[Media's Stranglehold on Storm and Stress - The Sorrows of Generation Z about Sex and Gender]. / Sturm und Drang im Würgegriff der Medien ­ Die Leiden der jungen Generation am eigenen Geschlecht.

Media's Stranglehold on Storm and Stress - The Sorrows of Generation Z about Sex and Gender Abstract: The feeling of not belonging to one's birth sex is not new; one can trace this phenomenon back even to ancient mythology. Although it has always been rare, there has recently been a sharp increase in gender identity deviations among adolescents. This text addresses this problem by asking to what extent this development also results from upheavals in the cultural landscape and, above all, in media technology. Do they cause young people to believe they are in the "wrong gender" and, in extreme cases, to strive for transition? We present the most salient cornerstones of the planned German self-determination law (Self-ID), most of which, however, are unlikely to do justice to the underlying problem. The text concludes by describing several unanswered questions concerning this matter and by attempting to propose first answers. The advantages of a gender-exploratory over the trans affirmative therapy approach are summarized.

The role of pornography in the sex life of young adults-a cross-sectional cohort study on female and male German medical students.

BACKGROUND: Due to easy online accessibility of pornography its consumption is popular among adolescents and young adults. Considering recently developed frameworks on the effects of sexual media, we assessed how increased consumption of pornography is associated with the experience of certain aspects of offline and online sexual activity in German medical students. METHODS: Between April 2018 and March 2020 medical students from the Technical University of Munich in Germany were anonymously surveyed with regards to their sexual behavior, consumption of pornography, and use of social media. 468 students (female: n = 293; male: n = 175) were included in the current analysis. Data was analyzed using simple and multiple Poisson regression analysis. RESULTS: Only 7.3% of female students but the majority of male students (79.1%) consumed pornography more than 4 times in the last 4 weeks. Female and male students who reported to be inspired by pornography (female: 52.0%, male: 74.6%) and who have enjoyed the experience of anal intercourse in their life (female: 17.1%, male: 32.2%) consumed pornography more frequently. Female students who have experienced a "threesome" (9.0%), have sent erotic pictures of themselves (33.5%), or use social media in their dating life (27.6%) consumed pornography more frequently. Male students who did not experience a sexual transmitted disease (82.9%) and did not cheat on their partner (68.0%) consumed pornography more frequently (results of multiple Poisson regression analysis; all p < 0.05). CONCLUSIONS: Many students consider pornography as inspiration for their sex life and frequent consumption of pornography seems to be associated with gender specific characteristics congruent with short-term sexual quality. The desire of adolescents and young adults for practical information about sexual intercourse should be addressed openly and a proper understanding of the sexuality shown in pornography should be taught.

[About the heterogeneity in adolescents with gender identity disorder: differential importance of psychiatric comorbidity and considerations of individual psychodynamics]. / Heterogenität von Geschlechtsidentitätsstörungen bei Jugendlichen: Zur differenziellen Bedeutung der psychiatrischen Komorbidität und individuellen Psychodynamik.

Gender identity disorder (GID), gender dysphoria (GD) respectively, is considered a multifactorial disease whose etiology is subject to complex bio-psycho-social conditions, each with different weighting. As a result, therapists, who treat children and adolescents with GID/GD, have to deal with a very heterogeneous group with individually varying causes, differing psychopathology and varying disease progression. In addition to general psychiatric aspects of development, particularly psychiatric comorbidity, but also the different individual psychodynamics--i. e. the specific constellation of conflicts and possible ego deficits and structural deficits in the learning history of the person are of differential importance. In regard to the indication for gender reassignment measures this sometimes is relevant for the decision. The difficulties arising for decision making and the usefulness of a systematic evaluation of case reports as a basis for further optimization of the treatment recommendations are illustrated by two case reports. In the course of this, also the disadvantages and potential dangers of too early diagnostic definition and introduction of gender somato-medical and legal measures are shown exemplarily.

Effectiveness of a multimodal inpatient treatment for adolescents with anorexia nervosa in comparison with adults: an analysis of a specialized inpatient setting : treatment of adolescent and adult anorexics.

