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This study examined a broad variety of adverse childhood experiences in a consecutive sample of female adolescent inpatients with borderline personality disorder (BPD; n = 44) compared with a clinical control (CC; n = 47) group with mixed... more
This study examined a broad variety of adverse childhood experiences in a consecutive sample of female adolescent inpatients with borderline personality disorder (BPD; n = 44) compared with a clinical control (CC; n = 47) group with mixed psychiatric diagnoses. BPD was diagnosed using a structured clinical interview; different dimensions of childhood adversity were assessed using the Childhood Experiences of Care and Abuse Questionnaire, the Parental Bonding Instrument, and the Family Assessment Device. A history of childhood adversity was significantly more common in patients with BPD than in the CC group. Using a multivariate model, sexual abuse (OR = 13.8), general family functioning (OR = 8.9), and low maternal care (OR = 7.6) were specific and independent predictors of adolescent BPD. The results increase our knowledge of the specific role of different dimensions of childhood adversity in adolescent BPD. They have important implications for prevention and early intervention as ...
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Handedness and cognitive abilities in a representative sample of adolescents and young adults. The relationship between laterality and cognitive ability was examined in a representative sample of adolescents and young adults between 16... more
Handedness and cognitive abilities in a representative sample of adolescents and young adults. The relationship between laterality and cognitive ability was examined in a representative sample of adolescents and young adults between 16 and 30 years of age. The study was designed as a possible replication of Annett's data supporting her right-shift theory (rst), but included other measures of laterality as well. We found, as Annett did, that strong right-handedness was associated with a weak left hand rather than a strong right hand. However, we could not confirm two other predictions of the rst with our data: The nonverbal IQ was significantly lower in both extreme groups of handedness than in the two middle groups. Because of the sample size this rather small effect, explaining only 1.9% of the variance, is significant, but it disappears with other kinds of grouping for handedness. We could not find the linear decline in nonverbal IQ from the left to the right extreme of handed...
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ABSTRACT Die vorliegende Studie untersucht die spezifische Wirksamkeit musiktherapeutischer Technik und Modellfaktoren in der Therapie primärer Kopfschmerzen im Jugendalter. Ein bereits evaluiertes musiktherapeutisches Behandlungsmanual... more
ABSTRACT Die vorliegende Studie untersucht die spezifische Wirksamkeit musiktherapeutischer Technik und Modellfaktoren in der Therapie primärer Kopfschmerzen im Jugendalter. Ein bereits evaluiertes musiktherapeutisches Behandlungsmanual für Kinder mit Migräne wurde für Jugendliche mit primären Kopfschmerzen adaptiert und in einer zweiarmigen, kontrollierten Studie im Parallelgruppendesign im Vergleich zu einem Attention-Placebo (rhythmuspädagogischen Angebot) mit gleicher Dosis-Zeit-Relation auf seine Wirksamkeit hin untersucht. Aufbauend auf Überlegungen zu den Wirkfaktoren von Psychotherapie, wurden beide Behandlungen durch die gleichen Therapeuten realisiert, um allgemeine Wirkfaktoren (z. B. therapeutische Beziehung), sowie Placebo- und Erwartungseffekte, zu erhalten. Die primären symptomrelevanten Zielkriterien, Schmerzfrequenz und Intensität wurden durch Tagebücher über jeweils acht Wochen vor der Therapie, im Anschluss an die Therapie sowie ein halbes Jahr nach Abschluss der Behandlung (6-Monate Follow-Up) erhoben. Sekundäre Zielkriterien wie die Schmerzempfindung (SES), die gesundheitsbezogene Lebensqualität (KIDSCREEN-27), Verhaltensprobleme (SDQ-Deu) und die Therapiezufriedenheit der Angehörigen (HZFB) wurden zu unterschiedlichen Zeitpunkten über Fragebögen erhoben. An der Studie nahmen insgesamt 78 Jugendliche im Alter zwischen 12 und 17 Jahren teil, von denen 71 das gesamte Studienprotokoll durchliefen. Teilnehmer der Experimental (n = 34) und Kontrollgruppe (n =37) zeigen eine Reduktion der Kopfschmerzhäufigkeit im Prä-Post Vergleich. Es zeigen sich keine statistisch signifikanten Unterschiede zwischen den Gruppen. Es zeigen sich keine Veränderungen der sekundären Zielkriterien. Die Ergebnisse werden im Kontext der psychotherapeutischen Prozessforschung und der Etablierung der Musiktherapie dargestellt und kritisch diskutiert.
