An appraisal of chemotherapy: in the blood or in the brain?
Explore the source record for details and available documents.
Antineoplastic Combined Chemotherapy Protocols↗
Biomedical subjects
M H Schmidt
Publications and source records attributed to M H Schmidt.
Role of the lateral preoptic area in sleep-related erectile mechanisms and sleep generation in the rat.
Penile erections are a characteristic phenomenon of paradoxical sleep (PS), or rapid eye movement sleep. Although the neural mechanisms of PS-related erections are unknown, the forebrain likely plays a critical role (Schmidt et al., 1999). The preoptic area is implicated in both sleep generation and copulatory mechanisms, suggesting it may be a primary candidate in PS erectile control. Continuous recordings of penile erections, body temperature, and sleep-wake states were performed before and up to 3 weeks after ibotenic acid lesions of the preoptic forebrain in three groups of rats. Neurotoxic lesions involving the medial preoptic area (MPOA) and anterior hypothalamus (n = 5) had no significant effects on either erectile activity or sleep-wake architecture. In contrast, bilateral lesions of the lateral preoptic region, with (n = 4) or without (n = 5) MPOA involvement, resulted in a significant decrease in the number of erections per hour of PS, number of PS-related erections, and PS phases exhibiting an erection. Lesion analysis revealed that the candidate structures for PS erectile control include both the lateral preoptic area (LPOA) and ventral division of the bed nucleus of the stria terminalis; however, lesions of the LPOA were the most effective in disrupting PS erectile activity. LPOA lesioning also resulted in a long-lasting insomnia, characterized by the significant increase in wakefulness and decrease in slow wave sleep (SWS). PS architecture and waking-state erections remained unchanged after lesion in all groups. These data identify an essential role of the LPOA in both PS-related erectile mechanisms and SWS generation. Moreover, higher erectile mechanisms appear to be context-specific because LPOA lesioning selectively disrupted PS-related erections while leaving waking-state erections intact.
Animals↗
Comorbidity in ADHD-children: effects of coexisting conduct disorder or tic disorder on event-related brain potentials in an auditory selective-attention task.
In children with attention-deficit hyperactivity disorder (ADHD) some deficits in auditory information processing seem to exist. Further, comorbidity of ADHD with conduct disorder (CD) and tic disorder (Tic) is quite common but not yet fully understood. Thus, we investigated the effects of these two disturbances, when combined with ADHD, on electrophysiological correlates of auditory information processing. An auditory selective-attention task was used, and temporal as well as frontal lobe sensitive event-related electrical brain activity indicators like mismatch negativity (MMN) and negative difference wave (Nd), as well as P300 were registered in four groups of children (healthy controls, ADHD-only, and combined ADHD + CD as well as ADHD + Tic; total number 42). Performance measures showed that ADHD + CD had a higher impact on errors and reaction times than ADHD + Tic. The MMN effect indicated that all ADHD groups showed lower MMN amplitudes compared to normals, but only the group with ADHD + CD suffered from a significant deficiency in automatic auditory information processing. Nd and P300 amplitudes showed no significant group differences. It may be assumed that neurodynamic sufficiency in ADHD-only and ADHD + Tic children seems to be similarly impaired while there might be a greater deficit in ADHD + CD.
Attention↗
Epidemiology and prognosis of specific disorders of language and scholastic skills.
Data from a prospective longitudinal study on the development of children born at biological and psychosocial risk were utilised to examine language and learning abilities of 320 children at ages 4.5 and 8 years. Following the research criteria of the ICD-10, specific developmental disorders of speech and language and specific developmental disorders of scholastic skills were diagnosed. Data were also provided for a clinical and general low achievement group according to less stringent criteria. Frequencies in the risk population were low for specific disorders (ICD-10) (0.6%-3.7% depending on age and type of disorder). Higher frequencies were found when a clinical definition (0.6%-13.6%) or overall low achievement score (0.6%-18.6%) was chosen. The impact of well-documented organic and psychosocial risks was analysed. Organic risk affected language abilities at 4.5 years of age but neither language nor learning abilities at 8 years of age. Psychosocial aspects of a child's environment proved to be associated with both specific language and learning abilities. Stability of language disorders, association between language and reading/spelling disorders as well as gender effects were investigated.
Achievement↗
Oppositional children differ from healthy children in frontal brain activation.
