[Psychiatry in the GDR as a "niche" - Between adaptation and autonomy]. / Psychiatrie in der DDR als "Nische" ­ Zwischen Anpassung und Freiraum.

BACKGROUND: With the help of statements from contemporary witnesses, it shall be deduced, if and to what extent Psychiatry was experienced as a shelter for employees and patients in the state controlled society of the GDR and which effort of adaptation to the authoritarian regime was needed to organize protected and protective spaces, here called "niches". METHOD: 74 guide-based interviews from subjects including former patients and different staff groups of the East german Psychiatry were analyzed qualitatively. RESULTS: Many quotations show, that Psychiatry in the GDR was experienced as a "niche" for dissenting people and could offer a certain amount of protection for patients. On the other hand, the autonomy of the psychiatric care was often violated by political intrusions regarding individual treatments. Moreover, treatment autonomy was restricted by harsh shortages in supplies. CONCLUSION: Psychiatrists in the GDR could protect their patients through their actings and so Psychiatry could establish a "niche" for patients and employees. However, establishing such protected spaces required efforts in adaptation. In reverse, Psychiatry has also been politically instrumentalised - either directly through unjustified admissions and exit restrictions or indirectly by a stigmatization of dissenters and removing them from society.

Social inequality, social networks, and health: a scoping review of research on health inequalities from a social network perspective.

BACKGROUND: This review summarises the present state of research on health inequalities using a social network perspective, and it explores the available studies examining the interrelations of social inequality, social networks, and health. METHODS: Using the strategy of a scoping review, as outlined by Arksey and O'Malley (Int J Sci Res Methodol 8:19-32, 2005), our team performed two searches across eight scientific, bibliographic databases including papers published until October 2021. Studies meeting pre-defined eligibility criteria were selected. The data were charted in a table, and then collated, summarised, and reported in this paper. RESULTS: Our search provided a total of 15,237 initial hits. After deduplication (n = 6,168 studies) and the removal of hits that did not meet our baseline criteria (n = 8,767 studies), the remaining 302 full text articles were examined. This resulted in 25 articles being included in the present review, many of which focused on moderating or mediating network effects. Such effects were found in the majority of these studies, but not in all. Social networks were found to buffer the harsher effects of poverty on health, while specific network characteristics were shown to intensify or attenuate the health effects of social inequalities. CONCLUSIONS: Our review showed that the variables used for measuring health and social networks differed considerably across the selected studies. Thus, our attempt to establish a consensus of opinion across the included studies was not successful. Nevertheless, the usefulness of social network analysis in researching health inequalities and the employment of health-promoting interventions focusing on social relations was generally acknowledged in the studies. We close by suggesting ways to advance the research methodology, and argue for a greater orientation on theoretical models. We also call for the increased use of structural measures; the inclusion of measures on negative ties and interactions; and the use of more complex study designs, such as mixed-methods and longitudinal studies.

Electroconvulsive therapy in children and adolescents in Europe-a systematic review of the literature complemented by expert information and guideline recommendations.

The first documented pediatric use of Electroconvulsive therapy (ECT) occurred in Europe in 1941. Since then, predominantly successful treatments and reasonable side effects have been reported in severely ill minors. Nevertheless, a shy reluctance determines the controversy about ECT in young patients. This study describes the use of ECT in children and adolescents in Europe. We systematically searched the literature concerning the practice of ECT in minors in all 53 European countries. In addition, we surveyed European experts about national practices and compared guidelines for ECT in minors. The search yielded 79 publications from 18 European countries, mainly from Western Europe, Israel, and Turkey. National data were available from eight countries. These showed an interestingly high relationship between the number of minors treated with ECT and the general use of ECT. No persistent deficits or deaths were reported. On the other hand, no randomized clinical trial was found, and many publications lacked relevant information. Accordingly, the appraisal of the evidence in the guidelines varies considerably. Experts from 13 European countries consistently reported infrequent and unsystematic use of ECT in minors. ECT has been used successfully in minors in Europe with reasonable complications and side effects. Adverse effects on the developing brain, as often suspected, have not been scientifically supported in eight decades. Nevertheless, the use of ECT in Europe is sparse and dependent on accidental circumstances. High-quality evidence is needed, as well as improved knowledge and training of child and adolescent psychiatrists.

