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Helmut Remschmidt

Publications and source records attributed to Helmut Remschmidt.

At least 19 recordsLinked to original sources
PubMed2007

[Phenomenology and co-morbidity of childhood onset obsessive compulsive disorder].

OBJECTIVES: The goal of the study was to investigate the contents and comorbidity features of obsessive-compulsive disorder in children and adolescents. METHOD: 55 patients (29 males, 26 females), mainly inpatients selected from university clinics for child and adolescent psychiatry (95%), were investigated. Structured diagnostic interviews were used to interview patients and their parents. RESULTS: The mean age of onset for obsessive-compulsive disorders was 11.3 years. In males the onset was slightly earlier than among females, but this difference was not significantly significant. Compulsions mostly referred to washing and cleaning, checking, repeating, ordering, and counting. Most frequently, obsessions included thought about contamination, catastrophes, sexuality, and aggression. According to parental reports, the rate of comorbidity was high (lifetime diagnosis: 69%, current diagnosis: 53%), with anxiety, depressive, hyperkinetic, conduct, and eating disorders being the most frequent co-morbid conditions. Obsessive-compulsive symptoms were more intense in those patients who had a greater number of lifetime diagnoses of other psychiatric disorders. Comparing the rates found when structured interviews were carried out according to the study protocol to those for clinicians, clinicians were found to have diagnosed mixed obsessional thoughts and acts (presenting obsessional thoughts, as well as compulsive acts) less frequently. CONCLUSIONS: The results of this investigation are well in line with those of international studies on obsessive-compulsive disorders. The rates of disorders found were dependent on the diagnostic methods used. A potentially promising approach for further investigation is the sub-typing of patients according to symptom dimensions.

Adolescent↗
PubMed2006

Prevalence of movement disorders in adolescent patients with schizophrenia and in relationship to predominantly atypical antipsychotic treatment.

OBJECTIVE: To examine prevalence of movement disorders (MDs) such as tardive dyskinesia (TD), parkinsonism or akathisia in an adolescent population with schizophrenia and in relationship to predominantly atypical antipsychotic treatment. METHOD: Ninety-three patients (aged 19.6+/-2.2 years) were ascertained in this cross-sectional/retrospective study. 76 patients (81.7%) received atypical, 10 (10.8%) typical antipsychotics and 7 (7.5%) combinations of atypical/typical antipsychotics. MD symptoms were assessed using Tardive Dyskinesia Rating Scale (TDRS), Abnormal Involuntary Movement Scale (AIMS), Extrapyramidal Symptom Scale (EPS), Barnes Akathisia Scale (BAS). RESULTS: Movement disorder symptoms were found in 37 patients (39.8%) fulfilling strict/subthreshold criteria for TD (5.4/11.8%), parkinsonism (2.2/25.8%) or akathisia (1.1/11.8%), respectively. Patients treated with typical antipsychotics displayed a significantly higher EPS-score (P=0.036) and a tendency towards a higher BAS-score (P=0.061) compared to patients with atypical antipsychotics. Treatment durations with typical/atypical antipsychotics showed trends towards advantages of atypical antipsychotics with regard to parkinsonism/akathisia symptoms (P=0.061; P=0.054), but not with regard to TD symptoms (P=0.003), possibly due to confounding effects. CONCLUSION: Under treatment with atypical antipsychotics MD symptoms are less prevalent and less pronounced than under typical antipsychotics. We speculate that the finding of relatively high prevalence rates of subthreshold MD symptoms may be, at least partially, explained by previous or combined therapy with typical antipsychotics.

Adolescent↗
PubMed2006

[Switching from a short-acting to a long-acting methylphenidate preparation: a multicentre, open study in children with ADHD].