An atypical EEG pattern of frontal brain activation, which has been found in children and adults with emotional disorders, also is hypothesized to be present in disruptive behavior disorders. One hundred nineteen children (4 1/2 and 8 years of age) were examined with regard to the following questions: (1) Do children who are diagnosed with oppositional defiant disorder (ODD) exhibit an atypical pattern of frontal brain activation? (2) Can this pattern be demonstrated in preschool children (4 1/2 years of age) as well as in school children (8 years)? (3) Are there gender differences in these patterns similar to those that have been demonstrated in adults? Spontaneous EEG activity was subjected to power spectral analysis. In oppositional preschool and elementary school girls, the well-known pattern of lower left frontal than right frontal activation emerged that has been found previously in emotionally disordered children. Healthy girls showed no frontal brain asymmetry at 4 1/2 years of age, and left frontal activation at 8 years. In contrast, healthy boys demonstrated a greater right than left frontal activation, whereas ODD boys did not display any frontal brain asymmetry. Thus, the pattern of frontal brain activation seems to be gender-specific. The atypical activation pattern in oppositional children is hypothesized to be a biological substrate of negative affective style.
Age Factors↗
[Obsessive-compulsive disorder, frontostriatal system and the effect of the serotonergic system].
OBJECTIVES: Focal issues of recent research on obsessive-compulsive disorders have been the involvement of the frontostriatal system in the patho-physiology, as well as the manner of effect and efficacy of the serotonin reuptake inhibitors that unfold their specific efficacy in the frontostriatal system. The course of treatment among adolescent inpatients with obsessive-compulsive disorder was analyzed with regard to the medications used and their effects upon the course of treatment. METHODS: The data for all adolescents with obsessive-compulsive disorder admitted as inpatients to the Hospital for Child and Adolescent Psychiatry and Psychotherapy in Mannheim since 01.01.1990 were analyzed with regard to medication and the parameters for course and outcome. RESULTS: Five patients dropped out of treatment, five patients received no medication, eight received sulpiride, ten were treated with clomipramine, and three with fluvoxamine. The average length of inpatient stay was longer for the groups treated with sulpiride and clomipramine than for the group that received no medication, but equivalent for these two medication groups. The success of treatment for obsessive-compulsive disorder was rated as higher in these two groups than in the group without medication. On sulpiride, patients gained weight and exhibited fatigue and increased levels of prolactin. On clomipramine, half of the patients exhibited cardiac side effects. CONCLUSIONS: This small, nonrandomized medicated sample analyzed under non-double-blind conditions shows no difference in the efficacy of clomipramine and sulpiride under post hoc analysis. Rather, the side effects that occurred in patients on clomipramine indicate a more frequent use of SSRI to increase compliance as regards medication intake.
Adolescent↗
[Reference tables for representation of ICD-10 diagnoses in DSM-IV].
Proceeding from the Clinical Descriptions and Diagnostic Guidelines of the ICD-10, a table of reference to DSM-IV is presented for mental disorders. Emphasis is placed upon childhood and adolescent mental disorder pictures. Allowance is made in the corresponding notes for greater content differences in the operationalization of individual disorder pictures. However, the table can only serve as a pointer to diagnoses in DSM-IV that correspond to those in ICD-10. In the interests of greater diagnostic security, these should be checked in individual cases against the diagnostic criteria. In the forefront certain theoretical considerations with regard to the comparison of the two classification systems are illustrated by means of selected disorder pictures.
Adult↗
[Psychological testing in theory and practice exemplified by intelligence testing].
OBJECTIVES: The U.S.-American standards of quality for psychological diagnostics tests were published in 1998 in German translation under the title "Standards für pädagogisches und psychologisches Testen". The relevance of these Standards for studies of psychological testing in child and adolescent psychiatry is discussed. Important intelligence tests will be assessed on the basis of these standards for studies of psychological testing in children and adolescents. METHODS: Relevant standards were presented and discussed. The intelligence tests HAWIK-R, HAWIK-III, K-ABC, AID, PSB, I-S-T 70, SPM, CFT 20, CMM-LB, SON-R 2 1/2-7, SON-R 5 1/2-17 were analyzed with regard to whether or not they fulfilled the Standards under inclusion of the test manuals, test reviews, and empirical studies from the literature. RESULTS: The intelligence tests listed differ widely in the extent to which they meet the Standards. CONCLUSIONS: The Standards appear, at least in part, to be relevant to studies of psychological testing in child and adolescent psychiatry. The intelligence tests used in such studies should be critically examined with regard to their quality and whether or not they are suitable for the issues to be resolved. Given their completely outdated standard, it is recommended to refrain from further use of PBS and I-S-T 70.
Adolescent↗
[Where can pre-implantation diagnosis lead?].
Explore the source record for details and available documents.
Child↗
'Everybody looks at my pubic bone'--a case report of an adolescent patient with body dysmorphic disorder.
OBJECTIVE: Body dysmorphic disorder (BDD) was described for the first time more than 100 years ago, but it is still unknown to many clinicians. Although the onset usually occurs during adolescence, BDD has received little attention in the adolescent psychiatric literature. METHOD: The case and treatment of a 16-year-old female patient is described. RESULTS: The patient, suffering from the overvalued belief of a dislocated pubic bone, a comorbid mild depressive episode, BDD associated rituals and social avoidance, was treated successfully with a combination of exposure and response prevention and 125 mg/day of doxepine. CONCLUSION: If BDD is diagnosed early in the course and treated appropriately, it is possible to obtain a satisfying outcome.
