Bifokale Perspektive in der Arbeit mit Familien mit psychisch erkrankten Eltern

Zusammenfassung Hintergrund Psychisch erkrankte Eltern stellen einen Risikofaktor für die transgenerationale Weitergabe psychischer Störungen dar. In der Psychiatrie mit ihrem Fokus auf das Individuum werden Patient*innen nicht immer als Eltern erkannt. Ziel der Arbeit Entwicklung und Evaluation eines Trainings für medizinische Fachkräfte zur Unterstützung einer Familienorientierung in der Psychiatrie unter der Maßgabe einer bifokalen Perspektive, die den Indexpatienten und die Familie mit Schwerpunkt auf die Kinder im Blick behält, werden vorgestellt. Methoden Zur Etablierung der bifokalen Perspektive in Einstellungen, Wissen und Fertigkeiten wurde ein halbtägiges Training, bestehend aus einer Vorlesung und einem Seminar, entwickelt. Dieses wurde im Rahmen des Konsortiums Children of Mentally Ill Parents – Research-Network (CHIMPS-NET) an 7 Standorten in Deutschland in den dortigen Erwachsenen- sowie Kinder- und Jugendpsychiatrien durchgeführt. Der Bedarf wurde vor dem Training per Online-Fragebogen erfasst. Die Implementation wurde durch die qualitative Auswertung von Gedächtnisprotokollen der Trainerinnen begleitet. Ergebnisse und Diskussion Das Training konnte erfolgreich mit 120 Teilnehmenden durchgeführt werden, wobei das Ziel einer berufsgruppenübergreifenden Schulung des gesamten Personals, auch pandemiebedingt, nicht realisiert und die übenden Elemente des Trainings nicht gut genutzt werden konnten. Die Auswertung der Fragebogen, die ca. 50 % der Teilnehmenden ausfüllten, ergab bei der Gruppe der teilnehmenden Psychologinnen und Ärztinnen bereits eine deutliche Familienorientierung. Die qualitative Protokollauswertung aller Standorte zeigte den hohen Bedarf nach institutionsübergreifender Vernetzung und klaren Standardprozeduren, z. B. im Umgang mit Kindeswohlgefährdung.

Enabling Transdisciplinary Collaboration: Stakeholder Views on Working With “Children With Mentally Ill Parents” Research Groups

Working collaboratively and openly together with stakeholders has become a common phenomenon in research. While previous studies have gathered a clear picture on researchers' attitudes, motivations, and barriers for actively involving stakeholders in transdisciplinary research, the stakeholder perspective is yet unknown. Therefore, this paper sets out to identify how stakeholders perceive transdisciplinary collaborations with researchers. This paper in particular reveals the enablers and barriers for such collaborations from the viewpoint of stakeholders. To do so, we look at how stakeholders, who were actively involved in the governance structure of two “children with mentally ill parents” research groups in Austria, perceived their collaboration with researchers. We used a mixed-method, quantitative-qualitative design. We conducted an online survey and interviews with the members of the advisory board and competence group. These stakeholders reported great satisfaction with the transdisciplinary collaboration and emphasized the value of different expertise. As the most important enablers for successful, transdisciplinary collaboration stakeholders emphasized researchers' open-mindedness toward new perspectives and approaches, flexibility to adapt to the research process along the way, and creativity dealing with diverse backgrounds and skills. Stakeholders further underlined the importance of a person facilitating the collaboration process between researchers and stakeholders to resolve any tensions and insecurities. Concluding, researchers' attitudes, and in particular their understanding of the value of stakeholder involvement in research are key enablers for successful transdisciplinary research collaborations.

Associations of Family Functioning and Social Support With Psychopathology in Children of Mentally Ill Parents: Multilevel Analyses From Different Rating Perspectives

Offspring of mentally ill parents is at heightened risk for psychological symptoms. The identification of environmental factors that predict their mental health is crucial for the development of preventive and therapeutic measures. In the current study, we addressed the combined role of family functioning and social support by taking mentally ill patients’, their partners’, and children’s perspectives into account. The cross-sectional sample included n=195 families (195 patients, 127 partners, and 295 children). Family members completed questionnaires related to family functioning, social support as well as parental and child psychopathology. We conducted multilevel analyses to investigate the associations with internalizing and externalizing problems in children. Family functioning and social support were significantly associated with child internalizing and externalizing problems. However, results varied depending on the rating perspective. We found significant interaction effects of family functioning and social support on child psychopathology. The findings point to the importance of family functioning and social support as potential targets for interventions. Findings should be replicated in future longitudinal studies.

