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The case history of a 15 1/2-year-old boy is presented who suffers from screaming fits during the night and epilepsia. The problem has existed since he was eight. He lives alone with his mother in a "partner-like" relationship. The previous diagnosis, namely epilepsy, has masked any possible psychodynamic element. Our diagnostic instruments were: 1. Standardized diagnostics with DSM III-R; 2. psychoanalytically oriented psychodiagnostics; 3. long term EEG-video-monitoring, which eventually succeeded in differentiating his multiple symptoms. Using these methods we were able to differentiate a sleep disorder (somnambulism) from his grandmal epilepsy. We changed his anticonvulsive pharmacological therapy and introduced an individual psychotherapy ("Katathymes Bilderleben"). This kind of psychotherapy is applied for the first time as a therapy for somnambulism. By using this therapeutic concept we cured our patient from his symptoms.

We present outcome data of 171 children with psychosomatic and child-psychiatric disorders and discuss the pros and cons of two standardized multiaxial diagnostic systems (DSM III and the Multiaxial System of Rutter 1975). Results and arguments were considered until a clearcut choice fell for the DSM-III. As a major conclusion we introduce the BAT-Index, a factor derived by comparing the psychosocial stressors (Axis 4 DSM III) to the highest level to adaptive functioning past year (Axis 5 DSM III) which can be helpful in estimating the to be expected changes and complications in therapeutic settings and gives us a good prognostic assessment of the patient.

Early morbidity and neurological development in 40 term infants with UApH less than or equal to 7,00 (6,60-7,00) were investigated. Group 1: 18 infants (45%) responded well to the measures of primary resuscitation--they never revealed any neurological symptoms and their growth and development were normal. Group 2: 15 infants (37,5%) who responded less well to primary resuscitation initially had mild to moderate neurological symptoms subsiding during the first few days of life. There were 2 cases of necrotizing enterocolitis and 4 cases of moderate meconium aspiration syndrome. Apgar scores, pH and blood-gases were worse than in group 1. At discharge and on follow-up all children appeared clinically normal. Group 3: 7 infants (17,5%) with severe neurological signs were not responding well to resuscitation. They were referred to the intensive care nursery and treated for cerebral edema (hyperventilation, pentobarbital, steroids). 2 infants with severe meconium aspiration syndrome recovered entirely. Two children had evidence of cerebral involvement as demonstrated by means of computerized tomography of the head, but were normal on follow-up. Three children with distinct signs of cerebral palsy developed cerebral atrophy and microcephaly, presumably due to hypoxic-ischemic encephalopathy. Early morbidity, comprising all 22 infants from group 2 and 3 amounts to 55%, morbidity up to an average age of 14,7 month includes 5 infants from group 3 (suspected cerebral lesions in 2, microcephalus in 3) and thus comes to 12,5% of the total.

A 10 5/12 year old boy was presented with seizures of uncertain origin on to the psychosomatic ward of our University Children's Hospital. The question and problem was the distinction of psychogenic versus epileptogenic origin (repeatedly performed EEG's had shown normal findings, the seizures did not response to anticonvulsive therapy). The exploration of a psychodynamic causes of the presenting problem was excluded by family therapeutic and psychoanalytical case history and psychodynamic interview. The first pathological finding was seen with registration of a long term EEG with typical findings of temporal central spikes and waves as seen in the benign rolandic-epilepsia. The following diagnostic considerations were discussed and differentiated. a) benign rolandi epilepsia b) malign rolandi epilepsia c) psychomotoric seizures d) rolandic spikes as symptomatic finding of a brain tumor. The definite diagnosis was finally confirmed by a cerebral computer-tomography which showed a large expensive process in the interferior right regio temporalis, which was identified histologically after operation as a oligodendrogliom grad-I. The tumor was removed successfully as a whole without any neurological defects.