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H Remschmidt

Publications and source records attributed to H Remschmidt.

At least 127 records · Page 7Linked to original sources
PubMed1996

Course and outcome in adolescent anorexia nervosa.

OBJECTIVE: To investigate course, outcome, and psychiatric comorbidity in adolescent anorexia nervosa by repeated follow-up assessment. METHOD: Thirty-four subjects (88%) of an original sample of 39 inpatients were followed up personally 3 and 7 years after discharge and classified according to DSM-III-R eating disorder categories. Standardized psychometric instruments were used to assess specific eating disorder symptoms, concomitant general psychopathology, and comorbid psychiatric diagnoses. RESULTS: After 7 years, 1 patient (3%) had anorexia nervosa, 4 patients (12%) bulimia nervosa, and 10 patients (29%) eating disorder not otherwise specified (EDNOS). Anxiety disorders (41%) and affective disorders (18%) were the most prevalent comorbid psychiatric disorders. Concomitant general psychopathology was significantly related to the outcome of the eating disorder. CONCLUSIONS: According to our results, the majority of former adolescent anorexic inpatients had shown substantial improvement in their eating disorders symptomatology after 7 years. Patients with persisting eating disorders mostly suffered from restrictive symptoms. The prevalence and distribution of psychiatric comorbidity were similar to those of adult-onset anorexia nervosa. Subjects with a worse outcome of the eating disorder also displayed higher levels of general psychopathology.

Adolescent↗
PubMed1996

Body weight in acute anorexia nervosa and at follow-up assessed with percentiles for the body mass index: implications of a low body weight at referral.

OBJECTIVE: A systematic epidemiological comparison of body weights of patients with anorexia nervosa can be enhanced by the use of age percentiles for the body mass index. METHOD: To demonstrate the feasibility of this approach, body mass indices of 81 female adolescents with anorexia nervosa were calculated from anthropometric data upon admission for inpatient treatment and at follow-up and set into relationship to the age-dependent distribution of the body mass index in a large and representative sample of the German population. The percentiles were used to visualize the weight increase over time of each former patient by aligning the body mass index at referral with the respective body mass index at follow-up. RESULTS: Upon admission most adolescents had body mass indices below the third age centile. The distribution of body mass indices at outcome suggests a continuum between death of complications related to starvation, chronic anorexia, residual anorexia, and a low body weight Patients with very low body weights at referral had a poor prognosis, because their body weights tended to remain below the minimal normal weight for height. These conditions were statistically best described by categorical analysis, because they were nonlinear to a certain extent. DISCUSSION: The results indicate that the body mass index at referral influences the amount of weight that an individual patient gains in the future.

Adolescent↗
PubMed1996

Use of percentiles for the body mass index in anorexia nervosa: diagnostic, epidemiological, and therapeutic considerations.

OBJECTIVE: Percentiles for the body mass index (BMI) offer a possibility to epidemiologically assess the linear weight criterion of 85% average body weight commonly used for the diagnosis of anorexia nervosa. METHOD: BMI values corresponding to 85% average body weight were calculated and assessed with percentiles derived from epidemiological studies in both the United States and Germany. The underweight range was characterized epidemiologically. RESULTS: The weight criterion used for the diagnosis of anorexia nervosa corresponds to BMI values between the 5th and 10th centiles in both populations. In epidemiological terms the lowest BMI values in individuals aged 10 years and older occur during adolescence. In the general population BMI values <16 kg/m2 are rarely observed. Upon the use of higher BMI cutoffs in the underweight range females clearly predominate. The BMI increase associated with the 5th or 10th centile in the age range between 18 and 30 years is quite low suggesting that many underweight females in the general population gain only minimal weight during this age span. DISCUSSION: The diagnostic, epidemiological, and therapeutic implications for anorexia nervosa are discussed.

Adolescent↗
PubMed1996

Changing views: new perspectives in child psychiatric research.

