Zentrum Psychosoziale Medizin KLINIKEN Kinder- und Jugendpsychiatrie und Psychotherapie Psychiatrie und Psychotherapie Psychosomatische Medizin und Psychotherapie VORKLINIK Medizinische Psychologie und Medizinische Soziologie Ethik und Geschichte der Medizin Göttingen 11/08

Modul 5.1. Nervensystem und Psyche Block PSYCHO Vorlesungen Psychiatrie und Psychotherapie + Kinder- und Jugend- psychiatrie und Psychotherapie Psychosomatische Medizin und Psychotherapie Arbeits- und Sozialmedizin Biometrie/Epidemiologie Ethik Humangenetik Klinische Pharmakologie Neuroradiologie Nuklearmedizin

Modul 5.1. Nervensystem und Psyche Block PSYCHO Seminare Psychiatrie und Psychotherapie Unterricht am Krankenbett (UaK) Kinder- und Jugendpsychiatrie und Psychotherapie Psychosomatische Medizin und Psychotherapie (einschließlich Seminar)

Modul 5.1. Nervensystem und Psyche Block PSYCHO Klausur Hörsäle Hörsaal 81 Gruppen 1-6 Hörsaal Psy Gruppen 7-11 Hörsaal 542 Gruppen 12-16 Fächer: Psychiatrie und Psychotherapie Kinder- und Jugendpsychiatrie und Psychotherapie Psychosomatische Medizin und Psychotherapie Humangenetik Klinische Pharmakologie u. Pharmakotherapie Medizin des Alterns und des alternden Menschen

Ansprechpartner: Modulkoordinator: Prof. Dr. Borwin Bandelow Sekretariat: Frau Bünte: Mo-Fr 9-13 (Skripte, Scheine) Modulassistentin: Frau Dr. Sylva Link Plan des Praktikums: www.psychiatrie.med.uni-goettingen.de Göttinger Psychiatrie-Skript, Psychosomatik-Skript: - Sekretariat Frau Bünte - Lehrmittelserver

KURZLEHRBUCH PSYCHIATRIE Bandelow/Gruber/Falkai KURZLEHRBUCH PSYCHIATRIE Empfohlenes Lehrbuch für das Modul 5.1 (Nervensystem und Psyche) Enthält auch: Kinder- und Jugendpsychiatrie Psychotherapie 24,95 €

Entlang der Lebenslinie Seelische Störungen Beginnen oft in der Kindheit Zeigen vielfach einen charakteristischen Verlauf Können lebenslang anhalten Bedürfen einer altersangepassten Diagnostik/Behandlung

ADHS und Lebenslinie Impulsivität Unaufmerksamkeit Hyperaktivität Educational intent: to illustrate the 3 core symptoms of ADHD - inattention, hyperactivity and impulsivity SPEAKERS’ NOTES Complicating comorbidity should be raised and it should be explained that the core symptoms will be covered in more detail in module 2. Additionally, supplement with the following case-studies (Julia, inattentive and Joe, combined/ predominantly impulsive) if you wish: Julia, 14 years old, is being presented by both of her parents because her school performance is getting worse and she doesn’t feel like doing her homework or studying for school. Julia thinks that studying is not worth it, and classes and especially teachers are only getting on her nerves. Her parents bother her the whole day and she can’t please anybody at all. Her parents explain that she always had problems at school. Even in her first year at primary it was obvious that Julia was day-dreaming, that she did not follow the teacher and that she needed much more time than everybody else because she was always doing something different. Reading and writing were especially difficult for her right from the beginning. Dyslexia was diagnosed in her second year, although she always did quite well in intelligence tests. Her current teacher explains that she has always known Julia as a kind of dreamer. She seems to tire very quickly and the latter parts of her written tests are full of careless mistakes – and not only in dictation. Julia used to be quite an open person who tried very hard to fulfil everybody’s expectations. Now, however, there is a growing realisation that Julia does not feel like trying anymore. Her attitude is worsening and she seems very unhappy. She complains that everybody always complains about her. She always resolves to concentrate more both at home and at school and to try to finish things, but she finds this very hard – other things are always coming into her mind. The problem is compounded because she’s always looking for things – she lives in absolute chaos and loses things all the time. In a recent test, Julia scored an average IQ. She does try very hard but gets distracted easily, interrupts frequently, asks how much longer things will take and seems focused on failure. ********** Joe, 7 years old, charming and bright, has earned the reputation of ‘class clown’, mostly because he tends to answer questions before the teacher has completed them. He can’t wait to get his ice-cream at school dinner but, on one occasion, proceeded to drop it on another child’s head. Joe was a lot of fun in nursery school, but his teachers and friends are now annoyed by his stampeding habits and frequent interruptions. His mother describes him as ‘a bull in a china shop’ and finds it very hard to take him shopping. He is so unpredictable and impetuous that he often makes irrelevant comments to strangers. His teachers now find him a nuisance and, on two occasions, he has been excluded from school. He is fast losing friends and becoming increasingly miserable and lonely as a result. Impulsivität Unaufmerksamkeit Hyperaktivität Döpfner et al 2002