Headache impact and socioeconomic status: findings from a study of the German Migraine and Headache Society (DMKG).

BACKGOUND: Headache disorders are not only among the most prevalent, they are also among the most disabling disorders worldwide. This paper investigates the association between headache impact on daily life and the socioeconomic status (SES) of headache sufferers. METHODS: Data stem from a random general population sample in Germany. Respondents who reported having headache for at least a year and were aged ≥ 18 years were included in the study. A standardized questionnaire addressing headache and headache treatment was filled in during the face-to-face survey. The impact of headache on daily life was measured using the German version of the Headache Impact Test (HIT-6). RESULTS: Higher headache impact was found in low and medium SES compared to high SES. After adjustment for sociodemographics, headache-related factors (analgesic use, headache duration, headache frequency, migraine diagnosis), depressive symptoms, physical inactivity and obesity, an increased odds ratio of having higher headache impact in low SES compared to high SES was found: OR = 1.83, 95% CI [1.43, 2.23], p = .014. When the interactions "SES*obesity", "SES*depressive symptoms", and "SES*physical inactivity" were added, the results showed a significant interaction effect of "SES*obesity". Obese persons with low SES were 3.64 times more likely to have higher headache impact than non-obese persons with low SES. No significant differences between obese and non-obese persons were found in the medium and high SES groups. CONCLUSIONS: SES is an important factor that should not be neglected in headache awareness campaigns and headache treatment. Longitudinal studies are needed in the future to investigate whether lifestyle interventions, such as weight reduction, can help to reduce headache impact in people in lower SES.

[COVID-19 and Psychiatric Disorders in Minors: Changes in Inpatient Treatment According to Hospital Statistics]. / COVID-19 und psychische Störungen bei Minderjährigen: Veränderungen der Behandlungen nach der Krankenhausstatistik.

COVID-19 and Psychiatric Disorders in Minors: Changes in Inpatient Treatment According to Hospital Statistics Abstract: Increased rates of psychiatric disorders and psychiatric emergencies in children and adolescents stemming from the COVID-19 pandemic have been reported, with more children and adolescents suffering from internalizing disorders. This study analyzes whether the increased rates led to increased rates of inpatient treatment in child and adolescent psychiatric and pediatric hospitals in Germany as well as a change in diagnoses of the treated patients. We analyzed routine hospital data ("InEK" data, § 21 KHG data files) from a prepandemic (2019) and a pandemic (2021) half-year regarding changes in the number of cases, diagnoses, and length of stay (LoS) in child and adolescent psychiatry and pediatrics. We also investigated the development of psychiatric emergencies in minors. We found an increase in internalizing problems (depression, anorexia nervosa, trauma-related disorders) and a decrease in externalizing problems among the admitted psychiatric inpatients. Further, we observed a halving of cases treated for alcohol intoxication. However, we discovered no change for the frequency of psychiatric emergency treatments nationwide. A more detailed analysis revealed that, in areas with a low number of child and adolescent psychiatry inpatient beds, emergency care was prioritized and LoS decreased, whereas in areas with a fair bed-to-inhabitant ratio among minors, there was a trend toward increased LoS, also in pediatric departments. We recommend continued monitoring of inpatient care after the pandemic, with special attention paid to underprivileged children and adolescents such as those with externalizing problems.

[Parental Stress: Psychometric Evaluation of the German Version of the Parental Stress Scale in the General Population]. / Stress durch Elternschaft: Psychometrische Evaluation der deutschen Version der Parental Stress Scale in der Allgemeinbevölkerung.

