Meinolf Noeker

Resilienz: Funktionale Adaptation an widrige Umgebungsbedingungen

Resiliente Kinder, Jugendliche und Erwachsene sind dadurch gekennzeichnet, dass ihnen eine funktionale Adaptation an widrige, oftmals traumatische Umgebungsbedingungen in einer Weise gelingt, so dass langfristig ein kompensiertes, gesundes psychologisches Funktionsniveau und Entwicklungsergebnis erreicht wird. Im Fokus der Resilienzforschung steht die Identifikation der protektiven Faktoren, die als Moderatormerkmale die Wirkung der Risikofaktoren auf den Outcome lindern oder neutralisieren. An der Entwicklung von Resilienz sind adaptive Systeme auf vier Ebenen beteiligt: personale Kompetenzen des Kindes (Stressverarbeitung, Selbstregulation, Motivation, Lernen), des Familiensystems (Bindung, Interaktion, Erziehung), Ressourcen des sozialen Netzwerkes (Schule, Gleichaltrige) und gesellschaftlich-kulturelle Faktoren (Normen, Werte). Biologische (genetische, endokrine, neurobiologische) Resilienzfaktoren konnen die Impulskontrolle, Handlungsplanung und Emotionsregulation bei der Stressregulation starken. Ju...

Development of mental health dysfunction in childhood epilepsy

A marked prevalence of mental health dysfunction in childhood epilepsy has been documented in the literature. While several individual risk factors have been identified, which are statistically associated with an impaired mental health outcome, there is a lack of knowledge on the pathways taken by these risk factors on disease development and treatment. The relevant literature of the last decade will be reviewed in this paper to provide evidence for the conceptual framework presented here. Thus, the emergence of mental health dysfunction in childhood epilepsy is analyzed under three levels. Pathogenetic causes: These involve both the underlying CNS pathology and the associated epilepsy disorder characterized by specific time of onset duration type and severity. Mediators and moderators connecting causes to outcomes: These comprise, firstly, the differentiation between the intervening role of anti-epileptic drugs and their positive psychotropic impact via suppression of seizure activity and transient cognitive impairments, as against their negative psychotropic side-effects; secondly, the psychological processes of adaptation which entail responding to three major demands (adherence to treatment requirements, exercising self-control and lifestyle modification to reduce seizure activity, and coping with the psychosocial stressors secondary to living with epilepsy); thirdly, the age-dependent level of neurocognitive and behavioral functioning; and, fourthly, contextual risks and protective factors within the family and social environment. Mental health outcome: This encompasses three major domains: risks for learning disability, for impairments of health-related quality of life, and for psychopathology. The proposed framework serves the development and validation of hypotheses and can be applied to testing procedures aimed at investigating the emergence of mental health dysfunction in childhood epilepsy. On the scientific level, it provides an appropriate tool to approach childhood epilepsy in general, whereas on the clinical level, it facilitates the assessment and management of individual patients.

Health-related quality of life of children and adolescents with growth hormone deficiency or idiopathic short stature - part 2: available results and future directions.

Research on the health-related quality of life (HrQoL) impact of short stature and its treatment in children and adolescents has developed recently. Based on a PubMed literature search, studies addressing this issue were identified and considerable methodological problems mainly related to the HrQoL instruments used and conflicting results are discussed in this mini review. Additionally, this mini review identifies a need for further research and indicates potential directions.

Assessment of Health-Related Quality of Life and Patient Satisfaction in Children and Adolescents with Growth Hormone Deficiency or Idiopathic Short Stature – Part 1: A Critical Evaluation of Available Tools

The concept of health-related quality of life (HrQoL) reflects the subjective perception of health and includes aspects of well-being and functioning in physical, emotional, mental and social life domains. Nowadays, HrQoL has become a relevant treatment outcome from epidemiological and clinical perspectives and is also broadly employed in health economic analyses. To assess HrQoL generic as well as condition-specific instruments are used. The former are applicable to a wide range of health conditions and aim at measuring HrQoL across different conditions. The latter focus on capturing the impact of a specific disease. Although HrQoL research in adults is now well-advanced, there are still open questions regarding how to assess HrQoL in pediatric conditions, such as short stature. Eight generic (one chronic-generic) and seven condition-specific (one treatment-specific) instruments used in HrQoL research in short stature of youth are described. Additionally, this mini review identifies a need for further research and indicates potential directions.