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Based on the results of adult studies that have shown a subgroup of basic symptoms to have a predictive value for later schizophrenic disorder, a cross-sectional study on 36 schizophrenic and 75 nonschizophrenic adolescent psychiatric... more
Based on the results of adult studies that have shown a subgroup of basic symptoms to have a predictive value for later schizophrenic disorder, a cross-sectional study on 36 schizophrenic and 75 nonschizophrenic adolescent psychiatric inpatients was performed to elucidate the specificity of prodromal signs in early age groups. The occurrence of any single basic symptom does not show schizophrenic specificity in adolescents, but the number of basic symptoms in the categories of the Bonn Scale for the Assessment of Basic Symptoms is increased in schizophrenic patients compared with subjects with other diagnoses. The interrelation between minus symptoms and cognitive symptoms exerts a higher amount of cognitive disturbances given a certain level of irritation in schizophrenic adolescents. With the help of odds ratios, the seven most discriminating cognitive items could be elucidated including perception, information processing and action tendency.
Research Interests: Cognitive Science, Evolution, Adolescent, Comparative Study, Medicine, and 15 moreInformation Processing, Humans, Female, Classification, Male, Clinical Sciences, Prevalence, International Classification of Diseases, Early Detection, Nosology, Cross sectional Study, Adolescent Behavior, Age Groups, Cognition disorders, and Neuropsychological Tests
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Research Interests: Genetics, Neuroscience, Psychology, Neurology, Psychosis, and 15 moreNeuroimaging, Schizophrenia, Polymorphism, Psychopathology, Medicine, Humans, Duration of Untreated Psychosis, Phenotype, Sensory Gating, Biological markers, Early Diagnosis, Genetic Markers, Neurosciences, Psychiatric Status Rating Scales, and Endophenotype
To describe the topography of the N700 component of the scalp-recorded visual event-related potential (ERP) and to provide fundamental knowledge of the conditions under which it occurs. We examined the time-course of visual ERP in... more
To describe the topography of the N700 component of the scalp-recorded visual event-related potential (ERP) and to provide fundamental knowledge of the conditions under which it occurs. We examined the time-course of visual ERP in response to the short (100ms) and prolonged (7s) presentation of simple salient visual stimuli separated by long interstimulus intervals employing high-resolution 64-channel DC-EEG. Current source density (CSD) mapping and spatio-temporal dipole source analysis were performed. CSD analysis revealed highly significant bilateral current sinks over occipito-temporal areas from about 450ms up to 1s after stimulus offset (visual N700). CSD topography and dipole source analysis suggested late prolonged activation of extrastriate visual areas which did not depend merely upon a stimulus offset response, afterimages or blinking, as confirmed by control conditions. Our findings provide basic knowledge about the time-course of sensory activation. We found that passive watching of rare salient short stimuli automatically evoked sustained activity in the extrastriate visual cortex up to 1s after stimulus offset. Visual N700 provides a promising tool for important insights into the cortical mechanisms of stimulus post-processing. Its role in associative learning of temporally non-overlapping stimuli (automatic ultra-short-term sensory memory) should be explored.
Research Interests: Engineering, Psychology, Electrophysiology, Electroencephalography, Medicine, and 15 moreBrain Mapping, Humans, Female, Clinical, Male, Current Density, Dipole, Clinical Neurophysiology, High Resolution, Adult, Analysis of Variance, Current Source Density, Blinking, photic stimulation, and Medical and Health Sciences
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Research Interests: Injury Prevention, Adolescent, Medicine, Drug Use, Aggressive Behavior, and 15 moreGermany, Humans, Female, Male, Child and Adolescent Psychology, Interpersonal Relations, Deliberate Self Harm, Cross Section, Behavior Problems, Age Factors, Health surveys, Living Standards, Cross Sectional Studies, Outcome measure, and Paediatrics and reproductive medicine
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This study describes the relation of different types of childhood trauma to the degree of dissociative experiences. Subjects were 198 consecutively admitted adolescent psychiatric patients, 11 to 19 years old (89 inpatients and 109... more
This study describes the relation of different types of childhood trauma to the degree of dissociative experiences. Subjects were 198 consecutively admitted adolescent psychiatric patients, 11 to 19 years old (89 inpatients and 109 outpatients). All patients completed the Adolescent Dissociative Experiences Scale. A Checklist of Traumatic Childhood Events was filled out by clinicians. The results showed an increase in the degree of dissociative experiences in patients with a history of sexual abuse, physical abuse, neglect, and stressful life events. With the exception of life events, a moderate form of traumatic experience had the same effect on dissociative experiences as severe forms. The strongest effect was found for emotional neglect, which seems to be an important pathogenic risk factor. The results suggest that therapists and researchers should be aware that even less severe forms of abuse and neglect may have a significant impact on the development of dissociative psychopathology in adolescents.
