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Zusammenfassung: Fragestellung: Ziel der vorliegenden Studie war es, Einflussfaktoren auf den Erkrankungsverlauf von Kindern und Jugendlichen mit der Diagnose einer Psychose aus dem schizophrenen Formenkreis in einer stationären Eingliederungsmaßnahme zu untersuchen. Methodik: 33 Patient_innen (Durchschnittsalter 19.4 Jahre, SD = 2.3), davon 12 (36 %) weiblich, nahmen teil. Diese wurden mit klinischen Interviews (IRAOS, SANS/SAPS), neuropsychologischen Tests (WAIS-IV, TMT) und Fragebögen (FBB, BSCL) untersucht. Ergebnis: Korreliert waren das neuropsychologische Funktionsniveau und die prämorbide kognitive Leistungsfähigkeit, ebenso der Behandlungserfolg aus Patientensicht und eine gute Beziehung zum Therapeuten bzw. zur Therapeutin, außerdem eine stärkere Negativsymptomatik mit einer längeren Dauer der unbehandelten Psychose (DUP) und einem längeren ersten Krankenhausaufenthalt. Schlussfolgerung: Mögliche Ansatzpunkte zur besseren Behandlung von Jugendlichen mit Psychosen aus dem schizophrenen Formenkreis stellen eine Verkürzung der DUP und eine gute therapeutische Beziehung dar.

The selective norepinephrine reuptake inhibitor atomoxetine is potentially among the first-line pharmacotherapy options for ADHD. Therapeutic drug monitoring (TDM) with the quantification and interpretation of atomoxetine serum concentrations is used to determine an individual dose followed by an optimal effectiveness and minimal side effects. The aim of this retrospective pharmacokinetic–pharmacodynamic analysis was to derive age-appropriate recommendations for the implementation of TDM to improve the efficacy and tolerability of atomoxetine in children and adolescents. Using the analytical method of high-performance liquid chromatography with UV detection, 94 serum concentrations of 74 patients between 6 and 21 years of age were determined. Therapeutic effectiveness and side effects were evaluated according to the categories “low”, “moderate”, and “significant”. As part of TDM, a time interval with maximum concentrations of 1–3 h after the administration of atomoxetine was determined for blood sampling. In this time interval, a significant correlation between the weight-normalized dose and the serum concentrations was found. The efficacy as well as the tolerability proved to be mainly moderate or significant. A preliminary therapeutic reference range was between 100 and 400 ng/ml. Naturalistic studies have limitations. Therefore, and due to a limited study population, the results have to be regarded as preliminary observations that must be confirmed in further studies. The preliminary therapeutic reference range for children and adolescents proved to be narrower than the reference range for adult patients. However, due to good efficacy and tolerability an exact reference range remained difficult to determine.

In the early 1920s, it was discovered that nutrition is associated with what is known today as Attention-Deficit/Hyperactivity Disorder (ADHD) and that certain foods can worsen the symptoms. In previous studies, approximately 60% of the participants experience at least a 40% reduction in ADHD symptoms after an oligoantigenic diet (OD). The purpose of this study was to evaluate ADHD symptoms in children approximately 3.5 years after completing a 4-week oligoantigenic diet. Among 28 participants who completed the 4-week diet, 21 were re-assessed for this study after 3.5 years. The severity of ADHD symptoms was assessed with the ADHD-Rating-Scale-IV (ARS). Of 21 participants, 14 fulfilled the responder criterion, whereas 7 did not. At follow-up, 28% of the participants were taking medication. The mean ARS total score improved significantly from T1: M = 29.62 (SD = 9.80) to T2: M = 15.86 (SD = 8.56) between the time points before and after the diet (d = −1.91). There was also a lower ARS total score at the follow-up T5: M = 16.00 (SD = 10.52) compared to before the diet (d = −1.17). This study shows that individually adjusted nutrition significantly improved the ADHD symptomatology of the participants long-term. This suggests that an oligoantigenic diet with subsequent individual nutritional recommendations could become an additional treatment option for children with ADHD.