OBJECTIVES: The objective was to evaluate the safety and efficacy of a switch in medication to a single daily dose of OROS-Methylphenidate (OROS-MPH, Concerta) in clinically stable children and adolescents with ADHD. METHODS: A prospective, multi-centre open-label study was carried out for a period of three weeks in 213 patients aged 6-16 years with ADHD who had previously been treated with IR-MPH. Their medication was switched to a single daily dose of OROS-MPH. Primary endpoints were changes in the IOWA Conners Inattention/Overactivity Subscale and the global assessment of efficacy as rated by parents and teachers. The safety of the medication was evaluated by means of recording adverse events. The development of weight, sleep quality, and appetite were also observed. RESULTS: Switching the medication from IR-MPH to OROS-MPH resulted in a significant positive effect as evidenced by caregivers' ratings of core symptoms. Corresponding ratings by teachers revealed no significant difference from baseline values. The global efficacy was rated by teachers as "good" or "excellent" for 55% of the cases, by caregivers for 79% thereof, and by investigators in 77% of the cases, respectively. The study medication was well tolerated. The most frequent adverse events were headache (8.9%) and rhinopharyngitis (7.0%). No unexpected adverse events occurred. CONCLUSIONS: Changing patients' medication from IR-MPH to a single daily dose of OROS-MPH resulted in a significant improvement of ADHD symptoms as rated by parents. In a school setting, the efficacy of OROS-MPH was comparable to that of IR-MPH.

Adolescent↗
PubMed2006

[A university department as a psychiatric service centre for children and adolescents].

The article reports on a system of care for psychiatrically ill children and adolescents that has been designed, established and expanded since 1980 by a university department in a rural region. The department is responsible for the mental health care of three counties with altogether 807 000 inhabitants. The development of this system of care was due in great part to the model program of the German Federal Government for the reform of mental health care that comprised 14 model regions, out of which the region of Marburg and its surrounding counties was the only one with a focus on the situation of psychiatrically ill children and adolescents. With the aid of this model program, a comprehensive evaluation of existing psychiatric services was carried out and at the same time, new services for this clientele were established such as a mobile child and adolescent psychiatric service and a day hospital. A particular focus was laid on the development of a complete network of psychiatric services with manifold, and over the years well proven, cooperation measures. Finally, the quality of mental health care was significantly increased by a continuous evaluation of services and the implementation of two institutes for psychotherapeutic training. Several research initiatives in the field of social psychiatry have contributed to this amelioration and at the same time, to a successful integration of mental health care and research.

Adolescent↗
PubMed2006

[An integrative research model for child and adolescent psychiatry bringing together biological, psychological and social research approaches].

After some general remarks on the current situation of child and adolescent psychiatric research in Germany, a research concept is presented which in the course of 30 years of testing and further development has proven to be successful both in the inauguration of scientific projects, as well as in the qualification of trainees and co-workers. The nucleus of this concept is a research unit that is to a large extent independent of the daily health care routine. Some of the unit staff members are natural scientists holding permanent positions, complemented by a secondary labour force of young doctors and psychologists aspiring to a scientific career. This research unit provides supply for scientific projects and basic research, as well as for the development of new methods. The unit was endorsed by a Clinical Research Group funded by the German Research Foundation (DFG) that proved of value as power supply for research (e.g. by raising substantial third-party funds) and as an instrument for the qualification of young scientists. The article describes some results of four research projects derived from this approach (schizophrenia research, dyslexia research, research on Asperger syndrome, quality assurance, and therapy evaluation research).

Academies and Institutes↗
PubMed2006

[Genetics of dyslexia].

Dyslexia is a very common developmental disorder. The aetiology of this complex disorder must in large part still be clarified. Dyslexia segregates in families and the risk for a sibling to become dyslexic is 3.5-fold increased. Different phenotypic dimensions are correlated with dyslexia. These are mainly phonological awareness, phonological decoding, orthographic coding, auditory short-term memory, and rapid naming. The correlated dimensions segregate in families and were found to be heritable. The heritability of word reading lies between 50% and 60%, and that of spelling between 50% and 70%. Based on genome wide linkage analyses, nine candidate gene regions (DYX1-DYX9) could be identified. Recently, four candidate genes, DCDC2, KIAA0319, ROBO1 and DYX1C1 were identified by systematic association analyses. All these genes play a function role in neuronal migration, making them promising candidate genes for dyslexia. However, a functionally relevant mutation has not yet been identified. The comorbidity between dyslexia and ADHD and between dyslexia and SLI could be explained, at least in part, by genetic factors. For future research, all relevant factors playing a functional role in dyslexia should be investigated in sufficiently large samples. This research should integrate genetic, neurobiological, and environmental factors. For an understanding of causes, it is very helpful to understand the interaction between different factors, namely gene-environmental and gene-gene interaction. In a recent project funded by the EU in the Sixth Framework (www.neurodys.com), the worldwide largest sample of children with dyslexia will be sampled and investigated. The goal of this project is to investigate the biological basis of dyslexia in order to improve the basis for the development of successful diagnostics and therapies.

