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Biomedical subjects

A Warnke

Publications and source records attributed to A Warnke.

At least 37 records · Page 2Linked to original sources
PubMed2003

[Quality of life of children and adolescents with psychiatric disorders. Results of the 1st multicenter study with an inventory to assess the quality of life in children and adolescents].

OBJECTIVE: A newly developed, disorder-nonspecific instrument to measure the quality of life in children and adolescents (ILK, Mattejat et al., 1998) was tested with regard to its ability to differentiate between psychiatric in- and outpatient samples. METHODS: 626 children and adolescents from regionally different in- and outpatient clinics completed the ILK questionnaire. The data obtained were first described and then analyzed by means of logistic regression analysis. RESULTS: Whereas the descriptive analysis revealed that inpatients evaluated all areas of life more unfavorably than outpatients did, the logistic regression analysis modified these results. It became evident that some of the findings obtained were due to the effects of age and/or gender. However, given age and gender as covariates, there still remained some important life domains in which inpatients were more impaired than outpatients. CONCLUSIONS: The ILK turned out to be an efficient and economic instrument to measure the quality of life in children and adolescents depending on the severity of their disorder. Moreover, it is sensitive to effects of age and gender. As the ILK is able to reliably identify areas with a reduced quality of life, it offers valuable starting points for indications, therapy planning and initial therapeutic interventions.

Activities of Daily Living↗
PubMed2003

[Formal genetic findings in attention-deficit/hyperactivity-disorder].

Twin, family and adoption studies have led to a solid understanding of the contribution of both genetic and environmental factors to the development of attention deficit/hyperactivity disorder (ADHD). We review recent studies under consideration of both methodological aspects and relevant findings. Heritability estimates in the range of 0.6 - 0.8 surpass those for most other child and adolescent psychiatric disorders. First degree relatives have elevated rates for ADHD, affective disorders, conduct disorders and substance abuse and dependency. The ADHD subtype of the index patient does not predict the subtype of other family members affected with ADHD; hence non-genetic factors seemingly account for this intrafamilial variability. Because the familial rates for ADHD are not higher in families of female in comparison to male index patients, there is no indication that the genetic loading is higher in affected females. Recently, rater effects have been discussed broadly: Whereas the heritability estimates are uniformly high independent of the informant (mother, father, teacher), the correlations between quantitatively rated symptoms are low between different informants. Knowledge of the formal genetic aspects of ADHD is a prerequisite for understanding the results of recent molecular genetic studies.

Adolescent↗
PubMed2002

[Children in the drive for thinness. How early anorexia nervosa modifies development].

In adolescents and young women, the prevalence of anorexia nervosa is 0.5-1%. Approximately 5% of all anorectics are younger than 12 years of age. Frequent psychiatric concomitant conditions that develop during the long-term course are depression or dysthymia (in our own patient material approximately 14%) and anxiety (some 28%). In our own studies, healing success was achieved in 54% of the cases; 18% achieved partial remission with remnant symptoms of an unspecific eating disorder, and 28% continued to exhibit anorectic and/or bulimic symptoms. Of prognostic importance were eating disorders in the child's first year and the duration of the catamnesis. The prognosis of anorexia nervosa with onset in childhood does not appear to differ significantly from that of anorexia with onset in adolescence or adulthood.

Adolescent↗
PubMed2002

Structural brain abnormalities specific to childhood-onset schizophrenia identified by neuroimaging techniques.

This review discusses functional and structural brain abnormalities in childhood-onset schizophrenia identified by neuroimaging techniques. Published literature regarding both morphological and functional neuroimaging is discussed, regarding also the diversity of neuroimaging findings which partly reduces their reliability. The findings in early onset schizophrenia are compared with those of adult patients. The results of long-term investigations of structural abnormalities in early onset schizophrenia are given particular attention. The most consistent findings are ventricular enlargement and reduced total brain volume. Further, volumetric changes in the temporal and frontal cortex, thalamus, basal ganglia and limbic system are reported, as are hemispheric asymmetries and, conversely, reduction of normal differences. Findings regarding the corpus callosum and cerebellum are less consistent. In patients whose schizophrenia commenced in early childhood, the differences were generally more marked than in adolescence- or adult-onset schizophrenia. Atrophy of total brain volume was progressive throughout the course of the disorder. It is probable that neuroanatomical cerebral abnormalities present prior to disease onset play an etiopathogenic role in the development of schizophrenia.

Adolescent↗
PubMed2002

5-HT2A promoter polymorphism -1438G/A in children and adolescents with obsessive-compulsive disorders.

