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Quadflieg N, Naab S, Schlegl S, Bauman T, Voderholzer U. Inpatient Treatment Outcome in a Large Sample of Adolescents with Anorexia Nervosa. Nutrients 2023; 15:4247. [PMID: 37836531 PMCID: PMC10574756 DOI: 10.3390/nu15194247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
Anorexia nervosa is an illness affecting primarily adolescent girls and young women. Clinical guidelines recommend early intervention, with inpatient treatment for more severe cases. We present an evaluation of a multi-modal cognitive-behavioral inpatient treatment (CBT-E) involving carers in specialized units for adolescents. Routine data of 962 adolescent inpatients (26 boys) (mean age 15.48 [1.26]; range 12-17 years) were analyzed. Predictors of good body weight outcome (achieving a discharge BMI of at least 18.5 kg/m2) were identified by logistic regression analysis. Mean inpatient treatment lasted 96.69 (45.96) days. The BMI increased significantly from 14.93 (1.38) kg/m2 at admission to 17.53 (1.58) kg/m2 at discharge (z = 26.41; p < 0.001; d = 1.708). Drive for thinness decreased from 29.08 (9.87) to 22.63 (9.77; z = 18.41; p < 0.001; d = 0.787). All other subscores of the Eating Disorder Inventory also decreased significantly, with small to medium effect sizes. General psychopathology also showed significant decreases. The Beck Depression Inventory-II score decreased from 26.06 (11.74) to 16.35 (12.51; z = 18.41; p < 0.001; d = 0.883). A good body weight outcome was predicted by a higher BMI at admission (OR = 1.828), age at onset at 15 years or higher (OR = 1.722), and higher Somatization (OR = 1.436), Anxiety (OR = 1.320), and Bulimia (OR = 1.029) scores. CBT-E involving carers is an efficient intervention for adolescents with anorexia nervosa.
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Affiliation(s)
- Norbert Quadflieg
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Ludwig-Maximilians-University Munich (LMU), 80336 Munich, Germany; (S.S.); (U.V.)
| | - Silke Naab
- Schoen Clinic Roseneck Affiliated with the Medical Faculty of the University of Munich (LMU), 83209 Prien, Germany; (S.N.); (T.B.)
| | - Sandra Schlegl
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Ludwig-Maximilians-University Munich (LMU), 80336 Munich, Germany; (S.S.); (U.V.)
| | - Tabea Bauman
- Schoen Clinic Roseneck Affiliated with the Medical Faculty of the University of Munich (LMU), 83209 Prien, Germany; (S.N.); (T.B.)
| | - Ulrich Voderholzer
- Department of Psychiatry and Psychotherapy, LMU University Hospital, Ludwig-Maximilians-University Munich (LMU), 80336 Munich, Germany; (S.S.); (U.V.)
- Schoen Clinic Roseneck Affiliated with the Medical Faculty of the University of Munich (LMU), 83209 Prien, Germany; (S.N.); (T.B.)