Adolescent↗
PubMed2006

[How successful is inpatient treatment in child and adolescent psychiatry? Preliminary results of the Marburg Evaluation Project].

OBJECTIVES: From 1999 to 2006, the inpatient treatment of a complete clinical sample in a child and adolescent psychiatric hospital was evaluated in a naturalistic effectiveness study in order to obtain detailed information about the outcome of the therapies. METHODS: The project was realized as a longitudinal 1-sample design with measurements at three points in time (admission assessment; discharge assessment and 6-week follow-up; 1 1/2 year follow-up). An essential part of the assessments was conducted using standardized telephone interviews with the parents of the inpatients. The project included 1,321 inpatients; the 1 1/2 year follow-up was accomplished for 776 cases. RESULTS: In all repeated measurements, there were highly significant effects. The pre-post effect sizes were higher than 1. The effects which were achieved during inpatient treatment were stable over time with a slight improvement after treatment. The outcome of different diagnostic groups showed significant differences at the 1 1/2 year follow-up. CONCLUSIONS: The results should be used in the counselling of patients and their parents prior to starting therapy. It should be investigated whether the favourable results can be generalized for inpatient treatments in other hospitals of child psychiatry.

Adolescent↗
PubMed2006

Clinical drug monitoring in child and adolescent psychiatry: side effects of atypical neuroleptics.

OBJECTIVE: The aim of this study was to improve and evaluate the practibility of a method for the assessment of drug-associated side effects, and we implemented a clinical drug monitoring for atypical neuroleptics. METHODS: Side effects of initially hospitalized patients treated with clozapine (n = 16), olanzapine (n = 16), and risperidone (n = 19) were prospectively monitored on a weekly basis for the first 3 weeks. In the case of stable medication, measurements of all variables were made every 4 weeks or upon discharge. We used the Dosage Record Treatment Emergent Symptom Scale (DOTES) in a supplemented version to measure the presence and severity of side effects. RESULTS: Drowsiness and decreased motor activity were common, especially in the first 2 weeks. Orthostatic hypotension, increased salivation, constipation, and nasal congestion were seen in more than 30% to 60% of patients treated with clozapine and were less common in adolescents treated with olanzapine and risperidone. Rigidity, tremor, and dystonia were seen in 5% to 15% of patients treated with risperidone and olanzapine. The average weight gain after 6 weeks of treatment with the atypical neuroleptics was significantly higher for the olanzapine group (4.6 +/- 1.9 kg) than for the risperidone (2.8 +/- 1.3 kg) and clozapine (2.5 +/- 2.9 kg) groups. CONCLUSIONS: The authors' supplemented DOTES version is generally applicable to clinical use in mental health centers. The differences among the side effects of these three agents may affect compliance with medication and medical risks of metabolic syndrome, diabetes, and cardiovascular disease. More research on the short- and long-term safety of psychotropic drugs in children and adolescents, using standardized methods, should be considered.

Adolescent↗
PubMed2006

Serum levels of olanzapine and its N-desmethyl and 2-hydroxymethyl metabolites in child and adolescent psychiatric disorders: effects of dose, diagnosis, age, sex, smoking, and comedication.

