Use of a neonatal blood pressure cuff to monitor blood pressure in the adult finger--comparison with a standard adult arm cuff

This study examined the comorbidity of substance use disorders and other psychiatric disorders in adolescent populations. The study population was comprised of 100 consecutive admissions, ages 13 to 17, to an acute care adolescent psychiatric inpatient unit for substance use disorders. Patients were assessed using the Personal Experience Screening Questionnaire (PESQ) and the substance-use disorder portion of the Structured Clinical Interview for DSM III-R (SCID-R). Thirty-three (33%) patients were identified as having a substance abuse or dependence diagnosis. There was no significant difference in the age between substance users and nonsubstance users. There were significantly more whites in the substance-using group. Sixty percent of all adolescents interviewed had histories of sexual or physical trauma, with trauma being significantly more common in the substance-using group. There were no significant differences in the number or type of other Axis I or Axis II diagnoses between the two groups. While substance users and nonsubstance users had no significant difference in the number of past psychiatric hospitalizations, nonsubstance users had significantly more past medical hospitalizations. These results indicate that high rates of comorbid substance abuse and psychiatric disorders exist in adolescents, and more in-depth study of comorbidity among adolescents is warranted.     

Psychiatric disorders and sexual risk among adolescents in mental health treatment.

Objective: To examine the relationship between psychiatric disorders and sexual behaviors among adolescents receiving mental health treatment. Adolescents in mental health treatment have been found to have higher rates of HIV risk behavior than their peers, but data concerning the relationship between psychopathology and risk are inconsistent and limited. Method: Eight hundred and forty adolescents (56% female, 58% African American, mean age = 14.9 years) and their parents completed computerized assessments of psychiatric symptoms via the Computerized Diagnostic Interview Schedule for Children (Shaffer, 2000a, 2000b). Adolescents also reported on sexual risk behaviors (vaginal/anal sex, condom use at last sex) and completed urine screens for a sexually transmitted infection (STI). Results: Adolescents meeting criteria for mania, externalizing disorders (oppositional defiant, conduct, and attention-deficit/hyperactivity disorders), or comorbid for externalizing and internalizing disorders (major depressive, generalized anxiety, and posttraumatic stress disorders) were significantly more likely to report a lifetime history of vaginal or anal sex than those who did not meet criteria for any psychiatric disorder (odds ratio [OR] = 2.0, 2.3, and 1.9, respectively). Adolescents meeting criteria for mania were significantly more likely to have 2 or more partners in the past 90 days (OR = 3.2) and to test positive for a STI (OR = 4.3) relative to adolescents who did not meet criteria for a psychiatric disorder. Conclusions: The presence of internalizing and externalizing disorders, especially mania, suggests the need for careful screening and targeting of adolescent sexual behavior during psychiatric treatment. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changing patterns of inpatient care for children and adolescents at the Menninger Clinic, 1988–1994.

The authors describe trends in inpatient psychiatric length of stay (LOS) and admissions for the population of children and adolescents (N?=?784) at the Menninger Clinic from 1988 to 1994. During this period, median LOS declined dramatically from 7 months to 3 weeks, whereas admissions increased 4-fold. The diagnostic case mix changed substantially, with a crossover in modal principal diagnosis from personality disorder to affective disorder. Use of medications became almost universal. Diagnosis and medication use became less important determinants of LOS over time. The practical implications of these patterns include higher patient turnover, fewer inpatient clinical contact hours, and heightened importance of continuity with outpatient care. Research should center on the impact of declining LOS on clinical and functional outcomes for children and adolescents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Platelet serotonin measures in adolescents with conduct disorder

Dysregulation of serotonergic function has been associated with aggression in several studies involving children, adolescents, and adults. This study investigated the relationship of platelet serotonergic measures to conduct disorder type, severity of aggression, and social skills impairment. Standardized assessments of diagnosis, aggression, impulsivity, and social skills were obtained from 43 male adolescents (ages 13-17) incarcerated at an involuntary residential treatment facility for juvenile offenders. Blood samples were collected and assayed for whole blood serotonin (5-HT) and platelet [3H]-paroxetine-labeled 5-HT-transporter binding. Whole blood 5-HT was higher in adolescents with conduct disorder, childhood type than in subjects with conduct disorder, adolescent type. Whole blood 5-HT was positively correlated with violence rating of the current offense and total offense points, and staff ratings of social skills impairment. Our findings are consistent with a relationship between 5-HT dysregulation and aggressive behavior in incarcerated adolescent boys with conduct disorder, particularly of childhood onset.     