Adolescent↗
Quantitative and qualitative aspects of obsessive-compulsive behaviour in children with attention-deficit hyperactivity disorder compared with tic disorder.
OBJECTIVE: Within the framework of associated psychopathology in child psychiatric disorders, this study focused on quantitative and qualitative aspects of obsessive-compulsive behaviour (OCB) in both attention-deficit hyperactivity disorder (ADHD) and chronic tic disorder/Tourette's disorder (TD). METHOD: Forty-two healthy controls, 41 children with ADHD and 38 children with TD, aged 9-13 years, were investigated using the Leyton Obsessional Inventory--Child Version (LOI-CV), the Child Behaviour Checklist (CBCL) and an expert-rated structured parent interview to reflect a cross-informant view of OCB. RESULTS: Unexpectedly, self-reports of children with ADHD rather than children with TD showed the highest OCB scores in the LOI-CV. Qualitatively, ADHD-related OCB focused on the item subsets concerning 'dirt and contamination', 'repetition', 'overconscientiousness', and 'hoarding'. In the parent-rated CBCL, similar levels of OCB were reported for ADHD and TD patients. In contrast, only children with TD showed clinically relevant OCB according to expert ratings. CONCLUSION: Not only young TD patients but also children with ADHD should be investigated and monitored carefully for quantitative and qualitative aspects of OCB comorbidity.
Adolescent↗
The psychosocial outcome of adolescent-onset schizophrenia: a 12-year followup.
This study examines the educational/occupational outcome and social situation of patients treated for schizophrenia in adolescence (age at admission 11.5-17.9 years; mean 16.0 years). Out of 96 consecutively admitted patients between 1976 and 1987, 85 (89%) could be traced and 65 (68%) were reassessed more than 10 years after the first episode. At followup, 54 of the 65 (83%) had had at least one further inpatient-treated episode and 48 (74%) were receiving psychiatric treatment. Thirty-seven (57%) of the subjects were at least moderately impaired with respect to vocational functions (i.e., did not achieve their premorbid educational/occupational goals). Serious social disability was found in 42 (66%) of the 64 subjects for whom social disability data were available. Regarding means of maintenance, 49 (75%) were financially dependent, supported by parents or public assistance. Impairments were comparable for males and females. History of treatment (longer duration of inpatient stay; more than two inpatient episodes) was found to be predictive of lower vocational functioning at followup. Severity of positive symptoms and more than two inpatient episodes in the early course of illness predicted social disabilities in young adulthood. Findings support the view that, because of early onset, the long-term perspective for many adolescent-onset schizophrenia patients is that of poor social adjustment, severe functional impairment, and high socioeconomic dependence and suggest that consequences are more severe than in adult-onset schizophrenia.
Acute Disease↗
Behavioral sequelae of perinatal insults and early family adversity at 8 years of age.
OBJECTIVE: This prospective longitudinal study investigated the simultaneous impact of early biological and psychosocial risk factors on behavioral outcome at school age. METHOD: A cohort of 362 children born between 1986 and 1988 with different biological (perinatal insults) and psychosocial risk factors (family adversity) was followed from birth to school age. When their children were aged 8 years, parents of 89.0% of the initial sample completed the Child Behavior Checklist (CBCL). RESULTS: More externalizing as well as internalizing problems were found in children born into adverse family backgrounds, whereas no differences at broad-band syndrome level were apparent between groups with varying obstetric complications. Children with family risk factors had higher scores on 5 of the 8 CBCL scales (including attention, delinquent, and aggressive problems), whereas children with perinatal risk factors had more social and attention problems than children in the nonrisk groups. With one exception, no interactions between risk factors emerged, indicating that perinatal and family risk factors contributed independently to outcome. The differences between risk groups applied irrespective of gender. CONCLUSIONS: The adverse impact of family adversity clearly outweighed the influence of obstetric complications in determining behavioral adjustment at school age.
Child↗
Primary cutaneous T-cell-rich B-cell lymphoma and Hodgkin's disease in a patient with Gardner's syndrome.
A 50-year-old patient, suffering from familial polyposis (Gardner's syndrome), initially presented with several nodules on his left arm. Histological examination revealed primary cutaneous T-cell-rich B-cell lymphoma (TCRBCL). Staging procedures failed to detect any systemic involvement. Three years after total excision of the tumours, the patient presented with a non-specific dermatitis, enlarged axillary lymph nodes and splenomegaly. Histological and immunohistochemical examination of lymph node and spleen biopsy specimens resulted in the diagnosis of Hodgkin's disease (HD) of the nodular sclerosis type. Sequence analysis of single cells micromanipulated from skin and from lymph node lesions indicated that both lymphoma infiltrates were derived from the same precursor germinal centre B-cell clone. This is a case showing a clonal relationship between TCRBCL and HD, providing support to the B-cell origin of Hodgkin and Reed-Sternberg cells.
