment Projective Picture System (AAP). We did not find any significant gender differences for patients with and without a PD. Our results revealed a higher percentage of unresolved attachment status in patients with a PD. The in-depth analysis of the total sample showed that patients with a PD demonstrated more traumatic material in their attachment interviews indicating a greater severity of attachment trauma. Furthermore, patients with a PD reported higher scores on emotional and physical neglect. Intervention strategies targeting traumatic attachment-related themes might be useful to treat adolescents with PD.

Unresolved attachment and identity diffusion in adolescence

This study examined the severity of unresolved attachment underlying adolescent identity diffusion. Our sample consisted of 180 inpatient adolescents aged 14 to 18 years (77% female, M age = 15.13, SD = 1.35; 23% male, M age = 14.85, SD = 1.41) and 84 age-matched non-clinical adolescents (52% female, M age = 16.14, SD = 1.21; 48% males, M age = 15.98, SD = 1.07). We used the Adult Attachment Projective Picture System (AAP) interview to assess attachment representations and the Assessment of Identity Development in Adolescence (AIDA) questionnaire to evaluate the severity of identity diffusion. Our results demonstrate a higher amount of unresolved attachment and identity diffusion in the patient sample than in the control sample. Furthermore, patients with an unresolved attachment status scored higher on identity diffusion than those with no unresolved attachment pattern. Interestingly, this was not found in the control group. Furthermore, patients with a greater severity of unresolved attachment showed the highest maladaptive identity development scores. Psychotherapeutic interventions integrating attachment-related aspects might be useful to treat young people with identity diffusion.

Treatment of psychiatric comorbidities and interaction patterns in Coffin-Siris syndrome: A case report of a 4-year-old girl

Coffin-Siris syndrome (CSS) is a rare genetic disorder and often co-occurs with attention-deficit hyperactivity disorder (ADHD) and autism spectrum (ASD). The present case study illustrates possible therapeutic interventions of these common psychiatric comorbidities taking into account the family interaction patterns. This can contribute to improve holistic management and overall level of functionality.

Comparative study of children's mental health outcomes in Tyrol, Austria, and South Tyrol, Italy, during the COVID-19 pandemic

PURPOSE

This study aimed to compare the mental health outcomes of children in North Tyrol, Austria, and South Tyrol, Italy, during the coronavirus disease 2019 (COVID-19) pandemic, considering the sociocultural and contextual differences between the two regions.

METHODS

The Tyrolean COVID-19 Children's Study (TCCS: n = 401; June 2021 to July 2021) and the Corona and Psyche in South Tyrol 2021 Study (COP‑S; n = 3402; May 2021 to June 2021) were used for data analyses. Both studies employed cross-sectional designs and collected data through online questionnaires completed by children aged 7-13 years and their parents. Various psychosocial assessment tools including the Child and Adolescent Trauma Screening, Children Anxiety Test, Child Behavior Check List, Screen for Child Anxiety Related Emotional Disorders, and Health Behaviour in School-Aged Children were used in the surveys.

RESULTS

The comparison between North Tyrol and South Tyrol revealed no significant differences in perceived threats, trauma, or anxiety among children. Similarly, there were no substantial disparities in psychosomatic complaints, indicating similar manifestations of emotional distress across the two regions.

CONCLUSION

The comparative analysis of children's mental health outcomes in North Tyrol and South Tyrol during the COVID-19 pandemic confirmed the analogous influence of sociocultural and contextual factors on their wellbeing. Despite presumable variations in pandemic events, management strategies, and healthcare systems, the study suggests comparable resilience among children and highlights the importance of sociocultural factors in shaping their wellbeing. The findings emphasize the need for comprehensive understanding and targeted interventions to support children's mental health during challenging times.

[Effects of the COVID-19-Pandemic on the AffectiveWell-Being of Preschool Children]

The aim of this study was to determine the predictive value of corona-specific variables and post-traumatic stress symptoms associated with the COVID-19-pandemic, considering sociodemographic data and health-related quality of life, on the affective well-being of preschool children and to identify predictors of positive and negative affect. A secondary analysis of third-party assessment data by parents of three- to six-year-old preschool children from the Tyrolean COVID-19 Children's Study at two measurement time points (123 records at t₁ in summer 2020; 467 records at t₂ in winter 2020/21) was conducted. To answer the research question hierarchical multiple regression analyses were performed.The largest part of the variance explanation of affective well-being was explained by health-related quality of life: while self-esteem and psychological well-being were measurement-time-independent, effects of physical well-being, preschool, family, and friends were only significant in winter. Coronaspecific variables caused additional variance explanation due to subjective threat experience in winter; post-traumatic stress symptoms had an effect at both measurement-times. In times of crisis children's self-esteem, psychological well-being, and post-traumatic stress symptoms should be considered.Measurement-time-dependent results suggest that the pandemic course plays a decisive role regarding the influence on children's affective well-being. Everyday life and routines must be redefined accordingly and communicated to the children.

[Transitional psychiatric needs and identity development of adolescents in Tyrol]

BACKGROUND

Due to the structural separation of child and adolescent psychiatric treatment and adult psychiatric treatment, a switch between these two systems upon the age of 18 is necessary. Considering the importance of an organized transition, patients from an age of 17 were asked about their transition needs and aspects of their identity development. Thus future improvements in the treatment structures in this sensitive phase should derive.

METHODS

With the help of the Transition Readiness and Appropriateness Measure (TRAM), the transition-specific needs of 17 to 24-year-old patients (N = 42) at the Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy in Hall in Tirol were surveyed. In addition, the connection between identity development and transition was examined using the Assessment of Identity Development in Adolescence (AIDA).

RESULTS

Almost 80% of the patients stated that they needed further care. 'Patient-related factors' and 'family support' were described as barriers to the willingness to transition. A significant connection was found between identity development and the willingness or need for transition (r = 0.431, p < 0.01), although this was more pronounced in relation to the need for transition (r = 0.821 p < 0.01). In addition, those affected stated that they were frequently and severely burdened by stress, 45% reported self-injurious behavior, 48% suicidal thoughts or behavior in the last six months. In terms of psychopathology, anxiety and depression were among the most common symptoms. In terms of functional impairment, the 'relationships' area was the most affected.

CONCLUSIONS

The study provides initial insights into the transition-specific characteristics and needs of patients in transition age. The integration of standardized measuring instruments in institutional care systems, which individually record the transition-related needs, the willingness and need of young people in transition age, can facilitate targeted and needs-based treatment or transition. Interdisciplinary cooperation between child and adolescent psychiatry and adult psychiatry as well as a continuous transfer of the therapeutic relationships in the transition process should also be guaranteed.

Differences in perceived threat and trauma in children during the COVID-19 pandemic

BACKGROUND

The past 2 years of the COVID-19 pandemic were stressful for most children and adolescents; some children may have experienced a high level of stress and trauma. To date, no study has examined self-reported stress and trauma levels due to COVID-19 in children. This study aimed to assess perceived threat, exposure and trauma symptoms in children aged 7-13 years. In addition, we explored whether parent-reported factors could predict a higher risk of COVID-19 vulnerability in their children.

