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.     

Radiofrequency treatment of tachyarrhythmias in children and adolescents

INTRODUCTION: Radiofrequency ablation has been extensively used in adults to treat supraventricular and ventricular tachycardia. In children and adolescents few data are available on its safety and efficacy. METHODS: 28 patients (mean age 12.8) with symptomatic tachyarrhythmias underwent catheter ablation; 21 children had atrioventricular accessory pathways (11 right connections, 9 lef connections and one midseptal pathway), 3 had intranodal tachycardia, 2 had ventricular tachycardia and 2 had atrial tachycardia. Only four patients had associated structural anomalies. RESULTS: Success rate was 71.4% (20 patients). The success per cents in each group were: in intranodal tachycardias 100%; we failed in the two patients with ventricular tachycardias; in accessory pathways 76.1% and 50% in atrial tachycardia. There were no recurrences of arrhythmia in a mean chase period of 24 months (12-46). Major complications were only observed in one patient who developed a Wallenberg syndrome after ablation. CONCLUSIONS: Radiofrequency catheter ablation appears to be a safe and effective method to treat arrhythmias in children and adolescents, which in most cases can supersede surgery. Alow incidence of complications is reported, although long term damage on endocardial structures remains yet to be determined.     

Fatigue in children and adolescents with cancer

Mitochondrial DNA (mtDNA) forms a semi-autonomous asexually reproducing genome in eukaryotic organisms. It plays an essential role in the life cycle through the control of energy production, by the inherently dangerous process of oxidative phosphorylation. The asymmetric nature of its inheritance--almost exclusively through the female--imposes different evolutionary constraints on males and females, and may lie at the heart of anisogamy. This review examines the implications of recent findings on the biology of mtDNA for reproduction and inheritance in mammals.     

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.     

Risperidone treatment of children and adolescents with pervasive developmental disorders: a prospective open-label study

OBJECTIVE: To investigate the short-term safety and efficacy of risperidone in the treatment of children and adolescents with pervasive developmental disorders. METHOD: This was a 12-week, prospective, systematic, open-label trial that included 18 subjects (15 boys and 3 girls) with a mean age of 10.2 +/- 3.7 years. The sample included 11 subjects with autistic disorder, 3 with Asperger's disorder, 1 with childhood disintegrative disorder, and 3 with pervasive developmental disorder not otherwise specified. Fourteen subjects had comorbid mental retardation. Behavioral ratings were obtained during two baseline visits and again after 12 weeks of risperidone treatment. RESULTS: The optimal dose of risperidone for the 18 subjects was 1.8 +/- 1.0 mg/day. On the basis of the global improvement item of the Clinical Global Impression Scale, 12 of 18 subjects were considered responders. Significant improvement was seen in measures of interfering repetitive behavior, aggression and impulsivity, and some elements of impaired social relatedness. The most common side effect was weight gain (range 10 to 35 lb). CONCLUSIONS: These preliminary results suggest that risperidone may be effective for improving interfering behavioral symptoms in some children and adolescents with pervasive developmental disorders. Double-blind, placebo-controlled studies are needed before definitive statements of safety and efficacy can be made.     

Pharmacologic treatment of dyslipidemias: Analysis of initiation recommendations and drug selection]

According to the NCEP resins and nicotinic acid were selected as drugs of choice to treat hypercholesterolemia. Gemfibrozil and nicotinic acid were recommended for patients with HDL cholesterol below 35 mg/dl. Current concepts of efficacy and side effects lead to the following recommendations. a) type IIa severe hypercholesterolemia (LDL > 220 mg/dl): HGMC inhibitors or combined therapy with resins and nicotinic acid, fenofibrate, or bezafibrate. b) Moderate hypercholesterolemia (LDL < 220 mg/dl): bezafibrate and/or acipimox if HDL is < 35 mg/dl; fenofibrate, bezafibrate and/or acipimox if HDL > 35 mg/dl. As second line drugs, the HGMC inhibitors. c) Type IIb hyperlipidemia: first line, acipimox; second line, fibrates associated to acipimox. d) Type III hyperlipidemia: first line, fibrates; second line, an association of HGMC inhibitors and fibrates or acipimox. e) Type IV moderate hyperlipidemia (TG < 500 mg/dl): first line, acipimox, second line, fibrates alone or in association with acipimox. As general remarks, lovastatin has been effective and well tolerated in 98% of cases. Pravastatin seems to have very little side effects. Acipimox, a nicotinic acid derivative is especially effective in elevating HDL2b levels and decreasing LDL III. Given its adequate tolerance, acipimox has replaced nicotinic acid.     

Behavioral symptoms among children and adolescents. Screening with the help of a questionnaire in a group of children aged 4 to 17 years

A Danish translation of "The Child Behavior Checklist" (CBCL), developed by Achenbach and Edelbrock in Vermont, was standardized on 1,300 children aged between four and 17 years in the county of Fyn. The response rate was 61.4% and lowest among boys. Responders were compared to non-responders on different variables generated by the Danish Statistical Institute. No significant differences emerged across the two groups with respect to analysed confounders. We found a mean total CBCL score of 15-20 out of 232 possible points with considerable variation. The 95 percentile reflects a possible cut-off score for behavioural deviance or "psychiatric abnormality". This varied from 35 points in four to five years old girls to 58 points in six to ten years old boys. Parents reported hyperactivity and restlessness in 6.8% of six to ten year-old boys. Depression and sadness were reported in about 2% of all children six years or older. Six point three percent of all girls of 11-16 years selfreported obsessions. The 11-16 year-olds generally reported more symptomatic behaviour than their parents and teachers did about them.     

