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Biomedical subjects

Gerd Lehmkuhl

Publications and source records attributed to Gerd Lehmkuhl.

34 records · Page 2Linked to original sources
PubMed2004

[Differential diagnostic correlations of sleep and attention disorders in childhood--comorbid psychological and organic illnesses].

Sleep disorders in childhood are a common phenomenon. A highly differenciated diagnostic effort is required as sleep in children is extremely variable between individuals, undergoes a constant natural development and depends of cultural influences on sleep behavior. The pathogenesis is predominantly due to environmental variables, especially to the child-parent interaction. Besides somatic diseases, as Sleep Related Breathing Disorders, Restless legs syndrome and nocturnal seizures play an etiologic role. Psychological and somatic factors in the development of sleep disorders have in common that they exercise a serious negative impact on cognitive daytime functioning and behavior. In this paper the interdependence of somatic and psychological factors and the relations between disturbed nighttime sleep and impaired daytime functioning will be discussed. Especially in Attention-Deficit Hyperactivity Disorder these relations can be demonstrated. Conclusions are drawn for a specific, stepwise diagnostic approach in children's sleep disorders.

Adolescent↗
PubMed2003

[Play therapy--psychotherapy with play as the medium: I. General introduction, psychoanalytic and client-centered approaches].

Play therapies are psychotherapies with the medium of play primarily for children under 12 years of age, which can be differentiated according to their theoretical constructs and actual practice. Play therapies have gained importance and relevance in the 1990's, reflected in a wide range of publications. Following trends can be discerned: narrow concepts defined by individual schools of psychotherapy have been left. Different forms of play therapy, as well as behavioural and family therapy have been integrated. Focussed short-term and therapies for specific disorders have been developed. The aim of the first part of this paper is to present an overview of traditional forms of playtherapy, with a focus on the Individual Therapy of A. Adler, the Analytic Psychotherapy of C. G. Jung, Sandplay Therapy of D. Kalff and child-centered (non-directive) play therapy.

Child↗
PubMed2003

[Play therapy--psychotherapy with play as the medium: II. New developments].

A wide array of new forms and combinations of play therapy have been developed. The aim of the second part of this paper is to present an overview of these newer approaches, including: focussed therapies for specific disorders; behavioural approaches like the Cognitive-Behavioral Play Therapy and the Parent-Child Interaction Therapy; various combinations with family therapy; and therapies especially for preschool children like Filial Therapy, Developmental Play Therapy and Thera-play. Following a phase of experiments and combinations, the empirical evaluation of many play-therapy forms is needed. Especially questions of the differential indication of specific play-therapies and their effectiveness in the therapeutical practice need to be studied.

Child↗
PubMed2003

[Sleep disorders in childhood and adolescence].

Sleep disorders in children are very common and their impact on emotional and cognitive functions is considerable. Various pathogenetic factors have to be considered, especially a disturbed sleep-wake rhythm but also organic or psychiatric causes. Symptoms and pathogenetic factors for sleep disorders in children are quite different from adults. In children especially parent-child interactional factors and developmental aspects of the sleep architecture have to be taken into account what necessitates a different diagnostic approach. This article describes systematically typical sleep disorders in children and gives practical advices for an anamnestic and diagnostic access to the subject.

Adolescent↗
PubMed2002

[Subjective quality of life of children and adolescents with psychiatric disorders: development and validation of a new assessment scale].