METHOD

Cross-sectional data were collected from 752 children to assess COVID-19 threat, exposure and trauma symptoms using the self- and parent-reported Child and Adolescent Trauma Screening Self-Report (CATS) Trauma questionnaire. We used exploratory analyses (factor analysis of mixed data and hierarchical clustering) to identify subgroups (i.e., clusters) of children sharing similar characteristics in the dataset. Linear regression modeling was applied to determine the likelihood of higher threat and vulnerability in children with parent-reported COVID-19 threat, exposure, CATS trauma symptoms, behaviors on the Child Behavior Checklist (CBCL), and posttraumatic growth (PTG).

RESULTS

We identified a high-risk group of children reporting clinically relevant trauma symptoms and COVID-19-related fears. Parents' reports of trauma could be used to identify children at high risk.

CONCLUSIONS

Approximately 25% of children reported moderate to clinically relevant levels of trauma symptom. It is especially important to offer adequate support to these children to ease the trauma and prevent their symptoms from developing into psychopathology.

Attachment Trauma Is Associated with White Matter Fiber Microstructural Alterations in Adolescents with Anorexia Nervosa before and after Exposure to Psychotherapeutic and Nutritional Treatment

In the present study, we explore the role of attachment for microstructural white matter (WM) changes in adolescents with anorexia nervosa (AN) before and after exposure to short-term and nutritional treatment. The case sample consisted of 22 female adolescent inpatients with AN (mean age: 15.2 ± 1.2 years) and the control sample were 18 gender-matched healthy adolescents (mean age: 16.8 ± 0.9 years). We performed a 3T MRI in the patient group during the acute state of AN and after weight restoration (duration: 2.6 ± 1 months) and compared the data to a healthy control group. To classify attachment patterns, we used the Adult Attachment Projective Picture System. In the patient sample, over 50% were classified with an attachment trauma/unresolved attachment status. Prior to treatment exposure, fractional anisotropy (FA) reductions and concordant mean diffusivity (MD) increases were evident in the fornix, the corpus callosum and WM regions of the thalamus, which normalized in the corpus callosum and the fornix post-therapy in the total patient sample (p < 0.002). In the acute state, patients with an attachment trauma demonstrated significant FA decreases compared to healthy controls, but no MD increases, in the corpus callosum and cingulum bilaterally, which remained decreased after therapy. Attachment patterns seem to be associated with region-specific changes of WM alterations in AN.

Evaluation of visual food stimuli paradigms on healthy adolescents for future use in fMRI studies in anorexia nervosa

BACKGROUND

Mostly, visual food stimuli paradigms for functional Magnetic Resonance Imaging are used in studies of eating disorders. However, the optimal contrasts and presentation modes are still under discussion. Therefore, we aimed to create and analyse a visual stimulation paradigm with defined contrast.

METHODS

In this prospective study, a block-design fMRI paradigm with conditions of randomly altering blocks of high- and low-calorie food images and images of fixation cross was established. Food pictures were rated in advance by a group of patients diagnosed with anorexia nervosa to address the dedicated perception of patients with eating disorders. To optimize the scanning procedure and fMRI contrasts we have analysed neural activity differences between high-calorie stimuli versus baseline (H vs. X), low-calorie stimuli versus baseline (L vs. X) and high- versus low-calorie stimuli (H vs. L).

RESULTS

By employing the developed paradigm, we were able to obtain results comparable to other studies and analysed them with different contrasts. Implementation of the contrast H versus X led to increased blood-oxygen-level-dependent signal (BOLD) mainly in unspecific areas, such as the visual cortex, the Broca´s area, bilaterally in the premotor cortex and the supplementary motor area, but also in thalami, insulae, the right dorsolateral prefrontal cortex, the left amygdala, the left putamen (p < .05). When applying the contrast L versus X, an enhancement of the BOLD signal was detected similarly within the visual area, the right temporal pole, the right precentral gyrus, Broca´s area, left insula, left hippocampus, the left parahippocampal gyrus, bilaterally premotor cortex and thalami (p < .05). Comparison of brain reactions regarding visual stimuli (high- versus low-calorie food), assumed to be more relevant in eating disorders, resulted in bilateral enhancement of the BOLD signal in primary, secondary and associative visual cortex (including fusiform gyri), as well as angular gyri (p < .05).

CONCLUSIONS

A carefully designed paradigm, based on the subject's characteristics, can increase the reliability of the fMRI study, and may reveal specific brain activations elicited by this custom-built stimuli. However, a putative disadvantage of implementing the contrast of high- versus low-calorie stimuli might be the omission of some interesting outcomes due to lower statistical power. Trial registration NCT02980120.

[Inpatient care in child and adolescent psychiatry-Who gets treatment?]

BACKGROUND AND RESEARCH QUESTION

This article presents and analyses the landscape for inpatient child and adolescent psychiatric care in Austria and examines current data from June 2022.

METHOD

In June 2022, the authors surveyed the current status of child and adolescent psychiatric primary care in Austria. Both systemised beds and day hospital beds as well as the number of specialists and assistant doctors were taken into account.

RESULTS

A bed index of 0.05 beds/1000 inhabitants (as of 6/2022) was calculated, which is below the guideline for beds needed and does not correspond with the need depicted for sufficient provision of care ("Österreichischer Strukturplan Gesundheit"). Moreover, in June 2022, 40 beds had to be closed due to staff shortages and 26.5 training positions were vacant across Austria.

DISCUSSION AND CONCLUSIONS

Even though the training ratio was raised to 1:2 as of 07.02.2022 within the framework of the "Mangelfachverordnung" for a limited period of time until 31.05.2027, it is hardly possible to guarantee sufficient mental health care according to the increased demand for child and adolescent psychiatry, especially in times of the pandemic. Measures need to be urgently taken to improve child and adolescent psychiatric treatment options. In order to ensure adequate care for the increasing number of mentally ill children and adolescents (a) the number of beds must be increased, (b) structural deficits have to improve, and (c) innovative treatment options in the sense of inpatient-equivalent treatment (home treatment) has to be considered.

[A three-country comparison of mental health and treatment options of children and adolescents with mental health problems in times after the COVID-19 pandemic]

BACKGROUND AND RESEARCH QUESTION

The Austrian Society for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy (ÖGKJP) is publishing a series of articles in a special issue of Neuropsychiatrie dealing with the current provision of care in child and adolescent psychiatry. Aim of this article is to give an overview of provision of care for children and adolescents with mental health problems in Austria, Germany, and Switzerland and then draw conclusions for the Austrian child and adolescent psychiatric care landscape.

METHOD

First, epidemiologic data as well as different traditions and treatment philosophies and their effect for provision of care in child and adolescent psychiatry in Austria, Germany and Switzerland are presented. Subsequently, data of provided child and adolescent psychiatric care in Austria and Germany are presented and related to each other.

RESULTS AND CONCLUSIONS

On the basis of the data presented, the current deterioration of mental health in children and adolescents due to the pandemic as well as the deficit of available inpatient beds (0.03-0.09) there is an urgent need for action in Austrian provision of child and adolescent psychiatric care. An improvement of the structural deficits in the child and adolescent psychiatric research and care landscape, a significant increase of capacities for inpatient treatment, day-care as well as outpatient treatment with establishment of modern treatment options such as home treatment is necessary.

