Prevalence of Somatic Symptoms and Somatoform Disorders among a German Adolescent Psychiatric Inpatient Sample.

Somatoform disorders (SD), commencing during adolescence, represent a major problem in health care systems. While literature underlines the high presence of mental health problems among children and adolescents afflicted by somatic symptoms in the general population, limited evidence is available on the prevalence of comorbid somatic symptoms in child and adolescent psychiatric populations. We assessed the prevalence of somatic symptoms, depression, and anxiety by validated questionnaires in an inpatient cohort. We further screened for the presence of SD. Out of 434 inpatients aged 11-17 years, 371 were included and a total of n = 288 (77.6%) children and adolescents participated in the study. A total of 93.8% of the inpatients reported somatic symptoms within the past six months and still almost half (45.7%) of the sample reported at least one somatic symptom within the last seven days prior to inquiry. Relating to the past six months, 59.5% were positively screened for SD, and 44.6% reported symptoms eligible for positive screening within the past seven days prior to the survey. Somatoform symptomatology was highly associated with anxiety and depression scores, but functional decline was amenable to the number of somatic symptoms only. We provide evidence that somatic symptoms are frequent in children and adolescents being treated in child and adolescent psychiatry and are relevant to everyday functioning. Screening for somatic symptoms should be introduced in the routine diagnostic procedures for early detection of SD in the commencing stages.

Child and adolescent psychiatry staff's knowledge on pain management.

OBJECTIVE: To assess the level of child and adolescent psychiatric staff's knowledge regarding pain management, to determine group differences between the medically more educated (physicians, nurses) and the less educated (psychologists, educators, special therapists) and to investigate the influence of gender, age, or professional experience as well as staff's own pain experiences. METHODS: A total of 193 staff members from different professional backgrounds from three independent child and adolescent psychiatry clinics in Northern Germany were tested using the German version of the Pediatric Nurses' Knowledge and Attitudes Survey Regarding Pain Shriner's revision (PNKAS-Sr). RESULTS: In total, the staff scored correctly 66% of the inventory questions. There was no difference between medically more educated and less educated staff members regarding the knowledge of pain management. The main factors influencing PNKAS score were age, profession, and pain education training. CONCLUSIONS: Although chronic pain is not one of the main aspects of continuing education in child and adolescent psychiatry, the resulting level of knowledge was comparable to results of similar surveys with paediatric staffs. Nevertheless, further education is needed to enhance knowledge and understanding of children's pain in child psychiatry staff in order to professionally treat patients with chronic somatic and mental illnesses.

[Parental responses to child pain : The role of parental and child somatic and anxiety symptoms]. / Elterliche Reaktionen auf kindliche Schmerzen : Die Rolle von kindlichen und elterlichen Somatisierungs- und Angstsymptomen.

BACKGROUND: Parental cognitive-affective and behavioural responses impact on the chronification of the child's pain. Whether mothers and fathers differ in their responses and whether top-down variables (parental somatization, anxiety symptoms) and bottom-up variables (child's pain-related disability, anxiety symptoms) impact on parental responses remains unresolved. OBJECTIVES: (1) A comparison of maternal and paternal somatization, anxiety, symptoms and their responses (parental catastrophizing, solicitousness) to children with chronic pain; (2) an analysis of the impact of top-down variables (parental somatization, anxiety symptoms) and bottom-up variables (child's pain-related disability, anxiety symptoms) on parental maladaptive responses. METHODS: Pediatric chronic pain and anxiety symptoms, parental somatization and anxiety symptoms, as well as parental responses in N =21 parent-child triads (child, mother, father; N = 21 each, total-N = 63; children: 50% female, 11-19 years, ∅15.14 years) were assessed via validated questionnaires during child and adolescent psychiatric treatment for child chronic pain. RESULTS: Mothers and fathers did not differ in somatization, anxiety symptoms and responses. Parental catastrophizing was higher if the child suffered from anxiety symptoms and from pain-related disability. Parental solicitousness was higher if parents reported more own anxiety symptoms. Younger children and girls received more solicitous responses. CONCLUSION: As shown by previous studies, parental and child anxiety symptoms, but not parental gender, play a pivotal role in modulating parental maladaptive pain-related responses. This should be taken into account in prevention as well as in the treatment of children with chronic pain and their caregivers.

Perceptual filling-in of negative coloured afterimages.

Filling-in of brightness, colour, and texture refers to the perceptual spreading of surround features onto the target area. This phenomenon has been extensively investigated in real images. Here, we study colour spreading in afterimages of disk-ring patterns, using a variety of colour combinations. We show that colour filling-in and filling-out in afterimages follow rules different from those found for real images, suggesting that the brain treats afterimages as genuine 'stimuli'.

Spatial extent and figural factors in backward masking.

Spatial and figural characteristics of backward masking were studied, with two collinear arcs presented end-to-end and serving as target and mask, respectively. Stimulus onset asynchrony was 50 ms while interstimulus interval was 0 ms. Mask exposure duration required for masking was determined as a function of target length with mask length as a parameter. The exposure duration of the mask required for complete masking varied directly with target length, but inversely with mask length. The fact that masking strength increased with mask duration while all other parameters were kept constant suggests that masking depended on stimulus termination asynchrony. Maximal masking occurred for target arcs as long as 5.0 deg of visual angle, exceeding previously reported distances. Misaligned or differently shaped stimuli produced less masking, suggesting that figural factors play a role in long-range backward masking.

Masking, persistence, and transfer in rotating arcs.

We demonstrate that the apparent length of a thin white arc on a black disk, rotating concentrically at 2.5 rps, varies with angular length and exposure duration. While short arcs (9-18 degrees ) gradually expand, long arcs (36-72 degrees ) first undergo a brief contraction, before they also expand. On average, perceived elongation asymptotes after 15 s equivalent to visual persistencies ranging from 68 to 170 ms. Using bi- and tri-colored arcs, we find that the apparent increase in length derives from the rear end of the rotating stimulus, while the initial shrinkage derives from contraction of the middle. After 15 s of adaptation, perceived length of the arc decays to actual stimulus length within an average of 6 s and, upon re-exposure of the arc, reaches its former value after only 5 s (priming). When the rotating arc is presented first to one eye and then to the other, apparent elongation transfers partially (46%), suggesting a contribution by the binocular cells in the visual cortex. A partial transfer (26%) also occurs from clockwise to counterclockwise rotation. When tested interocularly, the directional transfer is more pronounced (47%) and equals the interocular transfer under equidirectional conditions, suggesting that the directional transfer (cw versus ccw) might derive from non-directional cortical units. Whereas the initial contraction may be attributable to backward masking, the observed elongation likely reflects a cumulative build-up of after-discharge in cortical neurons over time.