Bright Light Therapy as Add-On to Inpatient Treatment in Youth With Moderate to Severe Depression: A Randomized Clinical Trial

Importance

Major depressive disorder is one of the most common mental disorders among adolescents, entailing severe, long-term psychosocial impairment and a high risk of chronicity. In view of the large number of patients requiring treatment, along with insufficient treatment responses with small effect sizes, innovative adjunctive treatment strategies are urgently needed.

Objective

To investigate whether the effect of adolescent psychiatric inpatient treatment as usual for major depressive disorder can be enhanced by simultaneous use of morning bright light therapy.

Design, Setting, and Participants

This was a double-blind, placebo-controlled randomized parallel-group trial with enrollment between March 2018 and November 2020 and follow-up completed in May 2021. The study took place among inpatients at 4 university hospitals for child and adolescent psychiatry across Germany. Of 248 eligible youth aged 12 to 18 years fulfilling ICD-10 criteria for major depressive disorder, 227 were randomized to bright light therapy (n = 116) or placebo red light (n = 111); 151 participants completed the study.

Interventions

Up to 20 sessions of either morning bright light therapy with an intensity of 10 000 lux or placebo red light (100 lux) in addition to multimodal inpatient treatment as usual over 4 weeks.

Main Outcomes and Measures

The primary outcome was the change in Beck Depression Inventory-II (BDI-II) score from baseline to posttreatment in the intention-to-treat sample.

Results

Among the 224 patients included in the intention-to-treat analyses (192 girls and 32 boys; mean [SD] age, 15.5 [1.4] years), the mean (SD) BDI-II score at baseline was 37.3 (8.7). BDI-II scores were significantly reduced after 4 weeks (postassessment) by a mean of -7.5 (95% CI, -9.0 to -6.0; Hedges g = 0.71). Bright light therapy had no impact on this change (no significant group × time effect). Loss to follow-up was 31% (n = 69) at 16 weeks and 49% (n = 110) at 28 weeks. There were 10 serious adverse events throughout the whole trial, which were not considered related to study treatment.

Conclusions and Relevance

The findings in this study did not indicate superiority of bright light therapy over placebo red light therapy in a large sample of adolescent inpatients with moderate or severe major depressive disorder. Both groups benefited equally from treatment as usual, showing relevant symptom reduction.

Trial Registration

German Clinical Trials Register: DRKS00013188.

An app-based training for adolescents with problematic digital-media use and their parents (Res@t digital): protocol for a cluster-randomized clinical trial

Background

Digital media-use disorders (DMUD) in adolescents are a rising phenomenon associated with psychological distress, comorbid mental disorders, and high burden on affected families. Since the ICD-11 introduced criteria for gaming disorder, these can now be transferred to describe additional DMUD associated with social media platforms and streaming services. Most evidence for effective treatments comes from cognitive-behavioral therapy (CBT). However, interventions based on theoretical models for adolescents and their parents are widely missing, leading to a significant clinical gap.

Methods

Res@t digital (Resource-Strengthening Training for Adolescents with Problematic Digital-Media Use and their Parents) is the app-based translation of the first model-based digital intervention for adolescents with DMUD and their parents based on CBT. It comprises separate but content-related modules for adolescents (Res@t-A) and parents (Res@t-P), applying multimodal techniques. The effectiveness of Res@t will be evaluated within a multicenter cluster-randomized controlled evaluator-blinded pre-post follow-up trial with the waitlist control group (CG). In addition to the Res@t program in the intervention group, both groups will receive treatment as usual within primary child and adolescent psychiatric/psychotherapeutic healthcare. The primary outcome addresses DMUD symptom reduction after 10 weeks. Secondary outcomes are related to a reduction in psychological and family-related problems and an increase in parental self-efficacy. All outcomes will be assessed using standardized self-report measures. A total of 1,334 participating adolescent-parent dyads from a large clinical network throughout Germany are planned to be included in the primary analyses based on an intention-to-treat approach, applying linear mixed models.

Discussion

Assuming superiority of Res@t over the control condition, the intervention has the potential to provide evidence-based treatment for a significant number of help-seeking families, supporting local healthcare structures and resources. It is a promising program for practicable implementation and flexible use in different settings.

Clinical trial registration

https://drks.de, DRKS00031043.

[Psychiatry in the GDR as a "niche" - Between adaptation and autonomy]

BACKGROUND

  With the help of statements from contemporary witnesses, it shall be deduced, if and to what extent Psychiatry was experienced as a shelter for employees and patients in the state controlled society of the GDR and which effort of adaptation to the authoritarian regime was needed to organize protected and protective spaces, here called "niches".

METHOD

  74 guide-based interviews from subjects including former patients and different staff groups of the East german Psychiatry were analyzed qualitatively.

RESULTS

  Many quotations show, that Psychiatry in the GDR was experienced as a "niche" for dissenting people and could offer a certain amount of protection for patients. On the other hand, the autonomy of the psychiatric care was often violated by political intrusions regarding individual treatments. Moreover, treatment autonomy was restricted by harsh shortages in supplies.

CONCLUSION

  Psychiatrists in the GDR could protect their patients through their actings and so Psychiatry could establish a "niche" for patients and employees. However, establishing such protected spaces required efforts in adaptation. In reverse, Psychiatry has also been politically instrumentalised - either directly through unjustified admissions and exit restrictions or indirectly by a stigmatization of dissenters and removing them from society.

[COVID-19 and Psychiatric Disorders in Minors: Changes in Inpatient Treatment According to Hospital Statistics]

COVID-19 and Psychiatric Disorders in Minors: Changes in Inpatient Treatment According to Hospital Statistics Abstract: Increased rates of psychiatric disorders and psychiatric emergencies in children and adolescents stemming from the COVID-19 pandemic have been reported, with more children and adolescents suffering from internalizing disorders. This study analyzes whether the increased rates led to increased rates of inpatient treatment in child and adolescent psychiatric and pediatric hospitals in Germany as well as a change in diagnoses of the treated patients. We analyzed routine hospital data ("InEK" data, § 21 KHG data files) from a prepandemic (2019) and a pandemic (2021) half-year regarding changes in the number of cases, diagnoses, and length of stay (LoS) in child and adolescent psychiatry and pediatrics. We also investigated the development of psychiatric emergencies in minors. We found an increase in internalizing problems (depression, anorexia nervosa, trauma-related disorders) and a decrease in externalizing problems among the admitted psychiatric inpatients. Further, we observed a halving of cases treated for alcohol intoxication. However, we discovered no change for the frequency of psychiatric emergency treatments nationwide. A more detailed analysis revealed that, in areas with a low number of child and adolescent psychiatry inpatient beds, emergency care was prioritized and LoS decreased, whereas in areas with a fair bed-to-inhabitant ratio among minors, there was a trend toward increased LoS, also in pediatric departments. We recommend continued monitoring of inpatient care after the pandemic, with special attention paid to underprivileged children and adolescents such as those with externalizing problems.

