Dr. med. Hans Steiner

Abstract

To investigate response to Divalproex sodium (DVPX) with respect to Reactive/Affective/Defensive/Impulsive (RADI) and Proactive/Instrumental/Premeditated (PIP) aggression among adolescent males with conduct disorder (CD), using results from a randomized, double-blind, placebo-controlled trial. It was hypothesized that DVPX response among participants with RADI aggression would be greater than among those with PIP aggression. Fifty-eight ethnically diverse males with severe CD were assigned to High Distress (HDCD) or Low Distress (LDCD) Conduct Disorder, corresponding with RADI and PIP aggression, respectively. Following a 1-week washout, all subjects were randomized to a high dose (up to 1,500 mg/day) or low dose (up to 250 mg/day) of DVPX. Baseline and endpoint assessments included Clinical Global Impression (CGI), Achenbach Self Report (YSR), and Weinberger Adjustment Inventory (WAI-62). Response to DVPX was significantly higher in the HDCD group (64%) than in the LDCD group (22%) in the high-dose treatment group (p = 0.03). Mean weekly WAI-62 distress scores declined significantly among the HDCD subjects than among LDCD subjects in the high-dose group. These results support the utility of mood stabilizing agents such as DVPX in treating patients with disorders characterized by the RADI pattern of aggression, including those with severe CD.

View details for DOI 10.1007/s10578-011-0234-5

View details for Web of Science ID 000294959500006

View details for PubMedID 21706221

Abstract

We assessed the prevalence of a range of psychopathology among African unaccompanied refugee minors (URMs) in Austria. Additionally, the predictive value of war exposure on PTSD symptoms was examined. Forty-one URMs were assessed with the Mini-International Neuropsychiatric Interview for children and adolescents, the Youth Self-Report, the UCLA PTSD Reaction Index and Facts About You. As expected, 56% of youth had at least one diagnosis by structured clinical interview. The most common diagnoses were adjustment disorder, PTSD and dysthymia. War affliction marginally predicted (p = 0.065) PTSD controlling for age and gender. URMs had high levels of psychopathology compared to norms. Their PTSD rates were somewhat lower than found in previous studies. We discuss methodological and substantive reasons for this finding. Future studies need to examine URMs across the entire diagnostic spectrum and employ multi-method designs to yield valid results. The psychopathology in URMs has clinical and forensic implications.

View details for DOI 10.1007/s10578-011-0219-4

View details for Web of Science ID 000290027700004

View details for PubMedID 21293919

Abstract

Adolescents with a migration background account for a substantial proportion of juveniles in custody. Psychosocial adversities pose a significant risk for criminal behaviour. So far, the nature of psychosocial adversities experienced by migrant youth is understudied. The aim of this study was to explore differences in psychosocial background in three ethnic groups (Turkish, former-Yugoslavian and Austrian) of detained juveniles in Austria. A semi-structured interview (Multidimensional Clinical Screening Inventory for delinquent juveniles, MCSI) was used to assess psychosocial background (e.g., trauma, family background, forensic and psychiatric family history, school history, psychiatric treatment received and criminal history) in juveniles entering an Austrian pre-trial detention facility. Of the 370 eligible participants, the final study sample consisted of 278 juveniles. The ethnic distribution was as follows: 55.4% Austrian (mean age 16.88 years, S.D.=1.52), 14% Turkish (mean age 16.28 years, S.D.=1.23), 30.6% former-Yugoslavian (mean age 16.47 years, S.D.=1.41). In the Austrian sample, family dysfunction was significantly more prevalent than in the Turkish or former-Yugoslavian samples. Mental health services were significantly less used by juveniles with migration background. Turkish juveniles had a significantly poorer school performance than Austrians. Juveniles from former-Yugoslavia had significantly less often attended schools offering secondary education. The results suggest that detained juveniles with migration background are poorly integrated into the educational and mental health system of the host society. Family systems, even if substantially dysfunctional, seem to be perceived as more stable by migrant youth than by Austrian youth.

View details for DOI 10.1016/j.psychres.2010.04.052

View details for Web of Science ID 000287113000033

View details for PubMedID 20627325

Abstract

PTSD in children and adolescents differs from the adult disease. Therapeutic approaches involve both psychotherapy and psychopharmacotherapy.The current paper aims at reviewing studies on psychopharmacological treatment of childhood and adolescent PTSD. Additionally, developmental frameworks for PTSD diagnosis and research along with an experimental model of quenching and kindling in the context of stress exposure are presented. We conducted an extensive literature search of reviews on psychopharmacotherapy as well as studies on psychopharmacological treatment for PTSD among children and adolescents. We used the database PubMed and focused on the time period of the last 10 years up to January 2009. Pertinent earlier papers were also included.There are a limited number of studies specifically assessing the psychopharmacological treatment of PTSD in children and adolescents. The vast majority of them lack verification in RCTs. Only the use of imipramine, divalproex sodium and sertraline were already evaluated in RCTs. Future studies should take into account developmental approaches to the diagnosis and treatment of PTSD in children and adolescents. In this context, different underlying neurobiological patterns, which are reflected in distinct clinical symptomatology, require a precise investigation and a symptom-orientated psychopharmacological approach.

View details for DOI 10.1007/s10578-010-0192-3

View details for Web of Science ID 000282783300004

View details for PubMedID 20567898

Abstract

This aim of this clinical trial was to study the effects of divalproex sodium (DVPX) in reducing Reactive/Affective/ Defensive/ Impulsive Aggression (RADI) in youth with Disruptive Behavior Disorders (DBD) in an outpatient clinic over a period of 3 months. We recruited forty participants with Oppositional Defiant Disorder or Conduct Disorder. Twenty participants received 12 weeks of openly titrated DVPX, whereas twenty participants served as a comparison control group. Primary efficacy measures were the Clinical Global Improvement-Severity (CGI-S) and CGI-C (Change) scales; secondary efficacy measures included standardized measures of aggression. Based on the CGI-S and CGI-C ratings, the DVPX group showed significant improvement by the last observation. Attrition rates were notably high, which is not surprising given the clinical population studied. This study provides further support for the efficacy of DVPX in decreasing RADI aggression in the context of DBD. These results are particularly noteworthy because the sociotherapeutic structures supporting patients in previous trials were not present.

View details for DOI 10.1007/s10578-009-0167-4

View details for Web of Science ID 000275426100003

View details for PubMedID 20043204

Abstract

Despite high rates of psychiatric morbidity among young offenders, few studies look closely at prevalence rates in terms of race/ethnicity or developmental stage. Seven hundred and ninety (790) incarcerated young people with a mean age of 18+/-1.2 years were examined. The racial/ethnic distribution was White (17%), African American (28%), Hispanic (47%) and Other (8%). White males had greater than average levels of psychosis; African American males showed lower than average alcohol dependence rates but higher levels of marijuana dependence. White females were more likely than Hispanic and African American females to have attention deficit-hyperactivity disorder and substance and stimulant dependence. Race/ethnicity and age differences can be useful when creating culturally-informed and developmentally appropriate interventions for incarcerated young people.

View details for Web of Science ID 000274700800016

View details for PubMedID 20173266

Abstract

The objective of the study was to identify sex-specific psychopathologic predictors of criminal recidivism among a representative sample of incarcerated youths.In this prospective longitudinal study, the Mini-International Psychiatric Interview for children and adolescents was used to assess psychopathology in juveniles entering an Austrian pretrial detention facility between March 2003 and January 2005. From the beginning of the study until January 2006, data on criminal history were obtained from the Integrierte Vollzugsverwaltung, a database containing criminal information of every individual incarcerated in Austria. Of the 370 eligible participants, the final study sample comprised 328 juveniles (56 girls and 272 boys, age range = 14-21 years, mean = 16.7).Reincarceration rates within the specified follow-up period were 52.6% for the boys and 37.5% for the girls. Using Cox forward stepwise regression and Kaplan-Meier analyses, age at first incarceration (B = -.296, Wald statistic = 17.11, P < .001) and oppositional defiant disorder (B = .751, Wald statistic = 19.25, P < .001) were identified as significant predictors for reoffending in boys. In girls, generalized anxiety disorder (B = 1.97, Wald statistic = 13.71, P < .001) was found to be a predictor for reoffending, whereas dysthymia (B = -1.44, Wald statistic = 4.02, P = .045) was found to serve as protective factor.Our study confirms high rates of reoffending after release from correctional facilities in both sexes. It further defines sex-specific psychopathologic risk factors for relapse in incarcerated juveniles. According to our results, in boys, oppositional defiant disorder and early age at first incarceration are predictive of reincarceration. In girls, anxiety disorder was found to be a risk factor for future offending, whereas dysthymia was found to have a protective influence. Consequently, rehabilitation programs should be sex specific.

View details for DOI 10.1016/j.comppsych.2008.09.014

View details for Web of Science ID 000269251100002

View details for PubMedID 19683609

Abstract

The aim of the present study was to analyze the psychometric properties of the Italian version of the Response Evaluation Measure (REM-71), a 71-item self-report measure previously developed for the assessment of defenses in adults and adolescents. The authors also examined the differences in the use of defenses based on sex and age (early adolescence, late adolescence, and early adulthood), and the association between defenses, psychosocial health, and psychologic distress in a large community sample.The Italian version of REM-71 was obtained through back-translation and administered to 1648 (1020 female subjects, mean age = 19.5 years, SD = +/-5.77) community subjects, aged between 13 and 68 years, voluntarily recruited among high school and university students in Milan, Italy, and the surrounding area. All subjects completed a self-report measure to assess demographic variables and satisfaction with life. A subsample (n = 1197) completed the Italian version of the Symptom Checklist-90-Revised to assess symptoms of psychologic distress.Results were highly consistent with those obtained in the original English version of the REM-71 and included satisfactory internal consistency of the measure. Factor analyses yielded 2 principal factors that showed overall stability across age and sex subgroups. Factor 1 and factor 2 defenses were significantly correlated, in line with theoretical expectations, with positive and negative aspects of various domains of life.Results provide further support for the structure and validity of the REM-71 as a useful instrument for the assessment of defenses in adolescents and adults and suggest no major cross-cultural differences in the organization of these defenses.

