[Guidelines for diagnosis and therapy].
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Adolescent↗
Biomedical subjects
B Blanz
Publications and source records attributed to B Blanz.
Psychosocial adversities underestimated in hyperkinetic children.
Abnormal psychosocial factors, assessed both clinically and by raters blind to clinical presentation, were examined in 21 hyperkinetic and 26 conduct disordered children. Blind raters found the frequency of psychosocial adversities to be similar in the two disorders. By contrast the clinical rater, who did know the diagnosis of patients, rated adverse psychosocial situations as much lower in hyperkinetic children than in children with conduct disorder. Logistic regression showed, particularly in the category of abnormal intrafamilial relationships (Lack of warmth in parent child relationship, Hostility or scapegoating of the child, Intrafamilial discord among adults), effects of the interaction between rater and knowledge of diagnosis. Clinical raters should be aware of abnormal psychosocial situations in hyperkinetic children and assess possible adverse effects on parents and children. Researchers should be aware of a possible bias in research interviews.
Adult↗
[Psychological health at school entrance].
INTRODUCTION: The rate of psychiatric disorders in childhood and adolescence was investigated in numerous studies and was found to be between 10% and 18%, boys having more problems to tackle than girls. These studies often concern school-age children, but it is sure that psychiatric disorders already occur in early childhood. In the present study, mental health was assessed in children of Jena, who were starting with school. A comparison with methodologically similar studies in Heidelberg and Cologne was possible. METHODS: The study was conducted in cooperation with the health department of Jena. Parents had to fill in the CBCL (Child Behaviour Checklist), which assesses behavioural disturbances and social competence. Participation was voluntary and anonymous. RESULTS AND DISCUSSION: From the total population of 1039 children 749 (72.0%) checklists were filled in by the parents. 674 (64.9%) checklists were completely filled in and included in the study. 86 out of 674 (64.9%) of the children had a psychiatric disorder, boys (13.4%) more often than girls (12.2%), especially in the scales "Externalizing disorders", "delinquent behaviour", "aggressive behaviour" and "attention deficit disorders". Children coming from certain areas (Lobeda, Winzerla) had not have more disturbances than children from the central part of the city. Only 8.1% of the parents of children with psychiatric disorders recognise such problems, and only 16.3% of these children had a visit with a physician or psychologist within the last year. This leads to the conclusion, that the sensitivity for psychiatric disorders of children must be improved.
Child↗
[Biological correlates of aggressive behavior].
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Adolescent↗
Pelvic ultrasound scanning of the ovaries in adolescent anorectic patients at low weight and after weight recovery.
In sixteen adolescent anorectic inpatients with secondary amenorrhea pelvic ultrasound examination of the ovaries was performed at lowest weight and after weight recovery. The outcome was assessed six months later at follow-up, assigning the patients to the categories of good, intermediate and poor outcome according to the modified Morgan and Russell criteria. At lowest weight all patients' ovaries were smaller than expected for age. After weight recovery the good outcome group had mature and fully developed ovaries whereas the ovarian morphology of patients with poor outcome remained prepubertal. The ovarian volume in the good outcome group was significantly higher than in the poor outcome group. From a threshold BMI of 17.8 upwards we observed a positive linear correlation between BMI and ovarian volume. At BMI 18 the probability for recovered ovaries was 53% rising to 82% at BMI 19.8, which was the highest noting in our study. Nevertheless, we could not find a clear cut-off BMI for definite prediction of recovered ovaries. Therefore, in patients with anorexia nervosa pelvic ultrasound is a very suitable method for determining the target weight required for recovery of ovarian function and resumption of menses. Normalized ovaries indicate favourable outcome and physical recovery.
Adolescent↗
Course of adolescent psychotic disorder with schizoaffective episodes.
This study examines educational/occupational outcome and social functioning of adolescents treated for psychosis (mean onset age 16.1 yrs +/- 1.3). In a sample of 157 subjects, 26 patients with schizoaffective episodes (defined as any episode meeting ICD-9 criteria for schizoaffective psychosis, occurring at any time during the course of illness) were compared to 101 patients with schizophrenia, and to 30 affective disordered patients, all without schizoaffective episodes. Follow-up information (mean interval 7.3 yrs +/- 4.3) was obtained on 130 subjects. The three groups did not differ concerning sex, duration of first inpatient treatment, symptoms and social competence at discharge, nor at follow-up. At the time of outcome subjects with schizoaffective episodes showed greater similarities to schizophrenic than to severe affective disorder. Educational and occupational impairment was found in 72% of the schizoaffective group (schizophrenic group 79%, affective group 40%), obvious or more severe social disability in 86% of the schizoaffective group (schizophrenic 79%, affective 40%). Disabilities regarding performance of specific social roles and specific downward educational and occupational drifts were found to be more marked in schizoaffective than in affective disorder. Implications for further research and clinical practice are discussed.
