Child Psychiatric Treatment Research Articles

How to meet the needs of youth with severe and enduring mental health problems: A qualitative study to barriers and facilitators in treatment

Youth with severe and enduring mental health problems (SEMHP) do not profit from regular child and adolescent psychiatric (CAP) treatment. Their changing and complex problems cause enormous suffering. To understand why these youth inadequately profit from CAP treatment, this qualitative study aimed to examine the experiences of youth with SEMHP, practitioners, and caregivers to identity barriers and facilitators in treatment. We conducted 31 semi-structured interviews with youth (n = 10), practitioners (n = 10), and caregivers of youth with SEMHP (n = 11). A thematic analysis was performed both deductively and inductively, and the perspectives of participants were compared. Results showed barriers and facilitators in five categories: before treatment, engagement and accountability, trust-based treatment, organization of care, and hopelessness. To restore epistemic trust, a shift from a risk-avoidance approach towards trust-based relationships in treatment is required. Additionally, organizing continuous and tailored care can prevent youth from slipping through the cracks of waiting lists and receiving inadequate treatment.

Adolescents in acute mental health crisis—Pilot-evaluation of a low-threshold program for emotional stabilization

BackgroundReferrals for child and adolescent acute psychiatric treatment have spiked in the last two years. To provide these adolescents with a fast-acting intervention, a novel treatment approach for acute emotional dysregulation was evaluated in this study.Methods156 adolescents between the age of 13 and 18 years who were admitted to a psychiatric unit for acute emotional or behavioral dysregulation participated in a 5-week-group program (Stress-Arousal- Regulation-Treatment, START) which consisted of two sessions per week (60 min/session). Pre- and post intervention psychometric measures were derived for each participant applying the Self-Control Scale (SCS-13), the FEEL-KJ capturing adaptive and maladaptive emotion regulation strategies, the Perceived Stress Scale (PSS-10), as well as the Strengths and Difficulties Questionnaire (SDQ).ResultsThe mean score of maladaptive emotion regulation strategies of the FEEL-KJ significantly decreased post treatment (d = −0.24, p = .001), while there was an increase in adaptive emotion regulation strategies (d = 0.25, p = .001). The post- intervention-assessment revealed significantly lower scores in the PSS-10 (d = −0.34, p < 0.001), as well as SDQ mental health problems (d = −0.17, p = .018) and disorders (d = −0.15, p = .015). The Self-Control Score increased significantly after the intervention (d = 0.21, p = .001).ConclusionsIn this large sample, the low-threshold intervention START significantly improved emotion regulation and self-control and reduced perceived stress as well as several scales of the strengths and difficulties questionnaire, pointing to a good feasibility and indicating efficiency to provide support to adolescents with acute mental health problems when applying this short-term treatment.

Transition from Child and Adolescent to Adult Psychiatry in a German Metropolitan Region: An Explorative Cross-Sectional Study

In psychiatry, the transition phase presents a particular challenge. The study aims to investigate gaps in care during the transition to adult psychiatry. After a qualitative preliminary study, 100 patients with previous child and adolescent psychiatric treatment were interviewed in a standardised way about the utilisation behaviour, the need for help and the experience during, before and after the transition phase. The data were analysed descriptively and using interval estimation (probability of coverage). A treatment gap of more than 3 months was documented in 75% of the patients*. The study showed that treatment interruption was experienced as a risk for further crises and that there was often a lack of information on further treatment options. The transition from child and adolescent to adult psychiatric treatment is not seamless and requires professional support.

The Requirement of a Situated Approach in the Treatment of Preschool Children with a Refugee Background: Discussion of a Case Study

In recent years, increasingly more German-born preschool children of refugee parents have been referred to the 'specialized consultation service for refugee minors' of the Department of Child and Adolescent Psychiatry at the University Hospital Münster. This 'change' in the use of the above-mentioned consultation service could be understood as a 'natural' consequence of the family life cycle of forced migrants who some years ago came to Germany as adolescents or young adults and started here a family. The treatment of 'preschoolers with a refugee background', as we may call this group of patients, confronts mental health practitioners with particular challenges. In this contribution, we specify some of these challenges and argue that, due to the deep intertwinement of different aspects of these patients' condition, a 'situated approach' is required when treating this population.When planning therapeutic interventions for preschoolers with refugee background, their families should be conceived as unified systems which in their social and transcultural embeddedness exhibit trans-individual vulnerabilities and resources. By discussing a case study, we illustrate how an extremely challenging child psychiatric treatment could succeed only on the condition that we focused on the interconnectedness of various factors determining not merely the patient's symptomatic behavior but, furthermore, the behavior of the family, i. e., on the condition of focusing on the situated nature of the problematic.

