Premorbid body weight predicts weight loss in both anorexia nervosa and atypical anorexia nervosa: Further support for a single underlying disorder.

OBJECTIVE For adolescents, DSM-5 differentiates anorexia nervosa (AN) and atypical AN with the 5th BMI-centile-for-age. We hypothesized that the diagnostic weight cut-off yields (i) lower weight loss in atypical AN and (ii) discrepant premorbid BMI distributions between the two disorders. Prior studies demonstrate that premorbid BMI predicts admission BMI and weight loss in patients with AN. We explore these relationships in atypical AN. METHOD Based on admission BMI-centile < or ≥5th, participants included 411 female adolescent inpatients with AN and 49 with atypical AN from our registry study. Regression analysis and t-tests statistically addressed our hypotheses and exploratory correlation analyses compared interrelationships between weight loss, admission BMI, and premorbid BMI in both disorders. RESULTS Weight loss in atypical AN was 5.6 kg lower than in AN upon adjustment for admission age, admission height, premorbid weight and duration of illness. Premorbid BMI-standard deviation scores differed by almost one between both disorders. Premorbid BMI and weight loss were strongly correlated in both AN and atypical AN. DISCUSSION Whereas the weight cut-off induces discrepancies in premorbid weight and adjusted weight loss, AN and atypical AN overall share strong weight-specific interrelationships that merit etiological consideration. Epidemiological and genetic associations between AN and low body weight may reflect a skewed premorbid BMI distribution. In combination with prior findings for similar psychological and medical characteristics in AN and atypical AN, our findings support a homogenous illness conceptualization. We propose that diagnostic subcategorization based on premorbid BMI, rather than admission BMI, may improve clinical validity. PUBLIC SIGNIFICANCE Because body weights of patients with AN must drop below the 5th BMI-centile per DSM-5, they will inherently require greater weight loss than their counterparts with atypical AN of the same sex, age, height and premorbid weight. Indeed, patients with atypical AN had a 5.6 kg lower weight loss after controlling for these variables. In comparison to the reference population, we found a lower and higher mean premorbid weight in patients with AN and atypical AN, respectively. Considering previous psychological and medical comparisons showing little differences between AN and atypical AN, we view a single disorder as the most parsimonious explanation. Etiological models need to particularly account for the strong relationship between weight loss and premorbid body weight

Lebenszufriedenheit langzeitüberlebender onkologischer Patienten mit Erkrankung in der Adoleszenz

Objectives: The aim of this study was to investigate the life satisfaction of German long-term survivors of cancer during adolescence and to identify predicting factors. Methods: Survivors of cancer during adolescence (n = 820; age at onset: M = 15.8, SD = 0.9, age at follow-up: M = 30.4, SD = 6.0 years) completed the Questions on Life Satisfaction (FLZM), a multidimensional instrument measuring the subjective satisfaction with the general and health-related life satisfaction. Data were compared with an age-matched German representative sample as well as with another group of chronic ill patients (cystic fibrosis). In addition, different predicting factors were investigated by means of several other questionnaires. Results: Survivors were significantly less satisfied with both their general (M = 53.6, SD = 35.5) as well as their health-related life satisfaction (M = 69.6, SD = 38.2) than the representative comparison group (M = 66.7, SD = 37.8; M = 87.9, SD = 39.1; p < .001, d = - 0.35). Important predicting factors were the cancer late-effects, mental health problems, and subjective quality of life. The type of cancer, however, was not significantly associated with the life satisfaction of the former patients. In comparison to the cystic fibrosis group there were no significant differences in the general and in the health-related module. Conclusions: Even years after successful medical treatment survivors of adolescent cancer experience a negative impact on their life satisfaction which is mostly affected by long-term health problems and psychological distress. The results therefore indicate that regularly long-term routine-follow up visits are necessary to identify lasting health effects as well as psychopathologies in order to restore and maintain life satisfaction

Evolution of Emergency Department Characteristics in Child and Adolescent Psychiatry: A Retrospective Review over Two Decades

Fragestellung: Stationäre Notaufnahmen aufgrund einer psychischen Krise stellen einen erheblichen Anteil der stationären Aufnahmen kinder- und jugendpsychiatrischer Kliniken dar und haben in den vergangenen Jahren stark zugenommen. Die Studie untersucht, wie sich Charakteristika dieser Patientinnen- und Patientengruppe einer universitären Versorgungsklinik über zwei Jahrzehnte hinweg verändert haben. Methodik: Es erfolgte eine retrospektive Auswertung der Notaufnahmen in den Jahren 1996, 2002, 2008 und 2014 der KJPPP Tübingen bezüglich soziodemografischer Daten, psychosozialer Umstände und Diagnosen. Ergebnisse: Insgesamt wurden N = 403 Notaufnahmen ausgewertet. Es zeigte sich eine Steigerung von Notaufnahmen im genannten Zeitraum von 405 %. Bezüglich der psychosozialen Umstände ergab sich eine Zunahme von Familiensituationen mit getrennten Eltern. Des Weiteren wurde bei den Patientinnen und Patienten eine deutliche Zunahme von Mehrfachdiagnosen festgestellt. Schlussfolgerungen: Über den Zeitraum von1996 bis 2014 ist ein erheblicher Anstieg von Notaufnahmen zu verzeichnen. Des Weiteren bestehen Hinweise auf ungünstigere psychosoziale Rahmenbedingungen und komplexere Erkrankungssituationen in späteren Jahren. Die Ergebnisse unterstreichen den Handlungsbedarf hinsichtlich der klinischen Versorgung von Kindern und Jugendlichen in akuten psychischen Krisen und deren Prävention, aber auch einer breiten gesellschaftlichen Diskussion zur Verbesserung der psychischen Gesundheit in der Entwicklung. Es besteht dringender Bedarf an prospektiven Studien zur differenzierten Betrachtung der Faktoren, die zum Anstieg von Notaufnahmen von Kindern und Jugendlichen führen

