Publications by authors named "Ulrike Lehmkuhl"

105 Publications

Sibling relationships of children and adolescents with mental disorders-Resource or risk factor?

J Fam Psychol 2020 Dec 11;34(8):918-926. Epub 2020 Jun 11.

Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charite-Universitatsmedizin Berlin.

Sibling relationships wherein at least one sibling suffers from a mental disorder have seldom been studied. The few existing studies found that children with mental disorders reported high levels of disputes within sibling relationships as well as less parental support and admiration. The aim of the present study was to examine the quality of sibling relationships in children and adolescents with a psychiatric diagnosis (clinical sample [CS]) as compared to an age and gender matched healthy control group (HC). One hundred fifty-six children and adolescents (nCS = 78/nHC = 78) between 8 and 18 years of age were recruited. The CS consisted of patients recruited from the daycare facility and inpatient unit of the Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy Charité-Universitätsmedizin Berlin. HC was matched by gender, sibling position, and age. Quality of sibling relationships was examined using the German version of the Sibling Relationship Questionnaire (SRQ-deu, self-report). Additionally, the Child Behavior Checklist (CBCL 4-18) was implemented in the CS to enable a classification into externalizing, internalizing, and combined disorders. The CS sample reported a warmer sibling relationship compared to the HC sample. Conflict within the sibling relationship differed significantly between participants with internalizing, externalizing, and combined disorders. Relevance of sibling relationships as a possible resource for children and adolescents with a mental illness is discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/fam0000721DOI Listing
December 2020

Alterations of empathy in mothers with a history of early life maltreatment, depression, and borderline personality disorder and their effects on child psychopathology.

Psychol Med 2020 05 22;50(7):1182-1190. Epub 2019 May 22.

Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Campus Virchow-Klinikum, Berlin, Germany.

Background: Early life maltreatment (ELM), borderline personality disorder (BPD), and major depressive disorder (MDD) have been associated with empathy deficits in different domains. Lack of maternal empathy has also been related to child behavioral problems. As ELM, BPD, and MDD often co-occur, we aimed to identify dissociable effects on empathy due to these three factors. In addition, we aimed to investigate their indirect effects via empathy on child psychopathology.

Methods: We included 251 mothers with and without MDD (in remission), BPD and ELM and their children, aged 5-12. We used the Interpersonal Reactivity Index as a measure of empathy on four different dimensions (personal distress, empathic concern, perspective taking, and fantasy) and the Child Behavior Checklist as a measure of child psychopathology.

Results: Having included all three factors (ELM, MDD, BPD) in one analysis, we found elevated personal distress in MDD and BPD, and lower levels of perspective-taking in BPD, but no effects from ELM on any empathy subscales. Furthermore, we found indirect effects from maternal BPD and MDD on child psychopathology, via maternal personal distress.

Conclusion: The present study demonstrated the dissociable effects of maternal ELM, MDD, and BPD on empathy. Elevated personal distress in mothers with BPD and MDD may lead to higher levels of child psychopathology.
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http://dx.doi.org/10.1017/S0033291719001107DOI Listing
May 2020

A comparison study of anxiety in children undergoing brain MRI vs adults undergoing brain MRI vs children undergoing an electroencephalogram.

PLoS One 2019 7;14(3):e0211552. Epub 2019 Mar 7.

Department of Child and Adolescent Psychiatry, LVR-Klinikum Düsseldorf/ Kliniken der Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany.

Background: Magnetic resonance imaging (MRI) of the brain in children and adolescents is a well-established method in both clinical practice and in neuroscientific research. This practice is sometimes viewed critically, as MRI scans might expose minors (e.g. through scan-associated fears) to more than the legally permissible "minimal burden". While there is evidence that a significant portion of adults undergoing brain MRI scans experience anxiety, data on anxiety in children and adolescents undergoing brain MRI scans is rare. This study therefore aimed to examine the prevalence and level of anxiety in children and adolescents who had MRI scans of the brain, and to compare the results to adults undergoing brain MRI scans, and to children and adolescents undergoing electroencephalography (EEG; which is usually regarded a "minimal burden").

Method: Participants were 57 children and adolescents who had a brain MRI scan (MRI-C; mean age 12.9 years), 28 adults who had a brain MRI scan (MRI-A; mean age 43.7 years), and 66 children and adolescents undergoing EEG (EEG-C; mean age 12.9 years). Anxiety was assessed on the subjective (situational anxiety) and on the physiological level (arousal), before and after the respective examination.

Results: More than 98% of children and adolescents reported no or only minimal fear during the MRI scan. Both pre- and post-examination, the MRI-C and the MRI-A groups did not differ significantly with respect to situational anxiety (p = 0.262 and p = 0.374, respectively), and to physiological arousal (p = 0.050, p = 0.472). Between the MRI-C and the EEG-C group, there were also no significant differences in terms of situational anxiety (p = 0.525, p = 0.875), or physiological arousal (p = 0.535, p = 0.189). Prior MRI experience did not significantly influence subjective or physiological anxiety parameters.

