Daniel Radeloff

Structural Alterations of the Social Brain: A Comparison between Schizophrenia and Autism

Autism spectrum disorder and schizophrenia share a substantial number of etiologic and phenotypic characteristics. Still, no direct comparison of both disorders has been performed to identify differences and commonalities in brain structure. In this voxel based morphometry study, 34 patients with autism spectrum disorder, 21 patients with schizophrenia and 26 typically developed control subjects were included to identify global and regional brain volume alterations. No global gray matter or white matter differences were found between groups. In regional data, patients with autism spectrum disorder compared to typically developed control subjects showed smaller gray matter volume in the amygdala, insula, and anterior medial prefrontal cortex. Compared to patients with schizophrenia, patients with autism spectrum disorder displayed smaller gray matter volume in the left insula. Disorder specific positive correlations were found between mentalizing ability and left amygdala volume in autism spectrum disorder, and hallucinatory behavior and insula volume in schizophrenia. Results suggest the involvement of social brain areas in both disorders. Further studies are needed to replicate these findings and to quantify the amount of distinct and overlapping neural correlates in autism spectrum disorder and schizophrenia.

Evaluation of a resistance-based model for the quantification of pulmonary arterial hypertension using MR flow measurements

To establish an estimate for the mean pulmonary arterial pressure (mPAP) derived from noninvasive data acquired with magnetic resonance (MR) velocity‐encoded sequences.

High-fat taste challenge reveals altered striatal response in women recovered from bulimia nervosa: A pilot study

Abstract Objectives. Individuals with anorexia nervosa (AN) and bulimia nervosa (BN) tend to have disordered thinking and eating behaviours in regards to fat containing foods. This is the first study to investigate neuronal pathways that may contribute to altered fat consumption in eating disordered patients. Methods. We used functional magnetic resonance imaging (fMRI) to compare responses to a high-fat cream stimulus, water, and a non-caloric viscous stimulus (CMC) to control for response to viscosity in individuals recovered from AN (N = 15), BN (N = 14) and a healthy control sample (CW, N = 18). Results. An interaction analysis (ANOVAR) comparing the three groups (AN, BN, CW) and the three conditions (cream, CMC, water) revealed significant differences in the left anterior ventral striatum (AVS). A post hoc analysis displayed a higher magnitude of response for the contrast cream/water in BN compared to AN or CW and for the contrast CMC/water in BN compared to AN. Conclusions. BN showed an exaggerated AVS response for the cream/water contrast in comparison to AN or CW. Moreover, BN showed an exaggerated AVS response for the CMC/water contrast in comparison to AN. These findings support the possibility that BN have an altered hedonic and/or motivational drive to consume fats.

Suicide in children and adolescents - a 13-year study with 78 cases

OBJECTIVE Updated and regional data about the circumstances of death and the psychosocial backgrounds of suicides can be helpful for improving suicide-preventive strategies in childhood and adolescence. METHOD All known cases of completed suicide in the period from 1996 to 2008 in persons ≤ 21 years of age from the Institute of Forensic Medicine, Frankfurt/Main were analysed in a retrospective study. We included 78 cases and matched them with a comparative sample of 1,797 adult suicides of persons > 21 years of age. RESULTS Within the chosen period there was a 44 % decrease in incidence of suicide in the group of ≤ 21-year-olds. The fraction of incarcerated persons in this group was 8.0 % compared to 2.56 % in the adult group. Differences from suicide in adulthood were also demonstrated in terms of suicide-related substance abuse (less detection of alcohol, more frequent detection of illicit drugs) and choice of methods (more deaths by being hit by a train). CONCLUSIONS Incarcerated adolescents are an important risk group for suicidal tendency and need increased, well-directed preventive measures. Clinical adolescent psychiatry should pay special attention to the indications in this study of an age-dependent association of drug use in suicide.

Withdrawal syndrome after abuse of GHB (Gamma-Hydroxybutyrate) and its physiological precursors - its relevance for child and adolescent psychiatrists

