Emotional abuse interacts with borderline personality in adolescent inpatients with binge-purging eating disorders.

PURPOSE: Childhood abuse is associated with an increased risk of developing eating disorders (EDs) as well as personality disorders (PDs). However, their interaction is still uncertain, particularly in adolescents. This study investigates the correlations between childhood emotional neglect (CEN), childhood emotional abuse (CEA), and obsessive-compulsive and borderline personality styles in female adolescent inpatients with eating disorders (EDs). METHODS: One hundred and twenty-eight inpatients (ages 14-18) were assessed, 54 were diagnosed with restricting-type anorexia nervosa (AN-R) and 33 with a binge-purging ED [BP-ED; comprising patients with binge-purging type anorexia nervosa (AN-BP), n = 15, and bulimia nervosa (BN), n = 18]. Fifty healthy participants made up the control group (CG). CEN and CEA were assessed with the Childhood Trauma Questionnaire, while the Personality Style and Disorder Inventory was implemented to determine personality styles. RESULTS: A MANOVA revealed a significant main effect of CEA on spontaneous-borderline personality style [F(8,119) = 17.1, p < 0.001, η2 = 0.126], as well as a main effect of ED group on spontaneous-borderline [F(2,119) = 3.1, p = 0.048, η2 = 0.050]. A significant interaction between ED group, CEA, and spontaneous-borderline was found [F(2,119) = 3.5, p = 0.034, η2 = 0.055] with BP-ED showing significantly higher scores in CEA (9.3 ± 4.0) and in spontaneous-borderline (14.2 ± 6.2). CONCLUSIONS: Considering CEA and borderline personality style in adolescent inpatients with BN or AN-BP may help improve the understanding of the etiology and maintenance of BP-ED and provide more effective treatment targets. LEVEL OF EVIDENCE: Level III, case-control analytic study.

[Cognitive flexibility in adolescent patients with unipolar affective disorders-gender differences]. / [Kognitive Flexibilität bei jugendlichen Patienten mit unipolaren Affektiven Störungen unter Berücksichtigung geschlechtsbezogener Unterschiede].

OBJECTIVE: Several studies have revealed impairments in cognitive functions among patients with affective disorders (AD). However, to date there are few neuropsychological studies on cognitive flexibility among adolescent patients with AD, especially on gender differences in AD. Here, we investigate cognitive functions, especially cognitive flexibility, in adolescent patients with unipolar AD (UAD) compared to a healthy control group (CG). METHOD: The study population consists of 17 male patients (Mage = 15.4 ± 1.3) and 22 female patients with UAD (Mage = 15.6 ± 1.4) as well as 20 male (Mage = 16.0 ± 1.0) and 30 female (Mage = 15.7 ± 0.9) healthy adolescents. A neuropsychological test battery was conducted, and depressive symptoms, psychological stress, and intelligence were also assessed. RESULTS: The analyses revealed no significant group differences regarding cognitive flexibility or visual processing speed, albeit slight better performance in motor processing speed for the CG. Furthermore, no gender differences were observed regarding cognitive flexibility, though female subjects general displayed better performance in processing speed. CONCLUSIONS: Overall, there are no indications for serious deficits and specific gender differences in cognitive flexibility or processing speed in adolescent patients with UAD. Independent of psychological distress, female subjects seem to have some advantages in processing speed.

Relationships between platelet MAO-B activity and personality styles in acute and weight-recovered young patients with anorexia nervosa.

OBJECTIVE: Previous studies have shown relationships between personality styles and markers of serotonergic functioning, but data on patients with anorexia nervosa (AN) are scarce. METHODS: The personality styles and disorder inventory was administered to 47 acute patients with anorexia nervosa (acAN), 27 weight-recovered patients (recAN) and 72 healthy controls (HC) aged between 14 and 21 years. Platelet monoamine oxidase (MAO-B) activity was assayed with [14C]-ß-phenylethylamine as substrate. RESULTS: AcAN had significant elevated scores on 9 of the 14 personality style subscales when compared to HC, whereas recAN were largely normal. Platelet MAO-B activity and "ambitious/narcissistic" scores correlated negatively in acAN. In recAN we found positive correlations between MAO-B and personality subscores. CONCLUSIONS: The inverse relationship between a cluster B personality style and MAO-B activity in acAN is in accordance with studies in other patient populations. In contrast, positive associations between problematic personality styles and MAO-B activity in recAN combined with the overall decreased MAO-B activity in this group adds to the existing evidence suggesting a general dysfunction of the serotonergic system as a trait marker for AN.

