1
|
Otter M, Kothgassner OD, Lepuschütz L, Drahos S, Plener PL. The impact of the COVID-19 pandemic on rates of adolescents receiving psychopharmacological medication in Austria. Child Adolesc Psychiatry Ment Health 2024; 18:10. [PMID: 38218981 PMCID: PMC10788023 DOI: 10.1186/s13034-023-00684-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 11/29/2023] [Indexed: 01/15/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has impacted many aspects of everyday life, including the (mental) healthcare system. An increase in depression and anxiety symptoms has been reported worldwide, and is particularly pronounced in females and young people. We aimed to evaluate changes in prescription rates for psychopharmacological medication, which is often used to treat depression and anxiety. METHOD Based on data from the Austrian public health insurance institutions, we conducted an interrupted time series analysis of antidepressants and antipsychotics, comparing prescription rate developments before and throughout the COVID-19 pandemic (2013 to 2021), with a special focus on adolescents (10-19 years) in comparison to the general population. Data were based on all public prescriptions in the outpatient sector nationwide. Age- and sex-stratified time-series models were fitted to the pre-COVID period (first quarter (Q1) of 2013 to second quarter (Q2) of 2020). These were used to generate forecasts for the period from the third quarter (Q3) of 2020 to the fourth quarter (Q4) of 2021, which were subsequently compared to observed developments in order to assess significant deviations from the forecasted development paths. RESULTS For the majority of the evaluated period, we found a significant excess of antidepressant prescriptions among both male and female adolescents (10-14 and 15-19 years) compared to the forecasted development path, while the general population was mostly within 97.5% confidence intervals of the forecasts. Regarding antipsychotics, the interrupted time series analysis revealed a significant excess in the group of female adolescents in almost all quarters, which was especially pronounced in the 15-19 age group. Prescription rates of antipsychotics in the general population only showed a significant excess in two quarters. CONCLUSION Increased rates of adolescents receiving psychopharmacological treatment echo the epidemiological trends of an increase in depression and anxiety symptoms reported in the literature. This increase is especially pronounced in female adolescents.
Collapse
Affiliation(s)
- M Otter
- Federation of Austrian Social Insurance Institutions, Kundmanngasse 21, 1030, Vienna, Austria
| | - O D Kothgassner
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Waehringerguertel 18-20, 1090, Vienna, Austria
| | - L Lepuschütz
- Federation of Austrian Social Insurance Institutions, Kundmanngasse 21, 1030, Vienna, Austria
| | - S Drahos
- Federation of Austrian Social Insurance Institutions, Kundmanngasse 21, 1030, Vienna, Austria
| | - P L Plener
- Department of Child and Adolescent Psychiatry, Medical University Vienna, Waehringerguertel 18-20, 1090, Vienna, Austria.
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Steinhoevelstr. 5, 89075, Ulm, Germany.
