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Objective: Dissemination of knowledge concerning normal and deviant development as well as child and adolescent psychiatric (CAP) disorders with a focus on diagnosis and treatment should represent an integral part of medical training at every medical school. Furthermore, it is of utmost importance that medical students acquire skills in communication and basic psychiatric assessment of children and adolescents. The article summarizes the current state of affairs of teaching in CAP in German medical schools., Method: All chairs of child and adolescent psychiatry were asked for detailed information on involvement in compulsory and noncompulsory medical training, scope of lectures in CAP, and courses for students of other disciplines., Results: In 25 out of 26 medical schools with a chair for CAP this medical specialty is already part of compulsory medical training. CAP is either taught in independent lectures or is integrated into lectures on psychiatry, pediatrics, and/or psychosomatics. The main lecture of 1.2 semester periods per week on average (range 0.1 to 2, the equivalent of 2 to 28 teaching units per semester) is complemented by numerous additional offers (internships, advanced courses, compulsory elective subjects). The CAP elective tertial of the "practical year" (final year of medical school in Germany) can be completed at all medical faculties with a CAP chair. CAP is often taught students of other disciplines as well, e.g., psychology or education., Conclusions: Given the importance of CAP, the overall goal should be to anchor CAP as a required specialty in all 35 medical schools in Germany.

Background:  Subthreshold-depression and anxiety have been associated with significant impairments in adults. This study investigates the characteristics of adolescent subthreshold-depression and anxiety with a focus on suicidality, using both categorical and dimensional diagnostic models., Methods:  Data were drawn from the Saving and Empowering Young Lives in Europe (SEYLE) study, comprising 12,395 adolescents from 11 countries. Based on self-report, including Beck Depression Inventory-II (BDI-II), Zung Self-Rating Anxiety Scale (SAS), Strengths and Difficulties Questionnaire (SDQ) and Paykel Suicide Scale (PSS) were administered to students. Based on BDI-II, adolescents were divided into three groups: nondepressed, subthreshold-depressed and depressed; based on the SAS, they were divided into nonanxiety, subthreshold-anxiety and anxiety groups. Analyses of Covariance were conducted on SDQ scores to explore psychopathology of the defined groups. Logistic regression analyses were conducted to explore the relationships between functional impairments, suicidality and subthreshold and full syndromes., Results:  Thirty-two percent of the adolescents were subthreshold-anxious and 5.8% anxious, 29.2% subthreshold-depressed and 10.5% depressed, with high comorbidity. Mean scores of SDQ of subthreshold-depressed/anxious were significantly higher than the mean scores of the nondepressed/nonanxious groups and significantly lower than those of the depressed/anxious groups. Both subthreshold and threshold-anxiety and depression were related to functional impairment and suicidality., Conclusions: Subthreshold-depression and subthreshold-anxiety are associated with an increased burden of disease and suicide risk. These results highlight the importance of early identification of adolescent subthreshold-depression and anxiety to minimize suicide. Incorporating these subthreshold disorders into a diagnosis could provide a bridge between categorical and dimensional diagnostic models., (© 2013 The Authors. Journal of Child Psychology and Psychiatry © 2013 Association for Child and Adolescent Mental Health.)

This investigation aimed to evaluate the German version of the BPQ as a screening instrument for borderline personality disorder (BPD) in a clinical sample. Furthermore, an association between self-esteem and BPD was examined. In a consecutive modus, 27 patients with BPD and 54 clinical controls (age range: 14 - 25 years) completed a self-report questionnaire and took part in a semi-structured interview. The German version of the BPQ revealed a high internal consistency (α = 0.95) and test-retest-reliability (r = 0.94). The criterion validity (r = 0.60) and the cut-off value (49) must be interpreted with caution due to the small sample size. BPD as well as 8 out of 9 subscales of the BPQ were significantly associated with lower self-esteem. A pre-screening using the BPQ within the clinical setting may facilitate early detection of BPD. In addition, building up self-esteem seems to be very important in the treatment of patients with BPD., (© Georg Thieme Verlag KG Stuttgart · New York.)

This study aimed to investigate a specific relationship between nonsuicidal self-injury (NSSI) and a variety of adverse childhood experiences (ACEs) over and above childhood abuse and their impact on frequency, severity, and functions of NSSI. A sample of 125 inpatients (aged 13 to 26) was consecutively recruited within a psychiatric university hospital. Frequency, methods and functions of NSSI were assessed by the Functional Assessment of Self-Mutilation (FASM), ACEs were assessed by the Childhood Experiences of Care and Abuse Questionnaire (CECA.Q). The 12 month prevalence of NSSI in this representative, clinical sample was 60.0%. Engagement in NSSI was significantly related to ACEs with highest associations for maternal antipathy and neglect. Whilst ACEs were not associated with frequency or severity of NSSI, some ACEs were significantly related to the automatic functions of NSSI (e.g., affect regulation, anti-dissociative function or self-punishment) as well as to a peer identification function. NSSI represents a frequent phenomenon among young clinical populations and seems to be specifically related to ACEs with maternal antipathy or neglect commonly featured over and above experiences of abuse. Since ACEs also influence the functions of NSSI such factors need to be examined as part of clinical care planning., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Background and Purpose: Previous imaging studies have described gray and white matter alterations in the cerebellum, the posterior aspects of the visual system and in the corpus callosum in patients with schizophrenia. Here, we investigated these regions in more detail using tract-based spatial statistics (TBSS). Additionally, we evaluated potential changes in lateralization of the optic radiation and the superior cerebellar peduncle., Material and Methods: We studied 12 patients with first-admission schizophrenia and a group of age-matched healthy controls. The diffusion tensor imaging data were preprocessed using tract-based spatial statistics and the obtained white matter skeleton was used to perform a regional analysis of fractional anisotropy in the corpus callosum, the optic radiation, and the superior and middle cerebellar peduncles., Results: Using TBSS, a significant reduction of fractional anisotropy in the whole corpus callosum and the optic radiation but not in the middle and superior cerebellar peduncles was found. Furthermore, a significantly decreased lateralization of the optic radiation and the superior cerebellar peduncles in patients was observed., Conclusion: Our findings substantiate the concept that schizophrenia is a neurodevelopmental disorder and indicate that changes in lateralization may play a key role in the pathogenesis of this disease., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

