Michael Kölch

Children’s Depression Rating Scale – Revised (CDRS-R)

OBJECTIVE The Childrens Depression Rating Scale - Revised (CDRS-R) is a semistructured, clinician-rated interview for the assessment of depression in children and adolescents. While the CDRS-R is frequently used in clinical studies to evaluate the treatment of juvenile depression, no validated German version is yet available. METHOD The CDRS-R was translated into German and tested on 60 inpatients (26 female, 34 male) between 7.5 to 17.9 years (mean = 13.8, standard deviation = 2.9) who were interviewed within the first week of treatment. K-SADS-PL and BDI-II resp. DIKJ were additionally used for validation. RESULTS The German version of the CDRS-R shows a high internal consistency (α = 0.90), and the item-total correlations are good. Correlations between CDRS-R and self-report questionnaires (DIKJ and BDI-II) are high. The mean CDRS-R score of patients with major depressive disorder is similar to the prior results of international studies. CONCLUSIONS The German translation of CDRS-R shows good psychometric properties. Its application may be helpful in diagnosing and monitoring depressive disorders in children and adolescents.

The German version of the self-injurious thoughts and behaviors interview (SITBI-G): a tool to assess non-suicidal self-injury and suicidal behavior disorder

BackgroundSelf-injurious thoughts and behaviors (SITBs) are common in adolescents. While there is no standardized interview in German to assess SITBs to date, the Self-Injurious Thoughts and Behaviors Interview (SITBI) is widely used in English-speaking countries. However, the SITBI has not been validated for the assessment of the recently issued DSM-5 Section 3 diagnoses of nonsuicidal self-injury (NSSI) and suicidal behavior disorder (SBD) yet. In the present study the psychometric properties of the German version of the SITBI (SITBI-G) were assessed. We also evaluated whether SITBI-G is a reliable and valid instrument to establish diagnoses of NSSI and SBD.MethodsA clinical adolescent sample (N = 111, f/m = 73/38, age range = 12-19 years) was recruited from the inpatient units of three departments of child and adolescent psychiatry in Germany. All participating patients were interviewed by using the SITBI-G, and DSM-5 criteria of NSSI and SBD were operationalized from the SITBI-G data. Additionally, participants were given the Self-Harm Behavior Questionnaire (SHBQ), and SITBI-G was retested in a subsample.ResultsThe SITBI-G shows moderate to good test-retest reliability, a very good interrater reliability, and a good construct validity. The results demonstrate that diagnoses of NSSI and SBD can be established using the SITBI-G, achieving moderate to good test-retest reliabilities and very good to perfect interrater reliabilities.ConclusionsOverall, the good psychometric properties of SITBI-G are comparable to the original version of the interview. Therefore, SITBI-G seems to be highly appropriate to assess SITBs, including the new DSM-5 Section 3 diagnoses NSSI and SBD in research and clinical contexts.

The EU-regulation on medicinal products for paediatric use: impacts on child and adolescent psychiatry and clinical research with minors.

BackgroundAt present the EU-regulation on medicinal products for paediatric use is in the final legislation phase. The Regulation will bring essential changes to the policy of research with minors, to funding and to regulations of drug development in Europe.MethodThe article analyses contents of the regulation and possible effects on research with and treatment of mentally ill minors.ResultsThe regulation seems to be a chance to improve pharmacological treatment for children and bring similar research conditions to Europe as they already exist in the US. Some terms of the regulation must be considered as critical due to vague definitions and ambiguously defined policies in some articles. The designated expert committee will be a powerful institution, but it remains to be seen whether this committee will act in the intended way. It is an existing and real danger that European child and adolescent psychiatry will be neglected by the new regulation, if there is no participation of scientists of this discipline in committees. The regulation makes it necessary for child and adolescent psychiatry to strengthen research in clinical trials and developmental psychopharmacology to get benefits from new legislation and improve health care for mentally ill minors.

Depression in Children and Adolescents

INTRODUCTION Prevalence rates for depression in children and adolescents are estimated up to 8.9%. Symptoms in this age group are different from those of depression in adults. Both neurobiological and psychosocial factors are involved in its development. METHODS Selective literature review. RESULTS Of note are both the high rate of spontaneous remissions in childhood (33%), and the high rate of depressions continuing into adulthood (80%). In addition far fewer evidence based treatments are available than for adults. Fluoxetine is currently the only medication licensed for use in children and adolescents for this indication. Tri- and tetracyclic antidepressants have not been shown in meta-analyses to be effective in children and adolescents. Most antidepressants lead to age related side effects, including attention deficit and in particular behavioral toxicity, which has to be taken seriously wherever there is a suicide risk. DISCUSSION The treatment of depression in childhood and adolescence should be based on multimodal interventions including psychotherapy, including cognitive behavioral therapy, which has proven effectiveness, psychosocial interventions and medications in severe cases. Patients with severe depression, especially suicidal minors, should be treated in patients units.

Non-suicidal self-injury as autonomous diagnosis - implications for research and clinic of the DSM-5 proposal to establish the diagnosis of Non-Suicidal Self-Injury in adolescents

In both classificatory systems DSM-IV and ICD-10 self-injury is a symptom of borderline personality disorder (BPD). But it has been shown empirically that self-injury can also occur independent of BPD, for example, as a component of depressive states or even in adolescents without classifiable psychopathology. The scientific discussion about future diagnostic criteria recently led to a proposal to include Non-Suicidal Self-Injury as an independent disorder in the upcoming DSM-5 classification system. Based on recent epidemiological studies of adolescents in Germany, one may assume that approximately 4% of all youths in middle to late adolescence would fulfill the prevalence criterion (criterion A) of the proposed DSM-5 disorder (that is, at least five self-injury incidents within the previous 12 months). A precise classification of Non-Suicidal Self-Injury based on empirical research is needed to further the research, treatment, and prevention of this diagnosis.