Agouti-related protein in patients with acute and weight-restored anorexia nervosa.

BACKGROUND: An imbalance in appetite-regulating neuropeptides of the central nervous system has been associated with anorexia nervosa (AN), but the mechanisms of action are poorly understood. Agouti-related protein (AGRP), an orexigenic mediator of the hypothalamus, increases food intake and decreases energy expenditure in times of negative energy balance. The aim of the present study was to investigate AGRP in acute and fully weight-restored patients with AN, as well as during weight gain. METHOD: Plasma AGRP and leptin levels were assessed using an enzyme-linked immunosorbent assay kit in a total of 175 female participants, including 75 patients with acute AN, 37 weight-restored AN patients and 63 healthy controls. Of the patients with acute AN, 33 were reassessed after partial weight gain. RESULTS: In weight-restored AN patients plasma AGRP levels were similar to those in healthy controls, whereas in patients with acute AN, AGRP was elevated. AGRP was inversely correlated with indicators of undernutrition such as body mass index and plasma leptin. In addition, AGRP levels normalized during weight gain of longitudinally assessed AN patients. CONCLUSIONS: Our results underline the significance of undernutrition and hypoleptinemia for the interpretation of peripheral AGRP concentrations. This provides support for the hypothesis that abnormal AGRP plasma levels in AN patients reflect undernutrition, rather than disease-specific traits.

The assessment of body image distortion in female adolescents with anorexia nervosa: the development of a Test for Body Image Distortion in Children and Adolescents (BID-CA).

The purpose of this study was to develop an instrument (Test for Body Image Distortion in Children and Adolescents, BID-CA) suitable for adolescents to detect and quantify body image distortion. Participants were patients with anorexia nervosa (AN; N=75), healthy age-matched control participants (N=268) and age-matched thin female athletes (N=50) with a mean age of 15.2 (standard deviation =2.0) years. We assessed body image distortion (arm, waist, and thigh) using the BID-CA and two scales of the Eating Disorder Inventory-2 (EDI-2; Drive for Thinness, Body Dissatisfaction). Diagnostic validity of the BIDCA was analyzed with receiver operating characteristic (ROC) curves. Additional regression analyses revealed the variables BID-CA thigh and EDI-2 Drive for Thinness to be the best at predicting body image distortion among AN patients. In conclusion, the BID-CA showed good diagnostic validity. It is efficient, language independent, time-saving and seems appropriate for children and adolescents.

[Personality disorders in childhood and adolescence]. / Persönlichkeitsentwicklung im Kindes- und Jugendalter.

The diagnosis of a personality disorder is defined by the fact that personality traits are formed by early childhood, but German clinicians very rarely diagnose children and adolescents with personality disorders. Opponents of diagnosing personality disorders in childhood want to avoid labeling and refer to the developmental aspect of the personality. Supporters argue that children and adolescents already possess a describable personality and the developmental process continues into adulthood. By recognizing the pathological personality tendencies early enough allows an early therapy which can prevent an acute progression. The aim of the present study was to ascertain whether the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II) is applicable for use with adolescents. This empirical study indicated that one-third of the adolescents investigated were still diagnosed with a personality disorder 1 year after the primary assessment. However, the present categorizing diagnosis system proved to be insensible for childhood and adolescence. This supports the notion that dimensional systems are needed to diagnose personality traits in childhood in adolescence.

Prospective evaluation of comorbidity and psychosocial need in children and adolescents with anorectal malformations. Part 2: evaluation of psychosocial need.

