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Biomedical subjects

H Remschmidt

Publications and source records attributed to H Remschmidt.

At least 181 records · Page 10Linked to original sources
PubMed1994

[Early manifestations of schizophrenic psychoses].

Schizophrenic disorders in childhood are rare. Only about 0.5 to 1% of all such disorders have their onset before age 9 and about 4% before age 14. In puberty and early adolescence, however, there is a marked increase in the frequency of such disorders. In childhood more boys seem to be affected, but during adolescence this difference seems to disappear. Possible etiological factors currently under discussion are genetic factors, neurointegrative deficits, attentional deficits, communication deficits and conspicuous premorbid features. With regard to the latter, the authors could show that positive and negative symptoms appear months or even years before the first manifestation of the disorder requiring inpatient treatment. From this perspective schizophrenic disorders in general and those with early onset in particular fit a dimensional model of illness better than a categorical one. In the development of preventive measures more attention to premorbid features is essential.

Adolescent↗
PubMed1994

[Follow-up dynamics of schizophrenic diseases in adolescence].

In the present study the clinical features of the first episode of schizophrenia were investigated retrospectively and the initial symptomatology was compared with follow-up findings. The study group consisted of 40 adolescents with chronic schizophrenia. During a one-year follow-up period positive and negative symptoms of schizophrenia and depressive symptomatology were evaluated every six weeks. When the patients entered the follow-up study the mean duration of their illness was 4.3 years. Our data revealed a close link between positive and negative symptoms during the period studied. Persistent positive symptomatology at the end of the first treatment period was predictive of high scores for positive and negative symptoms during the entire follow-up period. Furthermore, we were able to demonstrate that negative symptoms can be distinguished from depressive symptoms in the context of the schizophrenic symptomatology. Depressive states (Brief Psychiatric Rating Scale, BPRS) were closely related to the positive symptoms (assessed with the Andreasen scale SAPS), and the negative symptoms (SANS) were correlated with the anhedonia score on the BPRS. Our results suggest that productive symptomatology should be treated aggressively both initially and for a prolonged period of time thereafter. Positive and negative symptoms appear to be related to each other longitudinally. Thus we postulate a single disease process rather than two distinct types of adolescent schizophrenia.

Adolescent↗
PubMed1994

[Effect of clozapine on biogenic amines within the scope of drug treatment of schizophrenic psychoses in adolescence].

Longitudinal assessments (every six weeks for one year) were made of plasma norepinephrine, dopamine, epinephrine and 3-methoxy-4-hydroxyphenylglycol (MHPG) in 40 adolescents with schizophrenia, 20 on clozapine therapy and 20 on conventional medication. In addition to the plasma catecholamine determinations, serum levels of 5-HT were determined as a measure of serotoninergic status. All analyses were performed by HPLC-ECD (high-performance liquid chromatography with electrochemical detection). Clinical ratings of symptomatology were obtained with the Brief Psychiatric Rating Scale (BPRS) and the Andreasen scales for negative and positive symptoms (SANS and SAPS). Compared with the typical neuroleptic medication, clozapine administration was accompanied by a significant increase in plasma norepinephrine and MPHG and serum serotonin levels. The fluctuations in the biogenic amines were closely associated with the observed symptomatology. Plasma MHPG was linked to depressive symptoms (BPRS), and negative symptoms (SANS) were related to changes in the serum serotonin levels. The pathophysiological implications and clinical consequences of these findings are discussed.

Adolescent↗
PubMed1994

[Therapeutic capacities of a university child and adolescent clinic with regional responsibilities and associated facilities].

In a clinical population of more than 10,000 children and adolescents the therapies used were analyzed statistically. The sample consisted of all children and adolescents referred to the Department of Child and Adolescent Psychiatry of the University of Marburg or one of its associated facilities between 1983 and 1991. Usage at each facility (inpatient wards, outpatient clinic, day treatment ward, mobile child psychiatric service and child guidance clinic) was analyzed separately. The facilities differed markedly regarding the age and sex distribution of the clients, diagnoses made, types of treatment used and overall duration of treatment. Furthermore, the duration and intensity of different types of treatment (psychotherapy, functional therapies, parent- and family-oriented interventions, other context-oriented interventions, pharmacological treatment) differed substantially at the different facilities. Overall a central component of treatment was work with the parents and other family members; in quantitative terms, drug treatment was of minor importance. With many patients and families a combination of two or more different types of treatment was used; therefore it is very important to integrate the different therapies into a treatment plan tailored to the individual and with consistent goals. The results are discussed in connection with quality assurance.