| |
Collapse
|
2
|
Konicar L, Radev S, Prillinger K, Klöbl M, Diehm R, Birbaumer N, Lanzenberger R, Plener PL, Poustka L. Volitional modification of brain activity in adolescents with Autism Spectrum Disorder: A Bayesian analysis of Slow Cortical Potential neurofeedback. Neuroimage Clin 2021; 29:102557. [PMID: 33486138 PMCID: PMC7829342 DOI: 10.1016/j.nicl.2021.102557] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/18/2020] [Accepted: 01/02/2021] [Indexed: 11/29/2022]
Abstract
Autism spectrum disorder is (ASD) characterized by a persisting triad of impairments of social interaction, language as well as inflexible, stereotyped and ritualistic behaviors. Increasingly, scientific evidence suggests a neurobiological basis of these emotional, social and cognitive deficits in individuals with ASD. The aim of this randomized controlled brain self-regulation intervention study was to investigate whether the core symptomatology of ASD could be reduced via an electroencephalography (EEG) based brain self-regulation training of Slow Cortical Potentials (SCP). 41 male adolescents with ASD were recruited and allocated to a) an experimental group undergoing 24 sessions of EEG-based brain training (n1 = 21), or to b) an active control group undergoing conventional treatment (n2 = 20), that is, clinical counseling during a 3-months intervention period. We employed real-time neurofeedback training recorded from a fronto-central electrode intended to enable participants to volitionally regulate their brain activity. Core autistic symptomatology was measured at six time points during the intervention and analyzed with Bayesian multilevel approach to characterize changes in core symptomatology. Additional Bayesian models were formulated to describe the neural dynamics of the training process as indexed by SCP (time-domain) and power density (PSD, frequency-domain) measures. The analysis revealed a substantial improvement in the core symptomatology of ASD in the experimental group (reduction of 21.38 points on the Social Responsiveness Scale, SD = 5.29), which was slightly superior to that observed in the control group (evidence Ratio = 5.79). Changes in SCP manifested themselves as different trajectories depending on the different feedback conditions and tasks. Further, the model of PSD revealed a continuous decrease in delta power, parallel to an increase in alpha power. Most notably, a non-linear (quadratic) model turned out to be better at predicting the data than a linear model across all analyses. Taken together, our analyses suggest that behavioral and neural processes of change related to neurofeedback training are complex and non-linear. Moreover, they have implications for the design of future trials and training protocols.
Collapse
Affiliation(s)
- L Konicar
- Department of Child and Adolescence Psychiatry, Medical University of Vienna, Vienna, Austria.
| | - S Radev
- Department of Child and Adolescence Psychiatry, Medical University of Vienna, Vienna, Austria; Institute of Psychology, University of Heidelberg, Germany
| | - K Prillinger
- Department of Child and Adolescence Psychiatry, Medical University of Vienna, Vienna, Austria
| | - M Klöbl
- Neuroimaging Labs, Department of Psychiatry & Psychotherapy, Medical University of Vienna, Austria
| | - R Diehm
- Department of Child and Adolescence Psychiatry, Medical University of Vienna, Vienna, Austria
| | - N Birbaumer
- Wyss Center for Bio and Neuroengineering, Geneva, Switzerland
| | - R Lanzenberger
- Neuroimaging Labs, Department of Psychiatry & Psychotherapy, Medical University of Vienna, Austria
| | - P L Plener
- Department of Child and Adolescence Psychiatry, Medical University of Vienna, Vienna, Austria
| | - L Poustka
- Department of Child and Adolescence Psychiatry, Medical University of Göttingen, Göttingen, Germany
| |
Collapse
|
3
|
Malejko K, Tumani V, Rau V, Neumann F, Plener PL, Fegert JM, Abler B, Straub J. Neural correlates of script-driven imagery in adolescents with interpersonal traumatic experiences: A pilot study. Psychiatry Res Neuroimaging 2020; 303:111131. [PMID: 32585577 DOI: 10.1016/j.pscychresns.2020.111131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/03/2020] [Accepted: 06/18/2020] [Indexed: 01/22/2023]
Abstract
In adults, trauma imagery has proven to be a useful tool to assess the neural mechanisms of psychological trauma processing. In adolescents, heterogeneous results could be found for other tasks, however, a trauma imagery paradigm has not been evaluated. For this purpose, we investigated a trauma imagery paradigm with control scripts to assess neural correlates of traumatic experiences in youth. 15 adolescents, who had experienced a traumatic interpersonal event in the past and have developed clinically relevant symptoms, underwent an fMRI scan while listening to their individual trauma- versus two control scripts (positive/negative). We analysed a parametric contrast of the imagery phases (trauma > negative > positive) which revealed activity in the thalamus, dorsal anterior cingulate cortex, cuneus, dorsomedial prefrontal cortex and amygdala. Additionally, amygdala-activity correlated positively with depression-symptom-severity. Our data provide evidence for the feasibility of fMRI during a trauma imagery task in adolescents to investigate networks previously related to hyperarousal in adults with PTSD. Further, we demonstrate the specificity of the activated networks for trauma imagery as compared to imagery of other emotional situations. The task might be particularly useful to evaluate neural correlates of treatment in adolescents when hyperarousal is a target symptom.
