[Implications on the Diagnosis and Treatment of Narcissistic Personality Pathology in Adolescents Based on the Sequelae of the Covid-19 Pandemic]

The COVID-19 pandemic caused more adolescents with a pathological narcissistic personality to seek clinical as well as psychotherapeutic treatment due to suicidal crises, breakdown of social functioning and inability to continue school attendance. Recent study results show that youth with personality disorders (pd) had more trouble returning to school and to everyday life following pandemic related closures of schools. In a sample of adolescent patients with pd who were treated with transference focused psychotherapy (TFP-A) in a day-clinic programsignificantlymore juveniles remained absent fromschool during the pandemic then pre-pandemic. Only 42 % of the adolescents from the pandemic-group returned to school as a result of the treatment in comparison to 53%of the juvenile patients who returned to school after being treated before the pandemic. This might be explained by the specific effect the pandemic had on adolescents with narcissistic pd and their problem with being treated. Unfortunately, there is still hesitance in diagnosing and investigating narcissistic personality pathology in adolescence despite the knowledge that the early diagnosis and specified treatment could prevent unfavorable pathways and chronification of their severe problems. Changes in the conceptualization of pd in ICD-11 and DSM-5 enable a differentiated diagnosis beginning in late childhood. Furthermore, there are specialized manualized treatment approaches for adolescents with pd. This paper aims at illustrating the specific characteristics of narcissistic pd in youth as well as describing the symptom aggravation following the pandemic. It also points out the possibilities of a modified specialized treatment approach based on transference focused psychotherapy. Further research is needed to improve diagnostic and therapeutic modifications for juveniles with pd.

[COVID-19 and Psychiatric Disorders in Minors: Changes in Inpatient Treatment According to Hospital Statistics]

COVID-19 and Psychiatric Disorders in Minors: Changes in Inpatient Treatment According to Hospital Statistics Abstract: Increased rates of psychiatric disorders and psychiatric emergencies in children and adolescents stemming from the COVID-19 pandemic have been reported, with more children and adolescents suffering from internalizing disorders. This study analyzes whether the increased rates led to increased rates of inpatient treatment in child and adolescent psychiatric and pediatric hospitals in Germany as well as a change in diagnoses of the treated patients. We analyzed routine hospital data ("InEK" data, § 21 KHG data files) from a prepandemic (2019) and a pandemic (2021) half-year regarding changes in the number of cases, diagnoses, and length of stay (LoS) in child and adolescent psychiatry and pediatrics. We also investigated the development of psychiatric emergencies in minors. We found an increase in internalizing problems (depression, anorexia nervosa, trauma-related disorders) and a decrease in externalizing problems among the admitted psychiatric inpatients. Further, we observed a halving of cases treated for alcohol intoxication. However, we discovered no change for the frequency of psychiatric emergency treatments nationwide. A more detailed analysis revealed that, in areas with a low number of child and adolescent psychiatry inpatient beds, emergency care was prioritized and LoS decreased, whereas in areas with a fair bed-to-inhabitant ratio among minors, there was a trend toward increased LoS, also in pediatric departments. We recommend continued monitoring of inpatient care after the pandemic, with special attention paid to underprivileged children and adolescents such as those with externalizing problems.

[Parental Burden, Need for Support and Resources After Almost Two Years of COVID-19-Pandemic: Results of a Representative Study in Germany]

Studies assessing the burden of families in the second year of the COVID-19-pandemic and the need for support are scarce. Burden, negative and positive changes, resources, and the need for support during the COVID-19-pandemic of a representative sample of 1,087 parents (52,0 % female; mean age 40,4) of minors in Germany were assessed in December 2021. We used a mixed-method approach.More than 50 % percent of parents were burdened about the development of the pandemic (58,5 %), restrictions in activities outside (54,8 %), the mental health of others (54,0 %), and social distance (53,7 %). Parents reported negative changes in partnership (esp. increase in conflicts and crises; 29,4 %), school development (esp. deterioration of school performance; 25,7 %), and mental health of children (38,1 %). In retrospect, over one-third of the parents saw a need for better political communication (36,0 %) and financial support (34,1 %) during the pandemic. In December, 23,8 % of parents still reported the need for support: financial (51,3 %), social (26,6 %), and psychotherapy for themselves (25,8 %). However, parents reported positive changes, especially within the family, feelings of gratitude and new attitudes. Social interaction and positive activities were identified as resources. In the second year of the pandemic, parents experienced much burden and needed support. Interventions and policies should be more targeted and needs-oriented.

