PubMed Health⌕ Search

Biomedical subjects

Aribert Rothenberger

Publications and source records attributed to Aribert Rothenberger.

At least 37 records · Page 2Linked to original sources
PubMed2005

[The decisions of indication for inpatient child and adolescent psychiatric treatment].

OBJECTIVES: To date there has been little empirical investigation of the indications for hospitalising children in child and adolescent psychiatry wards. Therefore we analysed the decision-making models used to establish the criteria for admission to child and adolescent psychiatric clinics. It is assumed that the clinical experience and social orientation of the specialists involved, as well as the standpoint of their respective institutions of health care, play a significant role. METHODS: The decision-making models of 71 specialists working in the field of in- and outpatient child and adolescent psychiatry were recorded using an adapted structuring process. The hypotheses were examined by comparing the models used by the different professional groups working in inpatient units and by child and adolescent psychiatrists working in private practice to the decision-making models used by assistant medical directors and head physicians. RESULTS: The factors "clinical experience" and "profession group orientation" were found to be of only marginal importance. Only the inpatient nursing staff considered social factors in arriving at an indication. The influence of such "setting" variables is also evident in the fact that the outpatient staff used more narrowly defined criteria and rated their outpatient service as being more sustainable than did the physicians in the inpatient departments. The criteria used by all professions included being a danger to oneself and others, severity of symptoms, the assessment of outpatient resources and efficiency, prospects of success, and the need for intensive treatment. CONCLUSIONS: The results of this study provide a basis for further research and indicate the need for additional discussion of the indication criteria currently in use.

Adolescent↗
PubMed2005

Very early treatment with fluoxetine and reboxetine causing long-lasting change of the serotonin but not the noradrenaline transporter in the frontal cortex of rats.

Interactions of the serotonergic and noradrenergic system at different sites of the brain may be important for efficacy and side effects of antidepressant drugs. Further, serotonin and noradrenaline play a critical role in the development of neurons during brain maturation. To gain further insight how brain maturation and the two monoaminergic systems are influenced by drug treatment during early postnatal development, this animal study investigated possible effects on the noradrenaline and serotonin transporter density of the frontal cortex very early in postnatal life. Rats were treated from postnatal day 2 to 5 either with fluoxetine (5 mg/kg per day s.c.) or with reboxetine (10 mg/kg per day s.c.). At day 90 the serotonin and noradrenaline transporter density in the frontal cortex was measured by ligand binding assay. Fluoxetine treatment led to a significant long-lasting increase of serotonin (not noradrenaline) transporter density (Bmax = 1231 +/- 34) in the frontal cortex (compared with saline-treated controls (Bmax = 1112 +/- 58)). Reboxetine treatment (surprisingly) led to an even more enhanced serotonin transporter density (Bmax = 1322 +/- 46), while noradrenaline transporter density seemed to be unaffected. There were no significant differences for KD values. The results support the idea that serotonin seems to play an important role during early brain development. Moreover, drug-related modulation of the noradrenergic system during brain maturation seems to cross-influence the serotonergic system.

Animals↗
PubMed2005

Whither causal models in the neuroscience of ADHD?

In this paper we examine the current status of the science of ADHD from a theoretical point of view. While the field has reached the point at which a number of causal models have been proposed, it remains some distance away from demonstrating the viability of such models empirically. We identify a number of existing barriers and make proposals as to the best way for these to be overcome in future studies. These include the need to work across multiple levels of analysis in multidisciplinary teams; the need to recognize the existence of, and then model, causal heterogeneity; the need to integrate environmental and social processes into models of genetic and neurobiological influence; and the need to model developmental processes in a dynamic fashion. Such a model of science, although difficult to achieve, has the potential to provide the sort of framework for programmatic model-based research required if the power and sophistication of new neuroscience technologies are to be effectively exploited.

Attention Deficit Disorder with Hyperactivity↗
PubMed2005

The safety of non-stimulant agents for the treatment of attention-deficit hyperactivity disorder.

Due to their well-established efficacy and safety, stimulants are the drugs of first choice if medication for attention-deficit hyperactivity disorder (ADHD) is required. Nevertheless, for some individuals other, non-stimulant treatments are needed for several reasons. If so, atomoxetine is recommended as a second-line treatment. In addition, several tricyclic antidepressants, such as desipramine or imipramine, as well as alpha-2 agonists, especially clonidine or bupropion, might be efficient in treating ADHD, in particular in specific co-morbid conditions. Despite the fact that non-stimulant treatments in ADHD are usually well-tolerated with side effects being mostly moderate and transient, special safety aspects and precautions, specific for each drug, have to be considered whenever a non-stimulant treatment is chosen. This review focuses on the tolerability, occurrence of adverse events, precautions required to prevent severe adverse events, and essential pharmacological interaction in the treatment of ADHD symptoms by non-stimulants.