Collapse
Affiliation(s)
- K Malejko
- Ulm University, Department of Psychiatry and Psychotherapy III, Ulm, Germany.
| | - V Tumani
- Ulm University, Department of Psychiatry and Psychotherapy III, Ulm, Germany
| | - V Rau
- Ulm University, Department of Psychiatry and Psychotherapy III, Ulm, Germany
| | - F Neumann
- Ulm University, Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm, Germany
| | - P L Plener
- Ulm University, Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm, Germany; Medical University Vienna, Department of Child and Adolescent Psychiatry, Vienna, Austria
| | - J M Fegert
- Ulm University, Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm, Germany
| | - B Abler
- Ulm University, Department of Psychiatry and Psychotherapy III, Ulm, Germany
| | - J Straub
- Ulm University, Department of Child and Adolescent Psychiatry and Psychotherapy, Ulm, Germany
| |
Collapse
|
4
|
Malejko K, Brown RC, Plener PL, Bonenberger M, Abler B, Graf H. Neural correlates of social inclusion in borderline personality disorder and non-suicidal self-injury. PHARMACOPSYCHIATRY 2020. [DOI: 10.1055/s-0039-3403031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- K Malejko
- Universitätsklinikum Ulm, Institut für Psychiatrie, Germany
| | - RC Brown
- Universitätsklinikum Ulm, Institut für Psychiatrie, Germany
| | - PL Plener
- Universitätsklinikum Ulm, Institut für Psychiatrie, Germany
| | - M Bonenberger
- Universitätsklinikum Ulm, Institut für Psychiatrie, Germany
| | - B Abler
- Universitätsklinikum Ulm, Institut für Psychiatrie, Germany
| | - H Graf
- Universitätsklinikum Ulm, Institut für Psychiatrie, Germany
| |
Collapse
|
5
|
Abstract
Zusammenfassung
Gegenstand und Ziel: Kindesmisshandlung stellt eine individuelle und gesellschaftliche Belastung dar. Gesundheitsfachkräfte sind hierbei wichtige Akteure, haben aber häufig unzureichende Kompetenzen. Deshalb fördert das Bundesministerium für Gesundheit die Entwicklung eines Online-Kurses zu Kinderschutz in der Medizin. Diese Arbeit stellt erste Ergebnisse der Kursevaluation für die ärztlichen Teilnehmenden vor. Material und Methoden: Vor und nach Bearbeitung des Kurses wurde Bedarf, Qualität und Kompetenzvermittlung des Online-Kurses mittels Fragebögen evaluiert. An der Befragung beteiligten sich 178 ärztliche Absolventen. Ergebnisse: 74,2% der Befragten empfanden die Inhalte des Kurses als genau angemessen. Wissen und Handlungskompetenz nahmen durch Bearbeitung des Kurses signifikant zu (Cohen’s d = 1,28 und 1,06). Der häufigste Grund für den Abbruch des Kurses waren mangelnde zeitliche Ressourcen (68,4%). Schlussfolgerungen: Der Online-Kurs stellt eine gute Möglichkeit dar, notwendige Kenntnisse zu Kinderschutz in der Medizin zu erwerben oder diese auszubauen. Klinische Relevanz: Es müssen Möglichkeiten geschaffen werden, um die Verbreitung der Kursinhalte noch weiter voranzutreiben.
