Mental health problems (MHP) are common in adolescents. Help-seeking behavior (HSB) in this age group is low. An online intervention promoting HSB in adolescents with MHP (ProHEAD-Online) was evaluated in a randomized controlled trial. It was hypothesized that adolescents allocated to ProHEAD-Online would show increased real-world HSB after 12 months compared to adolescents in the control group. A multicenter randomized controlled trial was conducted in a school-based community setting in Germany. n = 1470 students (≥12 years, 74.6% female) with MHP and no HSB at baseline were randomized (ProHEAD-Online: n = 739; control: n = 731). Professional HSB of 4.5% (control) and 5.7% (ProHEAD-Online) was reported at the primary endpoint (OR = 1.27, 95% CI = [0.78, 2.10], p = 0.34). Age at baseline moderated the treatment effect (OR = 0.79, 95% CI = [0.64, 0.97], p = 0.03), ProHEAD-Online only improved HSB in younger adolescents. No significant differences by treatment arm on secondary outcomes (i.e., severity of MHP, health-related quality of life, attitudes toward help-seeking, perceived barriers to help-seeking, help-seeking intentions, and treatment satisfaction). Professional HSB in adolescents with MHP is low. An online intervention to increase HSB in adolescents with MHP was not superior to static online content. Improving HSB, particularly among older adolescents, remains challenging.

Psychosen vor dem Erwachsenenalter sind sehr selten und werden oft erst spät behandelt – mit z. T. gravierenden Auswirkungen auf kindliche Entwicklungsprozesse. Behandelt wird deshalb mit Psycho- und Pharmakotherapie sowie psychosozialen Interventionen.

Brain network architecture is anticipated to influence future grey matter loss in individuals at Clinical High Risk (CHR) for psychosis. However, existing studies on grey matter structural network properties in CHR are scarce and constrained by small sample sizes. Here, we examined network topology differences comparing a) CHR versus healthy controls (HC); b) CHR who transitioned to psychosis (CHR-T) versus those who did not (CHR-NT); and c) different subsyndromes. We included structural scans from 1842 CHR individuals and 1417 HC individuals from 31 sites within the Enhancing NeuroImaging Genetics through Meta-Analysis (ENIGMA) consortium. At the global level, CHR individuals exhibited lower structural covariance (q < 0.001; Cohen’s d = 0.164) and less optimal structural network configuration than HC (lower global efficiency and clustering coefficient, d = 0.100,0.087, qs <= 0.027). Though no global difference between CHR-T and CHR-NT, network distinctiveness of the frontal and temporal surface area networks was higher in CHR-T than CHR-NT (d = 0.223,0.237) and HC (d = 0.208,0.219) (qs < 0.001). Network distinctiveness of the frontal cortical thickness network was lower in CHR-T (d = 0.218, q < 0.001) than CHR-NT and HC (d = 0.165, q < 0.001). Importantly, higher network distinctiveness was associated with worse positive symptoms in CHR-NT (frontal surface area, q = 0.008, R2 = 0.013) and at trend with worse negative symptoms in CHR-T (frontal thickness, q = 0.063, R2 = 0.049). Further, the brief intermittent psychotic syndrome subgroup showed more severe network alterations. Together, brain structural networks inform symptoms and the risk of transition to psychosis in CHR individuals.

