Effects of Prodromal Stage and Untreated Psychosis on Subsequent Psychopathology of Schizophrenia: A Path Analysis.

BACKGROUND: To examine psychopathology present under prolonged antipsychotic treatment in schizophrenia and to analyse their relationship to both the duration of the prodromal stage (DPS; time between onset of first unspecific psychological symptoms and first schizophrenic symptoms) and the duration of untreated psychosis (DUP; time between the onset of psychosis and the initiation of antipsychotic treatment). METHODS: The psychopathology of 93 patients was assessed cross-sectionally using the Scales for the Assessment of Negative and Positive Symptoms and the Brief Psychiatric Rating Scale. DPS and DUP were assessed by means of the patient records and the Interview for the Retrospective Assessment of the Onset and Course of Schizophrenia and Other Psychoses. A path analysis using maximum likelihood estimation was conducted with the program Analysis of Moment Structures for Windows. RESULTS: The resulting path model indicated that DPS was predictive for a more severe negative symptomatology in schizophrenia, whereas DUP was associated with a more severe positive symptomatology in the long-term. Furthermore, DUP showed an inverse correlation with the age of the patients at the onset of both first unspecific psychological symptoms and first schizophrenic symptoms. CONCLUSION: A long prodromal stage suggests an increased risk of a long-term progression with negative symptoms in schizophrenia, whereas a delayed start of antipsychotic treatment could lead to an increased manifestation and severity of positive symptoms in the long term. These results underline the need to shorten the duration of the prodrome by an early detection and adequate intervention in patients with increased risk to develop psychosis.

[The history and development of the Zeitschrift für Kinder- und Jugendpsychiatrie - Review and outlook on the occasion of its 45th anniversary]. / Die Gründungsgeschichte und Entwicklung der Zeitschrift für Kinder- und Jugendpsychiatrie und Psychiatrie ­ Rückblick und Ausblick aus Anlass ihres 45-jährigen Bestehens.

The history and development of the Zeitschrift für Kinder- und Jugendpsychiatrie - Review and outlook on the occasion of its 45th anniversary Abstract. This article is based on archived documents and provides an overview of the founding of the Journal of Child and Adolescent Psychiatry and Psychotherapy and its precursor, the Yearbook of Adolescent Psychiatry and Allied Professions. The first volume of this journal appeared in 1973, 5 years after child and adolescent psychiatry had become an independent specialty in the Federal Republic of Germany. The founders of the journal and its first Editors-in-Chief were Hermann Stutte (1909-1982) and Hubert Harbauer (1019-1980). The Co-Editors and later Editors-in-Chief were Helmut Remschmidt and Martin Schmidt, who continued to edit the journal for the next 30 years. The Director of the publishing company at that time (Hans Huber, Bern), Walter Jäger (1916-2001), was a major factor in nurturing the journal. In 1975, he received an honorary doctorate from the Medical Faculty of the Philipps University of Marburg. Since the beginning, the journal has incorporated progressive developments and can be considered the leading organ in German-language child and adolescent psychiatry. With a current impact factor of 1.206, it holds rank 100 on the list of 142 international psychiatric journals.

[50 years specialty for child and adolescent psychiatry in Germany. History, current situation, and future perspectives]. / 50 Jahre Facharzt für Kinder- und Jugendpsychiatrie in DeutschlandGeschichte, Gegenwart und Zukunftsperspektiven 1.

50 years specialty for child and adolescent psychiatry in Germany. History, current situation, and future perspectives Abstract. Abstracts: Method: Review of the historical background and implementation of an independent medical specialty "child and adolescent psychiatry" (CAP) in Germany. Results: The implementation of an independent specialty for CAP in 1968 was crucial for the progressive further development of the discipline. The Enquête Commission "Psychiatry" of the Federal Government, followed by the Model Program "Psychiatry", the Staff Regulations for Psychiatry, the Agreement on the Social Psychiatry and the Psychotherapy Act have had significant impact on the care for psychiatrically ill children and adolescents and their families. This led to an institutional anchoring of new structures, covering three of the four leading principles of the Model Program, namely integration into medicine, community-based and appropriate care. Equality of psychiatric patients with other patient groups has, nevertheless, not yet been achieved and is still to be claimed. Current and future challenges are: (1) The realistic evaluation of new research methods and epochal trends and elimination of opposites, (2) the establishment of future-oriented research initiatives, (3) the intensive promotion of clinical and scientific staff members, and (4) a renewed attention for the subjective perspective of the illness. Conclusions: The implementation of an independent specialty "child and adolescent psychiatry" was an important stimulus for the further development of the discipline. Essential demands for the future will be: the integration of CAP into the curriculum for medical students and the promotion of young researchers within the scope of regional and supra-regional projects.