Research in child and adolescent psychiatry has remarkably changed during the last two decades. In general, there is a strong trend towards empirically based research in all relevant areas, including basic research as well as psychotherapy and prevention. Important contemporary research fields are: epidemiology, developmental psychopathology, family psychopathology, electrophysiology, neuropsychology, genetics, and the application of the new imaging techniques in child psychiatric disorders. Several methods applied in these fields have been developed in non-medical disciplines so that it has been and will be an interdisciplinary task to integrate them into child psychiatry as a medical discipline. New journals, most of them using an interdisciplinary approach, have substantially contributed to the spread of knowledge and have improved the quality of scientific contributions worldwide. Nevertheless, there are also deficits and shortcomings: In general, there is not enough support for research in the field of child psychiatry and developmental psychopathology. In many countries, there is also a deficit with regard to education and training of young researchers. There are not enough positions for senior researchers within departments of child and adolescent psychiatry, and there is also a deficit of research departments in the field without an overload of clinical tasks. However, in many places the given resources are not adequately used, and very often, there is also a lack of interdisciplinary cooperation. Besides these general shortcomings, there are also deficits with regard to conceptualization and evaluation of treatment methods and measures of prevention. To overcome these deficits and shortcomings will be an important task for the future.

Career Mobility↗
PubMed1996

Follow-up investigation of family relations in patients with anorexia nervosa.

In a group of 22 formerly anorectic inpatients (follow-up 3.8 years after treatment) and in a control group of 24 paralleled young women, the subjective perception of the family structure was assessed using the "Subjective Family Image (SFI)", in order to investigate the question whether the family structure of former anorectics differs from the controls and whether individual development of the former inpatients is associated with the experienced family structure. Empirical results are in favor of the following two hypotheses: 1) Compared to the control group, formerly anorectic inpatients experience family relationships as more complicated and less satisfying. The quality of family relationships in the patient group is reduced, even at the time of follow-up. 2) Individual outcome (individual course of the illness) and quality of family relationships at time of follow-up are associated. Patients with a good outcome experience family relationships as more positive than patients with a poor outcome. The accordance of these findings to other empirical results and their implications for clinical practice are discussed.

Adult↗
PubMed1996

[Familial clustering of conversion disorder].

This paper reports the result of a study conducted in a single family, in which members of three generations were affected by a conversion disorder. The phenotype and the age of onset were very similar in all the family members affected. The etiology is best understood in terms of a genetic condition and as the result of imitation and identification with an affected family member.

Adolescent↗
PubMed1996

Familial aggregation of spelling disability.

This study examined the familial aggregation of spelling disability in a sample of 32 German school-aged children and their relatives. The influence of two different diagnostic criteria (low-achievement criterion, and regression-based IQ-discrepancy criterion) on the rate of affectedness was investigated. Results revealed that 52.3-61.9% of the sibs and 26-34% of the parents were spelling disabled. Little evidence was found for an influence of the diagnostic criterion on the rate of affectedness.

Achievement↗
PubMed1996

[Contributions of pediatric and adolescent psychiatric and development psychological research on objective definition of the child welfare concept].

The term of "child well-being" is a rather vague notion in the German jurisdiction and has to be reinterpreted according to each single case. The present article describes the historical context and different attempts to come to a more concrete definition of the term suitable to serve as a guideline for expert opinion and jurisdiction. The authors discuss the question in which way scientific findings may enhance an objectivation of "child well-being", stressing especially contributions coming from the fields of developmental psychopathology, attachment research, interaction and family research and research on risk factors and protective factors.

Adolescent↗
PubMed1996

[Effect of an oligo-antigen diet on the behavior of hyperkinetic children].

The influence of an oligoantigenic diet on different dimensions of the behavior of 21 children diagnosed as having attention-deficit hyperactivity disorder (ADHD) was examined. Treatment effects were assessed with three subjective measures (two questionnaires and an interview) and three objective measures (two attention tests and actometer). The study was divided into three phases: baseline, diet and provocation, each lasting three weeks. A crossover design was used. A significant effect was found for the subjective measures, but not for the objective measures. The results are discussed in terms of possible types of effects, e. g. rater effects and environmental effects. It may be that the oligoantigenic diet influences only certain dimensions of hyperactivity.

Attention Deficit Disorder with Hyperactivity↗
PubMed1996

[Family diagnosis in psychological disorders of children and adolescents].

There are far more publications about family therapy than about family diagnostics. According to an old medical principle, however, diagnosis should always come first and therapy should follow. To help remedy this situation, over the past 15 years we have developed a family diagnostic inventory that is useful in clinical practice and allows development of adequate therapeutic approaches on the basis of a careful family diagnosis. The Marburg Family Diagnostic Scales, a part of this inventory, are described and their use is illustrated by examples from a clinical case report. The scales have shown to be useful for therapy planning and for the evaluation of family oriented interventions.