Gender-associated differences in the psychosocial and developmental outcome in patients affected with the bladder exstrophy-epispadias complex

To identify problems in the long‐term psychosocial and developmental outcome specific to patients with the bladder exstrophy‐epispadias complex (BEEC), using a self‐developed semi‐structured questionnaire, as there are various techniques of reconstruction to repair BEEC but to date neither patients nor surgeons have a clear answer about which type gives the most acceptable long‐term results.

Münchhausen-by-proxy-Syndrom als Kindesmisshandlung

ZusammenfassungDas Münchhausen-by-proxy-Syndrom (MbpS) ist eine Form der Kindesmisshandlung, die darauf beruht, dass eine nahe stehende Person (in der Regel die Mutter) bei einem Kind Anzeichen einer Krankheit vortäuscht oder aktiv erzeugt, um es wiederholt zur medizinischen Abklärung vorzustellen. Ärzte werden so verleitet, nicht indizierte, multiple, oft invasive Eingriffe vorzunehmen. Der Beitrag stellt folgende 3 Aspekte in den Vordergrund: 1. das Spektrum charakteristischer Warnhinweise für den Verdacht auf ein MbpS sowie Kriterien zur Abgrenzung anderer Formen eines zwar exzessiven, aber grundsätzlich nicht misshandelnden medizinischen Inanspruchnahmeverhaltens; 2. die kurz- und langfristigen, physischen und psychischen Traumatisierungsfolgen dieser Form von Kindesmisshandlung und deren psychopathologische Wirkmechanismen; 3. praxisorientierte Strategien der Identifikation, der Abklärung und des Managements in Ambulanz und Klinik im Zusammenwirken mit psychiatrisch-psychologischen Kollegen sowie dem Familiengericht und der Jugendhilfe.AbstractMunchhausen syndrome by proxy (MbpS; factitious disorder by proxy) as a form of child abuse is characterized by a child presented for symptoms that have been faked or fabricated by a person responsible for the child (mostly the mother). Paediatricians are thus induced to perform not indicated, multiple and often invasive procedures. Three major issues are delineated: (1) characteristic features and warning signs of MbpS as well as criteria for differentiating excessive but nevertheless not abusing forms of exaggerated illness behavior; (2) short and long term as well as physical and psychological sequelae of traumatic experience and possible psychopathological pathways; (3) strategies of identification and management out-patient and in in-patient setting in cooperation with child psychiatry/psychology and with child protection services and the court.

Functional Abdominal Pain in Childhood: From Etiology to Maladaptation

Objective: To review the extant literature on functional abdominal pain in childhood through the lens of the developmental psychopathology perspective and to systematize research results by means of a two-stage pathway model in which the emergence of functional abdominal pain and its potential transition into a somatoform adjustment disorder is outlined. Methods: Using electronic searches for published studies and previous reviews about functional abdominal pain. Results: An association of functional abdominal pain with internalizing symptoms, poor well-being of family members, major life events and daily stressors is found. The impact of stress on pain seems to be moderated by the children’s coping style and their perceived competence and self-efficacy to manage the pain experience. There is evidence for the influence of modeling and operant mechanisms on pain experiences. A new term, ‘somatoform adjustment disorder’, and its relation to functional abdominal pain is discussed. Conclusions: It seems that those children with functional abdominal pain who cannot adapt to the pain indeed run the risk of developing a somatoform adjustment disorder.