Impairment in face processing in autism spectrum disorder: a developmental perspective.

Findings on face identity and facial emotion recognition in autism spectrum disorder (ASD) are inconclusive. Moreover, little is known about the developmental trajectory of face processing skills in ASD. Taking a developmental perspective, the aim of this study was to extend previous findings on face processing skills in a sample of adolescents and adults with ASD. N = 38 adolescents and adults (13-49 years) with high-functioning ASD and n = 37 typically developing (TD) control subjects matched for age and IQ participated in the study. Moreover, n = 18 TD children between the ages of 8 and 12 were included to address the question whether face processing skills in ASD follow a delayed developmental pattern. Face processing skills were assessed using computerized tasks of face identity recognition (FR) and identification of facial emotions (IFE). ASD subjects showed impaired performance on several parameters of the FR and IFE task compared to TD control adolescents and adults. Whereas TD adolescents and adults outperformed TD children in both tasks, performance in ASD adolescents and adults was similar to the group of TD children. Within the groups of ASD and control adolescents and adults, no age-related changes in performance were found. Our findings corroborate and extend previous studies showing that ASD is characterised by broad impairments in the ability to process faces. These impairments seem to reflect a developmentally delayed pattern that remains stable throughout adolescence and adulthood.

Pilot study on HTR2A promoter polymorphism, -1438G/A (rs6311) and a nearby copy number variation showed association with onset and severity in early onset obsessive-compulsive disorder.

A previous study showed that a single nucleotide polymorphism (SNP), -1438G/A (rs6311), found in the transcriptional control region of the gene that encodes the serotonin-receptor 2A (HTR2A) was associated with obsessive-compulsive disorder (OCD) in a sample of children and adolescents. In this study, we reanalyzed the association of this SNP with OCD in an enlarged population of 136 cases (55 previous + 81 new cases) and compared them to 106 newly recruited, healthy, age-matched controls. We also investigated whether this SNP or its copy number variations (CNV) was associated with OCD severity and age of onset. The CNV was analyzed in a DNA region located near rs6311. The results confirmed the association between the A-allele and early onset OCD in children and adolescents, with an odds ratio (OR) of 1.69 [95% CI (1.17, 2.46); p = 0.005]. Strikingly, we found that carriers of one copy (deletion) of the CNV were associated with a very early onset OCD (2.5 years earlier than the typical onset), and they had increased CY-BOCS scores (8.7 points higher compared to "normal" CNV and duplications); which is related to increased severity of OCD symptoms (p = 0.031; p = 0.004, respectively). Compared to the normal CNV and duplications, the association between the deletion and OCD showed an OR of 7.56 [95% CI (1.32, 142.84); p = 0.020]. These results pointed to the functional importance of this promoter region of HTR2A; it influenced the occurrence, the onset, and the severity of OCD.

Early-onset schizophrenia.

The available study findings on the course and outcome of schizophrenia beginning in childhood or adolescence can be summarized as follows. (1) Schizophrenic psychoses that arise before the age of 13 have a very poor prognosis. The disease usually continues to progress in adolescence and adulthood. It can be diagnosed with the same criteria that are used for adults. (2) Patients whose disease is of acute onset, with productive schizophrenic manifestations such as hallucinations and delusions (positive manifestations), have a better prognosis than those whose disease begins insidiously and takes an unfavorable course, with depressive states and continually worsening impairment of cognitive function. (3) The patient's premorbid personality plays a major role. Patients who were described as socially active, intelligent, and integrated children and adolescents before they became ill have a better prognosis than those who were intellectually impaired, timid, introverted and uncommunicative before they became ill. (4) The prognosis seems to be better for patients who have no family history of schizophrenia, those whose families cooperate well, and those whose condition improves rapidly during inpatient treatment. (5) The few available studies on the course and outcome of schizophrenia beginning in childhood and early adolescence confirm that they are much worse than in adult-onset schizophrenia. (6) A 42-year longitudinal study of patients with childhood-onset schizophrenia revealed their suicide rate to be higher than that of patients with adult-onset schizophrenia. No further longitudinal studies are available to confirm this finding.

