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Background: Early diagnosis and treatment of mental illnesses is hampered by the lack of reliable markers. This study used machine learning models to uncover diagnostic and risk prediction markers for eating disorders (EDs), major depressive disorder (MDD), and alcohol use disorder (AUD)., Methods: Case-control samples (aged 18-25 years), including participants with Anorexia Nervosa (AN), Bulimia Nervosa (BN), MDD, AUD, and matched controls, were used for diagnostic classification. For risk prediction, we used a longitudinal population-based sample (IMAGEN study), assessing adolescents at ages 14, 16 and 19. Regularized logistic regression models incorporated broad data domains spanning psychopathology, personality, cognition, substance use, and environment., Results: The classification of EDs was highly accurate, even when excluding body mass index from the analysis. The area under the receiver operating characteristic curves (AUC-ROC [95 % CI]) reached 0.92 [0.86-0.97] for AN and 0.91 [0.85-0.96] for BN. The classification accuracies for MDD (0.91 [0.88-0.94]) and AUD (0.80 [0.74-0.85]) were also high. The models demonstrated high transdiagnostic potential, as those trained for EDs were also accurate in classifying AUD and MDD from healthy controls, and vice versa (AUC-ROCs, 0.75-0.93). Shared predictors, such as neuroticism, hopelessness, and symptoms of attention-deficit/hyperactivity disorder, were identified as reliable classifiers. In the longitudinal population sample, the models exhibited moderate performance in predicting the development of future ED symptoms (0.71 [0.67-0.75]), depressive symptoms (0.64 [0.60-0.68]), and harmful drinking (0.67 [0.64-0.70])., Conclusions: Our findings demonstrate the potential of combining multi-domain data for precise diagnostic and risk prediction applications in psychiatry., Competing Interests: Declaration of competing interest Dr. Banaschewski served in an advisory or consultancy role for Lundbeck, Medice, Neurim Pharmaceuticals, Oberberg GmbH, Shire. He received conference support or speaker's fee by Lilly, Medice, Novartis and Shire. He has been involved in clinical trials conducted by Shire & Viforpharma. He received royalties from Hogrefe, Kohlhammer, CIP Medien, Oxford University Press. Dr. Barker has received honoraria from General Electric Healthcare for teaching on scanner programming courses. Dr. Poustka served in an advisory or consultancy role for Roche and Viforpharm and received speaker's fee by Shire. She received royalties from Hogrefe, Kohlhammer and Schattauer. M. John Broulidakis receives a salary from medical device manufacturer Emteq Labs for which he works as a research scientist. Emteq Labs had no role, financial or otherwise, in the STRATIFY or IMAGEN projects or this paper in particular. Views expressed in this paper do not necessarily reflect those of Emteq Labs. The present work is unrelated to the above grants and relationships. The other authors report no biomedical financial interests or potential conflicts of interest., (Copyright © 2024. Published by Elsevier B.V.)

Background: Personality traits have been associated with eating disorders (EDs) and comorbidities. However, it is unclear which personality profiles are premorbid risk rather than diagnostic markers., Methods: We explored associations between personality and ED-related mental health symptoms using canonical correlation analyses. We investigated personality risk profiles in a longitudinal sample, associating personality at age 14 with onset of mental health symptoms at ages 16 or 19. Diagnostic markers were identified in a sample of young adults with anorexia nervosa (AN, n = 58) or bulimia nervosa (BN, n = 63) and healthy controls (n = 47)., Results: Two significant premorbid risk profiles were identified, successively explaining 7.93 % and 5.60 % of shared variance (R c 2 ). The first combined neuroticism (canonical loading, r s  = 0.68), openness (r s  = 0.32), impulsivity (r s  = 0.29), and conscientiousness (r s  = 0.27), with future onset of anxiety symptoms (r s  = 0.87) and dieting (r s  = 0.58). The other, combined lower agreeableness (r s  = -0.60) and lower anxiety sensitivity (r s  = -0.47), with future deliberate self-harm (r s  = 0.76) and purging (r s  = 0.55). Personality profiles associated with "core psychopathology" in both AN (R c 2  = 80.56 %) and BN diagnoses (R c 2  = 64.38 %) comprised hopelessness (r s  = 0.95, 0.87) and neuroticism (r s  = 0.93, 0.94). For BN, this profile also included impulsivity (r s  = 0.60). Additionally, extraversion (r s  = 0.41) was associated with lower depressive risk in BN., Limitations: The samples were not ethnically diverse. The clinical cohort included only females. There was non-random attrition in the longitudinal sample., Conclusions: The results suggest neuroticism and impulsivity as risk and diagnostic markers for EDs, with neuroticism and hopelessness as shared diagnostic markers. They may inform the design of more personalised prevention and intervention strategies., Competing Interests: Declaration of competing interest Dr. Banaschewski served in an advisory or consultancy role for ADHS digital, Infectopharm, Lundbeck, Medice, Neurim Pharmaceuticals, Oberberg GmbH, Roche, and Takeda. He received conference support or speaker's fee by Medice and Takeda. He received royalties from Hogrefe, Kohlhammer, CIP Medien, Oxford University Press. Dr. Poustka served in an advisory or consultancy role for Roche and Viforpharm and received speaker's fee by Shire. She received royalties from Hogrefe, Kohlhammer and Schattauer. The present work is unrelated to these relationships. The other authors report no biomedical financial interests or potential conflicts of interest., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Digital Beacons of Hope? The Challenges and Potentials of Digital Health Applications for Children and Adolescents with Mental Disorders in Germany Abstract: With the Digital Healthcare Act, Germany has taken a decisive step toward promoting high-quality, evidence-based digital health applications (DiHAs). Presently, there is a significant gap in the provision of mental health services throughout Germany, particularly regarding children and adolescents and especially in the aftermath of the COVID-19 pandemic. DiHAs as low-threshold, location- and time-independent additional mental health services - may offer a way to address this situation. Particularly in the emerging generation of digital natives, there is a high demand for digital mental health services. However, despite the rapidly growing supply of DiHAs for adults, there is a lack of approved DiHAs for children and adolescents with mental disorders. Rather, the demand for care is left to the unregulated market of diverse internet- and mobile-based interventions; early studies have questioned the evidence base, safety, and quality. This discrepancy arises from various specific challenges and risks that reduce incentives to develop DiHAs for this particularly vulnerable target group, including (1) limited evidence, (2) high complexity in study execution, (3) high complexity in the development of applications, (4) poorly researched specific risks, and (5) high regulatory requirements. This article discusses these challenges and risks and outlines the perspectives for a high-quality, safe, and evidence-based digital mental healthcare for children and adolescents.

