[The ecology of ticks, tick-borne diseases and biological tick control in Baden-Württemberg]. / Ökologie von Zecken als Überträger von Krankheitserregern in Baden-Württemberg und biologische Zeckenbekämpfung.

Ticks and tick-borne diseases are of great significance for the health of humans and animals. However, the factors influencing their distribution and dynamics are inadequately known. In a project financed by the Baden-Württemberg Ministry of the Environment, Climate and Energy Industry, as part of the program BWPLUS, interdisciplinary specialists work together to determine the influence of weather, (micro)climate, habitat, land use, human activities, and the population dynamics of host animals on the distribution and abundance of ticks and the diseases that they transmit in Baden-Württemberg. The project comprises four modules: the large-scale distribution of ticks in Baden-Württemberg (module 1), detailed studies of host-tick-pathogen interaction in relation to the microclimate (module 2), and the spatial occurrence of important tick-borne pathogens (module 3). The fourth module involves the comprehensive analysis and synthesis of all data in order to determine the relative importance of the factors studied and to develop a risk model. Recently, intensive investigations into tick control have been undertaken using various entomopathogenic fungi and nematodes as well as a parasitoid wasp. Our aim was to determine whether these natural enemies could be used to effectively reduce the number of free-living ticks.

[ICD-10 diagnosis and quality of life. A pilot study of quality of life of children and adolescents with psychiatric disorders]. / ICD-10 Diagnostik und Lebensqualität. Pilotstudie zur Lebensqualität psychisch auffälliger Kinder und Jugendlicher.

OBJECTIVE: The present study examined whether the quality of life in children and adolescents with psychological disorders, as judged by the patients themselves and their mothers, differed according to the various ICD-10 diagnoses or the number of axes involved. METHODS: 151 children/adolescents and 125 mothers, referred consecutively to the clinic, completed the Inventory for Evaluation of Quality of Life in Children and Adolescents (Inventar zur Erfassung der Lebensqualität bei Kindern und Jugendlichen; ILK) by Mattejat et al. ICD-10 diagnoses were grouped for evaluation. RESULTS: No significant interaction between the five diagnostic axes and the several domains of quality of life was found. However, mothers of children and adolescents with attention deficit/hyperactivity disorders and/or conduct disorder more often tended to judge their children's quality of life as unsatisfactory in all domains, while the patients themselves did not. Thus, rather than the children themselves it seems to be the children's environment which considers "external disorders" to be distressing. CONCLUSIONS: The authors conclude that the quality of life as measured by the ILK cannot be captured by ICD-10 criteria. Apparently it is not so much the diagnosis itself but its subjective meaning that has the most essential impact on an individual's assessment of quality of life.

Spectrum of cognitive, behavioural and emotional problems in children and young adults with Down syndrome.

In comparison to most other groups with intellectual disability individuals with Down syndrome are at lower risk for significant psychopathology, although relative to their typically developing peers they have higher rates of behavioural and emotional problems. A total of 43 Down syndrome patients (21 females and 22 males), who ranged in age from 5.33 to 30.58 years, were examined for the presence of age-related changes in the spectrum of externalizing and internalizing problems. Intelligence tests included Hamburg-Wechsler-Intelligenz Test für Kinder III (HAWIK-III), Hamburg-Wechsler-Intelligenz Test für Erwachsene (HAWIE-R) and Kaufman-Assessment-Battery for Children, German Version (K-ABC). Behavioural and emotional problems were assessed by the the Strengths and Difficulties Questionnaire for Parents, German Version (SDQ) and the Clinical Assessment Scale for Child and Adolescent Psychopathology (CASCAP). IQ was significantly inversly related to the age of patients. Externalizing behaviours (dominant, opposing/refusing, impulsiveness, inattention and increased motor activity) were significantly higher in the 5-10 years old group, whereas internalizing behaviours (shy/insecure, low self confidence, decreased motor activity) where more prevalent in adolescents and adults (10-30 years). Possible relationships between this age-related changes and increased risks of later-onset psychopathology (depression and dementia) are discussed.

[The quality of life of chronically ill and psychiatrically disturbed children. Initial experiences with an inventory for assessing quality of life in children and adolescents]. / Zur Lebensqualität chronisch kranker und psychisch auffälliger Kinder. Erste Erfahrungen mit dem Inventar zur Erfassung der Lebensqualität bei Kindern und Jugendlichen (ILK).

