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Wuebken K, Bermpohl F, Boedeker K, Hindi Attar C, Kluczniok D, Schoofs N, Fuchs A, Neukel C, Herpertz SC, Brunner R, Winter SM, Kaess M, Jaite C, Dittrich K. The mediating role of attachment and anger: exploring the impact of maternal early-life maltreatment on child abuse potential. Front Psychiatry 2023; 14:1267038. [PMID: 37965361 PMCID: PMC10641504 DOI: 10.3389/fpsyt.2023.1267038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 10/02/2023] [Indexed: 11/16/2023] Open
Abstract
Background Maternal early-life maltreatment (ELM) increases the risk of subsequent child maltreatment, but the underlying mechanisms of these intergenerational effects remain largely unknown. Identifying these mechanisms is crucial for developing preventive interventions that can break the cycle of abuse. Notably, previous research has shown that ELM often results in attachment insecurity and altered anger characteristics. Therefore, this study determines whether these characteristics mediate the relationship between maternal history of ELM and child abuse potential. Methods The study sample included 254 mothers, of whom 149 had experienced ELM to at least a moderate degree. Maternal ELM was assessed using the Childhood Experience of Care and Abuse (CECA) interview. Attachment insecurity, trait anger and anger expression, and maternal abuse potential were assessed using the Vulnerable Attachment Questionnaire (VASQ), State-Trait Anger Expression Inventory (STAXI), and Child Abuse Potential Inventory (CAPI), respectively. Results The severity of maternal ELM predicted higher child abuse potential, with attachment insecurity and anger suppression mediating this effect. Specifically, higher levels of maternal ELM were associated with greater attachment insecurity and increased anger suppression, resulting in a higher child abuse potential. Although higher levels of trait anger were directly associated with higher child abuse potential, this parameter did not mediate the relationship with ELM. In addition, no significant associations were observed between outwardly expressed anger and ELM or child abuse potential. All analyses were adjusted for maternal mental disorders, years of education, and relationship status. Discussion Attachment insecurity and anger suppression may serve as pathways linking the maternal history of ELM to the risk of child abuse, even when considering maternal psychopathology. Overall, our findings indicate that interventions aimed at strengthening attachment and improving anger suppression may be beneficial for all mothers with ELM history and high child abuse potential, not just those who suffer from mental illness.
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Affiliation(s)
- Karolina Wuebken
- Department of Psychiatry and Psychotherapy, Charité—Universitätsmedizin Berlin, Charité Campus Mitte, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Charité—Universitätsmedizin Berlin, Charité Campus Mitte, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Katja Boedeker
- Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité—Universitätsmedizin Berlin, Charité Campus Virchow, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Catherine Hindi Attar
- Department of Psychiatry and Psychotherapy, Charité—Universitätsmedizin Berlin, Charité Campus Mitte, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Dorothea Kluczniok
- Department of Psychiatry and Psychotherapy, Charité—Universitätsmedizin Berlin, Charité Campus Mitte, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Nikola Schoofs
- Department of Psychiatry and Psychotherapy, Charité—Universitätsmedizin Berlin, Charité Campus Mitte, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Anna Fuchs
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Corinne Neukel
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Sabine C. Herpertz
- Department of General Psychiatry, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Romuald Brunner
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Sibylle Maria Winter
- Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité—Universitätsmedizin Berlin, Charité Campus Virchow, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
| | - Michael Kaess
- Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, Heidelberg University Hospital, Heidelberg, Germany
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Charlotte Jaite
- Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité—Universitätsmedizin Berlin, Charité Campus Virchow, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
- Department of Clinical Psychology and Psychotherapy in Childhood and Adolescence, University of Hildesheim, Hildesheim, Germany
| | - Katja Dittrich
- Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité—Universitätsmedizin Berlin, Charité Campus Virchow, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Berlin, Germany
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2
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Watrin-Avino LM, Forbes FJ, Buchwald MC, Dittrich K, Correll CU, Bermpohl F, Bödeker K. Affect Recognition, Theory of Mind, and Empathy in Preschool Children with Externalizing Behavior Problems-A Group Comparison and Developmental Psychological Consideration. Children (Basel) 2023; 10:1455. [PMID: 37761416 PMCID: PMC10529822 DOI: 10.3390/children10091455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/19/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023]
Abstract
Preschool mental disorders are often associated with significant interpersonal problems, related to impaired affect recognition, theory of mind (ToM), and empathy. To date, these skills have not been studied together in preschoolers with externalizing behavior problems (EBPs). The aim of the present study was to investigate whether and to what extent preschool children with EBPs show impairments in affect recognition, ToM, and empathy. Preschoolers with EBPs, defined by current psychiatric treatment and T-scores ≥ 60 on the externalizing problem scale of the Child Behavior Checklist (CBCL/1½-5 or 6-18R) were compared to non-clinical controls (HCs), defined by no past and no current psychiatric treatment and T-scores < 60 on all CBCL broad-band scales. Groups were compared on affect recognition (NEuroPSYchological Assessment-II), affective ToM (Test of Emotion Comprehension), cognitive ToM (Extended Theory-of-Mind Scale), parent-reported emotional contagion, attention to others' feelings, and prosocial action (Empathy Questionnaire), IQ and language (Wechsler Preschool and Primary Scale of Intelligence-III Matrices, Active and Passive Vocabulary test), controlling for age, sex, and language abilities. Compared to 28 HCs, 22 preschoolers with EBPs (total sample meanage = 5.5 years +/- 0.8 years, range= 4.2-6.9 years, males 66%) had significantly greater impairments in cognitive ToM (p = 0.0012, η2 = 0.266), attention to others' feelings (p = 0.0049, η2 = 0.222), and prosocial action (p = 0.0070, η2 = 0.210), each representing strong effect sizes. EBPs were significantly related to cognitive domains, like prosocial action (r = -0.501), cognitive ToM (r = -0.425), and attention to others' feelings (r = -0.332), but not to affective domains of social cognition. Social cognitive development may be impaired as early as preschool age and should be promoted before the child starts school.
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Affiliation(s)
- Laura M. Watrin-Avino
- Department of Child and Adolescent Psychiatry, Charité Campus Virchow, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.J.F.); (M.C.B.); (K.D.); (C.U.C.); (K.B.)
| | - Franziska J. Forbes
- Department of Child and Adolescent Psychiatry, Charité Campus Virchow, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.J.F.); (M.C.B.); (K.D.); (C.U.C.); (K.B.)
| | - Martin C. Buchwald
- Department of Child and Adolescent Psychiatry, Charité Campus Virchow, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.J.F.); (M.C.B.); (K.D.); (C.U.C.); (K.B.)
| | - Katja Dittrich
- Department of Child and Adolescent Psychiatry, Charité Campus Virchow, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.J.F.); (M.C.B.); (K.D.); (C.U.C.); (K.B.)
| | - Christoph U. Correll
- Department of Child and Adolescent Psychiatry, Charité Campus Virchow, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.J.F.); (M.C.B.); (K.D.); (C.U.C.); (K.B.)
- The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, NY 11004, USA
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hofstra University, Hempstead, NY 11549, USA
- The Feinstein Institutes for Medical Research, Center for Psychiatric Neuroscience, Northwell Health, New Hyde Park, NY 11030, USA
- DZPG, German Center for Mental Health, Partner Site Berlin, 10785 Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Neuroscience, Charité Campus Mitte, Charité—University Medicine Berlin, 10117 Berlin, Germany;
| | - Katja Bödeker
- Department of Child and Adolescent Psychiatry, Charité Campus Virchow, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany; (F.J.F.); (M.C.B.); (K.D.); (C.U.C.); (K.B.)
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Roth M, Kluczniok D, Roepke S, Heim C, Herpertz SC, Hindi Attar C, Dittrich K, Boedeker K, Winter SM, Ridder NS, Poppinga SK, Bermpohl F. Relationship between Borderline Personality Disorder, Emotional Availability, and Cortisol Output in Mother-Child Dyads. Psychopathology 2023; 56:90-101. [PMID: 35073545 DOI: 10.1159/000521519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 12/09/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Mothers with borderline personality disorder (BPD) often show altered emotional availability toward their own child and heightened stress vulnerability. The aims of the present study were (1) to examine total cortisol output in saliva during mother-child interaction in mothers with BPD and their children and (2) to test whether maternal nonhostility as a subscale of emotional availability mediates the relationship between maternal BPD and child total cortisol output. METHODS We investigated 16 mothers with BPD and 30 healthy control mothers (HC) and 29 children of mothers with BPD and 33 children of HC mothers. Children were between 5 and 12 years old. Salivary cortisol was collected prior to and twice after an episode of a 21-min standardized play situation between mother and child. Nonhostility was rated using the emotional availability scales. Analyses of covariance were computed to test for group differences in total cortisol output (measured with area under the curve with respect to ground). Pearson's correlation was calculated to test the association between maternal and child total cortisol output. To test the second question, a mediation analysis according to Preacher and Hayes was conducted. RESULTS Mothers with BPD and their children had lower total cortisol output. Maternal and child total cortisol output was significantly correlated. Contrary to our hypothesis, maternal nonhostility did not mediate the relationship between BPD and child total cortisol output. CONCLUSION Results imply that the hormonal stress activity of mothers with BPD and their children is altered, which may reflect modified stress regulation and stress vulnerability in mother and child and may impact on mother-child interaction. The finding of a positive association between mother's and child total cortisol output could indicate an intergenerational transmission of these alterations.
