Max H. Friedrich

Omega-3 Fatty Acids Supplementation in Children with Autism: A Double-blind Randomized, Placebo-controlled Pilot Study

BACKGROUND There is increasing evidence that fatty acid deficiencies or imbalances may contribute to childhood neurodevelopmental disorders. METHODS We conducted a randomized, double-blind, placebo-controlled 6-week pilot trial investigating the effects of 1.5 g/d of omega-3 fatty acids (.84 g/d eicosapentaenoic acid, .7 g/d docosahexaenoic acid) supplementation in 13 children (aged 5 to 17 years) with autistic disorders accompanied by severe tantrums, aggression, or self-injurious behavior. The outcome measure was the Aberrant Behavior Checklist (ABC) at 6 weeks. RESULTS We observed an advantage of omega-3 fatty acids compared with placebo for hyperactivity and stereotypy, each with a large effect size. Repeated-measures ANOVA indicated a trend toward superiority of omega-3 fatty acids over placebo for hyperactivity. No clinically relevant adverse effects were elicited in either group. CONCLUSIONS The results of this study provide preliminary evidence that omega-3 fatty acids may be an effective treatment for children with autism.

Mental health issues in unaccompanied refugee minors.

Previous studies about unaccompanied refugee minors (URMs) showed that they are a highly vulnerable group who have greater psychiatric morbidity than the general population. This review focuses on mental health issues among URMs. Articles in databases PsycINFO, Medline and PubMed from 1998 to 2008 addressing this topic were reviewed. The literature had a considerable emphasis on the assessment of PTSD symptoms. Results revealed higher levels of PTSD symptoms in comparison to the norm populations and accompanied refugee minors. In several studies, age and female gender predicted or influenced PTSD symptoms. The existing literature only permits limited conclusions on this very hard to reach population. Future research should include the analysis of long-term outcomes, stress management and a more thorough analysis of the whole range of psychopathology. Additionally, the development of culturally sensitive norms and standardized measures for diverse ethnic groups is of great importance.

Pathways to dissociation: Intrafamilial versus extrafamilial trauma in juvenile delinquents.

Dissociation is postulated to occur as a function of particular types of child abuse or chronic abuse. Additionally, there is an ongoing controversy examining the perpetrator’s relationship to the victim in the development of dissociation. In this study, reports of traumatic events experienced both in the family environment and in the community were used to examine the relationship between dissociative disorder as defined by DSM-IV (pathological dissociation), and dissociation as a defense mechanism. The first objective was to identify whether the site of the trauma or the quantity of trauma correlated more significantly with symptoms of dissociation. The second objective was to explore a potential correlation between topics that participants choose to disclose during a standardized Stress Inducing Speech Task (SIST), and symptoms of dissociation. The third objective was to examine the relationship between the age of occurrence, the duration of trauma, and symptoms of dissociation. Fifty-two delinquent juveniles completed measures (including the SCID-D, REM-71, CTQ, CTI, SIST) assessing traumatic experiences, psychopathological dissociation, and dissociation as defense mechanism. Blind raters scored the SIST for intrafamilial and extrafamilial trauma. The perpetrator’s relationship to the victim, site of the trauma, quantity of the trauma, age of occurrence, and duration of the trauma were analyzed by descriptive statistics and Pearson partial correlations. Significant correlations were found between symptoms of pathological dissociation and intrafamilial trauma. Significant correlations were not found between extrafamilial trauma and pathological dissociation and dissociation as defense mechanism. All these correlations held constant the chronicity of traumas reported. The results obtained in this study through blind and independent assessment suggest that special trauma characteristics (i.e., childhood trauma perpetrated by a family member) rather than sheer cumulative effects of trauma may have greater implications for the development of pathological dissociation. The relationships to dissociation as a defense were much weaker.

Sex-specific predictors of criminal recidivism in a representative sample of incarcerated youth.