View details for DOI 10.1016/j.comppsych.2008.09.010

View details for Web of Science ID 000266820100011

View details for PubMedID 19486736

Abstract

This study examined prevalence rates of psychiatric disorders among young offenders after they were incarcerated for nine months.A total of 790 youths were surveyed, including a significant proportion of females (N=140, 18%), nine months after incarceration. The Structured Clinical Interview for DSM-IV with portions of the Diagnostic Interview for Children and Adolescents and the Structured Interview for DSM-IV Personality were used.Even when conduct disorder and oppositional defiant disorder were excluded, 88% of males and 92% of females had a psychiatric disorder (including substance use disorder); more than 80% of offenders met criteria for some type of substance use disorder. Gender differences were found for anxiety disorders (males 26%, females 55%, p<.01), marijuana dependence (males 32%, females 24%, p=.04), marijuana abuse (males 19%, females 11%, p=.04), and stimulant dependence (males 25%, females 44%, p<.01).Despite nine months of incarceration, young offenders continued to show high levels of psychiatric and substance use disorders.

View details for Web of Science ID 000266493800017

View details for PubMedID 19487357

Abstract

Although previous research has investigated the stress response in acutely anorexic patients, there is currently little research addressing this response in recovering adolescent anorexic girls. Therefore, this study investigated partially and fully weight-restored anorexic adolescent girls' psychological and physiological response to a standardized stressor.We measured the heart rate and affect of 17 adolescent recovering anorexic patients and 40 healthy age-matched controls during two conditions of the Stress Induced Speech Task (SIST): Free Association and Stress Task. Recovering patients were either partially or fully weight-restored.Compared to the controls, the recovering anorexic girls reported greater overall habitual psychological distress and higher levels of negative affect during the standardized stressor. However, recovering patients did not show a muted heart rate response during the stressor. Neither recovering anorexics nor controls demonstrated a correspondence between heart rate and positive or negative affect.Although the physiological stress response of recovering adolescent anorexic patients was similar to controls, the psychological response of partially and fully weight-restored anorexic adolescents appears similar to that of acutely anorexic adolescents. Treatment implications are discussed in terms of the persistence of negative affect and treatment resistance.

View details for DOI 10.1007/s10578-008-0112-y

View details for Web of Science ID 000262490300004

View details for PubMedID 18618238

Abstract

Previous studies about unaccompanied refugee minors (URMs) showed that they are a highly vulnerable group who have greater psychiatric morbidity than the general population. This review focuses on mental health issues among URMs. Articles in databases PsycINFO, Medline and PubMed from 1998 to 2008 addressing this topic were reviewed. The literature had a considerable emphasis on the assessment of PTSD symptoms. Results revealed higher levels of PTSD symptoms in comparison to the norm populations and accompanied refugee minors. In several studies, age and female gender predicted or influenced PTSD symptoms. The existing literature only permits limited conclusions on this very hard to reach population. Future research should include the analysis of long-term outcomes, stress management and a more thorough analysis of the whole range of psychopathology. Additionally, the development of culturally sensitive norms and standardized measures for diverse ethnic groups is of great importance.

View details for DOI 10.1186/1753-2000-3-13

View details for PubMedID 19341468

Abstract

To examine the relationship between personality type and physiological response to stress among juvenile delinquents.Delinquent males (N = 42, mean age 16.5, SD = 1) recruited from a convenience sample at local juvenile detention facility were compared to a male control sample from a local high school (N = 79; mean age 16.1, SD = 0.8). All participants completed the Weinberger Adjustment Inventory and a Stress-Inducing Speech Task during both of which heart rate was measured.Compared to controls, delinquent youths showed significantly lower heart rates under both free association and stress conditions (p < 0.05) and a lower rate of increase during stressful stimuli (p < 0.05). Among delinquents, those with a non-reactive personality type appeared to show consistently lower levels of physiological arousal as measured by heart rate.Delinquents consistently had lower overall levels of arousal as measured by heart rate. In delinquent boys, we also found a persistently low arousal group with a non-reactive psychological pattern. This combination may be a forerunner of future psychopathy or a product of the developmental trajectory that leads to and results from psychopathic behavior.

View details for DOI 10.1024/1422-4917.36.3.185

View details for Web of Science ID 000256407000005

View details for PubMedID 18622978

Abstract

Delinquent juveniles are at extreme risk for suicide with death rates 4 times higher than in the general population. Whereas psychopathologic risk factors for suicidal behavior in nonforensic adolescent populations are well defined, psychopathologies associated with suicidality in delinquent juveniles are not yet clear. The objective of this study was to determine gender-specific psychopathologic profiles associated with suicidality in detained juveniles.The Massachusetts Youth Screening Instrument-Second Version, the Youth Self-Report, and the Mini-International Neuropsychiatric Interview for children and adolescents were used to investigate juveniles in an Austrian pre-trial detention facility. The study sample consisted of all juveniles entering the system between March 2003 and January 2005. Of the 370 eligible participants, 319 completed the study (53 girls and 266 boys; age range, 14 to 21 years; mean = 16.67, SD = 1.45 years).We found significantly higher prevalence rates of both current (p < .01) and lifetime (p < .001) suicidality in girls than in boys. Suicidal boys exhibited more psychopathology and a wider range of psychopathology compared to nonsuicidal boys. For suicidal girls, psychopathologies appeared more circumscribed (all relevant p values < .04). Using signal detection methods, major depressive disorder, attention-deficit/hyperactivity disorder, and social phobia identified boys at highest risk of suicidality, while a diagnosis of posttraumatic stress disorder identified girls at highest risk.Suicidality levels are high in delinquent adolescents, especially in girls. Psychopathologic risk factors seem to be gender specific in this population. Not only depression, but also psychopathologies that usually do not arouse strong suspicion for an association with suicidal behavior, i.e., social phobia and ADHD in boys and PTSD in girls, might increase suicide risk. Further research in other countries is needed to replicate our results with respect to sociocultural influences.

View details for Web of Science ID 000250620700019

View details for PubMedID 17960977

Abstract

We examined the efficacy of divalproex sodium (DVP) for the treatment of PTSD in conduct disorder, utilizing a previous study in which 71 youth were enrolled in a randomized controlled clinical trial. Twelve had PTSD. Subjects (all males, mean age 16, SD 1.0) were randomized into high and low dose conditions. Clinical Global Impression (CGI) ratings for core PTSD symptoms (Intrusion, avoidance and hyper arousal) were primary outcome measures, weekly slopes of impulsivity secondary ones. Intent-to-treat analyses showed significant positive associations between receiving high dose of DVP CGI's. Parallel analyses comparing outcome by drug level achieved strengthened the results.

View details for DOI 10.1007/s10578-007-0055-8

View details for Web of Science ID 000248055300002

View details for PubMedID 17570057

Abstract

To examine the structure of emotions and affective dysregulation in juvenile delinquents.Fifty-six juvenile delinquents from a local juvenile hall and 169 subjects from a local high school were recruited for this study. All participants completed psychometric testing for trait emotions followed by measurements of state emotions under two conditions (free association and stress condition). Finally, delinquent participants completed a detailed assessment of past trauma using the Childhood Trauma Interview (CTI).Delinquents exhibit significantly higher levels of negative state and trait emotions when compared to a high school sample. In the delinquent sample chronicity of physical trauma affects the longstanding variable of trait emotionality and severity of trauma, specifically emotional abuse and witnessing violence, shapes negative emotional outcomes in state emotionality. In addition, delinquents appear to experience a wider range of emotions than the comparison sample and were more likely to experience a confluence of state emotions of sadness and anger under stressed conditions.Adolescent delinquents appear to have a different experience of negative emotions than comparison adolescents. The experience of emotions appears to differ in state and trait conditions. These emotions may be related to childhood experiences of trauma.

View details for Web of Science ID 000247265400006

View details for PubMedID 17417724

Abstract

Although there are extensive data on the relationship between personality and stress reactivity in adults, there is little comparable empirical research with adolescents. This study examines the simultaneous relationships between long term functioning (personality, defenses) and observed stress reactivity (affect) in adolescents.High school students (N = 169; mean age 16; 73 girls) were asked to participate in two conditions of the Stress Induced Speech Task (SIST): Free Association and Stressful Situation. Immature and mature defenses, distress and restraint personality dimensions, and negative and positive affect were examined.Greater reported use of immature defenses was significantly associated with negative affect, whereas greater reported use of mature defenses was significantly associated with greater positive affect. Although personality style was also a significant predictor of negative affect across two out of three conditions, defenses were better overall predictors of affect than were personality dimensions. Gender was also a significant predictor of negative affect, wherein girls reported more negative affect than boys.Defenses and personality style predict affective response during a moderately stressful task. Immature defenses and, to a lesser extent, the distress personality dimension predict mobilization of negative affect, whereas mature defenses predict the reporting of positive affect. These results relate to processes central to psychotherapy: defensive responding, personality style, and affective reactivity during the recounting of stressful events.

View details for DOI 10.1007/s10578-007-0046-9

View details for Web of Science ID 000247265400003

View details for PubMedID 17356922

Abstract

Since the clinical observations published by Janz in 1957, the presence of personality irregularities in patients with juvenile myoclonic epilepsy (JME) has been described repeatedly, but never quantified using standardized assessments. The aim of the present study was to investigate whether juveniles with a short history of JME exhibit psychopathological symptoms and/or personality irregularities.We used standardized assessments, the Youth Self Report (YSR) and the Weinberger Adjustment Inventory (WAI).Of 38 patients who fulfilled the study entry criteria, 25 agreed to participate and completed all surveys. On the YSR, our sample exhibited twice the amount of psychiatric symptoms than age-matched norms. Furthermore, psychopathological symptoms increased with duration of JME. According to WAI results, JME significantly affected self-restraint: patients with longer disease duration showed less self-control.Adolescents with JME present not only with neurological abnormalities but also with significant psychopathology and personality irregularities. Our data suggest that psychological and behavioral changes are dynamic processes dependent on the progression of the disease.

View details for DOI 10.1016/j.yebeh.2007.03.008

View details for Web of Science ID 000247216900007

View details for PubMedID 17466599

Abstract

To determine whether impulsive aggression (IA) is a meaningful clinical construct and to ascertain whether it is sufficiently similar across diagnostic categories, such that parallel studies across disorders might constitute appropriate evidence for pursuing indications. If so, how should IA be assessed, pharmacological studies designed, and ethical issues addressed?Experts from key stakeholder communities, including academic clinicians, researchers, practicing clinicians, U.S. Food and Drug Administration, National Institute of Mental Health, industry sponsors, and patient and family advocates, met for a 2-day consensus conference on November 4 and 5, 2004. After evaluating summary presentations on current research evidence, participants were assigned to three workgroups, examined core issues, and generated consensus guidelines in their areas. Workgroup recommendations were discussed by the whole group to reach consensus, and then further iterated and condensed into this report postconference by the authors.Conference participants agreed that IA is a substantial public health and clinical concern, constitutes a key therapeutic target across multiple disorders, and can be measured with sufficient precision that pharmacological studies are warranted. Additional areas of consensus concerned types of measures, optimal study designs, and ethical imperatives.Derived from scientific evidence and clinical experience, these consensus-driven recommendations can guide the design of future studies.

