[Changes in OPD-CA Axis Structure During Inpatient Psychodynamic Treatment of Adolescents Suffering from Comorbid Disorders of Conduct and Emotions]

[Changes in the Level of Conflict through Psychodynamic Psychotherapy: The Perspective of Adolescent Patients and their Therapists]

Changes in the level of structure and conflict are, in addition to alleviating of symptoms, central goals of psychodynamic therapies. This study examines this question with a focus on intrapsychic development-impairing conflicts in the sense of the OPD-CA on a sample of 121 adolescents and their 46 therapists. At the beginning, in the middle and at the end of the M = 73.27 hours (SD = 17.40) therapy, they assessed the level of conflict and structure from the patients' and the therapists' perspectives. The results show large effect sizes with regard to the reduction of the overall conflict level from the point of view of the therapists (η2 = .33). While the therapists reported higher initial values in almost all intrapsychic conflicts and significant linear decreases over time, the therapy tended to sensitize the patients to the existence of an intrapsychic development-impairing conflict. With regard to the structural level, which was already quite good at the start of treatment, there were no significant changes over time. However, the overall structural level and the conflict scales contributed to the explanation of the variance in the severity of symptoms at the end of therapy.

[Quality measurement in psychodynamic psychotherapy: Diagnosis-specific courses, the influence of different informants, and their view of moderators of change]

Quality measurement in psychodynamic psychotherapy: Diagnosis-specific courses, the influence of different informants, and their view of moderators of change Abstract. This study uses a naturalistic design to assess the course and effectiveness of long-term psychodynamic therapies from the perspective of adolescent patients and their mothers. It looks at the context of different moderators of change, including the characteristics of the patient, the therapist, and the therapy. Assessments of the internalizing, externalizing, and overall symptom burden using the Youth Self Report (YSR) and the Child Behavior Checklist (CBCL) were collected on 161 patients and their mothers at three timepoints - the beginning, middle, and end of therapy. The assessments of both informants showed a decrease in symptoms over the course of therapy with similar effect sizes (η² = .25 for the patients, η² = .31 for their mothers). The adolescents differentiated more between the diagnosis groups, reported higher symptom intensities at the beginning, and saw fewer changes in the second half of the therapy than their mothers. Psychodynamic long-term therapy was particularly effective for internalizing disorders according to both parents and patients. Both informants differed, however, in their evaluation of short-term therapy. An examination of the moderators of change in the mothers' evaluation (difference value of the total symptom burden between the beginning and end) showed that the therapist and therapy characteristics predicted change, whereas for adolescents, the patient characteristics have the greatest influence.

[Changes in the scales "attachment" and "control" of the OPD-KJ "structure" axis for inpatients of a pediatric and adolescent psychiatric clinic]

Changes in the scales "attachment" and "control" of the OPD-KJ "structure" axis for inpatients of a pediatric and adolescent psychiatric clinic Abstract. Abstracts: Despite the great importance of structural deficits in adolescent patients, studies on changes that occur in the course of their inpatient psychiatric treatment are lacking. This study assesses the effectiveness of inpatient psychodynamic psychotherapy, the scales "attachment" and "control" of the "structure" axis of Operationalized Psychodynamic Diagnostics in Childhood and Adolescence (OPD-KJ). The study was carried out by dual case leaders (psychotherapist and pedagogue/nurse) on 75 patients (12-18 years) at the beginning and at end of 8 weeks of therapy. Correlations between the dimensions were investigated Pearson's r. Subsequently, we analyzed the four subdimensions of control and attachment using analyses of variance with repeated measurement (RM-ANOVA) to determine whether and to what extent these different subdimensions changed over time. Finally, we performed analyses of variance with age, sex, and diagnosis as between-person factors to assess their influence on the trajectories of both dimensions. Results show that both the attachment and the control dimension of OPD-CA improved in the course of the adolescents' treatment. This finding, however, was diagnosis-specific: Only adolescents with affective disorders and phobias showed these improvements, whereas no change was found for adolescents with emotional and behavioral disorders beginning in childhood and adolescence. Implications for research and clinical practice are discussed.

[Levels of structural integration in adolescents and the relationship to later mental disorders - A longitudinal study]

Levels of structural integration in adolescents and the relationship to later mental disorders - A longitudinal study Abstract. Objective: Psychological disorders frequently manifest during adolescence. Because of the multifactorial influencing factors, the courses of the diseases are heterogeneous, from relapsing-remitting to chronic. This study investigated whether the level of structural integration of the Operationalized Psychodynamic Diagnostics in Childhood and Adolescence (OPD-CA) correlates with later symptomatic burden. Method: This long-term study assessed the levels of structural integration according to the OPD-CA of 60 adolescents (mean age = 15.6; SD = 0.9). Seven years later, we then measured symptomatic burden (SCID axis I and II) and overall burden (GAF, BSI-GSI) (73.3 % follow-up participation rate). Results: The results showed high correlations between deficient structural integration in adolescence and later symptoms and overall burden in early adulthood. Conclusion: The follow-up examination after a 7-year time period showed significant correlations, which argue for the predictive value of structural integration. This suggests that early specific treatment, e.g., in the form of intensive psychotherapy, be urgently recommended in order to influence this course.

