Stabilization of Circadian Rhythm, Its Augmentation by Bright Light Treatment and Its Importance for ADHD and Depression of Adolescents

Objective: ADHD is characterized by the progressive development of, impulsiveness, attentional difficulties and sometimes also excessive hyperactivity. Main biological reason is a quantitative reduction of the neurotransmitter dopamine in the forebrain. A lack of dopamine is also typical for depressive disorders. Methods: Bright light therapy is proven to be effective in treating depression. Purpose of our study is to verify the therapeutic effectiveness of Bright light therapy in subjects affected by ADHD. Results: Results show a significant improvement which lasts for at least 4 weeks, which is superposed by regulation of the circadian rhythm. Initial decrease of especially morning saliva melatonin levels, due to regular sleep under in-patient conditions, is followed by symptom improvement and a raising evening melatonin level, due to activation during the day. This level decreases as soon as activation is ceased. Conclusion: Bright light therapy seems to be effective as add-on therapy for ADHD, but in fact, stabilization of the circadian rhythm is the most important therapeutic intervention, either for ADHD or for depression, as demonstrated in another study.

Sleep problems, strengths and difficulties in elementary school children

Aim: To assess behavioral and sleep disturbances in childhood, it is necessary to implement standardized brief questionnaires for children and their parents. Especially complaints of insomnia often are underdiagnosed in pediatric medicine. Methods: We developed a sleep questionnaire (K?SI-KJ) and used it together with German versions of the SDQ (parent and child reports) for epidemiologic studies in Cologne. The sleep questionnaire obtains 33 items for parents and 28 items for children. Ratings were dichotomized for this analysis in “sometimes/ often present” versus “not present”. The German versions of SDQ contain 5 subscales each with 5 items. Data from a sample of 1490 children of fourth grade in elementary schools inCologne(age ranged from 8 to 11 years) are shown. Results: Children indicate signs of sleep disturbances in higher frequency than their parents do. Concerning gender and ethnical group, there no significant differences can be shown. Children with signs of insomnia, dyssomnia, daytime sleepiness or restless sleep?showed significantly higher scores for all relevant SDQ subscales in parental and children's reports. Children with signs of parasomnia showed higher scores concerning emotional problems and the SDQ total score. Children with enuresis showed higher scores for all SDQ subscales and the total score.

Clinical high-risk criteria of psychosis in 8–17-year-old community subjects and inpatients not suspected of developing psychosis

BACKGROUND In children and adolescents compared to adults,clinical high-risk of psychosis(CHR)criteria and symptoms are more prevalent but less psychosis-predictive and less clinically relevant.Based on high rates of non-converters to psychosis,especially in children and adolescents,it was suggested that CHR criteria were:(1)Pluripotential;(2)A transdiagnostic risk factor;and(3)Simply a severity marker of mental disorders rather than specifically psychosis-predictive.If any of these three alternative explanatory models were true,their prevalence should differ between persons with and without mental disorders,and their severity should be associated with functional impairment as a measure of severity.AIM To compare the prevalence and severity of CHR criteria/symptoms in children and adolescents of the community and inpatients.METHODS In the mainly cross-sectional examinations,8–17-year-old community subjects(n=233)randomly chosen from the population register of the Swiss Canton Bern,and inpatients(n=306)with primary diagnosis of attention-deficit/hyperactivity disorder(n=86),eating disorder(n=97),anxiety including obsessive–compulsive disorder(n=94),or autism spectrum disorder(n=29),not clinically suspected to develop psychosis,were examined for CHR symptoms/criteria.Positive items of the Structured Interview for Psychosis-Risk Syndromes(SIPS)were used to assess the symptomatic ultra-high-risk criteria,and the Schizophrenia Proneness Instrument,Child and Youth version(SPI-CY)was used to assess the 14 basic symptoms relevant to basic symptom criteria.We examined group differences in frequency and severity of CHR symptoms/criteria usingχ^(2) tests and nonparametric tests with Cramer’s V and Rosenthal’s r as effect sizes,and their association with functioning using correlation analyses.RESULTS The 7.3%prevalence rate of CHR criteria in community subjects did not differ significantly from the 9.5%rate in inpatients.Frequency and severity of CHR criteria never differed between the community and the four inpatient groups,while the frequency and severity of CHR symptoms differed only minimally.Group differences were found in only four CHR symptoms:suspiciousness/persecutory ideas of the SIPS[χ2(4)=9.425;P=0.051,Cramer’s V=0.132;and Z=-4.281,P<0.001;Rosenthal’s r=0.184],and thought pressure[χ^(2)(4)=11.019;P=0.026,Cramer’s V=0.143;and Z=-2.639,P=0.008;Rosenthal’s r=0.114],derealization[χ2(4)=32.380;P<0.001,Cramer’s V=0.245;and Z=-3.924,P<0.001;Rosenthal’s r=0.169]and visual perception disturbances[χ^(2)(4)=10.652;P=0.031,Cramer’s V=0.141;and Z=-2.822,P=0.005;Rosenthal’s r=0.122]of the SPI-CY.These were consistent with a transdiagnostic risk factor or dimension,i.e.,displayed higher frequency and severity in inpatients,in particular in those with eating,anxiety/obsessive–compulsive and autism spectrum disorders.Low functioning,however,was at most weakly related to the severity of CHR criteria/symptoms,with the highest correlation yielded for suspiciousness/persecutory ideas(Kendall’s tau=-0.172,P<0.001).CONCLUSION The lack of systematic differences between inpatients and community subjects does not support suggestions that CHR criteria/symptoms are pluripotential or transdiagnostic syndromes,or merely markers of symptom severity.

