Interdisciplinary Clinic Research Articles

"Ups and Downs, Joys and Sorrows" - Assessment and Clinical Relevance of Patient Priorities in an Interdisciplinary Parkinson's Disease Clinic.

Barriers to communication and inaccurate provider assumptions about patient priorities limit the delivery of comprehensive, high-quality, patient-centered care (PCC) to people with Parkinson's (PWP). This study aimed to analyze priorities of PWP using a qualitative, unstructured single-question survey and to test associations with validated quality of life (QOL) measures. During appointments at a subspecialty, interdisciplinary clinic, PWP (n=139) provided written responses to the prompt: "What is important for your care team to know about you?" Patient Health Questionnaire, Montreal Cognitive Assessment, and Hoehn and Yahr scales were obtained through retrospective chart review. Key qualitative themes were identified through grounded theory analysis, and associations with quantitative health measures were tested with correlation analyses. Common themes included participant health (eg, PD-related goals and comorbidities), non-illness identities (eg, family or community role), and the psychosocial impact of PD (eg, losing independence and uncertainty). Positive sentiments (n=73), such as motivation and optimism, were more common than negative sentiments (n=45), such as loss and fear. There was moderate concordance between worsened mental health and uncertainty (rho=0.206, p=0.02) and inverse concordance between worsened mobility and gratitude (rho=-0.174, p=0.04). The range of priorities that PWP want to share with their care team is more diverse than that of common provider assumptions, is correlated with clinical outcomes such as mental health and mobility, and may not be captured by existing QOL assessment tools. An open-ended, qualitative prompt should be incorporated into routine specialist care for PWP as a valuable QOL indicator.

Experiences After Stroke-Who Needs An Interdisciplinary Clinic Anyway?

Abstract Background Unmet needs, including access to rehabilitation, support and information, are experienced by a high proportion of stroke survivors after discharge from acute and rehabilitation services (McKevitt et al.,2011). All stroke patients should be offered a structured health and social care review six-months post-diagnosis (UK Guidelines on Stroke 2016). We aim to describe patients profile including their unmet needs who attended an Interdisciplinary Stroke Clinic situated within a Dublin teaching hospital. Methods Data was collected for all patients attending an Interdisciplinary Stroke Clinic from March 2023-April 2024, including demographic information, self-reported unmet needs and residual deficits identified using modified Greater Manchester Stroke Assessment Tool (GMSAT). Access to post-acute rehabilitation was recorded. Analysis was conducted using Microsoft Excel. Results Clinic attendance: 251 patients, 13-month period (150males, 101females; mean age 68.7yrs; range 17.27-95.5yrs). Majority of patients attended their appointment alone (n=144). Ischaemic stroke was most prevalent stroke-type of attendees (n=160). Post-acute stroke rehabilitation was accessed in 27% of cases (68/251). Group mean Clinical Frailty Scale score was 3.5 (scale 0-8) equating to ‘managing well/vulnerable’. Regarding patient-reported unmet needs, the following themes were identified, mobility (18%), fatigue (13.5 %), pain (8.5%), memory (5.5%), speech (5%) and mood (3.6%). On GMSAT assessment, fatigue (64%), mobility (49%), falls (44%), dysphagia (30%) was the most frequently identified chronic issues. As a clinical-specialist lead clinic, most issues were dealt at clinic-level with physiotherapy intervention targeting mobility/gait/spasticity (45.4%) and speech and language therapy for swallow/language management (20%) initiated. Conclusion Data from this novel Interdisciplinary Stroke Clinic supports previous research indicating many stroke survivors continue to experience chronic issues, frequently mobility, swallowing and fatigue; some of which can be addressed by stroke-specific therapists. The importance of establishing clinical-specialist led post-acute stroke review clinics/pathways in the Irish setting is highlighted. Analysis of data pertaining to stroke patient readmission is underway.

A combined tropical medicine and psychiatry approach to patients with possible delusional infestation.

