Abstract Background Adolescents who engage in nonsuicidal self-injury (NSSI) show a high sensitivity to ostracism, and its effects may be amplified by dysregulated stress-system function. However, ecologically grounded experimental studies examining multilevel stress responses in adolescent mental health remain scarce. We used a novel, ecologically valid in-person ostracism paradigm to assess subjective, autonomic, and endocrine responses in adolescents with recent NSSI and to characterize stress trajectories. Methods Fifty adolescents with recent NSSI (mean age = 16.40 years, 76% female) were randomized (1:1) to live social inclusion or exclusion in a face-to-face ball-toss task based on the Cyberball paradigm. Salivary cortisol was sampled at five points from pre-task to 40 min post-task. Heart rate (HR) and heart rate variability (HRV) were recorded at baseline and during the interaction. Subjective stress, tension, and NSSI urges were assessed before and after the task. Perceived exclusion and psychological need threat were also assessed. Results We found clear ostracism effects on perceived exclusion and basic psychological need threat. Cortisol declined across the paradigm in both conditions (inclusion/exclusion), but the decline was flatter after exclusion, indicating attenuated hypothalamic-pituitary-adrenal axis downregulation. HR decreased modestly over time across conditions, and HRV diverged by condition: it decreased during exclusion and increased during inclusion. There were no condition-related changes in self-reported stress, tension, or NSSI urges. Conclusions These findings suggest a decoupling between subjective and psychobiological stress systems in adolescents with NSSI in response to ostracism, characterized by rapid parasympathetic withdrawal and a blunted HPA axis downregulation. This pattern may reflect heightened physiological sensitivity to social threat despite limited conscious distress. Trial registration : This study has been registered at the German Clinical Trials Register (ID: DRKS00025905, https://drks.de/search/en/trial/DRKS00025905 ).

BACKGROUND:Differentiation of borderline personality disorder (BPD) and bipolar I disorder (BD) has been challenging. The assessment of shared symptoms in the context of the overall personality functioning, the patient's sense of self, and the quality of his object (interpersonal) relations is proposed to be valuable for the differential diagnosis of these disorders. METHODS:We empirically investigated the level of personality organization (PO), identity integration, and quality of object relations in patients suffering from BD or BPD using the Structured Interview of Personality Organization (STIPO) and the Level of Personality Functioning Scale (LPFS) in 34 BPD and 28 BD patients as well as 27 healthy control persons. Group comparisons and a logistic regression model were calculated to analyze group differences. RESULTS:The BPD group showed significantly greater impairment in several domains of personality functioning, namely "identity", and "self- and other-directed aggression", while showing lower impairment in "moral values". The overall level of PO in the BPD group was significantly lower when excluding not only BPD but any personality disorder (PD) in the BD sample. Severity of impaired personality structure had a major impact on symptom load independent of the main diagnosis BD or BPD. CONCLUSIONS:Our data show greater impairment in personality functioning in BPD than in BD patients. BD patients present with varying levels of PO, whereas in BPD severe deficits in PO are pathognomonic. The level of PO has a significant impact on symptom severity in both BD and BPD patients. Therefore, careful assessment of PO should be considered for differential diagnosis and adequate treatment planning.

The aim of this study was examining the efficacy of the Maudsley Model of Anorexia Nervosa Treatment for Adolescents and Young Adults (MANTRa) compared to individual psychotherapy that can be considered as standard in Austria (TAU-O). In this cohort study, 92 patients between 13 and 21 years suffering from full-syndrome, atypical or weight-restored anorexia nervosa (AN) received either 24–34 individual MANTRa sessions ( n  = 45) or TAU-O ( n  = 47). Outcome variables were age- and sex-related BMI, eating disorder and comorbid psychopathology at 6-, 12- and 18-month post baseline as well as acceptability of treatment and therapeutic alliance. Both treatments resulted in significant improvements in age- and sex related BMI and reductions in eating disorder and comorbid psychopathology over time with significant differences between groups in favour of MANTRa. The percentage of participants with fully remitted AN was significantly higher in the MANTRa group compared to TAU-O at 18-month follow-up (MANTRa: 46% vs. TAU-O: 16%, p  = 0.006). Satisfaction with both treatments was high. MANTRa is an effective treatment programme for adolescents and young adults with AN. Randomised controlled trials comparing MANTRa with existing treatments are necessary. The trial was registered at clinicaltrials.gov (Identifier: NCT03535714).