Conclusions: In this study, children and adolescents undergoing a brain MRI scan did not experience significantly more anxiety than those undergoing an EEG, or adults undergoing MRI scanning. Therefore, a general exclusion of minors from MRI research studies does not appear reasonable.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0211552PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6405132PMC
December 2019

Subjective evaluation of outpatient treatment for adolescent patients with anorexia nervosa.

Eat Weight Disord 2020 Apr 29;25(2):445-452. Epub 2018 Nov 29.

Department of Clinical Psychology, Freie Universität Berlin, Berlin, Germany.

Background: The current study investigates determinants of treatment evaluation by adolescent outpatients with anorexia nervosa (AN) and the accordance with their parents' and psychotherapists' evaluation.

Sampling And Methods: The sample included 50 female adolescent outpatients (mean age: 16.9 ± 1.8) with AN (DSM-IV). They were randomly assigned to either cognitive-behavior therapy (CBT) or dialectical-behavior therapy (DBT). Before (T1) and after treatment (T2) diagnostic interviews as well as self-report questionnaires were administered measuring eating disorder-specific and general psychopathology. The subjective evaluation of the therapy was assessed by a self-report questionnaire. Data on the evaluation of treatment of 42 parents were considered as well as treatment evaluations of the therapists for 48 patients.

Results: Our results revealed significant correlations of treatment satisfaction between parents and therapists, whereas patients and therapists as well as patients and parents did not agree in their treatment evaluation. The change in body mass index (BMI) was a significant predictor of the patients' treatment satisfaction.

Conclusion: Adolescent patients displaying high severity of AN at the beginning of treatment put little emphasis on the importance of body weight even after treatment. Satisfaction ratings of this special group of patients could be heavily distorted and have to be interpreted carefully.

Level Of Evidence: Level I, randomized controlled trial.
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http://dx.doi.org/10.1007/s40519-018-0620-0DOI Listing
April 2020

Impact of Maternal Early Life Maltreatment and Maternal History of Depression on Child Psychopathology: Mediating Role of Maternal Sensitivity?

Child Psychiatry Hum Dev 2019 04;50(2):278-290

Department of Child and Adolescent Psychiatry, Centre for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.

The study addresses the impact of maternal early life maltreatment (ELM) and maternal history of depression (HoD) on offspring's mental health. Maternal sensitivity was examined as a potential mediator explaining the relationship between maternal ELM, maternal HoD and child psychopathology. Participants were 194 mothers with and without HoD and/or ELM as well as their children between 5 and 12 years. Maternal sensitivity was assessed using the Emotional Availability Scales. Parent and teacher ratings were utilized to assess child psychopathology. Path analyses showed an indirect effect of maternal HoD on parents' ratings of child psychopathology with maternal sensitivity as mediating variable. In contrast, maternal ELM was directly linked to teachers' ratings of child psychopathology; this effect was not mediated by maternal sensitivity. Our results indicate that the impact of maternal HoD, maternal ELM, and maternal sensitivity on offspring psychopathology might vary depending on the context in which child psychopathology is assessed.
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http://dx.doi.org/10.1007/s10578-018-0839-zDOI Listing
April 2019

Clinical characteristics of early onset anorexia nervosa.

Eur Eat Disord Rev 2018 09 26;26(5):519-525. Epub 2018 Jun 26.

Department for Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.

The aim of the current paper is to evaluate clinical characteristics of 30 children with early onset anorexia nervosa (EO-AN; age = 12.2 ± 1.6 years) compared with 30 patients with adolescent onset AN (AO-AN; age = 15.9 ± 0.7 years) and 60 age-matched healthy controls. Statistical analyses included one-way analyses of variance with three planned comparisons and chi-square tests. Compared with AO-AN, EO-AN patients displayed more restrictive eating behaviour (p = 0.038), received more tube-feeding (p = 0.024), and had less problems with self-esteem (p < 0.001) and perfectionism (p = 0.001). EO-AN patients have similar eating disorder pathology (p = 0.183), body-image distortion (p = 0.060), and number of hospitalizations (p = 0.358) as AO-AN. Only a third of EO-AN patients suffer from low self-esteem. Overall, core AN pathology seems similar in EO-AN and AO-AN. However, EO-AN patients show differences in their pathological eating behaviour and the need for tube-feeding.
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http://dx.doi.org/10.1002/erv.2614DOI Listing
September 2018

Follow-up Assessment of Cognitive Remediation Therapy in Adolescent Anorexia Nervosa: A Pilot Study.

Eur Eat Disord Rev 2017 03;25(2):104-113

Department for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité - Universitätsmedizin Berlin, Germany.

Objective: Cognitive remediation therapy (CRT) is a specialized treatment approach targeting cognitive weaknesses in anorexia nervosa (AN). Regarding follow-up effects of CRT, there are only few studies available; for adolescents, there are no data.

