Christine Vesely

University of Vienna, Wien, Vienna, Austria

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Publications (16)50.8 Total impact

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    ABSTRACT: Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most commonly diagnosed disorders in child and adolescent psychiatry. Patients with ADHD show increased risk for comorbid psychiatric disorders such as mood disorders, anxiety disorders, tic disorders and disruptive behavior disorders. Using criteria and methods of evidence-based medicine, in this paper possible algorithms for ADHD and comorbid disorders are presented. In conclusion, these algorithms aim to support health care professionals and can serve as guideline in decision making in pharmacotherapy. Stimulants are first-line medication treatment of ADHD without comorbid disorder. In co-existing aggression, major depressive disorder and tic disorder treatment with stimulants should be initialized at first. Only in case of unchanged persistence of comorbid symptoms specific pharmacological therapy should be combined. In comorbid anxiety disorders atomoxetine can be used as first-line treatment.
    Neuropsychiatrie: Klinik, Diagnostik, Therapie und Rehabilitation: Organ der Gesellschaft Österreichischer Nervenärzte und Psychiater 02/2007; 21(3):187-206. · 1.38 Impact Factor
  • Ralf Gössler, Christine Vesely, Max H Friedrich
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    ABSTRACT: Self-mutilation of the genitals in man is a rare phenomenon mainly occurring in young males. The importance of conflicts about the male role, difficulties with the male identification in childhood and feeling of guilt for sexual offences are discussed in the literature. The influence of developmental crisis on this symbolic form of automutilation will be discussed in our case report. We present a case of a young schizophrenic man whose illness started in adolescence. He committed genital automutilation already in early adolescence, as a young male he autocastrated himself. We demonstrate the connection of specific problems of development in adolescence and psychopathology. Autocastration will be discussed as a "psychotic" solution of the adolescent conflict of dependence. Developmental conflicts may be important pathoplastic factors who may lead to severe psychopathology and misbehavior. Additionally to a psychopharmacological treatment a specific adolescent- and conflictoriented psychotherapy for solving the developmental conflicts in young schizophrenic patients should be established.
    Psychiatrische Praxis 06/2002; 29(4):214-7. · 1.64 Impact Factor
  • Ralf Gößler, Christine Vesely, Max H. Friedrich
    Psychiatrische Praxis 01/2002; 29(4):214-217. DOI:10.1055/s-2002-30677 · 1.64 Impact Factor
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    ABSTRACT: In a single inpatient case study, a schizophrenic patient with tardive dyskinesia after prolonged treatment with typical neuroleptics was treated with the new atypical neuroleptic quetiapine, a dibenzothiazepin-derivative. Within 2 weeks of treatment with quetiapine, symptoms of tardive dyskinesia improved; 10 weeks after starting treatment tardive dyskinesia stopped completely. Over the same period, dopamine D2 receptor occupancy decreased substantially, as measured by IBZM-SPECT after 14 and 77 days of treatment.
    International Clinical Psychopharmacology 02/2000; 15(1):57-60. DOI:10.1097/00004850-200015010-00010 · 3.10 Impact Factor
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    ABSTRACT: We investigated 341 children and adolescents to evaluate the relevance of psychosocial factors in idiopathic headache. According to the criteria of the International Headache Society, 151 subjects had migraine and 94 had tension-type headache (TTH). Ninety-six subjects were headache-free controls. Psychosocial factors covered family and housing conditions, school problems, relations in the peer group, and several other items. We found that migraine patients did not differ from headache-free controls. Patients with TTH more often had divorced parents than the headache-free controls, and they had fewer peer relations than migraineurs and controls. In addition, migraine patients were significantly more often absent from school due to headache. All other psychosocial factors failed to discriminate between the three study groups. In conclusion, this controlled study in children and adolescents suggests that migraine is not related to family and housing conditions, school situation, or peer relations, whereas TTH is associated with a higher rate of divorced parents and fewer peer relations.
    Cephalalgia 02/1999; 19(1):32-43. DOI:10.1046/j.1468-2982.1999.1901032.x · 4.12 Impact Factor
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    ABSTRACT: We investigated the striatal dopamine-2 (D2) receptor occupancy caused by different antipsychotic substances in 18 psychotic patients (16 with schizophrenic and two with schizoaffective disorder according to DSM-IV) with single photon emission computed tomography (SPECT) using 123I-iodobenzamide (IBZM) as tracer substance. Four patients were treated with the novel antipsychotic compound quetiapine (300-700 mg/day), six with clozapine (300-600 mg/ day) and eight with haloperidol (10-20 mg/day). They were compared with eight healthy controls. Measurement of S/F ratios and consecutive calculation of D2 receptor occupancy revealed a significantly lower striatal D2 occupancy rate with quetiapine and clozapine in comparison to haloperidol. In correspondence with the low striatal D2 receptor occupancy rates and again in contrast to the haloperidol treatment group, there were no extrapyramidal motor side-effects (EPS) in the quetiapine and clozapine treatment groups. Therefore, the reported data support the position that quetiapine can be considered to be an atypical antipsychotic substance due to its relatively weak striatal D2 receptor blocking property and therefore its low propensity to induce EPS.