[Operationalized Psychodynamic Diagnosis - Structure Questionnaire (OPD-SQ) in Youth: First Results on Reliability and Validity]

Operationalized Psychodynamic Diagnosis - Structure Questionnaire (OPD-SQ) in Youth: First Results on Reliability and Validity The OPD structure axis questionnaire (OPD-SQ) demonstrated good empirical findings and usability in therapeutic work. Therefore, the aim of this study was to verify the OPD-SQ for an adolescent sample in order to further implement the questionnaire as an economic instrument in clinical childhood and adolescence psychiatry routine. The overall sample consisted of 180 adolescent inpatients (72.8 % female) and 152 pupils (57.9 % female). In order to test reliability, Cronbach's alpha and discriminatory power were assessed. To test validity, YSR11-18 data was collected for the overall sample, and further data (AIDA, LoPF Q12-18, SKID-II, WISC-IV) was collected for the inpatient-sample. Cronbach's alpha was satisfactory for overall OPD-SQ, and all dimensions and sub-dimensions. The differences in mean values between inpatients and pupils were as expected. When controlled for overall symptom severity, gender differences lost significance. Adolescents with one or more SCID-II diagnoses had significantly lower psychic structure. Both construct-related questionnaires (AIDA, LoPF Q12-18) correlated high with OPD-SQ, no correlations were found for psychic structure and intelligence. OPD-SQ proved to be well applicable for the use on adolescents and can be implemented as an economic instrument for the measure of psychic structure in clinical adolescent psychiatry routine.

[The Psychoanalytic-interactional Method (PIM): A Psychodynamic Treatment for Adolescents with Severe Disorders of Personality Functioning]

The Psychoanalytic-interactional Method (PIM): A Psychodynamic Treatment for Adolescents with Severe Disorders of Personality Functioning The psychoanalytic-interactional method (PIM) was developed as a psychodynamic treatment for adult patients with severe disorders of personality functioning (Streeck u. Leichsenring, 2015). However, it is also well suited for the treatment of adolescent patients because its techniques fit with specific conditions of adolescence. A modified version of the PIM for adolescents (Streeck-Fischer, Cropp, Streeck, Salzer, 2016) has proven to be efficacious. The paper describes the basic principles of the PIM and names aspects that have to be taken into account in the treatment of adolescents with severe disorders of personality functioning. Finally, previous empirical results regarding the PIM treatment in adolescence are presented.

The Effect of Abuse History on Adolescent Patients with Feeding and Eating Disorders Treated through Psychodynamic Therapy: Comorbidities and Outcome

OBJECTIVES

The first aim of our study was to compare the characteristics and comorbidities of patients with eating disorders between those who suffered from a childhood abuse and those who did not. Our second aim was to analyze the differences in the outcome of the psychodynamic therapy between abused and not abused patients.

METHODS

Twenty-six adolescent patients with eating disorders were assessed. Adolescent were evaluated by a single expert psychiatrist by checklists and questionnaires: EDI 3, SCL 90, BIS11, Dissociative Experiences Scale, Global Assessment of Functioning, SCID II, and CTQ-Self control (SF). According to the results of CTQ-SF (cut-off ≥ 8), patients were divided into two groups: those who had experienced a history of abuse and those who had not. They underwent a psychodynamic psychotherapy and were assessed again after 12 months.

RESULTS

Eleven patients (42.3%) had a history of abuse according to CTQ score. No significant differences were found in abused and not abused patients in their demographic, clinical, and comorbid characteristics (sex, age, type of eating disorder, comorbid impulse control, personality, and addictive disorders). Abused patients showed a significantly higher score in many scale. The psychotherapeutic intervention in patients with a history of abuse resulted only in a significant decrease in symptom checklist-90 (SCL-90) psychoticism dimension (p < 0.05), whereas in patients with no history of abuse a significant decrease was found for SCL-90 somatization, obsessive-compulsive and phobic anxiety dimensions, the SCL-90 Global Severity Index, the Eating Disorder Inventory-3 interceptive deficits, and the dissociative experience scale.

CONCLUSION

Regarding the first aim of our study, we proved that history of abuse is not significantly related to patient comorbidities. Regarding our second aim, history of abuse was related to patient improvement only for psychotic symptoms; whereas patients who had not experienced an abuse improved in a variety of symptoms. Thus, abuse history can be considered as a negative prognostic factor for patients with eating disorders undergoing dynamic psychotherapy. However, this psychotherapy may have a role in preventing early psychotic disorders in patients with and without an history of abuse.