Mentoring and self-efficacy for advanced nursing practice: a philosophical approach for nurse practitioner preceptors

The purpose of this study was to compare persons with antisocial personality disorder (ASP) with those who meet the adult criteria for ASP but fail to meet the criteria for childhood conduct disorder. Sociodemographic data, medical history, and psychiatric symptoms exhibited during a recent hospital admission were compared in the two groups by chart review. The two groups were virtually indistinguishable, except that patients without childhood conduct disorder were less likely to smoke or consume alcohol, were less likely to have spent time in a training school/boot camp as a child or adolescent, were less likely to have been admitted for a recent suicide attempt, and were less likely to have conned others. We conclude that persons meeting the adult criteria for ASP but not the childhood conduct disorder criteria essentially suffer the same disorder as those who meet full ASP criteria but are less severely affected.     

Prevalence of psychiatric disorders in children and youth: An agenda for advocacy by school psychology.

Reviews 12 epidemiological studies, published 1987–1990, that describe the prevalence of childhood and adolescent psychiatric disorders, assesses the studies' methodological standards and limitations, and offers an agenda for the practice of school psychology. A typical school of 1,000 students could be expected to have between 180 and 220 students with diagnosable psychiatric disorders, most frequently anxiety disorders, conduct disorder, oppositional defiant disorder, and attention deficit disorder. In secondary school populations, depression and suicidal behaviors are also prevalent. Recommendations for actions at practitioner, district, and governmental levels that will include school psychologists in planning about how to meet these very significant mental health needs of children and adolescents are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Significance of family relations for coping with psychological disorders--results of an empirical study of therapy prognosis of children and adolescents with psychological disorders

The importance of family relations for the therapy of psychiatric disorders in children and adolescents is discussed reporting results from an empirical study carried out in an inpatient sample of a child and adolescent psychiatric unit with regard to the quality of mother-child resp, father-child relation and its influence on coping processes. Whether adolescents suffering from a psychiatric disorder are able to cope with their problems during the course of a therapy, depends on their individual and social resources. Therapy outcome is to a great extent influenced by the emotional quality of their family relations. Hostility and rejection as well as unstructured and disorganized parental behavior contribute to a negative outcome. A differentiated analysis shows further that the relation between the adolescents and their fathers is particularly important for therapy prognosis. Nevertheless, one has to consider the respective relations with both parents for therapy prognosis, as problems with one parent may be partly compensated by a good relationship with the other parent. Finally, the cooperation between parents and clinical staff is discussed. Data and experiences show that interest and readiness of parents (mothers as well as fathers) for a close cooperation are higher than generally expected.     

DSM-IV field trials for oppositional defiant disorder and conduct disorder in children and adolescents

OBJECTIVE: The purpose of the field trials for oppositional defiant disorder and conduct disorder was to select valid diagnostic thresholds for these disorders and to compare the psychometric properties of DSM-IV criteria for oppositional defiant disorder and conduct disorder with previous DSM diagnostic formulations. METHOD: Structured diagnostic interviews, standardized clinician's validation diagnoses, and multiple measures of impairment were obtained for 440 clinic-referred children and adolescents aged 4-17 years. RESULTS: A diagnostic threshold of four symptoms of oppositional defiant disorder optimized identification of impaired children, improved agreement somewhat with the clinician's validation diagnosis, and had somewhat better test-retest agreement than DSM-III-R. In the case of conduct disorder, the optimal time window for ascertainment of symptoms was clarified. A diagnostic threshold of three symptoms of conduct disorder maximized accurate identification of impaired children and agreement with the clinician's validation diagnosis and resulted in slightly better test-retest agreement than DSM-III-R. Compared with the DSM-III-R definition, the DSM-IV definition of oppositional defiant disorder was somewhat more prevalent, but the prevalence of conduct disorder was essentially unchanged. CONCLUSIONS: DSM-IV definitions of oppositional defiant disorder and conduct disorder are somewhat better than DSM-III-R definitions in terms of internal consistency and test-retest agreement, and the validity of the DSM-IV definition of oppositional defiant disorder is slightly better than that of DSM-III-R.     

Psychiatric comorbidity among referred juveniles with major depression: fact or artifact?

