Agreement between youth-reported and parent-reported psychopathology in a referred sample

Objective: The study examined parent-youth agreement regarding reports on psychopathology among adolescents suffering from psychiatric disorders. Method: A total of 1,718 patients between the age of 11 and 18, as well as their parents, were assessed using the child behavior checklist (CBCL), and the youth self-report (YSR). Results: Poor to low agreement between parent- and adolescent-reported problem behavior on the internalizing scale, the total problem scale and moderate agreement concerning the externalizing scale of the CBCL and the YSR were found. Independent from the amount of psychiatric diagnoses, adolescents reported significantly less behavioral problems than their parents. Concerning externalizing problems, parent-youth disagreement was stronger for patients suffering from comorbid psychiatric disorders, than for adolescents displaying only one psychiatric disorder. Conclusion: In clinically referred children, parents are likely to emphasize the severity of the difficulties, whereas adolescents’ under-report symptoms

Systematic reviews and meta-analyses of treatment interventions for Internet use disorders: Critical analysis of the methodical quality according to the PRISMA guidelines

Rationale As a result of concerns about predominantly online behavioral addictions, an increasing number of systematic reviews and meta-analyses (SRMA) of treatment interventions for internet use disorders (IUD) are being recorded. This review was designed to (a) systematically identify the evidence base of SRMA and to (b) critically appraise the quality of reporting according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Methods Four databases were searched until August 2022 to systematically identify SRMA. PRISMA indicators were evaluated on a three-level response format to obtain an overall score operationalizing the quality of reporting (score range: 0–84). Additionally, the percentage of adherence to the PRISMA indicators was calculated. Results Reporting quality of 23 SRMA, comprising 12 systematic reviews and 11 meta-analyses was evaluated. Quality scores ranged from 25 to 77 (M: 52.91; SD: 17.46). Results of the critical appraisal revealed deviations from the PRISMA indicators, including missing information on (a) registration of a study protocol, (b) statistical synthesis methods (c) evaluation of certainty of evidence, and (d) risk of bias assessment. Eleven (47.83%) of the SRMAs partially adhered, and twelve (52.17%) completely adhered to the PRISMA indicators. Conclusion This first critical appraisal on the reporting quality of SRMA on treatment interventions for IUD highlights limitations of the evidence base. Inadequate reporting compromises the practical utility and validity of SRMA and may complicate ongoing efforts of consensus on evidence-based interventions for IUD. Future research should focus on sufficient and transparent reporting of the methodological approach

The German version of the Anorectic Behavior Observation Scale (ABOS)

Objective: To assess the performance of the German version of the Anorectic Behavior Observation Scale (ABOS) as a parent-report screening instrument for eating disorders (ED) in their children. Methods: Parents of 101 ED female patients (80 with Anorexia Nervosa; 21 with Bulimia Nervosa) and of 121 age- and socioeconomic status (SES)-matched female controls completed the ABOS. Results: Confirmatory factor analysis supported the original three-factor structure model of the ABOS. Cronbach’s alpha coefficients indicated good internal consistency for the three factors and the total score in the total sample. The best cut-off point (100% sensitivity and specificity) in the German version was ≥23. Conclusion: The ABOS may be a useful additional instrument for assessing ED

Emotional abuse interacts with borderline personality in adolescent inpatients with binge-purging eating disorders