What Works for Whom? Differential Effects of Predictive Validity of Parenting Behaviours: Externalizing Versus Internalizing Behaviour Problems

A variety of instruments are available for assessing parental and child behaviour in the context of interaction observation. This study investigated whether the Laboratory Parenting Assessment Battery (Lab-PAB) can be used to make predictive statements about the therapeutic success of child psychiatric treatment. The success of therapy was measured through pre- and post-intervention assessments using the Child Behavior Checklist (CBCL) and the Parent-Infant Relationship Global Assessment Scale (PIR-GAS). A particular focus was placed on discriminating between externalizing and internalizing problems of the child. It was observed that positive items of the interaction offer a greater resource for the therapeutic success of children with externalizing problems than stopping negative behaviour of the parents. In the case of internalizing problems, the elimination of negative interaction items seems to be essential for a good therapy success.

Inpatient care in child and adolescent psychiatry-Who gets treatment?

This article presents and analyses the landscape for inpatient child and adolescent psychiatric care in Austria and examines current data from June 2022. 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. Abed 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, 40beds had to be closed due to staff shortages and 26.5 training positions were vacant across Austria. Even though the training ratio was raised to 1:2 as of 07.02.2022 within the framework of the "Mangelfachverordnung" for alimited 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.

Experiences of Violence During Inpatient Child and Adolescent Psychiatric Treatment: An Explorative Study with Implications for Child Protection

Experiences of Violence During Inpatient Child and Adolescent Psychiatric Treatment: An Explorative Study with Implications for Child Protection Abstract. Objective: Educational and medical institutions care for children and adolescents by providing supervision, schooling, education, therapy, and protection. Nevertheless, children in institutional care are exposed to potential danger through maltreatment and abuse. Method: As part of the establishment of the protection concept at the University Hospital for Child and Adolescent Psychiatry in Würzburg, a retrospective patient survey was conducted. The study population consisted of former inpatient clients from 2006 and 2007, who at the time of the catamnesis were of legal age. The survey was conducted by mail. In addition to items on their experiences of violence, the questionnaire included established scales to assess treatment satisfaction and quality of life (FBB-K, WHO-BREF). Results: Of 568 former patients, 87 (15.3 %) provided valid responses (59 female, mean age at the time of the survey: 24.5 years): 35 former patients (40.2 % of the participants) reported experiences of violence during their inpatient treatment (26 victims only, 7 experiences as victims and perpetrators, and 2 perpetrators only). Experiences as victims mainly included emotional violence (34.5 %), but also physical (5.7 %) and sexual violence (10.3 %). Conclusion: We found a significant correlation between experiences of violence, on the one hand, and retrospective treatment satisfaction and current quality of life, on the other hand. The results of the survey underline the importance of establishing protection concepts in clinics and other institutions.

Characteristics of the population of aparent-child unit: early interaction-based treatment as achance in child and adolescent psychiatry

In inpatient child psychiatric parent-child treatment, the child is admitted as apatient and the parents as accompanying persons. Due to the importance of parent-child interaction in the development and maintenance of mental disorders in children, parents are integrated more centrally in the treatment of children with emotional or behavioral disorders. In order to further expand this form of treatment in the future and to make it more effective, the characteristics of the previous utilization population of achild psychiatric parent-child unit in Tyrol were examined with regard to child symptomatology and the burden on parents. The Child Behavior Checklist 1½-5, Child Behavior Checklist 6-18R, and Tröster's (2011) Parent Stress Inventory scores of 96parent-child pairs were used to examine child symptom expression and parent stress. The 6-10year old patients had higher T‑scores (M = 76.9, SD = 7.1) than the 0-5year old patients (M = 63.1, SD = 12.4) on the CBCL total scale, t (50) = -3.52, p < 0.001. On the EBI total scale, the 0-5year old patients and the 6-10year old patients did not differ in terms of T‑scores, t (54) = -0.75, p = 0.459, as well as in the EBI child domain t (54) = -1.75, p = 0.087 and in the EBI parent domain, t (54) = 0.19, p = 0.846. Also, the four diagnostic groups did not differ in the EBI total scale, F (4,58) = 1.34, p = 0.266, nor in the parent domain of the EBI, F (4,58) = 1.44, p = 0.232, nor in the child domain of the EBI, F (4,58) = 2.81, p = 0.033. Early identification and treatment of behavioral or mental disorders in very young children seems crucial to prevent long-term negative consequences as well as chronicity. Parent-child therapies should generally focus on identifying and changing current dysfunctional patterns of interaction between parent and child.