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Affiliation(s)
- Maria Roth
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Mitte, Berlin, Germany
| | - Dorothea Kluczniok
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Mitte, Berlin, Germany
| | - Stefan Roepke
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Christine Heim
- Department of Medical Psychology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Mitte, Berlin, Germany
| | - Sabine C Herpertz
- Department for General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Catherine Hindi Attar
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Mitte, Berlin, Germany
| | - Katja Dittrich
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow, Berlin, Germany
| | - Katja Boedeker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow, Berlin, Germany
| | - Sibylle M Winter
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Virchow, Berlin, Germany
| | - Neele S Ridder
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Mitte, Berlin, Germany
| | - Sina K Poppinga
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Mitte, Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Mitte, Berlin, Germany
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4
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Winter SM, Dittrich K, Dörr P, Overfeld J, Moebus I, Murray E, Karaboycheva G, Zimmermann C, Knop A, Voelkle M, Entringer S, Buss C, Haynes JD, Binder EB, Heim C. Immediate impact of child maltreatment on mental, developmental, and physical health trajectories. J Child Psychol Psychiatry 2022; 63:1027-1045. [PMID: 35266137 DOI: 10.1111/jcpp.13550] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The immediate impact of child maltreatment on health and developmental trajectories over time is unknown. Longitudinal studies starting in the direct aftermath of exposure with repeated follow-up are needed. METHOD We assessed health and developmental outcomes in 6-month intervals over 2 years in 173 children, aged 3-5 years at study entry, including 86 children with exposure to emotional and physical abuse or neglect within 6 months and 87 nonmaltreated children. Assessments included clinician-administered, self- and parent-report measures of psychiatric and behavioral symptoms, development, and physical health. Linear mixed models and latent growth curve analyses were used to contrast trajectories between groups and to investigate the impact of maltreatment features on trajectories. RESULTS Maltreated children exhibited greater numbers of psychiatric diagnoses (b = 1.998, p < .001), externalizing (b = 13.29, p < .001) and internalizing (b = 11.70, p < .001) symptoms, impairments in cognitive (b = -11.586, p < .001), verbal (b = -10.687, p < .001), and motor development (b = -7.904, p = .006), and greater numbers of medical symptoms (b = 1.021, p < .001) compared to nonmaltreated children across all time-points. Lifetime maltreatment severity and/or age at earliest maltreatment exposure predicted adverse outcomes over time. CONCLUSION The profound, immediate, and stable impact of maltreatment on health and developmental trajectories supports a biological embedding model and provides foundation to scrutinize the precise underlying mechanisms. Such knowledge will enable the development of early risk markers and mechanism-driven interventions that mitigate adverse trajectories in maltreated children.
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Affiliation(s)
- Sibylle M Winter
- Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Berlin, Germany
| | - Katja Dittrich
- Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Berlin, Germany
| | - Peggy Dörr
- Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Berlin, Germany
| | - Judith Overfeld
- Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Psychology, Berlin, Germany
| | - Imke Moebus
- Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Psychology, Berlin, Germany
| | - Elena Murray
- Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Berlin, Germany
| | - Gergana Karaboycheva
- Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Berlin, Germany.,Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Psychology, Berlin, Germany
| | - Christian Zimmermann
- Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Berlin, Germany
| | - Andrea Knop
- Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Psychology, Berlin, Germany
| | - Manuel Voelkle
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sonja Entringer
- Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Psychology, Berlin, Germany.,Development, Health, and Disease Research Program, University of California, Irvine, Orange, CA, USA
| | - Claudia Buss
- Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Psychology, Berlin, Germany.,Development, Health, and Disease Research Program, University of California, Irvine, Orange, CA, USA
| | - John-Dylan Haynes
- Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin Center for Advanced Neuroimaging, Berlin, Germany
| | - Elisabeth B Binder
- Department of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Christine Heim
- Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Psychology, Berlin, Germany.,Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
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5
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Martins J, Czamara D, Sauer S, Rex-Haffner M, Dittrich K, Dörr P, de Punder K, Overfeld J, Knop A, Dammering F, Entringer S, Winter SM, Buss C, Heim C, Binder EB. Childhood adversity correlates with stable changes in DNA methylation trajectories in children and converges with epigenetic signatures of prenatal stress. Neurobiol Stress 2021; 15:100336. [PMID: 34095363 PMCID: PMC8163992 DOI: 10.1016/j.ynstr.2021.100336] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/01/2021] [Accepted: 05/01/2021] [Indexed: 12/12/2022] Open
Abstract
Childhood maltreatment (CM) is an established major risk factor for a number of negative health outcomes later in life. While epigenetic mechanisms, such as DNA methylation (DNAm), have been proposed as a means of embedding this environmental risk factor, little is known about its timing and trajectory, especially in very young children. It is also not clear whether additional environmental adversities, often experienced by these children, converge on similar DNAm changes. Here, we calculated a cumulative adversity score, which additionally to CM includes socioeconomic status (SES), other life events, parental psychopathology and epigenetic biomarkers of prenatal smoking and alcohol consumption. We investigated the effects of CM alone as well as the adversity score on longitudinal DNAm trajectories in the Berlin Longitudinal Child Study. This is a cohort of 173 children aged 3-5 years at baseline of whom 86 were exposed to CM. These children were followed-up for 2 years with extensive psychometric and biological assessments as well as saliva collection at 5 time points providing genome-wide DNAm levels. Overall, only a few DNAm patterns were stable over this timeframe, but less than 10 DNAm regions showed significant changes. At baseline, neither CM nor the adversity score associated with DNAm changes. However, in 6 differentially methylated regions (DMRs), CM and the adversity score significantly moderated DNAm trajectories over time. A number of these DMRs have previously been associated with adverse prenatal exposures. In our study, children exposed to CM also presented with epigenetic signatures indicative of increased prenatal exposure to tobacco and alcohol, as compared to non-CM exposed children. These epigenetic signatures of prenatal exposure strongly correlate with DNAm regions associated with CM and the adversity score. Finally, weighted correlation network analysis revealed a module of CpGs exclusively associated with CM. While our study identifies DNAm loci specifically associated with CM, especially within long non-coding RNAs, the majority of associations were found with the adversity score with convergent association with indicators of adverse prenatal exposures. This study highlights the importance of mapping not only of the epigenome but also the exposome and extending the observational timeframe to well before birth.
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Affiliation(s)
- Jade Martins
- Dept. of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Darina Czamara
- Dept. of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Susann Sauer
- Dept. of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Monika Rex-Haffner
- Dept. of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Katja Dittrich
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Virchow, Department of Child and Adolescent Psychiatry, Augustenburger Platz 1, D-13353 Berlin, Germany
| | - Peggy Dörr
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Virchow, Department of Child and Adolescent Psychiatry, Augustenburger Platz 1, D-13353 Berlin, Germany
| | - Karin de Punder
- Natura Foundation, Research and Development, Numansdrop, 3281, NC, Netherlands
| | - Judith Overfeld
- Charité − Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Institute of Medical Psychology, Campus Charité Mitte, Luisenstraße 57, 10117 Berlin, Germany
| | - Andrea Knop
- Charité − Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Institute of Medical Psychology, Campus Charité Mitte, Luisenstraße 57, 10117 Berlin, Germany
| | - Felix Dammering
- Charité − Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Institute of Medical Psychology, Campus Charité Mitte, Luisenstraße 57, 10117 Berlin, Germany
| | - Sonja Entringer
- Charité − Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Institute of Medical Psychology, Campus Charité Mitte, Luisenstraße 57, 10117 Berlin, Germany
- University of California, Irvine, Development, Health, and Disease Research Program, Orange, CA, USA
| | - Sibylle M. Winter
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Virchow, Department of Child and Adolescent Psychiatry, Augustenburger Platz 1, D-13353 Berlin, Germany
| | - Claudia Buss
- Charité − Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Institute of Medical Psychology, Campus Charité Mitte, Luisenstraße 57, 10117 Berlin, Germany
- University of California, Irvine, Development, Health, and Disease Research Program, Orange, CA, USA
| | - Christine Heim
- Charité − Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Institute of Medical Psychology, Campus Charité Mitte, Luisenstraße 57, 10117 Berlin, Germany
- Dept. of Biobehavioral Health, College of Health & Human Development, The Pennsylvania State University, University Park, PA, USA
| | - Elisabeth B. Binder
- Dept. of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, 30329, USA
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6
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Dammering F, Martins J, Dittrich K, Czamara D, Rex-Haffner M, Overfeld J, de Punder K, Buss C, Entringer S, Winter SM, Binder EB, Heim C. The pediatric buccal epigenetic clock identifies significant ageing acceleration in children with internalizing disorder and maltreatment exposure. Neurobiol Stress 2021; 15:100394. [PMID: 34621920 PMCID: PMC8482287 DOI: 10.1016/j.ynstr.2021.100394] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/26/2021] [Accepted: 09/09/2021] [Indexed: 01/15/2023] Open
Abstract
Background Studies reporting accelerated ageing in children with affective disorders or maltreatment exposure have relied on algorithms for estimating epigenetic age derived from adult samples. These algorithms have limited validity for epigenetic age estimation during early development. We here use a pediatric buccal epigenetic (PedBE) clock to predict DNA methylation-based ageing deviation in children with and without internalizing disorder and assess the moderating effect of maltreatment exposure. We further conduct a gene set enrichment analysis to assess the contribution of glucocorticoid signaling to PedBE clock-based results. Method DNA was isolated from saliva of 158 children [73 girls, 85 boys; mean age (SD) = 4.25 (0.8) years] including children with internalizing disorder and maltreatment exposure. Epigenetic age was estimated based on DNA methylation across 94 CpGs of the PedBE clock. Residuals of epigenetic age regressed against chronological age were contrasted between children with and without internalizing disorder. Maltreatment was coded in 3 severity levels and entered in a moderation model. Genome-wide dexamethasone-responsive CpGs were derived from an independent sample and enrichment of these CpGs within the PedBE clock was identified. Results Children with internalizing disorder exhibited significant acceleration of epigenetic ageing as compared to children without internalizing disorder (F1,147 = 6.67, p = .011). This association was significantly moderated by maltreatment severity (b = 0.49, 95% CI [0.073, 0.909], t = 2.322, p = .022). Children with internalizing disorder who had experienced maltreatment exhibited ageing acceleration relative to children with no internalizing disorder (1–2 categories: b = 0.50, 95% CI [0.170, 0.821], t = 3.008, p = .003; 3 or more categories: b = 0.99, 95% CI [0.380, 1.593], t = 3.215, p = .002). Children with internalizing disorder who were not exposed to maltreatment did not show epigenetic ageing acceleration. There was significant enrichment of dexamethasone-responsive CpGs within the PedBE clock (OR = 4.36, p = 1.65*10–6). Among the 94 CpGs of the PedBE clock, 18 (19%) were responsive to dexamethasone. Conclusion Using the novel PedBE clock, we show that internalizing disorder is associated with accelerated epigenetic ageing in early childhood. This association is moderated by maltreatment severity and may, in part, be driven by glucocorticoids. Identifying developmental drivers of accelerated epigenetic ageing after maltreatment will be critical to devise early targeted interventions.
