Behandlung der posttraumatischen Belastungsstörung bei Kindern und Jugendlichen

Zusammenfassung

Auf der Basis einer systematischen Literaturrecherche wird der aktuelle Wissensstand zur Wirksamkeit psychotherapeutischer und pharmakotherapeutischer Behandlungsmethoden von posttraumatischen Belastungsstörungen im Kindes- und Jugendalter zusammengefasst und bewertet. Es konnten 19 kontrollierte und randomisierte klinische Studien zur Psychotherapie, jedoch keine zur Pharmakotherapie gefunden werden.

Die Wirksamkeit kognitiv-behavioraler Therapieprogramme ist inzwischen gut belegt, wobei die Einbeziehung eines Elternteils bzw. einer Pflegeperson in die Behandlung sich günstig auszuwirken scheint. Für Eye Movement Desensitization and Reprocessing (EMDR) und für multisystemische Familientherapie gibt es erste erfolgversprechende Studien, deren Ergebnisse allerdings wegen kleiner Fallzahlen und fehlender Replikation als vorläufig angesehen werden müssen. Kontrollierte klinische Studien zur Pharmakotherapie fehlen für das Kindes- und Jugendalter, sodass hierzu keinerlei gesicherte Erkenntnisse vorliegen. Zu fordern sind weitere klinische Studien an dieser zahlenmäßig relevanten und teilweise schwer beeinträchtigten Zielgruppe. Untersuchungen zur differenziellen Indikation verschiedener Therapieansätze und zur Wirksamkeit von Kombinationsbehandlungen, z.B. Psychotherapie plus Pharmakotherapie, stehen aus.

Summary

Based on a systematic literature search, the current state of knowledge on the efficacy of psychotherapeutic and pharmacologic treatment of posttraumatic stress disorders in children and adolescents is summarized and reviewed. Nineteen randomized controlled clinical trials were found for psychotherapy, and none for pharmacotherapy.

The efficacy of cognitive behavioral treatment programs has been substantiated, with the participation of a parent or caretaker in the treatment seeming to be beneficial. There are promising studies for Eye Movement Desensitization and Reprocessing (EMDR) and for Multisystemic Family Therapy. However, because of small sample sizes and lacking replication, their results have to be regarded as provisional. Up to now, there are no controlled clinical trials on pharmacological treatments for traumatized children and adolescents.

More studies on this numerically relevant and partly severely impaired group are to be claimed. Studies on differential indication of different treatment approaches and on the efficacy of combination treatments, as psychotherapy plus pharmacotherapy, are lacking.

Schlüsselwörter

Posttraumatische Belastungsstörung - Kinder und Jugendliche - Psychotherapie - Pharmakotherapie

Keywords

Posttraumatic stress disorder - children and adolescents - psychotherapy - pharmacotherapy

