Preliminary validation of the Klenico diagnostic software self-report module through comparison with the diagnostic gold standard in an outpatient routine clinical sample.

Background: Inaccuracy in current diagnostic procedures for mental disorders can lead to misdiagnosis and increase the burden on the healthcare system. Therefore, Klenico, a diagnostic software designed to support comprehensive and efficient clinical diagnostic procedures that is easy to apply in everyday clinical practice, was developed. This study aimed to take the first step toward validating the Klenico self-report module. Methods: Data of 115 patients from a German psychotherapeutic outpatient clinic were included in this study. Criterion validity was tested by comparing Klenico with the diagnoses based on the structured clinical interview for DSM-IV (SCID). Construct validity was investigated by comparing Klenico with commonly used self-reporting questionnaires. Results: The results showed that most of the Klenico disorder domains were able to differentiate between corresponding diagnoses and other diagnoses, confirming criterion validity. Construct validity was demonstrated by high correlations with the compared convergent questionnaire scales and non-significant or low correlations with most of the divergent scales. Conclusions: These preliminary results demonstrate the psychometric properties of the Klenico self-report module and imply that the Klenico system has high potential to improve the accuracy of diagnostic procedures in everyday clinical practice.

Effects of Expectancy on Cognitive Performance, Mood, and Psychophysiology in Healthy Adolescents and Their Parents in an Experimental Study.

OBJECTIVE: Placebo effects on cognitive performance and mood and their underlying mechanisms have rarely been investigated in adolescents. Therefore, the following hypotheses were investigated with an experimental paradigm: (1) placebo effects could be larger in adolescents than in adults, (2) parents' expectations influence their adolescents' expectations and placebo effects, and (3) a decrease in stress levels could be an underlying mechanism of placebo effects. METHODS: Twenty-six healthy adolescents (13.8 ± 1.6 years, 14 girls) each with a parent (45.5 ± 4.2 years, 17 mothers) took part in an experimental within-subjects study. On two occasions, a transdermal patch was applied to their hips and they received an envelope containing either the information that it is a Ginkgo patch to improve cognitive performance and mood, or it is an inactive placebo patch, in counterbalanced order. Cognitive performance and mood were assessed with a parametric Go/No-Go task (PGNG), a modification of California Verbal Learning Test, and Profile of Mood Scales (POMS). Subjects rated their expectations about Ginkgo's effects before patch application as well as their subjective assessment of its effects after the tests. An electrocardiogram and skin conductance levels (SCLs) were recorded and root mean square of successive differences (RMSSD), high-frequency power (HF), and the area under the curve of the SCL (AUC) were analyzed as psychophysiological stress markers. RESULTS: Expectations did not differ between adolescents and parents and were correlated concerning reaction times only. Overall, expectations did not influence placebo effects. There was only one significant placebo effect on the percentage of correct inhibited trials in one level of the PGNG in adolescents, but not in parents. RMSSD and HF significantly increased, and AUC decreased from pre- to post-patch application in adolescents, but not in parents. CONCLUSION: With this experimental paradigm, we could not induce relevant placebo effects in adolescents and parents. This could be due to aspects of the study design such as application form and substance, and that healthy subjects were employed. Nevertheless, we could show that adolescents are more sensitive to psychophysiological reactions related with interventions which could be part of the underlying mechanisms of placebo effects in adolescents.

Comparison of gut-directed hypnotherapy and unspecific hypnotherapy as self-help format in children and adolescents with functional abdominal pain or irritable bowel syndrome: a randomized pilot study.