Psychoses on the Schizophrenia Spectrum in Adolescence: A Cross-sectional Study of Factors Influencing Neuropsychology, Treatment Outcome, and Negative Symptoms

Disorders with neurodevelopmental aetiology such as Attention-Deficit/Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD) and Schizophrenia share commonalities at many levels of investigation despite phenotypic differences. Evidence of genetic overlap has led to the concept of a continuum of neurodevelopmental impairment along which these disorders can be positioned in aetiological, pathophysiological and developmental features. This concept requires their simultaneous comparison at different levels, which has not been accomplished so far. Given that cognitive impairments are core to the pathophysiology of these disorders, we provide for the first time differentiated head-to-head comparisons in a complex cognitive function, visual search, decomposing the task with eye movement-based process analyses. N = 103 late-adolescents with schizophrenia, ADHD, ASD and healthy controls took a serial visual search task, while their eye movements were recorded. Patients with schizophrenia presented the greatest level of impairment across different phases of search, followed by patients with ADHD, who shared with patients with schizophrenia elevated intra-subject variability in the pre-search stage. ASD was the least impaired group, but similar to schizophrenia in post-search processes and to schizophrenia and ADHD in pre-search processes and fixation duration while scanning the items. Importantly, the profiles of deviancy from controls were highly correlated between all three clinical groups, in line with the continuum idea. Findings suggest the existence of one common neurodevelopmental continuum of performance for the three disorders, while quantitative differences appear in the level of impairment. Given the relevance of cognitive impairments in these three disorders, we argue in favour of overlapping pathophysiological mechanisms.

Introduction Despite the growing evidence base for psychotropic drug treatment in pediatric patients, knowledge about the benefit-risk ratio in clinical practice remains limited. The ‘Therapeutic Drug Monitoring (TDM)-VIGIL’ study aimed to evaluate serious adverse drug reactions (ADRs) in children and adolescents treated with antidepressants and/or antipsychotics in approved (‘on-label’), and off-label use in clinical practice. Methods Psychiatric pediatric patients aged 6-18 years treated with antidepressants and/or antipsychotics either on-label or off-label were prospectively followed between October 2014 and December 2018 within a multicenter trial. Follow-up included standardized assessments of response, serious ADRs and therapeutic drug monitoring. Results 710 youth (age=14.6±2.2 years, female=66.6%) were observed for 5.5 months on average; 76.3% received antidepressants, 47.5% antipsychotics, and 25.2% both. Altogether, 55.2% of the treatment episodes with antidepressants and 80.7% with antipsychotics were off-label. Serious ADRs occurred in 8.3% (95%CI=6.4–10.6%) of patients, mainly being psychiatric adverse reactions (77.4%), predominantly suicidal ideation and behavior. The risk of serious ADRs was not significantly different between patients using psychotropics off-label and on-label (antidepressants: 8.1% vs. 11.3%, p=0.16; antipsychotics: 8.7% vs 7.5%, p=0.67). Serious ADRs occurred in 16.6% of patients who were suicidal at enrollment versus 5.6% of patients who were not suicidal (relative risk 3.0, 95%CI=1.9-4.9). Conclusion Off-label use of antidepressants and antipsychotics in youth was not a risk factor for the occurrence of serious ADRs in a closely monitored clinical setting. Results from large naturalistic trials like ours can contribute to bridging the gap between knowledge from randomized controlled trials and real-world clinical settings.

Nutrients 13(7), 2356 (2021). doi:10.3390/nu13072356 special issue: "Special Issue "Current Understanding of Vitamin D in Chronic Diseases, Acute Respiratory Infections and All-Cause Mortality" / Special Issue Editors: Prof. Dr. Sara Gandini, Guest Editor; Dr. Harriet Johansson, Guest Editor; Dr. Davide Serrano, Guest Editor; Prof. Dr. Sara Raimondi, Guest Editor; Dr.ssa Patrizia Gnagnarella, Guest Editor", Published by MDPI, Basel

The influence of food intake on behavior problems of children with Attention-Deficit/Hyperactivity Disorder (ADHD) was already described in the early 20th century. Eliminating food components by using the Oligoantigenic Diet (OD) leads to reduction of ADHD symptoms for more than two-thirds of patients. The aim of our study was to reveal how to identify foods having an impact on ADHD symptomatology. Therefore, 28 children with ADHD participating in this uncontrolled, open trial were examined before and after a restricted elimination diet. They kept a daily 24-h recall nutrition and behavior journal and filled out the abbreviated Conners’ scale (ACS) to identify foods which increased ADHD symptoms. The study was completed by 16 children (13 m/3 f). After four weeks of elimination diet the individual food sensitivities were identified in a reintroduction phase. A repetitive increase of ADHD symptoms by at least two points in ACS after food introduction hints at food sensitivity. Twenty-seven food sensitivity reactions were identified. Most of the participants were sensitive to more than one food. Food intolerances could not be identified without preceding OD. The combination of OD and subsequent food challenge appears as a valid method to identify individual food sensitivity in ADHD.