Traumatic experiences and maltreatment are highly prevalent among adolescents in foster or institutional care and have severe long-term effects on mental health. Childhood maltreatment increases the risk of revictimization. This study aimed to evaluate the efficacy of the internet-based prevention program EMPOWER YOUTH in reducing victimization experiences among youth with care experience. A total of 163 youth, that is, adolescents in foster or institutional care, adopted adolescents, or young care leavers aged 14 to 21 years ( M age = 17.68 years; SD = 2.11) were randomized to the six-module guided program or a wait-list control group. The primary endpoint was the decrease in victimization experiences at an 18-week follow-up. Secondary endpoints included risk perception, aggressive tendencies, empathy, prosocial behavior, depressiveness, post-traumatic stress symptoms, and loneliness. About half of the youth exhibited increased psychopathology. No significant interaction between time-point and group was found for victimization measures, though both groups saw a significant reduction over time ( p = 0.012, η p 2 = 0.06; p = 0.017, η p 2 = 0.06). The intervention group showed a significant increase in perception of thrill-seeking and rebellious risks ( p = 0.036, η p 2 = 0.04; p = 0.026, η p 2 = 0.05). While EMPOWER YOUTH effectively increased risk perception of thrill-seeking and rebellious behaviors, it should be considered an add-on to more intensive interventions for common mental health disorders in this vulnerable group, rather than a stand-alone online program.

Background: Research has demonstrated the damaging effects of poly-victimization on the mental health of children and adolescents. However, few studies have been conducted in high-risk youth in care (Y-IC) samples., Objective: The study examines the frequency of lifetime victimization and the association of poly-victimization and victimization types on depressiveness, suicidality, and feelings of loneliness among Y-IC., Participants and Setting: 164 participants aged 14 and 21 years (M = 17.39, SD = 1.95), who live in family-based care or residential care., Methods: The Juvenile Victimization Questionnaire (JVQ) was used to assess lifetime victimization. The Patient Health Questionnaire (PHQ-9), and the Loneliness Scale-SOEP (LS-S) to measure depressiveness, suicidality, and loneliness. Hierarchical regression models were calculated., Results: Participants reported on average 12.66 (SD = 6.58) victimization experiences. The female and diverse gender groups reported higher rates of victimization, loneliness, depressiveness, and suicidality than the males. Participants in residential care reported more victimizations and stronger feelings of loneliness than those in family-based care. Poly-victimization was not associated with any of these internalizing symptoms but peer victimization was significantly associated with depressiveness (β = 0.23, p = .002) and loneliness (β = 0.22, p = .006), sexual victimization with depressiveness (β = 0.22, p = .004)., Conclusion: Y-IC show high levels of victimization and internalizing symptoms, with higher burden on girls and youth living in residential care. Findings underscore the relevance of social exclusion experiences among peers within Y-IC. Interventions should address multiple forms of victimization, with a special focus on sexual and peer victimization., Competing Interests: Declaration of competing interest None., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Identifying youths most at risk to COVID-19-related mental illness is essential for the development of effective targeted interventions., Aims: To compare trajectories of mental health throughout the pandemic in youth with and without prior mental illness and identify those most at risk of COVID-19-related mental illness., Method: Data were collected from individuals aged 18-26 years ( N = 669) from two existing cohorts: IMAGEN, a population-based cohort; and ESTRA/STRATIFY, clinical cohorts of individuals with pre-existing diagnoses of mental disorders. Repeated COVID-19 surveys and standardised mental health assessments were used to compare trajectories of mental health symptoms from before the pandemic through to the second lockdown., Results: Mental health trajectories differed significantly between cohorts. In the population cohort, depression and eating disorder symptoms increased by 33.9% (95% CI 31.78-36.57) and 15.6% (95% CI 15.39-15.68) during the pandemic, respectively. By contrast, these remained high over time in the clinical cohort. Conversely, trajectories of alcohol misuse were similar in both cohorts, decreasing continuously (a 15.2% decrease) during the pandemic. Pre-pandemic symptom severity predicted the observed mental health trajectories in the population cohort. Surprisingly, being relatively healthy predicted increases in depression and eating disorder symptoms and in body mass index. By contrast, those initially at higher risk for depression or eating disorders reported a lasting decrease., Conclusions: Healthier young people may be at greater risk of developing depressive or eating disorder symptoms during the COVID-19 pandemic. Targeted mental health interventions considering prior diagnostic risk may be warranted to help young people cope with the challenges of psychosocial stress and reduce the associated healthcare burden.

