Fritz Mattejat

The Children of Mentally Ill Parents

INTRODUCTION The children of mentally ill parents have a higher risk of developing mental illnesses themselves over the course of their lives. This known risk must be taken into account in the practical provision of health care. METHODS Selective literature review. RESULTS The increased psychiatric risk for children of mentally ill parents is due partly to genetic influences and partly to an impairment of the parent-child interaction because of the parents illness. Furthermore, adverse factors are more frequent in these families, as well as a higher risk for child abuse. Genetic and psychosocial factors interact with one another. For example, genetic factors moderate environmental effects; that is, the effect of adverse environmental factors depends on the genetic substrate. DISCUSSION Preventive measures for children of mentally ill parents urgently need improvement. In this article, positively evaluated programs of preventive measures are discussed. Essential prerequisites for success include appropriate, specialized treatment of the parental illness, psychoeducative measures, and special support (e.g. self-help groups) as indicated by the familys particular needs.

Wirksamkeit psychiatrischer und psychotherapeutischer Behandlungen bei psychischen Störungen von Kindern und Jugendlichen

OBJECTIVE In recent years, a large and growing body of research on the effectiveness of treatments for psychiatric disorders in childhood and adolescence has been published; however the large number makes it difficult to get an overview on the current status of research. The aim of this article is to systematically review the existing meta-analyses and reviews disorders on the four most frequent childhood and adolescent psychiatric disorders (anxiety disorder, depression, ADHD, conduct disorder) and to present an up-to-date summary on the effects of treatment for those disorders. METHODS This article is based on a systematic literature search, which produced 112 meta-analyses and reviews on the efficacy of psychological and psychiatric interventions in childhood and adolescence published between 2000 and 2007. The articles resulting from the literature search were evaluated according to clearly defined criteria. Presentation of the results follows a dichotomous classification (internalizing vs. externalizing disorders), with Part II of this article reporting the results on ADHD and conduct disorders. RESULTS The majority of reviews published between 2000 and 2007 focuses on the treatment of depressive disorders and ADHD. Only for ADHD is the use of medication (stimulants) considered to be the most efficacious treatment option available. For the remaining three disorders, psychotherapy is recommended as the most effective treatment of choice. A combination of psychological and pharmacological treatments is an important option in ADHD and depressive disorders. Considering the efficacy, treatments for ADHD and anxiety disorders produce higher effect-sizes than do interventions for depressive and conduct disorders. For all disorders, there are several desiderata (content and methodological aspects) to be incorporated into future research. CONCLUSIONS Empirically supported treatment recommendations can be derived for anxiety disorders, depressive disorders, ADHD and conduct disorders. Finally, important implications for research and practice are discussed.Zusammenfassung: Fragestellung: In den letzten Jahren hat die Forschung zur Wirksamkeit von Therapien bei psychisch gestorten Kindern und Jugendlichen erfreulicherweise einen starken Aufschwung genommen. Mittlerweile liegen sehr viele Reviews und Metaanalysen zu den Forschungsergebnissen vor, so dass es schwer ist, einen Uberblick uber den aktuellen Forschungsstand zu gewinnen. Ziel der vorliegenden Arbeit war es, die vorliegenden Reviews und Metaanalysen in systematischer Weise auszuwerten, um den aktuellen Ergebnisstand der Therapie-Wirksamkeitsforschung bei den vier haufigsten psychischen Storungen von Kindern und Jugendlichen (Angststorungen, depressive Storungen, ADHS, Storungen des Sozialverhaltens) zusammenfassend zu charakterisieren. Methodik: Grundlage der vorliegenden Arbeit war eine systematische Literaturrecherche; in die Auswertung wurden 112 Metaanalysen bzw. Reviews zur Wirksamkeit psychotherapeutischer und psychiatrischer Behandlungsansatze im Kindes- und Jugendalter eingeschlossen, die zw...