View details for DOI 10.1097/CHI.0b013e31802f1454

View details for Web of Science ID 000244428800006

View details for PubMedID 17314717

Abstract

Oppositional defiant disorder (ODD) is a common clinical problem in children and adolescents. Oppositionality and associated types of aggressive behavior are among the most common referral problems in child psychiatry. Grouped among the disruptive behavior disorders, ODD is frequently comorbid with other psychiatric conditions and often precedes the development of conduct disorder (CD), substance abuse, and severely delinquent behavior. Youth with ODD may also have specific CD behaviors, such as aggression. Although compared with CD there exists a smaller and less sophisticated empirical database for ODD, this parameter draws upon the existing ODD and CD literature to make recommendations regarding diagnosis and treatment of ODD. The etiology of ODD is complex and its development is based on a cumulative risk/protective factor model that combines biological, psychological, and social factors. Recommended treatment is multimodal and extensive, involving individual and family psychotherapeutic approaches, medication, and sociotherapy. Methodologically sound controlled clinical trials are lacking.

View details for DOI 10.1097/01.chi.0000246060.62706.af

View details for Web of Science ID 000243146600021

View details for PubMedID 17195736

Abstract

Early physical maturation has long been considered a risk factor for the development of delinquent girls. The basis of this relationship has not been fully explored or understood. This review summarises the current literature and research on early physical maturation in adolescent females and places it within a developmental perspective. The process of early physical maturation is also placed within a biopsychosocial model so that risk and protective factors arising from the biological, social, family, education and peer environments can be ascertained. A complex model of maturation and environmental-social interaction is constructed and currently supported by research, but it is clear that a great deal of further work is necessary to fully understand this process.

View details for Web of Science ID 000240404300022

View details for PubMedID 16930146

Abstract

Research on ethnic minority populations has shown them to be undertreated, underdiagnosed and perceived as more psychopathological in comparison to the Caucasian population. This study aimed to assess ethnic variation of self-perceived psychopathology in a population of incarcerated youths. The Youth Self-Report (YSR) was completed by 5964 incarcerated adolescents (95% male; mean age = 16.5) in the California Youth Authority (CYA) system. Overall, ethnic minorities (African-Americans and Hispanics) self-report lower levels of psychiatric problems than Caucasians. These differences were more pronounced in males than females. Further research is needed to better ascertain the reasons for these differences.

View details for DOI 10.1007/s10597-006-9056-5

View details for Web of Science ID 000241716700004

View details for PubMedID 16897411

Abstract

Little is known about how deeply medication treatment penetrates different levels of the mind/brain system. Psychopathology consists of relatively simple constructs (e.g., anger, irritability), or complex ones (e.g., responsibility). This study examines the efficacy of a specific compound, divalproex sodium (DVPX), on the various levels of psychopathology, utilizing a previous study in which 71 youth with conduct disorder were enrolled in a randomized controlled 7-week clinical trial. We examined weekly slopes of "emotional cognitions" of varying degrees of complexity obtained by Weinberger Adjustment Inventory (WAI), measuring more basic states, such as anger, depression, happiness and anxiety, and complex states, such as impulse control, consideration of others, responsibility and self-esteem. Intent-to-treat analyses showed significant associations between assignment to the active treatment and improvement in depression and impulse control. This is a rare clinical trial, which provides preliminary evidence for the different profiles of efficacy of medication treatment.

View details for DOI 10.1007/s10578-006-0019-4

View details for Web of Science ID 000240472800005

View details for PubMedID 16927177

Abstract

Patterns of low autonomic arousal have consistently been related to delinquency and disruptive behavior disorders (DBD) in children and adolescents. Findings on another stress regulating mechanism, the hypothalamic pituitary adrenal (HPA) axis, have been inconsistent, which may partly be due to not considering specific stress reactivity measures. Therefore, the aim of the present study was to investigate the relationship between disruptive behavior in male adolescents and their HPA and autonomic reactivity to a standard public speaking task (PST).Responsivity to the PST of cortisol, heart rate (HR), skin conductance level (SCL) and self-reported negative feelings was measured, and compared between 12and14-year-old boys who attended a delinquency diversion program (DP), with and without DBD (DP+, n=22 and DP-, n=49, resectively), and matched normal controls (NC, n=30). DBD diagnoses were based on a structured psychiatric interview.The DP+ group, but not the DP- group, showed a significantly decreased cortisol and HR response during the PST as compared with the NC group. No significant effects were found for SCL. All subjects connoted the task negatively.The results indicate that low cortisol and HR responsivity to stress may be a neurobiological marker for delinquent boys with DBD, but not for those without DBD. Directions for future research and clinical implications are discussed.

View details for DOI 10.1016/j.psyneuen.2006.05.005

View details for Web of Science ID 000240302300005

View details for PubMedID 16831519

Abstract

To evaluate the effectiveness and safety of risperidone in children and adolescents with bipolar disorder characterized by aggression and mania, despite treatment with mood stabilizers.A retrospective chart review of patients seen in an outpatient pediatric mood disorders clinic over an 18-month period was performed. Data were extracted from charts of patients who had a diagnosis of bipolar disorder with aggression that was uncontrolled on a mood stabilizer; as a result, these patients had risperidone added to their regimen.Four boys (aged 7-15 years) and two girls (aged 8 and 14 years) were treated with risperidone (mean dosage, 0.85 mg/day) for 3-16 months. Aggressive behavior improved in all patients after risperidone was started and remained improved for the duration of follow-up. Other symptoms of mania also improved. Risperidone was generally well tolerated. Sedation and akathisia were reported in one patient.The addition of risperidone to a mood stabilizer may improve aggression and other symptoms of mania in pediatric patients with bipolar disorder who do not respond adequately to a mood stabilizer alone. The long-term efficacy and safety of this regimen should be evaluated in a controlled clinical trial.

View details for Web of Science ID 000239111900010

View details for PubMedID 16879141

Abstract

The psychopharmacology of aggression in youth is relatively unexplored, even though such maladaptive aggression manifests across many different diagnoses.This study was a 12-week, open-label trial with divalproex sodium (DVPX) in 24 bipolar offspring 6-18 years of age (mean age = 11.3 years; 17 boys) with mixed diagnoses of major depression, cyclothymia, attention-deficit/hyperactivity disorder (ADHD), and oppositional defiant disorder (ODD). The Overt Aggression Scale (OAS) was used to measure aggression in 4-week intervals. We measured serum gamma-butyric acid (GABA) and glutamate levels at baseline and week 12.Seventy-one percent of evaluable subjects were considered responders to DVPX treatment by the OAS. There was a significant correlation between the Young Mania Rating Scale (YMRS) and OAS scores at week 0 (p = 0.036) and week 12 (p = 0.025). Serum DVPX level did not correlate with treatment response.These youths who are at high risk for bipolar disorder experienced an overall decrease in aggressive behavior in response to DVPX. Age or gender did not predict a positive response to DVPX. This study is the first report of treatment efficacy of a mood stabilizer for aggression in youth at high risk for bipolar disorder.

View details for Web of Science ID 000238459000004

View details for PubMedID 16768633

Abstract

To review prevention programs, psychosocial and psychopharmacologic treatments, and service delivery configurations for children and adolescents with maladaptive aggression. To propose a research agenda for disorders of aggression in child and adolescent psychiatry.Recent empirical studies were reviewed using searches of MEDLINE and PsycINFO (text terms: aggression, antisocial, violence, conduct, oppositional, psychosocial treatment, psychopharmacology, and prevention), relevant books, review articles, and bibliographies.Articles met the following criteria: published in an English-language, peer-reviewed journal between 1980 and 2005, included a focus on individuals < 18 years old, and included an outcome measure of relevant significance.Results of 154 randomized, controlled psychosocial treatment trials, 20 controlled psychopharmacology studies, 4 open-label medication studies, and 2 psychopharmacology meta-analyses were reviewed.Prevention programs show promise for reducing future aggression in at-risk populations. Empirical support is available for the effectiveness of multifocused psychosocial treatments in reducing aggression in children and adolescents. Atypical antipsychotics, lithium, divalproex sodium, and stimulants for conduct problems associated with attention-deficit/hyperactivity disorder have empirical support for reducing aggression in selected patient populations.Therapeutic nihilism in the treatment of aggressive children and adolescents with conduct problems is no longer warranted. Multifocused psychosocial interventions given early in life to at-risk children have the most support for effectiveness. However, treatments for children who routinely present to the child psychiatrist with already well-established disorders of aggression are neither robust nor well-established. Further research into maladaptive aggression in referred children and adolescents within and across psychiatric diagnoses is important for the field of child and adolescent psychiatry.

View details for Web of Science ID 000238171700016

View details for PubMedID 16841631

Abstract

This article first reviews ways to assess children in the justice system who may benefit from psychopharmacologic treatments. Second, it summarizes the emerging understanding of the nature of aggression and violence and the utility of using the schema of reactive ("hot") and proactive ("cold") aggression as a way to consider pharmacologic options. Third, it summarizes the current published studies on the treatment of conduct disorder, which roughly corresponds to the population of children in the juvenile justice system. Finally, it examines the ways that different classes of medications might be considered when approaching juvenile delinquents and the ways that psychopharmacology could be used as part of an overall treatment plan.