ZusammenfassungÄngste und Depressionen bei Jugendlichen haben schon in den Jahren vor der COVID-19-Pandemie zugenommen und dann im Pandemiegeschehen noch einmal eine deutliche Steigerung erfahren. In diesem Artikel werden die unterschiedlichen klinischen Ausdrucksformen dieser emotionalen Syndrome detailliert dargestellt und auch die Entwicklungswege einer Kombination beider Störungen expliziert. Auch subklinische Formen von Angst und Depression haben schon deutliche klinische Auswirkungen und beeinträchtigen die Entwicklungsaufgaben der Adoleszenz. Die „avolitionale Depression“ (Depression mit schweren Antriebsstörungen) wird als Sonderform erwähnt. Pathogenetische Bausteine – von einer genetischen Vulnerabilität bis zu psychosozialen Belastungsfaktoren – kommen im Licht der Tatsache zur Diskussion, dass Ängste und Depressionen beim weiblichen Geschlecht im Jugendalter etwa doppelt so häufig auftreten wie beim männlichen. Die Einbettung der Störungen in das aktuelle Zeitgeschehen zeigt die besondere Bedeutung der selbstreflexiven Emotion „Scham“ im jugendlichen Entwicklungsprozess. Vor einer Verknappung und Dysfunktionalität des emotionalen Dialogs zwischen wichtigen Bezugspersonen und Kindern muss gewarnt werden. Dessen Rolle für die Selbst- und Affektregulation der Jugendlichen ist nicht zu unterschätzen. Den Abschluss bildet eine Übersicht über die wichtigsten therapeutischen Maßnahmen bei Ängsten und Depressionen im Jugendalter.

Adaptive parent–child interaction plays a major role in healthy child development. Caregiver mental health problems can negatively impact parent–child interaction. In turn, interactional quality is often studied as a predictor of child outcome. However, child characteristics supposedly shape parent–child interactions as well. Given associations between child and caregiver mental health and child temperament, this study aimed at differentiating their effects on dyadic interaction quality in adolescence. Child temperament and character at age 5 were investigated as longitudinal predictors of observed mother–adolescent interactional quality at age 14 in a community sample ( N = 76). It was examined whether these effects were independent of maternal and child mental health and earlier dysfunctional interaction. Lower novelty seeking, higher reward dependence, and higher cooperativeness separately predicted higher dyadic interactional quality at age 14. Controlling regressions for dysfunctional interaction at age 5, which was a significant negative predictor of later interactional quality, cancelled out the effects of novelty seeking and cooperativeness. Past or concurrent maternal or child psychopathology did not explain variance in mother–adolescent interaction. Applying backward selection, a model including reward dependence and dysfunctional interaction at age 5 and concurrent maternal stress showed the best fit for explaining dyadic interaction quality. Results suggest that enduring rather than transient child features predict interactional quality in a community sample. Effects of temperament are not better explained by those of psychopathology, but a combination of child, maternal, and dyadic features predicted dyadic behaviour best. Selective prevention should target parenting in the context of challenging child characteristics specifically.

Anxiety and depression among young people had already increased in the years before the COVID-19 pandemic and then experienced a significant increase again during the pandemic. In this article the different clinical forms of expression of these emotional syndromes are presented in detail and the developmental paths of a combination of both disorders are also explained. Even subclinical forms of anxiety and depression already have clear clinical implications and impair the developmental tasks of adolescence. The "avolitional depression" (depression with severe drive disorders) is mentioned as a special form. Pathogenetic building blocks-from genetic vulnerability to psychosocial stressors-come up for discussion in light of the fact that anxiety and depression are about twice as common in adolescent females as in males. The embedding of the disorders in current events shows the special importance of the self-reflective emotion of shame in the adolescent development process. The scarcity and dysfunctionality of emotional dialogue between significant caregivers and children must be cautioned against. Its role in adolescents' self-regulation and affect regulation should not be underestimated. Finally, an overview of the most important therapeutic measures for anxiety and depression in adolescence is presented.

ZusammenfassungDie Psychotherapie bei Kindern und Jugendlichen kann sich nicht nur auf die Veränderung und Linderung von Symptomen konzentrieren, sondern sollte auch die kognitiv-emotionalen Ressourcen der Person beachten, der Affektregulation und den Lebensthemen eine Bedeutung geben sowie innere Konflikte und interaktionelle Problemthemen in den Fokus nehmen. Aufbau und Entwicklung des Selbstkonzepts besitzen eine zentrale Bedeutung. Die Rolle des Gedächtnisses darf bei der Betrachtung von bewussten und unbewussten Prozessen nicht außer Acht gelassen werden. Der Entwicklung der Mentalisierung kommt auch eine wichtige Rolle bei der Entwicklung psychischer Strukturen zu. Eine operationalisierte psychodynamische Diagnostik im Kindes- und Jugendalter stützt sich auf das Untersuchungsinstrument OPD-KJ in seiner 2. Version. Beziehungsmuster, Konfliktthemen, strukturelle Ressourcen des Selbst und die subjektiven Behandlungsvoraussetzungen werden nach klar definierten Kriterien eingeschätzt. Das Manual kann helfen, die Therapieindikation über die nosologische Einschätzung hinaus zu verfeinern und zu ergänzen.

