[The origin of a differentiated neuropsychopharmacotherapy for children and adolescents: an analysis of psycho- and neuropharmacology in the 1940s and 50s]. / Die Anfänge einer differenzierten Neuropsychopharmakotherapie bei Kindern und Jugendlichen. Untersuchung zur Psycho- und Neuropharmakologie in den 40er und 50er Jahren des vorigen Jahrhunderts.

Objective: The origin of a differentiated approach to neuropsychopharmacotherapy in children and adolescents can be traced back to the 1940s and 50s. Certain clinical disorders in the range of psychiatry and neurology were treated with a multiplicity of substances. Method: We conducted an exclusive screening of 700 medical records of patients under 18 years of age from a psychiatric university hospital in Jena (from 1942­1945) and 89 files of children who attended Trüper's approved school in Jena between 1946 and 1954. Results: Differentiated therapies were administered for ailments such as acute anxiety states, erethism, hyperkinetic syndrome, enuresis, migraine, sleep disturbance, epilepsy, Sydenham's chorea, spasticity, neuralgia, neuritis, dizziness, pain syndrome, tetany, and syphilis. Conclusions: Interventions for mental disorders were relatively unspecific before the development of neuroleptic and antidepressant agents. During this time, multitudes of treatments were implemented for neurovegetative disorders, psychoneuroses, and different kinds of psychopathies. Barbiturates were administered in both pure and mixed forms. Additionally, since mental disorders were frequently caused by physical disorders, they could be eliminated or improved by the use of chemotherapeutics. Other somatic therapies like convulsive shock treatment with camphor and cardiazol, malaria treatments, hypoglycemic shock therapy, and electroconvulsive treatment have been applied in patients with schizophrenia.

[Johannes Trüper--mediator between child and adolescent psychiatry and pedagogy]. / Johannes Trüper--Mittler zwischen Kinderpsychiatrie und Pädagogik.

OBJECTIVE: The development of the child and adolescent psychiatry as an independent speciality is not only a result of sub-specialisation within medicine or psychiatry but also a result of interaction with pedagogy, psychology, and philosophy. Within this framework, pedagogy (and more specifically orthopedagogy) has played an essential scientific role. This will be demonstrated by the work of Johannes Trüper. METHODS: A short description of his life and an evaluation of his scientific work is presented based on earlier publications and archive studies. RESULTS: Trüper founded a famous approved school on Sophienhöhe close to Jena in 1892 and was a co-founder of "Die Kinderfehler" (1896), one of the leading journals for research in pedagogy and child psychiatry in its time. The psychiatrist and philosopher Theodor Ziehen regarded as one of the pioneers of child psychiatry, gained practical child psychiatric experience as a consultant liaison psychiatrist at the approved school which was run by Johannes Trüper. Wilhelm Strohmayer, another psychiatrist from Jena, also belongs to the founding fathers of child psychiatry in Germany with his book "Vorlesungen uber die Psychopathologie des Kindesalters für Mediziner und Pädagogen" (1910) which is based on his consultant work on Sophienhöhe. CONCLUSION: The close and direct collaboration between psychiatry and pedagogy, which lead to an early development of child psychiatry as a speciality in Jena, can be regarded as a particularity in the scientific development.

Endophenotype properties of niacin sensitivity as marker of impaired prostaglandin signalling in schizophrenia.

BACKGROUND: Disruption of arachidonic acid pathways and prostaglandin signalling has been implicated in the pathophysiology of schizophrenia. AIMS: We intended to study prostaglandin signalling in groups of young schizophrenia patients, first-degree relatives, and healthy controls in order to assess effects of heritability on this biological marker-one important endophenotype criterion. METHOD: Namely, we assessed intensity of methylnicotinate skin flushing using optical reflection spectroscopy. Tests were applied to 19 adolescent first-episode schizophrenia patients, 21 first-degree relatives, and groups of age and gender matched healthy controls. RESULTS: Compared to healthy controls, attenuation of skin flushing at low niacin concentrations was found only in schizophrenia patients, but not in first-degree relatives. CONCLUSION: While our results indicate niacin hyposensitivity as reliable biological marker in schizophrenia, they do not provide clear evidence for its heritability. Particularly, the results in adolescent schizophrenia patients are suggestive for the perception of attenuated niacin flushing as secondary to the pathophysiology at the onset of schizophrenic illness, namely increased oxidative stress, alterations of unspecific immune-response or inflammation-like processes.

Changes of pain perception, autonomic function, and endocrine parameters during treatment of anorectic adolescents.

OBJECTIVES: The underlying mechanisms of reduced pain perception in anorexia nervosa (AN) are unknown. To gain more insight into the pathology, the authors investigated pain perception, autonomic function, and endocrine parameters before and during successful treatment of adolescent AN patients. METHOD: Heat pain perception was assessed in 15 female adolescent AN patients and matched controls. Results were correlated with autonomic and endocrine parameters (free triiodothyronine, free cortisol). Autonomic function was studied using heart rate variability and pupillary light reflex assessment. To investigate the influence of therapy on these parameters, data were obtained at three different time points. RESULTS: Heat pain thresholds were significantly increased in the acute state and decreased after weight had been regained for 6 months. Similarly, an increased parasympathetic tone was present in the acute state only. The relative amplitude of the pupillary light reflex showed a positive correlation to pain thresholds over time and predicted disease progression. In addition, the authors found a negative correlation between increased pain thresholds and low free cortisol. CONCLUSION: Increased pain thresholds are associated with increased parasympathetic tone and a hypothyroid state in AN. This may either indicate common central mechanisms or suggest a causative interaction.

Phonological processing in dyslexic children: a study combining functional imaging and event related potentials.

Difficulties in phonological processing are currently considered one of the major causes for dyslexia. Nine dyslexic children and eight control children were investigated using functional magnetic resonance imaging (fMRI) during non-oral reading of German words. All subjects silently read words and pronounceable non-words in an event related potentials (ERP) investigation, as well. The fMRI showed a significant difference in the activation in the left inferior frontal gyrus between the dyslexic and control groups, resulting from a hyperactivation in the dyslexics. The ERP scalp distribution showed a significant distinction between the two groups concerning the topographic difference for left frontal electrodes in a time window 250-600 ms after stimulus onset for non-word reading. Both the fMRI and the ERP results support differences in phonological processing between dyslexic and normal-reading children.