Objective: Parental cancer increases the risk of psychosocial problems in adolescents. We investigated the frequency and efficacy of adolescents' coping strategies and relationships between those strategies and mental health status. Age and gender differences regarding coping and mental health were also investigated., Methods: In total, 214 adolescents from 167 families participated in a cross-sectional, multicenter study. All participants were recruited from standard oncological care. Among the participants, 52% utilized a child-centered intervention program. Adolescents' coping skills were measured using KIDCOPE. Mental health status was rated by adolescents and parents by the SDQ for symptomatology and the KIDSCREEN for well-being., Results: We found that 29% of the adolescents showed emotional and behavioral problems. We found gender differences in mental health status but not in coping. Adolescents used a broad spectrum of coping strategies. Active problem-solving, distraction, acceptance, wishful thinking and seeking social support were the most frequently used coping strategies. The utilization of certain coping skills was mediated by their perceived efficacy. Problem-focused or approach-oriented coping strategies generally are associated with better mental health, while avoidance-oriented coping are associated with worse mental health. Emotion-focused coping was associated with both lower and higher mental health., Conclusion: The strategies used by adolescents to cope with parental cancer are associated with their mental health. Problem-solving and approach-oriented coping strategies should be facilitated by psychological interventions regardless of age and gender. Age and gender differences in adolescents' mental health should be further investigated because these differences are not explained by differences in coping strategies., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: Visual impairments in schizophrenia have been suggested to be partly caused by early processing deficits of the magnocellular (M) pathway. This might include disturbed interactions between the M and parvocellular (P) pathways and especially impaired M priming, which can disturb highlighting of relevant information. Such disorders may result from neurodevelopmental irregularities, which are assumed to be substantially involved in schizophrenia. This study sought to test the hypothesis that M priming is impaired in schizophrenia. In order to elucidate this neurodevelopmental aspect, we investigated patients with different ages of schizophrenia onset. This provided a useful design to integrate visual information processing in a neurodevelopmental model of schizophrenia., Method: Nine stimulus conditions were used to investigate the M- and P-pathways and their interaction in a pattern reversal VEP paradigm. N80 generators were analyzed using source localization (Brain Electrical Source Analysis software: BESA). Forty schizophrenia patients (early-onset=19; adult-onset=21) were compared with age- and gender-matched healthy controls (early-onset controls=19; adult-onset controls=21). Hypotheses were tested using a bootstrap resampling procedure., Results: The N80 component was represented by a single dipole located in the occipital visual cortex. The bootstrap analysis yielded significant differences between early-onset schizophrenia patients and controls. We found lower amplitudes in response to mixed M-P conditions and normal amplitudes in response to isolated P- and M-biased stimulation. Concerning the latencies, significant differences were found between adult-onset subjects and their controls, with prolonged latencies for schizophrenia patients., Conclusions: The early VEP component N80 evoked by mixed M-P conditions is assumed to be a correlate of M priming and showed reduced amplitude in early-onset schizophrenic patients but not in adult-onset patients. These findings point towards an M priming deficit in early-onset patients and are compatible with a neurodevelopmental hypothesis of schizophrenia, probably reflecting asynchronies in brain maturational abnormalities occurring at different ages of illness onset., (Copyright © 2012 Elsevier B.V. All rights reserved.)

A behaviorally inhibited temperament in early childhood has been identified as a potential risk factor for anxiety disorders in children and adolescents. The purpose of our investigation was the development and evaluation of the factor structure, reliability and validity of the first retrospective parent report measure to assess behavioral inhibition in infants and toddlers. Principal Component Analysis of the Retrospective Infant Behavioral Inhibition Scale (RIBI) supported a three factor solution of the core features of BI in two unselected samples. Internal consistency and inter-rater agreement of both parent judgments were >.90 and >.70. Scores of the RIBI were positively correlated with the parent report temperament questionnaire IBQ and a laboratory-based test at age 14 months with the child.

A specific composition of temperament traits with high novelty seeking (NS), high harm avoidance (HA), and low reward dependence (RD) has been attributed to adult patients with borderline personality disorder (BPD). This study examined whether an analogue personality profile is specifically associated with adolescent BPD. The female study sample comprised 33 adolescents with BPD, 35 clinical controls (CCs), and 31 healthy controls (HCs). Dimensions of temperament and character were measured according to Cloninger's biopsychosocial model of personality. Significantly higher means of NS and HA but lower means of RD could be determined in the adolescents with BPD compared with the CCs and the HCs. The comparable findings of this specific temperament constellation in adolescents and adult patients with BPD suggest that heritable factors such as temperamental traits may contribute to the vulnerability for developing BPD. Early identification of a "borderline temperament" may facilitate early intervention and lower the risk for developing BPD.

Data about the prevalence of school absenteeism and its correlation with emotional and behavioural problems in Germany is scarce, in particular regarding excused absenteeism. This study aims to close the gap by examining a sample of 2,679 pupils attending the different types of secondary school (Hauptschule, Realschule, Gymnasium), who participated in a clinical trial for the prevention of truancy (WE-STAY-Project). Pupils' mean age was 14 years (M = 13.94, SD = 0.85, Range = 11-19) and gender distribution was balanced (49.35% males, 50.65% females). Using a self-report questionnaire, pupils where asked on how many days they had missed school on average per month during the last school year (excused and unexcused). Emotional and behavioural problems were measured by using the "Strengths and Difficulties Questionnaire" (SDQ). 4.1% of the pupils reported to have missed school without a valid excuse on more than four days per month (unexcused absenteeism). 6.1% had missed school having an excuse on more than ten days per month (excused absenteeism). Both, unexcused and excused absenteeism, showed an increase of emotional and behavioural problems dependent on the intensity of absenteeism. In conclusion, these findings show the relevance of school absenteeism in Germany. In the future, more attention should be given to pupils with also excused absenteeism.

Background: Family interactions with schizophrenia patients and caregivers rated as high expressed emotion (EE) are characterized by increased negative non-verbal behaviour. Head position is one important component of non-verbal behaviour and has not been examined in relation to EE before. The aim of this pilot study was to investigate the influence of caregivers' EE on the head position of adolescents with schizophrenia and their caregivers., Sampling and Methods: 15 adolescent schizophrenia patients and 17 non-patient adolescents were videotaped during a 10-min problem-solving task with their caregiver. The head position was coded by the Berner System of Non-Verbal Behaviour. The caregivers' EE level (high EE vs. low EE) was measured by the Five-Minute Speech Sample., Results: Adolescent patients and non-patients showed a higher frequency of averted head positions towards high EE caregivers compared to low EE caregivers (β = 47.85, t = 2.41, p = 0.023). They displayed longer mean times of averting towards high EE caregivers compared to low EE caregivers (β = -1.78, t = -2.51, p = 0.018). An indirect approach was shown more frequently by adolescent patients towards low EE compared to high EE caregivers (β = 39.99, t = 2.31, p = 0.028). In contrast, non-patient adolescents showed a more indirect approach towards high EE caregivers compared to low EE caregivers. Caregivers of schizophrenia patients had head positions with a straight ahead lowered approach for a longer time compared to caregivers of non-patients (β = -29.75, t = -2.51, p = 0.018). Within the patient and non-patient groups, low EE caregivers showed longer total times of positions with a straight ahead lowered approach than high EE caregivers., Conclusions: High EE communication may be characterized by a higher ratio of averting head position in adolescents, which is especially pronounced in adolescents with schizophrenia. Low EE communication seems to be better adjusted by a more indirect approach being shown by the adolescent and straight ahead lowered head positions by the caregiver, especially when the adolescent suffers from schizophrenia., (Copyright © 2012 S. Karger AG, Basel.)

