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Andreas Warnke

Publications and source records attributed to Andreas Warnke.

At least 19 recordsLinked to original sources
PubMed2007

[Phenomenology and co-morbidity of childhood onset obsessive compulsive disorder].

OBJECTIVES: The goal of the study was to investigate the contents and comorbidity features of obsessive-compulsive disorder in children and adolescents. METHOD: 55 patients (29 males, 26 females), mainly inpatients selected from university clinics for child and adolescent psychiatry (95%), were investigated. Structured diagnostic interviews were used to interview patients and their parents. RESULTS: The mean age of onset for obsessive-compulsive disorders was 11.3 years. In males the onset was slightly earlier than among females, but this difference was not significantly significant. Compulsions mostly referred to washing and cleaning, checking, repeating, ordering, and counting. Most frequently, obsessions included thought about contamination, catastrophes, sexuality, and aggression. According to parental reports, the rate of comorbidity was high (lifetime diagnosis: 69%, current diagnosis: 53%), with anxiety, depressive, hyperkinetic, conduct, and eating disorders being the most frequent co-morbid conditions. Obsessive-compulsive symptoms were more intense in those patients who had a greater number of lifetime diagnoses of other psychiatric disorders. Comparing the rates found when structured interviews were carried out according to the study protocol to those for clinicians, clinicians were found to have diagnosed mixed obsessional thoughts and acts (presenting obsessional thoughts, as well as compulsive acts) less frequently. CONCLUSIONS: The results of this investigation are well in line with those of international studies on obsessive-compulsive disorders. The rates of disorders found were dependent on the diagnostic methods used. A potentially promising approach for further investigation is the sub-typing of patients according to symptom dimensions.

Adolescent↗
PubMed2006

Increased mRNA levels of the mitochondrial complex I 75-kDa subunit. A potential peripheral marker of early onset schizophrenia?

Recently, the dopamine D3-receptor mRNA on blood lymphocytes and platelet mitochondrial complex I were suggested as biological markers of schizophrenia in adults. We investigated the mRNA level of the dopamine D3-receptor and complex I subunits in whole blood cells of early-onset schizophrenic patients compared to healthy controls using quantitative real-time PCR. We found an increased mRNA expression of the complex I 75-kDa subunit (referred to beta-actin in schizophrenic patients (0.57 +/- 0.24 versus 0.23 +/- 0.18 in controls, P < 0.01)), but were unable to analyse the dopamine D3-mRNA expression. This increase appears to be inherent to schizophrenia, because it was found in neuroleptic-naive patients and it was not affected by neuroleptic treatment. Our preliminary findings suggest the mitochondrial complex I as a potential peripheral marker of schizophrenia and its involvement in the pathophysiology of this illness.

Actins↗
PubMed2006

The extent of social anxiety in combination with mental disorders.

The aim of the study was to investigate the extent of social anxiety in different mental disorders. A total of 341 patients aged 7-18 years participated in the study. To measure social anxiety, the German version (SPAIK) of the Social Phobia and Anxiety Inventory for Children (SPAI-C) was used. Subgroups were built dependent on mental disorders. A total score above 20, which was assumed to indicate social anxiety, was observed in children with selective mutism (n = 9; M = 22.68; SD = 11.29) and in children with Asperger's Syndrome (n = 7; M = 20.77; SD = 13.77). Patients who had the following mental disorders also showed a higher total score of social anxiety: obsessive-compulsive disorder, anorexia nervosa, schizophrenia, depression and conduct disorder. In none of these disorders, however, did the mean total score exceed the cut-off of 20.

Adolescent↗
PubMed2006

[Therapeutic drug monitoring in child and adolescent psychiatry--practical recommendations].

The therapy of children and adolescents with psychotropic drugs differs from that of adults. Due to the differences in the pharmacokinetic behaviour of the drugs used that are dependent on a child's, respectively an adolescent's stage of development, the same dosages as recommended for adults cannot be used. Moreover, many of the drugs used have not been approved for use in children and adolescents. Thus the criteria which guarantee their efficacy and safety for use in adults do not apply for their use in children and adolescents. Therefore therapeutic drug monitoring (TDM) is a general indication for the administration of psychotropic drugs in children and adolescents. TDM enables the clinician to adjust the dosage of a drug according to the characteristics of the individual patient. It is also a valid tool to increase the safety of therapy and optimise therapy with psychotropic drugs. However, standardized studies are also needed to find therapeutic ranges of plasma concentrations for children and adolescents. Such studies will deliver new insights into the pharmacokinetic and pharmacodynamic behaviour of drugs used in child and adolescent psychiatry. The present contribution begins with a brief description of the strategy of TDM in psychiatry, followed by a discussion of the characteristics of pharmacotherapy in child and adolescent psychiatry and the reasons for the general indication of TDM in children and adolescents. Finally, recommendations are given for the routine performance of TDM. For a detailed treatment of TDM in psychiatry, the interested reader is referred to the AG-NP-TDM Expert Group Consensus Guidelines published earlier (Baumann et al., 2004).