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Affiliation(s)
- Felix Dammering
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Psychology, Berlin, Germany
| | - Jade Martins
- Dept. of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Katja Dittrich
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Dept. of Child & Adolescent Psychiatry, Psychotherapy, and Psychosomatics, Berlin, Germany
| | - Darina Czamara
- Dept. of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Monika Rex-Haffner
- Dept. of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Judith Overfeld
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Psychology, Berlin, Germany
| | - Karin de Punder
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Psychology, Berlin, Germany
| | - Claudia Buss
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Psychology, Berlin, Germany.,University of California, Irvine, Development, Health, and Disease Research Program, Orange, CA, USA
| | - Sonja Entringer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Psychology, Berlin, Germany.,University of California, Irvine, Development, Health, and Disease Research Program, Orange, CA, USA
| | - Sibylle M Winter
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Dept. of Child & Adolescent Psychiatry, Psychotherapy, and Psychosomatics, Berlin, Germany
| | - Elisabeth B Binder
- Dept. of Translational Research in Psychiatry, Max Planck Institute of Psychiatry, Munich, Germany
| | - Christine Heim
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Psychology, Berlin, Germany.,Dept. of Biobehavioral Health, The Pennsylvania State University, University Park, PA, USA
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Dittrich K, Boedeker K, Kluczniok D, Hindi Attar C, Winter SM, Roepke S, Heim C, Herpertz SC, Bermpohl F. Elevated inflammatory markers in women with remitted major depressive disorder and the role of early life maltreatment. Brain Behav Immun 2021; 97:219-225. [PMID: 34339804 DOI: 10.1016/j.bbi.2021.07.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 07/07/2021] [Accepted: 07/28/2021] [Indexed: 12/17/2022] Open
Abstract
Major depressive disorder (MDD) has been linked to elevated inflammation markers. It remains unclear whether the elevation of C-reactive protein (CRP) and interleukin-6 (IL-6) levels are not only observable in acute MDD but also in patients after remission. MDD is a common sequela of early life maltreatment (ELM), which has also been associated with elevated inflammation markers. While the majority of studies investigated (acute) MDD and ELM as isolated predictors of inflammation, a few studies found inflammation levels to be more pronounced in patients with MDD that were exposed to ELM. This investigation included both ELM and MDD in one study and aimed at distinguishing between the effects of MDD in remission (rMDD) and ELM and investigating potential accumulative effects on the inflammatory markers CRP and IL-6 in a population of N = 126 women (n = 122 for CRP and n = 66 for IL-6). We further investigated how disorder characteristics (course and severity) and specific types of ELM affect levels of CRP and IL-6. We found that rMDD predicted levels of CRP and IL-6 and physical abuse predicted levels of CRP when considering both predictors simultaneously, while other types of ELM did not. A later onset of MDD and a shorter time interval since the last episode were associated with higher levels of IL-6. Our findings contribute to the existing literature on the association between MDD and inflammation, suggesting that elevated levels of inflammation markers may persist even after remission of MDD. Our findings on physical abuse as a specific predictor of CRP in the presence of rMDD suggest that different types of ELM could result in distinct inflammation profiles.
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Affiliation(s)
- Katja Dittrich
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Virchow-Klinikum, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Berlin, Germany.
| | - Katja Boedeker
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Virchow-Klinikum, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Berlin, Germany
| | - Dorothea Kluczniok
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Charité Mitte, Department of Psychiatry and Neurosciences, Berlin, Germany
| | - Catherine Hindi Attar
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Charité Mitte, Department of Psychiatry and Neurosciences, Berlin, Germany
| | - Sibylle M Winter
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Virchow-Klinikum, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Berlin, Germany
| | - Stefan Roepke
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Benjamin Franklin, Department of Psychiatry and Neurosciences, Berlin, Germany
| | - Christine Heim
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Psychology, Berlin, Germany; Pennsylvania State University, College of Health and Human Development, Department of Biobehavioral Health, PA, USA
| | - Sabine C Herpertz
- University Hospital Heidelberg, Centre for Psychosocial Medicine, General Psychiatry, Heidelberg, Germany
| | - Felix Bermpohl
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Campus Charité Mitte, Department of Psychiatry and Neurosciences, Berlin, Germany
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Dörk M, Müller B, Stange JE, Herseni J, Dittrich K. Co-Designing Visualizations for Information Seeking and Knowledge Management. Open Information Science 2020. [DOI: 10.1515/opis-2020-0102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractCreativity is a crucial factor in finding novel and useful visualization and interaction techniques, but its emergence is contingent on the right conditions. The focus of visualization research has traditionally been on techniques, and to a lesser degree on the process of creating them with domain experts and end users. This paper focuses on the collaborative design of visualizations for information seeking and knowledge management. The difficult, yet common challenge in any visualization project is to find meaningful visual representations and useful interaction techniques to carry out complex analysis tasks. The unique difficulty for preparing co-design activities for visualization lies in the gap between the abstract nature of data and the concrete form of visual representations. To bridge this gap, our co-design framework for visualization places particular emphasis on actors, activities, and artifacts as categories that expand the focus of visualization design beyond the traditional triad of users, tasks, and data. Drawing from general co-design principles, the framework is developed and validated during the course of two case studies in the context of information management systems and library collection databases. Based on observed patterns during the case studies, practical tactics provide advice on carrying out co-design in information visualization.
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Fuchs A, Dittrich K, Neukel C, Winter S, Zietlow AL, Kluczniok D, Herpertz SC, Hindi Attar C, Möhler E, Fydrich T, Bermpohl F, Kaess M, Resch F, Bödeker K. Hair cortisol moderates the association between obstetric complications and child wellbeing. Psychoneuroendocrinology 2020; 121:104845. [PMID: 32861165 DOI: 10.1016/j.psyneuen.2020.104845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 06/25/2020] [Accepted: 08/11/2020] [Indexed: 10/23/2022]
Abstract
Obstetric complications (OC) may have implications for later health outcomes. However, there is a lack of research examining the association between OC and behavior problems or quality of life (HRQoL). We aimed to close this gap and further investigate functioning of the hypothalamus-pituitary-adrenal (HPA)-axis as a potential physiological vulnerability moderating the association between OC and behavior problems and HRQoL. We investigated 232 mothers and their five to 12-year-old children. Presence of OC during the pre-, peri-, and postnatal phases was determined by interviewing mothers. Children's behavior problems (CBCL, TRF) and HRQoL (Kidscreen rated by mothers and children) were assessed. Children gave 3 cm strands of hair for analysis of hair cortisol (HC). Structural equation modeling analyses with a latent variable of child outcome ("distress"), OC as predictor and HC as a potential moderator were conducted. OC significantly predicted distress (β = .33, p < .01). The model showed a good fit to the data: χ2(14)=15.66, p < .33, CFI=.99, TLI=.99, RMSEA=.02, 90 %CI [.00, .06], SRMR=.04. In addition, HC moderated the association between OC and distress (β=-.32, p < .01). The moderation model also showed a good fit: χ2(14) =7.13, p = .93, CFI=1.00, TLI=1.06, RMSEA=.00, 90 %CI [.00, .02], SRMR=.03. Results indicated that the association between OC and distress was significant only when children had low HC-levels. This was also the case for both externalizing and internalizing behavior problems. Our results underline the notion of OC as a risk factor for child behavior problems and wellbeing and point to an important role of the children's physiological set-up such as HPA-functioning.
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Affiliation(s)
- Anna Fuchs
- University Hospital Heidelberg, Centre for Psychosocial Medicine, Department of Child and Adolescent Psychiatry, Heidelberg, Germany; Department of Psychology, Pennsylvania State University, University Park, PA, USA.
| | - Katja Dittrich
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Campus Virchow-Klinikum, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Berlin, Germany
| | - Corinne Neukel
- University Hospital Heidelberg, Centre for Psychosocial Medicine, Department of General Psychiatry, Heidelberg, Germany
| | - Sibylle Winter
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Campus Virchow-Klinikum, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Berlin, Germany
| | - Anna-Lena Zietlow
- University Hospital Heidelberg, Centre for Psychosocial Medicine, Institute of Medical Psychology, Heidelberg, Germany
| | - Dorothea Kluczniok
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Campus Charité Mitte, Department of Psychiatry and Psychotherapy, Berlin, Germany
| | - Sabine C Herpertz
- University Hospital Heidelberg, Centre for Psychosocial Medicine, Department of General Psychiatry, Heidelberg, Germany
| | - Catherine Hindi Attar
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Campus Charité Mitte, Department of Psychiatry and Psychotherapy, Berlin, Germany
| | - Eva Möhler
- University Hospital Heidelberg, Centre for Psychosocial Medicine, Department of Child and Adolescent Psychiatry, Heidelberg, Germany
| | - Thomas Fydrich
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Felix Bermpohl
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Campus Charité Mitte, Department of Psychiatry and Psychotherapy, Berlin, Germany
| | - Michael Kaess
- University Hospital Heidelberg, Centre for Psychosocial Medicine, Department of Child and Adolescent Psychiatry, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Franz Resch
- University Hospital Heidelberg, Centre for Psychosocial Medicine, Department of Child and Adolescent Psychiatry, Heidelberg, Germany
| | - Katja Bödeker
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Campus Virchow-Klinikum, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Berlin, Germany
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Kluczniok D, Bertsch K, Hindi Attar C, Neukel C, Fuchs A, Jaite C, Dittrich K, Bödeker K, Heinz A, Winter S, Brunner R, Herpertz SC, Bermpohl F. Early life maltreatment and depression: Mediating effect of maternal hair cortisol concentration on child abuse potential. Psychoneuroendocrinology 2020; 120:104791. [PMID: 32683140 DOI: 10.1016/j.psyneuen.2020.104791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 07/02/2020] [Accepted: 07/02/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Maternal early life maltreatment (ELM) and history of depression can bear a risk for adverse development in the child. One neurobiological pathway for the transmission of both maternal ELM and remitted depression (MDD) might be altered maternal cortisol levels. In the present study, we examine (1) main and interacting effects of maternal ELM and remitted MDD on hair cortisol concentration (HCC) in mothers, whether (2) maternal HCC explains the association between maternal ELM or remitted MDD and maternal child abuse potential, and (3) whether maternal child abuse potential as well as maternal HCC are associated with maternal report of child well-being. METHODS The current study involved 127 mother-child dyads. Maternal history of ELM and psychopathology were assessed via the Mini International Neuropsychiatric Interview (M.I.N.I.) and Childhood Experience and Care (CECA) interview. The Child Abuse Potential Inventory (CAPI) was used to assess maternal child abuse and neglect potential. We applied the Kidscreen-27 parent report to study child well-being. To assess HCC, hair strands were taken from the mothers. To test the research questions, a two-factorial analysis of covariance, mediation analysis using ordinary least squares regressions with bootstrapping, and Pearson correlations were calculated. RESULTS Mothers with ELM had significantly increased HCC. There was no effect of remitted MDD on HCC, nor an interaction effect of both factors. HCC was a significant mediator of the association between maternal ELM and maternal child abuse potential. Maternal child abuse potential as well as HCC were significantly associated with reduced child well-being. DISCUSSION Our data suggest that adverse experiences in childhood are associated with altered HPA-axis functioning reflected in increased levels of HCC. HPA-axis activity is not altered in mothers with remitted MDD. From a clinical point of view, one might speculate that the partially mediating effect of maternal HCC could indicate a starting point in the prevention of the intergenerational cycle of abuse.