Background Brain-derived neurotrophic factor (BDNF) influences brain plasticity and feeding behaviour, and it has been linked to anorexia nervosa in numerous studies. Findings in mostly adult patients point to reduced serum BDNF levels in the acute stage of anorexia nervosa and rising levels with weight recovery. However, it is unclear whether this increase leads to normalization or supranormal levels, a difference that is potentially important for the etiology of anorexia nervosa and relapse. Methods We measured serum BDNF at admission (n = 149), discharge (n = 130), 1-year follow-up (n = 116) and 2.5-year follow-up (n = 76) in adolescent female patients with anorexia nervosa hospitalized for the first time, and in healthy controls (n = 79). We analyzed associations with body mass index, eating disorder psychopathology and comorbidities. Results Serum BDNF was only nominally lower at admission in patients with anorexia nervosa compared to healthy controls, but it increased continuously and reached supranormal levels at 2.5-year follow-up. BDNF was inversely associated with eating disorder psychopathology at discharge and positively associated with previous weight gain at 1-year follow-up. Limitations We compensated for attrition and batch effects using statistical measures. Conclusion In this largest longitudinal study to date, we found only nonsignificant reductions in BDNF in the acute stage of anorexia nervosa, possibly because of a shorter illness duration in adolescent patients. Supranormal levels of BDNF at 2.5-year follow-up could represent a pre-existing trait or a consequence of the illness. Because of the anorexigenic effect of BDNF, it might play an important predisposing role for relapse and should be explored further in studies that test causality.

European child & adolescent psychiatry 30(7), 1081-1094 (2021). doi:10.1007/s00787-020-01595-4, Published by Steinkopff, Darmstadt

OBJECTIVE: Nocturnal enuresis (NE), daytime urinary incontinence (DUI), and fecal incontinence (FI) are common disorders in childhood and are frequently accompanied by comorbid psychiatric disorders. Despite a high association between urinary and fecal incontinence with psychiatric and neurodevelopmental disorders, research on comorbidity between incontinence and anorexia nervosa (AN) remains scarce. Yet, it is well known that somatic consequences of AN include metabolic and gastrointestinal disorders. The study sought to assess the prevalence of incontinence and constipation in children and adolescents with AN and to examine associations of these two symptoms with body weight at admission and with BMI changes during inpatient treatment. METHODS: Data collected between 2015 and 2017 by a multicenter German web-based registry for AN were analyzed. Three hundred and forty-eight patients with AN (96.3% female, mean age = 15.1 ± 1.8 years) were assessed regarding AN subtype, psychiatric comorbidity, body weight, incontinence, and constipation. RESULTS: Overall, 27.6% of patients had constipation, 1.8% had NE and 1.8% DUI. Prevalence of constipation did not significantly differ between AN subtypes. Constipation did not lead to any significant differences in weight/BMI changes during inpatient treatment. DISCUSSION: This is the largest study of incontinence and constipation in patients with AN, so far. Our results indicate that constipation is highly prevalent in adolescent patients with AN and reflects a clinically relevant condition. Despite, patients with AN do not have an increased prevalence of incontinence compared with the general population. Future studies should include medical examinations like ultrasound and physical examination of the lower abdomen to evaluate the severity of constipation.

Recent discussions in the literature, along with the revision of the Diagnostic and Statistical Manual (DSM) [2], suggest aetiological commonalities between the highly comorbid Attention-Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD). Addressing this discussion requires studying these disorders together by comparing constructs typical to each of them. In the present study, we investigate global processing, known to be difficult for participants with ASD, and Intra-Subject Variability (ISV), known to be consistently increased in participants with ADHD, in groups, aged 10-13 years, with ADHD (n=25), ASD without comorbid ADHD (ASD-) (n=13) and ASD with ADHD (ASD+) (n=18) in comparison with a typically developing group (n=22). A Copying task, typically requiring global processing and in this case particularly designed using equally complex stimuli to also measure ISV across trials, was selected. Oculomotor measures in this task proved to be particularly sensitive to group differences. While increased ISV was not observed in the present task in participants with ADHD, both ASD groups needed to look longer on the figure to be drawn, indicating that global processing takes longer in ASD. However, the ASD+ group needed to fixate on the figure only between drawing movements, whereas the ASD-group needed to do this throughout the drawing process. The present study provides evidence towards ASD and ADHD being separate, not-overlapping, disorders. Since the pure ASD-group was affected more by central coherence problems than the ASD+ group, it may suggest that neuropsychological constructs interact differently in different clinical groups and sub-groups.

