Michael Günter

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.

What can Actigraphy Add to the Concept of Labschool Design in Clinical Trials

Pharmacological intervention with methylphenidate (MPH) is very common and helpful in the treatment of attention-deficit/ hyperactivity disorder (ADHD). It ameliorates inattention, impulsivity and hyperactivity and improves psychosocial functioning. The core symptoms of ADHD are problematic mainly in demanding structured situations such as in the classroom. It was argued that MPH does not only lead to a decrease of hyperactivity in these situations but may also result in a general dampening of motor activity during non-structured leisure time. Unfortunately, only few clinical trials have investigated this practically important issue and thus it is still a matter of debate. It follows that many parents hesitate to accept psychotropic drugs for their children. To elucidate this problem in the current study, not only overall behavioral ratings (half-day blocks) but also day-long actigraphy was applied during an analogue classroom setting, where structured and non-structured situations alternated over time. Fourty-nine children with ADHD were assessed for treatment effects of once-daily extended-release and twice daily immediate-release methylphenidate (MPH) as well as placebo. Both MPH regimes yielded improved behavioral ratings during morning and afternoon, while actigraphy showed reduced motor activity in structured situations, but not during leisure time. Furthermore, the movement information obtained with actigraphy during structured situations could be differentiated from the one gained with overall behavioral ratings. Thus, while behavioral ratings provide a valid estimate of the overall symptomatology, additional information gathered with actigraphy may help to differentiate the impact of medication on hyperactive movement in different situations during the day. This may reflect a more valid picture of a childs real life and improve the quality of clinical trials. Thus, both methods may be regarded as complementary for the assessment of drug effects in children with ADHD and should be a standard of further laboratory school protocols in clinical trials.

Attention deficit hyperactivity disorder (ADHD): An affect-processing and thought disorder?

In the literature on child and adolescent psychoanalysis attention deficit hyperactivity disorder () is described as complex syndrome with wide‐ranging psychodynamic features. Broadly speaking, the disorder is divided into three categories: 1. a disorder in early object relations leading to the development of a maniform defence organization in which object‐loss anxieties and depressed affects are not worked through via symbolization but are organized in a body‐near manner; 2. a triangulation disorder in which the cathexis of the paternal position is not stable; structures providing little support alternate with excessive arousal, affect regulation is restricted; 3. current emotional stress or a traumatic experience. I suggest taking a fresh look at from a psychoanalytic vantage point. With respect to the phenomenology of the disorder, the conflict–dynamic approach should be supplemented by a perspective regarding deficits in α‐function as constitutive for . These deficits cause affect‐processing and thought disorders compensated for (though not fully) by the symptomatology. At a secondary level, a vicious circle develops through the mutual reinforcement of defective processing of sense data and affects into potential thought content, on the one hand, and secondary, largely narcissistic defence processes on the other. These considerations have major relevance for the improved understanding of and for psychoanalytic technique.

Engaging Brazilian Street Children in Play: Observations of Their Family Narratives

Story stem assessments allow children to create narratives in response to brief portrayals of family-based relational challenges. These methods can provide insights into children’s perceptions of close relationships, which is particularly useful for vulnerable children. We conducted a feasibility study of story stem assessments with school-age street children—a previously unstudied population—to explore whether they would understand family-based story scenarios similarly to children in more stable families. Comparisons to children in low income and middle-class conditions were made on the basis of performance characteristics and “narrative coherence.” Street children demonstrated capacities to elaborate family narratives nearly as proficiently as children in the other groups, yet they also displayed unique vulnerabilities. Implications for research with this population are discussed.

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.

PURE GOLD OF PSYCHOANALYSIS OR PURE CHEMISTRY? HOW CAN WE HANDLE THE COUNTER‐TRANSFERENCE AND THE PSYCHOANALYST'S SUPER‐EGO CONFLICTS IN COMBINED TREATMENT?1

The use of drugs during psychoanalysis as well as the psychoanalytical treatment of patients who need psychopharmacological medication raise a whole series of problems that are also the subject of controversial discussion. Nevertheless, the body of literature available on this topic is still quite small. Medication is invariably an outside parameter that is introduced into the psychoanalysis and it can cause a blind spot in the psychoanalytic treatment. On the other hand, as we are treating severely disturbed patients, we are confronted with a growing necessity to introduce medication into the psychoanalytic setting. The paper discusses the related conflicts of the psychoanalyst and shows in a case report how an analytic stance can go hand in hand with adequate medication. The paper argues that we have to accept the state of the art in psychiatry and at the same time continue to talk about medication in terms of psychological processes even though it poses a conflict and is also a threat to our narcissistic equilibrium.