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C Wewetzer

Publications and source records attributed to C Wewetzer.

At least 19 recordsLinked to original sources
PubMed2005

[Combination treatment in children and adolescent with obsessive compulsive disorders].

Obsessive-compulsive disorders in childhood and adolescence include recurrent undesired (obsessive) thoughts and/or compulsive actions. Modern therapeutic strategies attempt to deal appropriately with the complexity of the condition through the use of multimodal concepts. These include behavioral therapy involving confrontation and the prevention of reactions, family-centered interventions and pharmacotherapy, which, in Germany, currently means the application of fluvoxamine or clomipramine.

Adolescent↗
PubMed2004

Transmission disequilibrium studies in children and adolescents with obsessive-compulsive disorders pertaining to polymorphisms of genes of the serotonergic pathway.

Pharmacological and challenge study data showed an involvement of the serotonergic system in the development of obsessive-compulsive disorder (OCD). We studied transmission disequilibrium of polymorphisms in three candidate genes of the serotonergic pathway in 64 trios comprising patients with early onset OCD and both of their parents. Polymorphisms of the following genes were studied: tryptophan hydroxylase 1 (rs1800532), serotonin transporter (polymorphism in the promoter region; 5-HTTLPR) and the serotonin 1 B receptor (rs6296). This is, to our knowledge, one of the first family based association studies pertaining to children and adolescents with OCD. We did not detect transmission disequilibrium of the investigated polymorphisms in OCD. Hence, these polymorphisms do not play a major role in the genetic predisposition to early onset OCD.

Adolescent↗
PubMed2002

5-HT2A promoter polymorphism -1438G/A in children and adolescents with obsessive-compulsive disorders.

Positive association between obsessive compulsive disorder (OCD) and the A-allele of the 5-HT(2A)-receptor promoter polymorphism -1438G/A has recently been reported in adults. We performed an association analysis of this polymorphism in 55 children and adolescents with OCD and in 223 controls consisting of unrelated students. We detected statistically significant differences in genotype (P < 0.05) and allele frequencies (P < 0.05) between individuals with OCD and controls. In this, to our knowledge, first association study based on children and adolescents with OCD, we confirm an association of the A-allele of the 5-HT2A receptor gene with OCD.

Adolescent↗
PubMed2001

Olanzapine in children and adolescents with chronic anorexia nervosa. A study of five cases.

Psychopathology in severely anorexic patients often seems to be of compulsive and delusional quality rendering therapeutic approaches extremely difficult. With conventional therapeutic regimes failing, administration of the novel antipsychotic olanzapine induced remarkable improvement in five cases reported here. Paranoid ideation concerning body image or weight gain decreased and sedative effects helped to reduce inner tensions and phobia with respect to food intake. Olanzapine, therefore, might represent an important therapeutic tool in anorexic patients who present the following characteristics: long-term history of anorexia nervosa mostly with several hospitalisations, missing perception of their severe state of illness, refusal of therapy, delusional quality of anorexic thinking, risk of discontinuation of therapy with life-threatening consequences.

Adolescent↗
PubMed2001

Long-term outcome and prognosis of obsessive-compulsive disorder with onset in childhood or adolescence.

The aim of the catch-up follow-up study is to describe the long-term outcome of obsessive-compulsive disorder (OCD) with onset in childhood and adolescence. The psychiatric morbidity in adulthood including personality disorders was assessed and predictors in childhood for the course of obsessive-compulsive symptoms were examined. The total study group consisted of the entire patient population treated for OCD at our departments for child and adolescent psychiatry between 1980 and 1991. We reassessed 55 patients personally by way of structured interviews. The mean age of onset of OCD was 12.5 years and the mean follow-up time was 11.2 years. At the follow-up investigation 71% of the patients met the criteria for some form of psychiatric disorder, while 36% were still suffering from OCD. Of the patients with a present diagnosis of OCD 70% had at least one further clinical disorder (especially anxiety and affective disorders). The most frequent personality disorders diagnosed were obsessive-compulsive (25.5%), avoidant (21.8%), and paranoid (12.7%) personality disorders. In-patient treatment, terminating treatment against advice and tics in childhood or adolescence significantly correlated with more severe OC symptoms in adulthood.

