The Use of Biopsy and "No-Biopsy" Approach for Diagnosing Paediatric Coeliac Disease in the Central European Region.

OBJECTIVES: The current European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) guidelines introduced the option to diagnose coeliac disease (CD) in children and adolescents without upper endoscopy if the defined criteria are met. The aim of our study was to evaluate how frequently paediatric gastroenterologists in Central Europe used the "no-biopsy" approach and how often the duodenal biopsy could have been omitted. METHODS: Medical records of patients aged < 19 years diagnosed with CD in 2016 from five European countries were analysed, focusing on levels of transglutaminase antibodies (TGA) at the time of diagnosis and on whether the diagnosis was confirmed using duodenal biopsy or "no-biopsy" approach. Clinical presentation and delays until final diagnosis were analysed according to diagnostic approach. RESULTS: Data from 653 children (63.9% female, median age: 7 years, range: 7 months-18.5 years) from Croatia, Hungary, Germany, Italy, and Slovenia were analysed. One fifth (n = 134) of included children were asymptomatic at diagnosis. Of 519 symptomatic children, 107 (20.6%) were diagnosed by the "no-biopsy" approach. Out of the remaining 412 children who underwent duodenal biopsies, 214 (51.9%) had TGA ≥ 10 times upper level of normal (ULN) and would have been eligible for the "no-biopsy" approach. Signs and symptoms of malabsorption were more frequent in children diagnosed without duodenal biopsies. There were no differences in diagnostic delays with respect to the diagnostic approach. CONCLUSION: In this cohort, about 60% of symptomatic CD patients could have been diagnosed without duodenal biopsies. The aim of the "no-biopsy" approach was to make the diagnostic procedure less challenging without compromising its reliability. However, this option was applied only in 20%, in spite of fewer burdens to the family and reduced costs. The reasons for this discrepancy are unknown. Physicians should be made more aware about the reliability of CD diagnosis without biopsies when the ESPGHAN guidelines for CD diagnosis are followed.

Social anxiety disorder and emotion regulation problems in adolescents.

BACKGROUND: Social anxiety disorder (SAD) in adolescents may be associated with the use of maladaptive emotion regulation (ER) strategies. The present study examined the use of maladaptive and adaptive ER strategies in adolescents with SAD. METHODS: 30 adolescents with SAD (CLIN) and 36 healthy adolescents for the control group (CON) aged between 11 and 16 years were assessed with the standardized questionnaires PHOKI (Phobiefragebogen für Kinder und Jugendliche) for self-reported fears as well as FEEL-KJ (Fragebogen zur Erhebung der Emotionsregulation bei Kindern und Jugendlichen) for different emotion regulation strategies. RESULTS: Compared to controls, adolescents with SAD used adaptive ER strategies significantly less often, but made use of maladaptive ER strategies significantly more often. There was a significant positive correlation between maladaptive ER and social anxiety in adolescents. Examining group differences of single ER strategy use, the CLIN and CON differed significantly in the use of the adaptive ER strategy reappraisal with CLIN reporting less use of reappraisal than CON. Group differences regarding the maladaptive ER strategies withdrawal and rumination, as well as the adaptive ER strategy problem-solving were found present, with CLIN reporting more use of withdrawal and rumination and less use of problem-solving than CON. CONCLUSIONS: Promoting adaptive emotion regulation should be a central component of psychotherapy (cognitive behavioral therapy-CBT) for social anxiety in adolescents from the beginning of the therapy process. These findings provide rationale for special therapy programs concentrating on the establishment of different adaptive ER strategies (including reappraisal). As an increased use of maladaptive ER may be associated with SAD in adolescents, it may be paramount to focus on reduction of maladaptive ER (for example withdrawal and rumination) from the beginning of the psychotherapy process. Incorporating more ER components into psychotherapy (CBT) could increase the treatment efficacy. Further investigations of the patterns of emotion regulation in specific anxiety groups like SAD in adolescents is needed to continue to optimize the psychotherapy (CBT) concept.

Somatic complaints in children and adolescents with social anxiety disorder.

BACKGROUND: Associations of social anxiety disorder (SAD) with various somatic symptoms have been already reported in the literature several times. The present study investigated somatic complaints in children and adolescents with SAD compared to controls and evaluated the relationship between social anxiety and somatic symptom severity. METHODS: Thirty children and adolescents with SAD were compared with 36 healthy age-matched controls. Self-reported fears were assessed using the Phobiefragebogen für Kinder und Jugendliche (PHOKI); emotional and behavioral problems were assessed using the Child Behavior Checklist (CBCL/4-18); and the Gießener Beschwerdebogen für Kinder und Jugendliche (GBB-KJ) was used to assess 59 somatic symptoms. RESULTS: Parents and youth with SAD reported higher somatic symptom severity compared to controls. Youth with SAD more frequently reported stomach pain, circulatory complaints, and fatigue than controls. Specific group differences between SAD and control youth were found for the following single somatic symptoms: faintness, quickly exhausted, sensation of heat, stomachache, nausea, dizziness, and sudden heart complaints. Parents of girls with SAD reported higher somatic symptom severity than parents of boys with SAD. CONCLUSIONS: The results demonstrated a significant positive association between somatic symptoms and social anxiety in youth. The results of the present study can help to develop improved screening measurements, which increase the proportion of children and adolescents with SAD receiving proper treatment.

