[Psychosomatic diseases of adolescents]. / Psychosomatische Krankheiten des Jugendlichen.

Psychosomatic reactions and disturbancies occur frequently in adolescence. Their dramatic presentation is characteristic for the inner feeling of uniqueness, instability and loneliness of this phase of life. Grownups seem far away and unable to understand what is really going on. The pediatrician being consulted needs special interest and knowledge of the specific dynamics of adolescence and should remember his own youth. He should avoid involving the patient into unnecessary and harmful physical examinations, because they tend to aggravate and fixate the symptom. He must succeed as competent listener without reminding the youngster of the wellment advises of parents and teachers. Often he will feel entangled into a voyage through a jungle of emotions and somatic signals where his function will be to guide and accompany his young patient safely out into the light of adulthood. This paper presents a pediatric and psychodynamic approach to some frequent psychosomatic disorders of adolescence. It discusses Anorexia Nervosa, Bulimia Nervosa, Somatisation Syndrome, Conversion Syndrome, suicidal attempt and physical conditions affected by psychological factors.

[Non-epileptic sleep disorders (somnambulism) in epilepsy. Diagnostic and therapeutic possibilities]. / Nichtepileptische Schlafstörungen (Somnambulismus) bei Epilepsie. Diagnostische und therapeutische Möglichkeiten.

The case history of a 15 1/2-year-old boy is presented who suffers from screaming fits during the night and epilepsia. The problem has existed since he was eight. He lives alone with his mother in a "partner-like" relationship. The previous diagnosis, namely epilepsy, has masked any possible psychodynamic element. Our diagnostic instruments were: 1. Standardized diagnostics with DSM III-R; 2. psychoanalytically oriented psychodiagnostics; 3. long term EEG-video-monitoring, which eventually succeeded in differentiating his multiple symptoms. Using these methods we were able to differentiate a sleep disorder (somnambulism) from his grandmal epilepsy. We changed his anticonvulsive pharmacological therapy and introduced an individual psychotherapy ("Katathymes Bilderleben"). This kind of psychotherapy is applied for the first time as a therapy for somnambulism. By using this therapeutic concept we cured our patient from his symptoms.

Changes in psychopathology of parents of NOFT (non-organic failure to thrive) infants during treatment.

This clinical case-study of 50 infants suffering from NOFT (non-organic failure to thrive) and their parents supports the idea that the feeding problem is intimately related to parental disorders. We find a high rate (70%) of parental psychopathology (axis I diagnosis applying DSM-III-R) at the time of referral and a significant reduction (to 37%) during treatment of the infants and their parents. After a year only 12% of the parents were diagnosed with psychiatric disorders. In contrast personality disorders (axis II diagnosis applying DSM-III-R) show more stability and can be regarded as a trait variable, whereas the psychiatric disorders are of a more reactive nature. These conclusions may be influenced somewhat by the strictly hospital based design of our pilot study (infants and parents contacted only after clinical referral) and by inclusion only of firstborn infants. Nevertheless, they point to the psychopathology of parents as a main cause for non-organic failure to thrive. Psychopathological traits such as severe attachment behavior problems and primary bonding difficulties may have been latent and only became manifest due to the task of nurturing an infant for the first time.

[Rolandic spikes as an electroencephalography manifestation of oligodendroglioma]. / Rolandic Spikes als elektroenzephalographische Manifestation eines Oligodendroglioms.

A 10 5/12 year old boy was presented with seizures of uncertain origin on to the psychosomatic ward of our University Children's Hospital. The question and problem was the distinction of psychogenic versus epileptogenic origin (repeatedly performed EEG's had shown normal findings, the seizures did not response to anticonvulsive therapy). The exploration of a psychodynamic causes of the presenting problem was excluded by family therapeutic and psychoanalytical case history and psychodynamic interview. The first pathological finding was seen with registration of a long term EEG with typical findings of temporal central spikes and waves as seen in the benign rolandic-epilepsia. The following diagnostic considerations were discussed and differentiated. a) benign rolandi epilepsia b) malign rolandi epilepsia c) psychomotoric seizures d) rolandic spikes as symptomatic finding of a brain tumor. The definite diagnosis was finally confirmed by a cerebral computer-tomography which showed a large expensive process in the interferior right regio temporalis, which was identified histologically after operation as a oligodendrogliom grad-I. The tumor was removed successfully as a whole without any neurological defects.

Comparing the German versions of the Strengths and Difficulties Questionnaire (SDQ-Deu) and the Child Behavior Checklist.

The Strengths and Difficulties Questionnaire (SDQ) is a brief behavioural screening questionnaire that can be completed in about 5 minutes by the parents and teachers of 4-16 year olds. The scores of the English version correlate well with those of the considerably longer Child Behavior Checklist (CBCL). The present study compares the German versions of the questionnaires. Both SDQ and CBCL were completed by the parents of 273 children drawn from psychiatric clinics (N = 163) and from a community sample (N = 110). The children from the community sample also filled in the SDQ self-report and the Youth Self Report (YSR). The children from the clinic sample received an ICD-10 diagnosis if applicable. Scores from the parent and self-rated SDQ and CBCL/YSR were highly correlated and equally able to distinguish between the community and clinic samples, with the SDQ showing significantly better results regarding the total scores. They were also equally able to distinguish between disorders within the clinic sample, the only significant difference being that the SDQ was better able to differentiate between children with and without hyperactivity-inattention. The study shows that like the English originals, the SDQ-Deu and the German CBCL are equally valid for most clinical and research purposes.