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Herpertz-Dahlmann B, Dahmen B, Zielinski-Gussen IM, Seitz J. [New aspects in etiology and treatment of adolescent anorexia nervosa-a postulated bio-psycho-social model and the impact of the COVID-19 pandemic]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2024; 67:400-408. [PMID: 38498187 PMCID: PMC10995062 DOI: 10.1007/s00103-024-03856-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 02/26/2024] [Indexed: 03/20/2024]
Abstract
Anorexia nervosa is one of the most frequent chronic disorders of adolescence associated with a high mortality. During the COVID-19-pandemic, the number of hospitalized children and adolescents with anorexia nervosa significantly increased. This article outlines new research findings to decode the etiology of this serious disorder, especially a genetic disposition and changes of metabolism. Against the background of increasing rates during the COVID-19 pandemic, the importance of the gene-environment interaction is discussed, and new treatment forms are described. Besides the development of new biological treatment strategies, there is also some important progress in psychotherapeutic interventions. Carers should always be integrated when treating children and adolescents with anorexia nervosa, which is especially emphasized in the new "home treatment" setting. The new concept of anorexia nervosa as a metabo-psychiatric disorder gives us hope for new research ideas and treatment strategies in this often-debilitating disorder of childhood and adolescence.
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Affiliation(s)
- Beate Herpertz-Dahlmann
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters der RWTH Aachen, Neuenhofer Weg 21, 52074, Aachen, Deutschland.
| | - Brigitte Dahmen
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters der RWTH Aachen, Neuenhofer Weg 21, 52074, Aachen, Deutschland
| | - Ingar M Zielinski-Gussen
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters der RWTH Aachen, Neuenhofer Weg 21, 52074, Aachen, Deutschland
| | - Jochen Seitz
- Klinik f. Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, LVR-Klinikum Essen, 45147, Essen, Deutschland
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Thaventhiran T, Wong BHC, Pilecka I, Masood S, Atanda O, Clacey J, Tolmac J, Wehncke L, Romaniuk L, Heslin M, Tassie E, Chu P, Bevan-Jones R, Woolhouse R, Mahdi T, Dobler VB, Wait M, Reavey P, Landau S, Byford S, Zundel T, Ougrin D. Evaluation of intensive community care services for young people with psychiatric emergencies: study protocol for a multi-centre parallel-group, single-blinded randomized controlled trial with an internal pilot phase. Trials 2024; 25:141. [PMID: 38389089 PMCID: PMC10885519 DOI: 10.1186/s13063-024-07974-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 02/06/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Over 3000 young people under the age of 18 are admitted to Tier 4 Child and Adolescent Mental Health Services (CAMHS) inpatient units across the UK each year. The average length of hospital stay for young people across all psychiatric units in the UK is 120 days. Research is needed to identify the most effective and efficient ways to care for young people (YP) with psychiatric emergencies. This study aims to evaluate the clinical effectiveness and cost-effectiveness of intensive community care service (ICCS) compared to treatment as usual (TAU) for young people with psychiatric emergencies. METHODS This is a multicentre two-arm randomized controlled trial (RCT) with an internal pilot phase. Young people aged 12 to < 18 considered for admission at participating NHS organizations across the UK will be randomized 1:1 to either TAU or ICCS. The primary outcome is the time to return to or start education, employment, or training (EET) at 6 months post-randomization. Secondary outcomes will include evaluations of mental health and overall well-being and patient satisfaction. Service use and costs and cost-effectiveness will also be explored. Intention-to-treat analysis will be adopted. The trial is expected to be completed within 42 months, with an internal pilot phase in the first 12 months to assess the recruitment feasibility. A process evaluation using visual semi-structured interviews will be conducted with 42 young people and 42 healthcare workers. DISCUSSION This trial is the first well-powered randomized controlled trial evaluating the clinical and cost-effectiveness of ICCS compared to TAU for young people with psychiatric emergencies in Great Britain. TRIAL REGISTRATION ISRCTN ISRCTN42999542, Registration on April 29, 2020.
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Affiliation(s)
| | | | | | | | | | - Joe Clacey
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Jovanka Tolmac
- Central and North-West London NHS Foundation Trust, London, UK
| | - Leon Wehncke
- North-East London NHS Foundation Trust, London, UK
| | | | | | | | | | - Rhys Bevan-Jones
- Cwm Taf Morgannwg University Health Board, Wales, UK
- Cardiff University, Wales, UK
| | | | - Tauseef Mahdi
- Berkshire Healthcare NHS Foundation Trust, Bracknell, UK
| | | | - Mandy Wait
- South London and Maudsley NHS Foundation Trust, Beckenham, UK
| | | | | | | | - Toby Zundel
- South London and Maudsley NHS Foundation Trust, Beckenham, UK
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Goldschmidt AB, Tortolani CC, Accurso EC, Dunbar EMP, Egbert AH, Donaldson D, Donaldson AA. Adapting family-based treatment for adolescent anorexia nervosa delivered in the home: A novel approach for improving access to care and generalizability of skill acquisition. J Eat Disord 2023; 11:130. [PMID: 37543601 PMCID: PMC10403819 DOI: 10.1186/s40337-023-00850-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 07/26/2023] [Indexed: 08/07/2023] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a serious mental illness associated with high rates of morbidity and mortality. Family-based treatment (FBT) is a well-established treatment for adolescent AN, yet it is underutilized in community settings and is unavailable to many families, particularly those from lower income and racial and ethnic minority backgrounds. Furthermore, some families do not respond optimally to FBT, possibly because of challenges translating skills acquired in office-based treatment settings to naturalistic settings. Home-based treatment could reduce barriers to access and enhance generalization of newly learned treatment skills. Home-based models demonstrate initial feasibility, acceptability, and efficacy for adolescent AN, however, FBT principles have yet to be applied as a stand-alone intervention in a home-based level of care. This paper describes the rationale for and process of adapting FBT principles/interventions to improve fit within a home-based model delivered in the context of community mental health, and discusses potential strengths and opportunities associated with this approach. RESULTS Adaptations were made through consultation with collaborating community agencies and were guided by the complex interventions framework. The primary modifications included: (1) altered dose; (2) multiple family meals; (3) additional support for meal preparation and supervision; (4) clinician attendance at medical appointments; (5) cultural adaptation; and (6) introduction of distress tolerance and emotion regulation skills. CONCLUSIONS Implementing FBT in the home may present one promising and novel approach to enhance engagement and treatment outcomes for adolescents with restrictive eating disorders, particularly those who are underserved, but evaluation of efficacy/effectiveness is needed.
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Affiliation(s)
- Andrea B Goldschmidt
- Department of Psychiatry, Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
| | - Christina C Tortolani
- Department of Counseling, Educational Leadership, and School Psychology, Rhode Island College, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University/The Miriam Hospital, Providence, RI, USA
| | - Erin C Accurso
- Department of Psychiatry and Behavioral Sciences, Weill Institute for Neurosciences, University of California, San Francisco, CA, USA
| | | | - Amy H Egbert
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University/The Miriam Hospital, Providence, RI, USA
- Department of Psychological Sciences, University of Connecticut, Connecticut, Storz, USA
| | - Deidre Donaldson
- Department of Family Medicine, Warren Alpert Medical School of Brown University/Gateway Healthcare, Providence, RI, USA
| | - Abigail A Donaldson
- Department of Pediatrics, Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI, USA
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Graf D, Lerch S, Böhnke U, Reichl C, Kindler J, Koenig J, Kaess M. Treatment outcome of an intensive psychiatric home treatment for children and adolescents: a non-randomized controlled pilot evaluation. Eur Child Adolesc Psychiatry 2023; 32:685-695. [PMID: 34853908 PMCID: PMC8635478 DOI: 10.1007/s00787-021-01919-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 11/19/2021] [Indexed: 12/29/2022]
Abstract
Home treatment (HT) may offer an effective and cost-efficient alternative to inpatient treatment for children and adolescents with acute mental disorders. This study introduces and evaluates a pilot HT project from Bern, Switzerland, with HT completely replacing an inpatient treatment. A total of n = 133 children and adolescents with acute mental disorders and inpatient treatment needs were treated either in the new HT program (n = 37) or in an active control group with inpatient treatment as usual (I-TAU, n = 96). Psychopathological burden was assessed by the Health of the Nation Outcome Scale for Children and Adolescents clinician-rated (HoNOSCA) and self-rated (HoNOSCA-SR) at the time of admission and at discharge. Treatment effects were assessed and compared using Augmented Inverse Probability Weights to adjust for baseline differences and to control for treatment duration. Participants ranged in age from 6 to 17 years (M = 13.71 years, SD = 2.93), 54% were female. HT resulted in significant improvements in the HoNOSCA (d = 0.79, p < .001) and HoNOSCA-SR (d = 0.63, p = .006). No significant differences on treatment effects were observed between HT and the reference group I-TAU in the HoNOSCA (d = 0.01, p = .96) or the HoNOSCA-SR (d = 0.11, p = .63). Overall, results indicate HT to be an effective alternative for children and adolescents with acute mental health disorders instead of hospitalization. Further evaluation with random group allocation and long-term follow-up should attempt to replicate and extend the current findings.
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Affiliation(s)
- Daniel Graf
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Stefan Lerch
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Ulrich Böhnke
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Corinna Reichl
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Jochen Kindler
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Julian Koenig
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany.