Social inequality, social networks, and health: a scoping review of research on health inequalities from a social network perspective

BACKGROUND

This review summarises the present state of research on health inequalities using a social network perspective, and it explores the available studies examining the interrelations of social inequality, social networks, and health.

METHODS

Using the strategy of a scoping review, as outlined by Arksey and O'Malley (Int J Sci Res Methodol 8:19-32, 2005), our team performed two searches across eight scientific, bibliographic databases including papers published until October 2021. Studies meeting pre-defined eligibility criteria were selected. The data were charted in a table, and then collated, summarised, and reported in this paper.

RESULTS

Our search provided a total of 15,237 initial hits. After deduplication (n = 6,168 studies) and the removal of hits that did not meet our baseline criteria (n = 8,767 studies), the remaining 302 full text articles were examined. This resulted in 25 articles being included in the present review, many of which focused on moderating or mediating network effects. Such effects were found in the majority of these studies, but not in all. Social networks were found to buffer the harsher effects of poverty on health, while specific network characteristics were shown to intensify or attenuate the health effects of social inequalities.

CONCLUSIONS

Our review showed that the variables used for measuring health and social networks differed considerably across the selected studies. Thus, our attempt to establish a consensus of opinion across the included studies was not successful. Nevertheless, the usefulness of social network analysis in researching health inequalities and the employment of health-promoting interventions focusing on social relations was generally acknowledged in the studies. We close by suggesting ways to advance the research methodology, and argue for a greater orientation on theoretical models. We also call for the increased use of structural measures; the inclusion of measures on negative ties and interactions; and the use of more complex study designs, such as mixed-methods and longitudinal studies.

Headache impact and socioeconomic status: findings from a study of the German Migraine and Headache Society (DMKG)

BACKGOUND

Headache disorders are not only among the most prevalent, they are also among the most disabling disorders worldwide. This paper investigates the association between headache impact on daily life and the socioeconomic status (SES) of headache sufferers.

METHODS

Data stem from a random general population sample in Germany. Respondents who reported having headache for at least a year and were aged ≥ 18 years were included in the study. A standardized questionnaire addressing headache and headache treatment was filled in during the face-to-face survey. The impact of headache on daily life was measured using the German version of the Headache Impact Test (HIT-6).

RESULTS

Higher headache impact was found in low and medium SES compared to high SES. After adjustment for sociodemographics, headache-related factors (analgesic use, headache duration, headache frequency, migraine diagnosis), depressive symptoms, physical inactivity and obesity, an increased odds ratio of having higher headache impact in low SES compared to high SES was found: OR = 1.83, 95% CI [1.43, 2.23], p = .014. When the interactions "SES*obesity", "SES*depressive symptoms", and "SES*physical inactivity" were added, the results showed a significant interaction effect of "SES*obesity". Obese persons with low SES were 3.64 times more likely to have higher headache impact than non-obese persons with low SES. No significant differences between obese and non-obese persons were found in the medium and high SES groups.

CONCLUSIONS

SES is an important factor that should not be neglected in headache awareness campaigns and headache treatment. Longitudinal studies are needed in the future to investigate whether lifestyle interventions, such as weight reduction, can help to reduce headache impact in people in lower SES.

Knowledge hardly translates to reality-A randomized controlled trial on sexual abuse prevention for girls with intellectual disabilities

Objective

People with intellectual disabilities (ID) are at higher risk of being sexually abused and developing psychiatric disorders in consequence. The effects of behavior prevention programs for children with ID have rarely been investigated. Previous studies suffer from methodical weaknesses, such as the lack of a control group, small sample size, or invalid outcome measures. This study aimed at demonstrating the efficacy of a prevention program by overcoming these flaws.

Methods

A group prevention program was developed and evaluated. One hundred and six girls aged from 8 to 12 years with mild ID were enrolled in a randomized controlled study, comparing the training to a sham intervention. Effects were examined in a three-time follow-up design as individual changes in preventive knowledge (board game, verbal reports) and preventive behavior (role-play, in situ tests). Participants' behaviors were videotaped and rated by three blinded raters.

Results

Girls from the intervention group (n = 64) showed significant improvements in preventive knowledge compared with the control group (n = 39) but showed non-significant improvements for preventive behavior. In situ tests with realistic seduction situations revealed no improvement. The intervention proved to be safe, but several risks need to be considered.

Discussion

This is the first study that evaluates a behavioral prevention program on sexual abuse for children with ID on a high level of evidence. Group interventions empowering girls with ID to recognize abuse situations are suitable to enhance sexual preventive knowledge but are less suitable to enhance preventive behavior. Naturalistic settings are indispensable for providing evidence for preventive interventions in children with ID.

Attitudes toward innovative mental health treatment approaches in Germany: E-mental health and home treatment

E-mental health and home treatment are treatment approaches that have proven to be effective, but are only slowly implemented in the German health care system. This paper explores the attitudes toward these innovative treatment approaches. Data was collected in two large, non-clinical samples representative of the German population in spring 2020 (N = 2,503) and winter 2020/2021 (N = 2,519). Statistical associations between variables were examined using two-tailed tests. Binary and multinomial logistic regressions were performed to predict attitudes toward online-based treatment concepts and home treatment approaches. Only few (<20%) people preferred online-based treatment approaches, while a larger proportion (~50%) could imagine being treated at home. Overall, younger subjects were more open to online-therapy approaches, while people with lower education preferred more often a traditional therapy setting. Acceptance of online-therapy did not raise significantly during the first months of the COVID-19 pandemic. When different online-based treatment options were available, the probability of accepting home treatment significantly increased with increasing levels of therapeutic support. Further promotion of acceptance for online-therapy and home treatment seems to be necessary. In the future, more information on innovative treatment approaches should be actively provided.

Physical Activity is Associated with Less Analgesic Use in Women Reporting Headache-A Cross-Sectional Study of the German Migraine and Headache Society (DMKG)

INTRODUCTION

The aim of this analysis is to determine whether regular physical activity is associated with less analgesic use in men and women suffering from headache disorders based on population-based cross-sectional data.

METHODS

We used data from a random general population sample in Germany that comprised 2477 participants aged ≥ 14 years. A standardized questionnaire addressing headache and headache treatment was filled in during the face-to-face survey.

RESULTS

Thirty-nine percent of the participants reported headache. Of these, 37.5% of men and 33.6% of women were physically active. Of the participants with headache, 43.3% reported taking analgesics on < 2 days a month, 40.7% on 2-5 days a month, 10.1% on 6-10 days a month, and 5.9% on > 10 days a month. Frequent headache, severe impact of headache on daily life, and depressive symptoms were associated with higher analgesic use in both men and women. For women, physical inactivity was associated with the frequency of analgesic use adjusted for sociodemographic and headache-related variables. For men, results did not suggest any association between physical inactivity and frequency of analgesic use.

