TY - THES A1 - Geissler, Julia Maria T1 - Neuropsychological Endophenotypes of Attention-Deficit/Hyperactivity Disorder T1 - Neuropsychologische Endophänotypen des Aufmerksamkeitsdefizit-/Hyperaktivitätssyndroms N2 - Attention-Deficit/Hyperactivity Disorder (ADHD) endophenotypes as a link between phenotype and genotype were the focus of the present work. Candidate endophenotypes were investigated via neuropsychological tasks during the simultaneous recording of a 21-channel electroencephalogram. Since endophenotypes are assumed to more closely reflect genetic variation, the influence of ADHD-associated genes Catechol-O-methyl transferase (COMT), the dopamine transporter (DAT, SLC6A3) and Latrophilin-3 (LPHN3) was analysed. Response inhibition was assessed with a cued Continuous Performance Test, for working memory we used an n-back task, sensory gating was measured via the paired clicks paradigm and response time variability (RTV) was quantified by the standard deviation of reaction times. The sample comprised medicated (N=36) and unmedicated (N=42) ADHD patients and matched control children and adolescents (N=41). The electrophysiological correlate of response inhibition was the centroid location during response execution and inhibition, and the degree of anteriorization (NGA). Sensory gating reflects the attenuation of the P50 response to the second of two auditory stimuli presented in short succession. Working memory was examined during target and non-target trials, reflecting specific information processing stages: early sensory processing (P100 and N100), selection of material (P150), memory retrieval (N300), event categorization (P300) and updating of working memory content (P450). Performance was quantified in terms of omission errors reflecting inattention and false alarms reflecting impulsivity, as well as speed and variability of reactions. Unmedicated ADHD patients had more omission errors and more variable reaction times, pointing to difficulties with attention and state regulation. NGA did not prove an optimal endophenotype candidate, since it was not yet developed in approximately half of the examined children and adolescents. It was independent of diagnosis; however ADHD risk alleles for DAT conferred lower NGA as well as more variable reaction times across groups. DAT genotype interacted with diagnosis on the level of centroid location, however, it did not manifest in performance deficits. In the case of sensory gating, homozygosity for the DAT allele associated with ADHD (10R) conferred impairment. ADHD was only relevant in participants without genetic risk, where patients without medication struggled most with suppression. In the working memory task, DAT modulated the timing of material selection in interaction with cognitive load and diagnosis: under high load unmedicated patients showed delayed responses, while under low load risk carriers on medication had faster responses than controls. Early processing and event-categorization were stronger in unmedicated ADHD with risk genotype, but dampened without risk. An interesting trend emerged for LPHN3, where carrying all risk variants was associated with higher NGA in ADHD patients irrespective of medication. This warrants further study, as the haplotype also exerts a positive influence on sensory gating specifically in patients. At the same time within the genetic risk group, unmedicated patients had the weakest NGA. However, the LPHN3 risk haplotype effected more posterior Go centroids, putatively facilitating response execution, which is supported by a higher number of false alarms. When inhibition was required, the risk variants led to more posterior centroids in unmedicated compared to medicated patients as well as controls, speaking to differences in inhibition-related brain activation. While as expected the risk haplotype led to compromised gating in unmedicated ADHD, this was reversed in healthy controls where the haplotype was acting in a protective manner with enhanced filtering. During working memory operations, the risk haplotype showed stronger N300 responses suggesting investment of more resources. While COMT did not exert an influence on NGA directly, carriers of the risk allele (met) had more posterior centroids both during response execution and inhibition, and displayed more variable responses in addition to being more prone to false alarms. Unmedicated patients produced smaller P300 during successful execution of responses than controls in absence of the risk allele, while with risk they had shorter latencies and presumably tend