TDM in Saxonia (Germany).

Conca et al. complain insufficient TD use in Italy. This survey suggests that the situation and possibly also the reasons are similar in the German Federal Republic.

[Patient satisfaction with outpatient psychological services]. / Patientenzufriedenheit mit ambulanten psychologischen Dienstleistungen.

A validated questionnaire regarding patient satisfaction with psychological services is reported. There is a German and an Italian version, with a total sample size of 655 persons. Based on satisfaction criteria generated by the patients themselves, a preliminary version and consecutively the final version, computed according to psychometric criteria, were developed. Internal consistency complied with scientific requirements (Cronbach alpha=0.95 and 0.96, respectively). The outcome was a one-dimensional satisfaction factor, empirically subdivided into "relationship" and "treatment outcome". Main indication of the questionnaire is the demonstration of process quality. There are also preliminary results with respect to congruence validity.

St. John's wort may improve some symptoms of attention-deficit hyperactivity disorder.

There is evidence for the efficacy of noradrenaline and serotonin reuptake inhibitors treating attention-deficit hyperactivity disorder (ADHD). In this open trial, we checked St. John's wort, a serotonin and noradrealine reuptake inhibitor, and actually used as an antidepressant, for this indication. Three 14-16-year-old male psychiatric outpatients, diagnosed with ADHD have been rated at baseline and while taking St. John's wort or a placebo, respectively, by the Conner Scale and by the Continuous Performance Test, to determine its efficacy as a treatment option for ADHD. Patients' mean scores improved for Conners' hyperactivity, inattention and immaturity factors. Although the sample size is very small and therefore generalisation is very difficult, this observation indicates that St. John's wort might be a slightly effective treatment for ADHD also.

Observational study: Matricaria chamomilla may improve some symptoms of attention-deficit hyperactivity disorder.

OBJECTIVE: Noradrenaline and serotonin reuptake inhibitors have been proven to be effective in some cases of ADHD. In this open trial, Matricaria chamomilla, a serotonin and noradrealine reuptake inhibitor, actually used as an antidepressant, has been checked for this indication. METHOD: Three 14-16-year-old male psychiatric outpatients, diagnosed with attention-deficit disorder (ADHD) have been rated at baseline and while taking Matricaria chamomilla to determine its efficacy as a treatment for ADHD. Improvement was valuated using comparisons of Conners' parent ratings. RESULTS: Patients' mean scores improved for Conners' hyperactivity, inattention and immaturity factors. CONCLUSIONS: Although the sample size is very small and therefore generalization is very difficult, this observation indicates that Matricaria chamomilla might be a slightly effective treatment also for ADHD.

Panax ginseng may improve some symptoms of attention-deficit hyperactivity disorder.

OBJECTIVE: In this open trial, Panax ginseng, a serotonin and norepinephrine reuptake inhibitor, actually used as an antidepressant, has been investigated for its efficacy in the treatment of attention-deficit hyperactivity disorder (ADHD) patients. METHOD: Three 14-17-year-old male psychiatric outpatients, diagnosed with ADHD disattention type have been rated at baseline and while taking Panax ginseng to determine its efficacy as a treatment for ADHD. Improvement was determined using comparisons of Conners' parent ratings. RESULTS: Patients' mean scores improved for Conners' hyperactivity, inattention, and immaturity factors. CONCLUSIONS: Although the sample size is very small and generalization is very difficult, this observation indicates that Panax ginseng may be a slightly effective treatment for ADHD.

[Long-term effects of prepartal mother-child-attachment]. / Langzeitauswirkungen der pränatalen Mutter-Kind-Bindung.

There is much controversial discussion about possible associations of delivery and the perinatal period and later developmental parameters, but recent studies practically not include any possible influence of mother-child attachment during pregnancy and in the postnatal period. This long-time observation should indicate possible associations of this kind. The results show, that avoidant attachment during pregnancy may have some negative influence on later attachment. Furthermore, prenatal ambivalent attachment may lead to also ambivalent attachment in the postnatal period. Prenatally secure attachment may help to beware later avoidant attachment and vice versa. As our results indicate, intrauterine fetal movements do not predict later attachment.

[Neuropsychiatric bases of the methylphenidate-therapy of the attention deficit/hyperactivity disorder (ADHD)]. / Neuropsychiatrie des Methylphenidat bei der Aufmerksamkeits-Defizit/Hyperaktivitäts-Störung (ADHS).