The aim of this study was to assess dose-related steady-state serum concentrations of olanzapine (OLZ) and its metabolites N-desmethyl OLZ (DMO) and 2-hydroxymethyl OLZ (2-OH-OLZ) (assessed by high-performance liquid chromatography) in 122 child and adolescent psychiatric patients (age 16.9 +/- 2.2, range, 10-21 years; 74 males, 48 females) with a variety of diagnoses: schizophrenia group (n = 80); nonschizophrenia group (n = 29); anorexia nervosa (AN) group (n = 13). Median OLZ serum concentrations were 32.7 (range, 1-118; all patients), 37.7 (2-115; schizophrenia group), and 18.7 (1-63, AN group) ng/mL. The median OLZ concentration-to-dose (C/D) ratio (n = 122) was 2.6, with 90% of the distribution between 0.8 and 5.5 (ng/mL)/(mg/d). OLZ concentration was significantly correlated with DMO (r = 0.567; P < 0.0005) but not with 2-OH-OLZ (r = 0.122; P = 0.188). Daily OLZ dose was correlated with OLZ concentration in all (r = 0.684; P < 0.0005), schizophrenic (r = 0.542; P < 0.0005), and AN (r = 0.805; P = 0.001) patients, respectively. Patients aged less than 16 years displayed similar C/D for OLZ (P = 0.58) but higher C/D for DMO (P = 0.003) than those 16 years or older. AN patients received lower median OLZ doses (7.5; 5-15 mg) than schizophrenic patients (12.5; 2.5-40 mg), even after correcting for body mass index (P = 0.02). OLZ dose did not differ (P = 0.088) between smokers and nonsmokers, but smokers showed lower C/D for OLZ than nonsmokers (P = 0.008). C/D for OLZ was 38% higher (P = 0.041) under comedication with selective serotonin reuptake inhibitors when compared with OLZ monotherapy. Multiple linear regression analysis revealed that 46% of the variation of OLZ concentration can be explained by dose, diagnosis, age, sex, smoking, and comedication. The data are compared with the literature, and the relevance of therapeutic antipsychotic drug monitoring in previously sparsely investigated subgroups, such as children and adolescents or patients with AN, is emphasized.

Adolescent↗
PubMed2006

Twin study on heritability of activity, attention, and impulsivity as assessed by objective measures.

OBJECTIVE: The purpose of this study was to assess heritability of activity, attention, and impulsivity by comparing young monozygotic (MZ) twins with dizygotic (DZ) twins using objective measures. METHOD: The OPTAx test is an infrared motion analysis to record the movement pattern during a continuous performance test. Seventeen MZ and 12 same sexed DZ twin pairs in the range of 6 to 12 years were tested. The zygosity was determined by DNA-fingerprinting. The measures under investigation were activity (microevents and spatial scaling), impulsivity (errors of commission), and attention (accuracy and variability). For statistical analyses, the classical model of Falconer and the ACE and ADE genetic model for twin data were applied in order to estimate the proportion of the variance in activity, impulsivity and attention that is due to genetic effects. RESULTS: The respective coefficients of intraclass correlations in MZ twins ranged between .35 and .65 whereas for DZ twins the correlations were between .12 and .88. The heritability estimates resulting from both models were about 30% for 4 of the 5 measures, but none of these was significantly different from 0. CONCLUSION: We found no significant influence of genetic factors for activity, attention, and impulsivity. The authors conclude that further investigation of heritability of ADHD is necessary using larger sample sizes and objective measures.

Attention↗
PubMed2006

[Influencing factors on the course of supervised visitations in a parental counselling office].

We report about a youth welfare service tool called supervised visitation (SV). SVs are intended to maintain contact and emotional relationship between child and absent parent. In the present study, we assessed a number of supposed influencing factors on course and result of SV. 55 % of the SV cases could eventually be transferred to regular contact without supervision. The majority of SV cases could be finished after a couple of months. The number of accompanying counselling sessions was often higher than the number of SVs themselves, a result stressing the significance of counselling. Younger as well as older children did benefit from SV. Opposed to some of the literature, in our study the success of SV did not depend on kind of referral or custody, specific indications, or the length of contact interruptions. We found a tendency though that a high number of risk factors is a potential risk for SV success.

Adolescent↗
PubMed2005

Strong genetic evidence of DCDC2 as a susceptibility gene for dyslexia.

We searched for linkage disequilibrium (LD) in 137 triads with dyslexia, using markers that span the most-replicated dyslexia susceptibility region on 6p21-p22, and found association between the disease and markers within the VMP/DCDC2/KAAG1 locus. Detailed refinement of the LD region, involving sequencing and genotyping of additional markers, showed significant association within DCDC2 in single-marker and haplotype analyses. The association appeared to be strongest in severely affected patients. In a second step, the study was extended to include an independent sample of 239 triads with dyslexia, in which the association--in particular, with the severe phenotype of dyslexia--was confirmed. Our expression data showed that DCDC2, which contains a doublecortin homology domain that is possibly involved in cortical neuron migration, is expressed in the fetal and adult CNS, which--together with the hypothesized protein function--is in accordance with findings in dyslexic patients with abnormal neuronal migration and maturation.