[Transitional and Adolescent Psychiatry in Austria: A Pilot Study on the Attitudes of Experts]. / Transitions- und Adoleszenzpsychiatrie in Österreich: Eine Pilotuntersuchung zur Sicht von Expert(innen).

Transitional and Adolescent Psychiatry in Austria: A Pilot Study on the Attitudes of Experts Abstract. OBJECTIVE: This pilot study establishes baseline data on the current situation of transitional processes in Austrian psychiatry. We sought to gather information on the specific problems and needs occurring during the transition of mentally ill adolescents from child and adolescent to adult psychiatry. METHOD: Professionals (psychiatrists, psychologists, psychotherapists) working in child and adolescent psychiatry and adult psychiatry (N = 86) were assessed by means of an online survey concerning their experience with the transition of young adults. RESULTS: Almost all of the subjects queried (98.8 %) considered the current system inappropriate, and the majority (70.9 %) thought that patients would not tolerate transition from youth to adult psychiatric institutions very well. Only 16.3 % reported having a structured transition protocol at their workplace. Further 83.7 % expressed the need to improve collaboration between adolescent and adult psychiatry. CONCLUSIONS: This sample of Austrian healthcare professionals describes large deficits regarding transitional issues in psychiatry. There is an urgent need to establish structured protocols for transition, especially since experiences occurring during this vulnerable period are crucial to the mental health of young people later in life.

[Significance of thiopurine s-methyltransferase gene test in a clinical case]. / Thiopurin s-metil-transzferáz gén vizsgálatának jelentosége egy eset kapcsán.

Thiopurine s-methyltransferase enzyme is responsible for the metabolism of immunosuppressant thiopurines, which are used in inflammatory bowel diseases, acute lymphoblastic leukemia and autoimmune diseases. Because of the relative narrow therapeutic index of thiopurines serious or life threatening side effects can occur. A total of 28 variant alleles of the gene coding for the thiopurine s-methyltransferase enzyme are responsible for altered catalytic activity of the enzyme. Patients with one non-functional (heterozygous) allele have intermediate, while those with two non-functional (homozygous) alleles have low enzyme activity. Using polymerase chain reaction/restriction fragment length polymorphism and direct DNA sequencing the authors determined the G238C, G460A and A719G polymorphisms of the thiopurine s-methyltransferase gene in a child with Crohn's disease who developed thiopurine-induced severe agranulocytosis. The presence of the G460A and A719G polymorphic alleles in homozygous forms were detected which corresponded to the *3A variant allele. This variant has been shown to be associated with lower enzyme activity and low amount of the enzyme resulting in thiopurine toxicity and agranulocytosis. These findings underline the need for genotyping of the thiopurine s-methyltransferase variants prior to thiopurine treatment.

The Bielefeld attachment questionnaires: overview and empirical results of an alternative approach to assess attachment.

The Bielefeld Client Expectations Questionnaire and the Bielefeld Partnership Expectations Questionnaire are two parallel German language self-report tools of adult attachment. The Bielefeld questionnaires are different from others in two important ways: (a) Attachment patterns are operationalized as configurations of scale scores, which allow qualitative distinctions in terms of functioning; and (b) five empirically identified attachment patterns are distinguished. A partially-secure pattern is described for the first time. Both instruments yield good psychometric properties, and the current results support their validity. The aim of the present article is to inform an international audience about an original approach for assessing attachment and to encourage its adaptation and standardization in other languages.

[How do mentally ill parents evaluate their children's quality of life? Associations with the parent's illness and family functioning]. / Wie beurteilen psychisch kranke Eltern die gesundheitsbezogene Lebensqualität ihrer Kinder? Zusammenhänge zur elterlichen Erkrankung und zur Funktionalität der Familie.

To assess health-related quality of life (hrQoL) of children with a mentally ill parent, and its associations with the parent's illness (diagnoses, severity of disease, current symptoms) and family functioning, 51 mentally ill parents rated their children's hrQoL using the KINDL-R, a multidimensional hrQoL questionnaire for children. Parents rated their current psychiatric symptoms on the SCL-14 (Symptom Checklist-14) and family functioning on the FB-A ("Familienbögen"). The parents' therapists (psychologists or psychiatrists) provided psychiatric diagnoses as well as global ratings of disease severity (CGI) and patient's family functioning. Compared to the general population, parents rated their children's hrQoL significantly lower concerning the dimensions "Psychological Well-Being" and "Family': HrQoL ratings were moderately correlated with the parent's current depressive symptoms and moderately to highly correlated with family functioning from the parent's perspective. Lower depression severity and higher family functioning were associated with higher hrQoL ratings. Parents with affective disorders rated their children's hrQoL significantly lower than did parents with a diagnosis of substance abuse. Results show the importance of family functioning for parents' view of children's hrQoL and the influence of psychiatric symptoms on ill parents' reports. These findings are in line with previous results concerning potential psychological and behavioural problems in children of mentally ill parents. Family interventions and multi-informant assessment should be used in this high-risk group.