    Psychopharmacology 11/1997; 133(4):323-8. DOI:10.1007/s002130050409 · 3.99 Impact Factor
  • The Journal of Clinical Psychiatry 03/1997; 58(2):88. DOI:10.4088/JCP.v58n0206e · 5.14 Impact Factor
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    ABSTRACT: Seventeen psychiatric patients (11 with schizophrenia, 5 with other psychotic disorders, and 1 with obsessive-compulsive disorder) were examined by single photon emission computed tomography with 123I-iodobenzamide (IBZM) as tracer. Patients were treated with risperidone in two different dosage groups (3 mg and 8 mg) and haloperidol (10-20 mg) and compared with eight healthy control subjects. There was a statistically significant difference in basal ganglia/frontal cortex ratios of IBZM binding between controls and all treatment groups. A statistically significant difference was also found concerning these ratios and percentage of dopamine D2 receptor occupancy rates between the treatment groups with lowest ratios and highest percentage of D2 receptor occupancy in the group of patients treated with haloperidol, followed by the group treated with 8 mg of risperidone and the group treated with 3 mg of risperidone.
    Psychiatry Research 12/1996; 68(1):23-30. DOI:10.1016/S0925-4927(96)02839-9 · 2.68 Impact Factor
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    ABSTRACT: At two headache centers, one for children and adolescents and the other for adults, we investigated patients aged 5-80 years with episodic or chronic tension-type headache to evaluate the relation between age and headache characteristics as well as analgesics intake. We found an increasing headache frequency and duration, an increasing variability of the headache location, and an increasing frequency of nausea with increasing age. All other headache features did not depend on age. Additionally, our study revealed a marked increase of analgesics use in adults compared to children and adolescents. In conclusion, children, adolescents, and adults referred for tension-type headache show minor differences in some headache features, but a marked change of analgesics intake. The different headache symptoms may be causally related to age, but an influence of medication or other factors must also be considered.
    Pain 10/1996; 67(1):53-8. DOI:10.1016/0304-3959(96)03117-X · 5.84 Impact Factor
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    ABSTRACT: We investigated the influence of age on the IHS criteria for migraine and tension-type headache in 437 consecutive children and adolescents and found the following age-associated statistically significant differences: migraine duration, occurrence of migraine aura, and bilateral location of tension-type headache were more often fulfilled by adolescents, whereas aggravation of headache by physical activity (in migrainous disorder) and photophobia (in migraine with aura) were more often fulfilled by children. Accordingly, there are only a few differences concerning the fulfillment of the IHS criteria for migraine and tension-type headache in children and adolescents. Independent of age, the intensity of headache and the presence or absence of nausea are most important for differentiating the two major types of idiopathic headache. The sensitivity of the IHS criteria for migraine could be increased by reducing the minimum duration of migraine and by allowing the diagnosis of migraine when severe headache is associated with nausea, even though the criteria of location, quality, and aggravation by physical activity are not fulfilled.
    Headache The Journal of Head and Face Pain 05/1996; 36(4):231-8. · 3.19 Impact Factor
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    ABSTRACT: The aim of this study was to investigate whether the IHS criteria for migraine and tension-type headache depend on gender. Among 409 children and adolescents with recurrent idiopathic headache seen at a university outpatient clinic, girls had significantly more often migraine with aura. Also, there was a trend towards a higher frequency of tension-type headache in girls. In migraine, aggravation of headache by physical activity and occurrence of aura symptoms were more common in females, whereas vomiting and phonophobia occurred more often in males. In tension-type headache, females more often reported mild intensity of headache. All other criteria were similar in both sexes. Age influenced the expression of some of the accompanying symptoms in the various types of migraine, but had only minimal influence on other diagnostic criteria of migraine and tension-type headache in females as well as in males. Our study suggests that the frequency of migraine (except that of migraine with aura) is similar among girls and boys, that tension-type headache may occur more often in girls, and that gender has some influence on the IHS criteria for migraine, but almost no influence on those of tension-type headache.
    Cephalalgia 05/1996; 16(2):107-12. DOI:10.1046/j.1468-2982.1996.1602107.x · 4.12 Impact Factor
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    ABSTRACT: We investigated the influence of age on the IHS criteria for migraine and tension-type headache in 437 consecutive children and adolescents and found the following age-associated statistically significant differences: migraine duration, occurrence of migraine aura, and bilateral location of tension-type headache were more often fulfilled by adolescents, whereas aggravation of headache by physical activity (in migrainous disorder) and photophobia (in migraine with aura) were more often fulfilled by children, Accordingly, there are only a few, differences concerning the fulfillment of the IHS criteria for migraine and tension-type headache in children and adolescents. Independent of age, the intensity of headache and the presence or absence of nausea are most important for differentiating the two major types of idiopathic headache. The sensitivity of the IHS criteria for migraine could be increased by reducing the minimum duration of migraine and by allowing the diagnosis of migraine when severe headache is associated with nausea, even though the criteria of location, quality, and aggravation by physical activity are not fulfilled.