Child and adolescent psychiatric and therapeutic treatment needs in care settings in the Lower Austrian industrial district. Asurvey of the demand situation

Ein steigender kinder- und jugendpsychiatrischer Versorgungsbedarf ist in den letzten Jahren deutlich zu beobachten. Die vorliegende Studie befasst sich mit 20 Kinder- und Jugendhilfeeinrichtungen im Industrieviertel (Niederösterreich) und dem kinder- und jugendpsychiatrischen Behandlungsbedarfs der 439 dort fremduntergebrachten Kinder und Jugendlichen. Es zeigen sich bei 270 (62 %) der Kinder und Jugendlichen psychiatrische Auffälligkeiten und bei 220 (50,1 %) ein oder mehrere psychiatrische Diagnosen. Davon sind 200 Kinder und Jugendlichen bereits in einer kinder- und jugendpsychiatrischen Behandlung. Bei elf Einrichtungen besteht ein Behandlungsbedarf von 80–100 % der fremduntergebrachten Kinder und Jugendlichen. Es ergibt sich daraus ein hochbelastetes Helfer:innensystem und eine große Versorgungsnotwendigkeit in den Einrichtungen. Eine intensivere Vernetzung und Zusammenarbeit der involvierten Institutionen bzw. Helfer:innensysteme und einer Weiterentwicklung des Kinder- und Jugendpsychiatrischen Angebots wäre wünschenswert, um den steigenden psychiatrischen Behandlungsbedarf bei Kindern und Jugendlichen adäquat begegnen zu können.Zusatzmaterial onlineZusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s40211-022-00419-y) enthalten.

Lower-Income Predicts Increased Smartphone Use and Problematic Behaviors Among Schoolchildren During COVID-19 Related School Modification: A Longitudinal Study.

BackgroundAs the coronavirus disease 2019 (COVID-19) has continued for a couple of years, the long-term effects of the pandemic and the subsequent school curriculum modification on the mental health of children and parents need to be investigated. To clarify the changes that can occur during one school year and to predict the risk factors for vulnerable groups, this study identified parameters relative to children’s screen time, their problematic behavior, and parental depression.MethodsA total of 186 participants were analyzed who were parents of elementary schoolchildren in South Korea. These parents were required to complete a web-based questionnaire twice. The questionnaires were conducted in June 2020 and September 2021. Participants’ general demographics including family income, children’s screen time, sleep patterns, problematic behavior, and parental depression were assessed via the parental questionnaire that included various measurement tools.ResultsChildren’s body mass index (BMI) increased significantly in 2021 (18.94 ± 3.75 vs. 18.14 ± 3.30, P < 0.001). Smartphone frequency of use per week (5.35 vs. 4.54, P < 0.001) and screen time per day (3.52 vs. 3.16, P < 0.001) significantly increased during the period of the COVID-19 pandemic. The television screen time (2.88 vs. 3.26, P < 0.001), frequency of viewing (3.77 vs. 4.77, P < 0.001), and children’s problematic behaviors significantly decreased (9.15 vs. 11.85, P < 0.001). A lower income household was a key predictor of increased smartphone frequency (B = 1.840, 95% confidence interval [CI], 0.923–2.757, P < 0.001) and smartphone screen time (B = 1.992, 95% CI, 1.458–2.525, P < 0.001). The results showed that the lower income household (B = 5.624, 95% CI, 2.927–8.320, P < 0.001) and a child’s psychiatric treatment history (B = 7.579, 95% CI, 5.666–9.492, P < 0.001) was the most significant predictor of problematic behaviors of children and parental depression (B = 3.476, 95% CI, 1.628–5.325, P < 0.001; B = 3.138, 95% CI, 1.827–4.450, P < 0.001).ConclusionThis study suggested that children’s smartphone screen time and BMI increased during COVID-19 because of the school curriculum modification following school closures in South Korea. The increased children’s problematic behaviors and parental depression were predicted by lower-income households and the previous psychiatric history of children. These results indicate that multiple social support systems to the vulnerable group are needed during the ongoing pandemic and that a modified school setting is required.

