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Psychodynamic therapy for adolescents suffering from co-morbid disorders of conduct and emotions in an in-patient setting: a randomized controlled trial

Published online by Cambridge University Press:  12 November 2013

S. Salzer ,
C. Cropp ,
U. Jaeger ,
O. Masuhr  and
A. Streeck-Fischer
S. Salzer*
Affiliation:
Clinic of Psychosomatic Medicine and Psychotherapy, University of Goettingen, Germany
C. Cropp
Affiliation:
Asklepios Clinic Tiefenbrunn, Rosdorf, Germany
U. Jaeger
Affiliation:
Asklepios Clinic Tiefenbrunn, Rosdorf, Germany
O. Masuhr
Affiliation:
Asklepios Clinic Tiefenbrunn, Rosdorf, Germany
A. Streeck-Fischer
Affiliation:
Asklepios Clinic Tiefenbrunn, Rosdorf, Germany International Psychoanalytic University (IPU) Berlin, Germany
*
* Address for correspondence: S. Salzer, D.Sc., Clinic of Psychosomatic Medicine and Psychotherapy, Georg-August University of Goettingen, von-Siebold-Str. 5, 37075 Goettingen, Germany. (Email: ssalzer@gwdg.de)
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Abstract

Background

Co-morbid disorders of conduct and emotions can be regarded as childhood antecedents of further negative developments (e.g. manifestation of personality disorders in adulthood). We evaluated a manualized psychodynamic therapy (PDT) for adolescents with these co-morbid disorders.

Method

In a randomized controlled trial (RCT), 66 adolescents diagnosed with mixed disorders of conduct and emotions (F92 in ICD-10) were randomly assigned to a manualized in-patient PDT group or a waiting list/treatment-as-usual (WL/TAU) control condition. Diagnoses according to DSM-IV were also documented. Patients were compared using rates of remission as the primary outcome. The Global Severity Index (GSI) and the Strengths and Difficulties Questionnaire (SDQ) were used as secondary measures. Assessments were performed at baseline, post-treatment and at the 6-month follow-up.

Results

The sample consisted of severely impaired adolescents with high rates of further co-morbid disorders and academic failure. Patients in the treatment group had a significantly higher rate of remission [odds ratio (OR) 26.41, 95% confidence interval (CI) 6.42–108.55, p < 0.001]. Compared with the control group, the PDT group resulted in significantly better outcomes on the SDQ (p = 0.04) but not the GSI (p = 0.18), with small between-group effect sizes (SDQ: d = 0.38, GSI: d = 0.18). However, the scores of patients treated with PDT were post-treatment no longer significantly different from normative data on the GSI and within the normal range on the SDQ. The effects in the treatment group were stable at follow-up. Furthermore, most patients were reintegrated into educational processes.

Conclusion

PDT led to remarkable improvement and furthered necessary preconditions for long-term stabilization. In future, PDT should be compared to other strong active treatments.

Keywords

Adolescentsconduct disorderin-patient treatmentpsychodynamic therapyrandomized controlled trial
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 10 , July 2014 , pp. 2213 - 2222
Copyright
Copyright © Cambridge University Press 2013 

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