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Biomedical subjects

J M Fegert

Publications and source records attributed to J M Fegert.

At least 19 recordsLinked to original sources
PubMed2006

Methylphenidate exerts no neurotoxic, but neuroprotective effects in vitro.

Methylphenidate (MPH) is the most common used drug in child and adolescent psychiatry. Despite of this fact, however, little is known about its exact pharmacological mechanisms. Here we investigated the toxic effects of MPH in vitro in human embryonic kidney (HEK-293) cells stably expressing the human dopamine transporter (HEK-hDAT cells) and in cultured rat embryonic (E14.5) mesencephalic cultures. MPH alone (up to 1 mM) affected neither the growth of HEK-hDAT cells nor the survival of dopaminergic (DA) neurons in primary cultures after treatment up to 72 h. No differences in neuronal arborisation or in the density of synapses were detected. 1-methyl-4-phenylpyridinium (MPP(+)) showed no toxic effect in HEK-293 cells, but had significant toxic effects in HEK-hDAT cells and DA neurons. MPH (1 microM - 1 mM) dose-dependently reduced this cytotoxicity in HEK-hDAT cells and primary mesencephalic DA neurons. The presented results show that application of MPH alone does not have any toxic effect on DA cells in vitro. The neurotoxic effects of MPP(+) could be significantly reduced by co-application of MPH, an effect that is most likely explained by MPH blocking the DAT.

Animals↗
PubMed2005

[Serotonin reuptake inhibitors in children. Warnings on the administration, results analysis, and recommendations].

Recent reports and recommendations from national and international health care regulatory authorities have informed us that serotonin reuptake inhibitors (SSRI) are contraindicated as new treatment for those under 18 years of age with depressive illness. They conclude that SSRI carry the risk of increased suicide-related behavior; although there was no completed suicide. The European Medicine Agency (EMEA) and German regulatory agency (BfArM) advise that these components generally should not be used in this age group except in their other, approved indications. However, it is acknowledged that they may sometimes be chosen, depending on individual clinical needs. Based on these data, the Commission for Child and Adolescent Developmental Psychopharmacology of the German Scientific Society for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy is trying to give recommendations for the use of SSRI in clinical practice. Recent studies demonstrate that combining SSRI with psychological treatment such as cognitive behavioral therapy may reduce the risk of suicidal behavior in depressed children and adolescents.

Child↗
PubMed2002

[Specific features and problems in the pharmacotherapy of schizophrenic psychoses in children and adolescents].

The present article reviews the specific problems of the off-label use of atypical and typical neuroleptics in the treatment of adolescent patients with schizophrenia. There is a considerable gap in the empirical knowledge of treatment efficacy and long term safety in adult populations as compared to children and adolescents. This means that in most in-patients with early onset schizophrenia some sort of typical or atypical neuroleptic drug is currently used beyond license. From a legal point of view there is no protection for treated children or adolescents and their parents as the manufacturer of these pharmaceutical products does not assume liability for off-label use. Whether the doctor can be held liable in these cases, depends on the quality of the information he provides to his patients and the patients' consent. Legal changes such as the Food and Drug Administration Modernization Act (FDAMA) and Pediatric Rule in the USA have brought forward more research to the benefit of children and adolescents. In 2002 a trend has been noticed in both the European and the German Parliament to improve the general conditions for using drugs that are well-established in adult medicine for the treatment of children.

Adolescent↗
PubMed2001

Discriminant validity of the child behaviour checklist CBCL-4/18 in German samples.

This study examined the discriminant validity of the German version of CBCL in two large samples of referred and non-referred children and adolescents which were matched for age, sex and socio-economic status. The combined sample that was used for statistical analysis consists of 2,058 referred and 2,058 non-referred boys and girls between 4 and 18 years of age (mean age: referred boys= 10.9 years, non-referred boys = 10.9 years, referred girls=11.3 years, non-referred girls=11.1 years). Referral status was used as validity criterion. Statistical procedures included Odds Ratios, Total Predictive Values, ROC analyses and discriminant analyses. Results indicated that the discriminant validity of the German version of CBCL is comparable to the original English version. With the use of CBCL Total Problem Score as predictor (cut-off T > or = 60) 83.8% of children and adolescents could correctly be classified (sensitivity 83.6%, specificity 83.9%). Symptoms of the "Attention Problems Scale" show the highest discriminative power to distinguish between disturbed and undisturbed children and adolescents.