OBJECTIVES: The assessment of the quality of life in chronically ill children as well as in children with emotional and behavioural problems. METHODS: A series of questionnaires (Inventar zur Erfassung der Lebensqualität bei Kindern und Jugendlichen, ILK, Mattejat et al.) were administered to 360 patients and 288 mothers at the Vienna University Children's Hospital. RESULTS: The results clearly show that patients with diabetes rate themselves as the most emotionally burdened and impaired in nearly all aspects of life: a picture which is confirmed by their mothers. Children and adolescents with psychological problems judge the initial problem as well as their social environment as significantly more burdensome. The respective mothers of these psychologically ill children feel that their impairments are greater in more aspects of life than do mothers of children who are chronically ill. The children generally pinpoint most of their difficulties in the areas "ability to occupy myself" and "psychological health". Among adolescents the most negative ratings occur in the areas "school", "psychological health", and "initial problem". CONCLUSIONS: The child's problems seem to weigh heavily upon the mothers. Interventions aimed at adolescents and mothers should be based on problem solving: supportive and anxiety-reducing approaches seem best suited for chronically ill children. Children with psychological problems primarily need problem-centred and practical support.

Changes in attention with hypo- and hyperglycaemia in children with insulin dependent diabetes mellitus.

UNLABELLED: We compared the results of a computerized attention test (TOVA) in 38 children with insulin dependent diabetes mellitus in relation to various spontaneously occurring blood glucose levels. Testing was performed at the following blood glucose levels: <3.3 mmol/1 (hypoglycaemia), 3.3-8.3 mmol/1 (normoglycaemia) and >8.3 mmol/1 (hyperglycaemia). The attention (sum of errors and response time) varied significantly with the blood glucose level (P = 0.002). The highest number of errors of omission and the longest response time was observed during the test run with hypoglycaemia. Age, sex, age at manifestation of the disease, metabolic control and the results of the intelligence test had no significant influence on these results. We found that attention in children with diabetes was significantly reduced compared to TOVA norms especially during mild hypoglycaemia (P < 0.001). Irrespective of the blood glucose levels, reaction time and the variability of the reaction time differed significantly between TOVA norms and diabetic children (P < 0.01). CONCLUSION: In children with diabetes mellitus a significant reduction in attention was found at mild hypoglycaemia but as well at low normal blood glucose levels. Attention deficits due to transient lowering of blood glucose may therefore occur in diabetic children even before they are aware of hypoglycaemic symptoms.

[The "troubled" child from the existential analysis viewpoint]. / Das "auffällige" Kind aus existenzanalytischer Sicht.

Fundamental principles of the "Logotherapy and Existential Analysis", which was founded by FRANKL and further developed by LANGLE, are examined from the view of the Clinical Child and Adolescent Psychology with regard to theoretical aspects as well as to their practice-oriented relevance for the Child and Adolescent Psychiatry and Pediatry. Applying the "existential analytic diagnostic scheme" central subject-matters of finding the purpose in life as personal and existential basic motivations are considered in the differential-diagnostic proceedings and permits--as demonstrated by examples--a holistic consideration of specific problems. The indication of a functional, counseling-attendant or psychotherapeutic intervention depends on the impairment in the dimensions of personal and/or existential meaning-frustration. Finally the significance of personal attitude towards differential diagnosis as well as towards the motivation for therapy is emphasized, a criterion non considered in actual versions of international diagnostic schemes as ICD-10 or DSM-IV.

[Mental health--personality--existentialism. An empirical contribution from the existential analytic viewpoint]. / Seelische Gesundheit--Personalität--Existentialität. Ein empirischer Beitrag aus existenzanalytischer Sicht.

For the purposes of a survey of the correlation between psychic health-personhood-existentiality 211 predominantly higher qualified and in elevated professional positions working adults at the age of 18 to 70 years (43,6% male, 56,4% female) were examined with the Trierer-Persönlichkeitsfragebogen (TPF-Becker, 1989) and the Existenz-Skala (Längle & Orgler, 1991). The results show, that existentiality was found to be a correlative for psychic health to a medium extent in several subscales of the TPF; personhood correlates with psychic health only in the dimension self-transcendence, but not in the dimension self-distance.

[Effect of psychotherapeutic interventions on weight reduction and personality development of a 13-year-old boy with Prader-Willi syndrome]. / Der Einfluss psychotherapeutischer Interventionen auf die Gewichtsreduktion und die Persönlichkeitsentwicklung eines 13jährigen Knaben mit Prader-Willi-Syndrom (PWS).

