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Family accommodation (FA) refers to the participation of family members in obsessive-compulsive disorder (OCD) rituals. Most studies have focused on maternal accommodation; consequently, little is known about fathers’ accommodation of OCD. The current study aims to extend the existing literature by examining maternal versus paternal accommodation of OCD symptoms. The sample consisted of 209 children with OCD (Mean [M] age = 14.1 years) and their parents (NMothers = 209, NFathers = 209) who had completed the Family Accommodation Scale- Parent Report (FAS-PR). Paired t-test and chi-square analyses were used to compare FA of OCD symptoms between mothers and fathers. Linear regression was used to examine correlates of maternal and paternal FA and its impact on treatment outcomes. Mothers reported significantly higher levels of daily FA than fathers. Correlates of maternal and paternal accommodation included OCD symptom severity, emotional and behavioral difficulties, and parent psychopathology. Both maternal and paternal FA significantly predicted worse treatment outcomes. Both mothers and fathers accommodate child OCD symptoms with high frequency, and in similar ways. Although mothers accommodate to a greater extent than fathers, both maternal and paternal involvement in rituals are a significant predictor of the child’s treatment response. Results emphasise the need to consider the whole family system, including fathers, in understanding and treating OCD in children. Electronic supplementary material The online version of this article (10.1007/s10802-020-00678-9) contains supplementary material, which is available to authorized users.

A subset of patients with obsessive-compulsive disorder (OCD) present with symptoms that indicate risk. In some cases of OCD, risk is only apparent, merely reflecting the content of obsessional fears which are never acted upon (e.g. intrusive thoughts of harming others). In contrast, genuine risk can arise in OCD as an unintended consequence of engaging in compulsions or avoidance (e.g. skin damage caused by washing with bleach). In both situations, risk can cause confusion among clinicians regarding diagnosis and /or hinder access to appropriate treatment. The current article adds to the small existing literature on risk in OCD by presenting case examples illustrating different types of risk in the context of pediatric OCD, along with a discussion of their implications for management. The cases highlight that it is crucial that risk in OCD is considered carefully within the context of the phenomenology of the disorder. In many cases, treatment should follow the usual OCD treatment protocols and both apparent and genuine risk resolve with successful treatment of the OCD. In some cases, there may be a need to actively manage genuine risk. In these instances, it is essential that risk management is carefully integrated into a program of evidence-based treatment for OCD.

The Reizdarm-Fragebogen (RDF) is the first German questionnaire to assess subjectively perceived symptom severity of irritable bowel syndrome (IBS). Thus far, this was only possible in the context of a medical examination by a practitioner. The goal of the current study was to assess differences in RDF scores among IBS patients and other clinical and non-clinical populations. Further, the study aimed to define a cut-off score for the presence of IBS and thereby, to evaluate the RDF as screening instrument in IBS diagnosis.The study sample consisted of 372 individuals (62.6% male, mean age=41±17 years). 17.5% (of the sample) were IBS patients, 9.9% received treatment for chronic inflammatory bowel disease, 12.1% of the participants were recruited from a psychosomatic clinic, and 50.5% belonged to a control group. All participants filled out the 13 item RDF.The IBS patients' RDF scores differed significantly from those of other clinical and non-clinical subsamples [t(98.82)=13.61, p0.001]. Except for the subscale "bloating" this difference was consistently found for all RDF subscales ("diarrhea", "constipation", and "pain and feeling of tension"). With respect to the identification of a cut-off for IBS diagnosis, a score of 32 showed both good sensitivity (90.80%) and specificity (75.56%).The RDF is an efficient instrument for the assessment of subjectively perceived symptom severity in IBS. Based on the current findings and its good psychometric properties it can be used as a screening instrument for IBS in both clinical practice and research.Mit dem Reizdarm-Fragebogen (RDF) wurde erstmals ein deutschsprachiges Instrument zur Erfassung der subjektiv wahrgenommenen Symptombelastung bei einem Reizdarm-Syndrom (RDS) vorgestellt. Bis dato lagen ausschließlich Instrumente zur ärztlichen Einschätzung der Symptomschwere in deutscher Sprache vor. Das Ziel der vorliegenden Arbeit war es, Unterschiede zwischen RDS-Patienten und verschiedenen klinischen und nicht-klinischen Kontrollgruppen hinsichtlich der Skalen des Fragebogens zu untersuchen sowie einen Cut-Off-Wert für das Vorliegen eines RDS zu ermitteln. Auf Basis eines solchen Cut-Off-Werts sollte die Qualität des RDF als Screening-Instrument beurteilt werden.An der Studie nahmen 372 Personen teil (62,6% männlich, mittleres Alter=41±17 Jahre). 17,5% der Teilnehmer hatten eine RDS-Diagnose, 19,9% wurden wegen einer chronisch-entzündlichen Darmerkrankung behandelt, 12,1% waren Patienten in einer psychosomatischen Reha-Klinik und 50,5% gehörten zu einer gesunden Kontrollgruppe. Alle Teilnehmer füllten den 13 Items umfassenden RDF aus.Hinsichtlich des RDF-Gesamtwerts zeigten sich signifikante Unterschiede zu allen anderen klinischen- und nicht-klinischen Kontrollgruppen [t(98,82)=13,61, p0,001]. Mit Ausnahme der Subskala „Völlegefühl“ zeigten sich diese Unterschiede auch für die Subskalen „Diarrhoe“, „Konstipation“ sowie „Schmerz und Spannungsgefühl“ des RDFs. Bezogen auf das Vorliegen eines RDS kann das Instrument bei einem Cut-Off-Wert von 32 als sensitiv (90,80%) und angemessen spezifisch (75,56%) gelten.Der RDF kann als effizientes Instrument zur Erfassung der subjektiv wahrgenommenen Symptombelastung bei RDS gelten. Mit seinen sehr guten psychometrischen Qualitäten kann er sowohl im klinischen als auch im wissenschaftlichen Kontext als Screening-Instrument eingesetzt werden.