Die Marburger Beurteilungsskala zum Asperger-Syndrom (MBAS) - ein Screening-Verfahren für autistische Störungen auf hohem Funktionsniveau

Zusammenfassung: Einleitung: Das Asperger-Syndrom (AS) ist eine Storung von unsicherer nosologischer Validitat, deren Abgrenzung zum sogenannten High-functioning Autismus sehr schwierig ist. Diese Storungen werden bis heute leider erst sehr spat erkannt, oft werden zunachst einige andere Diagnosen gestellt. Ziel der vorliegenden Untersuchung ist es, ein Instrument (MBAS) vorzustellen, welches fur die Erfassung dieser Storungen sensibel ist. Methodik: Der Fragebogen wurde insgesamt 91 Probanden (44 mit einer autistischen Diagnose, 47 mit nicht-autistischen Diagnosen) vorgelegt. Ergebnisse: Die Items der MBAS erweisen sich uberwiegend als mittelschwer und uberwiegend gut trennscharf. Die interne Konsistenz der gesamten Skala ist als sehr hoch zu bewerten (Cronbach’s alpha = .91). Es liegt eine konvergente Validitat der Ergebnisse aus der MBAS und dem ADI-R vor (r = 0.61, p = .001) Vergleicht man die gebildeten Gruppen «autistisch» vs. «nicht autistisch» in Bezug auf den Gesamtscore miteinander, so zeigt sic...

Efficacy of inpatient and home treatment in psychiatrically disturbed children and adolescents. Follow-up assessment of the results of a controlled treatment study.

In two German child and adolescent psychiatric treatment and research centers, a controlled treatment study was conducted in which two randomized treatment groups (in-patient treatment and home treatment) were compared. Subjects were children and adolescents with severe psychiatric disorders, for whom normal outpatient treatment was not sufficient (mean age of the patients was 11 years and 9 months at the beginning of treatment). The results showed no differences in therapy outcome between the two treatment modalities. In a further study, the results of which are presented here, a follow-up assessment (average follow-up interval: 3 years and 8 months) of the two treatment groups (follow-up sample of the inpatient treatment group: n=33; home treatment group: n=35) was untertaken in order to investigate the course of the psychiatric disturbances and the long-term effects of the treatments. As measurement categories for the outcome “adaption at school” and “number of marked symptoms” were used in pre-, post- and follow-up assessment. The most important results are 1) The number of marked psychiatric symptoms and the adaptation at school or work exhibit the same type of course over time. Post-treatment scores are much better when compared to pre-treatment scores, but decline slightly upon follow-up, although they remain significantly better than the pre-treatment scores. Thus, the study shows that improvements relating to the psychiatric symptoms are quite stable after several years. 2) There were no relevant differences between the treatment modalities “inpatient treatment” and “home treatment” in terms of effect-size upon follow-up, and in inferential analysis. Any tendency towards difference was in favor of home treatment. So the results give strong support to the conclusion that at least for a specific group of patients (about 15% of those patients usually treated in an inpatient setting) residential treatment can be replaced by home treatment and that the long-term therapeutic outcome of home treatment is stable and persistent. Thus, in terms of psychiatric care and clinical practice, our results provide empirical support to the idea that home treatment should be used more frequently and much more broadly in the future.

[Efficacy of psychiatric and psychotherapeutic interventions in children and adolescents with psychiatric disorders--a systematic evaluation of meta-analyses and reviews. Part I: Anxiety disorders and depressive disorders].

OBJECTIVE In recent years, a large and growing body of research on the effectiveness of treatments for psychiatric disorders in childhood and adolescence has been published; however, the large number makes it difficult to get an overview on the current status of research. The aim of this article is to systematically review the existing meta-analyses and reviews on the four most frequent childhood and adolescent psychiatric disorders (anxiety disorder, depression, ADHD, conduct disorder) and to present an up-to-date summary on the effects of treatment for those disorders. METHODS This article is based on a systematic literature search, which produced 112 meta-analyses and reviews on efficacy of psychological and psychiatric interventions in childhood and adolescence published between 2000 and 2007. The articles resulting from the literature search were evaluated according to clearly defined criteria. Presentation of the results follows a dichotomous classification (internalizing vs. externalizing disorders), with Part I of this article reporting the results on anxiety disorders and depressive disorders. RESULTS The majority of reviews published between 2000 and 2007 focuses on the treatment of depressive disorders and ADHD. Only for ADHD is the use of medication (stimulants) considered to be the most efficacious treatment option available. For the remaining three disorders, psychotherapy is recommended as the most effective treatment of choice. A combination of psychological and pharmacological treatments is an important option in ADHD and depressive disorders. Considering the efficacy, treatments for ADHD and anxiety disorders produce higher effect-sizes than do interventions for depressive and conduct disorders. For all disorders, there are several desiderata (content and methodological aspects) to be incorporated into future research. DISCUSSION Empirically supported treatment recommendations can be derived for anxiety disorders, depressive disorders, ADHD and conduct disorders. Finally, important implications for research and practice are discussed.