CONCLUSIONS

There are both sex-unspecific and sex-specific factors associated with analgesic use among men and women with headache. In women with increased analgesic use, promoting physical activity may reduce analgesic use. For men, education about the therapeutic effects of physical activity for headaches is an important resource.

[Parental Stress: Psychometric Evaluation of the German Version of the Parental Stress Scale in the General Population]

Parental stress has negative impact on parents and their children. Parental stress may be of special interest for family and child well-being due to Covid-19 pandemic. A reliable and valid assessment of parental stress would be beneficial both in research and clinical practice. The Parental Stress Scale (PSS) is internationally well established as an economic and psychometric valid assessment. It consists of 18 items. The study evaluated the factor structure of the German version of the PSS in a general population (n=386 parents with children<16 years) for the first time. The sample was part of a representative sample (n=2519). The confirmatory factor analysis did not confirm internationally previously reported models. Eliminating one item, the explorative factor analysis suggested a two factor structure with the dimensions "lack of confident" and "worries and strain". Both subscales showed a good internal consistence (McDonalds ω≥0,87). We observed correlations of the PSS-17 items with family dysfunction and elevated scores for depressive or anxiety symptoms, but not with sociodemographic factors. One conclusion is that the multidimensional construct of parental stress maybe is not comprehensively represented by the PSS. For the use in clinical practice and research this has to be taken into account. Albeit, the German version of the PSS is an economic, reliable and valid assessment.

Possible Effects of Bright Light Therapy on Electroencephalogram-Vigilance in the Treatment of Depression in Adolescents: A Pilot Study

BACKGROUND

Chronotherapeutic treatments for depression, such as bright light therapy (BLT), are non-invasive and produce almost no side effects. However, study evidence for reliable neurobiological changes associated with treatment response is still rare. Several studies using EEG-vigilance indicate higher arousal and a later decline during resting state in adult depressive patients compared to healthy controls. To our knowledge, there are no study reports on EEG-vigilance in depressive youth to date.

METHODS

A total of 11 adolescents with depression receiving BLT were compared to 11 age and gender-matched patients with depression receiving treatment as usual (TAU). The BLT was administered in the morning for 2 weeks on five consecutive days per week. The depressive symptomatology was assessed using the Beck Depression Inventory (BDI-II) and the resting state electroencephalogram (EEG) of 20 min was recorded. EEG and BDI-II were assessed before and after 10 days of treatment. Vigilance level and vigilance decline were estimated using the VIGALL toolbox.

RESULTS

Brain arousal increased after 10 days of bright light therapy in adolescents with depression. Severe depressive symptoms were associated with higher brain arousal levels; the BDI-II sum score correlated negatively with the amount of drowsiness.

LIMITATIONS

The sample size was small and participants' brain arousal at baseline was not matched and differed between BLT and TAU groups.

CONCLUSION

The BLT might have an additional effect on brain arousal. EEG-vigilance seems to be a reliable and valid marker for neurobiological changes that are probably associated with depression and its treatment and, therefore, might be of clinical relevance.

[Assessment of General Family Functioning: Psychometric Evaluation of the German Version of the Brief Assessment of Family Functioning Scale]

The functionality of the family system is not only a central theme in developmental psychology and family research, but also plays a key role in many physical illnesses and mental disorders. Despite its high relevance, there are only a very few brief and user-friendly self-report measures assessing general family functioning. This gap is closed by the Brief Assessment of Family Functioning Scale (BAFFS), which consists of three items of the General Functioning Scale of the internationally well-established Family Assessment Device. In this study, the German version (KSAFF) of the BAFFS was psychometrically evaluated for the first time in a large and representative general population sample (n=2463). Using multigroup confirmatory factor analyses, strong measurement invariance was shown for relevant subsamples (women vs. men; participants in partnerships with vs. without children) with good model fit. Although one of the three items, which is the only negatively formulated item, yielded insufficient psychometric item characteristics, the internal consistency was Cronbach's α=0.71. As an indication of adequate construct validity, associations of family functioning with socioeconomic status as well as with current depression and anxiety were found in accordance with the hypothesis. Although application experiences and psychometric analyses of the German version of the BAFFS in relevant clinical samples are pending, this three-item self-report measure can be recommended as an economic, user-friendly assessment device for general family functioning, particularly since it yielded satisfactory to good psychometric properties in the general population.

[Use of Electronic Cigarettes (e-cigs) and e-Shishas by Children and Adolescents: Evidence Paper of the Joint Addiction Commission of the German Societies and Professional Associations of Child and Adolescent Psychiatry and Psychotherapy]

Use of Electronic Cigarettes (e-cigs) and e-Shishas by Children and Adolescents: Evidence Paper of the Joint Addiction Commission of the German Societies and Professional Associations of Child and Adolescent Psychiatry and Psychotherapy Abstract. The particular risks associated with the consumption of electronic cigarettes (e-cigs) in children and adolescents are not sufficiently considered in the health policy discourse. The present article evaluates the current dissemination and consumption patterns of e-cigarettes as well as the health risks attached to children and adolescents. Based on data from current national and international studies, there has been a clear increase in the consumption of e-cigarettes over the past years. This stands in sharp contrast to the overall decline in tobacco consumption among both children and adolescents in Germany. Young people without tobacco experience are now consuming more frequently e-cigarettes than those who occasionally or regularly use tobacco. They also are experimenting more frequently with conventional cigarettes if they have previously consumed e-cigarettes. The largely unregulated availability of e-cigarette products to the newest generation, such as JUUL, led to a dramatic increase in their prevalence among high-school students in the USA. Products with high nicotine content and multiple flavors are being marketed intensively as trendy lifestyle products to young user groups via advertising and social media campaigns. These products are also becoming increasingly relevant in Germany. The success of tobacco prevention in recent years is presently jeopardized by the ongoing effective advertising for e-cigarettes. The Addiction Commission of the German Child and Youth Psychiatric Federations and Scientific Societies therefore call for an immediate, strict, and comprehensive ban of e-cigarette advertising.

[Consequences of the corona pandemic on social networks in families at risk]

Hintergrund

Die Maßnahmen zur Reduktion des Infektionsgeschehens im Rahmen der Coronapandemie brachten insbesondere für Familien mit schulpflichtigen Kindern erhebliche Einschränkungen mit sich. Besonders betroffen sind Risikofamilien, die bereits vor der Pandemie mit psychischen Störungen, Armut oder beengtem Wohnraum konfrontiert waren.

Fragestellung

Wie stellen sich Zusammensetzung und Dynamik der sozialen Netzwerke von Risikofamilien während des Lockdowns dar?

Material und Methode

„Mixed-methods“-Analyse auf Basis von 19 qualitativen Leitfadeninterviews und 18 standardisiert erhobenen egozentrierten Netzwerken mit 224 von den Befragten („ego“) genannten Personen („alter“).

