Klaus Schmeck

Temperament and disruptive behavior disorders

In several studies on children with conduct disorder, difficult temperament in infancy was one of the major variables in the explanation of later aggressive behavior. According to these studies, subjects with a combination of high novelty seeking, low harm avoidance and low reward dependence (NS high, HA + RD low) should be most at risk for the development of disruptive behavior disorders. The Junior Temperament and Character Inventory was given to a clinical sample of 65 adolescent patients of both sexes with the diagnoses of conduct disorder (with and without attention deficit hyperactivity disorder), emotional disorder (anxiety disorder, obsessive-compulsive disorder, depressive disorder), eating disorder (anorexia, bulimia) or personality disorder (borderline and narcissistic personality disorder). High novelty seeking and low harm avoidance were significantly correlated with externalizing symptoms like aggression and delinquency. In conduct-disordered children and adolescents, we found significantly higher scores of NS compared to the other clinical groups and the normative population, and significantly lower scores of harm avoidance compared to the other clinical groups, but not compared to the normative population. The relative risk of having a conduct disorder was markedly higher in those children and adolescents with elevated scores of novelty seeking.

Discriminant validity of the child behaviour checklist CBCL-4/18 in German samples

Abstract This study examined the discriminant validity of the German version of CBCL in two large samples of referred and non-referred children and adolescents which were matched for age, sex and socio-economic status. The combined sample that was used for statistical analysis consists of 2,058 referred and 2,058 non-referred boys and girls between 4 and 18 years of age (mean age: referred boys=10.9 years, non-referred boys=10.9 years, referred girls=11.3 years, non-referred girls=11.1 years). Referral status was used as validity criterion. Statistical procedures included Odds Ratios, Total Predictive Values, ROC analyses and discriminant analyses. Results indicated that the discriminant validity of the German version of CBCL is comparable to the original English version. With the use of CBCL Total Problem Score as predictor (cut-off T≥ 60) 83.8 % of children and adolescents could correctly be classified (sensitivity 83.6 %, specificity 83.9 %). Symptoms of the “Attention Problems Scale” show the highest discriminative power to distinguish between disturbed and undisturbed children and adolescents.

Intensity dependence of auditory evoked potentials (AEPs) as biological marker for cerebral serotonin levels: effects of tryptophan depletion in healthy subjects.

Abstract Rationale: The intensity dependence of the auditory evoked potentials (AEP) has been suggested to be a specific biological marker of central serotonergic activity. Objective: While previous studies used circumstantial evidence to support this hypothesis, we manipulated (decreased) cerebral levels of serotonin directly by using tryptophan depletion. Methods: Twelve healthy young subjects were investigated using placebo and two different amino acid mixtures in a double blind cross over design on three different occasions. AEPs recorded during tryptophan depletion were analyzed by dipole analysis and regional sources using methods published in the literature. Results: For none of the mixtures a significant effect of tryptophan depletion was found. There was a trend towards reduced intensity dependency after tryptophan depletion, especially in the right hemisphere. This reduction correlated with the amount of reduced tryptophan in plasma. Conclusions: The results indicate, in contrast to earlier indirect studies, that the intensity dependence of AEPs is not a specific marker of central serotonergic activity.

Comparative efficacy of once-a-day extended-release methylphenidate, two-times-daily immediate-release methylphenidate, and placebo in a laboratory school setting.

AbstractBackgroundGiven the dosing limitations of methylphenidate short–acting preparations in treating ADHD, galenics with longer release of the substance were developed mainly to avoid drug intake during school hours.ObjectivesThis investigation was conducted to assess the efficacy and the duration of action of a new extended-release formulation of methylphenidate (Medikinet® retard) as a once–daily treatment for children with attention–deficit hyperactivity disorder (ADHD).MethodThis was a randomized, double–blind, crossover multicentre study with three treatment conditions: once–daily extended–release methylphenidate, twice–daily immediate–release methylphenidate and placebo given to 79 children (8–14 years old) with ADHD. Daily assessments in an analogue classroom setting included blind ratings of attention and deportment and a performance measure (math test) obtained 5 times over an 8–hour period. Secondary measures included an ADHD rating scale, based on DSMIV/ ICD–10 separately rated for the morning and the afternoon.ResultsBoth active treatment conditions displayed significant time course effects and were superior to placebo in improving all efficacy measures. Once a day extended–release methylphenidate was not different from the same dose of twice daily immediate–release methylphenidate.ConclusionsThese data provide support for the benefit of this novel, once-daily methylphenidate preparation in the treatment of ADHD. The longer duration of action of Medikinet Retard has the potential to simplify psychostimulant treatment, thus reducing dose diversion and eliminating the need for in–school administration.