The Berkeley Puppet Interview (BPI) enables us to investigate psychological symptoms of children aged four to eight years under a multi-informant perspective by the means of self and parent report measures. 45 families with one parent suffering from cancer have been examined with regard to internalizing and externalizing symptoms of the children. Results have been compared to two different age-appropriate samples (Swiss preschool study of Basel and German KiGGS study). A small, highly selective sample of twelve children aged four to eight years could have been examined both from the self and parent perspective. Our results show, that four to eight year old children of cancer patients do not differ from other children of the same age in the way they express emotional symptoms in the BPI, but they are judged more emotionally burdened than other children by their parents (SDQ). Self and parent report do not significantly correlate. It seems as if parents in families struck by a cancer disease see their children's emotional symptoms more pronounced than the children themselves do express in the puppet interview. Implications for clinical and research practice will be discussed.

Background: Borderline personality disorder (BPD) is known to be associated with high rates of comorbidity and severe impairment of psychosocial functioning in adults. The aim of this study was to investigate Axis I and Axis II disorders, as well as psychosocial functioning, in a clinical sample of adolescents with BPD and to compare these with participants with mixed psychiatric diagnoses., Methods: Female adolescent patients were consecutively recruited from the child and adolescent psychiatry department of a university hospital. Axis I and Axis II diagnoses were assessed by experienced clinicians using well-established semistructured interviews, along with psychosocial functioning., Results: The final sample (87 participants) comprised 31 participants with a diagnosis of BPD and 56 participants with mixed psychiatric diagnoses. The most common comorbid disorders in the adolescent BPD sample were mood, eating, dissociative, and substance use disorders in Axis I, and cluster C personality disorders in Axis II. The BPD group showed a significantly higher average number of comorbid Axis I and Axis II diagnoses and significantly lower psychosocial functioning compared with the clinical control group. Regression analyses revealed that psychosocial functioning was predicted by socioeconomic status and comorbid disorders, as well as the unique influence of BPD itself., Conclusion: Adolescent BPD in females is accompanied by high rates of psychiatric comorbidity and poor psychosocial functioning. This underscores the need for diagnosis of BPD at its early stages, in order to facilitate appropriate interventions., (Copyright © 2012 S. Karger AG, Basel.)

Aims: To investigate the prevalence of pathological internet use (PIU) and maladaptive internet use (MIU) among adolescents in 11 European countries in relation to demographic, social factors and internet accessibility., Design: Cross-sectional survey., Setting: The 7th Framework European Union (EU) funded project, Saving and Empowering Young Lives in Europe (SEYLE), is a randomized controlled trial (RCT) evaluating interventions for risk behaviours among adolescents in Austria, Estonia, France, Germany, Hungary, Ireland, Israel, Italy, Romania, Slovenia and Spain, with Sweden serving as the coordinating centre., Participants: A total of 11 956 adolescents (female/male: 6731/5225; mean age: 14.9 ± 0.89) recruited from randomly selected schools within the 11 study sites., Measurements: Internet users were classified by gender into three categories: adaptive, maladaptive and pathological, based on their score in the Young Diagnostic Questionnaire for Internet Addiction (YDQ)., Findings: The overall prevalence of PIU was 4.4%; it was higher among males than females (5.2% versus 3.8%) and differed between countries (χ(2)  = 309.98; d.f. = 20; P < 0.001). PIU correlated significantly with mean hours online and male gender. The highest-ranked online activities were watching videos, frequenting chatrooms and social networking; significantly higher rates of playing single-user games were found in males and social networking in females. Living in metropolitan areas was associated with PIU. Students not living with a biological parent, low parental involvement and parental unemployment showed the highest relative risks of both MIU and PIU., Conclusions: Across a range of countries in Europe, using the Young Diagnostic Questionnaire for Internet Addiction yields a prevalence of 'pathological internet use' of 4.4% among adolescents, but varies by country and gender; adolescents lacking emotional and psychological support are at highest risk., (© 2012 The Authors, Addiction © 2012 Society for the Study of Addiction.)

Objective: To examine whether deficits in focal lateralized motor system activation would differentiate between subjects with schizophrenia/schizoaffective disorder and subjects with a major depressive episode. Reductions of Bereitschaftspotential amplitude have been described for both diagnostic groups., Methods: We analyzed multi-channel lateralized movement-related potentials (LMRP) during choice reaction movements in 16 schizophrenic/schizoaffective patients in partial remission with predominant negative symptoms, 18 patients with a non-psychotic major depression and two healthy control groups age-matched to the respective patient groups (20/23 subjects)., Results: A significant reduction of lateralized potentials over the (pre-)motor areas immediately preceding and around movement execution was found only in subjects with schizophrenia/schizoaffective disorder but not with a major depressive episode. Reduced LMRP amplitudes correlated with negative symptoms (SANS score). Other movement stages (preceding response-locked 'contingent negative variation' during response selection and post-movement evaluation during motor postimperative negative variation) were not affected in the same way., Conclusions: Deficits in focal motor cortex activation during movement execution may reflect rather schizophrenia-specific deficits in fronto-striatal circuits. A general lack of drive and depressed mood did not alter the degree of lateralization of motor activation during movement execution., Significance: Lateralization of movement-related potentials could differentiate psychotic from non-psychotic disorders on the group level., (Copyright © 2012 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.)

Attention deficit hyperactivity disorder is one of the most frequent neuropsychiatric disorders in childhood. Transcranial magnetic stimulation studies based on muscle responses (motor-evoked potentials) suggested that reduced motor inhibition contributes to hyperactivity, a core symptom of the disease. Here we employed the N100 component of the electroencephalographic response to transcranial magnetic stimulation as a novel marker for a direct assessment of cortical inhibitory processes, which has not been examined in attention deficit hyperactivity disorder so far. We further investigated to what extent affected children were able to regulate motor cortical inhibition, and whether effects of age on the electroencephalographic response to transcranial magnetic stimulation were compatible with either a delay in brain maturation or a qualitatively different development. N100 amplitude evoked by transcranial magnetic stimulation and its age-dependent development were assessed in 20 children with attention deficit hyperactivity disorder and 19 healthy control children (8-14 years) by 64-channel electroencephalography. Amplitude and latency of the N100 component were compared at rest, during response preparation in a forewarned motor reaction time task and during movement execution. The amplitude of the N100 component at rest was significantly lower and its latency tended to be shorter in children with attention deficit hyperactivity disorder. Only in controls, N100 amplitude to transcranial magnetic stimulation was reduced by response preparation. During movement execution, N100 amplitude decreased while motor evoked potential amplitudes showed facilitation, indicating that the electroencephalographic response to transcranial magnetic stimulation provides further information on cortical excitability independent of motor evoked potential amplitudes and spinal influences. Children with attention deficit hyperactivity disorder showed a smaller N100 amplitude reduction during movement execution compared with control children. The N100 amplitude evoked by transcranial magnetic stimulation decreased with increasing age in both groups. The N100 reduction in children with attention deficit hyperactivity disorder at all ages suggests a qualitative difference rather than delayed development of cortical inhibition in this disease. Findings further suggest that top-down control of motor cortical inhibition is reduced in children with attention deficit hyperactivity disorder. We conclude that evoked potentials in response to transcranial magnetic stimulation are a promising new marker of cortical inhibition in attention deficit hyperactivity disorder during childhood.

