Katrin Skala

Phosphatidylethanol: normalization during detoxification, gender aspects and correlation with other biomarkers and self-reports.

Phosphatidylethanol (PEth) is a direct ethanol metabolite, and has recently attracted attention as biomarker of ethanol intake. The aims of the current study are: (1) to characterize the normalization time of PEth in larger samples than previously conducted; (2) to elucidate potential gender differences; and (3) to report the correlation of PEth with other biomarkers and self‐reported alcohol consumption. Fifty‐seven alcohol‐dependent patients (ICD 10 F 10.25; 9 females, 48 males) entering medical detoxification at three study sites were enrolled. The study sample was comprised of 48 males and 9 females, with mean age 43.5. Mean gamma glutamyl transpeptidase (GGT) was 209.61 U/l, average mean corpuscular volume (MCV) was 97.35 fl, mean carbohydrate deficient transferrin (%CDT) was 8.68, and mean total ethanol intake in the last 7 days was 1653 g. PEth was measured in heparinized whole blood with a high‐pressure liquid chromatography method, while GGT, MCV and %CDT were measured using routine methods. PEth levels at day 1 of detoxification ranged between 0.63 and 26.95 µmol/l (6.22 mean, 4.70 median, SD 4.97). There were no false negatives at day 1. Sensitivities for the other biomarkers were 40.4% for MCV, 73.1% for GGT and 69.2% for %CDT, respectively. No gender differences were found for PEth levels at any time point. Our data suggest that PEth is (1) a suitable intermediate term marker of ethanol intake in both sexes; and (2) sensitivity is extraordinary high in alcohol dependent patients. The results add further evidence to the data that suggest that PEth has potential as a candidate for a sensitive and specific biomarker, which reflects longer‐lasting intake of higher amounts of alcohol and seemingly has the above mentioned certain advantages over traditional biomarkers.

Suicidal ideation and temperament: An investigation among college students

BACKGROUND Suicide is a major health problem accounting for up to 1.5 percent of all deaths worldwide and represents one of the most common causes of death in adolescents and young adults. A number of studies has been performed to establish risk factors for suicide in patients with psychiatric disorders including temperamental features. This study set out to assess the relationship between suicidal ideation and temperament in young adults. METHODS A cross-sectional sample of healthy college students (n=1381) was examined using a self-rating questionnaire. Suicidal ideation, social background, educational status, substance abuse, and affective temperament according to TEMPS-M were assessed. Predictors of lifetime suicidal ideation were examined in multivariate logistic regression analyses. RESULTS Suicidal ideation was reported by 12.5% of all subjects at some point in their life and was higher in nicotine dependents, youth with alcohol related problems and users of illicit substances as well as in youth with lower educational status. Lifetime suicidal ideation was associated with the anxious, depressive and cyclothymic temperament in both sexes and the irritable temperament in males. These results remained significant after adjustment for smoking status, frequency of alcohol consumption, drug experience and educational status in a multivariate logistic regression analysis. LIMITATIONS The use of self-rating instruments always reduces objectivity and introduces the possibility of misreporting. CONCLUSIONS Considering the fact that many subjects completing suicide have never been diagnosed with mental disorders it might be reasonable to include an investigation of temperament in screenings for risk of suicide. This might be especially useful for health care professionals without mental health care background.

Adolescence and Alcohol: a review of the literature

SummaryUp to two thirds of adolescents consume alcohol and about a quarter engage in abusive behavior at some point. Many users begin alcohol use at young ages, and binge drinking is a dominant pattern for a proportion of youth. Because neurogenesis is inhibited by ethanol, consequences of adolescent alcohol abuse include changes in brain development and impairment of neurocognitive performance. A variety of mental and psychosocial problems are also often witnessed in alcohol abusing youth. Apart from the influence exerted by genetic and psychosocial factors, the chance of developing problematic alcohol consumption is increased by consumption in a binge drinking manner and by first contact with alcohol at a young age. Discrimination of alcohol consumption within the frames of normal adolescent behavior from problematic use is still a challenging issue. Different prevention programs provide treatment either directly to the adolescent, in the context of the school, or within the frame of the adolescent’s family. Although some of these efforts have been shown to be effective in reducing alcohol misuse in youth, hardly any intervention reveals satisfactory outcomes in a long-term prospect. Successful prevention strategies would need to comprise treatment of current neuropsychological impairment as well as of comorbid mental health problems and concurrent other substance misuse.ZusammenfassungBis zu zwei Drittel aller Jugendlichen konsumieren Alkohol und ungefähr ein Viertel hat Erfahrung mit missbräuchlichem Alkoholkonsum. Viele Konsumenten beginnen bereits in sehr jungen Jahren, und Komatrinken ist nach wie vor ein bei Jugendlichen verbreitetes Phänomen. Alkohol verhindert die Neurogenese, sodass Alkoholmissbrauch im Jugendalter zu Veränderungen in der Gehirnentwicklung sowie zu einer Verminderung der Leistung im neurokognitiven Bereich führt. Bei alkoholmissbrauchenden Jugendlichen finden sich weiters häufig verschiedene psychische und psychosoziale Probleme. Neben genetischen und psychosozialen Einflüssen wird das Risiko, im Erwachsenenalter eine Alkoholabhängigkeit zu entwickeln, durch frühen Konsumbeginn sowie Konsum großer Mengen in kurzer Zeit wie beim Komatrinken erhöht. Nach wie vor sehr schwierig gestaltet sich die Unterscheidung eines normalen Alkoholkonsums im Rahmen der Adoleszenz von problematischem Gebrauch. Verschiedene Präventionsprogramme arbeiten direkt mit den Jugendlichen oder in deren schulischem oder familiärem Umfeld. Wenngleich durch manche dieser Interventionen Alkoholmissbrauch bei Jugendlichen reduziert werden konnte, zeitigt kaum eine Strategie zufriedenstellende langfristige Ergebnisse. Erfolgreiche Präventionsstrategien müssten die Therapie neuropsychologischer Beeinträchtigung, komorbider psychischer Erkrankungen und eines etwaigen multiplen Substanzkonsums miteinbeziehen.