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Affiliation(s)
- Dorothea Kluczniok
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Germany.
| | - Katja Bertsch
- Department of Psychology, Ludwig Maximilian University Munich, Germany; Department for General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Germany
| | - Catherine Hindi Attar
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Germany
| | - Corinne Neukel
- Department for General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Germany
| | - Anna Fuchs
- Section for Disorders of Personality Development, Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany; Department of Psychology, Pennsylvania State University, University Park, PA, USA
| | - Charlotte Jaite
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité Campus Virchow, Charité - Universitätsmedizin Berlin, Germany
| | - Katja Dittrich
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité Campus Virchow, Charité - Universitätsmedizin Berlin, Germany
| | - Katja Bödeker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité Campus Virchow, Charité - Universitätsmedizin Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Germany
| | - Sibylle Winter
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité Campus Virchow, Charité - Universitätsmedizin Berlin, Germany
| | - Romuald Brunner
- Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Sabine C Herpertz
- Department for General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Germany
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Dittrich K, Bermpohl F, Kluczniok D, Hindi Attar C, Jaite C, Fuchs A, Neukel C, Herpertz SC, Brunner R, Winter SM, Lehmkuhl U, Roepke S, Kaess M, Heim C, Boedeker K. Alterations of empathy in mothers with a history of early life maltreatment, depression, and borderline personality disorder and their effects on child psychopathology. Psychol Med 2020; 50:1182-1190. [PMID: 31115280 DOI: 10.1017/s0033291719001107] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Early life maltreatment (ELM), borderline personality disorder (BPD), and major depressive disorder (MDD) have been associated with empathy deficits in different domains. Lack of maternal empathy has also been related to child behavioral problems. As ELM, BPD, and MDD often co-occur, we aimed to identify dissociable effects on empathy due to these three factors. In addition, we aimed to investigate their indirect effects via empathy on child psychopathology. METHODS We included 251 mothers with and without MDD (in remission), BPD and ELM and their children, aged 5-12. We used the Interpersonal Reactivity Index as a measure of empathy on four different dimensions (personal distress, empathic concern, perspective taking, and fantasy) and the Child Behavior Checklist as a measure of child psychopathology. RESULTS Having included all three factors (ELM, MDD, BPD) in one analysis, we found elevated personal distress in MDD and BPD, and lower levels of perspective-taking in BPD, but no effects from ELM on any empathy subscales. Furthermore, we found indirect effects from maternal BPD and MDD on child psychopathology, via maternal personal distress. CONCLUSION The present study demonstrated the dissociable effects of maternal ELM, MDD, and BPD on empathy. Elevated personal distress in mothers with BPD and MDD may lead to higher levels of child psychopathology.
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Affiliation(s)
- Katja Dittrich
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Campus Virchow-Klinikum, Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Campus Charité Mitte, Berlin, Germany
| | - Dorothea Kluczniok
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Campus Charité Mitte, Berlin, Germany
| | - Catherine Hindi Attar
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Campus Charité Mitte, Berlin, Germany
| | - Charlotte Jaite
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Campus Virchow-Klinikum, Berlin, Germany
| | - Anna Fuchs
- Department of Child and Adolescent Psychiatry, University Hospital Heidelberg, Centre for Psychosocial Medicine, Heidelberg, Germany
| | - Corinne Neukel
- University Hospital Heidelberg, Centre for Psychosocial Medicine, General Psychiatry, Heidelberg, Germany
| | - Sabine C Herpertz
- University Hospital Heidelberg, Centre for Psychosocial Medicine, General Psychiatry, Heidelberg, Germany
| | - Romuald Brunner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Regensburg, Regensburg, Germany
| | - Sibylle Maria Winter
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Campus Virchow-Klinikum, Berlin, Germany
| | - Ulrike Lehmkuhl
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Campus Virchow-Klinikum, Berlin, Germany
| | - Stefan Roepke
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Campus Benjamin Franklin, Berlin, Germany
| | - Michael Kaess
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christine Heim
- Charité -Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Institute of Medical Psychology, Berlin, Germany
- Department of Biobehavioral Health, Pennsylvania State University, College of Health and Human Development, Pennsylvania, USA
| | - Katja Boedeker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Campus Virchow-Klinikum, Berlin, Germany
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Pennington E, Camargo C, Hanania N, Holguin F, Tubman R, Zigmont E, Nelson G, Dittrich K, Ortega H, Busse W. P210 INDICATORS OF ASTHMA EXACERBATION BEFORE INITIATION OF BIOLOGIC THERAPY: A REAL-WORLD EXPERIENCE. Ann Allergy Asthma Immunol 2019. [DOI: 10.1016/j.anai.2019.08.277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Kluczniok D, Dittrich K, Hindi Attar C, Bödeker K, Roth M, Jaite C, Winter S, Herpertz SC, Roepke S, Heim C, Bermpohl F. [Erratum to: Oxytocin and maltreatment potential : Influence of maternal depression, borderline personality disorder and experience of early childhood maltreatment]. Nervenarzt 2019; 90:732. [PMID: 31089782 DOI: 10.1007/s00115-019-0729-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Dorothea Kluczniok
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus, Große Hamburger Straße 5-11, 10115, Berlin, Deutschland.
| | - Katja Dittrich
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Charité - Universitätsmedizin Berlin, Campus Virchow, Berlin, Deutschland
| | - Catherine Hindi Attar
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus, Große Hamburger Straße 5-11, 10115, Berlin, Deutschland
| | - Katja Bödeker
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Charité - Universitätsmedizin Berlin, Campus Virchow, Berlin, Deutschland
| | - Maria Roth
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus, Große Hamburger Straße 5-11, 10115, Berlin, Deutschland
| | - Charlotte Jaite
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Charité - Universitätsmedizin Berlin, Campus Virchow, Berlin, Deutschland
| | - Sibylle Winter
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Charité - Universitätsmedizin Berlin, Campus Virchow, Berlin, Deutschland
| | - Sabine C Herpertz
- Klinik für Allgemeine Psychiatrie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Stefan Roepke
- Klinik für Psychiatrie und Psychotherapie, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Deutschland
| | - Christine Heim
- Klinik für Medizinische Psychologie, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Deutschland
| | - Felix Bermpohl
- Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Psychiatrische Universitätsklinik der Charité im St. Hedwig-Krankenhaus, Große Hamburger Straße 5-11, 10115, Berlin, Deutschland
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Reichl C, Kaess M, Fuchs A, Bertsch K, Bödeker K, Zietlow AL, Dittrich K, Hartmann AM, Rujescu D, Parzer P, Resch F, Bermpohl F, Herpertz SC, Brunner R. Childhood adversity and parenting behavior: the role of oxytocin receptor gene polymorphisms. J Neural Transm (Vienna) 2019; 126:777-787. [DOI: 10.1007/s00702-019-02009-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 05/05/2019] [Indexed: 12/22/2022]
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15
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Dittrich K, Boedeker K, Kluczniok D, Jaite C, Hindi Attar C, Fuehrer D, Herpertz SC, Brunner R, Winter SM, Heinz A, Roepke S, Heim C, Bermpohl F. Child abuse potential in mothers with early life maltreatment, borderline personality disorder and depression. Br J Psychiatry 2018; 213:412-418. [PMID: 29792587 DOI: 10.1192/bjp.2018.74] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Early life maltreatment (ELM), borderline personality disorder (BPD) and major depressive disorder (MDD) have been shown to increase the potential of abuse. Emotion regulation is an identified mediator for the association of ELM and BPD with abuse potential. Until now, there has been no study to account for the co-occurrence of these risk factors in one analysis, although BPD and MDD are known as common sequelae of ELM. This is paired with a lack of studies investigating the effects of abuse potential on child well-being.AimsOur study aims at (a) disentangling the effects of maternal ELM, MDD and BPD on abuse potential; (b) exploring the role of emotion regulation as a mediator; and (c) testing for intergenerational effects of abuse potential on child psychopathology. METHOD The research design included 114 mothers with/without ELM, BPD and MDD in remission and their children, all of which were between 5 and 12 years of age. A path analysis was conducted to investigate the multiple associations between our variables. RESULTS ELM, MDD and BPD were all associated with abuse potential, with emotion regulation acting as a mediator for BPD and MDD. Furthermore, an elevated abuse potential was related to higher psychopathology in the child. CONCLUSIONS History of ELM as well as the common sequelae, BPD and MDD, pose risks for child abuse. Our findings suggest improvement of emotion regulation as a potential target for intervention programs. These programs should also aim at non-substantiated cases because even an elevated abuse potential affected child mental health.Declaration of interestNone.
