[Scabies therapy in Germany : Results of a nationwide survey with a special focus on the efficacy of first-line therapy with permethrin]. / Skabiestherapie in Deutschland : Ergebnisse einer bundesweiten Umfrage mit besonderem Fokus auf die Wirksamkeit der Erstlinientherapie mit Permethrin.

BACKGROUND: According to the current scabies guideline, topical treatment with permethrin 5% cream is the first-line therapy of common scabies in Germany. However, in the course of growing incidence of scabies in recent years there have been increasing numbers of reports of reduced efficacy in standard therapy. OBJECTIVE: To establish a better understanding for the efficacy of scabies therapy under practice conditions, a survey focusing on the first-line therapy with permethrin was conducted in dermatological hospitals, outpatient clinics and dermatology practices. METHODS: The postal survey addressed all dermatologically active physicians in Germany and queried diagnostic methods, the individual initial treatment, the estimated efficacy of permethrin therapy, the frequency and reasons for therapy failures under permethrin and the therapeutic approach in case of failure of the initial therapy. RESULTS: The efficacy of permethrin was rated with 73% by 187 physicians. About 74% reported to treat initially with 5% permethrin cream. The most common reasons identified for treatment failure were application errors, lack of compliance and inadequate hygiene measures. Suspected diminished efficacy or development of resistance against permethrin and re-infestations were also mentioned. In the case of ineffectiveness of initial therapy, most clinicians opt for oral ivermectin, a repetition of permethrin therapy or a combination of both. CONCLUSION: Although there are localized reports of decreased effectiveness of permethrin therapy, results of this survey point towards a persisting high efficacy of first-line standard treatment of scabies with permethrin 5% cream in Germany.

[Complications of cosmetic piercings and tattoos in the head and neck region]. / Komplikationen bei kosmetischen Piercings und Tätowierungen im Kopf-Hals-Bereich.

Piercings and tattoos have gained popularity across all cultural environments during the past century, and one in ten Europeans are now pierced. While tattoos are often restricted to the rest of the body, piercings are common at facial sites such as ears, nose, lips, and tongue. Complications following piercings are not uncommon. Infections can rapidly spread across the auricular cartilage and require antibiotic and often surgical treatment. Mild trauma (i.e., piercing the earlobe) can lead to excessive scar formation due to fibroblast proliferation. Keloids have a particularly high rate of recurrence and are therefore difficult to treat. Due to recent developments in the field of permanent makeup, tattooing techniques are also increasingly applied in the head and neck region. Here, complications such as infection or allergic reactions can occur. Topical medication or laser procedures are the usual therapeutic options.

Family conflict tendency and ADHD.

A lack of perseverance, poor attention, and poorly modulated behaviour are important criteria of Attention Deficit Hyperactive Disorder (ADHD). Instructions often have to be repeated, sometimes even by different family members before a child with ADHD attends and complies. We hypothesised that a child with ADHD might cause less disagreement in families with almost no conflicts. Responses to the Mannheim Parents Interview and teacher's form of the Conners scale completed by families of 15 boys (ages 6 to 12 years), diagnosed with ADHD were compared with those of a matched, healthy control group of 15 boys. Parents completed a form assessing the family's cooperation and child-rearing practices. Having few family conflicts, i.e., almost no Verbal Disagreement may reduce Physical Punishment and Anger and Disregard and augment the Openness to another's needs and, for that reason, have protective effects on children's behaviour modulation.

Family coherence and ADHD.

A lack of perseverance, poor attention, and poorly modulated behaviour are important criteria of Attention Deficit Hyperactivity Disorder (ADHD). Instructions often must be repeated, sometimes even by different family members, before a child with ADHD attends and complies. The hyperkinetic child might cause less disruption in families with high coherence. Families of 15 boys (aged 6 to 12 years) diagnosed with ADHD using the Mannheim Parent's Interview and the teacher's form of the Conners scale were compared with a matched healthy control group of 15 boys. Parents completed a form assessing the family's cooperation and childrearing practices. Intrafamilial coherence seems to have little positive association with the family's characteristics, especially for boys with Attention Deficit Hyperactivity Disorder. Low coherence among family members may reduce ADHD symptoms and may have protective effects on children with ADHD.

Features in families of boys with hyperkinetic and emotional disorders.

Standardized assessment of a family's characteristics (conflict management, cohesion, etc.) is not used routinely, although these variables may play an important role in the course of psychological disorders in children. The present study investigated differences within the features of families of children with hyperkinetic and emotional disorders. Families of 20 boys diagnosed with Attention Deficit Hyperkinetic Disorder and 20 boys with Emotional Disorder (ages 6-12 years) by giving the Mannheim Parents Interview and the teacher's form of the Conners scale were included for evaluation and compared with a matched, healthy control group of 20 boys. Parents were asked to complete a form assessing the family's characteristics ("Familienklima-Testsystem"), including Cohesion, Expressiveness, Conflict Tendency, Individual Independence, Achievement Orientation, Intellectual-Cultural Orientation, Active-Recreational Orientation, Moral-Religious Emphasis, and Organization. Comparison of groups was made by the Kruskal-Wallis test and Mann-Whitney U test. There are significantly more conflicts in families whose children belong to the two disorder groups. Compared with a matched healthy control group, there is low Expressiveness, Independence, and Cultural and Active-Recreational Orientation in the Emotional Disorder group and a significant lack of Organization and Cohesion in the Attention Deficit Hyperkinetic Disorder group. Altogether there seems to be a significant association of Attention Deficit Hyperkinetic Disorder symptoms with the family's Cohesion and Organization. One implication is that therapists focus their efforts not only on the children with disorders but also on their families.

[Early childhood psychosis versus early childhood autism? Differential diagnosis based on one week observation in an inpatient setting]. / Frühkindliche Psychose versus Frühkindlicher Autismus? Differentialdiagnose aufgrund einer einwöchigen Beobachtung im stationären Setting.

We report on the case of a 4-year old child suffering for the past six months from a lingering psychotic development. Several months of outpatient observation did not permit a clear differential diagnosis of either childhood autism or an early psychosis. During a one-week inpatient stay at our hospital recurring productive-psychotic episodes were observed that finally led to the exclusion of the diagnosis of "childhood autism" (ICD-10 F 84.0 (Dilling et al., 1993)) and to the diagnosis of "other disintegrative childhood disorder" (ICD-10: F 84.3 (Dilling et al., 1993)).

Epidemiology of benzodiazepine dependence.

The charts of 10,861 patients of the Innsbruck University Department of Psychiatry were evaluated for this study. The patients were in- and outpatients admitted between January 1978 and September 1981. WHO criteria were used for the diagnosis of dependence. 1,743 inpatients and 2,130 outpatients were dependent on psychotropic substances (most of them being alcoholics). 57 (1.1%) resp. 73 (1.3%) suffered from polydrug abuse including benzodiazepines. Only nine inpatients and 21 outpatients were addicted to benzodiazepines only. Details of benzodiazepine dependence are discussed.