Ergebnisse

Netzwerke werden durch die Krise geschwächt. Gleichzeitig sind sie wichtigste Ressource der Bewältigung. Unterstützung fehlt v. a. bei der Sorge um die psychisch erkrankten Kinder. Wichtigste Quellen von Unterstützung sind die erweiterte Familie und institutionelle Einrichtungen. Letztere waren in der Krise oft nur noch eingeschränkt oder gar nicht mehr zu erreichen. Im Idealfall sind die verbliebenen Beziehungen stark genug, um die Situation zu überstehen. Im schlimmsten Fall werden die Kinder nicht nur aus institutionellen Strukturen entlassen (Kita, Schule, medizinische und therapeutische Hilfen), sondern verschwinden ganz und gar aus der institutionellen und gesellschaftlichen Obhut. Ihr Wohl hängt dann allein von den Kompetenzen ihrer Eltern ab.

Schlussfolgerung

In Zeiten von Kontaktbeschränkungen benötigen Risikofamilien besondere Aufmerksamkeit. Es genügt nicht, darauf zu warten, dass sie von sich aus um Hilfe oder eine Notbetreuung für die Kinder bitten. Institutionen sollten proaktiv praktische und informationelle Unterstützung anbieten.

[Coping in families with members suffering from a mental disorder]

Hintergrund

Belastungen und Bewältigungen während des Lockdowns in Familien mit psychisch erkrankten Mitgliedern wurden bisher noch nicht beschrieben.

Ziel der Arbeit

Erste Erkenntnisse hierzu sollen gewonnen werden, um Fragestellungen für weitere Forschungen abzuleiten.

Material und Methoden

Narrative Interviews an einer anfallenden Stichprobe von gesunden Familien (n = 4), Familien mit psychisch erkrankten Kindern (n = 12) und Familien mit psychisch erkrankten Eltern (n = 3). Die quantifizierende Auswertung der von 2 Rater*innen vergebenen In-vivo-Codes in den Kategorien „Probleme“ und „Bewältigung“ erfolgt mithilfe von numerischen Verhältnissen und Detailanalysen der Codes, die zwischen den Familien unterscheiden.

Ergebnisse

Der Lockdown brachte eine große Zahl von Problemen in allen Familien mit sich. Während bei Familien mit kranken Kindern die Einschränkungen das größte Problem sind, berichten Familien mit kranken Eltern v. a. über einen Mangel an Unterstützung. Familien mit erkrankten Mitgliedern berichten häufiger über riskante Bewältigungsmuster, insbesondere Rumination und Schuldabwehr und seltener über protektive Bewältigung, insbesondere die Mobilisierung sozialer Unterstützung.

Schlussfolgerung

Beide Risikogruppen bedürfen gezielter Interventionen, die sich insbesondere auf adaptives Elternverhalten und Mobilisierungsstrategien richten sollten.

Brain Arousal as Measured by EEG-Assessment Differs Between Children and Adolescents With Attention-Deficit/Hyperactivity Disorder (ADHD) and Depression

Objective: Disturbed regulation of vigilance in the wake state seems to play a key role in the development of mental disorders. It is assumed that hyperactivity in adult ADHD is an attempt to increase a general low vigilance level via external stimulation in order to avoid drowsiness. For depression, the avoidance of stimulation is interpreted as a reaction to a tonic increased vigilance state. Although ADHD is assumed to start during childhood, this vigilance model has been barely tested with children diagnosed for ADHD so far. Methods: Resting-state EEG (8 min) measures from two groups of children diagnosed with either ADHD [N = 76 (16 female, 60 male), age: (mean/SD) 118/33 months] or depression [N = 94 (73 female, 21 male), age: 184/23 months] were analyzed. Using the VIGALL toolbox, EEG patterns of vigilance level, and regulation were derived and compared between both groups. In correlation analysis, the relations between vigilance measures, attentional test performance (alertness and inhibition), and mental health symptoms were analyzed. Results: Children with ADHD differed from children with most prominent depressive symptoms in brain arousal regulation and level, but EEG vigilance was not related to behavior problems and not related to the attentional test performance. Brain arousal was dependent on the age of the participant in the whole sample; younger children showed lower vigilance stages than teenagers; this effect was not present when analyzed separately for each diagnostic group. EEG assessment time and received medication had no effect on the EEG vigilance. Discussion: Although based on a small sample, this explorative research revealed that EEG vigilance level is different between children with ADHD and with depression. Moreover, even the standard procedure of the clinical routine EEG (resting state) can be used to differentiate brain arousal states between participants with ADHD and depression. Because routine EEG is not specialized to vigilance assessment, it may not be sufficiently sensitive to find vigilance-symptomatology associations. Further research should address developmental changes in EEG measurements in children and use bigger samples of participants within the same age range.

A short note on the reliability of perceptual timing tasks as commonly used in research on developmental disorders

OBJECTIVES

Perceptual timing tasks are frequently applied in research on developmental disorders, but information on their reliability is lacking in pediatric studies. We therefore aimed to assess the reliability of the four paradigms most frequently used, i.e., time discrimination, time estimation, time production, and time reproduction.

METHODS

Based on the data from our recent longitudinal study by Marx et al. (Front Hum Neurosci 11:122, 2017), we estimated the internal consistency and test-retest reliability of these tasks in children with ADHD and typically developing children. Individual thresholds were used as dependent measures for the time discrimination task, whereas absolute error and accuracy coefficient scores were used for the other three tasks.

RESULTS

Although less commonly used, the time estimation paradigm was the most robust measure of perceptual timing in terms of internal consistency and test-retest reliability in both ADHD and typically developing children, whereas the most frequently used paradigms showed poor internal consistency (time reproduction) and poor test-retest reliability (time discrimination). Compared to the absolute errors, accuracy coefficients showed almost exclusively higher internal consistency and test-retest reliability.

CONCLUSIONS

Our findings call for more frequent use of the time estimation paradigm in studies of perceptual timing in ADHD. The time reproduction paradigm should be re-considered, avoiding pooling of a wide range of time intervals (2-48 s). The accuracy coefficient score is the more reliable and the more intuitive dependent variable and should be preferred in future timing research. To increase the reliability of the timing measurement, each experimental session should be performed twice, if possible.

Effectiveness of a mindfulness-oriented substance use prevention program for boys with mild to borderline intellectual disabilities: study protocol for a randomised controlled trial

BACKGROUND

Boys with mild to borderline intellectual disabilities (MBID) are at particular risk to drink in harmful ways once they start to consume alcohol. Interventions based on mindfulness have been proven to be effective in preventing substance use, but mostly for adults with MBID. A mindfulness oriented intervention targeting 11-17 years old boys will be tested in a randomised controlled trial. Study aim is to investigate the benefits of this new intervention compared to an active control condition within a 12 months follow-up.