Hintergrund: Der chronische Missbrauch von Gamma-Hydroxybutyrat (GHB) als Designerdroge, sowie seiner beiden physiologischen Vorlaufermolekule Gamma-Butyrolakton (GBL) und 1,4-Butanediol (1,4-BD), stellt eine Problematik fur den Kinder- und Jugendpsychiater dar. Vor allem der akute Entzug von GHB ist aufgrund seines zum Teil protrahierten Verlaufs mit deliranten und kardiovaskularen Symptomen auch fur den Kinder- und Jugendpsychiater von Bedeutung. Methodik: In der vorliegenden Arbeit werden biologische und theoretische Grundlagen zum GHB-/GBL-/1,4-BD-Entzugssyndrom, sowie ausgewahlte bisher in der Literatur berichtete Kasuistiken eines schweren GHB-/GBL-Entzugssyndroms in Bezug auf eine mogliche Therapie zusammengestellt. Ergebnisse: Bei der Therapie eines akuten GHB-Entzugssyndroms zeigte sich in mehreren Fallen eine hoch dosierte Verabreichung von Benzodiazepinen als eine wirksame und gunstige Therapieoption. Berichtete Komplikationen waren neben den pharmakologischen Nebenwirkungen einer Therapie mit ...BACKGROUND The chronic abuse of Gamma-Hydroxybutyrate (GHB) as a designer drug as well as its physiological precursors Gamma-Butyrolactone (GBL) and 1,4-Butandiole (1,4-BD) confronts child and adolescent psychiatrists with new challenges. The acute withdrawal of GHB with its cardiovascular and delirant symptoms is of particular importance for child and adolescent psychiatrists. METHODS In the present paper theoretical and biological aspects of acute GHB-/GBL-/1,4-BD-withdrawal syndrome are presented, and selected cases are discussed as regards potential treatment. RESULTS High dose treatment with benzodiazepines was successful in some cases of acute GHB-/GBL-/1,4-BD-withdrawal syndrome. Complications were severe dystonia under neuroleptic treatment, and also side-effects of treatment with benzodiazepines. Further problems were vegetative symptoms, electrocardiographic changes, rhabdomyolysis, acute renal failure, and death. CONCLUSION Acute GHB-withdrawal syndrome is a life-threatening condition which requires immediate intensive care treatment along with continuous monitoring of vital parameters. As acute GHB-withdrawal syndrome can present with symptoms close to psychotic episodes or acute alcohol withdrawal this condition is relevant for child and adolescent psychiatrists.

Suizide im Kindes- und Jugendalter

OBJECTIVE Updated and regional data about the circumstances of death and the psychosocial backgrounds of suicides can be helpful for improving suicide-preventive strategies in childhood and adolescence. METHOD All known cases of completed suicide in the period from 1996 to 2008 in persons ≤ 21 years of age from the Institute of Forensic Medicine, Frankfurt/Main were analysed in a retrospective study. We included 78 cases and matched them with a comparative sample of 1,797 adult suicides of persons > 21 years of age. RESULTS Within the chosen period there was a 44 % decrease in incidence of suicide in the group of ≤ 21-year-olds. The fraction of incarcerated persons in this group was 8.0 % compared to 2.56 % in the adult group. Differences from suicide in adulthood were also demonstrated in terms of suicide-related substance abuse (less detection of alcohol, more frequent detection of illicit drugs) and choice of methods (more deaths by being hit by a train). CONCLUSIONS Incarcerated adolescents are an important risk group for suicidal tendency and need increased, well-directed preventive measures. Clinical adolescent psychiatry should pay special attention to the indications in this study of an age-dependent association of drug use in suicide.

Entzugsdelir nach Missbrauch von GHB-(Gamma-Hydroxybutyrat) und seiner Vorstufen

Hintergrund: Der chronische Missbrauch von Gamma-Hydroxybutyrat (GHB) als Designerdroge, sowie seiner beiden physiologischen Vorlaufermolekule Gamma-Butyrolakton (GBL) und 1,4-Butanediol (1,4-BD), stellt eine Problematik fur den Kinder- und Jugendpsychiater dar. Vor allem der akute Entzug von GHB ist aufgrund seines zum Teil protrahierten Verlaufs mit deliranten und kardiovaskularen Symptomen auch fur den Kinder- und Jugendpsychiater von Bedeutung. Methodik: In der vorliegenden Arbeit werden biologische und theoretische Grundlagen zum GHB-/GBL-/1,4-BD-Entzugssyndrom, sowie ausgewahlte bisher in der Literatur berichtete Kasuistiken eines schweren GHB-/GBL-Entzugssyndroms in Bezug auf eine mogliche Therapie zusammengestellt. Ergebnisse: Bei der Therapie eines akuten GHB-Entzugssyndroms zeigte sich in mehreren Fallen eine hoch dosierte Verabreichung von Benzodiazepinen als eine wirksame und gunstige Therapieoption. Berichtete Komplikationen waren neben den pharmakologischen Nebenwirkungen einer Therapie mit ...BACKGROUND The chronic abuse of Gamma-Hydroxybutyrate (GHB) as a designer drug as well as its physiological precursors Gamma-Butyrolactone (GBL) and 1,4-Butandiole (1,4-BD) confronts child and adolescent psychiatrists with new challenges. The acute withdrawal of GHB with its cardiovascular and delirant symptoms is of particular importance for child and adolescent psychiatrists. METHODS In the present paper theoretical and biological aspects of acute GHB-/GBL-/1,4-BD-withdrawal syndrome are presented, and selected cases are discussed as regards potential treatment. RESULTS High dose treatment with benzodiazepines was successful in some cases of acute GHB-/GBL-/1,4-BD-withdrawal syndrome. Complications were severe dystonia under neuroleptic treatment, and also side-effects of treatment with benzodiazepines. Further problems were vegetative symptoms, electrocardiographic changes, rhabdomyolysis, acute renal failure, and death. CONCLUSION Acute GHB-withdrawal syndrome is a life-threatening condition which requires immediate intensive care treatment along with continuous monitoring of vital parameters. As acute GHB-withdrawal syndrome can present with symptoms close to psychotic episodes or acute alcohol withdrawal this condition is relevant for child and adolescent psychiatrists.