Beating the odds: an approach to the topic of resilience in children and adolescents

SummaryThe concept of good mental functioning despite negative influences first arose more than a hundred years ago and has received increasing interest during the last decades. For a long time, lack of unified definition of concept and terms rendered research difficult to compare. Nowadays, consent is reached on a definition of resilience as “an individual’s ability to properly adapt to stress and adversity” and a large number of studies have been performed trying to identify factors that render children resilient. Among these, interpersonal factors like gender, intelligence, aspects of character and temperament as well as genes; factors within the family like a stable and positive relation to an adult; and factors of the broader environment like being integrated into the community have been those most articulately pointed out by research. Although, to date, research on resilience has been extensive, there is still a lack of robust, comparative, empirical studies allowing policy formulation for fostering resilience in children at risk.ZusammenfassungDas Konzept von psychischer Stabilität trotz widriger Umstände, welches vor mehr als hundert Jahren erstmals entstand, hat vor allem während der letzten Jahrzehnte zunehmend an Beachtung gewonnen. Das Fehlen einer einheitlichen Definition des Konzeptes an sich sowie der jeweiligen Begrifflichkeiten machte es jedoch über lange Zeit schwierig, Forschungsergebnisse zu vergleichen. Heute wird Resilienz als „die Fähigkeit eines Individuums, Krisen durch Rückgriff auf persönliche Ressourcen zu meistern“ definiert und in vielen Studien wurde und wird versucht, Faktoren, welche Resilienz bei Kindern fördern, zu identifizieren. Hierbei stellten sich persönliche Faktoren wie Geschlecht, Intelligenz, bestimmte Züge von Charakter und Temperament, Aspekte innerhalb der Familie wie etwa eine positive, stabile Beziehung zu einem Erwachsenen sowie Faktoren des Umfeldes wie das Eingebunden sein in eine Gemeinschaft als am stärksten wirksam heraus. Wenngleich es bis heute unzählige Untersuchungen zum Thema Resilienz gibt, fehlt es dennoch noch immer an robusten, vergleichbaren, empirischen Studien als Grundlage für Strategien zur Stärkung der Resilienz bei gefährdeten Kindern.

Experiences of Domestic and School Violence Among Child and Adolescent Psychiatric Outpatients.

The experience of cumulative childhood adversities, such as exposure to domestic violence or abuse by caregivers, has been described as risk factor for poor mental health outcomes in adolescence and adulthood. We performed an investigation of experience of violence in all patients aged 6 to 20 years who had consulted the Department of Child and Adolescent Psychiatry, Medical University of Vienna, as outpatients during the period of one year. We were using the Childhood Trauma Interview (CTI) in order to obtain information on the kind of violence. Seventy-five percent of all patients had reported experiences of violence. These youth were significantly more often involved in acts of school violence, thus a significant correlation between experience of domestic violence and violence at school could be revealed. The results of our study emphasize the need for interventions preventing violence both in domestic and in school environments.

Emotional expressiveness and avoidance in narratives of unaccompanied refugee minors.