View details for DOI 10.1016/j.chc.2005.12.003

View details for Web of Science ID 000236523900013

View details for PubMedID 16527667

Abstract

Successful treatment of conduct disorder remains difficult. On the basis of a positive response to divalproex among adolescent boys with conduct disorder, we conducted an analysis of the impact of baseline comorbid diagnoses and personality factors on the likelihood of treatment response to divalproex.Seventy-one adolescent boys with conduct disorder (DSM-IV) and a history of at least 1 offense against persons were randomly assigned to receive high- or low-dose divalproex for 7 weeks. Evaluations included best estimate diagnoses, the Clinical Global Impressions-Severity of Illness scale (CGI-S) and CGI-Improvement scale (CGI-I), the 62-item Weinberger Adjustment Inventory (WAI-62) assessment of distress and restraint, the Response Evaluation Measure assessment of immature and mature defenses, and the Achenbach Youth Self-Report assessment of overall psychopathology. All were conducted at study entry and exit, and the WAI-62 was conducted weekly throughout the 7-week study period. Treatment response was defined as a rating of much improved or very much improved on the CGI-I. Data were collected from June 1997 to April 1998.Fifty-eight subjects completed the study and were eligible for inclusion in the analysis. Plasma divalproex level (p = .003) and immature defenses (p = .004) were significant positive predictors of treatment response, while restraint (p = .01) and level and range of psychopathology (p = .04) were significant predictors of nonresponse. Comorbidities or distress (p = .06) were not significantly associated with treatment outcome.Predictors of response to divalproex treatment for conduct disorder were identified, despite the small sample size in this study. The pattern of positive and negative predictors of response to divalproex, an antikindling agent, tends to support a model of kindling-reinforced reactive/affective/defensive/impulsive aggression among adolescent boys with conduct disorder. Additional studies are needed to identify more subtle predictors of treatment response and to clarify the mechanisms contributing to the development of conduct disorder.

View details for Web of Science ID 000234415900007

View details for PubMedID 16401155

Abstract

Divalproex sodium is an anticonvulsant that is used extensively in adults with indications for epilepsy, acute mania and migraine prophylaxis. It has been used in children and adolescents as a first-line agent for mania in bipolar disorder. Its efficacy as a mood stabilizer has been established, and there have been studies outlining its efficacy as an agent effective in the treatment of conduct disorder, disruptive behavior disorders, aggression and explosive disorder. Longer-acting formulations are now available that cause less gastrointestinal side effects and can also be taken once a day, thus potentially increasing adherence, an important factor in this patient population. Future directions would include developing a more potent valproic acid formulation with fewer side effects, completing randomized controlled trials to establish the efficacy of divalproex sodium in various other pediatric psychiatric disorders, establishing the relative efficacy of the compound in head-to-head comparisons with other mood stabilizers, examining systematically the value of the compound in multimodal pediatric psychiatric treatment packages, and complete effectiveness trials that demonstrate the short- and long-term effectiveness of the compound in the real world of clinicians. In this drug profile, divalproex sodium and its uses in the pediatric population for psychiatric conditions are reviewed.

View details for PubMedID 15853487

Abstract

The comparable efficacy and improved safety of the atypical antipsychotics compared with the traditional antipsychotic agents in the treatment of schizophrenia and other disorders in adults have prompted the use of these agents in children and adolescents. The atypical antipsychotics are increasingly being used in children and adolescents with a variety of different psychiatric diagnoses, including schizophrenia, bipolar disorder, autism/pervasive developmental disorders, conduct disorder, depression, anxiety disorders, tic disorders, delirium, and eating disorders. Unfortunately, clinical use of these agents in pediatric patients has far exceeded the limited evidence from randomized controlled trials. This article reviews the available evidence from the published literature on the use of the atypical antipsychotics in children and adolescents with schizophrenia, bipolar disorder, and maladaptive aggression associated with autism/pervasive developmental disorders and conduct disorder/disruptive behavior disorders.

View details for Web of Science ID 000232011600005

View details for PubMedID 16124839

Abstract

Knowledge regarding psychopharmacology is increasingly based on clinical trials and rational algorithms. Medications are increasingly regarded as useful adjuncts in the treatment of maladaptive aggression, whether it appears as a target symptom or as a complication of a whole range of psychopathology. Properly integrated into a treatment package that uses psychotherapies and environmental manipulation, medications can provide relief from one of the most destructive forms of psychopathology. Still, more controlled clinical trials are needed, especially those comparing active interventions and those testing the synergistic and antagonistic effects of different treatment modalities.

View details for Web of Science ID 000221414200006

View details for PubMedID 15162638

Abstract

This study examined the relationship of dissociative symptoms, abuse and neglect, and gender to mean heart rate (HR) in two types of interviews. Participants were 25 female and 16 male delinquent adolescents. Dissociative symptoms and abuse and neglect were assessed by structured interviews. Participants were randomized to one of two conditions, to describe either their most stressful life experience or their free association thoughts. Greater dissociative symptoms were associated with lower mean HR, whereas abuse and neglect, being a girl, and participating in the free association task were associated with higher mean HR. The finding that high levels of dissociative symptoms may be related to a suppression of autonomic physiological responses to stress support Bremner's conceptualization (J. D. Bremner, 1999) that dissociative symptoms comprise one of two subtypes of the acute stress response, differing physiologically as well as subjectively from a predominantly hyperarousal or intrusive symptom response.

View details for Web of Science ID 000188745900007

View details for PubMedID 15027793

Abstract

Dissociation is postulated to occur as a function of particular types of child abuse or chronic abuse. Additionally, there is an ongoing controversy examining the perpetrator's relationship to the victim in the development of dissociation. In this study, reports of traumatic events experienced both in the family environment and in the community were used to examine the relationship between dissociative disorder as defined by DSM-IV (pathological dissociation), and dissociation as a defense mechanism. The first objective was to identify whether the site of the trauma or the quantity of trauma correlated more significantly with symptoms of dissociation. The second objective was to explore a potential correlation between topics that participants choose to disclose during a standardized Stress Inducing Speech Task (SIST), and symptoms of dissociation. The third objective was to examine the relationship between the age of occurrence, the duration of trauma, and symptoms of dissociation. Fifty-two delinquent juveniles completed measures (including the SCID-D, REM-71, CTQ, CTI, SIST) assessing traumatic experiences, psychopathological dissociation, and dissociation as defense mechanism. Blind raters scored the SIST for intrafamilial and extrafamilial trauma. The perpetrator's relationship to the victim, site of the trauma, quantity of the trauma, age of occurrence, and duration of the trauma were analyzed by descriptive statistics and Pearson partial correlations. Significant correlations were found between symptoms of pathological dissociation and intrafamilial trauma. Significant correlations were not found between extrafamilial trauma and pathological dissociation and dissociation as defense mechanism. All these correlations held constant the chronicity of traumas reported. The results obtained in this study through blind and independent assessment suggest that special trauma characteristics (i.e., childhood trauma perpetrated by a family member) rather than sheer cumulative effects of trauma may have greater implications for the development of pathological dissociation. The relationships to dissociation as a defense were much weaker.

View details for DOI 10.1097/01.nmd.0000105372.88982.54

View details for Web of Science ID 000187438200003

View details for PubMedID 14671454

Abstract

Children and adolescents who are the biological offspring of individuals with bipolar disorder (BD) (bipolar offspring) represent a population rich in potential for revealing important aspects in the development of BD. Multiple cross-sectional assessments of psychopathology in bipolar offspring have confirmed high incidences of BD, as well as mood and behavioral disorders, and other psychopathology in this population. Longitudinal studies of offspring have begun to shed light on precursors of BD development. Other assessments of bipolar offspring have included dimensional reports of psychiatric and psychosocial functioning, temperament assessments, and descriptions of family environments and parenting styles. Neurobiological studies in bipolar offspring are just beginning to yield findings that may be related to the underlying neuropathophysiology of BD. The future holds promise for longitudinal studies of bipolar offspring incorporating all of these facets, including genetic analyses, to further elucidate the factors involved in the evolution of BD.

View details for DOI 10.1002/ajmg.c.20011

View details for Web of Science ID 000186309000004

View details for PubMedID 14601034

Abstract

We wished to characterize temperament of children at high risk for bipolar disorder (BD).We collected data from the Dimensions of Temperament-Revised (DOTS-R) from 53 biological offspring of at least one parent with BD.Overall, our cohort differed from population means for the DOTS-R, having decreased Activity Level-General scores, and increased Approach, and Rhythmicity-Sleep scores. Offspring with psychiatric disorders differed from those without in having decreased Flexibility, Mood, and Task Orientation scores. Temperament profiles for diagnostic categories of BD and attention-deficit/hyperactivity disorder were performed in a descriptive manner.Self- or parent-report of temperament was used rather than clinical observation. Temperament characterization was cross-sectional and retrospective rather than prospective and may overlap with clinical diagnoses.Assessment of temperament may be useful in characterizing bipolar offspring. Decreased flexibility and task orientation, and presence of negative moods may be correlated with development of psychopathology.

View details for DOI 10.1016/S0165-0327(02)00105-2

View details for Web of Science ID 000186218700002

View details for PubMedID 14550931

Abstract

This paper addresses and compares the impact of organized, more intensive sports participation with lower intensity participation among high school student-athletes. Subjects included 770 high school students who reported being active in organized school sports. Mental health, physical health, and coping skills were assessed as indicated by factor scores derived from the Juvenile Wellness and Health Survey (JWHS-76). Results indicate that compared to students who were less active, competitive sports participation was associated with fewer mental health problems, fewer total risks, and fewer eating and dietary problems for both girls and boys. These results provide initial support for the association between youth participation in competitive sports and mental health.

View details for Web of Science ID 000185904700005

View details for PubMedID 14601918

Abstract

This study examined the utility of three personality typologies in predicting global functioning in a non-clinic sample of adolescents. Participants were 140 students from middle class suburban public high schools (74 girls; mean age = 16.0 +/- 1.2; 70.7% Caucasian, 11.4% African American, 7.1% Asian, 7.1% Hispanic, and 3.6% other) who completed psychometrically sound standardized measures of personality. They were combined into three four quadrant personality typologies. Global Assessment of Functioning (GAF) ratings were based on clinical interviews utilizing DSM criteria and were obtained by raters blind to self-report results. All three systems overlapped modestly but significantly. Each model detected significant GAF differences among quadrants. There was no gender difference in representation among the quadrants of the three systems. Results suggest that compared with unitary dimensions of personality, typologies concurrently utilizing two dimensions of personality functioning better capture individual differences on a complex psychological construct such as global functioning. Further research is warranted to examine the utility of these typological systems in predicting global functioning across a variety of clinical and nonclinical adolescent populations, and to determine how other aspects of global functioning may influence or interact with personality typologies.

