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Biomedical subjects

M H Schmidt

Publications and source records attributed to M H Schmidt.

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

[Comorbidity of compulsive disorders in childhood and adolescence].

OBJECTIVE: The cross-sectional comorbidity of child and adolescent inpatients with obsessive-compulsive disorder (OCD) was assessed. METHODS: The hospital records of all inpatients treated for OCD since 1976 (31 girls, 46 boys) were compared with data from a prospective epidemiological longitudinal study (90 girls, 84 boys) in two age cohorts (< 15 years; > or = 15 years) with regard to comorbid psychiatric diagnoses. Additionally, psychiatric Axis I diagnoses of patients with a supplementary diagnosis of compulsive symptoms (n = 45) were descriptively assessed in the client population. RESULTS: In the subgroup of OCD patients < 15 years, boys showed a higher incidence of tic disorders. OCD girls > or = 15 years showed a tendency toward more frequent comorbid affective disorders and a significant result regarding concurrent eating disorders. Eighteen of 27 female patients with supplementary compulsive symptoms requiring clinical intervention had an Axis I diagnosis of eating disorder. CONCLUSIONS: Due to different criteria of classification, diverging definitions of comorbidity and different age cohorts and samples, studies on comorbidity in OCD patients are difficult to compare. The frequency of comorbid psychiatric disorders may be over-estimated if the general prevalence of psychiatric disorders in terms of gender and age is not taken into account.

Adolescent↗
PubMed2003

Risperidone-associated steatohepatitis and excessive weight-gain.

We report on a 17-year-old girl who developed steatohepatitis and marked weight gain during risperidone treatment for paranoid psychosis. Viral, metabolic, and other causes of liver disease were excluded. Although the exact mechanism of antipsychotic associated weight gain is unclear, the impact of risperidone on the serotonergic system and on neuropeptide Y, a stimulator of food intake, might be implicated in the development of obesity. Additionally, weight gain-related hyperleptinemia could be a link between overweight and hepatotoxicity via cytokines. Physicians should routinely monitor body weight, liver function, fasting blood glucose, and lipid profiles in children and adolescents at the beginning of risperidone therapy. Additionally, patients complaining about weight gain should be monitored more carefully during the maintenance phase.

Adolescent↗
PubMed2003

Risperidone-induced marked elevation of serum creatine kinase in adolescence. A case report.

We report on a 17-year-old boy who developed a marked increase in serum creatine kinase (CK) (9743 U/l) during treatment with risperidone for catatonic psychosis. Known causes of elevated CK such as delirium, malignant neuroleptic syndrome, infection, cocaine overdose, trauma, and intramuscular injections were ruled out. Vital signs remained always within the normal range. On discontinuation of risperidone, serum CK concentrations returned to 105 U/l within 1 week and remained within normal limits. While a transient moderate increase in CK activity at admission may be related to acute psychosis, risperidone seems to be the causative agent for the later marked elevation. To our knowledge, this is the first reported case of risperidone-associated elevation of serum CK in an adolescent. While discontinuation of risperidone does not seem necessary in patients with a moderate increase of serum CK, withdrawal of neuroleptics is warranted in more severe cases.

Adolescent↗
PubMed2002

[Motor, cognitive and socio-emotional development of 11-year-olds with early childhood risk factors: late sequelae].

OBJECTIVES: The investigation of the impact of early childhood risk factors on developmental outcome at the age of 11 years. METHODS: The onset and course of developmental and behavioral disturbances were examined in a prospective longitudinal study of a sample of 362 children born with different risks. Organic (obstetric complications) and psychosocial risks (family adversity) were varied in a two-factorial design. Measures of motor, cognitive and social-emotional outcome were obtained from 341 children aged 11 years (168 boys, 173 girls, corresponding to 94.2% of the initial sample). Previous assessments had been conducted at the ages of 3 months, and again at the ages of 2, 4 1/2 and 8 years. RESULTS: The negative impact of early risk factors persisted into late childhood. Rates of developmental and behavioral disturbances in high-risk children were up to three times higher than in non-risk children. Both organic and psychosocial risks contributed to adverse outcomes. While organic complications were related to disturbances in motor and cognitive development, the detrimental effects of psychosocial adversity pertained to social-emotional functioning. Late sequelae of pre- and perinatal complications were found especially in cognitive outcome and school performance. The cumulative effect of early risks was best explained by summing up the single risk effects. CONCLUSIONS: Early risk factors have specific and long-term sequelae resulting in adverse school outcomes at later ages.