Purpose: Both, children of somatically ill parents and children of single-mothers are at risk to develop mental health problems and low QoL. This study investigates the effect on children when their single-mothers are exposed to cancer., Methods: In a Cross-sectional design a sample of N=47 children of single-mothers exposed to parental cancer was compared to a sample of N=135 children of mothers (living in partnership) exposed to cancer (multi informant approach)., Results: SDQ and KIDSCREEN showed no differences between children of single-mothers and children of mothers in partnership. In the focused sample older children (11-17 years) showed more conduct problems than younger children (4-10 years). The differences between the types of assessment was significant for conduct problems., Conclusion: Single-parenting and parental cancer as a double burden don't increase the risk for mental health problems and low QoL of children. The results for conduct problems will be discussed., (© Georg Thieme Verlag KG Stuttgart · New York.)

The link between focal motor system activation and reafferent sensory feedback is thought to be crucial for the perception that a movement is actively performed. In this article, we examine how schizophrenia affects the relationship between motor and somatosensory system activation. Movement-related potential source analysis allowed us to separate and compare motor activation deficits and reafferent feedback processing. We analyzed lateralized movement-related potentials during choice reaction movements in 16 subjects with schizophrenia/schizoaffective disorder. These subjects had partial remissions with predominantly negative symptoms and were compared to an age-matched healthy control group. In the schizophrenia/schizoaffective group, dipole source analysis indicated a significantly reduced lateralized sensorimotor activation immediately preceding movement execution. In contrast, activation by reafferent feedback was relatively unimpaired. Subjects with schizophrenia/schizoaffective disorder lacked a focal motor and reafferent sensory processing correlation, which can be identified through a significantly different regression slope from healthy controls. Reduced action-related motor system activation in subjects with schizophrenia/schizoaffective disorder was associated with preserved activation by reafferent sensory feedback. Most importantly, motor-sensory tuning, i.e. a specific enhancement of sensory information necessary to monitor movements, could not be found in subjects with schizophrenia/schizoaffective disorder. Our data provide further evidence for disturbed motor-sensory interactions in schizophrenia., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Several diffusion tensor imaging (DTI) studies involving adults and adolescents with schizophrenia have examined fractional anisotropy (FA) in the corpus callosum (CC) with conflicting findings. This may be due to confounding factors such as the chronicity of the disorder, long-term medication with psychotropics or methodological differences. To provide a clearer picture of early alterations, we examined 13 adolescents with first-admission schizophrenia and 13 healthy controls using a region-of-interest approach based on probabilistic voxel classification. We quantified FA in four subdivisions of the CC and hypothesized that adolescents with schizophrenia display a reduced FA in the genu associated with 'hypofrontality' and a reduced FA in the body of the CC linked to the heteromodal association cortex. Fiber integrity measurements revealed significant FA decreases in the genu and body of the CC in adolescents with schizophrenia compared to healthy controls. These findings emphasize the central role of the CC in even the early stages of schizophrenia and lend weight to hypotheses about frontal alterations and the central role of the heteromodal association cortex in the aetiopathogenesis of the disorder., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

The early detection and treatment of persons at-risk for psychosis is currently regarded a promising strategy in fighting the devastating consequences of psychotic disorders. The two current at-risk approaches, i.e., the "ultra high risk" and the "basic symptom" criteria, were mainly developed on adult samples. Initial evidence suggests, however, that they cannot simply be applied to children and adolescents. For ultra high risk criteria, there is indication of some attenuated psychotic symptoms being potentially non-specific in adolescents and of brief limited intermittent symptoms being difficult to clinically classify in children when observable behavioral correlates are missing. For basic symptoms, too, only preliminary indication of their usefulness in children and adolescents exists. Since developmental peculiarities in the assessment of basic symptoms should be considered, a child and youth version of the Schizophrenia Proneness Instrument (SPI-CY) was developed. In conclusion, research on the clinical-prognostic validity of the at-risk criteria and their potential adoption to the special needs of children and adolescents is needed. If a Prodromal Risk Syndrome for Psychosis or Attenuated Psychotic Symptoms Syndrome will be included into DSM-V, it has to be highlighted that its suitability for children and adolescents is only insufficiently known.

Motor system calibration depends crucially on the adjustment to the consequences of a movement, which often occur when the movement itself is already completed. The mechanisms by which reafferent feedback information is compared to the programmed movement remain unclear. In the current study, the hypothesis of a short term memory trace in the motor cortex which outlasts quick movements and is generated independently from reafferent feedback was challenged by temporal deafferentation. Post-movement cortical potentials were recorded by high-resolution EEG during a reaction time task which required speeded unilateral right-hand or left-hand button presses. We analysed lateralized motor N700 (motor post-imperative negative variation), a post-movement component, under temporary deafferentation achieved through application of a blood pressure tourniquet in ten healthy adult subjects. Motor N700 persisted under deafferentation in the absence of reafferent tactile and proprioceptive feedback input into the sensorimotor cortex, which was abolished under deafferentation. Source analysis pointed towards continuing activation in the pre-/primary motor cortex. Thus, motor post-processing can be dissociated from reafferent sensory feedback. Motor cortex activation outlasts quick movements for about a second also in the absence of a reafferent signal. Continuing motor cortex activation could act as an internal motor model in motor learning and allow better adjustment of movements according to the evaluation of their consequences., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Background: Hyperactivity is one of the core symptoms in attention deficit hyperactivity disorder (ADHD). However, it remains unclear in which way the motor system itself and its development are affected by the disorder. Movement-related potentials (MRP) can separate different stages of movement execution, from the programming of a movement to motor post-processing and memory traces. Pre-movement MRP are absent or positive during early childhood and display a developmental increase of negativity., Methods: We examined the influences of response-speed, an indicator of the level of attention, and stimulant medication on lateralized MRP in 16 children with combined type ADHD compared to 20 matched healthy controls., Results: We detected a significantly diminished lateralisation of MRP over the pre-motor and primary motor cortex during movement execution (initial motor potential peak, iMP) in patients with ADHD. Fast reactions (indicating increased visuo-motor attention) led to increased lateralized negativity during movement execution only in healthy controls, while in children with ADHD faster reaction times were associated with more positive amplitudes. Even though stimulant medication had some effect on attenuating group differences in lateralized MRP, this effect was insufficient to normalize lateralized iMP amplitudes., Conclusions: A reduced focal (lateralized) motor cortex activation during the command to muscle contraction points towards an immature motor system and a maturation delay of the (pre-) motor cortex in children with ADHD. A delayed maturation of the neuronal circuitry, which involves primary motor cortex, may contribute to ADHD pathophysiology.