Zusammenfassung. Fragestellung: Das Ziel der vorliegenden Untersuchung ist es, das neuropsychologische Funktionsniveau, die Behandlungszufriedenheit und die Medikation bei Kindern und Jugendlichen zu evaluieren, die an einer Psychose aus dem schizophrenen Formenkreis erkrankt sind und zum Zeitpunkt der Untersuchung an einer stationären Eingliederungsmaßnahme in dem Kinder- und Jugendwohnheim Leppermühle teilnahmen. Zusätzlich sollen bekannte Prädiktoren auf ihren Einfluss auf verschiedene Verlaufsvariablen hin untersucht werden. Methodik: Es konnten 42 Patienten (37.2 %) der insgesamt 113 Bewohner des Kinder- und Jugendwohnheims mit einer entsprechenden Diagnose untersucht werden. Ergebnisse: Die Patienten waren bei Erkrankungsbeginn durchschnittlich 14.5 Jahre alt und zum Zeitpunkt der Untersuchung waren sie im Mittel 20.0 Jahre alt. Für den Gesamtintelligenzquotient lag der Wert bei 87.0 Punkten, für den Trail Making Test Teil A (TMT-A) bei 73.1 Punkten und für den Trail Making Test Teil B (TMT-B) bei 75.6 Punkten. Die Behandlungszufriedenheit lag in allen Skalen und Subskalen des Fragebogens zur Beurteilung der Behandlung (FBB) bei 2.50 bis 3.50 Punkten, was einer guten Bewertung entspricht. Die Medikation entsprach nicht in allen Punkten den Leitlinien. Als Prädiktoren für das neuropsychologische Funktionsniveau konnte nur die prämorbide kognitive Leistungsfähigkeit bestätigt werden. Schlussfolgerungen: Die gefundenen Ergebnisse im Wechsler Adult Intelligence Score IV (WAIS-IV) und im TMT-A/B sprechen für eine deutliche Beeinträchtigung der Patienten im neuropsychologischen Funktionsniveau und decken sich überwiegend mit den Werten bisher durchgeführter Studien.

Objective: Relationships between sleep, screen-based media, and ADHD symptomatology were investigated using a case- and community-based approach. Method: N = 357 healthy and N = 61 children with ADHD (12.72 ± 2.83 years) completed a sleep and media questionnaire. To measure ADHD symptomatology, parents filled out the Strengths and Weaknesses of ADHD symptoms and Normal behavior (SWAN) scale. Two samples were formed: a matched ( N = 61 patients and N = 61 controls) and a community sample ( N = 357 healthy participants and N = 20 patients). Results: Compared with controls, participants with ADHD reported delayed sleep onset and more screen time on school days. Adolescent patients showed more behavior promoting delayed sleep phase. In the community sample, media time, sleep deviation, and circadian rhythm were correlated with ADHD symptomatology. Furthermore, media time, sleep-wake behavior, and sleep deviation were predictive of ADHD symptomatology (variance explained = 4%-15%). Conclusion: Longer media time and inadequate sleep-wake behavior increase the risk of ADHD-like symptoms. However, research using objective assessments is needed to disentangle this distinct association and to provide possible directions for intervention.

Abstract. Objective: The first web-based registry for childhood and adolescent anorexia nervosa (AN) in Germany was established to systematically collect demographic and clinical data. These data as well as information on how young individuals with AN can find access to healthcare services are presented. Method: Patients´ data from child and adolescent psychiatry departments of 12 university hospitals and two major nonuniversity hospitals in Germany were collected between January 2015 and December 2016. All patients met the ICD-10 diagnostic criteria for (atypical) AN. Sociodemographic data, type and amount of healthcare utilization before admission, and clinical data at admission and discharge were compiled. Results: 258 patients with a mean age of 14.7 years and a mean BMI at admission of 15.3 kg/m2 were included. The parents and patients had a higher educational level than the general German population. More than 80 % of the patients reported having utilized healthcare before hospitalization. The mean duration of outpatient treatment before hospitalization was 7 months. Conclusions: There seem to be major barriers to specialist treatment for young patients with AN in Germany, which should be analyzed in future studies.