Psychiatrische Erkrankungen bei Verwandten von Patienten mit Anorexia nervosa und Bulimia nervosa

BACKGROUND Family studies of anorexia (AN) and bulimia (BN) nervosa in relatives of patients with eating disorders compared to control subjects are rare in German-speaking countries. METHODS A German multicenter study compared first-, second- and third-degree relatives of 65 adolescent AN subjects (n = 746), 21 adolescent BN subjects (n = 265) and relatives of 11 adolescent depressive control subjects (n = 157), as well as those of 37 adolescent healthy control subjects (n = 480). Assessments included the Diagnostic Interview for Genetic Studies (DIGS), the short form of the Family Interview of Genetic Studies (FIGS), and the Eating Disorder Family History Interview. RESULTS Rates of anorexia nervosa and major depressive disorder (trend) were significantly (p < .01) higher among the first- and second-degree relatives of anorexic and bulimic subjects than among the relatives of healthy controls. Most results were more prominent among relatives of bulimic index patients. Nevertheless, the frequencies were lower in this sample than in comparable US-American samples. CONCLUSIONS The data confirm the hypothesis of familial vulnerability to anorexia and bulimia nervosa. The observed differences in comorbidity patterns among eating-disordered relatives may be due to an age effect of the index patients.Zusammenfassung: Fragestellung: Im deutschen Raum gibt es kaum Familienuntersuchungen von Patienten mit Anorexia und Bulimia nervosa. Methodik: In einer Multizenter Studie wurde das Auftreten psychiatrischer Erkrankungen bei Familienangehorigen 1., 2. und 3. Grades von 65 anorektischen (n = 746) und 21 bulimischen Patienten (n = 265) mit denen von 37 gesunden Kontrollen (n = 480) sowie 11 depressiven Patienten (n = 157) verglichen. Messinstrumente waren u.a. das Diagnostische Interview fur Genetische Studien bzw. das Familien Interview fur Genetische Studien. Ergebnisse: Die Pravalenz von Anorexia nervosa (signifikant) sowie von depressiven Storungen (Trend) war bei Verwandten 1. und 2. Grades von Patienten mit Essstorungen gegenuber der gesunden Gruppe erhoht. Die meisten Ergebnisse waren eher bei den Familien bulimischer Patienten ausgepragt. Die Pravalenzraten fur psychiatrische Erkrankungen waren insgesamt prozentual niedriger als in vergleichbaren US amerikanischen Stichproben. Schlussfolgerung: Die ...

Male suicide rates in German prisons and the role of citizenship

Purpose Prisoners are at a particularly high risk of suicide. In contrast to other psychosocial risk factors it remains unclear to what degree the risk of suicide differs between prisoners with local citizenship and foreigners. In order to provide more detailed information for suicide prevention in prisons, this study aims to compare suicide rates (SR) between these populations in German criminal custody. Methods Based on a German national database of completed suicide in custody, suicides by prisoners were analysed and compared with epidemiological data of the prison population and the general population, stratified for German and foreign citizenship. Data analysis was adjusted for differences in the age distribution of both populations by calculating standard mortality ratios (SMR) for suicide. Results SR were higher in prisoners with German citizenship than those with foreign citizenship (SR = 76.5 vs. SR = 42.8, P<0.01). This association was not specific to the prison population, as the higher SR in citizens compared to non-citizens (SR = 19.3 vs. SR = 9.0, P<0.01) were also found in the general population. The association between prison suicide and citizenship was comparable in juvenile and adult prisoners, indicating its relevance to both the juvenile and adult detention systems. Conclusion Imprisonment is associated with a substantially increased risk of suicide in both German and non-German citizens, a finding which needs to be taken into consideration by the justice system. The lower suicide risk in non-German citizens is independent of whether or not they are in custody.

Suizid und Suizidalität unter adoleszenten Häftlingen

Following accidents, suicide is the second leading cause of death in adolescence. This stage of life has the most suicide attempts of all age groups. In addition to mentally ill juveniles, adolescent delinquents represent a high-risk group for suicidal behavior and completed suicide. In particular, the population of detainees, an extreme form of juvenile delinquency, have a 16- to 18-fold higher risk of suicidal behavior and suicide compared to the general population. Because the composition of juvenile detainees differs greatly from that of detained adults, age-specific scientific approaches and prevention programs are needed. This task cannot be addressed by juvenile detention staff alone, but rather demands close cooperation between adolescent psychiatrists, psychologists, prison medical staff, legal experts and prison officers to use the opportunity for suicide prevention in juvenile detention facilities.