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Affiliation(s)
- Katja Dittrich
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy,Charité - Universitätsmedizin Berlin,corporate member of Freie Universität Berlin,Humboldt-Universität zu Berlin and Berlin Institute of Health,Germany
| | - Katja Boedeker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy,Charité - Universitätsmedizin Berlin,corporate member of Freie Universität Berlin,Humboldt-Universität zu Berlin and Berlin Institute of Health,Germany
| | - Dorothea Kluczniok
- Department of Psychiatry and Psychotherapy,Charité - Universitätsmedizin Berlin,corporate member of Freie Universität Berlin,Humboldt-Universität zu Berlin and Berlin Institute of Health,Germany
| | - Charlotte Jaite
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy,Charité - Universitätsmedizin Berlin,corporate member of Freie Universität Berlin,Humboldt-Universität zu Berlin and Berlin Institute of Health,Germany
| | - Catherine Hindi Attar
- Department of Psychiatry and Psychotherapy,Charité - Universitätsmedizin Berlin,corporate member of Freie Universität Berlin,Humboldt-Universität zu Berlin and Berlin Institute of Health,Germany
| | - Daniel Fuehrer
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy,Charité - Universitätsmedizin Berlin,corporate member of Freie Universität Berlin,Humboldt-Universität zu Berlin and Berlin Institute of Health,Germany
| | - Sabine C Herpertz
- Centre for Psychosocial Medicine, General Psychiatry,University Hospital Heidelberg,Germany
| | - Romuald Brunner
- Department of Child and Adolescent Psychiatry,Centre for Psychosocial Medicine,University Hospital Heidelberg,Germany
| | - Sibylle Maria Winter
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy,Charité - Universitätsmedizin Berlin,corporate member of Freie Universität Berlin,Humboldt-Universität zu Berlin and Berlin Institute of Health,Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy,Charité - Universitätsmedizin Berlin,corporate member of Freie Universität Berlin,Humboldt-Universität zu Berlin and Berlin Institute of Health,Germany
| | - Stefan Roepke
- Department of Psychiatry and Psychotherapy,Charité - Universitätsmedizin Berlin,corporate member of Freie Universität Berlin,Humboldt-Universität zu Berlin and Berlin Institute of Health,Germany
| | - Christine Heim
- Institute of Medical Psychology,Charité - Universitätsmedizin Berlin,corporate member of Freie Universität Berlin,Humboldt-Universität zu Berlin and Berlin Institute of Health,GermanyandDepartment of Biobehavioral Health,College of Health and Human Development,Pennsylvania State University,Pennsylvania,USA
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy,Charité - Universitätsmedizin Berlin,corporate member of Freie Universität Berlin,Humboldt-Universität zu Berlin and Berlin Institute of Health,Germany
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16
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Kluczniok D, Boedeker K, Hindi Attar C, Jaite C, Bierbaum AL, Fuehrer D, Paetz L, Dittrich K, Herpertz SC, Brunner R, Winter S, Heinz A, Roepke S, Heim C, Bermpohl F. Emotional availability in mothers with borderline personality disorder and mothers with remitted major depression is differently associated with psychopathology among school-aged children. J Affect Disord 2018; 231:63-73. [PMID: 29453011 DOI: 10.1016/j.jad.2018.02.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 01/15/2018] [Accepted: 02/05/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Both, maternal borderline personality disorder (BPD) and maternal major depressive disorder (MDD) are often associated with adverse consequences for children, including increased risk for child behavior problems. Reduced maternal emotional availability might play a critical role in transmitting maternal psychopathology on the child. Our aim was to investigate the association between emotional availability and maternal BPD and MDD in remission (rMDD), and if this interrelatedness mediates the association between maternal mental disorders and child behavior problems. METHODS The interaction of 178 mother-child dyads was assessed during a play situation using the Emotional Availability Scales. Children were between 5 and 12 years old. Regression analyses were used to investigate the impact of maternal BPD and maternal rMDD on emotional availability. Ordinary least squares regression analyses using bootstrapping were conducted to investigate the mediating effect of emotional availability on the association between maternal mental disorders and child behavior problems. RESULTS Mothers with BPD showed increased hostility during mother-child interaction, whereas history of MDD was associated with reduced sensitivity. Maternal hostility was a mediator between maternal BPD and number of child psychiatric disorders, as well as externalizing and internalizing behavior. Maternal sensitivity mediated the association between maternal rMDD and number of child psychiatric disorders, as well as internalizing child behavior. CONCLUSIONS Our data suggest that mothers with BPD show a qualitatively different pattern of emotional availability compared to mothers with rMDD. These patterns might reflect two separate pathways of transgenerational transmission of aspects of maternal mental disorders, where intervention and training programs could start: maternal rMDD impacts on child behavior problems via reduced sensitivity, and maternal BPD via increased hostility, which could both be addressed with specific therapeutic interventions.
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Affiliation(s)
- Dorothea Kluczniok
- Charité-Universitätsmedizin Berlin, Campus Mitte, Department of Psychiatry and Psychotherapy, Charité, Berlin, Germany.
| | - Katja Boedeker
- Charité-Universitätsmedizin Berlin, Campus Virchow, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité, Berlin, Germany
| | - Catherine Hindi Attar
- Charité-Universitätsmedizin Berlin, Campus Mitte, Department of Psychiatry and Psychotherapy, Charité, Berlin, Germany
| | - Charlotte Jaite
- Charité-Universitätsmedizin Berlin, Campus Virchow, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité, Berlin, Germany
| | - Anna-Lena Bierbaum
- Charité-Universitätsmedizin Berlin, Campus Virchow, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité, Berlin, Germany
| | - Daniel Fuehrer
- Charité-Universitätsmedizin Berlin, Campus Virchow, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité, Berlin, Germany
| | - Luisa Paetz
- Charité-Universitätsmedizin Berlin, Campus Mitte, Department of Psychiatry and Psychotherapy, Charité, Berlin, Germany
| | - Katja Dittrich
- Charité-Universitätsmedizin Berlin, Campus Virchow, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité, Berlin, Germany
| | - Sabine C Herpertz
- Department for General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Germany
| | - Romuald Brunner
- Section for Disorders of Personality Development, University of Heidelberg, Germany
| | - Sibylle Winter
- Charité-Universitätsmedizin Berlin, Campus Virchow, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité, Berlin, Germany
| | - Andreas Heinz
- Charité-Universitätsmedizin Berlin, Campus Mitte, Department of Psychiatry and Psychotherapy, Charité, Berlin, Germany
| | - Stefan Roepke
- Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Department of Psychiatry and Psychotherapy, Charité, Berlin, Germany
| | - Christine Heim
- Charité-Universitätsmedizin Berlin, Campus Mitte, Department of Medical Psychology, Charité, Berlin, Germany
| | - Felix Bermpohl
- Charité-Universitätsmedizin Berlin, Campus Mitte, Department of Psychiatry and Psychotherapy, Charité, Berlin, Germany
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17
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Fuchs A, Jaite C, Neukel C, Dittrich K, Bertsch K, Kluczniok D, Möhler E, Attar CH, Brunner R, Bödeker K, Resch F, Bermpohl F, Kaess M. Link between children's hair cortisol and psychopathology or quality of life moderated by childhood adversity risk. Psychoneuroendocrinology 2018; 90:52-60. [PMID: 29433073 DOI: 10.1016/j.psyneuen.2018.02.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 02/04/2018] [Accepted: 02/04/2018] [Indexed: 12/27/2022]
Abstract
The hypothalamus-pituitary-adrenal axis (HPAA) and its end product, the glucocorticoid cortisol, has been shown to be associated with psychopathology. Determining cortisol concentrations in hair (HCC) allows the investigation of long-term HPAA-activity. There is a significant scarcity of studies investigating the link between HCC and psychopathology and quality of life in child and adolescent samples. In addition, as the HPAA constitutes a feedback system enabling adaption to environmental demands, it is important to consider the socio-environmental context that the children grow up in. We therefore investigated the associations between child HCC and psychopathology/quality of life and compared these links in two groups of five to 12-year-olds: children living with mothers who report experiences of early life maltreatment (ELM) (high-risk group) and children whose mothers did not report any ELM (low-risk group). We expected that, under conditions of a high-risk environment, elevated HPAA-functioning would be associated with low levels of psychopathology and high levels of quality of life in children. Under low-risk conditions, elevated HPAA-functioning would be associated with high levels of psychopathology and low levels of quality of life in children. For the complete sample of N = 130 children, three-months HCC did not significantly predict child psychopathology or quality of life. However, there was a significant moderating effect of group membership: In the high-risk group, high levels of HCC were significantly associated with high levels of self-reported quality of life. In the low-risk group, there was no association between HCC and self-reported quality of life. For child psychopathology, in the low-risk group, high levels of HCC were significantly associated with high levels of teacher reported behavior problems, whereas in the high-risk group, the association did not reach significance. Our results underline the importance of accounting for the social environment children grow up in when investigating the link between HCC and child psychopathology and quality of life.
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Affiliation(s)
- Anna Fuchs
- Department of Child and Adolescent Psychiatry, Heidelberg University, Blumenstraße 8, 69115, Heidelberg, Germany.
| | - Charlotte Jaite
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Corinne Neukel
- Department of General Psychiatry, Heidelberg University, Voßstraße 4, 69115, Heidelberg, Germany
| | - Katja Dittrich
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Katja Bertsch
- Department of General Psychiatry, Heidelberg University, Voßstraße 4, 69115, Heidelberg, Germany
| | - Dorothea Kluczniok
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany.
| | - Eva Möhler
- Department of Child and Adolescent Psychiatry, Heidelberg University, Blumenstraße 8, 69115, Heidelberg, Germany
| | - Catherine Hindi Attar
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Romuald Brunner
- Department of Child and Adolescent Psychiatry, Heidelberg University, Blumenstraße 8, 69115, Heidelberg, Germany
| | - Katja Bödeker
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Franz Resch
- Department of Child and Adolescent Psychiatry, Heidelberg University, Blumenstraße 8, 69115, Heidelberg, Germany
| | - Felix Bermpohl
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany.
| | - Michael Kaess
- Department of Child and Adolescent Psychiatry, Heidelberg University, Blumenstraße 8, 69115, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Bolligenstrasse 111, 3000, Bern 60, Switzerland
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18
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Dittrich K, Fuchs A, Bermpohl F, Meyer J, Führer D, Reichl C, Reck C, Kluczniok D, Kaess M, Hindi Attar C, Möhler E, Bierbaum AL, Zietlow AL, Jaite C, Winter SM, Herpertz SC, Brunner R, Bödeker K, Resch F. Effects of maternal history of depression and early life maltreatment on children's health-related quality of life. J Affect Disord 2018; 225:280-288. [PMID: 28843077 DOI: 10.1016/j.jad.2017.08.053] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 07/27/2017] [Accepted: 08/16/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND There is a well-established link between maternal depression and child mental health. Similar effects have been found for maternal history of early life maltreatment (ELM). However, studies investigating the relationship of children's quality of life and maternal depression are scarce and none have been conducted for the association with maternal ELM. The aim of the present study was to investigate the effects of maternal history of ELM and depression on children's health-related quality of life and to identify mediating factors accounting for these effects. METHODS Our study involved 194 mothers with and without history of depression and/or ELM and their children between five and 12 years. Children's health-related quality of life was assessed by maternal proxy- and child self-ratings using the KIDSCREEN. We considered maternal sensitivity and maternal parenting stress as potential mediators. RESULTS We found an effect of maternal history of depression but not of maternal history of ELM on health-related quality of life. Maternal stress and sensitivity mediated the effects of maternal depression on child global health-related quality of life, as well as on the dimensions Autonomy & Parent Relation, School Environment (maternal and child rating), and Physical Wellbeing (child rating). LIMITATION Due to the cross-sectional design of the study, causal interpretations must be made with caution. Some scales yielded low internal consistency. CONCLUSIONS Maternal impairments in areas of parenting which possibly developed during acute depression persist even after remission of acute affective symptoms. Interventions should target parenting stress and sensitivity in parents with prior depression.