[Characteristics of the population of a parent-child unit: early interaction-based treatment as a chance in child and adolescent psychiatry]

BACKGROUND

In inpatient child psychiatric parent-child treatment, the child is admitted as a patient and the parents as accompanying persons. Due to the importance of parent-child interaction in the development and maintenance of mental disorders in children, parents are integrated more centrally in the treatment of children with emotional or behavioral disorders. In order to further expand this form of treatment in the future and to make it more effective, the characteristics of the previous utilization population of a child psychiatric parent-child unit in Tyrol were examined with regard to child symptomatology and the burden on parents.

METHODS

The Child Behavior Checklist 1 ½-5, Child Behavior Checklist 6-18R, and Tröster's (2011) Parent Stress Inventory scores of 96 parent-child pairs were used to examine child symptom expression and parent stress.

RESULTS

The 6-10 year old patients had higher T‑scores (M = 76.9, SD = 7.1) than the 0-5 year old patients (M = 63.1, SD = 12.4) on the CBCL total scale, t (50) = -3.52, p < 0.001. On the EBI total scale, the 0-5 year old patients and the 6-10 year old patients did not differ in terms of T‑scores, t (54) = -0.75, p = 0.459, as well as in the EBI child domain t (54) = -1.75, p = 0.087 and in the EBI parent domain, t (54) = 0.19, p = 0.846. Also, the four diagnostic groups did not differ in the EBI total scale, F (4,58) = 1.34, p = 0.266, nor in the parent domain of the EBI, F (4,58) = 1.44, p = 0.232, nor in the child domain of the EBI, F (4,58) = 2.81, p = 0.033.

CONCLUSIONS

Early identification and treatment of behavioral or mental disorders in very young children seems crucial to prevent long-term negative consequences as well as chronicity. Parent-child therapies should generally focus on identifying and changing current dysfunctional patterns of interaction between parent and child.

Children's Mental Health During the First Two Years of the COVID-19 Pandemic: Burden, Risk Factors and Posttraumatic Growth - A Mixed-Methods Parents' Perspective

The COVID-19 pandemic and the accompanying containment measures such as physical distancing and school closures led to major changes in children's everyday lives. By means of a mixed-methods study, the "Tyrolean COVID-19 Children's Study" investigated the effects of the pandemic and factors influencing mental health and health-related quality of life of North Tyrolean (Austria) and South Tyrolean (Italy) children aged 3-13 years. Parents filled out N = 2,691 online questionnaires (951 preschool children: 3-6 years; 1,740 schoolchildren: 7-13 years) at four measurement time points (March 2020, December 2020, June 2021, December 2021). For both age groups, children's mental health outcomes (internalising problems, posttraumatic stress symptoms) were worse in December 2021 (t4) than children's mental health outcomes in March 2020 (t1). With regard to aggressive behaviour, this difference was only found among schoolchildren. Thematic analysis of an open ended, written question revealed the following positive changes in children during the Corona crisis: (1) the importance of intra- and extra-familial relationships, (2) new competences and experiences, (3) values and virtues, (4) use of time, and (5) family strength. Using multilevel modelling, threat experience, economic disruption, and perceived posttraumatic growth were shown to be the strongest predictors of all outcomes. Additionally, male gender was shown to be a predictor of aggressive behaviour. In terms of age, schoolchildren showed more internalising problems, aggressive behaviour, and threat experience than preschool children. With regard to time, parents in December 2021 reported more threat experience in older children and less perceived posttraumatic growth in both older and younger children, than parents at the beginning of the pandemic. Targeted support for vulnerable children may prevent longer-term development of psychopathologies and contribute to society's psychosocial resilience in the current COVID-19 pandemic. Moreover, sustainable promotion of children's posttraumatic growth can also contribute to children's mental health and could even offer a chance to turn the crisis into an opportunity.

Attachment status is associated with gray matter recovery in adolescent anorexia nervosa: Findings from a longitudinal study

The aim of the present study was to investigate whether grey matter (GM) reductions in acute anorexia nervosa (AN) are (i) valid for adolescents (age 14–18 years), (ii) reversible following short‐term psychotherapeutic and nutritional therapy and (iii) depend on psychological components like attachment trauma. 3T MRI including a high‐resolution T1 MPRAGE was performed in 22 female adolescents in the acute state of AN (age: 15.2 ± 1.2 years) and after weight restoration (duration: 2.6 ± 1 months, n = 18) and compared with 18 gender‐matched healthy controls. The Adult Attachment Projective Picture System was used to classify resolved and unresolved attachment patterns. GM decreases were localized in extensive cortical areas including the insula, prefrontal and cingulate cortices as well as subcortical regions during acute AN, which partially increased after therapy with a relative sparing of the hippocampus and parahippocampal gyrus. The resolved group showed more GM recovery in regions of the left hippocampus and parahippocampal gyrus, bilateral cerebellar regions, right precuneus and adjacent cingulate cortices relative to the unresolved pattern. Structural anomalies in adolescent AN that recovered after treatment may be primarily the consequence of malnutrition, whereas several regions did not display significant recovery. Attachment status seems to influence region‐specific GM recovery.

The effects of probiotics administration on the gut microbiome in adolescents with anorexia nervosa-A study protocol for a longitudinal, double-blind, randomized, placebo-controlled trial

Objective

Knowledge on gut–brain interaction might help to develop new therapies for patients with anorexia nervosa (AN), as severe starvation‐induced changes of the microbiome (MI) do not normalise with weight gain. We examine the effects of probiotics supplementation on the gut MI in patients with AN.

Method

This is a study protocol for a two‐centre double‐blind randomized‐controlled trial comparing the clinical efficacy of multistrain probiotic administration in addition to treatment‐as‐usual compared to placebo in 60 patients with AN (13–19 years). Moreover, 60 sex‐ and age‐matched healthy controls are included in order to record development‐related changes. Assessments are conducted at baseline, discharge, 6 and 12 months after baseline. Assessments include measures of body mass index, psychopathology (including eating‐disorder‐related psychopathology, depression and anxiety), neuropsychological measures, serum and stool analyses. We hypothesise that probiotic administration will have positive effects on the gut microbiota and the treatment of AN by improvement of weight gain, gastrointestinal complaints and psychopathology, and reduction of inflammatory processes compared to placebo.

Conclusions

If probiotics could help to normalise the MI composition, reduce inflammation and gastrointestinal discomfort and increase body weight, its administration would be a readily applicable additional component of multi‐modal AN treatment.

Patients with anorexia nervosa face profound alterations of the gut microbiome which does not normalise with weight gain.

Alterations in the gut microbiome in patients with anorexia nervosa are linked to psychopathological symptoms and neurophysiological deficits, for example, related to the reward system.

This is the first study examining the effects of probiotics administration in adolescents with anorexia nervosa using a randomized controlled trial design.

