Angelika Schlarb

S3-Leitlinie Nicht erholsamer Schlaf/Schlafstörungen

Somnologie 2017 · 21:2–44 DOI 10.1007/s11818-016-0097-x Online publiziert: 27. Februar 2017

Placebo effects in children: a review

Of more than 155,000 PubMed citations found with the search term “placebo,” only ~9,000 (5.8%) included the terms “children” or “adolescents.” When all these papers were screened, only ~2,000 of them investigated the placebo effect per se, and of those, only ~50 (2.5%) discussed the placebo effect in children and adolescents. In this narrative review, we explore four aspects of the placebo response in children and adolescents: (i) the legal and ethical limitations and restrictions for the inclusion of children in clinical trials as well as in experimental (placebo) research that may explain the poor knowledge base; (ii) the question of whether or not the placebo effect is larger in children and adolescents as compared with adults; (iii) whether the mechanisms underlying the placebo effect are similar between children and adults; and (iv) whether mediators and moderators of the placebo effect are comparable between children and adults. We finally discuss some of the consequences from the current placebo research in adults that may affect both experimental and clinical research in children and adolescents.

Chronotype-related differences in childhood and adolescent aggression and antisocial behavior – A review of the literature

Eveningness has been found to negatively affect adolescents’ sleep and daytime functioning. Furthermore, eveningness is associated with greater impulsivity than morningness. Externalizing behavior could be chronotype-related, implying that the alteration of the circadian rhythm itself is connected to aspects of emotion and emotion regulation. The present study investigated chronotype-related differences in emotional and behavioral problems, especially aggression and antisocial behavior in children and adolescents. We conducted a comprehensive search via web of knowledge (MEDLINE, web of science), EBSCO, Ovid, PubMed, Google Scholar and PsycINDEX using the keywords: chronotype, chronobiology, morningness, eveningness, owls and larks as well as diurnal preference to fully capture every aspect of chronotype. For aggression we used the search terms: aggression, anger, hostility, violence, anti-social behavior, conduct disorder, oppositional defiant disorder, delinquency, social adjustment and externalizing behavior. N = 13 studies were included concerning chronotype, childhood, adolescence and antisocial behavior. Results showed that children and adolescents being E-types were more affected by daytime impairments. Additionally, behavioral and emotional problems as aggression or antisocial behavior were more pronounced in E- than in M-types. Our findings support an association of eveningness and the impact of aggression on children and adolescents. Longitudinal investigations should be conducted in order to insure causality of the effects in question. In addition, the elevated vulnerability toward aggression in evening types demonstrates the need for prevention and intervention programs that educate youths in proper sleep hygiene and evoke an awareness of the consequences of a habitually diminished sleep quality. Abbreviations: M/E: morningness–eveningness; M-type: morning-type; I-type: intermediate-type; E-type: evening-type; CEM: Chronotype Emotional-Behavior Model.

Of larks and hearts — morningness/eveningness, heart rate variability and cardiovascular stress response at different times of day

Inter-individual differences in the circadian period of physical and mental functions can be described on the dimension of morningness/eveningness. Previous findings support the assumption that eveningness is related to greater impulsivity and susceptibility to stress than morningness. Heart rate variability (HRV) serves as a physiological correlate of self- and emotional regulation and has not yet been investigated in relation to chronotypes. The study explores differences in HRV and other cardiovascular measures in morning- and evening-types at rest and under stress at different times of day (8-11 a.m. or 4-7 p.m.). Students (N=471) were screened for chronotype and n=55 females (27 morning- and 28 evening-types) were recruited for testing. These participants performed a mental arithmetic task while heart rate (HR) and blood pressure (BP) were recorded. Spectral components and a time-domain measure of HRV were calculated on HR data from resting and mental stress periods. Evening-types had significantly higher HR and systolic BP, but lower HRV than morning-types both at baseline and during stress. Stress induced in the evening had a significantly stronger impact on absolute and baseline corrected physiological measures in both chronotypes. The interaction of chronotype and testing time did not reach the level of significance for any of the dependent variables. The enhanced physiological arousal in evening-types might contribute to increased vulnerability to psychological distress. Hence, previous behavioral findings are supported by the physiological data of this study.

Association between sleep patterns and daytime functioning in children with insomnia: The contribution of parent-reported frequency of night waking and wake time after sleep onset

OBJECTIVE The aim of this study was to investigate the association between sleep patterns and daytime functioning in children with insomnia. Furthermore, the role of frequency of night waking and wake time after sleep onset for daytime functioning was analyzed in the context of total sleep time and sleep onset latency. METHODS Families with children with parent-perceived sleep problems were recruited for diagnostic clarification and subsequent treatment (if indicated) at an outpatient clinic. Out of 49 families seeking help, 34 children (age 5.2-10.9 years, mean 7.1 years) and their parents were included in the present study. Sleep and sleep problems were assessed by a structured clinical interview according to the diagnostic criteria of the International Classification of Sleep Disorders (ICSD-II). Parents kept a sleep diary over two weeks. In addition, they answered the Child Behavior Checklist, questions concerning the daytime sleepiness of their children, as well as a structured clinical interview assessing comorbid mental disorders. RESULTS Reduced parent-reported total sleep time predicted more delinquent behavior and more concentration problems. Independent of total sleep time and frequency of night waking, longer parent-reported wake time after sleep onset was associated with greater daytime sleepiness, which in turn predicted more social problems. CONCLUSIONS Besides total sleep time, wake time after sleep onset could be another important determinant for specific aspects of daytime functioning in children with insomnia.