Adolescent↗
[Does cognitive performance of adolescents with anorexia nervosa change with treatment?].
In the present pilot study 52 inpatients with anorexia nervosa were examined with regard to cognitive impairments. A psychological assessment was made on admission (T1) and shortly before discharge (T2), the focus being on fluency aspects of cognitive functioning. The results showed high test scores at T1 on all cognitive measures and improvement in cognitive functioning in the course of inpatient treatment. However, the level of cognitive functioning was not correlated with weight loss or duration of illness. Patients who were discharged with a BMI below 17.5 kg/m2 scored even higher at T1 (reaction time, concentration task) than those with a BMI above 17.5 kg/m2, pointing to a negative association between cognitive performance and outcome (target weight). Psychopathological variables that may play a role and that should therefore be considered in future research are discussed.
Adolescent↗
[Cognitive deficits in animals fed a hypocaloric diet: analogies to neuropsychological deficits in anorexia nervosa?].
Improvement in cognitive functions with weight gain in patients with anorexia nervosa leads to the assumption of cognitive functions decrease during long-lasting self-starvation. In the present study the effects of chronic undernutrition on learning abilities, in rodents were investigated in an open-field test and a passive avoidance paradigm. The findings suggest that cognitive deficits after a weight loss of 32% of normal weight may be caused by undernutrition. Further research is necessary to clarify other influencing conditions and identify the underlying biochemical mechanisms.
Animals↗
[Treatment of hyperkinetic children in the home environment].
Twenty children with hyperkinetic disorders with or without conduct disorders were treated in a home-treatment setting, as an alternative to inpatient treatment, by nurses specialized in child psychiatry and under the constant supervision of an experienced child psychiatrist. Conduct disorders were influenced positively in the child's natural surroundings. Parents were trained as co-therapists. Good cooperation by the family is required for therapy to have positive effects. Case studies serve to illustrate how treatment can be conducted at home.
Attention Deficit Disorder with Hyperactivity↗
Course of patients diagnosed as having schizophrenia during first episode occurring under age 18 years.
Of 118 child and adolescent schizophrenic patients (ICD-9: 295.x; mean onset age 16.0 years), 97 (82.2%) could be completely investigated at follow-up (mean interval 7.4 years; mean age 23.1 years). At follow-up 30% of the patients were semi-dependent or dependent, 72% still required psychiatric treatment, 44% were at least moderately impaired with regard to educational/occupational functions and 58% with regard to social functions; 73% had experienced at least one further schizophrenic episode. Comparison with schizophrenia beginning in adulthood showed that the impairment in social function was much greater in the younger group of patients. These results support the belief that schizophrenic psychoses starting in adolescence have a worse outcome than those beginning in adulthood. The most efficient indicators for a worse outcome were long duration of inpatient treatment at first admission, a high number of symptoms and low social competence at discharge.
Adolescent↗
[School refusal--a catamnestic study on the diagnostic concept ov "school phobia" and "school anxiety"].
Twenty-six patients diagnosed with school refusal were examined 2.4 years after inpatient treatment. The long-term course of patients with "school phobia" (school refusal unrelated to school) and that of patients with "school anxiety" (school refusal related to school) were compared. In addition, an attempt was made to identify variables predictive of a good outcome. The mean age of the 12 patients with "school phobia" and the 14 patients with "school anxiety" was 12.7 years at the start of inpatient treatment. The assessment of psychiatric disturbances was based on structured interviews for parents and adolescents (MEI and MADEL, 1989) and the dimensional assessment scales of functioning for children and adolescents (MSBF). The variables assessed for predictive value were taken from the patients' records during inpatient treatment and from the hospital documentation system. There was no difference in outcome between the two syndrome groups. There was a tendency to less autonomy in the patients with "school phobia". Girls had a better outcome than boys, as did patients with less absence from school prior to inpatient treatment. Overall there was no difference in the outcome of "school phobia" and "school anxiety". Therefore a new classification should be considered.
Adolescent↗
[Reversible changes in brain volume in anorexia nervosa].
Cranial computed tomography (CT) was performed in three different samples of young women with anorexia nervosa before and after treatment. The biggest changes in cerebrospinal fluid volume were observed in the supratentorial and extracerebral-subarachnoid area, with smaller changes in the ventricles. These changes, as assessed by different methods of volumetric and planimetric measurement, were statistically significant and were correlated with the changes in body weight. Two patient groups could be distinguished on the basis of the presence or absence of cerebellar pseudoatrophy in the initial CT, and these groups also showed differences in preclinical and clinical course.