OBJECTIVE: The high levels of psychiatric comorbidity reported in juveniles meeting operational definitions of depressive disorders raise both substantive and methodological concerns about whether depression with comorbid disorders should be classified as two disorders or as different manifestations of the same condition. Our purpose was to clarify issues of diagnostic heterogeneity and diagnostic overlap in juvenile depression. METHOD: The sample consisted of consecutively referred children and adolescents (N = 424) comprehensively evaluated with structured diagnostic interviews and psychosocial assessments. RESULTS: A clinical picture compatible with the diagnosis of major depression was identified in 40% of these referred youths. Children meeting criteria for major depression had prototypical symptoms of the disorder, a chronic course, and severe psychosocial dysfunction. In addition, they frequently met criteria for attention-deficit hyperactivity disorder, conduct disorder, and anxiety disorders. These comorbidity findings were not due to symptom overlap among major depression and the co-occurring disorders. For the most part, comorbid disorders preceded the onset of major depression by several years. CONCLUSIONS: Juvenile depression has a chronic course, severe dysfunction, and high levels of psychiatric comorbidity. Despite symptom overlap, our work suggests that major depression and other conditions may represent different disorders.     

A study of replanted permanent teeth in different age groups

In the inpatient treatment of acute psychiatric episodes in children and adolescents, the psychiatrist must set up an initial treatment plan incorporating one or more psychotherapeutic modalities and adapt this plan to the patient's clinical course. This article summarises the clinical experience of a model unit at the University of Heidelberg, the result of a collaboration between the Department of General Psychiatry and the Department of Child and Adolescent Psychiatry at the Clinic of Psychiatry. A series of 116 adolescent admissions was reviewed for clinical diagnosis, the nature and frequency of psychotherapeutic modalities, and the role of family involvement in patient care. Differential and adaptative approaches to the selection of treatment modalities in the context of an acute care setting are emphasised.     

Course of psychiatric and substance abuse syndromes co-occurring with bipolar disorder after a first psychiatric hospitalization

BACKGROUND: Patients with bipolar disorder frequently meet criteria for other psychiatric and substance abuse diagnoses. To clarify relationships among these disorders, the authors examined the course of syndromes co-occurring with bipolar disorder for 12 months after a first hospitalization. METHOD: Seventy-seven patients were recruited from consecutive inpatient admissions who met DSM-III-R criteria for bipolar disorder, manic or mixed with psychosis. The 12-month syndromal course of co-occurring DSM-III-R alcohol and drug abuse disorders, posttraumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and other anxiety disorders were longitudinally recorded. RESULTS: The rates of all syndromes, except other anxiety disorders, were elevated. OCD demonstrated an interval course that frequently mirrored the course of the bipolar disorder. The courses of PTSD and substance abuse syndromes were separate from that of the bipolar disorder in many of those with both syndromes. Alcohol and drug abuse syndromes were strongly correlated. CONCLUSION: The obsessive-compulsive syndrome may represent an alternative expression of bipolar disorder in some patients. In contrast, PTSD appears to represent a truly separate disorder, which is possibly more prevalent in bipolar patients due to a shared risk factor. Substance abuse does not appear to simply result from attempts at self-medication or from the impulsivity of mania. These results suggest that future studies examining the course of syndromes co-occurring with bipolar disorder are warranted.     

Differential diagnosis of attention deficit and conduct disorders using conditional probabilities.

Attention deficit and conduct disorders require an important yet often difficult differential diagnosis. Prior efforts to determine which symptoms are optimal for making this differential diagnosis have been limited by a reliance on statistics that do not supply the probability of the disorders given a symptom's presence (positive predictive power) or the probability that the disorder is not present given the absence of the symptom (negative predictive power). This investigation examined the utility of these latter statistics in the differential diagnosis of childhood attention deficit and conduct disorders. The data consisted of symptoms from a standardized maternal psychiatric interview collected for a sample of 76 clinic-referred boys. Results indicated that some symptoms are optimal as inclusion criteria, some as exclusion criteria, some as neither, and some as both. Furthermore, some symptoms that have been traditionally associated with the diagnosis of one disorder were actually found to be more useful in the diagnosis of the other disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Rituximab: a new therapeutic monoclonal antibody for non-Hodgkin''s lymphoma

Little is known about the psychiatric diagnosis and treatment of adolescents who sexually offend. We therefore describe an adolescent sex offender who met DSM-IV criteria for multiple paraphilias (except for the age criterion), bipolar type II disorder, and OCD, whose paraphilic urges and behaviors, depression, and violent obsessions responded to open label fluoxetine after failing to respond to long-term residential treatment. Although only a single and uncontrolled observation, this case suggests that some adolescent sex offenders may in fact have paraphilias, and that paraphilias in adolescents, like those in adults, may respond to serotonin reuptake inhibitors.     

Interactive effects of attention deficit hyperactivity disorder and conduct disorder on early adolescent substance use.