OBJECTIVE: Psychosocial treatments for chronic abdominal pain in childhood or adolescence are effective, but time consuming and hardly available. In the present study, gut-directed hypnotherapy (GDHT) and unspecific hypnotherapy (UHT) were compared to evaluate the feasibility and efficacy of a hypnotherapeutic self-help intervention. PARTICIPANTS AND METHODS: Children/adolescents between 6 and 17 years of age with chronic abdominal pain were randomized to GDHT or UHT. The treatment period was 12 weeks each. Measurements were performed before and after treatment. The primary outcome was a pain diary. Analysis was carried out as per protocol. RESULTS: Of 45 participants included, 13 were lost to follow-up. Thirty-two participants (14 GHDT, 18 UHT) were analyzed. Dropouts had higher pain severity. Completers in both conditions showed good adherence and a similar decrease in days with pain and pain duration. Pain intensity decreased only in the UHT condition. Eleven participants (two GDHT, nine UHT) achieved clinical remission (>80% improvement) and 13 participants (seven GDHT, six UHT) improved significantly (30-80%). CONCLUSION: Results suggest a high efficacy of standardized home-based hypnotherapy for children/adolescents with abdominal pain. Children/adolescents with high pain severity are at risk of dropping out. The UHT condition showed slight evidence of superiority, but conditions were equivalent on most outcomes. Taken together, self-help approaches based on hypnotherapy could close a treatment gap and prevent chronification.

Sleep and somatic complaints in university students.

BACKGROUND: Sleep problems are common among university students. Poor sleep is associated with impaired daily functioning, increased risk of psychiatric symptoms, and somatic complaints such as pain. Previous results suggest that poor sleep exacerbates pain, which in turn negatively affects sleep. The purpose of the present study was to determine prevalence rates, comorbidity, and role of depression as a factor of moderating the relationship between sleep and physical complaints in German university students. SAMPLES AND METHODS: In total, 2443 German university students (65% women) completed a web survey. Self-report measures included the Pittsburg Sleep Quality Index, three modules of the Patient Health Questionnaire, and a questionnaire on the functional somatic syndromes (FSSs). RESULTS: More than one-third (36.9%) reported poor sleep as assessed by the Pittsburgh Sleep Quality Index. Somatoform syndrome was identified in 23.5%, and the prevalence of any FSS was 12.8%. Self-reported sleep quality, sleep onset latency, sleep disturbances, use of sleep medications, and daytime dysfunctioning were significant predictors of somatoform syndrome, whereas sleep efficiency and sleep duration influenced somatic complaints indirectly. Moderate correlations were found between stress, anxiety, somatoform syndrome, depression, and overall sleep quality. The effect of somatic complaints on sleep quality was associated with the severity of depression. Anxiety shows direct effects on somatization and depression but only indirect associations with sleep quality.

PreDictor Research in Obesity during Medical care - weight Loss in children and adolescents during an INpatient rehabilitation: rationale and design of the DROMLIN study.

BACKGROUND: Obesity in adults and children is increasing worldwide at alarming rates. Obese children and adolescents are likely to become obese adults with increased risk of a number of comorbidities. In addition to preventing the development of obesity at young age, it is necessary to individualize the therapy of already obese children and adolescents in order to increase the likelihood of weight loss and maintenance. Therefore, the aim of this study is to identify predictors which play a significant role in successful weight loss and weight loss maintenance in children and adolescents. METHODS/DESIGN: Over a one year period, 60 obese children and adolescents between 9 to 17 years of age shall be recruited at an inpatient children rehabilitation facility in Germany. They will be investigated twice within a few days following admission and prior to discharge. The study will be an integrated component of an established inpatient weight-loss and in part psychosomatic therapy. The collected data can be grouped into four clusters: 1) demographic, sociometric and psychometric data, 2) objective and subjective parameters of body condition, 3) autonomic nervous system regulated functions and 4) objective and subjective parameters for eating behavior. Primary outcome is the change of the body mass index standard deviation score (BMI-SDS). In order to evaluate the data appropriately, all examinations will be also conducted in a normal-weight reference group, matched for age and gender. DISCUSSION: For some of the collected parameters the time span between measures may be too short. Therefore, a 6 months, 1 year and 2 year follow-up will be performed for evaluating the different predictors and their influence in regard to a successful intervention. Further middle- and long-term follow-up studies are planned. TRIAL REGISTRATION: The study protocol was approved by the Ethics Committee of the University Hospital Tübingen, Germany. This study is registered at the German Clinical Trials Register (DRKS) with the clinical trial number DRKS00005122.

Rome III criteria in parents' hands: pain-related functional gastrointestinal disorders in community children and associations with somatic complaints and mental health.