• Literatur

• 1 Ackerman P, Newton J, McPherson W, Jones J, Dykman R. Prevalence of post-traumatic stress disorder and other psychiatric diagnosis in three groups of abused children (sexual, physical, and both). Child Abuse Neglect 1998; 22: 759-74.
• 2 Cohen J. Practice parameters for the assessment and treatment of children and adolescents with posttraumatic stress disorder. J Am Acad Child Adolesc Psychiatry 1998; 37 (10 Suppl): 4S-26S.
• 3 Essau CA, Conradt J, Petermann F. Häufigkeit der Posttraumatischen Belastungsstörung bei Jugendlichen: Ergebnisse der Bremer Jugendstudie. Z Kinder- und Jugendpsychiatrie und Psychotherapie 1999; 27: 37-45.
• 4 Paolucci E, Odone, Genuis ML, Violato C. A meta-analysis of the published research on the effects of child sexual abuse. J Psychology 2001; 135: 17-36.
• 5 Putnam FW. Ten-year research update review: Child sexual abuse. J Am Acad Child Adolesc Psychiatry 2003; 42: 269-78.
• 6 Spataro J, Mullen PE, Burgess PM, Wells DL, Moss SA. Impact of child sexual abuse on mental health: Prospective study in males and females. Br J Psychiatry 2004; 184: 416-21.
• 7 Sachs-Ericsson N, Blazer D, Plant E, Arnow B. Childhood Sexual and Physical Abuse and the 1-Year Prevalence of Medical Problems in the National Comorbidity Survey. Health Psychology 2005; 24: 32-40.
• 8 De Bellis M, Thomas L. Biologic findings of posttraumatic stress disorder and child maltreatment. Current Psychiatry Reports 2003; 05 (02) 108-17.
• 9 Nemeroff C. Neurobiological consequences of childhood trauma. J Clin Psychiatry 2004; 65 (Suppl. 01) 18-28.
• 10 Perry B. The neurodevelopmental impact of violence in childhood. In: Schetky D, Benedek E. (eds). Textbook of child and adolescent forensic psychiatry. Washington, D.C: American Psychiatric Press, Inc; 2001: 221-38.
• 11 van der Kolk B. The neurobiology of childhood trauma and abuse. Child Adolesc Psychiatric Clinics North Am 2003; 12: 293-317.
• 12 Cohen J, Berliner L, Mannarino AP. Psychosocial and pharmacological interventions for child crime victims. J Traumatic Stress 2003; 16: 175-86.
• 13 Taylor TL, Chemtob CM. Efficacy of Treatment for Child and Adolescent Traumatic Stress. Arch Pediatr Adolesc Med 2004; 158: 786-91.
• 14 Cohen J, Mannarino AP. A treatment study for sexually abused preschool children: initial findings. J Am Acad Child Adolesc Psychiatry 1996; 35: 42-50.
• 15 Cohen J, Mannarino AP. Interventions for sexually abused children: initial treatment outcome findings. Child Maltreatment 1998; 03: 17-26.
• 16 Cohen J, Deblinger E, Mannarino AP, Steer RA. A multisite, randomized controlled trial for children with sexual abuse-related PTSD symptoms. J Am Acad Child Adolesc Psychiatry 2004; 43: 393-402.
• 17 Cohen J, Mannarino A, Knudsen K. Treating sexually abused children: 1 year follow-up of a randomized controlled trial. Child Abuse Neglect 2005; 29: 135-45.
• 18 Deblinger E, Lippmann J, Steer RA. Sexually abused children suffering posttraumatic stress symptoms: initial treatment outcome findings. Child Maltreatment 1996; 01: 310-21.
• 19 Deblinger E, Stauffer L, Steer RA. Comparative efficacies of supportive and cognitive behavioral group therapies for young children who have been sexually abused and their nonoffending mothers. Child Maltreatment 2001; 06: 332-43.
• 20 Jaberghaderi N, Greenwald R, Rubin A, Oliaee SZand, Dolatabadi S. A comparison of CBT and EMDR for sexually-abused Iranian girls. Clinical Psychology Psychother 2004; 11: 358-68.
• 21 King N, Tonge B, Mullen P, Myerson N, Heyne D, Rollings S. et al. Treating sexually abused children with posttraumatic stress symptoms: a randomized clinical trial. J Am Acad Child Adolesc Psychiatry 2000; 39: 1347-55.
• 22 Chemtob C, Nakashima J, Hamada R. Psychosocial intervention for postdisaster trauma symptoms in elementary school children: a controlled community field study. Arch Pediatr Adolesc Med 2002; 156: 211-6.
• 23 Kazak AE, Alderfer MA, Streisand R, Simms S, Rourke MT, Barakat LP. et al. Treatment of Posttraumatic Stress Symptoms in Adolescent Survivors of Childhood Cancer and Their Families: A Randomized Clinical Trial. J Family Psychology 2004; 18: 493-504.
• 24 Stein BD, Jaycox LH, Kataoka SH, Wong M, Tu W, Elliott MN. et al. A mental health intervention for schoolchildren exposed to violence: a randomized controlled trial. JAMA 2003; 290: 603-11.
