TY - JOUR A1 - Leopold, Karolina A1 - Bauer, Michael A1 - Bechdolf, Andreas A1 - Correll, Christoph U. A1 - Holtmann, Martin A1 - Juckel, Georg A1 - Lambert, Martin A1 - Meyer, Thomas D. A1 - Pfeiffer, Steffi A1 - Kittel‐Schneider, Sarah A1 - Reif, Andreas A1 - Stamm, Thomas J. A1 - Rottmann‐Wolf, Maren A1 - Mathiebe, Josephine A1 - Kellmann, Eva L. A1 - Ritter, Philipp A1 - Krüger‐Özgürdal, Seza A1 - Karow, Anne A1 - Sondergeld, Lene‐Marie A1 - Roessner, Veit A1 - Sauer, Cathrin A1 - Pfennig, Andrea T1 - Efficacy of cognitive‐behavioral group therapy in patients at risk for serious mental illness presenting with subthreshold bipolar symptoms: Results from a prespecified interim analysis of a multicenter, randomized, controlled study JF - Bipolar Disorders N2 - Objective Most patients with bipolar disorders (BD) exhibit prodromal symptoms before a first (hypo)manic episode. Patients with clinically significant symptoms fulfilling at‐risk criteria for serious mental illness (SMI) require effective and safe treatment. Cognitive‐behavioral psychotherapy (CBT) has shown promising results in early stages of BD and in patients at high risk for psychosis. We aimed to investigate whether group CBT can improve symptoms and functional deficits in young patients at risk for SMI presenting with subthreshold bipolar symptoms. Method In a multicenter, randomized, controlled trial, patients at clinical risk for SMI presenting with subthreshold bipolar symptoms aged 15‐30 years were randomized to 14 weeks of at‐risk for BD‐specific group CBT or unstructured group meetings. Primary efficacy endpoints were differences in affective symptomatology and psychosocial functioning at 14 weeks. At‐risk status was defined as a combination of subthreshold bipolar symptomatology, reduction of psychosocial functioning and a family history for (schizo)affective disorders. A prespecified interim analysis was conducted at 75% of the targeted sample. Results Of 128 screened participants, 75 were randomized to group CBT (n = 38, completers = 65.8%) vs unstructured group meetings (n = 37, completers = 78.4%). Affective symptomatology and psychosocial functioning improved significantly at week 14 (P < .001) and during 6 months (P < .001) in both groups, without significant between‐group differences. Findings are limited by the interim character of the analysis, the use of not fully validated early detection interviews, a newly adapted intervention manual, and the substantial drop‐outs. Conclusions Results suggest that young patients at‐risk for SMI presenting with subthreshold bipolar symptoms benefit from early group sessions. The degree of specificity and psychotherapeutic interaction needed requires clarification. KW - at‐risk KW - bipolar disorder KW - CBT KW - early intervention KW - group treatment KW - prodromal KW - serious mental illness KW - subthreshold bipolar Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-215469 VL - 22 IS - 5 SP - 517 EP - 529 ER - TY - JOUR A1 - Pfennig, Andrea A1 - Leopold, Karolina A1 - Bechdolf, Andreas A1 - Correll, Christoph U. A1 - Holtmann, Martin A1 - Lambert, Martin A1 - Marx, Carolin A1 - Meyer, Thomas D. A1 - Pfeiffer, Steffi A1 - Reif, Andreas A1 - Rottmann-Wolf, Maren A1 - Schmitt, Natalie M. A1 - Stamm, Thomas A1 - Juckel, Georg A1 - Bauer, Michael T1 - Early specific cognitive-behavioural psychotherapy in subjects at high risk for bipolar disorders: study protocol for a randomised controlled trial JF - TRIALS N2 - Background: Bipolar disorders (BD) are among the most severe mental disorders with first clinical signs and symptoms frequently appearing in adolescence and early adulthood. The long latency in clinical diagnosis (and subsequent adequate treatment) adversely affects the course of disease, effectiveness of interventions and health-related quality of life, and increases the economic burden of BD. Despite uncertainties about risk constellations and symptomatology in the early stages of potentially developing BD, many adolescents and young