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İnce B, Phillips M, Schmidt U. Intensive community and home-based treatments for eating disorders: a scoping review study protocol. BMJ Open 2023; 13:e064243. [PMID: 36792335 PMCID: PMC9933757 DOI: 10.1136/bmjopen-2022-064243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
INTRODUCTION Institutionally based intensive treatment modalities (inpatient, day patient and residential treatments) for eating disorders (EDs) are associated with high treatment costs and significant challenges for patients and carers, including access difficulties and disruption to daily routines. Intensive community and home-based treatments have been suggested as alternatives to institutionally based intensive treatments for other severe mental illnesses, with promising clinical, social and health economic outcomes. The possible advantages of these treatments have been proposed for EDs, but this emerging area of research has not yet been systematically investigated. This scoping review aims to map the available literature on intensive community and home treatments for EDs, focusing on their conceptualisation, implementation and clinical outcomes. METHODS This proposed scoping review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol extension for Scoping Reviews checklist and the Joanna Briggs Institute Reviewer's Manual. This review will include any peer-reviewed study concerning intensive community and home-based treatments for any EDs, with no restrictions on geographical context or study design. Grey literature will also be considered. The literature search will be conducted in four databases: PubMed, PsycInfo, MEDLINE and Web of Science. Two researchers will independently screen the titles, abstracts and text of the returned articles for eligibility. Data charting and analysis will consist of a narrative description of the included studies, quantitative and qualitative findings relative to the aims of this scoping review. Gaps in the literature will be highlighted to inform future research, clinical practice, and policy. ETHICS AND DISSEMINATION Ethical approval is not required as all data are available from public sources. The results of this scoping review will be disseminated through peer-reviewed publication, conference presentation, and social media.
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Affiliation(s)
- Başak İnce
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Matthew Phillips
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
- Eating Disorder Outpatients Service, South London and Maudsley NHS Foundation Trust, London, UK
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Goldschmidt AB, Tortolani CC, Egbert AH, Brick LA, Elwy AR, Donaldson D, Le Grange D. Implementation and outcomes of home-based treatments for adolescents with anorexia nervosa: Study protocol for a pilot effectiveness-implementation trial. Int J Eat Disord 2022; 55:1627-1634. [PMID: 36324297 PMCID: PMC10018372 DOI: 10.1002/eat.23796] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/28/2022] [Accepted: 07/28/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Although family-based treatment (FBT) is considered a first-line treatment for adolescent anorexia nervosa (AN), it is underutilized in community settings and is unavailable to many families for a multitude of practical reasons (e.g., costs of treatment, transportation constraints). Adapting FBT interventions for delivery in home-based and community-based settings may reduce pragmatic barriers to treatment uptake and engagement. METHODS This pilot effectiveness-implementation trial will assess outcomes, implementation, and mechanisms of FBT adapted for the home setting (FBT-HB), delivered in the context of community-based behavioral health agencies. Adolescents with AN-spectrum disorders (n = 50) and their caregivers will be randomly assigned to either FBT-HB or home-based treatment as usual (TAU; integrated family therapy approach). Caregivers and adolescents will provide data on weight, eating, and putative treatment mechanisms, including caregiver self-efficacy and adolescent eating-related and weight-related distress. Implementation constructs of feasibility, acceptability, and appropriateness will be measured among providers and participating families. HYPOTHESES We expect that FBT-HB will be feasible, acceptable, and appropriate, and will outperform TAU in terms of improvements in adolescent weight and eating-related psychopathology. We further expect that caregiver self-efficacy and adolescent eating-related and weight-related distress, but not general distress, will show greater improvements in FBT-HB relative to TAU and will be associated with better adolescent weight and eating outcomes in FBT-HB. POTENTIAL IMPLICATIONS The proposed study has clear potential to advance scientific and clinical understanding of the real-world effectiveness of FBT for AN, including whether adapting it for the home setting improves its accessibility and effects on treatment outcome.
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Affiliation(s)
| | - Christina C. Tortolani
- Department of Counseling, Educational Leadership, and School Psychology, Rhode Island College, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University/The Miriam Hospital, Providence, RI, USA
| | - Amy H. Egbert
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University/The Miriam Hospital, Providence, RI, USA
| | - Leslie A. Brick
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University/The Miriam Hospital, Providence, RI, USA
| | - A. Rani Elwy
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University/The Miriam Hospital, Providence, RI, USA
| | - Deidre Donaldson
- Department of Family Medicine, Warren Alpert Medical School of Brown University/Gateway Healthcare, Providence, RI, USA
| | - Daniel Le Grange
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA
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Sarrió-Colas L, Ferré-Grau C, Monteso-Curto P, Adell-Lleixà M, Albacar-Riobóo N, Lleixá-Fortuño M. The experiences of parents as caregivers of adolescents with mental illnesses, the impact of the crisis and the admission to a day hospital. Arch Psychiatr Nurs 2022; 37:45-51. [PMID: 35337438 DOI: 10.1016/j.apnu.2021.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 12/11/2020] [Accepted: 06/11/2021] [Indexed: 11/27/2022]
Abstract
AIM The aim of this study was to analyze the caregiving experience of parents whose adolescent children with a mental illness require admission to a day treatment hospital for mental health services. METHOD The study used qualitative interpretative research methods. A total of 18 parents participated in the semi-structured interviews. Data were then transcribed and analyzed in accordance with established methods for the analysis of inductive thematic data. RESULTS Seven themes were identified: questioning an unseen disease, abnormal behavior, a long road, truancy and loss of parental authority, internalized stigma on admission, regaining the meaning of life and an uncertain future. DISCUSSION The experience of the parents was analyzed and various emotional, psychological and interpersonal barriers were found that influenced the help-seeking for the adolescent's treatment. IMPLICATIONS FOR PRACTICE Nursing interventions should be based on detecting barriers and validating the experience of parents with mentally ill adolescents.
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Affiliation(s)
- Lídia Sarrió-Colas
- Faculty of Nursing, Rovira i Virgili University, Campus Terres de l'Ebre, Tortosa, Spain; Fundation Pere Mata Terres de l'Ebre, Amposta, Spain.
| | - Carme Ferré-Grau
- Faculty of Nursing, Rovira i Virgili University, Campus Catalunya, Tarragona, Spain
| | - Pilar Monteso-Curto
- Faculty of Nursing, Rovira i Virgili University, Campus Terres de l'Ebre, Tortosa, Spain
| | - Mireia Adell-Lleixà
- Faculty of Nursing, Rovira i Virgili University, Campus Terres de l'Ebre, Tortosa, Spain; Hospital de la Santa Creu de Jesús-Tortosa, Spain
| | - Núria Albacar-Riobóo
- Faculty of Nursing, Rovira i Virgili University, Campus Terres de l'Ebre, Tortosa, Spain
| | - Mar Lleixá-Fortuño
- Faculty of Nursing, Rovira i Virgili University, Campus Terres de l'Ebre, Tortosa, Spain; Faculty of Nursing, Rovira i Virgili University, Campus Catalunya, Tarragona, Spain; Terres de l'Ebre Health Region, Tortosa, Spain
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Pauli D, Flütsch N, Hilti N, Schräer C, Soumana M, Häberling I, Berger G. Home treatment as an add-on to family-based treatment in adolescents with anorexia nervosa: A pilot study. EUROPEAN EATING DISORDERS REVIEW 2022; 30:168-177. [PMID: 35001459 PMCID: PMC9303788 DOI: 10.1002/erv.2882] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 11/25/2021] [Accepted: 12/24/2021] [Indexed: 11/10/2022]
Abstract
Objective This pilot study examines the feasibility and the effectiveness of add‐on home treatment (HT) to family‐based treatment (FBT) in adolescents with anorexia nervosa (AN). The HT intervention is delivered by specialised nurses and aims at supporting patients and parents to re‐establish family meals in the home environment. Method We performed a 3‐month study in AN patients with a waiting‐list control design comparing 45 (43 females, 2 males) adolescents receiving FBT augmented with HT compared to 22 (21 females, 1 male) participants receiving FBT alone on the waiting list for additional HT. Eating disorder diagnosis, psychopathology and severity of clinical symptoms were assessed using the Eating Disorder Examination (EDE) interview, the Eating Disorders Inventory (EDI‐2) and clinical parameters (BMI, menstrual status, level of over‐exercising) at baseline and after 3 months. Results After 3 months of treatment, both treatment groups showed a significant early weight gain, a reduction in the rate of AN diagnoses assessed with the EDE interview and a reduction in EDI‐2 total scores. The combined HT/FBT group showed a significantly greater increase in BMI than the FBT‐only group. In the combined HT/FBT group, none of the patients had to be admitted to hospital, while three (13.6%) of the FBT‐only group had to be referred to inpatient treatment. Discussion Our results suggest that HT augmented FBT might be useful compared to FBT alone in terms of early weight gain and might reduce the risk of hospital admission in adolescent AN. Home treatment as an add‐on to family‐based treatment seems to be a well‐accepted and very effective method for the treatment of eating disorders in adolescence. Combining family‐based treatment with home treatment thus seems to even enhance the therapy effectiveness of FBT in terms of initial weight gain as well as psychopathology
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Affiliation(s)
- Dagmar Pauli
- Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland
| | - Nicole Flütsch
- Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland
| | - Nadine Hilti
- Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland
| | - Christiane Schräer
- Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland
| | - Mariama Soumana
- Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland
| | - Isabelle Häberling
- Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland
| | - Gregor Berger
- Department of Child and Adolescent Psychiatry, University of Zurich, Zurich, Switzerland
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Discharge interventions from inpatient child and adolescent mental health care: a scoping review. Eur Child Adolesc Psychiatry 2022; 31:857-878. [PMID: 32886222 PMCID: PMC9209379 DOI: 10.1007/s00787-020-01634-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/26/2020] [Indexed: 11/26/2022]
Abstract
The post-discharge period is an extremely vulnerable period for patients, particularly for those discharged from inpatient children and adolescent mental health services (CAMHS). Poor discharge practices and discontinuity of care can put children and youth at heightened risk for readmission, among other adverse outcomes. However, there is limited understanding of the structure and effectiveness of interventions to facilitate discharges from CAMHS. As such, a scoping review was conducted to identify the literature on discharge interventions. This scoping review aimed to describe key components, designs, and outcomes of existing discharge interventions from CAMHS. Nineteen documents were included in the final review. Discharge interventions were extracted and summarized for pre-discharge, post-discharge, and bridging elements. Results of this scoping review found that intervention elements included aspects of risk assessment, individualized care, discharge preparation, community linkage, psychoeducation, and follow-up support. Reported outcomes of discharge interventions were also extracted and included positive patient and caregiver satisfaction, improved patient health outcomes, and increased cost effectiveness. Literature on discharge interventions from inpatient CAMHS, while variable in structure, consistently underscore the role of such interventions in minimizing patient and family vulnerability post-discharge. However, findings are limited by inadequate reporting and heterogeneity across studies. There is a need for further research into the design, implementation, and evaluation of interventions to support successful discharges from inpatient child and adolescent mental health care.