- Department of Psychiatry and Psychotherapy, University Hospital, 79106 Freiburg, Germany
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Besse-Flütsch N, Bühlmann C, Fabijani N, Ruschetti GG, Smigielski L, Pauli D. Home treatment as an add-on to family-based treatment for adolescents with anorexia nervosa compared with standard family-based treatment and home-based stress reduction training: study protocol for a randomized clinical trial. J Eat Disord 2023; 11:135. [PMID: 37580810 PMCID: PMC10424408 DOI: 10.1186/s40337-023-00861-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/04/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Family-based treatment (FBT) is currently the most effective evidence-based treatment approach for adolescents with anorexia nervosa (AN). Home treatment (HT) as an add-on to FBT (FBT-HT) has been shown to be acceptable, feasible and effective. The described three-arm randomized clinical trial (RCT) is intended to investigate whether FBT-HT demonstrates higher efficacy compared to standard outpatient FBT with supplemental mindfulness-based stress reduction training (FBT-MBSR). METHODS This RCT compares FBT-HT to standard outpatient FBT and FBT-MBSR as a credible home-based control group in terms of efficacy and delivery. Adolescents with AN or atypical AN disorder (n = 90) and their parent(s)/caregiver(s) are to be randomly assigned to either FBT, FBT-HT or FBT-MBSR groups. Eating disorder diagnosis and symptomatology are to be assessed by eating disorder professionals using standardized questionnaires and diagnostic instruments (Eating Disorder Examination, Eating Disorder Inventory, Body Mass Index). In addition, parents and caregivers independently provide information on eating behavior, intrafamily communication, stress experience and weight. The therapeutic process of the three treatments is to be measured and assessed among both participants and care providers. The feasibility, acceptability and appropriateness can thus also be evaluated. DISCUSSION We hypothesize that FBT-HT will be an acceptable, appropriate and feasible intervention and, importantly, will outperform both established FBT and FBT-MBSR in improving adolescent weight and negative eating habits. Secondary outcome measures include the reduction in the stress experienced by caregivers, as well as the regulation of perceived expressed emotions within the family, while the intrafamily relationships are hypothesized to mediate/moderate the effectiveness of FBT. The proposed study has the potential to enhance the scientific and clinical understanding of the efficacy of FBT for AN, including whether the addition of HT to FBT versus another home-based adjunct intervention improves treatment outcomes. Furthermore, the study aligns with public health priorities to optimize the outcomes of evidence-based treatments and integrate the community setting. Trial registration This study is registered at ClinicalTrials.gov (NCT05418075).
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Affiliation(s)
- Nicole Besse-Flütsch
- Department of Child and Adolescent Psychiatry, Psychiatric University Hospital Zürich, University of Zürich, Neumünsterallee 3, 8032, Zurich, Switzerland.
| | - Claudia Bühlmann
- Department of Child and Adolescent Psychiatry, Psychiatric University Hospital Zürich, University of Zürich, Neumünsterallee 3, 8032, Zurich, Switzerland
| | - Natalie Fabijani
- Department of Child and Adolescent Psychiatry, Psychiatric University Hospital Zürich, University of Zürich, Neumünsterallee 3, 8032, Zurich, Switzerland
| | - Gian Giacomo Ruschetti
- Department of Child and Adolescent Psychiatry, Psychiatric University Hospital Zürich, University of Zürich, Neumünsterallee 3, 8032, Zurich, Switzerland
| | - Lukasz Smigielski
- Department of Child and Adolescent Psychiatry, Psychiatric University Hospital Zürich, University of Zürich, Neumünsterallee 3, 8032, Zurich, Switzerland
| | - Dagmar Pauli
- Department of Child and Adolescent Psychiatry, Psychiatric University Hospital Zürich, University of Zürich, Neumünsterallee 3, 8032, Zurich, Switzerland
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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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Weindl D, Peper-Bösenkopf J, Mares T, Noske J. [Child and adolescent psychiatric and therapeutic treatment needs in care settings in the Lower Austrian industrial district. A survey of the demand situation]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2023; 37:33-38. [PMID: 35581522 PMCID: PMC9113075 DOI: 10.1007/s40211-022-00419-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 05/03/2022] [Indexed: 11/25/2022]
Abstract
An increasing need for child and adolescent psychiatric care is clearly observed in recent years. The present study deals with 20 child and youth care facilities taking care of 439 children and adolescents, in the industrial district, in Lower Austria. The aim of the study is to evaluate treatment needs of this special group of patients. The care facilities reported that 270 children and adolescents (62%) show psychiatric problems. Of these, 220 (50.1%) are diagnosed with one or more psychiatric diagnoses, and 200 children and adolescents are receiving child and adolescent psychiatric treatment. Eleven care facilities reported the necessity for treatment in 80-100% of their accommodated children and adolescents. This results in highly stressful working conditions for professional psychosocial helpers and high treatment needs within their fosterlings. It is evident that more intensive networking and cooperation between institutions and helpers involved is necessary. Further, the development of new, low-threshold child and adolescent psychiatric services would be desirable to adequately meet the increasing need for psychiatric treatment in children and adolescents.
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Affiliation(s)
- Dina Weindl
- KJPP Hinterbrühl, 2371, Hinterbrühl, Österreich.