Purpose Childhood abuse is associated with an increased risk of developing eating disorders (EDs) as well as personality disorders (PDs). However, their interaction is still uncertain, particularly in adolescents. This study investigates the correlations between childhood emotional neglect (CEN), childhood emotional abuse (CEA), and obsessive-compulsive and borderline personality styles in female adolescent inpatients with eating disorders (EDs). Methods One hundred and twenty-eight inpatients (ages 14-18) were assessed, 54 were diagnosed with restricting-type anorexia nervosa (AN-R) and 33 with a binge-purging ED [BP-ED; comprising patients with binge-purging type anorexia nervosa (AN-BP), n = 15, and bulimia nervosa (BN), n = 18]. Fifty healthy participants made up the control group (CG). CEN and CEA were assessed with the Childhood Trauma Questionnaire, while the Personality Style and Disorder Inventory was implemented to determine personality styles. Results A MANOVA revealed a significant main effect of CEA on spontaneous-borderline personality style [F(8,119) = 17.1, p < 0.001, η2 = 0.126], as well as a main effect of ED group on spontaneous-borderline [F(2,119) = 3.1, p = 0.048, η2 = 0.050]. A significant interaction between ED group, CEA, and spontaneous-borderline was found [F(2,119) = 3.5, p = 0.034, η2 = 0.055] with BP-ED showing significantly higher scores in CEA (9.3 ± 4.0) and in spontaneous-borderline (14.2 ± 6.2). Conclusions Considering CEA and borderline personality style in adolescent inpatients with BN or AN-BP may help improve the understanding of the etiology and maintenance of BP-ED and provide more effective treatment targets. Level of evidence Level III, case–control analytic study

Study protocol for a randomised controlled trial of an e-health stepped care approach for the treatment of internet use disorders versus a placebo condition: the SCAPIT study

Introduction Excessive internet use can lead to problems for some individuals. The WHO has introduced Gaming Disorder in the International Classification of Diseases-11 (ICD-11). Previous research has shown that other internet applications can cause serious mental health problems as well. It is important to provide measures of prevention, early intervention and therapy for internet use disorders (IUDs). Methods and analysis The study ‘Stepped Care Approach for Problematic Internet use Treatment’ is a randomised, two-arm, parallel-group, observer-blind trial. The aim of the study is to investigate if a stepped care approach is effective to reduce symptom severity for IUD. The sample is primarily recruited online with a focus on employees in companies with support of health insurances. After screening, the stepped care approach depends on the success of the previous step—that is, the successful reduction of criteria—and comprise: (1) app-intervention with questionnaires and feedback, (2) two telephone counsellings (duration: 50 min) based on motivational interviewing, (3) online therapy over 17 weeks (15 weekly group sessions, eight individual sessions) based on cognitive–behavioural therapy. A follow-up is conducted after 6 months. A total of 860 participants will be randomised. Hierarchical testing procedure is used to test the coprimary endpoints number of Diagnostic and Statistical Manual of Mental Disorders, fifth edition and ICD-11 criteria. Primary analysis will be performed with a sequential logit model. Ethics and dissemination The study has been approved by the Ethics Committees of the Universities of Lübeck (file number: 21-068), Mainz (file number: 2021-15907) and Berlin (file number: 015.2021). Results will be reported in accordance to the CONSORT statement. If the approach is superior to the control condition, it may serve as part of treatment for IUD. Trial registration number DRKS00025994