Objective The aim of this study was to examine a cohort of unaccompanied refugee minors (URMs) by means of psycholinguistic methods in order to obtain a more subtle picture of their degree of traumatization. Methods Twenty-eight participants were included in the Stress-Inducing Speech Task (SIST) consisting of a free association (FA) and a stress (STR) condition. Narratives were examined by means of (1) quantitative parameters (word count); (2) psycholinguistic variables (temporal junctures, TJs), narrative structure, referential activity (RA)—a measure of emotional expressivity; and (3) content analysis ratings. Results Word count was significantly lower than in age-matched norms. In the FA condition, TJs were lower, but in the STR condition, rates were comparable. RA was significantly higher in both conditions. Content analysis ratings showed that the experiences described by these youths were potentially traumatic in nature. Conclusions This pattern of narrative shows a mixture of fulfilling the task demand, while containing an emotionally charged narrative. Narrative structure was absent in the FA condition, but preserved in the STR condition, as URMs struggled with the description of non-normative events. This indicates that these youths have not yet emotionally dealt with and fully integrated their trauma experiences.

Attention deficit hyperactivity disorder and substance abuse: An investigation in young Austrian males

BACKGROUND Many studies have found an association between Substance Use Disorders (SUDs) and Attention Deficit Hyperactivity Disorder (ADHD) in children, adolescents and adults. We intended to determine whether substance abuse and SUDs are associated with former and current ADHD symptomatology in a non-clinical sample of 17 and 18 year old males. METHOD A representative sample of 3280 young men (6.8% of all males born in Austria in the respective year) was investigated during the examination for military service. We collected data on past (WURS) and current (ADHD symptom checklist) ADHD symptomatology, substance abuse, parental substance use and abuse and motives for substance use. RESULTS Measured by WURS, 10.1% had scored positive for past ADHD symptoms. 2.7% of all subjects stated that they have been treated for ADHD and 1.5% reported that they had at one point received pharmacological treatment for the condition. Abuse of alcohol, nicotine and illicit substances was significantly (p<.01) more frequent in subjects with ADHD syndrome. Perceived parental alcohol abuse increased the risk for ADHD in the offspring. Motives for substance use differed greatly between groups. LIMITATIONS The sample consists of men only. Subjects had to be fit enough to be enlisted military service, generating a possible bias towards healthier subjects. The cross-sectional design does not allow conclusions about the temporal relationships between ADHD symptoms and substance abuse. CONCLUSION Identification of vulnerability factors for comorbid ADHD and SUD in adolescence should be intensified. Preventive strategies ought to be established.

“The Buoy”: Utilization of a low-threshold ambulatory setting for traumatized children and adolescents in Austria

SummaryBackgroundThis investigation intended to assess the use of an outpatient clinic providing low-threshold, short-term trauma therapy for children and adolescents across the first 6 years of its existence.MethodsA retrospective analysis of the records of all patients undergoing treatment in this institution between 2001 and 2007 (n = 2510) has been performed. We evaluated demographic data, reason for contacting the unit, the referring person or institution, the person or institution in charge of the care and custody of the child, the number of contacts with the clinic, presence of physical or psychiatric illness of a parent, and medications prescribed.ResultsAges of patients ranged from 1 to 17. Gender distribution was even. Having experienced the death of a relative, experienced violence, or having witnessed traumatic death were the main reasons for presentation. The utilization rates of immigrants rose throughout the observation period. Children from foster care were seen less frequently than expected. Medication was hardly prescribed.ConclusionsAmple utilization of this institution clearly demonstrates the need for short-term acute outpatient trauma therapy for children and adolescents. Efforts to provide easily accessible institutions for youth who experience traumatic events should be stepped up.ZusammenfassungGrundlagenDiese Untersuchung hatte zum Ziel, die Inanspruchnahme einer Ambulanz, welche niedrigschwellige, Trauma-fokussierte Kurzpsychotherapie für Kinder und Jugendliche anbietet, während der ersten sechs Jahre ihres Bestehens zu untersuchen.MethodikWir führten eine retrospektive Analyse der Krankengeschichten aller zwischen 2001 und 2007 behandelten Patienten (n = 2510) durch und dokumentierten demographische Daten, Gründe für die Behandlung, zuweisende Institution, Obsorge berechtigte Person oder Institution, die Anzahl der Kontakte, psychische oder körperliche Erkrankung eines Elternteils und verschriebene Medikation.ErgebnisseDie behandelten Patienten waren zwischen 1 und 17 Jahre alt, die Geschlechterverteilung war gleichmäßig. Häufigster Anlass für eine Kontaktaufnahme waren der Tod eines Verwandten, die Tatsache, Zeuge eines gewaltsamen Todes geworden zu sein oder andere Gewalterfahrungen. Die Inanspruchnahme durch Migranten stieg während des Untersuchungszeitraumes laufend an. Kinder aus Pflegefamilien suchten die Institution seltener als erwartet auf. Medikation wurde kaum verschrieben.SchlussfolgerungenDie intensive Nutzung dieser Institution zeigt deutlich den großen Bedarf an kurzfristiger akuter Traumatherapie für Kinder und Jugendliche. Bemühungen, leicht zugängliche Institutionen für traumatisierte Kinder und Jugendliche zur Verfügung zu stellen, sollten intensiviert werden.