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5
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Sevecke K, Wenter A, Böge I. [Inpatient care in child and adolescent psychiatry-Who gets treatment?]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2022; 36:179-187. [PMID: 36348224 PMCID: PMC9643980 DOI: 10.1007/s40211-022-00443-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/13/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND RESEARCH QUESTION This article presents and analyses the landscape for inpatient child and adolescent psychiatric care in Austria and examines current data from June 2022. METHOD In June 2022, the authors surveyed the current status of child and adolescent psychiatric primary care in Austria. Both systemised beds and day hospital beds as well as the number of specialists and assistant doctors were taken into account. RESULTS A bed index of 0.05 beds/1000 inhabitants (as of 6/2022) was calculated, which is below the guideline for beds needed and does not correspond with the need depicted for sufficient provision of care ("Österreichischer Strukturplan Gesundheit"). Moreover, in June 2022, 40 beds had to be closed due to staff shortages and 26.5 training positions were vacant across Austria. DISCUSSION AND CONCLUSIONS Even though the training ratio was raised to 1:2 as of 07.02.2022 within the framework of the "Mangelfachverordnung" for a limited period of time until 31.05.2027, it is hardly possible to guarantee sufficient mental health care according to the increased demand for child and adolescent psychiatry, especially in times of the pandemic. Measures need to be urgently taken to improve child and adolescent psychiatric treatment options. In order to ensure adequate care for the increasing number of mentally ill children and adolescents (a) the number of beds must be increased, (b) structural deficits have to improve, and (c) innovative treatment options in the sense of inpatient-equivalent treatment (home treatment) has to be considered.
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Affiliation(s)
- Kathrin Sevecke
- Medizinische Universität Innsbruck, Christoph-Probst-Platz, Innrain 52, 6020, Innsbruck, Österreich.
- Abteilung für Kinder- und Jugendpsychiatrie, Psychotherapie und Psychosomatik, Tirol Kliniken, Milser Straße 10, 6060, Hall i. T., Österreich.
| | - Anna Wenter
- Medizinische Universität Innsbruck, Christoph-Probst-Platz, Innrain 52, 6020, Innsbruck, Österreich
- Institut für Psychologie, Fakultät für Psychologie und Sportwissenschaft, Leopold-Franzens-Universität Innsbruck, Universitätsstraße 5-7, 6020, Innsbruck, Österreich
| | - Isabel Böge
- Universitätsklinikum Graz, Auenbruggerplatz 1, 8036, Graz, Österreich
- Abteilung für Kinder- und Jugendpsychiatrie und Psychotherapie, LKH II, Wagner-Jauregg Platz 1, 8053, Graz, Österreich
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Zechmeister-Koss I, Goodyear M, Grössmann N, Wolf S. Integrating home treatment into the Austrian child and adolescent mental health care system: an implementation science perspective. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2022; 36:28-39. [PMID: 34699039 DOI: 10.1007/s40211-021-00404-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/22/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND In Austria, similar to other countries, health care planners have considered implementing home treatment (HT) programs for children and adolescents with mental health problems. However, introducing any new service innovation into the complex environment of the child and adolescent mental health care system requires context and implementation issues to be taken into account in advance. METHODS We identified implementation themes from international HT models and developed a questionnaire with open-ended implementation-related questions for Austrian professionals. We analysed the qualitative results alongside the domains in the Context and Implementation of Complex Interventions (CICI) framework to detect key implementation challenges for HT in Austria. RESULTS We found six implementation themes in international HT models, which formed the basis for development of the questionnaire. Within the qualitative data from ten Austrian professionals who responded to the questionnaire, we identified implementation challenges in all eight context and all four implementation domains of the CICI framework. CONCLUSIONS Key implementation challenges detected highlight the need to address the fit of HT within existing sociocultural norms and limited available human resources. Regional context-specific solutions need to be found on how to embed this new element best into the existing provider and financing structures. This calls for monitoring and evaluation alongside implementation to support decision-making.