The Transformation of Chinese Cultural Images of the Plague through Chinese Characters, Legends and Folkways

The human experience of survival from a plague is about distinguishing the sick from the healthy as quickly as possible, establishing a barrier to stop the infection, and protecting healthy people. Nevertheless, the various quarantine rules and the acceptance and compliance of the population are a kind of battle between policy implementers and the public. This paper tries to understand how Chinese cultural attitudes (Henderson, 1984) unconsciously influence the Chinese people to be most cooperative with the strict containment and quarantine measures to confront the COVID-19 pandemic. This article begins with the Chinese characters, exemplified by the four characters of disease and plague, to discuss how the pictograph nature and spatial structural way profoundly shaped the cultural mind. Then, through plague-related Chinese legends, stories and folklore, the paper sets out the Chinese cultural attitudes which are also manifested in the analogical associations between disease, plague and seasons, the balance of the five elements of the universe and ghosts, gods and the government bureaucrats in the Kingdom of the Heaven. All of these approaches are well in line with Jung's method of associative amplification as a way to locate the archetypal wisdom that assures survival.

[Changes in the provision of primary care and psychotherapy in Germany during the first two lockdowns in 2020 and 2021: A two-wave survey giving consideration to gender identity and sexual orientation]

INTRODUCTION

Measures against the COVID-19 pandemic led to restrictions in ambulatory health care in Germany. While the restrictions have been described from claims data, the patients' perspective has been missing. Lesbian, gay, bisexual, trans-, inter- and asexual persons (LGBTIA) might have been particularly affected by these restrictions because of their vulnerability. Thus, our research questions were: 1) How did the restrictions during the pandemic influence primary care and psychotherapy in Germany from the patients' perspective? 2) Are there differences between LGBTIA and cis-heterosexual persons regarding these restrictions?

METHODS

We conducted an online survey with two survey waves in March/April 2020 and January/February 2021. Sampling was conducted via multiplicators and via snowball sampling. Amongst others, the survey contained open-ended questions regarding primary care and psychotherapy. From the answers of the first survey wave we constructed quantitative items for the second survey wave. Descriptive and inferential statistical analysis was conducted, including linear regression with R.

RESULTS

6,784 participants took part in the survey (2,641 in the first survey wave), 5,442 of whom identified as LGBTIA. Categories of changes in primary care were: no health care utilization, no changes in primary care, insecurity regarding primary care, and changes in primary care which could be less frequent utilization, differing procedures or changes in ways of communication. In the second wave, LGBTIA participants rated the worsening of primary care during the pandemic as being more pronounced. Regarding psychotherapy, the change can be described as no change in care, changes in the form of therapy, treatment in emergencies only and a longer break from psychotherapy. There was no different rating by LGBTIA persons compared to cis-heterosexual persons in the second survey wave. Telephone and video consultations were more common in psychotherapy than in primary care.

DISCUSSION

LGBTIA persons were oversampled, so the sample included more people from urban areas than the German population. Due to the online survey form, older people were underrepresented relative to their numbers in the general German population.

CONCLUSION

With respect to future pandemics GENERAL practitioners in primary care must be prepared that psychotherapy might be paused and delayed for some time. Video and telephone consultations should be offered to overcome pandemic-related restrictions in the future. General practitioners should know the gender identity and sexual orientation of their patients in order to proactively address health care barriers.

[Trends in place of death for nursing home residents in an urban district during the COVID-19 pandemic: An analysis of death registry data]

BACKGROUND

The nursing home is a common place of death; however, little is known about the place of death with respect to the people living there. Was there a difference in the frequencies of the places of death of nursing home residents in an urban district and in the individual facilities before and during the COVID-19 pandemic?

METHODS

Full survey of deaths by retrospective analysis of death registry data from the years 2018 to 2021.