Recent studies proposed a general psychopathology factor underlying common comorbidities among psychiatric disorders. However, its neurobiological mechanisms and generalizability remain elusive. In this study, we used a large longitudinal neuroimaging cohort from adolescence to young adulthood (IMAGEN) to define a neuropsychopathological (NP) factor across externalizing and internalizing symptoms using multitask connectomes. We demonstrate that this NP factor might represent a unified, genetically determined, delayed development of the prefrontal cortex that further leads to poor executive function. We also show this NP factor to be reproducible in multiple developmental periods, from preadolescence to early adulthood, and generalizable to the resting-state connectome and clinical samples (the ADHD-200 Sample and the Stratify Project). In conclusion, we identify a reproducible and general neural basis underlying symptoms of multiple mental health disorders, bridging multidimensional evidence from behavioral, neuroimaging and genetic substrates. These findings may help to develop new therapeutic interventions for psychiatric comorbidities., (© 2023. The Author(s).)

Objective: Adolescence is a critical period for circadian rhythm, with a strong shift toward eveningness around age 14. Also, eveningness in adolescence has been found to predict later onset of depressive symptoms. However, no previous study has investigated structural variations associated with chronotype in early adolescence and how this adds to the development of depressive symptoms., Method: Assessment of 128 community-based adolescents (51% girls) at age 14 and 19 years was performed. Using whole-brain voxel-based morphometry, baseline (at age 14) regional gray matter volumes (GMVs), follow-up (at age 19) regional GMVs, and longitudinal changes (between 14 and 19) associated with Morningness/Eveningness Scale in Children score and sleep habits at baseline were measured. The association of GMV with depressive symptoms at 19 years was studied, and the role of potential clinical and genetic factors as mediators and moderators was assessed., Results: Higher eveningness was associated with larger GMV in the right medial prefrontal cortex at ages 14 and 19 in the whole sample. GMV in this region related to depressive symptoms at age 19 in catechol-O-methyltransferase (COMT) Val/Val, but not in Met COMT, carriers. Larger GMV also was observed in the right fusiform gyrus at age 14, which was explained by later wake-up time during weekends., Conclusion: In adolescence, eveningness and its related sleep habits correlated with distinct developmental patterns. Eveningness was specifically associated with GMV changes in the medial prefrontal cortex; this could serve as a brain vulnerability factor for later self-reported depressive symptoms in COMT Val/Val carriers., (Copyright © 2022 American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.)

Objective: Neuropsychological dysfunction exists in anorexia nervosa (AN). Cognitive Remediation Therapy (CRT), mainly evaluated in adults with AN, targets these impairments., Methods: Adolescent inpatients (age = 11-17 years) with AN were randomized to 5 weeks of either 10 sessions of individually delivered CRT or non-specific cognitive-training (NSCT). Co-primary outcomes included cognitive domain 'flexibility' [composite score of Wisconsin Card Sorting Test (WSCT) and Trail Making Test (TMT-4)] and 'central coherence' [composite score of Central Coherence Index (CCI) and Group Embedded Figures Test (GEFT)] at end of treatment (FU1). Secondary outcomes included individual test scores and self-reported everyday-life flexibility at FU1 and at 6-months post-treatment (FU2). Independent sample t-tests, Pearson chi-square-tests and mixed models for repeated measures (MMRM) analyses were conducted., Results: In 56 females (age = 15.1 ± 1.5 years), CRT was not superior to NSCT at FU1 regarding 'flexibility' (p = 0.768) or 'central coherence' (p = 0.354), nor at FU2 (p = 0.507; p = 0.624) (effect sizes = 0.02-0.26). Both groups improved over time in central coherence (CCI p = 0.001; GEFT p < 0.001), self-reported flexibility (p = 0.002) and WCST (p = 0.18), but not TMT-4 (p = 0.286). NSCT was superior to CRT regarding self-reported planning/organisation ability at FU1 (p < 0.001) and FU2 (p = 0.003)., Conclusions: CRT was not superior to NSCT in adolescent inpatients with AN. More randomized controlled studies are needed., (© 2022 Eating Disorders Association and John Wiley & Sons Ltd.)

