Bright light treatment as mono-therapy of non-seasonal depression for 28 adolescents.

BACKGROUND: Bright light therapy, an effective therapeutic option for depressive adults, could provide safe, economic, and effective rapid recovery also in adolescents. METHODS: Twenty-eight volunteers, between 14 and 17 years old and suffering from mild depressive disorder according to DSM-IV criteria, completed the study. This was a randomized cross-over trial, i.e. that 14 patients received first placebo (50 lux) for 1 h a day for 1 week and then bright light therapy (2,500 Lux) for 1 week. Fourteen patients received first bright light therapy and then placebo. For assessment of depressive symptoms, Beck's depression inventory scales were administered 1 week before and 1 day before placebo treatment, on the day between placebo and verum treatment, on the day after verum treatment and 1 week after verum treatment. Saliva melatonin and cortisol samples were collected at 08:00 and 20:00 h, 1 week before and 1 day before placebo treatment, on the day between placebo and verum treatment, on the day after verum treatment and 1 week after verum treatment and assayed for melatonin and cortisol to observe any change in circadian timing. RESULTS: BDI scores improved significantly. The assays of saliva showed significant differences between treatment and placebo. No significant adverse reactions were observed. CONCLUSION: Antidepressant response to bright light treatment in this age group was statistically superior to placebo.

European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that persists into adulthood in the majority of cases. The evidence on persistence poses several difficulties for adult psychiatry considering the lack of expertise for diagnostic assessment, limited treatment options and patient facilities across Europe. METHODS: The European Network Adult ADHD, founded in 2003, aims to increase awareness of this disorder and improve knowledge and patient care for adults with ADHD across Europe. This Consensus Statement is one of the actions taken by the European Network Adult ADHD in order to support the clinician with research evidence and clinical experience from 18 European countries in which ADHD in adults is recognised and treated. RESULTS: Besides information on the genetics and neurobiology of ADHD, three major questions are addressed in this statement: (1) What is the clinical picture of ADHD in adults? (2) How can ADHD in adults be properly diagnosed? (3) How should ADHD in adults be effectively treated? CONCLUSIONS: ADHD often presents as an impairing lifelong condition in adults, yet it is currently underdiagnosed and treated in many European countries, leading to ineffective treatment and higher costs of illness. Expertise in diagnostic assessment and treatment of ADHD in adults must increase in psychiatry. Instruments for screening and diagnosis of ADHD in adults are available and appropriate treatments exist, although more research is needed in this age group.

Ginkgo biloba treating patients with attention-deficit disorder.

Various medications such as clonidine facilitate calming, enhance frustration tolerance and reduce aggression in attention-deficit disorder (ADD) patients. The use of Ginkgo biloba was studied as an herbal alternative. Six psychiatric outpatients diagnosed with ADD were rated at baseline and while taking Ginkgo biloba to determine its efficacy as a treatment for ADD. Comparisons of Wender Utah ratings within subject were used to measure behavioral changes in the subjects. During Ginkgo biloba treatment, the patients' mean scores improved significantly overall and in hyperactivity, inattention, and immaturity factors. This preliminary study indicates that Ginkgo biloba might be a beneficial and useful treatment of ADD, with minimal side effects.

St John's Wort treating patients with autistic disorder.

Problems of eye contact and expressive language limit the effectiveness of educational and behavioral interventions in patients suffering from pervasive developmental disorders. For that reason, additive psychopharmacological interventions are sometimes needed to improve symptomatology. In our preliminary open trial, three male patients with autistic disorder, diagnosed by ICD-10 criteria, completed an open trial of St John's Wort. Subjects were included in the study if their eye contact and expressive language was inadaequate for their developmental level and if they had not tolerated or responded to other psychopharmacologic treatments (methylphenidate, clonidine or desipramine). Parent and mentor ratings on the Aberrant Behavior Checklist, irritability, stereotypy, and inappropriate speech factors improved slightly during treatment with St John's Wort. Clinician ratings (Psychiatric Rating Scale Autism, Anger and Speech Deviance factors; Global Assessment Scale; Clinical Global Impressions efficacy) did not improve significantly. St John's Wort was only modestly effective in the short-term treatment of irritability in some patients with autistic disorder.

First preliminary results of an observation of Ginkgo Biloba treating patients with autistic disorder.

Deficits in reciprocal social interaction, verbal and nonverbal communication, and imaginative activity are the main characteristics of autism. From the psychopharmacological point of view, clonidine, metylphenidate and neuroleptics may improve some of these aspects, but with a remarkable risk of adverse side effects. In our observational study, three patients received 2 x 100 mg Ginkgo Biloba EGb 761 for 4 weeks and showed some improvement on the Aberrant Behavior and Symptom Checklist. These results suggest, that Ginkgo Biloba might be effective at least as an add-on therapy.