Adrenergic alpha-Agonists↗
PubMed2004

Olfactory deficits in anorexia nervosa.

OBJECTIVE: Young patients admitted to the hospital due to anorexia nervosa report reduced pleasure and impaired perception of smell while eating. So far, two studies on odour identification ability in eating disorders did not suggest any significant deficits. Therefore a new and more detailed method of olfactory testing may be needed, in order to determine the subjective impairment of olfaction. METHOD: By using all three subtests of the recently developed smell test called "Sniffin'Sticks", the olfactory deficits were assessed in more detail and the results of female anorectic patients (n = 17) were compared with those of healthy females (n = 15). RESULTS: By examining the anorectic patients no deficits in the subtest odour identification were found. On the contrary, in the subtests odour discrimination and odour threshold deficits of the anorectic patients were detected. CONCLUSION: Reduced olfactory perception might be considered as a common deficit in anorexia nervosa with possible influences and consequences for therapy.

Adolescent↗
PubMed2004

Training of slow cortical potentials in attention-deficit/hyperactivity disorder: evidence for positive behavioral and neurophysiological effects.

BACKGROUND: Learned self-control of slow cortical potentials (SCPs) may lead to behavioral improvement in attention-deficit/hyperactivity disorder (ADHD). Hence, training effects should also be reflected at the neurophysiological level. METHODS: Thirteen children with ADHD, aged 7-13 years, performed 25 SCP training sessions within 3 weeks. Before and after training, the German ADHD rating scale was completed by parents, and event-related potentials were recorded in a cued continuous performance test (CPT). For a waiting-list group of nine children with ADHD, the same testing was applied. RESULTS: ADHD symptomatology was reduced by approximately 25% after SCP training. Moreover, a decrease of impulsivity errors and an increase of the contingent negative variation were observed in the CPT task. CONCLUSIONS: This study provides first evidence for both positive behavioral and specific neurophysiological effects of SCP training in children with ADHD.

Adolescent↗
PubMed2004

Time reproduction in finger tapping tasks by children with attention-deficit hyperactivity disorder and/or dyslexia.

AIM: Deficits in timing and sequencing behaviour in children with dyslexia and with attention-deficit hyperactivity disorder have already been identified. However many studies have not controlled for comorbidity between dyslexia and ADHD. This study investigated timing performance of children with either dyslexia or ADHD, or ADHD + dyslexia or unaffected children using a finger tapping paradigm. METHOD: Four groups of children (ADHD x Dyslexia) with a total of 68 children were compared using a four factorial design with two between-subject factors (ADHD (yes/no), dyslexia (yes/no)) and two within-subject factors, inter-stimulus interval (263, 500, 625, 750, 875 and 1000 ms) and tapping condition (free tapping, synchronous tapping, and unpaced tapping). In addition the complexity of rhythm reproduction pattern (unpaced tapping) was varied (simple/complex). RESULTS: No significant differences were found either in the ability of the ADHD or the dyslexia groups to sustain a self-chosen free tapping rate or to generate a stable inter-response interval either by synchronising to a signal or in reproducing a given interval without the previous pacing signal. Response averages showed the expected asynchrony and variability. In rhythm pattern reproduction the groups did not differ significantly in their ability to reproduce rhythms. However, a significant two way interaction effect between dyslexia and complexity was apparent indicating that the difference in levels of performance for simple versus complex rhythms was more pronounced for dyslexia than for the two other groups. CONCLUSION: The results indicate that motor timing ability in the millisecond range below 1000 ms in children with ADHD and/or dyslexia is intact. The performance of the comorbid group was revealed to be similar to the performance of the single disorder groups, but both the dyslexic groups were relatively worse than either the ADHD-only or the unimpaired group at reproducing complex versus simple rhythms.

Attention Deficit Disorder with Hyperactivity↗
PubMed2004

Foreword -- ADHD in the scientific and political context.