Background:Unaccompanied refugee minors (URMs) are a particularly vulnerable subgroup of refugees, frequently exhibiting high levels of distress and a wide range of trauma-related symptoms. They are at risk of poor mental health outcomes such as developing complex posttraumatic stress disorder, an emergent mental disorder associated with re-experiencing, hyperarousal, and avoidance of trauma-related stimuli. Methods:We conducted a qualitative analysis of interviews with 28 unaccompanied refugee minors from African countries residing in Austria. Results:Three main strands of narrative focus were identified: war-related experiences, present experiences in the new home country, and different coping strategies. Conclusions:The results of this study suggest that URM narratives are highly complex and that URM require supportive networks and psychotherapeutic care.

Die limitierte nonverbale Kommunikation ist einer der meistgenannten Nachteile der Psychotherapie per Videokonferenz (VP). Es wurden die Antworten von 284 Psychotherapeut:innen in einer Umfrage zum Thema »Online-Psychotherapie« einer qualitativen Inhaltsanalyse unterzogen. Die Ergebnisse gliederten sich in die drei Hauptkategorien »Verlust der nonverbalen Kommunikation«, »Verlust der Leiblichkeit« und »Verlust der Atmosphäre«. Es wurde gezeigt, dass die nonverbale Kommunikation im Online-Setting auf vielfältige Weise verloren geht und sich dies insbesondere auf die Gegenübertragungsgefühle in der Arbeit mit Patient:innen mit schweren Persönlichkeitsstörungen limitierend auswirkt.

OBJECTIVE:We aimed to evaluate longitudinal changes in set-shifting and central coherence in a predominantly adolescent cohort with anorexia nervosa (AN) and to explore whether these factors predict long-term eating disorder outcomes. METHOD:Ninety-two female patients with AN (mean age: 16.2, range: 13-21 years) completed neurocognitive tests (Rey Complex Figure Test, Adapted Version of the Wisconsin Card Sorting Test) before and after 12 months of psychotherapeutic treatment (n = 45 Maudsley AN Treatment, MANTRa; n = 47 standard psychotherapy; groups not randomised). Eating disorder severity was assessed at baseline, after 6, 12 and 18 months. RESULTS:Central coherence (indicated by an increase in the Rey Figure Style Index) and set-shifting (indicated by a reduction in the percentage of perseverative errors) significantly improved over the course of treatment, with similar outcomes across groups. Lower central coherence was associated with higher eating disorder severity. Individuals with lower baseline set-shifting ability tended to have worse eating disorder outcomes in the long-term. However, this trend did not reach statistical significance in a multilevel linear mixed model. CONCLUSIONS:Neurocognitive difficulties in adolescents and young adults with AN can improve after treatment. Interventions specifically addressing flexibility in thinking and behaviour may contribute to treatment success.

OBJECTIVE:"Supporting Carers of Children and Adolescents with Eating Disorders in Austria" (SUCCEAT), a skills training for parents, delivered via workshops (WS) or online modules (ONL), has been proven to be effective in terms of parental distress, caregiver skills, and adolescents' outcome. This study examined the adherence to and the acceptability and feasibility of SUCCEAT. METHOD:One-hundred parents (86% mothers) of adolescents with anorexia nervosa participated in the 8-week training. Parents were assigned to the WS (n = 50) or ONL (n = 50) format using a quasi-randomised design. Adherence, acceptability, and feasibility were assessed using self-report questionnaires. RESULTS:Adherence to the sessions was high (66%-98%) for both groups. The usage of the material was comparable between the groups. However, in the WS group, participants actively approached the coaches (71.8% vs. 48.9% often/very often) or other parents (63% vs. 4.4% often/very often) more often. Perceived helpfulness was high in both groups, overall satisfaction and practicability were higher in the WS group. CONCLUSIONS:Good adherence, acceptability, and feasibility were confirmed for both formats of SUCCEAT, with minimal advantages of the WS regarding satisfaction and contact with other parents and coaches. Thus, both formats can be recommended for implementation in clinical routine.