Early Detection of Temperament Risk Factors: A Comparison of Clinically Referred and General Population Children

Despite an extensive literature on associations between early childhood temperament and behavior problems, most of this evidence is based on general population samples. Hence, relatively little is known about the temperament characteristics of children who have been referred for in- or outpatient treatment of emotional and/or behavioral problems. Whether temperament-to-behavior problems identified in community samples would also be found in samples of clinically referred children is poorly understood. To redress this limitation, we compared temperament attributes of a predominantly preschool-aged sample of children referred for treatment of emotional and/or behavioral disorders (N = 87) with those from a similarly-aged general population sample (N = 85) by using the Integrative Child Temperament Screener (ICTS)-a new nine-item scale to identify clinically significant temperament attributes. Behavioral symptoms in the clinical sample were assessed through diagnostic interviews in combination with the Child Behavior Checklist (CBCL), which was also administered to the general population children. Compared with general population children, referred children exhibited substantially higher scores on all ICTS subscales except behavioral inhibition. Furthermore, areas under the curve analyses showed that discrimination of both groups based on CBCL scales could be improved by adding the ICTS. Overall, the findings fill a long-standing gap in evidence regarding temperament characteristics of children with serious emotional and/or behavioral symptoms and suggest a useful role for the ICTS in assessment, screening, and prevention.

Unresolved Attachment Mediates the Relationship Between Childhood Trauma and Impaired Personality Functioning in Adolescence

The present study investigates the mediating effect of attachment trauma on the relationship between childhood maltreatment and personality functioning in 199 adolescents (12-18 years) using a novel approach of an in-depth analysis of attachment-related traumatic contents during an attachment interview (AAP). Our findings demonstrate that adolescents with a high amount of traumatic attachment-related material show a lower resilience when facing traumatic childhood experiences, resulting in a greater severity of personality dysfunction. In particular, the associations between emotional abuse and neglect and the domains of identity, empathy, self-direction, and intimacy were mediated by the severity of attachment trauma. These results advance our understanding of the different nuances of attachment-related traumatic material and how they might shape personality structure in an adolescent age group.

Affective responses to climbing exercises in children and adolescents during in-patient treatment for mental health disorders a pilot study on acute effects of different exercise interventions

The aim of the present study was to compare acute effects of a climbing intervention (CI) on affective responses with a different exercise intervention (swimming, SI) and an occupational therapy intervention (OTI) in children and adolescents during in-patient treatment for mental health disorders. The following study was designed as a cross-over study. Participants completed three single 60 min interventions of CI, SI and OTI. Affective responses were assessed pre and post intervention and at 20 and 40 min during intervention. The sample consisted of 33 children and adolescents in mental-health inpatient care (ᴓage: 13.3 ± 2.2 years, ♀=39.4%). A significant time effect was seen in all interventions in increasing positive and reducing negative affect, p<.028, eta²>0.144. Repeated measures ANOVAs revealed a significant time by intervention effect for affective valence (p=.011, eta²=0.09), but not for perceived activation, favouring CI over SI and OCT between pre-test and the first 20 or 40 min, respectively. All interventions showed similar effects on affective responses pre to post interventions. CI seems to increase affective valence more strongly during intervention compared to SI and OTI. The present results may have implications for therapy adherence and acute emotion regulation in children and adolescent in-patients with mental health disorders.

Offline und online Peer-Viktimisierung und der Zusammenhang mit emotionalen Problemen

Zusammenfassung. Sowohl online als auch offline Peer-Viktimisierung (PV) in ihrer direkten und indirekten Form stehen als Stressoren in einem Zusammenhang mit emotionalen Problemen bei Jugendlichen. Welche Faktoren diesen Zusammenhang vermitteln, ist noch nicht ausreichend geklärt. Die vorliegende Studie beschäftigt sich auf Grundlage von Stress-‍, Coping- und kognitiven Theorien mit maladaptiver Emotionsregulation und kognitiver Bewertung als potenziell vermittelnde Faktoren. Dazu wurden die Daten von 755 Schüler_innen im Alter von 10 bis 20 Jahren analysiert. Knapp zwei Drittel der befragten Jugendlichen hat im letzten halben Jahr PV erlebt. Dabei geht im Gegensatz zu den anderen Viktimisierungsformen indirekte offline PV mit häufiger maladaptiver Emotionsregulation einher. Diese wiederum steht im Zusammenhang mit der kognitiven Bewertung von PV als Belastungsfaktor und mündet schlussendlich in schwereren emotionalen Problemen. Konsequenzen aus diesen Ergebnissen und Therapieoptionen werden diskutiert.

[Validation of a German-Language Version of the Multidimensional Offline and Online Peer Victimization Scale (MOOPV) in Adolescent Students]

Peer victimisation (PV) in childhood and adolescence can come along with psychological stress through the life span. Even though there exist a large number of questionnaires that measure PV, evidence of the use is often missing. Particularly instruments for capturing cyberbullying lack psychometric calculations such as factor analysis for investigating scales and data on validity and reliability. An exception constitutes the Multidimensional Offline and Online Peer Victimization Scale (MOOPV) of Sumter et al., which is only available in Dutch. This questionnaire is not medium-specifically designed, has been psychometrically properly explored, and differentiates between direct and indirect as well as online and offline PV. The present study aims to investigate the psychometric properties of the German version of the Multidimensional Offline and Online Peer Victimization Scale (MOOPV). The factor structure, validity and reliability was examined in a sample of 777 pupils aged 10-20. Confirmatory factor analysis supported the original four-factor model. The scales direct offline, indirect offline, direct online, and indirect online demonstrated high internal reliability and construct validity. The MOOPV can be used as a validated instrument in research and practice to capture PV in childhood and adolescence.

[Levels of structural integration in adolescents and the relationship to later mental disorders - A longitudinal study]

Levels of structural integration in adolescents and the relationship to later mental disorders - A longitudinal study Abstract. Objective: Psychological disorders frequently manifest during adolescence. Because of the multifactorial influencing factors, the courses of the diseases are heterogeneous, from relapsing-remitting to chronic. This study investigated whether the level of structural integration of the Operationalized Psychodynamic Diagnostics in Childhood and Adolescence (OPD-CA) correlates with later symptomatic burden. Method: This long-term study assessed the levels of structural integration according to the OPD-CA of 60 adolescents (mean age = 15.6; SD = 0.9). Seven years later, we then measured symptomatic burden (SCID axis I and II) and overall burden (GAF, BSI-GSI) (73.3 % follow-up participation rate). Results: The results showed high correlations between deficient structural integration in adolescence and later symptoms and overall burden in early adulthood. Conclusion: The follow-up examination after a 7-year time period showed significant correlations, which argue for the predictive value of structural integration. This suggests that early specific treatment, e.g., in the form of intensive psychotherapy, be urgently recommended in order to influence this course.

[Current state of the scientific literature on effects of therapeutic climbing on mental health - conclusion: a lot to do]

BACKGROUND

Therapeutic Climbing is applied in physiological as well as in psychological rehabilitation programs. Systematic reviews have been conducted, evaluating the physiological effects of therapeutic climbing. The aim of the following article is a review on existing literature about the psychological effects of climbing therapy.

METHODS

We searched the databases of PubMed, Scholar and ScienceDirect up to December 2017 in German and English language. Trials were included if they assessed psychological variables in climbing interventions.