adults seek help, and most of them suffer substantially from symptoms already leading to impairments in psychosocial functioning in school, training, at work and in their social relationships. We aimed to identify subjects at risk of developing BD and investigate the efficacy and safety of early specific cognitive-behavioural psychotherapy (CBT) in this subpopulation. Methods/Design: EarlyCBT is a randomised controlled multi-centre clinical trial to evaluate the efficacy and safety of early specific CBT, including stress management and problem solving strategies, with elements of mindfulness-based therapy (MBT) versus unstructured group meetings for 14 weeks each and follow-up until week 78. Participants are recruited at seven university hospitals throughout Germany, which provide in-and outpatient care (including early recognition centres) for psychiatric patients. Subjects at high risk must be 15 to 30 years old and meet the combination of specified affective symptomatology, reduction of psychosocial functioning, and family history for (schizo) affective disorders. Primary efficacy endpoints are differences in psychosocial functioning and defined affective symptomatology at 14 weeks between groups. Secondary endpoints include the above mentioned endpoints at 7, 24, 52 and 78 weeks and the change within groups compared to baseline; perception of, reaction to and coping with stress; and conversion to full BD. Discussion: To our knowledge, this is the first study to evaluate early specific CBT in subjects at high risk for BD. Structured diagnostic interviews are used to map the risk status and development of disease. With our study, the level of evidence for the treatment of those young patients will be significantly raised. KW - cognitive-behavioural psychotherapy KW - bipolar disorders KW - early recognition KW - intervention study KW - of-the-literature KW - ultra-high risk KW - spectrum disorder KW - early intervention KW - rating scale Y1 - 2014 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-116279 SN - 1468-6694 SN - 1745-6215 VL - 15 IS - 161 ER - TY - THES A1 - Ko, Chiou-Shiue T1 - Die institutionelle Frühförderung in Deutschland und in Taiwan im Vergleich T1 - A comparison of early intervention between Germany and Taiwan N2 - Durch die Bestrebungen und mit der Unterstützung von Fachleuten und Wissenschaftlern wurde das Frühfördersystem in Taiwan mittels der Verankerung des Kinderwohlfahrtsgesetzes 1993 Schritt für Schritt geplant und aufgebaut, wobei die Entwicklung schnell voran ging und geht. Obwohl bei der Arbeit mit Kindern mit Entwicklungsgefährdungen und -verzögerungen durchaus viele Erfolge zu verzeichnen sind, müssen weitere Schwierigkeiten und Hindernisse überwunden werden. Um dieses Frühfördersystem zu stärken und vervollkommnen, beschäftigen sich viele Fachleute und Wissenschaftler mit der Sammlung und Analyse ausländischer Erfahrungen. Sie versuchen, mögliche Potenziale für das eigene System zu finden und diese zu integrieren. In dieser Arbeit werden erstmals die Frühfördersysteme in Deutschland und in Taiwan verglichen. Die Forschungsarbeit beabsichtigt, die Frühfördersysteme in Deutschland und in Taiwan durch den Vergleich zu reflektieren und daraus Folgerungen für die quantitative und qualitative Weiterentwicklung des Frühfördersystems in Taiwan abzuleiten. Die Intention soll sein, das Frühfördersystem in Taiwan mittels der Erfahrungen aus dem Ausland (i.d.F. Deutschland) projektiv zu verbessern und zu optimieren. Nach dem 1. Kapitel, der Einführung in die Fragestellung, die Zielsetzung und die Methode der Arbeit, werden im 2. Kapitel die Probleme und Potenziale der vergleichenden Sonderpädagogik dargestellt und die Forschungsmethodologie, die dieser Arbeit zugrunde liegt, vorgestellt. Das 3. Kapitel beinhaltet die Darstellung und Analyse des Frühfördersystems in Deutschland (Ziele and Prinzipien der Frühförderung, Aufbau und Organisation der Frühförderung, Aufgabenbereiche und Unterstützungsstrukturen in der