METHODS

In this randomised controlled proof of concept study, 82 boys with MBID who consumed any alcohol during the last year will be randomised either to the 6 week mindfulness oriented intervention or the control group receiving a control intervention equal in dose and length. The intervention group undergoes mindfulness training combined with interactive drug education, while the control group completes a health training combined with the same education. In the intention-to-treat analysis the primary outcome is the self-reported delay of first post-intervention drunkeness within a 12 months follow-up time span, measured weekly with a short app-based questionnaire. Secondary outcome is the use of alcohol, tobacco and other drugs within 30 days post-intervention. Changes in neurobiological behavioural parameters, such as impulse control, reward anticipation, and decision making, are also investigated. Other secondary outcomes regard trait mindfulness, emotion regulation, psychopathological symptoms, peer networks, perceived stress, and quality of life. In addition, a prospective registry will be established to record specific data on the population of 11-17 year old boys with MBID without any alcohol experience.

DISCUSSION

This study offers the opportunity to gain first evidence of the effectiveness of a mindfulness-oriented program for the prevention of substance use for boys with MBID.

TRIAL REGISTRATION

German Clinical Trials Register, DRKS00014042 . Registered on March 19th 2018.

[Media-associated disorders in childhood and adolescence: Evidence paper of the joint addiction commision of the German societies and professional associations of child and adolescent psychiatry and psychotherapy]

Media-associated disorders in childhood and adolescence: Evidence paper of the joint addiction commision of the German societies and professional associations of child and adolescent psychiatry and psychotherapy Abstract. Media-associated disorders (MAD) describe the problematic use of the internet, certain electronic devices in general as well as digital applications. During childhood and adolescence, digital games and social media are the most commonly used applications. In May 2019, as first MAD "gaming disorder" was included as a clinical diagnosis in the ICD-11. The prevalence of MAD in German children and adolescents is estimated to lie between 3 % and 5 %. In most cases, MAD are accompanied by psychiatric comorbidities. MAD ensue because of dysfunctional learning processes in combination with general and specific risk factors. They are associated with neural changes like those of substance-associated addictions. Diagnostics can be based on validated questionnaires and clinical exploration, though a standardized diagnostic path is not yet common. Treatment depends on the level of severity and generally comprises outpatient, day-clinic, and inpatient therapy approaches with elements from cognitive-behavioral therapy and under parental involvement. Suitable treatments are not yet available in all German regions and have also not been sufficiently evaluated. Moreover, only a few studies exist on the efficacy of prevention measures addressing MAD in children and adolescents. Thus, further research is strongly required.

Use of outpatient medical care by headache patients in Germany: a population-based cross-sectional study

Background

Headache sufferers in need of professional health care often do not utilize the care available, and factors influencing headache-specific physician consultation are not yet understood. Objectives of this study are (1) to assess self-reported headache-specific physician consultations and (2) to identify headache-related and sociodemographic predictors.

Methods

Data of a random sample of the general population in Germany aged ≥14 years were analyzed (N = 2461). A multivariate binary logistic regression was conducted to identify a parsimonious model to predict physician consultation.

Results

50.7% of the participants with headache reported at least one headache-specific physician consultation during lifetime. Of these, 53.6% had seen one, 26.1% two, and 20.3% more than two physicians because of their headaches. The odds of physician consultation increased with the number of headache days per month (HDM) [(reference HDM < 1) HDM 1–3 (OR = 2.29), HDM 4–14 (OR = 2.41), and HDM ≥15 (OR = 4.83)] and increasing Headache Impact Test score (HIT-6) [(reference “no or little impact”) moderate impact (OR = 1.74), substantial impact (OR = 3.01), and severe impact (OR = 5.08)]. Middle-aged participants were more likely to have consulted than younger and older ones [(reference 14–34 years) 35–54 years (OR = 1.90), 55–74 years (OR = 1.96), ≥75 years (OR = 1.02)]. The odds of physician consultation among self-employed subjects were lower than among employed manual workers (OR = 0.48). The living environment (rural versus urban) did not have an influence on the consultation frequency.

Conclusion

The results indicate that apart from burden-related factors (headache frequency; headache impact), health care utilization patterns are also influenced by patients’ occupational status and age. Further research is needed to analyze whether the lower consultation rate means that the self-employed have a higher risk of chronification or that they have more effective self-management strategies regarding headache.

Feasibility of a Complex Setting for Assessing Sleep and Circadian Rhythmicity in a Fragile X Cohort

INTRODUCTION

Sleep, circadian rhythms, (mental) health, and development are assumed to be intertwined. However, differentiated and reliable parameters of sleep and circadian rhythms are particularly difficult to assess for Fragile X (FXS) individuals. As those parameters need to be observed in complex settings, the feasibility of measurements for people with FXS was to be proven. Findings from this pilot study can inform further research and help to estimate sample sizes for future studies on FXS patients.

METHODS AND SAMPLE

Nine individuals (male and female) with full mutation of the FMR1 gene were integrated in the study and underwent a complex measurement including actigraphy, sleep log, and 24-h saliva sampling in order to examine profiles of melatonin and cortisol, and a polysomnography.

RESULTS

Seven actigraphy profiles, eight sleep logs, eight saliva profiles and seven polysomnographic data sets were collected. Complete data were analyzed for six individuals [mean age 14.87 years (SD 4.12), mean BMI 25.90 (SD 4.44)] were collected. No drop outs due to the constraints of the assessment were registered.

DISCUSSION

All assessments and the setting in total were tolerated well by participants and caregivers. Procedures were adapted to individual needs of the participants.

CONCLUSION

All its components and the setting in total are absolutely feasible in the specific population of FXS individuals. Losses during consenting and recruiting have to be planned as well as high amounts of interindividual variances have to be taken into account.

Perceptual timing in children with attention-deficit/hyperactivity disorder (ADHD) as measured by computer-based experiments versus real-life tasks: protocol for a cross-sectional experimental study in an ambulatory setting

INTRODUCTION

The goal of this study is to get a better understanding of the fundamentals of perceptual timing deficits, that is, difficulties with estimating durations of explicitly attended temporal intervals, in children with attention-deficit/hyperactivity disorder (ADHD). Whereas these deficits were repeatedly demonstrated in laboratory studies using computer-based timing tasks, we will additionally implement a more practical task reflecting real-life activity. In doing so, the research questions of the planned study follow a hierarchically structured path 'from lab to life': Are the timing abilities of children with ADHD really disturbed both in the range of milliseconds and in the range of seconds? What causes these deficits? Do children with ADHD rather display a global perceptual timing deficit, or do different 'timing types' exist? Are timing deficits present during real-life activities as well, and are they based on the same mechanisms as in computerised tasks?

METHODS AND ANALYSES

A quasi-experimental study with two groups of male children aged 8-12 years (ADHD; controls) and with a cross-sectional design will be used to address our research questions. Statistical analyses of the dependent variables will comprise (repeated) measures analyses of variance, stepwise multiple regression analyses and latent class models. With an estimated dropout rate of 25%, power analysis indicated a sample size of 140 subjects (70 ADHD, 70 controls) to detect medium effect sizes.