Zusammenfassung. Fragestellung: Die stationäre Behandlung von Patientinnen mit Anorexia nervosa (AN) wird in Bezug auf ihre mittel- und langfristigen Wirkungen und Nebenwirkungen kontrovers diskutiert. In der deutschen S3-Leitlinie zur Diagnostik und Behandlung der Essstörungen wird die Notwendigkeit eines auf Essstörungen spezialisierten Therapeutenteams betont. Die Versorgung von Kindern und Jugendlichen mit AN in deutschen Kliniken wurde im Hinblick auf aktuelle Diagnostik- und Behandlungskonzepte untersucht. Methodik: Ein Fragebogen wurde an 163 deutsche kinder- und jugendpsychiatrische/-psychosomatische Kliniken versandt, der die Versorgungsstrukturen im Hinblick auf allgemeine Charakteristika der Kliniken sowie Diagnostik und Therapie von Kindern und Jugendlichen mit AN erfasst. Ergebnisse: Alle Kliniken, die Patientinnen mit Essstörungen behandeln (N = 84), bieten Einzeltherapie, familienbasierte Interventionen und Psychoedukation an. Nahezu alle Kliniken definieren ein Zielgewicht. Die angestrebte vorgegebene Gewichtszunahme pro Woche beträgt im Mittel 486 g/Woche (von 200 g bis 700 g/Woche; SD = 117). Alle weiteren diagnostischen und therapeutischen Maßnahmen werden nicht von allen Kliniken durchgeführt. Schlussfolgerungen: In dieser ersten Untersuchung der Versorgungsstrukturen von Kindern und Jugendlichen mit der Diagnose AN in Deutschland konnte gezeigt werden, dass trotz einheitlich integrierter leitliniengerechter Basisbehandlung die Versorgung von Patientinnen mit der Diagnose AN in Bezug auf Diagnostik, Gewichtsrestitution und spezifischer einzel- und gruppentherapeutischer Interventionen deutlich unterschiedlich gehandhabt wird.

Background Visual attention in Schizophrenia (SZ) differs from that of neuro-typical controls, and scan-path abnormalities have been proposed as a robust marker of the disorder (Nishiura et al., 2007). In free viewing paradigms, a restricted area of visual exploration has been reported as a robust atypical finding in SZ participants across a variety of depicted contents (Beedie et al., 2011), and has been shown to be a highly efficient discriminator between SZ and healthy controls (Benson et al., 2012). Moreover, speaking about what one sees during the act of looking has been shown to impact visual exploration behavior (Klein et al., 2014). Finally, despite clinical and genetic-biological relationships between schizophrenia, autism and ADHD (Owen & O’Donovan, 2017) there is, to our knowledge, yet no direct comparison between these neurodevelopmental disorders using eye tracking. The “head-to-head” comparison is the primary objective of this study. Methods We tested four groups of adolescent and young adults, namely early-onset Schizophrenia (SZ, N=21, 15 males, mean age ± 1 standard deviation 19.7±1.7 years), Attention Deficit Hyperactivity Disorder (ADHD, N=28, 15 males, 19.9±1.4 years), Autism (ASD, N=26, 25 males, 19.7±1.9 years), and typical controls (TD, N= 29, 12 males, 19.8±1.6 years). The ocular-motor task battery comprised of different free viewing tasks including free viewing of different kinds of social interactions in static pictures whilst solely viewing versus viewing-plus speaking (in counterbalanced order). Eye movements were recorded with 1.000Hz using the EyeLink 1000+ system and analyzed with Data Viewer Eyelink Software and MATLAB (Version R2017a, Mathworks, USA). Statistical Analysis was performed in SPSS Statistics 2.3 (IBM, USA). Results Visual attention of SZ patients manifested significant less gaze scatter than TD whilst merely looking at the images. During looking and speaking, however, the two groups had a similar spatial scatter of fixations. Preliminary analyses indicate that participants with ADHD and ASD did not differ from TD in this measure. Discussion Constraint gaze scatter in visual exploration is a robust and discriminating finding in schizophrenia that has been associated with the negative symptomatology of the disorder. The present results confirm our previous findings (Klein et al., 2014) and suggest that the act of speaking may partially counteract and compensate the restricted visual scanning performed by SZ participants, thus contributing to a better understanding of Visual Attention in SZ and its differentiation from other neurodevelopmental disorders.