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[Assertive care as new treatment perspective for Austria]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2022; 36:188-191. [PMID: 36342615 PMCID: PMC9722889 DOI: 10.1007/s40211-022-00446-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/21/2022] [Indexed: 11/09/2022]
Abstract
Although intensive, assertive treatment options in child and adoledcent psychiatry have been successfully evaluated and established in several countries, this development is just beginning in Austria. As part of the so called home-treatment, care is provided by a multiprofessional team to patients with severe mental disorders, who would otherwise be treated in an inpatiet setting at their own home. This opens up the opportunity for a better generalizability of therapeutic progress and an intensive work with the family system. Alternative models for inpatient care like home-treatment, show the potential for intensive therapeutic options independent of building structures. Further development of this therapeutic option based on evaluated model projects is desirable within the Austrian health care system.
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Khalfan N, Coventry C, Cawthorpe D. A New Acute-At-Home Child and Adolescent Clinical Service: Evaluation of Impact. Psychiatry Investig 2022; 19:29-36. [PMID: 34986555 PMCID: PMC8795601 DOI: 10.30773/pi.2021.0158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/06/2021] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE An Acute at Home (AAH) clinical service was implemented to reduce emergency and inpatient admissions to the regional tertiary child and adolescent mental health system. This paper examines describes the served the population and impact on emergency and inpatient admissions. METHODS Analysis of re-admission rates for those enrolled before and after the May 2019 implementation of the AAH service in comparison over the same time period to an unexposed comparison group. In addition the groups were compared on clinical and demographic variables comparing those exposed and those not exposed to the AAH service. RESULTS The results indicated that the AAH group experienced reduced rates of readmission and lengths of stay post-exposure. Family composition, sex, seven Adverse Childhood Experience survey items, and nine Western Canada Waitlist Child Mental Health Priority Criteria Score items distinguished those exposed to AAH compared to those who were not. Thirteen of 19 independent variables indicated greater pathology in the AAH group with less likelihood of potential of danger to self. CONCLUSION The present results indicate a substantial benefit of the AAH service via reducing readmissions and lengths of stay. The quantitative measures warrant a careful qualitative examination of the AAH processes along with ongoing monitoring of the program's effect.
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Affiliation(s)
- Noorani Khalfan
- Child and Adolescent Addictions and Mental Health and Psychiatry Program, Alberta Health Services, Calgary, Canada
| | - Carol Coventry
- Child and Adolescent Addictions and Mental Health and Psychiatry Program, Alberta Health Services, Calgary, Canada
| | - David Cawthorpe
- Child and Adolescent Addictions and Mental Health and Psychiatry Program, Alberta Health Services, Calgary, Canada.,Cumming School of Medicine, Departments of Psychiatry & Community Health Sciences, Institute for Child & Maternal Health, Alberta Children's Hospital Research Institute, The University of Calgary, Calgary, Canada
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Boege I, Corpus N, Weichard M, Schepker R, Young P, Fegert JM. Long-term outcome of intensive home treatment for children and adolescents with mental health problems - 4 years after a randomized controlled clinical trial. Child Adolesc Ment Health 2021; 26:310-319. [PMID: 34477291 DOI: 10.1111/camh.12500] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Admission rates to child and adolescent mental health inpatient units in Germany are substantial (58.831 admissions in 2019). Historically, different treatment pathways have not been available. The evidence suggests that home treatment could be an alternative. The objective of this study was to assess the long-term stability of treatment gains among children and adolescents treated for serious mental health problems with home treatment (HT) as compared with inpatient treatment-as-usual (TAU). METHODS Hundred patients were enrolled and randomized into an intervention (HT n = 54) and control group (TAU n = 46). Follow-up data were available after 8.4 months (n = 78) (T3) and after 4.3 years (n = 51) (T4). The primary outcome measured was overall level of functioning, for which the Children's Global Assessment Scale (CGAS) was used. Secondary outcomes included severity of patient impairment and parental competency in dealing with their child's symptoms, measured using the Health of the Nation Outcome Scales (HoNOSCA). A qualitative interview with parents was performed at T3 and T4. RESULTS Treatment effects remained stable for both groups at T3 and T4 (p < .001). After 4.3 years 70% of the parents in the intervention group stated satisfaction with the treatment received, while only 36.8% of the parents within the control group rated themselves as satisfied. 43.7% of parents in the home treatment group reported that the most helpful aspect of this pathway was the prompt and intensive professional help and advice they received as primary caregivers at home. CONCLUSIONS Home treatment may be considered a viable alternative to inpatient care.
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Affiliation(s)
- Isabel Boege
- CAP, ZfP Suedwuerttemberg, Ravensburg, Germany.,CAP, Universitaet Ulm, Ulm, Germany
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Flütsch N, Hilti N, Schräer C, Soumana M, Probst F, Häberling I, Berger G, Pauli D. Feasibility and acceptability of home treatment as an add-on to family based therapy for adolescents with anorexia nervosa. A case series. Int J Eat Disord 2021; 54:1707-1710. [PMID: 34227130 PMCID: PMC8457051 DOI: 10.1002/eat.23567] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 06/08/2021] [Accepted: 06/08/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study examines the feasibility, acceptability, and preliminary effect sizes on outcome measures of home treatment (HT) as an add-on to family-based therapy (FBT) in adolescents with anorexia nervosa (AN). The HT intervention is delivered by specialized nurses and aims at supporting patients and parents to re-establish family meals in the home environment. METHOD Forty-five (43 female, 2 male) adolescents meeting ICD 10 criteria for anorexia nervosa or atypical anorexia nervosa received FBT augmented with HT over 12 weeks. Eating disorder (ED) diagnosis, psychopathology and severity of clinical symptoms were assessed using the Eating Disorder Examination (EDE) interview, the Eating Disorders Inventory (EDI-2) at baseline (BL) and after 3-months RESULTS: All participants and parents were retained and found HT acceptable. At the end of Treatment (EOT) participants showed a significant early weight gain, a reduction in the AN psychopathology assessed with the EDE interview and a reduction in EDI-2 total scores. None of the patients had to be admitted to hospital. Treatment satisfaction was high in both patients and parents. DISCUSSION Findings provide preliminary evidence that HT is feasible, acceptable and produces clinically significant improvements in targeted outcome.
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Affiliation(s)
- Nicole Flütsch
- Department of Child and Adolescent PsychiatryUniversity of ZurichZürichSwitzerland
| | - Nadine Hilti
- Department of Child and Adolescent PsychiatryUniversity of ZurichZürichSwitzerland
| | - Christiane Schräer
- Department of Child and Adolescent PsychiatryUniversity of ZurichZürichSwitzerland
| | - Mariama Soumana
- Department of Child and Adolescent PsychiatryUniversity of ZurichZürichSwitzerland
| | - Fabian Probst
- Department of Child and Adolescent PsychiatryUniversity of ZurichZürichSwitzerland
| | - Isabelle Häberling
- Department of Child and Adolescent PsychiatryUniversity of ZurichZürichSwitzerland
| | - Gregor Berger
- Department of Child and Adolescent PsychiatryUniversity of ZurichZürichSwitzerland
| | - Dagmar Pauli
- Department of Child and Adolescent PsychiatryUniversity of ZurichZürichSwitzerland
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Herpertz-Dahlmann B. Intensive Treatments in Adolescent Anorexia Nervosa. Nutrients 2021; 13:1265. [PMID: 33924294 PMCID: PMC8068891 DOI: 10.3390/nu13041265] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/30/2021] [Accepted: 04/04/2021] [Indexed: 12/26/2022] Open
Abstract
Approximately one-fifth to one-third of patients with adolescent anorexia nervosa (AN) need intensive care in the course of their illness. This article provides an update and discussion on different levels of intensive care (inpatient treatment (IP), day patient treatment (DP) and home treatment (HoT)) in different health care systems based on recently published literature. Important issues discussed in this article are new recommendations for the refeeding process and the definition of target weight as well as principles of medical stabilization and psychotherapeutic approaches. The pros and cons of longer or shorter hospitalization times are discussed, and the advantages of stepped care and day patient treatment are described. A new promising intensive treatment method involving the patient, their caregivers and the direct home environment is introduced. Parents and caregivers should be included in treatment research to foster collaborative work with the attending clinicians. There is an urgent need to evaluate the mid- to long-term outcomes of various intensive treatment programs to compare their effectiveness and costs across different health care systems. This could help policy makers and other stakeholders, such as public and private insurances, to enhance the quality of eating disorder care.