Objective: Research in adolescent depression has found aberrant intrinsic functional connectivity (iFC) among the ventral striatum (VS) and several brain regions implicated in reward processing. The present study probes this question by taking advantage of the availability of data from a large youth cohort, the IMAGEN Consortium., Methods: iFC data from 303 adolescents (48% of them female) were used to examine associations of VS connectivity at baseline (at age 14) with depressive disorders at baseline and at 2-year (N=250) and 4-year (N=219) follow-ups. Eleven regions of interest, key nodes of the reward system, were used to probe the reward network and calculate the connectivity strength of the VS within this network (VS connectivity rw ). The main analyses assessed associations of VS connectivity rw with depressive disorders, anhedonia, and low mood using logistic regression. Autoregressive models accounting for carryover effects over time were conducted to further evaluate these brain-behavior associations., Results: Higher right VS connectivity rw was associated with higher probability of depressive disorders at baseline (odds ratio=2.65, 95% CI=1.40, 5.05). This finding was confirmed in the autoregressive model, adjusting for carryover effects of the depressive disorders across the three time points. VS connectivity rw was not predictive of depressive disorders at follow-up assessments. Longitudinal associations between VS connectivity rw and anhedonia emerged in the structural equation model: left VS connectivity rw was associated with anhedonia at 2 years (odds ratio=2.20, 95% CI=1.54, 3.14), and right VS connectivity rw was linked to anhedonia at 4 years (odds ratio=1.87, 95% CI=1.09, 3.21). VS connectivity rw did not predict low mood at any time point in the structural equation model., Conclusions: The connectivity strength of the VS within the reward network showed distinct patterns of association with depressive disorders and anhedonia from mid to late adolescence, suggesting that the role of this circuitry in depression changes with age. This study replicates, in an independent sample, the association between the VS and depression previously reported in younger adolescents. The findings suggest a role of VS connectivity rw in anhedonia but not in low mood.

Background: The global estimate of the number of children in institutional care is around 5 million, with around 1 million of these children living in Europe. In Germany, about 75,000 children and adolescents find themselves in the foster care system and about 93,000 additional children and adolescents are living in institutions. Traumatic experiences and neglect in childhood are highly prevalent among these youth in care and are related to severe long-term effects. Childhood maltreatment and abuse can increase the risk of future victimization experiences. Although youth in care are at risk of victimization or revictimization, no specific evidence-based prevention program has been designed to address these specific needs., Objective: This study aims to evaluate the efficacy of a newly developed 6-module internet-based prevention program of victimization for youth in care, named EMPOWER YOUTH., Methods: In a randomized controlled trial, the intervention group will be compared to a waiting-list control group with an unblinded 1:1 allocation ratio. Assessments will take place before randomization (baseline) and at follow-up 18 weeks after baseline (ie, 12 weeks after finishing the last module of the program). The primary endpoint is the number of victimization, and online and offline bullying experiences (composite score) at the 18-week follow-up. Secondary endpoints are risk-taking behavior, aggressive tendencies, empathy, prosocial behavior, depressiveness, and loneliness at follow-up. The expected outcome requires a sample size of 156 subjects to achieve a power of 80%. Assuming a 30% dropout rate at follow-up, we require 225 participants to be allocated to the trial. Participants are youth in care, that is, adolescents in foster care, adopted adolescents, or young care leavers aged 14 to 21 years., Results: Ethical approval was granted by the Ethics Committee of the Medical School Berlin in March 2021 (MSB-2021/55). Recruitment started in September 2021 and is planned until November 2022. The results are expected to be published in January 2023., Conclusions: Given the increased likelihood for future victimization experiences among youth in care, there is a strong need for a low-threshold intervention specifically for this high-risk age group. There are no existing nationwide mental health programs exclusively for youth in care in Germany., Trial Registration: German Clinical Trials Register DRKS00024749; https://tinyurl.com/tjaahayw., International Registered Report Identifier (irrid): DERR1-10.2196/34706., (©Birgit Wagner, Laurence Reuter, Betteke Maria van Noort. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 14.06.2022.)