Delusional infestation (DI) is a well-recognized delusional disorder presenting as the persisting belief of being infested. Combined clinics have been run by dermatology and psychiatry in a small number of centres. In this article we focus on our Liverpool University Hospitals NHS Foundation Trust clinic hosted at the Liverpool School of Tropical Medicine, UK, where we run a specialist clinic for DI. We describe the specific set-up and approach of our clinic as a guide for clinicians working in specialties likely to see patients with DI (including tropical medicine, infectious diseases and dermatology) who may either want to set up similar clinics or be better equipped to manage DI patients promptly within existing practice. We describe the details of the clinic's approach. Between 2018 and 2023, the service saw 208 patients, of which 82.7% could be assessed and 55.7% had DI. The female:male ratio was 2:1. Interdisciplinary combined clinics with medical and psychiatry consultants working together offer an approach to managing this rare, challenging and high-consequence condition.

Phrenic neuropathy etiologies and recovery trajectories in outpatient rehabilitation and neuromuscular medicine clinics: A retrospective analysis.

Phrenic neuropathy (PhN) impairs diaphragm muscle function, causing a spectrum of breathing disability. PhN etiologies and their natural history are ill-defined. This knowledge gap hinders informed prognosis and management decisions. This study aims to help fill this knowledge gap on PhN etiologies, outcomes, and recovery patterns, especially in the context of nonsurgical clinical practice. This was a retrospective study from two interdisciplinary clinics, physiatry and neurology based. Patients were included if PhN was identified, and other causes of hemi-diaphragm muscle dysfunction excluded. Patients were followed serially at the discretion of the neuromuscular-trained neurologist or physiatrist. Recovery was assessed using pulmonary function tests (PFTs), diaphragm muscle ultrasound (US) thickening ratio, and patient-reported outcomes in patients presenting within 2 years of PhN onset. We identified 151 patients with PhN. The most common etiologies were idiopathic (27%), associated with cardiothoracic procedure (24%), and intensive care unit (17%). Of these patients, 117 (77%) were evaluated within 2 years of PhN onset. Of patients included in outcome analyses, 64% saw improvement on serial US, 50% on serial PFTs and 79% reported symptomatic improvement at an average of 15, 16, and 17 months, respectively. A clear majority of PhN patients show improvement in diaphragm muscle function, but on average, improvements took 15-17 months depending on the assessment type. These insights are vital for developing tailored treatments and can guide physicians in prognosis and decision-making, especially if more invasive interventions are being considered.

Implementation of CYP2C19 and CYP2D6 genotyping to guide antidepressant use in a large rural health system.

We describe the implementation and ongoing maintenance of CYP2C19 and CYP2D6 focused pharmacogenetic (PGx) testing to guide antidepressant and antianxiety medication prescriptions in a large rural, nonprofit health system. Depression and anxiety are common psychiatric conditions. Sanford Health implemented PGx testing for metabolism of cytochrome P450 (CYP) isozymes 2C19 and 2D6 in 2014 to inform prescribing for multiple medications, including antidepressant and antianxiety therapies. As guidelines, genotype to phenotype translation, panel offerings, and other resources are updated, we adapt our approach. We make educational and informational materials available to providers and patients. Pharmacogenomic clinical pharmacists review PGx results with discrete values and provide guidance documentation in the electronic medical record. A robust clinical decision support system is in place to provide interruptive alerts, noninterruptive alerts, and genomic indicators. A referral-based interdisciplinary clinic is also available to provide in-depth education to patients regarding PGx results and implications. Additionally, partnering with our health plan has expanded access to PGx testing for patients with anxiety or depression. The implementation and maintenance of Sanford Health's PGx program to guide antidepressant and antianxiety medication use continues to evolve and requires a multipronged approach relying on both human and informatics-based resources.