Positive association between obsessive compulsive disorder (OCD) and the A-allele of the 5-HT(2A)-receptor promoter polymorphism -1438G/A has recently been reported in adults. We performed an association analysis of this polymorphism in 55 children and adolescents with OCD and in 223 controls consisting of unrelated students. We detected statistically significant differences in genotype (P < 0.05) and allele frequencies (P < 0.05) between individuals with OCD and controls. In this, to our knowledge, first association study based on children and adolescents with OCD, we confirm an association of the A-allele of the 5-HT2A receptor gene with OCD.

Adolescent↗
PubMed2001

A study of cranial computer tomograms in very early and early onset schizophrenia.

The cranial computer-assisted tomograms of 19 patients suffering from schizophrenic psychoses with onset by age of 14 were examined. The emphasis was on the extent of the inner liquor spaces. Compared to healthy controls, at the beginning of illness a significant enlargement was revealed only in the patient group with very early onset schizophrenia (VEOS, onset prior to the age of 12), whereas children with early onset (EOS, 12 to 14 years of age) showed no significant brain pathology. As a second result, an increase in the extent of the inner liquor spaces seems to correlate with the duration of illness. It is therefore concluded that psychoses interfere with neurodevelopmental processes and cause more severe brain pathology in very young children, already detectable at the onset of the illness. EOS, on the other hand, induces progressive morphological abnormalities over the course of the illness.

Adolescent↗
PubMed2001

Olanzapine in children and adolescents with chronic anorexia nervosa. A study of five cases.

Psychopathology in severely anorexic patients often seems to be of compulsive and delusional quality rendering therapeutic approaches extremely difficult. With conventional therapeutic regimes failing, administration of the novel antipsychotic olanzapine induced remarkable improvement in five cases reported here. Paranoid ideation concerning body image or weight gain decreased and sedative effects helped to reduce inner tensions and phobia with respect to food intake. Olanzapine, therefore, might represent an important therapeutic tool in anorexic patients who present the following characteristics: long-term history of anorexia nervosa mostly with several hospitalisations, missing perception of their severe state of illness, refusal of therapy, delusional quality of anorexic thinking, risk of discontinuation of therapy with life-threatening consequences.

Adolescent↗
PubMed2001

Long-term outcome and prognosis of obsessive-compulsive disorder with onset in childhood or adolescence.

The aim of the catch-up follow-up study is to describe the long-term outcome of obsessive-compulsive disorder (OCD) with onset in childhood and adolescence. The psychiatric morbidity in adulthood including personality disorders was assessed and predictors in childhood for the course of obsessive-compulsive symptoms were examined. The total study group consisted of the entire patient population treated for OCD at our departments for child and adolescent psychiatry between 1980 and 1991. We reassessed 55 patients personally by way of structured interviews. The mean age of onset of OCD was 12.5 years and the mean follow-up time was 11.2 years. At the follow-up investigation 71% of the patients met the criteria for some form of psychiatric disorder, while 36% were still suffering from OCD. Of the patients with a present diagnosis of OCD 70% had at least one further clinical disorder (especially anxiety and affective disorders). The most frequent personality disorders diagnosed were obsessive-compulsive (25.5%), avoidant (21.8%), and paranoid (12.7%) personality disorders. In-patient treatment, terminating treatment against advice and tics in childhood or adolescence significantly correlated with more severe OC symptoms in adulthood.

Adolescent↗
PubMed2001

Changes of the brain electrical fields during the continuous performance test in attention-deficit hyperactivity disorder-boys depending on methylphenidate medication.

OBJECTIVE: The continuous performance test (CPT) is successfully applied to evaluate attentional performance in attention-deficit hyperactivity disorder (ADHD)-children. The aim of the present study was to investigate the changes of the topographic P300-features in relation to methylphenidate-medication and to different attentional processes in primer- and distractor-conditions. METHODS: Twenty-one-channel-ERPs of 17 ADHD-boys were analyzed with reference-independent methods. Four quasi stable microstates within the time frames of conventional P100, P200, P3a and P3b components were identified by means of a data-driven segmentation procedure. RESULTS: In segment 3 topographical assessment yielded a significant occipital and right-shift of the positive centroid, longer centroid distance and higher amplitudes in primer- than in distractor conditions. MPH increased the amplitude and distance in primer and distractor-condition, without changing the topography. In segment 4 the electric field strength of distractor-conditions collapsed, whereas the primer condition showed a strong fronto-parietally oriented potential-field. There was a tendency to higher amplitudes due to MPH-medication. CONCLUSIONS: These results indicate a robust neurophysiologic differentiation of cognitive processes. MPH activates an early (P3a) covert attention process indicated by increased amplitudes and centroid. No effects were seen in later processes. Based on these effects, we propose to use the amplitude- and distance-increase in microstate 3 as an indicator of MPH efficacy in ADHD-boys.

