NEUROPSYCHIATRIE最新文献

Background: Mental health rehabilitation for children and adolescents was implemented in Austria from 2018 onwards based on a rehabilitation plan from 2016. In the meantime, three rehabilitation centres have been set up and put into operation in 3 different supply zones (East, North, South).

Methods: An inquiry was made to the ÖGK for up-to-date figures regarding admission and diagnoses and a statement by the heads of the Austrian rehabilitation centres was used to document and critically analyse the implementation of mental health rehabilitation for children and adolescents in Austria on the basis of these data and facts and in the light of the previous plans.

Results: A total of 96 treatment places were opened and put into operation in the three centres. The fourth center is scheduled to go into operation in 2022. With this, the bed rate will be in the calculated range, but well below the assumptions of the rehabilitation plan 2016. With regard to the structural quality criteria, in particular, the conceptualisation and calculation of personnel structures are not to be regarded as sufficient. The implementation of the 2016 rehabilitation plan was only partial, as only MHR Type I centers were established. The use seems to be sufficient after three years of operation, whereby the diagnostic spectrum shows that children and adolescents with acute problems (stress disorders, depressive episode) were more likely to be cared for.

Conclusion: Fortunately, the described mental health rehabilitation centers have gone into operation and have been well received. However, it should be noted that the original concept has been abandoned or reduced, that the structural quality and conceptualization should be reconsidered, and it is strongly recommended to implement the original concept.

Background: A considerable number of child and adolescent psychiatry inpatient units in Germany suffer from a significant shortage of doctors, which endangers the current system of nation-wide availability of high-quality child and adolescent inpatient services.

Methods: Drawing on recent data, this article pictures the status quo of child and adolescent psychiatry inpatient services in Germany. The authors then discuss the pros and cons of different suggestions of how to cope with the doctor shortage crisis in child and adolescent psychiatry.

Results: The following options for action are suggested: reduction of service provision across the board, shift from personnel-intensive inpatient towards home-based treatment, trans-sectoral cooperation by means of tele-psychiatry, delegation of clinical responsibilities to psychologists, limiting ward physicians' tasks to mere medical care of patients, improvement of working conditions in inpatient units, recruitment of doctors from abroad, and increased recruiting efforts at medical school level. From the authors' viewpoint, the latter option offers the best chance of lasting success; however, this requires a long-term, nationwide approach and considerable efforts of all departments involved.

In Austria there is a lack of registered experts in the field of forensic child and adolescent psychiatry. Their tasks include the assessment of young people in various legal issues, but there is also a lack of child and adolescent psychiatrists for treatment and care for mentally ill adolescents in prison. This lack means that child psychiatric questions are often answered by psychologists or adult psychiatrists.In the group of incarcerated young people, there is an increased proportion of mental illnesses. However, it is also known that young people with-primarily externalizing-mental illnesses also show a significantly increased risk of becoming delinquent. Specialized youth psychiatric treatment can also have a (relapse) preventive effect.To ascertain the exact requirement in Austria, the figures are lacking. These numbers should be collected urgently.Furthermore, a structured training for forensic child and adolescent psychiatrists should be expanded and a platform for exchange and supervision of child psychiatrists working in forensic topics would be desirable. If it is possible to cover the need in this area, the goal that children and adolescents are only examined by specially trained child and adolescent psychiatrists, can be achieved.

Transition in psychiatry describes the transition from child psychiatric to adult psychiatric care. This transition is not purely medical, it takes place on many levels of care. Transition in the narrow sense describes the targeted and planned process of making this change ideal for patients and medical treaters.Due to the legally fixed border to be an adult at the age of 18 years and different financing systems for children and adults, there is often a break in care of psychiatric ill adolescents. The few available studies show that only about a quarter of patients are satisfied with the process of transition and 90% of employees in the healthcare system also experience this phase as deficient.So far there are no general concepts for an orderly transition in Austria, different individual solutions are available regionally.It is necessary to include all professional groups involved, but due to the regionally very heterogeneous supply, adapted concepts are necessary. It is aimed to include a meeting of all involved professionals, the establishment of good communication and flexibility regarding to the age of transition. Concerning the need for specialized transition facilities, there is currently a lack of solid data in Austria, these data should be collected. Likewise, legal framework conditions would have to be specified and then outpatient, day clinic and inpatient settings would have to be created under child psychiatric and adult psychiatric co-management in order to support the process of transition as best as possible.

An increasing need for child and adolescent psychiatric care is clearly observed in recent years. The present study deals with 20 child and youth care facilities taking care of 439 children and adolescents, in the industrial district, in Lower Austria. The aim of the study is to evaluate treatment needs of this special group of patients. The care facilities reported that 270 children and adolescents (62%) show psychiatric problems. Of these, 220 (50.1%) are diagnosed with one or more psychiatric diagnoses, and 200 children and adolescents are receiving child and adolescent psychiatric treatment. Eleven care facilities reported the necessity for treatment in 80-100% of their accommodated children and adolescents. This results in highly stressful working conditions for professional psychosocial helpers and high treatment needs within their fosterlings. It is evident that more intensive networking and cooperation between institutions and helpers involved is necessary. Further, the development of new, low-threshold child and adolescent psychiatric services would be desirable to adequately meet the increasing need for psychiatric treatment in children and adolescents.