OBJECTIVE The objective of the study was to identify sex-specific psychopathologic predictors of criminal recidivism among a representative sample of incarcerated youths. METHOD In this prospective longitudinal study, the Mini-International Psychiatric Interview for children and adolescents was used to assess psychopathology in juveniles entering an Austrian pretrial detention facility between March 2003 and January 2005. From the beginning of the study until January 2006, data on criminal history were obtained from the Integrierte Vollzugsverwaltung, a database containing criminal information of every individual incarcerated in Austria. Of the 370 eligible participants, the final study sample comprised 328 juveniles (56 girls and 272 boys, age range = 14-21 years, mean = 16.7). RESULTS Reincarceration rates within the specified follow-up period were 52.6% for the boys and 37.5% for the girls. Using Cox forward stepwise regression and Kaplan-Meier analyses, age at first incarceration (B = -.296, Wald statistic = 17.11, P < .001) and oppositional defiant disorder (B = .751, Wald statistic = 19.25, P < .001) were identified as significant predictors for reoffending in boys. In girls, generalized anxiety disorder (B = 1.97, Wald statistic = 13.71, P < .001) was found to be a predictor for reoffending, whereas dysthymia (B = -1.44, Wald statistic = 4.02, P = .045) was found to serve as protective factor. CONCLUSION Our study confirms high rates of reoffending after release from correctional facilities in both sexes. It further defines sex-specific psychopathologic risk factors for relapse in incarcerated juveniles. According to our results, in boys, oppositional defiant disorder and early age at first incarceration are predictive of reincarceration. In girls, anxiety disorder was found to be a risk factor for future offending, whereas dysthymia was found to have a protective influence. Consequently, rehabilitation programs should be sex specific.

Suicidal ideation among Viennese high school students.

ZusammenfassungHINTERGRUND: Suizidalität umspannt ein weites Spektrum von Suizidgedanken bis hin zu Suizidhandlungen. Darüber hinaus, Suizidgedanken kommen in der jungen Population häufiger vor als bei Erwachsenen. Dies lässt auf entwicklungsspezifische Elemente schließen. Wir erhoben die Lebenszeitprävalenz von Suizidgedanken und die damit assoziierten psychosozialen Faktoren bei SchülerInnen von Wiener Höheren Schulen. DESIGN: SchülerInnen (n = 214; Durchschnittsalter 15,4 Jahre) dreier Höherer Schulen in Wien füllten einen anonymisierten Fragebogen aus, der Hauptrisikofaktoren für suizidales Verhalten bei Jugendlichen und demographische Merkmale erfasste. ERGEBNISSE: Einundachtzig SchülerInnen (37,9%) berichteten, bereits einmal im Leben Suizidgedanken gehabt zu haben, wobei die Lebenszeitprävalenz der Suizidgedanken bei Mädchen signifikant höher als bei Jungen war (48,5% vs. 29,1%, p = .004). Weiters waren Suizidgedanken bei den Wiener SchülerInnen assoziiert mit einem Leben in nicht-intakter Familie, Substanzmissbrauch (Alkohol/Drogen), Depression, Rauchen und auch mit dem Schultyp (die höchste Prävalenz der Suizidgedanken fand sich bei GymnasiastInnen). Nach Berücksichtigung signifikanter Variablen, waren bei SchülerInnen der Wiener Höheren Schulen weibliches Geschlecht, Schultyp, Substanzmissbrauch und Zigarettenkonsum signifikant mit der Lebenszeitprävalenz von Suizidgedanken assoziiert. SCHLUSSFOLGERUNGEN: Den psychosozialen Faktoren, die im Zusammenhang mit Suizidgedanken bei Jugendlichen stehen, sollte im Rahmen der Suizidprävention und Gesundheitsförderung mehr Aufmerksamkeit geschenkt werden.SummaryOBJECTIVE: Suicidality spans a spectrum ranging from suicidal thoughts to suicidal acts, and suicidal ideation is more prevalent in youth populations, suggesting important developmental issues. We assessed the prevalence of lifetime suicidal ideation and associated psychosocial factors among Viennese high school students. METHOD: An anonymous self-report survey assessing demographic characteristics and the major psychiatric risk factors of teenage suicide was completed by students at three Viennese high schools (n = 214; mean age 15.4 years). RESULTS: Eighty-one (37.9%) high school students reported having had suicidal thoughts at some point in their lives, girls significantly more often than boys (48.5% vs. 29.1%, P = 0.004). Furthermore, lifetime suicidal ideation in Viennese high school students was associated with living in broken-home families, cigarette smoking, substance problems (alcohol/drugs), self-reported depression, and high school type (the highest prevalence was in grammar school). After adjusting for confounders, we found that female gender, substance problems, school type and cigarette smoking were significantly associated with lifetime suicidal ideation in Viennese high school students. CONCLUSIONS: The psychosocial factors associated with adolescent suicidal ideation require attention in the contexts of suicide prevention and mental health promotion.