Methods: Forty-eight adolescents with AN were assigned to receive either CRT and treatment as usual (TAU) or TAU alone. Assessments were performed at baseline (n = 48) and compared with assessments at a 6-month follow-up (n = 33). Outcome measures were set-shifting, central coherence, eating disorder and general psychopathology.

Results: The completion rate was higher in CRT compared with TAU. There were no significant differences in neuropsychological and clinical variables. Changes in body mass index percentile showed a trend towards significance for CRT. Dropout analyses revealed no significant predictors.

Conclusions: Results provide a first insight into follow-up-assessments of CRT in adolescent AN. More randomized controlled studies are needed to clarify the long-term effects of CRT. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.
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http://dx.doi.org/10.1002/erv.2501DOI Listing
March 2017

Cognitive Flexibility in Juvenile Anorexia Nervosain Relation to Comorbid Symptoms of Depression, Obsessive Compulsive Symptoms and Duration of Illness.

Z Kinder Jugendpsychiatr Psychother 2017 Sep 12;45(5):371-380. Epub 2016 Dec 12.

2 These authors contributed equally to this manuscript.

Objective: Whereas the evidence in adolescents is inconsistent, anorexia nervosa (AN) in adults is characterized by weak cognitive flexibility. This study investigates cognitive flexibility in adolescents with AN and its potential associations with symptoms of depression, obsessive compulsive disorder (OCD), and duration of illness.

Methods: 69 patients and 63 age-matched healthy controls (HC) from 9 till 19 years of age were assessed using the Trail-Making Test (TMT) and self-report questionnaires.

Results: In hierarchical regression analyses, set-shifting ability did not differ between AN and HC, whereas AN patients reported significantly higher rates of depression symptoms and OCD symptoms. Age significantly predicted set-shifting in the total sample. Only among AN patients aged 14 years and older did set-shifting decline with increasing age.

Discussion: The presence of AN with depression or OCD symptoms or the duration of illness do not influence cognitive flexibility in children and adolescents. Early interventions may be helpful to prevent a decline in cognitive flexibility in adolescent AN with increasing age.
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http://dx.doi.org/10.1024/1422-4917/a000493DOI Listing
September 2017

Psychiatric Disorders and Personality Styles in Mothers of Female Adolescent Patients with Eating Disorders.

Z Kinder Jugendpsychiatr Psychother 2017 Sep 17;45(5):361-369. Epub 2016 Nov 17.

3 Department of Audiology and Phoniatrics, Charité-University Medicine Berlin, Germany.

Objective: To provide further insight into the presently poorly understood role of familial psychopathology in the development of eating disorders (ED).

Method: The present study assesses psychiatric and personality disorders listed on Axis I and II of the DSM-IV in 27 mothers of adolescent patients with anorexia (AN mothers) and 14 bulimia nervosa (BN mothers) as well as 22 mentally healthy girls (CG mothers) on a categorical level. Furthermore, we conducted a dimensional diagnostic regarding personality styles and personality traits.

Results: AN and BN mothers showed increased rates of Axis I disorders, especially affective, substance use, and anxiety disorders. Differences on Axis II did not reach statistical significance. However, BN mothers showed higher occurrences of paranoid, negativistic, and schizotypal personality styles compared to the other groups. BN mothers further showed higher occurrences than CG mothers of the personality traits excitability, aggressiveness, physical complaints, openness, and emotionality. AN mothers differed significantly from CG mothers on the scale demands.

Conclusions: Increased occurrence of psychopathology on both categorical and dimensional levels in mothers of patients with AN and BN supports the assumption of a familial accumulation of psychopathology in ED. Longitudinal studies and genetic analyses should clarify a possible cause-effect relationship and interactions between familial dynamics and adolescent ED.
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http://dx.doi.org/10.1024/1422-4917/a000495DOI Listing
September 2017

Cognitive performance in children with acute early-onset anorexia nervosa.

Eur Child Adolesc Psychiatry 2016 Nov 15;25(11):1233-1244. Epub 2016 Apr 15.

Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.

When anorexia nervosa (AN) occurs in children below the age of 14 years, it is referred to as early-onset AN (EO-AN). Over the last years, there has been an increased focus on the role of cognitive functioning in the development and maintenance of AN. Adults with AN show inefficiencies in cognitive functions such as flexibility and central coherence. Systematic neuropsychological examinations of patients with EO-AN are missing. Thirty children with EO-AN and 30 adolescents with AN, as well as 60 healthy controls (HC) underwent an extensive neuropsychological examination. ANOVAs with post hoc tests and explorative regression analyses were conducted. Patients with EO-AN (mean age = 2.17 ± 1.57 years) showed no significant differences in flexibility, inhibition, planning, central coherence, visuospatial short- and long-term memory or recognition in comparison to HC (mean age = 11.62 ± 1.29 years). Performance of adolescents with AN (mean age = 15.93 ± 0.70 years) was not significantly different compared to HC (mean age = 16.20 ± 1.26 years). Explorative regression analyses revealed a significant interaction of age and group for flexibility (adjusted R  = 0.30, F = 17.85, p = 0.013, η  = 0.32). Contrary to expectations, the current study could not confirm the presence of inefficient cognitive processing in children with EO-AN compared to HC. Nonetheless, the expected age-related improvement of flexibility might be disrupted in children and adolescents with AN. Longitudinal neuropsychological examinations are necessary to provide more information about the role of cognitive functioning in the development and maintenance of AN.
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http://dx.doi.org/10.1007/s00787-016-0847-0DOI Listing
November 2016