OBJECTIVE Medication is commonly used in anorexia nervosa (AN) despite largely missing high grade evidence. Olanzapine (OLZ) is the best-evidenced substance used off-label in this group, with conflicting outcome regarding BMI, clinical and safety parameters. Therefore, it is important to strictly assure quality of treatment with OLZ in AN by using 'Therapeutic Drug Monitoring' according to AGNP-guidelines, including serum levels and adverse drug reactions (ADRs) to support safety for adolescents with AN and attempt to generate an initial age- and disorder-specific therapeutic reference range. METHOD Sixty-five adolescents with AN (aged 10-18) treated with OLZ (98% female; 97.5% AN-restricting-type) were prospectively observed, ADRs reported, and correlations between dosage and serum levels measured at trough level were calculated, a preliminary therapeutic range defined. RESULTS Mean dosage of OLZ was 8.15 (SD: 2.91) mg and 0.19 (SD: 0.07) mg/kg respectively, average concentration was 26.57 (SD: 13.46) ng/mL. Correlation between daily dosage/dosage per kg and serum level was 0.72 (**p < 0.001)/0.65 (**p < 0.001), respectively. ADRs with impairment were rare (6.3%). 75% improved clinically (CGI). BMI increased significantly by 1.5 kg/m2 (t = 10.6, p < 0.001). A preliminary therapeutic reference range is 11.9 and 39.9 ng/mL. CONCLUSIONS OLZ in the hands of specialists is a well-tolerated and safe treatment adjunct for adolescents with AN.

Objective: Anorexia nervosa (AN) is a highly debilitating disease which frequently results in chronification and often originates in adolescence. Personality traits have been associated with the onset and maintenance of AN; moreover, study results indicated a worse treatment outcome in patients with AN and comorbid personality disorder (PD). However, research on PD in adolescent AN is scarce. Methods: The sample consists of 73 female adolescent patients with AN. We investigated comorbid PD and AN symptom severity performing the International Personality Disorder Examination (IPDE) and the Eating Disorder Inventory 2 (EDI-2). Results: Almost a third (27.4%) of all participants were diagnosed with comorbid PD. They had significantly higher EDI-2 total scores reflecting overall stronger symptom severity, as well as significantly higher scores in the subscales "ineffectiveness," "interpersonal distrust," "interoceptive awareness," "asceticism," "impulse regulation," and "social insecurity." Conclusion: PD is an important and frequent comorbid condition in adolescent AN and should be addressed in diagnostic and treatment planning. Early diagnosis of comorbidity could have an impact on choosing specialized treatment for adolescents with AN and PD in order to enhance the outcome.

Social restrictions during the COVID-19 pandemic had a major impact on the mental health of youth. We analyzed a sample of 274 adolescents and young adults that participated in an online survey. We used the Brief Symptom Inventory 18 (BSI 18) and the Perceived Stress Scale to assess mental health status. Furthermore, we assessed the frequency and intensity of social media use in all participants. More than 50 % of the adolescents and young adults reported clinically relevant scores for somatization, depression, anxiety, and perceived stress. Females had significantly higher mental health burdens than males. Although adolescents used social media more frequently and intensely than young adults, the results showed no correlation with psychopathology. Young adults had significantly higher scores compared to adolescents in somatization, depression, and perceived stress the more time they spent on social media. Our results emphasise that frequency and intensity of social media use alone were not associated with worsemental health.However, the adverse effects of socialmedia use have to be considered carefully.

