Psychopathologie und elterlicher Stress bei 3- bis 6-jährigen Kindern mit Ausscheidungsstörungen

Objective: Incontinence and functional gastrointestinal disorders are common in young children and are associated with higher rates of psychological symptoms and mental disorders. This article focuses on the mutual association between incontinence and related toilet refusal syndrome, parental stress, and children’s psychopathology especially in young children. Methods: Children’s psychological symptoms, mental disorders, and parental stress levels were assessed in 38 parent-child dyads involving children with incontinence and 42 dyads of typically developing (TD) children. Results: Compared to TD children, patients had higher internalizing and externalizing CBCL scores and higher rates of clinically relevant externalizing problems. However, the rates of clinically relevant internalizing problems and mental disorders did not differ. The parents of children with incontinence reported signifi cantly higher stress levels regarding child-related stress factors (PSI-CD) than did parents of TD children. However, there were no clinically relevant parental stress scores on a group level, which remained below the clinical range (T-value < 60). When simultaneously analyzed, children’s (comorbid) mental disorders but not incontinence had a major impact on parental stress. Conclusions: Despite moderate stress levels, incontinence symptoms, urinary and fecal incontinence are highly prevalent in young children. However, stress among parents of young children was mainly elicited by any (comorbid) mental disorder.Fragestellung: Ausscheidungsstörungen (AS) wie funktionelle Harn- und Stuhlinkontinenz sind sehr häufi ge Störungen im Vorschulalter und sind mit einer erhöhten Prävalenz von psychopathologischen Symptomen und psychischen Störungen bei den betroffenen Kindern assoziiert. Innerhalb der vorliegenden Arbeit wird der wechselseitige Zusammenhang von funktioneller Harn- und Stuhlinkontinenz sowie dem damit in Verbindung stehenden Toilettenverweigerungssyndrom auf die kindliche Psychopathologie und das elterliche Stresserleben speziell bei jungen Kindern untersucht. Methode: Psychopathologische Symptome, psychische Störungen und elterliche Stressbelastung wurden in 38 Eltern-Kind-Dyaden bei Kindern mit vorhandener AS und in 42 Dyaden bei Kindern ohne AS untersucht. Ergebnisse: Kinder mit AS wiesen höhere Werte von internalisierendem und externalisierendem Problemverhalten auf und waren häufi ger von klinisch relevanter externalisierender Symptomatik betroffen. Nichtsdestotrotz war die Prävalenz psychischer Störungen vergleichbar. Eltern von Kindern mit AS berichteten signifi kant höhere kindbezogene Stresslevel. Dennoch zeigte sich auf Gruppenebene kein klinisch bedeutsamer elterlicher Stress und die mittleren Stresslevel lagen unterhalb des Bereichs der klinischen Auffälligkeit (T-Wert < 60). Bei gleichzeitiger Betrachtung des Einfl usses von AS und psychischen Störungen zeigten sich letztere als ausschlaggebend für den elterlichen Stress. Schlussfolgerungen: Trotz moderater Stresslevel konnte eine generell hohe Prävalenz von AS Symptomen bei 3–6-Jährigen aufgezeigt werden. Elterlicher Stress war jedoch bedeutsamer mit einer (komorbiden) psychischen Erkrankung assoziiert

Translated article: Exposure or Stabilization: How Do Behavioral Therapists Plan the Outpatient Treatment of Patients with Post-Traumatic Stress Disorder?

<div>Background: According to national and international guidelines,</div><div>trauma-focused treatments such as trauma-focused cognitive-</div><div>behavioral therapies or eye movement desensitization</div><div>and reprocessing (EMDR) are first-choice methods in the treatment</div><div>of patients with post-traumatic stress disorder (PTSD).</div><div>Meta-analyses consistently show highest effect sizes for these</div><div>treatments. This results in clear implications for the treatment</div><div>of patients with PTSD. The present study aimed to assess the</div><div>implementation of a psychological treatment of PTSD patients</div><div>according to the therapy guidelines. Reports to the evaluator</div><div>for the German health-care system in the process of application</div><div>for outpatient psychotherapy are analyzed. Patients and</div><div>Methods: 1,053 reports were analyzed. Finally, 167 reports</div><div>mentioning a traumatic event, the diagnosis of a PTSD, or a</div><div>trauma-focused treatment were included in the study. Results:</div><div>74.3% of the treatment plans were rated as conforming to the</div><div>guidelines (i.e., trauma-focused exposure for patients with</div><div>PTSD diagnosis and no trauma-focused exposure for patients</div><div>without PTSD diagnosis). In 70.3% of the reports to the evaluator</div><div>for patients with PTSD, trauma-focused exposure was described.</div><div>There were no indications that the diagnosis of a PTSD</div><div>was applied too often by established therapists. The overall validity</div><div>of the diagnoses was high. Conclusion: For approximately</div><div>30% of the patients with PTSD, outpatient psychotherapists</div><div>did not mention trauma-focused exposure therapy in their reports,</div><div>i.e. the treatment with the highest clinical evidence was</div><div>not used. Further studies should be made to clarify the reasons</div><div>for this.</div

