Geschwister epilepsiekranker Kinder: Welche Auswirkungen haben idiopathische Epilepsien im Kindesalter auf die psychosoziale Anpassung, die Geschwisterbeziehung und das Selbstkonzept der Geschwister?

BACKGROUND

Psychosocial adjustment, relationship and self-concept in siblings of children with idiopathic epilepsy was compared with healthy controls.

PATIENTS

173 persons--68 siblings, 62 mothers and 43 fathers--from the study group (children with idiopathic epilepsy) and matched controls were investigated.

METHODS

Child Behaviour Checklist (CBCL), Self-Description-Questionnaire I and II (SDQ) and Sibling Relationship Questionnaire (SRQ) were used.

RESULTS

There were more somatic complaints of the siblings reported by the mothers of the study group. They also noted more nurturance of the sibling than mothers of healthy children did. The data of the fathers showed more dominance of the sibling. Siblings of children with epilepsy showed more prosocial action towards their classmates. In families with a new diagnosed epilepsy the fathers noticed more problems in school und somatic complaints of the siblings. The number of seizures, which were seen by the sibling, not the absolute number of seizures, had an influence on the behavior of the siblings; these siblings had more social problems than siblings, who had never seen a seizure.

CONCLUSIONS

We suggest a close cooperation with the families and constant inclusion in the treatment as claimed by recent systemic family medicine. Resource-orientated and salutogenetic aspects should be given a greater focus in modern work with families and especially siblings.

[Family dynamics and chronic illness: children with diabetes in the context of their families]

The present study is based on the assumption of an interaction between family functioning and chronic illness. Using a systemic approach, the intra-familial situation of families with a diabetes-affected child is examined. 44 families were evaluated using a family diagnostic instrument ("Familienbögen") and compared with 31 control families with a healthy child. Furthermore, the study looked at the influence of the level of family functioning on glycemic control, as measured by HbA1c values, and vice versa. Families with a child affected by diabetes showed significantly more dysfunctional domains and higher discrepancies of the ratings in the family diagnostic instrument (p < 0.05). Unexpectedly, no significant interaction between family functioning and glycemic control was found. Poor glycemic control therefore did not have any negative effects on the family dynamics, in fact, the opposite was often the case. Also, the relationship between siblings was judged more positively when one of the siblings was chronically ill (p < 0.05). The results show that despite the fact that diabetes in children may lead to an increase in impairment of intra-familial dynamics, it may, at the same time, offer opportunities for an improvement of family relationships. However, if physiological parameters deteriorate in the child (poor glycemic control), family problems seem to become less important. Success in the treatment of diabetes patients should therefore not only be measured by the quality of glycemic control, but also by considering psychological factors and aspects of family dynamics.

[ICD-10 diagnosis and quality of life. A pilot study of quality of life of children and adolescents with psychiatric disorders]

OBJECTIVE

The present study examined whether the quality of life in children and adolescents with psychological disorders, as judged by the patients themselves and their mothers, differed according to the various ICD-10 diagnoses or the number of axes involved.

METHODS

151 children/adolescents and 125 mothers, referred consecutively to the clinic, completed the Inventory for Evaluation of Quality of Life in Children and Adolescents (Inventar zur Erfassung der Lebensqualität bei Kindern und Jugendlichen; ILK) by Mattejat et al. ICD-10 diagnoses were grouped for evaluation.

RESULTS

No significant interaction between the five diagnostic axes and the several domains of quality of life was found. However, mothers of children and adolescents with attention deficit/hyperactivity disorders and/or conduct disorder more often tended to judge their children's quality of life as unsatisfactory in all domains, while the patients themselves did not. Thus, rather than the children themselves it seems to be the children's environment which considers "external disorders" to be distressing.

CONCLUSIONS

The authors conclude that the quality of life as measured by the ILK cannot be captured by ICD-10 criteria. Apparently it is not so much the diagnosis itself but its subjective meaning that has the most essential impact on an individual's assessment of quality of life.

[The quality of life of chronically ill and psychiatrically disturbed children. Initial experiences with an inventory for assessing quality of life in children and adolescents]

OBJECTIVES

The assessment of the quality of life in chronically ill children as well as in children with emotional and behavioural problems.

METHODS

A series of questionnaires (Inventar zur Erfassung der Lebensqualität bei Kindern und Jugendlichen, ILK, Mattejat et al.) were administered to 360 patients and 288 mothers at the Vienna University Children's Hospital.

RESULTS

The results clearly show that patients with diabetes rate themselves as the most emotionally burdened and impaired in nearly all aspects of life: a picture which is confirmed by their mothers. Children and adolescents with psychological problems judge the initial problem as well as their social environment as significantly more burdensome. The respective mothers of these psychologically ill children feel that their impairments are greater in more aspects of life than do mothers of children who are chronically ill. The children generally pinpoint most of their difficulties in the areas "ability to occupy myself" and "psychological health". Among adolescents the most negative ratings occur in the areas "school", "psychological health", and "initial problem".

CONCLUSIONS

The child's problems seem to weigh heavily upon the mothers. Interventions aimed at adolescents and mothers should be based on problem solving: supportive and anxiety-reducing approaches seem best suited for chronically ill children. Children with psychological problems primarily need problem-centred and practical support.