There is a growing interest in delivering videoconferencing psychotherapy (VCP) due to the enormous impact of the COVID-19 pandemic on our lives since the beginning of severe restrictions worldwide in March 2020. Scientific literature has provided interesting results about the transition to remote sessions and its implications, considering different psychotherapy orientations. Less is known about whether and how VCP affects psychodynamic psychotherapeutic approaches and reports on remote work with severe and complex mental health problems such as severe personality disorders are still scarce. The aim of the study was to examine the experiences of psychodynamic psychotherapists, mainly delivering Transference-Focused Psychotherapy (TFP), with the transition and delivery of VCP during the first wave of the COVID-19 pandemic. Four hundred seventy-nine licensed psychotherapists completed an online survey during the peak of the pandemic. Survey data were analyzed using qualitative analysis. Results are presented and discussed concerning advantages and disadvantages regarding the access to psychotherapy, the specificity of the online video setting, bodily aspects, the quality of the therapeutic relationship, the therapeutic process including technical aspects and therapist’s experience. Furthermore, we analyzed and discussed the statements concerning transference and countertransference reactions differentiating between high-level borderline and neurotic patients and low-level borderline patients. Our results support the importance to identify patients who potentially benefit from VCP. Further research including more prospective randomized controlled trials are needed to investigate the therapeutic implications of the findings.

Anorexia nervosa (AN) is a highly debilitating mental illness with multifactorial etiology. It oftentimes begins in adolescence, therefore understanding the pathophysiology in this period is important. Few studies investigated the possible impact of the acute state of illness on white matter (WM) tissue properties in the developing adolescent brain. The present study expands our understanding of the implications of AN and starvation on WM integrity. 67 acutely ill adolescent patients suffering from AN restricting type were compared with 32 healthy controls using diffusion tensor imaging assessing fractional anisotropy (FA) and mean diffusivity (MD). We found widespread alterations in the vast majority of the WM regions with significantly decreased FA and increased MD in the AN group. In this highly selective sample in the acute stage of AN, the alterations are likely to be the consequence of starvation. Still, we cannot rule out that some of the affected regions might play a key role in AN-specific psychopathology.

This study evaluated the short-term outcome of a multimodal inpatient treatment concept for adolescents with anorexia nervosa (AN). In this prospective observational study, a cohort of 126 female adolescents with AN (age range: 11–17, mean age: 14.83) was longitudinally followed from admission to discharge (average duration of stay: 77 days). We used gold-standard clinical interviews and self-report data, as well as DSM-5 remission criteria, to evaluate the treatment outcome. From admission to discharge, body-mass-index (BMI) significantly improved by 2.6 kg/m2. Data from clinical interviews and self-reports yielded similar improvements in restraint eating and eating concerns (large effects). Lower effects were observed for variables assessing weight/shape concerns and drive for thinness. At discharge, 23.2% of patients showed full remission of AN, 31.3% partial remission, and 45.5% no remission according to DSM-5 criteria. Differences in remission groups were found regarding AN severity, age at admission, and use of antidepressant medication. Living with both parents, longer duration of inpatient treatment and the use of antipsychotic medication were significantly associated with higher BMI change. The findings provide evidence for the short-term effectiveness of our inpatient treatment concept. We recommend using DSM-5 based remission criteria to evaluate the treatment outcome to improve the comparability of studies.

