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Biomedical subjects

Gerd Lehmkuhl

Publications and source records attributed to Gerd Lehmkuhl.

At least 19 recordsLinked to original sources
PubMed2006

[Personality disorder traits in childhood and adolescence: concepts, methodological approaches and empirical results].

OBJECTIVE: The practical and theoretical advantages of the diagnosis and classification of personality disorder traits in childhood and adolescence remain controversial topics, the investigation of which is particularly neglected in German-speaking countries. METHOD: This review reports in detail research findings on the diagnostic validity and on the stability of personality disorder dimensions from childhood and adolescence to adulthood. RESULTS: On the one hand, the latest research findings refer to the validity of diagnoses of personality disorder in adolescence, and on the other, to the stability of personality traits over the course of development. Evidence of the continuity of personality disorder traits from adolescence to adulthood, however, is still lacking. Dimensional approaches are considered superior with regard to the assessment of personality disorder traits, particularly since they reflect development aspects, and also due to their higher sensitivity in this respect. CONCLUSIONS: Longitudinal studies during both childhood and adolescence are required in order to assess the continuity, or the instability, respectively, of dimensionally assessed personality profiles and the influence of infant personality factors on the development of psychopathology.

Adolescent↗
PubMed2006

Cybernetic principles in the systematic concept of hypothalamic feeding control.

Research on biological mechanisms of eating behavior and related disorders, such as obesity and anorexia nervosa, has become a large field of research in the last 15 years. With the discovery of peptides related to hypothalamic control of food intake (e.g. leptin and ghrelin) the search for the biological 'master key' of feeding control was renewed. As a result, mid-20th century biological concepts based on systematic and cybernetic thoughts fell into oblivion. This review highlights discoveries of hypothalamic-controlled feeding and eating behavior with a cybernetic and systematic perspective. Interestingly, older ideas of hypothalamic function offer possibilities for the incorporation of new molecular discoveries into systematic concepts of feeding behavior.

Animals↗
PubMed2006

[A new treatment program for children with sleep disorders--concept, practicability, and first empirical results].

Sleep disorders are common in childhood. We introduce a new psychological treatment program for children with sleep disorders. The program consists of different educational modules and can be conducted in single and group setting. In this case study, the program was implemented with a small group of parents (4 participants) in order to receive information on the efficacy of treatment. Sleep behaviour and children's well-being were improved in all cases. Moreover, the assessment of the treatment concept was extremely positively rated without any exception.

Child↗
PubMed2005

[Multimodal treatment concepts in children and adolescents with attention deficit/hyperactive disorder].

ADHD is usually associated with such comorbidities as aggression, dissocial behavior, anxiety, depression, and dyslexia or a poor ability to do sums. This fact must receive careful consideration both during the diagnostic work-up and when deciding an appropriate treatment strategy. In order to take proper account of these comorbidities when deciding treatment strategies, it must not be forgotten that in addition to medication with psychostimulants, multimodal therapeutic approaches also make good sense.

Adolescent↗
PubMed2005

[Aggressive behaviour and substance abuse among schizophrenic adolescents compared to antisocial adolescents--a follow-up study].

OBJECTIVES: The objective of this study was to analyze aggressive behaviour towards others by schizophrenic as opposed to antisocial adolescents, and the influence of substance abuse before, during and after their hospitalization. METHODS: We analyzed 21 schizophrenic adolescents and compared their aggressive behaviour and their substance abuse to that of 21 antisocial juveniles before and during their hospitalization and again at the time of a follow-up interview. The two samples were matched for age, sex and intelligence. In a first step, data were gathered from the hospital records, in a second step, for follow-up data we conducted standardized telephone interview with the patient and his or her parent or caregiver. Within the analysis we focused on aggressive behaviour towards other people and objects, as well as on criminal acts and regular substance abuse. RESULTS: We found less aggressive behaviour among psychotic patients during and post-hospitalization than among their antisocial counterparts. As inpatients, the acutely psychotic juveniles were at higher risk for aggressive acts, but adequate treatment subdued their offensive behaviour. In the long term, there were fewer criminal arrests among psychotic patients. Only in connection with their substance abuse, their aggressive misconduct towards others increased. CONCLUSIONS: Our results suggest that drug treatment during adolescence might help to lessen the risk of aggressive behaviour towards others.

Adolescent↗
PubMed2005

[Sleep disorders in children with attention-deficit hyperactivity disorder--results of a polysomnographic study].

OBJECTIVES: We report results of a polysomnographic study carried out with children aged 6 to 12 years with either ADHD or a sleep disorder. The study focussed on whether the sleep structure and architecture of n = 36 ADHD children with and without sleep disorders differed from that of either n=15 children with sleep disorders or n=87 children without sleep disorders. Moreover, we assessed whether there was an increased risk for co-morbid sleep-related breathing disorders among ADHD children. METHODS: All children underwent polysomnography in a paediatric clinic. Principal variables of the sleep structure and architecture as well as cardiorespirographic measures were analysed. RESULTS: Our findings demonstrate that sleep problems in children with ADHD seem to be unspecific concurrent symptoms since the sleep structure of sleep-disordered ADHD children and children with sleep disorders was similar. Only minor differences were found between non-sleep-disturbed ADHD children and healthy children without sleep problems. CONCLUSIONS: We conclude that sleep problems in ADHD are independent co-morbid symptoms without any pathogenetic relationship to vigilance functions in ADHD. The cardiorespirographic analyses showed that a subgroup of ADHD children with sleep problems may be at increased risk for co-morbid sleep-related breathing disorder. This finding is potentially important for differential diagnostic considerations in ADHD.

