1: J Am Acad Child Adolesc Psychiatry. 2001 Mar;40(3):355-63. Related Articles, Links
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Motivational effects on inhibitory control in children with ADHD.

Slusarek M, Velling S, Bunk D, Eggers C.

Clinic for Child and Adolescent Psychiatry, University of Essen, Germany. michael.slusarek@uni-essen.de

OBJECTIVE: The problems children with attention-deficit/hyperactivity disorder (ADHD) encounter in tasks measuring inhibitory control are often theoretically related to deficits in cognitive processes. This study investigated the effects of different motivational incentives on the ability of children to inhibit intended or ongoing actions. METHOD: In a large German industrial town, 33 children with ADHD were compared with 33 members of a combined group of children with major depressive disorder, anxiety disorders, oppositional defiant disorder, or conduct disorder, and 33 children without any psychiatric disorder with respect to their performances in a stop-signal task. The children received continuous feedback under high- or low-incentive conditions. The children's performance was compared in terms of qualitative (inhibition rate) and quantitative (reaction time) measures. RESULTS: There were no indications of deficits in sustained attention in children with ADHD. Under conditions of low incentives, children with ADHD were less able to inhibit their reactions and had longer stop-signal reaction times. But when given high incentives, children with ADHD performed the task as well as both other groups. CONCLUSIONS: Supposed deficits in children with ADHD should be regarded from a perspective that differentiates performance from ability. Furthermore, the findings support a motivational explanation of the origins of lowered inhibitory control in children with ADHD.

PMID: 11288778 [PubMed - indexed for MEDLINE]

2: Prax Kinderpsychol Kinderpsychiatr. 2001 Jan;50(1):16-30. Related Articles, Links

[Characteristics of communication of schizophrenic, neurotic, and healthy adolescents]

[Article in German]

Wiemer P, Bunk D, Eggers C.

Rheinische Kliniken Essen, Klinik fur Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Postfach 103043, 45030 Essen.

Research on communication skills in psychotic patients demonstrates that in dialogues schizophrenics neglect the needs of the listener. There are only few linguistic studies which investigate the speech of schizophrenic children and adolescents. The verbal and non-verbal communication of schizophrenic, neurotic, and healthy adolescents during a problem solving situation was transcribed and compared by a content analysis. The transcripts were screened for dialogue control and communication disturbance of verbal/non-verbal activities of the speaker and listener: Dialogue control was defined by the variables signals of the speaker or signals of hearer and eye or body contact of the test person to the experimenter. Communication disturbance was defined as the amount of incomprehensible articulation and selections. Neurotic test persons produce the highest signals of speaker rate. In dialogues with neurotic and schizophrenic test persons the experimenter uses more signals of hearer than in dialogues with healthy test persons. In dialogues with neurotic test persons the experimenter shows more signals of the speaker than in dialogues with healthy test persons. Schizophrenics neglect more often the statements of the experimenter than in other dialogues and vice versa. Although the experimenter was instructed to restricted verbal behavior the communication intensified in the neurotic group. The communication in the schizophrenic group was characterized by frequent communication disturbance.

PMID: 11233570 [PubMed - indexed for MEDLINE]

3: J Autism Dev Disord. 2000 Feb;30(1):29-38. Related Articles, Links
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Schizophrenia with onset before the age of eleven: clinical characteristics of onset and course.

Eggers C, Bunk D, Krause D.

Rheinische Landes- und Hochschulklinik, Klinik fur Kinder- und Jugendpsychiatrie, Essen, Germany.

This study reports on the long-term course of 11 patients (6 girls, 5 boys) with childhood onset schizophrenia (COS, age at onset < 10 years). Patients were examined twice (mean follow-up period 38 years after onset). The premorbid development is assessed in terms of the Modified Premorbid Adjustment Scale (M-PAS) and additionally described by distinct psychopathological categories. The psychopathology at the onset of psychosis and at the second follow-up examination was assessed by categorical application of the Positive and Negative Syndrome Scale (PANSS). The outcome was rated with the Disability Assessment Score (DAS). The course of psychotic episodes and intervals between them is presented according to DSM-IV subtype classifications. Ten of 11 patients presented premorbid developmental peculiarities that were not adequately covered by the M-PAS subscales. Whereas in the 4 patients with acute onset of psychosis the positive PANSS-type was predominant, in the 7 patients with an insidious onset the negative PANSS-type prevailed. The nature of the diagnostic subtypes varied markedly across the course of the illness. In case of a continuous predominant catatonic symptomatology the outcome was poor. Detailed case descriptions help to illuminate the heterogeneous psychopathology of COS. Various temporary premorbid behavioral peculiarities were precursors of COS. A differentiation between premorbid and prodromal signs proved to be arbitrary. Our results contradict the assumption that COS is characterized only by a negative symptomatology.

PMID: 10819118 [PubMed - indexed for MEDLINE]

4: Eur Child Adolesc Psychiatry. 1999;8 Suppl 1:I29-35. Related Articles, Links
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Symptom dimensions in the course of childhood-onset schizophrenia.