Adolescent↗
[Follow-up of schizoaffective psychoses in adolescence].
Of 156 adolescent inpatients with psychotic disorders (ICD-9: 295.0 to 296.9), 25 had a schizoaffective psychosis with onset before age 18. Of these, 21 were followed up an average of 6.5 years later. Six of the subjects had had only one schizoaffective episode and 15 had had a second episode an average of 14 months later. Half of the subjects had had schizoaffective episodes only. More of the patients with an initial affective episode developed schizoaffective psychosis than of those with an initial schizophrenic episode. On average there had been 0.91 episodes per year during the follow-up period. Seventy-one percent of the subjects had been unable to continue their education or work at the previous level and most had marked deficits in social adaptation. The level of social competence at the end of the first episode was of predictive value for the later social handicap. A comparison with other groups of patients of the same age showed that those with affective disorders had faired better and those with schizophrenia appeared to have the poorest outcome. The schizoaffective group tended to resemble the schizophrenic group more closely than the affective group. Patients whose schizoaffective disorder began in adulthood had fewer problems on the educational and occupational level, better social adaptation and fewer episodes per year and had spent less time in inpatient treatment than those whose disorder had begun before age 18.
Adolescent↗
Clozapine for schizophrenia.
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Adolescent↗
[Effect of timing and chronicity of stressors on the emotional development of children and adolescents. Results of a prospective epidemiologic longitudinal study of 8 to 18 years].
In a prospective epidemiological study with assessments at ages 8, 13 and 18 it could be demonstrated that if all risk factors are analyzed at the same time recent stressors are more important than stressors and disturbances in early childhood. But from a chronological point of view early stressors were found to be at least as important as later ones because the early stressors play a role in the development of some of the later ones. The effects of stressors were sex-specific to some extent: Boys were more seriously affected when of elementary school age, whereas girls were more affected in early childhood and in adolescence. Chronic stress proved to be more important than acute life events, the later being not only a cause but also a consequence of emotional disturbances. Children with early disturbances sometimes even had lower rates of disorders in adolescence if they had been brought up in an overprotective manner.
Adolescent↗
[Diagnosis of stressful life events in clinical routine practice using a (half) standardized interview].
50 in-patients and 50 out-patients were assessed with a semi-structured interview based on the revised version of axis V (abnormal psychosocial situations) of the Multi-axial Classification Scheme. The interviewer was not acquainted with the patient's history. The information acquired during in-patient treatment was comparable to that obtained by interview, whereas during out-patient treatment, less information with lower reliability was obtained than on the interview. The study also shows that certain psychosocial factors can be identified better by interview and others by clinical assessment.
Adolescent↗
[Prevalence and follow-up of psychiatric disorders in childhood and adolescence. Results of a prospective epidemiologic longitudinal study from ages 8-18 years].
In a prospective longitudinal epidemiological study with assessments at age 8, 13 and 18 the prevalence rate for psychiatric disorders remained constant at about 16%. The sex ratio for severe disorders was male dominated even in adolescence, which was a consequence of the high rate of unsocialized disturbances of conduct in boys. Persistence of psychiatric disorders between age 13 and 18 was about 50%, as had previously been the case between age 8 and 13. One child in four suffered from a psychiatric disorder for at least 10 years. In childhood, conduct disorders had a very poor prognosis and emotional disorders a very good one. In adolescence, the course of disorders depended on an interaction between diagnosis and gender. Boys with unsocialized disturbances and girls with emotional problems had a poor prognosis.
Adaptation, Psychological↗
What happens to electrical brain activity when anorectic adolescents gain weight?
We investigated 39 adolescent anorectic inpatients (27 cross-sectionally. 12 longitudinally) and, as controls, 12 emotionally disturbed inpatients with auditory evoked potentials (AEP) of subcortical and cortical origin. Different intensities of the stimuli were applied in an augmenting/reducing paradigm to test the ability to modulate auditory inputs. In addition, cranial CT was performed in each anorectic patient as well as in another group of 12 child psychiatric controls. Three main results were found: (1) anorectics may have difficulty in modulating auditory stimuli adequately at the subcortical level, even after gaining weight. At the cortical level, their modulation did not differ significantly from controls. (2) a systematic dissociation of the AEP amplitude response between subcortical and cortical CNS levels was seen mainly in anorectics when they had low body weight. This may suggest an uncoupling of cortical versus subcortical neuronal systems. After weight gain, anorectics had less subcortical/cortical dissociation of AEP, which was never seen in controls. Thus, to reach regular modulation of sensory information anorectics should gain normal weight and eating behavior in good time. (3) CT results showed no significant correlation with AEP findings. So far, the functional role of pseudoatrophy in anorectics remains unknown.
Adolescent↗