Collapse
|
6
|
Lemay JF, Lanzinger S, Pacaud D, Plener PL, Fürst-Burger A, Biester T, Hilgard D, Lilienthal E, Galler A, Berger G, Holl RW. Metabolic control of type 1 diabetes in youth with autism spectrum disorder: A multicenter Diabetes-Patienten-Verlaufsdokumentation analysis based on 61 749 patients up to 20 years of age. Pediatr Diabetes 2018; 19:930-936. [PMID: 29582531 DOI: 10.1111/pedi.12676] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 03/14/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND A paucity of reports in the literature exists concerning the co-existence between autism spectrum disorder (ASD) and type 1 diabetes (T1D). OBJECTIVE To compare clinical characteristics, diabetes management and metabolic control in youth with T1D and ASD (T1D-ASD) with youth without ASD (T1D-non ASD). METHODS Using the German/Austrian diabetes patient follow-up registry, this study analyzed aggregated data from the last available year of observation for each patient with T1D, ages 1-20 with consistent data on insulin regimen and glycated hemoglobin (A1C), between January, 2005 and March, 2017. RESULTS From 61 749 patients, 150 (0.24%) were identified as T1D-ASD. Non-adjusted comparisons showed similar results for mean age at onset and duration of diabetes, but not for gender (male: T1D-ASD: 85.3%; T1D-non ASD: 52.8%; P < .001). Unadjusted comparisons showed no difference for severe hypoglycemia, diabetic ketoacidosis, insulin doses, insulin pump therapy, and body mass index. A statistical difference was observed for A1C (P-value .01) and in the number of blood glucose (SMBG) tests/day (median [interquartile range]: T1D-ASD 6.0 [4.4-7.0]; T1D-non ASD 5.0 [4.4-7.0]; P-value < .001). After adjusting for age, gender, duration of diabetes, and year of observation, only SMBG remained significant (P-value .003). T1D-ASD used psycho-stimulants (15.3% vs 2.2%; P-value < .001), antipsychotics (10.7% vs 0.6%; P-value < .001), and antidepressive medications (3.6% vs 0.7%; P-value < .001) more frequently. CONCLUSION Metabolic control was similar in the T1D-ASD group compared to T1D-non ASD despite their comorbidity. Awareness of ASD remains important in T1D treatment, as both conditions require long-term multi-disciplinary medical follow-up for optimal outcomes.
Collapse
Affiliation(s)
- J-F Lemay
- Department of Paediatrics, Alberta Children's Hospital/Cumming School of Medicine (University of Calgary), Calgary, Canada
| | - S Lanzinger
- University of Ulm, Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, Ulm, Germany.,German Centre for Diabetes Research (DZD), Munich, Germany
| | - D Pacaud
- Department of Paediatrics, Alberta Children's Hospital/Cumming School of Medicine (University of Calgary), Calgary, Canada
| | - P L Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | | | - T Biester
- AUF DER BULT, Diabetes Centre for Children and Adolescents, Hannover, Germany
| | - D Hilgard
- Department of Paediatrics, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany
| | | | - A Galler
- Charité - University Medicine of Berlin, Pediatric Endocrinology and Diabetology, Berlin, Germany
| | - G Berger
- Medical University Vienna, Dept. of Pediatric and Adolescent Medicine, Vienna, Austria
| | - R W Holl
- University of Ulm, Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology, Ulm, Germany.,German Centre for Diabetes Research (DZD), Munich, Germany
| | | |
Collapse
|
7
|
Abstract
BACKGROUND Social media presents an important means for social interaction, especially among adolescents, with Instagram being the most popular platform in this age-group. Pictures and communication about non-suicidal self-injury (NSSI) can frequently be found on the internet. METHODS During 4 weeks in April 2016, n = 2826 (from n = 1154 accounts) pictures which directly depicted wounds on Instagram were investigated. Those pictures, associated comments, and user accounts were independently rated for content. Associations between characteristics of pictures and comments as well as weekly and daily trends of posting behavior were analyzed. RESULTS Most commonly, pictures depicted wounds caused by cutting on arms or legs and were rated as mild or moderate injuries. Pictures with increasing wound grades and those depicting multiple methods of NSSI generated elevated amounts of comments. While most comments were neutral or empathic with some offering help, few comments were hostile. Pictures were mainly posted in the evening hours, with a small peak in the early morning. While there was a slight peak of pictures being posted on Sundays, postings were rather evenly spread across the week. CONCLUSIONS Pictures of NSSI are frequently posted on Instagram. Social reinforcement might play a role in the posting of more severe NSSI pictures. Social media platforms need to take appropriate measures for preventing online social contagion.