[Transgenerational Effects on Child Inhibition: The Role of Maternal History of Abuse, Depression and Impulsivity].

Prax Kinderpsychol Kinderpsychiatr 2016;65(6):423-40

Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters Charité - Universitätsmedizin Berlin 10117 Berlin Deutschland https://www.charite.de/

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http://dx.doi.org/10.13109/prkk.2016.65.6.423DOI Listing
January 2017

[Feedback on Cognitive Remediation Therapy from Adolescents with Anorexia Nervosa - A Qualitative Study].

Psychother Psychosom Med Psychol 2016 Aug 2;66(8):324-31. Epub 2016 Aug 2.

Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Charité-Universitätsmedizin Berlin.

Background: Cognitive remediation therapy (CRT) is a relatively new therapy for patients with anorexia nervosa (AN). There is an increased demand to include the patient view during the evaluation of treatment programs. So far, there is no structured evaluation of the subjective view of adolescents with AN on CRT available.

Methods: 20 patients with AN between the ages of 12 and 18 years completed 10 CRT sessions. 19 patients (age: 15.6±1.3; BMI-percentile: 2.4±3.5) filled out a feedback questionnaire on their subjective CRT experience. The positive and negative aspects of CRT from a patient's perspective were inducted from the feedback material using the 'Qualitative content analysis' from Mayring, allowing the data to be summarized into different categories. The software program MAXQDA 11 was used for the data analysis.

Results: The final category system consisted of 6 general categories, which in turn were summarized into 4 main categories: "general therapy perception", "content specific therapy perception", "relationship to everyday life" and "relationship with CRT therapist". 10 patients described CRT (53%) as 'fun'. 12 patients (63%) noticed positive changes in their everyday lives, which they attributed to their participation in CRT. 4 patients (21%) were not able to notice any changes in their everyday lives. 3 patients (16%) valued the good atmosphere during the CRT sessions and 6 patients (32%) found CRT to be a welcome distraction from their daily lives on the ward. 5 patients (26%) mentioned that CRT was too demanding and that difficulties arose during their reflection on thinking styles.

Discussion: Overall, CRT is evaluated positively by adolescent patients with AN. A small number of patients reports difficulties with CRT and experiences CRT as strenuous. This positive evaluation of CRT is in line with results from the few qualitative studies in adults with AN. Due to a potential social desirability bias, the patient's perspective should be interpreted with slight caution.

Conclusion: CRT is received well by adolescents with AN and poses an interesting, new therapy module in the eating disorder field.
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http://dx.doi.org/10.1055/s-0042-111005DOI Listing
August 2016

Cognitive Function in Adolescent Patients with Anorexia Nervosa and Unipolar Affective Disorders.

Eur Eat Disord Rev 2016 May 23;24(3):232-40. Epub 2015 Dec 23.

Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité-University Medicine Berlin, Berlin, Germany.

Studies have shown impairments in cognitive function among adult patients with anorexia nervosa (AN) and affective disorders (AD). The association between cognitive dysfunctions, AN and AD as well as the specificity for these psychiatric diagnoses remains unclear. Therefore, we examined cognitive flexibility and processing speed in 47 female adolescent patients with AN, 21 female adolescent patients with unipolar affective disorders and 48 female healthy adolescents. All participants completed a neuropsychological test battery. There were no significant group differences regarding cognitive function, except for psychomotor processing speed with poorer performance in patients with AN. A further analysis revealed that all groups performed with the normal range, although patients with AN were over represented in the poorest performing quartile. We found no severe cognitive impairments in either patient group. Nevertheless, belonging to the AN group contributed significantly to poor performances in neuropsychological tasks. Therefore, we conclude that the risk for cognitive impairments is slightly higher for patients with AN.
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http://dx.doi.org/10.1002/erv.2425DOI Listing
May 2016

Cognitive Remediation Therapy for Children with Anorexia Nervosa.

Z Kinder Jugendpsychiatr Psychother 2015 Sep;43(5):351-5

1 Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité - Universitätsmedizin Berlin.