Adult↗
PubMed2001

[Long-term course of childhood or adolescence onset obsessive-compulsive disorder: psychosocial adaptation in adulthood].

OBJECTIVE: The aim of the study was to investigate the long-term course of obsessive-compulsive disorder (OCD) with onset in childhood or adolescence. This presentation focuses on the social adjustment of the former patients in adulthood. METHODS: Fifty-five out of 116 patients with childhood OCD classified according to DSM-IV criteria were interviewed personally using structured interviews. Mean age at onset of OCD was 12.5 years, and mean follow-up time was 11.2 years. RESULTS: Despite the evident burden of mental disorder at the time of the follow-up, 76% led their own lives without being overly dependent upon their parents. 84% had no problems that impaired either school or their occupation. 73% were rated as maintaining satisfying social contacts, but only 54% were in a relationship at follow-up. CONCLUSIONS: In agreement with other studies we found an association between the level of psychosocial adjustment and the course of obsessive-compulsive symptoms. Summing up, social adjustment and psychosexual functioning seem to be more impaired than occupational functioning. The relatively good adjustment of our sample indicates that most patients have found a way of managing their lives, albeit still suffering from mental disorders.

Adaptation, Psychological↗
PubMed2001

[Differences between adolescent patients with anorexia and bulimia nervosa with reference to psychological and psychosocial markers].

OBJECTIVES: We present a retrospective study of 140 patients (110 with anorexia nervosa, 30 with bulimia nervosa), hospitalized between 1982-1992 at the Department of Child and Adolescent Psychiatry at the University of Wuerzburg, Germany. METHODS: All patients met the ICD-10 criteria for anorexia nervosa or bulimia nervosa. We collected data from basic documentation and the multiaxial classification (MAS), using a variety of standard instruments such as Anis 32, MMPI, BDI, HAWIK-R and HAWIE. RESULTS: Our findings show significant differences between the two populations. At the time of their first admission anorectic patients were somewhat younger than their bulimic counterparts (14.5 years vs. 16.5 years, respectively). With regard to the typical symptoms of either disorder, the two populations differ in their eating behavior on the factor bulimia described by Anis-32. A comparison of personality features reveals that anorectic patients scored lower than bulimic patients on the MMPI scales, especially on psychopathology, but higher on depression in the BDI. Other characteristics of anorectic patients include a higher-than-average IQ, more enmeshment and overprotectiveness in family relations, more separation anxiety and insufficient communication skills at school. By contrast, bulimic patients demonstrated poorer scholastic performance and more discipline problems at school, while communication among family members was impaired.

Adolescent↗
PubMed2001

[Agranulocytosis in a child with schizophrenia treated with clozapine--clinical findings and therapy, a case report].

OBJECTIVES: The indication of clozapine therapy is governed by special guidelines due to a 1%-3% risk of clozapine-induced agranulocytosis. Up to now there has never been a report of such a case in a child with schizophrenia. The case report presented here is concerned with the clinical features and the treatment of clozapine-induced agranulocytosis in childhood schizophrenia. METHODS: It deals with the treatment of a 12-yearold boy with a schizophrenic psychosis. The psychotic symptoms before treatment and during inpatient treatment are described. The procedures for the diagnosis and treatment of the clozapine-induced agranulocytosis are presented. RESULTS: Clozapine medication may induce agranulocytosis in the treatment of a child with a schizophrenic psychosis. The highly specific guidelines governing its use must be followed as well in the treatment of very early onset schizophrenia. An agranulocytosis may result following 15 weeks of clozapine medication. The treatment with granulocyte colony-stimulating factor seems to support normalization of the blood picture.

Agranulocytosis↗
PubMed2001

[Personality disorders and psychiatric comorbidity in obsessive-compulsive disorder and anorexia nervosa].