Irritable bowel syndrome symptoms among German students: prevalence, characteristics, and associations to somatic complaints, sleep, quality of life, and childhood abdominal pain

Objectives Irritable bowel syndrome (IBS) is a common disorder in the general population, and is linked to considerable impairments in daily functioning. Little is known about the prevalence of IBS symptoms among students. This study examined the prevalence and characteristics of IBS, sex differences, associations to other somatic complaints and sleep, quality of life (QoL), and childhood abdominal pain in a German university student population. Methods Using an Internet-based questionnaire, we assessed IBS criteria (according to Rome III), health complaints, health-related QoL (12-item short-form), healthcare-seeking behavior, absenteeism from classes, and subjective attributions in a sample of 2399 university students (mean age: 24.16 years; 1701 female and 696 male students). Results The prevalence of IBS-like symptoms was 18.1% with a significant difference between male (15.2%) and female (21.0%) students. Logistic regression models showed that being long-term student doubles the risk for having IBS [adjusted Odds ratio (OR)=2.16], as did the presence of other health problems: recurrent backaches (adjusted OR=2.15), troubles falling asleep (adjusted OR=1.52), and recurrent abdominal pain during childhood (adjusted OR=2.01). The IBS group had significant impairment on 12-item short-form physical and mental dimensions compared with asymptomatic students. Approximately 60% of participants fulfilling IBS criteria never consulted a physician. Male students attributed their symptoms significantly more to nutrition than female students did, who attributed their symptoms significantly more often to stress and anxiety. Conclusion IBS is a common syndrome among German university students and goes along with impaired health-related QoL. According to our data, students reporting recurrent abdominal pain in childhood are especially at risk for IBS.

JuSt – a multimodal program for treatment of insomnia in adolescents: a pilot study

Insomnia is the most prevalent sleep disorder in adolescents. A number of studies have evaluated the efficacy of the management of chronic insomnia in adults. Behavioral therapy for insomnia is the treatment of first choice, encompassing education about sleep and sleep hygiene, stimulus control, relaxation techniques, and cognitive strategies to combat nocturnal ruminations. Special programs for adolescents are lacking. In this study an age-oriented treatment program for adolescents (JuSt) was developed and evaluated. Eighteen adolescents and their parents participated in a psychological short-term treatment comprising six sessions. First results show that the treatment was well accepted by the adolescents and their parents and led to a significant reduction in sleep problems, such as sleep onset, sleep efficacy, sleep duration, and feeling rested as well as in cognitive parameters, such as ruminations and mental health. Randomized controlled studies are needed to evaluate the efficacy of this new approach to treat insomnia in adolescents.

Subjective Sleep Quality Exclusively Mediates the Relationship Between Morningness-Eveningness Preference and Self-Perceived Stress Response

Eveningness preference has been associated with lower sleep quality and higher stress response compared with morningness preference. In the current study, female morning (n = 27) and evening (n = 28) types completed the Pittsburgh Sleep Quality Index (PSQI) and were additionally challenged with an arithmetic stress-induction task. Evening types reported lower subjective sleep quality and longer sleep latency than morning types. Furthermore, evening types reported higher self-perceived stress after the task than morning types. Subjective sleep quality fully mediated the relationship between morningness-eveningness preference and stress response. Poor sleep quality may, therefore, contribute to the elevated health risk in evening types. (Author correspondence: karolin.roeser@uni-wuerzburg.de)

Rome III criteria in parents' hands: pain-related functional gastrointestinal disorders in community children and associations with somatic complaints and mental health

Objectives To determine (a) the prevalence of Rome III abdominal pain-related functional gastrointestinal disorders in a western community sample of children, (b) their associations with sociodemographic factors, and (c) whether children fulfilling Rome III abdominal pain diagnoses show higher rates of psychological distress and somatization. Methods Data were collected from parents of 6–10-year-old children who were recruited from 22 public grammar schools in Germany. A total of 1537 questionnaires were included in the analysis. Abdominal pain-related functional gastrointestinal disorders were diagnosed on the basis of questionnaire responses by Rome III criteria. Further, somatic complaints as well as emotional and behavioral problems were assessed. Results In total, 7.7% of children aged 6–10 years fulfilled the criteria for at least one Rome III abdominal pain-related functional gastrointestinal disorder according to their parents. The most prevalent diagnoses were irritable bowel syndrome (4.9%) and functional abdominal pain (2.0%). Assigned diagnoses were not associated with sociodemographic factors. We could confirm that abdominal pain-related functional disorders, especially irritable bowel syndrome, were strongly associated with somatization and emotional problems in community. Conclusion Rome III abdominal pain-related functional gastrointestinal disorders are a common health problem in children and are, even in community, strongly associated with other somatic complaints and psychological distress.

Change mechanisms in psychotherapy: Multiperspective assessment and relation to outcome

Abstract The study aimed at constructing a reliable and valid post-session questionnaire measuring general change mechanisms of psychotherapy with correspondent versions for patient and therapist perspectives. Therefore, 253 inpatients in early, middle, and late stages of psychotherapy completed the newly developed Scale for the Multiperspective Assessment of General Change Mechanisms in Psychotherapy (SACiP) and diverse outcome measures. The psychometric qualities of the SACiP were excellent as shown by (a) exploratory factor analyses on patient and therapist ratings, (b) confirmatory factor analyses on later measuring times, and (c) high internal consistencies. Supporting construct validity, the SACiP predicted outcome, as shown by correlational analyses and mixed effects modeling. Patient evaluations of change mechanisms were better predictors of outcome than the corresponding therapist evaluations.