Clinical classification of infant nonsynostotic cranial deformity.

OBJECTIVE: Based on a pilot study including >400 children and a comprehensive database analysis of >2500 children, we sought to define the craniofacial norm and to objectify the categorization of positional head deformity. STUDY DESIGN: A database was created containing clinical information on children assessed for nonsynostotic cranial deformity. The findings of standardized anthropometric measurements were compared with data from a group of 401 healthy children with a normal head shape collected in terms of a prospective pilot study. Using a statistical analysis of all anthropometric craniofacial measurements, cut-off percentiles for discriminating different groups of deformation and severity classes were generated. RESULTS: Normative percentiles for all dimensions in cranial vault anthropometric measurements during the first year of life were calculated. Children with definite nonsynostotic head deformity could be clearly allocated into 3 different groups: positional plagiocephaly (abnormal Cranial Vault Asymmetry Index), positional brachycephaly (abnormal Cranial Index), and combined positional plagiocephaly and brachycephaly (abnormal Cranial Vault Asymmetry Index and Cranial Index). Additionally, a reliable 3-level severity categorization (mild, moderate, and severe) for each group of cranial deformation could be obtained according to age and sex. CONCLUSIONS: Our results allow a meaningful and reliable classification of nonsynostotic early childhood cranial deformity.

[Alexithymia and specific relationship patterns in a clinical sample]. / Alexithymie und spezifische Beziehungsmuster in einer klinischen Stichprobe.

OBJECTIVES: Alexithymia is characterized by deficits in perceiving, differentiating and regulating affects, both one's own affects and those of others. It is often related to interpersonal problems which are a major reason for seeking psychotherapy. This study assesses the relationship between alexithymia, specific relationship patterns and interpersonal problems in a clinical inpatient sample. METHODS: We evaluated alexithymia (Toronto-Alexithymia-Scale-26: TAS-26), relationship patterns (Relationship Patterns Questionnaire-II; RPQ-II) and interpersonal problems (Inventory of Interpersonal Problems: IIP) in 152 patients with various mental disorders upon admission to an inpatient clinic for psychosomatic medicine and psychotherapy. RESULTS: Alexithymia (TAS-20) was significantly negatively associated with self-assertion (RPQII) and significantly positively associated with overall interpersonal problems (IIP-total score). Specifically, the interpersonal style associated with alexithymia was characterized by cold, socially avoidant, nonassertive and exploitable behavior (IIP-subscales). CONCLUSIONS: Alexithymia in patients with mental disorders is linked to specific relationship patterns and interpersonal problems at the beginning of an inpatient psychotherapy. Because interpersonal problems, and especially the therapeutic alliance, are strong predictors of outcome in individual psychotherapy, specific attention should be paid to this relationship in the treatment of alexithymic patients.

Percentile-based assessment of craniosynostosis.

Perioperative assessment of craniosynostosis is based mostly on subjective scores. In this study, we sought to find an objective method to assess cranial deformation based on normative craniofacial percentiles. Anthropometric datasets from 104 (79 males, 25 females) patients with craniosynostoses were included. Anthropometric data were compared with normative age-dependent percentiles. Deviations above the 90th or below the 10th percentile were defined as significant cranial deformation. The cohort comprised 69 children with sagittal, 22 metopic, nine coronal, two bicoronal, one lambdoid, and one with coronal + lambdoid craniosynostosis. Most children with sagittal synostosis were above the 90th percentile for cranial circumference and length, whereas only 27.9% were below the 10th percentile for cranial width. Most (83%) children with scaphocephaly had cranial indices below the 10th percentile. For trigonocephaly, we found normal cranial circumference values in most patients (10th-90th percentile), 40.9% were above the 90th percentile for cranial length, and 63.1% and 57.9% were above the 90th percentiles for sagittal and transverse circumferences. For unicoronal synostosis transverse circumference was above the 90th percentile in 83.3% of children. Matching of anthropometric data of craniosynostosis patients with craniofacial norms could be useful in grading the clinical picture and potentially adapting the operative procedure.