Journal of Child and Adolescent PsychopharmacologyVol. 31, No. 6 Brief ReportLetter to the Editor: Cannabidiol Treatment—Is There an Effect on Cognitive Functioning, Quality of Life, and Behavior? A Case ReportClaudia M. Klier, Günther P. Amminger, Oswald D. Kothgassner, Clarissa Laczkovics, and Anna FelnhoferClaudia M. KlierAddress correspondence to: Claudia M. Klier, MD, Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Waehringer Guertel 18-20, Vienna 1090, Austria E-mail Address: claudia.klier@meduniwien.ac.athttps://orcid.org/0000-0003-0696-8904Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria.Comprehensive Center Pediatrics, Medical University Vienna, Vienna, Austria.Search for more papers by this author, Günther P. Ammingerhttps://orcid.org/0000-0001-8969-4595Orygen, The National Centre of Excellence in Youth Mental Health, The University of Melbourne, Melbourne, Australia.Search for more papers by this author, Oswald D. Kothgassnerhttps://orcid.org/0000-0002-3243-0238Comprehensive Center Pediatrics, Medical University Vienna, Vienna, Austria.Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria.Search for more papers by this author, Clarissa Laczkovicshttps://orcid.org/0000-0002-0492-2286Comprehensive Center Pediatrics, Medical University Vienna, Vienna, Austria.Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria.Search for more papers by this author, and Anna Felnhoferhttps://orcid.org/0000-0002-0081-7489Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria.Comprehensive Center Pediatrics, Medical University Vienna, Vienna, Austria.Search for more papers by this authorPublished Online:17 Aug 2021https://doi.org/10.1089/cap.2020.0203AboutSectionsView articleView Full TextSupplemental MaterialPDF/EPUBView Supplemental Data Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetails Volume 31Issue 6Aug 2021 InformationCopyright 2021, Mary Ann Liebert, Inc., publishersTo cite this article:Claudia M. Klier, Günther P. Amminger, Oswald D. Kothgassner, Clarissa Laczkovics, and Anna Felnhofer.Letter to the Editor: Cannabidiol Treatment—Is There an Effect on Cognitive Functioning, Quality of Life, and Behavior? A Case Report.Journal of Child and Adolescent Psychopharmacology.Aug 2021.447-449.http://doi.org/10.1089/cap.2020.0203Published in Volume: 31 Issue 6: August 17, 2021Online Ahead of Print:July 15, 2021PDF download

Skills trainings for caregivers of patients with anorexia nervosa (AN) have been proven to be effective in improving caregiver skills and reducing caregivers' psychopathology. The effects on patients, especially adolescents, are largely unknown. The aim of this study was to evaluate the effectiveness of a caregivers' skills training program (Supporting Carers of Children and Adolescents with Eating Disorders in Austria, SUCCEAT, workshop or online version) on adolescents with AN delivered as workshops (WS) or online (ONL). Outcomes are Body-Mass-Index (BMI) percentile, eating psychopathology (Eating Disorder Examination, EDE), attitudinal and behavioural dimensions of eating disorders (Eating Disorder Inventory-2), motivation to change (AN Stages of Change Questionnaire), emotional and behavioural problems (Youth Self-Report) and quality of life (KINDL). All outcome variables significantly improved across both SUCCEAT groups (WS and ONL) and were sustained at 12-month follow-up. The online and workshop delivery of SUCCEAT were equally effective. Most effect sizes were in the medium-to-high range. Full or partial remission was observed in 72% (WS) and 87% (ONL) of patients. Caregiver skills trainings, either delivered as workshops or online modules, are highly recommended to complement treatment as usual.

Interventions for main carers of adult patients with anorexia nervosa (AN) can reduce the caregiving burden and increase caregiver skills. However, the effectiveness and feasibility for carers of adolescent patients, the optimal form of the intervention and long-term outcomes are largely unknown. We evaluated the efficacy and feasibility of the “Supporting Carers of Children and Adolescents with Eating Disorders in Austria” (SUCCEAT) workshop vs. online intervention. Main caregivers (parents) of adolescent patients with AN were randomly allocated to a workshop (n = 50) or online version (n = 50). Participants were compared to a non-randomised comparison group (n = 49) receiving multi-family or systemic family therapy. Primary (General Health Questionnaire) and secondary outcomes were obtained at baseline, three-month and 12-month follow-up. Adherence was high for workshop and online participants (6.2 and 6.7 sessions completed out of 8). Intention-to-treat analyses revealed significant pre–post reductions in the primary outcome for the workshop (d = 0.87 (95%conficence interval (CI): 0.48; 1.26)) and online (d = 0.65 (95%CI: 0.31; 0.98)) intervention that were sustained at the 12-month follow-up. There was no significant group difference (p = 0.473). Parental psychopathology and burden decreased and caregiver skills increased in all groups; the improvement of caregiver skills was significantly higher in SUCCEAT participants than in the comparison group. Online interventions for parents of adolescents with AN were equally effective as workshops. The improvements remained stable over time.