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Affiliation(s)
- Katja Dittrich
- Charité - Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Berlin, Germany.
| | - Anna Fuchs
- University Hospital Heidelberg, Centre for Psychosocial Medicine, Department of Child and Adolescent Psychiatry, Heidelberg, Germany
| | - Felix Bermpohl
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Berlin, Germany
| | - Justus Meyer
- Charité - Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Berlin, Germany; Vivantes Clinical Centre Spandau, Department of Psychiatry, Psychotherapy and Psychosomatics, Berlin, Germany
| | - Daniel Führer
- Charité - Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Berlin, Germany
| | - Corinna Reichl
- University Hospital Heidelberg, Centre for Psychosocial Medicine, Department of Child and Adolescent Psychiatry, Heidelberg, Germany
| | - Corinna Reck
- Ludwig-Maximilians-University Munich, Department of Child and Adolescent Clinical Psychology and Counseling Psychology, Munich, Germany
| | - Dorothea Kluczniok
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Berlin, Germany
| | - Michael Kaess
- University Hospital Heidelberg, Centre for Psychosocial Medicine, Department of Child and Adolescent Psychiatry, Heidelberg, Germany; University Hospital of Child and Adolescent Psychiatry and Psychotherapy, Bern, Switzerland
| | - Catherine Hindi Attar
- Charité - Universitätsmedizin Berlin, Department of Psychiatry and Psychotherapy, Berlin, Germany
| | - Eva Möhler
- University Hospital Heidelberg, Centre for Psychosocial Medicine, Department of Child and Adolescent Psychiatry, Heidelberg, Germany
| | - Anna-Lena Bierbaum
- Charité - Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Berlin, Germany
| | - Anna-Lena Zietlow
- University Hospital Heidelberg, Center for Psychosocial Medicine, Institute of Medical Psychology, Germany
| | - Charlotte Jaite
- Charité - Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Berlin, Germany
| | - Sibylle Maria Winter
- Charité - Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Berlin, Germany
| | - Sabine C Herpertz
- University Hospital Heidelberg, Center for Psychosocial Medicine, General Psychiatry, Germany
| | - Romuald Brunner
- University Hospital Heidelberg, Centre for Psychosocial Medicine, Department of Child and Adolescent Psychiatry, Heidelberg, Germany
| | - Katja Bödeker
- Charité - Universitätsmedizin Berlin, Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Berlin, Germany
| | - Franz Resch
- University Hospital Heidelberg, Centre for Psychosocial Medicine, Department of Child and Adolescent Psychiatry, Heidelberg, Germany
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19
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Zietlow AL, Nonnenmacher N, Reck C, Mueller M, Herpertz SC, Neukel C, Fuchs A, Bermpohl F, Fuehrer D, Kluczniok D, Attar CH, Jaite C, Dittrich K, Boedeker K. Early life maltreatment but not lifetime depression predicts insecure attachment in women. Arch Womens Ment Health 2017; 20:477-486. [PMID: 28612177 DOI: 10.1007/s00737-017-0731-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 05/10/2017] [Indexed: 12/31/2022]
Abstract
Early life maltreatment (ELM) poses a risk for the development of insecure attachment and depression over the life span, depending on the type of maltreatment (physical, sexual, emotional, neglect) and its severity. The aim of this study was to investigate the influence of ELM and lifetime depression on adult insecure attachment in a female sample (N = 188), consisting of n = 81 women with ELM and n = 107 without ELM. Women with ELM reported significantly higher scores on insecure attachment than women without ELM. A significant interaction effect for ELM × lifetime depression was found: Contradictory to the hypotheses, women with ELM but without lifetime depression scored highest on avoidant attachment, differing significantly from women with ELM and lifetime depression, even though the severity of ELM was higher among women with ELM and lifetime depression and they experienced significantly more severe neglect and sexual abuse, but not physical or emotional abuse. Regression analyses revealed that ELM was the only predictor of avoidant attachment, explaining 15.5% of the variance. Results underline the strong influence of ELM on adult attachment and are of special importance for prevention and intervention programs.
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Affiliation(s)
- Anna-Lena Zietlow
- Center for Psychosocial Medicine, Institute of Medical Psychology, Heidelberg University Hospital, Bergheimer Str. 20, 69115, Heidelberg, Germany.
| | - Nora Nonnenmacher
- Center for Psychosocial Medicine, General Psychiatry, Heidelberg University Hospital, Heidelberg, Germany
| | - Corinna Reck
- Department of Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Mitho Mueller
- Department of Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Sabine C Herpertz
- Center for Psychosocial Medicine, General Psychiatry, Heidelberg University Hospital, Heidelberg, Germany
| | - Corinne Neukel
- Center for Psychosocial Medicine, General Psychiatry, Heidelberg University Hospital, Heidelberg, Germany
| | - Anna Fuchs
- Center for Psychosocial Medicine, Department of Child and Adolescent Psychiatry, Heidelberg University Hospital, Heidelberg, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Daniel Fuehrer
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité Campus Virchow, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Dorothea Kluczniok
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Catherine Hindi Attar
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Charlotte Jaite
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité Campus Virchow, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Katja Dittrich
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité Campus Virchow, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Katja Boedeker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité Campus Virchow, Charité - Universitätsmedizin Berlin, Berlin, Germany
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20
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Kluczniok D, Boedeker K, Fuchs A, Hindi Attar C, Fydrich T, Fuehrer D, Dittrich K, Reck C, Winter S, Heinz A, Herpertz SC, Brunner R, Bermpohl F. EMOTIONAL AVAILABILITY IN MOTHER-CHILD INTERACTION: THE EFFECTS OF MATERNAL DEPRESSION IN REMISSION AND ADDITIONAL HISTORY OF CHILDHOOD ABUSE. Depress Anxiety 2016; 33:648-57. [PMID: 26697826 DOI: 10.1002/da.22462] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 11/03/2015] [Accepted: 11/24/2015] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The association between maternal depression and adverse outcomes in children is well established. Similar links have been found for maternal childhood abuse. One proposed pathway of risk transmission is reduced maternal emotional availability. Our aim was to investigate whether sensitive parenting is impaired in mothers with depression in remission, and whether among these mothers childhood abuse has an additional impact. METHODS The mother-child interaction of 188 dyads was assessed during a play situation using the Emotional Availability Scales, which measure the overall affective quality of the interaction: maternal sensitivity, structuring, nonhostility, and nonintrusiveness. Mothers with depression in remission were compared to healthy mothers. Children were between 5 and 12 years old. Group differences and impact of additional childhood abuse were analyzed by one-factorial analyses of covariance and planned contrasts. RESULTS Mothers with depression in remission showed less emotional availability during mother-child interaction compared to healthy control mothers. Specifically, they were less sensitive and, at trend-level, less structuring and more hostile. Among these mothers, we found an additional effect of severe maternal childhood abuse on maternal sensitivity: Mothers with depression in remission and a history of severe childhood abuse were less sensitive than remitted mothers without childhood abuse. CONCLUSIONS Our data suggest that depression impacts on maternal emotional availability during remission, which might represent a trait characteristic of depression. Mothers with depression in remission and additional severe childhood abuse were particularly affected. These findings may contribute to the understanding of children's vulnerability to develop a depressive disorder themselves.
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Affiliation(s)
- Dorothea Kluczniok
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Katja Boedeker
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité Campus Virchow, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Anna Fuchs
- Section for Disorders of Personality Development, Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Catherine Hindi Attar
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Fydrich
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Daniel Fuehrer
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité Campus Virchow, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Katja Dittrich
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Corinna Reck
- Department of Psychology, Ludwig Maximilian University Munich, Munich, Germany
| | - Sibylle Winter
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité Campus Virchow, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sabine C Herpertz
- Department for General Psychiatry, Center of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Romuald Brunner
- Section for Disorders of Personality Development, Clinic of Child and Adolescent Psychiatry, Centre of Psychosocial Medicine, University of Heidelberg, Heidelberg, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Charité Campus Mitte, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Kurtulus-Waschulewski I, Dittrich K, Bernhard MK, Wahl G, Schuster V. Letter Regarding "Adult-Onset Ligneous Conjunctivitis with Detection of a Novel Plasminogen Gene Mutation and Anti-Plasminogen IgA Antibody: A Clinicopathologic Study and Review of Literature" by Y. Tu et al. Semin Ophthalmol 2015; 32:261-262. [PMID: 26270466 DOI: 10.3109/08820538.2015.1065334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | - K Dittrich
- b Children's Hospital, University of Leipzig , Leipzig , Germany
| | - M K Bernhard
- b Children's Hospital, University of Leipzig , Leipzig , Germany
| | - G Wahl
- a Department of Oral Surgery , Rheinische Friedrich-Wilhelms-Universität , Bonn , Germany
| | - V Schuster
- b Children's Hospital, University of Leipzig , Leipzig , Germany
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Abstract
Multilayered liposome (MLV) formation from water/organic-solvent (W/O) emulsions was studied. A fundamental liposome population parameter, the E(ratio), was defined and used to estimate the bilayer number and water spacing in MLV liposomes. MLVs prepared from W/O emulsions have optimum drug entrapment at an emulsion-lipid/emulsion-water ratio of ∼0.33. Drug entrapment is typically 50 to 65% under these optimal conditions.