towards premature reactions. Additionally, it brought out impairments in sensory gating, thus making unmedicated patients less able to filter out irrelevant information, while they were able to compensate with the protective genotype. The influence of COMT on sensory gating seems to be specific for ADHD, as this gene was of no consequence in healthy controls. In the working memory task, met was beneficial for updating as reflected by P450 amplitude. In ADHD irrespective of medication COMT did not change P450 strength, but for controls this effect was observed. N2 - Endophänotypen als Bindeglied zwischen Phänotyp und Genotyp des Aufmerksamkeitsdefizit-/Hyperaktivitätssyndroms (ADHS) besitzen großes Potential als diagnostische Marker. Im Fokus der vorliegenden Arbeit standen Antworthemmung, Arbeitsgedächtnis, Reaktionszeitvariabilität (RTV) und sensorisches Gating als Kandidaten-Endophänotypen, sowie die Untersuchung des Einflusses genetischer Varianten in den ADHS-assoziierten Genen COMT, DAT und LPHN3. Die Stichprobe im Kindes- und Jugendalter bestehend aus medizierten (N=36) und unmedizierten (N=42) ADHS-Patienten sowie gesunden Kontrollen (N=41) wurde neuropsychologisch untersucht bei simultaner Ableitung eines 21-Kanal-EEGs. Die NoGo-Anteriorisierung (NGA) als elektrophysiologisches Korrelat der Antworthemmung basiert auf der Lage der Feldschwerpunkte (Zentroide) der P300 in Antwortausführungs- (Go) und Inhibitionstrials (NoGo). Sensorisches Gating beschreibt die Unterbindung der Reizweiterleitung bei schneller Reizfolge zur Prävention kortikaler Überstimulation, was sich in einer gedämpften P50-Amplitude zeigt. Um sowohl frühe als auch späte Aspekte des arbeitsgedächtnisbezogenen Informationsverarbeitungsprozesses zu erfassen, wurden ereigniskorrelierte Komponenten korrespondieren mit früher sensorischer Verarbeitung (P100 und N100), Materialselektion (P150), Abruf von Gedächtnisinhalten (N300), Ereigniskategorisierung (P300) und Aktualisierung der Arbeitsgedächtnisinhalten (P450) analysiert. Auslassungsfehler dienten als Indikator für Aufmerksamkeitdefizite, Falschalarme als Indikator für Impulsivität. Unmedizierte ADHD-Patienten zeigten neben variableren Reaktionszeiten mehr Auslassungsfehler, was Hinweise auf Defizite in Aufmerksamkeit und Zustandsregulation gibt. Die NGA erwies sich als beschränkt geeigneter Endophänotyp, da viele Probanden im eingeschlossenen Altersspektrum keine NGA aufwiesen. Die NGA war bei Trägern der DAT-Risikovariante (10R) schwächer ausgeprägt. Nur in Anwesenheit eines protektiven 9R-Allels korrespondierte Stimulanzienmedikation mit einer Anteriorisierung beider Zentroide. Während homozygote 10R-Träger Beeinträchtigungen im sensorischen Gating zeigten, kam ohne genetisches Risiko die Diagnose zum Tragen, da hier die Gruppe mit unmedizierten ADHS die größten Defizite aufwies. Während der Arbeitsgedächtnisaufgabe modulierte DAT die Materialauswahl in Interaktion mit kognitivem Load: unter hohem Load zeigten Patienten ohne Medikation genotypunabhängig verzögerte Reaktionen, während bei niedrigem Load medizierte Patienten mit Risikogenotyp die kürzesten Latenzen aufwiesen. Während bei unmediziertem ADHD der DAT-Risikogenotyp mit höheren P150-Amplituden und somit verstärkter Ressourcenallokation zur Materialselektion korrespondierte, zeigte diese Gruppe bei Vorhandensein eines 9R-Allels gedämpfte P100-Amplituden im Vergleich zu medizierten Patienten und Kontrollen, was auf abnorme frühe sensorischen Verarbeitung hinweist. Zuletzt bedeutete der DAT-Risikogenotyp für unmediziertes ADHS höhere P300-Amplituden, während diese Gruppe mit dem protektiven Genotyp die schwächsten P300-Reaktionen (Ereigniskategorisierung) zeigten. Ein interessanter Trend zeigte sich für den LPHN3-Risikohaplotyp, der bei ADHS medikationsunabhängig mit besserer NGA assoziiert war. Auf Zentroidebene zeigten Risikohaplotypträger mehr posterior gelegene Go-Zentroide, was die Reaktionsausführung begünstigt und sich in einer höheren Anzahl an Falschalarmen niederschlägt. Bei erforderlicher Inhibition ging der Risikohaplotyp bei unmedizierten Patienten mit mehr posterioren Zentroiden als in den Vergleichsgruppen einher, was für Unterschiede in inhibitionsspezifischer Gehirnaktivität spricht. In Bezug auf sensorisches Gating erzeugte der LPHN3-Haplotyp gegenläufige Effekte in Patienten und Kontrollen. Während der Risikohaplotyp in der unmedizierten ADHS-Gruppe erwartungsgemäß mit schwächerem Gating assoziiert war, wirkte er in Kontrollen und medizierten Patienten protektiv in Form überlegener Filterfähigkeiten. Der