Within paediatric disciplines and in particular in child and adolescent psychiatry very little work is available regarding the quality of life (QoL) of patients. After using literature search and interviews for identifying the relevant QoL domains, a set of self report questionnaires (for the parents: proxy rating) was developed (C-version: children 10 to 14 years, A-version: adolescents 14 to 18 years, P-version: parental proxy rating about child/adolescent). It was aimed at an almost identical wording within each questionnaire version in regard to the different QoL domains. The questionnaires should not primarily address symptomatology (like e.g. the Child Behaviour Checklist by Achenbach and Edelbrock 1983). After a pilot phase ensuring adequacy and appropriateness of the forms, the questionnaires were field tested in a consecutive series of nearly 700 patients which were referred to the Cologne university department of child and adolescent psychiatry for diagnosis and treatment between 1996 and 2000. The intended structure of the questionnaire system with symptom and functioning scales concerning the domains: "physical performance, fatigue, anxiety, depression, peer group, school, family, beliefs, general QoL" and some further single questions was confirmed by psychometric testing (validity and reliability). Interscale correlations were in general moderate, exhibiting the expected pattern. Analyses of variances using the method of "known groups comparisons" showed e.g. age, sex, and diagnosis related effects hinting towards clinically meaningful differences. The questionnaire forms were well accepted and understood by patients and parents and the wording of the addressed topics was reported to be adequate. Further work will include the psychopathological findings and will focus on specific subgroups of patients (e.g. different diagnoses) as well as on the longitudinal observation of special patient groups, e.g. patients with eating disorders. It can be concluded that the new QoL instruments were successfully employed in a consecutive series of patients and showed very sufficient psychometric properties.

Adolescent↗
PubMed2002

[Early detection and intervention in childhood and adolescent psychoses].

Research into schizophrenic disorders increasingly focusses on the early stage of the disease (prodrome). Experience in rehabilitation treatment and relapse prevention have led to new diagnostic and treatment strategies before the onset of schizophrenia that could contribute to disease prevention. The present article reports on the latest research results. From the point of view of medical practice negative symptoms and cognitive dysfunctions play a major role in the assessment of prodromal signs. Psychosocial and psychotherapeutic interventions are available for treating patients in the prodromal phase. But so far, there has not been sufficient data to recommend the use of antipsychotics before the onset of schizophrenia.

Adolescent↗
PubMed1999

An Early Onset Rehabilitation Program for Children and Adolescents after Traumatic Brain Injury (TBI): Methods and First Results.

Survived traumatic brain injuries (TBI) are one of the most serious challenges to the patient's future life. Recent literature increasingly questions the long believed protective effects of functional cerebral plasticity in children. Although TBI in children and adolescents is frequent, they are less frequently admitted to rehabilitation centers as in-patients than adults. This emphasizes the role of out-patient treatment. The progressing study described here aims to achieve a contribution to a comprehensive approach in TBI-rehabilitation for youngsters. A two-stage multimethodal program, starting with stimulation in coma while the patient is on the intensive care unit, and neuropsychological therapy after regaining consciousness is to be evaluated in a controlled, prospective and randomized study. After including nearly 50 % of the planned sample (100 persons), some preliminary results can be mentioned with all applicable caution. The effectiveness of the applied therapy can be stated here with respect to the posttraumatic development of intellectual abilities in the 6- and 12 months follow ups. Moreover, in the control group development of psychopathological alterations was found to a considerable degree and also lower ratings in a quality of life questionnaire, compared to the experimental group. It is expected to prove these differences statistically, after the total sample has been included, and thus equal distributions have been achieved in all predictive variables.

Journal Article↗
PubMedDate not supplied

[Evidence based therapy of children and adolescents with attention deficit/hyperactivity hyperkinetic syndrome (ADHS)].

The article reviews the empirical research on the efficacy of pharmacological and psychological treatment of children and adolescents with attention deficit hyperactivity disorders (ADHD). The importance of evidence based treatment is stressed. Then the results of the internationally most important treatment study in this field, the US Multimodal Treatment Study of Children with ADHD (MTA-Study) are summarized. The study shows the efficacy of both pharmacological therapy (mainly stimulant treatment) and behaviour therapy. The combination of both interventions was not clearly superior to drug treatment plus counselling (medical management). However, Reanalyses show better effects of combined treatment. In the German speaking countries the Cologne Multimodal Interventions Study (COMIS) was conducted. Some main results of this study are summarised. Evidence based conclusions regarding the efficacy of different psychological and pharmacological interventions based on meta analyses, review articles and empirical studies are summarised.

Adolescent↗
PubMedDate not supplied

[Treatment effects of combined cognitive behavioral therapy with parent training in hyperkinetic syndrome].