ETHICS AND DISSEMINATION

Ethics approval was obtained from the ethics committee of the Faculty of Medicine, University of Rostock. Results will be disseminated to researcher, clinician and patient communities in peer-reviewed journals and at scientific conferences, at a meeting of the local ADHD competence network and on our web page which will summarise the study results in an easily comprehensible manner.

TRIAL REGISTRATION NUMBER

DRKS00015760.

[The Care of Intellectually Disabled Children and Adolescents with Psychiatric Disorders in Hospitals for Child and Adolescent Psychiatry and Psychotherapy in Germany]

OBJECTIVE

This study explores the care situation of children and adolescents with intellectual disabilities (ID) suffering from mental problems in Germany in 2014. It complements the study of Hennicke, which was conducted a decade ago.

METHOD

All clinics and departments of child and adolescent psychiatry in Germany (n=138) were contacted via mail or personally and requested to fill out a questionnaire. We received data from one-third (n=46) of all hospitals contacted.

RESULTS

Eight hospitals (17%) offered specialized services for this client base as either inpatient or outpatient treatment. Three hospitals (7%) provided both. Average proportions of children with ID treated were 6.6% for inpatient, 7.9% for day hospital, and 3% for outpatient services. More than half of responding institutions (54%) judged inpatient services as being defective. Slightly less (43%) reported their outpatient services as being defective or inadequate. For the treatment of mental disorders in young patients with ID, different treatments were used, according to the degree of the ID and applying the standard of child and adolescent psychiatry. Some interventions were used independently of the degree of ID, such as practical exercises, interventions in the patient environment (parents, family). Other interventions, such as psychotherapy were used to a lesser degree when the degree of ID increased. Youth with mild ID received twice as much psychotherapeutic interventions compared to children and adolescents with severe ID. The latter received more psychopharmacotherapy instead. Youth with severe ID received twice as much (67%) psychotropic medication compared to children and adolescents with mild ID.

CONCLUSION

The defective care situation of the highly vulnerable children and adolescents with ID did not change much between 2004 and 2014. The amount of specialized care services increased only marginally. Non-pharmacological treatments were used to a larger extent, compared to psychotropic medication, independent of the degree of ID.

Methylphenidate promotes the interaction between motor cortex facilitation and attention in healthy adults: A combined study using event-related potentials and transcranial magnetic stimulation

OBJECTIVE

This study investigated simultaneously the impact of methylphenidate (MPH) on the interaction of inhibitory and facilitative pathways in regions processing motor and cognitive functions.

METHOD

Neural markers of attention and response control (event-related potentials) and motor cortical excitability (transcranial magnetic stimulation) and their pharmacological modulation by MPH were measured simultaneously in a sample of healthy adults (n = 31) performing a cued choice reaction test.

RESULTS

Methylphenidate modulated attentional gating and response preparation processes (increased contingent negative variation) and response inhibition (increased nogo P3). N1, cue- and go-P3 were not affected by MPH. Motor cortex facilitation, measured with long-interval cortical facilitation, was increased under MPH in the nogo condition and was positively correlated with the P3 amplitude.

CONCLUSION

Methylphenidate seems particularly to enhance response preparation processes. The MPH-induced increased motor cortex facilitation during inhibitory task demands was accompanied by increased terminal response inhibition control, probably as a compensatory process.

Mild or borderline intellectual disability as a risk for alcohol consumption in adolescents - A matched-pair study

BACKGROUND

Studies that investigate the association between mild or borderline intellectual disability (MBID) and alcohol use in adolescents have not examined whether MBID is an independent risk factor for drinking.

AIM

It is important to examine whether MBID is a risk factor for alcohol consumption by controlling concomitant factors in a matched-pair design.

METHOD

Overall, 329 students from two schools for children with MBID self-reported their drinking behavior via questionnaires, and 329 students from regular schools were matched to this group by gender, age, family composition, and parental drinking behavior. Matched pairs were compared based on alcohol consumption and motivation to drink.

RESULTS

MBID is a protective factor, as disabled adolescents drink less on average. This effect is mainly due to larger proportions of youth with MBID who are abstinent. When male adolescents with MBID begin to drink, they are at an increased risk for intoxication and subsequent at-risk behaviors. Motivations to drink were explained by an interaction between MBID and consumption patterns.

CONCLUSIONS

For male adolescents with MBID, there appears to be an "all-or-nothing" principle that guides alcohol consumption, which suggests a need for special interventions for this group.

A de novo nonsense mutation in ZBTB18 plus a de novo 15q13.3 microdeletion in a 6-year-old female

ZBTB18 has been proposed as candidate gene for microcephaly and abnormalities of the corpus callosum based on overlapping microdeletions of 1q43q44. More recently, de novo mutations of ZBTB18 have been identified in patients with syndromic and non-syndromic intellectual disability. Heterozygous microdeletions of 15q13.3 encompassing the candidate gene CHRNA7 are associated with developmental delay or intellectual disability with speech problems, hypotonia, and seizures. They are characterized by significant variability and reduced penetrance. We report on a patient with a de novo ZBTB18 nonsense mutation and a de novo 15q13.3 microdeletion, both in a heterozygous state, identified by next generation sequencing and array-CGH. The 6-year-old girl showed global developmental delay, absent speech, therapy-refractory seizures, ataxia, muscular hypotonia, and discrete facial dysmorphisms. Almost all of these features have been reported for both genetic aberrations, but the severity could hardly been explained by the microdeletion 15q13.3 alone. We assume an additive effect of haploinsufficiency of ZBTB18 and CHRNA7 in our patient. Assembling the features of our patient and the published patients, we noted that only one of them showed mild anomalies of the corpus callosum. Moreover, we hypothesize that nonsense mutations of ZBTB18 are associated with a more severe phenotype than missense mutations. This report indicates that haploinsufficiency of additional genes beside ZBTB18 causes the high frequency of corpus callosum anomalies in patients with microdeletions of 1q43q44 and underlines the importance of an NGS-based molecular diagnostic in complex phenotypes.

Acute alcohol intoxication among adolescents-the role of the context of drinking

This study aims (1) to describe the context of drinking among adolescents with acute alcohol intoxication (AAI) by gender, (2) to explore temporal changes in the context of drinking and (3) to analyse the association between the context of drinking and blood alcohol concentration (BAC). A retrospective chart review of 12- to 17-year-old inpatients with AAI (n = 1441) of the years 2000 to 2006 has been conducted in five participating hospitals in Germany. Gender differences in the context of drinking were tested with t test and chi² test. Differences over time were analysed using logistic regressions. Multivariate linear regression was used to predict BAC. Girls and boys differed in admission time, drinking situation, drinking occasion and admission context. No temporal changes in drinking situation and in admission to hospital from public locations or places were found. Higher BAC coincided with male gender and age. Moreover, BAC was higher among patients admitted to hospital from public places and lower among patients who drank for coping.