Time Trends in Psychopathology. A 21-year comparison from Germany.

OBJECTIVE: Time-trend studies are required to learn about children's mental health status in changing societies. Some international studies have already analyzed secular trends over periods of 10 to 25 years, but the results are inconsistent. Our study aims to detect German time trends of psychopathology in children aged 8-11, from the first large Child Behavior Checklist (CBCL)-based study in Marburg/Germany 1987 until the present day (2008). METHOD: Parents filled in the CBCL to report psychopathological symptoms in their children. The school-based samples from the years 1987 and 2008 were matched for sex, age, and socioeconomic status. The matched samples each consists of 212 girls and boys (girls: 50.5 %, boys: 49.5 %). MANCOVAs and ANCOVAs were used to test differences in mean CBCL scale scores. RESULTS: Somatic symptoms showed a significant increase from 1987 to 2008. Similar trends were found for other internalizing symptoms, but did not reach significance. Externalizing symptoms showed no significant increase. Boys showed more aggressive or delinquent behavior and attention problems than girls. The children with the lowest socioeconomic status showed the highest symptom levels in both assessment years. CONCLUSIONS: The increase in somatic problems might be an effect of changes in expected school performance and economic aspects. The overall high rate of psychopathology in children highlights the necessity of effective prevention and intervention programs, particularly regarding families with lower socioeconomic status.

[Self-report and parental report of empathy in adolescents with autism]. / Selbst- und Fremdbeurteilung der Empathie bei Jugendlichen mit Autismus.

OBJECTIVE: A deficit in empathy has repeatedly been described as a central feature of autistic disorders. However, little is known about how adolescents with autism evaluate their own empathic abilities, and how their parents judge these skills. The present study assesses affective components of empathy via both self-report and parental report. METHOD: 18 boys with autism and 18 typically developing boys participated in the study. A German translation of the Bryant Index of Empathy was used for the self-assessment of empathy. Parents rated the empathic abilities of their sons using a German version of the Griffith Empathy Measure. Both questionnaires are comparable with regards to content and mainly tap into affective components of empathy. RESULTS: Self-reports of empathy in adolescents with autism did not differ from controls. In contrast, parents of adolescents with autism judged their sons to be less empathic compared to parents of typically developing adolescents. CONCLUSIONS: The discrepancy between unimpaired self-reported empathy and parental report of impaired empathy in adolescents with autism might result from their difficulties in effectively conveying empathic feelings to other people. Alternatively, the results may be explained by impaired introspection on inner experiences in individuals with autism.

Health-related quality of life in children and adolescents with autism spectrum disorder.

OBJECTIVE: This study evaluates self- and proxy-reported health-related quality of life (HRQOL) in children and adolescents with autism spectrum disorders (ASD). The study also compares HRQOL in ASD patients with a healthy control sample and a psychiatric reference sample. METHOD: 42 children and adolescents (39 male, mean age: 12.7 ± 2.6 years, mean IQ: 100.5 ± 20.7) with the diagnosis of autism spectrum disorder (ASD) and their parents completed the Inventory for the Assessment of Quality of Life in Children and Adolescents (ILK). RESULTS: Mean ILK LQ 0-28 scores were 20.6 (± 4.6) (self-report version) and 18.2 (± 4.0) (proxy version). Compared to a reference sample, mean ILK scores from the ASD sample were at the 47th percentile (self-report) and the 33rd percentile (proxy). Compared to children and adolescents with psychiatric disorders, self-reported ILK scores correlated with the 69th percentile, and proxy-reported ILK scores correlated with the 67th percentile. Self-reported HRQOL was significantly higher than proxy-reported HRQOL. No significant correlation was found between HRQOL and age, IQ, or autistic symptoms. CONCLUSIONS: HRQOL in children and adolescents with ASD seems to be better than in other psychiatric disorders, but lower than in healthy controls.