Adolescent↗
PubMed2001

[Long-term course of childhood or adolescence onset obsessive-compulsive disorder: psychosocial adaptation in adulthood].

OBJECTIVE: The aim of the study was to investigate the long-term course of obsessive-compulsive disorder (OCD) with onset in childhood or adolescence. This presentation focuses on the social adjustment of the former patients in adulthood. METHODS: Fifty-five out of 116 patients with childhood OCD classified according to DSM-IV criteria were interviewed personally using structured interviews. Mean age at onset of OCD was 12.5 years, and mean follow-up time was 11.2 years. RESULTS: Despite the evident burden of mental disorder at the time of the follow-up, 76% led their own lives without being overly dependent upon their parents. 84% had no problems that impaired either school or their occupation. 73% were rated as maintaining satisfying social contacts, but only 54% were in a relationship at follow-up. CONCLUSIONS: In agreement with other studies we found an association between the level of psychosocial adjustment and the course of obsessive-compulsive symptoms. Summing up, social adjustment and psychosexual functioning seem to be more impaired than occupational functioning. The relatively good adjustment of our sample indicates that most patients have found a way of managing their lives, albeit still suffering from mental disorders.

Adaptation, Psychological↗
PubMed2001

[Agranulocytosis in a child with schizophrenia treated with clozapine--clinical findings and therapy, a case report].

OBJECTIVES: The indication of clozapine therapy is governed by special guidelines due to a 1%-3% risk of clozapine-induced agranulocytosis. Up to now there has never been a report of such a case in a child with schizophrenia. The case report presented here is concerned with the clinical features and the treatment of clozapine-induced agranulocytosis in childhood schizophrenia. METHODS: It deals with the treatment of a 12-yearold boy with a schizophrenic psychosis. The psychotic symptoms before treatment and during inpatient treatment are described. The procedures for the diagnosis and treatment of the clozapine-induced agranulocytosis are presented. RESULTS: Clozapine medication may induce agranulocytosis in the treatment of a child with a schizophrenic psychosis. The highly specific guidelines governing its use must be followed as well in the treatment of very early onset schizophrenia. An agranulocytosis may result following 15 weeks of clozapine medication. The treatment with granulocyte colony-stimulating factor seems to support normalization of the blood picture.

Agranulocytosis↗
PubMed2001

[Personality disorders and psychiatric comorbidity in obsessive-compulsive disorder and anorexia nervosa].

The aim of this prospective longitudinal study was to examine the course of adolescent anorexia nervosa and obsessive-compulsive disorder (OCD) (fulfilling DSM-III-R criteria) to compare psychiatric comorbidity and personality disorders of both groups. Because anorexia nervosa patients are mainly female, we compared them only with female OCD patients. Ten years after discharge the whole sample (32 female patients; 100%) of a group of 39 (32 female; 7 male) anorexia nervosa patients could be reexamined personally. 25 (61%) female patients of a group of 116 patients (41 female; 75 male) with obsessive-compulsive disorder were also reexamined. The anorexia nervosa patients were interviewed using the Structured Interview for Anorexia and Bulimia nervosa (SIAB [39]) to assess eating disorder symptomatology. To examine comorbid psychiatric disorders we used the Composite International Diagnostic Interview, WHO [44] and SCID-II [45] for personality disorders. One fourth of the patients with anorexia nervosa (AN) and 20% of the patients with obsessive-compulsive disorder had a personality disorder according to DSM-III-R. Most of them were "Cluster C"-personality disorders (AN: 28%; OCD: 20%). In the group of the female OCD patients 8% schizoid, 4% schizotype and 12% paranoid personality disorders were observed. The most prevalent psychiatric disorders were anxiety (AN: 28%; OCD: 20%) and affective disorders (AN: 16%; OCD: 16%). Our results support the view that in the course of anorexia nervosa and in obsessive-compulsive disorder there is a high prevalence of psychiatric comorbidity and "Cluster C"-personality disorders according to DSM-III-R. These results might confirm a model of a high vulnerability of the serotonergic neurotransmitter system in patients with anorexia nervosa or OCD.

Adolescent↗
PubMed2000

[Personality disorders and psychiatric morbidity in adolescent anorexia nervosa. Results of a prospective 10 year catamnesis].