Generation climate crisis, COVID-19, and Russia–Ukraine-War: global crises and mental health in adolescents

Climate change, COVID-19, and the Russia-Ukraine War are some of the great challenges of our time. These global crises affect young people in a particularly vulnerable phase of their lives. The current study aimed to assess the impact of these crises on mental health (depression, anxiety, and health-related quality of life) in secondary school students in Germany. Furthermore, we assessed known predictors of mental health, such as socio-economic factors, individual life stressors, and resilience factors (self-efficacy, expressive flexibility) as covariates. In our sample of 3998 pupils, pandemic- and climate-related distress were linked to greater depression and anxiety and reduced health-related quality of life. War-related distress was associated with greater anxiety. Critically, these associations remained significant after controlling for all covariates, supporting the incremental predictive value of the crises measures. The study reveals a significant impact of the crises on the mental health of the current generation of adolescents. As such it suggests that mental health policies should include interventions that help youth to cope with the stress caused by the crises

辅助干预措施是否能改善患有创伤后应激障碍的成年患者接受创伤心理 治疗的治疗效果？一项系统综述

Background: According to clinical guidelines, trauma-focused psychotherapies (TF-PT) such as trauma-focused cognitive behavioural therapy (TF-CBT) and eye movement desensitization and reprocessing (EMDR) are recommended as first-line treatments for posttraumatic stress disorder (PTSD). TF-CBT and EMDR are equally effective and have large effect sizes. However, many patients fail to respond or have comorbid symptoms or disorders that only partially decline with TF-PT. Thus, there is growing interest in augmenting TF-PT through adjuvant interventions. Objective: The current systematic review aims to assess whether adjuvant interventions improve outcome among adult PTSD patients receiving TF-PT. Methods: We searched the databases PubMed, PILOTS, Web of Science and the Cochrane Library for controlled clinical trials examining whether adjuvant interventions lead to more symptom reduction in adult PTSD patients receiving TF-PT. Thirteen randomized controlled trials fitted the inclusion criteria. These were evaluated for internal risk of bias using the Cochrane Handbook for Systematic Review of Interventions. Results: Most studies have a substantial risk for internal bias, mainly due to small sample sizes. Thus, no strong conclusion can be drawn from the current empirical evidence. Preliminary evidence suggests that exercise and cortisol administration may have an adjuvant effect on PTSD symptom reduction. Breathing biofeedback showed a trend for an adjuvant effect and an effect for accelerated symptom reduction. Conclusions: Currently, it is not possible to formulate evidence-based clinical recommendations regarding adjuvants interventions. While several adjuvant interventions hold the potential to boost the effectiveness of TF-PT, the realization of sufficiently powered studies is crucial to separate plausible ideas from interventions proven to work in practice.Antecedentes: De acuerdo a las guías clínicas, las psicoterapias con foco en el trauma (TF-PT, por su sigla en inglés), así como la terapia cognitivo-conductual con foco en el trauma (TF-CBT, por su sigla en inglés) y la terapia de reprocesamiento y desensibilización por movimientos oculares (EMDR) son recomendadas como tratamientos de primera línea para el Trastorno de Estrés Postraumático (TEPT). TF-CBT y EMDR son igualmente efectivas y tienen grandes tamaños de efecto. Sin embargo, muchos pacientes no responden, tienen síntomas comórbidos u otros trastornos que sólo disminuyen parcialmente con