Zeitschrift Fur Kinder-Und Jugendpsychiatrie Und Psychotherapie最新文献

Changes in the Psychiatric Prevalence and Stress Level Among Clients of Residential Youth Care Centers in Switzerland? An Evaluation of the Routine Diagnostics of a Swiss Youth HomeAbstract: Objective: The sharp rise in inpatient admissions of adolescents poses a challenge for both psychiatric care and policymakers. Residential facilities within the youth welfare system are becoming increasingly burdened at the care interfaces. However, we cannot determine the extent of the problem because of the broad lack of studies on the prevalence of mental disorders and their severity in residential youth homes - especially in light of the lack of long-term studies of their presumed increase. An analysis of data from the Burghof Pestalozzi-Jugendstätte - an institution of the youth welfare system in German-speaking Switzerland providing comprehensive psychiatric and psychological care - should result in better information. Method: We analyzed the frequency of ICD-10 diagnosis categories, the global psychosocial functioning level according to MAS Axis VI, a so-called dissocialization index, and other variables statistically using systematically documented retrospective data on all 448 admissions between 2008 and 2022. Results: The prevalence of mental disorders was very high at 80-90 %. It was both cumulatively comorbid, with a shift from mainly externalizing to increasingly internalizing symptoms, a deterioration in the level of psychosocial functioning and performance on socialization pathways, and a decrease in age at admission. Conclusions: Increasing the pressure to address the psychiatric care needs of young people is becoming more and more noticeable in residential youth care facilities, which are confronted with a growing responsibility for psychiatric care tasks. Because the demands on social and vocational integration remain unchanged, these facilities must be able to respond by increasing both their effectiveness and their capacity.

Changes in the Utilization in a Flexible and Integrated Model Project for Child and Adolescent Psychiatry in GermanyAbstract: Objectives: We tested hypotheses regarding patients in a flexible and integrative care model of a Child and Adolescent Psychiatry unit offering intensive treatment in an outpatient setting (TIBAS) (intervention group, IG) compared to a control group (CG): reduction in inpatient/daycare treatment and length of stay, increase in outpatient care in hospital, lower readmission and emergency admission rates. Method: We included patients treated between 2018 and 2021 based on routine data from the statutory health insurance system. We formed matched comparison groups from structurally similar control clinics using propensity score matching. The comparison of the IG and the CG referred to the year before and after study inclusion. Results: We analyzed data from a total of 1,806 children and adolescents. The evaluation points towards a strengthening of outpatient care in the IG. However, we found no reduction in the duration of inpatient or daycare treatment nor in the length of stay in the IG compared to the CG across all diagnoses, nor did we determine a decrease in readmission or emergency admission rates. Conclusions: The results indicate an intensification of outpatient care in the model hospital, without evidence of its effects on inpatient utilization. Evaluations of patient-related outcomes of the model project with a comparison group will follow.

Genetic Diagnostics in Children and Adolescents with Mental DisordersAbstract: In Germany, genetic testing is part of the guideline-based diagnostic work-up for patients with intellectual disability. This is particularly the case for patients who show additional symptoms (i. e. malformations, epilepsy) or abnormal growth (i. e. microcephaly or macrocephaly). Implementation of diagnostic genetic testing is currently hampered by the still-limited practical experience of colleagues practicing child and adolescent psychiatry (CAP) and the little-practiced interaction with physicians working in clinical genetics. Additionally, the current funding modalities for genetic testing are not well-suited for routine clinical care in CAP. This paper presents a guide for physicians working in CAP who aim to implement guideline-based genetic testing into their routine clinical care. It focuses on steps relevant to ordering genetic testing, from obtaining informed consent to receiving and reporting the test results to those affected.

Objective: While structured treatment programs for children and adolescents with psychiatric disorders exist, their geographic distribution remains unclear. Specialized addiction treatment facilities for young patients are particularly scarce in Germany. This study examines access to child and adolescent psychiatric care using a driving time-based isochrone analysis to identify regional disparities. Methods: We mapped outpatient clinics, inpatient departments, day clinics as well as specialized addiction centers and calculated the isochrones for 30, 60, 90, and 120 minutes of driving time. We then aggregated the resulting geometric areas and applied them to the Global Human Settlement Population Grid 2025 to estimate the number of German inhabitants with access to these centers within the specified time frames. Results: While 98 % of Germans can reach a psychiatric care unit within 1 hour, the coverage is lower for specialized addiction clinics (60.5%). Within 120 minutes, more than 95 % of Germans can reach a center of any network. In addition to the generally underserved rural areas, such as those in northeastern Germany, specialized addiction clinics are underrepresented across all regions. Conclusion: Germany's adolescent psychiatric care is relatively strong, though some regions still face limited access and pose challenges to patients, especially regarding acute crisis interventions, where long travel times delay urgent care.