Adolescent↗
PubMed2000

[Legal binding character of guidelines].

Guidelines as recommendations by the medical associations concerning the diagnosis and treatment of certain diseases do not have the character of judicial norms. However, they may have an impact on decision-making in court. Within social security insurance law, and especially in medical malpractice litigation, the medical standard has become a legal term. As far as statements in guidelines render the actual standard as affirmed, the more binding is their character with respect to judicial questions. This article deals with this interplay between medical quality assurance and the legal demands on medical action. As a basis for discussion of this issue the relevant jurisdiction will be represented. Its impact on the guidelines for child and adolescent psychiatry will be pointed out as a concrete example.

Adolescent↗
PubMed2000

[Children and adolescents with mental disorders as orphans of managed care?].

Failure of incentive to investigation in infantile pharmaceutical trials has lead to insufficient supply with drugs within pediatrics and child- and adolescent psychiatry in Germany. In practice, drugs that are approved for adults are used to treat minors as a remedy. In many areas such "off label use" has become the medical standard and is therefore owed by the doctor under medical malpractice law. The principle of economy, that rules the law of public health insurance, forbids the prescription of drugs, that are not tested. However, as minors have the right to equal protection, the principle of economy can not prohibit off label use to the determent of minors. By virtue of the European orphan drug direction we can expect an improvement of drug supply in the field of pediatrics and child- and adolescent psychiatry in the long run. But meanwhile it would be unethical and unlawful to deny minors through restrictions on drug prescription a standard treatment, where the medical standard demands off label use of a pharmaceutical product.

Adolescent↗
PubMed1999

[Psychopharmacological therapy of self-injurious behavior in mentally retarded individuals].

Neurobiological research has implicated the dopamine and serotonin system in the pathogenesis of self-injurious behavior. The efficacy of antipsychotic drugs has been questioned. Opened and controlled investigations have shown risperidone is effective for reducing self-injurious behaviour in mentally retardation. We report about 3 mentally retarded patients which were given open-label risperidone for 12 weeks. They participated in a detailed assessment of behaviour symptoms at baseline and the repetitive behaviour was weekly rated with the disability assessment schedule (DAS). All three patients responded.

Adult↗
PubMed1999

[Sexual violence in the reality of life in mentally handicapped young girls and women--results of a research project].

Subject of the study is the situation of 12- to 25-year-old girls and women from Berlin with a mental handicap who have experienced sexualised violence. 367 residential institutions of the Behindertenhilfe Berlin (aid for the handicapped) as well as 15 selected advice and consultancy facilities with amongst others a range of offers on problems of sexual violence. The return from the residencies was 68.7%. The gained individual data for the first time show the belonging to a sex for the residents. The group that was relevant for the study--altogether 147 girls and young women--was cared for in 31 institutions. The heads of the institutions provided information about more than 116 of these inhabitants. Every third to fourth resident (32 out of 116) was concerned by sexualised violence. This high extend of experience of sexualised violence in mentally handicapped female residents is directly opposed to an utterly insufficient psychosocial care situation. On one side the access to the questioned advice and consultancy centres is considerably limited for this clientele. Furthermore, heads of institutions of the Behindertenhilfe rather fall back on experts with medical-psychiatric knowledge, but not necessarily with knowledge of the handling of problems of sexual violence. Suggestions for the necessary improvement of the care situation of concerned girls and women with a mental handicap are being made.

Adolescent↗
PubMed1999

[Brief report of the working group OPD-CA (children and adolescents) Axis I: subjective dimensions, resources, and preconditions for treatment].

The progress of work in adaptation axis I of OPD (operationalized psychodynamic diagnostic) to axis I OPD-CA (children and adolescents) is delineated. The items are now classified as subjective dimensions, resources and preconditions for treatment. Overlapping with the multi-axial classification for children and adolescents as used in Germany (MAS) was eliminated and important items for child and adolescent psychiatric and psychotherapeutic treatment were added. In the field of personal dimensions only subjective impairment will be covered. Resources were accentuated for the benefit of peer relationships. Motivation for treatment is now differentiated between a more global motivation for change and motivation for psychotherapeutic treatment. In order to reduce ambiguity the term of compliance was transformed into ability for therapeutic agreement. The possibility of realization of therapeutic indication was added.