Parental stress has negative impact on parents and their children. Parental stress may be of special interest for family and child well-being due to Covid-19 pandemic. A reliable and valid assessment of parental stress would be beneficial both in research and clinical practice. The Parental Stress Scale (PSS) is internationally well established as an economic and psychometric valid assessment. It consists of 18 items. The study evaluated the factor structure of the German version of the PSS in a general population (n=386 parents with children<16 years) for the first time. The sample was part of a representative sample (n=2519). The confirmatory factor analysis did not confirm internationally previously reported models. Eliminating one item, the explorative factor analysis suggested a two factor structure with the dimensions "lack of confident" and "worries and strain". Both subscales showed a good internal consistence (McDonalds ω≥0,87). We observed correlations of the PSS-17 items with family dysfunction and elevated scores for depressive or anxiety symptoms, but not with sociodemographic factors. One conclusion is that the multidimensional construct of parental stress maybe is not comprehensively represented by the PSS. For the use in clinical practice and research this has to be taken into account. Albeit, the German version of the PSS is an economic, reliable and valid assessment.

[Assessment of General Family Functioning: Psychometric Evaluation of the German Version of the Brief Assessment of Family Functioning Scale]. / Die Erfassung des allgemeinen familiären Funktionsniveaus: Psychometrische Evaluation der deutschen Version der Brief Assessment of Family Functioning Scale.

The functionality of the family system is not only a central theme in developmental psychology and family research, but also plays a key role in many physical illnesses and mental disorders. Despite its high relevance, there are only a very few brief and user-friendly self-report measures assessing general family functioning. This gap is closed by the Brief Assessment of Family Functioning Scale (BAFFS), which consists of three items of the General Functioning Scale of the internationally well-established Family Assessment Device. In this study, the German version (KSAFF) of the BAFFS was psychometrically evaluated for the first time in a large and representative general population sample (n=2463). Using multigroup confirmatory factor analyses, strong measurement invariance was shown for relevant subsamples (women vs. men; participants in partnerships with vs. without children) with good model fit. Although one of the three items, which is the only negatively formulated item, yielded insufficient psychometric item characteristics, the internal consistency was Cronbach's α=0.71. As an indication of adequate construct validity, associations of family functioning with socioeconomic status as well as with current depression and anxiety were found in accordance with the hypothesis. Although application experiences and psychometric analyses of the German version of the BAFFS in relevant clinical samples are pending, this three-item self-report measure can be recommended as an economic, user-friendly assessment device for general family functioning, particularly since it yielded satisfactory to good psychometric properties in the general population.

A short note on the reliability of perceptual timing tasks as commonly used in research on developmental disorders.

OBJECTIVES: Perceptual timing tasks are frequently applied in research on developmental disorders, but information on their reliability is lacking in pediatric studies. We therefore aimed to assess the reliability of the four paradigms most frequently used, i.e., time discrimination, time estimation, time production, and time reproduction. METHODS: Based on the data from our recent longitudinal study by Marx et al. (Front Hum Neurosci 11:122, 2017), we estimated the internal consistency and test-retest reliability of these tasks in children with ADHD and typically developing children. Individual thresholds were used as dependent measures for the time discrimination task, whereas absolute error and accuracy coefficient scores were used for the other three tasks. RESULTS: Although less commonly used, the time estimation paradigm was the most robust measure of perceptual timing in terms of internal consistency and test-retest reliability in both ADHD and typically developing children, whereas the most frequently used paradigms showed poor internal consistency (time reproduction) and poor test-retest reliability (time discrimination). Compared to the absolute errors, accuracy coefficients showed almost exclusively higher internal consistency and test-retest reliability. CONCLUSIONS: Our findings call for more frequent use of the time estimation paradigm in studies of perceptual timing in ADHD. The time reproduction paradigm should be re-considered, avoiding pooling of a wide range of time intervals (2-48 s). The accuracy coefficient score is the more reliable and the more intuitive dependent variable and should be preferred in future timing research. To increase the reliability of the timing measurement, each experimental session should be performed twice, if possible.

[Use of Electronic Cigarettes (e-cigs) and e-Shishas by Children and Adolescents: Evidence Paper of the Joint Addiction Commission of the German Societies and Professional Associations of Child and Adolescent Psychiatry and Psychotherapy]. / Nutzung elektronischer Zigaretten (E-Zigaretten) und E-Shishas durch Kinder und Jugendliche.