Affective Symptoms↗
PubMed2002

[Is there a temporal correlation between substance abuse and psychosis in adolescents?].

OBJECTIVES: The temporal relationship between substance abuse and symptoms of psychosis in adolescent patients was examined. METHODS: The hospital records of all adolescent inpatients admitted to the Central Institute of Mental Health in Mannheim during the period from 1976-1997 with a first-time diagnosis of psychosis were examined retrospectively for evidence of co-morbid substance abuse. RESULTS: In 18 of a total of 165 psychotic patients, co-morbid substance abuse was present, whose frequency rose after 1988, with a renewed increase since 1996. Two of the 18 adolescents began taking drugs only after the appearance of the first symptoms of psychosis, in 13 others the abuse was already well established, while for the final three patients the onset of psychotic symptoms and substance abuse was congruent, occurring within the same month. A close temporal correlation between symptoms of psychosis and substance abuse was established for amphetamines (including ecstasy), LSD and excessive abuse of cannabis. CONCLUSIONS: Substance abuse constitutes a risk factor for the development of psychoses without, however, necessarily being a direct trigger of psychosis.

Adolescent↗
PubMed2002

[Psychological symptoms in children of alcoholic fathers].

OBJECTIVES: In spite of a growing interest in recent years in epidemiological research on behavior problems of children of alcoholics (COAs), few prospective longitudinal child psychiatric studies have been conducted up to now. METHODS: In the Mannheim Study of Risk Children, an ongoing prospective study of high risks, the data of 219 children (26 COAs and 193 non-COAs) were analyzed from birth to the age of 11 years. Sociodemographic data, organic and psychosocial risk factors, the number and severity of behavior problems, and the rate of expansive and introversive disorders have been investigated. RESULTS: The family status of the COAs was characterized by the father's lower level of education as well as by socioeconomic difficulties and more numerous adverse life events. Other psychosocial problems such as marital conflict and a lack of coping mechanisms were also more frequent in COA families. A significantly higher rate of expansive symptoms and disorders was found in children of alcoholic fathers from the age of two years on. CONCLUSIONS: Children of alcoholic fathers represent a group at risk for the early onset of psychiatric problems and are deserving of more attention in prevention and early intervention programs.

Alcoholism↗
PubMed2002

[Vascular ligation for severe obstetrical hemorrhage: review of the literature].

OBJECTIVE: Assess the contribution of vascular ligation in the treatment of severe obstetrical hemorrhage. Method. We reviewed the anatomic and pathophysiological basis of vascular ligation analyzing the technique, results, and indications for this conservative procedure for the severe post-partum hemorrhage. New developments in suture techniques for uterine bleeding are under study. RESULTS: Outcome after uterine artery ligation is good. A stepwise procedure with progressive ligation of the uterine and ovarian arteries is a good solution (100% success). Bilateral ligation of the hypogastrics can provide success in 66% of cases. Vascular ligation can be an alternative between embolization and hysterectomy. CONCLUSION: Ligation of the bleeding vessels preserves the patient's life and uterus. More than fifty pregnancies have been reported after vascular ligation.

Arteries↗
PubMed2001

Marker gene polymorphisms in hyperkinetic disorder--predictors of clinical response to treatment with methylphenidate?