Adolescence is a period of major brain reorganization shaped by biologically timed and by environmental factors. We sought to discover linked patterns of covariation between brain structural development and a wide array of these factors by leveraging data from the IMAGEN study, a longitudinal population-based cohort of adolescents. Brain structural measures and a comprehensive array of non-imaging features (relating to demographic, anthropometric, and psychosocial characteristics) were available on 1476 IMAGEN participants aged 14 years and from a subsample reassessed at age 19 years (n = 714). We applied sparse canonical correlation analyses (sCCA) to the cross-sectional and longitudinal data to extract modes with maximum covariation between neuroimaging and non-imaging measures. Separate sCCAs for cortical thickness, cortical surface area and subcortical volumes confirmed that each imaging phenotype was correlated with non-imaging features (sCCA r range: 0.30-0.65, all P FDR  < 0.001). Total intracranial volume and global measures of cortical thickness and surface area had the highest canonical cross-loadings (|ρ| = 0.31-0.61). Age, physical growth and sex had the highest association with adolescent brain structure (|ρ| = 0.24-0.62); at baseline, further significant positive associations were noted for cognitive measures while negative associations were observed at both time points for prenatal parental smoking, life events, and negative affect and substance use in youth (|ρ| = 0.10-0.23). Sex, physical growth and age are the dominant influences on adolescent brain development. We highlight the persistent negative influences of prenatal parental smoking and youth substance use as they are modifiable and of relevance for public health initiatives., (© 2020. The Author(s).)

Heavy drinker adolescents: altered brainstem microstructure., (© 2019 Society for the Study of Addiction.)

There is limited research concerning the relationship between neuropsychological assessment and self-report of executive functioning in adolescent anorexia nervosa (AN); available studies demonstrate only low to moderate correlations. Therefore, this study examines the association between neuropsychological test performance and self-report in AN. Forty adolescent inpatients with AN completed an extensive neuropsychological assessment, including set-shifting, central coherence, and questionnaires assessing executive functioning in daily life (BRIEF-SR). Their parents filled out an analog version (BRIEF-PF). Statistical analyses revealed low to medium positive and negative correlations between neuropsychological measures and BRIEF subscales. Similarly, self- and parental ratings were only slightly positively correlated, with patients scoring significantly higher than their parents on two subscales. The results support previous findings of modest correlations between self-report and performance-based testing and emphasize the importance of a multiple format assessment of executive functioning in adolescent AN.

This study examines the effects of puberty and sex on the intrinsic functional connectivity (iFC) of brain networks, with a focus on the default-mode network (DMN). Consistently implicated in depressive disorders, the DMN's function may interact with puberty and sex in the development of these disorders, whose onsets peak in adolescence, and which show strong sex disproportionality (females > males). The main question concerns how the DMN evolves with puberty as a function of sex. These effects are expected to involve within- and between-network iFC, particularly, the salience and the central-executive networks, consistent with the Triple-Network Model. Resting-state scans of an adolescent community sample (n = 304, male/female: 157/147; mean/std age: 14.6/0.41 years), from the IMAGEN database, were analyzed using the AFNI software suite and a data reduction strategy for the effects of puberty and sex. Three midline regions (medial prefrontal, pregenual anterior cingulate, and posterior cingulate), within the DMN and consistently implicated in mood disorders, were selected as seeds. Within- and between-network clusters of the DMN iFC changed with pubertal maturation differently in boys and girls (puberty-X-sex). Specifically, pubertal maturation predicted weaker iFC in girls and stronger iFC in boys. Finally, iFC was stronger in boys than girls independently of puberty. Brain-behavior associations indicated that lower connectivity of the anterior cingulate seed predicted higher internalizing symptoms at 2-year follow-up. In conclusion, weaker iFC of the anterior DMN may signal disconnections among circuits supporting mood regulation, conferring risk for internalizing disorders.

Objective: We examined predictors and moderators of treatment outcome in mothers and children diagnosed with ADHD in a large multicentre RCT., Method: In total, 144 mother-child dyads with ADHD were randomly assigned to either a maternal ADHD treatment (group psychotherapy and open methylphenidate medication, TG) or to a control treatment (individual counselling without psycho- or pharmacotherapy, CG). After maternal ADHD treatment, parent-child training (PCT) for all mother-child dyads was added. The final analysis set was based on 123 dyads with completed primary outcome assessments (TG: n = 67, CG: n = 56). The primary outcome was the change in each child's externalizing symptoms. Multiple linear regression analyses were performed., Results: The severity of the child's externalizing problem behaviour in the family at baseline predicted more externalizing symptoms in the child after PCT, independent of maternal treatment. When mothers had a comorbid depression, TG children showed more externalizing symptoms after PCT than CG children of depressive mothers. No differences between the treatment arms were seen in the mothers without comorbid depression., Conclusions: Severely impaired mothers with ADHD and depressive disorder are likely to need additional disorder-specific treatment for their comorbid psychiatric disorders to effectively transfer the contents of the PCT to the home situation (CCTISRCTN73911400).

