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Biomedical subjects

G Lehmkuhl

Publications and source records attributed to G Lehmkuhl.

At least 19 recordsLinked to original sources
PubMed1999

[Urodynamics in diagnosis and therapy of "enuresis"--relevance for child and adolescent psychiatry].

Enuresis and functional urinary incontinence are clinically and pathophysiologically heterogeneous disorders. They differ with regard to their urodynamics, i.e. with regard to the function or dysfunction of the urinary tract. In addition to general measures such as history, physical examination, urinalysis, questionnaires and flow charts, noninvasive sonography and uroflowmetry with pelvic-floor EMG play an important role in diagnosis and therapy. Rates of pathological findings are especially high among day-wetting children and nocturnal enuretics with micturition problems. This group requires a detailed diagnosis, especially children with detrusor-sphincter discoordination, which can be treated effectively by means of uroflow-biofeedback. The relevance of these methods in child and adolescent psychiatry are discussed in detail and practical recommendations are made.

Adolescent↗
PubMed1999

[Abbreviated Psychopathological Scale in basic documentation in child and adolescent psychiatry--results of a multicenter study].

The short form of the Clinical Assessment Scale of Child and Adolescent Psychopathology (CASCAP) assesses psychopathological features only on the level of symptom domains and not on the level of single symptoms. The instrument is part of the basic documentation of child and adolescent psychiatry. Based on the multicenter study sample of CASCAP the ratings of the symptom domains in the different centers were analysed. Inpatients receive higher ratings than outpatients on nearly all symptom domains. Only minor differences could be found between the centres. Advantages and disadvantages of this short version are discussed.

Adolescent↗
PubMed1998

Screening for mutations in the neuropeptide Y Y5 receptor gene in cohorts belonging to different weight extremes.

OBJECTIVE: The neuropeptide Y (NPY) Y5 receptor is presumed to be involved in the regulation of food intake. DESIGN: To investigate the possible role of this receptor in weight regulation, the whole coding region of the NPY Y5 receptor gene was screened for mutations using temperature gradient gel electrophoresis (TGGE). Detected mutations were screened in extended cohorts. STUDY COHORTS AND METHODS: Cohorts of 87 extremely obese children and adolescents, 15 underweight subjects and 25 patients with anorexia nervosa (AN) were initially screened by TGGE. Extended samples of these cohorts (160 obese children and adolescents; mean body mass index (BMI) 33.5 +/- 6.4 kg/m2, 128 underweight subjects; mean BMI 18.4 +/- 1.0 kg/m2 and 58 patients with AN; mean BMI 14.6 +/- 1.7 kg/m2) were screened to determine the frequencies of a detected mutation and a detected polymorphism in the NPY Y5 receptor gene. In addition, a previously described polymorphism in the first intron of the NPY Y1 receptor gene was analysed. RESULTS: The coding region of the NPY Y5 receptor gene encompasses one exon. A single mutation, which results in a non-conservative amino acid substitution in the first extracellular domain of the receptor (Glu-4-Ala), and one silent polymorphism (Gly-426-Gly-Gly) at nucleotide position 1278 (G-->A) were detected by TGGE. Both tests for association and linkage to the NPY Y1 and NPY Y5 receptor polymorphisms were negative among all cohorts. The Glu-4-Ala mutation was found only in a single patient with AN and her mother. CONCLUSION: The results do not support a major role of the NPY Y5 receptor gene in the variability of body weight in children and adolescents.

Adolescent↗
PubMed1998

No evidence for involvement of the leptin gene in anorexia nervosa, bulimia nervosa, underweight or early onset extreme obesity: identification of two novel mutations in the coding sequence and a novel polymorphism in the leptin gene linked upstream region.

Mutations in the leptin gene can result in profound obesity in both rodents and humans. In humans, serum leptin levels correlate with body mass index (BMI: kg m(-2)). However, in patients with anorexia nervosa (AN) leptin levels are lower than in BMI-matched healthy controls. We had previously argued that genes involved in weight regulation should be considered as candidate genes for AN. To investigate this hypothesis we screened the coding region of the leptin gene and part of the leptin gene linked upstream region (LEGLUR) in 49 patients with AN and 315 children and adolescents with extreme obesity. Two novel mutations in the coding region (Ser-91-Ser; Glu-126-Gln), each found in a single proband, and a novel polymorphism in the LEGLUR (position -1387 G/A; frequency of both alleles approximately 0.50) were identified. Tests for association of LEGLUR polymorphism alleles were negative by comparing allele frequencies between 115 AN patients, 71 bulimia nervosa patients, 315 extremely obese children and adolescents, 141 healthy underweights and 50 controls that were not selected for body weight. Tests for transmission disequilibrium were also negative. Hence, an influence of variations in the leptin gene on eating disorders or extreme early onset obesity could not be detected.

Adolescent↗
PubMed1998

[Diagnosis and differential diagnosis of sleep disorders in children].