role play sessions with simulated patients; small pilot studies consider that compassion can also be taught within the undergraduate curriculum, simply by empowering students towitness compassionate acts.Havingmore evidence on how these skills may influence adherence behaviorswould reinforce the importance of addressing and teaching these soft skills during medical curricula. Because there are no studies specifically underpinning empathy in schizophrenia, it remains unclear what is the impact of it in the managing of patients with this disease, where adherence problems are responsible for such a great burden. Empathic understanding in exploring and clarifying the patient's subjective experiences is fundamental and is of great value for psychiatric examination. Increasing these abilities may be a first step in building a compassionate environment and strong therapeutic alliance and, thus, enhancing adherence to medication. This is clear evidence of how pharmacologic and empathic approaches are both essential and should be combined for better clinical responses and outcomes.

In this report, we present a case of a 16,9-year-old patient with multiple substance use disorder (cannabis, MDMA, cocaine, ecstacy), severe depression, social phobia and narcissistic personality disorder. We administered Cannabidiol (CBD) capsules in different dosages (starting dosage 100 mg up to 600 mg over 8 weeks) after unsuccessful treatment with antidepressants. CBD was a safe and well tolerated medication for this patient. Upon treatment with CBD and cessation of the antidepressant medication, the patient improved regarding depressive as well as anxiety symptoms including simple phobias and symptoms of paranoia and dissociation. Furthermore, the patient quit abusing illegal drugs including THC without showing withdrawal symptoms. This is the first report of CBD medication in a patient with multiple substance use disorder with a positive outcome. Until today it is not clear if CBD holds promise as a therapeutic option in substance use disorder as RCTs are lacking, but in this single case the substance seems to work in various domains.

There is limited research exploring attachment style and defenses in adolescents. The purpose of the current research is to explore the relationship between adolescent attachment style and development of defense mechanisms, as well as attachment style and problem behaviors. A total of 1487 students from two California high-schools completed three self-report questionnaires to establish defense mechanisms, psychiatric symptoms, and attachment style. Attachment styles characterized by a positive self-image predict greater levels of mature defense mechanisms, and lower levels of immature defense mechanisms, both in the interpersonal and intrapsychic domains. Relationships between insecure attachment styles and psychopathology were mediated by greater levels of immature defense mechanisms. These results provide initial compelling evidence that: a) attachment style is an important determinant of the type of defense mechanisms utilized by the individual to maintain psychological stability; and b) defense mechanisms serve to transmit the detrimental effects of insecure attachment style on psychological health.

Supporting Carers of Children and Adolescents with Eating Disorders in Austria (SUCCEAT) is an intervention for carers of children and adolescents with anorexia nervosa and atypical anorexia nervosa. This paper describes the study protocol for a randomised controlled trial including the process and economic evaluation. Carers are randomly allocated to one of the 2 SUCCEAT intervention formats, either 8 weekly 2-hr workshop sessions (n = 48) or web-based modules (n = 48), and compared with a nonrandomised control group (n = 48). SUCCEAT includes the cognitive-interpersonal model, cognitive behavioural elements, and motivational interviewing. The goal is to provide support for carers to improve their own well-being and to support their children. Outcome measures include carers' distress, anxiety, depression, expressed emotions, needs, motivation to change, experiences of caregiving, and skills. Further outcome measures are the patients' eating disorder symptoms, emotional problems, behavioural problems, quality of life, motivation to change, and perceived expressed emotions. These are measured before and after the intervention, and 1-year follow-up.