"Psychose ist eine psychiatrische Erkrankung, die durch eine grobe Beeinträchtigung der Realitätstestung charakterisiert ist und sich typischerweise durch das Auftreten von Wahnsymptomen, Halluzinationen, desorganisierter Sprache oder desorganisiertem oder katatonem Verhalten manifestiert." Bis zu 1/3 der Psychosen haben ihren Beginn im Kindes- und Jugendalter. Pathophysiologisch wird ein Zusammenspiel von genetischen und umweltbedingten Faktoren angenommen, die zu einer Veränderung dopaminerger und glutamaterger Neurotransmission im Gehirn führen. Die klinische Diagnostik fußt auf der psychopathologischen Erhebung der Symptome, wobei somatische Ursachen ausgeschlossen werden müssen. Im Zentrum der Therapie steht die Pharmakotherapie mit Antipsychotika in Kombination mit psychotherapeutischen und psychosozialen Interventionen. Die Pharmakotherapie sollte im Verlauf eng monitiert werden, da metabolische Nebenwirkungen die Langzeitmortalität beeinflussen und Gegenmaßnahmen früh einsetzen müssen. Psychotherapeutische Methoden fokussieren u. a. auf kognitive Verzerrungen und soziale Kognitionen und können das psychosoziale Funktionsniveau signifikant verbessern. Die Prognose wird von Erkrankungsbeginn, Residualsymptomatik, beleitenden kognitiven Einschränkungen und der Therapiecompliance geprägt. Der Verlauf, auch der chronischen Psychosen, ist aber sehr heterogen, wobei für den einzelnen Patienten davon ausgegangen werden sollte, dass "alles möglich ist".

Introduction: Stress affects many adolescents and is associated with physical and mental health symptoms that can have a negative impact on normative development. However, there are very few evidence-based, specific treatment approaches. The aim of the study was to investigate an eight-session group intervention using components of Acceptance and Commitment Therapy (ACT) enriched with elements of CBT (psychoeducation, problem solving) and art therapy, compared to a waitlist control (WLC) group, regarding its efficacy in reducing stress and associated symptoms. Methods: We conducted a randomized controlled trial in eight cohorts. Eligible participants were 13-18 years old with elevated stress levels. Via block-randomization (n = 70), participants were allocated to receive ACT (n = 38) or WLC (n = 32) and subsequent ACT. We used a multimodal assessment (self-reports, interviews, ecological momentary assessment, physiological markers) before treatment (T1), after the training of the ACT group (T2) and after subsequent training in the WLC group (T3). Primary outcome was perceived stress at T2 assessed with the Perceived Stress Scale. The trial was preregistered at the German Clinical Trials Register (ID: DRKS00012778). Results: Results showed significantly lower levels of perceived stress in the ACT group at T2, illustrating superiority of ACT compared to WLC with a medium to large effect size (d = 0.77). Furthermore, the training was effective in the reduction of symptoms of school burnout and physical symptoms associated with stress. Conclusion: Indicated prevention, especially when based on the principles of ACT and CBT, seems efficient in significantly decreasing stress in adolescents with increased stress.