Sleep disorders in children are very common and their impact on emotional and cognitive functions is considerable. Clinical work necessitates an interdisciplinary access to the subject because the scope of sleep medicine is related to various medical disciplines (e.g. paediatric neurology, pulmology and child psychiatry). Although many sleep problems are seen in both children and adults diagnoses, symptoms and pathogenetic factors are quite different in the two groups. In childhood especially parent-child interactional factors and developmental aspects of the sleep architecture and the sleep-wake cycle have to be taken into account leading to different diagnostic and therapeutic approaches. In this article we focus on important developmental aspects of childrens' sleep problems. Their relationship to neurologic, paediatric and psychiatric diseases is demonstrated and finally clear indications to diagnostic procedures, especially polysomnography, are given.

Child↗
PubMed1998

Molecular genetics of nocturnal enuresis: clinical and genetic heterogeneity.

Forty-two children with nocturnal enuresis (27 with primary, 4 with secondary nocturnal enuresis and 11 with combined primary nocturnal enuresis and daytime wetting) were selected retrospectively from a study of 167 consecutive children with enuresis. The aim of the study was to collect formal genetic data, perform molecular genetic linkage-analyses with five microsatellite markers on chromosomes 13q, 12q or 8q and specify the associations between genetic findings and clinical, as well as psychiatric diagnoses. Positive linkage of nocturnal enuresis to one of the microsatellite markers was possible in 27 children from 23 families and was not possible in 15 children. Somatic findings in both the groups with and without possible assignment of nocturnal enuresis to a marker were heterogeneous. Psychiatrically, a low rate of behavioural problems was apparent. These findings support the hypothesis of genetic and phenotypical heterogeneity of nocturnal enuresis, without linkage of specific psychiatric and somatic phenotypes to certain chromosome markers.

Child↗
PubMed1998

[Incidence of psychiatric symptoms and somatic complaints in 4- to 10-year-old children in Germany as judged by parents--a comparison of norm-oriented and criteria-oriented models].

OBJECTIVES: To analyze the frequency of behavioral/emotional problems and somatic complaints of children aged four to ten as rated by their parents. METHOD: The analysis is based on the PAK-KID study on behavioural and emotional problems and psychosocial competencies of children and adolescents in Germany. In a nationally representative sample of N = 1030 children aged four to ten years the parents rated their child using the Child Behavior Checklist. RESULTS: The prevalence rates of the symptoms are presented. Additionally global prevalence rates based on three different models were calculated and compared. They range from 13.1% to 28.3%. The issues of defining cutoffs necessary for the calculation of prevalence rates are discussed.

Affective Symptoms↗
PubMed1998

[Comparison of 2 clinics with reference to axis 5 of the MAS: different patient populations or regional characteristics?].

OBJECTIVE: The university departments of child psychiatry in Cologne and Berlin were compared to assess whether quantitative differences in reported abnormal psychosocial situations (Axis 5 MAS of ICD-10) are due to a difference in patient population or coding practices or to particular regional conditions. METHOD: Data were analyzed for 593 patients seen in Cologne in 1992/93 and for 685 patients seen in Berlin in the same period. The broader social situation was described by sociodemographic data from the respective city. RESULTS: Berlin showed about twice as many psychosocial stressors per patient as Cologne. Consistent relationships between axis 5 stress ratings and other parameters indicated the validity of the data. Only a few points of inconsistency in the data were found. The sociodemographic data for both cities revealed a greater number of single parents as well a a higher rate of suicide in Berlin. CONCLUSIONS: Indicators for the validity of the clinical data analyzed were found. Some special internal clinical and regional conditions were identified as contributing to the quantitative differences between the two university departments.

Adolescent↗
PubMed1998

[Forms of juvenile aggression].

Delinquent behaviour has its roots in early childhood: Hyperactivity and impulsivity are its precursors, especially if rules are not clearly set in kindergarten and school and if aggressive behaviour is tolerated. Conduct disorders are classified into several subgroups with different treatment strategies. Epidemiologically there is no evidence of an increase of aggression and delinquency in childhood and adolescence. As only a small portion of children and adolescents with aggression and conduct problems are considered to be in need of treatment by their parents, early and intensive intervention is necessary.

Adolescent↗
PubMed1997

Serotonin transporter gene-linked polymorphic region: allele distributions in relationship to body weight and in anorexia nervosa.

Several lines of evidence implicate a role for the serotonergic system in body weight regulation and eating disorders. The magnitude and duration of postsynaptic responses to serotonin (5-HT) is directed by the transport into and release from the presynaptic neuron. Recently, a common polymorphism of a repetitive element in the region of the serotonin transporter (5-HTT) gene-linked polymorphic region (5-HTTLPR) was identified that results in a system of two common alleles. The activity of the 5-HTT, as measured in in vitro assays and in human lymphoblastoid cell lines, is dependent on the respective genotype. We thus hypothesized that this polymorphism is relevant for weight regulation in general and is possibly involved in the etiology of anorexia nervosa (AN). Allele frequencies and genotypes were determined in a total of 385 unrelated obese children, adolescents and adults, 112 underweight subjects and 96 patients with AN. Furthermore, both parents of 98 obese children and adolescents and of 55 patients with AN, respectively, were genotyped, thus allowing to test for both association and linkage. The comparison of allele frequencies between obese and underweight probands provided no evidence for a major role of the 5-HTTLPR in weight regulation. Patients with AN had allele frequencies not significantly different to those observed for obese and underweight individuals.