Bunk D, Eggers C, Klapal M.

Klinik fur Kinder- und Jugendpsychiatrie Universitat Essen, Germany. detlef.bunk@uni-essen.de

The symptom dimensions of childhood-onset schizophrenia (COS) are described by focussing on the clinical features of 44 patients at onset of illness during the first episode and at follow-up investigation 42 years after onset. All subjects were re-diagnosed according to DSM IV. The symptomatology was evaluated with the Positive and Negative Symptom Scale (PANSS) at onset and at follow-up. Two principal component factor analyses with varimax-rotation were applied to the complete items set of the PANSS. The frequencies of positive, negative, and global symptoms were compared longitudinally in an ANOVA-repeated measures design. The factor analysis revealed 5 orthogonal symptom dimensions (factors) at onset of psychosis: Cognition, social withdrawal, antisocial behaviour, excitement, and reality distortion. At follow-up a five-factor solution was found, too, but different dimensions emerged: a positive, negative, excitement, cognitive, and anxiety/depression component which fits to the 5-factor model of White et al. (1997). The first psychotic episode of EOS is accompanied with more unspecific symptoms such as social withdrawal and antisocial behavior. In the later stages of (COS) the structure of symptom dimensions changes to that known from adult-onset schizophrenia (AOS). The results indicate that COS and AOS are comparable nosological entities and that more than 3 dimensions are required to describe the relevant clinical symptom structure. Positive and global symptoms decreased significantly during the course of illness. The frequencies of negative symptoms did not change which demonstrates their disabling impact.

Publication Types:

PMID: 10546981 [PubMed - indexed for MEDLINE]

5: Eur Child Adolesc Psychiatry. 1999;8 Suppl 1:I21-8. Related Articles, Links
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The ESSEN study of childhood-onset schizophrenia: selected results.

Eggers C, Bunk D, Volberg G, Ropcke B.

Rheinische Kliniken Essen, Klinik fur Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Germany.

INTRODUCTION: We present the results of a 42 year long-term follow-up of 44 patients (19 males, 25 females) with childhood-onset schizophrenia (COS, age at onset: 7-14 years) who could be traced for a second follow-up examination 27 years after the first follow-up. METHOD: Data from interviews, clinical records, premorbid and social disability assessments were evaluated for statistical analyses. The symptomatology observed during the whole course of illness was rediagnosed by DSM-IV criteria. RESULTS: The paranoid, catatonic, and schizoaffectives subtypes appeared most frequently. There have been no gender differences in age of first psychiatric symptoms (AFS), AFPS, and age of first hospitalization. Kaplan-Meier's survival-analysis carried out for AFPS with sex as the grouping factor revealed that the cumulative prevalence appears to be earlier in females (between 7 and 15 years) than in males (between 10 and 18 years). Of the 44 patients 50 % had a continuing severe course. Patients with onset before 12 years of age were characterized by a chronic/insidious onset, marked premorbid abnormalities, and by a poorer remission. Premorbid features of social withdrawal and reluctance indicated a risk for social disability within the later course. CONCLUSION: COS, as a rare but severe variant of schizophrenia, frequently develops from premorbid social maladaptation to an insidious onset but is subsequently followed by a transition to a course and outcome not distinguishable from that of adult-onset schizophrenia.

Publication Types:

PMID: 10546980 [PubMed - indexed for MEDLINE]

6: Nervenarzt. 1998 Mar;69(3):238-42. Related Articles, Links
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[The 5 factor model of childhood schizophrenia]

[Article in German]

Klapal M, Eggers C, Bunk D, Koriath H.

Klinik fur Kinder- und Jugendpsychiatrie, Rheinische Landes- und Hochschulklinik, Essen.

Forty-four first-admission patients with childhood-onset schizophrenia (age at onset < or = 14 years) were examined retrospectively for 30 clinical symptoms using the Positive and Negative Syndrome Scale (PANSS; 15). A principal component analysis with varimax rotation was applied to the full item set of this scale and revealed five orthogonal independent symptom groups: cognition affect, social withdrawal, anti-social behavior, excitement, and reality distortion. In order to validate these psychopathological dimensions we analyzed the relation between the five factor scores and outcome variables (Disability Assessment Schedule, DAS-M; 13) several years after onset: Social withdrawal was correlated with poor outcome; reality distortion was related to good outcome (P < 0.01). A multivariate ANOVA identified group differences in the anti-social behavior factor between acute and insidious onset of illness and between boys and girls; patients with an acute onset scored significantly higher on the excitement factor than those with an insidious onset (P < 0.05). According to our results more than two dimensions are necessary to describe the psychopathology of childhood-onset schizophrenia, similar to adolescent- and adult-onset schizophrenia.

PMID: 9565978 [PubMed - indexed for MEDLINE]

7: Schizophr Bull. 1997;23(1):105-17. Related Articles, Links

The long-term course of childhood-onset schizophrenia: a 42-year followup.

Eggers C, Bunk D.

