Rapid amelioration of anorexia nervosa in a male adolescent during metreleptin treatment including recovery from hypogonadotropic hypogonadism.

With this case report we support our medical hypothesis that metreleptin treatment ameliorates starvation related emotional, cognitive and behavioral symptomatology of anorexia nervosa (AN) and show for the first time strong effects in a male patient with AN. A 15.9 year old adolescent with severe AN of eight-month duration was treated off-label with metreleptin. Hyperactivity was assessed with accelerometry. Visual analogue scales (VAS), validated self- and clinician rating scales and lab results tracked changes from baseline to end of the 24-day dosing period and a five-month follow-up. Substantial improvements of mood and eating disorder related cognitions and hyperactivity set in after two days of treatment. During dosing, sub-physiological testosterone and TT3 levels normalized; clinically libido reemerged. Weight did not increase substantially during the dosing period. During follow-up target weight was attained; mood did not deteriorate; hyperactivity ceased. The results substantiate the strong effects seen in female cases and underscore the need for a double-blind placebo-controlled trial to confirm the observed strong, multiple and rapid onset beneficial effects of metreleptin in AN.

Short-term metreleptin treatment of patients with anorexia nervosa: rapid on-set of beneficial cognitive, emotional, and behavioral effects.

To examine the hypothesis that normalization of low circulating leptin levels in patients with anorexia nervosa ameliorates hyperactivity, three seriously ill females with hyperactivity were treated off-label with metreleptin (recombinant human leptin) for up to 14 days. Drive for activity, repetitive thoughts of food, inner restlessness, and weight phobia decreased in two patients. Surprisingly, depression improved rapidly in all patients. No serious adverse events occurred. Due to obvious limitations of uncontrolled case series, placebo-controlled clinical trials are mandatory to confirm the observed rapid onset of beneficial effects. Our findings suggest an important role of hypoleptinemia in the mental and behavioral phenotype of anorexia nervosa.

[Assessment of the maturity of juvenile and young adult offenders according to §105 of German juvenile law: a developmental psychology perspective]. / Die Reifebeurteilung Heranwachsender nach § 105 JGG und der Umgang mit jungen erwachsenen Straftäterinnen und Straftätern aus entwicklungspsychologischer Sicht.

Assessment of the maturity of juvenile and young adult offenders according to §105 of German juvenile law: a developmental psychology perspective Abstract. Since 1953, according to § 105 of the German JGG (Jugendgerichtsgesetz/Juvenile Court Act), it has been possible to convict offenders aged 18.0 y-20y 11 mo either as juveniles or as adults, depending on their developmental status. Yet unambiguous criteria defining the individual stages of development are available neither to judges nor to experts. Thus, for this age group this may lead judges to make arbitrary decisions impairing the right of equal treatment before the law in Germany. In the absence of clear criteria for assessing maturity, experts nearly always recommend judging such offenders as juveniles. Recent findings from the neurosciences and developmental psychology show that not only juveniles but adolescents and young adults up to the age of 25y usually have significant potential for development. After an overview of the legal practices pertaining to juveniles in Germany and throughout Europe, we propose alternatives for the individual assessment of maturity.

Successful methylphenidate treatment of early onset extreme obesity in a child with a melanocortin-4 receptor gene mutation and attention deficit/hyperactivity disorder.

We present the case report of a 2 year old boy with early onset extreme obesity (body mass index (BMI) 34.2 kg/m²; body mass index standard deviation score (BMI-SDS) 5.4) who is heterozygous for a non-conservative functionally relevant melanocortin MC(4)receptor mutation (Glu308Lys) and who also showed severe symptoms of attention deficit/hyperactivity disorder (ADHD). Treatment with the stimulant methylphenidate led to a sharp decrease of BMI to 21.8 kg/m² (BMI-SDS 2.8) within 24 months. We discuss potential mechanisms for this unusually large weight loss and suggest a potential link between the melanocortinergic and the dopaminergic systems, and the sympathetic nervous system. The potential benefit of methylphenidate in obese melanocortin MC(4)receptor mutation carriers with and without co-morbid ADHD warrants further studies.

[A good care of students in their residency (PJ students)--a win-win-situation]. / Betreuung Studierender im Praktischen Jahr--Eine Win-Win-Situation.

The provision of good mentors and education to medical students in their residency (PJ students) bears three essential advantages: 1) If the students feel themselves in good hands, they will co-operate effectively, thereby reducing the burden of the medical staff. 2) Contented students are potential advertisers for other interns, clinical trainees, medical students in residency and Ph.D. students. 3) Given the lack of doctors, providing students with good mentors and training is a valuable long-term strategy for the recruitment of doctors; in the event of later employment, former students in residency represent employees who are motivated, well trained, and familiar with hospital routine--a classical win-win situation.

Induced delusional disorder. a review of the concept and an unusual case of folie à famille.

Induced delusional disorder (or shared paranoid disorder), also known as folie à deux, is a fairly uncommon disturbance characterized by the presence of similar psychotic symptoms in two or more individuals. Most often the symptoms are delusional. Usually the 'primary' case, i.e. the individual who first develops psychotic symptoms, can be distinguished from one or more 'secondary' cases, in whom the symptoms are induced. We discuss the concept of shared paranoid disorder and consider various aetiological, clinical and diagnostic issues related to the disturbance. We also describe a case of folie à famille, this condition being a type of shared paranoid disorder. The case involves a couple and their 12-year-old son. The boy's father is the 'primary' case, whilst the boy and his mother are both 'secondary' cases. The boy was admitted to our child and adolescent psychiatric unit for in-patient treatment. Treatment success was moderate in terms of improving the features of folie à famille in the three individuals involved.