A 12.10-year old boy (actual weight 88.8 kg, actual height 131.2 cm; 228% overweight) with Prader-Willi-syndrome achieved, after repeated ineffective therapy attempts over a period of 10 years, a weight reduction of 11.8 kg (185% overweight) during a 9-week in-patient treatment. In the following out-patient phase of therapy a further weight reduction of 20 kg (109% overweight) was achieved over a period of 16 months. Apart from the usual modes of action of therapy (reduced energy intake, physical exercise, behaviour modification), family therapeutic and special education interventions were used. These achieved an improvement of the patient's self-esteem, an increase in his competence to act and in his autonomy concerning his diet management, as well as a positive experience of his own abilities and social acceptance by other children and the stabilisation of the dysfunctional family system. It may be assumed that this therapeutic success is dependent on consequent compliance with the system model.

Salivary IgA concentration is influenced by the saliva collection method.

Measurement of salivary IgA is useful for the non-invasive assessment of secretory immunity, especially in children and infants. In our study, the influence of three commonly used methods ("spitting", "suction", "Salivette") of saliva collection on the yield of salivary IgA concentration was analysed in 54 samples of salivary secretion collected from six healthy children according to a cross over protocol. Nephelometrically determined IgA concentrations were significantly lower in saliva collected by the Salivette device (mean +/- SEM: 23 +/- 7 mg/l) than in saliva collected by the suction (46 +/- 8 mg/l) or spitting method (48 +/- 8 mg/l). Salivary flow assessed by the spitting method was inversely correlated with salivary IgA concentration. We conclude that salivary IgA assessment is influenced by the saliva collection method, and that studies dealing with this topic should accurately describe the methods used for collecting saliva so that data may be properly compared.

Production of reactive oxygen species by tubular epithelial cells in culture.

Reactive oxygen species (ROS) have been implicated in the pathogenesis of toxic, ischemic and immunologically-mediated renal injury. Although substantial evidence exists for the production of ROS by glomerular cells, little is known about production of these reactive oxygen metabolites by renal tubular cells. We examined the ability of cultured cells from different segments of the rabbit nephron to elaborate ROS. Under basal conditions, cells of the proximal tubule, cortical collecting duct, and papillary collecting duct produced superoxide anion and hydrogen peroxide. Exposure to opsonized zymosan or heat-aggregated gamma globulin significantly increased ROS production by all three tubular cell types. The production of superoxide anion and hydrogen peroxide was time dependent and increased with increasing concentrations of the stimulating factors. These experiments indicate that renal tubular cells have the potential to participate in renal injury via elaboration of highly-reactive oxygen metabolites.

[The "Adaptive Intelligence Diagnostic Test" in clinical practice: 3 case examples]. / Das "Adaptive Intelligenz Diagnostikum" (AID) in der klinischen Praxis: drei Fallbeispiele.

After the main advantages of the new German intelligence test-battery "Adaptive Intelligence Diagnosticum" (AID) are stated, this paper gives several case-studies in order to illustrate AID's support to clinical psychology. The case-studies are all quoted from a Child-Guidance-like institution. They allow inferences which might not be likely to be gained by some other tests. Besides, they serve for pursuing practical handling, computation, and interpretation of the AID.

[Rooming-in as a therapeutic possibility for a 6-year-old autistic girl]. / Rooming-in als Therapiechance für ein sechsjähriges autistisches Mädchen.

The possibilities of rooming-in as a form of therapy for the psychic abnormal child are demonstrated on the basis of the example of a mother-child-therapy, which lasted six weeks and happened during the stay of mother and child on our station. The patient was a six year old, intellectually retarded girl with autistic behavior disturbances. The points of main effort in our therapeutical interventions were set on reaching a higher selfreliance of the patient as far as every day life-routine was concerned, further more on increasing the child's social and intellectual capabilities and on eliminating the girl's sleeping troubles. In order to reach these aims we started a training in behavior modification (operant conditioning, modeling) for mother and child. The remarkable developmental progresses of our patient are attributed most of all to the thorough efforts that were made in order to improve the abilities of the girl by modifying the contact between mother and child. Besides, the possibility of being able to use the whole day for therapy, to discuss and,--if necessary--to correct immediately the learning experiences that have been made, seems to be a great chance for reaching the appropriate forms of action and interaction in a quicker way.

Visual perception disabilities in epileptic children at the beginning of schooling.

Even among normally intelligent epileptic children learning difficulties occur with relative frequency. It seemed plausible to assume that visual perception problems play an important role. We decided, therefore, to analyse the quantity and quality of such disabilities. 42 epileptic children between 5 and 8 years of age, all capable of attending school, were tested with M. Frostig's Developmental Test of Visual Perception. The results can be summarized as follows: 1. The average perceptual quotient fell below the normal range. 2. There were significant differences in perceptual ability between children with primary generalized epilepsy and those with generalized secondary or partial epilepsy, to the disadvantage of the latter group. 3. In particular the Scaled Score of Subtest II measuring figure ground perception proved to be a sensitive criterion. The Subtest is therefore recommended as a screening method to uncover visual perception deficiencies in epileptic children prior to the beginning of schooling.