Adolescent Psychiatry↗
PubMed1999

[Institutional handling of sexual abuse: experiences, evaluations, and desires of nonabusing parents of sexually abused children].

This article describes experiences of parents of sexual abused children and their evaluations of institutional interventions on sexual child abuse. Results are presented of a study investigating 'individual and institutional reactions on sexual child abuse'. The number of contacted institutions, personnel experiences with these institutions and resulting requirements are described. The results are based on a sample of 47 (82.5%) girls and 10 (17.5%) boys (range 6-18 years) and interviews with their 'non-abusing' parents. 28 (49.1%) of these children were abused by a member of the family, 29 (50.9%) children by non-familiar persons. It could be shown that 70.2% of the children had contacted four or more different institutions soon after the sexual abuse had been revealed. In cases of sexual abuse by a family member the first contacted institution was the Youth-and-Health-Care-System whereas in cases of sexual abuse by non-familiar persons mostly the police was contacted. Nevertheless in most cases both judicial and supporting approach were chosen. Additionally to concrete advices and professional competences the interviewed parents reported that emotional warmth was a very helpful aspect of the professional intervention. Generally the perspective of the parents seems to give some interesting informations about 'consumer satisfaction'.

Adolescent↗
PubMed1999

[Children suffering from atopic eczema and their families. A qualitative investigation of the effects on family and their coping styles].

UNLABELLED: Research in the field of the impact of chronic illness is nowadays often based on concepts such as coping and stress adaptation. From the point of view of the family chronic illness influences family functioning, while coping behavior is influenced by the families resources. There is little research done on this interaction. This article focuses on atopic eczema. METHODS: Qualitative free interviews of more than two hours duration each, had been done with all family members of families with a child suffering from severe chronic atopic eczema until the age of (pre-) puberty. A family interview with all members of the family has also been transcribed. The interpretation of the data is based on the qualitative content analysis and the grounded theory. The results from 5 families (24 interviews) lead to a typology of familial coping. The implications of this typology are discussed.

Adaptation, Psychological↗
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↗
PubMed1997

[The emotional development of children].

In the context of pre-school and school medical examinations in the public health service in Germany general rating of the cognitive and motor skills of a child is often included. In contrast thereto, emotional development and emotional situation of children are still a domain of intuition. The present article reviews the developmental psychology and psychopathology of emotions. Data of a video analysis of non-verbal emotional behaviour during a verbal task are presented with respect to shame and associated motor behaviour. In a child psychiatric recourse population (n = 2353), the developmental aspect of major child psychopathology, is pointed out in the context of the ICD-10 diagnostic system.

Affective Symptoms↗
PubMed1997

[Sleep behavior in the first 3 years of life].

A review of the literature on sleeping "disorders" in infants and toddlers shows that sleep problems are very common. We report the results of a German multicenter epidemiological study on a birth cohort (N = 1314). The children had medical examinations at 4 weeks, 3 months, 6 months, 1 year, 18 months, 2 years and 3 years. Most of the information on the sleeping behavior was gathered by structured interview and questionnaires. This paper gives information on the prevalence and the persistence of sleep problems in one to three year old children in Germany. Statistical analysis of correlations between breastfeeding and sleep and the place of sleep are reported. The consequences of sleep problems on the family overall well-being are also examined.

Child, Preschool↗
PubMed1997

[The value of different sources of information in evaluating psychiatric disorders in adolescence--a comparison of parental judgment and self-assessment by adolescents].

Data from the national representative epidemiologic survey (PAK-KID-study) assessed by the German versions of Achenbach'S Child Behavior Checklist and Youth Self-Report of N = 1757 parents and their children aged 11 to 18 years are compared by using the corresponding Cross-Informant-Scales. On all problem scales adolescents report more problems than parents. For some scales the differences between girls and their parents are higher than between boys and their parents (social withdrawal, somatic complaints, anxious/depressed, attention problems, internalizing and total score). Averaged Pearson correlations of the eight subscales are in a moderate rage (r < 0.50). For all problem scales an agreement of 30% in the area of high problems (> PR95) is found. If one informant scores above PR95 the Relative Risk of the other one scoring in this range too is significantly higher than one for nearly all scales.

Adolescent↗