The foreword focuses on the three main critical questions within the political debate: (1) Is ADHD a psychiatric disorder? (2) Is there over-diagnosis and overtreatment of ADHD? (3) Are psychostimulants dangerous drugs? After discussing the problems within the context of general scientific and merely European political context, the authors conclude with a positive outlook comprising (1) step-up of research in ADHD, (2) exercised control over diagnosis and treatment, (3) the need for training and continuous personal development for doctors, and (4) Improvement of information to teachers and parents. The presented supplement on "ADHD -- beyond core symptoms. Not only a European perspective" underlines this perspective and reflects a broad spectrum of ADHD-related activities currently underway in Europe while having the worldwide development of the field in mind.

Attention Deficit Disorder with Hyperactivity↗
PubMed2004

European clinical guidelines for hyperkinetic disorder -- first upgrade.

BACKGROUND: The validity of clinical guidelines changes over time, because new evidence-based knowledge and experience develop. OBJECTIVE: Hence, the European clinical guidelines on hyperkinetic disorder from 1998 had to be evaluated and modified. METHOD: Discussions at the European Network for Hyperkinetic Disorders (EUNETHYDIS) and iterative critique of each clinical analysis. Guided by evidence-based information and based on evaluation (rather than metaanalysis) of the scientific evidence a group of child psychiatrists and psychologists from several European countries updated the guidelines of 1998. When reliable information is lacking the group gives a clinical consensus when it could be found among themselves. RESULTS: The group presents here a set of recommendations for the conceptualization and management of hyperkinetic disorder and attention deficit/hyperactivity disorder (ADHD). CONCLUSION: A general scheme for practice in Europe could be provided, on behalf of the European Society for Child and Adolescent Psychiatry (ESCAP).

Alleles↗
PubMed2004

EINAQ -- a European educational initiative on Attention-Deficit Hyperactivity Disorder and associated problems.

BACKGROUND: Continuing Medical Education (CME) plays an important role in quality management, especially as quality assurance, for the improvement of healthcare in child and adolescent psychiatry. This requires responsibility regarding quality standards of clinical practice throughout Europe as outlined by the European Union of Medical Specialists (UEMS). OBJECTIVE: Therefore, steps should be undertaken to improve specialists' medical care and harmonize it in Europe. Attention-Deficit Hyperactivity Disorder (ADHD) with its many co-existing developmental disorders/problems is the central healthcare problem in child and adolescent psychiatry with high impact on society. Therefore, it was chosen as the target. METHOD: A European Interdisciplinary Network for ADHD Quality Assurance (EINAQ) was founded, didactic material was developed and a faculty of experts from several European countries established to offer all over Europe harmonized courses on ADHD and associated problems. RESULTS: Pilot courses were given in Germany in 2003/2004 and were highly appreciated by the participants. Further courses in Germany and other European countries will take place in 2004. CONCLUSION: EINAQ seems to be on the right track to be part of CME and specialized networks for healthcare in ADHD to improve the provision for mental health problems in children and adolescents in Europe. Cooperative projects with official European bodies like the UEMS -- Section on Child and Adolescent Psychiatry/Psychotherapy and the European Society of Child and Adolescent Psychiatry could strengthen the impact of EINAQ.

Adolescent Psychiatry↗
PubMed2004

Neuronal network models of ADHD -- lateralization with respect to interhemispheric connectivity reconsidered.

BACKGROUND: Recent research on structural and functional anatomy related to ADHD has concentrated on fronto-striatocerebellar circuits. These findings and resultant neurobiological models of ADHD may explain some of the disturbances. On the other hand, there is some evidence that the restricted look at anterior-posterior anomalies might neglect the important additional information of lateralization problems related to hemispheric connectivity. OBJECTIVE: Hence, the role of lateralization in the pathophysiology of ADHD should be reconsidered. METHOD: After a short review of imaging studies in ADHD the special role of the corpus callosum (including the influence of its anomalies on general brain development, lateralization and functioning) is outlined and the first case of total agenesis of corpus callosum in a child with ADHD is presented and discussed within this context. CONCLUSIONS: In view of the remaining inconsistencies concerning structural and functional brain anomalies in ADHD, attention should be paid not only to anterior- posterior but also to left-right aspects of functional and structural brain anomalies. This should include disturbances probably related to anomalies of the corpus callosum, especially in regard to co-existing problems like dyslexia and developmental coordination disorder.

Agenesis of Corpus Callosum↗
PubMed2004

Co-existing disorders in ADHD -- implications for diagnosis and intervention.

