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Anorexia nervosa (AN) and bulimia nervosa (BN) are complex disorders characterized by disordered eating behavior where the patient's attitude towards weight and shape, as well as their perception of body shape, are disturbed. Formal genetic studies on twins and families suggested a substantial genetic influence for AN and BN. Candidate gene studies have initially focused on the serotonergic and other central neurotransmitter systems and on genes involved in body weight regulation. Hardly any of the positive findings achieved in these studies were unequivocally confirmed or substantiated in meta-analyses. This might be due to too small sample sizes and thus low power and/or the genes underlying eating disorders have not yet been analyzed. However, some studies that also used subphenotypes (e.g., restricting type of AN) led to more specific results; however, confirmation is as yet mostly lacking. Systematic genome-wide linkage scans based on families with at least two individuals with an eating disorder (AN or BN) revealed initial linkage regions on chromosomes 1, 3 and 4 (AN) and 10p (BN). Analyses on candidate genes in the chromosome 1 linkage region led to the (as yet unconfirmed) identification of certain variants associated with AN. Genome-wide association studies are under way and will presumably help to identify genes and pathways involved in these eating disorders. The elucidation of the molecular mechanisms underlying eating disorders might improve therapeutic approaches.

The current status of child and adolescent psychiatric genetics appears promising in light of the initiation of genome-wide association studies (GWAS) for diverse polygenic disorders and the molecular elucidation of monogenic Rett syndrome, for which recent functional studies provide hope for pharmacological treatment strategies. Within the last 50 years, tremendous progress has been made in linking genetic variation to behavioral phenotypes and psychiatric disorders. We summarize the major findings of the Human Genome Project and dwell on largely unsuccessful candidate gene and linkage studies. GWAS for the first time offer the possibility to detect single nucleotide polymorphisms and copy number variants without a priori hypotheses as to their molecular etiology. At the same time it is becoming increasingly clear that very large sample sizes are required in order to enable genome wide significant findings, thus necessitating further large-scaled ascertainment schemes for the successful elucidation of the molecular genetics of childhood and adolescent psychiatric disorders. We conclude by reflecting on different scenarios for future research into the molecular basis of early onset psychiatric disorders. This review represents the introductory article of this special issue of the European Child and Adolescent Psychiatry.

As heritability is high in attention-deficit/ hyperactivity disorder (ADHD), genetic factors must play a significant role in the development and course of this disorder. In recent years a large number of studies on different candidate genes for ADHD have been published, most have focused on genes involved in the dopaminergic neurotransmission system, such as DRD4, DRD5, DAT1/SLC6A3, DBH, DDC. Genes associated with the noradrenergic (such as NET1/SLC6A2, ADRA2A, ADRA2C) and serotonergic systems (such as 5-HTT/SLC6A4, HTR1B, HTR2A, TPH2) have also received considerable interest. Additional candidate genes related to neurotransmission and neuronal plasticity that have been studied less intensively include SNAP25, CHRNA4, NMDA, BDNF, NGF, NTF3, NTF4/5, GDNF. This review article provides an overview of these candidate gene studies, and summarizes findings from recently published genome-wide association studies (GWAS). GWAS is a relatively new tool that enables the identification of new ADHD genes in a hypothesis-free manner. Although these latter studies could be improved and need to be replicated they are starting to implicate processes like neuronal migration and cell adhesion and cell division as potentially important in the aetiology of ADHD and have suggested several new directions for future ADHD genetics studies.

Diese Arbeit präsentiert fortgeschrittene statistische Auswertungsmethoden für Beobachtungsstudien anhand von 7 Original-Publikationen der Kohortenstudien getABI und BILANZ. Eingesetzt wurden die multivariable Cox-Regression inklusive Interaktionen und Effektmodifikationen, neue Regressionsmethoden für den Eintritt der peripheren arteriellen Verschlusskrankheit (PAVK) und ein gleitender Durchschnitt als zeitabhängige Therapievariable. Neue Erkenntnisse zur Ätiologie und Prognose der PAVK sowie schweren osteoporotischen Frakturen bei Pausen in der Bisphosphonat-Langzeittherapie wurden erzielt.

Diese Arbeit präsentiert fortgeschrittene statistische Auswertungsmethoden für Beobachtungsstudien anhand von 7 Original-Publikationen der Kohortenstudien getABI und BILANZ. Eingesetzt wurden die multivariable Cox-Regression inklusive Interaktionen und Effektmodifikationen, neue Regressionsmethoden für den Eintritt der peripheren arteriellen Verschlusskrankheit (PAVK) und ein gleitender Durchschnitt als zeitabhängige Therapievariable. Neue Erkenntnisse zur Ätiologie und Prognose der PAVK sowie schweren osteoporotischen Frakturen bei Pausen in der Bisphosphonat-Langzeittherapie wurden erzielt.