[Efficacy of psychiatric and psychotherapeutic interventions in children and adolescents with psychiatric disorders--a systematic evaluation of meta-analyses and reviews. Part II: ADHD and conduct disorders].

OBJECTIVE In recent years, a large and growing body of research on the effectiveness of treatments for psychiatric disorders in childhood and adolescence has been published; however the large number makes it difficult to get an overview on the current status of research. The aim of this article is to systematically review the existing meta-analyses and reviews disorders on the four most frequent childhood and adolescent psychiatric disorders (anxiety disorder, depression, ADHD, conduct disorder) and to present an up-to-date summary on the effects of treatment for those disorders. METHODS This article is based on a systematic literature search, which produced 112 meta-analyses and reviews on the efficacy of psychological and psychiatric interventions in childhood and adolescence published between 2000 and 2007. The articles resulting from the literature search were evaluated according to clearly defined criteria. Presentation of the results follows a dichotomous classification (internalizing vs. externalizing disorders), with Part II of this article reporting the results on ADHD and conduct disorders. RESULTS The majority of reviews published between 2000 and 2007 focuses on the treatment of depressive disorders and ADHD. Only for ADHD is the use of medication (stimulants) considered to be the most efficacious treatment option available. For the remaining three disorders, psychotherapy is recommended as the most effective treatment of choice. A combination of psychological and pharmacological treatments is an important option in ADHD and depressive disorders. Considering the efficacy, treatments for ADHD and anxiety disorders produce higher effect-sizes than do interventions for depressive and conduct disorders. For all disorders, there are several desiderata (content and methodological aspects) to be incorporated into future research. CONCLUSIONS Empirically supported treatment recommendations can be derived for anxiety disorders, depressive disorders, ADHD and conduct disorders. Finally, important implications for research and practice are discussed.Zusammenfassung: Fragestellung: In den letzten Jahren hat die Forschung zur Wirksamkeit von Therapien bei psychisch gestorten Kindern und Jugendlichen erfreulicherweise einen starken Aufschwung genommen. Mittlerweile liegen sehr viele Reviews und Metaanalysen zu den Forschungsergebnissen vor, so dass es schwer ist, einen Uberblick uber den aktuellen Forschungsstand zu gewinnen. Ziel der vorliegenden Arbeit war es, die vorliegenden Reviews und Metaanalysen in systematischer Weise auszuwerten, um den aktuellen Ergebnisstand der Therapie-Wirksamkeitsforschung bei den vier haufigsten psychischen Storungen von Kindern und Jugendlichen (Angststorungen, depressive Storungen, ADHS, Storungen des Sozialverhaltens) zusammenfassend zu charakterisieren. Methodik: Grundlage der vorliegenden Arbeit war eine systematische Literaturrecherche; in die Auswertung wurden 112 Metaanalysen bzw. Reviews zur Wirksamkeit psychotherapeutischer und psychiatrischer Behandlungsansatze im Kindes- und Jugendalter eingeschlossen, die zw...

Lebensqualität bei psychisch kranken Kindern und Jugendlichen

Zusammenfassung: Fragestellung: Das neu entwickelte krankheitsunspezifische Instrument zur Messung der Lebensqualitat von Kindern und Jugendlichen (ILK, Mattejat et al., 1998) sollte hinsichtlich seiner Differenzierungsfahigkeit zwischen ambulanten und stationaren psychiatrischen Stichproben uberpruft werden. Methodik: 626 kinder- und jugendpsychiatrische Patienten aus regional unterschiedlichen Kliniken und Praxen wurde der ILK-Bogen vorgelegt. Die so gewonnenen Daten werden deskriptiv dargestellt und mit Hilfe logistischer Regressionen genauer analysiert. Ergebnisse: Wahrend eine rein deskriptive Betrachtung zeigt, dass stationar behandelte Kinder und Jugendliche durchweg alle Lebensbereiche als belastender erleben, relativiert sich dieses Ergebnis durch die Regressionsanalyse. Hier zeigt sich, dass die deskriptiv gefundenen Unterschiede zwischen stationaren und ambulanten Patienten teilweise auf Alters- und/oder Geschlechtseffekte zuruckzufuhren sind; in einigen Lebensbereichen jedoch erweisen sich die...OBJECTIVE A newly developed, disorder-nonspecific instrument to measure the quality of life in children and adolescents (ILK, Mattejat et al., 1998) was tested with regard to its ability to differentiate between psychiatric in- and outpatient samples. METHODS 626 children and adolescents from regionally different in- and outpatient clinics completed the ILK questionnaire. The data obtained were first described and then analyzed by means of logistic regression analysis. RESULTS Whereas the descriptive analysis revealed that inpatients evaluated all areas of life more unfavorably than outpatients did, the logistic regression analysis modified these results. It became evident that some of the findings obtained were due to the effects of age and/or gender. However, given age and gender as covariates, there still remained some important life domains in which inpatients were more impaired than outpatients. CONCLUSIONS The ILK turned out to be an efficient and economic instrument to measure the quality of life in children and adolescents depending on the severity of their disorder. Moreover, it is sensitive to effects of age and gender. As the ILK is able to reliably identify areas with a reduced quality of life, it offers valuable starting points for indications, therapy planning and initial therapeutic interventions.