Effects of psychotherapy with children and adolescents revisited: A meta-analysis of treatment outcome studies.

A meta-analysis of child and adolescent psychotherapy outcome research tested previous findings using a new sample of 150 outcome studies and weighted least squares methods. The overall mean effect of therapy was positive and highly significant. Effects were more positive for behavioral than for nonbehavioral treatments, and samples of adolescent girls showed better outcomes than other Age?×?Gender groups. Paraprofessionals produced larger overall treatment effects than professional therapists or students, but professionals produced larger effects than paraprofessionals in treating overcontrolled problems (e.g., anxiety and depression). Results supported the specificity of treatment effects: Outcomes were stronger for the particular problems targeted in treatment than for problems not targeted. The findings shed new light on previous results and raise significant issues for future study. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preventing substance abuse with children and adolescents.

Reviews research, from 1977 to 1984, on the prevention of tobacco, alcohol, and drug abuse with children and adolescents. The review is organized according to an intervention focus on the agent, environment, and host. A study, involving 193 6th graders and skills and attention-placebo interventions, examined methods and results of host-oriented skills intervention to prevent cigarette smoking. Results suggest that attention-placebo interventions (e.g., oral quizzes, games, debates) were insufficient to prevent smoking. Based on the review, conceptual and methodological progress in substance abuse prevention research is noted. Suggestions for future research include technological improvements necessary to implement preventive interventions on a wide scale. Highlighted are the importance of careful designs: manipulation checks on independent variables; process data collection; multimodal measures of self-report, behavioral, and physiological variables; and multivariate statistical analyses in studies on interventions to prevent tobacco, alcohol, and drug abuse with children and adolescents. (75 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Quality-of-life assessment in children and adolescents with asthma

Health-related quality of life has become an essential part of health outcome measurement in chronic disorders. However, it is only recently that health professionals have focused on quality-of-life assessment in children and adolescents. Several generic, as well as the asthma-specific quality-of-life instruments specifically designed for use in children and adolescents are reviewed in this article with particular regard to the conceptual and methodological features of the measures and their applicability in clinical studies. The recently published Child Health Questionnaire is a useful generic instrument to comprehensively assess quality of life, in particular when comparing young people with different chronic disorders. The Pediatric Asthma Quality-of-life Questionnaire has shown responsiveness to change over time, but it lacks age-specificity with regard to psychosocial issues and comprehensiveness of quality-of-life assessment. In contrast, the Childhood Asthma Questionnaire provides three different versions for different target ages. However, its generic part is not reflective of the respondent's health status. The other asthma-specific instruments have major conceptual deficiencies when used as a single measure for quality-of-life assessment. In the absence of a single ideal instrument, the use of batteries of quality-of-life instruments is therefore recommended and further research is required to identify the impact that age and developmental status have on quality-of-life assessment.     

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)     

Psychopathology in children and adolescents with developmental disorders

Children and adolescents with developmental disorders suffer from a wide range of psychopathology. However, there are no published studies examining this subject exclusively in this population using recent diagnostic criteria. The primary purpose of this paper is to report on the diagnosis encountered in a clinical setting using DSM-III-R. The medical records of all individuals assessed in a specialized program during a 1-year period were reviewed looking at their demographic features, diagnoses, and target behaviors. Our sample consisted of 233 subjects and contained significantly more boys than girls. The most common psychiatric diagnoses were oppositional defiant disorder and attention deficit hyperactivity disorder. Pica, organic mental disorder NOS, and Autistic Disorder were more often encountered in individuals with low intellectual functioning. Depressive disorders, posttraumatic stress disorder, and developmental speech/language disorders were diagnosed more in high functioning subjects. The most common symptom was impulsivity. This retrospective study highlights the need for more rigorous examination of current diagnostic concepts and criteria in children and adolescents with developmental disorders. Prospective studies should be conducted with standardized instruments in clinics and community samples to provide more information on psychiatric disorders in this population.     

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)     

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)     

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.     

Memory functioning in children and adolescents with autism.

Objective: Memory functioning in children and adolescents ages 5–19 with autism (n = 50) and typically developing controls (n = 36) was assessed using a clinical assessment battery, the Test of Memory and Learning (TOMAL). Method: Participant groups were statistically comparable in age, nonverbal IQ, handedness, and head circumference, and were administered the TOMAL. Results: Test performance on the TOMAL demonstrated broad differences in memory functioning in the autism group, across multiple task formats, including verbal and nonverbal, immediate and delayed, attention and concentration, sequential recall, free recall, associative recall, and multiple-trial learning memory. All index and nearly all subtest differences remained significant even after comparing a subset of the autism group (n = 36) and controls that were matched for verbal IQ (p > .05). However, retention of previously remembered information after a delay was similar in autism and controls. Conclusions: These findings indicate that performance on measures of episodic memory is broadly reduced in autism, and support the conclusion that information encoding and organization, possibly due to inefficient cognitive processing strategies, rather than storage and retrieval, are the primary factors that limit memory performance in autism. (PsycINFO Database Record (c) 2011 APA, all rights reserved)