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Affiliation(s)
- Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH, Neuenhofer Weg 21, D-52074 Aachen, Germany
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Sprengeler MK, Mattheß J, Eckert M, Richter K, Koch G, Reinhold T, Vienhues P, Berghöfer A, Fricke J, Roll S, Keil T, Ludwig-Körner C, Kuchinke L, von Klitzing K, Schlensog-Schuster F. Efficacy of parent-infant psychotherapy compared to care as usual in children with regulatory disorders in clinical and outpatient settings: study protocol of a randomised controlled trial as part of the SKKIPPI project. BMC Psychiatry 2021; 21:118. [PMID: 33639894 PMCID: PMC7913440 DOI: 10.1186/s12888-021-03112-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/09/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The first years of life are a significant period for child development, when children are particularly sensitive and prone to crises. This early phase lays the foundation for healthy growth. Clinical assessment of psychological symptoms in early infancy and adequate treatment are both important in improving the diagnostic outcome and preventing later long-term developmental consequences. The most common psychological problems in the first 3 years of life are regulatory disorders. The aim of this trial is to investigate the efficacy of Parent-Infant Psychotherapy (PIP) for infants and young children (aged 0-36 months, diagnosed with at least one regulatory disorder) and their mothers, compared to care as usual (CAU). METHODS In this open multicentre randomised controlled trial, 160 mother-infant dyads are randomised to receive PIP or CAU for 6 weeks of intervention in clinical or outpatient (including home treatment) settings. The primary outcome is the maternal sensitivity (sensitivity scale of the Emotional Availability Scales (EAS)) after 6 weeks. Secondary outcomes include assessment of interaction, mental health problems, attachment, development, psychological factors, treatment adherence, health care system utilisation, and costs, after 6 weeks and 12 months. DISCUSSION This study will evaluate whether a manualised focus-based short-term psychodynamic psychotherapeutic intervention in mother-child dyads improves the care situation for families of children diagnosed with regulatory disorders, and helps prevent long-term psychopathologies. Assessment of the intervention in different settings will support the development of more tailored interventions for affected infants and their mothers. TRIAL REGISTRATION German Clinical Trial Register, ID: DRKS00017008 . Registered 03/20/2019.
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Affiliation(s)
- Mona Katharina Sprengeler
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Leipzig, Liebigstrasse 20a, 04103, Leipzig, Germany.
| | - Janna Mattheß
- International Psychoanalytic University Berlin, Berlin, Germany
| | - Melanie Eckert
- International Psychoanalytic University Berlin, Berlin, Germany
| | - Katharina Richter
- International Psychoanalytic University Berlin, Berlin, Germany
- Institute of Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Gabriele Koch
- International Psychoanalytic University Berlin, Berlin, Germany
| | - Thomas Reinhold
- Institute of Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Petra Vienhues
- Fachklinik für Psychiatrie, Psychosomatik und Psychotherapie, DIAKO Nordfriesland, Flensburg, Germany
| | - Anne Berghöfer
- Institute of Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Julia Fricke
- Institute of Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Stephanie Roll
- Institute of Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Thomas Keil
- Institute of Social Medicine, Epidemiology, and Health Economics, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany
- State Institute of Health, Bavarian Health and Food Safety Authority, Bad Kissingen, Germany
| | | | - Lars Kuchinke
- Psychological Methods and Evaluation, International Psychoanalytic University Berlin, Berlin, Germany
| | - Kai von Klitzing
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Leipzig, Liebigstrasse 20a, 04103, Leipzig, Germany
| | - Franziska Schlensog-Schuster
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Leipzig, Liebigstrasse 20a, 04103, Leipzig, Germany
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Ougrin D, Corrigall R, Stahl D, Poole J, Zundel T, Wait M, Slater V, Reavey P, Byford S, Ivens J, Crommelin M, Hayes D, Middleton K, Young P, Taylor E. Supported discharge service versus inpatient care evaluation (SITE): a randomised controlled trial comparing effectiveness of an intensive community care service versus inpatient treatment as usual for adolescents with severe psychiatric disorders: self-harm, functional impairment, and educational and clinical outcomes. Eur Child Adolesc Psychiatry 2021; 30:1427-1436. [PMID: 32885344 PMCID: PMC8440265 DOI: 10.1007/s00787-020-01617-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 08/04/2020] [Indexed: 10/24/2022]
Abstract
Clinical guidelines recommend intensive community care service treatment (ICCS) to reduce adolescent psychiatric inpatient care. We have previously reported that the addition of ICCS led to a substantial decrease in hospital use and improved school re-integration. The aim of this study is to undertake a randomised controlled trial (RCT) comparing an inpatient admission followed by an early discharge supported by ICCS with usual inpatient admission (treatment as usual; TAU). In this paper, we report the impact of ICCS on self-harm and other clinical and educational outcomes. 106 patients aged 12-18 admitted for psychiatric inpatient care were randomised (1:1) to either ICCS or TAU. Six months after randomisation, we compared the two treatment arms on the number and severity of self-harm episodes, the functional impairment, severity of psychiatric symptoms, clinical improvement, reading and mathematical ability, weight, height and the use of psychological therapy and medication. At six-month follow-up, there were no differences between the two groups on most measures. Patients receiving ICCS were significantly less likely to report multiple episodes (five or more) of self-harm (OR = 0.18, 95% CI: 0.05-0.64). Patients admitted to private inpatient units spent on average 118.4 (95% CI: 28.2-208.6) fewer days in hospitals if they were in the ICCS group compared to TAU. The addition of ICCS to TAU may lower the risk of multiple self-harm and may reduce the duration of inpatient stay, especially in those patients admitted for private care. Early discharge with ICCS appears to be a viable alternative to standard inpatient treatment.
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Affiliation(s)
- Dennis Ougrin
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK
| | | | - Daniel Stahl
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK
| | - Jason Poole
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK
| | - Toby Zundel
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK
| | - Mandy Wait
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK
| | - Victoria Slater
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK
| | - Paula Reavey
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK
| | - Sarah Byford
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK
| | - John Ivens
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK
| | | | - Daniel Hayes
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK
| | - Kerry Middleton
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK
| | | | - Eric Taylor
- grid.13097.3c0000 0001 2322 6764King’s College London, London, UK
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Boege I, Schepker R, Grupp D, Fegert JM. Kinder- und jugendpsychiatrische stationsäquivalente Behandlung (StäB): Therapieoption – für alle oder für wenige? ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2020; 48:348-357. [DOI: 10.1024/1422-4917/a000711] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung. Fragestellung: Aufsuchende stationsäquivalente Behandlung (StäB) ist seit dem 01.01.2017 in Deutschland möglich und seit dem 01.01.2018 abrechenbar. Dennoch wird StäB unter Infragestellung der Machbarkeit der Rahmenbedingungen derzeit nur an wenigen Standorten der Kinder- und Jugendpsychiatrie und Psychotherapie in Deutschland regelhaft angeboten. Ziel war es, anhand der ersten 58 stationsäquivalent behandelten Kinder und Jugendlichen am ZfP Südwürttemberg (2018–2019) die Machbarkeit und Kosten von StäB zu evaluieren. Methodik: Es wurden alle seit dem 01.01.2018 konsekutiv stationsäquivalent behandelten Fälle eingeschlossen und anhand von rein deskriptiven Analysen in SPSS.25 evaluiert. Ergebnisse: Die durchschnittliche Behandlungsdauer betrug 37.95 Tage (SD 15.35), 86.2 % aller Familien beendeten die Behandlung regelgerecht, es kam nur bei drei Patientinnen und Patienten zu einem einvernehmlichen Behandlungsabbruch, fünf mussten in eine stationäre Behandlung verlegt werden. Es wurden primär internalisierende Störungen indiziert (70.7 %), während externalisierende Störungen nur ein Viertel der Behandlungsfälle ausmachten (27.8 %). Kosten einer StäB beliefen sich im Durchschnitt auf 8779,25 €. Schlussfolgerungen: StäB stellt eine neue Behandlungsform im familiären Umfeld dar, welche täglich stattfindet. Multiprofessionalität der Behandlung ist Voraussetzung. Eine Umsetzung in den gegebenen Rahmenbedingungen ist möglich. Eine Akzeptanz von den Familien ist gegeben, die durchschnittliche Behandlungsdauer liegt leicht über dem stationären Bundesdurchschnitt.
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Affiliation(s)
- Isabel Boege
- ZfP Südwürttemberg, Akademisches Lehrkrankenhaus der Universität Ulm, Ravensburg, Deutschland
- KJPP Universität Ulm, Ulm, Deutschland
| | - Renate Schepker
- ZfP Südwürttemberg, Akademisches Lehrkrankenhaus der Universität Ulm, Ravensburg, Deutschland
| | - Dieter Grupp
- ZfP Südwürttemberg, Akademisches Lehrkrankenhaus der Universität Ulm, Ravensburg, Deutschland
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López-Pelayo H, Aubin HJ, Drummond C, Dom G, Pascual F, Rehm J, Saitz R, Scafato E, Gual A. "The post-COVID era": challenges in the treatment of substance use disorder (SUD) after the pandemic. BMC Med 2020; 18:241. [PMID: 32731868 PMCID: PMC7392642 DOI: 10.1186/s12916-020-01693-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/01/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Citizens affected by substance use disorders are high-risk populations for both SARS-CoV-2 infection and COVID-19-related mortality. Relevant vulnerabilities to COVID-19 in people who suffer substance use disorders are described in previous communications. The COVID-19 pandemic offers a unique opportunity to reshape and update addiction treatment networks. MAIN BODY Renewed treatment systems should be based on these seven pillars: (1) telemedicine and digital solutions, (2) hospitalization at home, (3) consultation-liaison psychiatric and addiction services, (4) harm-reduction facilities, (5) person-centered care, (6) promote paid work to improve quality of life in people with substance use disorders, and (7) integrated addiction care. The three "best buys" of the World Health Organization (reduce availability, increase prices, and a ban on advertising) are still valid. Additionally, new strategies must be implemented to systematically deal with (a) fake news concerning legal and illegal drugs and (b) controversial scientific information. CONCLUSION The heroin pandemic four decades ago was the last time that addiction treatment systems were updated in many western countries. A revised and modernized addiction treatment network must include improved access to care, facilitated where appropriate by technology; more integrated care with addiction specialists supporting non-specialists; and reducing the stigma experienced by people with SUDs.