Mood Changes following Acute Tryptophan Depletion in Healthy Adults

A decrease in central serotonergic activity following plasma tryptophan depletion has been shown to provoke a deterioration of mood. We studied the impact of sex and aggressive traits on mood changes following tryptophan depletion in healthy volunteers. Twelve healthy subjects (6 males, 6 females, 24–31 years), who were screened for psychiatric and non-psychiatric medical illness, were administered a tryptophan-depleting amino acid mixture (TD) and a placebo mixture on two different occasions in a double-blind crossover design. Psychometric measures included the preliminary determination of aggressive traits and depression and repeated assessments of mood and emotionality. The tryptophan-free amino acid mixture caused a marked depletion of plasma tryptophan with lowest levels occurring between 3 and 5 h after TD. Maximum changes in mood occurred about 10 h after TD, but only in high-aggressive women who scored significantly higher in arousal, anger and depressed mood, whereas low-aggressive women and men did not show any effect of TD. In addition, we could not confirm an increase in aggressive mood (anger) after TD in males with higher scores of trait aggression, presumably because the level of trait aggression was not high enough in this group. Due to the small sample size, our results that tryptophan depletion exerts a rapid mood-lowering effect on healthy women with pre-existing aggressive traits can only be seen as preliminary and have to be confirmed in further studies with larger samples.

Verhaltensauffälligkeiten von Kindern und Jugendlichen in Deutschland, den Niederlanden und den USA Eine kulturvergleichende Studie mit der Child Behavior Checklist

ZusammenfassungZiel der Studie ist eine kulturvergleichende Analyse der Beurteilungen von Verhaltensauffälligkeiten von Kindern und Jugendlichen im Alter von 4 bis 18 Jahren durch ihre Eltern in Deutschland, den Niederlanden und den USA anhand der Child Behavior Checklist (CBCL). Die Analysen werden in einer deutschen Feldstichprobe (n = 1622) und einer niederländischen Feldstichprobe (n = 2076) durchgeführt und mit den von Achenbach [1] publizierten Daten für die nationale US-Stichprobe verglichen. Basis der Analysen ist die Skalierung der CBCL in der Version von 1991. Die Analysen werden für vier Alters- und Geschlechtsgruppen (4- bis 11 jährige Jungen/Mädchen und 12- bis 18 jährige Jungen/Mädchen) durchgeführt. Insgesamt lassen sich nur relativ geringfügige Unterschiede zwischen den 3 Stichproben nachweisen. Die mittleren Effektstärken schwanken in den einzelnen Stichproben zwischen –0,04 und 0,35. Damit werden andere kulturvergleichende Analysen mit der CBCL bestätigt, in denen ebenfalls überwiegend geringfügige Kultureffekte nachgewiesen wurden. Solange noch keine für die Bundesrepublik repräsentative Stichprobe vorliegt, kann eine Orientierung an der amerikanischen Normierung erfolgen.SummaryThe goal of the study was a cross-cultural comparison of the parent ratings of behavior problems of children and adolescents aged 4–18 years in Germany, The Netherlands and the United States using the Child Behavior Checklist (CBCL). The analyses were undertaken in a German community sample (n = 1622) and a Dutch community sample (n = 2076). The results were compared with the data published by Achenbach for the national US sample. The analyses were based on the scales of the 1991 CBCL version and were performed for four age and sex groups (4- to 11-year-old boys/girls and 12- to 18-year-old boys/girls). In general, relatively minor differences could be detected between the three random samples. The range in the different samples was between –0.04 and 0.35, which is in line with other cross-cultural analyses using the CBCL. As long as no representative norms for Germany are available, the American norms can serve as an orientation for German studies using the CBCL.

Behandlungsstandards für jugendliche Sexualstraftäter — eine Synopse

Die hier wiedergegebenen Behandlungsstandards sind methodisch im Expertenkonsens entstanden. Die o.g. Teilnehmer waren zunachst gebeten worden, spontan jeweils 10 Thesen zum Thema der Behandlungsstandards zu verschriftlichen. Auf der Grundlage der Rucklaufe wurden eine thematisch gegliederte Synopse zusammengestellt, deren teilweise divergierende Positionen in zweimaligen Expertenrunden diskutiert und unter Zuhilfenahme von Erfahrungen aus der je eigenen Praxis und der Literatur modifiziert und erganzt wurde.

Fluglärm und psychosoziale Hintergrundbelastung von Kindern und Jugendlichen: Gibt es Zusammenhänge zu psychischen oder psychosomatischen Störungen?

Fur die Bewohner von dichtbesiedelten und industrialisierten Landern ist ein erhohter Gerauschpegel inzwischen so sehr zum gewohnten Teil ihrer Umgebung geworden, das dies oft kaum noch bewust zur Kenntnis genommen wird. Wenn dieser Gerauschpegel als storend oder belastigend empfunden wird, sprechen wir von Larm als »Schall, der fur Betroffene unerwunscht ist oder geeignet, sie psychisch, physisch, sozial oder okonomisch zu beeintrachtigen.« (Guski 1987, S. 9) Besonders belastigend wird Larm erlebt in Ruhe- oder Nachtzeiten und in ansonsten ruhigen Umgebungen. Dies trifft in besonderem Mase zu in den westdeutschen Tiefflug-gebieten, in denen bis vor kurzem dusengetriebene Militarflugzeuge sowohl der deutschen Luftwaffe als auch auslandischer Streitkrafte bis hinunter zu einer Mindestflughohe von 75 Metern uber Grund Ubungsfluge durchfuhren konnten. (Inzwischen ist die Mindestflughohe auf 300 Meter hochgesetzt worden.)