Gene polymorphisms of the dopamine D4 receptor (DRD4) and serotonin transporter (5-HTT) are under discussion as potential genetic risk factors for hyperkinetic disorder (HD). In this disorder, treatment with the psychostimulant methylphenidate (MPH; Ritalin) induces calming effects and amelioration in only 70% of the patients. MPH blocks the reuptake of dopamine, thus enhancing synaptic dopamine which in turn antagonizes the release of prolactin (PL). Genotyping HD patients for DRD4 and 5-HTT polymorphisms and measuring PL concentrations, we report on an association between the combination DRD4*7/5HTT LL genotype and a reduced improvement in general functioning accompanied by different PL levels upon MPH treatment. Thus, our study supports the hypothesis that marker gene polymorphism may be helpful in identifying MPH non-responders.

Adolescent↗
PubMed2001

Efficacy of inpatient and home treatment in psychiatrically disturbed children and adolescents. Follow-up assessment of the results of a controlled treatment study.

In two German child and adolescent psychiatric treatment and research centers, a controlled treatment study was conducted in which two randomized treatment groups (in-patient treatment and home treatment) were compared. Subjects were children and adolescents with severe psychiatric disorders, for whom normal outpatient treatment was not sufficient (mean age of the patients was 11 years and 9 months at the beginning of treatment). The results showed no differences in therapy outcome between the two treatment modalities. In a further study, the results of which are presented here, a follow-up assessment (average follow-up interval: 3 years and 8 months) of the two treatment groups (follow-up sample of the inpatient treatment group: n = 33; home treatment group: n = 35) was undertaken in order to investigate the course of the psychiatric disturbances and the long-term effects of the treatments. As measurement categories for the outcome "adaption at school" and "number of marked symptoms" were used in pre-, post- and follow-up assessment. The most important results are 1) The number of marked psychiatric symptoms and the adaptation at school or work exhibit the same type of course over time. Post-treatment scores are much better when compared to pre-treatment scores, but decline slightly upon follow-up, although they remain significantly better than the pre-treatment scores. Thus, the study shows that improvements relating to the psychiatric symptoms are quite stable after several years. 2) There were no relevant differences between the treatment modalities "inpatient treatment" and "home treatment" in terms of effect-size upon follow-up, and in inferential analysis. Any tendency towards difference was in favor of home treatment. So the results give strong support to the conclusion that at least for a specific group of patients (about 15% of those patients usually treated in an inpatient setting) residential treatment can be replaced by home treatment and that the long-term therapeutic outcome of home treatment is stable and persistent. Thus, in terms of psychiatric care and clinical practice, our results provide empirical support to the idea that home treatment should be used more frequently and much more broadly in the future.

Adaptation, Psychological↗
PubMed2001

Effectiveness of home treatment in children and adolescents with externalizing psychiatric disorders.

OBJECTIVE: The study examines effectiveness of home treatment in children and adolescents with severe externalizing behavior disorders. METHODS: Fifty patients with ICD-10 diagnosis F90, F91, or F92 aged 5-16 years were treated in a home treatment setting for 3.5 months. Assessments were made using multiple informants (patients, parents, therapists, supervisors, and clinicians not involved in the treatment) to evaluate psychiatric symptoms, various aspects of psychosocial functioning, and global treatment outcome. RESULTS AND CONCLUSIONS: Findings showed a significant decrease in psychiatric symptoms and improvement in psychosocial adjustment. Positive treatment effects were seen in almost every area of social functioning. The child's compliance and the therapist's professionalism were found to be the most important predictors of treatment outcome. Findings suggest that extent of achieved home treatment effects in externalizing disorders is similar to that in internalizing disorders.

Adolescent↗
PubMed2001

Differential development of infants at risk for psychopathology: the moderating role of early maternal responsivity.