Perceptions of family relationships in adolescents with anorexia nervosa and their unaffected sisters

Abstract. The family relationships of patients with anorexia nervosa (AN) have been extensively studied over recent years. However, using case-control designs with unrelated controls is subject to various cultural and familial biases. Studying subjective differential perceptions of family relationships in sister-pairs discordant for the disorder may overcome some of these limitations. The aim of the present study was therefore, to investigate subjective perceptions of family environments in a clinically ill sample of female adolescent patients with acute AN and in their healthy sisters using the Subjective Family Image Test. We found significantly lower perceived individual autonomy and higher perceived cohesion in patients compared with their sisters but no difference in perceived emotional connectedness. Lower perceived individual autonomy of the ill children resulted mainly from their relationships with mothers but also in part from their relationships with fathers. This observed pattern might contribute to the maintenance of the disorder and should be addressed in individual and family interventions.

Responses to conflict, family loss and flight: posttraumatic stress disorder among unaccompanied refugee minors from Africa

ObjectiveTo investigate African unaccompanied refugee minors (URMs) living in Austria for posttraumatic stress disorder (PTSD) prevalence and related symptoms, comorbidity, demographics and coping strategies.Method“UCLA PTSD Index and inventories” and “Scales for Children Afflicted by War and Persecution (SCWP)” were used to assess 41 African URMs.ResultsThe study revealed lower PTSD rates than measured among URMs in previous studies. Girls were more likely to develop PTSD. PTSD was significantly correlated with single war-related traumatic events. The depression score for the sample was above the clinical cut-off value.ConclusionsTrauma-specific psychopathology was less severe than reported in other studies. These findings could be explained by concepts of resilience. Other implications, such as response bias, are discussed.ZusammenfassungAnliegenUnbegleitete minderjährige Flüchtlinge sind oftmals als Patienten vorstellig in kinder- und jugendpsychiatrischen Einrichtungen. Neben vorhandenen sprachlichen Barrieren existieren in der Literatur wenige Daten zu dieser heterogenen Patientenpopulation. Vorliegende Studie fokussiert die aus Afrika stammenden, unbegleiteten, minderjährigen Flüchtlinge (URMs) in Österreich und untersucht das Vorhandensein etwaiger psychischer Störungen, insbesondere jener einer posttraumatischen Belastungsstörung (PTBS) und etwaiger begleitender Symptome und Komorbiditäten. Auch werden in diesem Zusammenhang Coping-Strategien erfasst.MethodeBei den insgesamt 41 afrikanischen URMs, die innerhalb von Österreich rekrutiert werden konnten, wurden neben „UCLA PTSD Index und Inventare“ auch „Scales for Children Afflicted by War and Persecution (SCWP)“ als Untersuchungsinstrumente eingesetzt.ErgebnisseIm Vergleich mit vorhandenen Daten in der Literatur zeigten sich in vorliegender Studie niedrigere PTBS Werte. Die Vulnerabilität für PTBS war für Mädchen erhöht. Die Diagnose einer PTBS stand in einem signifikanten Zusammenhang mit einmaligen kriegsbezogenen traumatischen Ereignissen. Die Depressions-Skala für das Sample befand sich über den klinischen Cut-off Werten.SchlussfolgerungenDie traumaspezifische Psychopathologie war unterhalb der in anderen Studien aufgezeigten Werte. Diese Ergebnisse könnten durch eine mögliche erhöhte Resilienz erklärt werden. Weiterführende Erklärungsmodelle werden diskutiert.