BACKGROUND: It is only recently that "comorbidity" in ADHD has come to the forefront as one of the most important aspects of the disorder. It is agreed that, often, these problems are at least as important as ADHD in contributing to the longer term outcome in the individual child. OBJECTIVE: To provide the reader with basic information about clinics and treatment of "comorbidity" in ADHD. METHOD: Review of the empirically based literature. RESULTS: ADHD exists in a surprisingly high frequency together with a broad range of child neuropsychiatric disorders. This is accompanied with many still unresolved treatment problems. CONCLUSION: It would not be appropriate to develop ADHD-services where clinicians would only have expertise in ADHD as such. Anyone working with children, adolescents and adults with ADHD would need to have training in general neuropsychiatry. Further research in this field is urgently needed.

Age Factors↗
PubMed2004

Comparative efficacy of once-a-day extended-release methylphenidate, two-times-daily immediate-release methylphenidate, and placebo in a laboratory school setting.

BACKGROUND: Given the dosing limitations of methylphenidate short-acting preparations in treating ADHD, galenics with longer release of the substance were developed mainly to avoid drug intake during school hours. OBJECTIVES: This investigation was conducted to assess the efficacy and the duration of action of a new extended-release formulation of methylphenidate (Medikinet retard) as a once-daily treatment for children with attention-deficit hyperactivity disorder (ADHD). METHOD: This was a randomized, double-blind, crossover multicentre study with three treatment conditions: once-daily extended-release methylphenidate, twice-daily immediate-release methylphenidate and placebo given to 79 children (8-14 years old) with ADHD. Daily assessments in an analogue classroom setting included blind ratings of attention and deportment and a performance measure (math test) obtained 5 times over an 8-hour period. Secondary measures included an ADHD rating scale, based on DSMIV/ ICD-10 separately rated for the morning and the afternoon. RESULTS: Both active treatment conditions displayed significant time course effects and were superior to placebo in improving all efficacy measures. Once a day extended-release methylphenidate was not different from the same dose of twice daily immediate-release methylphenidate. CONCLUSIONS: These data provide support for the benefit of this novel, once-daily methylphenidate preparation in the treatment of ADHD. The longer duration of action of Medikinet Retard has the potential to simplify psychostimulant treatment, thus reducing dose diversion and eliminating the need for in-school administration.

Adolescent↗
PubMed2004

Non-stimulant medications in the treatment of ADHD.

BACKGROUND: Stimulants are the first-line medication in the psychopharmacological treatment of attention-deficit hyperactivity disorder (ADHD). However, 10 to 30% of all children and adults with ADHD either do not respond to or do not tolerate treatment with stimulants. OBJECTIVE: To describe alternative treatment approaches with various non-stimulant agents, especially atomoxetine. METHOD: General review of empirically based literature concerning efficacy and safety of the substances. RESULTS: A large and still increasing body of data supports the usefulness of atomoxetine, a once daily dosing, and new selective noradrenalin reuptake inhibitor, with few side effects. Atomoxetine has been licensed in the US for use in ADHD across the lifespan, and is currently under consideration in Europe. Other non-stimulant substances, such as tricyclic antidepressants (TCAs) and alpha-2-adrenergic agonists, which are used to treat ADHD, are also reviewed. TCAs have been well studied and shown to be efficacious in the treatment of ADHD, but are limited by side effects. The number of studies documenting the efficacy of alpha-2-adrenergic agonists is still limited. Some experimental studies support a potential role of cholinergic drugs such as acetylcholinesterase inhibitors (tacrine, donepezil) as well as novel nicotinic analogues (ABT-418). CONCLUSION: Non-stimulant agents have been shown to be effective in treatment of ADHD. Especially, atomoxetine seems promising and newline drugs are in development.

Antidepressive Agents, Tricyclic↗
PubMed2004

Areas for future investment in the field of ADHD: preschoolers and clinical networks.

BACKGROUND: Two areas ripe for future investment in the field of ADHD are identified. ADHD in the preschool years is a key area for future study and development. Many questions relating to its validity and diagnosis remain unanswered, although there is a growing demand for treatment in daily practice. The lack of conformity of diagnosis and treatment of children with ADHD in daily practice to international best-practice guidelines represent unsolved problems. Investment in ADHD networks connecting different services and different professions across European nations may help to reduce these problems. OBJECTIVE: To describe recent developments and future trends in relation to preschool ADHD and ADHD clinical network. METHODS: Selective review and interpretation of empirical data. CONCLUSION: Further studies are required to disentangle the various pathways into ADHD during preschool especially in relation to the background of early gene-environment interaction. This will improve the management of preschoolers with ADHD especially in the area of prevention and risk reduction. There will be an increasing demand for networks for the diagnosis and treatment of children with ADHD.

Attention Deficit Disorder with Hyperactivity↗