Impulsivity in ADHD children

Da die Erforschung impulsiven Verhaltens bei hyperkinetischen Kindern bis dato eher stiefmütterlich erfolgt ist, wurde in dieser Studie zunächst die Dimension „Impulsivität“ mittels unterschiedlicher Instrumente ermittelt und sodann ergebnisbezogen verglichen. An dieser Studie nahmen 31 Jungen mit einem Hyperkinetischen Syndrom sowie eine gleichgroße männliche Kontrollgruppe (Altersdurchschnitt 9;4 Jahre) teil. Die Kinder absolvierten jeweils zwei computergestützte Impulsivitätstests: den Delay of Gratification Test (im folgenden DGT) sowie den Continuous Performance Test (im folgenden CPT). Zusätzlich wurde das impulsive Verhalten der Jungen mit Hilfe von zwei Lehrer-Fragebögen erhoben [Teachers Report Form (im folgenden TRF); Conners Teacher Rating Scale (im folgenden CTRS)]. Da sich die beiden gängigen Klassifikationssysteme ICD-10 und DSM-IV bezüglich der Dimensionen „Impulsivität“ und „Hyperaktivität“ voneinander unterscheiden, wurde neben impulsivem Verhalten zusätzlich die motorische Aktivität mittels eines Radar-Aktometers mit der Absicht untersucht, einen Beitrag bezüglich des Zusammenhangs zwischen „Impulsivität“ und „Hyperaktivität“ zu leisten. Erwartungsgemäß zeigten sich im Ergebnis signifikante Unterschiede zwischen den beiden Gruppen hinsichtlich des impulsiven Verhaltens sowie der motorischen Unruhe. Demgegenüber erbrachte die Überprüfung des Zusammenhangs der einzelnen Instrumente zur Messung impulsiven Verhaltens nicht durchgängig signifikante Korrelationen. Das Impulsivitäts-Item des CTRS wies keinen signifikanten Zusammenhang mit dem CPT auf und korreliert mäßig signifikant mit dem DGT. Diese Befunde führten zur Entwicklung eines Modells, welches das Konstrukt „Impulsivität“ umfassend operationalisiert und es der „Hyperaktivität“ als unabhängige Dimension der Hyperkinetischen Störung gegenüberstellt.(DIPF/Orig.)As research on impulsive behaviour in hyperactive children has been rather neglected, this study first measured impulsivity using several instruments and then compared the outcomes. 31 boys with ADHD participated in this study as well as an equal sized male control group (mean age 9;4 years). Each subject completed two computerised tests of impulsivity: the Delay of Gratification Test (DGT) as well as the Continuous Performance Test (CPT). Additionally, the boy’s impulsive behaviour was rated by two questionnaires for teachers (the Teacher Report Form, TRF, and the Conners Teacher Rating Scale, CTRS). Apart from impulsive behaviour the motor activity was measured, as the classification systems ICD-10 and DSM-IV differ on the concepts of “impulsivity” and “hyperactivity”. The assessment was undertaken using a radar-actometer in order to find an association between “impulsivity” and “hyperactivity”. As expected, there was a significant difference between the two groups concerning impulsive behaviour and motor activity. As opposed to that result, the correlations of the several instruments that measure impulsive behaviour were not constantly significant. The impulsivity-item on the CTRS is not associated with the CPT and correlates moderate significantly with the DGT. These results led to the development of a model that includes the construct of “impulsivity” as separate dimension of ADHD.(DIPF/Orig.

Psychopathology and psychotherapy in adolescents with anorexia and bulimia nervosa