Research Interests: Cognitive Science, Psychiatry, Adolescent, Medicine, Humans, and 15 moreChild, Child Sexual Abuse, Child Abuse, Hospitalization, Female, Male, Child and Adolescent Psychology, Dissociative disorders, Mental Disorders, Clinical Sciences, Adult, Life Change Events, Ambulatory Care, Age of Onset, and Psychiatric Status Rating Scales
Prenatal stress is known to be a potential risk factor for cognitive, behavioural and motor development that even last until adolescence. A consensus of how 'prenatal... more
Prenatal stress is known to be a potential risk factor for cognitive, behavioural and motor development that even last until adolescence. A consensus of how 'prenatal stress' can be measured, in which trimester of pregnancy women should be studied and whether subjective feelings of being stressed are associated with a hormonal response is still lacking. To close this gap, a prospective longitudinal study was conducted in pregnant women. 108 subjects were asked to fill out questionnaires concerning pregnancy-related anxiety, perceived stress, marital satisfaction, critical life events and to collect salivary cortisol in each trimester of pregnancy. Fear of giving birth increases until the end of pregnancy, and marital satisfaction is highest at the end of pregnancy. Perceived stress is related to a hormonal response in cortisol only in the first (r = 0.18, p < 0.10) and second (r = 0.18, p < 0.10) trimesters of pregnancy. Critical life events are linked to raised cortisol levels in early pregnancy only (r = 0.28, p < 0.01). Prenatal stress can be operationalized by using different subjective as well as physiological stress measures. Only in the first half of pregnancy self-report and physiological stress measures seem to be associated.
Research Interests: Cognitive Science, Fear, Motor Development, Medicine, Anxiety, and 15 moreEmotions, Marital Satisfaction, Marriage, Cortisol, Humans, Female, Clinical Sciences, Analysis of Variance, Longitudinal Study, ANXIETY, Physiological Stress Markers, Gestation, Personal Satisfaction, LIFE EVENT, and hydrocortisone
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Recent evidence points to the existence of a neurobiological attunement between mother and child, e.g., associations between maternal and child hypothalamic-pituitary-adrenal (HPA) axis functioning. As maternal history of abuse (HoA) has... more
Recent evidence points to the existence of a neurobiological attunement between mother and child, e.g., associations between maternal and child hypothalamic-pituitary-adrenal (HPA) axis functioning. As maternal history of abuse (HoA) has been shown to negatively affect mother-child interaction and HPA-axis functioning, we theorized those experiences to exert an influence on cortisol attunement, and we examined the role of infant gender in this context. Shortly after birth of their first child, a community sample of women was screened using the Childhood Trauma Questionnaire. Mothers reporting moderate or severe sexual and/or physical abuse were included in the maltreatment group (n = 41; MG) and compared with a non-maltreated comparison group (n = 47; CG). At the child's age of 5 months, mother and infant baseline salivary cortisol was collected on two consecutive days between 11 and 1 o'clock. Correlation analyses confirmed an association between maternal and infant salivar...
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Early visual impairments probably partially caused by impaired interactions between magnocellular (M) and parvocellular (P) pathways (M priming deficit), and disturbances of basic self-awareness or self-disorders (SDs) are core features... more
Early visual impairments probably partially caused by impaired interactions between magnocellular (M) and parvocellular (P) pathways (M priming deficit), and disturbances of basic self-awareness or self-disorders (SDs) are core features of schizophrenia. The relationships between these features have not yet been studied. We hypothesized that the M priming was impaired in first-episode patients and that this deficit was associated with visual aspects of SDs. To investigate early visual processing in a sample of first-episode schizophrenia patients and to explore the relationships between M and P functioning and visual aspects of SDs addressed by the Examination of Anomalous Self-Experience (EASE) interview. Nine stimulating conditions were used to investigate M and P pathways and their interaction in a pattern reversal visually evoked potential (VEP) paradigm. N80 at mixed M- and P-conditions was used to investigate magnocellular priming. Generators were analyzed using source localiz...
