Steffen Weirich

Childhood trauma and dissociation in patients with alcohol dependence, drug dependence, or both - a multi-center study.

BACKGROUND The aims of this study were to examine the level of dissociative symptoms in patients with different substance related disorders (alcohol dependence, drug dependence, and combined alcohol and drug dependence), and to investigate the influence of potentially traumatic events in childhood, age, gender, and posttraumatic stress disorder on the relationship between dissociative symptoms and type of substance abuse. METHODS Of the 459 participants (59.7% male) 182 (39.7%) were alcohol-dependent (A), 154 (33.6%) were drug-dependent (D), and 123 (26.8%) were dependent on both, alcohol and drugs (AD) based on the DSM-IV criteria for a current diagnosis. Participants completed the Childhood Trauma Questionnaire (CTQ) and the Dissociative Experiences Scale (DES). The International Diagnostics Checklist (IDCL) was administered to diagnose PTSD. RESULTS Higher levels of dissociation were observed in patients with drug dependence as compared to patients with mere alcohol dependence (mean DES group A: 9.9+/-8.8; group D: 12.9+/-11.7; group AD: 15.1+/-11.3). However, when severity of potentially traumatic events in childhood, PTSD, age and gender were included in the analysis, the influence of the type of substance abuse did not prove to be statistically significant. The variable most strongly related to dissociative symptoms was severity of potentially traumatic events in childhood, in particular emotional abuse, even after controlling for PTSD and other potential confounders. CONCLUSIONS It seems appropriate to screen SUD patients for dissociative symptoms, especially those with a more complex risk profile including (additional) drug abuse, female gender, younger age and most importantly a history of childhood trauma.

Unterschiede und Gemein-samkeiten zwischen plötzlichem Säuglingstod (SIDS), Münchhausen-Syndrom by proxy (MSBP) mit tödlichem Ausgang und Infantizid

INTRODUCTION Sudden infant death syndrome (SIDS) is the most common type of post-neonatal death in infants under 1 year of age. It is defined as the sudden death of an infant that is unexpected on the basis of the childs history and unexplained by a thorough post-mortem examination. The incidence of SIDS in Germany has fallen from 1.7 per 1000 live births in 1990 to 0.62 in 2000. In the U.K. the incidence was 0.56 in 1998. According to the literature, 5 to 11 percent of deaths recorded as SIDS may be disguised homicides. These homicides can be caused by a Munchausens syndrome by proxy (MSBP). Munchausens syndrome by proxy is defined as an extreme form of abuse wherein the caregivers produce symptoms of illness in a child by means of internal or by external manipulation. Using case reports, this paper examines some difficulties in differentiating between SIDS, MSBP, and homicide. CASE REPORT In a family with three children, the youngest daughter died suddenly of suffocation at the age of 17 months. Before her death, the child had been admitted 11 times to different hospitals for various reasons. The mother reported that her daughter was admitted for epileptic seizures, suffocation attacks, and diarrhoea. No noticeable organic signs or symptoms were found during the childs stays in a hospital. The girl was discharged each time without symptoms and without a clear-cut diagnosis. Toxicological analysis of the blood revealed the presence of caffeine. Clinically, an accidental death appeared to be unlikely. CONCLUSIONS When assessing cases of SIDS, a MSBP, or homicide, practitioners should be on the lookout for recurrent symptoms of illness, repeated hospitalisation and/or consultation of physicians, multiple diagnostic procedures without establishment of a clear-cut diagnosis, a certain resistance to therapy, illness or unnatural death of siblings, and repeated signs of poisoning or suffocation. Differentiation between SIDS, MSBP, and homicide should be extensive and done with great care since the legal consequences differ vastly according to the facts of the matter.

Modified magnesium and lipoproteins in children with attention deficite hyperactivity disorder (ADHD)

Abstract Objective. Polyunsaturated fatty acids (PUFAs) have shown to be helpful in the therapy of ADHD. Various stabilizing co-factors may contribute to this effect, as like magnesium (Mg). Mg supports fatty acid enzyme activity and is essential for the neuronal activity. However, the way of Mg to influence psychic processes, particularly in ADHS, is not yet known precisely. Therefore, in this study the concentrations of further lipid parameters were assessed. We intended to prove, if there is a lack of Mg and someone different lipoprotein concentration in ADHD patients compared to controls. Methods. In nine boys with ADHD (8.2 ± 0.6 years) and 11 controls (7.9 ± 0.87 years), blood serum Mg, total cholesterol, triglycerides, Lipoprotein Lipase, total Phospholipids, Apolipoproteins a and b, HDL- and LDL-cholesterol were measured, under two different stressful conditions. Results. In ADHD, Mg and HDL concentrations were significantly higher and Apob lower than in controls. Conclusions. Contrary to our supposition, in ADHD was no lack, but an excess of Mg. HDL was hightened and Apob lowered. Lipoprotein metabolism seems to be modified in ADHD.