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Affiliation(s)
- C Pidgeon
- Eli Lilly Research Laboratories, Indianapolis, Indiana, 46285
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Pohl M, Dittrich K, Ehrich J, Hoppe B, Kemper M, Klaus G, Schmitt C, Hoyer P. Behandlung der Purpura-Schönlein-Henoch-Nephritis bei Kindern und Jugendlichen. Monatsschr Kinderheilkd 2013. [DOI: 10.1007/s00112-013-2896-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Obesity in children and adolescents is associated with multiple comorbidities, including metabolic, cardiovascular, gastrointestinal, pulmonary, orthopedic and psychological disorders. In fact, cardiovascular and metabolic impairments in childhood and adolescence constitute major risk factors for developing cardiovascular disease in adulthood. Thus, obesity in childhood and adolescence leads to a higher morbidity and mortality in adulthood. Therefore, strong emphasis must be laid on the prevention and therapy of childhood obesity. Treatment requires a multidisciplinary and multiphase approach including dietary management, physical activity, pharmacotherapy and bariatric surgery. This paper reviews the different comorbidities of childhood obesity supporting the notion of a multidisciplinary therapy concept.
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Affiliation(s)
- M Neef
- Department of Women and Child Health, Hospital for Children and Adolescents, University of Leipzig, Liebigstraße 20a, D-04103 Leipzig, Germany.
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Raschpichler M, Dittrich K, Sorge I, Hirsch W, Wagner I, Gausche R, Bertram R, Körner A. MR-basierte Quantifizierung von Ganzkörper- und Leberfett bei Kindern und Jugendlichen. ROFO-FORTSCHR RONTG 2011. [DOI: 10.1055/s-0031-1286225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Landgraf K, Friebe D, Kratzsch J, Dittrich K, Herberth G, Kiess W, Erbs S, Körner A. Chemerin serum levels are associated with parameters of obesity and vascular inflammation in children. DIABETOL STOFFWECHS 2011. [DOI: 10.1055/s-0031-1277298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Friebe D, Neef M, Kratzsch J, Erbs S, Dittrich K, Garten A, Petzold-Quinque S, Blüher S, Reinehr T, Stumvoll M, Blüher M, Kiess W, Körner A. Leucocytes are a major source of circulating nicotinamide phosphoribosyltransferase (NAMPT)/pre-B cell colony (PBEF)/visfatin linking obesity and inflammation in humans. Diabetologia 2011; 54:1200-11. [PMID: 21298414 PMCID: PMC3071946 DOI: 10.1007/s00125-010-2042-z] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Accepted: 12/07/2010] [Indexed: 01/11/2023]
Abstract
AIMS/HYPOTHESIS Nicotinamide phosphoribosyltransferase (NAMPT) is a multifunctional protein potentially involved in obesity and glucose metabolism. We systematically studied the association between circulating NAMPT, obesity, interventions and glucose metabolism and investigated potential underlying inflammatory mechanisms. METHODS Fasting morning NAMPT serum levels were measured in cohorts of lean vs obese children, cohorts of intervention by lifestyle, exercise and bariatric surgery, and during an OGTT. In addition, mRNA expression, protein production and enzymatic activity of NAMPT were assessed from isolated leucocytes and subpopulations. RESULTS Circulating NAMPT was significantly elevated in obese compared with lean children and declined after obesity interventions concomitantly with the decline in BMI, high-sensitivity C-reactive protein (hsCrP) and leucocyte counts. Circulating NAMPT significantly correlated with glucose metabolism and cardiovascular variables in univariate analyses, but only the association with glucose response during an OGTT was independent from BMI. We therefore assessed the NAMPT dynamic following an oral glucose load and found a significant decline of NAMPT levels to 77.0 ± 0.1% as a function of time, and insulin-to-glucose ratio during an OGTT in obese insulin-resistant adolescents. Circulating NAMPT was, however, most strongly associated with leucocyte counts (r = 0.46, p < 0.001). The leucocyte count itself determined significantly and independently from BMI insulin resistance in multiple regression analyses. We systematically evaluated NAMPT expression among several tissues and found that NAMPT was predominantly expressed in leucocytes. In subsequent analyses of leucocyte subpopulations, we identified higher NAMPT protein concentrations in lysates of granulocytes and monocytes compared with lymphocytes, whereas granulocytes secreted highest amounts of NAMPT protein into cell culture supernatant fractions. We confirmed nicotinamide mononucleotide enzymatic activity of NAMPT in all lysates and supernatant fractions. In monocytes, NAMPT release was significantly stimulated by lipopolysaccharide (LPS) exposure. CONCLUSIONS Leucocytes are a major source of enzymatically active NAMPT, which may serve as a biomarker or even mediator linking obesity, inflammation and insulin resistance.
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Affiliation(s)
- D. Friebe
- University Hospital for Children & Adolescents, University of Leipzig, Liebigstr. 20A, 04103 Leipzig, Germany
| | - M. Neef
- University Hospital for Children & Adolescents, University of Leipzig, Liebigstr. 20A, 04103 Leipzig, Germany
| | - J. Kratzsch
- Institute of Laboratory Medicine, Clinical Chemistry & Molecular Diagnostics, University of Leipzig, Leipzig, Germany
| | - S. Erbs
- Heart Centre–Department of Cardiology, University of Leipzig, Leipzig, Germany
| | - K. Dittrich
- University Hospital for Children & Adolescents, University of Leipzig, Liebigstr. 20A, 04103 Leipzig, Germany
| | - A. Garten
- University Hospital for Children & Adolescents, University of Leipzig, Liebigstr. 20A, 04103 Leipzig, Germany
| | - S. Petzold-Quinque
- University Hospital for Children & Adolescents, University of Leipzig, Liebigstr. 20A, 04103 Leipzig, Germany
| | - S. Blüher
- University Hospital for Children & Adolescents, University of Leipzig, Liebigstr. 20A, 04103 Leipzig, Germany
| | - T. Reinehr
- Department of Pediatric Nutritional Medicine, Vestisches Hospital for Children and Adolescents Datteln, University of Witten/Herdecke, Witten/Herdecke, Germany
| | - M. Stumvoll
- Department of Medicine, University of Leipzig, Leipzig, Germany
- Leipzig University Medical Center, IFB Adiposity Diseases, Leipzig, Germany
| | - M. Blüher
- Department of Medicine, University of Leipzig, Leipzig, Germany
- Leipzig University Medical Center, IFB Adiposity Diseases, Leipzig, Germany
| | - W. Kiess
- University Hospital for Children & Adolescents, University of Leipzig, Liebigstr. 20A, 04103 Leipzig, Germany
- Leipzig University Medical Center, IFB Adiposity Diseases, Leipzig, Germany
| | - A. Körner
- University Hospital for Children & Adolescents, University of Leipzig, Liebigstr. 20A, 04103 Leipzig, Germany
- Leipzig University Medical Center, IFB Adiposity Diseases, Leipzig, Germany
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Sauerstein K, Amann K, Rascher W, Dittrich K. Reaktivierung von Windpocken nach Rituximabtherapie. Klin Padiatr 2011. [DOI: 10.1055/s-0031-1273809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Rückert F, Benz K, Plank C, Dittrich K. Einfluss der Glucocorticoidbehandlung auf den Verlauf der Membranoproliferativen Glomerulonephritis (MPGN) bei Kindern. Klin Padiatr 2011. [DOI: 10.1055/s-0031-1273838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hinkes B, Dittrich K, Nevinny-Stickel-Hinzpeter C, Amann K, Rascher W. Ein neue COL4A5 Mutation als Ursache eines X-chromosomalen Alport-Syndroms bei einer Jugendlichen mit persistierender Mikrohämaturie. Klin Padiatr 2011. [DOI: 10.1055/s-0031-1273866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Dittrich K, Benz K, Schroth M, Amann K, Rascher W. „Natürlicher Verlauf“ einer unerkannten und unbehandelten Hypertonie. Klin Padiatr 2011. [DOI: 10.1055/s-0031-1273886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lanczak J, Plank C, Rascher W, Schmidt W, Kläver K, Amann K, Dittrich K. Fanconi-Syndrom bei interstitieller Nephritis durch HHV6-Infektion? Klin Padiatr 2011. [DOI: 10.1055/s-0031-1273882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hoyer-Kuhn HK, Dittrich K, Fehrenbach H, Plum G, Beck B, Hoppe B. Orale Applikation von Oxalobacter formigenes zur Reduktion von Plasmaoxalat-Spiegeln bei der PH I - Zwei Fallberichte. Klin Padiatr 2011. [DOI: 10.1055/s-0031-1273821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Benz K, Amann K, Dötsch J, Rascher W, Dittrich K. Rezidivierende interstitielle Nephritiden bei Dent's disease. Klin Padiatr 2011. [DOI: 10.1055/s-0031-1273872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Galiano M, Plank C, Amann K, Dötsch J, Rascher W, Dittrich K. Starker Gewichtsverlust und Hypokaliämie als Zeichen der humoralen Transplantatabstoßung. Klin Padiatr 2011. [DOI: 10.1055/s-0031-1273862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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36
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Jacobi PA, Kufer V, Fröhlich T, Dittrich K, Rascher W. Nephrotisches Syndrom bei einem 16-jährigen Patienten mit M. Wilson. Klin Padiatr 2011. [DOI: 10.1055/s-0031-1273822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Friebe D, Neef M, Erbs S, Dittrich K, Kratzsch J, Kovacs P, Blüher M, Kiess W, Körner A. Retinol binding protein 4 (RBP4) is primarily associated with adipose tissue mass in children. ACTA ACUST UNITED AC 2010; 6:e345-52. [PMID: 20950077 DOI: 10.3109/17477166.2010.491228] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Retinol binding protein 4 (RBP4) is a novel adipocytokine that may link obesity and insulin resistance. We aimed to discriminate between primary and secondary associations of RBP4 with obesity and related disease. DESIGN We applied clinical and experimental approaches to investigate the association of RBP4 levels with normal development, obesity, metabolic and cardiovascular parameters in 68 lean and 61 obese children. RESULTS RBP4 significantly increased with age and pubertal development in healthy lean children. Obese children had significantly higher RBP4 levels compared with lean controls (30.5±1.4 vs. 26.3±1.1 mg/L, P<0.05) and there was a clear association with BMI independent of age (r=0.33, P<0.0001). RBP4 levels correlated significantly with parameters of lipid and glucose metabolism, as well as cardiovascular parameters in univariate analyses. Multiple regression analyses confirmed the strong association of RBP4 with BMI z-score and age, while the association with most metabolic and cardiovascular parameters was abolished. To assess whether the association of RBP4 with obesity may be attributable to adipogenesis, we evaluated RBP4 expression and secretion during adipocyte differentiation using the human SGBS cell line. In preadipocytes, RBP4 mRNA expression was nearly undetectable but increased during differentiation up to approximately 1600-fold (P<0.05). Likewise, RBP4 secretion was restricted to mature adipocytes, further indicating that RBP4 is strongly related to differentiation of adipocytes. CONCLUSION RBP4 is a marker of adipose tissue mass and obesity already evident in children. The association of RBP4 with metabolic and cardiovascular sequelae of obesity appears to be secondary to the underlying relationship wtih body fat.