Background Superior visual search is a replicated finding in the literature on Autism Spectrum Disorder (ASD). Conversely, results from the literature on Attention-Deficit/Hyperactivity Disorder (ADHD) are more mixed, with some studies showing typical performance and others pointing out less efficient serial search in ADHD. Finally, most studies on visual search in Schizophrenia highlighted deficits in focal attentional processing. However, similarities between attentional impairments in the three clinical groups have also been reported. The primary goal of our study is to determine the diagnostic specificity of search deficits. To our knowledge, the literature systematically comparing the visual search performance in patients with ADHD and Schizophrenia is limited to one study, while no study has so far included an ASD group in the comparison. Methods Four groups of young adults, namely 29 typically developing (TD; 19.8±1.6, 41% males), 26 with ASD (19.7±1.9, 96% males), 28 with ADHD (19.9±1.4, 54% males) and 21 with Early-Onset Schizophrenia (SCZ; 19.7±1.7, 71% males) were presented a visual search task in which they had to quickly detect a target item among several similar-to-target distractor items. Eye movements were recorded binocularly with the Eye Link 1000+ system. Participants were matched on age and full-scale IQ. The ocular-motor behaviour was analysed using Data Viewer 3.2 and SPSS 2.3. Results Initiation of search – latency of the first saccade on the search grid – was typical in all participants except those with SCZ, who had significant higher intra-subject variability (ISV) than both TD and ADHD, but no delay in initiating search. Within search, ASD manifested significantly reduced mean and ISV of total search duration – between the first saccade on the grid and the last fixation on target – and of the first part of search – between the first saccade on the grid and the first fixation on target – in comparison with all other groups, including TD. Conversely, SCZ and ASD were significantly more variable than TD and ADHD regarding the duration of first fixation on target, while also being, to a lesser extent, slower than ADHD, but not than TD. Additionally, SCZ needed a higher frequency of fixations on target than ASD, but not compared to ADHD or TD, before making a decision. In the post-search phase – between the onset of the last fixation on target and the button press on the keyboard – SCZ were the slowest and most variable group, followed by ASD and ADHD who differed?non-significantly? from controls. The overall search performance – between trial onset and button press – resulted in typical manual mean RT in ASD and ADHD while being atypically longer in SCZ, compared to all other groups. Compared to TD, ISV was at par in ADHD, lower in ASD, and higher in SCZ. Discussion Results suggest that the ability to extract individual targets is intact in ASD and ADHD. However, ASD only show a bias toward local information, as indicated by more variable first fixation duration, despite intact global processing. By contrast, lower search efficiency in SCZ might be explained by both (a) abnormal global processing due to impairment in the guidance mechanisms that affect the time until the first fixation on target, and (b) a deficit in central discrimination, with resulting difficulties in extracting critical features of the target.

Background According to the Neurodevelopmental continuum hypothesis, neurodevelopmental disorders such as ADHD, Autism and Schizophrenia, should be conceptualised as lying on a continuum of neurodevelopmental impairment, with the individual disorders reflecting different degrees of abnormal brain development and resulting functional impairment. The model also hypothesizes that these disorders lie on a gradient of severity, suggesting that they might differ to some extent quantitatively but also qualitatively. The severity of neurodevelopmental impairment is also expressed by the severity of cognitive impairment and persistence of functional impairment. The main objective of the present study was therefore to investigate commonalities and differences among the three conditions in various cognitive subdomains using standard ocular-motor paradigms. Methods Four groups of young adults were included: 21 with Early-Onset Schizophrenia (“SCZ”, 19.7±1.7, 15 males), 26 with Autism Spectrum Disorder (“ASD”, 19.7±1.9, 25 males), 28 with Attention-Deficit/Hyperactivity Disorder (“ADHD”, 19.9±1.4, 15 males), 29 typically developing participants (“TD”, 19.8±1.6, 12 males). Participants were matched on age and full-scale IQ. Eye movements were recorded binocularly at 1000 Hz using the Eye Link 1000+ system while four basic ocular-motor tasks (prosaccade (PRO), antisaccade (ANT), memory-guided saccade (MEM), fixation (FIX)) were administered in counterbalanced order. Eye movements were analysed with Data Viewer 3.2, SPSS 2.3 and MorePower 6.1. Results With respect to standard deviation of saccadic reaction times (SRTSD), ASD and ADHD did not differ from TD for PRO, ANTI, MEM. Conversely, SCZ were significantly more variable in all tasks than TD, but not compared to ASD and ADHD. Furthermore, SCZ were significantly slower than TD and ASD, but not ADHD, in PRO and ANT. Compared to TD, increased percentage of anticipatory saccades was found for MEM in ASD and ADHD, only marginally for PRO in ASD, again for all tasks in SCZ, when compared to both TD and ASD and, in less extent, to ADHD in ANT. A significantly higher percentage of direction errors during ANT was common to all clinical groups, this inhibitory deficit being significantly more severe in SCZ than ASD, but not compared to ADHD. Increased frequency of intrusive saccades during FIX was found in SCZ and ASD, and marginally in ADHD, when compared to TD. As for microsaccades, SCZ and ASD showed a higher frequency of microsaccades for FIX (condition without distractors) and PRO (preceding correct saccades), only SCZ for ANT (both preceding correct saccades and direction errors), compared to TD. Discussion Results suggest psychomotor slowing, unique for SCZ, as compared to ASD and ADHD, as indicated by increased mean RT in PRO. Conversely, increased anticipatory saccades and direction errors support the presence of inhibition deficits across groups, suggesting a common (pre-)frontal functional impairment. Of note, mean RT discriminates the clinical groups better than ISV, thus emerging as a trans-diagnostic process to the three conditions and, uniquely for SCZ as a deficit independent of the specific tasks administered here. Finally, atypical microsaccadic frequency might suggest common abnormalities in motor response preparation in SCZ and ASD. Across all tasks, participants with SCZ appear more impaired than those with ADHD and ASD, while the performance of ADHD was often in between SCZ and ASD, possibly in line with the idea of a continuum of neurodevelopmental impairment.