Adolescent↗
PubMed1994

[The value of various forms of therapy in a university child and adolescent psychiatric clinic and associated facilities. Methodological aspects and contents of therapy documentation within the scope of quality assurance].

This study is an extension of an investigation by the same authors in which the treatment provided by a university child psychiatry department and associated facilities was analyzed. First a system for the assessment of therapeutic measures for children and adolescents with psychiatric disorders and their families is presented. Then the frequency of use of the different forms of therapy in a sample of more than 10,000 referred children and adolescents is discussed. The statistical analysis was conducted separately for the different facilities (inpatient wards, outpatient clinic, day treatment ward, mobile child psychiatric service and child guidance clinic). The results show the relative importance of the different types of treatment in the field of child and adolescent psychiatry. Furthermore, they show how the frequency and intensity of use of the different treatment forms varies in the different facilities. In some treatment categories (e.g. pharmacological treatment) there are significant differences among facilities, whereas in others (e.g. parent counseling and family-oriented interventions) the rate of usage is about the same at all facilities. With regard to methodology, the question is discussed of how treatment effectiveness can be assessed and documented in a practicable and meaningful way.

Adolescent↗
PubMed1993

Depression in anorexia nervosa at follow-up.

This study set out to investigate the correlation between depressive symptomatology and the eating disorder psychopathology at a 3-year follow-up after discharge of 34 adolescent anorexia nervosa patients. Three standardized rating instruments were employed to assess depression and two defined outcome criteria were used to assess the eating disorder. Correlation analysis revealed that there was a consistent and significant association between the severity of eating disorder symptoms and the degree of depression at follow-up. According to the subscales of the average outcome score of Morgan and Russell (Psychological Medicine 5:355-371, 1975), depression was related more to social maladaptation than to the specific eating disorder psychopathology.

Adolescent↗
PubMed1993

[Trance states--a case report].

For the first time, trance states have been included in the International Classification (ICD-10) as a separate identity. The case of a 13-year-old boy is presented and the diagnostic process discussed especially the differentiation between trance states and epilepsy. Psychotherapy and the in-patient treatment course are described including the factors facilitating a positive outcome.

Adolescent↗
PubMed1992

[Importance of developmental psychopathology for understanding psychiatric disorders and diseases in childhood and adolescence].

Though the concept of developmental psychopathology is broadly discussed nowadays, a real integration of the different aspects of developmental psychology, developmental neurology and developmental physiology is not yet achieved. Elements that have to be considered to arrive at such an integrative view are pointed out. Sex differences and individual differences as well as the issue of continuity and change of behavior in the developmental process, the meaning of risk factors and protective factors and prediction research have to be considered. The importance of the developmental perspective with respect to the classification of psychopathological features is stressed and the problems that arise when trying to integrate this perspective into the existing classification schemes. Finally, it is shown how--by means of logistic models--the complex interaction between very heterogeneous factors, for example the connection between biological and psychosocial influences in the developmental process, can be described.

Adolescent↗
PubMed1992

[Subgroups of hyperkinetic disorders--explorative studies with reference to questionnaires and immunologic parameters].

In this paper, the main questions examined are: 1. The relationship between clinically diagnosed hyperkinetic syndrome (HKS) and 3 questionnaires for parents (Child Behavior Checklist (CBCL) by Achenbach and Edelbrock, Enzephalopathie-Fragebogen by Meyer-Probst and 10-Item scale by Conners). 2. The relationship between the clinical psychiatric diagnosis and the questionnaires and allergological parameters. In order to answer these questions, a sample of 122 psychiatric patients with "extraversive" behavior disturbances (HKS: N = 104, other "extraversive" disorders, mainly conduct disorders (EVD): N = 18) was examined prospectively and sequentially. The preliminary results are: a) The children with HKS, the children with EVD and the children with HKS and conduct disorder could be differentiated by several subscales (Especially by "introversive" symptoms) of the CBCL and the Fragebogen by Meyer-Probst. The Conners scale showed significant differences between the groups on only one item. b) The children with HKS, especially those without conduct disorder, had two to three times as many allergies as the children with HKS and conduct disorders or those with EVD.

Attention Deficit Disorder with Hyperactivity↗