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Affiliation(s)
- Ingrid Zechmeister-Koss
- Austrian Institute for Health Technology Assessment GmbH (AIHTA), Garnisongasse 7/20, 1090, Vienna, Austria.
| | | | - Nicole Grössmann
- Austrian Institute for Health Technology Assessment GmbH (AIHTA), Garnisongasse 7/20, 1090, Vienna, Austria
| | - Sarah Wolf
- Austrian Institute for Health Technology Assessment GmbH (AIHTA), Garnisongasse 7/20, 1090, Vienna, Austria
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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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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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Zechmeister-Koss I, Grössmann N, Wolf S. [Effectiveness and Safety of Home Treatment in Child and Adolescent Mental Health Care: A Systematic Literature Review]. PSYCHIATRISCHE PRAXIS 2021; 49:11-21. [PMID: 34416782 DOI: 10.1055/a-1517-6171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE In child and adolescent psychiatry, home treatment is becoming increasingly important due to limited inpatient care capacities and changing treatment philosophies. This paper examines its effectiveness and safety. METHODS We did a systematic literature search and summarized the home treatment model characteristics as well as the evidence on its benefits and harms narratively. RESULTS In the six identified studies, improvements in symptoms were found in both, home and institutionalized treatment. In the long-term, home treatment seems to be slightly superior and involves fewer hospital days. However, a best-practice model cannot be derived from the data available. CONCLUSION Home treatment can be considered as an alternative to inpatient treatment, but requires coordination with other mental health care elements and further evaluation.
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Affiliation(s)
| | - Nicole Grössmann
- Austrian Institute for Health Technology Assessment GmbH (AIHTA)
| | - Sarah Wolf
- Austrian Institute for Health Technology Assessment GmbH (AIHTA)
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10
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Noske J, Thun-Hohenstein L. [Cooperation between child and adolescent psychiatry and youth welfare concerning socio-educational residence for children and adolescents]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2021; 35:9-16. [PMID: 33244668 PMCID: PMC7954707 DOI: 10.1007/s40211-020-00378-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 11/05/2020] [Indexed: 11/30/2022]
Abstract
Kinder- und Jugendpsychiatrie und Kinder- und Jugendhilfe betreuen viele gemeinsame Kinder und Jugendliche. Insbesondere bei den schwierigsten Kindern und Jugendlichen ist eine Kooperation am meisten gefordert. Viele dieser schwierigen Kinder und Jugendlichen kommen aus schwierigen Lebensverhältnissen, sind häufig traumatisiert und zeigen stark externalisierendes Verhalten. Die Unterbringung in einer extrafamilialen Wohnform stellt die Beteiligten aller Systeme häufig vor große Probleme. Die Kinder- und Jugendpsychiatrie kann auf allen Ebenen wertvolle Beiträge leisten. Einerseits im Rahmen der spezifischen Kinder- und Jugendpsychiatrischen Diagnostik und Behandlung, ganz besonders im Konsiliar- und Liäsondienst und/oder in kooperativen Einrichtungen oder Betreuungsformaten. Dieses Angebot wird anhand der von der Kinder- und Jugendhilfe angebotenen Wohnformen diskutiert und konkrete Vorschläge zur Umsetzung diese Kooperation dargestellt.
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Affiliation(s)
- Judith Noske
- Abteilung für Kinder- und Jugendpsychiatrie Hinterbrühl, Krankenhaus Mödling, Fürstenweg 8, 2371, Hinterbrühl, Österreich.,Arbeitsgruppe Versorgung der Österreichischen Gesellschaft für Kinder und Jugendpsychiatrie, Psychosomatik und Psychotherapie (ÖGKJP), Wien, Österreich
| | - Leonhard Thun-Hohenstein
- Universitätsklinik für Kinder- und Jugendpsychiatrie, Salzburger Landeskliniken, Campus Christian Doppler Klinik, Paracelsus Medizinische Privatuniversität, Ignaz Harrerstraße 75, 5020, Salzburg, Österreich. .,Arbeitsgruppe Versorgung der Österreichischen Gesellschaft für Kinder und Jugendpsychiatrie, Psychosomatik und Psychotherapie (ÖGKJP), Wien, Österreich.