Use of Electronic Cigarettes (e-cigs) and e-Shishas by Children and Adolescents: Evidence Paper of the Joint Addiction Commission of the German Societies and Professional Associations of Child and Adolescent Psychiatry and Psychotherapy Abstract. The particular risks associated with the consumption of electronic cigarettes (e-cigs) in children and adolescents are not sufficiently considered in the health policy discourse. The present article evaluates the current dissemination and consumption patterns of e-cigarettes as well as the health risks attached to children and adolescents. Based on data from current national and international studies, there has been a clear increase in the consumption of e-cigarettes over the past years. This stands in sharp contrast to the overall decline in tobacco consumption among both children and adolescents in Germany. Young people without tobacco experience are now consuming more frequently e-cigarettes than those who occasionally or regularly use tobacco. They also are experimenting more frequently with conventional cigarettes if they have previously consumed e-cigarettes. The largely unregulated availability of e-cigarette products to the newest generation, such as JUUL, led to a dramatic increase in their prevalence among high-school students in the USA. Products with high nicotine content and multiple flavors are being marketed intensively as trendy lifestyle products to young user groups via advertising and social media campaigns. These products are also becoming increasingly relevant in Germany. The success of tobacco prevention in recent years is presently jeopardized by the ongoing effective advertising for e-cigarettes. The Addiction Commission of the German Child and Youth Psychiatric Federations and Scientific Societies therefore call for an immediate, strict, and comprehensive ban of e-cigarette advertising.

[Overweight/Obesity of Children and Adolescents and its Association with Internalising and Externalising Disorders]. / Übergewicht von Kindern und Jugendlichen und sein Zusammenhang mit internalisierenden und externalisierenden psychischen Auffälligkeiten.

Overweight/Obesity of Children and Adolescents and its Association with Internalising and Externalising Disorders Research in child and adolescent psychiatry increasingly deals with the association between mental disorder and weight. This paper provides an overview of national and international studies on the relationship between body composition and mental illness in children and adolescents, with a focus on the representation of individual internalizing and externalizing disturbance patterns. The majority of studies in this area are based on the so-called one-compartment model of body composition in terms of the Body Mass Index (BMI) or on the classification as "overweight" or "obese". Associations between mental disorders and body composition were described in two directions: On one hand, both externalising and internalising symptoms are associated with obesity, and on the other hand there are also more psychopathological symptoms among overweight children and adolescents. Longitudinal studies suggest effects in both directions. While externalising symptoms and weight are thought to be related from infancy on, this connection seems to be evident for internalising disorders not earlier than for early school age. It is also known from the literature that psychopharmacological medication affects weight and body growth - especially with psychostimulants, but also with neuroleptics and antidepressants. We found only a few studies describing the relationship between body composition and psyche in more complex models with two or more compartments.

Effectiveness of a mindfulness-oriented substance use prevention program for boys with mild to borderline intellectual disabilities: study protocol for a randomised controlled trial.

BACKGROUND: Boys with mild to borderline intellectual disabilities (MBID) are at particular risk to drink in harmful ways once they start to consume alcohol. Interventions based on mindfulness have been proven to be effective in preventing substance use, but mostly for adults with MBID. A mindfulness oriented intervention targeting 11-17 years old boys will be tested in a randomised controlled trial. Study aim is to investigate the benefits of this new intervention compared to an active control condition within a 12 months follow-up. METHODS: In this randomised controlled proof of concept study, 82 boys with MBID who consumed any alcohol during the last year will be randomised either to the 6 week mindfulness oriented intervention or the control group receiving a control intervention equal in dose and length. The intervention group undergoes mindfulness training combined with interactive drug education, while the control group completes a health training combined with the same education. In the intention-to-treat analysis the primary outcome is the self-reported delay of first post-intervention drunkeness within a 12 months follow-up time span, measured weekly with a short app-based questionnaire. Secondary outcome is the use of alcohol, tobacco and other drugs within 30 days post-intervention. Changes in neurobiological behavioural parameters, such as impulse control, reward anticipation, and decision making, are also investigated. Other secondary outcomes regard trait mindfulness, emotion regulation, psychopathological symptoms, peer networks, perceived stress, and quality of life. In addition, a prospective registry will be established to record specific data on the population of 11-17 year old boys with MBID without any alcohol experience. DISCUSSION: This study offers the opportunity to gain first evidence of the effectiveness of a mindfulness-oriented program for the prevention of substance use for boys with MBID. TRIAL REGISTRATION: German Clinical Trials Register, DRKS00014042 . Registered on March 19th 2018.

