Follow-up Assessment of Cognitive Remediation Therapy in Adolescent Anorexia Nervosa: A Pilot Study.

OBJECTIVE: Cognitive remediation therapy (CRT) is a specialized treatment approach targeting cognitive weaknesses in anorexia nervosa (AN). Regarding follow-up effects of CRT, there are only few studies available; for adolescents, there are no data. METHODS: Forty-eight adolescents with AN were assigned to receive either CRT and treatment as usual (TAU) or TAU alone. Assessments were performed at baseline (n = 48) and compared with assessments at a 6-month follow-up (n = 33). Outcome measures were set-shifting, central coherence, eating disorder and general psychopathology. RESULTS: The completion rate was higher in CRT compared with TAU. There were no significant differences in neuropsychological and clinical variables. Changes in body mass index percentile showed a trend towards significance for CRT. Dropout analyses revealed no significant predictors. CONCLUSIONS: Results provide a first insight into follow-up-assessments of CRT in adolescent AN. More randomized controlled studies are needed to clarify the long-term effects of CRT. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

[An international neuropsychological assessment tool for children, adolescents, and adults with anorexia nervosa ­ the German adaptation of the Ravello Profile]. / Eine internationale neuropsychologische Testbatterie für Kinder, Jugendliche und Erwachsene mit Anorexia nervosa - die deutsche Adaptation des Ravello Profils

OBJECTIVE: Adults with anorexia nervosa (AN) show weaknesses in several cognitive functions before and after weight restoration. There is a great demand for standardized examinations of executive functioning in the field of child and adolescent AN. Previous studies exhibited methodological inconsistencies regarding test selection and operationalization of cognitive functions, making the interpretation of their findings difficult. In order to overcome these inconsistencies, a neuropsychological assessment tool, the "Ravello Profile," was developed, though previously not available in German. This paper presents a German adaptation of the Ravello Profile and illustrates its applicability in children and adolescents via three case descriptions. METHODS: The Ravello Profile was adapted for the German-speaking area. The applicability of the Ravello Profile was evaluated in three children and adolescents with AN. RESULTS AND CONCLUSIONS: The cases presented confirm the feasible implementation of this adaptation of the Ravello Profile, both in children and adolescents. Hence, it enables a methodologically consistent examination of executive functioning in German-speaking children, adolescents, and adults with AN. Using the Ravello Profile, the role of cognitive functions in the development of AN can be systematically examined over a broad age range.

[Support for families with a parent diagnosed with cancer and children under the age of five--delineation of a counselling concept]. / Unterstützung von Familien mit einem an Krebs erkrankten Elternteil und Kindern unter fünf Jahren--Darstellung eines Beratungskonzeptes.

Parents of infants and young children, who have been diagnosed with cancer wish to protect their child from the emotional strains of their illness. They wonder, what the child can understand about the illness and how it is able to process or assimilate the experience of the illness. In fact, infants and young children are particularly sensitive to the degree of emotional burden and the mental state of their parents and will experience varying degrees of insecurity due to even small changes in their relationship with their parents. On the basis of psychological development parameters specific to this age group as well as scientific findings on risk and protection factors an integrated interaction based counseling approach was developed. Within this approach, support for the communication between parent and child in view of the specific strains of their illness, both non-verbal and in the child's early stages of verbal communication, is central. In the present article the counselling concept is described and illustrated by case studies. Application and limits are discussed.

[Male partners of cancer patients with underage children - psychological distress in comparison to the general population and the diseased partner]. / Partner von Krebspatientinnen mit minderjährigen Kindern - Psychische Belastung im Vergleich zur Allgemeinbevölkerung und zur krebskranken Partnerin.

The psychological distress of men with underage children, whose female partners have cancer, was examined using the Hospital Anxiety and Depression Scale (HADS). The sample (N=141) was compared with the partners who have cancer and a comparison group of men from the general population (N=154). The male partners of cancer patients were psychological strongly distressed. About half of the partners showed increased scores in anxiety and one third of the partners had a high level of depression. There was a high correlation within the couple. The male partners of cancer patients were significantly more distressed than the comparison group of men with underage children from the general population. It is very important to assess psychosocial support needs of partners of cancer patients and to provide adequate options of possible psychosocial treatment.

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.

[Diagnosis related groups (DRG) in child and adolescent psychiatry: results of a prospective pilot study]. / Diagnosis Related Groups (DRG) in der Kinder- und Jugendpsychiatrie: Ergebnisse einer prospektiven Pilotstudie.

Germany faces one of the biggest 'revolutions' in the health care system. As decided by the government in cooperation with medical boards and insurances, beginning with January 1st, 2003 all inpatient treatments will be paid on the basis of adapted Australian-Refined Diagnosis Related Groups. To date, hospitals are requested to obtain prospective databases in order to cluster homogeneous diagnostic groups and calculate realistic treatment-costs. Both psychiatry and child and adolescent psychiatry are so far excluded from the introduction of DRGs. However, most experts predict extensive shifts of patients into psychiatry (i.e. with comorbid internal diseases) under the pressure of short treatments in all non-psychiatric disciplines. Therefore, changes in the payment of psychiatric treatments are inevitably. As part of the DRG pilot-study, we created a catalogue adapted to child and adolescent psychiatry, which was used for 102 consecutively treated inpatients of a child and adolescent hospital. A total of 17.019 prospectively assessed procedures were obtained. Under clinical aspects, 11 categories of 'typical' disorders were analysed. Worst predictability of treatment costs was found for obsessive-compulsive disorders, personality disorders, and eating disorders. Comorbidity and complexity of the disorder was not related to the length of hospital treatment. Implications on future payment systems in child and adolescent psychiatry are discussed.