Zeitschrift Fur Kinder-Und Jugendpsychiatrie Und Psychotherapie最新文献

Analyzing the Care Situation for Children and Adolescents with Gender Dysphoria from the Perspective of Clinical Experts Abstract: Abstract. Objective: The use of healthcare services by minors with gender dysphoria has steadily increased in recent years. Long waiting times indicate the difficulties in providing professional care for this vulnerable patient group. The study analyzed the medical care situation in the German-speaking countries according to medical and/or therapeutic experts primarily treating minors with gender dysphoria. Method: We conducted 41 guideline-based interviews with experts and prepared a subsequent content analysis. Results: We could confirm an increasing demand over the last 10 years. Patients nowadays have more specific ideas and seem to be better informed. The experts attribute changes in demand to increased public presence of gender diversity, increasing tolerance and acceptance, and easier access to information. They assessed the care situation as inadequate; particularly care capacity is insufficient, and previous experiences in healthcare are often negative. The young age of the patients, comorbidities, and research gaps pose challenges regarding the indication. Patient satisfaction with somatomedical measures is rated as rather high, and experiences with detransitions are rare. Conclusions: From the experts' view, the need for health care is high and requires more research in addition to further education for social/educational and medical/psychological/therapeutic professionals.

Attitudes Toward Coercive Measures in Psychiatry: Indicators of Polarized Attitudes from a Representative German Sample Abstract: Objective: This study examined the attitudes of the German general population toward physical restraint (PR) and chemical restraint (CR) used in psychiatric settings to protect against self-endangerment and endangerment of others. Method: We analyzed attitudes toward coercive measures (CM) in a representative German sample (N = 2.485), exploring their distribution and association with sociodemographic factors using chi² tests and multinomial logistic regressions. Results: Two-thirds of subjects indicated acceptance of CR, whereas only 6 % approved PR. Rejection of CM was more common in people from West Germany (χ²(3) = 33.396, adj p < .001, φ = .116), rural areas (χ²(3) = 14.065, adj p = .018, φ = .057), and among individuals associated with right-wing political parties (χ²(3) = 17.602, adj p = .008, φ = .105). Conclusions: 67 % of the sample accept coercive medication, while a quarter reject it, which illustrates the heterogeneity of attitudes and the need for more information and education. Despite the political tendency toward more coercive elements in psychiatric treatment, this contradicts the professional discourse, which is why a public survey could be useful in sharpening professional policy positions.

Prevalence of Callous-Unemotional Traits in a German Adolescent Sample Abstract: Background: Both the DSM-5 and ICD-11 introduced the specifier "with impaired prosocial emotions (IPE)" to more accurately diagnose Conduct Disorder (CD) in adolescents with conduct problems and elevated callous-unemotional (CU) traits. Thus, this also emphasizes the importance of these traits in predicting future maladaptive development. In the general adult population, the prevalence of CU traits is 4.5 % and varies between 2-6 % in adolescents. This study examines the applicability of the t-values developed by the LSU Developmental Psychology Lab (2023) to assess clinically relevant or critical callous-unemotional (CU) traits in adolescents in the German general population. We investigate whether these internationally calculated t-values can be used validly for the German-speaking countries without calculating own t-values or cut-off values based on the sample. Methods: The sample consists of N = 1622 adolescents (50 % female), with an average age of M = 13.63 years, whom we recruited at schools. To categorize the present data, the study utilized age- and gender-based norms (t-scores) from the 2023 Developmental Psychopathology Lab's community sample. We employed t-tests and ANOVAs to determine significant age differences (11-14 years, 15-17 years), gender, and gender-by-age interaction effect groups. Results: Our findings indicate that 91.5 % of the sample falls within the normative group, 4.3 % are at risk, and 4.2 % display clinical characteristics. We observed significant age differences, while gender differences were not prominent. The interaction effects of age and gender were significant. Posthoc analyses revealed significant differences between male adolescents and between male and female adolescents across both age groups. Conclusion: The study provides valuable insights into the prevalence of CU traits in a German school sample. Understanding the distribution of CU traits is crucial for early detection and the development of tailored interventions. In addition to educational staff, professionals in the clinical context also benefit from early identification to initiate targeted diagnostic and therapeutic measures.

Participation in the Clinic for Child and Adolescent Psychiatry and Psychotherapy. Do Personality Traits Affect the Difference Between the Desire and Experience of Participation? Abstract: Objective: Participation and codetermination are important rights of children and adolescents. The present study examined discrepancies between the desire and experience of participation, their relationship with treatment satisfaction, and which patient-related variables are associated with the reported discrepancies. Method: Forty adolescents from the inpatient unit or the day clinic of the university clinic of Ruppin-Brandenburg answered a questionnaire concerning their desire for and experience of participation. Additionally, we assessed sociodemographic data and personality traits. Results: Patients experienced less participation than desired. The highest discrepancy was found in items concerning communication with family and friends. Two personality traits had significant positive effects on the discrepancy of desired and experienced participation: "suspicious schizotypical" and "loyal-dependent." Conclusion: Minors want more participation than they actually experience. We need flexible concepts, especially concerning communication with family and friends, to reduce the discrepancy between the desire and the experience of participation. Giving patients the possibility to participate and encouraging them to do so should be emphasized, especially with patients with the personality traits "suspicious-schizotypical" and "loyal-dependent."

The Prevalence of Mental Disorders Among Care Leavers Abstract: Objective: Formerly out-of-home placed young adults (i. e., care leavers) were exposed to a variety of cumulative psychosocial stress factors during their childhood. However, the knowledge about the prevalence of mental disorders among care leavers in German-speaking countries is scarce. This article addresses the prevalence of mental disorders among care leavers and discusses the implications for care systems. Method: Mental disorders, including personality disorders, were assessed using structured clinical interviews among 175 Swiss care leavers (mean age = 26.53 years, 32.00 % women). Descriptive information was presented as absolute and relative frequencies, and correlations and group comparisons were calculated using t-tests and χ²-tests. Results: 58.29 % of participants met the diagnostic criteria for at least one mental disorder, with substance use disorders (37.71 %), personality disorders (35.43 %), and attention-deficit/hyperactivity disorder (19.43 %) being the most common diagnoses. In comparison, women were more likely to have anxiety disorders and Cluster C personality disorders, while men were more likely to have alcohol use disorders. Conclusions: Our results indicate that approximately half of the Swiss care leavers meet the criteria for the diagnosis of at least one mental disorder in young adulthood. Young adulthood thus represents a sensitive phase for care leavers regarding mental disorders - similar to their peers in the general population. This poses a challenge for residential care institutions and psychiatric care systems to design and further expand preventive services for care leavers with high mental health burdens throughout the transition to adulthood.

Objective: Autoimmune psychosis (AP), defined as an isolated schizophreniform psychosis with no or only minimal neurological abnormalities stemming from autoantibody-associated cerebral processes, is a very rare and potentially underdiagnosed disorder in children and adolescents. Methods: This article reports the case of a 13-year-old boy who became acutely ill with a psychotic disorder following a respiratory infection. We describe the diagnosis and course of treatment in detail. Results: Following an extensive interdisciplinary workup, a probable glutamic acid decarboxylase (GAD)-associated AP was diagnosed that ultimately remitted completely with treatment. Conclusions: Autoimmune psychoses remain a relatively uncharted territory for the specialty of child and adolescent psychiatry. Good interdisciplinary cooperation is essential for patients with somewhat atypical psychotic symptoms, both in terms of diagnosis and treatment.