Tianeptine treating narcolepsy. Case report.

Modafinil and Methylphenidate are proven to be effective in treating Narcolepsy, but also antidepressants that enhance synaptic levels of noradrenaline and serotonin have been reported as having some therapeutic efficacy. The patient reported in this article received Tianeptine 37.5 mg for two consecutive months. One week after start of treatment improvement of both sleepiness and cataplexy could be noticed. He showed an improvement of the Epworth Sleepiness Scale Score from 22 up to 16.

Attachment as a component of attention-deficit hyperactivity disorder.

As Attention-Deficit Hyperactivity Disorder-like symptoms may reflect a somatic disorder or interactional problems of the child and parents or have a genetic basis, the ADHD-like symptoms seem as important as a genetic interpretation. This holds also for therapeutic interventions. In the clinic, 101 children with ADHD-like symptoms were assessed. Attachment classification was based on responses to the Parent-Child Reunion Inventory. Of 79 insecurely attached patients, 72 presented ADHD-like symptoms, whereas only 5 of 22 securely attached showed such symptoms.

Attributions for school success and failure by adolescent students with and without attention deficit hyperactivity disorder.

A study of possible differences in causal attributions between ADHD youth and non-ADHD controls is reported. 40 students (12 to 18 years of age), diagnosed with ADHD by a psychologist and a psychiatrist according to Conners' criteria were compared with healthy controls. Analyses confirmed that external attributions regarding luck were significantly higher for the ADHD group than for the 40 healthy controls. Implications of these findings for intervention in ADHD are discussed.

Effectiveness of the repetitive Transcranical Magnetic Stimulation (rTMS) of 1 Hz for Attention-Deficit Hyperactivity Disorder (ADHD).

ADHD it is a syndrome characterized by the progressive development of excessive hyperactivity, impulsiveness and attentional difficulties. The purpose of our study is to verify the therapeutic effectiveness of repetitive Transcranial Magnetic Stimulation (low frequency (1Hz, 1200 stim/die for five days)), applied on the impending scalp additional motor area, in a subject affected by ADHD. Results show a significant improvement that lasted for at least 4 weeks. Placebo control did not show any improvement.

Report on incidence of right-hand preference in 18 eating disordered patients.

Incidence of right-hand preference in a sample of eating disordered patients, 18 probands and 18 controls, was investigated. They completed questions regarding eight functional hand tasks. Preferred right-hand use, mainly externally directed and complex, was less represented among these eating disordered patients (14%) than in the 18 controls (58%).

Efficacy of risperidone treatment in Smith-Magenis syndrome (del 17 pll. 2).

Smith-Magenis syndrome (SMS) is a clinically recognizable multiple congenital anomaly and mental retardation syndrome caused by an interstitial deletion of chromosome 17 pll.2. Although the physical and molecular genetic features of SMS are increasingly well understood, work is more limited on SMS's behavioral phenotype, which includes self-injury, tantrums, aggression, attention deficit, and sleep disturbance. This case-report describes the lowering of the aggression level of a 13 year old individual with SMS.

A preliminary investigation of ADHD symptoms in persons with celiac disease.

OBJECTIVE: Several studies report a possible association of celiac disease (CD) with psychiatric and psychological disturbances, such as ADHD. METHOD: The authors assess 132 participants from 3 to 57 years of age (M = 19.3 years) affected by CD for the possibility of an associated ADHD-like symptomatology, using the Conner Scale Hypescheme, a behavioral scale similar to the Conners Rating Scales, before their gluten-free diet was started and 6 months later. RESULTS: The overall score improves significantly as well as most of the ADHD-like symptomatology specific features (Bonferroni-corrected, paired-sample t tests). CONCLUSION: The data indicate that ADHD-like symptomatology is markedly overrepresented among untreated CD patients and that a gluten-free diet may improve symptoms significantly within a short period of time. The results of this study also suggest that CD should be included in the list of diseases associated with ADHD-like symptomatology.

[The importance of family coherence for mentally handicapped children]. / Die bedeutung des innerfamiliären zusammenhaltes für behinderte.

A lack of perseverance, attention and poor modulated behaviour are important criterions of handicapped children (Dilling et al. 1993). Therefore, instructions have to be repeated quite often, sometimes even by different family members. For this reason, good family coherence might reduce symptoms significantly (Döpfner and Lehmkuhl 1995). The handicapped child might cause less disagreement in families with good coherence, which improves family;s features (Saile et al. 1995). Families of 15 handicapped children were included for evaluation and compared with a matched, healthy control group. Parents were asked to complete a form assessing the family;s features ("Familienklima-Testsystem", Schneewind et al. 1985), "Erziehungspraktiken", (Schneewind et al. 1985). Group comparison was made by the Mann-Whitney-U-Test. Our results strongly suggest, that good coherence seems to have positive effects on family;s features, especially by handicapped children. So we think, that on the one hand good coherence might reduce symptomatology and that on the other hand family's features have protective effects on handicapped children.