Background: Dopamine plays an important role in orienting, response anticipation and movement evaluation. Thus, we examined the influence of functional variants related to dopamine inactivation in the dopamine transporter (DAT1) and catechol-O-methyltransferase genes (COMT) on the time-course of motor processing in a contingent negative variation (CNV) task., Methods: 64-channel EEG recordings were obtained from 195 healthy adolescents of a community-based sample during a continuous performance task (A-X version). Early and late CNV as well as motor postimperative negative variation were assessed. Adolescents were genotyped for the COMT Val(158)Met and two DAT1 polymorphisms (variable number tandem repeats in the 3'-untranslated region and in intron 8)., Results: The results revealed a significant interaction between COMT and DAT1, indicating that COMT exerted stronger effects on lateralized motor post-processing (centro-parietal motor postimperative negative variation) in homozygous carriers of a DAT1 haplotype increasing DAT1 expression. Source analysis showed that the time interval 500-1000 ms after the motor response was specifically affected in contrast to preceding movement anticipation and programming stages, which were not altered., Conclusions: Motor slow negative waves allow the genomic imaging of dopamine inactivation effects on cortical motor post-processing during response evaluation. This is the first report to point towards epistatic effects in the motor system during response evaluation, i.e. during the post-processing of an already executed movement rather than during movement programming.

The German Aptitude Test for Medical Studies (TMS) was implemented in 2007. 12,194 persons registered for this test in 2011, which represents a 91% increase over 2007. The male/female ratio remained constant at 38:62. Its reliability among applicants to Heidelberg Medical Faculty was confirmed by Cronbach's α (≥ 0.75) and inter-item correlation (≥ 0.25, p < 10(-7)). The TMS contains nine items; using factor analysis these were allocated to the two components verbal-mathematical and spatial-figural ability. The verbal-mathematical items moderately correlate with the German Baccalaureate GPA (r = 0.33), while the spatial-figural items do not correlate (r = 0.07). Thus, the TMS is an admission instrument that appraise different cognitive abilities than the GPA. For the admission of students to our faculty their TMS scores are weighted at 39%, which has resulted in a diversification of our student cohorts., (Copyright © 2011. Published by Elsevier GmbH.)

Background: Dopamine plays an important role in orienting and the regulation of selective attention to relevant stimulus characteristics. Thus, we examined the influences of functional variants related to dopamine inactivation in the dopamine transporter (DAT1) and catechol-O-methyltransferase genes (COMT) on the time-course of visual processing in a contingent negative variation (CNV) task., Methods: 64-channel EEG recordings were obtained from 195 healthy adolescents of a community-based sample during a continuous performance task (A-X version). Early and late CNV as well as preceding visual evoked potential components were assessed., Results: Significant additive main effects of DAT1 and COMT on the occipito-temporal early CNV were observed. In addition, there was a trend towards an interaction between the two polymorphisms. Source analysis showed early CNV generators in the ventral visual stream and in frontal regions. There was a strong negative correlation between occipito-temporal visual post-processing and the frontal early CNV component. The early CNV time interval 500-1000 ms after the visual cue was specifically affected while the preceding visual perception stages were not influenced., Conclusions: Late visual potentials allow the genomic imaging of dopamine inactivation effects on visual post-processing. The same specific time-interval has been found to be affected by DAT1 and COMT during motor post-processing but not motor preparation. We propose the hypothesis that similar dopaminergic mechanisms modulate working memory encoding in both the visual and motor and perhaps other systems.

Maternal intuitive skills can be threatened as a result of severe deprivation or unresolved trauma in the own childhood and can even be inaccessible to the mother. A mother's own childhood experience of abuse maybe a risk factor for repeated child abuse. As a follow-up study to assess the emotional availability of abused mothers it was investigated how a physical or sexual abuse appears in the mother-child interaction and communication in the context of "cycle of abuse" and whether it could give effect to it. Interactions of mothers with abuse experience were compared with those of mothers without an abuse experience and evaluated five months postpartum with the Munich clinical communication scale (MKK). The results suggest that maltreatment experienced mothers show less emotion tuning to their child in a standardized interaction sequence.

So far there are contradictory findings concerning the degree of negative influence of attention deficit disorders, external or socio-emotional disorders on academic development of a child. Therefore the present epidemiologic study analyses the relationship between clinically relevant problems and academic achievement of fourth graders (measured by recommendation for secondary school: A-level, B-level or C-level). Children (N = 3910) were rated by their parents by anonymised questionnaires (Child Behavior Checklist CBCL) at the end of primary school. Especially in the field of attention deficit, somatic and anxiety/depression disorders, many children were in a clinically relevant range compared to German norm data. It became obvious that future C-level pupils are particularly strong, multiply problem troubled, with constantly higher problems at all subscales. Mainly attention deficit disorders proved to be relevant for academic achievement, but also delinquent behaviour and social problems, which enhance the relative risk of recommendation for B- or C-level considerably. Early applied preventive interventions supporting social and cognitive development seem therefore of central importance for the school career of primary school children.

To investigate associations between risky and pathologic internet use with depression, deliberate self-harm and suicidal behaviour among a representative sample of German adolescents. A total of 1,435 students (48% boys, 52% girls) from the area of Heidelberg/Germany were recruited during the SEYLE study, a European school-based intervention study and completed an assessment of different questionnaires, including the Young Diagnostic Questionnaire for the assessment of risky and pathological internet use, the Beck Depression Inventory, the Deliberate Self Harm Inventory, and the Paykel Suicide Scale. 80.7% of the students reported regular, 14.5% risky, and 4.8% pathological internet use. The risky and the pathological internet users showed significant higher rates of depression, deliberate self-harm and suicidal behaviour compared to students with regular internet use. Remarkably, there were no significant differences of levels of depression and suicidal behaviour between risky and pathological users. These results suggest that not only pathologic internet use but also risky internet use is associated with symptoms of depression, self-harm and suicidal behaviour. Therefore, more attention should be paid to adolescents with risky internet use for the early recognition of depression, self-harm and suicidality in adolescence.

By the current state of research, it cannot be answered clearly how adolescents experience anticipatory grief and if and to which extent this process differs from anticipatory grief of adults. The present study will fill this gap by providing both a quantitative and a qualitative description of anticipatory grief processes. Therefore, 74 adolescents and young adults (11-21 years), whose parents have suffered from cancer, completed an adapted version of the "Trauerfragebogen" (Weiser u. Ochsmann, 2002). Additionally a subsample of n = 38 took part in a qualitative guided interview. Based on these interviews, 16 categories were formed, that were assigned to two types of stressors. Beside communication and prioritization of family, different symptoms of grief were the central category in the loss-oriented type, where fears of loss, compassion and concern were of crucial importance. Also categories of the restoration-oriented type were strongly present. Thus, it seems that young people generally manage to accept their new role in the stressful family situation and they have a series of coping mechanisms available to do so. This was also reflected in the quantitative data, were the subscale "Inner Strength" reached the highest value. In the counselling of adolescents with cancer-diseased parents, both loss-oriented and restoration-oriented processes should equally be recognized and encouraged.

