Zeitschrift Fur Kinder-Und Jugendpsychiatrie Und Psychotherapie最新文献

Experiences of Violence During Inpatient Child and Adolescent Psychiatric Treatment: An Explorative Study with Implications for Child Protection Abstract. Objective: Educational and medical institutions care for children and adolescents by providing supervision, schooling, education, therapy, and protection. Nevertheless, children in institutional care are exposed to potential danger through maltreatment and abuse. Method: As part of the establishment of the protection concept at the University Hospital for Child and Adolescent Psychiatry in Würzburg, a retrospective patient survey was conducted. The study population consisted of former inpatient clients from 2006 and 2007, who at the time of the catamnesis were of legal age. The survey was conducted by mail. In addition to items on their experiences of violence, the questionnaire included established scales to assess treatment satisfaction and quality of life (FBB-K, WHO-BREF). Results: Of 568 former patients, 87 (15.3 %) provided valid responses (59 female, mean age at the time of the survey: 24.5 years): 35 former patients (40.2 % of the participants) reported experiences of violence during their inpatient treatment (26 victims only, 7 experiences as victims and perpetrators, and 2 perpetrators only). Experiences as victims mainly included emotional violence (34.5 %), but also physical (5.7 %) and sexual violence (10.3 %). Conclusion: We found a significant correlation between experiences of violence, on the one hand, and retrospective treatment satisfaction and current quality of life, on the other hand. The results of the survey underline the importance of establishing protection concepts in clinics and other institutions.

Metacognitions and interoceptive sensibility in the perception of premonitory urges in tic disorders across the lifespan Abstract. Objective: Depending on contextual factors, the prevalence of premonitory urges (PU) in patients with tic disorders (TD) increases with age and varies both intra- and interindividually. In youth, PUs correlate with metacognitions. In both youth and adults, interoceptive sensibility is altered compared to healthy controls. We examined the relationship between PUs, tics, metacognitions, and interoceptive sensibility across the lifespan regarding tic severity. Method: In an online survey, 53 participants reported their PUs on the Premonitory Urge for Tics Scale (PUTS) and tic severity on the Symptom Checklist for Tic Disorders (SBB-TIC). We assessed interoceptive sensibility via the Body Perception Questionnaire (BPQ-A) and metacognitions regarding tics with the Belief About Tics Scale (BATS). Results: Adults scored higher on the PUTS than youth. In youth, interoceptive sensibility increased with age; interoceptive sensibility correlated with PUTS. Metacognitions and interoceptive sensibility explained a significant amount of variance in premonitory urges, even after controlling for tic severity and age. Conclusions: The presumed cause of age-dependent development of PUs in youth lies in their neurophysiological maturing processes. However, negative metacognitions and interoceptive abilities also play an important role in the development and maintenance of PU and might be of therapeutic use in the treatment of TD.

Trends in Adolescents' Satisfaction with Their Inpatient Psychiatric Treatment: A Panel Analysis over 7 Years Abstract. Because the German legislature is increasingly enabling adolescents' participation in their psychiatric treatment, we traced changes in satisfaction of 6,893 patients at the end of their stay in 10 hospitals using BEST-J. The treatments resulted in a fair overall satisfaction without any improvement over the 7 years studied. In seven hospitals, we calculated deviation from the overall satisfaction based on annual surveys. Satisfaction with the psychotherapeutic relationship was good from the beginning, whereas the relationship with caregivers improved during the sample period. When new legal standards were introduced, we measured an improvement in some items concerning patient participation (coercive measures information, goals of treatment discussed). Patients were less satisfied with the information about their illness than with medication information. Initially poor satisfaction with leave regulations significantly improved over time. Respect for privacy also improved. Satisfaction with the environment and service organization scored substantially worse than the other items. Peer relations within the ward were rated close to overall satisfaction. The results point to benefits from training in psychotherapy and a growing awareness of closeness-distance issues and patients' rights. Nevertheless, psychoeducation and leave regulations require improvement. Furthermore, patients stated unmet needs for refurbishing and renovating buildings.

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.

Functional Constipation and Nonretentive Fecal Incontinence in Children and Adolescents: Clinical Guideline for Assessment and Treatment Abstract. Objective: Constipation and fecal incontinence are common disorders in children and adolescents and are associated with incapacitation and a high rate of comorbid psychological disorders. Functional constipation and nonretentive fecal incontinence can be differentiated according to the current Rome-IV classification systems. This interdisciplinary guideline aims to summarize the current state of knowledge regarding somatic and psychiatric assessment and treatment. It formulates consensus-based, practical recommendations. Methods: The members of the Guideline Commission consisted of 11 professional associations and a parental organization. The guideline was based on current literature searches, several online surveys, and consensus conferences based on standard procedures. Results: Functional constipation is much more common than nonretentive fecal incontinence. Constipation requires a detailed medical assessment to exclude somatic causes, especially in young children. Red flags are useful indicators of organic causes to be considered. Most cases of constipation are functional (approximately 95 %). Counseling, toilet training, disimpaction, and long-term oral laxatives, combined with cognitive-behavioral interventions, are most effective. The assessment and treatment of nonretentive fecal incontinence are similar. The rate of somatic factors is much lower (approximately 1 %). Laxatives can worsen outcomes and should be avoided. Comorbid psychological disorders are common (approximately 30 % to 50 %). They should be assessed and treated additionally according to evidence-based guidelines. Conclusions: The recommendations of this guideline were approved with a high consensus. Interdisciplinary cooperation is especially important, as somatic factors and comorbid psychological disorders and symptoms need to be considered. More research is required, especially regarding nonretentive fecal incontinence.