A Case of Catatonia in a 14-Year-Old Girl with Schizophrenia Treated with Electroconvulsive Therapy

This article presents a case of a 14-year-old female twin with schizophrenia who developed severe catatonia following treatment with olanzapine. Under a combined treatment with amantadine, electroconvulsive therapy (ECT), and (currently) ziprasidone alone she improved markedly. Severity and course of catatonia including treatment response were evaluated with the Bush-Francis Catatonia Rating Scale (BFCRS). This case report emphasizes the benefit of ECT in the treatment of catatonic symptoms in an adolescent patient with schizophrenic illness.

Relationships between a Dissociative Subtype of PTSD and Clinical Characteristics in Patients with Substance Use Disorders

ABSTRACT The increasing support for a dissociative subtype of post-traumatic stress disorder (PTSD-D) has led to its inclusion in DSM-5. We examined relationships between PTSD-D and relevant variables in patients with substance use disorders (SUD). The sample comprised N = 459 patients with SUD. The International Diagnostic Checklist and the Posttraumatic Diagnostic Scale were used to diagnose PTSD. In addition, participants completed the Childhood Trauma Questionnaire and the Dissociative Experiences Scale. The course of SUD was assessed by means of the European Addiction Severity Index. One-fourth of participants fulfilled a diagnosis of PTSD (25.3%). Patients with PTSD-D (N = 32, 27.6% of all patients with PTSD) reported significantly more current depressive symptoms, more current suicidal thoughts, more lifetime anxiety/tension, and more suicide attempts. The PTSD-D group also showed a significantly higher need for treatment due to drug problems, higher current use of opiates/analgesics, and a higher number of lifetime drug overdoses. In a regression model, symptoms of depression in the last month and lifetime suicide attempts significantly predicted PTSD-D. These findings suggest that PTSD-D is related to additional psychopathology and to a more severe course of substance-related problems in patients with SUD, indicating that this group also has additional treatment needs.

Living in the Fast Lane: Evidence for a Global Perceptual Timing Deficit in Childhood ADHD Caused by Distinct but Partially Overlapping Task-Dependent Cognitive Mechanisms

Dysfunctions in perceptual timing have been reported in children with ADHD, but so far only from studies that have not used the whole set of timing paradigms available from the literature, with the diversity of findings complicating the development of a unified model of timing dysfunctions and its determinants in ADHD. Therefore, we employed a comprehensive set of paradigms (time discrimination, time estimation, time production, and time reproduction) in order to explore the perceptual timing deficit profile in our ADHD sample. Moreover, we aimed to detect predictors responsible for timing task performance deficits in children with ADHD and how the timing deficits might be positively affected by methylphenidate. Male children with ADHD and healthy control children, all aged between 8 and 13 years, participated in this longitudinal study with three experimental sessions, where children with ADHD were medicated with methylphenidate at the second session but discontinued their medication at the remaining sessions. The results of our study reveal that children with ADHD were impaired in all timing tasks, arguing for a general perceptual timing deficit in ADHD. In doing so, our predictor analyses support the notion that distinct but partially overlapping cognitive mechanisms might exist for discriminating, estimating/producing, and reproducing time intervals. In this sense, working memory deficits in terms of an abnormally fast internal counting process might be common to dysfunctions in the time estimation/time production tasks and in the time reproduction task, with attention deficits (e.g., in terms of disruptions of the counting process) additionally contributing to time estimation/time production deficits and motivational alterations additionally contributing to time reproduction deficits. Methylphenidate did not significantly alter performance of the ADHD sample, presumably due to limited statistical power of our study. The findings of our study demonstrate a pivotal role of disturbed working memory processes in perceptual timing task performance in childhood ADHD, at the same time broadening the view for additional attentional and motivational determinants of impaired task performance.