Increasing the flexibility of medical degree courses as well as individual advice and curriculum planning are essential needs of pregnant students and student parents. The results of the Ulm Study gave the academic advisers in the Dean of Studies' office in Heidelberg a large number of suggestions on how to offer sensitive, competent and needs-based advice to this target group. Comprehensive reflection on many years of experience in giving advice and recent survey results leads to a series of concrete measures which will contribute to more family-friendliness in Heidelberg's medical school.

Objective: To investigate the neuroendocrinological stress response to acute psychosocial stress in a clinical sample of female adolescents engaging in nonsuicidal self-injury (NSSI)., Methods: The Trier Social Stress Test (TSST), a standardized psychosocial stress protocol, was performed in 14 female patients who engaged in NSSI and 14 healthy control subjects. NSSI was assessed by the Functional Assessment of Self-Mutilation (FASM). Salivary cortisol, heart rate, and affective states, assessed by the Positive and Negative Affect Schedule (PANAS), were measured during the TSST., Results: We found an attenuated cortisol response to acute psychosocial stress in female adolescents with NSSI, whereas no group differences were observed in heart rate and emotional response to the TSST., Conclusions: These findings indicate that the HPA axis is hyporesponsive in adolescents with NSSI. Therefore, reduced secretion of cortisol could play a role in promoting vulnerability of these individuals to acute stress and maladaptive stress responses., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

This study examines the question whether early childhood temperaments of children of mothers suffering from postnatal depression differs from children of non-depressed mothers. Children of clinically depressed mothers were assessed with regard to their temperament on two different dimensions and compared to a control group. The level of cortisol concentration in the children's saliva was the first variable. Saliva samples were gathered on three consecutive days to obtain a baseline, and before and after a mother-children interaction, which was interrupted by a still-face phase. As second variable the early childhood temperament was assessed with the Infant Behavior Questionnaire (IBQ). After the mother-children interaction the cortisol concentration levels of children of mothers suffering from postnatal depression were significantly lower. In the IBQ-Scales the children of depressed mothers showed significantly higher values on the scales Distress to Limitations and Activity. The significantly lower cortisol concentration in the saliva of children of mothers suffering from postpartum depression could be an indication that these children are already used to the fact that their mothers are not paying attention to them during the still-face phase. Overall, the results give rise to the assumption that postpartum depression does have an adverse impact on the development of affected children and that early intervention would be expedient to prevent the occurrence of pathological behavior characteristics and difficult mother-child relationships.

Objective: Given evidence that synchronisation of neuronal activity may be a correlate of cognition, we examined EEG coherence as function of age and inter-electrode distance in healthy children and adolescents in order to elucidate basic information for a better understanding of developmental disorders associated with deficits in cognitive functions., Methods: Based on a 64-channel eyes closed resting EEG we combined local and global coherence measures in order to reduce volume conduction and reference effects. We used a two point longitudinal design in order to analyze intraindividual change during school-age (n=40; 6-18 years). Coherence was analyzed within individually adjusted frequency bands and around iPF (= individual alpha peak frequency)., Results: Both local and global resting coherence was largest in the alpha range and particularly around iPF. Local synchronisation was larger in the left compared with the right hemisphere. Controlling for increases in iPF, synchronisation increased with age, with global changes being most pronounced in the alpha range. Moreover age-related changes suggest an earlier development in girls., Conclusions: Our data provides evidence that both local and global functional integration increases during normal development within school-age., Significance: This general pattern - combined with more specific effects of sex and frequency - may help to specify deviations in developmental disorders., (Copyright © 2011 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.)

The early detection and treatment of persons at risk for psychosis is currently regarded as a promising strategy in fighting the devastating consequences of psychotic disorders. The two current favored at-risk approaches, i.e., the «ultra high risk» and the «basic symptom» criteria, were developed mainly using adult samples. Initial evidence suggests, however, that they cannot simply be applied to children and adolescents. For «ultra-high risk» criteria, there is indication of some attenuated psychotic symptoms being potentially nonspecific in adolescents, and of brief limited intermittent symptoms being difficult to clinically classify in children when observable behavioral correlates are missing. For basic symptoms, too, only a preliminary indication of their usefulness in children and adolescents exists. Since developmental peculiarities in the assessment of basic symptoms should be considered, a child and youth version of the Schizophrenia Proneness Instrument (SPI-CY) was developed. In conclusion, research on the clinical-prognostic validity of the at-risk criteria and their potential adaption to the special needs of children and adolescents is needed. If a «Prodromal Risk Syndrome for Psychosis» or «Attenuated Psychotic Symptoms Syndrome» are included in the upcoming DSM-5, it should be highlighted that its suitability for children and adolescents is only insufficiently known.

Background: We aimed to investigate the influences of attention deficit/hyperactivity disorder (ADHD) on response evaluation, as reflected by the postimperative negative variation (PINV), a slow event-related potential., Methods: We investigated PINV as an indicator of performance uncertainty in an audio-visual contingent negative variation (CNV) paradigm with an interstimulus interval of 3 seconds. A constant, unilateral, quick motor reaction with either the right or the left thumb was required after an auditory forewarned (S1) visual imperative stimulus (S2). We examined 18 ADHD patients (combined or hyperactive-impulsive subtype) aged between 8 and 14 years and an age-, sex and IQ-matched control group of 19 healthy subjects using 64-channel high-density EEG. A first run was recorded drug-free, a second one under methylphenidate (MPH) medication in the ADHD group., Results: We found a significantly increased negativity of the PINV-component over the ventrolateral prefrontal cortex in ADHD children compared to the healthy control group. PINV amplitude was influenced by movement side, most likely due to the slightly more difficult task when left hand responses were required. After the intake of MPH, PINV amplitudes of ADHD children normalized., Conclusions: We conclude that children with ADHD are likely to be more uncertain about the correctness of their performance and interpret the increased PINV as a hint towards compensatory mechanisms for a deficit in the evaluation of contingencies. Further studies are needed to assess the exact extent to which remainders of eye-movement related potentials contribute to PINV amplitude despite the correction for eye-artifacts.

Background: While suicide is the second leading cause of death among young people in most industrial countries, non-fatal suicidal behaviour is also a very important public health concern among adolescents. The aim of this study was to investigate gender differences in prevalence and emotional and behavioural correlates of suicidal behaviour in a representative school-based sample of adolescents., Methods: A cross-sectional design was used to assess suicidal behaviour and various areas of emotional and behavioural problems by using a self-report booklet including the Youth Self-Report. One hundred sixteen schools in a region of Southern Germany agreed to participate. A representative sample of 5,512 ninth-grade students was studied. Mean age was 14.8 years (SD 0.73); 49.8% were female., Results: Serious suicidal thoughts were reported by 19.8% of the female students and 10.8% of the females had ever attempted suicide. In the male group, 9.3% had a history of suicidal thoughts and 4.9% had previously attempted suicide. Internalizing emotional and behavioural problems were shown to be higher in the female group (difference of the group means 4.41) while externalizing emotional and behavioural problems slightly predominated in male students (difference of the group means -0.65). However, the total rate of emotional and behavioural problems was significantly higher in the adolescent female group (difference of the group means 4.98). Using logistic regression models with suicidal thoughts or attempted suicide as dependent variables, the pseudo-R2 of gender alone was only 2.7% or 2.3%, while it was 30% or 23.2% for emotional and behavioural problems measured by the YSR syndrome scales. By adding gender to the emotional and behavioural problems only an additional 0.3% of information could be explained., Conclusions: The findings suggest that gender differences in non-fatal suicidal behaviour among adolescents can to a large extent be explained by the gender differences in emotional and behavioural problems during this age.