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Affiliation(s)
- Hugo López-Pelayo
- Grup Recerca Addiccions Clínic (GRAC-GRE), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clínic Barcelona, Rosselló 149, 08036, Barcelona, Spain. .,Socidrogalcohol (Spanish Society of Drug and Alcohol Specialists), Barcelona, Spain.
| | - Henri-Jean Aubin
- Département de psychiatrie et d'addictologie, Université Paris-Saclay, Route de l'Orme aux Merisiers - RD 128 91190 Saint-Aubin, Paris, France.,Centre de Recherche en Epidémiologie et Santé des Populations (CESP), INSERM 1018, Paris, France.,Groupe Hospitalo-Universitaire AP-HP, Paris, France
| | - Colin Drummond
- Addiction Psychiatry, Addictions Department, National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience King's College, 16 De Crespigny Park, Camberwell, London, SE5 8AF, UK.,European Federation of Addiction Societies (EUFAS), 16 De Crespigny Park, Camberwell, London, SE5 8AF, UK
| | - Geert Dom
- Antwerp University (UA, CAPRI), Antwerp, Belgium.,Belgian Professional Psychiatry Association, Antwerp, Belgium.,European Federation of Addiction Societies (EUFAS), Antwerp, Belgium.,European Psychiatric Association (EPA), Prinsstraat 13, 2000, Antwerp, Belgium
| | - Francisco Pascual
- SOCIDROGALCOHOL, Barcelona, Spain.,CAARFE, Valencia, Spain.,Departamento de Biología Aplicada, Alicante, Spain.,UCA, Alcoy, Alicante, Spain
| | - Jürgen Rehm
- Institute for Mental Health Policy Research & Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.,Dalla Lana School of Public Health and Department of Psychiatry, University of Toronto (UofT), 155 College St., Toronto, Canada.,Epidemiological Research Unit, Technische Universität Dresden, Klinische Psychologie and Psychotherapie, Dresden, Germany.,Department of International Health Projects, Institute for Leadership and Health Management, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - Richard Saitz
- Department of Community Health Sciences (CHS), Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA.,Medicine, Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, 02118, USA.,Grayken Center on Addiction, Boston Medical Center, Boston, MA, 02118, USA
| | - Emanuele Scafato
- WHO Collaborating Centre on Research and Health-Osservatorio Nazionale Alcol, Promotion on Alcohol and Alcohol-related Health, Problems (ITA-79), Istituto Superiore di Sanità, Rome, Italy.,Società Italiana di Alcologia - SIA, EUFAS Istituto Superiore di Sanità, Rome, Italy
| | - Antoni Gual
- Grup Recerca Addiccions Clínic (GRAC-GRE), Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Hospital Clínic Barcelona, Rosselló 149, 08036, Barcelona, Spain.,International Network on Brief Interventions for Alcohol and Other Drugs (INEBRIA), Barcelona, Spain
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Abstract
BACKGROUND Psychosis is an illness characterised by alterations in thoughts and perceptions resulting in delusions and hallucinations. Psychosis is rare in adolescents but can have serious consequences. Antipsychotic medications are the mainstay treatment, and have been shown to be effective. However, there is emerging evidence on psychological interventions such as cognitive remediation therapy, psycho-education, family therapy and group psychotherapy that may be useful for adolescents with psychosis. OBJECTIVES To assess the effects of various psychological interventions for adolescents with psychosis. SEARCH METHODS We searched the Cochrane Schizophrenia Group's study-based Register of Trials including clinical trials registries (latest, 8 March 2019). SELECTION CRITERIA All randomised controlled trials comparing various psychological interventions with treatment-as-usual or other psychological treatments for adolescents with psychosis. For analyses, we included trials meeting our inclusion criteria and reporting useable data. DATA COLLECTION AND ANALYSIS We independently and reliably screened studies and we assessed risk of bias of the included studies. For dichotomous data, we calculated risk ratios (RRs) and 95% confidence intervals (CIs) on an intention-to-treat basis. For continuous data, we used mean differences (MDs) and the 95% CIs. We used a random-effects model for analyses. We created a 'Summary of findings' table using GRADE. MAIN RESULTS The current review includes 7 studies (n = 319) assessing a heterogenous group of psychological interventions with variable risk of bias. Adverse events were not reported by any of the studies. None of the studies was sponsored by industry. Below, we summarise the main results from four of six comparisons, and the certainty of these results (based on GRADE). All scale scores are average endpoint scores. Cognitive Remediation Therapy (CRT) + Treatment-as-Usual (TAU) versus TAU Two studies compared adding CRT to participants' TAU with TAU alone. Global state (CGAS, high = good) was reported by one study. There was no clear difference between treatment groups (MD -4.90, 95% CI -11.05 to 1.25; participants = 50; studies = 1, very low-certainty). Mental state (PANSS, high = poor) was reported by one study. Scores were clearly lower in the TAU group (MD 8.30, 95% CI 0.46 to 16.14; participants = 50; studies = 1; very low-certainty). Clearly more participants in the CRT group showed improvement in cognitive functioning (Memory digit span test) compared to numbers showing improvement in the TAU group (1 study, n = 31, RR 0.58, 95% CI 0.37 to 0.89; very low-certainty). For global functioning (VABS, high = good), our analysis of reported scores showed no clear difference between treatment groups (MD 5.90, 95% CI -3.03 to 14.83; participants = 50; studies = 1; very low-certainty). The number of participants leaving the study early from each group was similar (RR 0.93, 95% CI 0.32 to 2.71; participants = 91; studies = 2; low-certainty). Group Psychosocial Therapy (GPT) + TAU versus TAU One study assessed the effects of adding GPT to participants' usual medication. Global state scores (CGAS, high = good) were clearly higher in the GPT group (MD 5.10, 95% CI 1.35 to 8.85; participants = 56; studies = 1; very low-certainty) but there was little or no clear difference between groups for mental state scores (PANSS, high = poor, MD -4.10, 95% CI -8.28 to 0.08; participants = 56; studies = 1, very low-certainty) and no clear difference between groups for numbers of participants leaving the study early (RR 0.43, 95% CI 0.15 to 1.28; participants = 56; studies = 1; very low-certainty). Cognitive Remediation Programme (CRP) + Psychoeducational Treatment Programme (PTP) versus PTP One study assessed the effects of combining two types psychological interventions (CRP + PTP) with PTP alone. Global state scores (GAS, high = good) were not clearly different (MD 1.60, 95% CI -6.48 to 9.68; participants = 25; studies = 1; very low-certainty), as were mental state scores (BPRS total, high = poor, MD -5.40, 95% CI -16.42 to 5.62; participants = 24; studies = 1; very low-certainty), and cognitive functioning scores (SPAN-12, high = good, MD 2.40, 95% CI -2.67 to 7.47; participants = 25; studies = 1; very low-certainty). Psychoeducational (PE) + Multifamily Treatment (MFT) Versus Nonstructured Group Therapy (NSGT, all long-term) One study compared (PE + MFT) with NSGT. Analysis of reported global state scores (CGAS, high = good, MD 3.38, 95% CI -4.87 to 11.63; participants = 49; studies = 1; very low-certainty) and mental state scores (PANSS total, high = poor, MD -8.23, 95% CI -17.51 to 1.05; participants = 49; studies = 1; very low-certainty) showed no clear differences. The number of participants needing hospital admission (RR 0.84, 95% CI 0.36 to 1.96; participants = 49; studies = 1) and the number of participants leaving the study early from each group were also similar (RR 0.52, 95% CI 0.10 to 2.60; participants = 55; studies = 1; low-certainty). AUTHORS' CONCLUSIONS Most of our estimates of effect for our main outcomes are equivocal. An effect is suggested for only four outcomes in the SOF tables presented. Compared to TAU, CRT may have a positive effect on cognitive functioning, however the same study reports data suggesting TAU may have positive effect on mental state. Another study comparing GPT with TAU reports data suggesting GPT may have a positive effect on global state. However, the estimate of effects for all the main outcomes in our review should be viewed with considerable caution as they are based on data from a small number of studies with variable risk of bias. Further data could change these results and larger and better quality studies are needed before any firm conclusions regarding the effects of psychological interventions for adolescents with psychosis can be made.
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Affiliation(s)
- Soumitra S Datta
- MRC Clinical Trials Unit, Institute of Clinical Trials & Methodology, University College London, London, UK
- Department of Palliative Care and Psycho-oncology, Tata Medical Centre, Kolkata, India
| | - Rhea Daruvala
- Department of Palliative Care and Psycho-oncology, Tata Medical Centre, Kolkata, India
| | - Ajit Kumar
- Latrobe Regional Hospital, Victoria, Australia
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Herpertz-Dahlmann B, Borzikowsky C, Altdorf S, Heider K, Dempfle A, Dahmen B. 'Therapists in action'-Home treatment in adolescent anorexia nervosa: A stepped care approach to shorten inpatient treatment. EUROPEAN EATING DISORDERS REVIEW 2020; 29:427-442. [PMID: 32558214 DOI: 10.1002/erv.2755] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 04/08/2020] [Accepted: 05/19/2020] [Indexed: 11/12/2022]
Abstract
OBJECTIVE It was the aim of this pilot study to apply a novel eating disorder (ED)-specific home treatment (HoT) to adolescents with anorexia nervosa (AN) and to investigate its feasibility, effects and safety. METHOD Twenty-two patients consecutively admitted to the hospital and fulfilling DSM-5 criteria for typical or atypical AN received HoT after 4-8 weeks of inpatient treatment. During the first two months of HoT, the patient and her family were visited on average three to four times per week, during the third and fourth months of HoT once or twice a week by a multi-professional team. Body mass index, ED and general psychopathology, quality of life and treatment satisfaction were assessed in the patients at admission, start and end of HoT and the 1-year follow-up as well as carers' skills and burden. RESULTS The majority of patients successfully achieved target weight within HoT and maintained it successfully at the 1-year follow-up. ED and general psychopathology in the patients and carers' skills improved significantly associated with a high treatment satisfaction. CONCLUSIONS HoT seems to be a promising new tool to improve outcome in adolescent AN and to reduce time of hospitalisation. Larger randomised controlled trials are needed to generalise these results.