Management of Idiopathic Short Stature: Psychological Endpoints, Assessment Strategies and Cognitive-Behavioral Intervention

Background: In 2007, a Conference on Idiopathic Short Stature (ISS) endorsed the definition of ISS as a statistical (auxologic) rather than a medical (pathologic) deviation from the norm. Consequently, the ultimate criteria for evaluation of treatment in ISS shift from medical to psychological endpoints. Objective: This review synthesizes empirical evidence of psychological outcomes in treated and untreated subjects with ISS, recommendations from the recent ISS Consensus Conference, theoretical concepts from pediatric psychology and rationales used for various intervention strategies to better evaluate and manage psychological endpoints in ISS in accordance with the Consensus Conference definition. Methods: Different measures of psychological outcome in ISS are reviewed to explain apparent heterogeneity among empirical study findings. Key issues include: (1) adaptation to major stressors associated with short stature (e.g., bullying, peer relations) and the correlation of adaptation failure with low socioeconomic status and impaired quality of life in adulthood; (2) development of valid and sensitive assessment tools; (3) clinical decision-making based on psychological assessment, ethical principles concerning informed consent and expectation of benefit from psychological treatment and (4) intervention approaches including counselling, cognitive-behavioral therapy, assertiveness training and growth hormone therapy. Conclusions: There are different but complementary strategies for medical and psychological enhancement of psychosocial outcome in subjects with ISS.

Fibromyalgie: Eine körperliche Krankheit oder unspezifische psychische Störung?

Zusammenfassung. Die Fibromyalgie (FM) ist eine multilokale, nichtentzundliche Schmerzstorung an bestimmten druckschmerzhaften Punkten des Bewegungsapparates. Hinzu treten multiple funktionelle Symptome wie Schlafstorungen, Magen- und Darmbeschwerden, Konzentrationsstorungen und nicht zuletzt psychische Beeintrachtigungen und Storungen (Depression, Angst, eingeschrankte Lebensqualitat). Bei Kindern und Jugendlichen stellt die FM eine eher seltene Extremform weitverbreiteter funktioneller Schmerzstorungen des Bewegungsapparates dar. Die medizinische Diagnostik ergibt keinen pathologischen Befund. Entsprechend kontrovers wird die Atiopathogenese diskutiert. Drei Storungsmodelle werden vorgestellt: (1) FM als organische Erkrankung auf der Basis einer genetischen Pradisposition, mit Regulationsstorungen der Hormonachse, des Vegetativums und der Neurotransmittersysteme, (2) FM als chronisch-funktionelle Schmerzstorung infolge einer Schmerzsensitivierung und -verstarkung (Wind-up-Phanomen), (3) FM als psychisch...

Neurocognitive development in children experiencing intrauterine growth retardation and born small for gestational age: pathological, constitutional and therapeutic pathways.

Interest in the neurocognitive and psychosocial outcomes in children who are born small for gestational age (SGA) has increased since the recent approval of growth hormone (GH) therapy in this indication. The objective of GH treatment in SGA children is to provide a symptomatic treatment for growth retardation. From a patient perspective, the ultimate goals of GH therapy are the reduction in the present or future risk of neurocognitive, psychological, social or occupational impairment, not the accompanying improvements in growth velocity and final height per se. Therefore, from a scientific perspective, neurocognitive and psychosocial endpoints become relevant domains of assessment to determine the final treatment benefit experienced by the patient born SGA. This article reviews recent available studies on developmental risks in SGA, and then transforms the empirical findings into an integrated conceptual framework on the sources and mediators of neurocognitive and psychosocial outcomes in intrauterine growth retardation and SGA. This framework depicts two distinct therapeutic pathways by which GH therapy may improve neurocognitive and behavioural outcomes. The first (‘traditional’) pathway is the prevention of exposure to short-stature-related stressors via an improvement in growth velocity and final height. The second pathway refers to potential metabolic, and thus neurotropic and psychotropic, effects of GH binding at receptors in the central nervous system, thus changing neuronal activity. To date, the existence and potential mechanisms of such physiologically and not psychologically mediated effects of GH on neurocognitive functioning in SGA patients remain hypothetical.