Background and Purpose: Imaging studies of patients with schizophrenia have described a variety of cerebral alterations. However, long-term medication and the chronicity of the disorder may have contributed substantially to these alterations. Studies examining patients in the early stages of the disorder reduce the possibility of such confounding factors but are rare. In light of this, the aim of the present study was to examine adolescents in the early stages of the disorder to observe primary structural brain abnormalities., Methods: Gray and white matter were measured in 13 adolescents with schizophrenia and 13 healthy controls matched for age, gender, handedness, and school type using voxel-based morphometry., Results: Subjects with schizophrenia displayed decreased gray matter in the cerebellar vermis, and alterations in the left putamen and in several parts of the visual system., Conclusions: These findings support cerebellar involvement in the pathogenesis of schizophrenia, and the alterations observed in several parts of the visual system may provide insights into the nature of hallucinations and delusional interpretations., (© 2010 by the American Society of Neuroimaging.)

Objectives: Validation of the German translation of a questionnaire and the corresponding interview for the assessment of adverse childhood experiences within the family environment and investigation of an association of these experiences with suicidal behaviour., Method: The questionnaire was tested in a consecutively recruited sample of 125 psychiatric inpatients (aged 13 to 25 years) at the University Hospital Heidelberg. Retests and corresponding interviews were also performed. Suicidal behaviour was measured by the Paykel Suicide Scale., Results: The questionnaire and interview showed very good internal consistency and retest reliability; the interrater reliability of the interview was good, and there was a significant correlation between the questionnaire and the interview. Suicidal behaviour was significantly associated to all adverse childhood experiences, but maternal neglect and antipathy proved to be the best predictors of suicidal behaviour., Conclusions: The CECA instruments are reliable and valid instruments for the assessment of adverse childhood experiences. They assess a broad spectrum of adverse childhood experiences including negative bonding experiences. The association of these experiences to higher levels of suicidal behaviour shows the importance of assessing such experiences in research and therapy.

Objectives: We aimed to further elucidate the functional and attentional regulation of cortical excitability in migraine patients., Methods: We investigated the cortical silent period (CSP) after transcranial magnetic stimulation as a measure of cortical inhibition under three conditions: resting condition, cortical preactivation during reaction preparation, and during the post-processing of a motor response using a visual contingent negative variation paradigm in adults with migraine with aura, migraine without aura and healthy controls., Results: CSP was reduced in individuals with migraine with aura and unaffected in those with migraine without aura under resting conditions. Along with the intensity of transcranial magnetic stimulation, CSP increased equally in all groups (equal slopes). Furthermore, the functional challenge by a contingent negative variation task requiring focused sustained attention led to a comparable reduction of CSP duration in all groups., Discussion: Our data provide further hints towards the conclusion that a specific cortical inhibition deficit in migraine with aura but not migraine without aura is due to a tonic imbalance and not related to increased reactions to phasic stressors. Given that CSP at rest is related to GABA-ergic inhibition whereas the CSP reduction during late contingent negative variation is thought to be related to dopaminergic disinhibition in the basal ganglia, our results point towards reduced GABA-ergic cortical inhibition related to dysfunctional thalamo-cortical loops, especially in migraine with aura.

Objectives: Quantitative EEG can monitor changes in brain function during development and may help to understand developmental disorders. However, current EEG-databases are primarily based on standardized frequency bands which disregard age-related changes in alpha peak frequency (PF) and therefore complicate the interpretation of spectral estimates in the theta and alpha range., Methods: We used a two point longitudinal design in order to analyze intraindividual changes in 40 healthy children and adolescents with age (T1: 6-18 years; interval approximately 4 years). Using a 64-channel eyes closed resting EEG we calculated absolute/relative power in individualized frequency bands (IFB: delta, theta, alpha1/2 and beta) based on PF., Results: PF increased with age, with changes being larger for children than adolescents. Controlling for changes in PF, changes in absolute/relative alpha1/2 power and in absolute beta power were minor. Relative beta power, however, increased while absolute/relative delta and theta power decreased massively. Sex-differences in PF did not reach significance. However, boys exhibited larger changes during adolescence than girls for all absolute power measures except alpha., Conclusion: Normal EEG development during school-age is mainly based on an absolute decrease of slow frequency activity and increases of PF which may be interpreted in terms of a reorganization of the EEG towards a higher frequency oscillatory scale rather than a maturation of the theta-alpha1/2 band power sequence. Age-related changes differed between boys and girls suggesting a different developmental timing for the sexes. In future studies a combined analysis of PF and IFB may help to specify deviations in developmental disorders., (Copyright © 2010 ISDN. Published by Elsevier Ltd. All rights reserved.)

Background: prospective studies concerning prenatal stress and its outcome on children's emotional development postulated a potential influence of prenatal hormonal levels or emotional stressors on child development [1-3]. In a retrospective study, an influence of maternal emotional stress on infant affective reactivity was found [4]., Aims: this study was conducted in order to confirm these findings in a prospective study design., Study Design: a prospective longitudinal study design was conducted with three study waves during pregnancy and one time point five months postnatally., Subjects: the final sample consisted of n=104 mother-infant dyads., Outcome Measures: Maternal baseline cortisol levels and emotional stress were assessed in each trimester of pregnancy. Children were examined with the infant reactivity battery according to Kagan & Snidman [5] at the age of five months., Results: mothers of children with high affective reactivity (cry score≥7) were significantly less depressed (p<.10) and perceived less stress (p<.05) in mid-pregnancy and were confronted with less external stress factors (p<.10) at the end of pregnancy. Cortisol levels did not differ in both groups in any pregnancy trimenon (p>.05)., Conclusions: these data add a new specific aspect to the 'fetal programming hypothesis' and are the first to confirm the speculative data from retrospective studies. Baseline cortisol does not seem to be the 'hormonal mediator' of this association. Therefore, cortisol stress reactivity or other neuroendocrine mechanisms should be assessed in future studies., (2010 Elsevier Ltd. All rights reserved.)

Background: 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., Sampling and Methods: 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., Results: 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)., Conclusion: 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., (Copyright © 2010 S. Karger AG, Basel.)