Risikohaplotyp zeigte bei Arbeitsgedächtnisaufgaben höhere N300-Amplituden als Indiz für Ressourceninvestition beim Abruf von Gedächtnisinhalten. Während sich die NGA als unabhängig vom COMT-Genotyp erwies, lagen die Zentroide bei Probanden mit Met-Allel weiter posterior, sie zeigten darüber hinaus eine variablere Leistung mit mehr Falschalarmen. Generell bedeutete die mit ADHS assoziierte COMT-Variante eine erhöhte RTV sowie schlechtere Gatingleistung in unmediziertem ADHD, während sie durch das protektive Val-Allele in die Lage versetzte, dieses Defizit ohne Medikation zu kompensieren. Dieser Einfluss von COMT auf sensorisches Gating war spezifisch für ADHS. In Aufgaben, welche das Arbeitsgedächtnis beanspruchen, war die Met-Variante von Vorteil für Aktualisierungsvorgänge (P450), was im Gegensatz zu den Gating-Effekten nur in Kontrollen auftrat. KW - Aufmerksamkeits-Defizit-Syndrom KW - Elektroencephalographie KW - Arbeitsgedächtnis KW - Endophänotyp KW - Antworthemmung KW - Latrophilin-3 KW - Dopamintransporter KW - Catechol-O-Methyltransferase KW - ADHD KW - Endophenotype KW - Latrophilin-3 KW - Response Inhibition KW - Sensory Gating Y1 - 2013 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-79221 ER - TY - JOUR A1 - Hautmann, Christopher A1 - Döpfner, Manfred A1 - Katzmann, Josepha A1 - Schürmann, Stephanie A1 - Wolff Metternich-Kaizman, Tanja A1 - Jaite, Charlotte A1 - Kappel, Viola A1 - Geissler, Julia A1 - Warnke, Andreas A1 - Jacob, Christian A1 - Hennighausen, Klaus A1 - Haack-Dees, Barbara A1 - Schneider-Momm, Katja A1 - Philipsen, Alexandra A1 - Matthies, Swantje A1 - Rösler, Michael A1 - Retz, Wolfgang A1 - Gontard, Alexander von A1 - Sobanski, Esther A1 - Alm, Barbara A1 - Hohmann, Sarah A1 - Häge, Alexander A1 - Poustka, Luise A1 - Colla, Michael A1 - Gentschow, Laura A1 - Freitag, Christine M. A1 - Becker, Katja A1 - Jans, Thomas T1 - Sequential treatment of ADHD in mother and child (AIMAC study): importance of the treatment phases for intervention success in a randomized trial JF - BMC Psychiatry N2 - Background The efficacy of parent-child training (PCT) regarding child symptoms may be reduced if the mother has attention-deficit/hyperactivity disorder (ADHD). The AIMAC study (ADHD in Mothers and Children) aimed to compensate for the deteriorating effect of parental psychopathology by treating the mother (Step 1) before the beginning of PCT (Step 2). This secondary analysis was particularly concerned with the additional effect of the Step 2 PCT on child symptoms after the Step 1 treatment. Methods The analysis included 143 mothers and children (aged 6–12 years) both diagnosed with ADHD. The study design was a two-stage, two-arm parallel group trial (Step 1 treatment group [TG]: intensive treatment of the mother including psychotherapy and pharmacotherapy; Step 1 control group [CG]: supportive counseling only for mother; Step 2 TG and CG: PCT). Single- and multi-group analyses with piecewise linear latent growth curve models were applied to test for the effects of group and phase. Child symptoms (e.g., ADHD symptoms, disruptive behavior) were rated by three informants (blinded clinician, mother, teacher). Results Children in the TG showed a stronger improvement of their disruptive behavior as rated by mothers than those in the CG during Step 1 (Step 1: TG vs. CG). In the CG, according to reports of the blinded clinician and the mother, the reduction of children’s disruptive behavior was stronger during Step 2 than during Step 1 (CG: Step 1 vs. Step 2). In the TG, improvement of child outcome did not differ across treatment steps (TG: Step 1 vs. Step 2). Conclusions Intensive treatment of the mother including pharmacotherapy and psychotherapy may have small positive effects on the child’s disruptive behavior. PCT may be a valid treatment option for children with ADHD regarding disruptive behavior, even if mothers are not intensively treated beforehand. Trial registration ISRCTN registry ISRCTN73911400. Registered 29 March 2007. KW - mothers KW - children KW - adult treatment KW - parent training KW - efficacy Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-227930 VL - 18 ER - TY - JOUR A1 - Grünblatt, Edna A1 - Oneda, Beatrice A1 - Ekici, Arif B. A1 - Ball, Juliane A1 - Geissler, Julia A1 - Uebe, Steffen A1 - Romanos, Marcel A1 - Rauch, Anita A1 - Walitza, Susanne T1 - High resolution chromosomal microarray analysis in paediatric obsessive-compulsive disorder JF - BMC Medical Genomics N2 - Background Obsessive-Compulsive Disorder (OCD) is a common and chronic disorder in which a person has