Evaluation of a Family-Based Intervention Program for Children of Mentally Ill Parents: Study Protocol for a Randomized Controlled Multicenter Trial

Background: Children of mentally ill parents have a three to seven times higher risk of developing mental disorders compared to the general population. For this high-risk group, specialized prevention and intervention programs have already been developed. However, there has been insufficient sytematic evaluation to date. Moreover, effectiveness and the cost-effectiveness data of the respective programs until today is very scarce and at the same time constitutes the pre-condition for the program's implementation into regular health care.Methods: The study consists of a two-group randomized controlled multicenter trial conducted at seven study sites throughout Germany and Switzerland. Participants are families with mentally ill parents and their children aged from 3 to 19 years. The intervention comprises 6 to 8 semi-structured sessions over a period of about 6 months. Topics discussed in the intervention include parental mental illness, coping, family relations and social support. Families in the control condition will receive treatment as usual. The children's mental health, assessed using the K-SADS-PL by blinded external raters will constitute the primary efficacy outcome. Further outcomes will be assessed from the parents' as well as from the children's perspectives. Participants are investigated at baseline, 6, 12, and 18 months after baseline assessment. In addition to the assessment of various psychosocial outcomes, a comprehensive health-economic evaluation will be performed.Discussion: This paper describes the evaluation of a family-based intervention program for children of mentally ill parents (CHIMPs) in the regular health care system in Germany and Switzerland. A methodically sophisticated study design has been developed to reflect the complexity of the actual health care situation. This trial will contribute to the regular health care for the high-risk group of children of mentally ill parents.Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT02308462; German Clinical Trials Register: DRKS00006806.

To casuistic progressive paralysis (several cases with acute and prolonged course)

Patient I. D b, tradesman, 50 years old, was delivered to the hospital on September 28, 1884 by his daughter. Anamnesis (from the daughter's words). Patient 50 years old, married 21 years old, has three children; his pedigree was not mentally ill; parents died in their advanced years. The patient himself always enjoyed good health until the last illness; In his youth he abused alcoholic beverages and, until the last day, was excessive in venere.

Childhood experiences pursue adulthood for better and worse: a qualitative study of adults' experiences after growing up with a severely mentally ill parent in a small-scale society

Background Growing up with a severely mentally ill parent can impact on subsequent adult life, and it can be extra challenging in a society with a small population, known as a small-scale society. Life in a small-scale society is characterised by multiple close relationships, lack of anonymity and a conservative attitude towards normal behaviour. Aims To look at the impact of growing up with a mentally ill parent on adult life in a small-scale society. Methods Data from semistructured interviews with 11 adult children of severely mentally ill parents were reanalysed and subjected to secondary analysis. Results The additional analysis resulted in four central themes: ‘becoming open and courageous’, ‘seeking and giving help’, ‘feeling uncertain and different’ and ‘being resilient and sensitive’. These were conflated into an overarching theme: ‘childhood experiences track into adulthood for better and worse’. The themes elucidate a diverse big picture and encompass positive and challenging features of adult life in a small-scale society. Conclusions The study ends with recommendations for the early establishment of collaboration and family-focused interventions with mentally ill parents and their children.

Family Functioning and Psychological Health of Children with Mentally Ill Parents

Parental mental illness can be linked to reduced family functioning, which is associated with more conflicts, less adaptability and cohesion as well as a disorganized pattern of everyday planning. Concurrently, family functioning is an important moderator for the influence of parental mental disorders on the development of the children. Consequently, the current study addresses the correlation of family functioning in families with mentally ill parents and the psychological health of the children. The sample consists of 67 mentally ill parents. Both parents and therapists completed questionnaires related to family functioning and the psychological health of the children. Family functioning was rated as dysfunctional in 38% of the families. The psychological health of the children was classified as clinical or subclinical in 43% of the cases. 52% of the children were rated to have no psychological problems. In families with good family functioning, children were assessed to have less psychological problems than in families with poor functioning. Children outside the clinical range lived in families with good family functioning and vice versa. Significant positive correlations were found between the FB-A scales, the CBCL/4-18 syndrome scales and the CBCL/4–18 total score. Results indicate that family functioning and psychological health of children in families with mentally ill parents correlate closely and represent potential targets for future family interventions.