TF-PT. Por lo tanto, hay un creciente interés en aumentar las TF-PT a través de intervenciones auxiliares. Objetivo: La presente revisión sistemática busca evaluar si las intervenciones auxiliares mejoran los resultados entre adultos con TEPT que reciben TF-PT. Métodos: Buscamos en las bases de datos Pubmed, PILOTS, Web of Science y en la Biblioteca Cochrane, estudios clínicos controlados que examinaran si las intervenciones auxiliares llevan a mayor reducción de síntomas en pacientes adultos con TEPT que reciben TF-PT. Trece estudios randomizados controlados cumplieron los criterios de inclusión. En estos se evaluó el riesgo interno de sesgo usando el Manual Cochrane para la Revisión Sistemática de Intervenciones. Resultados: La mayoría de los estudios tuvo un riesgo sustancial de sesgo interno, principalmente debido al pequeño tamaño muestral. Por lo tanrto, no se puede extraer conclusiones fuertes de la evidencia empírica actual. La evidencia preliminar sugiere que el ejercicio y la administración de cortisol puede tener un efecto auxiliar en la reducción de síntomas de TEPT. El biofeedback de la respiración mostró una tendencia hacia un efecto auxiliar y un efecto en la reducción acelerada de los síntomas. Conclusiones: Actualmente, no es posible formular recomendaciones clínicas basadas en la evidencia en relación a intervenciones auxiliares. Mientras varias intervenciones auxiliares mantienen potencial para aumentar la efectividad de las TF-PT, la realización de estudios con suficiente poder es crucial para separar las ideas plausibles de las intervenciones con efectividad probada en la práctica.背景：根据临床指南，创伤型心理治疗（TF-PT）如创伤中心的认知行为疗法（TF-CBT） 和眼球运动脱敏和再加工（EMDR）被推荐为创伤后应激障碍（ PTSD）的一线治疗方 法。 TF-CBT和EMDR同样有效并且具有大的效果量。然而，许多患者对治疗没有反应或患 有TF-PT只能部分减轻的共病症状。因此，人们越来越关注通过辅助干预增强TF-PT。 目的：本系统综述旨在评估辅助干预措施是否能改善接受TF-PT的成人PTSD患者的预后。 方法：我们搜索了PubMed，PILOTS，Web of Science和Cochrane的数据库中的对照临床试 验，考察辅助干预措施是否会导致接受TF-PT的成人PTSD患者症状减轻。有13项随机对照 试验符合纳入标准。使用Cochrane干预系统综述操作手册评估内部偏差风险。 结果：大多数研究存在较大的内部偏差风险，主要是由于样本量较小。因此，目前的经 验证据无法得出有力的结论。初步证据表明，运动和皮质醇给药可能对PTSD症状减轻有 辅助作用。呼吸生物反馈显示出可能有辅助效应的趋势和加速症状减轻的效果。 结论：目前，还不能制定关于辅助干预的循证临床建议。虽然有几种辅助干预措施具有 提高TF-PT有效性的潜力，至关重要的是还需要进行充分的研究将好想法与经证实在实践 中起作用的干预措施区分开来

Psychopathology and Parental Stress in 3–6-Year-Old Children with Incontinence

&lt;jats:p&gt; Abstract. Objective: Incontinence and functional gastrointestinal disorders are common in young children and are associated with higher rates of psychological symptoms and mental disorders. This article focuses on the mutual association between incontinence and related toilet refusal syndrome, parental stress, and children’s psychopathology especially in young children. Methods: Children’s psychological symptoms, mental disorders, and parental stress levels were assessed in 38 parent-child dyads involving children with incontinence and 42 dyads of typically developing (TD) children. Results: Compared to TD children, patients had higher internalizing and externalizing CBCL scores and higher rates of clinically relevant externalizing problems. However, the rates of clinically relevant internalizing problems and mental disorders did not differ. The parents of children with incontinence reported significantly higher stress levels regarding child-related stress factors (PSI-CD) than did parents of TD children. However, there were no clinically relevant parental stress scores on a group level, which remained below the clinical range (T-value &amp;lt; 60). When simultaneously analyzed, children’s (comorbid) mental disorders but not incontinence had a major impact on parental stress. Conclusions: Despite moderate stress levels, incontinence symptoms, urinary and fecal incontinence are highly prevalent in young children. However, stress among parents of young children was mainly elicited by any (comorbid) mental disorder. &lt;/jats:p&gt