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Affiliation(s)
- Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy of the RWTH Aachen, Aachen, Germany
| | - Christoph Borzikowsky
- Institute of Medical Informatics and Statistics, Kiel University and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Sophie Altdorf
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy of the RWTH Aachen, Aachen, Germany
| | - Kathrin Heider
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy of the RWTH Aachen, Aachen, Germany
| | - Astrid Dempfle
- Institute of Medical Informatics and Statistics, Kiel University and University Hospital Schleswig-Holstein, Kiel, Germany
| | - Brigitte Dahmen
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy of the RWTH Aachen, Aachen, Germany
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Mattheß J, Eckert M, Richter K, Koch G, Reinhold T, Vienhues P, Berghöfer A, Roll S, Keil T, Schlensog-Schuster F, von Klitzing K, Ludwig-Körner C, Kuchinke L. Efficacy of Parent-Infant-Psychotherapy with mothers with postpartum mental disorder: study protocol of the randomized controlled trial as part of the SKKIPPI project. Trials 2020; 21:490. [PMID: 32503611 PMCID: PMC7275538 DOI: 10.1186/s13063-020-04443-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/23/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND After the birth of a child, many mothers and fathers experience postpartum mental disorders like depression, anxiety, obsessive-compulsive disorder, stress or other illnesses. This endangers the establishment of a secure attachment between the children and their primary caregivers. Early problems in parent-child interaction can have adverse long-term effects on the family and the child's well-being. In order to prevent a transgenerational transmission of mental disorders, it is necessary to evaluate psychotherapeutic interventions that target psychologically burdened parents of infants or toddlers. The aim of this trial is to investigate the efficacy of Parent-Infant-Psychotherapy (PIP) for mothers with postpartum mental disorder and their infants (0-12 months). METHODS/DESIGN In this open, randomized controlled intervention trial 180 mother-infant-dyads will be included and randomly allocated to 12 sessions of PIP or care as usual. The interventions take place either in inpatient adult psychiatric departments or in outpatient settings with home visits. The primary outcome is the change in maternal sensitivity assessed by the Sensitivity subscale of the Emotional Availability Scale (EAS) through videotaped dyadic play-interactions after 6 weeks. Secondary outcomes are maternal psychopathology, stress, parental reflective functioning, infant development and attachment after 6 weeks and 12 months. In addition, maternal attachment (AAI) and reflective functioning (AAI) will be analyzed as potential moderators, and resource usage in the German health system as well as associated costs will be evaluated. DISCUSSION There is increasing demand for well-controlled studies on psychotherapeutic interventions in the postpartum period that do not only focus on particular risk groups. This randomized controlled trial (RCT) represents one of the first studies to investigate the efficacy of PIP in inpatient psychiatric departments and outpatient care centers in Germany. The results will fill knowledge gaps on the factors contributing to symptom reduction in postpartum mental disorders and improvements in mother-child relationships and help in developing preventive and therapeutic strategies for the fragmented German health care system. TRIAL REGISTRATION German Register for Clinical Trials, ID: DRKS00016353.
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Affiliation(s)
- J Mattheß
- International Psychoanalytic University, Stromstr. 3b, 10555, Berlin, Germany.
| | - M Eckert
- International Psychoanalytic University, Stromstr. 3b, 10555, Berlin, Germany
| | - K Richter
- Department of Psychiatry, Psychosomatics and Psychotherapy, Diakonissenkrankenhaus Flensburg, Flensburg, Germany
| | - G Koch
- International Psychoanalytic University, Stromstr. 3b, 10555, Berlin, Germany
| | - T Reinhold
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin, Berlin, Germany
| | - P Vienhues
- Department of Psychiatry, Psychosomatics and Psychotherapy, Diakonissenkrankenhaus Flensburg, Flensburg, Germany
| | - A Berghöfer
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin, Berlin, Germany
| | - S Roll
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin, Berlin, Germany
| | - T Keil
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin, Berlin, Germany
- Institute of Clinical Epidemiology and Biometry, University of Wuerzburg, Wuerzburg, Germany
- State Institute of Health, Bavarian Health and Food Safety Authority, Bad Kissingen, Germany
| | - F Schlensog-Schuster
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Leipzig, Leipzig, Germany
| | - K von Klitzing
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University of Leipzig, Leipzig, Germany
| | - C Ludwig-Körner
- Department of Psychiatry, Psychosomatics and Psychotherapy, Diakonissenkrankenhaus Flensburg, Flensburg, Germany
| | - L Kuchinke
- Department of Psychiatry, Psychosomatics and Psychotherapy, Diakonissenkrankenhaus Flensburg, Flensburg, Germany
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22
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Boege I, Schepker R, Fegert JM. [From home treatment to psychiatric ward-equivalent treatment (StäB) - A systematic review of outpatient treatment in Germany]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2020; 48:393-406. [PMID: 32100618 DOI: 10.1024/1422-4917/a000710] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
From home treatment to psychiatric ward-equivalent treatment (StäB) - A systematic review of outpatient treatment in Germany Abstract. Objective: In the past, home treatment was not available in Germany for children and adolescents with mental health problems. However, enactment of the PsychVVG law on 1 January 2017 has changed this, so that intensive home treatment (stationsäquivalente Behandlung, StäB) can now be offered as an alternative to inpatient treatment. This literature review a) analyzes existing German home treatment studies for effectiveness, b) determines from international reviews criteria for effective home treatment, and c) aligns these with the standardized StäB criteria. Method: We performed a systematic literature search in PubMed, Scopus, PsycINFO, and Cochrane Library referencing "hometreatment AND children" as well as "hometreatment AND adolesc*. Results: Flexibility, mobility, multiprofessionality, a wide spectrum of possible interventions, the option of inpatient admission, 24/7 availability as well as daily treatment sessions have been found to be factors for effective home treatment. In German studies, home treatment was shown to enhance psychosocial functioning, parental competences, long-term effectiveness, and acceptance by the families. The highest effect for home treatment was demonstrated in children and adolescents with externalizing disorders. Conclusion: Intensive home treatment (StäB) meets the criteria identified in the literature and is a good addition to existing treatment options for children and adolescents with mental health problems in Germany.
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Affiliation(s)
- Isabel Boege
- ZfP Südwürttemberg, Akademisches Lehrkrankenhaus der Universität Ulm, Ravensburg, Deutschland.,KJPP Universität Ulm, Ulm, Deutschland
| | - Renate Schepker
- ZfP Südwürttemberg, Akademisches Lehrkrankenhaus der Universität Ulm, Ravensburg, Deutschland
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Muskens JB, Herpers PCM, Hilderink C, van Deurzen PAM, Buitelaar JK, Staal WG. Intensive home treatment for adolescents in psychiatric crisis. BMC Psychiatry 2019; 19:412. [PMID: 31856770 PMCID: PMC6924140 DOI: 10.1186/s12888-019-2407-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 12/12/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescents with acute psychiatric disorders are typically treated with long-term clinical admission. However, long term admission may be associated with a variety of negative outcomes. This pilot study presents a new model of care, that is, the combined application of intensive home treatment and the possibility of short term stay at a psychiatric high & intensive care. METHODS In total 112 referred adolescents with mixed diagnoses participated in this longitudinal observational design. Clinical outcome was measured by the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) which measures the severity of multiple mental health problems. The HoNOSCA was clinician-rated at intake, after two months and after four months at discharge. Change in HoNOSCA total score was analysed with paired t-tests. Outcome moderators were gender, age, primary diagnosis, clinical admission, home treatment-time, medication and additional therapies. Follow up data were completed for 62 patients after two months and for 53 after four months. RESULTS Participants aged between 11 and 18 years (M = 14.8 years, SD = 0.3; 52% female). Mean HoNOSCA total score at intake was 18.8 (SD = 5.2), after two months 13.0 (SD = 5.0); after four months resulting in a score of 9.3 (SD = 5.2). None of the moderators tested showed a significant effect on HoNOSCA scores. However, a control group could not be used because of the severe psychopathology and high risk for suicidality and the lack of an effective treatment intervention for a comparable study group. CONCLUSION With a symptom decrease of over 50% within four months as measured by the HoNOSCA, including less risk for hospitalization, this new model appears promising and of clinical relevance. Nevertheless, further research regarding stability of treatment outcome is warranted and evaluation of long-term effects of this model in follow-up studies is needed.
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Affiliation(s)
- Jet B. Muskens
- Karakter, Child and Adolescent Psychiatry, University Centre, Reinier Postlaan 12, 6525 GC Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Kapittelweg 29, 6525 EN Nijmegen, The Netherlands
| | - Pierre C. M. Herpers
- Karakter, Child and Adolescent Psychiatry, University Centre, Reinier Postlaan 12, 6525 GC Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Kapittelweg 29, 6525 EN Nijmegen, The Netherlands
| | - Caroline Hilderink
- Karakter, Child and Adolescent Psychiatry, University Centre, Reinier Postlaan 12, 6525 GC Nijmegen, The Netherlands
| | - Patricia A. M. van Deurzen
- Karakter, Child and Adolescent Psychiatry, University Centre, Reinier Postlaan 12, 6525 GC Nijmegen, The Netherlands
| | - Jan K. Buitelaar
- Karakter, Child and Adolescent Psychiatry, University Centre, Reinier Postlaan 12, 6525 GC Nijmegen, The Netherlands
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboudumc, Nijmegen, The Netherlands
| | - Wouter G. Staal
- Karakter, Child and Adolescent Psychiatry, University Centre, Reinier Postlaan 12, 6525 GC Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Centre, Donders Institute for Brain, Cognition and Behaviour, Kapittelweg 29, 6525 EN Nijmegen, The Netherlands
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboudumc, Nijmegen, The Netherlands
- Faculty of Social Sciences, Leiden Institute for Brain and Cognition, Postzone C2-5, P.O.Box 9600, 2300 RC Leiden, The Netherlands
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Llanes-Álvarez C, Andrés-de Llano JM, Álvarez-Navares AI, Pastor-Hidalgo MT, Roncero C, Franco-Martín MA. Trends in Psychiatric Hospitalization of Children and Adolescents in Spain between 2005 and 2015. J Clin Med 2019; 8:E2111. [PMID: 31810229 PMCID: PMC6947568 DOI: 10.3390/jcm8122111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 11/13/2019] [Accepted: 11/26/2019] [Indexed: 11/16/2022] Open
Abstract
Eating disorders are on top of chronic conditions in children and adolescents, and the most severe cases may require hospitalization. Inpatient psychiatric treatment is one of the most expensive ones and therefore the efforts when treating eating disorders should focus on avoiding and shortening admissions, as well as preventing readmissions. Advances in of eating disorders treatment lie in an accurate knowledge of those patients requiring admission. This study examined the Conjunto Mínimo Básico de Datos-the largest public hospitalization database in Spain-to estimate the prevalence of eating and other psychiatric disorders during childhood and adolescence. It is a cross-sectional study of the hospital discharges in Castilla y León (Spain) from 2005 to 2015, in which patients under 18 years old with a psychiatric diagnosis at discharge were selected. Trends in the rates of hospitalization/1000 hospitalizations per year were studied by joinpoint regression analysis. Conclusions: eating disorders were the only group that presented an upward and continuous trend throughout the study period. This statistically significant increase showed an annual change of 7.8%.