Objective: Evidence-based treatment programs for children with anorexia nervosa (AN) are scarce, while their prognosis is negative and the incidence rate rises. A new therapeutic approach recently received positive attention: cognitive remediation therapy (CRT). This intervention targets inflexibility and the inability to perceive the bigger picture in persons with AN. So far, studies and case reports have focused on either adolescent or adult patients and less on young children with AN. This case report therefore describes and evaluates the implementation of CRT with a child with AN.

Method: A 12-year-old girl with severe chronic AN was treated with 10 sessions of CRT. Her clinical and neuropsychological evaluations before, directly after and 7 months after CRT are reported. Additionally, the patient's written and verbal feedbacks are reviewed.

Results: At the 7-month follow-up the patient showed a stable healthy weight and reported a reduced presence of psychopathology. Her neuropsychological performance directly after CRT and after 7 months did not improve.

Conclusions: The clinical evaluation of our case report suggests that CRT may be a promising add-on therapy in the clinical treatment of young girls with AN.
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http://dx.doi.org/10.1024/1422-4917/a000372DOI Listing
September 2015

Neuropsychological and Behavioural Short-Term Effects of Cognitive Remediation Therapy in Adolescent Anorexia Nervosa: A Pilot Study.

Eur Eat Disord Rev 2016 Jan 18;24(1):69-74. Epub 2015 Jul 18.

Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Charité-Universitätsmedizin Berlin, Berlin, Germany.

Objective: Cognitive remediation therapy (CRT) aims to strengthen weak cognitive flexibility and central coherence in adult and adolescent anorexia nervosa (AN). Currently, there are no studies in adolescents with AN that control for learning effects because of re-testing while evaluating CRT.

Method: Twenty in- and outpatients with AN aged 12 to 18 years received CRT. Assessment took place directly before and after the intervention. Performance was compared to 20 age-, gender-, IQ-, and test-retest interval matched healthy controls, which did not receive CRT.

Results: AN patients showed an improvement in flexibility on neuropsychological assessment directly after CRT, whereas HC did not improve over time. Self-report assessment of flexibility, as well as central coherence, did not show significant improvement after CRT.

Discussion: Results suggest that CRT may be beneficial for enhancing flexibility in adolescents with AN. However, randomized controlled studies are essential to determine the actual efficacy of this intervention.
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http://dx.doi.org/10.1002/erv.2383DOI Listing
January 2016

[Psychometric Properties of the Sibling Relationship Questionnaire in the German Version (SRQ-deu)].

Psychother Psychosom Med Psychol 2015 Sep 3;65(9-10):370-8. Epub 2015 Jun 3.

Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin.

The present study examines the psychometric properties of the German version of the Sibling Relationship Questionnaire (SRQ-deu, self-rating) in 961 children and adolescents aged 8-18 years. Internal consistency was satisfactory to high. Associations with other clinical instruments point in the expected direction and support the external validity of the SRQ-deu. A confirmatory factor analysis largely supported the 4-factor structure generated by the German version of the SRQ (SRQ-deu).
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http://dx.doi.org/10.1055/s-0035-1547228DOI Listing
September 2015

[A pilot study on the specificity of body image disturbance in anorexia nervosa].

Z Kinder Jugendpsychiatr Psychother 2015 Jan;43(1):57-67

Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Charité - Universitätsmedizin Berlin.

Objective: Body image disturbance (BID) is a central feature of anorexia nervosa (AN), but evidence for bodily-related disorders also exists for patients with cystic fibrosis (CF), who are frequently underweight. A comparison of BID in patients with AN, CF and controls serves to clarify the specificity of BID for AN.

Method: 22 patients with AN, 10 patients with CF, and 23 controls were tested with regard to perceptual and cognitive-affective components of BID. Further data concerning eating-disorder-related psychopathology were assessed.

Results: BID occurred in all patients with AN. Patients with CF perceived themselves as thinner than the controls did, and three of them exhibited BID. Patients with AN and CF did not differ regarding body satisfaction, and only controls showed higher satisfaction than patients with CF. Patients with AN and CF differed on desire for thinness, dissatisfaction with their body, and interoceptive awareness, with higher scores occurring in patients with AN.

Conclusions: Our pilot study reveals no severe psychopathology concerning body image in patients with CF. However, we did observe a general body dissatisfaction among these patients, probably associated with their being underweight. BID still seems to be a central diagnostic criterion for AN and should be carefully considered during therapeutic interventions.
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http://dx.doi.org/10.1024/1422-4917/a000333DOI Listing
January 2015

Effect of brain structure and function on reward anticipation in children and adults with attention deficit hyperactivity disorder combined subtype.

Soc Cogn Affect Neurosci 2015 Jul 22;10(7):945-51. Epub 2014 Oct 22.

Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany, Clinical Psychology and Psychotherapy, Freie Universität Berlin, Habelschwerdter Allee 45, D-14195 Berlin, Germany, Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Charitéplatz 1, D-10117 Berlin, Germany, and Department of Psychology, Humboldt Universität zu Berlin, Rudower Chaussee 18, D-12489 Berlin, Germany.