Adolescent↗
PubMed2006

[Treatment of social phobia in childhood and adolescence].

OBJECTIVES: The following article investigates the extent to which the current status of cognitive behavioral research on the treatment of socially phobic children and adolescents is reflected by the currently used guidelines for psychotherapy. METHODS: The current literature on research in psychotherapy was systematically reviewed. RESULTS: The results show the significance of single-setting treatment, of cognitive interventions, and of parental participation in the therapy. The results also show the limitations encountered if the treatment consists only of training social competence skills. CONCLUSIONS: The current treatment recommendations for socially phobic children must be supplemented and modified.

Adaptation, Psychological↗
PubMed2006

[Genetics of dyslexia].

Dyslexia is a very common developmental disorder. The aetiology of this complex disorder must in large part still be clarified. Dyslexia segregates in families and the risk for a sibling to become dyslexic is 3.5-fold increased. Different phenotypic dimensions are correlated with dyslexia. These are mainly phonological awareness, phonological decoding, orthographic coding, auditory short-term memory, and rapid naming. The correlated dimensions segregate in families and were found to be heritable. The heritability of word reading lies between 50% and 60%, and that of spelling between 50% and 70%. Based on genome wide linkage analyses, nine candidate gene regions (DYX1-DYX9) could be identified. Recently, four candidate genes, DCDC2, KIAA0319, ROBO1 and DYX1C1 were identified by systematic association analyses. All these genes play a function role in neuronal migration, making them promising candidate genes for dyslexia. However, a functionally relevant mutation has not yet been identified. The comorbidity between dyslexia and ADHD and between dyslexia and SLI could be explained, at least in part, by genetic factors. For future research, all relevant factors playing a functional role in dyslexia should be investigated in sufficiently large samples. This research should integrate genetic, neurobiological, and environmental factors. For an understanding of causes, it is very helpful to understand the interaction between different factors, namely gene-environmental and gene-gene interaction. In a recent project funded by the EU in the Sixth Framework (www.neurodys.com), the worldwide largest sample of children with dyslexia will be sampled and investigated. The goal of this project is to investigate the biological basis of dyslexia in order to improve the basis for the development of successful diagnostics and therapies.

Adolescent↗
PubMed2006

Clinical drug monitoring in child and adolescent psychiatry: side effects of atypical neuroleptics.

OBJECTIVE: The aim of this study was to improve and evaluate the practibility of a method for the assessment of drug-associated side effects, and we implemented a clinical drug monitoring for atypical neuroleptics. METHODS: Side effects of initially hospitalized patients treated with clozapine (n = 16), olanzapine (n = 16), and risperidone (n = 19) were prospectively monitored on a weekly basis for the first 3 weeks. In the case of stable medication, measurements of all variables were made every 4 weeks or upon discharge. We used the Dosage Record Treatment Emergent Symptom Scale (DOTES) in a supplemented version to measure the presence and severity of side effects. RESULTS: Drowsiness and decreased motor activity were common, especially in the first 2 weeks. Orthostatic hypotension, increased salivation, constipation, and nasal congestion were seen in more than 30% to 60% of patients treated with clozapine and were less common in adolescents treated with olanzapine and risperidone. Rigidity, tremor, and dystonia were seen in 5% to 15% of patients treated with risperidone and olanzapine. The average weight gain after 6 weeks of treatment with the atypical neuroleptics was significantly higher for the olanzapine group (4.6 +/- 1.9 kg) than for the risperidone (2.8 +/- 1.3 kg) and clozapine (2.5 +/- 2.9 kg) groups. CONCLUSIONS: The authors' supplemented DOTES version is generally applicable to clinical use in mental health centers. The differences among the side effects of these three agents may affect compliance with medication and medical risks of metabolic syndrome, diabetes, and cardiovascular disease. More research on the short- and long-term safety of psychotropic drugs in children and adolescents, using standardized methods, should be considered.