PURPOSE: Only a few patients with anorectal malformations (ARM) have satisfactory bowel functions. Studies of ARM have reported psychosocial problems in up to 73% of patients. The aim of the current study was to document the psychosocial needs of patients with ARM. METHODS: Between June 2004 and September 2005, 44 patients with ARM were treated; the sample included 30 patients (23 males and 7 females) aged 4-17. To focus on potential psychosocial strain, a comprehensive grading system with a sophisticated perspective of continence, associated malformations, number of surgical interventions and postoperative complications was introduced. For psychosocial screening, the following instruments were used: German "Basis-Dokumentation" (BADO), Impact on Family Scale (IFS), the Strengths and Difficulties Questionnaire (SDQ). All families assessed their own psychosocial needs. An extensive psychosocial programme was provided. RESULTS: Twenty-three patients were suffering severe burden according to the comprehensive grading system. Nearly half of the families reported increased financial stress, and one-third reported emotional or hyperactivity problems of the child. More than 70% confirmed psychosocial need. CONCLUSIONS: Paediatric surgeons should promote psychosocial support for all patients who suffer severe forms of ARM or its numerous associated malformations as well as for patients undergoing numerous surgical interventions or having many postoperative complications.

Psychopathology in underweight and weight-recovered females with anorexia nervosa.

OBJECTIVE: To compare general and eating disorder-specific psychopathology in patients with acute anorexia nervosa (acAN), weight-recovered patients (recAN) and healthy control women (HCW). METHODS: One hundred anorexia nervosa patients (66 acAN and 34 recAN) and 88 HCW were included in our study. Psychopathology was assessed by self-report questionnaires [Symptom Check List 90 Revised (SCL-90-R), Eating Disorder Inventory-2 (EDI- 2)] as well as by interview [Structured Interview of Anorexia Nervosa and Bulimic Syndromes (SIAB-EX)] and compared using multivariate analysis of variance. Plasma leptin levels were determined using enzyme linked immunosorbent assay. RESULTS: Mean comparisons indicated highly significant differences between acAN and recAN subjects on all psychopatholgy variables, except for perfectionism. RecAN subjects did not differ from HCW. Partial weight recovery was associated with decreasing levels of psychopathology. Correlational analyses suggested strong negative associations between leptin levels and psychopathology. CONCLUSION: Prolonged malnutrition, as indicated by suppressed plasma leptin levels, is strongly related to eating disorder-specific as well as general psychopathological symptoms. Weight recovery is associated with the absence of psychopathology. These data emphasize the interaction between somatic and psychological variables.

Platelet monoamine oxidase activity in underweight and weight-recovered females with anorexia nervosa.

INTRODUCTION: Central serotonergic pathways may play an important role in the etiology of anorexia nervosa (AN). Although platelet monoamine oxidase activity (MAO-B) has been proposed as an index of cerebral serotonin activity, studies in patients with AN are scarce. METHODS: Platelet MAO-B activity was determined in 59 acutely underweight AN patients (acAN, aged 14-29 years, BMI=15.2+/-1.4), 35 weight-recovered AN patients (recAN, aged 15-29, BMI=20.8+/-2.2) and 59 healthy control women (HCW, aged 14-26, BMI=21.6+/-2.1). Plasma leptin served as an indicator of malnutrition. Results were compared by ANCOVA controlling for confounding variables. RESULTS: Platelet MAO-B activity in acAN patients (5.2+/-1.4 nmol/10 (9)pltx15 min) was similar to HCW (5.5+/-1.9) but significantly lower in recAN patients (4.4+/-1.5). BMI and leptin showed a significant negative correlation with MAO-B activity in AN patients, but not in HCW. DISCUSSION: Our results highlight the importance of malnutrition for the interpretation of abnormalities in neurotransmitter systems in AN. Whether low MAO-B activity in weight-recovered AN patients indicates a premorbid trait or a secondary change due to recovery remains to be elucidated.

[Diagnostic of personality disorders in adolescence according to SCID-II]. / Diagnostik von Persönlichkeitsstörungen im Jugendalter nach SKID-II.