Kratom ( Mitragyna speciosa) is a prevalent medicinal plant used mainly for the stimulant and analgesic properties provided through multiple alkaloid compounds. Over the past decade, use of kratom has increased despite the limited knowledge of toxicities and adverse side effects. With the current opioid epidemic, both patients and providers are seeking alternative methods to treat both addiction and pain control, and kratom as an alternative means of treatment has increasingly entered the mainstream. In this article, we present the clinical course of a 47-year-old male who developed fatigue, pruritus, and abnormal liver tests (with a mixed hepatocellular/cholestatic pattern) approximately 21 days after beginning kratom. After extensive evaluation including a negligible alcohol history, negative hepatitis serologies, and inconclusive imaging, the patient was diagnosed with drug-induced liver injury (DILI) caused by kratom. Nine months after his liver tests returned to normal, he took kratom again, and after a latency of 2 days, he developed fatigue, pruritus, and loss of appetite along with abnormal liver tests (with the same biochemical profile as previously), consistent with a positive rechallenge. We believe, through the use of the Roussel-Uclaf Causality Assessment Method and expert opinion, that this is a highly likely or definite example of kratom-induced DILI. With the gaining popularity of this drug, it appears that DILI may be an important complication of kratom for providers to recognize.

Obsessive compulsive disorder (OCD) can severely impair children and young people’s academic performance as well as their social life. School nurses can help identify suspected cases of OCD as well as support those suffering from the condition.

A previous epidemiological study found an association between high sugar consumption and two year outcome of schizophrenia. The primary aim of the present pilot study was to assess the possible relationship between dietary sugar intake and the severity of schizophrenic symptoms in a group of 20 patients. A significant negative correlation (r = -0.54, p = 0.02) between dietary sugar and severity of schizophrenic symptoms, appears to be confounded by the effect of medication. Patients taking the antipsychotic drug clozapine consumed almost twice as much sugar as those taking other antipsychotic agents, (235.4+/-92.6 g/day versus 143+/-59, p = 0.02) and had less severe symptoms. Consumption of other nutrients showed no association with clozapine treatment. In a secondary analysis, severity of schizophrenic symptoms correlated with dietary intake of polyunsaturated fatty acids (r = -0.54, p = 0.02) and this was independent of the effect of medication. This finding is consistent with earlier studies.

The importance of omega-3 fatty acids for physical health is now well recognised and there is increasing evidence that omega-3 fatty acids may also be important to mental health. The two main omega-3 fatty acids in fish oil, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) have important biological functions in the CNS. DHA is a major structural component of neuronal membranes, and changing the fatty acid composition of neuronal membranes leads to functional changes in the activity of receptors and other proteins embedded in the membrane phospholipid. EPA has important physiological functions that can affect neuronal activity. Epidemiological studies indicate an association between depression and low dietary intake of omega-3 fatty acids, and biochemical studies have shown reduced levels of omega-3 fatty acids in red blood cell membranes in both depressive and schizophrenic patients. Five of six double-blind, placebo-controlled trials in schizophrenia, and four of six such trials in depression, have reported therapeutic benefit from omega-3 fatty acids in either the primary or secondary statistical analysis, particularly when EPA is added on to existing psychotropic medication. Individual clinical trials have suggested benefits of EPA treatment in borderline personality disorder and of combined omega-3 and omega-6 fatty acid treatment for attention-deficit hyperactivity disorder. The evidence to date supports the adjunctive use of omega-3 fatty acids in the management of treatment unresponsive depression and schizophrenia. As these conditions are associated with increased risk of coronary heart disease and diabetes mellitus, omega-3 fatty acids should also benefit the physical state of these patients. However, as the clinical research evidence is preliminary, large, and definitive randomised controlled trials similar to those required for the licensing of any new pharmacological treatment are needed.

A previous epidemiological study found an association between high sugar consumption and two year outcome of schizophrenia. The primary aim of the present pilot study was to assess the possible relationship between dietary sugar intake and the severity of schizophrenic symptoms in a group of 20 patients. A significant negative correlation (r = -0.54, p = 0.02) between dietary sugar and severity of schizophrenic symptoms, appears to be confounded by the effect of medication. Patients taking the antipsychotic drug clozapine consumed almost twice as much sugar as those taking other antipsychotic agents, (235.4+/-92.6 g/day versus 143+/-59, p = 0.02) and had less severe symptoms. Consumption of other nutrients showed no association with clozapine treatment. In a secondary analysis, severity of schizophrenic symptoms correlated with dietary intake of polyunsaturated fatty acids (r = -0.54, p = 0.02) and this was independent of the effect of medication. This finding is consistent with earlier studies.