High prevalence and high co-morbidity rates with frequently aggravating psychosocial problems make the attention-deficit/hyperactivity disorder (ADHD) of children, adolescents and adults an important target for research and healthcare. Recent findings suggest a dopaminergic fronto-striatal information processing deficit in ADHD-patients (executive functions). This review summarizes and presents, in the context of recent studies (MRI, f-MRI, PET, SPECT, Mapping Genes) the neurobiochemical bases of the methylphenidate-therapy, clinically successfully applied since almost one half century by the ADHD. The increased striatal dopamine transporter density by the ADHD-methylphenidate-responder is reported as a scientifically sound and useful clinical working model.

Family conflict tendency and ADHD.

A lack of perseverance, poor attention, and poorly modulated behaviour are important criteria of Attention Deficit Hyperactive Disorder (ADHD). Instructions often have to be repeated, sometimes even by different family members before a child with ADHD attends and complies. We hypothesised that a child with ADHD might cause less disagreement in families with almost no conflicts. Responses to the Mannheim Parents Interview and teacher's form of the Conners scale completed by families of 15 boys (ages 6 to 12 years), diagnosed with ADHD were compared with those of a matched, healthy control group of 15 boys. Parents completed a form assessing the family's cooperation and child-rearing practices. Having few family conflicts, i.e., almost no Verbal Disagreement may reduce Physical Punishment and Anger and Disregard and augment the Openness to another's needs and, for that reason, have protective effects on children's behaviour modulation.

Onset of coeliac disease: a prospective longitudinal study.

AIM: To make a prospective assessment of close family members of patients with coeliac disease (CD) by testing their endomysium (EMA) and antigliadin antibodies once a year over a period of 12 y and to investigate whether and when they would develop a positive serology for CD while on a gluten-containing diet. METHODS: Since first-degree relatives of CD patients have a high prevalence of CD, we screened 92 children and adolescents, all first-degree relatives of coeliac patients, for EMA and total IgA antibodies, once a year. RESULTS: Among 11 relatives, at the time of the first screening, 6 already had a positive serology and histology for CD, while 5 became positive only after a period of 2 to 5 y of negative testing. The jejunal mucosa biopsy of these five relatives with retarded positive serology for CD showed a flat mucosa in four of them and a partial villous atrophy in one. They were all HLA DQ2 positive and clinically silent for CD. CONCLUSION: CD can manifest itself after years of negative serological testing.

Brief report: melatonin facilitates sleep in individuals with mental retardation and insomnia.

Mentally retarded people typically exhibit poor sleep efficiency and reduced nocturnal plasma melatonin levels. The daytime administration of oral melatonin to those people, in doses that raise their plasma melatonin levels to the nocturnal range, can accelerate sleep onset. We examined the ability of similar, physiological doses to restore nighttime melatonin levels and sleep efficiency in mentally retarded subjects with sleep deficits. In a double-blind, placebo-controlled study, mentally retarded subjects (n = 20) received, in randomized order, a placebo and two melatonin doses (0.1, and 3.0 mg) orally 30 minutes before bedtime for a week. Treatments were separated by 1-week washout periods. Sleep data were obtained by polysomnography on the last three nights of each treatment period. The physiologic melatonin dose (0.3 mg) restored sleep efficiency (p < 0.0001), acting principally in the midthird of the night; it also elevated plasma melatonin levels (p < 0.0008) to normal. The lowest dose (0.1 mg) also improved sleep.

Features in families of boys with hyperkinetic and emotional disorders.

Standardized assessment of a family's characteristics (conflict management, cohesion, etc.) is not used routinely, although these variables may play an important role in the course of psychological disorders in children. The present study investigated differences within the features of families of children with hyperkinetic and emotional disorders. Families of 20 boys diagnosed with Attention Deficit Hyperkinetic Disorder and 20 boys with Emotional Disorder (ages 6-12 years) by giving the Mannheim Parents Interview and the teacher's form of the Conners scale were included for evaluation and compared with a matched, healthy control group of 20 boys. Parents were asked to complete a form assessing the family's characteristics ("Familienklima-Testsystem"), including Cohesion, Expressiveness, Conflict Tendency, Individual Independence, Achievement Orientation, Intellectual-Cultural Orientation, Active-Recreational Orientation, Moral-Religious Emphasis, and Organization. Comparison of groups was made by the Kruskal-Wallis test and Mann-Whitney U test. There are significantly more conflicts in families whose children belong to the two disorder groups. Compared with a matched healthy control group, there is low Expressiveness, Independence, and Cultural and Active-Recreational Orientation in the Emotional Disorder group and a significant lack of Organization and Cohesion in the Attention Deficit Hyperkinetic Disorder group. Altogether there seems to be a significant association of Attention Deficit Hyperkinetic Disorder symptoms with the family's Cohesion and Organization. One implication is that therapists focus their efforts not only on the children with disorders but also on their families.