    Headache The Journal of Head and Face Pain 03/1996; 36(4):231 - 238. DOI:10.1046/j.1526-4610.1996.3604231.x · 2.94 Impact Factor
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    ABSTRACT: We investigated 429 consecutive patients, aged 5 to 18 (mean: 11.0 +/- 3.1) years, diagnosed with migraine or tension-type headache. The patients underwent either MRI or exclusively clinical follow-up examinations. Magnetic resonance imaging revealed normal findings in 82.3% and structural changes in 17.7%. However, the vast majority of these changes had minimal or no pathological relevance, and a causal relationship to the patient's headache could not be proven in any case. In the non-MRI group, clinical follow-up examinations confirmed the initial diagnosis in all patients and MRI was not required in any of these subjects. In conclusion, our study shows a poor relation between recurrent headache fulfilling the criteria of migraine and tension-type headache and structural changes incidentally detected by MRI. In addition, it suggests that clinical follow-up examinations are reliable. Accordingly, MRI is not required for routine examination of recurrent headache in children and adolescents, but it should be performed in patients with abnormal neurological findings, atypical headache pattern, or significant change of preexisting headache.
    Headache The Journal of Head and Face Pain 03/1996; 36(2):83-90. DOI:10.1046/j.1526-4610.1996.3602083.x · 3.19 Impact Factor
  • European Psychiatry 01/1996; 11. DOI:10.1016/0924-9338(96)89362-X · 3.21 Impact Factor
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    ABSTRACT: We investigated whether the criteria for idiopathic headache published by the International Headache Society (IHS) are useful in childhood and adolescence and compared the diagnoses according to this classification with those of Vahlquist. We used a semi-structured questionnaire to examine a total of 437 children and adolescents referred consecutively to a headache outpatient clinic. Twenty-eight of 437 patients were excluded because of symptomatic or unclassifiable headache. Of 409 patients with idiopathic headache, 70.4% had definite migraine or tension-type headache (IHS 1.1, 1.2, 2.1, 2.2), 20.5% had a migrainous disorder (IHS 1.7) and 9.1% had headache of the tension-type not fulfilling the criteria (IHS 2.3). In the differential diagnosis of migraine and tension-type headache the intensity of pain, aggravation of headache by physical activity, nausea and vomiting were the most important features. The quality of pain, photo- and phonophobia were less helpful and location least important. The duration of migraine attacks was less than 2 h in 19.0% of the migraine patients. In general, the diagnostic criteria of migraine were highly specific but less sensitive, and those of tension-type headache highly sensitive but less specific. The agreement between IHS criteria and those of Vahlquist was marked (kappa = 0.57). We conclude that the IHS criteria are useful for classifying headache in children and adolescents referred to a headache outpatient clinic. A forthcoming modification of the IHS criteria should consider a reduction of the minimum duration of migraine attacks from 2 h to 1 h and should try to increase the sensitivity of the criteria for migraine and the specificity of the criteria for tension-type headache.
    Cephalalgia 03/1995; 15(1):13-21; discussion 4. DOI:10.1046/j.1468-2982.1995.1501013.x · 4.12 Impact Factor
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    ABSTRACT: School refusal is a multicausal disorder with an estimated prevalence of about 5%. Patients are at risk for developing educational, social, and behavioral problems. Studies evaluating therapeutic interventions are, however, rare. Objectives: We prospectively investigated adolescents with prolonged school refusal who took part in a standardized group treatment program to find out if the program was suited for this group and if comorbid problems influenced the therapeutic progress. Patients and Methods: We investigated 18 adolescents admitted for prolonged school refusal. They were 10-14 years old and met ICD-10 criteria for social phobia (F40.1). All attended 16 sessions of manual-based, cognitive behavioral group therapy (CBT) [Joormann und Unnewehr, 2002] and were psychologically tested before, during and at the end of CBT. Results: 14 patients completed the study and the pre- and posttherapeutic assessment. Social phobia, clinical, and depression scores improved but not significantly. Temperamental factors �persistence�, �self-directedness�, and �cooperativeness� were associated with better therapeutic success, �harm avoidance� with higher social phobia scores and a less substantial clinical improvement. All patients had at least one comorbid axis-1 diagnosis, most frequently separation anxiety. Nearly all patients had impaired executive functions, and nearly all parents had psychiatric problems. Conclusions: The Joormann and Unnewehr CBT program was somewhat effective. Considering the high number of comorbidities, longer duration of treatment, additional treatment components and parental psychotherapy are recommended.
    Verhaltenstherapie 17(3):175-181. DOI:10.1159/000104353 · 0.51 Impact Factor