View details for Web of Science ID 000185367800005

View details for PubMedID 14518624

Abstract

Offspring of parents with bipolar disorder, by virtue of their high-risk status for developing bipolar disorder, merit an investigation of the efficacy of treatment with mood stabilizers. Behavioral and mood difficulties in this population may represent prodromal forms of bipolar disorder. We studied the efficacy of divalproex in treating child and adolescent bipolar offspring with mood or behavioral disorders who did not yet meet criteria for bipolar I or II disorder.We studied 24 children aged 6-18 years (mean = 11.3 years; 17 boys/7 girls) with at least 1 biological parent with bipolar disorder. Participants were diagnosed by the Washington University in St. Louis Kiddie Schedule for Affective Disorders and Schizophrenia with at least 1 of the following DSM-IV disorders: major depressive disorder, dysthymic disorder, cyclothymic disorder, or attention-deficit/hyperactivity disorder. Subjects all had at least moderate affective symptoms (28-item Hamilton Rating Scale for Depression or Young Mania Rating Scale score > 12). After a 2-week washout period, subjects were treated with divalproex for 12 weeks, titrated to achieve serum levels of 50-120 micro g/mL (mean final dose = 821 mg/day; mean final serum level = 79.0 micro g/mL).One subject discontinued after 2 weeks due to continuation of symptoms. Of the remaining 23 subjects, 18 (78%) were considered responders by primary outcome criteria ("very much improved" or "much improved" on the Clinical Global Impressions-Improvement scale). Divalproex was well tolerated with no discontinuations due to adverse effects.Bipolar offspring with mood or behavioral disorders and at least mild affective symptoms may respond to divalproex treatment. Our study was limited by the open treatment, lack of a placebo group, and the heterogeneous nature of the sample. Controlled studies are warranted in the use of divalproex in symptomatic bipolar offspring.

View details for Web of Science ID 000184920400012

View details for PubMedID 12927009

Abstract

To use cluster analysis to identify psychological profiles and related mental health symptoms among male and female juvenile offenders.Juvenile offenders (N = 141) incarcerated in the California Youth Authority completed the Minnesota Multiphasic Personality Inventory (MMPI) and the Massachusetts Youth Screening Instrument-Version 2 (MAYSI-2).MMPI cluster analysis revealed four distinct profiles: two for male and two for female juvenile offenders. Among males, we identified one Normative cluster with no clinically elevated scores. A second male cluster, labeled Disorganized, exhibited clinical elevations on scales 8 (Schizophrenia), 6 (Paranoia), 4 (Psychopathic Deviate), and 7 (Psychasthenia). Among females, two clinically elevated profiles emerged. One Impulsive-Antisocial cluster consisted of clinical elevations on scale 4 (Psychopathic Deviate), which has been consistently associated with delinquent and antisocial behavior. The second cluster, labeled Irritable-Isolated, produced elevations on MMPI scales 4 (Psychopathic Deviate), 8 (Schizophrenia), 6 (Paranoia), and 7 (Psychasthenia). There were no significant sex, ethnicity, or offense differences across clusters, but the clusters exhibit distinct psychiatric profiles (MMPI) and mental health symptoms (MAYSI-2).The findings indicate that not only do female offenders have more acute mental health symptoms and psychological disturbances than male offenders, they exhibit qualitatively distinct psychiatric profiles. Results reinforce the need for assessment of mental health symptoms for male and female juvenile offenders as well as sex-appropriate treatments.

View details for DOI 10.1097/01.CHI.0000046877.27264.F6

View details for Web of Science ID 000183750800007

View details for PubMedID 12819436

Abstract

Patients with eating disorders have been found to have problems with Interoceptive Awareness. This study seeks to examine this issue in an experimental paradigm. In the present study, we investigated the hypothesis that, in addition to lowering a body's autonomic stress response, a state of starvation also lowers the psychological stress response. Results indicated that those with anorexia nervosa showed a muted physiology, but they did not show a complete denial of negative emotion. No relation was seen, however, between their affective and physiological responses to a stress task, which contrasted results found for the controls.

View details for Web of Science ID 000182440200003

View details for PubMedID 12723902

Abstract

We tested a questionnaire assessing defenses in school age children and compared the results with their mothers' reports of the same. Thirty-four children (56% male, mean age 8.5) completed the Response Evaluation Measure for Youth (REM-Y) twice over three weeks. Simultaneously, mothers completed the parent version of this measure (REM-P) about their children. In these questionnaires, factor 1 defenses (less adaptive; broken down into intrapersonal and interpersonal defenses) are assessed separately from factor 2, or more adaptive, defenses. Only lower level, interpersonal defenses, such as acting out, were recognized by mothers in their children. The children's intrapersonal defenses, along with factor 2 reactions, were reported less by mothers than by children.

View details for Web of Science ID 000182440200004

View details for PubMedID 12723903

Abstract

Children of parents with bipolar disorder (bipolar offspring) represent a rich cohort for study with potential for illumination of prodromal forms of bipolar disorder. Due to their high-risk nature, bipolar offspring may present phenomenological, temperamental, and biological clues to early presentations of bipolar disorder. This article reviews the evidence for establishing bipolar offspring as a high-risk cohort, the studies which point to possible prodromal states in bipolar offspring, biological findings in bipolar offspring which may be indicators of even higher risk for bipolar disorder, initial attempts at early intervention in prodromal pediatric bipolar disorder, and implications for future research.

View details for DOI 10.1016/S0006-3223(03)00061-1

View details for Web of Science ID 000183339900004

View details for PubMedID 12788239

Abstract

This article explores the complex relationship between dissociation and psychiatric trauma. Dissociation is described as a defense reaction, a risk factor for the development of posttraumatic stress disorder, and as a set of syndromal disturbances. The authors discuss various models proposed for the relationship between these. They outline developmental considerations in diagnosis and treatment and end by discussing further needed research.

View details for DOI 10.1016/S1056-4993(02)00103-7

View details for Web of Science ID 000182120400006

View details for PubMedID 12725010

Abstract

Maladaptive aggression in youth is one of the most common and troublesome reasons for referrals to child psychiatrists. It has a complex relationship with psychopathology. There are several syndromes, which are primary disturbances of clustered maladaptive aggression, most notably oppositional defiant disorder and conduct disorder. However, problems with aggression also appear in a wide range of other disturbances, such as bipolar disorder, posttraumatic stress disorder, and mood disorders. Additionally, aggression is normative, serves an adaptive purpose and can be situationally induced. These complexities need to be carefully addressed before targeting maladaptive aggression psychopharmacologically. We summarize the literature on the psychopharmacology of maladaptive aggression in youth, focusing on disorders without cognitive impairment. We delineate the subtypes of aggression which are most likely to respond to medication (reactive-affective-defensive-impulsive in their acute and chronic form) and conclude with a discussion of specific medication strategies which are supported by controlled clinical trials and clinical experience.

View details for Web of Science ID 000184683600013

View details for PubMedID 12679744

Abstract

There are several different types of legal competence, such as competence to waive Miranda rights, competence to confess, and competence to stand trial. Although it can be surmised that many of the underlying factors that influence the different legal competencies are similar, little research has been conducted to empirically test this hypothesis. In the present study, juveniles' and young adults' understanding and appreciation of their Miranda rights and their ability to stand trial were measured. Age, suggestibility, average grades in school, and frequency of previous police involvement were also examined as possible factors that influence both types of legal knowledge. Results indicated that Miranda competence and adjudicative competence are indeed strongly related, especially for juveniles. Also, age and suggestibility were found to predict Miranda competence, whereas suggestibility and average school grades predicted competence to stand trial. Patterns of findings often diverged for juveniles and young adults. Implications for legal policy are discussed.

View details for DOI 10.1002/bsl.543

View details for Web of Science ID 000183945800008

View details for PubMedID 12808697

Abstract

Eating disorders are prevalent and complicated disorders which are difficult to treat. Unicausal and main effects models are not likely to do justice to the complexity of psychopathology encountered, as one considers etiology and pathogenesis. Risk and protection can arise out of several domains: biological, psychological and social. Risk and protective factors aggregate in specific developmental phases and interact to produce adverse outcomes. Temperamental factors, eating dysregulation, attachment, deficient self regulation and sociocultural ideals of health and beauty all contribute to pathogenesis. Applying the insights of developmental psychopathology to these disorders has considerable potential to lead to early and preventive interventions. Reviewing the current literature from this perspective and updating a similar discussion from 8 years ago, we witness a continued accumulation of quality empirical data. Compared to previous reviews, the field's attention has shifted to psychosocial/cultural domains relevant to eating, away from biological risk. In the aggregate, these data make possible the increasing differentiation of eating disorders from other psychopathology, and the specific pathways in which anorexia and bulimia may develop. Understanding of risk and vulnerability still outweighs our knowledge of protective factors and resilience. While an ideal study would be longitudinal, such studies are still extremely difficult to conduct and costly, thus, forcing us to further our understanding from lagged designs, cross-sectional data and case control studies. While these have many limitations, they do seem to produce an increasingly coherent account of the development of these disorders and prepare us for more targeted and longitudinal study of high risk populations.

View details for PubMedID 12567214

Abstract

In past research the Child Behavior Checklist (CBCL) has differentiated among various diagnostic categories for children and adolescents. However, research has not been conducted on whether the CBCL differentiates among diagnostic categories for children at high risk for development of psychopathology. This study compares four diagnostic groups [bipolar disorder (BD), attention/deficit-hyperactivity disorder (ADHD), Depressed/Anxious and No Diagnosis] within a cohort of 58 children of bipolar parents to determine whether their CBCL scores will replicate the scores of children not at high risk for bipolar disorder. The cohort of children of bipolar parents received elevated scores on the CBCL scales in comparison with non-clinical populations. In addition, the CBCL distinguished between children of bipolar parents with and without clinical disorders. Finally the BD group differed from the ADHD group only on the Aggressive Behaviors, Withdrawn and Anxious/Depressed subscales of the CBCL. Therefore the CBCL did not discriminate between the BD and ADHD groups as it had in previous studies of children with BD and unspecified family history. It is possible that this discrepancy is due to a group of children of bipolar parents with ADHD who are currently prodromal for bipolar disorder and therefore received higher scores on the CBCL based on prodromal symptomatology. A longitudinal follow-up of this cohort is necessary to ascertain whether this is the case.