RESULTS

Seven articles were included in the following review. Effectiveness of climbing therapy was studied in a) adult inpatients with mental disorders (n = 3), b) adult outpatients with mental disorders (n = 1), c) children with motoric deficits and disabilities (n = 2), d) healthy adults (n = 1). All trials had major methodological limitations. Control groups if present, were defined differently. Three trials assessed self-efficacy and revealed enhanced self-efficacy after the climbing intervention. No psychological differences were seen between aerobic exercise and climbing therapy in healthy adults. Acute positive affective changes were seen in in-patients with major depressive disorders after a climbing session compared to a relaxation session.

CONCLUSION

The effectiveness of climbing therapy on psychological outcomes remains unclear. Limited evidence with varying age groups (children and adults) and a high risk of bias shows enhanced self-efficacy through climbing therapy. There is a need for further studies in children and adults on psychological outcomes through climbing therapy, especially in comparison with aerobic activity interventions.

Use of the Adult Attachment Projective Picture System in the formulation of a case of an adolescent refugee with PTSD

Forced displacements and their psychosocial consequences in adolescent refugees and their families have received increasing attention in recent years. Although supportive family relations play a key role in buffering the impact of traumatization in adolescents, parental ability to provide such is often subject to extreme pressure. Under conditions of forced dislocation and fear, maladaptive interpersonal strategies in the parent-child relationships may develop, contributing to the onset of psychopathology. We explore new aspects of attachment-related issues for the understanding and treatment of adolescent refugees who have experienced multiple traumas in their childhood. We used a multimethod assessment battery including the Adult Attachment Projective Picture System (AAP), the Structured Clinical Interview, the Youth Self Report and the Wechsler Intelligence Scale in an adolescent boy with post-traumatic stress disorder (PTSD). Our subject was an adolescent refugee from the Middle East who demonstrated an unresolved attachment when confronted with loss and fear. His responses on the AAP evoked aspects of insecure-unresolved attachment, including his belief that it is not safe to trust in attachment figures, his limited access to traumatic attachment experiences, his impaired ability to take concrete actions when dealing with threatening attachment situations and the unintentional role-reversal shed new light on our understanding of his traumatic experiences, family functioning and psychopathological symptoms. Our results demonstrate the utility of the AAP in an adolescent refugee with PTSD by expanding our knowledge of a diverse range of experiences across the interpersonal, cognitive, cultural and developmental contexts that formed the basis for an individualized treatment plan.

Disorder-specific attachment characteristics and experiences of childhood abuse and neglect in adolescents with anorexia nervosa and a major depressive episode

For the first time, the present study investigates disorder‐specific attachment characteristics and childhood trauma in adolescent inpatients with anorexia nervosa (n = 30, girls/boys: 28/2, age: M = 14.84, SD = 1.20), a major depressive episode (n = 30, girls/boys: 27/3, age: M = 15.14, SD = 1.50), and controls (n = 60, girls/boys: 44/16, age: M = 16.10, SD = 1.20). We used the Structured Clinical Interview to diagnose Axis I disorders, the Adult Attachment Projective Picture System to classify attachment representations, and the Childhood Trauma Questionnaire to assess child maltreatment. Our findings demonstrate an overrepresentation of the unresolved attachment status in the patient samples. A one‐way analysis of variance succeeded by Bonferroni post hoc tests indicated that adolescents with anorexia nervosa show more isolation and dissolution of boundaries between life and death when confronted with situations of solitude. Although they report moderate to severe levels of traumatic childhood experiences, they tend to minimize those. Adolescents with a major depressive episode report higher levels of emotional abuse and neglect in their childhood, leaving them in a state of failed protection and danger during attachment distress. Integrating these attachment‐related characteristics into specific psychotherapeutic interventions might be associated with a better outcome in that age group.

[Prevalence and characteristics of peer victimisation in adolescent psychiatric inpatients]

Prevalence and characteristics of peer victimisation in adolescent psychiatric inpatients Abstract. Objective: Repeated and long-lasting victimisation, as defined by bullying, represents a wide spread health hazard. The aim of the present study was to present the prevalence of bullying in adolescent psychiatric inpatients. We analysed relations between bullying and sociodemographic and psychopathological variables. Furthermore, we investigated the number and nature of bullies, feasible resources, and parental perception on bullying in adolescence. Method: In total, 128 adolescent inpatients were surveyed with a bullying questionnaire and youth self-report. In addition, their clinical symptomatology was investigated. Results: Bullying affected one third of our sample. Male and female victims showed significantly more internal problems. Girls in addition revealed more external behaviour problems. Unlike non-suicidal, self-harming behaviour, suicidal ideation and suicidal behaviour occurred significantly more in patients with bullying experience. Conclusion: A significant number of adolescent in our sample experienced bullying and associated psychological strains. This should especially be considered in child and adolescent anamnesis.

[Psychodynamics in organisation and cooperation of child and adolescents institutions]

According to underlying law (Krankenanstaltengesetz) the internal structure of Departments of Child and Adolescent Psychiatry (CAP) represents a matrix structure, defining formal roles and tasks of the personel. In contrast, external cooperation is defined in several different laws. Furthermore, patients and their systems are exhibiting a high tensional potential. These different influences can cause more or less severe enmeshments. Thus, during the treatment of this patients it is necessary to take into account the possibility of these enmeshments. It should be answered by special forms of care of the relationship between professionals and families. These special forms of relational care can be delivered by clear organizational structures and must undergo reflective processes on a regular basis. The planning and delivery of those structures is clearly seen as a central responsibility of the management of a CAP-Department.

[Usage patterns of internet and computer games : Results of an observational study of Tyrolean adolescents]

BACKGROUND

The use of digital media such as the Internet and Computer games has greatly increased. In the western world, almost all young people regularly use these relevant technologies. Against this background, forms of use with possible negative consequences for young people have been recognized and scientifically examined. The aim of our study was therefore to investigate the prevalence of pathological use of these technologies in a sample of young Tyrolean people.

METHODS

398 students (average age 15.2 years, SD ± 2.3 years, 34.2% female) were interviewed by means of the structured questionnaires CIUS (Internet), CSV-S (Computer games) and SWE (Self efficacy). Additionally, socio demographic data were collected.

RESULTS

In line with previous studies, 7.7% of the adolescents of our sample showed criteria for problematic internet use, 3.3% for pathological internet use. 5.4% of the sample reported pathological computer game usage. The most important aspect to influence our results was the gender of the subjects. Intensive users in the field of Internet and Computer games were more often young men, young women, however, showed significantly less signs of pathological computer game use.

CONCLUSIONS

A significant percentage of Tyrolean adolescents showed difficulties in the development of competent media use, indicating the growing significance of prevention measures such as media education. In a follow-up project, a sample of adolescents with mental disorders will be examined concerning their media use and be compared with our school-sample.

Emotional dysregulation and trauma predicting psychopathy dimensions in female and male juvenile offenders

BACKGROUND

Psychopathy is a specific syndrome that predicts future violent and aggressive behavior in adults. Studies in youth and adults have demonstrated a strong association between early traumatic incidents and later dissocial behavior. Moreover, the impact of personality pathology and emotional dysregulation on aggressive and violent behavior is well established. However, few studies have addressed the relationship between early traumatization and psychopathic traits in adolescents.

METHOD

The present study examined associations between both general dimensions of personality pathology and early traumatic experiences and the dimensions of psychopathy in 170 male and 171 female adolescent detainees.