Comparing stress levels in children aged 2–8 years and in their accompanying parents during first-time versus repeated voiding cystourethrograms

ZusammenfassungHINTERGRUND: Invasive Prozeduren wie die MCU bedeuten für Kinder und Eltern eine hohe Stressbelastung. Ziel der vorliegenden Studie war es, zu untersuchen, ob sich die Stressbelastung von Kindern und deren begleitenden Eltern bei erstmaliger und wiederholter Miktionszystourethrographie (MCU) unterscheidet. Darüber hinaus sollte die Beziehung zwischen elterlichem Verhalten (das kindliche Coping förderndes und den kindlichen Distress förderndes Verhalten), elterlicher Stressbelastung und kindlicher Stressbelastung bei erstmaliger und wiederholter MCU untersucht werden. METHODIK: In einer prospektiven Studie wurde das Distressverhalten von 31 Kindern im Alter von 2 bis 8 Jahren bei wiederholter MCU untersucht. Eine Parallelstichprobe von 31 Kindern mit erstmaliger MCU diente als Kontrollgruppe. Kindliches und elterliches Verhalten während der MCU wurde von drei unabhängigen Beobachtern mittels einer standardisierten Beobachtungsskala (CAMPIS-R, Blount et al.) kodiert. Die Kinder beurteilten ihre Stressbelastung anhand einer Gesichterskala. Eltern und Radiologen schätzten die kindliche Stressbelastung anhand einer visuellen Analogskala ein. Ergänzend schätzten die Eltern ihre eigene Stressbelastung ebenfalls auf einer visuellen Analogskala ein. ERGEBNISSE: Kinder mit wiederholter MCU unterscheiden sich in ihrer Stressbelastung nicht von Kindern mit erstmaliger MCU, die elterliche Stressbelastung ist jedoch bei wiederholter MCU signifikant geringer. In beiden Gruppen findet sich eine signifikante positive Korrelation zwischen Distress förderndem Verhalten der Eltern und kindlichem Distress, sowie zwischen elterlicher Stressbelastung und kindlichem Distress. Zwischen Coping förderndem Verhalten der Eltern und kindlichem Distress bzw. elterlicher Stressbelastung konnten in keiner der beiden Gruppen signifikante Korrelationen gefunden werden. Elterliche Stressbelastung und Distress förderndes Verhalten der Eltern waren nur bei wiederholter MCU signifikant positiv korreliert. Im Coping und Distress fördernden Verhalten der Eltern zeigten sich keine signifikanten Unterschiede zwischen erstmaliger und wiederholter MCU. SCHLUSSFOLGERUNGEN: Die kindliche Stressbelastung ist bei wiederholter MCU vergleichbar hoch wie bei erstmaliger MCU. Obwohl die elterliche Stressbelastung bei wiederholter MCU geringer ist, erweist sich das spontane Verhalten der Eltern als ineffektiv bzw. sogar kontraindiziert zur Verringerung der kindlichen Stressbelastung. In einem nächsten Schritt sollten weiterführende Studien zu effizienten Beratungs- und Trainingsprogrammen für Eltern und Kinder bei wiederholter MCU folgen.SummaryOBJECTIVES: Invasive procedures such as voiding cystourethrograms (VCUGs) cause distress in both children and their accompanying parents. The main purpose of this study was to examine whether stress levels in children and their parents differ during first-time and repeated VCUGs. The second objective was to examine the relationship between parental behavior (behavior promoting child coping and behavior promoting child distress), parental stress levels and child distress in first-time versus repeated VCUGs. METHODS: In a prospective study, the distress behavior of 31 children aged 2–8 years who were undergoing a repeated VCUG was examined. A second group of 31 children who were undergoing a VCUG for the first time served as a control sample. Child and parental behavior during the VCUG was coded by three independent observers using a standardized rating scale (CAMPIS-R, Blount et al.). Children reported on their stress levels using a faces scale; parents and radiologists rated the childs distress on a visual analog scale. Similarly, parents assessed their own stress levels on a visual analog scale. RESULTS: The stress levels of children undergoing a repeated VCUG do not differ from those of children undergoing a VCUG for the first time, but parental stress levels were significantly lower during repeated VCUGs. In both VCUG groups there was significant positive correlation between parental distress-promoting behavior and child distress, and between parental stress levels and child distress. Parental coping-promoting behavior showed no significant correlation with child distress or parental stress levels in either VCUG group. Parental stress levels and parental distress-promoting behavior correlated positively only for repeated VCUGs. Neither parental coping- nor distress-promoting behavior differed between first-time versus repeated VCUG groups. CONCLUSIONS: Repeated VCUGs and first-time VCUGs are both highly distressing procedures for children. Even though parental stress levels are lower during repeated VCUGs, spontaneous parental behavior proves to be ineffective or even counterproductive in reducing the childs distress. Further research into efficient counseling and training methods for parents and children undergoing VCUGs is required.