This study examined the interactive effects of attention deficit hyperactivity disorder (ADHD) and conduct disorder (CD) diagnosis on early adolescent substance use in a cross-sectional study of 202 middle school students. ADHD diagnosis alone did not suggest increased risk for substance use, but more adolescents with both ADHD and CD reported use of tobacco, alcohol, marijuana, and other drugs than did adolescents with either disorder alone. Dimensionally scored impulsivity-hyperactivity symptoms, not symptoms of inattention, appeared to account for the association with ADHD. Results illustrate the need to continue examination of the role of ADHD in the development of substance use and later abuse, especially as it relates to the onset of conduct problems in adolescence that mark liability for early onset substance abuse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Relapse in Alcohol- and Drug-Disordered Adolescents With Comorbid Psychopathology: Changes in Psychiatric Symptoms.

This study examined reciprocal relationships between posttreatment substance use and psychiatric symptoms in adolescents with both a substance use disorder and an Axis I mental health disorder. Participants (13-18 years old) were recruited from inpatient treatment centers and interviewed during treatment and monthly for 6 months. Participants who relapsed (N = 103; 48% female) reported the incidence and severity of psychiatric symptoms experienced before and after their 1st posttreatment substance use. The number of symptoms and depression symptoms experienced were related to use of stimulants and other drugs during relapse. There was evidence for both self-medication (symptom reduction) and rebound (symptom exacerbation) effects of substance use on symptom severity. These results demonstrate that, for adolescents with both substance use and mental health disorders, psychiatric symptoms are 1 factor influencing posttreatment substance use. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Course and outcome in adolescent anorexia nervosa

OBJECTIVE: To investigate course, outcome, and psychiatric comorbidity in adolescent anorexia nervosa by repeated follow-up assessment. METHOD: Thirty-four subjects (88%) of an original sample of 39 inpatients were followed up personally 3 and 7 years after discharge and classified according to DSM-III-R eating disorder categories. Standardized psychometric instruments were used to assess specific eating disorder symptoms, concomitant general psychopathology, and comorbid psychiatric diagnoses. RESULTS: After 7 years, 1 patient (3%) had anorexia nervosa, 4 patients (12%) bulimia nervosa, and 10 patients (29%) eating disorder not otherwise specified (EDNOS). Anxiety disorders (41%) and affective disorders (18%) were the most prevalent comorbid psychiatric disorders. Concomitant general psychopathology was significantly related to the outcome of the eating disorder. CONCLUSIONS: According to our results, the majority of former adolescent anorexic inpatients had shown substantial improvement in their eating disorders symptomatology after 7 years. Patients with persisting eating disorders mostly suffered from restrictive symptoms. The prevalence and distribution of psychiatric comorbidity were similar to those of adult-onset anorexia nervosa. Subjects with a worse outcome of the eating disorder also displayed higher levels of general psychopathology.     

Comparative effectiveness of day hospital and inpatient psychiatric treatment.

Employed a pre–posttreatment control group design to compare the treatment effects of partial hospitalization to those of full-time hospitalization. Ratings of home and community adjustment were obtained from community informants (relatives or close friends) for 2 groups of Ss: (a) 24 day-hospital clients (partial hospitalization condition) matched on age (average age 32 yrs), education, and intelligence with (b) 24 inpatient clients (full-time hospitalization condition), and from an unmatched sample of 79 consecutive inpatient admissions. Treatment outcome was measured by clients' pre- and postscores on the Personal Adjustment and Role Skills scale. Results show that all groups evidenced improvement 2 mo after treatment started, particularly on measures of symptom reduction. Although patterns of improvement were comparable for both settings in univariate data analyses, multiple discriminant function analysis indicated that the day hospital sample evidenced greater gains in attentiveness and in employment. Gains favoring the day hospital sample were more striking for the unmatched 3-group comparison than for the matched 2-group comparison. Findings indicate that partial hospitalization is an attractive alternative to inpatient psychiatric hospitalization. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hospital-based behavior modification program for adolescents: evaluation and predictors of outcome

This study is an evaluation of a residential short-term program (10-12 weeks) which utilizes a behavior modification program (BMP) in an inpatient unit for adolescents with mostly conduct problems. Evaluation included predictors of outcome such as age, gender, diagnosis, length of stay, father's presence, other treatments received, and presence of learning problems. The design used was a retrospective analysis of performance of patients on BMP measured by mean point earned in the first four weeks (pre-test) and the last 4 weeks of admission (post-test). Subjects were 60 adolescents aged 12-18 enrolled for at least eight weeks in the BMP. Findings showed that the BMP was generally beneficial especially for females and nonconduct-disordered patients. Factors such as father's presence, and absence of learning problems were associated with better outcome. Age and length of stay were not correlated with significant improvement. It was found that the BMP was effective in reducing frequency of undesirable behaviors for the majority of adolescents with conduct problems. However, males with a diagnosis of conduct disorder might require a longer stay for the program to be effective.