OBJECTIVES: The aim of the present study was to ascertain whether the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II) is applicable for use with adolescents. Furthermore, the diagnostic concordance between SCID-II and the clinicians' estimations of personality disorders (PD) is assessed. In addition, we identified predicting factors for personality disorders in adolescent psychiatric inpatients. METHODS: 110 adolescent psychiatric inpatients aged 14-18 years were assessed by means of SCID-II and a personality and disorder inventory (PSSI). RESULTS: 32.7% of the inpatients met the criteria for PD according to SCID-II. While agreement between the presence of any PD based on SCID-II and that found according to clinicians' estimations was low, moderate and very good agreement between SCID-II and clinicians' estimations was found with regard to borderline PD and histrionic PD. Logistic regression analyses identified "anorexia nervosa (binge-purging)", "attention-deficit/hyperactivity disorder/conduct disorder (ADHD/CD)" and "socioeconomic status" as good predictors for PD. CONCLUSIONS: The SCID-II - which was primarily developed for use with adults - is suitable for use among adolescents. Anorexia nervosa (binge-purging type) and ADHD/CD are closely associated with the development of PD in adolescents.

[Depressive disorders in children and adolescents]. / Depressive Störungen im Kindes- und Jugendalter.

Depressive disorders in children and adolescents are widespread, cause a strong impairment in everyday life and are of great risk for further development. This paper gives an overview on the symptomatology, epidemiology, comorbid disorders and the further course of the disorder. Etiologic factors are presented and empiric studies concerning the treatment of depressive disorders in children and adolescents are summarized. Based on the empirical evidence and clinical experience suggestions for the treatment are provided.

No increase in long-term risk for nicotine use disorders after treatment with methylphenidate in children with attention-deficit/hyperactivity disorder (ADHD): evidence from a non-randomised retrospective study.

OBJECTIVE: To evaluate long-term effects of methylphenidate (MPH) treatment in ADHD children on the development of nicotine use disorders (SUD-N). METHODS: Multisite retrospective non-randomised longitudinal study with 215 ADHD children (diagnosis at 9.2 years of age; reassessment for SUD-N at 21.9 years of age) strictly parallel allocated to MPH treated (n = 106) and drug naive (n = 109) children. RESULTS: There was no difference between the groups with respect to frequency (84% MPH; 89% non-MPH; chi(2) = 1.6; p = 0.21) and age of onset for first cigarette smoking (log rank 1.68; p = 0.19). Continuous smoking was reached by 51% (MPH) and 61% (non-MPH) of the patients. Survival analyses revealed a small and nominally significant delay in age of onset for continuous smoking in the MPH-group (log rank = 3.85; p = 0.049). Nicotine dependency was reached by 20% (MPH) and 27% (non-MPH). Age of onset does not differ between groups (log rank = 2.24; p = 0.13). DISCUSSION: Limited evidence due to the non-randomised nature of the study is given that MPH does not induce SUD-N. The data suggests there may be a beneficial effect of MPH on delay of onset for continuous nicotine consumption in ADHD patients.

[School truancy. A heterogeneous disturbing picture]. / Schulverweigerung. Ein heterogenes Störungsbild.

School truancy is not a diagnostic entity. It is rather a conglomeration of symptoms with various causal factors. With a prevalence of about 5% of all children attending school, three typical groups of anxious school truants can be differentiated: children with separation anxiety, with simple and social phobia as well as anxious and/or depressive symptoms. Anxious truants show depressive symptoms and separation anxiety significantly above chance, while school truancy is closely associated with social disorders, depression and oppositional behaviour and mostly occurs in boys. Psychosocial risk factors such as contact problems with peers, familial and school problems often play an important part. The increased comorbidity as well as various associated stress factors demand multiple behaviour and psychological diagnostics. Sophisticated therapeutic measures should regard this and focus on cognitive behaviour therapy as well as educative and supportive interventions.

Methylphenidate and substance abuse: a review of pharmacology, animal, and clinical studies.

This article reviews pharmacological, animal, and human evidence regarding the abuse liability of methylphenidate (MPH). Findings are not always consistent, but evidence converges to suggest that although intravenous methylphenidate has some abuse potential, there is very little potential for oral MPH abuse. Furthermore, the available data suggests that children with Attention-Deficit/Hyperactivity Disorder (ADHD) who are treated with MPH are at lower risk for substance use disorder later in life. More longitudinal, prospective studies are needed to assess the long term effects of MPH treatment in ADHD.

[Biological child and adolescent psychiatry and social psychiatry: controversies and comments]. / Biologische Kinder- und Jugendpsychiatrie und Sozialpsychiatrie: Kontroversen und Ergänzungen.