Abkürzungsverzeichnis………………………………………………………... 3 1\. Einleitung………………………………………………………………... 4 2\. Leistungssport als Risikofaktor………………………………………...7 3\. Psychiatrische Komorbidität…………………………………………… 9 3.1 Achse-I-Störungen nach DSM- IV…………………………………......9 3.2 Achse-II-Störungen nach DSM-IV……………………………………..11 4\. Krankheitsverleugnung…………………………………………………13 5\. Behandlung……………………………………………………………...15 5.1 Therapie der AN und BN im Jugendalter…………………………….15 5.2 Einbeziehung der Familie………………………………………………18 6\. Allgemeine Diskussion…………………………………………………21 7\. Zusammenfassung……………………………………………………...26 Literatur…………………………………………………………………………..29 Danksagung……………………………………………………………………..34 Erklärung…………………………………………………………………………36Anorexia Nervosa (AN) und Bulimia Nervosa (BN) stellen multifaktoriell bedingte Erkrankungen dar, die zu den häufigsten Krankheitsbildern in der Kinder- und Jugendpsychiatrie gehören. Ästhetische und gewichtsassoziierte Sportarten wurden in der Vergangenheit als soziokulturelle Risikofaktoren angesehen. In der vorliegenden Arbeit konnte erstmals gezeigt werden, dass keine erhöhte Gefährdung ästhetischer Leistungssportler, speziell rhythmischer Sportgymnastinnen, im Alter von 12 bis 18 Jahren für die Entwicklung einer Essstörung vorliegt. Das Vorliegen psychiatrischer Komorbiditäten wird eindeutig als prognostisch ungünstiger Faktor für die Entstehung und den Verlauf von Essstörungen angesehen. Diese Arbeit zeigt, dass psychiatrische Komorbiditäten bereits bei Jugendlichen mit AN sehr hoch sind und denen im Erwachsenenalter gleichen. Dabei unterscheiden sich die beiden Subtypen der AN nicht hinsichtlich der Auftretenshäufigkeit psychiatrischer Komorbiditäten voneinander. Zur Behandlung von jugendlichen Patienten mit Essstörungen gehören die somatische Rehabilitation, die psychotherapeutische Behandlung und die Integration der Familie. Da nur unzureichende Studien zur Wirksamkeit psychotherapeutischer Behandlungskonzepte bei Jugendlichen mit AN und BN vorliegen, wurde in dieser Arbeit die Effektivität der Dialektisch Behavioralen Therapie bei dieser Patientengruppe im stationären und ambulanten Setting untersucht und deren Wirksamkeit erstmals bestätigt. Die Einbeziehung der Familienangehörigen in den psychotherapeutischen Prozess stellt bei AN und BN eine wichtige Säule der Behandlung dar.Anorexia nervosa (AN) and bulimia nervosa (BN) are multifactorial diseases, which are among the most prevalent disorders in child and adolescent psychiatry. Aesthetic sports are often considered as a risk factor for the development of an eating disorder. The present professorial dissertation for the first time demonstrates no higher risk for competitive athletes aged 12 to 18 years to develop an eating disorder. Research shows that psychiatric comorbidity is a very unfavorable prognostic feature of outcome in AN. This work displays high psychiatric comorbidities in adolescents with AN, and found no differences between the amount of psychiatric comorbidities in adolescents compared to adults. A multimodal treatment approach is comprised of nutritional rehabilitation and treatment of medical complications, psychotherapeutic treatment and family counseling. To date, only a few randomized controlled trials of psychosocial interventions for adolescent outpatients exist. Therefore, the present professional dissertation examines for the first time the effectiveness of in- and outpatient Dialectical Behavior Therapy (DBT) in adolescents suffering from AN and BN. DBT has proven effective in the treatment of AN and BN in adolescence. The incorporation of family members in the treatment constitutes a main component of the treatment of eating disorders in adolescents

Dialektisch-Behaviorale Therapie für jugendliche Patientinnen mit Anorexia und Bulimia nervosa (DBT-AN/BN) - eine Pilotstudie

Die Dialektisch-Behaviorale Therapie (DBT) wurde ursprünglich von Linehan (1993a, b) entwickelt. Miller et al. (1997) modifizierten das Konzept erfolgreich für suizidale jugendliche Patienten mit komorbiden Symptomen einer instabilen Persönlichkeitsstörung. Mittlerweile wird die DBT im Erwachsenenbereich auch bei anderen Patientengruppen erfolgreich eingesetzt. Das vorrangige Ziel der Studie ist die Überprüfung der Effektivität von DBT bei stationären jugendlichen Patientinnen mit Anorexia und Bulimia nervosa. Im Rahmen einer Pilotstudie (n = 31) wird die Wirksamkeit des Behandlungskonzepts anhand eines Prä-Post-Vergleichs mit unterschiedlichen Messinstrumenten (SIAB, EDI-2, SCL-90-R, FBB) untersucht. Die ersten Ergebnisse sind ermutigend und lassen hoffen, dass sich durch diesen neuen Ansatz die Therapieergebnisse bei dieser Patientengruppe verbessern. (DIPF/Orig.)Dialectical behavior therapy (DBT) was originally developed by Linehan (1993a, b) and modified by Miller et al. (1997) for suicidal adolescents with borderline personality features. Meanwhile, this therapy has also successfully applied in other adult clinical groups. The prior aim of the study is to evaluate the effectiveness of DBT for inpatient adolescents with anorexia and bulimia nervosa. In this pilot study (n=31) the efficacy of this treatment will be evaluated in a pre-post comparison. Different instruments will be used (SIAB, EDI-2, SCL-90-R, FBB). The first results are promising and we must hope that this new approach will improve the future treatment. (DIPF/Orig.