View details for Web of Science ID 000178254700009

View details for PubMedID 12127602

Abstract

To study a large, population-based sample of adolescents with the goal of expanding our knowledge base about the relationship of coping and health outcomes.We examined 1769 nonclinical, high school students (48% girls, mean age 16 years, predominantly white) using one class period to establish a link between coping styles, health problems, and health risk behaviors. Instruments employed included the Coping Response Inventory - Youth form (abbreviated version) and the Juvenile Wellness and Health Survey. ANCOVAs were used to test the main effects of coping typology, gender, and their interaction on the five health domains.Findings were consistent with previous research and showed that approach coping correlated negatively with indicators of health problems and health risk behaviors, while avoidance coping correlated positively with these domains. The presence of both forms of coping mitigated the negative effects of avoidance coping.As early as mid-adolescence, habitual coping styles appear to be associated with significant health outcomes. In screening nonclinical samples the clinician can rely on habitual coping styles as indicators of potential health problems.

View details for Web of Science ID 000175406700006

View details for PubMedID 11996781

Abstract

To assess posttraumatic stress and its relationship to comorbid psychopathology, violence exposure, and personality traits in Russian male juvenile delinquents.Posttraumatic stress and comorbid psychopathology were assessed by a semistructured psychiatric interview (Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version) in 370 delinquent youths during winter-spring of 1999. In addition, violence exposure, personality, and psychopathology were assessed by self-reports.Most delinquents reported some degree of posttraumatic stress: 156 subjects (42%) fulfilled partial criteria and 87 (25%) fulfilled full DSM-IV criteria for posttraumatic stress disorder (PTSD). Violence-related experiences (witnessing and victimization) were the most common types of trauma. Higher levels of posttraumatic stress were accompanied by higher rates of comorbid psychopathology, with the most striking differences occurring between the groups with full versus partial PTSD criteria. Violence exposure was related to temperamental behavior activation (novelty seeking), whereas PTSD symptom scores were predominantly related to behavior inhibition and poor coping (high harm avoidance and low self-directedness).Similar to findings from American samples, Russian juvenile delinquents represent a severely traumatized population, mainly due to high levels of violence exposure. Those with full PTSD are the most severely traumatized and have highest rates of psychopathology, as compared to those with no or partial PTSD, and they require the most clinical attention and rehabilitation. Both exposure to violence and levels of posttraumatic stress are related to personality traits, which influence degree of exposure and individual perception of stress. The latter should be considered in individualized approaches to rehabilitation.

View details for Web of Science ID 000174118400012

View details for PubMedID 11886027

View details for Web of Science ID 000174337000014

View details for PubMedID 11927764

Abstract

The study explores the prenatal Child Abuse Potential (pCAP) scores derived from the Child Abuse Potential Inventory administered to expectant adolescent mothers. The aim of the study was to assess the association of the pCAP scores with maternal negative prenatal behaviors, and evaluate the contribution of the pCAP scores to neonatal morbidity.The pCAP scores, demographic data, and self-report on prenatal behaviors were obtained during the second half of the pregnancy in a sample of 45 poor single adolescent mothers. A pediatrician blind to the prenatal data reviewed the neonatal records to assess neonatal morbidity. Maternal prenatal records were reviewed for obstetric risk assessment by an obstetrician who was blind to the rest of the data. The relations among the pCAP scores, prenatal behaviors, and neonatal morbidity were analyzed.In the prenatal period, the pCAP scores were positively correlated with self-reported prenatal smoking and substance use. The multiple linear regression analysis showed that the pCAP scores significantly contributed to neonatal morbidity independently of obstetric risk factors.The Child Abuse Potential scores obtained during pregnancy in poor single adolescent mothers reflect domains of maternal functioning that are associated with negative prenatal behaviors and appear to be important for predicting neonatal morbidity. Further studies are warranted to validate the prenatal use of the Child Abuse Potential Inventory.

View details for Web of Science ID 000172247300006

View details for PubMedID 11766012

Abstract

To explore the correlates of high scores on the Child Abuse Potential Inventory in adolescent expectant mothers.Child Abuse Potential scores and data on demographics, pregnancy desire, history of maltreatment, psychological functioning, and perceived social support were obtained by self-report and semi-structured interview. The sample consisted of 50 poor single adolescents recruited from prenatal clinics during the second half of the pregnancy. The relationships among the variables were assessed using Pearson product-moment correlation and multiple regression strategies.Higher Child Abuse Potential scores were associated with higher maternal psychological distress, maternal history of psychiatric diagnosis, and lack of perceived support by the father of the baby. Older pregnant teenagers were more likely to report childhood history of maltreatment, higher psychological distress, and perceived and expected less support by the maternal mother. Expectant mothers who were raised by a single parent were more likely to have a history of childhood maltreatment, less likely to live with the father of the baby during their pregnancy and to expect less support from him.Child Abuse Potential scores, obtained during pregnancy in a sample of poor single adolescents provide a marker of maternal prenatal functioning and perceived social support. Further studies are warranted to validate prenatal use of the Child Abuse Potential Inventory (CAPI), which may help identify populations at particularly high risk for child abuse during pregnancy and inform strategies for early preventive interventions. Adolescent education on family planning, child rearing, and social support programs should address the importance of the fathers' role.

View details for Web of Science ID 000171209100006

View details for PubMedID 11587911

Abstract

Studies of substance abuse among delinquents have shown mixed results on criminal recidivism. The present study evaluates personality traits associated with substance abuse and recidivism among delinquent boys, and prospectively determines the extent to which these factors are predictive of criminal recidivism. 134 incarcerated boys (x = 15.9 +/- 1.1) completed the Weinberger Adjustment Inventory and the Substance Abuse Screening Inventory. Youth were prospectively followed for up to 4.5 years following release. Among incarcerated delinquents, personality traits are predictive of a positive substance abuse screen and recidivism. A trend indicating a possible interaction between personality and treatment is observed. If these findings are replicated, personality traits may play a role in predicting substance abuse as well as individual delinquent responses to treatment.

View details for Web of Science ID 000166878000003

View details for PubMedID 11227989

Abstract

The effect of family environment on the development of bipolar disorder (BD) in children is not known. We sought to characterize families with children at high risk for developing BD in order to better understand the contributions of family environment to the development of childhood BD.We collected demographic data and parental ratings on the Family Environment Scale (FES) for 56 children (aged 6-18 years) from 36 families with at least one biological parent with BD. The cohort had previously been psychiatrically diagnosed according to semistructured interviews.Statistical comparisons with normative data indicated that parents' ratings were significantly lower on the FES Cohesion and Organization scales and were significantly higher on the FES Conflict scale. Multivariate analyses of variance indicated that families with both parents having a mood disorder had no significantly different FES scores than families with only one parent with a mood disorder (BD). Diagnostic data indicated that while 54% of the children in the sample had an Axis I disorder and 14% had BD, FES scores did not differ significantly for subjects with or without an Axis I disorder, or with or without BD.Families with a bipolar parent differ from the average family in having less cohesion and organization, and more conflict. Despite this difference, it does not appear that the environment alone of families with a bipolar parent determines the outcome of psychopathology in the children, or that the psychopathology of the children determines the family environment.

View details for Web of Science ID 000168120300005

View details for PubMedID 11333066

Abstract

In this study, we compare health risks of adolescents with disordered eating to those of their peers without disordered eating. A self-report health survey from a community sample of 1769 high school students was used to compare emotional, medical, and social behaviors of these two groups. Risk data for disordered eating students was compared within and across genders. Adolescents with disordered eating are at increased risk for emotional and physical health problems compared to their peers. Overall health risks for boys and girls with disordered eating are quite similar. However, boys with disordered eating develop associated health risk profiles that differentiate them from male peers by having increased mental health, sexual and physical abuse, and general health problems. Girls with disordered eating have associated health risks for substance use and sexual risk-taking that distinguished them from their female peers.

View details for Web of Science ID 000166288700006

View details for PubMedID 11196014

Abstract

To explore the relationship between PTSD and trauma-spectrum symptoms, including personality and functional correlates, in long term pediatric cancer survivors (N = 40), we assessed these constructs with a structured interview for PTSD, a clinical interview, and self-report questionnaires. Thirty-five out of 40 participants (88%) currently met at least one trauma symptom at a functionally significant level. These survivors demonstrate high levels of restraint and low levels of distress, representative of a repressive adaptive style. After more than 5 years since treatment completion, the relatively high levels of current trauma-spectrum symptoms may reflect the long-term deleterious impact of childhood cancer.

View details for Web of Science ID 000166288700003

View details for PubMedID 11196011

Abstract

The authors examined the presence of posttraumatic stress symptoms (PTSS) in 20 patients requiring ventilation after acute respiratory distress. The subjects completed a semistructured interview about their ventilation experience that was subject to content and linguistic analysis. Subjects also completed two self-report measures to assess PTSS and socioemotional adjustment. Subjects who endorsed PTSS were more likely to use a narrative style suggesting emotional involvement in their recall of the stressful event. The authors indicate that the presence of PTSS is a common consequence of traumatic medical experiences and that denial of distress may be an adaptive short-term coping strategy.

View details for Web of Science ID 000166369100006

View details for PubMedID 11161119

Abstract

Perinatal medical illness has been associated with child maltreatment. Using a Child Protective Service (CPS) report as the defining event, this study explores to what extent perinatal morbidity is a risk factor for maltreatment.Medical charts of 206 children ages 0-3 years were reviewed. Data regarding birth history were collected and analyzed in three groups of children: children whose medical record indicated a report to CPS based on prenatal findings (Early Maternal Inadequacy group [EMI]), children whose medical record indicated a report to CPS based only on postnatal findings (Child Maltreatment group [CM]), and a control group without CPS report (NM).Compared to the CM and the NM groups, children in the EMI group showed significantly lower birth weight and higher neonatal morbidity as measured by Apgar scores, frequency of oxygen requirement and intubation at birth, frequency of admission to Neonatal Intensive Care unit, and frequency of neonatal medical problems. There was no significant difference between the CM and the NM groups in birth weight, gestational age, and other measures of morbidity.The results of the study suggest that perinatal complications are associated with prenatal maltreatment. Previously reported strong associations between neonatal morbidity and child abuse are more likely a result of antecedent prenatal maternal behaviors (early maternal inadequacy). Early maternal inadequacy, a clinically and demographically distinct phenomenon, is important due to serious health, development and financial implications and deserves further exploration.