Base Sequence↗
PubMed2005

Transmission disequilibrium of polymorphic variants in the tryptophan hydroxylase-2 gene in children and adolescents with obsessive-compulsive disorder.

Dysfunction of the central serotonergic system has been implicated in the pathophysiology of obsessive-compulsive disorder (OCD). The genetic contribution to the development of OCD is particularly high in early-onset OCD. The aim of this study was to investigate the effect of polymorphic variants in the gene of the novel brain-specific tryptophan hydroxylase-2 (TPH2), the rate-limiting enzyme of serotonin (5-HT) synthesis in the brain, in OCD with disease onset in childhood and adolescence. We analysed two common single nucleotide polymorphisms (SNPs) of TPH2 in the putative transcriptional control region and in intron 2 of the TPH2 gene in a unique family-based sample of OCD patients with onset of the disease in childhood and adolescence comprising 71 complete, independent trios. The transmission disequilibrium test was used to determine transmission of alleles and haplotypes from parents to offspring. In this first study of TPH2 in OCD, analysis of the SNPs, rs4570625 and rs4565946, revealed a significant preferential transmission of haplotype G-C to children and adolescents with OCD. Moreover, a trend towards preferential transmission of the C allele of SNP rs4565946 to the patients was found. The genotype relative-risk estimate for homozygous C allele carriers of SNP rs4565946 was 2.58 (95% CI 0.98-6.82). In conclusion, the results link TPH2 variations to the pathogenesis of early-onset OCD and further support the aetiological relevance of 5-HT signalling in OCD.

Adolescent↗
PubMed2005

Developmental dyslexia--recurrence risk estimates from a german bi-center study using the single proband sib pair design.

OBJECTIVE: Several studies have demonstrated a genetic component for dyslexia. However, both segregation and linkage analyses show contradictory results pointing at the necessity of an optimal ascertainment scheme for molecular genetic studies. Previously, we have argued that the single proband sib pair design (SPSP) would be optimal. The aims of this paper therefore are to demonstrate the practicability of the SPSP design and the estimation of recurrence risks for reading and writing. METHODS: We assessed spelling and reading in a family sample ascertained through the SPSP design. 287 families with at least two siblings and their parents were recruited. At least one child was affected with spelling disorder according to a one standard deviation (1SD) discrepancy criterion. RESULTS: Mean values for probands and their siblings were different for both the spelling and the reading phenotype. For the probands, variances of the phenotype spelling were smaller. These effects became stronger with more extreme selection criteria. Both siblings fulfilled the 1SD criterion for spelling and reading in 60.3 and 28.9% of the families, respectively, indicating a low cost efficiency of the double proband sib pair approach. A recurrence risk of 4.52 (CI: 4.07-4.93) was obtained for spelling when the 1SD criterion was applied to both siblings. Recurrence risk estimates were similar for reading. CONCLUSION: The study demonstrates the suitability of the SPSP design for genetic analysis of dyslexia. The recurrence risk estimates may be used for determining sample sizes in gene mapping studies.

Child↗
PubMed2005

Clozapine: weight gain in a pair of monozygotic twins concordant for schizophrenia and mild mental retardation.

Clozapine is an atypical antipsychotic known to cause considerable weight gain. The extent to which genetic factors determine weight gain is unknown. Here we report on a pair of female monozygotic twins concordant for schizophrenia and mild mental retardation who were treated with clozapine over 5.5 years. One twin gained a total of 53.1 kg and had a weight of 107.5 kg (BMI=38.1 kg/m2) at the end of the observation period. The other twin gained a total of 48.2 kg and finally had a weight of 100.4 kg (BMI=33.8 kg/m2). Because both patients experienced considerable weight gain during treatment, our observation suggests that the antipsychotic-induced weight gain is under strong genetic control.

Adult↗