Attention deficit hyperactivity disorder (ADHD) is associated with decreased ventral-striatal responsiveness during reward anticipation. However, previous research mostly focused on adults with heterogeneous ADHD subtype and divers drug treatment status while studies in children with ADHD are sparse. Moreover, it remains unclear to what degree ADHD is characterized by a delay of normal brain structure or function maturation. We therefore attempt to determine whether results from structural and functional magnetic resonance imaging (fMRI) are associated with childhood and adult ADHD combined subtype (ADHD-CT). This study used fMRI to compare VS structure and function of 30 participants with ADHD-CT (16 adults, 14 children) and 30 controls (20 adults, 10 children), using a monetary incentive delay task. Joint analyses of structural and functional imaging data were conducted with Biological Parametric Mapping. Reward anticipation elicited decreased ventral-striatal responsiveness in adults but not in children with ADHD-CT. Children and adults with ADHD showed reduced ventral-striatal volume. Taking these gray matter differences into account, the results remained the same. These results suggest that decreased ventral-striatal responsiveness during reward anticipation is present in adults but not in children with ADHD-CT, irrespective of structural characteristics. The question arises whether ventral-striatal hypoactivity is an ADHD correlate that develops during the course of illness.
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http://dx.doi.org/10.1093/scan/nsu135DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4483558PMC
July 2015

[The mental health of only children and of siblings with cancer - first results of a multicenter study in Germany].

Z Kinder Jugendpsychiatr Psychother 2014 Jul;42(4):223-32

Charité Universitätsmedizin Berlin, CVK, Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters.

Background: Children of parents with cancer are at risk of developing mental disorders. RESULTS from divorce research also reveal that sibling relationships can protect the mental health of children in difficult times.

Objective: Does having a sibling help to cope with an oncological disease of a parent and thus act as a protective factor?

Methods: A group of 271 children were examined in a multicenter study. 54 % made use of the offered psychosocial support. Only children (N = 89) and children with siblings (N = 182) were compared with respect to their mental health (Strength and Difficulties Questionnaire, SDQ, parental and self-assessment).

Results: The group comparison between only children and siblings showed no significant differences in the SDQ (assessed by healthy/ill parent). In the self-assessment 2 % of the only children and 9 % of the siblings showed significant results on the SDQ. The group comparison between only children and children with siblings failed to reveal any important differences in mental health. The study indicates that a negative relationship quality (Sibling Relationship Questionnaire, SRQ) is associated with increased problems in the peer group.

Conclusions: The existence of a sibling is not per se a protective factor. Only children do not show more signs of emotional stress than children with siblings.
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http://dx.doi.org/10.1024/1422-4917/a000295DOI Listing
July 2014

[Systematics of somatoform disorders in children and adolescents].

Prax Kinderpsychol Kinderpsychiatr 2013 ;62(9):639-53

Klinik für Psychiatrie, Psychotherapie und Psychosomatik des Kindes- und Jugendalters, Charité - Universitätsmedizin Berlin.

Somatoform disorders in children and adolescents are common and can cause significantly reduced wellbeing and quality of life. Considerable subjective impairment leads to a high number of doctors' visits, which along with a reoccurrence of negative findings, often results in a sense of helplessness in the patient and a lack of trust towards the physician. The criteria for somatoform disorders are illustrated based on the classification scheme ICD-10 and in consideration of the DSM-V. Referring to Noeker (2008) the special role of the parents for the development of somatoform disorders is explained. The typical clinical profile of somatoform disorders in children and adolescents is described. As a diagnostic instrument the newly developed Screening for Somatoform Disorders in Children and Adolescents (SOMS-CA) (Winter, Pfeiffer, Köberle, Lenz, Lehmkuhl, 2008) is introduced. Furthermore it is demonstrated that patients with somatoform disorders are seen predominantly within consulting and liaison services of the paediatric clinic. The importance of interdisciplinary cooperation between paediatrics and child and adolescent psychiatry and -psychotherapy in early diagnosis and introduction of appropriate treatment is highlighted.
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March 2014

[Somatoform disorders in childhood and adolescence].

Authors:
Ulrike Lehmkuhl

Prax Kinderpsychol Kinderpsychiatr 2013 ;62(9):637-8

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March 2014

"Glass fairies" and "bone children": adolescents and young adults with anorexia nervosa show positive reactions towards extremely emaciated body pictures measured by the startle reflex paradigm.

Psychophysiology 2014 Feb 11;51(2):168-77. Epub 2013 Nov 11.

Department of Child and Adolescent Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin, Berlin, Germany; Department of Psychiatry and Psychotherapy, Universitätsklinikum Halle (Saale), Halle, Germany.