Agreement between child self-report and parent-proxy report for functioning in pediatric chronic pain

PurposeAccurate assessment of chronic pain and functional disability in children and adolescents is imperative for guiding pain management interventions. Parents have multifaceted roles in their child’s pain experience and frequently provide parent-proxy reports of pain-related functioning. However, cross-informant variance is often observed with limited understanding of contributing factors. This study aims to examine the degree of alignment between child and parent-proxy reports for Patient-Reported Outcomes Measurement Information System (PROMIS) pain interference domain among children with chronic pain and to identify factors associated with improved child-parent agreement.MethodsThis study includes a sample of 127 youth (66.1% female) with mixed etiology chronic pain, ranging in age from 8 to 17 (M = 12.24; SD = 1.598), and their parent. Data was collected at an interdisciplinary pediatric pain clinic and online peer support groups. Measures of demographic, pain intensity, and functioning were collected.ResultsMeans of parent-proxy reports were significantly lower than child self-reports on the PROMIS (p < 0.05). A statistically significant association between child’s pain intensity (β = 0.953, P < 0.05) and the difference between child self-reported and parent-proxy reported PROMIS functional interference scores was found.ConclusionParents underestimated pain-related functional disability relative to children’s self-reports. The difference between the paired child self-report and parent-proxy report of functional disability was significantly associated with greater child self-reported pain intensity. Although parent-proxy reports in pediatric chronic pain is often used in research and practice, findings underscore the importance of incorporating child and adolescent self-report, when possible, to comprehensively capture the child’s pain experience and best inform clinical interventions.

Patient management with Head and Neck tumors-A nationwide data collection in oral and maxillofacial surgery.

This study analyzed oncologic patient management from initial tumor diagnosis to tumor follow-up in oral and maxillofacial surgery (OMFS) in Germany. A dynamic online questionnaire with a total of 44 questions was used to generate general and specific data regarding oncologic patient management with head and neck malignancies, supportive care, and (pre-) rehabilitation from initial tumor diagnosis to tumor follow-up and head and neck cancer center (HNCC) structures in OMFS in Germany. The questionnaire was sent to 81 OMFS departments affiliated with the German-Austrian-Swiss Working Group for Tumors of the Jaw and Facial Region (DÖSAK) and the German Association of Oral and Maxillofacial Surgery (DGMKG). Data analysis was conducted descriptively. Forty-eight OMFS departments participated (response rate 59.26%), of which 36/48 (75%) were certified HNCC. 28/34 (82.4%) reported subjective improvements in oncologic care, most often interdisciplinary collaboration (21/33, 63.64%) and clinic structure changes (21/34, 61.76%). Nearly all OMFS departments present patients in multidisciplinary tumor boards (45/46, 97.83%) and aim for osseous reconstruction post-tumor resection (43/44, 97.73%). Significant discrepancies regarding the frequency of masticatory-functional dental rehabilitation following osseous reconstruction were observed. Before oncologic therapy, patients are offered various supportive services, mostly psychotherapy and psycho-oncological support (24/26, 92.31%). Post-therapy, speech therapy (43/43, 100%), physiotherapy (40/43, 93.02%), lymphatic drainage, and follow-up rehabilitation (39/43, 90.7%, respectively) are most often offered. 17/43 (39.53%) have oncological nursing staff. 36/40 (90%) manage patients and side effects during adjuvant therapy, while 5/41 (12.2%) provide proprietary palliative care. 36/41 (87.8%) offer counseling to patients and families. Oncologic patient care in OMFS is highly standardized and potentially attributable to many certified HNCCs in Germany. Certain treatment aspects are handled differently, possibly due to institution-specific reasons. The high homogeneity in treatment protocols reflects the widespread high and comparable treatment quality of head and neck malignancies in OMFS in Germany.

The role of a dedicated transition process from pediatric to adult interdisciplinary care for persons with spina bifida.