Attention Deficit Disorder with Hyperactivity↗
PubMed2005

[The psychopathy-concept and its psychometric evaluation in childhood and adolescence].

In accordance with Robert Hare's concept, over twenty years the word psychopathy is used to describe a specific combination of affective and interpersonal traits in adults as subtype of antisocial personality disorder. Recently in North America personality traits of psychopathy have also been studied in juveniles (and children). The Psychopathy Checklist: Youth Version (PCL-YV) was developed to take the special conditions of adolescents into account and focuses on assessing personality dimensions from age 12 upwards. In juveniles with a high score, research with the PCL-YV demonstrated for example a lack of empathy, impulsivity and social adjustment disorder. Furthermore, researchers found associations between the number and severity of violent offences, early drug abuse and heightened recidivism. This paper discusses the concept of psychopathy for adolescents on the basis of 3 case reports. Biological determinants, experimental results and diagnostic aspects are described.

Adolescent↗
PubMed2005

[Less severe sexual child abuse and its sequelae: are there different psychic and psychosomatic symptoms in relation to various forms of sexual interaction?].

A typology of less severe sexual encounters was used to analyze short and long term sequelae of sexual abuse via intimate skin contact. Well known theoretical approaches on the harmful effects of sexual abuse were tested. Do we find different peri- and posttraumatic reactions dependent upon varied forms of sexual interactions with children? A cluster analysis was calculated with symptom variables that were described in 141 child statements taken out of written expert opinions. Afterwards variance analyses of these symptom clusters were conducted in reference to six different abuse constellations. Different symptom profiles were found for these six abuse constellations. Panic symptoms, shame related feelings, avoidant behavior and physical reactions showed significant results. The sequelae to different forms of less severe sexual child abuse differ and depend more upon the situational dynamic than upon the kind of relationship between adult and child.

Anxiety Disorders↗
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

Effectiveness of an adaptive multimodal treatment in children with Attention-Deficit Hyperactivity Disorder -- global outcome.

BACKGROUND: The meaning of different components within a multimodal treatment of ADHD remains to be further clarified. OBJECTIVE: To evaluate the effectiveness of behaviour therapy and drug treatment within an adaptive and individually tailored multimodal treatment for children with ADHD. METHOD: After an initial psychoeducation n = 75 school-children aged 6-10 years with a diagnosis of ADHD/HKD were assigned to either behaviour therapy (including continued psychoeducation) or medical management with methylphenidate plus psychoeducation. Depending on the effectiveness, the treatment was either terminated (if totally effective) with long-term aftercare and continuation of medication if needed, or (if partially effective) the other treatment component was added (combined treatment), or (if ineffective) the treatment components were replaced. Thus a treatment rationale was applied which resulted in an adaptive and individually tailored therapy -- similar to a strategy that may be useful in clinical practice. RESULTS: Of the children who started with behaviour therapy after initial psychoeducation 26% received a combined treatment in later treatment stages. In most of the cases (82%) with initial medical management, behaviour therapy was added. ADHD symptoms, individually defined behaviour problems and comorbid symptoms were significantly reduced during the course of treatment. On core measures large pre-post effect sizes were found. On teacher ratings combined treatment was more effective than behaviour therapy. CONCLUSIONS: Both, behaviour therapy and combined treatment are effective interventions within an adaptive and individually tailored multimodal treatment strategy.

Adaptation, Psychological↗
PubMed2004

[Children and adolescents with hyperkinetic disorder. Frequency of the claims diagnosis in primary care based on the data of a regional Statutory Health Insurance Sample--Versichertenstichprobe AOK Hessen/KV Hessen (1998-2001)].

OBJECTIVE: The study aims to estimate the frequency with which doctors of various groups submitted claims for the treatment of hyperkinetic disorder (HD; ICD-10) in children and adolescents in outpatient care in the period 1998-2001. METHOD DATABASE: 18.75% random sample of a regional Statutory Health Insurance for the years 1998 until 2001 with n = 41,930 children and adolescents (1998: 0 to 15 years old). Children with HD were defined according to the wording of the diagnosis (1998, 1999) and the ICD 10-code: F90.0-F90.9 (2000, 2001). RESULTS: Between 1998 and 2001 the percentage of children with a claims diagnosis of HD rose from 1.6% to 2.4% (administrative prevalence). The male to female ratio is about four to one (2001, boys: 3.8%; girls: 1.0%). The highest rate is seen in the age group of 7 to 10 years (2001, boys: 5.8%; girls: 1.4%). The diagnosis was documented by pediatricians in 54% of the children with HD, by GPs in 29% and by child and adolescent psychiatrists in 15%. Since 1998 child and adolescent psychiatrists became more important in the treatment of children with HD. CONCLUSION: The data show an increase of the administrative prevalence of hyperkinetic disorder. The estimates are within the lower range of the prevalences gained by representative population-based field studies.