RESULTS

Analyses revealed associations between physical abuse, emotional dysregulation and psychopathic traits in delinquent boys but not in delinquent girls.

CONCLUSION

Hypothesized relationships between trauma, personality pathology could only be confirmed in the lifestyle and antisocial, but not in the core affective and interpersonal facets of psychopathy.

Child and adolescent psychiatry patients coming of age: a retrospective longitudinal study of inpatient treatment in Tyrol

BACKGROUND

Mental illness is a common phenomenon at all ages. Various independent studies have shown that psychopathology is often expressed on a continuum from youth to adulthood. The aim of our study was to demonstrate a) the frequency of admission of former child and adolescent psychiatry inpatients (CAP-IP) to adult inpatient mental health facilities, and b) a potential longitudinal diagnostic shift. This is the first Austrian study designed to shed light on these issues.

METHODS

Nearly 1000 inpatient cases at a specialized child and adolescent care center were analyzed. These cases were then tracked using data matching with registry data from adult psychiatric institutions. Overall, our observational period was 23 years.

RESULTS

26 % of our sample of former CAP-IP used psychiatric inpatient mental health services as adults, thus indicating chronicity or reoccurrence. In line with previous literature, there were patients who stayed in the same diagnostic category as well as patients with a diagnostic shift from childhood to adulthood.

CONCLUSIONS

Childhood and adolescence is a very important period for early intervention and prevention of mental illness. Our findings support the notion of the continuity of psychopathology from youth into adulthood.

Eating disorders in adolescence: attachment issues from a developmental perspective

In the present article we review findings from an emerging body of research on attachment issues in adolescents with eating disorders from a developmental perspective. Articles for inclusion in this review were identified from PsychINFO (1966-2013), Sciencedirect (1970-2013), Psychindex (1980-2013), and Pubmed (1980-2013). First, we will outline the crucial developmental changes in the attachment system and discuss how they might be related to the early onset of the disease. Then we will report on the major results from attachment studies using self-report and narrative instruments in that age group. Studies with a developmental approach on attachment will be analyzed in more detail. The high incidence of the unresolved attachment pattern in eating disorder samples is striking, especially for patients with anorexia nervosa. Interestingly, this predominance of the unresolved category was also found in their mothers. To date, these transgenerational aspects are still poorly understood and therefore represent an exciting research frontier. Future studies that include larger adolescent samples and provide a more detailed description including symptom severity and comorbidity would contribute to a better understanding of this complex and painful condition.

[The dimensional-categorical hybrid model of personality disorders in DSM-5 from an adolescent psychiatric perspective - criticism and critical outlook]

By applying the dimensional-categorical hybrid model, Chapter III of the DSM-5 proposes a central innovation in the classification of personality disorders, the aim being a reduction of comorbidity and improvement of the construct as well as the discremental validity and stability of the diagnosis. The well-known categorical classification of personality disorders in Chapter II, however, remains valid. Based on the hybrid model the essential aspects of a personality disorders are as follows: the dimensional assessment of levels of personality functioning regarding disturbances in self (identity and self-direction) and interpersonal (empathy and intimacy) aspects on the one hand, and the existence of pathological personality traits on the other. Beside five higher-order traits, 25 specific trait facets are described. Moreover, a reduction in the number of personality disorder types is proposed, reflecting six instead of ten categories which are empirically best validated. The abandoned age limitation for the assessment of a personality disorder in Chapter III can be regarded as a clear statement with respect to the possibility and necessity of diagnosing and treating personality pathology in adolescence. By presenting an additional dimensional approach with a detailed description of personality functioning as well as specific pathological personality traits, the new hybrid model seems to principally be a useful approach for clinical purposes as well as research questions.

Tierquälerei als Symptom von Callous-Unemotional Traits bei inhaftierten Jungen und Mädchen

Tierquälerei zählt bei Kindern und Jugendlichen als Verhaltensauffälligkeit im Sinne der Störung des Sozialverhaltens. Die vorliegende Studie untersucht den Zusammenhang von Tierquälerei und Callous-Unemotional Traits (CU-Traits) als Psychopathy-Kerndimensionen bei inhaftierten Jungen und Mädchen (n = 334). Angewendet wurde die Psychopathy Checkliste für Jugendliche (PCL:YV). Es fanden sich bei den Jungen höchst signifikante Korrelationen zwischen den CU-Traits sowie den Psychopathy-Verhaltensdimensionen und Tierquälerei. Bei den Mädchen waren die Korrelationen geringfügig kleiner, fanden sich allerdings nicht für Tierquälerei und dem Interpersonalen Psychopathy-Faktor. Die männlichen Tierquäler zeigten sowohl für die CU-Traits als auch für die Psychopathy-Verhaltensdimensionen signifikant höhere PCL:YV-Werte als diejenigen Straftäter ohne Tierquälerei. Auch die weiblichen Tierquäler erreichten in allen Psychopathy-Dimensionen höhere Werte als die Nicht-Tierquäler bis auf den Interpersonalen Faktor. Diese Befunde wurden diskutiert und möglichen geschlechtsspezifischen Profilen zugeordnet. Tierquälerei scheint als Symptom für die Unterscheidung des Antisocial bzw. des Psychopathic Types der Antisozialen Persönlichkeitsstörung des DSM-V von Bedeutung zu sein.

Stabilität von Persönlichkeitspathologie bei jugendlichen Delinquenten

In dieser Follow-up-Studie wurde die Stabilität dimensional erfasster Persönlichkeitspathologie in einer Stichprobe ehemals inhaftierter weiblicher und männlicher Jugendlicher nach Ablauf von anderthalb Jahren untersucht. Es wurden 71 weibliche und männliche Jugendliche aus einer Kohorte vormals Inhaftierter im Mittel 17,1 Monate nach der Ersterhebung mit dem Dimensional Assessment of Personality Pathology- Basic Questionnaire (DAPP-BQ) nachuntersucht. Zur Klärung der Frage einer signifikanten Mittelwertsveränderung über die beiden Erhebungszeitpunkte hinweg wurde eine univariate Varianzanalyse mit Messwiederholung und zudem Rangkorrelationen berechnet. Die Ausprägungen für die DAPP-Subskalen Kognitive Verzerrung, Affektive Labilität, Argwohn, Unsichere Bindung, Reizsuche und Hartherzigkeit erwiesen sich als stabil. Demgegenüber waren signifikante Mittelwertsveränderungen bezüglich Identitätsprobleme, Oppositionalität, Selbstschädigung und Verhaltensprobleme auszumachen. Die vorliegenden Resultate entsprachen Ergebnissen mehrerer aktueller longitudinaler Studien. Als instabil erwiesen sich von anderen Autoren als „dysfunktionales Verhalten“ beschriebene persönlichkeitspathologische Merkmale, wohingegen stabilere Resultate für Persönlichkeitstraits (z. B. affektive Labilität und Hartherzigkeit) vorlagen. Diese Ergebnisse verweisen darauf, dass sich auch in einer Hochrisikopopulation delinquenter Jugendlicher das Konstrukt Persönlichkeit aus stabilen und instabilen Anteilen zusammensetzt. Die Auswirkungen auf die klinische Praxis werden diskutiert.