uncontrollable, reoccurring thoughts and behaviours. It is a complex genetic condition and, in case of early onset (EO), the patients manifest a more severe phenotype, and an increased heritability. Large (>500 kb) copy number variations (CNVs) previously associated with autism and schizophrenia have been reported in OCD. Recently, rare CNVs smaller than 500 kb overlapping risk loci for other neurodevelopmental conditions have also been reported in OCD, stressing the importance of examining CNVs of any size range. The aim of this study was to further investigate the role of rare and small CNVs in the aetiology of EO-OCD. Methods We performed high-resolution chromosomal microarray analysis in 121 paediatric OCD patients and in 124 random controls to identify rare CNVs (>50 kb) which might contribute to EO-OCD. Results The frequencies and the size of the observed rare CNVs in the patients did not differ from the controls. However, we observed a significantly higher frequency of rare CNVs affecting brain related genes, especially deletions, in the patients (OR = 1.98, 95% CI 1.02–3.84; OR = 3.61, 95% CI 1.14–11.41, respectively). Similarly, enrichment-analysis of CNVs gene content, performed with three independent methods, confirmed significant clustering of predefined genes involved in synaptic/brain related functional pathways in the patients but not in the controls. In two patients we detected \(de-novo\) CNVs encompassing genes previously associated with different neurodevelopmental disorders \(\textit{NRXN1, ANKS1B, UHRF1BP1}\)). Conclusions Our results further strengthen the role of small rare CNVs, particularly deletions, as susceptibility factors for paediatric OCD. KW - Medicine KW - OCD KW - CNV KW - Enrichment analysis KW - De-novo KW - Early-onset Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-172791 VL - 10 IS - 68 ER - TY - JOUR A1 - Kaiser, Anna A1 - Aggensteiner, Pascal-M. A1 - Holtmann, Martin A1 - Fallgatter, Andreas A1 - Romanos, Marcel A1 - Abenova, Karina A1 - Alm, Barbara A1 - Becker, Katja A1 - Döpfner, Manfred A1 - Ethofer, Thomas A1 - Freitag, Christine M. A1 - Geissler, Julia A1 - Hebebrand, Johannes A1 - Huss, Michael A1 - Jans, Thomas A1 - Jendreizik, Lea Teresa A1 - Ketter, Johanna A1 - Legenbauer, Tanja A1 - Philipsen, Alexandra A1 - Poustka, Luise A1 - Renner, Tobias A1 - Retz, Wolfgang A1 - Rösler, Michael A1 - Thome, Johannes A1 - Uebel-von Sandersleben, Henrik A1 - von Wirth, Elena A1 - Zinnow, Toivo A1 - Hohmann, Sarah A1 - Millenet, Sabina A1 - Holz, Nathalie E. A1 - Banaschewski, Tobias A1 - Brandeis, Daniel T1 - EEG data quality: determinants and impact in a multicenter study of children, adolescents, and adults with attention-deficit/hyperactivity disorder (ADHD) JF - Brain Sciences N2 - Electroencephalography (EEG) represents a widely established method for assessing altered and typically developing brain function. However, systematic studies on EEG data quality, its correlates, and consequences are scarce. To address this research gap, the current study focused on the percentage of artifact-free segments after standard EEG pre-processing as a data quality index. We analyzed participant-related and methodological influences, and validity by replicating landmark EEG effects. Further, effects of data quality on spectral power analyses beyond participant-related characteristics were explored. EEG data from a multicenter ADHD-cohort (age range 6 to 45 years), and a non-ADHD school-age control group were analyzed (n\(_{total}\) = 305). Resting-state data during eyes open, and eyes closed conditions, and task-related data during a cued Continuous Performance Task (CPT) were collected. After pre-processing, general linear models, and stepwise regression models were fitted to the data. We found that EEG data quality was strongly related to demographic characteristics, but not to methodological factors. We were able to replicate maturational, task, and ADHD effects reported in the EEG literature, establishing a link with EEG-landmark effects. Furthermore, we showed that poor data quality significantly increases spectral power beyond effects of maturation and symptom severity. Taken together, the current results indicate that with a careful design and systematic quality control, informative large-scale multicenter trials characterizing neurophysiological mechanisms in neurodevelopmental disorders across the lifespan are feasible. Nevertheless, results are restricted to the limitations reported. Future work will clarify predictive value. KW - electroencephalography (EEG) KW - data quality