Family coherence and ADHD.

A lack of perseverance, poor attention, and poorly modulated behaviour are important criteria of Attention Deficit Hyperactivity Disorder (ADHD). Instructions often must be repeated, sometimes even by different family members, before a child with ADHD attends and complies. The hyperkinetic child might cause less disruption in families with high coherence. Families of 15 boys (aged 6 to 12 years) diagnosed with ADHD using the Mannheim Parent's Interview and the teacher's form of the Conners scale were compared with a matched healthy control group of 15 boys. Parents completed a form assessing the family's cooperation and childrearing practices. Intrafamilial coherence seems to have little positive association with the family's characteristics, especially for boys with Attention Deficit Hyperactivity Disorder. Low coherence among family members may reduce ADHD symptoms and may have protective effects on children with ADHD.

Features in families and family relationships.

Standardized assessment of family features is not used routinely, although these factors may play an important role in the course of children's psychological disorders. The present study investigated the association among relationships within the families of 115 healthy children (M=8.2 yr., SD=2.13; 70 boys, 45 girls). 115 mothers and fathers were asked to complete a standardized questionnaire assessing the family features (Familienklima-Testsystem by Schneewind, et al.) and another asking for their estimation of emotional relationships of the members of the family (Subjektives Familianbild-Test System by Mattejat). Analysis showed that the parents' ratings indicated significantly more empathic fathers as well as significantly more autonomous mothers in well-organized, conflict-free families. Our results indicate an association between families' organization and measured scores for fathers' empathy and mothers' autonomy. Sufficient intrafamilial communication is associated with roles of the parents within the family. Psychotherapeutic interventions might focus on the families' organization.

Cognitive function and fMRI in patients with multiple sclerosis: evidence for compensatory cortical activation during an attention task.

Mild cognitive impairment has frequently been reported for patients in the early stages of multiple sclerosis. The aim of the present study was to measure whether altered cortical activation during a sustained attention task occurs along with limited extent of neuropsychological problems. Expanded brain activation of multiple sclerosis patients with normal motor function compared with healthy controls during a finger tapping paradigm has previously been reported. Compensatory brain activation in patients with multiple sclerosis compared with normal controls may also be observed when the subjects are performing cognitive functions. In 21 patients with clinically definite relapsing-remitting multiple sclerosis, a psychometric assessment was performed using the Wechsler Memory Scale (WMS) and the Multiple Sclerosis Functional Composite Score (MSFC). In addition, functional MRI was performed during a Paced Visual Serial Addition Task (PVSAT), a visual analogue of the Paced Auditory Serial Addition Task (PASAT). All patients were within 3 years of diagnosis and were not suffering from a relapse at the time of investigation. The multiple sclerosis patients were compared with a control group of 21 healthy volunteers matched for handedness, age, years of education and sex. With regard to psychometric results, the WMS general memory score showed statistically significant differences between patients and controls. We did not find differences for either the MSFC or the PASAT scores. A group analysis of the functional imaging data during the PVSAT revealed different activation patterns for patients compared with control subjects. In healthy volunteers, the main activation was found in the frontal part of the right gyrus cinguli (Brodmann area 32). In patients, the main activation was detected at the right hemispheric frontal cortex (Brodmann areas 6, 8 and 9). In addition, the left hemispheric Brodmann area 39 was activated. We interpret the different patterns of activation, accompanied with intact performance in a sustained attention task of our multiple sclerosis sample compared with healthy controls, as the consequence of compensatory mechanisms. This is an expression of neuronal plasticity during early stages of a chronic disease.

[Early childhood psychosis versus early childhood autism? Differential diagnosis based on one week observation in an inpatient setting]. / Frühkindliche Psychose versus Frühkindlicher Autismus? Differentialdiagnose aufgrund einer einwöchigen Beobachtung im stationären Setting.

We report on the case of a 4-year old child suffering for the past six months from a lingering psychotic development. Several months of outpatient observation did not permit a clear differential diagnosis of either childhood autism or an early psychosis. During a one-week inpatient stay at our hospital recurring productive-psychotic episodes were observed that finally led to the exclusion of the diagnosis of "childhood autism" (ICD-10 F 84.0 (Dilling et al., 1993)) and to the diagnosis of "other disintegrative childhood disorder" (ICD-10: F 84.3 (Dilling et al., 1993)).