Das Psychopathy-Konzept bei Mädchen

Die vorliegende Studie untersucht die Validität des Psychopathy-Konzepts bei delinquenten Mädchen und widmet sich der Frage, inwiefern sich Unterschiede zwischen Mädchen mit und ohne Psychopathy-Eigenschaften finden lassen. Anhand der Ergebnisse aus der Psychopathy-Checkliste Youth Version (PCL:YV) wurden 171 inhaftierte Mädchen (14 – 19 Jahre) in eine Gruppe mit hochausgeprägten Callous-unemotional Traits (CU-Gruppe), in eine mit hochausgeprägtem aggressiv-impulsivem Verhalten (Behavioral-Gruppe) sowie in eine Gruppe ohne Psychopathy-Eigenschaften eingeteilt und hinsichtlich allgemeiner Psychopathologie, ADHS, Traumatisierung, Heimaufenthalten sowie Gewaltdelikten mit Hilfe einfaktorieller ANOVAs verglichen. 30 % der Mädchen wiesen Psychopathy-Eigenschaften im Sinne von hochausgeprägten CU-Traits auf, 40 % zeigten ausschließlich extrem impulsiv-aggressives Verhalten. 15 % ließen sich aufgrund ihrer zu geringen Psychopathy-Ausprägung keiner Gruppe zuordnen, bei 15 % lagen keinerlei Auffälligkeiten vor. Sowohl die CU- als auch die Behavioral-Gruppe wiesen im Vergleich zu den Mädchen ohne Psychopathy signifikant mehr ADHS-Symptome sowie externalisierendes und internalisierendes Verhalten auf. Außerdem gaben sie mehr emotionale Misshandlung und mehr Heimaufenthalte an. Die beiden Psychopathy-Gruppen unterschieden sich nur dahingehend, dass die Behavioral-Gruppe signifikant mehr Gewaltstraftaten und Verurteilungen zeigten. Die gefundenen Unterschiede zwischen den delinquenten Mädchen mit hoch ausgeprägten Psychopathy-Eigenschaften im Vergleich zu denen ohne Psychopathy stärken die Annahme, dass es sich um ein valides Konzept handelt, welches eine spezifische Subgruppe unterscheiden kann. Gleichzeitig wird aufgrund der Heterogenität des Konzepts–Persönlichkeitsdimensionen sowie Verhaltensdimensionen–deutlich, dass eine differenzierte Betrachtung der Psychopathy-Dimensionen von übergeordneter Bedeutung ist.

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.

Persönlichkeitsstörungen im Jugendalter

Ziel dieses Beitrags ist es, die aktuelle Kontroverse zum Thema Persönlichkeitsstörungen im Jugendalter darzustellen und für den deutschsprachigen Raum Trends sowie Perspektiven in Forschung und Praxis seit 2009 zu skizzieren. Dazu wurden vor allem Publikationen aus der Kinder- und Jugendpsychiatrie und der Klinischen Kinderpsychologie neben wissenschaftlichen Beiträgen des 32. Kongresses der Deutschen Gesellschaft für Kinder- und Jugendpsychiatrie gesichtet. Aktuelle Forschungsergebnisse verweisen darauf, dass Persönlichkeitsstörungen im Jugendalter mittels der für Erwachsene entwickelten Instrumente zuverlässig erfasst werden können und diagnostiziert werden sollten. Zugleich fehlt es noch an spezifischen Instrumenten, welche die Besonderheiten von Persönlichkeitsstörungen im Jugendalter abbilden und von Adoleszenzkrisen differenzieren können. Die Prävalenz von Persönlichkeitsstörungen scheint im Jugendalter höher als im Erwachsenenalter zu liegen. Eine Subform der antisozialen Persönlichkeitsstörung, die auch bei Jugendlichen zu finden ist, stellt die Psychopathy dar. Insgesamt wird deutlich, dass es noch weiterer diagnostischer Langzeitstudien bedarf, um zu klären, unter welchen Bedingungen Persönlichkeitsstörungen manifest werden, welche Faktoren ihren Verlauf beeinflussen und wie sie sich durch Interventionen verändern lassen.

[Early onset psychosis: rationale and concept of a cognitive-behavioral intervention]

Early onset psychoses (EOP, age of onset between age 14 and 18 years) are known to be associated with a poorer outcome than adult onset psychoses, both in terms of psychotic symptoms and social remission. For adult patients with psychosis, numerous cognitive-behavioral interventions have proven their effectiveness in recent years. This contrasts with a dearth of findings for EOP, even though it can be considered as a variant of adult onset psychosis. Thus, we have developed a cognitive-behavioral therapy intervention that was specifically adapted to the characteristics and needs of young people suffering from psychosis. The concept of the intervention is outlined in the present article. Acceptability and feasibility of the intervention are currently undergoing evaluation in a randomised, controlled pilot study.

Epidemiologische Daten zu Persönlichkeitsdimensionen der Psychopathy bei Jungen und Mädchen

Fragestellung: Ziel der Arbeit war die Ermittlung von epidemiologischen Daten zu Psychopathy-Dimensionen bei Jugendlichen. Methodik: In einer forensischen Stichprobe (169 Jungen, 172 Mädchen), einer Klinik- (30 Jungen, 63 Mädchen) und einer Schulstichprobe (119 Jungen, 116 Mädchen) wurde die Psychopathy Checkliste für Jugendliche (PCL:YV) erhoben und anhand von drei unterschiedlichen konzeptionellen Überlegungen ausgewertet. Insgesamt nahmen 669 Jugendliche im Alter von 14–19 Jahren an der Untersuchung teil. Ergebnisse: Abhängig von dem zugrunde gelegten Schwellenwert fanden sich für die inhaftierten Jungen Prävalenzen von 63 % bis 27 %, für die inhaftierten Mädchen von 24 % bis 7 %. In der Klinik- und Schulstichprobe zeigten sich höhere Ausprägungen der Verhaltens- und niedrige Ausprägungen der Kernpersönlichkeitsdimensionen. In allen Stichproben ließen sich signifikant mehr Psychopathy-Eigenschaften bei den Jungen im Vergleich zu den Mädchen finden. Schlussfolgerungen: Es konnte gezeigt werden, dass bei Verwendung unterschiedlicher Modelle zur Auswertung der PCL:YV sehr verschiedene Prävalenzraten berechnet werden. Dabei treibt das Ausmaß der jugendtypischen und dissozialen Verhaltensmerkmale, die durch den Lifestyle und den Antisozialen Faktor abgebildet werden, den Psychopathy-Gesamtwert fälschlich in die Höhe, ohne dass hohe Ausprägungen der Kerndimensionen vorliegen. Zukünftig sollte auf die beiden Kernpersönlichkeitsdimensionen der Psychopathy fokussiert werden.

[Psychopathy, temperament and antisocial behaviour in girls]

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.