KW - attention-deficit/hyperactivity disorder (ADHD) KW - artifacts KW - multicenter study Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-228788 SN - 2076-3425 VL - 11 IS - 2 ER - TY - JOUR A1 - Geissler, Julia A1 - Jans, Thomas A1 - Banaschewski, Tobias A1 - Becker, Katja A1 - Renner, Tobias A1 - Brandeis, Daniel A1 - Döpfner, Manfred A1 - Dose, Christina A1 - Hautmann, Christopher A1 - Holtmann, Martin A1 - Jenkner, Carolin A1 - Millenet, Sabina A1 - Romanos, Marcel T1 - Individualised short-term therapy for adolescents impaired by attention-deficit/hyperactivity disorder despite previous routine care treatment (ESCAadol)-Study protocol of a randomised controlled trial within the consortium ESCAlife JF - Trials N2 - Background: Despite the high persistence rate of attention-deficit/hyperactivity disorder (ADHD) throughout the lifespan, there is a considerable gap in knowledge regarding effective treatment strategies for adolescents with ADHD. This group in particular often shows substantial psychosocial impairment, low compliance and insufficient response to psychopharmacological interventions. Effective and feasible treatments should further consider the developmental shift in ADHD symptoms, comorbidity and psychosocial adversity as well as family dysfunction. Thus, individualised interventions for adolescent ADHD should comprise a multimodal treatment strategy. The randomised controlled ESCAadol study addresses the needs of this patient group and compares the outcome of short-term cognitive behavioural therapy with parent-based telephone-assisted self-help. Methods/design: In step 1, 160 adolescents aged 12 to 17 years with a diagnosis of ADHD will undergo a treatment as usual (TAU) observation phase of 1 month. In step 2, those still severely affected are randomised to the intervention group with an Individualised Modular Treatment Programme (IMTP) or a telephone-assisted self-help programme for parents (TASH) as an active control condition. The IMTP was specifically designed for the needs of adolescent ADHD. It comprises 10 sessions of individual cognitive behavioural therapy with the adolescents and/or the parents, for which participants choose three out of 10 available focus modules (e.g. organisational skills and planning, emotion regulation, problem solving and stress management, dysfunctional family communication). TASH combines a bibliotherapeutic component with 10 counselling sessions for the parents via telephone. Primary outcome is the change in ADHD symptoms in a clinician-rated diagnostic interview. Outcomes are assessed at inclusion into the study, after the TAU phase, after the intervention phase and after a further 12-week follow-up period. The primary statistical analysis will be by intention-to-treat, using linear regression models. Additionally, we will analyse psychometric and biological predictors and moderators of treatment response. Discussion: ESCAadol compares two short-term non-pharmacological interventions as cost-efficient and feasible treatment options for adolescent ADHD, addressing the specific needs and obstacles to treatment success in this group. We aim to contribute to personalised medicine for adolescent ADHD intended to be implemented in routine clinical care. KW - ADHD KW - adolescents KW - attention-deficit/hyperactivity disorder KW - behaviour therapy KW - RCT KW - individualised modular treatment programme KW - telephone-assisted self-help Y1 - 2018 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-176061 VL - 19 IS - 254 ER - TY - JOUR A1 - Geissler, Julia M. A1 - Werner, Elisabeth A1 - Dworschak, Wolfgang A1 - Romanos, Marcel A1 - Ratz, Christoph T1 - German Law Reform Does Not Reduce the Prevalence of Coercive Measures in Residential Institutions for Children, Adolescents, and Young Adults With Intellectual and Developmental Disabilities JF - Frontiers in Psychiatry N2 - Background: Approximately 10% of children, adolescents and young adults with an intellectual and developmental disability (IDD) in Bavaria live in residential institutions. 