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Recent evidence from epidemiological studies suggests that the prevalence of eating disorders is rising in adolescents and the age of onset has fallen. An average prevalence rate for anorexia nervosa of 0.5% and for bulimia nervosa of... more
Recent evidence from epidemiological studies suggests that the prevalence of eating disorders is rising in adolescents and the age of onset has fallen. An average prevalence rate for anorexia nervosa of 0.5% and for bulimia nervosa of 0.5% was found for teenaged girls. For both disorders the highest incidence was found in females aged 10-19 years. Disordered eating attitudes and behaviors are common in a substantial proportion of adolescents and are associated with an increased risk of the manifestation of a full disorder or other forms of emotional or behavior problems (depression, anxiety, substance abuse, suicidal behavior). For both disorders a complex multifactorial aetiology has been postulated, involving the interaction of genetic predisposition and certain specific environmental risk factors, particularly social factors. Next to other comorbid psychiatric conditions medical complications resulting from semistarvation and purging often require an inpatient treatment. The mult...
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Headache is a recurrent somatic complaint in childhood and adolescence. In recent decades headache prevalence has increased while the age of onset has decreased. In most cases headache can be categorized as migraine or tension-type... more
Headache is a recurrent somatic complaint in childhood and adolescence. In recent decades headache prevalence has increased while the age of onset has decreased. In most cases headache can be categorized as migraine or tension-type headache without significant organic pathology, i.e. head trauma, structural lesion, etc. Diagnosis according to the criteria of the International Headache Society is based on subjective reports by patients and their parents. The basic tools of clinical assessment are history, physical examination and a headache diary. Laboratory tests, including electroencephalography and imaging studies should not, as a rule, be undertaken routinely. Pathophysiological models with an impact on therapeutic interventions will be discussed. Childhood headache is often treated inappropriately in daily practice despite the availability of various options (including environmental, drug, and psychological therapy). Psychological therapy (relaxation training, biofeedback, stres...
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The purpose of this review is to analyse nature, degree and consequences of attentional biases in patients with borderline personality disorder based on existing literature. The clinical importance of these phenomena in patients with... more
The purpose of this review is to analyse nature, degree and consequences of attentional biases in patients with borderline personality disorder based on existing literature. The clinical importance of these phenomena in patients with borderline personality disorder is strengthened and the link between theoretical models, empirical findings and therapeutic interventions is elaborated. This link between selective attention and borderline personality disorder is demonstrated on the basis of studies, which indicate a context between borderline pathology, affective disorders, anxiety disorders, and attention-deficit/hyperactivity disorders and also give evidence to neuropsychological deficits in patients with borderline personality disorder. The present article comparatively describes three theoretical models of borderline personality disorder and their possible links to attentional biases. The dialectical behavior approach postulates a pronounced attentional narrowing to emotional stimu...
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We would like to introduce several aspects of the analysis and modeling of the treatment process characterizing the cooperation within multi-professional treatment teams. We will determine what is meant by a treatment process in order to... more
We would like to introduce several aspects of the analysis and modeling of the treatment process characterizing the cooperation within multi-professional treatment teams. We will determine what is meant by a treatment process in order to then look at five views and four levels of their description. We will introduce possible methods for surveying and describing it. Currently an extensive analysis of the current state of the treatment process and of the weaknesses is underway in the Department of Child and Adolescent Psychiatry of the Heidelberg University Medical Center.
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An attempt to define "psychic structure" leads to the conclusion, that "structure" provides adaptive behavioral strategies for the interaction of the person with a physical and social world by representing experiences... more
An attempt to define "psychic structure" leads to the conclusion, that "structure" provides adaptive behavioral strategies for the interaction of the person with a physical and social world by representing experiences of earlier interactions in memory processes. Compatibility of different definitions of "structure" in psychopathology and psychoanalysis is being discussed. Developmental aspects of a "theory of mind" in children and of different modes of representation have to be addressed. A "multiple code theory" of W. Bucci is introduced. Conclusions for diagnosis and therapy in psychodynamic approaches will be drawn. It has to be faced, that children represent optimal structures in each level of psychic development, noting the importance of age-relevant normative measures.
