Depressive Jugendliche in stationärer Behandlung

Aims

The aims of the study were to present the indications for inpatient treatment of depressive diseases in adolescents, to show therapy concepts and to present the results of the evaluation of basis documentation over a 5-year period based on the situation in a psychiatric care hospital for children and adolescents.

Materials and methods

The basis documentation (BADO) over the 5-year period from 2003 to 2007 was evaluated according to age distribution, frequency of ICD-10 diagnoses, including comorbidities and risk stratification, and the therapeutic measures taken. The representative sample included 6,772 patients including 5,424 outpatients, 1,107 inpatients and 218 patients who were partly treated in hospital. The inpatients were mostly adolescents. The other 23 patients who were only seen in an advisory capacity were not considered further.

Results

The aims of treatment and motivation for inpatient treatment are compiled in an outpatient setting. Emergency admissions comprise almost 50% of admissions in adolescents. If an acute danger, such as suicidal tendency, exists it is necessary for the admission to clarify the legal aspects with the parents and also with the juvenile patient when possible. Symptoms of depression are present in almost every second patient and the reaction to multiple forms of stress is the main factor particularly in juveniles. Risk burdens are in particular psychiatric diseases of the parents and chronic conflict situations which can be aggravated by comorbid diseases of the juveniles, such as attention deficit hyperactivity syndrome (ADHS), anorexia, bulimia or obsessive-compulsive disorders. Severe functional limitations in several areas, such as school, profession, family and leisure are present in 65% of the patients. The diverse options for relationships within a multiprofessional, integrative treatment setting in a group of patients of the same age results in a rapid relief of the burden. This gives the patients and their parents the time and possibility to develop trust. Only approximately one-third of the 711 patients with symptoms of depression received medication therapy. The aim of relief is a prepared and when necessary accompanied transition to the familar situation or a new planned perspective in the inpatient treatment. For every second patient the treatment is continued further with measures by the youth welfare department and outpatient psychotherapy.

Discussion

Inpatient admission of juveniles with depression often rapidly leads to an initial relief and within a short time opens many chances for changes. Continuing risk factors and burdens explain the high risk of relapse and the high danger of chronification.     

Evaluation of a new Internet-based self-help guide for patients with bulimic symptoms in Sweden

The current study evaluated a new Internet-based self-help guide based on cognitive-behavioural therapy for patients with bulimic symptoms. Thirty-eight participants from a waiting list at an eating-disorder outpatient unit were assessed pre-treatment, post-treatment and at a 2-month follow-up using the Rating of Anorexia and Bulimia interview-revised version, an anamnesis questionnaire, the Eating Disorder Inventory-2 (EDI-2) and Symptom Check List-90-Revised (SCL-90R). The SCL-90R Global Severity Index and most EDI-2 subscales showed significant differences from pre-to post-treatment and the 2-month follow-up, apart from ineffectiveness, impulse regulation and social insecurity. Expert ratings revealed a significant reduction in vomiting, dietary restraints and weight phobia, with the exception of binge eating from pre-treatment to the 2-month follow-up. Exercise increased significantly, indicating that participants changed their method of compensation. An Internet-based self-help guide for bulimic symptoms is a promising new tool and can be used effectively as the first step in a stepped-care model. Further evaluations with randomized controlled trials are necessary.     

Prevention of substance use among adolescents through social and emotional training in school: A latent-class analysis of a five-year intervention in Sweden

The study considers the impact of a program for social and emotional learning in Swedish schools on use of drugs, volatile substances, alcohol and tobacco. The program was evaluated in an effectiveness study. Intervention students were compared longitudinally with non-intervention students using nonparametric latent class analysis to identify subgroups of students with similar use levels and trajectories. Statistically significant intervention-by-duration interactions, with medium to large effect sizes to the advantage of the SET students were found for all substances in one or more, but not all, of the latent classes. Favorable trajectories were found for non-users/light users of drugs, moderate sniffers, non-users/light users of alcohol, and occasional smokers. Only among heavy smokers was there a possible iatrogenic effect of SET. Such programs, given a duration of two years or more, may dampen increases in use with age and discourage early debut, although they are not specifically targeted at use itself.     