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11
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Schwarz J, Duve A, Hoffmann S, Heiser P, Pérez GR, Heinze M, von Peter S. Erfahrungen der Stakeholder mit den Modellvorhaben nach § 64b SGB V in der Kinder- und Jugendpsychiatrie und -psychotherapie – eine qualitative Studie. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2020; 48:358-368. [DOI: 10.1024/1422-4917/a000716] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung. Hintergrund und Fragestellung: Seit 2013 sind in Deutschland die Möglichkeiten für eine integrative Behandlungsform gemäß § 64b SGB (Sozialgesetzbuch) V erweitert worden. Diese sogenannte psychiatrische Modellversorgung (MV) ist in den letzten Jahren sowohl an einzelnen Kliniken der Erwachsenen- als auch der Kinder- und Jugendpsychiatrie und -psychotherapie (KJPP) eingeführt worden. Ziel der MV ist es, eine ambulante, individualisierte und kontinuierliche Behandlung anzubieten. In der vorliegenden Arbeit werden die Erfahrungen der Stakeholder mit dieser innovativen Behandlungsform untersucht. Methodik: An zwei kinder- und jugendpsychiatrischen Kliniken der MV wurden Fokusgruppen durchgeführt, an denen Mitarbeitende, Patientinnen und Patienten sowie Eltern (N = 36) teilnahmen. Es folgte eine qualitativ-inhaltsanalytische Auswertung. Ergebnisse: Aus Sicht aller Akteurinnen und Akteure bildet die ambulante Akut Behandlung (AAB) einen zentralen Modellbestandteil, die eine Behandlung von Patientinnen und Patienten mit akuten Beschwerden im Vorfeld, als Ersatz oder im Nachgang einer (teil)stationären Behandlung ermöglicht. Die Flexibilisierung der Behandlung und eine größere Behandlungs- und Behandlerkontinuität wurden als weitere Vorteile der MV genannt. Schließlich gelingt der Einbezug von Sorgeberechtigten im Rahmen der MV leichter, was für diese Akteursgruppe auch einige Herausforderungen mit sich bringt. Schlussfolgerungen: Die Einführung psychiatrischer MV in der KJPP hat komplexe Auswirkungen auf die Behandlungsabläufe und das Erleben aller beteiligten Akteurinnen und Akteure und wird von diesen als bedürfnisorientierte Ausweitung therapeutischer Unterstützungsmöglichkeiten erlebt.
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Affiliation(s)
- Julian Schwarz
- Medizinische Hochschule Brandenburg, Hochschulklinik für Psychiatrie und Psychotherapie, Immanuel Klinik, Rüdersdorf
| | - Annette Duve
- Vitos Klinik Hofheim für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Riedstadt
| | - Sabine Hoffmann
- Vitos Klinik Hofheim für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, Riedstadt
| | - Philip Heiser
- Südharz Klinikum Nordhausen, Klinik für Psychiatrie, Psychotherapie und Psychosomatik des Kindes- und Jugendalters, Nordhausen
| | - Guillermo Ruiz Pérez
- Medizinische Hochschule Brandenburg, Hochschulklinik für Psychiatrie und Psychotherapie, Immanuel Klinik, Rüdersdorf
| | - Martin Heinze
- Medizinische Hochschule Brandenburg, Hochschulklinik für Psychiatrie und Psychotherapie, Immanuel Klinik, Rüdersdorf
| | - Sebastian von Peter
- Medizinische Hochschule Brandenburg, Hochschulklinik für Psychiatrie und Psychotherapie, Immanuel Klinik, Rüdersdorf
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Boege I, Herrmann J, Wolff JK, Hoffmann U, Koelch M, Kurepkat M, Lütte S, Naumann A, Nolting HD, Fegert JM. CCSchool: a multicentre, prospective study on improving continuum of care in children and adolescents with mental health problems associated with school problems in Germany. BMC Health Serv Res 2018; 18:947. [PMID: 30522471 PMCID: PMC6282354 DOI: 10.1186/s12913-018-3713-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 11/14/2018] [Indexed: 11/10/2022] Open
Abstract
Background Most psychiatric disorders in childhood and adolescence cause impairment in academic performance. Early interventions in school are thought to reduce the burden of disorder and prevent chronicity of disorder, while a delay in reachable help may result in more severe symptoms upon first time presentation, often then causing upon first-time presentation immediate need of inpatient care. Methods The study aims at reducing hospitalization rates and increasing social participation and quality of life among children and adolescents by establishing collaborations between schools, mental health care services and youth welfare services. CCSchool offers children and