Background: More knowledge about characteristics of children and adolescents who need intensive levels of psychiatric treatment is important to improve treatment approaches. These characteristics were investigated in those who need youth Assertive Community Treatment (youth-ACT). Method: A cross-sectional study among children/adolescents and their parents treated in either a regular outpatient clinic or a youth-ACT setting in a specialized mental health treatment center in the Netherlands. Results: Child, parent and family/social context factors were associated with treatment intensification from regular outpatient care to youth-ACT. The combination of the child, parent, and family/social context factors adds substantially to the predictive power of the model (Nagelkerke R2 increasing from 36 to 45% for the three domains separately, to 61% when all domains are combined). The strongest predictors are the severity of psychiatric disorders of the child, parental stress, and domestic violence. Conclusions: Using a wide variety of variables that are potentially associated with treatment intensification from regular outpatient clinic to youth-ACT, we constructed a regression model illustrating a relatively strong relation between the predictor variables and the outcome (Nagelkerke R2 = 0.61), with three strong predictors, i.e. severity of psychiatric disorders of the child, parental stress, and domestic violence. This emphasizes the importance of a system-oriented approach with primary attention for problem solving and stress reduction within the system, in addition to the psychiatric treatment of the child, and possibly also the parents. Auteurs: Vijverberg, R., Ferdinand, R., Beekman, A., & van Meijel B.
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"A proportion of those with eating disorders have also experienced traumatic events and ongoing symptoms of PTSD such as re-experiencing of the trauma and nightmares. We implemented an innovative trauma intervention called Imagery Rescripting (ImRs) to explore whether for those undergoing inpatient treatment for an eating disorder (in an underweight phase), it would be possible to treat the various trauma-related symptoms as well as the eating problems. Since this has not been investigated before, we asked the participants in this study to recount their experiences. Twelve participants who were underweight, reported a past history of trauma and were in an inpatient eating disordertreatment program participated in ImRs therapy intervention. One of these participant did not engage in the ImRs therapy because she discontinued the inpatient ED treatment. Analysis of interviews with these participants found that -although they were reluctant before the start of the treatment- the ImRs treatment during their inpatient admission had given them hope again. They added that it was important to have support from group members, sociotherapists and therapists. They shared a number of ways that the ImRs treatment could be adapted to people with eating disorders. Their experiences indicated that given these factors it was possible to treat PTSD during an underweight phase. This is important: until now, treatment for eating disorders has not specifically been trauma-focused and these tips have scope to improve the ImRs intervention and eating disorder treatment more broadly in the future."
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BACKGROUND: Although enhancing physical activity (PA) is important to improve physical and/or cognitive recovery, little is known about PA of patients admitted to an inpatient rehabilitation setting. Therefore, this study assessed the quantity, nature and context of inpatients PA admitted to a rehabilitation center. METHODOLOGY/PRINICIPAL FINDINGS: Prospective observational study using accelerometry & behavioral mapping. PA of patients admitted to inpatient rehabilitation was measured during one day between 7.00-22.00 by means of 3d-accelerometery (Activ8; percentage of sedentary/active time, number of sedentary/active bouts (continuous period of ≥1 minute), and active/sedentary bout lengths and behavioral mapping. Behavioral mapping consisted of observations (every 20 minutes) to assess: type of activity, body position, social context and physical location. Descriptive statistics were used to describe PA on group and individual level. At median the 15 patients spent 81% (IQR 74%-85%) being sedentary. Patients were most sedentary in the evening (maximum sedentary bout length minutes of 69 (IQR 54-95)). During 54% (IQR 50%-61%) of the observations patients were alone) and in their room (median 50% (IQR 45%-59%)), but individual patterns varied widely. CONCLUSION/SIGNIFICANCE: The results of this study enable a deeper understanding of the daily PA patterns of patients admitted for inpatient rehabilitation treatment. PA patterns of patients differ in both quantity, day structure, social and environmental contexts. This supports the need for individualized strategies to support PA behavior during inpatient rehabilitation treatment.