Hand preference in attention deficit hyperactivity disorder.

In our Outpatient Department, we studied 56 subjects (41 males, 15 females; aged 5-16 yr.) with Attention Deficit Hyperactivity Disorder (ADHD) with respect to hand use in functional tasks via parental report. Left-hand use was markedly preferred, compared to that of a control group, more for complex than simple and for external (touching food and objects) than internal (scratching, rubbing eyes) tasks, suggesting a deficit in cerebral control of right-hand use. More patients were reported to have a left-hand preference than in the non-ADHD population. Furthermore, extent of laterality was greater for complex than simple external tasks and for external than for internal.

[Educational practices in families with children suffering from borderline disorders and healthy volunteers in comparison]. / Die erziehungspraktiken in familien mit borderlinekindern und gesunden im vergleich.

Standardized assessment of education is not used routinely although these factors may play an important role in the course of psychological disorders in children. Thus the aim of the present study was to investigate families of Borderline children with regard to differences with regard to education in their families. Families of 115 Borderline children (aged 6-12y), diagnosed by means of the Mannheim's Parents Interview (Esser et al. 1989) were included for evaluation and compared with a matched control group. Parents were asked to complete a form assessing education ("Erziehungspraktiken", Schneewind et al. 1985). Group comparison was made by the Mann-Whitney-U-test. The results show that there are less emotional attention, less material reinforcers and more physical punishment in families whose children belong to the Borderline children" group. It could be shown, that there seems to be a significant influence of Borderline symptomatology on education which should make therapists focus their efforts not only on the "index" children as such but also on their families.

Bupropion may support psychosocial treatment of nicotine-dependent adolescents: preliminary results.

STUDY OBJECTIVE: To assess the efficacy and safety of long-term bupropion therapy for nicotine dependence in adolescents. DESIGN: Prospective, double-blind, placebo-controlled trial. SETTING: Outpatient clinic in Innsbruck, Austria. SUBJECTS: Twenty-two adolescents, aged 16-19 years, with nicotine dependence. INTERVENTION: Participants were randomly assigned to receive bupropion 150 mg/day or placebo for 90 days. MEASUREMENTS AND MAIN RESULTS: Patients were classified as abstinent or relapsed on day 0 (when study drug was started) and again on days 30 and 90, according to their self-reports. Treatment failure was defined as relapse or nonattendance. Time to first treatment failure was the primary outcome measure. Mean cumulative abstinence duration was significantly greater in the bupropion group than in the placebo group (78.4 +/- 39.6 vs 30.2 +/- 19.2 days. p=0.0042). CONCLUSION: Bupropion seems to be an effective and well-tolerated pharmacologic adjunct to psychosocial and behavioral treatment programs for some adolescent nicotine-dependent patients. However, experienced clinicians should continuously monitor patients for adverse effects.

A placebo-controlled study of lofexidine in the treatment of children with tic disorders and attention deficit hyperactivity disorder.

This study evaluated the efficacy and safety of Lofexidine in treating children with tic disorders and attention deficit hyperactivity disorder (ADHD). Subjects from a specialty tic disorders clinic were randomly assigned to receive 8 weeks of treatment with lofexidine or placebo under double-blind conditions. Follow-up visits occurred every 2 weeks for safety monitoring and dose adjustment. Fourty-four medication-free subjects (41 boys and three girls; mean age of 10.4 years) with ADHD, combined type, and a tic disorder participated. After 8 weeks of treatment, lofexidine was associated with a mean improvement of 41% in the total score on the teacher-rated ADHD Rating Scale compared to 7% improvement for placebo. Eleven of 22 subjects who received lofexidine were blindly rated on the Clinical Global Scale-Improvement as either much improved or very much improved compared to none of 22 subjects who received placebo. The mean score on the parent-rated hyperactivity index improved by 29% in the lofexidine group and 18% in the placebo group, which was not a significant difference. On the Continuous Performance Test, commission errors decreased by 25% and omission errors by 20% in the lofexidine group, compared with increases of 33% in commission errors and of 36% in omission errors in the placebo group. Tic severity decreased by 27% in the lofexidine group, compared to 0% in the placebo group. One lofexidine subject with sedation withdrew at week 4. Lofexidine was associated with insignificant decreases in blood pressure and pulse. Lofexidine appears to be a safe and effective treatment for children with tic disorders and ADHD.