Objective High levels of expressed emotions (EE) and depressive symptoms (DS) are often found in caregivers of patients with anorexia nervosa (AN). Both parameters are considered to influence AN symptoms of the patient. Methods One hundred seventy adolescent women with AN and their caregivers were assessed at admission, discharge, at 1-year and 2.5-year follow up to evaluate AN symptoms of the patient and EE and DS of caregivers. Results The EE and DS were elevated at admission and decreased during treatment, criticism (as part of EE) exhibited again at the 2.5-year follow up. Caregivers of more severely ill patients reported significantly greater levels of EE and DS. Mothers were more affected than fathers. EE and DS were interrelated. Conclusion Caregivers of adolescent AN patients suffer from elevated levels of EE and DS. Further studies are needed to examine whether therapeutic interventions to reduce caregivers' EE and DS might have a positive influence on treatment outcome. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.

Objectives The influence of food intake on behavioural disorders was already described in the early 20th century. Elimination of individually allergenic food items from individual diets [“oligoantigenic diet” (OD)] showed promise to improve attention-deficit/hyperactivity disorder (ADHD) symptoms. However, only few of the positive results were evaluated by blinded symptom rating. Therefore the present study’s purpose was to evaluate the reliability of a non-blinded rating of the ADHD Rating Scale IV (ARS) for the assessment of OD effects in comparison to a blinded rating of the ARS based on pseudonymized video recordings. Methods Ten children (8m/2f) aged 8 to 14 with ADHD according to ICD-10 participated in an uncontrolled, open-label dietary intervention study. Food items, commonly related to intolerances, were eliminated for four weeks. Participants with > 40% improvement in the ARS between T1 (before the diet) and T2 (after the diet) were defined as responders. Nutrients with individual relevance to ADHD symptoms were identified in a following reintroduction phase (T3–T4) lasting 8–16 weeks. The ARS was completed by a non-blinded child and adolescent psychiatrist (T0-T4). Sessions were recorded on video, pseudonymized, and evaluated by three blinded raters. Complete data were captured for eight children. The inter-rater reliability between the non-blinded therapist and every blinded rater was determined by the intra-class correlation coefficient (ICC). Correlations according to Pearson and Spearman between the non-blinded and blinded rating were calculated for each rater. Results Two blinded raters and the non-blinded rater considered 5 of 8 (62.5%) children as responders, whereas one blinded rater disagreed as to the success of one case thus considering only 4 of 8 children as responders to the diet. Inter-rater reliability was assessed after each rater having scored 33 videos: The intra-class coefficients were >.9 for all raters (rater 1: ICC=.997, rater 2: ICC=.996, rater 3: ICC=.996) and the Spearman rho between the raters were high (n=33; rater 1: rho =.989, p

Objective: The Strengths and Weaknesses of ADHS–Symptoms and Normal Behavior (SWAN) Scale has been developed to support the dimensional assessment of ADHD symptoms by capturing variance on both poles of the ADHD continuum. The present study provides the first validation of the German version of SWAN (SWAN-DE). Method: Based on a sample of N1 = 343 children from the general population and N2 = 62 children with ADHD, both aged between 8 and 18 years, normality, internal consistency, test–retest reliability, and different validity indices were examined. Results: SWAN was characterized by normally distributed scores, good to excellent reliability, and factorial validity. It showed high diagnostic utility in discriminating between patients with ADHD and healthy controls and significant correlations to related clinical scales and neuropsychological constructs, such as intra-subject variability. Conclusion: The present study reveals the excellent psychometric properties of SWAN-DE, which can now be usefully applied in the German-speaking countries as well as in cross-national studies. Deutsche Forschungsgemeinschaft https://doi.org/10.13039/501100001659