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Affiliation(s)
| | - Jesús M. Andrés-de Llano
- Department of Pediatrics, Complejo Asistencial Universitario de Palencia, 34005 Palencia, Spain;
| | - Ana I. Álvarez-Navares
- Department of Psychiatry, University of Salamanca Health Care Complex, 37007 Salamanca, Spain; (A.I.Á.-N.); (C.R.)
| | | | - Carlos Roncero
- Department of Psychiatry, University of Salamanca Health Care Complex, 37007 Salamanca, Spain; (A.I.Á.-N.); (C.R.)
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John-Baptiste AA, Li L, Isaranuwatchai W, Osuch E, Anderson KK. Healthcare utilization costs of emerging adults with mood and anxiety disorders in an early intervention treatment program compared to a matched cohort. Early Interv Psychiatry 2019; 13:1439-1446. [PMID: 30688032 DOI: 10.1111/eip.12790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/06/2018] [Accepted: 12/26/2018] [Indexed: 11/26/2022]
Abstract
AIM The First Episode Mood and Anxiety Disorder Program (FEMAP) provides treatment to emerging adults with mood and anxiety disorders in an accessible, youth-friendly environment. We sought to investigate FEMAP's impact on the costs of care. METHODS We conducted a retrospective observational study of one-year health service costs using linked administrative datasets to compare emerging adults treated at FEMAP (FEMAP users) to propensity-score matched controls (non-users). Costs from the perspective of the Ontario Ministry of Health and Long-Term Care, included drug benefit claims, inpatient, physician and ambulatory care services. We used bootstrapping to perform unadjusted comparisons between FEMAP users and non-users, by cost category and overall. We performed risk-adjusted comparison of overall costs using generalized estimating equations. RESULTS FEMAP users (n = 366) incurred significantly lower costs compared to non-users (n = 660), for inpatient services (-$784, 95% confidence interval [CI] -$1765, -$28), ambulatory care services (-$90, 95% CI -$175, -$14) and drug benefit claims (-$47, 95% CI -$115,-$4) and significantly higher physician services costs ($435, 95% CI $276, $581) over 1 year. The unadjusted difference in overall costs was not significant (-$853, 95% CI -$2048, $142). Following adjustment for age, sex and age at first mental health diagnosis, the difference of -$914 (95% CI (-$2747, $919)) was also not significant. CONCLUSIONS FEMAP was associated with significantly lower costs of inpatient and ambulatory care services, and higher costs of physician services, however we are unable to conclude that FEMAP is cost-saving overall.
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Affiliation(s)
- Ava A John-Baptiste
- Department of Anesthesia & Perioperative Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Department of Epidemiology & Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Interfaculty Program in Public Health, Western University, London, Ontario, Canada.,Centre for Medical Evidence, Decision Integrity & Clinical Impact (MEDICI Centre), Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada.,Institute for Clinical Evaluative Sciences, London, Ontario, Canada
| | - Lihua Li
- Institute for Clinical Evaluative Sciences, London, Ontario, Canada
| | - Wanrudee Isaranuwatchai
- Centre for Excellence in Economic Analysis Research (CLEAR), St. Michael's Hospital, Toronto, Ontario, Canada.,Pharmacoeconomics Research Unit, Cancer Care Ontario, Toronto, Ontario, Canada.,Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Elizabeth Osuch
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Kelly K Anderson
- Department of Epidemiology & Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada.,Institute for Clinical Evaluative Sciences, London, Ontario, Canada.,Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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26
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Böge I, Schepker R, Fegert JM. [Intensive psychiatric care of children and adolescents in their natural environment : Alternatives to inpatient treatment]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:195-204. [PMID: 30627734 DOI: 10.1007/s00103-018-2874-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Mental health disorders are one of the main diseases in children and adolescents, the persistence rate into adulthood being around 50%. Early intervention is therefore essential. However, present treatment options reach only 50% of children and adolescents with mental health problems.The objective of this article is to depict why legal deficits complicated the establishment of outreach treatment in the past and to illustrate recent legal changes that now allow innovative outreach treatment programs that meet the need of children and adolescents with mental health issues.This review is based on pertinent publications that were retrieved by a selective literature search in PubMed and Cochrane Library concerning types of home treatment in child and adolescent psychiatry, with due reference to the authors' own experience with intensive home treatment.The literature shows that outreach work has been effective in many other countries. In Germany however, clear separation in finances between outpatient and inpatient treatment did not allow the establishment of outreach teams in the past. On 01.01.2017 a new law, the PsychVVG, entered into force, and now provides a sound legal basis for outreach work. Home treatment in the form of, for example, intensive outreach work that equals the intensity and frequency of inpatient treatment (StäB) or continuum of care school (CCSchool), a project that joins school-based diagnostic elements with school-based treatment, can now be installed and evaluated.Intensive outreach work, especially in child and adolescent psychiatry, will now be a good alternative to inpatient treatment that integrates parents into the treatment approach.
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Affiliation(s)
- Isabel Böge
- KJPP, Universität Ulm, Steinhövelstraße 5, 89075, Ulm, Deutschland. .,KJPP, ZfP Südwürttemberg, Weingartshoferstraße 2, 88214, Ravensburg, Deutschland.
| | - Renate Schepker
- KJPP, Universität Ulm, Steinhövelstraße 5, 89075, Ulm, Deutschland.,KJPP, ZfP Südwürttemberg, Weingartshoferstraße 2, 88214, Ravensburg, Deutschland
| | - Jörg M Fegert
- KJPP, Universität Ulm, Steinhövelstraße 5, 89075, Ulm, Deutschland
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Hay PJ, Touyz S, Claudino AM, Lujic S, Smith CA, Madden S. Inpatient versus outpatient care, partial hospitalisation and waiting list for people with eating disorders. Cochrane Database Syst Rev 2019; 1:CD010827. [PMID: 30663033 PMCID: PMC6353082 DOI: 10.1002/14651858.cd010827.pub2] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Clinical guidelines recommend outpatient care for the majority of people with an eating disorder. The optimal use of inpatient treatment or combination of inpatient and partial hospital care is disputed and practice varies widely. OBJECTIVES To assess the effects of treatment setting (inpatient, partial hospitalisation, or outpatient) on the reduction of symptoms and increase in remission rates in people with:1. Anorexia nervosa and atypical anorexia nervosa;2. Bulimia nervosa and other eating disorders. SEARCH METHODS We searched Ovid MEDLINE (1950- ), Embase (1974- ), PsycINFO (1967- ) and the Cochrane Central Register of Controlled Trials (CENTRAL) to 2 July 2018. An earlier search of these databases was conducted via the Cochrane Common Mental Disorders Controlled Trial Register (CCMD-CTR) (all years to 20 November 2015). We also searched the WHO International Clinical Trials Registry Platform and ClinicalTrials.gov (6 July 2018). We ran a forward citation search on the Web of Science to identify additional reports citing any of the included studies, and screened reference lists of included studies and relevant reviews identified during our searches. SELECTION CRITERIA We included randomised controlled trials that tested the efficacy of inpatient, outpatient, or partial hospital settings for treatment of eating disorder in adults, adolescents, and children, whose diagnoses were determined according to the DSM-5, or other internationally accepted diagnostic criteria. We excluded trials of treatment setting for medical or psychiatric complications or comorbidities (e.g. hypokalaemia, depression) of an eating disorder. DATA COLLECTION AND ANALYSIS We followed standard Cochrane procedures to select studies, extract and analyse data, and interpret and present results. We extracted data according to the DSM-5 criteria. We used the Cochrane tool to assess risk of bias. We used the mean (MD) or standardised mean difference (SMD) for continuous data outcomes, and the risk ratio (RR) for binary outcomes. We included the 95% confidence interval (CI) with each result. We presented the quality of the evidence and estimate of effect for weight or body mass index (BMI) and acceptability (number who completed treatment), in a 'Summary of findings' table for the comparison for which we had sufficient data to conduct a meta-analysis. MAIN RESULTS We included five trials in our review. Four trials included a total of 511 participants with anorexia nervosa, and one trial had 55 participants with bulimia nervosa. Three trials are awaiting classification, and may be included in future versions of this review. We assessed a risk of bias from lack of blinding of participants and therapists in all trials, and unclear risk for allocation concealment and randomisation in one study.We had planned four comparisons, and had data for meta-analyses for one. For anorexia nervosa, there may be little or no difference between specialist inpatient care and active outpatient or combined brief hospital and outpatient care in weight gain at 12 months after the start of treatment (standardised mean difference (SMD) -0.22, 95% CI -0.49 to 0.05; 2 trials, 232 participants; low-quality evidence). People may be more likely to complete treatment when randomised to outpatient care settings, but this finding is very uncertain (risk ratio (RR) 0.75, 95% CI 0.64 to 0.88; 3 trials, 319 participants; very low-quality evidence). We downgraded the quality of the evidence for these outcomes because of risks of bias, small numbers of participants and events, and variable level of specialist expertise and intensity of treatment.We had no data, or data from only one trial for the primary outcomes for each of the other three comparisons.No trials measured weight or acceptance of treatment for anorexia nervosa, when comparing inpatient care provided by a specialist eating disorder service and health professionals and a waiting list, no active treatment, or treatment as usual.There was no clear difference in weight gain between settings, and only slightly more acceptance for the partial hospital setting over specialist inpatient care for weight restoration in anorexia nervosa.There was no clear difference in weight gain or acceptability of treatment between specialist inpatient care and partial hospital care for bulimia nervosa, and other binge eating disorders. AUTHORS' CONCLUSIONS There was insufficient evidence to conclude whether any treatment setting was superior for treating people with moderately severe (or less) anorexia nervosa, or other eating disorders.More research is needed for all comparisons of inpatient care versus alternate care.