2015 saw media reports raising suspicions about excessive use of coercive measures (cM) in those institutions. Until a law reform at the end of 2017 made permission from family courts mandatory for cM, their use was governed by parental consent. The REDUGIA project conducted a representative survey comparing cM and their relation to challenging behaviour (cB) and employee stress in Bavaria pre and post reform. Methods: We sent questionnaires to 65 residential institutions for children, adolescents and young adults with IDD in 2017 (pre reform, T1) and 2019 (post reform, T2). To assess changes, we analysed data from all available questionnaire pairs (T1 and T2, N = 43). We calculated paired t-test and correlative analyses concerning the relationship between cB, cM, and employee stress. Results: The number of residents overall (T1: N = 1,661; T2: N = 1,673) and per institution (T1: m = 38.6 ± 32.0; T2: m = 38.9 ± 34.5, p = 0.920) remained stable. We did not see any changes in the Index cB (p = 0.508) or the proportion of residents per institution displaying various types of challenging behaviour (all ps>0.220). There was no change in the Index cM (p = 0.089) or any indicator of employee stress, all ps > 0.323. At follow-up, the Index cB correlated positively with the Index cM (r = 0.519 p < 0.001). Regarding employee stress, the Index cB correlated positively with the frequency of sick leave (r = 0.322, p = 0.037) and physical attacks on employees (r = 0.552, p < 0.001). The Index cM also correlated positively with the frequency of sick leave (r = 0.340, p = 0.028) and physical attacks on employees (r = 0.492, p = 0.001). Discussion: Coercive measures are not a general phenomenon, but are focused on specialised institutions. The law reform did not lead to changes in the number of children, adolescents and young adults with IDD affected by coercive measures in residential institutions in Bavaria. There were still large discrepancies between institutions in the prevalence of challenging behaviour and coercive measures. Coercive measures were associated with challenging behaviour and employee stress. Taken together, findings from REDUGIA emphasise the need to prevent challenging behaviour and thus coercive measures. KW - intellectual disabilities KW - developmental disabilities KW - challenging behaviours KW - employee stress KW - coercive measures KW - residential institutions Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-249030 SN - 1664-0640 VL - 12 ER - TY - JOUR A1 - Geissler, Julia A1 - Werner, Elisabeth A1 - Dworschak, Wolfgang A1 - Romanos, Marcel A1 - Ratz, Christoph T1 - Freiheitsentziehende Maßnahmen in bayerischen Heimeinrichtungen für Kinder, Jugendliche und junge Volljährige mit Intelligenzminderung JF - Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie N2 - Fragestellung: In Bayern leben etwa 10 % aller jungen Menschen mit Intelligenzminderung in Heimeinrichtungen. 2016 wurde in Presseberichten der Vorwurf unzulässiger freiheitsentziehender Maßnahmen formuliert. Im Rahmen des Projekts REDUGIA wurde in bayerischen Heimeinrichtungen eine repräsentative Erhebung zu freiheitsentziehenden Maßnahmen (FeM), herausforderndem Verhalten (hfV) und der Mitarbeiterbelastung (MaB) durchgeführt. Methodik: 65 Einrichtungen für junge Menschen mit Intelligenzminderung in Bayern wurde ein Fragebogen zu strukturellen Gegebenheiten sowie MaB, hfV und FeM zugesendet. Neben deskriptiven Auswertungen wurden korrelative Analysen bzw. Regressionsanalysen zum Zusammenhang zwischen hfV, FeM und MaB durchgeführt. Ergebnisse: Es wurden Daten zu 1839 Personen in 61 Einrichtungen erhoben. 84.3 % der Einrichtungen berichteten geringe Raten an hfV und FeM, während 15.7 % ein gehäuftes Vorkommen von hfV und FeM angaben. Auf n = 1809 Vollzeitäquivalente kam es innerhalb von 14 Tagen zu 639 körperlichen Angriffen durch Bewohner_innen. In 12 Monaten wurden problemverhaltensassoziiert 85 Krankmeldungen sowie 33 Versetzungsanträge/Kündigungen berichtet. Es zeigte sich ein signifikant positiver Zusammenhang zwischen hfV und FeM (R² = .307, F = 21.719, p < .001). Die Mitarbeiterbelastung korrelierte positiv mit hfV (r = .507, p < .001). Schlussfolgerungen: Die Studienbefunde weisen darauf hin, dass hfV sowie FeM bei jungen Menschen mit Intelligenzminderung kein flächendeckendes Phänomen darstellen, sondern sich auf wenige spezialisierte Einrichtungen fokussieren. Mögliche Maßnahmen zur Prävention von Problemverhalten und Freiheitsentzug werden diskutiert. N2 - Objective: In Bavaria, around 10 % of youths with an intellectual disability (ID) live in residential facilities. In 2015, media raised accusations of inadmissible use of coercive measures. The REDUGIA project carried out a representative survey in Bavarian facilities regarding coercive measures (FeM), challenging behavior (hfV), and employee stress (MaB). Method: We sent a questionnaire concerning structural conditions, MaB, hfV and FeM to 65 Bavarian facilities for young people with ID. In addition to preparing descriptive evaluations, we performed correlative and regression analyses concerning the relationship between hfV, FeM, and MaB. Results: We retrieved data from 1,839 subjects in 61 facilities. 