BackgroundAssociations between parent and child cortisol levels ("cortisol synchrony") are often reported and positive synchrony may mark dyadic regulation on a physiological level. Although dyadic behavior during interaction and adolescent borderline personality disorder (BPD) traits are linked with individual and dyadic regulatory capacities, little is known about how both factors influence parent-adolescent cortisol synchrony. We hypothesized that cortisol synchrony would differ depending on behavioral synchrony, i.e., smooth reciprocal dyadic interaction patterns, adolescent BPD traits, and their interactions.MethodsMultilevel state-trait modeling was implemented to investigate associations between concurrent mother-adolescent state cortisol and mother-adolescent average cortisol levels in a community sample of 76 mother-adolescent dyads. Three saliva samples were collected across interaction paradigms. Behavioral synchrony was observed, and adolescent BPD traits were evaluated using clinical interviews.ResultsFirst, behavioral synchrony and absence of BPD traits were linked with positive associations between adolescent and maternal state cortisol (positive synchrony), BPD traits with negative associations (negative synchrony). When interaction effects were examined, results were more nuanced. In low-risk dyads (higher behavioral synchrony, no BPD traits) asynchrony was found. When risk (BPD traits) and resource (higher behavioral synchrony) were combined, synchrony was positive. Lastly, in high-risk dyads (lower behavioral synchrony, adolescent BPD traits), negative synchrony was observed. Average adolescent and maternal cortisol levels were consistently positively associated in dyads with higher risk.ConclusionsPositive dyadic interaction patterns are associated with positive state cortisol synchrony in mother-adolescent dyads and could buffer the effect of BPD traits, possibly supporting the process of physiological regulation.

Zusammenfassung Bei hochbelasteten Familien chronisch kranker Kinder ist es notwendig psychosoziale Expertise direkt in den pädiatrischen Behandlungsprozess einzubeziehen. Hierzu wurde in der Heidelberger Universitätspädiatrie in einem Modellprojekt eine interdisziplinäre Familienmedizinische Sprechstunde, besetzt mit pädiatrischem sowie kinder- und jugendpsychiatrischem bzw. psychosomatischem Fachpersonal, eingerichtet. Es zeigt sich, dass die Implementierung der Sprechstunde, trotz eines hohen organisatorischen Aufwands, funktioniert und regelmäßig in Anspruch genommen wird. Erste Evaluationsergebnisse bestätigen die vorbeschriebenen hohen psychosozialen Belastungswerte der Familien. Sie deuten auf eine positive Bewertung der Sprechstunde und einen Wunsch nach dauerhaftem Angebot bei den betroffenen Familien hin. Erste Verlaufsergebnisse weisen auf eine signifikante Abnahme behandlungsbezogener Sorge sowie Verunsicherung und eine Reduktion behandlungsbezogener Probleme hin. Das Fehlen eines tragfähigen Finanzierungsmodells stellt für die dauerhaften Implementierung eine Herausforderung dar.

Frühe Gewalterfahrungen können schwerwiegende und lang anhaltende Auswirkungen auf die direkt Betroffenen, aber auch auf die nächste Generation haben. Anhand vorliegender Daten unserer Untersuchungen von Heidelberger und Berliner Mutter-Kind-Dyaden konnten wir zeigen, dass frühe Gewalterfahrungen zu Veränderungen auf behavioraler, hormoneller und neuronaler Ebene, einschließlich Persönlichkeitseigenschaften und Bindungsstil der betroffenen Frauen, führen, mit negativen Folgen für die Beziehung zu ihrem Kind. Die Kinder dieser Mütter mit frühen Gewalterfahrungen haben ein erhöhtes Risiko, misshandelt zu werden, in ihrer Entwicklung verzögert zu sein sowie eine psychische Störung zu entwickeln. Zudem weisen sie eine erhöhte Cortisolkonzentration und eine geringere Inhibitionskontrolle auf. Dabei spielt es eine Rolle, ob die Mutter frühe Gewalterfahrungen erlebt hat, selbst aber resilient ist, d. h. (bis zum Untersuchungszeitpunkt) keine psychische Störung entwickelt hat, oder ob sie zusätzlich zu den erlebten frühen Gewalterfahrungen auch eine psychische Störung entwickelt hat. Die Kinder von Müttern mit frühen Gewalterfahrungen und einer psychischen Störung scheinen in der Elternschaft besonders großem Stress ausgesetzt zu sein und weisen die schwersten Beeinträchtigungen und Risiken auf. Basierend auf den vorliegenden Ergebnissen werden Implikationen für die Praxis diskutiert und eine mögliche Intervention in Form eines Elterntrainings zur Stärkung der Mentalisierungsfähigkeit dargestellt.