There is an ongoing debate in the child and adolescent psychiatry on the question of 'nature or nurture', as it was pointed out many years ago by Michael Rutter (1986). Newer studies anchored in both areas support hypotheses of mutual interferences and give biological explanations for social behavior. To date, it is no question anymore, whether biological child and adolescent psychiatry and social psychiatry are contradictory or in line. They are in a steady process, look at the same development, the same symptom from different points of view. They describe it with concepts, which are not understood from the other position, because of different contexts and possible because of ideologic influences. The goal must be to find a common language--especially with respect to the patient.

[Socio-familial and epilepsy specific stress on women with epilepsy]. / Soziofamiliäre und epilepsiespezifische Belastungen von Frauen mit Epilepsie.

The Berlin longitudinal study on teratogenic effects of maternal epilepsy was conducted on children in 1976. Approximately 18 years later, 103 of these children's mothers were reassessed with regard to somatic, psychological, and social well-being or impairment. The families with previously diagnosed epileptic mothers (n = 59) and control families (n = 44) did not statistically differ in rates of family separation, divorce, or unemployment of the partners. There were also no significant differences in the mothers' current psychological quality-of-life status (SF-36) or their beliefs on internal or external disease control (FKK). There were, however, group differences in more closely illness-related aspects. In spite of an appreciable remission rate of 28% over the past 17 years, significantly more mothers in the epilepsy group still reported physical infirmities (GBB), reduced body-related quality of life (SF-36), and more family stress events (FAI). Their self-esteem and competence-related beliefs (FSKN) were significantly lower. They also tended to have a lower level of education or professional training, and some had never been employed. When measuring quality of life, severity of seizure (NHS3) and early epilepsy onset are the major risk factors, regardless of whether one uses epilepsy-specific (QOLIE-10) or general quality-of-life questionnaires (SF-36).

Pericardial effusions in anorexia nervosa.

Anorexia nervosa is an eating disorder that may be accompanied by cardiac symptoms of varying severity. So far disturbances like arrhythmias, mitral valve prolapse and loss of cardial ventricle mass have been described. Other somatic complications consist of electrolyte and acid-base imbalances, which in turn influence cardiac function. Between 1990 and 1999 we observed ten case reports from inpatient anorexic female adolescents, who developed pericardial effusions in the course of their illness. The diagnosis and course was revealed by echocardiography. No signs of heart failure could be noticed. In eight patients pericardial effusion remitted completely or partly by a concurrent increase in weight. A distinct pathophysiology for the development of pericardial effusion could not be revealed, but a correlation to restoration of weight seems to exist. Our report suggests that pericardial effusions are more frequent cardiac complications in anorexia nervosa than previously known. In most cases the clinical significance is doubtful.

[Day treatment in German child and adolescent psychiatry: analysis of data from a nationwide survey with respect to cost effectiveness]. / Tagesklinische Versorgung kinder- und jugendpsychiatrischer Patienten in Deutschland: Eine bundesweite Erhebung unter Berücksichtigung von Kosten-Nutzen-Aspekten.

Day treatment plays an increasingly important role in German child and adolescent psychiatry. In spite of a steady and ongoing increase of day treatment facilities over the past 15 years only few empicial data on the structure of German day treatment are available. The study refers to an Germany wide assessment of all day treatment centers (DTC). 45 out of 61 DTC responded (reply rate 74%). Analyses were done over 560 treatment places used by 69% male and 31% female patients mean ages 10 years and 2 months. Mean treatment duration is 104 days without differences with respect to the primary psychotherapeutic orientation (behavioral, psychodynamic, family therapy, other). Personnel is in 80.5% of the DTC below the governmental guidelines. Rates per day vary between 280 DM and 617 DM with a mean of 389 DM. Mean treatment costs per patient are 36.303 DM (min.: 12.825 DM; max.: 89.793 DM). Rates per day and duration of treatment are negatively correlated: The higher the rate per day, the shorter the treatment (explained variance: 17%). This correlation can only be explained indirectly by more personnel as associated with higher daily rates. However, more influential is the amount of time the children are present in day treatment per week: The longer the children are present, the shorter the duration of the whole treatment. Diagnosis, gender, and age only influence duration and costs of the treatment marginally. Network-effects as operationalized by the availability of additional inpatient and outpatient facilities did not influence costs and duration of day treatment.