Frühförderung, Familienorientierung, Finanzierung und gesetzliche Grundlagen, Evaluationsforschung, Entwicklungstendenzen, Problematiken und Perspektiven einer künftigen Frühförderung). Im 4. Kapitel wird analog zum 3. Kapitel das Frühfördersystem in Taiwan skizziert. Das 5. Kapitel gibt zuerst einen Überblick über die Einbettung der Frühförderung in die unterschiedlichen Kulturellen und gesellschaftlichen Kontextdimensionen in Deutschland und in Taiwan. Anschließend werden die oben genannten Gesichtspunkte der beiden Frühfördersysteme verglichen. Darüber hinaus wird in diesem Kapitel versucht, Möglichkeiten und Grenzen der jeweiligen Systeme in Deutschland und in Taiwan auszuloten. Zum Schluss werden im 6. Kapitel Folgerungen zur quantitativen und qualitativen Weiterentwicklung in Taiwan (einige Vorschläge könnten sich evtl. auch auf Deutschland beziehen) abgeleitet. Die Verbesserungsmöglichkeiten reichen von der politisch-juristischen über die administrative bis zur institutionellen Ebene. Sie werden in folgende Aspekte unterteilt: (1) politisch-juristischer Rahmen; (2) administrative Kooperation und Koordination; (3) Aufgabenfelder der Frühförderung (Früherkennung, Meldung und Überweisung, Diagnostik, Therapie und Förderung, Übergang, familienbezogene psychosoziale Unterstützung); (4) Elternpartizipation; (5) Intra- und interinstitutionelle Kooperation und Koordination. N2 - The special education for children at preschool in Taiwan was for long neglected. It wasn’t until 1993 that the early intervention for the children with developmental delays was in “Child Welfare Law Rectified” enacted and has hence been valued. After this legislation, the system of early intervention was step-by-step planned and constructed through the efforts and promotions of child care relevant professionals and scholars, in which development was pushed rapidly ahead. Nevertheless, there are difficulties and obstacles in the development of the early intervention in Taiwan which must be overcome. For the first time, the systems of early intervention in Germany and in Taiwan are compared in this dissertation. The research intents that the system of early intervention in Taiwan can be projective improved and optimalized with the assistance of the experiences from Germany. After the introductive formation of the question and the objective of the dissertation in chapter one, the problems and the potentials of this comparative study with its method are portrayed in chapter two. The chapter three represents the description and analysis of the system of early intervention in Germany (objectives, principles, areas of responsibility, organization and structure of services, family orientation, financing and legislation on early intervention, evaluation, developmental tendencies, problems and perspectives of the future early intervention). In chapter four, the system of early intervention in Taiwan is depicted analogously to the chapter three. The chapter five gives at first a general view that the systems of early intervention in Germany and in Taiwan are embedded within the historical and cultural contexts of one’s own country. Then both of them will be compared with their possibilities and limits. Finally, feasible suggestions with regard to the quantitative and the qualitative development of the system of early intervention in Taiwan (a few crucial points referring to Germany) are offered in chapter six. They are divided in the following aspects: (1) political-legislative frame; (2) administrative cooperation and coordination; (3) areas of responsibility (early recognition, early registration, diagnosis, furthering and therapy, transition, family psychosocial support); (4) participation of parents; (5) intra- and interinstitutional cooperation and coordination. KW - Deutschland KW - Frühförderung KW - Taiwan KW - Vergleich KW - Frühförderung KW - Frühfördersysteme KW - Deutschland KW - Taiwan KW - early intervention KW - Germany KW - Taiwan Y1 - 2005 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-14160 ER -