Adolescent↗
PubMed2005

Strong genetic evidence of DCDC2 as a susceptibility gene for dyslexia.

We searched for linkage disequilibrium (LD) in 137 triads with dyslexia, using markers that span the most-replicated dyslexia susceptibility region on 6p21-p22, and found association between the disease and markers within the VMP/DCDC2/KAAG1 locus. Detailed refinement of the LD region, involving sequencing and genotyping of additional markers, showed significant association within DCDC2 in single-marker and haplotype analyses. The association appeared to be strongest in severely affected patients. In a second step, the study was extended to include an independent sample of 239 triads with dyslexia, in which the association--in particular, with the severe phenotype of dyslexia--was confirmed. Our expression data showed that DCDC2, which contains a doublecortin homology domain that is possibly involved in cortical neuron migration, is expressed in the fetal and adult CNS, which--together with the hypothesized protein function--is in accordance with findings in dyslexic patients with abnormal neuronal migration and maturation.

Base Sequence↗
PubMed2005

Transmission disequilibrium of polymorphic variants in the tryptophan hydroxylase-2 gene in children and adolescents with obsessive-compulsive disorder.

Dysfunction of the central serotonergic system has been implicated in the pathophysiology of obsessive-compulsive disorder (OCD). The genetic contribution to the development of OCD is particularly high in early-onset OCD. The aim of this study was to investigate the effect of polymorphic variants in the gene of the novel brain-specific tryptophan hydroxylase-2 (TPH2), the rate-limiting enzyme of serotonin (5-HT) synthesis in the brain, in OCD with disease onset in childhood and adolescence. We analysed two common single nucleotide polymorphisms (SNPs) of TPH2 in the putative transcriptional control region and in intron 2 of the TPH2 gene in a unique family-based sample of OCD patients with onset of the disease in childhood and adolescence comprising 71 complete, independent trios. The transmission disequilibrium test was used to determine transmission of alleles and haplotypes from parents to offspring. In this first study of TPH2 in OCD, analysis of the SNPs, rs4570625 and rs4565946, revealed a significant preferential transmission of haplotype G-C to children and adolescents with OCD. Moreover, a trend towards preferential transmission of the C allele of SNP rs4565946 to the patients was found. The genotype relative-risk estimate for homozygous C allele carriers of SNP rs4565946 was 2.58 (95% CI 0.98-6.82). In conclusion, the results link TPH2 variations to the pathogenesis of early-onset OCD and further support the aetiological relevance of 5-HT signalling in OCD.

Adolescent↗
PubMed2005

Developmental dyslexia--recurrence risk estimates from a german bi-center study using the single proband sib pair design.

OBJECTIVE: Several studies have demonstrated a genetic component for dyslexia. However, both segregation and linkage analyses show contradictory results pointing at the necessity of an optimal ascertainment scheme for molecular genetic studies. Previously, we have argued that the single proband sib pair design (SPSP) would be optimal. The aims of this paper therefore are to demonstrate the practicability of the SPSP design and the estimation of recurrence risks for reading and writing. METHODS: We assessed spelling and reading in a family sample ascertained through the SPSP design. 287 families with at least two siblings and their parents were recruited. At least one child was affected with spelling disorder according to a one standard deviation (1SD) discrepancy criterion. RESULTS: Mean values for probands and their siblings were different for both the spelling and the reading phenotype. For the probands, variances of the phenotype spelling were smaller. These effects became stronger with more extreme selection criteria. Both siblings fulfilled the 1SD criterion for spelling and reading in 60.3 and 28.9% of the families, respectively, indicating a low cost efficiency of the double proband sib pair approach. A recurrence risk of 4.52 (CI: 4.07-4.93) was obtained for spelling when the 1SD criterion was applied to both siblings. Recurrence risk estimates were similar for reading. CONCLUSION: The study demonstrates the suitability of the SPSP design for genetic analysis of dyslexia. The recurrence risk estimates may be used for determining sample sizes in gene mapping studies.

Child↗
PubMed2005

[Validation of the German version of the Australian Scale of Asperger's Syndrome (ASAS)].