View details for Web of Science ID 000087428700006

View details for PubMedID 10905418

Abstract

The authors assessed somatic symptoms and the degree of association among somatic symptoms, global adjustment, trauma symptoms, and personality characteristics in long-term pediatric cancer survivors. Forty cancer survivors completed self-report questionnaires and clinical interviews. Participants' level of somatic symptoms fell between nonclinic and psychiatric populations. Somatic symptom scores correlated with general adjustment in the negative direction and with posttraumatic stress disorder (PTSD) scores in the positive direction. The majority of participants met at least partial current PTSD criteria. Because these survivors demonstrate a repressive adaptive style but endorse somatic symptoms, the latter may represent a method for detecting trauma-related distress in this population.

View details for Web of Science ID 000087918600008

View details for PubMedID 10906356

Abstract

To establish prodromal signs of and risk factors for childhood bipolar disorder (BD) by characterizing youths at high risk for BD.Structured diagnostic interviews were performed on 60 biological offspring of at least one parent with BD. Demographics, family histories, and parental history of childhood disruptive behavioral disorders were also assessed.Fifty-one percent of bipolar offspring had a psychiatric disorder, most commonly attention-deficit/hyperactivity disorder (ADHD), major depression or dysthymia, and BD. BD in offspring tended to be associated with earlier parental symptom onset when compared with offspring without a psychiatric diagnosis. Bipolar parents with a history of childhood ADHD were more likely to have children with BD, but not ADHD. Offspring with bilineal risk had increased severity of depressed and irritable mood, lack of mood reactivity, and rejection sensitivity, while severity of grandiosity, euphoric mood, and decreased need for sleep were not preferentially associated with such offspring.Bipolar offspring have high levels of psychopathology. Parental history of early-onset BD and/or childhood ADHD may increase the risk that their offspring will develop BD. Prodromal symptoms of childhood BD may include more subtle presentations of mood regulation difficulties and less presence of classic manic symptoms.

View details for Web of Science ID 000086190000014

View details for PubMedID 10761347

Abstract

In order to begin to compensate for a lack of data on the effects of athletic participation in the development of adolescent mental health patterns, as well as to assess general health of the adolescent population, the Juvenile Wellness and Health Inventory (JWHS-76) was administered to 1,769 high school students. Our results indicate that sports participation is associated with self-reported lower total risk scores, mental and physical health benefits, and an increased risk of injury. This suggests a positive role for organized sports participation in youth populations. Prospective studies are needed to assess the impact of different sports, mounting performance pressure, and transition into collegiate levels of participation.

View details for Web of Science ID 000085957600004

View details for PubMedID 10752009

Abstract

To assess history of trauma and dissociation in a group of juvenile delinquents and to assess how adolescents would respond to a structured interview for dissociative symptoms.Sixty-four adolescents in juvenile probation hall participated in 2 investigational sessions in 1996-1997. For session 1 they answered the Childhood Trauma Questionnaire (CTQ), the Response Evaluation Measure for Youth-71 (REMY-71), and the Weinberger Adjustment Inventory. For session 2 they were given the Childhood Trauma Interview (CTI) and the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D).In this sample 28.3% met criteria for a dissociative disorder and 96.8% endorsed a history of traumatic events. There were significant positive correlations between CTI and CTQ trauma scores and SCID-D and REMY-71 dissociative symptoms. All dissociative symptoms were endorsed, but depersonalization was the most common experience. There was a lack of congruence between the different methods of assessing dissociation.This study provides support for an early link between history of trauma and dissociation. Adolescents were able to answer questions from a structured interview assessing dissociation.

View details for Web of Science ID 000085580800018

View details for PubMedID 10714056

Abstract

To develop a broader understanding of young children's knowledge and beliefs about dieting and body dissatisfaction.Sixty-two third through sixth-grade boys and girls completed audiotaped interviews and questionnaires regarding eating behavior, attitudes toward dieting, and body dissatisfaction.Fifty percent of all children wanted to weigh less and 16% reported attempting weight loss. Children were well informed about dieting and were most likely to believe that dieting meant changing food choices and exercising as opposed to restricting intake. Their primary source of information was the family. Seventy-seven percent of children mentioned hearing about dieting from a family member, usually a parent.Young children are knowledgeable about dieting and the concept of dieting does not necessarily mean caloric restriction to them. These data suggest that the family can play a powerful role in countering the development of eating concerns and body dissatisfaction in children.

View details for Web of Science ID 000084531300008

View details for PubMedID 10590451

Abstract

This study examines the relationship between stressful life events and defense mechanisms. Eighty seven female adolescent patients completed the Adolescent Family Inventory of Life Events and Changes (A-FILE) assessing stressors in six domains of family life, and the Defense Style Questionnaire (DSQ) assessing 19 defense mechanisms grouped into Immature, Prosocial, and Mature clusters. Increasing stressors are significantly positively correlated with a more immature defense style. Results support the hypothesis that there is an iterative relationship between immature defenses and life stressors. These findings are compatible with a regression model of defense functioning and complement our previous results linking defenses to temperament.

View details for Web of Science ID 000082942800002

View details for PubMedID 10533290

View details for PubMedID 10087682

Abstract

Health problems of gay, lesbian, and bisexual (GLB) youth are reported as differing from those of heterosexual youth. Increased depression, suicide, substance use, homelessness, and school dropout have been reported. Most studies of GLB youth use clinical or convenience samples. The authors conducted a community school-based health survey that included an opportunity to self-identify as GLB.An anonymous self-report health care questionnaire was used during a community-based survey in 2 high schools in an upper middle class district.Significantly increased health risks for self-identified GLB youth were found in mental health, sexual risk-taking, and general health risks compared with self-identified heterosexuals, but not in health domains associated with substance abuse, homelessness, or truancy.Self-identified GLB youth in community settings are at greater risk for mental health, sexual risk-taking, and poorer general health maintenance than their heterosexual peers.

View details for Web of Science ID 000078832100018

View details for PubMedID 10087691

Abstract

The serotonin reuptake inhibitors are the treatment of choice for patients with obsessive-compulsive disorder; however, empirical support for this assertion has been weaker for children and adolescents than for adults.To evaluate the safety and efficacy of the selective serotonin reuptake inhibitor sertraline hydrochloride in children and adolescents with obsessive-compulsive disorder.Randomized, double-blind, placebo-controlled trial.One hundred eighty-seven patients: 107 children aged 6 to 12 years and 80 adolescents aged 13 to 17 years randomized to receive either sertraline (53 children, 39 adolescents) or placebo (54 children, 41 adolescents).Twelve US academic and community clinics with experience conducting randomized controlled trials.Sertraline hydrochloride was titrated to a maximum of 200 mg/d during the first 4 weeks of double-blind therapy, after which patients continued to receive this dosage of medication for 8 more weeks. Control patients received placebo.The Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS), the National Institute of Mental Health Global Obsessive Compulsive Scale (NIMH GOCS), and the NIMH Clinical Global Impressions of Severity of Illness (CGI-S) and Improvement (CGI-I) rating scales.In intent-to-treat analyses, patients treated with sertraline showed significantly greater improvement than did placebo-treated patients on the CY-BOCS (adjusted mean, -6.8vs -3.4, respectively; P=.005), the NIMH GOCS (-2.2 vs -1.3, respectively; P=.02), and the CGI-I (2.7 vs 3.3, respectively; P=.002) scales. Significant differences in efficacy between sertraline and placebo emerged at week 3 and persisted for the duration of the study. Based on CGI-I ratings at end point, 42% of patients receiving sertraline and 26% of patients receiving placebo were very much or much improved. Neither age nor sex predicted response to treatment. The incidence of insomnia, nausea, agitation, and tremor were significantly greater in patients receiving sertraline; 12 (13%) of 92 sertraline-treated patients and 3 (3.2%) of 95 placebo-treated patients discontinued prematurely because of adverse medical events (P=.02). No clinically meaningful abnormalities were apparent on vital sign determinations, laboratory findings, or electrocardiographic measurements.Sertraline appears to be a safe and effective short-term treatment for children and adolescents with obsessive-compulsive disorder.

View details for Web of Science ID 000077081400030

View details for PubMedID 9842950

Abstract

While there is a growing body of evidence that psychopathology is common among incarcerated boys, relatively little is known about the prevalence and manifestations of mental health problems among incarcerated girls. This study examines the incidence of posttraumatic stress disorder (PTSD) in a sample of 96 adolescent female offenders and its relation to socioemotional adjustment.Self-report questionnaires were used to tap socioemotional adjustment, and a semistructured interview was conducted to determine PTSD symptomatology.The results indicate that the rate of PTSD among incarcerated female delinquents not only is higher than that in the general population but surpasses the incidence of PTSD among incarcerated male delinquents. In addition, those who suffer from PTSD also tend to exhibit higher levels of distress and lower levels of self-restraint.These findings provide a starting point for more detailed investigations of the relations between trauma, psychopathology, and violence and suggest that the study of trauma may offer a new way of looking at links between victim and perpetrator.

View details for Web of Science ID 000076629100021

View details for PubMedID 9808933

Abstract

This practice guideline seeks to provide guidance to psychiatrists who regularly evaluate and manage patients with medical illnesses. The guideline is intended to delineate the knowledge base, professional expertise, and integrated clinical approach necessary to effectively manage this complex and diverse patient population. This guideline was drafted by a work group consisting of psychiatrists with clinical and research expertise in the field, who undertook a comprehensive review of the literature. The guideline was reviewed by the executive council of the Academy of Psychosomatic Medicine and revised prior to final approval. Some of the topics discussed include qualifications of C-L consultants, patient assessment, psychiatric interventions (e.g., psychotherapy, pharmacotherapy), medicolegal issues, and child and adolescent consultations.

View details for Web of Science ID 000075014800023

View details for PubMedID 9691717

Abstract

Caloric utilization is an important aspect of the clinical management of eating disorders. Caloric intake and body weight of 32 inpatient bulimic and anorectic girls and 30 normal adolescents were measured. Normal weight bulimics ate fewer calories while anorectics ate more calories per kilogram body weight compared with the control group. Anorectics have greater difficulty to eat sufficient calories to maintain their weight. These findings indicate that treatment should be extended beyond the point of time where normal weight is reached.