Awareness of early-onset anorexia nervosa.

The aim of the study was to determine whether physicians consider anorexia ner vosa as a possible diagnosis in children and adolescents presenting various somatic symptoms including significant weight loss. Questionnaires were handed out to participants of a nationa general medical congress in Austria. The questionnaire included two case vignettes of children with anorexia nervosa and questions about diagnosis, differential diagnoses and management Anorexia nervosa was considered as possible primary diagnosis in both cases by 3.8% of the respondents and 11.4% suspected a psychosomatic or psychiatric disorder as primary diagnosis in both cases. These findings demonstrate a limited awareness of anorexia nervosa and of a psy chosomatic or psychiatric origin of somatic symptoms including weight loss in children and ado lescents among physicians. Recognizing anorexia nervosa in an early stage and referring the patients for a psychiatric evaluation as soon as possible is a prerequisite for specialized treatmen and might improve the long-term outcome of this severe disorder. Increased educational efforts are required to improve the knowledge among primary care physicians about eating disorders.

Psychopathology among parents of children and adolescents with separation anxiety disorder

SummaryObjectiveTo examine psychopathology among parents of children and adolescents with separation anxiety disorder (SAD).MethodA case-control design was applied: parents of children and adolescents suffering from SAD (n = 30; age: 10.7 ± 1.8 a) were compared with parents of youth without any psychiatric disease (n = 30; age: 11.2 ± 1.8 a). The SCID-I, a structured clinical interview to assess psychopathology, was applied among the parents group.ResultsParents of children and adolescents suffering from SAD exhibited a significantly higher prevalence of psychopathology, mainly anxiety disorders and mood disorders, in comparison with the control group. Within anxiety disorders, mothers predominantly suffered from social phobia and specific phobia. Fathers most frequently suffered from obsessive-compulsive disorder and social phobia. Maternal anxiety disorder (current and lifetime) and maternal affective disorder (lifetime) proved to be significant predictors of SAD in youth.ConclusionsThe associations between parents’ psychopathology and the development of SAD in their children are discussed in the light of clinical implications, both in terms of psychotherapeutic care as well as treatment outcome.ZusammenfassungZielIn dieser Studie wird die Psychopathologie der Eltern von Kindern und Jugendlichen mit einer diagnostizierten Emotionalen Störung mit Trennungsangst untersucht.MethodeIn diesem Studiendesign werden Eltern und Jugendliche, welche die diagnostischen Kriterien einer Emotionalen Störung mit Trennungsangst erfüllten (n = 30; Alter: 10,7 ± 1,8 a) und gesunde Probanden (n = 30; Alter: 11,2 ± 1,8 a) verglichen. Das SKID-I, ein strukturiertes klinisches Interview für psychische Störungsbilder, wird für die Evaluierung der psychopathologischen Auffälligkeiten der Eltern verwendet.ErgebnisseDie Eltern von Kindern und Jugendlichen mit einer diagnostizierten Emotionalen Störung mit Trennungsangst haben verglichen mit der Kontrollgruppe eine signifikant höhere Prävalenz für psychiatrische Erkrankungen, vor allem im Bereich der Angststörungen und der affektiven Störungen.Bezüglich der Angststörungen erfüllen hierbei die Mütter häufig die diagnostischen Kriterien für Soziale Phobie und Spezifische Phobie. Die Väter hingegen zeigen zum Untersuchungszeitpunkt häufiger Zwangserkrankungen und Soziale Phobien. Mütterliche Angststörungen (current und lifetime) und affektive Erkrankungen (lifetime) haben sich als signifikante Prädiktoren erwiesen.SchlussfolgerungDer Zusammenhang zwischen elterlicher Psychopathologie und der Entwicklung einer Emotionalen Störung mit Trennungsangst wird hinsichtlich der psychotherapeutischen Interventionsmöglichkeiten und des damit zusammenhängenden Behandlungserfolges diskutiert.