Pharmacologic treatment for children and adolescents with anxiety disorders

Pediatric anxiety disorders are common illnesses that, if left untreated, may induce academic, family, and interpersonal problems. Cognitive-behavioral techniques and other psychotherapeutic interventions may be adequate for the treatment of most anxiety disorders. For patients with severe symptoms or for whom psychotherapeutic approaches are not adequate, medications are indicated. Among the available medications, the SSRIs are currently the first choice; however, other medications, such as the benzodiazepines and the TCAs, may be used alone or sometimes in combination with the SSRIs. Caution with respect to medication interactions and side effects is indicated. In particular, long-term side effects in these medications have not been well studied.     

Sadomasochism in children and adolescents: A contemporary treatment approach.

The nature and origins of sadomasochistic behavior in children is discussed in terms of psychoanalytic and social reinforcement theories. Research indicates that the child's search for intense emotional contact is central. A 2-phase contemporary approach to treatment that develops the correct emotional intensity between therapist and child and resolves resistances through such techniques as mirroring, joining, reframing, restraining, refocusing, and use of countertransference reactions is described. Clinical vignettes are provided as illustrations of these techniques. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Screening and treatment of children and adolescents with hypercholesterolemias and dyslipidemias

Evidence was provided that atherogenesis develops for several decades before pathological changes are manifested. It may thus be stated, that the "incubation period" of atherosclerotic pathological consequences is very long but it is reduced markedly already from childhood and adolescence in subjects with an atherogenic lipoprotein phenotype. Atherogenic lipoprotein phenotype comprises subjects suffering from one or more, frequently from a combination of several of the following metabolic indicators: hypercholesterolaemia, elevated levels of LDL-cholesterol, apolipoprotein B, lipoprotein (a), reduced levels of HDL-cholesterol and apolipoprotein A-1. The atherogenic lipoprotein phenotype is in 95% conditioned by inborn metabolic errors, i.e. familial hyperlipoproteinaemia and dyslipoproteinaemia. In the population the following are encountered most frequently: combined familial hyperlipidaemia, familial hypertriacylglycerolaemia and familial hypercholesterolaemia. Active screening and treatment of children and adolescents from these affected families is of great importance in primary prevention of atherosclerotic complications in adult age.     

Current concepts in milieu treatment of seriously disturbed children and adolescents.

In a variety of treatment settings, a therapeutic milieu provides intensive psychotherapeutic and psychoeducational experiences for disturbed children and young adolescents. It is generally agreed that effective psychosocial treatment requires a developmentally based treatment approach, collaborative parental involvement, and provision for ongoing staff support and training. In such settings, the treatment plan for each child reflects developmental, psychosocial, biological, cognitive, and neurointegrative aspects of the child's problems and identifies specific roles for psychotherapists, caseworkers, educators, occupational and recreational therapists, and parents (Alt, 1961; Pfeffer, 1979; Redl, 1959; Trieschman, 1969). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Residential treatment for emotionally disturbed children & adolescents in Tennessee

In some cases the differential diagnosis of the torsion of the testicles may be difficult also for the experienced clinician. It is reported on a new method of the delimitation of the torsion of the testicles compared with inflammatory changes of the testicles and the epididymis. By means of the ultrasound-Doppler-method the blood supply of the vasa spermatica is registered. Missing Doppler-signals in the direct measurement above the spermatic cord in comparison to the collateral side are typical for a complete torsion of the testicles.     

Compliance factors in the behavioural treatment of headache in children and adolescents.

161 children (aged 9–17 yrs) with migraine headaches participated in a behaviorally oriented treatment program. Data were collected on factors related to staying in treatment and adherence to treatment instructions. Older Ss were less likely to drop out during treatment. Also, Ss with fewer headaches were more likely to adhere to the treatment regimen. Findings are discussed in terms of parental involvement and patient autonomy. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluation and treatment of neurodevelopmental deficits in sexually aggressive children and adolescents.

Recent advances in developmental psychopathology demonstrate that comorbidities routinely appear in clinical samples of children and adolescents, particularly in those youngsters with disruptive behavior disorders and problems with aggressive behavior. This article discusses (a) the prevalence of comorbid neurodevelopmental deficits, particularly attention-deficit/hyperactivity disorder, in a clinical sample of 72 children and adolescents, ages 6-17, who displayed sexually aggressive behavior; (b) the theoretical implications of these findings; and (c) the relevance of this comorbidity for the clinical evaluation and treatment of sexually aggressive youth. Because adult models of psychopathology are limited, the need for a developmentally appropriate model for understanding sexual aggression in children is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Spondylolisthesis in children and adolescents

A study of spondylolysis and spondylolisthesis in 142 children and adolescents is reported. In twelve of the seventy-nine patients followed for over a year the affected vertebra slipped further by 10 per cent or more. Increasing slip occurred mainly during the adolescent growth spurt, and was greater when spinal bifida or other vertebral anomalies were present. If at presentation the slip is less than 30 per cent then further slip beyond 30 per cent is unlikely. Decompression posteriorly is advised when signs of nerve pressure are present. Indications for spinal fusion are suggested; the intertransverse method of fusion was used in sixty-nine patients.     