ADHS und Lebenslinie Differentialremission – DSM-IIIR ADHS 100 Educational intent: to illustrate that differences in remission rates reflect the definitions of remission applied (as much as the true course of the disorder) SPEAKERS’ NOTES Some useful definitions: Syndromatic remission is defined as failing the full diagnostic criteria for ADHD (ie having fewer than 8, or 57%, of the 14 possible symptoms for the syndrome) Symptomatic remission requires that the subject has fewer than the required number of symptoms for a subthreshold diagnosis (ie fewer than 5, or 36%, of the possible symptoms) Functional remission (full recovery) requires that the subject has fewer than 36% of the symptoms of ADHD and no impairment (ie a score on the Global assessment of functioning scale >60). In other words, remission of ADHD symptoms with age is not necessarily accompanied by an improvement in functioning.   Reference: Biederman J, Mick E & Faraone SV (2000). Age-dependent decline of symptoms of attention deficit hyperactivity disorder: impact of remission definition and symptom type. Am J Psychiatry; 157(5): 816-8. Differentialremission – DSM-IIIR ADHS 100 Syndromatische Remission 80 Symptomatische Remission Funktionsremission 60 Prozent (%) 40 20 <6 6-8 9-11 12-14 15-17 18-20 Biederman et al 2000

Möglicher Vorläufer von ADHS ADHS und Lebenslinie Educational intent: to describe the psychopathology of ADHD in toddlers References: Barkley RA (1998). Attention Deficit Hyperactivity Disorder, 2nd edition, chapter 6, pp186-207. New York: Guilford. Olson S (2002). Developmental perspectives. In: S Sandberg (Ed), Hyperactivity and Attention Disorder of Childhood. Cambridge: Cambridge University Press. SÄUGLINGE/ KLEINKINDER (1-3 Jahre) Schwieriges Temperament, Regulationsstörungen und eingeschränkte soziale Anpassung im Rahmen der Eltern/Kind-Interaktion Möglicher Vorläufer von ADHS Döpfner et al. 2000a

ADHS und Lebenslinie VORSCHULKINDER (3-6 Jahre) Verminderte Spielintensität und -dauer Motorische Unruhe Assoziierte Probleme und Folgen Entwicklungsdefizite Oppositionelles Trotzverhalten Probleme bei der sozialen Anpassung

ADHS und Lebenslinie GRUNDSCHULKINDER (6-12 Jahre) Ablenkbarkeit Motorische Unruhe Impulsives und störendes Verhalten Assoziierte Probleme und Folgen Spezifische Lernstörungen Aggressives Verhalten Geringes Selbstwertgefühl Klassenwiederholungen Ablehnung durch Gleichaltrige Beeinträchtigte Familien- beziehungen

ADHS und Lebenslinie JUGENDLICHE (13-17 Jahre) Planungs- und Organisationsprobleme Fortdauernde Unaufmerksamkeit Abnahme der motorischen Unruhe Assoziierte Probleme Aggressives, antisoziales und delinquentes Verhalten Alkohol- und Drogenmissbrauch Emotionale Probleme Unfälle

ADHS und Lebenslinie ERWACHSENE (18 Jahre und älter) Residualsymptome Assoziierte Probleme Andere seelische Erkrankungen Antisoziales Verhalten/Delinquenz Mangelnder schulischer und beruflicher Erfolg

ADHS und Geschichte Lang, lang ist‘s her … Educational intent: to indicate that an inappropriate level of restlessness in some children had been recognised as far back as 1846 SPEAKERS’ NOTES Heinrich Hoffman (1809-1894) demonstrated the problem of the inappropriately restless child quite well in his 19th-century children's tale. He described ‘Fidgety Phil’ in these terms: ‘won't sit still’ ‘wriggles’ ‘giggles’ ‘swings backwards and forwards and tilts up his chair’. Reference: Hoffman H (1846). The Story of Fidgety Philip. Full poem: Lang, lang ist‘s her … “Let me see if he is able To sit still for once at the table.“ Thus Papa bade Phil behave; And Mama looked very grave. But Fidgety Phil, He won't sit still; He wriggles, And giggles, And then, I declare, Swings backwards and forwards, And tilts up his chair, Just like any rocking horse— “Philip! I am getting cross!“ See the naughty, restless child Growing still more rude and wild, Till his chair falls over quite. Philip screams with all his might, Catches at the cloth, but then That makes matters worse again. Down upon the ground they fall, Glasses, plates, knives, forks and all. How Mama did fret and frown, When she saw them tumbling down! And Papa made such a face! Philip is in sad disgrace. Where is Philip? Where is he? Fairly cover'd up, you see! Cloth and all are lying on him; He has pull'd down all upon him! What a terrible to-do! Dishes, glasses, snapt in two! Here a knife, and there a fork! Philip, this is naughty work. Table all so bare, and ah! Poor Papa and poor Mama Look quite cross, and wonder how They shall make their dinner now. 1846 Lebenslinie und Geschichte einer seelischen Störung helfen die Stärken und Schwächen eines Faches richtig einzuordnen