Collapse
Affiliation(s)
- R C Brown
- Department for Child and Adolescent Psychiatry and Psychotherapy,University Hospital Ulm,Ulm,Germany
| | - T Fischer
- Freelancing data journalist,Berlin,Germany
| | | | - F Keller
- Department for Child and Adolescent Psychiatry and Psychotherapy,University Hospital Ulm,Ulm,Germany
| | - R Young
- MRC Social and Public Health Sciences Unit,University of Glasgow,Glasgow,Scotland
| | - P L Plener
- Department for Child and Adolescent Psychiatry and Psychotherapy,University Hospital Ulm,Ulm,Germany
| |
Collapse
|
8
|
Helbich M, Blüml V, de Jong T, Plener PL, Kwan MP, Kapusta ND. Urban-rural inequalities in suicide mortality: a comparison of urbanicity indicators. Int J Health Geogr 2017; 16:39. [PMID: 29084555 PMCID: PMC5663034 DOI: 10.1186/s12942-017-0112-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 10/20/2017] [Indexed: 11/10/2022] Open
Abstract
Background Urban–rural disparities in suicide mortality have received considerable attention. Varying conceptualizations of urbanity may contribute to the conflicting findings. This ecological study on Germany assessed how and to what extent urban–rural suicide associations are affected by 14 different urban–rural indicators. Methods Indicators were based on continuous or k-means classified population data, land-use data, planning typologies, or represented population-based accessibility indicators. Agreements between indicators were tested with correlation analyses. Spatial Bayesian Poisson regressions were estimated to examine urban–rural suicide associations while adjusting for risk and protective factors. Results Urban–rural differences in suicide rates per 100,000 persons were found irrespective of the indicator. Strong and significant correlation was observed between different urban–rural indicators. Although the effect sign consistently referred to a reduced risk in urban areas, statistical significance was not universally confirmed by all regressions. Goodness-of-fit statistics suggested that the population potential score performs best, and that population density is the second best indicator of urbanicity. Numerical indicators are favored over classified ones. Regional planning typologies are not supported. Conclusions The strength of suicide urban–rural associations varies with respect to the applied indicator of urbanicity. Future studies that put urban–rural inequalities central are recommended to apply either unclassified population potentials or population density indicators, but sensitivity analyses are advised. Electronic supplementary material The online version of this article (10.1186/s12942-017-0112-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- M Helbich
- Department of Human Geography and Spatial Planning, Utrecht University, Heidelberglaan 2, 3584 CS, Utrecht, The Netherlands.
| | - V Blüml
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, 1090, Vienna, Austria
| | - T de Jong
- Department of Logistics, University of Stellenbosch, Van der Sterrbuilding 3017, Bosmanstreet, Matieland, Stellenbosch, South Africa
| | - P L Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, 89075, Ulm, Germany
| | - M-P Kwan
- Department of Human Geography and Spatial Planning, Utrecht University, Heidelberglaan 2, 3584 CS, Utrecht, The Netherlands.,Department of Geography and Geographic Information Science, University of Illinois at Urbana-Champaign, Urbana, IL, 61801, USA
| | - N D Kapusta
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, 1090, Vienna, Austria
| |
Collapse
|
9
|
Brown RC, Witt A, Fegert JM, Keller F, Rassenhofer M, Plener PL. Psychosocial interventions for children and adolescents after man-made and natural disasters: a meta-analysis and systematic review. Psychol Med 2017; 47:1893-1905. [PMID: 28397633 DOI: 10.1017/s0033291717000496] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Children and adolescents are a vulnerable group to develop post-traumatic stress symptoms after natural or man-made disasters. In the light of increasing numbers of refugees under the age of 18 years worldwide, there is a significant need for effective treatments. This meta-analytic review investigates specific psychosocial treatments for children and adolescents after man-made and natural disasters. In a systematic literature search using MEDLINE, EMBASE and PsycINFO, as well as hand-searching existing reviews and contacting professional associations, 36 studies were identified. Random- and mixed-effects models were applied to test for average effect sizes and moderating variables. Overall, treatments showed high effect sizes in pre-post comparisons (Hedges' g = 1.34) and medium effect sizes as compared with control conditions (Hedges' g = 0.43). Treatments investigated by at least two studies were cognitive-behavioural therapy (CBT), eye movement desensitization and reprocessing (EMDR), narrative exposure therapy for children (KIDNET) and classroom-based interventions, which showed similar effect sizes. However, studies were very heterogenic with regard to their outcomes. Effects were moderated by type of profession (higher level of training leading to higher effect sizes). A number of effective psychosocial treatments for child and adolescent survivors of disasters exist. CBT, EMDR, KIDNET and classroom-based interventions can be equally recommended. Although disasters require immediate reactions and improvisation, future studies with larger sample sizes and rigorous methodology are needed.