The development of behaviour problems in infants born with biological risk (low birthweight) and psychosocial risk (psychosocially disadvantaged family) was studied in a sample of 347 children (171 males, 176 females) at the ages of 2, 4:6, and 8 years. In the search for factors that moderate the effects of early risks, the role of early responsive caregiving was examined. Results indicate that infants at psychosocial risk exhibited both more externalizing and internalizing problems across ages than infants not at psychosocial risk, while no overall differences were apparent between normal- and low-birthweight groups. With one exception, no interactions between biological and psychosocial risk factors emerged, suggesting that their simultaneous effect is largely additive. Maternal responsivity was found to moderate the effects of low birthweight on hyperkinetic and internalizing problems as well as to influence the consequences of family disadvantage on total problems. These findings stress the importance of early parenting in the behavioural development of at-risk children.

Analysis of Variance↗
PubMed2001

Child development after maternal tocolysis with beta-sympathomimetic drugs.

The psycho-social development of both preterm and term children whose mothers reported tocolytic treatment was assessed at the ages of 2, 4.5, and 8 years. Term children exposed to tocolysis showed a higher rate of psychiatric disorders as well as poorer cognitive and motor performance than controls. In the preterm children no adverse impact of tocolysis could be found. The results are discussed concerning possible ways in which tocolytic treatment may influence child development. Restrictions because of the preliminary character of this study and the need of further prospective studies to clarify the developmental impact of tocolysis are also considered.

Adrenergic beta-Agonists↗
PubMed2001

[Evaluated treatment approaches in child and adolescent psychiatry I].

OBJECTIVES: The principle of evidence-based medicine is to integrate data concerning the efficacy of interventions into clinical practice. This article assesses the level of evaluation of psychosocial, psychopharmacological and combined interventions for mental disorders in childhood and adolescence (autistic disorders, hyperkinetic disorders, conduct disorders, tic disorders, enuresis, and encopresis). METHODS: Three different levels of evaluation were defined for both psychosocial and psychopharmacological interventions: A (> or = 2 randomized controlled studies), B (1 randomized controlled study), and C (open studies and case studies). The level of evaluation was judged on the basis of original papers found in a comprehensive literature search. RESULTS: For most disorders presented in this article there are several A-level treatments. The efficacy of both psychosocial and psychopharmacological interventions that target specific problem behaviors or symptoms, respectively, has been repeatedly demonstrated with regard to autistic disorders. Many studies have evaluated treatment approaches for hyperkinetic disorders and conduct disorders. With regard to the treatment of tic disorders in children and adolescents, far more studies evaluated the efficacy of pharmacotherapy than of psychotherapy. CONCLUSIONS: Further research should compare the efficacy of different treatment approaches, examine specific and differential treatment effects and investigate combined treatment approaches.

Adolescent↗
PubMed2001

[Evaluated treatment approaches in child and adolescent psychiatry II].

OBJECTIVES: The principle of evidence-based medicine is to integrate data concerning the efficacy of interventions into clinical practice. This article assesses the level of evaluation of psychosocial, psychopharmacological and combined interventions for mental disorders in childhood and adolescence (schizophrenic disorders, affective disorders, phobias and anxiety disorders, obsessive-compulsive disorder, posttraumatic stress disorder, anorexia nervosa, and bulimia nervosa). METHODS: Three different levels of evaluation were defined for both psychosocial and psychopharmacological interventions: A (> or = 2 randomized controlled studies), B (1 randomized controlled study), and C (open studies and case studies). The level of evaluation was judged on the basis of original papers found in a comprehensive literature search. RESULTS: The number of controlled studies examining these disorders in children and adolescents is small, especially with regard to pharmacotherapy. However, the efficacy of (cognitive) behavior therapy for depressive disorders, phobias and anxiety disorders, as well as posttraumatic stress disorder has been demonstrated. CONCLUSIONS: There is still a considerable need to evaluate pharmacological treatment approaches for schizophrenic and affective disorders. Looking at psychosocial interventions in schizophrenic disorders, obsessive-compulsive disorder and eating disorders, specific aspects of treatment for young patients should be examined. Overall, the psychotherapy approach evaluated best is (cognitive) behavioral therapy.

