[Anorexia nervosa--the triad of metric index, BMI age-specific percentile curve and goal weight]. / Anorexia nervosa--Die Trias von Metrik-Index, BMI-Altersperzentilenkurve und Zielgewicht.

Cross sectional and longitudinal data from the Berlin Anorexia Study on the inpatient treatment of n = 133 adolescent females with the principal axis I diagnosis of an eating disorder (n = 104 anorexia nervosa, n = 19 bulimia nervosa, n = 10 eating disorders not otherwise specified; according to ICD-10 and DSM-IV criteria) indicate a significant shift in the frequency distribution of somatometrically assessed types of body shape among patients as categorized by the Metric Index, towards the leptomorphic phenotype (p < 0.050, chi 2/Fisher's). Three explanatory models are discussed. Diagnostic and therapeutic implications, particularly of the determination of target weight in anorexia nervosa based on the individual's type of body shape, are emphasized, and an operational algorithm is proposed which uses the Metric Index and sex-specific BMI age percentiles adjusted for type of body shape.

An evaluation of neuropsychological investigation methods for the mentally handicapped.

The neuropsychological diagnostics and rehabilitation have gained an important place in neuropsychiatry for the child and adolescent. The point is to which extent neuropsychological investigations are able to contribute to the evaluation of the mentally handicapped. Proceeding from Luria's concept of systematic brain activities, during the 70's and 80's neuropsychological tests for children and adults were developed in Europe and the U.S. These endeavoured to achieve a comprehension of the higher cortical functions on a metric basis. Starting from a developmental neuropsychological aspect, the authors have developed the Berlin Luria-Neuropsychological Procedures for children of the age between 8 and 12 years (BLN-K). Based on a patient random test with 9 children whose intelligence quotient was lower than 80, the principal question of BLN-K suitability for a differentiated diagnosis of intellectually impaired children was investigated. The problems and results are represented and discussed in detail.

Neuropsychological differentiation of subnormal arithmetic abilities in children.

For the neuropsychological diagnosis of a Specific disorder of arithmetic skills the standard is defined worldwide by the diagnostic guidelines of the two major classification systems of psychiatric disorders, the ICD- 10 and the DSM-IV, both of which use the discrepancy criterion as the key feature of the diagnosis. It becomes clear that following such guidelines can only mean an extensive diagnostic assessment of patients with subnormal arithmetic abilities, including the social and previous medical history followed by the exclusion of a present disorder or disability, often necessitating laboratory, neuroimaging and neurophysiological tests. In the neuropsychological diagnosis of a Specific disorder of arithmetical skills we found a stepwise approach including previously obtained test results to be most practical and economical. The assessment instruments such as intelligence tests, neuropsychological test batteries, academic achievement tests, specific neuropsychological tests, test batteries for arithmetic abilities or error analysis are discussed. An overview of case studies in the literature is given; however, the overwhelming majority of case reports on patients with arithmetic disabilities are casuistics of adult patients with an acquired loss of arithmetic abilities. The importance of a differentiated neuropsychological diagnosis is demonstrated by four of our own cases: of borderline deficient intelligence, a combined disorder of academic skills, congenital brain dysfunction, and a specific disorder of arithmetic skills. Especially the new quality in assessing arithmetic abilities with the NUCALC battery is demonstrated; diagnostic and therapeutic consequences are discussed.

The specific disorder of arithmetic skills. Prevalence studies in a rural and an urban population sample and their clinico-neuropsychological validation.

There is an often noted lack of research in the field of disorders of arithmetic skills. The present study assessed the prevalence in both an urban and a rural population sample of German schoolchildren, using standardized academic achievement tests. Eight school classes of third graders in each area were examined (n = 181,182; respectively). We found that 6.6 % (n = 12) of the rural and 6.59 % (n = 12) of the urban school children performed significantly worse in arithmetic than in their spelling tests. Since the diagnostic criteria for the Specific disorder of arithmetical skills and their significance are widely discussed, we attempted in a second step of the study to validate the diagnosis of the Specific disorder of arithmetical skills from a neuropsychological and medical viewpoint. For the validation we assessed clinical data, imaging and neurophysiologic studies as well as a neuropsychological test battery. Nine and five of the children, respectively, were available for this further evaluation. Although the majority of these probands (n = 10) had distinct arithmetic deficits, only three of them met the full diagnostic criteria of the ICD-10 for a Specific disorder of arithmetic skills. In a last step, we compared the data of both studies. Our data strongly support a thorough cliniconeurological, neuropsychological and academic assessment of students with a suspected Specific disorder of arithmetic skills. The current diagnostic criteria should be reconsidered and possibly modified towards a more psychopathologic definition. We stress the need that the condition becomes better known among all professions concerned with the care of children, as difficulties with acquiring arithmetic skills should be detected and approached appropriately as early as possible. The imperative demand of future empiric research is emphasized.