Collapse
Affiliation(s)
- R C Brown
- Department of Child and Adolescent Psychiatry and Psychotherapy,University Hospital Ulm,Steinhoevelstr. 5,89075 Ulm,Germany
| | - A Witt
- Department of Child and Adolescent Psychiatry and Psychotherapy,University Hospital Ulm,Steinhoevelstr. 5,89075 Ulm,Germany
| | - J M Fegert
- Department of Child and Adolescent Psychiatry and Psychotherapy,University Hospital Ulm,Steinhoevelstr. 5,89075 Ulm,Germany
| | - F Keller
- Department of Child and Adolescent Psychiatry and Psychotherapy,University Hospital Ulm,Steinhoevelstr. 5,89075 Ulm,Germany
| | - M Rassenhofer
- Department of Child and Adolescent Psychiatry and Psychotherapy,University Hospital Ulm,Steinhoevelstr. 5,89075 Ulm,Germany
| | - P L Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy,University Hospital Ulm,Steinhoevelstr. 5,89075 Ulm,Germany
| |
Collapse
|
10
|
Sukale T, Hertel C, Möhler E, Joas J, Müller M, Banaschewski T, Schepker R, Kölch MG, Fegert JM, Plener PL. [Diagnostics and initial estimation of refugee minors]. Nervenarzt 2017; 88:3-9. [PMID: 27853852 DOI: 10.1007/s00115-016-0244-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The number of underage refugees arriving in Germany has rapidly increased since 2015. Many of these children and adolescents have been and still are, exposed to a large number of stressful circumstances. The group of those helping refugee minors is heterogeneous with both volunteers and professional workers from the fields of child welfare and healthcare services. Easily applicable instruments to assess both burdens and resources are needed in order to plan appropriate interventions. This paper focuses on instruments for assessing the circumstances of refugee minors and includes pilot data of an online-based screening instrument to assess burdens and resources (providing online resource and trauma assessment for refugees, PORTA). Field application was tested by the staff of a clearing and preclearing institution with 33 cases and good practical feasibility was reported. Applying a simple to use screening instrument for refugee minors and their helpers, which is available in several languages creates the possibility of a shared definition of problems and solutions and is beneficial to helpers (e.g. volunteers, youth welfare services and medical doctors) as well as refugee minors.
Collapse
Affiliation(s)
- T Sukale
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitätsklinikum Ulm, Steinhoevelstraße 5, 89075, Ulm, Deutschland.