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Affiliation(s)
- Phillipa J Hay
- Western Sydney UniversityTranslational Health Research InstitutePenrithNew South WalesAustralia2751
- Western Sydney UniversitySchool of MedicineLocked Bag 1797Penrith South DCNSWAustralia2751
| | - Stephen Touyz
- University of SydneySchool of Psychology and Boden Institute School of MedicineSydneyNSWAustralia2006
| | - Angélica M Claudino
- Federal University of São Paulo (UNIFESP)Department of Psychiatry and Psychological MedicineRua Borges Lagoa 570 conj. 71São PauloSão PauloBrazil04038‐000
| | - Sanja Lujic
- UNSWCentre for Big Data Research in HealthCBDRH, Lowy Building, Level 4UNSW SydneyNSWAustralia2052
| | - Caroline A Smith
- Western Sydney UniversityNICM Health Research InstituteLocked Bag 1797PenrithNew South WalesAustralia2751
| | - Sloane Madden
- University of SydneyThe Children's Hospital at WestmeadSydneyAustralia
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Abstract
Systemic Treatment of Eating Disorders Abstract. Eating disorders (EDs) are deleterious illnesses that are associated with significant psychiatric and medical morbidity and mortality, considerable distress and impairment, marked caregiver burden, and high treatment costs. Because EDs commonly onset in adolescence and young adulthood, and with consistent evidence that early intervention results in the most promising treatment outcomes, an increasing amount of research has been devoted to the treatment of adolescent EDs. Although still less researched in adult presentations of EDs, the historical record of research on adolescent ED treatment over the last half-century principally supports family therapy. Current published clinical guidelines recommend an ED-specific family therapy as the first-line treatment of adolescents with anorexia nervosa (AN) and as a recommended treatment of adolescents with bulimia nervosa (BN). The number of treatment trials for adolescent AN has slowly grown over the last few decades and, more recently, family interventions include protocols extending to new populations and diagnoses, including BN. This narrative review summarizes existing family-based approaches to the treatment of adolescent EDs, integrating recent research findings. This article also includes discussion of methods, both current and proposed, that expand and adapt current family-based approaches in efforts to improve the breadth and scope of ED treatment in adolescence and young adulthood.
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Affiliation(s)
- Patrick Pasi
- Klinik für Konsiliarpsychiatrie und Psychosomatik, Universitätsspital Zürich
| | - Dagmar Pauli
- Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie, PUK Zürich
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Patton GC. Early supported discharge: getting adolescents back on track. Lancet Psychiatry 2018; 5:452-453. [PMID: 29731411 DOI: 10.1016/s2215-0366(18)30140-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 04/06/2018] [Accepted: 04/06/2018] [Indexed: 11/18/2022]
Affiliation(s)
- George C Patton
- Centre for Adolescent Health, Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia; Royal Children's Hospital, Parkville, VIC 3052, Australia.
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Ougrin D, Corrigall R, Poole J, Zundel T, Sarhane M, Slater V, Stahl D, Reavey P, Byford S, Heslin M, Ivens J, Crommelin M, Abdulla Z, Hayes D, Middleton K, Nnadi B, Taylor E. Comparison of effectiveness and cost-effectiveness of an intensive community supported discharge service versus treatment as usual for adolescents with psychiatric emergencies: a randomised controlled trial. Lancet Psychiatry 2018; 5:477-485. [PMID: 29731412 PMCID: PMC5994473 DOI: 10.1016/s2215-0366(18)30129-9] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 03/09/2018] [Accepted: 03/21/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Intensive community treatment to reduce dependency on adolescent psychiatric inpatient care is recommended in guidelines but has not been assessed in a randomised controlled trial in the UK. We designed a supported discharge service (SDS) provided by an intensive community treatment team and compared outcomes with usual care. METHODS Eligible patients for this randomised controlled trial were younger than 18 years and had been admitted for psychiatric inpatient care in the South London and Maudsley NHS Foundation Trust. Patients were assigned 1:1 to either the SDS or to usual care by use of a computer-generated pseudorandom code with random permuted blocks of varying sizes. The primary outcome was number of inpatient bed-days, change in Strengths and Difficulties Questionnaire (SDQ) scores, and change in Children's Global Assessment Scale (CGAS) scores at 6 months, assessed by intention to treat. Cost-effectiveness was explored with acceptability curves based on CGAS scores and quality-adjusted life-years (QALYs) calculated from the three-level EuroQol measure of health-related quality of life (EQ-5D-3L), taking a health and social care perspective. This study is registered with the ISRCTN Registry, number ISRCTN82129964. FINDINGS Hospital use at 6 months was significantly lower in the SDS group than in the usual care group (unadjusted median 34 IQR 17-63 vs 50 days, 19-125, p=0·04). The ratio of mean total inpatient days for usual care to SDS was 1·67 (95% CI 1·02-2·81, p=0·04), which decreased to 1·65 (0·99-2·77, p=0·057) when adjusted for differences in hospital use before randomisation. Scores for SDQ and CGAS did not differ between groups. The cost-effectiveness acceptability curve based on QALYs showed that the probability of SDS being cost-effective compared with usual care was around 60% with a willingness-to-pay threshold of £20 000-30 000 per QALY, and that based on CGAS showed at least 58% probability of SDS being cost-effective compared with usual care irrespective of willingness to pay. We recorded no adverse events attributable to SDS or usual care. INTERPRETATION SDS provided by an intensive community treatment team reduced bed usage at 6 months' follow-up but had no effect on functional status and symptoms of mental health disorders compared with usual care. The possibility of preventing admissions, particularly through features such as reduced self-harm and improved reintegration into school, with intensive community treatment should be investigated in future studies. FUNDING South London and Maudsley NHS Trust.
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Affiliation(s)
- Dennis Ougrin
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London and Maudsley NHS Foundation Trust, London, UK.
| | | | - Jason Poole
- South London and Maudsley NHS Foundation Trust, London, UK; Department of Psychology, London South Bank University, London, UK
| | - Toby Zundel
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Mandy Sarhane
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Daniel Stahl
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paula Reavey
- Department of Psychology, London South Bank University, London, UK
| | - Sarah Byford
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Margaret Heslin
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - John Ivens
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Zahra Abdulla
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Daniel Hayes
- South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Benita Nnadi
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Eric Taylor
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Abstract
School Attendance of Children with Mental Health Problems School can support a child's resilience as well as be a risk to the child's mental health. However school is an indicator of social participation, an aspect that flourished especially in the debate about inclusion. In this paper assistance opportunities are being discussed that are established to support children with a psychological disease in school. Three of the different concepts of funding priorities for special educational needs in the German system will be presented: "Förderschwerpunkt emotionale und soziale Entwicklung" (special needs in emotional and social development), "besonderer Förderbedarf "(special needs) and "Schulbegleitung" (school assistants). Also, the conditions for students of schools in hospitals and clinics will be analyzed and the reintegration process back to home school will be considered. It becomes unequivocal that there is little data about special assistance opportunities and that law structures in the federal states of Germany differ from each other and are partly unclear. The involvement of the three systems school, child and youth welfare service and child and youth psychiatry demands solid structures of communication and cooperation and a common continuous work across systems' borders during the child's school years.
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Kwok KHR, Yuan SNV, Ougrin D. Review: Alternatives to inpatient care for children and adolescents with mental health disorders. Child Adolesc Ment Health 2016; 21:3-10. [PMID: 32680359 DOI: 10.1111/camh.12123] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Intensive community services may provide an alternative to inpatient care but there is little systematic evidence of their efficacy. This article provides a systematic review of randomized controlled trials (RCTs) reporting efficacy of intensive community services versus inpatient care in youth. METHOD Data sources were identified by searching Medline, PsychINFO and EMBASE databases as of December 2014. RCTs comparing intensive community services versus inpatient care in children and adolescents (through age 18) were included. RESULTS Six unique RCTs including 569 youth were identified. The RCTs examined the efficacy of specialist outpatient treatment, multisystemic therapy, day patient treatment, intensive home treatment and supported discharge services versus inpatient care. Using intensive community services was associated with clinical improvements similar to inpatient care in most studies. Where differences in clinical outcomes existed, they tended to favour intensive community treatment. Using intensive community services was associated with shorter hospitalizations, lower costs and greater patient satisfaction. There were no independent replications of the results. Few studies investigated the use of intensive community treatment as an alternative to inpatient care in children and adolescents with severe immediate risk to self and others. CONCLUSIONS Intensive community services appear to be a viable alternative to inpatient care. Independent replication of results achieved by specific intensive community treatment models is a research priority.
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Affiliation(s)
- Ka Ho Robin Kwok
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King's College London, PO 85, De Crespigny Park, London SE5 8AF, UK
| | - Sze Ngar Vanessa Yuan
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King's College London, PO 85, De Crespigny Park, London SE5 8AF, UK
| | - Dennis Ougrin
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, King's College London, PO 85, De Crespigny Park, London SE5 8AF, UK
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