TY - JOUR A1 - Vloet, Timo D. A1 - Feteke, Stefanie A1 - Gerlach, Manfred A1 - Romanos, Marcel T1 - Das pharmakologische Management kinder- und jugendpsychiatrischer Notfälle : Evidenz und Qualitätssicherung JF - Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie N2 - Kinder- und jugendpsychiatrische Notfälle sind häufig und stellen die beteiligten Ärztinnen und Ärzte vor besondere Herausforderungen, da eine erhebliche Gefahr für die Patient_innen oder Dritte unter Anwendung möglichst wenig invasiver Mittel abzuwenden ist. In diesem Kontext werden neben haltgebenden, deeskalierenden und psychotherapeutischen Optionen häufig auch pharmakologische Interventionen eingesetzt. Da ein Mangel an systematisch erhobenen Daten besteht, findet die pharmakologische Notfallbehandlung in der Kinder- und Jugendpsychiatrie regelhaft im off-label-Bereich statt. Vor dem Hintergrund der komplexen klinischen und rechtlichen Anforderungen an die Ärztinnen und Ärzte werden im vorliegenden Artikel praxisrelevante Hinweise insbesondere zum pharmakologischen Management von in der Praxis häufig auftretenden kinder- und jugendpsychiatrischen Notfällen wie akuter Suizidalität, akut psychotischem Erleben, Delir und Bewusstseinsstörungen sowie akuter Intoxikation und Alkoholentzugssyndrom gegeben. Weiterhin werden Maßnahmen zur Qualitätssicherung und Arzneimittelsicherheit diskutiert. N2 - Emergencies in child and adolescent psychiatry are highly prevalent and often pose significant challenges to physicians, since substantial danger to the patient or others must be avoided through the application of largely moderate interventions. Besides using de-escalating strategies and exploiting psychotherapeutic options, the physician frequently employs psychopharmacological interventions. because of a lack of systematically assessed data, however, in emergencies in child and adolescent psychiatry most administrations of psychotropic drugs occur “off label.“ This review deduces practice-relevant recommendations for the pharmacological management of occurring child and adolescent emergencies such as acute suicidality, acute psychotic episodes, delirium, disorders of consciousness, acute intoxication, and alcohol withdrawal syndrome. We discuss the issue of quality and safety in pharmacological emergency strategies. T2 - The pharmacological management of emergencies in child and adolescent psychiatry KW - Psychiatrischer Notfall KW - Qualitätssicherung KW - Pharmakotherapie KW - Kinder und Jugendliche KW - TDM KW - psychiatric emergencies KW - quality assurance KW - pharmacotherapy KW - child and adolescent KW - TDM Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-280982 SN - 1422-4917 SN - 1664-2880 VL - 50 IS - 4 SP - 262-274 ER - TY - JOUR A1 - Buerger, Arne A1 - Vloet, Timo D. A1 - Haber, Lisa A1 - Geissler, Julia M. T1 - Third-wave interventions for eating disorders in adolescence - systematic review with meta-analysis JF - Borderline Personality Disorder and Emotion Dysregulation N2 - Context: Third-wave therapies have demonstrated efficacy as a treatment option for EDs in adulthood. Data on the suitability for EDs in adolescence are lacking. Objective: To estimate the efficacy of third-wave interventions to reduce ED symptoms in adolescents in randomized controlled trials (RCTs) and uncontrolled studies. Data sources: We systematically reviewed the databases PubMed (1976-January 2021), PsycINFO (1943-January 2021), and the Cochrane database (1995-January 2021) for English-language articles on third-wave therapies. References were screened for further publications of interest. Study selection: RCTs and pre-post studies without control group, comprising patients aged 11-21 years (mean age = 15.6 years) with an ED diagnosis (anorexia nervosa, bulimia nervosa, binge eating disorder, eating disorder not otherwise specified) investigating the efficacy of third-wave psychological interventions were included. Efficacy had to be evaluated according to the Eating Disorder Examination or Eating Disorder Examination-Questionnaire, the Eating Disorder Inventory-2, the Eating Disorder Inventory-3, or the Structured Interview for Anorexic and Bulimic Disorders for DSM-IV and ICD-10. The outcome assessed in the meta-analysis was the EDE total score. Data extraction: Independent extraction of data by two authors according to a pre-specified data extraction sheet and quality indicators. Data synthesis: We identified 1000 studies after removal of duplicates, assessed the full texts of 48 articles for eligibility, and included 12 studies with a total of 487 participants (female 97.3%/male 2.6%) in the qualitative synthesis and seven studies in the meta-analysis. Articles predominantly reported uncontrolled pre-post trials of low quality, with only two published RCTs. Treatments focused strongly on dialectical behaviour therapy (n = 11). We found moderate effects of third-wave therapies on EDE total score interview/questionnaire for all EDs (d = - 0.67; z = - 5.53; CI95% = - 0.83 to - 0.59). Descriptively, the effects appeared to be stronger in patients with BN and BED. Conclusion: At this stage, it is not feasible to draw conclusions regarding the efficacy of third-wave interventions for the treatment of EDs in adolescence due to the low quality of the empirical evidence. Since almost all of the identified studies used DBT, it is unfortunately not possible to assess other third-wave treatments' efficacy. KW - DBT KW - adolescence KW - eating disorders KW - third-wave psychotherapy KW - meta-analysis KW - review Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-260545 VL - 8 ER -