84.3 % of facilities reported low rates of hfV and FeM, while 15.7 % reported an increased incidence of hfV and FeM. For n = 1809 full-time position equivalents there were 639 physical attacks by residents over the course of 14 days. We observed 85 instances of sick leave and 33 transfer apllications/resignation associated with hfV. The frequency of hfV predicted the frequency of FeM (R² = 0.307, F = 21.719, p < .001). MaB correlated positively with hfV (r = 0.507, p < .001). Conclusions: The descriptive data indicate that hfV and FeM are not general phenomena but occur mainly in a circumscript number of highly specialized facilities. This emphasizes the need for prevention of hfV and FeM. T2 - Freedom-restricting measures in Bavarian residential facilities for children, adolescents, and young adults with intellectual disabilities KW - Geistige Behinderung KW - herausforderndes Verhalten KW - freiheitsentziehende Maßnahmen KW - Heimeinrichtungen KW - Mitarbeiterbelastung KW - intellectual disability KW - challenging behavior KW - coercive measures KW - residential institutions KW - employee stress Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-244859 SN - 1422-4917 SN - 1664-2880 VL - 49 IS - 4 ER - TY - JOUR A1 - Buerger, Arne A1 - Vloet, Timo D. A1 - Haber, Lisa A1 - Geissler, Julia M. T1 - Third-wave interventions for eating disorders in adolescence - systematic review with meta-analysis JF - Borderline Personality Disorder and Emotion Dysregulation N2 - Context: Third-wave therapies have demonstrated efficacy as a treatment option for EDs in adulthood. Data on the suitability for EDs in adolescence are lacking. Objective: To estimate the efficacy of third-wave interventions to reduce ED symptoms in adolescents in randomized controlled trials (RCTs) and uncontrolled studies. Data sources: We systematically reviewed the databases PubMed (1976-January 2021), PsycINFO (1943-January 2021), and the Cochrane database (1995-January 2021) for English-language articles on third-wave therapies. References were screened for further publications of interest. Study selection: RCTs and pre-post studies without control group, comprising patients aged 11-21 years (mean age = 15.6 years) with an ED diagnosis (anorexia nervosa, bulimia nervosa, binge eating disorder, eating disorder not otherwise specified) investigating the efficacy of third-wave psychological interventions were included. Efficacy had to be evaluated according to the Eating Disorder Examination or Eating Disorder Examination-Questionnaire, the Eating Disorder Inventory-2, the Eating Disorder Inventory-3, or the Structured Interview for Anorexic and Bulimic Disorders for DSM-IV and ICD-10. The outcome assessed in the meta-analysis was the EDE total score. Data extraction: Independent extraction of data by two authors according to a pre-specified data extraction sheet and quality indicators. Data synthesis: We identified 1000 studies after removal of duplicates, assessed the full texts of 48 articles for eligibility, and included 12 studies with a total of 487 participants (female 97.3%/male 2.6%) in the qualitative synthesis and seven studies in the meta-analysis. Articles predominantly reported uncontrolled pre-post trials of low quality, with only two published RCTs. Treatments focused strongly on dialectical behaviour therapy (n = 11). We found moderate effects of third-wave therapies on EDE total score interview/questionnaire for all EDs (d = - 0.67; z = - 5.53; CI95% = - 0.83 to - 0.59). Descriptively, the effects appeared to be stronger in patients with BN and BED. Conclusion: At this stage, it is not feasible to draw conclusions regarding the efficacy of third-wave interventions for the treatment of EDs in adolescence due to the low quality of the empirical evidence. Since almost all of the identified studies used DBT, it is unfortunately not possible to assess other third-wave treatments' efficacy. KW - DBT KW - adolescence KW - eating disorders KW - third-wave psychotherapy KW - meta-analysis KW - review Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-260545 VL - 8 ER - TY - JOUR A1 - Ziegler, Mirjam A1 - Kaiser, Anna A1 - Igel, Christine A1 - Geissler, Julia A1 - Mechler, Konstantin A1 - Holz, Nathalie E. A1 - Becker, Katja A1 - Döpfner, Manfred A1 - Romanos, Marcel A1 - Brandeis, Daniel A1 - Hohmann, Sarah A1 - Millenet, Sabina A1 - Banaschewski, Tobias T1 - Actigraphy-derived sleep profiles of children with and without