Externalizing behavior problems are related to social maladjustment. Evidence indicates associations between prenatal stress and child behavioral outcomes. It remains unclear how psychological distress vs. biological correlates of stress (cortisol) differentially predict externalizing behavior, and how their effects might differ as a function of child sex. 108 pregnant women from the community collected salivary cortisol and reported their perceived stress during each trimester of pregnancy. At child age 9 years (M = 9.01, SD = 0.55), 70 mothers and children reported on child behavior. Structural equation modelling was used to analyze how cortisol levels and perceived stress during pregnancy predicted current child externalizing behavior, considering the moderating effect of child sex. Perceived stress predicted higher externalizing behavior in boys (β = 0.42, p = 0.009) and lower externalizing behavior in girls (β = − 0.56, p = 0.014). Cortisol predicted lower externalizing behavior in boys (β = − 0.81, p < .001) and was not related to girls’ externalizing behavior (β = 0.37, p = 0.200). Prenatal stress affected externalizing behavior differently in girls vs. boys. These response patters in turn differed for indicators of psychological vs. biological maternal stress, encouraging an integrated approach. Findings indicate that perceived stress and cortisol may affect child development via different trajectories.

In a previous study we have shown that the response of perifused pineal glands to calcium was different according to the circadian stage at which the glands were removed. This difference may be explained by circadian changes in calcium channel function. Therefore in the present study we documented the effects of calcium channel blockers in perifused rat pineal glands removed in the middle of the light and dark spans (7 and 19 HALO (hours after light onset), in a L/D 12:12 regimen). Moreover, we have studied the effect of calcium channel blockers on adrenergically stimulated pineal glands removed 7 HALO. Inorganic (Co2+ and Cd2+) and organic (nifedipine and diltiazem) calcium channel blockers at 10(-4) mol/l all significantly reduced melatonin production and this inhibition was more effective with the glands removed 7 HALO. In a concentration of 10(-)5 mol/l, only Cd2+ and diltiazem reduced melatonin production significantly in pineal glands removed 7 HALO. Verapamil at 10(-4) and 10(-5) mol/l showed no significant effect on melatonin production in glands removed both during the light and dark spans. Mn2+ at 10(-4) mol/l (but not at 10[-5] mol/l) appeared to stimulate melatonin production in glands removed both during the light and the dark (significant increase only with glands removed during the dark). Cobalt showed an immediate short inhibitory effect on both isoproterenol and norepinephrine-stimulated melatonin release, whereas nifedipine showed a significant inhibition only on isoproterenol-stimulated melatonin release. These results strongly suggest a circadian stage dependence of the pineal gland response to some calcium channel blockers and the involvement of calcium in the release of melatonin from pinealocytes.

PURPOSE:Bullying and problematic Internet gaming (PIG) are two concerning phenomena among adolescents. Research suggests an association between them; however, longitudinal studies are scarce. Therefore, this study examined whether traditional and cybervictimization are prospective risk factors for PIG and how gender, school type, and age influence these relationships. METHODS:Adolescents (grades 5-13; N = 4,390) answered two surveys one year apart which were linked by individual codes. They were classified as "victims" based on the Olweus Bullying Questionnaire-Revised. Changes in PIG (T2-T1) were computed based on nine items reflecting the diagnostic criteria for DSM-5 Internet Gaming Disorder. RESULTS:Traditional and cybervictimization independently predicted changes in PIG. The emergence of traditional victimization only, cybervictimization only, and particularly, both forms of victimization simultaneously, was associated with an increase in PIG. A decrease in PIG was only found if victimization terminated in both contexts. Further, an additive effect was found if traditional victimization newly extended to cyberspace. For boys and B-level students, the emergence of traditional victimization was associated with a larger increase in PIG than for girls and A-level students, when compared to the absence of traditional victimization. For boys, this also applied for cybervictimization. DISCUSSION:The emergence of bullying victimization in either an offline or online context appears to be a risk factor for PIG. Importantly, victimization must be stopped in both contexts for a decrease in PIG. Therefore, prevention programs need to focus on bullying offline as well as online to counter PIG. Efforts should especially focus on boys and B-level students.