OBJECTIVE: There is evidence for an increased prevalence and an earlier onset of anorexia nervosa (AN) in adolescents. Early specialized treatment may improve prognosis and decrease the risk of a chronic course. The current study evaluates the effectiveness of a multimodal inpatient treatment for adolescent AN patients treated in a highly specialized eating disorder unit for adults. METHOD: 177 adolescents and 1,064 adult patients were included. The evaluation focused on eating behavior, depressive symptoms and general psychopathology. RESULTS: All measured variables decreased significantly in both groups during inpatient treatment. No differences were found concerning weight gain, improvement of global eating disorder symptomatology as well as depressive symptoms. However, adults showed a higher psychological distress and in this regard also a greater improvement. CONCLUSION: Results indicate that treating adolescent AN patients in a highly specialized eating disorder unit for adults can be an effective treatment setting for these patients.

[Subjective evaluation of DBT treatment by adolescent patients with eating disorders and the correlation with evaluations by their parents and psychotherapists]. / Subjektive Therapiebeurteilung jugendlicher Patientinnen mit Essstörungen und deren Ubereinstimmung mit Eltern- und Therapeutenbeurteilungen.

OBJECTIVE: The subjective evaluation of a psychotherapeutic treatment may be an essential aspect of the recovery from an eating disorder. Our study investigates the subjective treatment evaluation by patients with eating disorders and the accordance with their parents' and psychotherapist's evaluation. METHOD: In a sample of 41 eating-disorder patients (M(Age) = 16.3; SD = 1.26), their parents and psychotherapists, we used a questionnaire (FBB) to assess satisfaction with Dialectical Behavioral Therapy treatment. RESULTS: Our results show good ratings, as well as good correlations between patients and parents. CONCLUSIONS: The findings implicate the importance of assessing a subjective therapy rating in addition to objective parameters.

Short-term outcome of anorexia nervosa in adolescents after inpatient treatment: a prospective study.

The current study describes the short-term outcome of adolescent inpatient population suffering from anorexia nervosa (AN) and analyzes the clinical predictors of poor outcome in these patients. Fifty-seven female AN patients (mean = 15.8, SD = 1.3) admitted for inpatient treatment to a specialized eating disorder unit at a university medical center were reassessed 1 year after being discharged. Assessments were made at the beginning and at the end of the inpatient treatment as well as at the 1-year follow-up. Self-rating data and expert-rating interview data were obtained. Adequate data for 55 (96.5%) cases allowed for the assignment of an outcome category. A total of 28.1% of the patients' cases showed a good outcome, meaning the patients fully recovered, and 8.8% had an intermediate outcome, and 59.6% of the patients' cases had a poor outcome. Significant predictors of poor outcome included the patient's BMI at the beginning of the treatment as well as psychiatric comorbidity, and purging behavior. Adolescent AN is a severe disorder with a poor outcome in a substantial amount of adolescents.

Body image and attitudinal aspects of eating disorders in rhythmic gymnasts.

BACKGROUND: Aesthetic sports, especially on a competitive level, are often considered as a risk factor for the development of an eating disorder. A few studies have examined this issue in rhythmic gymnasts, but no reports on body image disturbance exist for these athletes compared to anorectic patients. SAMPLING AND METHODS: Fifty elite rhythmic gymnasts (average age 14.8 years) including the German national team, 58 female patients with anorexia nervosa (AN; average age 15.5 years), and 56 high school girls (average age 14.9 years) completed the Eating Disorder Inventory-2 and the Test for Detecting Body Image Distortion in Children and Adolescents (Test zur Erfassung der Körperbildstörung bei Kindern und Jugendlichen). Furthermore, body weight and height, body mass index, presence of amenorrhea and frequency of exercise were surveyed. RESULTS: Body mass index was significantly lower in the elite rhythmic gymnasts than in the high school students, and significantly higher than in the AN patients. Both the elite rhythmic gymnasts and the AN patients were significantly smaller than the high school students. The elite rhythmic gymnasts trained significantly more frequently compared with the AN group and the high school group. Regarding the Eating Disorder Inventory-2 and the Test for Detecting Body Image Distortion in Children and Adolescents, AN patients scored significantly higher on all explored subscales than both the elite rhythmic gymnasts and the high school students. CONCLUSIONS: Even though some physical similarities were found for the elite rhythmic gymnasts and the AN patients, contrary to previous studies, no noticeable problems related to attitudinal aspects of eating disorders were detected in the elite rhythmic gymnasts. A mildly distorted body image of the abdomen was identified in elite rhythmic gymnasts, while AN patients expressed a broad body image distortion and students expressed no body image distortion. Our data do not allow us to draw conclusions regarding prevalence rates, long-term effects or male athletes.