Adolescent↗
PubMed1996

[Focal hypersynchronous activity in the EEG of children with specific developmental deficits: is there a clinical relevance?].

Focal hypersynchronous activity in children with specific developmental deficits: Are there any clinical implications? To determine the frequency of focal hypersynchronous activity (HSA) in the EEGs of a child and adolescent psychiatry client population we evaluated 762 patients between 3 and 15 years old. Children with neurological problems, including epilepsy, craniocerebral trauma and psychotic disorders, and children on medication were excluded, as well as those with general developmental delays or abnormal EEG findings (except focal HSA). We then compared our data with those of two epidemiological investigations, in which 1.9% and 2.4%, respectively, of the children without psychiatric problems were found to have focal HSA. The children in our study with dyslexia or disorders of motor function had significantly higher rates of HSA. The boys with psychiatric findings (except those with speech and language disorders) appeared to have a higher rate of HSA. These findings support the hypothesis that focal HSA is probably an expression of a cerebral dysfunction of genetic origin. The symptomatology seems to depend on the moment of manifestation and the localization.

Adolescent↗
PubMed1995

Anorexia nervosa viewed as an extreme weight condition: genetic implications.

In anorexia nervosa, psychopathological features and reduced body weight are inseparable, suggesting a prominent role of behavioral factors in achievement and maintenance of extreme underweight. Due to the considerably higher prevalence of this eating disorder in females, anorexia nervosa contributes to the left end of the distribution of the body mass index, especially in the female sex. By reviewing the relevant literature we examined whether genetic research in anorexia nervosa can profit from considering this disorder as an extreme weight condition. For this purpose we compared genetic studies pertaining to both anorexia nervosa and the heritability of the body mass index. Whereas previous genetic studies in anorexia nervosa have mostly concentrated on the assessment of the familial psychopathology, further studies are warranted that additionally attempt to analyze the complex phenotype body weight in relatives of affected probands. Further insight into pathogenetic mechanisms underlying anorexia nervosa might be gained by contrasting the epidemiological, psychopathological and prognostic factors with those in severe obesity. Thus, epidemiological studies suggest that females are more likely to develop both extreme underweight and extreme obesity. A possible explanation for this phenomenon is that the, on average, higher percentage of total body weight composed of fat mass might predispose females towards the development of both extreme weight conditions.

Anorexia Nervosa↗
PubMed1995

Determination of clozapine and its major metabolites in serum samples of adolescent schizophrenic patients by high-performance liquid chromatography. Data from a prospective clinical trial.

This report describes a method for determination of clozapine and its major metabolites N-desmethylclozapine and clozapine N-oxide in serum samples of adolescent schizophrenic patients during maintenance therapy. The method includes deproteinization and subsequent high-performance liquid chromatography with electrochemical detection. The method shows sufficient sensitivity to quantitate clozapine, clozapine N-oxide and N-desmethylclozapine accurately at 0.5, 5, and 0.5 ng/ml, respectively. We were able to demonstrate for 16 patients receiving fixed doses of clozapine that the individual mean values calculated from six consecutive measurements revealed a strong linear dosage and serum level relationship (Pearson's coefficient of correlation): clozapine (r = 0.82, p = 0.0001); N-desmethylclozapine (r = 0.81, p = 0.0001); clozapine N-oxide (r = 0.91; p = 0.0001). Preliminary pharmacokinetic data are presented and dose-response relationship are discussed.

Administration, Oral↗
PubMed1995

The predictive value of depression in anorexia nervosa. Results of a seven-year follow-up study.

This study investigated the predictive value of depression in patients with adolescent anorexia nervosa. Thirty-four anorectic inpatients were assessed for DSM-III-R comorbid major depression at admission and at 3-year and 7-year follow-ups. Two standardized instruments, the Zung Self-rating Depression Scale and the Hamilton Depression Rating Scale, were applied to improve objective rating of depression. The findings suggest that severity of depressive symptoms at admission does not correlate with the severity of depression at follow-up, initial depressive psychopathology is not a valid prognostic indicator for the outcome of the eating disorder and at follow-up there is a highly significant relationship between depression and the outcome of anorexia nervosa. Patients with persisting eating disorder are also very likely to suffer from comorbid depression.

Adolescent↗