The aim of this prospective longitudinal study was to examine the course of adolescent anorexia nervosa and obsessive-compulsive disorder (OCD) (fulfilling DSM-III-R criteria) to compare psychiatric comorbidity and personality disorders of both groups. Because anorexia nervosa patients are mainly female, we compared them only with female OCD patients. Ten years after discharge the whole sample (32 female patients; 100%) of a group of 39 (32 female; 7 male) anorexia nervosa patients could be reexamined personally. 25 (61%) female patients of a group of 116 patients (41 female; 75 male) with obsessive-compulsive disorder were also reexamined. The anorexia nervosa patients were interviewed using the Structured Interview for Anorexia and Bulimia nervosa (SIAB [39]) to assess eating disorder symptomatology. To examine comorbid psychiatric disorders we used the Composite International Diagnostic Interview, WHO [44] and SCID-II [45] for personality disorders. One fourth of the patients with anorexia nervosa (AN) and 20% of the patients with obsessive-compulsive disorder had a personality disorder according to DSM-III-R. Most of them were "Cluster C"-personality disorders (AN: 28%; OCD: 20%). In the group of the female OCD patients 8% schizoid, 4% schizotype and 12% paranoid personality disorders were observed. The most prevalent psychiatric disorders were anxiety (AN: 28%; OCD: 20%) and affective disorders (AN: 16%; OCD: 16%). Our results support the view that in the course of anorexia nervosa and in obsessive-compulsive disorder there is a high prevalence of psychiatric comorbidity and "Cluster C"-personality disorders according to DSM-III-R. These results might confirm a model of a high vulnerability of the serotonergic neurotransmitter system in patients with anorexia nervosa or OCD.

Adolescent↗
PubMed2000

[Diagnostic testing methods for skill assessment in reading, writing, and arithmetic. A critical review].

OBJECTIVES: The diagnosis of a specific developmental disorder of reading, writing and arithmetic can be made based upon individually applied standardized methods for testing scholastic achievement and IQ. To make the choice of suitable methods easier for the administrator of the test, a critical survey of German-language methods for assessing skills in reading, writing and arithmetic is presented. METHODS: Test intention and psychometric properties for scholastic achievement are summarized. The methods are assessed with regard to their utility in the diagnosis of congenital alexia and dyscalculia. Supplementary suggestions for clinical assessment are given. RESULTS: In summary, beyond the primary school area there is a lack of current standardized methods that meet the current standards of quality. Particularly the assessment of arithmetic skills above those of the 4th grade level require resorting to methods of dubious curricular validity. Coverage is once again better for the upper elementary and middle school levels. CONCLUSIONS: There is a need for new constructions, respectively a need to update published scholastic achievement tests.

Adolescent↗
PubMed2000

[Contingent negative variation (CNV) in children with hyperkinetic syndrome--an experimental study using the Continuous Performance Test (CPT)].

OBJECTIVES: Evaluation of event-related potentials for selective attention in attention deficit/hyperactivity disordered children. METHODS: Selective attention processes were examined in a group of 18 boys aged 6 to 12 years with attention deficit/hyperactivity disorder and compared with the data of a control group of 21 age and sex matched boys. Parallel thereto the event-related potentials (ERP) were derived during the test at the electrode positions Fz, Cz, Pz, and Oz with reference to the linked ears. RESULTS: Two components of the contingent negative variation (CNV) with different topography were identified in the ERP following a preparatory stimulus (CNV-1: 600 to 1100 ms and CNV-2: 1000 to 1500 ms after the stimulus). There were no group differences at the behavioural level (number of correct detected targets, number of errors). Significant group differences resulted with regard to the topography of the two CNV components. Children with ADD showed an attenuated frontal CNV-1 amplitude and a trend towards increased CNV-1 and CNV-2 occipital amplitudes. CONCLUSIONS: The results support the hypothesis of impaired frontal inhibitory processes in children with ADD.

Attention↗
PubMed1999

Reading and spelling disorders: clinical features and causes.

Developmental dyslexia (specific reading and specific spelling disorder) is thought to stem from specific features in cognitive processing strongly related to biological maturation of the central nervous system which interact with non-biological learning conditions. The specific learning disorder should not be accounted for by mental age, gross neurological deficits, emotional disturbances or inadequate schooling. As a clinical guideline, the child's level in reading and spelling must be significantly below that expected for the population of children of the same mental age. The persistence rate is high and dyslexia is often associated with psychiatric problems. The etiology is not known. From the biological point of view, dyslexia is supposed to have a neurological basis. Neuroanatomical, neurophysiological, and neuropsychological correlates have been studied by means of autopsy, brain imaging, neurophysiological and neuropsychological methods. There is good evidence that dyslexia is determined by heritable cognitive components of reading and spelling processing. Experimental research focuses on characteristics of brain structure and cognitive skills related to the central nervous systems of auditory-phonological and visual information processing.

Brain↗