Parent-Child Treatment in Child and Adolescent Psychiatry: Models and Clinical Implementation Using the Example of a Modular Parent-Child Ward

The joint treatment of mentally ill children and their parents represents a special treatment concept in child and adolescent psychiatry. A study conducted by the Working Group (BAG) "Early Childhood" shows the current situation of care and possible models of child and adolescent psychiatric parent-child treatment in Germany. Using the parent-child ward of the Child and Adolescent Psychiatry Department in Magdeburg as an example, the combined treatment of mentally ill children and their parents is presented. The treatment approach consists of a three-week diagnostic phase, after which families are discharged again to their home environment followed by a five-week therapy block, for which the families have to be readmitted to the ward. With a focus on the parent-child relationship, the treatment concept - in contrast to regular child psychiatric treatments - is dynamically adapted to the quality of the parent-child interaction and not primarily related to the disorder of the children. First studies indicate the effectiveness of the special treatment setting and illustrate the efficiency of a joint treatment of parents and child, which, however, is associated with increased economic costs. Based on these results, the chances and limitations of parent-child wards are discussed and conclusions for parent-child treatment are drawn.

Satisfaction with in-patient child and adolescent psychiatric treatment: development and psychometric properties of the BEST questionnaires for adolescents and for parents

BackgroundInterest in the assessment of patient satisfaction with in-patient psychiatric treatment has steadily increased and several measurement tools are available for the quantification of patients’ experience. However, they are often uni-dimensional or focus mainly on therapeutic relationship and environment, and neglect other important issues such as information about treatment and participation. The BEST questionnaires were developed as comprehensive instruments that include items on all of the mentioned topics. The present study evaluates the psychometric properties of the BEST in a version for adolescents and for parents. Furthermore, the dimensionality of the satisfaction ratings is analyzed.MethodDescriptive statistics were applied to data of 1582 adolescents (mean age = 15.0 years, SD = 1.65; 62.4% female) and 1998 parents/guardians assessed in seven in-patient units across Germany. The factorial structure of the BEST questionnaires was determined by exploratory and confirmatory factor analyses, including a bifactor model.ResultsThe psychometric quality of the scales was strong. Correlations with another assessment instrument of patient satisfaction were good to high, indicating good convergent validity. Exploratory factor analyses revealed three factors in adolescents that were labelled as: Therapeutic relationship, environment, and general satisfaction and treatment success. For parents, the same three factors could be distinguished. Confirmatory bifactor models suggested that the vast majority of variance was accounted for by the general factor; the three specific factors provided some additional information. Agreement between the subscales of adolescents and their parents was only moderate. Parents were usually more satisfied.ConclusionsThe BEST questionnaires can be considered as reliable and valid instruments to not only assess the “classical” aspects of patient satisfaction, but to also assess newer fundamental topics such as children’s rights and treatment participation. For scientific usage, the total score seems superior because of the high explained variance by the general factor, but the subscale scores provide further information. The use of single items seems advantageous for quality management purposes.

Attitudes and perceptions of parents towards child and adolescent psychiatric consultation, diagnosis and treatment