Interdisciplinary care and pediatric to adult transitional programs have consistently shown medical and social value for individuals with complex medical conditions such as spina bifida (SB). Such interdisciplinary clinics are common in pediatrics but are rarely offered for adults. This survey-based study reports information related to transition, daily pain burden, and satisfaction with care delivery in an adult SB clinic. A 23-question survey that was based on empirical observations from the adult SB clinic was formulated, IRB approved, and distributed to adult patients. Many respondents had previously received care at the institution's pediatric SB clinic and completed transition to the adult program. Responses were de-identified, categorized, stored in a secure database, and statistically analyzed using SPSS. Of 245 patients approached, 116 (47%) surveys were completed and analyzed. Those who had a direct transition (defined as a less than 24-month gap in care) from the pediatric to the adult clinic comprised 44% (n = 51) of responders. The alternative group of 56% (n = 65) had a longer gap, disorganized or absent transition, or had pediatric care elsewhere. The study population had an average age of 36 years, had mostly received childhood care at the authors' institution, regardless of whether they made a direct transition or had a gap in care (68%), and held the diagnosis of open myelomeningocele (78%). Overall satisfaction with the clinic experience was high (mean score 9.04 on a 10-point subjective scale). Differences regarding independence in activities of daily living based on transition status were not significant, but on multivariate analysis, those who reported independence in activities of daily living had an almost 4-fold higher odds of daily pain (p = 0.024; OR 3.86, 95% CI 1.19-12.5). The most frequently identified areas for improvement included improved access to care and pain control. Pediatric transitional processes and interdisciplinary clinics may contribute to improved patient-perceived outcomes and satisfaction with their SB care in comprehensive settings. Further elucidation of barriers to pain control is warranted, in addition to ways in which comprehensive and longitudinal care can improve them.

Feasibility of aging in place clinics in low income senior housing

The purpose of this study was to describe the feasibility of implementing interdisciplinary senior housing clinics. Feasibility was based on evidence of resident participation, services provided, improvement in clinical outcomes and sustaining clinics over time. Data were collected prospectively in four senior housing communities which included approximately 375 residents 60 years of age and older. Over the 12-month implementation period, 228 residents were seen, 61 % of all residents. We gave 131 immunizations, checked 576 blood pressures, completed 92 foot care treatments, 69 hearing evaluations and cerumen removal, completed 16 advance directives, 119 Annual Wellness Visits, and 13 assessments for acute medical problems. Overall, 87 individuals (38 %) had a decrease in their blood pressures, 121 (54 %) maintained their pressures and 19 (8 %) had increases in blood pressures. We reached over half of the residents living in these communities and estimated we could financially maintain the clinics with reimbursement based on billing.

Perceived Responsibility for Bariatric Surgery, Eating, and Exercise Behaviors Among Adolescent Bariatric Surgery Candidates.

Background: Adolescents' perceived responsibility for weight management behaviors has yet to be studied in relation to bariatric surgery. The current study examined perceived responsibility to pursue bariatric surgery and engage in specific weight management behaviors among adolescents seeking bariatric surgery and its associations with demographic, family support, and eating disorder symptoms. Methods: Data were collected using retrospective chart review of adolescent bariatric surgery candidates presenting to a tertiary interdisciplinary clinic. Data included demographics and adolescents' self-report of (1) perceived responsibility (i.e., primarily adolescent; primarily parent; shared) for the decision to pursue bariatric surgery and weight management behaviors, (2) family support for eating and exercise behaviors, and (3) eating disorder symptoms. Analyses included one-way analysis of covariance, chi-squared tests, and Kruskal-Wallis tests. Results: Participants reporting primarily teen or shared responsibility for seeking bariatric surgery were older than those reporting primarily parent responsibility (p = 0.023). Teens perceiving primary responsibility for their own healthy eating reported less family encouragement for healthy eating (p = 0.011) and more eating disorder symptoms (p = 0.002) than those reporting primarily parent or shared responsibility. Teens reporting primary responsibility for exercise reported less family encouragement for healthy eating (p = 0.012) compared with those reporting shared responsibility. Conclusions: This study is the first to provide a description of health behavior responsibilities in a sample of adolescents with severe obesity seeking bariatric surgery. Not only will these insights improve our understanding of this population, but it can also inform presurgical discussions with adolescents and their parents.

Impact of Clinical Pharmacists in the Inflammatory Bowel Disease Clinic.