Objective: Health care personnel in Europe is increasingly involved in care of displaced persons from non-European countries; we investigated the spectrum of neurological disorders and medical management in refugees presenting to the emergency room (ER) of a German university hospital. Methods: We retrospectively studied ER-patients with refugee status (R-patients) during the peak of the European refugee crisis between July 2015 and February 2016 ( N = 100). Complaints on admission, medical management and diagnoses at discharge were compared to matched groups of German residents with migrational background (M-patients; N = 96) and to native Germans (N-patients; N = 95). Results: R-patients were mostly male young adults (75% male; mean age 33.2 years). Headache was the most frequent complaint in all groups (R-patients 38%; M-patients 43%; N-patients 24%). R-patients, however, presented much more often with possible or definite seizures (R-patients 27%; M-patients 9%; N-patients 15%). Initial triage, length of medical history and examination records, utilization of laboratory tests and cranial imaging did not differ between groups. However, time to diagnosis was considerably longer in R-patients (220 min; M-patients 151 min, N-patients 123 min). While strokes and other life-threatening emergencies were rare final diagnoses in R-patients, a substantial proportion was discharged with a diagnosis of non-epileptic seizures or a psychiatric disorder (20%; M-patients 6%; N-patients 7%). Conclusions: Refugee patients present with a spectrum of neurological disorders that not solely results from cultural differences but rather reflects the consequences of forced displacement. ER management of refugees requires more time, language skills and critically depends on psychosomatic/psychiatric expertise.

Objective: White matter microstructure alterations have recently been associated with depressive episodes during adolescence, but it is unknown whether they predate depression. The authors investigated whether subthreshold depression in adolescence is associated with white matter microstructure variations and whether they relate to depression outcome., Method: Adolescents with subthreshold depression (N=96) and healthy control subjects (N=336) drawn from a community-based cohort were compared using diffusion tensor imaging and whole brain tract-based spatial statistics (TBSS) at age 14 to assess white matter microstructure. They were followed up at age 16 to assess depression. Probabilistic tractography was used to reconstruct white matter streamlines spreading from the regions identified in the TBSS analysis and along bundles implicated in emotion regulation, the uncinate fasciculus and the cingulum. The authors searched for mediating effects of white matter microstructure on the relationship between baseline subthreshold depression and depression at follow-up, and then explored the specificity of the findings., Results: Lower fractional anisotropy (FA) and higher radial diffusivity were found in the anterior corpus callosum in the adolescents with subthreshold depression. Tractography analysis showed that they also had lower FA in the right cingulum streamlines, along with lower FA and higher mean diffusivity in tracts connecting the corpus callosum to the anterior cingulate cortex. The relation between subthreshold depression at baseline and depression at follow-up was mediated by FA values in the latter tracts, and lower FA values in those tracts distinctively predicted higher individual risk for depression., Conclusions: Early FA variations in tracts projecting from the corpus callosum to the anterior cingulate cortex may denote a higher risk of transition to depression in adolescents.

The aim of the current paper is to evaluate clinical characteristics of 30 children with early onset anorexia nervosa (EO-AN; age = 12.2 ± 1.6 years) compared with 30 patients with adolescent onset AN (AO-AN; age = 15.9 ± 0.7 years) and 60 age-matched healthy controls. Statistical analyses included one-way analyses of variance with three planned comparisons and chi-square tests. Compared with AO-AN, EO-AN patients displayed more restrictive eating behaviour (p = 0.038), received more tube-feeding (p = 0.024), and had less problems with self-esteem (p < 0.001) and perfectionism (p = 0.001). EO-AN patients have similar eating disorder pathology (p = 0.183), body-image distortion (p = 0.060), and number of hospitalizations (p = 0.358) as AO-AN. Only a third of EO-AN patients suffer from low self-esteem. Overall, core AN pathology seems similar in EO-AN and AO-AN. However, EO-AN patients show differences in their pathological eating behaviour and the need for tube-feeding., (© 2018 John Wiley & Sons, Ltd and Eating Disorders Association.)

Objective: Regarding executive functioning in anorexia nervosa (AN), little is known about differences between the restricting (AN-R) and binge eating/purging (AN-BP) subtypes. Especially for adolescents, there is sparse data. Hence, the current aim is to investigate differences in set-shifting, central coherence, and self-reported executive functioning across adolescent AN subtypes., Methods: Ninety AN-R, 21 AN-BP, and 63 controls completed an extensive assessment battery including neuropsychological tests for executive functioning and the self-report questionnaire Behavior Rating Inventory of Executive Functioning., Results: Patients with AN-R and AN-BP did not differ on neuropsychological measures, and both performed similarly to controls. Behavior Rating Inventory of Executive Functioning scores fell within the normal range with AN subtypes showing mostly comparable ratings. AN-BP patients scored higher on 2 composite indices and the "shift" subscale compared with AN-R., Conclusions: The results suggest similar cognitive functioning in adolescent AN subtypes as well as healthy controls. However, more research is needed to draw more general conclusions., (Copyright © 2018 John Wiley & Sons, Ltd and Eating Disorders Association.)