Adolescent↗
PubMed2004

[Does a morning dose of Methylphenidate Retard reduce hyperkinetic symptoms in the afternoon?].

OBJECTIVES: In order to treat children with Attention-deficit/Hyperactivity Disorder (ADHD) with a once-a-day stimulant several galenic approaches have been tried. The long acting methylphenidate (MPH, Medikinet-Retard) is a preparation with a two-step dynamic to release MPH (step one: acute; step two: prolonged). The efficacy of Medikinet-Retard, a new long-acting methylphenidate preparation, is analyzed based on the assessment of parents in the afternoon. METHODS: In a multicenter drug treatment study (placebo controlled, randomized, double-blind) 85 children (normal intelligence, age 6 to 16 years, diagnosis of ADHD according to DSM-IV) were investigated over 4 weeks with weekly visits. Forty-three children received Medikinet-Retard and forty-two children placebo. The weekly dose titration depending on body weight and symptomatology allowed a final maximum of 60 mg. The effects on ADHD as perveived by the parents were assessed weekly with a German symptom checklist for ADHD according to DSM-IV and ICD-10 (FBB-HKS). The differences between baseline and last week of treatment were compared statistically between groups. RESULTS: There was a large and statistically significant positive drug effect on ADHD symptomatology. The effect size of these differences was d = 1.2 (total score). Effects were found on inattention, hyperactivity and impulsity on the respective subscales. The efficacy of Medikinet-Retard was evaluated by the parents on an average as good. The rate of responders was four-times higher in the verum-group. The correlations of the changed scores in the parent ratings with the respective change scores in the teacher ratings were in the medium range. CONCLUSION: This is the first study with a German long-acting methylphenidate preparation (Medikinet-Retard). According to data based on parents' assessments, the drug showed very good clinical efficacy and safety in children with ADHD. Its two step galenic release of methylphenidate seems to be appropriate for a once-a-day (morning) stimulant in schoolchildren.

Adolescent↗
PubMed2004

[The effectiveness of stimulants of retard forms in children and adolescents with ADHD--a systematic overview].

Stimulants are the matter of choice to treat attention deficit/hyperactivity disorder (ADHD) pharmacologically. The period of effectiveness of immediate release stimulants is, however, often not satisfying. Currently a variety of retarded forms of methylphenidate and also amphetamine were developed in order to minimize the problems involved in a daily dose. This paper presents the clinical studies on effectiveness, period of effectiveness and the profile of side effects of different forms of stimulants. In the clinical practice the new retard products are effective alternatives. There is an advantage in giving this drug in a once daily single dose. At the same time, the side effects that are caused by an extended period of being effective have to be studied in detail. A more exact adaptation to the requirements of daily obligations and needs of children and adolescents is difficult to realize. Future research is supposed to test schemes of titration including immediate and sustained released stimulants.

Adolescent↗
PubMed2004

[Prevalence and stress factors of sleep disorders in children starting school].

Epidemiological studies of sleep disturbances in preschool and school-aged children are under-represented in international clinical research. Based on this fact we investigated the prevalence of insomnia and parasomnia in a representative sample of school-novices in Cologne in 2002 (Cologne Children's Sleep Study). We have also considered the relationship between sleep problems on the one hand and sleep hygienic variables, physical and somatic healthy factors and behavioral problems on the other. A high prevalence of insomnia problems (15%) and repeated nightmares (14%) in children of this age were found in parent's report. Thereas sleep-walking, night terrors and daytime sleepiness were reported less frequently. Children having a solid sleep-wake-schedule show significant less problems to fall into sleep and feel sleepy during the day. Moreover we focused the correlation between disturbed sleep and multiple influencing, as light irritating and noise. We found a two- to three times elevated risk for hyperactive and emotional problems for children with insomnia or parasomnia complaints with regard to the comorbidity of behavioural difficulties. These findings underline the necessity for diagnostic clarifying of sleep disturbances and intervention programs for behavioural disturbed and isolated sleep impaired children.

Attention Deficit Disorder with Hyperactivity↗
PubMed2004

[Dreams of children: content, structure and course].

Foulkes (1999) changed Freud's statement that the interpretation of dreams is the via regia to understanding the unconscious to the effect that studies of children's dreams can accomplish to the understanding of the developing consciousness and personality in early childhood. There is empirical proof of dreams being complex cognitive processes which differentiate increasingly and are not only automatic perception which is found in sleep laboratory studies conducted with children. Dreams develop in predictable stages for a long time. They start with static pictures followed by cinematic scenes which result in the end in active participation in the dream. In this context it seems important whether the sleep-EEG is carried out in laboratory or at home.

Adolescent↗