[Dialectical behavior therapy for adolescents with anorexia and bulimia nervosa (DBT-AN/ BN)--a pilot study]. / Dialektisch-behaviorale Therapie für jugendliche Patientinnen mit Anorexia und Bulimia nervosa (DBT-AN/BN) - eine Pilotstudie.

Dialectical behavior therapy (DBT) was originally developed by Linehan (1993a, b) and modified by Miller et al. (1997) for suicidal adolescents with borderline personality features. Meanwhile, this therapy has also successfully applied in other adult clinical groups. The prior aim of the study is to evaluate the effectiveness of DBT for inpatient adolescents with anorexia and bulimia nervosa. In this pilot study (n=31) the efficacy of this treatment will be evaluated in a pre-post comparison. Different instruments will be used (SIAB, EDI-2, SCL-90-R, FBB). The first results are promising and we must hope that this new approach will improve the future treatment.

[Family-oriented group therapy in the treatment of female patients with anorexia and bulimia nervosa--a pilot study]. / Familienorientierte Gruppentherapie zur Behandlung von Patientinnen mit Anorexia und Bulimia nervosa--eine Pilotstudie.

OBJECTIVES: Family therapy has proven effective in the treatment of anorexia nervosa (AN) and bulimia nervosa (BN) in adolescence. While cognitive-behavioural treatment has been shown to be effective in adult patients suffering from BN, there have been few studies on the effectiveness of psychotherapy in the treatment of adolescents. Since in the majority of AN patients their illness starts in mid-adolescence, and in late adolescence in BN patients, it is crucial to develop and evaluate treatment programmes for these disorders and age groups. In view of these arguments, a programme of group psychotherapy was set up for eating-disordered patients and their parents, combining disorder-specific psychoeducational components with a family group psychotherapy approach that is more open with regard to individual treatment goals. Patients participated together with their parents in the same group. METHODS: The treatment programme was evaluated within the framework of a naturalistic single-group study design. Pre-post changes were assessed. RESULTS: 32 female patients (29 with AN, 3 with BN) and their parents took part in the treatment programme. All of the families completed the programme, which was interpreted as a high rate of acceptance. Pre-post analysis revealed a decrease in the degree of eating-disorder symptoms. CONCLUSIONS: The advantages and disadvantages of this treatment programme, as well as the limitations of the pilot study are critically discussed.

Interaction of bone marrow stromal cells with lymphoblasts and effects of predinsolone on cytokine expression.

Cytokines play a key role in the differentiation, growth and survival of hematopoietic cells in the bone marrow (BM) stroma microenvironment. The mechanisms by which stromal derangements may contribute to the evolution of hematopoietic neoplasias are largely unknown. Here, we characterized BM stromal cells isolated from children with acute lymphoblastic leukemia and determined the effect of the interaction between stromal cells and lymphoblasts on cytokine expression as well as the effect of prednisolone using mono- and co-culture models. The analyses demonstrate that (1) stromal cells and lymphoblasts display different patterns of cytokine gene expression individually. (2) Stromal cells influence gene expression of cytokines in lymphoblasts and vice versa. (3) Glucocorticoid substitution inhibit cytokine gene expression in stromal cells. These findings indicate that stromal cells are important components involved in malignant hematopoiesis and also in response to therapy.