Adolescent↗
PubMed2001

[Mother-child interaction and externalizing disorders in elementary schoolchildren].

OBJECTIVES: The behavior of eight-year-old children with externalizing disorders (ADHD and CD) in interaction with their mothers was examined. METHODS/RESULTS: Mothers of ADHD children were more restrictive and negative towards their children and showed less adequate control than did mothers of normal children. ADHD children paid less attention, were less assertive and helpless, and were more impulsive than controls. CD children were more negative towards their mothers, and were more aggressive and provocative than normal children, while their mothers were more impatient. CONCLUSIONS: An interaction between aggressive child behavior and maternal restrictiveness contributed to increased conduct problems. Hyperactivity was enhanced by the interaction between the impulsive behavior of the child and the aversive maternal response.

Adult↗
PubMed2001

Functional polymorphism within the promotor of the serotonin transporter gene is associated with severe hyperkinetic disorders.

In children and adolescents, hyperkinetic disorder (HD) with conduct disorder (CD) and without CD and attention-deficit/hyperactivity disorder (ADHD) is known to be comorbid with psychiatric disorders (anxiety, depression, aggression), some of which are related to disturbed serotonergic neurotransmission. The efficiency of serotonergic signalling relates to the concentration of the neurotransmitter in the synaptic cleft and is controlled by the serotonin transporter (5-HTT), which selectively removes serotonin out of the synaptic cleft.(1)The activity of serotonin transport itself has been shown to be also controlled by a 5-HTT-linked polymorphism in its promotor region with a L/L genotype yielding higher levels of 5-HTT function than do L/S or S/S genotypes.(2) Considering an association between 5-HTT polymorphism, serotonergic neurotransmission and HD +/- CD, we genotyped for 5-HTT polymorphism and compared patients with controls. In contrast to the distribution of L/L: L/S: S/S in controls (0.245: 0.509: 0.245), we found an enhanced expression of the L/L genotype in HD patients with CD (0.393: 0.304: 0.304; chi(2) = 7.603; P = 0.0211) and a significant overexpression of L/L in HD without CD (0.542: 0.333: 0.125; chi(2) = 9.127; P = 0.0092). To our knowledge, this is the first finding providing evidence for an association between the 5-HTT polymorphism and hyperkinetic disorder, implying that serotonergic neurotransmission might be affected in this desease. As a consequence, for a successful treatment of these patients one should now also consider drugs which specifically modulate serotonergic signalling such as selective serotonin reuptake inhibitors.

Adolescent↗
PubMed2001

Suppression of cell division by pKi-67 antisense-RNA and recombinant protein.

The human antigen defined by the monoclonal antibody Ki-67 (pKi-67) is a human nuclear protein strongly associated with cell proliferation and found in all tissues studied. It is widely used as a marker of proliferating cells, yet its function is unknown. To investigate its function we suppressed pKi-67 expression by antisense RNA and overexpressed a partial structure of pKi-67 in HeLa cells. A BrdU-incorporation assay showed a significant decrease in DNA synthesis after antisense inhibition. Cell cycle analysis indicated a higher proportion of cells in G1 phase and a lower proportion of cells in S phase while the number of G(2)/M phase cells remained constant. Overexpression of a recombinant protein encoding three of the repetitive elements from exon 13 of pKi-67 had a similar effect to that obtained by antisense inhibition. The similarity of the effect of expressing 'Ki-67 repeats' and pKi-67 antisense RNA could be explained by a negative effect on the folding of the endogenous protein in the endoplasmatic reticulum. Furthermore excessive self-association of pKi-67 via the repeat structure could inhibit its nuclear transport, preventing it from getting to its presumptive site of action. We conclude that the Ki-67 protein has an important role in the regulation of the cell cycle, which is mediated in part by its repetitive elements.

Bromodeoxyuridine↗