Resultate der postoperativen Röntgenbestrahlung der Mammakarzinome

Ohne Zusammenfassung     

Allergic rhinoconjunctivitis, eczema, and sensitization in two areas with differing climates

In this 5-year follow-up study we compared the prevalence of allergic rhinoconjunctivitis, eczema, and sensitization, in relation to several background factors, in two Swedish regions (Göteborg and Kiruna). In Göteborg, a city on the southwest coast, the climate is mild and humid. Kiruna is a town north of the Arctic Circle. Questionnaire replies and results of interviews were collected from all 412 7–8-year-old children of a population-based sample (203 in Göteborg and 209 in Kiruna); in addition, 192 children from Göteborg and 205 from Kiruna were skin-prick tested for sensitization to common aero-allergens. After 5 years, at 12–13 years of age, almost all of the initial study cohort were re-investigated. At follow-up the prevalence of allergic rhinoconjunctivitis was 17%, eczema 23%, and sensitization 32%. Allergic rhinoconjunctivitis and eczema were as common in Göteborg as in Kiruna, whereas sensitization was far more common in Kiruna. Children born during the pollen season had allergic rhinoconjunctivitis less often – and were sensitized to pollen and animal protein less often – than those born during the rest of the year. Sensitization to birch pollen, cat protein, and horse protein was less common in children living in Göteborg, the region with the highest frequency of cat ownership and horseback riding, and with the longest birch-pollen season. The girls were more commonly horseback riders but the boys were more often sensitized to horses. The results reinforce our previous findings: indoor climate may affect the development of sensitization and allergic diseases, to some extent independently; and if exposure to antigen is unavoidable, high doses might be better than low doses.     

Problem-focused coping and satisfaction with activities of daily living in individuals with muscular dystrophy and postpolio syndrome.

The problems, problem-focused coping and satisfaction with activities of daily living in a total of 119 persons with muscular weakness are described. The study encompasses three groups: 33 persons with various types of muscular dystrophy, 46 with myotonic dystrophy and 40 with symptoms relating to the post-polio syndrome. A self-report instrument for Assessment of Problem-focused Coping (APC) was used. Most of the problems reported were connected with mobility and transportation and work, but the subjects used problem-focused coping relatively infrequently and few differences were found between the different groups or between the sexes. The most widely used problem-focused coping strategy was 'Devices and tricks'. The highest degree of satisfaction was noted for personal care and the lowest for mobility and transportation. The APC provides information about patients' evaluation of everyday situations, forming a complement to functional measurements in the field of rehabilitation.     

Guilt and shame – a semantic concept analysis of two concepts related to palliative care

Background: The theoretical viewpoint of the study was based on the fundamental motive in caring science, the suffering person and his/her health and life situation, which according to the philosophy of palliative care also includes the next of kin. The latter often wish to participate in the care of their loved ones and it is thus important for them to be able to make decisions that can generate a meaningful participation. Unfulfilled obligations or wrong decisions, concerning their dying relative, can result in experiences of guilt and shame in relation to the care of the loved one. A semantic concept analysis can provide a deeper understanding of these concepts and create a deeper insight into what the concepts mean for the individual. Aim: The aim of the study was to elucidate the meaning of and the distinction between the concepts of guilt and shame. Methods: Semantic concept analysis based on Koort and Eriksson. Findings: The findings show that guilt and shame are two separate concepts. Guilt contains meaning dimensions of being the cause of and sin. Shame contains meaning dimensions of something that gives rise to shame and ability to experience shame. The synonyms for each concept do not overlap each other. Conclusion: The semantic analysis creates an understanding of the concepts ontologically and provides a basis for theoretical, contextual and clinical understanding and development.