OBJECTIVES: To determine (a) the prevalence of Rome III abdominal pain-related functional gastrointestinal disorders in a western community sample of children, (b) their associations with sociodemographic factors, and (c) whether children fulfilling Rome III abdominal pain diagnoses show higher rates of psychological distress and somatization. METHODS: Data were collected from parents of 6-10-year-old children who were recruited from 22 public grammar schools in Germany. A total of 1537 questionnaires were included in the analysis. Abdominal pain-related functional gastrointestinal disorders were diagnosed on the basis of questionnaire responses by Rome III criteria. Further, somatic complaints as well as emotional and behavioral problems were assessed. RESULTS: In total, 7.7% of children aged 6-10 years fulfilled the criteria for at least one Rome III abdominal pain-related functional gastrointestinal disorder according to their parents. The most prevalent diagnoses were irritable bowel syndrome (4.9%) and functional abdominal pain (2.0%). Assigned diagnoses were not associated with sociodemographic factors. We could confirm that abdominal pain-related functional disorders, especially irritable bowel syndrome, were strongly associated with somatization and emotional problems in community. CONCLUSION: Rome III abdominal pain-related functional gastrointestinal disorders are a common health problem in children and are, even in community, strongly associated with other somatic complaints and psychological distress.

Mental Strain and Chronic Stress among University Students with Symptoms of Irritable Bowel Syndrome.

Aim. To investigate the degree of mental strain and chronic stress in a German community sample of students with IBS-like symptoms. Methods and Materials. Following an internet-based survey about stress, this study recruited 176 German university students (23.45 ± 2.48 years; 48.3% males) with IBS-like symptoms according to Rome III and 181 students without IBS (23.55 ± 2.82 years; 50.3% males) and compared them regarding current mental strain (SCL-90-R) and the extend of chronic stress. Beyond this, IBS subtypes, IBS severity, and health care utilization were assessed. Results. Students fulfilling IBS criteria showed significantly elevated values of mental strain and chronic stress. Nearly 40% of the IBS group (versus 20% of the controls) reached a clinically relevant value on the SCL-90-R global severity scale. IBS subtypes did not differ in terms of mental distress or chronic stress. Somatization, anxiety, and the chronic stressors "work overload," "social tension," and "dissatisfaction with job" were most closely connected to IBS symptom severity. Regarding health care utilization, our results show that consulting a physician frequently was not associated significantly with elevated mental strain or chronic stress but with IBS symptom severity. Conclusion. Our data contribute additional evidence to the distinct association between psychological stress and IBS in community samples.

Placebo effects in children: a review.

Of more than 155,000 PubMed citations found with the search term "placebo," only ~9,000 (5.8%) included the terms "children" or "adolescents." When all these papers were screened, only ~2,000 of them investigated the placebo effect per se, and of those, only ~50 (2.5%) discussed the placebo effect in children and adolescents. In this narrative review, we explore four aspects of the placebo response in children and adolescents: (i) the legal and ethical limitations and restrictions for the inclusion of children in clinical trials as well as in experimental (placebo) research that may explain the poor knowledge base; (ii) the question of whether or not the placebo effect is larger in children and adolescents as compared with adults; (iii) whether the mechanisms underlying the placebo effect are similar between children and adults; and (iv) whether mediators and moderators of the placebo effect are comparable between children and adults. We finally discuss some of the consequences from the current placebo research in adults that may affect both experimental and clinical research in children and adolescents.

Sleep characteristics, sleep problems, and associations of self-efficacy among German university students.

BACKGROUND: Sleep problems, especially insomnia, are a common complaint among adults. International studies on university students have shown prevalence rates between 4.7% and 36.2% for sleep difficulties, and 13.1% and 28.1% for insomnia. Sleep problems are associated with lower social and academic performance and can have a severe impact on psychological and physical health. OBJECTIVE: The goal of this study was to outline sleep characteristics, prevalence of sleep problems, insomnia, and associations with self-efficacy among German university students. METHODS: A total of 2196 university students (70.9% women; mean age 24.16 years) participated in the study. Sleep characteristics, sleep problems, insomnia, and self-efficacy were assessed using a questionnaire. RESULTS AND CONCLUSION: Analyses revealed that more than 16% of surveyed students needed more than 30 minutes to fall asleep. About 7.7% of the students suffered from insomnia. Short sleep was significantly associated with a considerably increased rate of insomnia (20%). Insomniacs showed lower self-efficacy than students without sleep problems.

