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IMPORTANCE: The ENIGMA clinical high risk (CHR) for psychosis initiative, the largest pooled neuroimaging sample of individuals at CHR to date, aims to discover robust neurobiological markers of psychosis risk. OBJECTIVE: To investigate baseline structural neuroimaging differences between individuals at CHR and healthy controls as well as between participants at CHR who later developed a psychotic disorder (CHR-PS+) and those who did not (CHR-PS-). DESIGN, SETTING, AND PARTICIPANTS: In this case-control study, baseline T1-weighted magnetic resonance imaging (MRI) data were pooled from 31 international sites participating in the ENIGMA Clinical High Risk for Psychosis Working Group. CHR status was assessed using the Comprehensive Assessment of At-Risk Mental States or Structured Interview for Prodromal Syndromes. MRI scans were processed using harmonized protocols and analyzed within a mega-analysis and meta-analysis framework from January to October 2020. MAIN OUTCOMES AND MEASURES: Measures of regional cortical thickness (CT), surface area, and subcortical volumes were extracted from T1-weighted MRI scans. Independent variables were group (CHR group vs control group) and conversion status (CHR-PS+ group vs CHR-PS- group vs control group). RESULTS: Of the 3169 included participants, 1428 (45.1%) were female, and the mean (SD; range) age was 21.1 (4.9; 9.5-39.9) years. This study included 1792 individuals at CHR and 1377 healthy controls. Using longitudinal clinical information, 253 in the CHR-PS+ group, 1234 in the CHR-PS- group, and 305 at CHR without follow-up data were identified. Compared with healthy controls, individuals at CHR exhibited widespread lower CT measures (mean [range] Cohen d = -0.13 [-0.17 to -0.09]), but not surface area or subcortical volume. Lower CT measures in the fusiform, superior temporal, and paracentral regions were associated with psychosis conversion (mean Cohen d = -0.22; 95% CI, -0.35 to 0.10). Among healthy controls, compared with those in the CHR-PS+ group, age showed a stronger negative association with left fusiform CT measures (F = 9.8; P < .001; q < .001) and left paracentral CT measures (F = 5.9; P = .005; q = .02). Effect sizes representing lower CT associated with psychosis conversion resembled patterns of CT differences observed in ENIGMA studies of schizophrenia (? = 0.35; 95% CI, 0.12 to 0.55; P = .004) and individuals with 22q11.2 microdeletion syndrome and a psychotic disorder diagnosis (? = 0.43; 95% CI, 0.20 to 0.61; P = .001). CONCLUSIONS AND RELEVANCE: This study provides evidence for widespread subtle, lower CT measures in individuals at CHR. The pattern of CT measure differences in those in the CHR-PS+ group was similar to those reported in other large-scale investigations of psychosis. Additionally, a subset of these regions displayed abnormal age associations. Widespread disruptions in CT coupled with abnormal age associations in those at CHR may point to disruptions in postnatal brain developmental processes.

Epidemiologische Studien weisen auf einen Anstieg von Ess-Störungen im Jugendlichenalter hin und konnten nachweisen, dass sich der Beginn der Erkrankungen auf jüngere Altersgruppen verschiebt. Die durchschnittliche Prävalenzrate für die Anorexia und Bulimia nervosa beträgt im Jugendlichenalter jeweils 0.5%. Das Hauptinzidenzalter liegt für beide Erkrankungen zwischen dem 10. und 19. Lebensjahr. Gestörte Einstellungen zum Essen sowie ein abnormes Essverhalten weist ein erheblicher Anteil Jugendlicher auf und geht mit einem erhöhten Risiko zur Manifestation eines Vollbildes einer Ess-Störung oder anderer Formen emotionaler Störungen oder Verhaltensauffälligkeiten einher (Depression, Angstsymtome, Substanzmissbrauch, suizidales Verhalten). Für beide Erkrankungen wird eine multifaktorielle Ätiologie postuliert mit einer Interaktion von genetischen Einflüssen und bestimmten spezifischen Umweltfaktoren, insbesondere soziokulturellen Einflüssen. Neben anderweitigen komorbid bestehenden psychiatrischen Störungen führen häufig medizinische Komplikationen im Zusammenhang des Gewichtverlustes und des «Purging»-Verhaltens zu stationären Behandlungen. Der multimodale therapeutische Zugang focussiert auf eine kontrollierte Gewichtsrestitution in Kombination mit spezifischen psychoedukativen und psychotherapeutischen Methoden, die sowohl die Patienten als auch ihre Familien miteinbeziehen.