Child and Adolescent Psychiatric Emergencies During the Second Wave of the SARS-CoV2-19 Pandemic: Findings from the Tubingen University Hospital

Child and Adolescent Psychiatric Emergencies During the Second Wave of the SARS-CoV2-19 Pandemic: Findings from the Tübingen University Hospita

Outcomes for Infants Born in Perinatal Centers Performing Fewer Surgical Ligations for Patent Ductus Arteriosus: A Swiss Population-Based Study

Objective To assess patent ductus arteriosus treatment variation between Swiss perinatal centers and to determine its effect on outcome in a population-based setting. Study design This was a retrospective cohort study of infants born less than 28 weeks of gestation between 2012 and 2017. Outcomes between surgically ligated and pharmacologically treated infants as well as infants born in centers performing ≤10% ligation (“low” group) and >10% (“high” group) were compared using logistic regression and 1:1 propensity score matching. Matching was based on case-mix and preligation confounders: intraventricular hemorrhages grades 3-4, necrotizing enterocolitis, sepsis, and ≥28 days’ oxygen supply. Results Of 1389 infants, 722 (52%) had pharmacologic treatment and 156 (11.2%) received surgical ligation. Compared with infants who received pharmacologic treatment, ligated infants had greater odds for major morbidities (OR 2.09, 95% CI 1.44-3.04) and 2-year neurodevelopmental impairment (OR 1.81, 95% CI 1.15-2.84). Mortality was comparable after restricting the cohort to infants surviving at least until day 10 to avoid survival bias. In the “low” group, 34 (4.9%) of 696 infants were ligated compared with 122 (17.6%) of 693 infants in the “high” group. Infants in the “high” group had greater odds for major morbidities (OR 1.49, 95% CI 1.11-2.0). Conclusions Our analysis identified a burden on infants receiving surgical ligation vs pharmacologic treatment in a population-based setting where there was no agreed-on common procedure. These results may guide a revision of patent ductus arteriosus treatment practice in Switzerland

Quantifying indices of short- and long-range white matter connectivity at each cortical vertex.

Several neurodevelopmental diseases are characterized by impairments in cortical morphology along with altered white matter connectivity. However, the relationship between these two measures is not yet clear. In this study, we propose a novel methodology to compute and display metrics of white matter connectivity at each cortical point. After co-registering the extremities of the tractography streamlines with the cortical surface, we computed two measures of connectivity at each cortical vertex: the mean tracts' length, and the proportion of short- and long-range connections. The proposed measures were tested in a clinical sample of 62 patients with 22q11.2 deletion syndrome (22q11DS) and 57 typically developing individuals. Using these novel measures, we achieved a fine-grained visualization of the white matter connectivity patterns at each vertex of the cortical surface. We observed an intriguing pattern of both increased and decreased short- and long-range connectivity in 22q11DS, that provides novel information about the nature and topology of white matter alterations in the syndrome. We argue that the method presented in this study opens avenues for additional analyses of the relationship between cortical properties and patterns of underlying structural connectivity, which will help clarifying the intrinsic mechanisms that lead to altered brain structure in neurodevelopmental disorders

Quantifying indices of short- and long-range white matter connectivity at each cortical vertex

Several neurodevelopmental diseases are characterized by impairments in cortical morphology along with altered white matter connectivity. However, the relationship between these two measures is not yet clear. In this study, we propose a novel methodology to compute and display metrics of white matter connectivity at each cortical point. After co-registering the extremities of the tractography streamlines with the cortical surface, we computed two measures of connectivity at each cortical vertex: the mean tracts' length, and the proportion of short- and long-range connections. The proposed measures were tested in a clinical sample of 62 patients with 22q11.2 deletion syndrome (22q11DS) and 57 typically developing individuals. Using these novel measures, we achieved a fine-grained visualization of the white matter connectivity patterns at each vertex of the cortical surface. We observed an intriguing pattern of both increased and decreased short- and long-range connectivity in 22q11DS, that provides novel information about the nature and topology of white matter alterations in the syndrome. We argue that the method presented in this study opens avenues for additional analyses of the relationship between cortical properties and patterns of underlying structural connectivity, which will help clarifying the intrinsic mechanisms that lead to altered brain structure in neurodevelopmental disorders