• 25 Cohen J, Mannarino A, Deblinger E. Child and parent trauma-focused cognitive behavioral therapy treatment manual. 2003
• 26 Celano M, Hazzard A, Webb C, McCall C. Treatment of traumagenic beliefs among sexually abused girls and their mothers: an evaluation study. J Abnorm Child Psychol 1996; 24: 1-16.
• 27 Berliner L, Saunders B. Treating fear and anxiety in sexually abused children: results of a controlled two-year follow-up study. Child Maltreatment 1996; 01: 294-309.
• 28 Chemtob CM, Nakashima JP, Carlson JG. Brief treatment for elementary school children with disaster-related posttraumatic stress disorder: a field study. J Clin Psychology 2002; 58: 99-112.
• 29 Soberman G, Greenwald R, Rule D. A controlled study of eye movement desensitization and reprocessing (EMDR) for boys with conduct problems. Journal of Aggression, Maltreatment, and Trauma 2002; 06: 217-36.
• 30 Wolpe J. The practice of behavior therapy. 4 ed. Stanford, CA: Pergamon Press; 1991
• 31 Trowell J, Kolvin I, Weeramanthri T, Sadowski H, Berelowitz M, Glasser D. et al. Psychotherapy for sexually abused girls: psychopathological outcome findings and patterns of change. BrJ Psychiatry 2002; 160: 234-47.
• 32 Brunk MA, Henggeler SW, Whelan JP. Comparison of multisystemic therapy and parent training in the brief treatment of child abuse and neglect. Journal of Consulting and Clinical Psychology 1987; 55: 171-8.
• 33 Hyde C, Bentovim A, Monck E. Some clinical and methodological implications of a treatment outcome study of sexually abused children. Child Abuse and Neglect 1995; 19: 1387-99.
• 34 Fantuzzo J, Jurecic L, Stovall A, Hightower A, Goins C, Schachtel D. Effects of adult and peer social initiations on the social behavior of withdrawn, maltreated preschool children. Journal of Consulting and Clinical Psychology 1988; 56: 34-9.
• 35 Cohen JA. Pharmacologic Treatment of Traumatized Children. Trauma Violence Abuse 2001; 02: 155-71.
• 36 Fegert J, Herpertz-Dahlmann B. Editorial. Zum Einsatz von selektiven Serotoninwiederaufnahmehemmern (SSRI) bei depressiven Kindern und Jugendlichen. Z Kinder- und Jugendpsychiatrie und Psychotherapie 2004; 32: 74-5.
• 37 Asnis G, Kohn S, Henderson M, Brown N. SSRIs versus non-SSRIs in post-traumatic stress disorder: an update with recommendations. Drugs 2004; 64: 383-404.
• 38 Famularo R, Kinscherff R, Fenton T. Propranolol treatment for childhood post-traumatic stress disorder, acute type: a pilot study. Am J Dis Child 1988; 142: 1244-7.
• 39 Perry B. Neurobiological sequelae of childhood trauma: PTSD in children. In: Murburg M. (Hrsg). Catecholamine function in post-traumatic stress disorder: emerging concepts. Washington: American Psychiatric Press; 1994: 233-55.
• 40 Harmon R, Riggs P. Clinical perspectives: clonidine for posttraumatic stress disorder in preschool children. J Am Acad Child Adolesc Psychiatry 1996; 35: 1247-9.
• 41 Stein D, Zungu-Dirwyi N, van der Linden G, Seedat S. Pharmacotherapy for post traumatic stress disorder (PTSD). The Cochrane Library. Issue 4 2004
• 42 Seedat S, Stein DJ, Ziervogel C, Middleton T, Kaminer D, Emsley RA. et al. Comparison of response to a selective serotonin reuptake inhibitor in children, adolescents, and adults with posttraumatic stress disorder. J Child Adolesc Psychopharmacol 2002; 12: 37-46.
• 43 Vitiello B, Heiligenstein J, Riddle M, Greenhill L, JM F. The Interface Between Publicly Funded and Industry-Funded Research in Pediatric Psychopharmacology: Opportunities for Integration and Collaboration. Biological Psychiatry 2004; 56: 3-9.
• 44 Chambless D, Hollon S. Defining empirically supported therapies. J Consulting and Clinical Psychology 1998; 66: 7-18.
• 45 Kaminer D, Seedat S, Stein D. Post-traumatic stress disorder in children. WPA Section report. World Psychiatry 2005; 04: 121-5.
• 46 Cohen J, Mannarino AP. A treatment study of sexually abused preschool children: outcome during 1-year follow-up. J Am Acad Child Adolesc Psychiatry 1997; 36: 1228-35.
• 47 Deblinger E, Steer RA, Lippmann J. Two-year follow-up study of cognitive behavioral therapy for sexually abused children suffering post-traumatic stress symptoms. Child Abuse Negl 1999; 23: 1371-8.