The mental structure provides every human with a potential repertoire of behavior. In every interaction a reactivation of past actualization- and representation processes concerning the particular prevailing context takes place. A child's mental structure should not be devaluated in comparison to a structure of an adult person. Levels of functioning depend on the developmental age. Structural dispositions consist of represented experiences of interaction. The so-called affect attenuement plays an important part in individual affect regulation. If the structural representation follows mechanisms of memory, procedural structural dispositions may be postulated, which affect the behavior besides iconic and symbolic representations. Within the structure affect dispositions are integrated. They are able to give value to certain contents of experience and reexperience. Disorders in the development of empathy are connected with impairments of the structural development. By inherent faintness of the regulation of affects or by sensitization and traumatization processes, which involve dissociative phenomena, the affective load of representations can be changed. This may result in structural deficits.

Self-mutilation as addictive behaviour has been mentioned in a few studies in recent years. We present the case of a girl with narcissistic borderline personality disorder (DSM III-R: 301.83, 301.81), who undertook multiple, repetitive self-mutilating acts. Self-mutilation is discussed as addictive behaviour in this case. We emphasize the evaluation of repetitive self-mutilating acts by applying criteria for addictive and dependence disorders, in order to achieve additional adequate strategies for treating patients showing this behaviour.

The following pharmacokinetic study was aimed at a comparison of the bioavailability of two different preparations of diazepam (Gewacalm and a further wellknown formulation). 40 healthy volunteers were subjected to a cross-over design in which plasma levels of diazepam were assayed after oral and intramuscular application of 10 mg of a preparation. In the comparison (N = 30) of oral bioavailability (rate and completeness of enteral absorption) no statistical difference between both preparations was observed. In the study of intramuscular bioavailability (N = 10), a trend of quicker and more complete resorption of Gewacalm was of statistical significance (p less than 0.05), however, because of the small number of subjects tested in the intramuscular study a replication study is advisable.

Suicide is one of the leading causes of death in adolescents and help-seeking behaviour for suicidal behaviour is low. School-based screenings can identify adolescents at risk for suicidal behaviour and might have the potential to facilitate service use and reduce suicidal behaviour. The aim of this study was to assess associations of a two-stage school-based screening with service use and suicidality in adolescents (aged 15 ± 0.9 years) from 11 European countries after one year. Students participating in the 'Saving and Empowering Young Lives in Europe' (SEYLE) study completed a self-report questionnaire including items on suicidal behaviour. Those screening positive for current suicidality (first screening stage) were invited to an interview with a mental health professional (second stage) who referred them for treatment, if necessary. At 12-month follow-up, students completed the same self-report questionnaire including questions on service use within the past year. Of the N = 12,395 SEYLE participants, 516 (4.2%) screened positive for current suicidality and were invited to the interview. Of these, 362 completed the 12-month follow-up with 136 (37.6%) self-selecting to attend the interview (screening completers). The majority of both screening completers (81.9%) and non-completers (91.6%) had not received professional treatment within one year, with completers being slightly more likely to receive it (χ2(1) = 8.948, V = 0.157, p ≤ 0.01). Screening completion was associated with higher service use (OR 2.695, se 1.017, p ≤ 0.01) and lower suicidality at follow-up (OR 0.505, se 0.114, p ≤ 0.01) after controlling for potential confounders. This school-based screening offered limited evidence for the improvement of service use for suicidality. Similar future programmes might improve interview attendance rate and address adolescents' barriers to care.

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 they highlight the need for specific strategies for involving the family.