In this study, we investigated the emotional processing of extremely emaciated body cues in adolescents and young adults with (n  =  36) and without (n =  36) anorexia nervosa (AN), introducing a new picture type, which was taken from websites that promote extreme thinness and is targeted specifically at adolescents interested in extreme thinness. A startle reflex paradigm was used for implicit reactions, while a self-assessment instrument was used for subjective responses. We found a significant group difference with a startle inhibition (appetitive response) among the patients and a startle potentiation (aversive response) among the controls, whereas no such difference for subjective measures was found. The results are in contrast to previous studies, which proposed a general failure to activate the appetitive motivational system in AN, but in keeping with findings from other addictions, where the same response pattern has been found. Implications for prevention and therapy are discussed.
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http://dx.doi.org/10.1111/psyp.12160DOI Listing
February 2014

[Magnetic resonance imaging (MRI) in children and adolescents – study design of a feasibility study concerning examination related emotions].

Z Kinder Jugendpsychiatr Psychother 2013 Nov;41(6):447-51

Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, CVK, Charité-Universitätsmedizin Berlin.

Numerous research centres apply magnetic resonance imaging (MRI) for research purposes in children. In view of this practical research, ethical concerns regarding the strains the study participants are exposed to during the MRI examination are discussed. The study evaluates whether an MRI examination induces negative emotions in children and adolescents which are more intense than the ones caused by electroencephalography (EEG), an examination method currently classified as causing "minimal stress." Furthermore, the emotional stress induced by the MRI examination in children and adolescents is compared with that induced in adults. The study gathers data on examination-related emotions in children (age 8-17;11, male and female) who undergo an MRI examination of the cerebrum with a medical indication. The comparison group is a sample of children and adolescents examined with EEG (age 8-17;11, male and female) as well as a sample of adults (age 18-65, male and female) examined with MRI. At present, the study is in the stage of data collection. This article presents the study design of the MRI research project.
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http://dx.doi.org/10.1024/1422-4917/a000260DOI Listing
November 2013

[An international neuropsychological assessment tool for children, adolescents, and adults with anorexia nervosa – the German adaptation of the Ravello Profile].

Z Kinder Jugendpsychiatr Psychother 2013 Nov;41(6):371-81

Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Charité-Universitätsmedizin Berlin.

Objective: Adults with anorexia nervosa (AN) show weaknesses in several cognitive functions before and after weight restoration. There is a great demand for standardized examinations of executive functioning in the field of child and adolescent AN. Previous studies exhibited methodological inconsistencies regarding test selection and operationalization of cognitive functions, making the interpretation of their findings difficult. In order to overcome these inconsistencies, a neuropsychological assessment tool, the "Ravello Profile," was developed, though previously not available in German. This paper presents a German adaptation of the Ravello Profile and illustrates its applicability in children and adolescents via three case descriptions.

Methods: The Ravello Profile was adapted for the German-speaking area. The applicability of the Ravello Profile was evaluated in three children and adolescents with AN.

Results And Conclusions: The cases presented confirm the feasible implementation of this adaptation of the Ravello Profile, both in children and adolescents. Hence, it enables a methodologically consistent examination of executive functioning in German-speaking children, adolescents, and adults with AN. Using the Ravello Profile, the role of cognitive functions in the development of AN can be systematically examined over a broad age range.
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http://dx.doi.org/10.1024/1422-4917/a000253DOI Listing
November 2013

[Investigation of practicability of OPD-CA for patients with migration background].

Prax Kinderpsychol Kinderpsychiatr 2013 ;62(4):285-99

Universitätsmedizin Berlin, Klinik für Psychiatrie, Psychotherapie und Psychosomatik des Kindes- und Jugendalters, Berlin.

32 clinical patients (5-15 years) were diagnosed with an OPD-CA interview-manual (Winter, 2004). To investigate practicability of OPD-CA for patients with migration background (N = 14) a comparison with patients without migration background (N = 18) was carried out. There were patients with different ethnical backgrounds. The OPD-CA covers the axes prerequisites for treatment, interpersonal relation, structure and conflicts. Both groups showed equal prerequisites for treatment, interpersonal relation and conflicts. Significant differences were rated in structure: Patients with migration background have fewer skills in control as well as self- and object-perception. The interpretation of these results remained unsettled and suggested a careful use of the axis structure of OPD-CA for patients with migration background. The replication with a larger sample in a multicultural team of therapists and raters would be important.
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http://dx.doi.org/10.13109/prkk.2013.62.4.285DOI Listing
August 2013

[Previous confrontation and reappraisal of "euthanasia" in national socialism by German pediatric and adolescent psychiatry].

Z Kinder Jugendpsychiatr Psychother 2013 ;41 Spec No:4-11

Klinik für Psychiatrie, Charité - Universitätsmedizin Berlin.

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http://dx.doi.org/10.1024/1422-4917/a000225DOI Listing
May 2013

[Childhood abuse in adolescents with anorexia nervosa compared to a psychiatric and healthy control group].