Syncope in children and adolescents

OBJECTIVES: The objectives of this study were to 1) define the incidence of syncope coming to medical attention among children and adolescents, 2) determine the outcome of syncope in these patients, and 3) determine changes over time in the evaluation and charges for evaluating this problem. BACKGROUND: Syncope occurs commonly in children and adolescents. However, the mid- and long-term outcome of children and adolescents who experience syncope is unknown. METHODS: Utilizing the Rochester Epidemiology Project, we determined the incidence, outcome and charges for medical evaluation for patients seeking medical attention for syncope during an early 5-year period (1950 to 1954) and a more recent 5-year period (1987 to 1991). RESULTS: The incidence of syncope coming to medical attention was 71.9 and 125.8/100,000 population for the early and more recent cohort, respectively. The incidence was higher for female than for male patients. The incidence peaked in 15- to 19-year old patients. Acute illness and noxious stimuli were associated with 24% and 23% of the episodes, respectively. Although long-term survival was not different from that of the general population, one child died suddenly, and another had hereditary prolonged QT interval syndrome. These were two of only six patients who had exertional syncope. Total charges for evaluation of syncope were similar in the two time periods. However, charges for testing procedures were greater for the more recent cohort. CONCLUSIONS: In general, syncope in children and adolescents is a benign event. Syncope occurring during exercise may identify patients with a potentially fatal condition. Detailed evaluation should be considered for patients who have syncope during exercise or who have a family history of syncope, sudden death, myocardial disease or arrhythmias. It may be prudent to obtain an electrocardiogram for all patients who seek medical attention for syncope.     

Trichobezoars in children and adolescents

BACKGROUND: Trichobezoars are composed of hair or fibres. The typical patient presenting with a trichobezoar is an adolescent girl experiencing mental disturbance or retardation. CASE REPORT: Three girls with trichobezoars were seen. Two of them, 4 and 15 years old, had serious digestive antecedents (corrosive oesophagogastritis and oesophageal atresia, respectively) and had undergone previous surgery. The third was a 13-year-old mentally retarded girl. In two cases, an enzymatic dissolution trial was unsuccessful, requiring secondary surgical removal after, in one case, ineffective gastroscopic removal complicated by an oesophageal perforation. The third child had an initial operative removal. DISCUSSION: Serious digestive antecedents may favour bezoars, a diagnosis that must be evoked in such patients presenting with chronic digestive symptoms. Enzymatic dissolution is ineffective for large bezoars, and gastroscopic removal carries some risks such as perforation or intestinal obstruction. Operative removal is usually indicated. Psychiatric follow-up is needed to prevent this complication in children with serious digestive antecedents and to reduce the risk of recurrences.     

Surgical treatment for partial epilepsy among Norwegian children and adolescents

We conducted a retrospective longitudinal self-controlled study of 64 patients aged 4-19 years treated with resective surgery for partial epilepsy from 1952 to 1988. Approximately 60% of patients experienced > 95% reduction in seizure frequency, and 70% had worthwhile improvement of at least 75% reduction. Seizure relief was more frequent among patients who underwent operation after 1978, and significant differences by time period of operation were noted for those with temporal lobe excisions and patients with normal tissue histology. The region of resection and the age at treatment did not provide significant information with respect to seizure outcome. Postresection electrocorticography (ECoG) and EEG of the first postoperative year predicted later seizure outcome. Small neurologic deficits were more common among patients resected in the temporal lobe than in patients resected in the frontal lobe. Half of the patients with preoperative unilateral focal activity and a third of those with bilateral focal activity had normal EEG postoperatively. One fourth had discontinued antiepileptic drug (AED) therapy. As expected, long-term mortality was significantly higher than the mortality of the general population. Seven patients died during follow-up. Two male patients committed suicide.     

Pancreatitis in children and adolescents

The literature on acardiac monsters has been reviewed. The following conclusions were drawn: 1. The probability of their appearance seems considerably higher among monoamniotic than diamniotic monochorionic twin pairs. 2. They seem more likely to occur within monozygotic (MZ) pairs in higher multiple births than in MZ twins. 3. The data are consistent with the suggestion that there is a slight female excess among them.     

Depression in children and adolescents

Depression in children and adolescents seems to be more common than it was 50 years ago. Figures of 0.5 to 2 per cent have been reported for the prevalence of prepubertal depression. After puberty, the prevalence increases and there is a marked female preponderance. In all likelihood, the prevalence of juvenile depression has also increased in Sweden as the figures for juvenile suicide increased between the 1950s and 1970s. Juvenile depression is recurrent and the risk of recurrence within 5-8 years has been determined to be 75-100 per cent. Before early adulthood, about 40 per cent of young people with depression are at risk of attempted suicide. The course of juvenile depression is chronic in at least 10 per cent of cases.     

Understanding the mental health needs of children and adolescents in residential treatment.

With the penetration of managed care approaches in child welfare, residential treatment services have come under increased scrutiny. In these circumstances it is critical to understand the clinically indicated use of these expensive interventions. As part of a community-reinvestment strategy of reform within a state child welfare agency, a needs-based assessment of children and adolescents was undertaken. A review of cases revealed that although the level of mental health need for many was significant, a substantial proportion of children in residential placement were not at high levels of risk. On the basis of these data, a process of placement review was designed and implemented for more effective use of residential treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)