Gardner Syndrome↗
Clinical and medico-legal aspects of home-based care by nurses as an alternative for inpatient treatment in child and adolescent psychiatry.
Increasing economic restrictions in the supply of inpatient care require the establishment of alternative treatment modalities also in the field of child and adolescent psychiatry. Therefore, home-treatment offers the possibility of effective interventions in the natural environment of the severely disturbed child and its family. In our study practical implementation of therapy was in the hands of nurses specializing in child and adolescent psychiatry. Various aspects of their therapeutic work with disordered children are focussed. Specific characteristics and problems of home-treatment-including interventions in the patient's psychosocial surroundings--are illuminated from the nurse's point of view.
Adolescent↗
Preconditions and outcome of inpatient treatment in child and adolescent psychiatry.
Inpatient care is expensive and should ideally be provided for children and adolescents with the most serious psychiatric disorders. However, only little is known about inpatient treatment, e.g. the factors influencing hospital admission, the content of care in the hospital, the appropriate norms for the duration of inpatient stays, the inpatient arrangements that result in the best outcomes, or connection with necessary aftercare services. There are many methodological problems with existing research. However, it can cautiously be concluded that psychiatric hospitalisation of children and adolescents is often beneficial, particularly if special aspects of treatment are fulfilled (e.g. good therapeutic alliance, treatment with a cognitive-based problem-solving skills training package, or planned discharge) and aftercare services are available. The continuum-of-care model is promising because it provides opportunities to achieve better integration between inpatient interventions and aftercare services.
Adolescent↗
No evidence for involvement of polymorphisms of the dopamine D4 receptor gene in anorexia nervosa, underweight, and obesity.
Family and twin studies suggest a genetic contribution to the etiology of anorexia nervosa (AN) and obesity. Genes involved in weight regulation can be considered as candidate genes for AN. The dopaminergic system has been implicated in weight regulation; previous results had suggested a possible involvement of the dopamine D4 receptor gene (DRD4). We screened for alleles of two different polymorphisms (13-bp deletion, 48-bp repeat) in the DRD4. For association tests, allele frequencies were compared between 109 inpatients with AN, 82 underweight students, and 327 extremely obese children and adolescents. For application of transmission disequlibrium tests (TDT) we additionally genotyped 57 and 137 trios comprising a patient with AN or an extremely obese child or adolescent, respectively, and both parents. All genotyping was performed with polymerase chain reaction fragment length polymorphism analyses. None of the association tests or TDT rendered nominal P values below 0.1. An influence of alleles of the DRD4 on the development of AN, underweight, or extreme early onset obesity was not detected. Am. J. Med. Genet. (Neuropsychiatr. Genet.) 88:594-597, 1999.
Adolescent↗
The effects of spinal or mesencephalic transections on sleep-related erections and ex-copula penile reflexes in the rat.
The neural mechanisms of penile erections during paradoxical sleep (PS) remain unknown since it has yet to be the subject of neurophysiological investigation. Using a new experimental model for sleep-related erection research in freely behaving rats, neural transections were undertaken to definitively elucidate the effects of paraplegia on PS-related erections and to determine at which brain level the mechanisms underlying PS erectile activity are generated. Continuous polygraphic recordings, as well as ex-copula penile reflexes, were performed in male Sprague Dawley rats before and after spinal (n = 4) or mesencephalic (n = 6) transections. Spinal transections virtually eliminated PS-related erections. Following mesencephalic transections, PS remained qualitatively intact in all rats. PS erectile activity, however, was severely disrupted, as shown by a significant decrease in the total number of erections, the number of erections per hour, and the percentage of PS phases exhibiting an erectile event. Finally, spinal and mesencephalic transections had contrasting effects on ex-copula penile reflexes. Spinal transections significantly shortened the latency to reflex induction and increased the percentage of tests eliciting an erectile event, whereas mesencephalic transections significantly increased the latency to reflex induction without affecting the percentage of tests eliciting an erectile event. These data suggest that the brainstem is not sufficient for the generation of PS erectile activity even though it is sufficient for the generation of other classic PS phenomena. We conclude that neural structures rostral to the mesencephalopn (i.e., the forebrain) are essential for the maintenance and integrity of PS related-erections. The reflex erection data suggest that spinal transection removes a tonic descending inhibition of erections, whereas such an inhibition not only remains intact, but appears enhanced following mesencephalic transection. We hypothesize that the forebrain plays a facilitatory role in erectile control, at least in part, through disinhibition of brainstem tonic anti-erectile mechanisms.
Animals↗