[Psychosomal dwarfism with reversible growth hormone deficiency (author's transl)]. / Psychosozialer Minderwuchs mit passagerem Wachstumshormonmangel.

The diagnosis of psychosocial dwarfism in a 9 year-old boy with severe growth retardation (-6 1/2 standard deviations) was deduced from the typical history. The bone age was severely retarded and in the first days after admission a deficiency of growth hormone and other pituitary hormones was established. The change in environment per se led to a spontaneous reversal of the growth hormone deficiency within a short time. A rapid catch up growth was observed over the subsequent 2 1/2 years, as well as a normalisation of the psychological retardation.

[Experiences with autogenic training groups (author's transl)]. / Erfahrungen mit dem Autogenen Training bei einer Kinder- und Elterngruppe.

According to I. H. Schultz, "Autogenic Training" has helped many children with psychosomatic symptoms. The children's symptoms were obviously influenced by disturbed family-situations and so we invited both children and parents to the "Autogenic Training". The treatment was carried out in two parallel groups, 6 children, 3 parents and 3 mothers. The process and the "outcome" of ten group-sessions are described.

[A testpsychological contribution to the etiology of autism (author's transl)]. / Ein testpsychologischer Beitrag zur Ursachenfrage des Autismus.

The results of two psychological experiments (WURST 1976a,b) with a group of ASPERGER autists and KANNER autists and a parallel group considering age and intelligence show, that neither the belief, autism appears as a possible consequence of a psychoorganic syndrom nor the assumption that autistic behaviour is caused by a perception defect, can be proved with testpsychological methods. However, it seems, that KANNERS point of view, referring to autism as an inborn disturbance of the emotional contact influenced also by negative environment comes closest to the problem.

[Combined therapy for a compulsion neurosis (author's transl)]. / Kombinierte Therapie bei einer Zwangsneurose.

Within the scope of the care of mother and child arranged according to behaviour therapeutic and playtherapeutic aspects, manifest fears of separation of a 6 year old, normal talented girl, could be largely reduced after ten meetings. The repeated occurrence of the primary symptoms after a longer, exclusive stay of the patient in her family, confirms the belief, that the striking behaviour of the girl does not express a starting psychotic process but points much more to the symptom-releasing and -reinforcing effect of the family environment. It is planned to continue the treatment in a family-therapeutic way.

[Intelligence prognosis for autistic children (author's transl)]. / Die Intelligenzprognose beim autistischen Kind

The degree of intelligence respectively development quotient, gained in the first test, proved to be a valuable prognosis for autistic children. This has been shown in repeated psychological tests with 13 autistic children (10 boys, 3 girls, aged 4.10-13.6). An at least minimal speech development has a better prognosis as consequence. Usually the patient gains an equal, sometimes an even better result in the second test if any development of speech can be registered. A correlation between progress of speech and improved intelligence and social interests was discovered. Therapeutic support of autistic children, nearly without the ability to speak, may improve development of social reaction and ability of learning. These results, waiting to be verified statistically, underline clearly the prognostic value of single indicators. They also indicate the high correlation between speech, intelligence and social integration.

[Etiology and therapy in anorexia nervosa (author's transl)]. / Zur Atiologie und Therapie der Anorexia Nervosa

ASPERGER (1963) mentioned as a very important etiological aspect of anorexia nervosa a desintegration of intellectual and thymical functions causing the fact, that these patients are not able to accept the role of an adult, especially that one of a woman. We discuss that statment in connexion with ERIKSON'S (1974) concept about "ego-identity" ("Ich-Identitat") and "negative-identity" ("negative Identitat"). The pathological family-structure seems to reinforce the situation and the existence of inadequate behavior of patients with anorexia nervosa, who are often introverted and predestinated for conditioning. The therapy of these patients should focuse on the development of ego-identity, including the treatment of the family members, the modification of the inadapted behavior and a special endocrinological therapy.

[Aerophagia - case history and differential diagnosis (author's transl)]. / Aerophagie. Fallbericht und Differentialdiagnose

Meteorism is a nonspecific symptom and it is difficult to exclude organic causes. In one of our patients, a 6 years old girl, the accumulation of gas had caused changes of the normal abdominal situs. Finally psychogenic aerophagia could be detected by exact analysis of the case history and the daily rhythm of meteorism. The situation within the family could be revealed as trigger mechanism and there an successful therapy was started.