Protection of mice against Philadelphia chromosome-positive acute lymphoblastic leukemia by cell-based vaccination using nonviral, minimalistic expression vectors and immunomodulatory oligonucleotides.

PURPOSE: Childhood Philadelphia chromosome positive (Ph(+)) acute lymphoblastic leukemia (ALL) has a poor prognosis. Because leukemia cell burden is reduced but not eradicated by polychemotherapy, improved treatment strategies should enhance those immune mechanisms responsible for the maintenance of complete remission. The aim of this study was to evaluate the protection of mice challenged with the syngeneic Ph(+) ALL cell line BM185 using genetically modified leukemia cell vaccines and immunomodulating oligonucleotides. EXPERIMENTAL DESIGN: Because retroviral vectors are ineffective at transducing nondividing primary cells from human hematopoietic malignancies, we first evaluated nonviral techniques (electroporation and ballistic transfer) using minimalistic immunogenically defined gene expression vectors to generate B7.1 or granulocyte macrophage colony-stimulating factor (GM-CSF)-expressing BM185 cells. Subsequently, protective vaccination experiments with these cells were performed in a leukemia challenge mouse model. RESULTS: Electroporation yielded a high transfection rate (82.6% for B7.1) with moderate GM-CSF secretion/1 x 10(6) cells (228 pg), whereas ballistic transfer led to a lower transfection rate (30.9%) with high GM-CSF secretion (614 pg). Secondly, we immunized mice with B7.1/interleukin 2- or B7.1/GM-CSF-expressing BM185 cell vaccines. We observed a better protection of mice that received the B7.1/GM-CSF vaccine compared with these receiving the B7.1/interleukin 2 vaccine. Protection was additionally enhanced by application of a double stem-loop immunomodulating oligonucleotide containing CpG motifs. CONCLUSION: Our data indicate that immunization with B7.1/GM-CSF-expressing cell vaccines generated by electroporation and application of double stem-loop immunomodulating oligonucleotide protected mice against a murine Ph(+) ALL challenge. Ultimately, this approach may also lead to clinical benefit in patients with Ph(+) ALL.

[Treatment of eating disorders in adolescents--the view of a child and adolescence psychiatric hospital]. / Behandlung von Essstörungen bei Jugendlichen aus Sicht der kinder- und jugendpsychiatrischen Klinik.

The paper presents--in the sense of clinical guidelines--reality of clinical care in a child and adolescence university hospital specialised on eating disorders. Need of a multimodal therapeutic approach is emphasized, including normalisation of weight and eating behaviour, nursing and pedagogical measures, individual, group and family therapy, completed by body therapy, art and music therapy and in case psychopharmacotherapy. Recommendations for overcoming weak spots are made.

"Glass fairies" and "bone children": adolescents and young adults with anorexia nervosa show positive reactions towards extremely emaciated body pictures measured by the startle reflex paradigm.

In this study, we investigated the emotional processing of extremely emaciated body cues in adolescents and young adults with (n = 36) and without (n = 36) anorexia nervosa (AN), introducing a new picture type, which was taken from websites that promote extreme thinness and is targeted specifically at adolescents interested in extreme thinness. A startle reflex paradigm was used for implicit reactions, while a self-assessment instrument was used for subjective responses. We found a significant group difference with a startle inhibition (appetitive response) among the patients and a startle potentiation (aversive response) among the controls, whereas no such difference for subjective measures was found. The results are in contrast to previous studies, which proposed a general failure to activate the appetitive motivational system in AN, but in keeping with findings from other addictions, where the same response pattern has been found. Implications for prevention and therapy are discussed.

Total synthesis of epohelmin B and its analogues.