Erfassung und Klassifikation von Persönlichkeitspathologie im Jugendalter

Fragestellung: Die Frage der Diagnostik und Klassifikation von Persönlichkeitsstörungen im Jugendalter ist immer noch eine kontrovers diskutierte Thematik. Methodik: In dieser Übersichtsarbeit werden die aktuellen Forschungsbefunde zur Komorbidität und Diagnostik von Persönlichkeitsstörungen im Jugendalter sowie ihre neurobiologischen und -psychologischen Korrelate dargelegt. Ergebnisse: Aktuelle Forschungsergebnisse verweisen einerseits darauf, dass Persönlichkeitsstörungen im Jugendalter mittels der für Erwachsene entwickelten Instrumente zuverlässig erfasst werden können. Andererseits wird bemängelt, dass kein einheitliches jugendspezifisches Konzept zur Erfassung von Persönlichkeitsstörungen existiert, das eine einheitliche Grundlage für die Erforschung dieses klinisch so bedeutsamen Störungsbildes bildet. Schlussfolgerungen: Es bedarf diagnostischer und Langzeitstudien im Rahmen von Netzwerken, die Aufschluss über die Frage der Klassifizierbarkeit von Persönlichkeitsstörungen in der Adoleszenz in Abgrenzung zu anderen jugendtypischen Störungsbildern geben.

Atomoxetine treatment and ADHD-related difficulties as assessed by adolescent patients, their parents and physicians

BACKGROUND

The degree of ADHD-related difficulties - reflecting overall impairment, social functioning, and quality of life - may be perceived differently by adolescent patients, parents and physicians. The primary aim of this study was to investigate ADHD-related difficulties during atomoxetine treatment, as perceived by the three different raters. Secondary objectives focused on effectiveness and tolerability of atomoxetine treatment in a population of adolescent patients with ADHD.

METHODS

Adolescents with ADHD, aged 12-17 years, received open-label atomoxetine (0.5-1.2 mg/kg/day) up to 24 weeks. ADHD-related difficulties at various times of the day were rated using the Global Impression of Perceived Difficulties (GIPD) instrument. Inter-rater agreement was analyzed using Cohen's Kappa with 95% confidence intervals (95% CI). ADHD-Rating Scale (ADHD-RS) and Clinical Global Impression Severity (GGI-S) scores were assessed by the investigator; and spontaneous adverse events, vital signs and laboratory parameters were collected for tolerability assessments.

RESULTS

159 patients received atomoxetine. Patients' baseline mean GIPD total ratings were significantly lower than parents' and physicians' scores (12.5 [95%CI 11.6;13.5] vs. 17.2 [16.2;18.2] and 18.8 [17.8;19.8]). For all raters, GIPD scores significantly improved over time. Changes were greatest within the first two weeks. Kappa coefficients varied between 0.186 [0.112;0.259] and 0.662 [0.529;0.795], with strongest agreements between parent and physician assessments, and significant improvements of patient/physician agreements over time (based on 95% CIs). ADHD-RS and CGI-S scores significantly improved over the course of the study (based on 95% CIs). Tolerability results were consistent with earlier reports.

CONCLUSION

ADHD-related difficulties were perceived differently by the raters in this open-label trial, but consistently improved during atomoxetine treatment. The GIPD instrument appeared sensitive to treatment-related change. These primarily quantitative findings may guide future studies to more systematically investigate the clinical and practical relevance of the differences observed. Additionally, in order to further validate these results, placebo- and comparator-controlled trials are recommended as well as inclusion of healthy controls and other patient populations.

CLINICAL TRIAL REGISTRY

ClinicalTrials.gov: NCT00191737.

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.

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.

Attachment representation in mothers of children with attention deficit hyperactivity disorder

Attachment research so far rarely has focused on attention deficit hyperactivity disorder (ADHD). This study is the first to examine the distribution of the attachment representation in mothers of children with ADHD. Considering results of clinical attachment studies we formulated the following hypothesis: the prevalence of maternal insecure and unresolved attachment representations increases with the degree of severity of children's ADHD symptoms. Therefore it is highest in mothers of children with ADHD who are treated clinically (group A). It is expressed less strongly in mothers of children with ADHD symptoms without need for clinical treatment (group B). In a control group of mothers whose children have no ADHD diagnosis (group C), there is the lowest prevalence of insecure and disorganized attachment representations. Within a period of 6 months from a total of 72 recruited children and their mothers screened according to participation criteria (e.g. ICD-10: F90 Hyperkinetic disorders), 13 mothers could be assigned to group A, 19 mothers to group B, and 19 mothers to group C. The attachment representation was assessed using the Adult Attachment Projective. To test the sequence order hypothesis we used the Jonckheere-Terpstra test (u = 3.78; p < 0.001). The increasing clinical conspicuity in the groups obviously is connected to a reduced prevalence of the autonomous attachment representations as well as to an increase of the insecure and unresolved attachment representations of the mothers. We interpret this result with respect to the treatment of children with ADHD as a vote for considering the family context as well as early intervention strategies which aim at the improvement of the quality of maternal sensitivity.

Der Einfluss emotionaler Stimuli auf die Arbeitsgedächtnisleistung bei weiblichen delinquenten Jugendlichen*

Zusammenfassung: Fragestellung: Die vorliegende Studie widmet sich der Frage, inwiefern bei inhaftierten Mädchen Defizite im Bereich des räumlichen Arbeitsgedächtnisses vorzufinden sind. Darüber hinaus wurde der Einfluss visueller emotionaler Stimuli auf das Arbeitsgedächtnis dissozialer weiblicher Jugendlicher untersucht sowie die Beziehung zwischen der Fehleranzahl in den verschiedenen Arbeitsgedächtnisvarianten und den Ausprägungen der Psychopathy * Wegen der Abgrenzung von dem Psychopathie-Begriff Kurt Schneiders wird durchgängig der Begriff Psychopathy verwendet, der sich auf das Psychopathy-Konzept nach Robert Hare bezieht. . Methodik: Eine Gruppe inhaftierter weiblicher Jugendlicher (n = 33) wurde mit nichtdelinquenten Gesamtschülerinnen der Klassen 10 und 11 (n = 20) verglichen. Drei Varianten des Subject-Ordered Pointing Task (SOPT: neutral, Erotik, Schrecken) und die Psychopathy-Checkliste Youth Version (PCL:YV) wurden mit beiden Gruppen durchgeführt. Ergebnisse: Varianzanalysen erbrachten signifikante Unterschiede zwischen den Gruppen bezüglich einer neutralen sowie einer Schreckvariante des SOPT, aber nicht bezüglich einer Variante mit erotischen Stimuli. Der Zusammenhang zwischen Psychopathy und der neutralen Variante, nicht hingegen für die Schreckvariante des SOPT, bestätigte sich. Schlussfolgerungen: Die Studie zeigte ähnliche Defizite in der neutralen Arbeitsgedächtnisbedingung bei inhaftierten weiblichen Jugendlichen, wie es aus der Literatur für männliche Dissoziale bekannt ist. Der fehlende Gruppenunterschied in der erotischen Bedingung des SOPT könnte einerseits mit einer verbesserten Leistung der oft sexuell traumatisierten delinquenten weiblichen Jugendlichen, andererseits mit einer erwarteten Verschlechterung in der Kontrollgruppe zusammenhängen. Die Arbeitsgedächtnisleistung auf der Basis von Schreckstimuli verwies darauf, dass Mädchen mit hohen Psychopathy-Werten anders als dissoziale Jungen möglicherweise doch empfänglich auf emotionale Stimuli reagieren.

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.