Adolescent↗
PubMed1997

Beta 3-adrenergic-receptor allele distributions in children, adolescents and young adults with obesity, underweight or anorexia nervosa.

OBJECTIVE: The missense mutation (64Trp to 64Arg) in the beta 3-adrenergic-receptor has previously been described to confer a genetic predisposition to the development of obesity. DESIGN: To test the hypothesis we evaluated allele frequencies in children, adolescents and young adults who belonged to different weight groups that were delineated with percentiles for the body mass index (BMI; kg/m2). SUBJECTS: 99 underweight probands (BMI < or = 15th percentile). 80 normal weight probands (BMI: 5th-85th percentile). 238 obese children and adolescents (BMI > or = 97th percentile). 84 patients with anorexia nervosa (AN). MEASUREMENTS: The cohorts were screened by polymerase chain reaction with subsequent restriction fragment length polymorphism (PCR-RFLP) analysis. Data were statistically analysed for association. In addition to these case control studies, the transmission disequilibrium test (TDT) was applied to 80 families of obese probands and to 52 families of patients with AN. RESULTS: Both the tests for association and linkage were negative. The Trp64Arg allele frequencies in the three weight groups (obesity: 0.071; normal weight: 0.081; underweight: 0.056) and the AN patients (0.054) were similar. Extremely obese individuals showed no excess of the Trp64Arg allele. No homozygotes for the Trp64Arg allele were detected. CONCLUSION: Heterozygosity for the Trp64Arg allele is not of major importance in regulation of body weight in individuals younger than 35 y. Additionally, the extreme obese subgroup is not enriched for the polymorphism.

Adolescent↗
PubMed1997

["Enuresis diurna" is not a diagnosis--new results on classification, pathogenesis and therapy of functional urinary incontinence in childhood].

Newer research results have shown that the previous classification of enuresis into nocturnal, nocturnal and diurnal and diurnal forms is not sufficient. Day wetting constitutes a heterogeneous group of syndromes, which should be considered as functional urinary incontinences and which require differentiated diagnostics and therapies. General aspects of functional urinary incontinence are discussed, including: classification, epidemiology, symptomatology, especially the association with urinary tract infections, vesicoureteral reflux, obstipation and encopresis. The rate of psychiatric problems seems to be increased compared to children with nocturnal enuresis. Methodological problems of previous studies are discussed. General guidelines regarding diagnostics and therapy include the requirement of sonography, uroflowmetry with pelvic-floor-EMG, urinalysis and specific therapy-forms. The three most important syndromes are urge incontinence with urge symptoms, frequent micturition, holding manoeuvres due to a physiological instability of the detrusor and lower, mostly secondary psychiatric symptoms. Voiding postponement is a general refusal syndrome with a psychiatric etiology, characterized by a postponement of micturition and retention of urine. The detrusor-sphincter-dyscoordination has as the main symptom a paradox contraction instead of relaxation of the bladder sphincter during micturition. It is recommended hat the previous classification should be left in favour of more specific diagnoses to ensure specific, causally effective therapies.

Child↗
PubMed1997

Clinical enuresis phenotypes in familial nocturnal enuresis.

The objective of the current study was to identify the associations between phenotype and genotype in children with nocturnal enuresis. Of the total of 167 wetting children, aged 5-10 years, without neurological or structural forms of incontinence, 110 were nocturnal enuretics. The examinations included a full psychiatric and psychological assessment, a paediatric and neurological examination, a family history with pedigree, ultrasonography, uroflowmetery, urinanalysis and bacteriology. Children with secondary nocturnal enuresis (n = 28) had a significantly higher rate of behavioural disorders, life events and continuous psychosocial stress than those with primary nocturnal enuresis (n = 82). Of the latter group, children with primary monosymptomatic nocturnal enuresis (n = 50) had an especially low rate of behavioural problems, when in comparison to primary non-monosymptomatic nocturnal enuretics (n = 32). Formal genetics point to a high genetic predisposition to nocturnal enuresis in all subgroups. Linkage studies to markers on chromosomes 8, 12 and 13 demonstrate both clinical, as well as genetic heterogeneity in nocturnal enuresis.

Chi-Square Distribution↗
PubMed1997

[From categorial to dimensional diagnosis].

The concepts of categorical and dimensional assessment approaches and their specific advantages--and disadvantages are described. A combination of both concepts within the framework of Multiple Assessment of Psychiatric Disturbances is proposed. This includes the different levels of behavioural and emotional disturbances, different assessment methods, the situational specificity of behavioural and emotional disturbances and individually tailored and treatment related assessment procedures. Thereby two phases are distinguished. In the first phase basic procedures of the Multiple Assessment of Psychiatric Disturbances are accomplished, which cover a broad spectrum of behavioural and emotional problems. In the second phase a differentiated picture of the-specific disturbance is assessed by using symptom-specific instruments of the Multiple Assessment of Psychiatric Disturbances. In a case report the diagnostic procedure is explained.

Adolescent↗