[Incidence and risk factors for mental abnormalities in children of psychiatric inpatients]. / Häufigkeit und Risikofaktoren für psychische Auffälligkeiten bei Kindern psychiatrischer Patienten.

Children of mentally ill parents are exposed to a variety of stress- and harmful life events. To which extent the mental illness of one or both parents affects their children's mental development is barely studied. Therefore, over a period of 6 months 142 patients with children below the age of 18 (n=237 children), who were admitted to the Dept. for Psychiatry and Psychotherapy 1 of the Paracelsus Medical University Salzburg, were questioned for abnormalities in their children's mental development. Additionally all these patients were assessed for their family situation, demographic data and psychiatric disorder. 38.4% (n=91) of the children showed mental abnormalities. The most common one were emotional (n=41), social (n=41) and learning (n=34) disabilities. Parental duration of the illness (p=0.001), age of the children (p=0.044), illness of both parents (p=0.008), longlasting family conflicts (p=0.003) and living with only one parent (p=0.012) were correlated significantly with mental abnormalities in children. The results confirm an increase risk for mental abnormalities in children of psychiatric patients. This risk varies with existing risk and protective factors, which can be partially influenced. Therefore children of mentally ill parents with problems in their mental development should be detected early. Even if genetic risk factors cannot be changed reducing known psychosocial risk factors and promotion protective factors can significantly influence a healthy development of these vulnerable children.

[Reliability and concordance validity of a German version of the Young Mania Rating Scale (YMRS-D)]. / Relabilität und Übereinstimmungsvalidität der deutschen Version der Young Mania Rating Scale (YMRS-D).

OBJECTIVE: The Young Mania Rating Scale (YMRS) is the most widely used assessment tool for severity of manic symptoms in bipolar patients. While the original English version has been translated to various different languages, a validated German translation of YMRS has not yet been available. METHODS: We translated the original English version to German (YMRS-D) and tested its use in clinical practice in 81 manic inpatients at two different psychiatric hospitals in Austria. The interviews were carried out by eight experienced and trained psychiatrists in random pairs of two interviewers. In order to assess concordance validity of YMRS-D, all patients were simultaneously rated using the Clinical Global Impression Rating Scale, Bipolar Version (CGIBP), by one of three experienced senior raters. RESULTS: Inter-Rater Reliability was assessed calculating the Intra-Class Correlation Coefficient and showed high values (between 0.79 and 0.97, all p<.001) in all items of the German Rating Scale. Internal Consistency analysis of the scale yielded a value of .74 (Cronbach's Alpha). Spearmans rank correlation coefficient for the total scores of CGI-BP and YMRS-G was high (0.91, p<.001), suggesting good concordance validity of YMRS-D. Sensitivity to change was assessed in a subgroup of 20 patients by comparing YMRS-D and CGI-BP total scores at inclusion and at an additional interview three weeks later which showed a highly significant correlation (r = -0,953; p<.0005). CONCLUSIONS: The German version of YMRS seems to be a valid, reliable and useful tool for the assessment and quantification of manic symptoms.

[Depression: diagnosis, treatment and course]. / Depression: diagnose, behandlung und verlauf.

Depressions are very common mental diseases. The diagnosis is made by psychopathology criteria and the course of the disorder. There is a growing body to the knowledge about etiology and treatment of depression - neuro-imaging, neuroplasticity, CREB and BDNF are all modified by antidepressants treatment and/or psychotherapy. As differential diagnoses, depressive syndromes on the basis of organic diseases but also burn-out syndromes may play a role, different therapeutic efforts are necessary. The treatment of depression consists of psychopharmacological and psychotherapeutic strategies, combinations of both are useful. Many psychopharmacological substances with differing mechanisms of action are available - combinations of antidepressants with complementing mechanisms are possible. The course of depressions is mainly influenced by "working therapies". Comorbid somatic diseases and their successful treatment are of relevance for the long term course.

[Child and adolescent bipolar disorder]. / Bipolar Affektive Störungen im Kindes- und Jugendalter.

The onset of bipolar disorders before the age of 10 is rare. First manifestation occurs most frequently between the age of 15 to 30. Children of a parent with bipolar disorder are at a fivefold risk for developing a bipolar disorder. Therefore, an elaborate family-history is essential for the assessment of potentially manic or depressive symptoms in children and adolescents. Basically, for all age groups the same diagnostic criteria according to ICD 10 are applied. Due to the differing symptoms for children and adolescents the finding of a diagnosis is considerably harder than for adults. Manic episodes before the age of 10 are characterized by increased activity, more risk taking behaviour and elevated emotional instability. In adolescents, however, behavioural disturbance with antisocial behaviour and drug-abuse are more common. Thus, typical misdiagnosis as ADHD or conduct disorders for children and adolescents are frequent. Aggravating the complexity, in up to 90 % both differential-diagnosis may occur as comorbid disorders. Furthermore, psychotic symptoms are more common than in adults and dysphoria is more likely than euphoric or depressive mood. Asymptomatic intervals rarely exist, whereas "ups" and "downs" in rapid succession are prevailing (rapid cycling). An early diagnosis, leading specific treatment, is essential for the prognosis of bipolar disorders. Additionally, structural (CCT or MRI) and laboratory examination are essential to expel endocrine or brain-organic diseases. Besides psychotherapeutic and psychoeducative methods, always including parents and attached persons, the psychopharmacological treatment is a major part of a multimodal treatment. The available substances partly have been in use for years and are appropriate for youngsters. These include mood stabilizers like lithium, divalproex and carbamazepine, which provide besides their acute antimanic effects also relapse-prophylactic properties. In addition atypical antipsychotics like risperidone, olanzapine and quetiapine have gained more and more importance in the treatment of manic states in children and adolescents during the last years. However the use of antidepressants in children and adolescents should be considered with great caution due to arguable efficacy and potentially severe adverse effects, i.e. amplification of suicidal ideation.