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Objective: This study was designed to determine patterns of regional brain activation during emotional stimulation in alexithymics as compared with normal controls., Method: We used 15O-water positron emission tomography and an emotional stimulation paradigm based upon autobiographic recall of either happy, sad or emotionally neutral situations. 10 normal subjects without medical or psychiatrical history were compared with 9 patients with somatoform disorder without any other DSM-IV diagnosis. TAS-20 was used as a measure for alexithymia, depression was measured using BDI., Results: Normal controls showed significantly greater activation than alexithymics in cingulate areas, corpus callosum, and right superior and inferior frontal gyrus. Alexithymics activated significantly more in cuneus and precuneus, thalamus (pulvinar), left medial frontal, right inferior temporal, left superior temporal regions, left precentral gyrus, and the cerebellum., Conclusions: During emotional autobiographic recall, alexithymia, either trait or state, is characterized by utilization of different brain regions when compared to normal controls. The areas activated by alexithymic persons largely comprise of language related regions, leaving out limbic and paralimbic areas.

The purpose of the following study was a multidimensional assessment of the course of anorexia nervosa. In our follow-up-study we were able to examine 41 out of 51 patients meeting DMS-111 R criteria for anorexia nervosa in our department at a mean follow-up of 5.3 years. At the first evaluation the patients were characterized by an early age of onset (mean 14.2 years), no or very little previous psychiatric treatment, and restrictive eating habits (72.5%); the mean age was 15.2 years. At the time of follow-up, the physical outcome was unfavourable for 50% of the patients; one patient had died. The psychosocial outcome was less favourable for 60%. Against the background of a neurotic structure, social and sexual disturbances were found although the patient's weight was often normal. Depressive symptoms and a "slimness ideal" were found among a large number of patients, just as much as the fear of gaining weight--which prove to be a reliable indicator for the continuation of an eating disorder. A multidimensional evaluation facilitates an assessment of the determinants of prognosis. Previous psychiatric treatment and low body weight were associated with an unfavourable, mention of problems/disturbances in the family environment with a good somatic outcome. Outpatient treatment indicates a favourable psychosocial outcome.

The notions hitherto existing of the beginnings of child analysis have to be rectified. The meaning of childhood neuroses within the scope of scientific theory, i.e. the sexual genesis of the neuroses can no longer be maintained. The approach of distinguishing between the latent period and the Oedipus complex as the two phases of sexual development can nowadays be considered to be refuted. The personality of the first children's analyst--Hermine Hug-Hellmuth--needs to be redescribed. She fell victim to her father-transference and deceased murdered by her nephew with the help of whom she had satisfied her own scientific ambitions.

Psychological disorders which become manifest as adolescent crises must be seen as complex phenomena and treated thoroughly: besides the genetic, biographic and psychosocial background of the youthful individual the cultural and economic aspects play an important role. Nevertheless we must admit that associated causal explanations, e.g. for accelerated or late development are lacking. Focal points for the subsequent symptom complexes of sexual behavior in puberty are: psychosexual prematurity or retardation, masturbation, homosexual relations, pubertal asceticism and premature and frequently changing sexual relations.

From 1966 to 1986, the Department of Child and Adolescent Psychiatry of the Psychiatric Hospital of the University of Heidelberg gave expert opinions at the request of criminal courts in 37 cases involving homicide and 8 attempted homicide. Eighteen of the offenders were between 14 and 17 years old ("Jugendliche" under German law), 17 between 18 and 20 ("Heranwachsende") and 2 over 20. The largest group (N = 18) consisted of maladjusted male adolescents who had grown up in disadvantageous surroundings, had limited education and, not infrequently following the example of other members of their families, tended to show aggressive behaviour, intolerance to frustration, emotional instability and uncontrolled drinking. The questions the expert was asked by the court were mainly concerned with: liability for crime (section 3 JGG), applicability of juvenile law to offenders aged 18 to 20 years (section 105 JGG) penal responsibility (section 20 and 21 StBG or section 51, Section 1 and 2 StGB a.F.), and measures under section 63 StGB. The court took the expert's position in 28 of the 33 decisions which we were able to obtain for examination; 2 other proceedings were quashed. The juridical classification of the homicides was attempted or completed first-degree murder in 17 and attempted or completed second-degree murder in 6 cases.

After considerable controversies during the last decades there is no longer any doubt about childhood schizophrenia as a disease, although within German-speaking countries its somewhat wider definition like in Anglo-Saxon child- and adolescent psychiatry is not accepted. The relation of early childhood autism to the nosologic entity of schizophrenia still remains speculative. The etiology of childhood schizophrenia is not known, equally not that of the even less frequent manic-depressive disease. Symptoms, course, and prognosis of childhood schizophrenia which developes between preschool age and the begin of puberty are described in detail.