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Affiliation(s)
- D Friebe
- University Hospital for Children & Adolescents, University of Leipzig, Leipzig, Germany
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Abstract
BACKGROUND Intrauterine growth restriction seems to be a risk factor for an aggravated course of secondary renal diseases in children. Catch-up growth after birth may play a critical role. We tested if there is an association between an aggravated course of nephritis in Henoch-Schönlein Purpura (PSHN) and low birth weight or early weight gain during infancy. PATIENTS We retrospectively analysed the clinical course of 34 children with PSHN. METHODS Patients were sorted according their birth weight standard deviation score (SDS) in tertiles. Early weight gain was defined as gain of weight standard deviation score >0.67 between birth and 2 years of age. RESULTS Patients with higher birth weight needed Cyclophosphamide in a higher rate than low birth weight children. In the high weight gain group (SDS gain >0.67) 9 of the 11 patients compared to 7 of 22 patients in the low weight gain group (SDS gain <0.67) presented with arterial hypertension during the initial manifestation of PSH nephritis (p=0.01). Median systolic blood pressure SDS in the high weight gain group was 1.54 (-1.39-4.71) versus 0.29 (0.52-4.05) in the low weight gain group (p=0.008). Nevertheless, other clinical parameters during first manifestation and follow-up were not relevantly different. CONCLUSION In contrast to the data of children with idiopathic nephrotic syndrome or IgA nephropathy, this study does neither provide evidence for an association between low birth weight nor early weight gain and the later course of PSHN. Interestingly, early weight gain was associated with a higher systolic blood pressure during the initial manifestation of PSHN.
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Affiliation(s)
- C Plank
- Department of Pediatrics, University Hospital Erlangen, Germany
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Friebe D, Neef M, Erbs S, Dittrich K, Ketzscher R, Kiess W, Adams V, Körner A. The Number of circulating endothelial progenitor cells is decreased in children with obesity. DIABETOL STOFFWECHS 2010. [DOI: 10.1055/s-0030-1253952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Friebe D, Dittrich K, Garten A, Petzold S, Kiess W, Körner A. Beyond the adipose tissue – granulocytes as an additional source of circulating NAMPT in obesity. DIABETOL STOFFWECHS 2010. [DOI: 10.1055/s-0030-1253981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Nüsken E, Dittrich K, Carbon R, Dötsch J. Considering laparoscopic salvage options--is pre-emptive omentectomy necessary in paediatric peritoneal patients? Klin Padiatr 2010; 222:252-4. [PMID: 20306383 DOI: 10.1055/s-0030-1247509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND In paediatric peritoneal dialysis patients, pre-emptive omentectomy is discussed controversially and literature provides only little data concerning this issue. Our aim was to evaluate the rate of omentum-majus-related problems in our patients, in whom omentectomy was generally not performed. Furthermore, we were interested in the success rates of laparoscopic adhesiolysis. PATIENTS AND METHODS Between 09/2006 and 03/2008, we regularly saw 18 peritoneal dialysis patients in whom we retrospectively analysed medical records to determine the rate of catheter-related complications. In addition, we evaluated the success rates of laparoscopic adhesiolysis. RESULTS During 355 dialysis months in 18 patients, we observed 7 omentum-majus-related obstructions in 6 patients (1/50.7 PM). The median age of the patients affected was 9 years, median filling volume at the time of the obstruction was 671 ml/m (2). Laparoscopic adhesiolysis was successful in 4 out of 7 episodes. In 3 cases, the catheter lumen was plugged by necrotic portions of the omentum and the catheters had to be replaced. CONCLUSION Our data confirm omentum-majus-related catheter obstruction as a major cause of catheter dysfunction. However, in comparison to literature, it remains unclear to which extent omentectomy can reduce the incidence of catheter obstruction in general (including e. g. obstruction due to coagulation). Thus, the decision to perform an omentectomy should be taken individually after careful consideration. In case of omentum-majus-associated obstruction, early but not late laparoscopic intervention proved to be a successful, minimally invasive technique to restore catheter function.
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Affiliation(s)
- E Nüsken
- Paediatric Nephrology, University of Erlangen-Nuremberg, Loschgestrasse 15, Erlangen, Germany.
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Galiano M, Plank C, Dittrich K, Beck B, Hoppe B, Dötsch J. Terminales Nierenversagen in den ersten Lebensmonaten als Erstmanifestation einer Hyperoxalurie Typ I. Klin Padiatr 2010. [DOI: 10.1055/s-0030-1251049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Nüsken EC, Dittrich K, Plank C, Amann K, Dötsch J. Parvovirus B19-assoziierte FSGS-Rekurrenz nach Nierentransplantation? Klin Padiatr 2010. [DOI: 10.1055/s-0030-1251063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Dittrich K, Plank C, Amann K, Dötsch J, Fehrenbach H, Kemper M, Konrad M, Pohl M, Weber L. Beeinflusst die Art der Behandlung das Outcome der IgA-Nephropathie bei Kindern? Klin Padiatr 2010. [DOI: 10.1055/s-0030-1251047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Dittrich K, Ross S, Benz K, Amann K, Dötsch J. Experience with Mycophenolate Mofetil as Maintenance Therapy in five Pediatric Patients with Severe Systemic Lupus Erythematosus. Klin Padiatr 2009; 221:425-9. [DOI: 10.1055/s-0029-1234130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Melchior C, Kiess W, Dittrich K, Schulz A, Schöneberg T, Körner A. [Slim despite a genetic predisposition for obesity--influence of environmental factors as chance? A case report]. Dtsch Med Wochenschr 2009; 134:1047-50. [PMID: 19421926 DOI: 10.1055/s-0029-1222565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
CASE HISTORY AND CLINICAL FINDINGS A 4-year-old, slightly overweight (BMI 18 kg/m2, BMI SDS 1.29 approximately 90.1 (th) percentile) and otherwise healthy girl presented with accelerated linear growth (99.6 (th) percentile) and hyperphagia due to loss of satiety feeling. These findings are consistent with melanocortin-4 receptor ( MC4R) mutations. GENETIC ANALYSIS AND DIAGNOSIS: We found the partially inactivating mutation Arg (165)Trp by direct sequencing of the MC4R coding region. Interestingly, the patient's mother is also heterozygous for this mutation, but lean (BMI 19 kg/m2). TREATMENT AND COURSE Carriers of MC4R mutations develop hyperphagia due to lack of satiety feeling as a result of central dysregulation. The reduction of energy intake and the encouragement of physical activity can be successful to control the body weight. CONCLUSION Early diagnosis can promote lifestyle intervention to prevent the development of obesity even in the presence of a genetic predisposition.
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Affiliation(s)
- C Melchior
- Institut für Biochemie, Molekulare Biochemie, Medizinische Fakultät, Universität Leipzig
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Sauerstein K, Zimmermann B, Benz K, Dittrich K, Rascher W, Dötsch J. Encouraging survival of infants with terminal renal failure combining dialysis and succeeding early transplantation. Klin Padiatr 2007; 219:288-91. [PMID: 17763295 DOI: 10.1055/s-2007-972568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Dialysis in newborns and infants is a very challenging field in pediatric nephrology and still associated with high mortality. This article is designed for pediatricians who advise parents of newborns with renal failure. It aims to provide information about the difficulties during the period of dialysis and outcome after successful transplantation. We report upon five patients who proceeded to end-stage renal failure within the first year of life. All patients received peritoneal dialysis; however, two had to be switched to hemodialysis for several months. Four patients received percutaneous endoscopic gastric tubes (PEG) to enable high caloric diet. At the age of 1.5 to 5 years all children were successfully transplanted achieving good renal function. With regard to severe complications, hospitalisation time and somatic development all patients showed a substantial improvement after renal transplantation. Growth velocity increased to above SDS +2 after transplantation and all children reached the milestones of development in due time. In conclusion, after renal replacement therapy is initialised in infants with end-stage renal failure, sufficient nutrition to improve weight gain and to achieve the earliest possible transplantation is mandatory. Early transplantation results in a catch-up of developmental delay in short time.
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Affiliation(s)
- K Sauerstein
- Department of Pediatrics, University of Erlangen-Nürnberg
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Abstract
Smoking in young men may trigger anti-GBM disease manifesting with hemoptysis. We present a male adolescent in whom hemoptysis was mistaken to be a sign of airway infection for several months and who later on underwent an unusual antibody-negative relapse. The 16-year-old patient had a history of smoking and therapy-refractant hemoptysis and, later, acute macrohematuria with renal insufficiency necessitating hemodialysis (initial creatinine 4.2 mg/ dl). Chest X-ray showed diffuse lung infiltration. Renal biopsy revealed linear IgG deposits along the glomerular basement membrane (GBM) and cellular crescents in 13/16 glomeruli, simultaneously increased anti-GBM antibodies were detected. Thus, anti-GBM glomerulonephritis was diagnosed. After treatment with prednisone, oral cyclophosphamide and plasmapheresis, chest X-ray and hemoptysis improved, but renal failure persisted. Anti-GBM antibodies were negative. 4 weeks later, the patient presented again with a clinical relapse of severe hemoptysis and respiratory insufficiency after smoke exposition. Despite negative anti-GBM antibodies, he was treated similarly to a relapse and after the second course of plasmapheresis the patients' general condition improved and hemoptysis subsided. During the next 10 months the patient was stable with negative antibodies. He was under intermittent hemodialysis until laboratory measurements showed improved renal function. Now, 30 months after the acute episode, the patient is off dialysis for 17 months with stable creatinine values of 1.9 - 2.4 mg/dl, and is currently being treated with antihypertensive medicaments, calcitriol, calciumacetate, natriumhydrogencarbonate and allopurinol. The prognosis of anti-GBM glomerulonephritis depends on serum creatinine and the need of dialysis at initial presentation. In these patients, one-year survival rate is 67% and 5% for kidney function. Of note, despite the unfavorable prognosis in our patient, renal function recovered after 1 year of hemodialysis treatment. It is important to consider that in patients with anti-GBM disease antibody-negative relapses are possible.
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Affiliation(s)
- K Benz
- Kinder- und Jugendklinik, Universität Erlangen-Nürnberg.
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