University of Essen, Clinic for Child and Adolescent Psychiatry, Germany.

This article presents results of a 42-year long-term followup of 44 patients (19 males, 25 females) with childhood-onset schizophrenia. Age at onset ranged from 6 to 14 years (mean =11.8 years). The patients and their first-degree relatives were interviewed in 1994, 27 years after the first followup, by the same investigator with the Present-State Examination (PSE) and the Disability Assessment Schedule. The clinical records were analyzed with the Instrument for the Retrospective Assessment of Onset of Schizophrenia and with sections of the PSE. The cases were rediagnosed according to DSM-III-R, based on longitudinal data obtained between onset and the first hospital admission. Although cumulative prevalence is earlier in females than in males, no gender differences exist in average age at onset. An acute onset was significantly more frequent after 12 years of age. An early age at onset was correlated with high social disability scores. Of the patients, 25 percent were completely, 25 percent partially, and 50 percent were poorly remitted at the second followup. None of the patients with chronic onset remitted completely. The results are discussed with respect to epidemiology, gender differences, and etiological hypotheses of childhood schizophrenia.

PMID: 9050117 [PubMed - indexed for MEDLINE]

8: Fortschr Neurol Psychiatr. 1993 Feb;61(2):38-45. Related Articles, Links

[The significance of psychodynamic relationship factors for psychopathogenesis in childhood Nazi persecution]

[Article in German]

Bunk D, Eggers C.

Rheinische Landes- u. Hochschul-Klinik, Klinik fur Kinder- u. Jugendpsychiatrie, Essen.

This study focuses on psychiatric disorders following extreme traumatisation experienced by children born during the Holocaust in World War II. According to numerous epidemiological investigations and case studies on survivors who lived through the Holocaust as children or in adulthood, these traumatic experiences are associated with a higher risk for various psychiatric disturbances during the entire life span. Besides the extreme psychological and physical distress during persecution and following traumatisation (parent-child-separation, discrimination while living in other countries) the coping with the trauma and the development of autonomy and ego-strength is additionally impaired by the specific psychodynamics of families with psychologically altered and disturbed parents. OBJECTIVE: What sort of psychodynamic parent-child relationships developed during traumatisation and after the war in subjects currently suffering from chronic impairment of mental health? METHOD: Retrospective analysis of 22 cases with applications for pensions of invalids evaluated by diagnostic categories. RESULTS: The implicit pressure on the children to be sensitive to the needs of their deprived parents places a sense of guilt on their attempts to develop autonomy. The parents were experienced as restrictive or overprotective on the one hand or liable to be rejected or to be intolerant on the other. The suffering and trauma continues to be perceived in family communication to the extent that coping with loss of relatives and the development of independence are impaired. CONCLUSION: The results are discussed critically in terms of current procedures for expertise on pension applications.

PMID: 8449476 [PubMed - indexed for MEDLINE]

9: Acta Paedopsychiatr. 1992;55(3):183-4. Related Articles, Links

Paranoid schizophrenics may not use irrelevant signals. The use of measures of blocking and of urinary dopamine.

Oades RD, Bunk D, Eggers C.

University Clinic for Child and Adolescent Psychiatry, Essen, Federal Republic of Germany.

Conditioned blocking tests for the use of superfluous (irrelevant) information in task-solving. Paranoid psychotic, obsessive-compulsive and healthy subjects usually showed normal blocking, but non-paranoid subjects tended to learn about the superfluous stimulus. Attenuated blocking was usually associated with increased dopamine utilization measured in 24h urine samples. This may reflect poor stabilization of response to neuroleptic medication.

PMID: 1357915 [PubMed - indexed for MEDLINE]

10: Prax Kinderpsychol Kinderpsychiatr. 1991 Apr;40(4):134-7. Related Articles, Links

[The effectiveness of the Background Interference Procedure in psychiatric differential diagnosis of organic brain damage in children]

[Article in German]

Bunk D, Schall U.

Klinik fur Kinder- und Jugendpsychiatrie, Universitat Gesamthochschule Essen.

The Background Interference Procedure (BIP) is an improved psychological test to discriminate brain damaged and non brain damaged adults. In the present study the efficiency of the BIP was compared to the psychometric standard for children, the Gottinger Formenreproduktions-Test, in a sample of 14 girls and 26 boys between 7 and 13 years with minimal brain dysfunction. The background interference condition increased significantly the error rate for the reproduction of the test items, and the BIP yielded a significant concurrent validity with neurological criteria. In particular, an impaired motor coordination was effectively predicted. It is concluded that the BIP is an efficient psychometric aid for determining the organic contribution to psychiatric syndromes in children.

PMID: 1857678 [PubMed - indexed for MEDLINE]

11: Prax Kinderpsychol Kinderpsychiatr. 1987 Jan;36(1):8-15. Related Articles, Links

[Disorders of cognitive function in children and adolescents with acute psychoses and those at risk for schizophrenia]

[Article in German]

Bunk D, Eggers C.

PMID: 3562406 [PubMed - indexed for MEDLINE]