RESULTS

Over the four-year period 14,598 people died, with 3,288 (22.5%) being residents of 31 different nursing homes. Over the reference period before the pandemic (March 1, 2018 to December 31, 2019) 1,485 nursing home residents died: 620 (41.8%) in hospital, 863 (58.1%) in a nursing home. During the pandemic period (March 1, 2020 to December 31, 2021) 1,475 death were registered: 574 (38.9%) in hospital and 891 (60.4%) in a nursing home. The mean age over the reference period was 86.5 years (±8,6; median 88.4; 47.9 to 106.2), in the pandemic period it was 86.7 years (±8,5; median 87.9; 43.7 to 111.7). Before the pandemic 1,006 deaths (67.7%) occurred in females, during the pandemic it was 969 (65.7%). The relative risk (RR) as a measure for the increase in the probabilty for an "in-hospital" death during the pandemic period was 0.94. In different facilities, the number of deaths per bed during the reference and the pandemic period varied between 0.26 and 0.98, and the RR from 0.48 to 1.61.

DISCUSSION

For all nursing home residents, the frequency of deaths was not increasing and no shift towards an "in-hospital" death was observed. Several nursing homes revealed substantial differences and opposing trends. The strength and the type of effects of facility-related circumstances remain unclear.

Back to the future: when children and adolescents return to office sessions following episodes of teletherapy

Analysts and psychotherapists are beginning to have more thorough and probing discussions about how the COVID-19 pandemic has affected their work. Shifting to online teletherapy has been necessary due to the public health measures put in place to curtail the spread of the virus. Much of the existing literature addresses how using online platforms for teletherapy works for adults. This paper instead looks at its effects on working with children and adolescents. A contrast between Winnicott's notion of holding and Bion's concept of container-contained is reviewed through a summary of a paper by Ogden. This author finds that holding might be more applicable to online work during a pandemic when the collective relationship to time and its usual parameters is severely upended. Containing could be more arduous and challenging online due to the lack of embodied presence to communicate and detect tiny nonverbal cues. A short questionnaire affirms that child analysts and psychotherapists have struggled with dimensions of online work that are particular to the developmental levels of their patients. Further, teletherapy may often not be a good fit for someone with learning differences.

Addictions: current perspectives

This paper seeks to integrate the perspectives of analytical psychology and neurobiology in order to understand the phenomenon of addiction in contemporary society, taking into account the COVID-19 pandemic. Jung emphasizes the role of the psyche's self-regulation and the development of consciousness in the individuation process. The search for experiences of transcendence is archetypal and can be achieved by the use of some substances or behaviours and can contribute to individuation. However, in contemporary society, many individuals seek to restore internal balance through behaviours that merely soothe discomfort. The difficulty in discerning use, abuse, and dependence, particularly in the case of behavioural addictions, is discussed and neurobiological factors are presented. Empathic relationships play a key role in this process as they can promote the integration of the right and left hemispheres, integrating non-verbal experiences and language, contributing to self-regulation. Jung emphasizes the importance of real encounters in the transformation process. Currently, meetings have become a source of anguish. The author concludes that more than ever it is necessary to invest in the quality of the interactions to prevent and treat addictions.

Die COVID-19-Pandemie im akutstationären Setting aus Sicht von Führungspersonen und Hygienefachkräften in der Pflege - Eine qualitative Studie

The COVID-19-pandemic in acute inpatient setting from nursing managers' and hygiene specialists' perspective - A qualitative study Abstract. Background: The COVID-19-pandemic is an unprecedented, exceptional situation and necessitates numerous adaptations of structures and processes in the acute inpatient setting.

AIM

The aim of this study was to explore how acute inpatient care was influenced by the pandemic and which implications may result for the future from nursing managers' and hygiene specialists' point of view.

METHODS

Qualitative study based on semi-structured interviews with five nursing managers and three hygiene specialists in four German acute care hospitals. Interviews were interpreted by using content analysis.

RESULTS

Interviewees described how everyday routines in their hospitals were adapted to the prioritized care for COVID-19 patients. Main challenges were uncertainty and anxiety among staff, relative scarcity of equipment and workforce resources and rapid implementation of new requirements for treatment capacities. This was addressed by targeted communication and information, large efforts to ensure resources and coordinated control of all processes by cross-department, interprofessional task forces.

CONCLUSIONS

Adaptations made to the structures and procedures of care delivery during the pandemic hold potential for future improvements of routine care, e. g. new workplace and skill mix models. To identify detailed practical implications, a renewed and deepened data analysis is needed at a later point of time, with a larger distance to the period of the pandemic.