BACKGROUND: Prevalence rates of overweight and obesity have increased in German children and adolescents in the last three decades. Adolescents with extreme obesity represent a distinct risk group. On the basis of data obtained by the German Child and Youth Survey (KiGGS) and the German district military offices we estimate that the group of extremely obese adolescents (BMI >= 35 kg/m2) currently encompasses approximately 200.000 adolescents aged 14 to 21 yrs. Conventional approaches focusing on weight reduction have largely proven futile for them. In addition, only a small percentage of adolescents with extreme obesity seek actively treatment for obesity while contributing disproportionately strong to health care costs. Because of somatic and psychiatric co-morbidities and social problems adolescents with extreme obesity require special attention within the medical care system.We have initiated the project "Medical and psychosocial implications of adolescents with extreme obesity - acceptance and effects of structured care, short: 'Youths with Extreme Obesity Study (YES)'", which aims at improving the medical care and social support structures for youths with extreme obesity in Germany. METHODS: We focus on identification of these subjects (baseline examination) and their acceptance of diagnostic and subsequent treatment procedures. In a randomized controlled trial (RCT) we will investigate the effectiveness of a low key group intervention not focusing on weight loss but aimed at the provision of obesity related information, alleviation of social isolation, school and vocational integration and improvement of self-esteem in comparison to a control group treated in a conventional way with focus on weight loss. Interested individuals who fulfill current recommended criteria for weight loss surgery will be provided with a structured preparation and follow-up programs. All subjects will be monitored within a long-term observational study to elucidate medical and psychosocial outcomes. Our aim is to evaluate realistic treatment options. Therefore inclusion and exclusion criteria are minimized.We will recruit adolescents (age range 14--21 years) with extreme obesity (BMI >= 35 kg/m2) (extreme group) within 24 months (120 per centre, 5 centres) as well as obese adolescents being at risk for developing extreme obesity (BMI >= 30 -- 34.9 kg/m2) (at risk group). Follow-up evalutations will be performed biannually after inclusion and is planned to be extended in case of additional funding. In sum, we aim at establishing evaluated health care structures for extremely obese adolescents. DISCUSSION: The results of YES will be of importance for a frequently neglected group of individuals, for whom current medicine has little to offer in terms of structured access to empirically evaluated therapeutic programs. Thus, the results will be both a help for the adolescents within the study and for others in the future given that the trial will lead to a positive finding. Moreover, it will help practitioners and therapists to deal with this neglected group of individuals.Trial registrationProject registration numbers for each subproject: 1.) ClinicalTrials.gov: NCT01625325, NCT01703273, NCT01662271, NCT01632098; 2.) Germanctr.de: DRKS00004172, DRKS00004195, DRKS00004198, DRKS00004197.

Sepsis is the dysregulated host response to an infection which leads to life-threatening organ dysfunction that varies by host genomic factors. We conducted a genome-wide association study (GWAS) in 740 adult septic patients and focused on 28day mortality as outcome. Variants with suggestive evidence for an association (p≤10-5) were validated in two additional GWA studies (n=3470) and gene coding regions related to the variants were assessed in an independent exome sequencing study (n=74). In the discovery GWAS, we identified 243 autosomal variants which clustered in 14 loci (p≤10-5). The best association signal (rs117983287; p=8.16×10-8) was observed for a missense variant located at chromosome 9q21.2 in the VPS13A gene. VPS13A was further supported by additional GWAS (p=0.03) and sequencing data (p=0.04). Furthermore, CRISPLD2 (p=5.99×10-6) and a region on chromosome 13q21.33 (p=3.34×10-7) were supported by both our data and external biological evidence. We found 14 loci with suggestive evidence for an association with 28day mortality and found supportive, converging evidence for three of them in independent data sets. Elucidating the underlying biological mechanisms of VPS13A, CRISPLD2, and the chromosome 13 locus should be a focus of future research activities. ; The project was supported by the Paul-Martini-Sepsis Research Group, funded by the Thuringian Ministry of Education, Science and Culture (ProExcellence; grant PE 108-2); the public funded Thuringian Foundation for Technology, Innovation and Research (STIFT) and the German Sepsis Society (GSS); the Jena Center of Sepsis Control and Care (CSCC), funded by the German Ministry of Education and Research (BMBF; 01 EO 1002, 01 EO 1502). The VISEP and MAXSEP trials from the SepNet Study Group had been supported by a BMBF grant (01 KI 0106) and by unrestricted grants from B. Braun, HemoCue, Novo Nordisk, Astra Zeneca GmbH, Wedel, Germany and Bayer HealthCare, Leverkusen, Germany. The exome sequencing study was funded in part by the Hellenic Institute for the Study of Sepsis. The GenOSept study was supported by the European Union and benefits from the 6th framework programme of RTD funding. The PROGRESS study is supported by the German Federal Ministry of Education and Research, grant numbers 01KI07110 (Giessen), 01KI07111 (Jena), 01KI07113 (Leipzig), 01KI07114 (Berlin), 01KI1010I (Leipzig), and 01KI1010D (Greifswald).