OBJECTIVES: The aim of the study was to validate the German version of the Australian Scale for Asperger's Syndrome (ASAS). Furthermore, the scoring of the ASAS as applied by the Australian authors was verified. METHODS: The mothers of 18 children with Asperger's Syndrome, those of 18 children referred for a possible diagnosis of Asperger's Syndrome, but who did not receive that diagnosis, and the mothers of 15 children with other mental disorders participated in the study. All of the children were inpatients at the University of Wuerzburg Hospital of Child and Adolescent Psychiatry. RESULTS: According to an analysis of variance, the scale successfully differentiates among the three samples. A stepwise discriminant analysis was performed. Classification results show that the membership of the three groups could be labelled accurately (accuracy rate: 60.78%). The ASAS's scoring methodology appears to yield good results for German patients. CONCLUSIONS: The scale appears to be an adequate tool for screening purposes in that it correctly discriminates children and adolescents with Asperger's Syndrome.

Adolescent↗
PubMed2005

[Aatypical antipsychotics in child and adolescent psychiatry--indications apart from schizophrenia].

OBJECTIVES: Given their special receptor profile, atypical antipsychotics are effective in the treatment of both positive and negative symptoms. Especially the serotonergic affinity suggests their potential utility for the treatment of depressive, anxious, and obsessive-compulsive symptoms as well. Reviewed here are the clinical experience with, studies of, and published reports on the use of atypical antipsychotics in the treatment of different psychiatric disorders other than schizophrenia in children and adolescents. METHODS: The literature from 1998-2004 was reviewed by means of PubMed and CurrentContents. RESULTS: In addition to schizophrenic symptoms, the therapeutic indications for atypical antipsychotics include tic disorders, bipolar affective disorders and mania, impulsiveness and disruptive behaviour, (auto-)aggression, and severe anorexia nervosa. Empirical data such as those from placebo-controlled double-blind or open-label studies in larger child and adolescent populations are rare. Substances are used mostly off-label. CONCLUSIONS: Atypical antipsychotics today comprise part of the standard psychopharmacotherapy in child and adolescent psychiatry. They have proved to be effective in the treatment of schizophrenia, tic disorders, impulsiveness, (auto-)aggression, and eating disorders.

Adolescent↗
PubMed2005

[Encopresis--predictive factors and outcome].

OBJECTIVES: comparison of diagnostic, clinical and therapeutic features and their predictive value for the outcome of encopresis in children and adolescents. METHODS: 85 children and adolescents (aged 9.6 +/- 3.2 years) with severe encopresis (ICD 10: F98.1) were investigated during inpatient treatment and 35 of them again 5.5 +/- 1.8 years later. Mentally retarded patients were excluded. Inpatient therapy consisted of treating constipation and/or stool regulation by means of laxatives, behavioural approaches, and the specific therapy of comorbid psychiatric disorders. RESULTS: During inpatient treatment 22% of the patients experienced total remission, 8% an unchanged persistence of symptoms. Of the 35 patients studied at follow-up 5.5 years later, 40% were symptom-free. As main result, prognostic outcome depended significantly on sufficient treatment of obstipation. Another important factor was the specific therapeutic approach to psychiatric comorbidity, especially to ADHD. The outcome for patients with comorbid ICD 10: F43 was significantly better than for the other patients. Those who were symptom-free at discharge had significantly better long-term outcomes. CONCLUSIONS: Decisive to the success of encopresis treatment were the stool regulation and the specific therapy of associated psychiatric illnesses, in particular of ADHD. Inpatient treatment revealed significantly better long-term outcomes where total remission had been achieved by the time of discharge from hospital.

Adolescent↗
PubMed2004

Altered response control and anterior cingulate function in attention-deficit/hyperactivity disorder boys.

OBJECTIVE: To investigate mechanisms and structures underlying prefrontal response control and inhibition in boys suffering from attention-deficit/hyperactivity disorder (ADHD). METHOD: Sixteen boys with ADHD and 19 healthy controls were investigated electrophysiologically during performance of a visual Go-Nogo task (Continuous Performance Test, CPT). An electrophysiological source localization method was employed to further analyze the data. RESULTS: The ADHD boys showed a significantly diminished central Nogo-P3, due to a lack of Nogo-related frontalization of the positive brain electrical field in this group. This two-dimensional effect was associated with a significantly reduced activation of the anterior cingulate cortex (ACC) in the ADHD boys in the Nogo condition of the CPT. Both groups did not significantly differ regarding the amplitude of the Nogo-N2. CONCLUSIONS: The results indicate deficits in prefrontal response control in unmedicated ADHD boys that do not seem to be specifically inhibitory in nature. A supposed dysfunction of the ACC in ADHD was confirmed.

Attention Deficit Disorder with Hyperactivity↗