[The Care of Intellectually Disabled Children and Adolescents with Psychiatric Disorders in Hospitals for Child and Adolescent Psychiatry and Psychotherapy in Germany]. / Kinder- und jugendpsychiatrische Versorgung von Kindern und Jugendlichen mit Intelligenzminderung und psychischen Störungen in Deutschland.

OBJECTIVE: This study explores the care situation of children and adolescents with intellectual disabilities (ID) suffering from mental problems in Germany in 2014. It complements the study of Hennicke, which was conducted a decade ago. METHOD: All clinics and departments of child and adolescent psychiatry in Germany (n=138) were contacted via mail or personally and requested to fill out a questionnaire. We received data from one-third (n=46) of all hospitals contacted. RESULTS: Eight hospitals (17%) offered specialized services for this client base as either inpatient or outpatient treatment. Three hospitals (7%) provided both. Average proportions of children with ID treated were 6.6% for inpatient, 7.9% for day hospital, and 3% for outpatient services. More than half of responding institutions (54%) judged inpatient services as being defective. Slightly less (43%) reported their outpatient services as being defective or inadequate. For the treatment of mental disorders in young patients with ID, different treatments were used, according to the degree of the ID and applying the standard of child and adolescent psychiatry. Some interventions were used independently of the degree of ID, such as practical exercises, interventions in the patient environment (parents, family). Other interventions, such as psychotherapy were used to a lesser degree when the degree of ID increased. Youth with mild ID received twice as much psychotherapeutic interventions compared to children and adolescents with severe ID. The latter received more psychopharmacotherapy instead. Youth with severe ID received twice as much (67%) psychotropic medication compared to children and adolescents with mild ID. CONCLUSION: The defective care situation of the highly vulnerable children and adolescents with ID did not change much between 2004 and 2014. The amount of specialized care services increased only marginally. Non-pharmacological treatments were used to a larger extent, compared to psychotropic medication, independent of the degree of ID.

Use of outpatient medical care by headache patients in Germany: a population-based cross-sectional study.

BACKGROUND: Headache sufferers in need of professional health care often do not utilize the care available, and factors influencing headache-specific physician consultation are not yet understood. Objectives of this study are (1) to assess self-reported headache-specific physician consultations and (2) to identify headache-related and sociodemographic predictors. METHODS: Data of a random sample of the general population in Germany aged ≥14 years were analyzed (N = 2461). A multivariate binary logistic regression was conducted to identify a parsimonious model to predict physician consultation. RESULTS: 50.7% of the participants with headache reported at least one headache-specific physician consultation during lifetime. Of these, 53.6% had seen one, 26.1% two, and 20.3% more than two physicians because of their headaches. The odds of physician consultation increased with the number of headache days per month (HDM) [(reference HDM < 1) HDM 1-3 (OR = 2.29), HDM 4-14 (OR = 2.41), and HDM ≥15 (OR = 4.83)] and increasing Headache Impact Test score (HIT-6) [(reference "no or little impact") moderate impact (OR = 1.74), substantial impact (OR = 3.01), and severe impact (OR = 5.08)]. Middle-aged participants were more likely to have consulted than younger and older ones [(reference 14-34 years) 35-54 years (OR = 1.90), 55-74 years (OR = 1.96), ≥75 years (OR = 1.02)]. The odds of physician consultation among self-employed subjects were lower than among employed manual workers (OR = 0.48). The living environment (rural versus urban) did not have an influence on the consultation frequency. CONCLUSION: The results indicate that apart from burden-related factors (headache frequency; headache impact), health care utilization patterns are also influenced by patients' occupational status and age. Further research is needed to analyze whether the lower consultation rate means that the self-employed have a higher risk of chronification or that they have more effective self-management strategies regarding headache.