| | - C Hertel
- SHG-Kliniken, Saarland-Heilstätten GmbH, Saarbrücken, Deutschland
| | - E Möhler
- SHG-Kliniken, Saarland-Heilstätten GmbH, Saarbrücken, Deutschland
| | - J Joas
- SHG-Kliniken, Saarland-Heilstätten GmbH, Saarbrücken, Deutschland
| | - M Müller
- SHG-Kliniken, Saarland-Heilstätten GmbH, Saarbrücken, Deutschland
| | - T Banaschewski
- Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Zentralinstitut für Seelische Gesundheit, Mannheim, Deutschland
| | - R Schepker
- Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Zentrum für Psychiatrie Südwürttemberg, Weissenau, Deutschland
| | - M G Kölch
- Klinik für Kinder- und Jugendpsychiatrie und -psychotherapie, Ruppiner Kliniken, Medizinische Hochschule Brandenburg, Neuruppin, Deutschland
| | - J M Fegert
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitätsklinikum Ulm, Steinhoevelstraße 5, 89075, Ulm, Deutschland
| | - P L Plener
- Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Zentralinstitut für Seelische Gesundheit, Mannheim, Deutschland
| |
Collapse
|
11
|
Straub J, Metzger CD, Plener PL, Koelch MG, Groen G, Abler B. Successful group psychotherapy of depression in adolescents alters fronto-limbic resting-state connectivity. J Affect Disord 2017; 209:135-139. [PMID: 27912160 DOI: 10.1016/j.jad.2016.11.024] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 08/31/2016] [Accepted: 11/15/2016] [Indexed: 11/19/2022]
Abstract
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.
Collapse
Affiliation(s)
- J Straub
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Germany
| | - C D Metzger
- Department of Psychiatry and Psychotherapy, Otto-von-Guericke University, Magdeburg, Germany; Leibniz Institute for Neurobiology, Magdeburg, Germany; Institute of Cognitive Neurology and Dementia Research (IKND), Otto-von-Guericke University, Magdeburg, Germany; German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany
| | - P L Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, Germany
| | - M G Koelch
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Germany; Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Medical School Brandenburg, Germany
| | - G Groen
- Department of Psychiatry and Psychotherapy III, University Hospital Ulm, Germany
| | - B Abler
- Department of Psychiatry and Psychotherapy III, University Hospital Ulm, Germany.
| |
Collapse
|
12
|
Abstract
Pharmacotherapeutic interventions are available for most psychiatric disorders in children. Evidence for these interventions varies, depending on the targeted disorders. For attention-deficit/hyperactivity disorder, a sound database on efficacy and safety of medication exists. For other common disorders or psychopathological phenomena like disruptive behavior, anxiety disorders, depressive disorders, or autism, data on efficacy and safety are much scarcer. This selective review aims to provide an overview about current psychopharmacological interventions in child and adolescent psychiatry. The literature indicates either a lower efficacy than other interventions or less beneficial effects compared to possible adverse events in these cases. Most guidelines recommend psychopharmacotherapy in children to be embedded in a psychosocial or therapeutic intervention plan. Decision for medication depends on the severity of symptoms, chronicity, and, most important, impairment of the child in academic performance, family relationships, and everyday life. The high rates of off-label use in the age group of children are often due to a lack of market authorization studies less indicative of low efficacy. As adverse events need to be monitored closely, pharmacotherapy should mainly be restricted to experienced mental health care providers.
Collapse
Affiliation(s)
- M Kölch
- Department for Child and Adolescent Psychiatry and Psychotherapy, Medical School Brandenburg, Neuruppin
| | - P L Plener
- Department for Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Ulm
| |
Collapse
|
13
|
Plener PL, Gatz SA, Schuetz C, Ludolph AG, Kölch M. A case of selective mutism in an 8-year-old girl with thalassaemia major after bone marrow transplantation. Pharmacopsychiatry 2011; 45:37-9. [PMID: 21989599 DOI: 10.1055/s-0031-1287776] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Selective mutism is rare with a prevalence below 1% in the general population, but a higher prevalence in populations at risk (children with speech retardation, migration). Evidence for treatment strategies is hardly available. This case report provides information on the treatment of selective mutism in an 8-year-old girl with preexisting thalassaemia major. As medications she received penicillin prophylaxis (500000 IE/d) and deferasirox (Exjade; 20-25mg/kg/d), an iron chelator. The preexisting somatic disease and treatment complicated the treatment, as there are no data about pharmacological combination therapy. Psychotherapy in day treatment, supported by the use of the SSRI fluoxetine (10 mg), led to a decrease in the selective mutism score from 33 to 12 points, GAF improved by 21 points. Mean levels of fluoxetine plus norfluoxetine were 287.8 ng/ml without significant level fluctuations.