Background: Limited evidence exists regarding pharmacist involvement and impact in inflammatory bowel disease (IBD) interdisciplinary clinic care models. The purpose is to describe pharmacist utilization in an interdisciplinary IBD clinic and evaluate clinical impact on patient quality of life. Methods: This was a retrospective cohort study comparing outcomes in patients with Crohn's disease initiated on therapy when the implementation of pharmacy services began (Early Phase) to the expansion of pharmacy services (Recent Phase). The primary outcome compared the proportion of patients referred to a pharmacist and those achieving a Harvey-Bradshaw Index (HBI) reduction of ≥3 points after therapy initiation. Results: 50 patients were included in the Early Phase and 43 patients in the Recent Phase. Utilization in pharmacy referrals increased from 48% (n = 24) in the Early Phase to 72% (n = 31) in the Recent Phase (P = 0.03). The proportion of patients achieving a HBI reduction of ≥3 points increased from 35% (n = 14) in the Early Phase to 51% (n = 18) in the Recent Phase (P = 0.23). Results also found a greater proportion of patients remaining steroid free in the Recent Phase compared to the Early Phase (50% vs 63%; P = 0.01) and C-reactive protein (CRP) improved significantly in the Recent Phase (-11) compared to (-3) in the Early Phase (P = 0.006). Conclusion: The utilization of pharmacists in an interdisciplinary IBD clinic increased and showed to impact patient care through improving symptom relief as seen by the achievement rate of the HBI score reduction, reducing steroid use after therapy initiation, and making clinically significant interventions.

A nationwide neurosurgical inter-disciplinary service for cancer-related refractory pain

PurposeNeurosurgical ablative procedures, such as cordotomy and cingulotomy, are often considered irreversible and destructive but can provide an effective and individualized solution for cancer-related refractory pain, when all other approaches have been unsuccessful. This paper provides an in-depth exploration of a novel approach to managing refractory cancer pain. It involves an interdisciplinary team led by a neurosurgeon at a renowned national referral center.Methodsa retrospective analysis of the medical records of all sequential patients who underwent their initial evaluation at our interdisciplinary refractory cancer pain clinic from February 2017 to January 2023.ResultsA total of 207 patients were examined in the clinic for a first visit during the study period. All patients were referred to the clinic due to severe pain that was deemed refractory by the referring physician. The mean age was 61 ± 12.3 years, with no significant sex difference (P = 0.58). The mean ECOG Performance Status score was 2.35. Conservative measures had not yet been exhausted in 28 patients (14%) and 9 patients were well controlled (4%). Neurosurgical ablative procedures were recommended for 151 (73%) of the patients. Sixty-six patients (32%) eventually underwent the procedure. 91 patients (44%) received a negative recommendation for surgery. Thirty-five patients (17%) were referred for further invasive procedures at the pain clinic.ConclusionAn Interdisciplinary cooperation between palliative care specialists, pain specialists, and neurosurgeons ensures optimal patient selection and provides safe and effective neurosurgery for the treatment of refractory cancer-related pain.

An integrated clinical approach to children at genetic risk for neurodevelopmental and psychiatric conditions: interdisciplinary collaboration and research infrastructure

BackgroundA sizeable proportion of pathogenic genetic variants identified in young children tested for congenital differences are associated with neurodevelopmental psychiatric disorders (NPD). In this growing group, a genetic diagnosis often precedes the emergence of diagnosable developmental concerns. Here, we describe DAGSY (Developmental Assessment of Genetically Susceptible Youth), a novel interdisciplinary ‘genetic-diagnosis-first’ clinic integrating psychiatric, psychological and genetic expertise, and report our first observations and feedback from families and referring clinicians.MethodsWe retrieved data on referral sources and indications, genetic and NPD diagnoses and recommendations for children seen at DAGSY between 2018 and 2022. Through a survey, we obtained feedback from twenty families and eleven referring clinicians.Results159 children (mean age 10.2 years, 57.2% males) completed an interdisciplinary (psychiatry, psychology, genetic counselling) DAGSY assessment during this period. Of these, 69.8% had a pathogenic microdeletion or microduplication, 21.5% a sequence-level variant, 4.4% a chromosomal disorder, and 4.4% a variant of unknown significance with emerging evidence of pathogenicity. One in four children did not have a prior NPD diagnosis, and referral to DAGSY was motivated by their genetic vulnerability alone. Following assessment, 76.7% received at least one new NPD diagnosis, most frequently intellectual disability (24.5%), anxiety (20.7%), autism spectrum (18.9%) and specific learning (16.4%) disorder. Both families and clinicians responding to our survey expressed satisfaction, but also highlighted some areas for potential improvement.ConclusionsDAGSY addresses an unmet clinical need for children identified with genetic variants that confer increased vulnerability for NPD and provides a crucial platform for research in this area. DAGSY can serve as a model for interdisciplinary clinics integrating child psychiatry, psychology and genetics, addressing both clinical and research needs for this emerging population.