Fallbericht einer 15-jährigen Patientin mit einer schweren wahnhaften Depression, behandelt mit Elektrokonvulsionstherapie

Electroconvulsive Therapy (ECT) of a 15-year-old female patient suffering from a severe delusional depression: a case report Abstract. OBJECTIVE Electroconvulsive Therapy (ECT) is a modern therapy of severe psychiatric disorders. However, ECT is rarely used in treating children and adolescents with psychiatric disorders. This case report refers about a 15-year-old female patient suffering from severe depressive episodes with psychotic symptoms treated with ECT. METHOD After unsuccessful combined behavioral therapy and medication, the patient received a total of 11 ECT treatments with right unilateral electrode placement. The severity of depressive symptoms was assessed by self (BDI-II) and external (HDRS21) scores before, during and after treatment. RESULTS A rapid decline of depressive symptoms was observed. CONCLUSION ECT provides a safe and effective method for the treatment of severe depressive disorders in childhood and adolescence and should be included earlier than usual into the standard therapeutic concepts.

Differential relationships of PTSD and childhood trauma with the course of substance use disorders

A large body of research documents the link between Posttraumatic Stress Disorder (PTSD) and the course of Substance Use Disorders (SUD). Similar relationships have been reported between Childhood Trauma (CT) and the course of illness in patients with SUD even in the absence of PTSD, but few studies have examined differential effects of PTSD and CT (independent of PTSD) in this population. We used the International Diagnostic Checklist (IDCL) and the Posttraumatic Diagnostic Scale (PDS) to diagnose PTSD in a sample of patients with SUD (N = 459). The Childhood Trauma Questionnaire (CTQ) and the European Addiction Severity Index (EuropASI) were administered to assess childhood trauma and addiction related problems including comorbid psychopathological symptoms. The sample was divided into three groups: patients with experiences of CT and PTSD (CT-PTSD), experiences of CT without PTSD (CT-only), and neither experiences of CT nor PTSD (No trauma) to examine their differential associations with the course and severity of SUD. Patients of both the CT-PTSD (n = 95) and the CT-only group (n = 134) reported significantly higher levels of anxiety and depression as well as more suicidal thoughts and suicide attempts during their lifetime than the No trauma group (n = 209). Regarding most variables a graded association became apparent, with the highest level of symptoms in the CT-PTSD group, an intermediate level in the CT-only group and the lowest level in the No trauma group. The CT-PTSD group also differed in almost all substance use variables significantly from the No trauma group, including a younger age at first use of alcohol and cannabis, more cannabis use in the last month, and more lifetime drug overdoses. Our results confirm the relationships of both CT and PTSD with psychiatric symptoms in patients with SUD. Thus, it seems important to include both domains into the routine assessment of SUD patients. Specific treatments for comorbid PTSD but also for other consequences of childhood trauma should be integrated into SUD treatment programs.

Pilotstudie zu psychiatrischen und sozialen Aspekten bei Kindern und Jugendlichen mit Fragilem-X-Syndrom (FRX)

Objective The study describes the burden of psychosocial risks of mental illnesses and the ways in which children and adolescents with fragile X syndrome (FRX) can be treated. Method Data from a sample of 34 patients with FRX younger than 18 years stemming from a prospective multicenter (n = 11) registry study (EXPLAIN) were analyzed with regard to psychosocial burden and Treatment. Results One third of all participants reported having relatives who suffer from FRX. The majority of participants were suffering themselves from one kind or another mental or neurological problems. Younger participants (< 14 years) tended to suffer from atactic disorders, epileptic seizures, and autistic symptoms. These disorders were usually treated by psychotropic drugs supplemented by logopedic therapies and occupational therapies (more than once a month). In our sample, 96.3 % of the younger patients and more than 57.1 % of the older patients were still living with their parents. Conclusions Patients with FRX often suffer from additional neurological and mental disorders. For that reason, they should be diagnosed and treated early on.

Psychiatrische und soziale Aspekte bei Patienten mit fragilem X-Syndrom (FRX)

OBJECTIVE The goal of the study was to describe the burden of psychosocial risks, of mental illnesses and the ways of treatment of patients with fragile X syndrome (FRX). METHOD Data from a sample of 46 FRX-patients stemming from a prospective multicenter (N = 12) registry study (EXPLAIN) were analyzed with regard to psychosocial burden and treatment. RESULTS More than 50 % of all participants reported about relatives suffering from FRX, too. The majority of participants did not finish school and was suffering from one or another kind of mental problems. Younger participants (< 18 yrs.) tended to suffer from expansive disorders. Older participants were rather burdened by internalizing symptoms and disorders. Disorders were usually treated by psychotropic drugs added by logopedic therapies and occupational therapies (more than once a month). In our sample 90.6 % of younger and more than 64.3 % of older patients were still living with their parents. CONCLUSIONS Patients with FRX often suffer from additional mental disorders and should be diagnosed and treated early.