Patients benefit--partners suffer? The impact of heart transplantation on the partner relationship

Terminal heart disease affects not only the patient, but also members of the patient's family, and especially the spouse. The aim of this prospective study of 26 couples was to collect information about the impact of heart transplantation on the partner relationship. Data were collected from patients and spouses when the patients were placed on the waiting list for transplantation, 1 year postoperatively, and 5 years postoperatively. The Family Assessment Measure (FAM III), a self-report instrument that provides quantitative indices of family functioning on seven interacting dimensions, was used. In the course of the transplant process, both patients and spouses reported a significant deterioration in the partner relationship in general. While patients perceived only one clear-cut point of conflict communication about emotions - as crucial, the spouses reported a significant worsening in role performance, communication, emotional involvement, and values and norms. These changes were discernible 1 year after transplantation and persisted for at least 5 years. We conclude that heart transplantation has a significant negative impact on the partner relationship 1-5 years after transplantation. Consequently, more attention should be paid to all aspects of the partner relationship in a holistic approach to the treatment of heart transplant recipients and their partners.

[Function and structure of families with chronically ill children]

In modern medicine especially the sick child often points out the limits of the psychosocial potentialities. This project investigates the function, structure, coping mechanisms, power and weakness of families with chronically ill children. We investigated 28 children from the nephrological ward and 55 patients from the cardiological department and also their families with the FAM III and compared the obtained T-scores with the results of the control-group (76 families, t-test, analysis of variance). Families with patients after renal transplantation (NTX) pointed out significant worse T-scores than the group with patients on CAPD or with preterminal renal insufficiency and CG (p < 0.05). Within the cardiological groups the differences were not statistically significant, on the other hand the group with patients before heart-operation and the group with patients after palliative heart-operation had better T-scores than the CT (p < 0.05). These results demonstrate that families with children suffering from a chronic renal or heart disease mobilize substantial resources to cope with these problems. By contrast the results of the families with patients after NTX or successful heart surgery are significant worse than the control-group and the other investigated patients groups. Our results come to the conclusion that especially after successful NTX or heart-surgery a psychosocial care of these families is necessary.

[Function and structure of families with an epileptic child]

Although the impact of psycho-social factors on the individual patient with epilepsy has been widely investigated, the influence of the illness on the family as a whole is still underestimated. By means of the Family Assessment Measure (FAM III), a well-validated instrument, we investigated which measurable influence the epilepsy of one child had on the functioning of the families. Data from a group of 72 families with a child suffering from epilepsy (EG), but without any other handicap were analysed and compared with those of 75 families with a child with severe mental retardation (SMG) and 76 control families (CG). Data were gathered through home visits. Only complete families were studied. Results showed that the EG was similar to the SMG in all 3 scales of FAM III, but differed significantly from the CG. In 26% of the families in EG and in 19% of the SMG clear signs of family malfunctioning were found, as compared with 6.5% of the CG. Family disfunctioning in EG was of a greater variety that in SMG. We found that within the EG the type of seizures (41 patients with generalized tonic clonic fits, 10 with complex partial seizures and 21 with absences) did not have any impact on the results. In addition, neither the duration of the illness nor the absolute length of seizure-free periods seemed to matter. Only families who had the subjective feeling that their children were still suffering from epilepsy showed significantly higher rates of family malfunctioning. Summarizing, we found that epilepsy in a child can have a severe impact, not only on his individual life and on the mother-child relationship, but on the functioning of his family as the whole. This fact should be taken into account in the treatment of these children and should influence family counselling, as well.

Psychogenic relapses in childhood epilepsy in puberty and adolescence

Epileptic patients who, after years of being free from symptoms, have relapses during puberty or adolescence (some-times coinciding with a reduction in therapy) pose special therapeutic and diagnostic problems. Because of pubertal lability, the cause of a relapse might seem to be "organic", especially if the EEG also shows a "deterioration", yet psychogenic factors must not be disregarded. On the basis of typical case studies, a characteristic constellation is presented. The achievement of a "well-behaved" child at first dramatically improves and this correlates with the success of antiepileptic therapy. Then individuation and further development cannot adequately take place because the family unit is not functioning properly. At a critical stage of development, the excessive expectations of the parents lead to too much stress on the child, thus destroying the balance within the family system, which has hitherto been maintained only with difficulty. Attempts to improve the situation by changing the medication (increasing the dose or switching to another drug) fail. If, however, it is realized that the symptoms are of psychogenic origin, adequate therapeutic interventions (e.g. adequate schooling or professional training as well as psychotherapy) promise good results.

Discrimination of taste and preference for sweet in premature babies

A modified method for registering non-nutritive sucking behaviour with and without taste stimulation enabled us to study taste perception of premature babies. We wanted to study how babies who had no extrauterine taste experience reacted to one or more stimuli with water and 33% glucose. Eight randomly selected healthy newborns (three of them being SGA without further symptoms), exclusively fed by gastric tube, were studied. The mean gestational age at the time of the study was 35.5 weeks. They were studied five times with water and five times with glucose just before feeding. In seven babies the sucking response to glucose was greater than that to water from the first trial onwards. Sucking response increased with repeated glucose stimulation, but remained the same with water stimulation. The eighth baby behaved completely differently. We concluded from our results that premature babies with a postconceptional age of 35 weeks can discriminate between sweet and not-sweet. The greater sucking response to glucose than to water at the first trial implies a genetic factor in the preference for sweet in humans.

[Psychosocial dwarfism--a rare form of growth disorder]

Psychosocial dwarfism is a syndrome caused by emotional deprivation (maternal deprivation), characterized by symptoms of delayed motor and intellectual development, abnormal eating and drinking habits, enuresis and encopresis, aggressiveness and a pathological family structure. Diagnosis of psychosocial dwarfism is easy if the case history is carefully elicited and the growth hormone level is determined within the first few days following change in environment (e.g. hospitalization). Difficulty in reaching the correct diagnosis or misdiagnosis can occur if the symptomatology is not studied in its entirety. Diagnosis at the earliest possible stage is very important for the further development of the child, since behavioural disturbances and growth retardation are reversible with environmental change. This is demonstrated by the presentation of the case history of a 6 year-old boy--the third case reported in the German literature.