[Media-associated disorders in childhood and adolescence: Evidence paper of the joint addiction commision of the German societies and professional associations of child and adolescent psychiatry and psychotherapy]. / Medienbezogene Störungen im Kindes- und Jugendalter: Evidenzpapier der Gemeinsamen Suchtkommission der kinder- und jugendpsychiatrischen und psychotherapeutischen Fachgesellschaft und Verbände (DGKJP, BAG, BKJPP).

Media-associated disorders in childhood and adolescence: Evidence paper of the joint addiction commision of the German societies and professional associations of child and adolescent psychiatry and psychotherapy Abstract. Media-associated disorders (MAD) describe the problematic use of the internet, certain electronic devices in general as well as digital applications. During childhood and adolescence, digital games and social media are the most commonly used applications. In May 2019, as first MAD "gaming disorder" was included as a clinical diagnosis in the ICD-11. The prevalence of MAD in German children and adolescents is estimated to lie between 3 % and 5 %. In most cases, MAD are accompanied by psychiatric comorbidities. MAD ensue because of dysfunctional learning processes in combination with general and specific risk factors. They are associated with neural changes like those of substance-associated addictions. Diagnostics can be based on validated questionnaires and clinical exploration, though a standardized diagnostic path is not yet common. Treatment depends on the level of severity and generally comprises outpatient, day-clinic, and inpatient therapy approaches with elements from cognitive-behavioral therapy and under parental involvement. Suitable treatments are not yet available in all German regions and have also not been sufficiently evaluated. Moreover, only a few studies exist on the efficacy of prevention measures addressing MAD in children and adolescents. Thus, further research is strongly required.

[Comparison of Inpatients in Child Psychiatry in Rostock Between 1960 and 2015]. / Vergleich der stationären Kinderpsychiatrie 1960 und 2015 in Rostock.

Comparison of Inpatients in Child Psychiatry in Rostock Between 1960 and 2015 Since its beginnings, child psychiatry has been subject to permanent change due to social changes and thus different expectations of the field, developments in diagnostics, therapy and the respective classification systems. After 1949 Child and Adolescent Psychiatry in the German Democratic Republic (GDR) underwent an independent and somatically oriented development. Although assumed that there was systematic injustice in inpatient facilities of child psychiatry in the GDR, no study from this period has been published to our knowledge up to now. The work presented here begins to close this gap by comparing data from 1960 with current data (2015) of the Child and Adolescent Psychiatry Department at the Rostock Medical Center. Significant differences between results from 1960 and 2015 indicate a currently higher number of admissions, only half the length of stay, an alignment in the gender ratio, a trend towards adolescent patients, a shift away from the 1960 dominant intelligence impairment towards behavioural and emotional disorders, a higher proportion of children and adolescents treated with drugs, and more specialist follow-up treatments after the inpatient stay in 2015. We found no evidence of forced medication in 1960. The discussion also addresses the danger of a solitary development of child psychiatry away from a medical to a more social psychiatric, educational and therapeutic subject.

[Mindfulness in Development-oriented Approaches to Substance Use Prevention and Therapy: Rationale, Design and Objectives of the Research Consortium IMAC-Mind]. / Achtsamkeit in der entwicklungsorientierten Suchtprävention und -therapie: Rational, Design und Ziele des Forschungsverbundes IMAC-Mind.

Mindfulness in Development-oriented Approaches to Substance Use Prevention and Therapy: Rationale, Design and Objectives of the Research Consortium IMAC-Mind Substance use disorders (SUD) are a major contributor to morbidity and mortality. They are typically initiated during adolescence and can have fatal implications for healthy development. Despite substantial scientific advances, there remains a need to prioritize research directed at reducing risks for SUD, particularly in vulnerable periods and populations from a developmental perspective. Research indicates that reward sensitivity, impulsivity, deficient self-regulation, and stress reactivity develop markedly in childhood and adolescence and play an important role in the initiation and maintenance of SUD. A growing number of research results suggest that these factors can be favorably influenced by mindfulness-based interventions and that mindfulness-based exercises can be successfully integrated into established prevention and treatment programs. In this paper we summarize the conceptual relationships between the development and maintenance of addiction disorders and mindfulness, discuss existing empirical findings with regard to childhood and adolescence, and present the aims, study designs and intervention models of the subprojects from the ongoing research network "IMAC-Mind: Improving Mental Health and Reducing Addiction in Childhood and Adolescence through Mindfulness: Mechanisms, Prevention and Treatment".