Children's Depression Rating Scale - Revised (CDRS-R) Entwicklung einer deutschen Version und psychometrische Gütekriterien in einer klinischen Stichprobe

OBJECTIVE The Childrens Depression Rating Scale - Revised (CDRS-R) is a semistructured, clinician-rated interview for the assessment of depression in children and adolescents. While the CDRS-R is frequently used in clinical studies to evaluate the treatment of juvenile depression, no validated German version is yet available. METHOD The CDRS-R was translated into German and tested on 60 inpatients (26 female, 34 male) between 7.5 to 17.9 years (mean = 13.8, standard deviation = 2.9) who were interviewed within the first week of treatment. K-SADS-PL and BDI-II resp. DIKJ were additionally used for validation. RESULTS The German version of the CDRS-R shows a high internal consistency (α = 0.90), and the item-total correlations are good. Correlations between CDRS-R and self-report questionnaires (DIKJ and BDI-II) are high. The mean CDRS-R score of patients with major depressive disorder is similar to the prior results of international studies. CONCLUSIONS The German translation of CDRS-R shows good psychometric properties. Its application may be helpful in diagnosing and monitoring depressive disorders in children and adolescents.

Nicht-suizidale Selbstverletzung als eigenständige Diagnose

In both classificatory systems DSM-IV and ICD-10 self-injury is a symptom of borderline personality disorder (BPD). But it has been shown empirically that self-injury can also occur independent of BPD, for example, as a component of depressive states or even in adolescents without classifiable psychopathology. The scientific discussion about future diagnostic criteria recently led to a proposal to include Non-Suicidal Self-Injury as an independent disorder in the upcoming DSM-5 classification system. Based on recent epidemiological studies of adolescents in Germany, one may assume that approximately 4% of all youths in middle to late adolescence would fulfill the prevalence criterion (criterion A) of the proposed DSM-5 disorder (that is, at least five self-injury incidents within the previous 12 months). A precise classification of Non-Suicidal Self-Injury based on empirical research is needed to further the research, treatment, and prevention of this diagnosis.

Paediatric European Risperidone Studies (PERS): context, rationale, objectives, strategy, and challenges

Abstract In children and adolescents with conduct disorder (CD), pharmacotherapy is considered when non-pharmacological interventions do not improve symptoms and functional impairment. Risperidone, a second-generation antipsychotic is increasingly prescribed off-label in this indication, but its efficacy and tolerability is poorly studied in CD, especially in young people with normal intelligence. The Paediatric European Risperidone Studies (PERS) include a series of trials to assess short-term efficacy, tolerability and maintenance effects of risperidone in children and adolescents with CD and normal intelligence as well as long-term tolerability in a 2-year pharmacovigilance. In addition to its core studies, secondary PERS analyses will examine moderators of drug effects. As PERS is a large-scale academic project involving a collaborative network of expert centres from different countries, it is expected that results will lead to strengthen the evidence base for the use of risperidone in CD and improve standards of care. Challenging issues faced by the PERS consortium are described to facilitate future developments in paediatric neuropsychopharmacology.

Die Auswirkungen der 12. und der 14. Novelle zum AMG auf die Forschung mit Arzneimitteln für Kinder

Zusammenfassung: Gegenstand: Die 12. Novelle des Arzneimittelgesetzes (AMG) setzt die EU-Direktive 2001/20/EG um und bringt Veranderungen fur die universitare Forschung in der Kinder- und Jugendpsychiatrie mit sich. Die 14. Novelle regelt u.a. die Kennzeichnung von Arzneimitteln. Methode: Die Auswirkungen auf verschiedene Bereiche der klinischen Forschung, die Gestaltung von klinischen Prufungen mit und ohne Sponsor (IITs), auf die weitere Entwicklung der Pharmakosicherheit und die Arzneimittelentwicklung fur Minderjahrige werden anhand der bisherigen Praxis und der neuen Rechtslage dargestellt und zusammengefasst. Insbesondere wird auf die besonders relevanten Bereiche off-label use, Langzeitsicherheit, Anwendungsbeobachtungen und Therapieoptimierungsstudien eingegangen. Ergebnisse: Die neue Rechtslage lasst die bisherige Praxis der Anwendungsbeobachtungen und Therapieoptimierungsstudien nicht mehr zu, sondern vereinheitlicht Anforderungen und Verfahrensregeln fur alle klinischen Prufungen am Menschen. S...

[The psychopharmacological treatment of depressive disorders in childhood and adolescence - developments and standards since the «black box» warning].

Depending on symptom severity, psychopharmacological treatment can be a valuable option in the treatment of depressive disorders in childhood and adolescence. This review provides recommendations for clinical treatment, focusing on suicidality and treatment-resistant patients. The quality of studies regarding the psychopharmacological therapy of depressive disorders in childhood and adolescence has improved since the «black box» warning of the FDA concerning the occurrence of suicidality under treatment with selective serotonin reuptake inhibitors (SSRIs). In Germany, there is proof for a trend toward a more evidence-based psychopharmacological treatment approach within recent years.