CONCLUSION

The results suggest gender differences in the context of drinking. The context of drinking needs to be considered in the development and implementation of target group-specific prevention and intervention measures. What is known: • The context of drinking, e.g. when, where, why and with whom is associated with episodic heavy drinking among adolescents. What is new: • Male and female inpatients with acute alcohol intoxication differ with regards to the context of drinking, i.e. in admission time, drinking situation, drinking occasion and admission context. • Being admitted to hospital from public places is associated with higher blood alcohol concentration.

Patterns in Identity Change and Development in Relationships With Mothers and Friends

Traditional research about identity status has been followed by investigations of identity change that challenge the notion of a general increase in maturity during adolescence while also calling for a more contextualized view on identity processes. This study examines changes in identity measured by the Identity Scale of the Erikson Psychosocial Stage Inventory. In a group of 294 high school students, four different trajectories were found between sophomore and senior years. The authors explored whether relationships with mothers and friends would be associated to identity trajectories. Our results show that a decremental change in identity was related to persistent problems with mothers and friends. For mothers, a lack of communication and for friends, persistent conflicts were related to decremental identity changes.

Developmental Hazards Among Young Alcohol Intoxicated Patients

PURPOSE

The rising numbers of alcohol intoxicated adolescents (AIA) treated in emergency care units in several European countries have drawn attention to this target group for prevention. To our knowledge, this is the first study to assess a broad array of developmental hazards and their stability in AIA and to compare their distribution with representative samples (RS).

METHODS

A multisite cohort study of AIA aged 13-17 years assessed, in the hospital (t0) and 6 months later (t1), (family) violence, cannabis and alcohol use, school problems, delinquency, homelessness, depression, and suicidality, using items from representative German surveys: Children and Adolescent Health Survey (KiGGS), Childhood Trauma Questionnaire and Communities That Care Youth Survey. We calculated the differences between AIA and RS and corresponding 95% confidence intervals. For AIA respondents who completed t0 and t1 information, we calculated prevalence/persistence/incidence of developmental hazards and corresponding 95% confidence interval.

RESULTS

A total of 342 AIA participated at t0, 228 at t1 (67%). AIA had a significantly higher burden of concomitant risks regarding physical and emotional family abuse, (sexual) victimization, cannabis use, binge drinking, school expulsion, police arrest, gang membership, and being violent. Six months after hospitalization, emotional family abuse (34.1%), cannabis use (23.5%), depression (14.8%), and being violent (13.2%) were especially prevalent.

CONCLUSIONS

Developmental hazards are up to six times more prevalent in AIA than in RS. Therefore, when assessing the risk profile of AIA, it is important to consider developmental hazards as well as detrimental alcohol use.

Long-term outcomes after adolescent in-patient treatment due to alcohol intoxication: A control group study

BACKGROUND

The long-term psychosocial development of adolescents admitted to in-patient treatment with alcohol intoxication (AIA) is largely unknown.

METHODS

We invited all 1603 AIAs and 641 age- and sex-matched controls, who had been hospitalized in one of five pediatric departments between 2000 and 2007, to participate in a telephone interview. 277 cases of AIA and 116 controls (mean age 24.2 years (SD 2.2); 46% female) could be studied 5-13 years (mean 8.3, SD 2.3) after the event. The control group consisted of subjects who were admitted due to conditions other than alcohol intoxication. Blood alcohol concentration on admission was systematically measured in the AIA but, owing to the retrospective study design, not in the control group. Subtle alcohol intoxication could therefore not be entirely ruled out in the control group. Long-term outcome measures included current DSM-5 alcohol use disorders (AUD), drinking patterns, illicit substance use, regular smoking, general life satisfaction, use of mental health treatment, and delinquency.

RESULTS

AIA had a significantly elevated risk to engage in problematic habitual alcohol use, to exhibit delinquent behaviors, and to use illicit substances in young adulthood compared to the control group. Severe AUD also occurred considerably more often in the AIA than the control group.

CONCLUSIONS

In the majority of AIAs, further development until their mid-twenties appears to be unremarkable. However, their risk to develop severe AUD and other problematic outcomes is significantly increased. This finding calls for a diagnostic instrument distinguishing between high- and low-risk AIAs already in the emergency room.

Prediction of Long-Term Outcomes in Young Adults with a History of Adolescent Alcohol-Related Hospitalization

AIMS

Empirical data concerning the long-term psychosocial development of adolescents admitted to inpatient treatment with alcohol intoxication (AIA) are lacking. The aim of this study was to identify the factors that, at the time of admission, predict future substance use, alcohol use disorders (AUD), mental health treatment, delinquency and life satisfaction.

METHODS

We identified 1603 cases of AIA treated between 2000 and 2007 in one of five pediatric departments in Germany. These former patients were invited to participate in a telephone interview. Medical records were retrospectively analyzed extracting potential variables predicting long-term outcomes.

RESULTS

Interviews were conducted with 277 individuals, 5-13 [mean 8.3 (SD 2.3)] years after treatment, with a response rate of 22.7%; of these, 44.8% were female. Mean age at the interview was 24.4 (SD 2.2) years. Logistic and linear regression models revealed that being male, using illicit substances and truancy or runaway behavior in adolescence predicted binge drinking, alcohol dependence, use of illicit substances and poor general life satisfaction in young adulthood, explaining between 13 and 24% of the variance for the different outcome variables.

CONCLUSIONS

This naturalistic study confirms that known risk factors for the development of AUD also apply to AIA. This finding facilitates targeted prevention efforts for those cases of AIA who need more than the standard brief intervention for aftercare.

Treatment of aggressive behavior problems in boys with intellectual disabilities using zuclopenthixol

OBJECTIVE

Disruptive or challenging behavior problems pose a threat to children and adolescents with intellectual disabilities and their caregivers. Psychopharmacological treatment is mostly studied with new-generation antipsychotics and has been criticized for adverse side effects. This study examined the effect of the classic antipsychotic zuclopenthixol.

METHODS

A total of 39 boys (ages 8.0-17.11 years) with learning disabilities were included and examined for a response to zuclopenthixol during a 6 week period of open label treatment. Doses started low and were adapted individually. From responders, zuclopenthixol was randomly withdrawn for 12 weeks. Responses to withdrawal were observed by external raters using the Modified Overt Aggression Scale.

RESULTS

Of all patients included into the study, 15 were not randomized because of insufficient therapeutic effect, adverse event, or noncompliance. Kaplan-Meier estimations showed less aggressive behavior problems for the continuing subgroup (n=9) than in the placebo group (n=15). Individual doses stayed <10 mg/day.

CONCLUSIONS

Zuclopenthixol proved to be effective in reducing challenging behavior in boys even at low doses.