Psychological burden in patients with angina and unobstructed coronaryarteries-underestimated, underexplored, undertreated.

Patients with angina and unobstructed coronary arteries (ANOCA) are frequently encountered in clinical practice. These cases represent adiagnostic and therapeutic challenge and are often characterized by along patient journey until adiagnosis of coronary vasomotor disorders is established. Moreover, the unsatisfactory management of such patients leads to insecurity, ongoing symptoms, and psychological sequelae such as anxiety or depression. Currently, the psychological burden in patients with ANOCA is underestimated, underexplored, and undertreated. This review gives anew perspective on the pathophysiology of coronary vasomotor disorders including psychological risk factors and calls for comprehensive care by interdisciplinary ANOCA clinics.

The impact of implementing a virtual interdisciplinary dysphagia clinic in independent sector care homes - Early identification and management of dysphagia and malnutrition is vital

The impact of implementing a virtual interdisciplinary dysphagia clinic in independent sector care homes - Early identification and management of dysphagia and malnutrition is vital

A Longitudinal Investigation of Nasolabial Changes With and Without Revision Surgery in Patients with Non-Syndromic Unilateral Cleft Lip and Palate.

To determine a baseline of anticipated change in nasolabial appearance following primary repair of unilateral cleft lip/palate and evaluate the degree to which revision surgery improves nasolabial appearance. Retrospective chart review. Patients treated at the Lancaster Cleft Palate Clinic interdisciplinary clinic. Twenty-three patients with complete unilateral cleft lip and palate who underwent primary surgical repair and 19 additional patients who underwent subsequent revision surgery were included. Patients in the non-revision group underwent a Tennison-Randall triangular flap lip repair at 3mo. Patients in the revision group underwent a modification of the Nakajima straight-line repair after primary Tennison-Randall triangular flap lip repair at an average age of 141mo. A modification of the Asher-McDade Aesthetic Index was utilized to evaluate Nasolabial Frontal (NLF), Nasolabial Profile (NLP), Vermillion Border (VB), and total change in appearance. Scores for patients in the revision group were evaluated before and after revision while appearance for patients without revision was evaluated at 3 distinct ages. Scores were averaged across time-points and inter-rater reliability was assessed. Nasolabial appearance in the non-revision sample did not change significantly over time, except for nasal profile. Scores improved after revision surgery - NLP: 3.48 to 2.97, (p = 0.001); NLF: 3.50 to 2.95 (p = 0.001); and Total Nasolabial Score: 3.29 to 3.01 (p = 0.004), with no significant change in VB. Decisions regarding need for nasolabial revision surgery may be made as early as 5yo with successful outcomes following secondary surgery improving appearance except for vermillion border appearance.

Ups and Downs, Joys and Sorrows: Assessing Patient Priorities in an Interdisciplinary PD Clinic

Ups and Downs, Joys and Sorrows: Assessing Patient Priorities in an Interdisciplinary PD Clinic

Evaluating the impact of an interdisciplinary integrated limb preservation service operating concurrently with a single-specialty service.