Introduction: The "Cutting Down Programme" (CDP), a brief psychotherapeutic intervention for treating nonsuicidal self-injury (NSSI) in adolescents, was comparable to high-quality treatment as usual (TAU) in a previous randomized controlled trial (RCT). Objective: The aim of the study was to evaluate the long-term outcomes of the CDP over up to 4 years. Methods: Assessments of NSSI, suicide attempts, borderline personality disorder (BPD), depression, and quality of life took place 2 to 4 years (T3) after enrollment in a RCT. The evolution of NSSI, suicide attempts, depression, and quality of life was analyzed using (generalized) linear mixed-effects models. Ordered logistic regression was used for analyzing BPD diagnoses. Data from T0, T2, and T3 are reported. Results: Out of 74 patients, 70 (95%) were included in the T3 assessment. The frequency of NSSI events alongside with suicide attempts and depression further decreased between T2 and T3 and BPD between T0 and T3 in both groups. Quality of life remained stable in both groups between T2 and T3. Both groups received substantial but comparable additional treatment between T2 and T3. More treatment sessions during the follow-up period were linked to larger improvements of NSSI. Conclusions: The CDP was found to be as effective as TAU in promoting recovery from NSSI and comorbid symptoms in the long term. Results suggest that treatment effects from a brief psychotherapeutic intervention may endure and even further improve after completion of the program. However, additional treatment seems to improve chances for recovery independent from CDP versus TAU.

For families of chronically ill children with a high level of psychosocial stress, it is necessary to involve child and adolescent psychiatric or psychosomatic specialists directly in the pediatric treatment process. For this purpose, a family consultation was set up in the Heidelberg University Pediatrics as part of a model project, which deals with these families in an interdisciplinary and systemic way. It shows that the implementation of the consultation works despite a high organizational effort and is regularly used. The first evaluation results confirm the already described high levels of psychosocial stress in the affected families. They indicate a positive assessment of the consultation and a desire for a permanent offer. First follow-up results indicate a significant decrease in treatment-related concerns, uncertainty and a reduction in treatment-related problems. The lack of a viable funding model poses a challenge for long-term implementation.

Introduction: Recently, acceptance- and commitment therapy (ACT) gained increasing interest. Studies show good efficacy in the treatment of patients presenting with several psychologic and somatic complaints. The present systematic review and meta-analysis addresses effectiveness of ACT-based interventions to reduce stress in children, adolescents, and young adults compared to control conditions. Methods: The meta-analysis was pre-registered at PROSPERO (CRD42019117440). Randomized controlled trials (RCTs) and quasi-randomized controlled trials (qRCT) in German or English language comparing the effects of ACT-based interventions to control conditions (e.g., treatment as usual, waitlist control) on stress-related outcome measures in youth were considered for inclusion. The target population was subjects 0-18 years of age. The databases PubMed, PsychInfo, Cochrane Database, CINAHL, and Web of Science were searched systematically up to July 2023. A random effect meta-analysis and a risk of bias assessment according to the procedure outlined in the Cochrane Handbook of Systematic Reviews were conducted. Results: The search resulted in 187 studies, of which eight studies with 976 participants were finally subjected to meta-analysis. Studies implemented ACT both in school-based group settings and in single settings and both as a universal and indicated prevention. Analyses yielded a significant main effect (Hedges' g = -0.20; 95% confidence interval [-0.36; -0.05]), indicating that interventions based on ACT resulted in greater reduction of stress compared to control conditions. Conclusion: ACT appears effective at reducing stress in youth. Further research is needed due to methodological shortcomings of existing studies. Small sample sizes, heterogenous studies, methodological shortcomings, and evidence of publication bias limit the conclusions that can be drawn from this meta-analysis.