AimsThe aim of the study was to assess the attitudes and perceptions of parents towards child and adolescent psychiatric consultation, diagnosis and treatment.The hypothesis of the study was there are significant problems in the domains of attitude and perceptions of parents towards child and adolescent psychiatric consultation, diagnosis and treatment.BackgroundParents are an important stake holder in child and adolescent psychiatry and mental health care service models. There is scarce literature from developing countries regarding attitudes and perceptions of parents towards child and adolescent psychiatric consultation, diagnosis and treatment.MethodThis study was conducted at the Child and Adolescent Psychiatry Clinic, Department of Psychiatry at a Tertiary Care Institution. Eligibility criteria comprised of parents of children and adolescents who had come for consultation. The parents were provided information of the study and those willing to participate were included in the study. A convenience sample of 100 parents was considered for the study. The parents were interviewed using a specially designed survey comprising 30 questions with Yes/No response developed by the authors for the purpose of the study. Informed consent and Institutional Ethics Committee Clearance was obtained. Data were analysed using SPSS.ResultWe found that the majority of parents were from urban area (72%) and mothers comprised 68%. We found that 46% of parents did not want a psychiatric diagnosis and 35 % parents felt stigmatized for seeing a psychiatrist for their child. Sixty nine percentage of parents preferred counseling as the first line of treatment and 31% preferred medicines as the first line of treatment. We found that 33 % felt additional psychological tests could be useful and 54% of parents felt brain imaging and blood tests could be useful for their child. Majority of parents expected basic improvement for their child within 1 week(32%) and expected full improvement by 1 month(82%). Fifty three percent of parents had searched online information prior to consulting and found useful information. However, 38% of the parents felt confused after reading online information and 69 % of parents were more worried about giving medications after referring online information.ConclusionOur study provides useful key insights from parent's perspective in child and adolescent psychiatric services. Implications exist for future research as well as policy perspectives on the role, attitudes and expectations of parents as vital stake holders in child and adolescent psychiatry.

Parental responses to child pain : The role of parental and child somatic and anxiety symptoms

HintergrundElterliche kognitiv-affektive und verhaltensbezogene Reaktionen können die Chronifizierung von kindlichen Schmerzen beeinflussen. Unklar ist, ob Mütter und Väter unterschiedlich reagieren und inwieweit Top-down- (elterliche Somatisierung, Angstsymptome) und Bottom-up-Variablen (kindliche schmerzbezogene Beeinträchtigung, Angstsymptome) die elterlichen Reaktionen modulieren.Ziele der Arbeit(1) Vergleich der Somatisierung, Angstsymptome und elterlichen Reaktionen (Katastrophisieren, Zuwendung) von Müttern und Vätern chronisch schmerzkranker Kinder und (2) Untersuchung des Einflusses von Top-down- und Bottom-up-Variablen auf die elterlichen Reaktionen.MethodeEltern-Kind-Triaden (Kind, Mutter, Vater; je N = 21, Gesamt‑N = 63; Kinder: 50 % weiblich, 11–19 Jahre, ∅15,14 Jahre) wurden während einer kinder- und jugendpsychiatrischen Behandlung ihrer chronischen Schmerzen hinsichtlich der kindlichen Schmerzen und Angstsymptome, elterlicher Somatisierung und Angstsymptome und elterlichen Reaktionen mit validierten Fragebögen erfasst.ErgebnisseMütter und Väter unterschieden sich nicht in Somatisierung, Angstsymptomen und Reaktionen. Eltern katastrophisierten stärker, wenn ihre Kinder sowohl unter Angstsymptomen als auch unter stärkerer schmerzbezogener Beeinträchtigung litten. Elterliche Zuwendung war verstärkt, wenn Eltern selbst Angstsymptome angaben. Jüngere Kinder und Mädchen erhielten mehr Zuwendung.DiskussionIm Einklang mit vorherigen Studien zeigt sich, dass elterliche und kindliche Angstsymptome, nicht aber das elterliche Geschlecht als modulierende Faktoren der elterlichen maladaptiven Reaktionen eine Rolle spielen. Dies sollte in Prävention und Therapie von Kindern mit chronischen Schmerzen und deren Bezugspersonen berücksichtigt werden.

Cooperation between child and adolescent psychiatry and youth welfare concerning socio-educational residence for children and adolescents

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.

Intensive outpatient treatment - a therapy option for all patients in child and adolescent psychiatry or just for a few?

Intensive outpatient treatment - a therapy option for all patients in child and adolescent psychiatry or just for a few? Abstract. Objective: "Child and adolescent psychiatric ward-equivalent treatment" (= stationsäquivalente Behandlung, StäB) is an intensive daily home treatment that has now become available in Germany. Conditions for StäB services were negotiated were negotiated, authorized and came into force by German healthcare commissioners and hospitals on 1 January 2018. However, to date few hospitals in Germany offer StäB, and its feasibility has been questioned. This study evaluates the first 58 cases of StäB in the Department of Child and Adolescent Psychiatry, ZfP Südwürttemberg (2018-2019). Method: All patients admitted consecutively to StäB from 1 January 2018 to 15 August 2019 were included and evaluated solely using descriptive analyses in SPSS.25. Results: The average length of stay in StäB was 37.95 days (SD 15.35). 86.2 % of the families completed treatment, with 3 patients discontinuing treatment and 5 patients needing inpatient admission. Unlike in the literature, internalising disorders predominated (70.7 %), whereas externalizing disorders were diagnosed in only 27.8 % of the patients. The cost of treatment in StäB was on average 8779.25 €. Conclusions: StäB is a viable and well-accepted new treatment alternative for patients requiring inpatient admission. The multiprofessionality of treatment as well as daily contacts are required. Feasibility under the conditions set is given. The average length of stay is slightly longer, but the costs are lower than those of inpatient treatment.