This study examined the efficacy of an interdisciplinary limb preservation service (LPS) in improving surgical outcomes for diabetic foot ulcer (DFU) patients compared to traditional care. Data from January 1, 2017 to September 30, 2020 were retrospectively reviewed. An interdisciplinary LPS clinic began on August 1, 2018, coexisting with a preexisting single specialty service. Primary outcomes were major/minor amputation rates and ratios and hospital length of stay. Surgical endpoints pre- and post-LPS launch were compared. Among 976 procedures for 731 unique DFU patients, most were male (80.4%) and Hispanic (89.3%). Patient demographics were consistent before and after LPS initiation. Major amputation rates decreased by 45.5% (15.4%-8.4%, p=0.001), with outpatient procedures increasing over 5-fold (3.3% pre-LPS to 18.7% post-LPS, p<0.001). Hospital stay reduced from 10.1 to 8.5days post-LPS (p<0.001). The major to minor amputation ratio declined from 22.4% to 12.7%. The interdisciplinary LPS improved patient outcomes, marked by fewer major amputations and reduced hospital stays, suggesting the model's potential for broader application.

An integrative, systemic day-clinic approach for the treatment of psychiatric disorders in young adults: a detailed study of two cases

IntroductionMore than 75% of the psychiatric disorders arise before the age of 30. Adolescence and young adulthood pose numerous developmental challenges like identity development, educational and occupational concerns, gaining autonomy and boundary-setting skills. The adolescent crises, which can involve a broad spectrum of psychiatric symptoms, demands a multidisciplinary approach to diagnosis and treatment.ObjectivesOur goal is to present a best practice example of an interdisciplinary day clinic through two case presentations, aiming improving innovative strategies for assessment/treatment of psychiatric disorders in young adulthood.MethodsVia two comprehensive case presentations, we will introduce a psychotherapeutic day-clinic concept from a psychiatric training hospital in Germany.ResultsThe day clinic’s interdisciplinary team uses therapeutic approaches like dynamic, cognitive-behavioral, and systemic therapy to understand young adults beyond just their symptoms. Milieu-therapeutic methods, family constellations, socio-therapeutic approaches and non-verbal therapies are incorporated into our concept. Case 1: A 20-year-old male patient, previously diagnosed with schizophrenia, was referred due to symptoms of living in an unreal world with perceived magical abilities and family conflicts. In the evaluation the features of high-functioning autism spectrum disorder (ASD) were more prominent than the psychotic symptoms. Developmental history and diagnostic tools yielded the diagnosis of ASD. Magical abilities in an unreal world appears to align more closely with repetitive/restrictive patterns of behavior, hereby we excluded in the follow-up the diagnosis of schizophrenia. Psychoeducation, social-skills-training and family interventions helped him to comprehend his strengths and discover a clearer direction in his life.Case 2: Another 20-year-old male patient was referred with depressive symptoms, a sense of emptiness and self-mutilation. Following routine evaluation, we employed systemic methods (genogram constellations) to gain deeper insight into the patient’s psychopathology. His mother’s migration history from Thailand, coupled with unfulfilled aspirations, echoed in his recurring thought: “Where are my roots?” During follow-up, we recognized his passive stance toward therapeutic change, addressed through a systemic intervention known as ‘taking the side of non-change.’ This shifted his position from resistance to openness. Non-verbal approaches, family interventions, and corrective in-vivo experiences significantly contributed to his stabilization.ConclusionsSpecialized psychiatric centers tailored to the unique needs of young adults play a critical role in evaluating, diagnosing, and treating psychiatric crises during this developmental stage. Achieving this requires the implementation of interdisciplinary holistic therapeutic approaches.Disclosure of InterestNone Declared

30. Comparison of Signs & Symptoms among Pediatric Patients with Lichen Sclerosis (LS) & Vitiligo: Preliminary Findings from an Interdisciplinary Vulvar Dermatology Clinic

30. Comparison of Signs & Symptoms among Pediatric Patients with Lichen Sclerosis (LS) & Vitiligo: Preliminary Findings from an Interdisciplinary Vulvar Dermatology Clinic