In the past cognitive behavioral treatment concepts failed to demonstrate their clinical effectiveness in the treatment of ADHD children. We combined a cognitive treatment package (CBT) with a special focus on self-instructional and self-management skills with a subsequent parent management training (PMT) in order to reduce academic problems and oppositional/aggressive behavior. 18 children with a diagnosis of ADHD combined type and Oppositional Defiant Disorder participated in the study. In an A-B study design the effects of a 12 weeks treatment phase (6 weeks CBT; 6 weeks PMT) were compared with a preceding 4 weeks baseline. Core symptoms of ADHD, conduct and homework problems were assessed by weekly administration of parent and teacher questionnaires. CBT was effective in reducing the core symptoms of ADHD at home, in school and concerning homework problems. Moreover conduct problems at home and in school were reduced. PMT resulted in a further amelioration of the cited symptoms. We conclude that CBT is an important component in the treatment of ADHD provided that aspects of generalization are considered. PMT is a useful adjunct to CBT due to its effectiveness in situations where children still have problems of self guidance.

Aggression↗
PubMedDate not supplied

[General practice of pedagogic management by teachers of hyperkinetic attention deficit disordered children in the classroom].

Attention Deficit/Hyperactivity Disorder is one of the most common behavior disorders in child and adolescent psychiatry. The problems resulting from the core symptoms of the disorder often endure into adolescence and adulthood placing these children at significant long-term risk for academic psychological and social morbidity. Despite the importance of the school in this process relatively few teachers of regular schools have sufficient knowledge about the foundations and principles of treatment concerning ADHD nor do they receive adequate training how to deal with ADHD related problems in the classroom. Moreover there is a significant lack of cooperation between schools, parents and therapeutic institutions inhibiting a multimodal treatment. This article resumes the experiences of a 3 months ADHD intervention program for teachers in a Cologne elementary school. It gives informations and advices for appropriate measurements in the classroom setting that include: 1. intensive information of teachers about the disorder, 2. intensified involvement of teachers in the treatment process and 3. the implementation of distinct didactic elements and well structured principles of behavior therapy in the school lessons.

Adolescent↗
PubMedDate not supplied

[School refusal: classification, developmental psychopathology, prognosis and therapeutic approaches].

In many cases the refusal of school is one manifestation of a complex psychiatric disorder. There is an increased comorbidity with depression, phobia and other anxiety disorders. The program of therapy should be conceptualized as multimodal. In general there is no rapid remission of the symptoms. As catamnestic studies proved, long-term consequences should be anticipated concerning the occupational integration as well as further psychiatric morbidity. Triggering and sustainable factors are heterogeneous and there is no typical psychosocial pattern.

Adolescent↗
PubMedDate not supplied

[Patterns of behaviour of juvenile smokers and non-smokers].

Preventing habitual smoking by young people forms an important goal of health promotion in schools. In achieving this target, information is needed about the age at which smoking becomes a temptation for young people as well as knowledge about the attitudes that are associated with smoking. At two elementary schools and at one grammar school in a community of a former coalmining area, 985 German pupils aged 11-18 years were interviewed with the Youth Self Report (YSR) together with a questionnaire concerning their smoking habits. The rate of smoking among the pupils rose from the age group 11-15 years to the age group 16-18 years (in this age access to cigarettes is no longer restricted by law) from 12% to 63%; between the sexes there is no difference in smoking habits. According to the scales of the YSR in both types of school, smokers scored significantly higher on scales of "antisocial" and ,,aggressive behaviour". On the other hand non-smokers scored significantly higher on the scale "social problems". The significantly higher rate of smokers in both elementary schools compared with the corresponding rate in the grammar school will be interpreted by two interrelated explanations: the influence of lower social class as well as the lack of the deferred gratification pattern as an ingredient of the culture in elementary schools. The difference between smoking and non-smoking juveniles according to the scales of the YSR can be explained by the association of smoking behaviour with the juvenile culture of deviant groups on the one hand and by the attitudes of the non-smokers, who are more reluctant in joining peer groups. The results support a strategy for effectively preventing habitual smoking habits of juveniles in schools by combining youth activities inside and outside the schools.

Adolescent↗