[Hypnotherapeutic treatment approaches in children and adolescents suffering from functional abdominal pain]. / Hypnotherapeutische Behandlungsansätze bei funktionellen Bauchschmerzen im Kindes- und Jugendalter.

Functional abdominal pain significantly impairs day-to-day function. It is one of the most frequent somatic complaints among children and adolescents. For most of those affected, despite some indication of their possible presence, physiological factors fail to explain the symptoms adequately. The increased level of psychological symptoms suggests that the focus should be on behavioural and psychological aspects. Brief hypnotherapeutic treatment methods show encouraging results. A review of the current literature; potential mechanisms of effective intervention and their practical applicability are discussed.

Recurrent abdominal pain in children and adolescents - a survey among paediatricians.

OBJECTIVE: Little is known about prevalence and usual treatment of childhood and adolescent recurrent abdominal pain (RAP) in outpatient paediatricians' practice. This study's primary objective was to acquire insights into the usual paediatricians' treatment and their estimation of prevalence, age and gender of RAP patients. Further objectives were to assess to which extent family members of patients report similar symptoms, how paediatricians rate the strain of parents of affected children and adolescents and how paediatricians estimate the demand for psychological support. METHODS: Provided by a medical register, 437 outpatient paediatricians received a questionnaire to assess their perception of several psychosomatic problems and disorders including recurrent abdominal pain. RESULTS: According to paediatricians' estimation, 15% of all visits are caused by patients with RAP. In 22% of these cases of RAP, at least one family member has similar problems. In about 15% of all RAP cases, parents ask for professional psychological support concerning their children's issues, whereas 40% of paediatricians wish for psychological support considering this group of patients. CONCLUSIONS: Estimated frequencies and paediatricians' demands show the need for evidence-based psychological interventions in RAP to support usual medical treatment.

Irritable bowel syndrome symptoms among German students: prevalence, characteristics, and associations to somatic complaints, sleep, quality of life, and childhood abdominal pain.

OBJECTIVES: Irritable bowel syndrome (IBS) is a common disorder in the general population, and is linked to considerable impairments in daily functioning. Little is known about the prevalence of IBS symptoms among students. This study examined the prevalence and characteristics of IBS, sex differences, associations to other somatic complaints and sleep, quality of life (QoL), and childhood abdominal pain in a German university student population. METHODS: Using an Internet-based questionnaire, we assessed IBS criteria (according to Rome III), health complaints, health-related QoL (12-item short-form), healthcare-seeking behavior, absenteeism from classes, and subjective attributions in a sample of 2399 university students (mean age: 24.16 years; 1701 female and 696 male students). RESULTS: The prevalence of IBS-like symptoms was 18.1% with a significant difference between male (15.2%) and female (21.0%) students. Logistic regression models showed that being long-term student doubles the risk for having IBS [adjusted Odds ratio (OR)=2.16], as did the presence of other health problems: recurrent backaches (adjusted OR=2.15), troubles falling asleep (adjusted OR=1.52), and recurrent abdominal pain during childhood (adjusted OR=2.01). The IBS group had significant impairment on 12-item short-form physical and mental dimensions compared with asymptomatic students. Approximately 60% of participants fulfilling IBS criteria never consulted a physician. Male students attributed their symptoms significantly more to nutrition than female students did, who attributed their symptoms significantly more often to stress and anxiety. CONCLUSION: IBS is a common syndrome among German university students and goes along with impaired health-related QoL. According to our data, students reporting recurrent abdominal pain in childhood are especially at risk for IBS.

[Psychological diagnostics of functional abdominal pain in children and adolescents]. / Psychologische Diagnostik funktioneller Abdominalschmerzen bei Kindern und Jugendlichen.

Given the high prevalence and possible psychosocial consequences of functional abdominal pain in children and adolescents, appropriate instruments for early diagnostics are required to work effectively against long-term chronic courses of this disorder. This report describes several self-report scales and reviews their applicability. In addition, questionnaires and interviews which assess pain intensity and associated factors as well as specific instruments for assessing functional abdominal pain in children and adolescents are introduced. It can be declared that none of the examined instruments grasps all relevant factors of pain. Especially in German there are only few appropriate diagnostic instruments for functional abdominal pain in children.