Objective: Whereas the evidence in adolescents is inconsistent, anorexia nervosa (AN) in adults is characterized by weak cognitive flexibility. This study investigates cognitive flexibility in adolescents with AN and its potential associations with symptoms of depression, obsessive compulsive disorder (OCD), and duration of illness., Methods: 69 patients and 63 age-matched healthy controls (HC) from 9 till 19 years of age were assessed using the Trail-Making Test (TMT) and self-report questionnaires., Results: In hierarchical regression analyses, set-shifting ability did not differ between AN and HC, whereas AN patients reported significantly higher rates of depression symptoms and OCD symptoms. Age significantly predicted set-shifting in the total sample. Only among AN patients aged 14 years and older did set-shifting decline with increasing age., Discussion: The presence of AN with depression or OCD symptoms or the duration of illness do not influence cognitive flexibility in children and adolescents. Early interventions may be helpful to prevent a decline in cognitive flexibility in adolescent AN with increasing age.

Objective: This study aimed to identify discrete neuropsychological profiles and their relationship to clinical symptoms in 253 female children and adolescents with anorexia nervosa (AN) and 170 healthy controls (HCs) using a standardised neuropsychological assessment battery., Method: Hierarchical cluster analysis was used to identify the optimum number of clusters, and participants were assigned using K-means cluster analysis. Confirmatory discriminant function analysis determined which combination of neuropsychological variables best distinguished the clusters., Results: Three distinct clusters in the AN sample emerged- AN cluster 1 (19%) - "neuropsychologically low average to average"; AN cluster 2 (33%) - "verbal/visuo-spatial discrepancy"; and AN cluster 3 (48%) - "verbally strong and neuropsychologically average to high average". Two distinct clusters in HCs were identified. HC cluster 1 (48%) demonstrated poor visuo-spatial memory scores and high verbal fluency scores, whilst HC cluster 2 (52%) scored within the average range on all neuropsychological tasks. Neuropsychological performance was associated with clinical symptoms of body mass index centile, Eating Disorder Examination subscale and global score, anxiety, depression and obsessions, and compulsions between the AN and HC groups. However, niether significant differences emerged between AN clusters only nor HC clusters only at the post-hoc level., Discussion: An underlying neuropsychological heterogeneity may exist in AN. We encourage future studies to investigate whether the identified profiles and their association with clinical characteristics are replicable. We cautiously suggest that neuropsychological profiling may have potential to both inform future research and have possible clinical benefits through individually tailored treatment strategies., (© crowncopyright 2016.)

When anorexia nervosa (AN) occurs in children below the age of 14 years, it is referred to as early-onset AN (EO-AN). Over the last years, there has been an increased focus on the role of cognitive functioning in the development and maintenance of AN. Adults with AN show inefficiencies in cognitive functions such as flexibility and central coherence. Systematic neuropsychological examinations of patients with EO-AN are missing. Thirty children with EO-AN and 30 adolescents with AN, as well as 60 healthy controls (HC) underwent an extensive neuropsychological examination. ANOVAs with post hoc tests and explorative regression analyses were conducted. Patients with EO-AN (mean age = 2.17 ± 1.57 years) showed no significant differences in flexibility, inhibition, planning, central coherence, visuospatial short- and long-term memory or recognition in comparison to HC (mean age = 11.62 ± 1.29 years). Performance of adolescents with AN (mean age = 15.93 ± 0.70 years) was not significantly different compared to HC (mean age = 16.20 ± 1.26 years). Explorative regression analyses revealed a significant interaction of age and group for flexibility (adjusted R 2  = 0.30, F = 17.85, p = 0.013, η p 2  = 0.32). Contrary to expectations, the current study could not confirm the presence of inefficient cognitive processing in children with EO-AN compared to HC. Nonetheless, the expected age-related improvement of flexibility might be disrupted in children and adolescents with AN. Longitudinal neuropsychological examinations are necessary to provide more information about the role of cognitive functioning in the development and maintenance of AN.