The aim of the current prospective study was to examine at regular intervals the course of the eating disorder symptoms and the psychiatric (co-) morbidity including personality disorders among juvenile patients who fulfilled the DSM-III-R criteria for anorexia nervosa. Ten years after release from hospital all 39 patients (100%), as well as a control group parallelized for age, gender and occupational status were personally followed-up. Symptoms of eating disorders were documented by means of the Standardized Interview for Anorexia and Bulimia nervosa (SIAB, Fichter et al., 1991), the Composite International Diagnostic Interview (WHO, 1990) was applied to diagnose psychiatric (co-) morbidity, and the Structured Clinical Interview (SKID-II, Spitzer et al., 1993) to assess personality disorders. Compared to the control group, at the time of follow-up a significantly greater number of patients were suffering from a psychiatric disorder, primarily an anxiety disorder, an affective disorder or from drug, respectively alcohol abuse. Personality disorders, chiefly anxious-avoidant types on the DSM-III-R were diagnosed among almost one-fourth of the patients. Our findings indicate that anorexia nervosa is not a developmental disorder limited to puberty but a disorder associated both cross-sectionally as well as longitudinally with other psychiatric disorders.

Adult↗
PubMed2000

Leptin suppresses semi-starvation induced hyperactivity in rats: implications for anorexia nervosa.

Semi-starvation induced hyperactivity (SIH) occurs in rodents upon caloric restriction. We hypothesized that SIH is triggered by the decline in leptin secretion associated with food restriction. To test this hypothesis, rats, which had established a stable level of activity, were treated with leptin or vehicle via implanted minipumps concomitantly to initiation of food restriction for 7 days. In a second experiment treatment was initiated after SIH had already set in. In contrast to the vehicle-treated rats, which increased their baseline activity level by 300%, the development of SIH was suppressed by leptin. Furthermore, leptin was able to stop SIH, after it had set in. These results underscore the assumed major role of leptin in the adaptation to semi-starvation. Because SIH has been viewed as a model for anorexia nervosa, we also assessed subjective ratings of motor restlessness in 30 patients with this eating disorder in the emaciated state associated with hypoleptinemia and after increments in leptin secretion brought upon by therapeutically induced weight gain. Hypoleptinemic patients ranked their motor restlessness higher than upon attainment of their maximal leptin level during inpatient treatment. Thus, hypoleptinemia might also contribute to the hyperactivity frequently associated with anorexia nervosa.

Animals↗
PubMed1999

[Current developments in the treatment of obsessive-compulsive disorders in children and adolescents].

For the treatment of obsessive-compulsive disorders during childhood and adolescence, multidimensional therapeutical approaches have proven useful in clinical practice. First controlled studies have demonstrated the efficacy of both psychotherapeutical and pharmacological strategies. Exposure and response prevention are considered the most efficient psychotherapeutical methods. On the basis of the available data, the question of the pharmacological dose can not be answered definitely. For Clomipramin, the dose most probably is between 75 mg and 150 mg, where as for Fluoxetine and Fluvoxamine 20 mg-60 mg and 100 mg-250 mg respectively. However, it has to be kept in mind that sometimes improvement of symptoms is not seen after 8-10 weeks of treatment. Basically it can be stated that to date there is an urgent need for therapeutical studies of obsessive-compulsive disorders in the childhood and adolescence. Most relevant would be studies evaluating pharmacological treatment versus a placebo control groups and carefully designed controlled psychotherapeutical treatment studies as well studies comparing pharmacological and psychotherapeutical approaches.

Adolescent↗
PubMed1999

[Body weight regulation in anorexia nervosa with special attention to leptin secretion].

Underweight is a key symptom in anorexia nervosa. In this review we summarize recent findings pertaining to weight regulation in this eating disorder. The observation that a body mass index below 13 kg/m2 upon admission for inpatient treatment is associated with a high mortality rate and chronic persistence of underweight is of obvious clinical relevance. A lowered leptin secretion, which results from the weight loss, is presumably of major importance for the development of amenorrhea. We discuss findings pertaining to a reduced body weight in other psychiatric disorders during adolescence in the light of Kretschmer's findings related to body frame and psychopathology.

Animals↗
PubMed1999

Body image distortion in Anorexia Nervosa--is there really a perceptual deficit?