Collapse
|
14
|
Kapusta ND, Voracek M, Etzersdorfer E, Niederkrotenthaler T, Dervic K, Plener PL, Schneider E, Stein C, Sonneck G. Characteristics of police officer suicides in the Federal Austrian Police Corps. Crisis 2011; 31:265-71. [PMID: 21134846 DOI: 10.1027/0227-5910/a000033] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Suicide rates among police officers may be high because of strong occupational stressors. AIMS This study examined the suicide rate and suicide characteristics among police officers in the Federal Austrian Police Force. METHODS All suicides among policemen during the period 1996-2006 were analyzed retrospectively on the basis of personalized police record files from all Austrian police departments. Information on sex, age, marital status, children, region, method and place of suicide, suicide notes, position, and length of service was extracted from these files. The general Austrian population, adjusted for sex and age composition, served as the comparison group. RESULTS The suicide rate among male police officers was 30.2/100,000 (SD 11.0), which was comparable to the suicide rate in the adjusted general population (30.5/100,000; SD 2.9). The female police officer suicide rate was 1.8/100,000, while the corresponding suicide rate of the adjusted female general population was 12.5/100,000 (SD 1.7). Firearms were the most frequent suicide method (77.8%), and the incidence of suicide notes was 30.8%. CONCLUSIONS Suicide rates among police officers seem comparable to those of the age-adjusted general population. Given the healthy-worker effect, these results still suggest an increased risk of suicide among police officers. These findings should stimulate further research on stressors and risk factors for suicide among officers and should also encourage departments to increase awareness regarding suicidal signs among officers.
Collapse
Affiliation(s)
- N D Kapusta
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Währinger Gürtel 18–20, Vienna, Austria.
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Plener PL, Sukale T, Ludolph AG, Stegemann T. "Stop Cutting--Rock!": A Pilot Study of a Music Therapeutic Program for Self-Injuring Adolescents. ACTA ACUST UNITED AC 2009. [DOI: 10.1177/1943862109356928] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
16
|
Plener PL, Libal G, Keller F, Fegert JM, Muehlenkamp JJ. An international comparison of adolescent non-suicidal self-injury (NSSI) and suicide attempts: Germany and the USA. Psychol Med 2009; 39:1549-1558. [PMID: 19171079 DOI: 10.1017/s0033291708005114] [Citation(s) in RCA: 191] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study examined the prevalence of non-suicidal self-injury (NSSI), suicide attempts, suicide threats and suicidal ideation in a German school sample and compared the rates with a similar sample of adolescents from the midwestern USA by using cross-nationally validated assessment tools. METHOD Data were provided from 665 adolescents (mean age 14.8 years, S.D.=0.66, range 14-17 years) in a school setting. Students completed the Self-Harm Behavior Questionnaire (SHBQ), the Ottawa Self-Injury Inventory (OSI) and a German version of the Center for Epidemiological Studies-Depression Scale (CES-D). RESULTS A quarter of the participants (25.6%) endorsed at least one act of NSSI in their life, and 9.5% of those students answered that they had hurt themselves repetitively (more than four times). Forty-three (6.5%) of the students reported a history of a suicide attempt. No statistically significant differences were observed between the German and US samples in terms of self-injury or suicidal behaviors. CONCLUSIONS By using the same validated assessment tools, no differences were found in the prevalence and characteristics of self-injury and suicidal behaviors between adolescents from Germany and the USA. Thus, it seems that NSSI has to be understood as worldwide phenomenon, at least in Western cultures.
Collapse
Affiliation(s)
- P L Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Germany.
| | | | | | | | | |
Collapse
|