In-Hospital Suicides in Children and Adolescents: First Analyses of the Werner Felber Institute Database on Child and Adolescent Psychiatric Wards Abstract: Suicide is a significant challenge and a clinical phenomenon among adolescents and young adults. Suicide risk for youth receiving inpatient psychiatric treatment is likely increased, given higher levels of psychosocial strain among inpatients than among youth in the general population. Objective: To report on the number, frequency, and characteristics of in-hospital suicide attempts and suicides among children and adolescents receiving inpatient psychiatric treatment. Methods: Our analyses are based on the Werner-Felber-Institute Database, which includes all cases from 2019 to 2024, inasmuch as data on age, gender, or year of suicidal behavior were available. Assessment of characteristics related to suicidal behavior included data on hazardousness, lethality, psychopathology, likelihood for discovery, method, and motive. Results: Eight cases of suicide and 85 suicide attempts were reported among youth, with a mean age of 15.63 and 15.84 years. Compared to in-hospital suicide behavior in adults, these numbers were substantially lower for suicide but substantially higher for suicide attempts. Most suicide attempts among children and adolescents took place within the hospital building, using intoxication. Conclusions: The results provide first insights into suicide behavior among youth receiving inpatient psychiatric treatment. The high number of suicide attempts points to a significant risk constellation even while in clinical care. To delineate targeted preventive interventions, we need greater accuracy in data collection.

Prevalence and Correlates of Smoking Behavior Among Patients with Substance Use Disorders in a Specialized Adolescent Psychiatric Outpatient Clinic Abstract: Objective: Germany lacks recent data on the incidence and severity of tobacco use and tobacco use disorders (TUD) in high-risk populations, especially among adolescent outpatients with substance use disorders (SUDs). Method: We collected data from N = 134 adolescents in a specialized SUD outpatient unit for adolescent psychiatric patients using structured interviews (consumption and disorder symptoms) and a sociodemographic caregiver questionnaire (education, subjective financial status, and housing status). Descriptive data and linear regression models present possible associations between consumption, disorder diagnoses, and social demographics. Results: There were high 30-day prevalence rates for smoking (95 %), daily smoking (79 %), heavy or very heavy smoking (61 % and 23 % among smokers, respectively), and past-year TUD (77 %). Daily average consumption of M = 11.0 cigarettes was associated with a lower age at first use (M = 12.6 years), which in turn was lower for those with a lower level of education and a worse financial situation. Conclusions: The extremely high prevalence of smoking, early onset of use, and high rate of TUD highlight the urgent need for tailored smoking cessation programs for adolescents with SUD.

Objective: Adolescent borderline personality disorder (BPD) is associated with an elevated risk of suicidal behavior, with suicide reattempts often considered a hallmark of the disorder. However, empirical evidence linking BPD to suicide reattempts in youth remains limited and inconsistent. This study investigates whether BPD predicts suicide reattempts in a high-risk clinical adolescent sample. Method: We drew our data from two longitudinal clinical samples (n = 323, 87 % female, M_age = 15.11, SD_age = 1.54) with specialized treatment for self-harm and risk-taking behavior. We assessed BPD and suicide attempts at baseline and two annual follow-ups, using multinomial logistic regression to test whether BPD at baseline predicted suicide reattempts. Results: Overall, 21 % of adolescents reported at least one suicide reattempt during the follow-up period. While a BPD diagnosis and a higher number of fulfilled BPD criteria were significantly associated with ever having attempted suicide, neither was significantly associated with suicide reattempts. Conclusion: Among adolescents receiving specialized care, BPD is linked to a history of suicide attempts but does not independently predict repeated attempts, challenging assumptions about chronic suicidal risk and treatment resistance as defining features of BPD and underscoring the need to differentiate between initial and recurrent suicidal behaviors.

A Stepped Bereavement Care Model for Children and Young People Abstract: Objective: Losing a caregiver can have a profound impact on the health and quality of life of children and young people (CYP). The provision of needs-based support for this group is questionable. Germany lacks a structured framework that could organize bereavement care for CYP, incorporate the various professional groups and institutions involved, and lead to the establishment of quality standards. This article discusses an Irish stepped-care model at an international level. Adapting it to the German context and disseminating can contribute to the professionalization of bereavement care for CYP. Method: We adapted the stepped-care model through an iterative consensus process involving experts in psychology, psychotherapy, grief counselling, bereavement support, and social work. Results: The German adaptation outlines a four-stage model, beginning at the societal level. Support is tailored to the specific needs of CYP and their families, with support options including the social environment, low-threshold services, and psychotherapy. Facilitating transitions between the levels of care is particularly important to accommodate the dynamic nature of support needs. Conclusions: Establishing a stepped-care framework can contribute to a more needs-based approach to caring for bereaved CYP. Implementing this model requires a systematic identification of needs to avoid potential gaps in care.