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Biomedical subjects

H Remschmidt

Publications and source records attributed to H Remschmidt.

At least 145 records · Page 8Linked to original sources
PubMed1995

[Responsibilities and problems in quality assurance in psychiatry and psychotherapy in childhood and adolescence].

The goals of quality assurance in child and adolescent psychiatry and psychotherapy and related problems are reviewed. Three dimensions of quality assurance are differentiated: the substantive aspect (quality of the treatment process and results, quality of structural aspects of treatment facility) the area (diagnosis, therapy, staff training) and the tasks to be accomplished in the process of quality assurance (development of standards, assessment of the current situation, comparison of current situation with standards, planning and implementation of changes). Several important problems related to quality assurance are outlined and the most urgent tasks discussed in detail (development of quality standards and assessment of the current situation). It is proposed that quality assurance documentation is divided into four parts: documentation of structural characteristics of facility, basic documentation about patient, documentation of diagnostic and treatment services provided, and documentation of evaluation of services provided. An example of a therapy evaluation method (Questionnaire for Therapy Evaluation, QTE) is described.

Adolescent↗
PubMed1994

Partial trisomy 16p in an adolescent with autistic disorder and Tourette's syndrome.

A partial trisomy 16p was identified in a 14-year-old male adolescent with autistic disorder. He additionally showed complex motor and vocal phenomena, including some simple tics which had first appeared in childhood. Whereas these simple tics were of subclinical significance, an additional diagnosis of Tourette's syndrome (TS) appears justified. The case report illustrates the diagnostic difficulties in assessing psychiatric symptomatology associated with both disorders, especially complex motor and vocal phenomena. The cytogenetic finding is discussed critically in the light of other chromosome abnormalities reported in both TS and autistic disorder. Chromosome 16p should be considered as a candidate region especially for autistic disorder.

Adolescent↗
PubMed1994

Human dopamine D4 receptor gene: frequent occurrence of a null allele and observation of homozygosity.

We report a null mutation in the first exon of the human dopamine D4 receptor (DRD4) gene. The mutation is predicted to result in a truncated non-functional protein and is the first natural nonsense mutation found in a human dopamine receptor gene. It occurs with a frequency of about 2% in the general population. The distribution of the mutation was found to be similar in healthy controls and patients suffering from psychiatric diseases which included schizophrenia, bipolar affective disorder and Tourette's syndrome, indicating that heterozygosity for this mutation in the DRD4 gene is not causally related to major psychiatric diseases. We also identified an adult male who is homozygous for this mutation. He shows no symptoms of major psychiatric illness, but he displays somatic ailments including acousticous neurinoma, obesity and some disturbances of the autonomic nervous system. Some of these symptoms might be related to the absence of functional DRD4 protein.

Alleles↗
PubMed1994

Psychosocial milestones in normal puberty and adolescence.

Puberty and adolescence are not generally times of great stress and turmoil. The storm-and-stress theory has a long history, but can no longer be supported by recent empirical research. A modern approach to the psychosocial changes of these phases is based on the concept of developmental tasks in an age-appropriate and stage-appropriate way. Biological processes can influence an individual's psychological and psychosocial state, but psychological and psychosocial events may also influence the biological systems. Therefore, the timing and outcome of pubertal processes can be modified by psychosocial factors. The most important psychological and psychosocial changes in puberty and early adolescence are the emergence of abstract thinking, the growing ability of absorbing the perspectives or viewpoints of others, an increased ability of introspection, the development of personal and sexual identity, the establishment of a system of values, increasing autonomy from family and more personal independence, greater importance of peer relationships of sometimes subcultural quality, and the emergence of skills and coping strategies to overcome problems and crises. All these changes can be looked on as developmental tasks during normal development, but they can also help in understanding developmental deviations and psychopathological disorders. From the viewpoint of developmental psychopathology, several psychiatric disorders of puberty and adolescence can be seen in a new light.

Adolescent↗
PubMed1994

[Reliability and validity of the German version of the Youth Self Report].

The aim of the present study was to investigate certain aspects of the reliability and validity of a German version of the Youth Self-Report (total behavior problem score) and to establish norms. In a sample of 252 patients from various child and adolescent psychiatric services and in an unselected sample of 1343 students from nearby schools high coefficients of internal consistency and split-half reliability (> 0.9) were obtained. An additional 105 students were tested and then retested after 5 weeks and again the rank correlations were high (boys: 0.86; girls: 0.90). The patients had higher total problem scores than the non-patients matched for age, sex, socioeconomic status, type of school and status as a foreigner. Patients with a diagnosis on axis 1 (psychiatric syndrome) or axis 5 (abnormal psychosocial situations) of the Multi-axial Classification Scheme were more maladjusted (higher total behavior problem score) than those without such a diagnosis. As expected, the score for the inpatients (N = 99) was higher than for the outpatients (N = 153). Because of the encouraging results, which justify further use of the Youth Self-Report, norms for the total behavior problem score (T-scores, percentiles) were calculated separately for the boys (N = 2085) and girls (N = 2119) from the general population (10-17 years of age).

Adolescent↗
PubMed1994

[Children of psychotic parents--a neglected risk group].

Children of psychotic parents form a special risk group with an increased probability to develop psychiatric disorders. After an introductory presentation of the most important research findings, it is shown that, up to now, children of psychotic parents have not been paid much attention to in the literature. A concept for prevention is introduced that may serve as an orientation for planning and realizing preventive measures for children of psychotic parents. The prevention program comprises interventions aimed to improve coping strategies with the parental psychosis as well as specific preventive interventions to improve the situation of the children. Finally, principles are presented that should be acknowledged by specialists when doing preventive work.

Adolescent↗
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↗