Z Kinder Jugendpsychiatr Psychother 2013 Mar;41(2):99-107; quiz 107-8

Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Charité-Universitätsmedizin Berlin.

Objectives: Some studies suggest that both early sexual and early physical abuse are non-specific risk factors for the later development of eating disorders (EDs). However, only little is known about the role of emotional abuse in EDs.

Methods: The sample included 77 inpatients with Anorexia nervosa (AN-R: n = 50; AN-BP: n = 27), 26 psychiatric control participants and 44 healthy control participants, all of whom were females. The diagnosis of AN and the diagnosis of psychiatric control participants were confirmed by structured interviews (SIAB-EX, Fichter & Quadflieg, 1999; CIDI-DIA-X,Wittchen & Pfister, 1997). Childhood traumatization was assessed by a self-report questionnaire [Childhood Trauma Questionnaire (CTQ) German Version, Krischer & Sevecke, 2011].

Results: The results indicated there were higher rates of sexual and physical abuse as well as physical and emotional neglect in patients with AN-BP than in patients with AN-R and in healthy control participants, with no significant differences between patients with AN-R and control participants. Furthermore, patients with AN-BP had significantly higher rates on the CTQ subscale "emotional abuse" than patients with AN-R, psychiatric control participants and healthy control participants.

Conclusions: Future studies should investigate whether emotional abuse is specific to adolescents with AN-BP compared to adolescents with other psychiatric disorders.
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http://dx.doi.org/10.1024/1422-4917/a000217DOI Listing
March 2013

CID: a valid incentive delay paradigm for children.

J Neural Transm (Vienna) 2013 Aug 22;120(8):1259-70. Epub 2013 Jan 22.

Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.

Despite several modifications and the wide use of the monetary incentive delay paradigm (MID; Knutson et al. in J Neurosci 21(16):RC159, 2001a) for assessing reward processing, evidence concerning its application in children is scarce. A first child-friendly MID modification has been introduced by Gotlib et al. (Arch Gen Psychiatry 67(4): 380-387, 2010); however, comparability in the results of different tasks and validity across different age groups remains unclear. We investigated the validity of a newly modified MID task for children (CID) using functional magnetic resonance imaging. The CID comprises the integration of a more age appropriate feedback phase. We focused on reward anticipation and their neural correlates. Twenty healthy young adults completed the MID and the CID. Additionally, 10 healthy children completed the CID. As expected, both paradigms elicited significant ventral and dorsal striatal activity in young adults during reward anticipation. No differential effects of the tasks on reaction times, accuracy rates or on the total amount of gain were observed. Furthermore, the CID elicited significant ventral striatal activity in healthy children. In conclusion, these findings demonstrate evidence for the validity of the CID paradigm. The CID can be recommended for the application in future studies on reward processing in children, adolescents, and in adults.
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http://dx.doi.org/10.1007/s00702-012-0962-0DOI Listing
August 2013

[May a sibling relationship be protective in coping with parental illness/stressful life events?].

Prax Kinderpsychol Kinderpsychiatr 2012 ;61(7):524-38

Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Charité Universitätsmedizin Berlin, Campus Virchow-Klinikum.

From a psychosocial point of view, the children of parents who suffer from cancer are regarded as not being sufficiently provided for, as well as being at greater risk for developing a psychiatric illness. Protective factors are marital satisfaction, open communication within the family and a good relationship with their parents. Results stemming from research on divorce have shown that sibling relationships may act as a protective factor against suffering a psychiatric illness after a stressful life event. The aim of this literature review is to examine the possible influence that a positive sibling relationship may have in coping with parental (oncological) illness/stressful life events. A review of the existing literature has revealed that little research has been conducted to this date addressing the question at hand. Altogether, the existence of a positive sibling relationship has shown to have a protective effect when having to deal with the burden of a stressful life event.
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http://dx.doi.org/10.13109/prkk.2012.61.7.524DOI Listing
December 2012

[Support for families with a parent diagnosed with cancer and children under the age of five--delineation of a counselling concept].

Prax Kinderpsychol Kinderpsychiatr 2012 ;61(6):396-413

Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Charité - Universitätsmedizin Berlin.

Parents of infants and young children, who have been diagnosed with cancer wish to protect their child from the emotional strains of their illness. They wonder, what the child can understand about the illness and how it is able to process or assimilate the experience of the illness. In fact, infants and young children are particularly sensitive to the degree of emotional burden and the mental state of their parents and will experience varying degrees of insecurity due to even small changes in their relationship with their parents. On the basis of psychological development parameters specific to this age group as well as scientific findings on risk and protection factors an integrated interaction based counseling approach was developed. Within this approach, support for the communication between parent and child in view of the specific strains of their illness, both non-verbal and in the child's early stages of verbal communication, is central. In the present article the counselling concept is described and illustrated by case studies. Application and limits are discussed.
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http://dx.doi.org/10.13109/prkk.2012.61.6.396DOI Listing
November 2012