Objective: To elucidate the contributions of modality-dependent post-processing in auditory, motor and visual cortical areas to short-term memory., Methods: We compared late negative waves (N700) during the post-processing of single lateralized stimuli which were separated by long intertrial intervals across the auditory, motor and visual modalities. Tasks either required or competed with attention to post-processing of preceding events, i.e. active short-term memory maintenance., Results: N700 indicated that cortical post-processing exceeded short movements as well as short auditory or visual stimuli for over half a second without intentional short-term memory maintenance. Modality-specific topographies pointed towards sensory (respectively motor) generators with comparable time-courses across the different modalities. Lateralization and amplitude of auditory/motor/visual N700 were enhanced by active short-term memory maintenance compared to attention to current perceptions or passive stimulation. The memory-related N700 increase followed the characteristic time-course and modality-specific topography of the N700 without intentional memory-maintenance., Conclusions: Memory-maintenance-related lateralized negative potentials may be related to a less lateralised modality-dependent post-processing N700 component which occurs also without intentional memory maintenance (automatic memory trace or effortless attraction of attention). Encoding to short-term memory may involve controlled attention to modality-dependent post-processing., Significance: Similar short-term memory processes may exist in the auditory, motor and visual systems., (Copyright © 2010 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.)

Background:   Focusing on early identification of developmental risk factors, this study examined the question whether maternal report of child behaviour during early infancy is related to a laboratory measure of behavioural inhibition at 14 months of age., Method:   A sample of 101 mother-infant pairs was recruited from local obstetric units. The Infant Behaviour Questionnaire (IBQ) was presented at 4 months postnatal age. Child behavioural inhibition was assessed at 14 months in a laboratory procedure., Results:   Infant distress to novelty as measured by the IBQ at 4 months postnatal age was found to be associated with toddler's fear score/behavioural inhibition at 14 months (p = .003). Distress-to-limitations subscore, smile/laughter subscore, activity subscore, and soothability subscore of the IBQ showed no correlation with behavioural inhibition., Conclusions:   Behavioural inhibition, as a potential risk factor for childhood shyness and anxiety, can be predicted by maternal judgment of infant distress to novelty at age 4 months. The Infant Behaviour Questionnaire therefore might be used to identify infants presumably at risk for childhood anxiety disorders., (© 2009 Association for Child and Adolescent Mental Health.)

Background: There have been only a few reports illustrating the moderate effectiveness of suicide-preventive interventions in reducing suicidal behavior, and, in most of those studies, the target populations were primarily adults, whereas few focused on adolescents. Essentially, there have been no randomized controlled studies comparing the efficacy, cost-effectiveness and cultural adaptability of suicide-prevention strategies in schools. There is also a lack of information on whether suicide-preventive interventions can, in addition to preventing suicide, reduce risk behaviors and promote healthier ones as well as improve young people's mental health.The aim of the SEYLE project, which is funded by the European Union under the Seventh Framework Health Program, is to address these issues by collecting baseline and follow-up data on health and well-being among European adolescents and compiling an epidemiological database; testing, in a randomized controlled trial, three different suicide-preventive interventions; evaluating the outcome of each intervention in comparison with a control group from a multidisciplinary perspective; as well as recommending culturally adjusted models for promoting mental health and preventing suicidal behaviors., Methods and Design: The study comprises 11,000 adolescents emitted from randomized schools in 11 European countries: Austria, Estonia, France, Germany, Hungary, Ireland, Israel, Italy, Romania, Slovenia and Spain, with Sweden serving as the scientific coordinating center. Each country performs three active interventions and one minimal intervention as a control group. The active interventions include gatekeeper training (QPR), awareness training on mental health promotion for adolescents, and screening for at-risk adolescents by health professionals. Structured questionnaires are utilized at baseline, 3- and 12-month follow-ups in order to assess changes., Discussion: Although it has been reported that suicide-preventive interventions can be effective in decreasing suicidal behavior, well-documented and randomized studies are lacking. The effects of such interventions in terms of combating unhealthy lifestyles in young people, which often characterize suicidal individuals, have never been reported. We know that unhealthy and risk-taking behaviors are detrimental to individuals' current and future health. It is, therefore, crucial to test well-designed, longitudinal mental health-promoting and suicide-preventive interventions by evaluating the implications of such activities for reducing unhealthy and risk behaviors while concurrently promoting healthy ones., Trial Registration: The German Clinical Trials Register, DRKS00000214.

Nonsuicidal self-injury (NSSI) usually starts in adolescence. International studies report prevalence rates between 3 and 37% (for Germany between 15 and 26%) in adolescents. From a neurobiological perspective, there is evidence that primarily the serotonergic system is involved in the origin and maintenance of this behaviour. NSSI is often used by adolescents to influence aversive affective states, but sometimes serves other functions as well, such as self-punishment or anti-dissociation. To date there are many assessment instruments, some of which are available in a German translation. Regarding psychotherapeutic interventions there is evidence for a good efficacy of dialectical behavioral therapy for adolescents (DBT-A). There is little evidence for psychopharmacological interventions in childhood and adolescence; thus treatment should focus on psychotherapeutic interventions.

Background: Previous research has implicated a general hypervigilance for negative emotional words in adults with borderline personality disorder (BPD) as compared to healthy controls. The purpose of this study was to assess initial orienting to negative and positive emotional faces in female adolescents with BPD., Method: Adolescent patients with BPD (n = 30), adolescent patients with other psychiatric diagnoses (n = 29) and adolescent healthy comparison subjects (n = 29) were tested with the visual dot probe task to examine attentional orienting to emotional and neutral faces., Results: In contrast to the adolescent healthy comparison subjects, both the adolescent patients with BPD and the adolescent patients with other psychiatric diagnoses showed a stronger orienting to negative emotional stimuli. However, no differences were found between the clinical groups. Data regarding positive stimuli showed that BPD is not associated with a specific orienting to positive faces., Conclusions: These findings suggest that attentional orienting to negative faces is not specific to adolescent patients with BPD but also affects adolescent patients with other psychiatric diagnoses. Furthermore, no distortion in information processing concerning positive cues was observed in adolescent patients with BPD. If these findings were confirmed, further BPD research could no longer assume that BPD is specifically associated with distortions in initial orienting processes., (Copyright 2010 S. Karger AG, Basel.)

Background: Dissociation has been recognized as a relevant factor within the context of traumatization. Since childhood maltreatment as well as child birth can be regarded as a potential trauma, this study examined dissociation in a sample of 58 young mothers with a history of abuse in comparison to a control group., Methods: All women with newborn children were contacted by mail and presented with the Childhood Trauma Questionnaire. Women who reached a cutoff for moderate or severe sexual and/or physical abuse and whose children were term babies with Apgar scores >7 were included in the study to form the index group (n = 58); the control group was formed by matching mothers with no reported experiences of physical and/or sexual abuse (n = 61). Dissociative experiences were assessed by the Scale of Dissociative Experiences (German version of the Dissociative Experiences Scale)., Results: The results show that mothers with a history of physical or sexual abuse - matched for infant gender, maternal education, marital status, number of infants and birth weight - had significantly more dissociative experiences., Conclusions: Maternal history of abuse significantly increases maternal dissociative experiences, which has frequently been postulated but never empirically shown in a prospective design in a sample of young mothers. As maternal psychopathology has been found to have a profound impact on child development, specifically in the first year of life, these data are of immediate relevance for preventive efforts when targeting at-risk mother-infant dyads., (Copyright 2010 S. Karger AG, Basel.)