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Quality management for screening programmes of preschool children is a valuable tool to manage the process of investigation, data computing and evaluation of data and its systemic biases. As an example the quality of structure and... more
Quality management for screening programmes of preschool children is a valuable tool to manage the process of investigation, data computing and evaluation of data and its systemic biases. As an example the quality of structure and processing of the system was evaluated for selected criteria in order to prove plausibility. Results identify computing process as a main criterion for quality management since it includes individuality of the investigator as well as the several factors due to the setting of investigation process (time, premises, computing, plausibility and individual factors). As a main influencing factor could be identified the time-span for investigation and commitment of the investigator. Selected training facilities for the investigators could improve quality and commitment and are qualified as an instrument for quality protection.
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Adopting a therapeutic view on diagnosis in child and adolescent psychiatry a psychodynamic diagnostic manual seems to be necessary, that may provide reliability in the assessment of intrapsychic processes. Multiaxial diagnosis of... more
Adopting a therapeutic view on diagnosis in child and adolescent psychiatry a psychodynamic diagnostic manual seems to be necessary, that may provide reliability in the assessment of intrapsychic processes. Multiaxial diagnosis of children's and adolescent's psychiatric disturbances may thus be completed with additional psychodynamic assessment procedures. In adults an operationalized procedure of psychodynamic assessment (OPD) already exists. In child and adolescent psychiatry a working group for psychodynamic diagnostic (OPD-KJ) has been founded. In 4 areas (subjective experiences of disturbances, relationships, intrapsychic conflicts and psychic structure) diagnostic manuals are being worked out. Fundamental questions of developmental psychopathology and diagnostic procedures have to be addressed. The basic proposition takes into account that children should not be psychodynamically compared with adults, but normally have a basic capacity to adapt to environment on a high...
Research Interests: Psychology, Psychoanalysis, Psychometrics, Child Development, Adolescent, and 12 morePsychoanalytic Theory, Germany, Humans, Child, Child and Adolescent Psychology, Mental Disorders, Adult, Psychoanalytic Interpretation, Sensitivity and Specificity, Psychoanalytic Therapy, Psychiatric Status Rating Scales, and quality assurance in health care
A patient with primary Hodgkin's disease of the lung is described. Special features of this case were alcohol-induced chest pain as the main presenting clinical symptom and the documentation of the evolution of the pulmonary mass by... more
A patient with primary Hodgkin's disease of the lung is described. Special features of this case were alcohol-induced chest pain as the main presenting clinical symptom and the documentation of the evolution of the pulmonary mass by serial X-rays. Complete remission was achieved by lobectomy and subsequent MOPP-therapy. Since then the patient has been in unmaintained remission for 36 months.
Research Interests: Pain, Humans, Alcohol Drinking, Male, Adult, and 4 moreHodgkin disease, Vincristine, Prednisone, and lung neoplasms
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Zusammenfassung: Gegenstand der vorliegenden Studie ist die Darstellung eines neu entwickelten, computergestützten Testverfahrens im Rahmen der Legastheniediagnostik (der Heidelberger Lautdifferenzierungstest zur auditiv-kinästhetischen... more
Zusammenfassung: Gegenstand der vorliegenden Studie ist die Darstellung eines neu entwickelten, computergestützten Testverfahrens im Rahmen der Legastheniediagnostik (der Heidelberger Lautdifferenzierungstest zur auditiv-kinästhetischen Wahrnehmungstrennschärfe, kurz: HD-LT) sowie dessen Erprobung an einer Stichprobe von 133 Zweit- und 139 Viertkläßlern im Heidelberger Raum. Der HD-LT wurde einer Itemanalyse unterzogen, seine Testgütekriterien bestimmt und vorläufige Prozentrangnormen für die 2. und 4. Klasse aufgestellt. Es ergaben sich im Durchschnitt hohe Schwierigkeitsindizes in beiden Klassenstufen, das heißt der Test fällt relativ leicht aus. Die Testgütekriterien sind weitgehend zufriedenstellend. Der HD-LT weist in beiden Klassenstufen statistisch bedeutsame Zusammenhänge mit der Rechtschreibleistung auf. In der 2. Klasse werden 30% der Varianz der Rechtschreibung durch den HD-LT erklärt, in der 4. Klasse sind es 10%. Der Lautdifferenzierungsfähigkeit kommt demnach besonders...