Sexuality and affection among elderly German men and women in long-term relationships: results of a prospective population-based study

Satisfaction with sexual activity i.e. sexual satisfaction and the importance of sexuality and affection were analysed using data from the German “Interdisciplinary Longitudinal Study of Adult Development” (ILSE). At three measurement points, 1993–1995, 1997–1998, and 2004–2006 i.e. subjects' ages of 63, 67, and 74 years, participants' reports about their affection and sexual activity were collected. The sample of completed records used for this study consisted of 194 urban non-institutionalised participants, 68% male, all living with partners. Median levels of sexual satisfaction were reported, fluctuating between the measurement points of ages 63 to 74. Between baseline, first and second follow-up no differences were found in levels of sexual satisfaction, though at measurement points age 63 and 67 women were more satisfied than men. When measured at age 74, affection was given a higher priority than sexual activity. Although men and women reported similar priorities, sexual activity and affection were more important for men than for women. Satisfaction within the relationship can be predicted by the importance of affection, but not by that of sexual activity. Our results confirm the thesis of the ‘second language of sexuality’: for humans in their later years affection seems to be more important than for younger individuals.

[Sexual abuse prevention programs for individuals with mental retardation]

The paper reviews international research on sexual abuse prevention for individuals with mental retardation and programs implemented in Germany. Using Pubmed, PsycINFO, and various search engines, 263 studies and 128,080 search results for programs were retrieved, of which twelve international studies and six national programs met several inclusion criteria. Studies provided evidence for the effectiveness of prevention programs. Clinical significance, however, is restricted by methodological limitations. None of the programs found throughout Germany has yet been evaluated. Implications for future research in the field of sexual abuse prevention for children and adolescents with mental retardation are discussed.

[Internalizing problem behaviour and cannabis use: associations and variables of influence in a cross-sectional study of 14- to 23 year old cannabis users]

Regarding the association between internalizing problem behaviour and cannabis use in adolescents and young adults, several studies were published in recent time. Using cross-sectional data from adolescent and young adult cannabis users of the project "CAN Stop" (n = 239; age 14-23), associations between internalizing problem behaviour, cannabis effects expectancies, number of psychosocial problems and severity of dependence were analysed with an age- and gender-sensitive perspective. By describing young cannabis users, we seek to deepen the understanding of the association between cannabis use and internalizing problem behaviour. Cannabis users with normal-range YSR/YASR-profiles, internalizing problem behaviour, externalizing problem behaviour or combined problems differ significantly regarding their age of first cannabis use, age of regular cannabis use and number of both cannabis and alcohol use days. Regarding cannabis effects expectancies, cannabis users with externalizing problem behaviour show a broader variation of positive expectancies. Internalizing problems were associated with impairing and sedating effects expectancies.

Therapeutic drug monitoring of zuclopenthixol in a double-blind placebo-controlled discontinuation study in adults with intellectual disabilities and aggressive behaviour

The trial was a double-blind, placebo-controlled comparison with a discontinuation design. 49 mentally retarded patients with aggressive behaviour were treated with zuclopenthixol at a dose of 2-20 mg/d. At each visit the clinical effect was evaluated. Correlations between dose, serum concentration, and efficacy measures were calculated. The mean dose was 10.0 mg/day (±5.17); the mean serum concentration 4.19 ng/mL (±3.16). Associations of dosage, serum concentration and clinical efficiency did not result in coherent patterns. Correlations with clinical efficiency measures appeared to be contradictory for dosage and serum concentrations, respectively. As no consistent associations between dosage, serum concentration, and clinical efficiency measures were found, different hypotheses explaining the results are discussed.

A Case of Catatonia in a 14-Year-Old Girl with Schizophrenia Treated with Electroconvulsive Therapy

This article presents a case of a 14-year-old female twin with schizophrenia who developed severe catatonia following treatment with olanzapine. Under a combined treatment with amantadine, electroconvulsive therapy (ECT), and (currently) ziprasidone alone she improved markedly. Severity and course of catatonia including treatment response were evaluated with the Bush-Francis Catatonia Rating Scale (BFCRS). This case report emphasizes the benefit of ECT in the treatment of catatonic symptoms in an adolescent patient with schizophrenic illness.

Modified magnesium and lipoproteins in children with attention deficit hyperactivity disorder (ADHD)

OBJECTIVE

Polyunsaturated fatty acids (PUFAs) have shown to be helpful in the therapy of ADHD. Various stabilizing co-factors may contribute to this effect, as like magnesium (Mg). Mg supports fatty acid enzyme activity and is essential for the neuronal activity. However, the way of Mg to influence psychic processes, particularly in ADHS, is not yet known precisely. Therefore, in this study the concentrations of further lipid parameters were assessed. We intended to prove, if there is a lack of Mg and someone different lipoprotein concentration in ADHD patients compared to controls.

METHODS

In nine boys with ADHD (8.2 ± 0.6 years) and 11 controls (7.9 ± 0.87 years), blood serum Mg, total cholesterol, triglycerides, Lipoprotein Lipase, total Phospholipids, Apolipoproteins a and b, HDL- and LDL-cholesterol were measured, under two different stressful conditions.

RESULTS

In ADHD, Mg and HDL concentrations were significantly higher and Apob lower than in controls.

CONCLUSIONS

Contrary to our supposition, in ADHD was no lack, but an excess of Mg. HDL was hightened and Apob lowered. Lipoprotein metabolism seems to be modified in ADHD.

Intelligence moderates impulsivity and attention in ADHD children: an ERP study using a go/nogo paradigm

OBJECTIVES

If the cardinal symptoms of ADHD - hyperactivity, impulsivity and inattention - are combined with a learning disability (70 ≥ IQ < 85), the question arises whether a child shows hyperkinetic behaviour because of intellectual overload in a challenging situation, for example at school. Perhaps, this behaviour is not a primary attention deficit disorder but an impulse control disorder, determined by the primarily intelligence level. It raised the question whether attention deficit and impulse control regarded as behavioural inhibition deficit may depend on intelligence and therefore should be separated into distinct clinical entities.

METHODS

A total of 45 children (15 with ADHD, 15 with learning disabilities (LD), 15 with ADHD and learning disabilities) were compared in a matched-pair design with 42 control children using a go/no go paradigm (visual continuous performance test, CPT). The dependent variable was the target P3 amplitude, averaged from a 10-20 EEG measurements under distinct trigger conditions. For statistical analysis, a three-factor analysis of variance (MANOVA) with repeated measurements was used. In a subsequent regression analysis with residuals, the influence of intelligence (IQ) was calculated and a "parallel analysis of variance" was conducted.

RESULTS

No differences in the P3 amplitudes in the comparison ADHD-control group were found. Reduced P3 amplitudes as main effects in the LD group compared with controls were found and a significant group-dependent interaction on reduced P3 amplitudes comparing ADHD + LD versus control group. Using residuals (IQ), this interaction was not longer verifiable.

CONCLUSION

Impulsivity and attention deficit as the cardinal symptoms of ADHD, regarded as behavioural inhibition deficit, are essentially moderated by the primary intelligence, rather than by an attention deficit. The lower the IQ, the more ADHD surfaces as a disturbed impulsivity and lesser as an attention deficit.