The component model of treatment in child and adolescent psychiatry: Theoretical concept and empirical results

The paper describes the theoretical concept and practical realization of the component model of treatment in child and adolescent psychiatry. Treatment procedures in a university department of child and adolescent psychiatry are analyzed based on a sample of 4545 patients in different settings (in patient, day patient, and outpatient settings) and applying five different treatment components (individual psychotherapy with the patient, functional therapies, parent- and family-oriented interventions, other environmental interventions and psychotropic medication).These five treatment components were applied in variable combination to different disorders and in various settings.Treatment success based on therapists’ ratings is described regarding a variety of ICD-9 diagnoses. Effect sizes were calculated for outpatient treatments (total sample 1682) and for inpatient treatments (total sample 1490). The effect size in the outpatient setting was 1.01 for normal completers vs. drop-outs, 1.27 for normal completers vs. non-beginners, and 0.34 for non-beginners vs. drop-outs.The corresponding effect sizes for inpatients were 0.74 for normal completers vs. drop-outs 1.27 for normal completers vs. non-beginners, and 0.84 for non-beginners vs. drop-outs.In spite of some methodological restrictions, the results of this naturalistic study can be used to improve empirically based treatment procedures under realistic clinical conditions.

Evidenzbasierte Prinzipien und Grundkomponenten familientherapeutischer Interventionen bei psychischen Störungen von Kindern und Jugendlichen

Zusammenfassung. In einer Ubersicht werden die wichtigsten empirischen Befunde zur Wirksamkeit von familienorientierten Methoden bei psychischen Storungen von Kindern und Jugendlichen dargestellt. Empirisch bestatigt sind psychoedukative Modelle, kognitiv-behaviorale Elterntrainings und einige spezielle familientherapeutische Modelle im engeren Sinne, bei denen kognitiv-behaviorale und systemorientierte Konzepte und Methoden verbunden werden. In einem zweiten Schritt wird aufgezeigt, dass viele empirisch validierte storungsspezifische Behandlungsprogramme eine familienorientierte Komponente beinhalten. In einem dritten Schritt werden die Gemeinsamkeiten wirksamer familientherapeutischer Verfahren herausgearbeitet. Zu ihnen zahlen eine fachlich fundierte und differenzierte Beratung, die Gestaltung einer therapeutischen Beziehung, in der eine zielgerichtete Zusammenarbeit moglich ist, die Aktivierung der familiaren Ressourcen, die Anregung von Veranderungen im kognitiv-emotionalen Bereich und die konkrete A...

Zur Lebensqualität von psychisch kranken Kindern und ihren Eltern

Zusammenfassung. Ausgangspunkt der Untersuchung sind Studien, in denen psychisch gestorte Kinder und Jugendliche zu ihrer Lebensqualitat befragt wurden. Die vorliegende Studie ist der Frage nachgegangen, ob sich ahnliche Ergebnisse zeigen, wenn die Eltern von psychisch gestorten Kindern und Jugendlichen zur Lebensqualitat ihrer Kinder befragt werden. Hierzu wurden 604 Eltern von ambulant und stationar behandelten kinder- und jugendpsychiatrischen Patienten die Elternversion des Inventars zur Erfassung der Lebensqualitat bei Kindern und Jugendlichen (ILK-Elternbogen) vorgelegt. Ergebnisse: (1) Auch bei den Elternangaben sind die Ergebnisse bei stationaren Patienten auf allen ILK-Skalen ungunstiger als bei den ambulanten Patienten. Daruber hinaus zeigen sich bei einer Reihe von Skalen signifikante Alters- und Geschlechtseffekte. (2) Die Eltern fuhlen sich selbst durch die aktuelle Problematik des Kindes/Jugendlichen und durch die Tatsache, dass ihr Kind/Jugendlicher behandelt wird, zu einem hohen Prozentsat...