Combined cognitive, psychomotor and electrophysiological biomarkers in major depressive disorder.

The diagnosis of major depressive disorder (MDD) should be based on multimodal evidence, because MDD not only affects mood, but also psychomotor and cognitive functions. Clinical markers such as executive dysfunctions and a reduction in daily motor activity have been observed in MDD. Neurophysiological biomarkers have also been described. In this study, we investigate the utility of combining biomarkers related to executive dysfunctions, motor activity, neurophysiological patterns (i.e. alpha power asymmetry and EEG-vigilance as indicators of brain arousal), and the interaction of these parameters in the diagnosis of MDD. Twenty (female: 11) patients with MDD (age: 51.05 ± 10.50) and 20 (female: 13) healthy controls (HC; age: 47.15 ± 12.57) underwent a 10-min resting EEG. Executive dysfunctions were assessed using the Trail Making Test B (TMT B). Motor activity was analysed by actigraphy measurements. MDD patients displayed significant impairments in executive functions and reduced daily motor activity. In the EEG, MDD patients showed more right than left frontal activity and lower brain arousal relative to HC. TMT B and asymmetrical frontal alpha power alone discriminated between MDD patients and HC with an accuracy of 78%. The interaction of motor activity and the EEG-vigilance stage alongside TMT B increased the accuracy of the discrimination test to 81%. This improved accuracy suggests that the combination of these biomarkers in a discriminant analysis resulted in a more reliable identification of MDD patients.

A de novo nonsense mutation in ZBTB18 plus a de novo 15q13.3 microdeletion in a 6-year-old female.

ZBTB18 has been proposed as candidate gene for microcephaly and abnormalities of the corpus callosum based on overlapping microdeletions of 1q43q44. More recently, de novo mutations of ZBTB18 have been identified in patients with syndromic and non-syndromic intellectual disability. Heterozygous microdeletions of 15q13.3 encompassing the candidate gene CHRNA7 are associated with developmental delay or intellectual disability with speech problems, hypotonia, and seizures. They are characterized by significant variability and reduced penetrance. We report on a patient with a de novo ZBTB18 nonsense mutation and a de novo 15q13.3 microdeletion, both in a heterozygous state, identified by next generation sequencing and array-CGH. The 6-year-old girl showed global developmental delay, absent speech, therapy-refractory seizures, ataxia, muscular hypotonia, and discrete facial dysmorphisms. Almost all of these features have been reported for both genetic aberrations, but the severity could hardly been explained by the microdeletion 15q13.3 alone. We assume an additive effect of haploinsufficiency of ZBTB18 and CHRNA7 in our patient. Assembling the features of our patient and the published patients, we noted that only one of them showed mild anomalies of the corpus callosum. Moreover, we hypothesize that nonsense mutations of ZBTB18 are associated with a more severe phenotype than missense mutations. This report indicates that haploinsufficiency of additional genes beside ZBTB18 causes the high frequency of corpus callosum anomalies in patients with microdeletions of 1q43q44 and underlines the importance of an NGS-based molecular diagnostic in complex phenotypes.

The role of sleep problems and circadian clock genes in attention-deficit hyperactivity disorder and mood disorders during childhood and adolescence: an update.

A more recent branch of research describes the importance of sleep problems in the development and treatment of mental disorders in children and adolescents, such as attention-deficit hyperactivity disorder (ADHD) and mood disorders (MD). Research about clock genes has continued since 2012 with a focus on metabolic processes within all parts of the mammalian body, but particularly within different cerebral regions. Research has focused on complex regulatory circuits involving clock genes themselves and their influence on circadian rhythms of diverse body functions. Current publications on basic research in human and animal models indicate directions for the treatment of mental disorders targeting circadian rhythms and mechanisms. The most significant lines of research are described in this paper.