Exploiting moderate hypoxia to benefit patients with brain disease: Molecular mechanisms and translational research in progress

Hypoxia is increasingly recognized as an important physiological driving force.A specific transcriptional program,induced by a decrease in oxygen(O2)availability,for example,inspiratory hypoxia at high altitude,allows cells to adapt to lower O2 and limited energy metabolism.This transcriptional program is partly controlled by and partly independent of hypoxia-inducible factors.Remarkably,this same transcriptional program is stimulated in the brain by extensive motor-cognitive exercise,leading to a relative decrease in O2 supply,compared to the acutely augmented O2 requirement.We have coined the term“functional hypoxia”for this important demand-responsive,relative reduction in O2 availability.Functional hypoxia seems to be critical for enduring adaptation to higher physiological challenge that includes substantial“brain hardware upgrade,”underlying advanced performance.Hypoxia-induced erythropoietin expression in the brain likely plays a decisive role in these processes,which can be imitated by recombinant human erythropoietin treatment.This article review presents hints of how inspiratory O2 manipulations can potentially contribute to enhanced brain function.It thereby provides the ground for exploiting moderate inspiratory plus functional hypoxia to treat individuals with brain disease.Finally,it sketches a planned multistep pilot study in healthy volunteers and first patients,about to start,aiming at improved performance upon motor-cognitive training under inspiratory hypoxia.

Applying latent tree analysis to classify Traditional Chinese Medicine syndromes(Zheng)in patients with psoriasis vulgaris

OBJECTIVE:To treat patients with psoriasis vulgaris using Traditional Chinese Medicine(TCM),one must stratify patients into subtypes(known as TCM syndromes or Zheng)and apply appropriate TCM treatments to different subtypes.However,no unified symptom-based classification scheme of subtypes(Zheng)exists for psoriasis vulgaris.The present paper aims to classify patients with psoriasis vulgaris into different subtypes via the analysis of clinical TCM symptom and sign data.METHODS:A cross-sectional survey was carried out in Beijing from 2005-2008,collecting clinical TCM symptom and sign data from 2764 patients with psoriasis vulgaris.Roughly 108 symptoms and signs were initially analyzed using latent tree analysis,with a selection of the resulting latent variables then used as features to cluster patients into subtypes.RESULTS:The initial latent tree analysis yielded a model with 43 latent variables.The second phase of the analysis divided patients into three subtype groups with clear TCM Zheng connotations:'blood deficiency and wind dryness';'blood heat';and'blood stasis'.CONCLUSIONS:Via two-phase analysis of clinic symptom and sign data,three different Zheng subtypes were identified for psoriasis vulgaris.Statistical characteristics of the three subtypes are presented.This constitutes an evidence-based solution to the syndromedifferentiation problem that exists with psoriasis vulgaris.