Elevated serum leptin levels following rapid therapeutically induced weight gain in anorexia nervosa (AN) patients are discussed as a potential biomarker for renewed weight loss as a result of leptin-related suppression of appetite and increased energy expenditure. This study aims to analyze the predictive value of leptin levels at discharge as well as the average rate of weight gain during inpatient or day patient treatment for body weight at 1-year follow-up. 121 patients were recruited from the longitudinal Anorexia Nervosa Day patient versus Inpatient (ANDI) trial. Serum leptin levels were analyzed at referral and discharge. A multiple linear regression analysis to predict age-adjusted body mass index (BMI-SDS) at 1-year follow-up was performed. Leptin levels, the average rate of weight gain, premorbid BMI-SDS, BMI-SDS at referral, age and illness duration were included as independent variables. Neither leptin levels at discharge nor rate of weight gain significantly predicted BMI-SDS at 1-year follow-up explaining only 1.8 and 0.4 % of the variance, respectively. According to our results, leptin levels at discharge and average rate of weight gain did not exhibit any value in predicting weight at 1-year follow-up in our longitudinal observation study of adolescent patients with AN. Thus, research should focus on other potential factors to predict weight at follow-up. As elevated leptin levels and average rate of weight gain did not pose a risk for reduced weight, we found no evidence for the beneficial effect of slow refeeding in patients with acute AN.

Objective Recent preliminary studies indicated a seasonal association of BMI at admission to inpatient treatment for anorexia nervosa (AN), indicating lower BMI in the cold season for restrictive AN. An impaired thermoregulation was proposed as the causal factor, based on findings in animal models of AN. However, findings regarding seasonality of BMI and physical activity levels in the general population indicate lower BMI and higher physical activity in summer than in winter. Therefore, we aimed to thoroughly replicate the findings regarding seasonality of BMI at admission in patients with AN in this study. Method AN subtype, age- and gender-standardized BMI scores (BMI-SDS) at admission, mean daily sunshine duration and ambient temperature at the residency of 304 adolescent inpatients with AN of the multi-center German AN registry were analyzed. Results A main effect of DSM-5 AN subtype was found (F(2,298) = 6.630, p = .002), indicating differences in BMI-SDS at admission between restrictive, binge/purge and subclinical AN. No main effect of season on BMI-SDS at admission was found (F(1,298) = 4.723, p = .025), but an interaction effect of DSM-5 subtype and season was obtained (F(2,298) = 6.625, p = .001). Post-hoc group analyses revealed a lower BMI-SDS in the warm season for restrictive AN with a non-significant small effect size (t(203.16) = 2.140, p = .033; Hedges′g = 0.28). Small correlations of mean ambient temperature (r = −.16) and daily sunshine duration (r = −.22) with BMI-SDS in restrictive AN were found. However, the data were widely scattered. Conclusions Our findings are contrary to previous studies and question the thermoregulatory hypothesis, indicating that seasonality in AN is more complex and might be subject to other biological or psychological factors, for example physical activity or body dissatisfaction. Our results indicate only a small clinical relevance of seasonal associations of BMI-SDS merely at admission. Longitudinal studies investigating within-subject seasonal changes might be more promising to assess seasonality in AN and of higher clinical relevance.

BACKGROUND Therapeutic drug monitoring is becoming increasingly important in psychiatric therapy, especially in children. However, for several reasons, it cannot yet be implemented as a daily routine in clinical or outpatient settings. To evaluate new, noninvasive procedures, blood and saliva (oral fluid) samples were collected from patients with attention-deficit/hyperactivity disorder (ADHD) who were also being administered methylphenidate (MPH). The study's main purposes were to correlate MPH concentrations in serum and saliva between subjects and to analyze intraindividual variation of serum concentration. METHODS Thirty-six patients with ADHD (27 children and 9 adults) on MPH medication were included for drug analysis. MPH and its major metabolite ritalinic acid were quantified using liquid chromatography-tandem mass spectrometry measurements. The following correlations were investigated: (1) between drug concentrations in serum and saliva, and (2) between pH value and saliva to serum concentration ratio. Furthermore, the mean intraindividual MPH-concentration fluctuation in saliva under constant frame conditions was analyzed. RESULTS After quantification, MPH concentrations were approximately 5 times higher in the saliva than in the serum, whereas the concentrations of ritalinic acid were much lower in saliva. We found significant correlations between concentrations of MPH in serum and saliva (r = 0.51, P < 0.05). Saliva MPH measures, compared with serum, were pH-dependent (r = -0.56, P < 0.01). Daily coefficient of variance of saliva concentration in children taking constant medication was 27.3% (11%-42%), whereas the coefficient of variance for the ratio of saliva to serum was 122% (2%-2060%). CONCLUSIONS Our data indicate that the interindividual variation in saliva to serum concentrations is rather high, whereas the intraindividual variation is fairly low, as already shown in the literature for repeated citalopram serum measurements. Saliva may well serve as an alternative matrix for therapeutic drug monitoring of MPH in patients with ADHD, especially for follow-up examinations. Future research should focus on analyzing the relationship between drug levels in saliva and clinical effects as well as on understanding the mechanisms that generate saliva drug concentrations. These are essential steps before potential clinical use.