Perceived and ideal body image were analysed in 36 inpatients with Anorexia Nervosa (AN) and 18 control patients (age 11-23 years). A computer-based image distortion technique allowed distortion of the whole body and of body parts. Subjects rated their own image. A body perception index (BPI) was calculated by dividing estimated dimension with real dimension. There was no general overestimation of body dimensions in AN patients in comparison to controls but AN patients more often under- or overestimated their body dimensions. Control patients showed a significant lower ideal BPI than AN patients, whose ideal body shape was similar to the observed body shape. Profile analyses of the body part estimation procedure revealed significant differences between groups in the ideal body shape at the body regions thigh, hip, waist and chest with control patients again showing a lower BPI.

Adolescent↗
PubMed1998

[Possible pathophysiologic, diagnostic and therapeutic implications of new findings on leptin secretion within the scope of anorexia nervosa].

OBJECTIVES: Leptin is a hormone synthesized in adipocytes and secreted into the bloodstream. It plays an important role in the regulation of body weight, the adaptation to semi-starvation and in reproductive function. Hence, clinical studies pertaining to anorexia nervosa can serve to further elucidate the functions of this hormone in light of the unique features of this disorder. METHODS: Circulating concentrations of leptin are exceedingly low during the acute stage of anorexia nervosa. Which symptoms result from these diminished concentrations must be clarified. Furthermore, research is required to evaluate whether or not a too rapid weight gain might induce a physiological counter-regulation which would predispose to renewed loss of weight. RESULTS: This review summarizes findings to date pertaining to leptin secretion in patients with anorexia nervosa. In addition, possible diagnostic, pathophysiological and therapeutic implications are discussed.

Adipose Tissue↗
PubMed1996

Course and outcome in adolescent anorexia nervosa.

OBJECTIVE: To investigate course, outcome, and psychiatric comorbidity in adolescent anorexia nervosa by repeated follow-up assessment. METHOD: Thirty-four subjects (88%) of an original sample of 39 inpatients were followed up personally 3 and 7 years after discharge and classified according to DSM-III-R eating disorder categories. Standardized psychometric instruments were used to assess specific eating disorder symptoms, concomitant general psychopathology, and comorbid psychiatric diagnoses. RESULTS: After 7 years, 1 patient (3%) had anorexia nervosa, 4 patients (12%) bulimia nervosa, and 10 patients (29%) eating disorder not otherwise specified (EDNOS). Anxiety disorders (41%) and affective disorders (18%) were the most prevalent comorbid psychiatric disorders. Concomitant general psychopathology was significantly related to the outcome of the eating disorder. CONCLUSIONS: According to our results, the majority of former adolescent anorexic inpatients had shown substantial improvement in their eating disorders symptomatology after 7 years. Patients with persisting eating disorders mostly suffered from restrictive symptoms. The prevalence and distribution of psychiatric comorbidity were similar to those of adult-onset anorexia nervosa. Subjects with a worse outcome of the eating disorder also displayed higher levels of general psychopathology.

Adolescent↗
PubMed1996

Body weight in acute anorexia nervosa and at follow-up assessed with percentiles for the body mass index: implications of a low body weight at referral.

OBJECTIVE: A systematic epidemiological comparison of body weights of patients with anorexia nervosa can be enhanced by the use of age percentiles for the body mass index. METHOD: To demonstrate the feasibility of this approach, body mass indices of 81 female adolescents with anorexia nervosa were calculated from anthropometric data upon admission for inpatient treatment and at follow-up and set into relationship to the age-dependent distribution of the body mass index in a large and representative sample of the German population. The percentiles were used to visualize the weight increase over time of each former patient by aligning the body mass index at referral with the respective body mass index at follow-up. RESULTS: Upon admission most adolescents had body mass indices below the third age centile. The distribution of body mass indices at outcome suggests a continuum between death of complications related to starvation, chronic anorexia, residual anorexia, and a low body weight Patients with very low body weights at referral had a poor prognosis, because their body weights tended to remain below the minimal normal weight for height. These conditions were statistically best described by categorical analysis, because they were nonlinear to a certain extent. DISCUSSION: The results indicate that the body mass index at referral influences the amount of weight that an individual patient gains in the future.

Adolescent↗