adolescents, aged six to 18 years, who present with psychiatric problems associated to school problems, a standardized screening and diagnostic procedure as well as treatment in school if necessary. Students can participate in CCSchool in three federal states of Germany if they a) show symptoms vindicating a mental health diagnosis, b) present with confirmed school problems and c) have a level of general functioning below 70 on the children global assessment of Functioning (C-GAF). Intervention takes place in three steps: module A (expected n = 901, according to power calculation) with standardized diagnostic procedures; module B (expected n = 428) implies a school-based assessment followed by a first intervention; module C (expected n = 103) offering school-based interventions with either four to six sessions (basic, 80% of patients) or eight to 12 sessions (intensive, 20% of patients). Primary aim is to evaluate the effectiveness of CCSchool, in reducing the need of hospitalization in children with mental health problems. The analyses will be conducted by an independent institute using mainly data collected from patients and their caregivers during study participation. Additionally, claims data from statutory health insurances will be analysed. Relevant confounders will be controlled in all analyses. Discussion Evaluation may show if CCSchool can prevent hospitalizations, enhance social participation and improve quality of life of children and adolescents with mental health problems by providing early accessible interventions in the school setting. Trial registration Deutsches Register Klinischer Studien, Trial registration number: DRKS00014838, registered on 6th of June 2018.
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Affiliation(s)
- Isabel Boege
- CAP, ZfP Suedwuerttemberg, Weingartshoferstrasse 2, 88214, Ravensburg, Germany. .,CAP, Universitaet Ulm, Ulm, Germany.
| | - Julia Herrmann
- CAP, ZfP Suedwuerttemberg, Weingartshoferstrasse 2, 88214, Ravensburg, Germany
| | | | | | - Michael Koelch
- CAP, Universitaet Ulm, Ulm, Germany.,CAP, Ruppiner Kliniken, Brandenburg Medical School, Neuruppin, Germany
| | - Marc Kurepkat
- Clinische Studien Gesellschaft (CSG), Berlin, Germany
| | - Steffen Lütte
- Clinische Studien Gesellschaft (CSG), Berlin, Germany
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[Future development of child and adolescent psychiatry in Austria]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT ÖSTERREICHISCHER NERVENÄRZTE UND PSYCHIATER 2017; 31:144-149. [PMID: 28853042 DOI: 10.1007/s40211-017-0242-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 07/22/2017] [Indexed: 12/28/2022]
Abstract
Anniversaries are turningpoints for reflexions of the past and planing for the future. In conclusion of all papers in this actual issue one can say tha CAP has reached a respected place in the medical landscape. Also internationally, the work of Austrian child and adolescent psychiatrist is recognised and respected. CAP is cooperating as an respected discipline with adjacent specialties as pediatrics and psychiatry as well as with external partners as Kinder- und Jugendhilfe (social child welfare).Anyway, the actual situation shows several deficits concerning patient care on all levels of the health system as well as in education and training of sufficient numbers of child and adolescent psychiatrists.
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Schmidt SJ, Holtmann M, Herpertz-Dahlmann B, Schimmelmann BG. [Transdiagnostic approaches in psychotherapy: Relevance for the treatment of children and adolescents]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2016; 44:417-420. [PMID: 27855552 DOI: 10.1024/1422-4917/a000487] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Stefanie J Schmidt
- 1 Universitätsklinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Bern
| | - Martin Holtmann
- 2 LWL-Universitätsklinik Hamm für Kinder- und Jugendpsychiatrie, Psychotherapie und Psychosomatik, Ruhr-Universität Bochum
| | - Beate Herpertz-Dahlmann
- 3 Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, RWTH Aachen
| | - Benno G Schimmelmann
- 1 Universitätsklinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Bern.,4 Universitätsklinik für Kinder- und Jugendpsychiatrie, Psychotherapie und Psychosomatik, Universitätsklinikum Hamburg Eppendorf, Hamburg
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