A concise synthesis of the pyrrolizidine alkaloid epohelmin B (1) and a series of analogues is described. The key steps en route to this lanosterol synthase (oxidosqualene cyclase) inhibitor comprise a highly practical "azonia-Cope rearrangement", which sets the chiral amine center with excellent optical purity, a ring-closing metathesis (RCM) reaction catalyzed by a readily prepared and now also commercially available ruthenium-indenylidene complex, a manganese-catalyzed epoxidation of the resulting eight-membered cycloalkene derivative, and a nosyl-deprotection/transannular-epoxide-opening cascade to forge the pyrrolizidine core. Digression from the route leading to the natural product in the final stages allowed for the preparation of several "epohelmin-like" compounds with modified side chains, which is necessary for investigations into a possible functional relationship with other known lanosterol synthase inhibitors.

Psychopathology in elite rhythmic gymnasts and anorexia nervosa patients.

This study investigates current psychopathology and psychological distress in elite rhythmic gymnasts. Due to a strong emphasis on leanness in aesthetic sports and the controversial findings in literature regarding the role of anorexia nervosa (AN) in such sports, we compared elite rhythmic gymnasts (n=51) to inpatients with AN (n=55) as a disease control group and to high school students (n=53) as a "normal" control group. We assessed psychopathology using the Symptom Checklist (SCL-90-R). Moreover, body height, weight, Body Mass Index (BMI) and the presence of amenorrhea were assessed. Regarding physical aspects, the rhythmic gymnasts showed an intermediate position between the two other groups. In terms of psychopathology, significant differences were found between the gymnasts and the AN patients, while no differences were detected between the gymnasts and the "normal" control group. Depression discriminated best between the three groups. Elite rhythmic gymnasts may show a lean, almost anorexic-like physique. Nevertheless, no psychological distress comparable to that of AN patients was found. Therefore, even though analogies to AN might seem obvious in elite rhythmic gymnasts, this study is putting emphasis on the importance of a careful consideration of psychological distress and psychopathology.

Gender identity disorders in childhood and adolescence: currently debated concepts and treatment strategies.

INTRODUCTION: Gender identity disorders (GID) can appear even in early infancy with a variable degree of severity. Their prevalence in childhood and adolescence is below 1%. GID are often associated with emotional and behavioral problems as well as a high rate of psychiatric comorbidity. Their clinical course is highly variable. There is controversy at present over theoretical explanations of the causes of GID and over treatment approaches, particularly with respect to early hormonal intervention strategies. METHODS: This review is based on a selective Medline literature search, existing national and international guidelines, and the results of a discussion among experts from multiple relevant disciplines. RESULTS: As there have been no large studies to date on the course of GID, and, in particular, no studies focusing on causal factors for GID, the evidence level for the various etiological models that have been proposed is generally low. Most models of these disorders assume that they result from a complex biopsychosocial interaction. Only 2.5% to 20% of all cases of GID in childhood and adolescence are the initial manifestation of irreversible transsexualism. The current state of research on this subject does not allow any valid diagnostic parameters to be identified with which one could reliably predict whether the manifestations of GID will persist, i.e., whether transsexualism will develop with certainty or, at least, a high degree of probability. CONCLUSIONS: The types of modulating influences that are known from the fields of developmental psychology and family dynamics have therapeutic implications for GID. As children with GID only rarely go on to have permanent transsexualism, irreversible physical interventions are clearly not indicated until after the individual's psychosexual development ist complete. The identity-creating experiences of this phase of development should not be restricted by the use of LHRH analogues that prevent puberty.

Chemokine IL-8 and chemokine receptor CXCR3 and CXCR4 gene expression in childhood acute lymphoblastic leukemia at first relapse.

In this study, we examined the gene expression of interleukin (IL)-8, CXCR3, and CXCR4 in leukemic cells from 100 children with relapsed B-cell progenitors (BCP) acute lymphoblastic leukemia (ALL), using quantitative real-time polymerase chain reaction (RT-PCR). IL-8, CXCR3, and CXCR4 were expressed in almost all bone marrow (BM) samples. The CXCR4 expression significantly correlated with known prognostic factors at relapse: time point and site of relapse. Patients who had a combined BM relapse (n=21) had lower IL-8 and CXCR4 expression than those who had an isolated BM relapse (n=79). The CXCR3 expression was higher in female patients (n=39) than in male patients (n=61). However, this did not reach prognostic relevance in relapsed ALL.