Recurrent depression in childhood and adolescence and low childhood socioeconomic status predict low cardiorespiratory fitness in early adulthood

Cardiorespiratory fitness (CRF) strongly influences health, but very little is known about the childhood determinants of adult CRF. Our longitudinal study investigated whether childhood psychopathology and socioeconomic status (SES) were related to adult CRF in 1647 Finnish male military conscripts. Childhood psychopathology was assessed at the age of eight using the Rutter and Children's Depression Inventory questionnaires. Parental education and family structure were used to assess childhood SES. In late adolescence, depressive symptoms were assessed with the Beck Depression Inventory and smoking with a questionnaire. CRF in early adulthood was examined with the Cooper's 12-minute run test. General linear models showed that low parental education (p=0.001), depressive symptoms in childhood (p=0.035) and late adolescence, smoking, underweight, and overweight/obesity (all p<0.001) independently predicted lower CRF. The interaction between depressive symptoms in childhood and adolescence was significant (p=0.003). In adolescents with depressive symptoms, childhood depressive symptoms (p=0.001) and overweight/obesity (p<0.001) predicted lower CRF. In adolescents without depressive symptoms, conduct problems in childhood predicted lower CRF in the initial models, but the effect disappeared after taking into account smoking and body mass index. Mediational analysis confirmed these results. We lacked data on physical activity and only studied males at three time-points. Recurrent depression in childhood and adolescence and low SES in childhood predict lower adult CRF. Conduct problems in childhood predict lower CRF, but the effect is mediated by overweight/obesity and smoking. Psychiatric treatment for children and adolescents should promote physical activity, particularly for children with low SES.

Conduct disorder and antisocial personality disorders: challenges for treatment in adolescence and young adulthood

Aggressive behaviour is a typical phenomenon in childhood and adolescence. Aggression is one of the frequent reasons for parents to seek child and adolescent psychiatric and psychotherapeutic treatment. Disorders with increased aggressive behaviour, such as conduct or oppositional defiant disorder, carry an increased risk for long-lasting negative impact on well-being, especially when comorbid with substance abuse or affective symptoms. Barriers for treatment are frequently a lack of insight into consequences and non-compliance with intervention shown by adolescents. In addition, interdisciplinary intervention needs to combine psychiatric and psychotherapeutic interventions as well as complex interventions supported by the youth welfare system, and in particular including families. Further research is needed for the implementation of evidence-based treatments in routine care as well in special populations, such as girls with conduct disorders or youth with substance abuse.

38.3 IT’S ALL ABOUT THE RELATIONSHIP

The capacity to relate is integral to being human. Throughout the history of medicine, and likely during the prehistoric precursors to medicine, the physician-patient relationship was the foundation of care and healing. In fact, the definition of physician is “a person who is skilled in the art of healing.” This presentation explores the importance, relevance, and necessity of an effective physician-patient relationship in child, adolescent, and family psychiatric treatment.

Implementing a salutogenic treatment model in a clinical setting of emergency child and adolescent psychiatry in Sweden.

Emergency care in child and adolescent psychiatry often lacks a coherent treatment model. This study reports on the development and implementation of a salutogenic treatment model at the Child & Adolescent Psychiatric Emergency Unit in Malmö, Sweden. The development and implementation involved all staff categories and was guided by a recognized authority on salutogenesis. Generalized resistance resources (GRR) were identified that could be implemented at the unit to improve patients' sense of coherence. Eight GRR were developed and implemented at the unit. During the 6-month period following the implementation, patients (n = 41) and parents reported satisfaction with the treatment, while mental health improved between admission and discharge, and both treatment length and readmission rates were reduced. A salutogenic treatment model involving GRR seems to be a promising approach in child and adolescent psychiatric emergency treatment.