Background: Cognitive remediation therapy (CRT) is a relatively new therapy for patients with anorexia nervosa (AN). There is an increased demand to include the patient view during the evaluation of treatment programs. So far, there is no structured evaluation of the subjective view of adolescents with AN on CRT available., Methods: 20 patients with AN between the ages of 12 and 18 years completed 10 CRT sessions. 19 patients (age: 15.6±1.3; BMI-percentile: 2.4±3.5) filled out a feedback questionnaire on their subjective CRT experience. The positive and negative aspects of CRT from a patient's perspective were inducted from the feedback material using the 'Qualitative content analysis' from Mayring, allowing the data to be summarized into different categories. The software program MAXQDA 11 was used for the data analysis., Results: The final category system consisted of 6 general categories, which in turn were summarized into 4 main categories: "general therapy perception", "content specific therapy perception", "relationship to everyday life" and "relationship with CRT therapist". 10 patients described CRT (53%) as 'fun'. 12 patients (63%) noticed positive changes in their everyday lives, which they attributed to their participation in CRT. 4 patients (21%) were not able to notice any changes in their everyday lives. 3 patients (16%) valued the good atmosphere during the CRT sessions and 6 patients (32%) found CRT to be a welcome distraction from their daily lives on the ward. 5 patients (26%) mentioned that CRT was too demanding and that difficulties arose during their reflection on thinking styles., Discussion: Overall, CRT is evaluated positively by adolescent patients with AN. A small number of patients reports difficulties with CRT and experiences CRT as strenuous. This positive evaluation of CRT is in line with results from the few qualitative studies in adults with AN. Due to a potential social desirability bias, the patient's perspective should be interpreted with slight caution., Conclusion: CRT is received well by adolescents with AN and poses an interesting, new therapy module in the eating disorder field., (© Georg Thieme Verlag KG Stuttgart · New York.)

Objective: Cognitive remediation therapy (CRT) aims to strengthen weak cognitive flexibility and central coherence in adult and adolescent anorexia nervosa (AN). Currently, there are no studies in adolescents with AN that control for learning effects because of re-testing while evaluating CRT., Method: Twenty in- and outpatients with AN aged 12 to 18 years received CRT. Assessment took place directly before and after the intervention. Performance was compared to 20 age-, gender-, IQ-, and test-retest interval matched healthy controls, which did not receive CRT., Results: AN patients showed an improvement in flexibility on neuropsychological assessment directly after CRT, whereas HC did not improve over time. Self-report assessment of flexibility, as well as central coherence, did not show significant improvement after CRT., Discussion: Results suggest that CRT may be beneficial for enhancing flexibility in adolescents with AN. However, randomized controlled studies are essential to determine the actual efficacy of this intervention., (Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.)

Since 2007, more than 600 patients have been diagnosed with anti-N-methyl-D-aspartate (NMDA) receptor encephalitis, with almost 40 % of those affected being children or adolescents. In early phases of the illness, this life-threatening disease is characterized by psychiatric symptoms, such as depression, anxiety, obsessions, hallucinations or delusions. Consequently, a high percentage of patients receive psychiatric diagnoses at first, hindering the crucial early diagnosis and treatment of the anti-NMDA receptor encephalitis. We report on a 15-year-old girl initially presenting with pathological eating behaviour and significant weight loss resulting in an (atypical) anorexia nervosa (AN) diagnosis. Her early course of illness, diagnostic process, treatment and short-term outcome are described. This case report aims to raise awareness about the association between anorectic behaviour and anti-NMDA receptor encephalitis and highlight the importance of multidisciplinary teams in child and adolescent services.

Objective: Evidence-based treatment programs for children with anorexia nervosa (AN) are scarce, while their prognosis is negative and the incidence rate rises. A new therapeutic approach recently received positive attention: cognitive remediation therapy (CRT). This intervention targets inflexibility and the inability to perceive the bigger picture in persons with AN. So far, studies and case reports have focused on either adolescent or adult patients and less on young children with AN. This case report therefore describes and evaluates the implementation of CRT with a child with AN., Method: A 12-year-old girl with severe chronic AN was treated with 10 sessions of CRT. Her clinical and neuropsychological evaluations before, directly after and 7 months after CRT are reported. Additionally, the patient's written and verbal feedbacks are reviewed., Results: At the 7-month follow-up the patient showed a stable healthy weight and reported a reduced presence of psychopathology. Her neuropsychological performance directly after CRT and after 7 months did not improve., Conclusions: The clinical evaluation of our case report suggests that CRT may be a promising add-on therapy in the clinical treatment of young girls with AN.

Objective: Adults with anorexia nervosa (AN) show weaknesses in several cognitive functions before and after weight restoration. There is a great demand for standardized examinations of executive functioning in the field of child and adolescent AN. Previous studies exhibited methodological inconsistencies regarding test selection and operationalization of cognitive functions, making the interpretation of their findings difficult. In order to overcome these inconsistencies, a neuropsychological assessment tool, the "Ravello Profile," was developed, though previously not available in German. This paper presents a German adaptation of the Ravello Profile and illustrates its applicability in children and adolescents via three case descriptions., Methods: The Ravello Profile was adapted for the German-speaking area. The applicability of the Ravello Profile was evaluated in three children and adolescents with AN., Results and Conclusions: The cases presented confirm the feasible implementation of this adaptation of the Ravello Profile, both in children and adolescents. Hence, it enables a methodologically consistent examination of executive functioning in German-speaking children, adolescents, and adults with AN. Using the Ravello Profile, the role of cognitive functions in the development of AN can be systematically examined over a broad age range.