Klaus-Jürgen Neumärker’s research while affiliated with Humboldt-Universität zu Berlin and other places

The relevance of repeated body mass index (BMI) assessments for long-term outcome in anorexia nervosa (AN) was studied. Two-hundred and twelve adolescent patients aged 10-18 (Mean 14.9) years from five sites were followed up for an average of 8.3 years after first admission. Various predictors of BMI at follow-up were analyzed. In comparison to subjects with normal BMI (>17.5) at final follow-up, subjects with BMI <17.5 had significantly lower age-adjusted BMI prior to onset of the disorder and at discharge from first admission. In addition, all outcome scores indicated poorer functioning in the group with BMI < 17.5. The BMI prior to onset of AN, the BMI at first hospital admission and discharge, and the BMI at final follow up were significantly correlated across time. Higher BMI prior to onset of AN, higher BMI at first discharge, and lower age at first admission predicted a normal BMI (>17.5) at follow-up in a model of logistic regression. The long-term outcome of adolescent AN reflects the normal tracking of BMI over time. Presumably, the tracking in AN patients is somewhat reduced in comparison to healthy subjects.

Zusammenfassung Karl Leonhard gilt als einer der letzten Vertreter der Nervenheilkunde, die die Fächer Psychiatrie und Neurologie gleichermaßen in Klinik und Wissenschaft beherrschten. Aus Frankfurt am Main kommend, war er von 1955 bis 1957 zunächst in Erfurt, danach bis zur Emeritierung 1970 als Ordinarius und Direktor an der Psychiatrischen und Nervenklinik der Humboldt-Universität zu Berlin. Ein 1962 an Leonhard ergangener Ruf an die J.-W.-Goethe-Universität Frankfurt am Main führte zu politischen und persönlichen Irritationen. Seine wissenschaftlichen Arbeiten setzte er bis kurz vor seinem Tod am 23.4.1988 an der Berliner Charité fort. In der Tradition von Carl Wernicke und Karl Kleist stehend, entwickelte Leonhard mit seiner differenzierten phänomenologischen Analyse psychopathologischer Befunde eine ebenso differenzierte nosologische Klassifikation endogener Psychosen. Die Beschreibung zykloider Psychosen, die sich in Verlauf und Prognose von den unsystematischen und systematischen Schizophrenien unterscheiden, und der nosologischen Differenzierung uni- und bipolarer Depressionen setzte Leonhard neue Maßstäbe in Klinik, Therapie und Forschung endogener Psychosen. Seine Vorstellungen vom Stellenwert des Biologischen im Verhalten des Menschen wurden unter ideologischen Gesichtspunkten zwar kritisiert, führten dennoch zu einer erweiterten Sicht der Leistungen der menschlichen Psyche. Die Beschreibung normaler und abnormer Persönlichkeiten und das Konzept akzentuierter Wesenszüge waren die Grundlagen für seine auf die Individualität des Patienten und dessen Neurose ausgerichtete Individualtherapie. Leonhards Einfluss auf die Neurologie und Neuropsychologie hält mit seinen Vorstellungen über Theorie und Praxis der Hirnlokalisation, insbesondere der Beschreibung von Aphasie- und Agraphieformen, bis in die Gegenwart an.

The course and clinical predictors of rehospitalization were studied in a large sample of adolescent patients with anorexia nervosa who had been treated at five European sites and been followed-up. Two-hundred and twelve adolescent patients first admitted for in-patient treatment, aged 10-18 (Mean 14.9) years and 94.8% female, were followed-up for an average of 8.3 years after first admission at sites in (former East and West Berlin, Zurich, Sofia, and Bucharest). Clinical history data were collected by use of standardized item-sheets at first admission. Semi-structured interviews including ratings of eating pathology and psychosocial outcome were performed at follow-up. About 44.8% (95/212) of the patients required at least one readmission. Rates of rehospitalization were significantly higher at the Eastern sites (Sofia and Bucharest). Significant predictors of readmission were paternal alcoholism, history of anorexia nervosa in the family, eating disorder in infancy, periodic overactivity, lower weight increase at first admission, and lower BMI at first discharge. In a model of logistic regression analysis, five variables (paternal alcoholism, eating disorder in infancy, periodic overactivity, low weight increase during first admission, and low BMI at first discharge) correctly classified 69% of the participants into cases with single or repeated admissions. Patients with repeated admissions had a less favorable long term outcome and had higher rates of persisting psychopathology at follow-up. Rehospitalization reflects the chronic course in a sizable proportion of adolescent patients with anorexia nervosa. Family psychopathology may have an effect both in terms of genetic vulnerability and environmental stress leading to unfavorable courses. The strong effect of insufficient weight gain during first admission and lower BMI at first discharge emphasizes the importance of adequate interventions. Readmissions carry the risk for later poor psychosocial and psychiatric outcomes.

Karl Bonhoeffer, student of Carl Wernicke, is known as one of the outstanding psychiatrists and neurologists. His name stands for the description of the choreatic movements (Bindearm-Chorea) as well as for the symptomatic psychosis (organic psychosis). From 1912–1938 Bonhoeffer was director of the psychiatric and neurology university hospital of the Charité in Berlin. Under his leadership, important and essential influence and results came from his colleagues and working team consistent of Creutzfeldt, Kramer, Straus, Kronfeld, Kalinowski, Scheller and Zutt in nearly all fields of neuropsychiatry. Bonhoeffer's attitude towards sterilization was contradictory to the beliefs of the time. Like his son, the theologian Dietrich Bonhoeffer, he strictly refused euthanasia.Dietrich and Klaus Bonhoeffer and his sons-in-law H. von Dohnanyi and F. Schleicher were murdered because of their resistance to the Nazis in April 1945.

Despite its chequered history, Kahlbaum's 1874 description of catatonia (tension insanity) and its categorization as a clinical illness is in outline still valid. Kahlbaum also acknowledged the existence of catatonia in children. Corresponding case studies have also been analyzed. The originators and disciples of the Wernicke-Kleist-Leonhard school proved catatonia in early childhood as a discrete entity with specific psychopathology. This does not mean that catatonic symptoms do not occur in other illnesses and in particular in organic psychoses. These are, however, of a totally different nature. Autism, as first described in connection with schizophrenic negativism by Bleuler in 1910, is one of the key symptoms of schizophrenia. As identified by Kanner in 1943, abnormal social interaction and communication, together with retarded development, are the main characteristics of autism in early childhood. Asperger's concept of autistic disorder (1944), although based on psychopathological theory, did not include retardation in development as an aspect. Consequently, autistic behavior can occur in a variety of mental disorders. Research into possible etiological and pathogenetic factors has been undertaken, but no clear link found as yet.