attention-deficit/hyperactivity disorder (ADHD) over two weeks — comparison, precursor symptoms, and the chronotype JF - Brain Sciences N2 - Although sleep problems are common in children with ADHD, their extent, preceding risk factors, and the association between neurocognitive performance and neurobiological processes in sleep and ADHD, are still largely unknown. We examined sleep variables in school-aged children with ADHD, addressing their intra-individual variability (IIV) and considering potential precursor symptoms as well as the chronotype. Additionally, in a subgroup of our sample, we investigated associations with neurobehavioral functioning (n = 44). A total of 57 children (6–12 years) with (n = 24) and without ADHD (n = 33) were recruited in one center of the large ESCAlife study to wear actigraphs for two weeks. Actigraphy-derived dependent variables, including IIV, were analyzed using linear mixed models in order to find differences between the groups. A stepwise regression model was used to investigate neuropsychological function. Overall, children with ADHD showed longer sleep onset latency (SOL), higher IIV in SOL, more movements during sleep, lower sleep efficiency, and a slightly larger sleep deficit on school days compared with free days. No group differences were observed for chronotype or sleep onset time. Sleep problems in infancy predicted later SOL and the total number of movements during sleep in children with and without ADHD. No additional effect of sleep problems, beyond ADHD symptom severity, on neuropsychological functioning was found. This study highlights the importance of screening children with ADHD for current and early childhood sleep disturbances in order to prevent long-term sleep problems and offer individualized treatments. Future studies with larger sample sizes should examine possible biological markers to improve our understanding of the underlying mechanisms. KW - sleep KW - actigraphy KW - attention-deficit/hyperactivity disorder (ADHD) KW - intra-individual variability (IIV) KW - chronotype KW - children KW - continuous performance task (CPT) KW - precursor symptoms KW - ESCAlife Y1 - 2021 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-250084 SN - 2076-3425 VL - 11 IS - 12 ER - TY - JOUR A1 - Fekete, Stefanie A1 - Kulpok, Christine A1 - Taurines, Regina A1 - Egberts, Karin A1 - Geissler, Julia A1 - Gerlach, Manfred A1 - Malonga Makosi, Dorothée A1 - König, Jochem A1 - Urschitz, Michael S. A1 - Toni, Irmgard A1 - Neubert, Antje A1 - Romanos, Marcel T1 - Value of a web-based pediatric drug information system to prevent serious adverse drug reactions in child and adolescent psychiatry JF - Journal of Neural Transmission N2 - Psychotropic drugs are frequently prescribed ‘off-label’ to children and adolescents and carry the risk of serious adverse drug reactions (sADR). We examined the frequency of sADRs of psychotropic drugs in pediatric inpatients and explored their potential preventability through following the recommendations of a web-based pediatric drug information system (PDIS). The potential socio-economic impacts of using this online system is also addressed. Routine clinical data from all inpatients treated in a child and adolescent psychiatry department between January 2017 and December 2018 were retrospectively examined for the occurrence of sADRs as defined by the European Medicines Agency. The preventability of the sADRs was assessed based on the information of the PDIS. Furthermore, the expected prolongation of the hospital stay due to sADRs was calculated as well as the associated treatment costs. The study was supported by the Innovation Fund of the Joint Federal Committee, grant number 01NVF16021. In total, 1036 patients were screened of whom 658 (63.5%) received psychopharmacological treatment. In 53 (8.1%) of these patients 54 sADRs were documented, of which 37 sADRs were identified as potentially preventable through PDIS. Mitigating sADR through PDIS would likely have prevented prolonged hospital stays and conferred considerable savings for health insurance companies. PDIS provides systematic and evidence-based information about pediatric psychopharmacotherapy and helps to prevent prescribing errors. Therefore, PDIS is a useful tool to increase drug therapy safety in child and adolescent psychiatry. Further prospective studies are needed to confirm the results. KW - adverse effects KW - pharmacovigilance KW - drug safety KW - psychotropic drugs KW - mental health Y1 - 2023 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-324817 VL - 130 IS - 1 ER -