View details for Web of Science ID 000074049400005

View details for PubMedID 9628058

Abstract

Empirical work on psychopathology and delinquency requires concise and specific instruments. The Weinberger Adjustment Inventory (WAI), was correlated with the Minnesota Multiphasic Personality Inventory (MMPI) using a sample of incarcerated adolescent males (N = 178). The distress dimension of the WAI was significantly and positively associated with scales 2, 4 and 7 of the MMPI. The restraint dimension was significantly and positively associated with the Lie and K scales of the MMPI. Distress and restraint were distinct dimensions. The WAI may be a brief and helpful personality measure, determining responses to conflict and subjective stress in delinquents with poor reading skills and other special education impairments. The length of the WAI makes it especially suitable for populations such as incarcerated adolescent males who exhibit short attention spans and frequent episodes of noncompliant and resistant behavior.

View details for Web of Science ID 000074049400006

View details for PubMedID 9628059

Abstract

To critically review the research in juvenile anorexia nervosa and bulimia nervosa over the past 10 years and highlight recent advances in normal development as it pertains to these disorders and their diagnosis, prevention, and treatment.Computerized search methods were combined with manual searches of the literature. A detailed review of the most salient articles is provided. Preference was given to studies involving children and adolescents that approached the subject from a developmental perspective.The information from these studies is presented in a developmental framework. Research in eating disorders has progressed, but definitive longitudinal data are still absent from the literature. Research specific to treatment of child and adolescent eating disorders remains rare.Data approaching eating disorders from a developmental perspective are available in only a few studies. Research is needed addressing normative data on the development of eating behavior and specific risk and resilience factors for pathology in specific developmental periods. Especially lacking are studies regarding the continuities and discontinuities of eating disturbances across the life span. Best documented are epidemiological studies of prevalence and incidence, long-term outcome in anorexia nervosa, and short-term treatment response in bulimia.

View details for Web of Science ID 000072657600011

View details for PubMedID 9549954

Abstract

Prospective observations of the defense styles of normal individuals suggest that the quality of the childhood family environment may influence the maturity of defense styles used in adulthood. In this study, 106 female adolescent psychiatric patients completed the Defense Style Questionnaire, and the Family Environment Scale (FES). Positive family characteristics such as cohesion and expressiveness, as measured by the FES, were correlated with the report of Mature Defenses. Negative family characteristics such as conflict were correlated with the report of Immature Defenses. Similar although weaker correlations were found after controlling for the effects of depression and defensiveness on the self-report measures.

View details for Web of Science ID 000072516800005

View details for PubMedID 9540242

Abstract

This summary of the practice parameters describes the diagnosis, treatment, and prevention of conduct disorder in children and adolescents. The rationales for these recommendations are based on a review of the scientific literature and clinical consensus, which are contained in the complete document. Clinical features of youths with conduct disorder include predominance in males, low socioeconomic status, and familial aggregation. Important continuities to oppositional defiant disorder and antisocial personality disorder have been documented. Extensive comorbidity, especially with other externalizing disorders, depression, and substance abuse, has been documented and has significance for prognosis. Clinically significant subtypes exist according to age of onset, overt or covert conduct problems, and levels of restraint exhibited under stress. To be effective, treatment must be multimodal, address multiple foci, and continue over extensive periods of time. Early treatment and prevention seem to be more effective than later intervention.

View details for Web of Science ID A1997XZ47300039

View details for PubMedID 9334562

Abstract

These practice parameters address the diagnosis, treatment, and prevention of conduct disorder in children and adolescents. Voluminous literature addresses the problem from a developmental, epidemiological, and criminological perspective. Properly designed treatment outcome studies of modern psychiatric modalities are rare. Ethnic issues are mentioned but not fully addressed from a clinical perspective. Clinical features of youth with conduct disorder include predominance in males, low socioeconomic status, and familial aggregation. Important continuities to oppositional defiant disorder and antisocial personality disorder have been documented. Extensive comorbidity, especially with other externalizing disorders, depression, and substance abuse, has been documented and has significance for prognosis. Clinically significant subtypes exist according to age of onset, overt or covert conduct problems, and levels of restraint exhibited under stress. To be effective, treatment must be multimodal, address multiple foci, and continue over extensive periods of time. Early treatment and prevention seem to be more effective than later intervention.

View details for PubMedID 9334568

Abstract

Previous studies have suggested an association between temperament and eating disorder pathology. The purpose of this study was to differentiate on the basis of temperament among patients with anorexia, bulimia, and major depression. In this study, 101 adolescent girls completed the Revised Dimensions of Temperament Survey (Self), a self-report measure that identifies nine dimensions of temperament. Significant differences were found between the diagnostic groups while controlling for disturbances in mood and defensiveness. Specific subscales differentiated the subjects with anorexia from those with bulimia. These data support the concept of using temperament to differentiate patients with related psychiatric syndromes.

View details for Web of Science ID A1997WL68300006

View details for PubMedID 9063043

Abstract

This study utilizes a unique method to examine reports of stressful life events provided by eating disordered and non-eating disordered adolescents. Subjects (all females) participated in a standardized procedure to obtain reports of stressful life events. The Life Events and Coping Inventory (LECI) was used to categorize reported stressors. Eating disorder subjects discussed more stressors than non-eating disorder subjects only when eating disorder events were included. Furthermore, eating disorder subjects reported more events that could not be classified within the LECI and were rated as non-normative. The findings point to the importance of qualitative rather than purely quantitative approaches to stressful life events assessment with adolescents.

View details for Web of Science ID 000071849700005

View details for PubMedID 9494237

Abstract

Despite the great need for assessment of the adaptive and defensive style of adolescents, there are few instruments available to assess these characteristics. We assessed Vaillant's defense hierarchial model in adolescents, using Bond's self-report questionnaire (DSQ) for adults adopted for adolescents. In all cases, the factor structure in adolescents differed from adults, which may represent a manifestation of development.

View details for Web of Science ID A1996VD05500001

View details for PubMedID 8810112

Abstract

To modify an existing instrument to provide a valid assessment of defense mechanisms in adolescents and to examine defense structure and usage as a function of age, sex, and mental health status.Six hundred ninety-three subjects (187 nonclinic adolescents, 229 internalizing females, 99 incarcerated male delinquents, and 178 nonclinic adults) completed the modified Defense Style Questionnaire (DSQ), which yielded 19 defense scores.Factor analyses of the 19 defense scores on the adolescent sample yielded three factors: Immature, Mature, and Prosocial Defenses. These were similar to those from studies of adults. Additional factor analyses were conducted on defense scores of subjects grouped by age, sex, and mental health status. The Immature and Mature Factors were relatively consistent across groups, but the Prosocial Factor varied by group. Multivariate analyses of variance and analyses of variance on individual and composite defense scores revealed differences by age, sex, and mental health status.Although the modified DSQ needs further work to improve its psychometric properties, it is clearly fruitful to assess adolescent defense mechanisms. Results from extant studies of adults and males on the structure of defenses cannot be validly extrapolated to other age groups and to females.

View details for Web of Science ID A1996VK05500022

View details for PubMedID 8885589

Abstract

This study compared self-perception of defense patterns with objective and independent ratings of general adjustment in normal adolescents.Self-perception of defense utilization by 140 high school students was measured by an adolescent version of Bond's Defense Style Questionnaire. The DSM-III-R Global Assessment of Functioning Scale was used by clinicians in determining general adjustment.Defense style and adjustment were significantly related; greater maturity of defense style was associated with better global adjustment, and conversely, greater immaturity of defense style was associated with a lower level of functioning.Adolescents' self-perceived defense patterns have conscious correlates associated with general adjustment. This study extends the validity of the defense mechanism paradigm to the adolescent age group.

View details for Web of Science ID A1996UN63200018

View details for PubMedID 8633700

Abstract

The Revised Dimensions of Temperament Survey, which assesses nine dimensions of temperament, and the Defense Style Questionnaire, used to assess defense mechanisms, were completed by 107 female adolescents. Temperament was found to be strongly correlated with defense style, particularly with immature defenses (p = 0.0001). The findings support the hypothesis that the biological dimension of temperament is correlated with specific defense mechanisms.

View details for Web of Science ID A1996VP57900004

View details for PubMedID 8936796

Abstract

Youth violence poses a major public health problem. It is important to find treatable predictors of recidivism. Our Subjects had committed offenses of physical and sexual assault. The personality dimensions of restraint and distress were rated by two independent and blind raters from narratives of offender's committing offenses, which were obtained at baseline during incarceration. Inter and intrarater kappas for each narrative were significant. In a 10-13 year follow-up, subjects lowest in self- restraint had significantly higher recidivism and their reoffenses differed in quality. Restraint may be influenced by clinical intervention and constitutes a new target in the treatment of delinquents.

View details for Web of Science ID A1996VP57900001

View details for PubMedID 8936793

Abstract

Repressive defense style, characterized by low levels of self-reported distress and high levels of defensiveness, has been well studied in adult patients. This study identified four adaptive styles (repressor, impression manager, low anxious, and high anxious) in an adolescent psychosomatic patient sample (n = 120) by standardized psychometric examination. Adolescents with an active medical diagnosis on DSM III-R axis III or with an axis I diagnosis associated with physical symptoms (conversion disorder, somatization disorder, and psychological factors affecting physical condition) were more likely to be repressors. Those with affective disorders were more likely to be impression managers. Implications for pediatric and psychiatric management are discussed.

View details for PubMedID 7976330

Abstract

To examine the relationship between psychiatric disorder and psychological characteristics at 6-year follow-up of adolescent-onset anorexia nervosa.Twenty-three subjects were interviewed by telephone using the Structured Clinical Interview for DSM-III-R diagnosis. These subjects and 23 demographically similar controls completed standardized questionnaires that assessed their defense and coping styles, level of depression, defensiveness, and eating disorder psychopathology.Of the anorexic subjects 35% had no DSM-III-R diagnosis, 43% an eating disorder, (9% anorexia nervosa, 17% bulimia nervosa, 22% eating disorder not otherwise specified), 30% an affective disorder, and 43% an anxiety disorder at follow-up. Factors at presentation associated with good outcome included greater use of mature defenses, less depression, and a lower drive for thinness. Psychological characteristics of anorexic subjects with good outcome resembled those of controls except that the former anorexics expressed greater dissatisfaction with their bodies and reported less use of cognitive avoidance as a coping mechanism. Anorexic subjects with continuing psychiatric problems differed from controls on most of the measures studied.Distribution of psychiatric disorders at follow-up is similar for adolescent and adult-onset anorexia nervosa. Self-report measures of some psychological characteristics are useful prognostic indicators. Absence of psychiatric disorder at follow-up is associated with normalization of many psychological characteristics.

View details for Web of Science ID A1993MD60300019

View details for PubMedID 8282670

Abstract

We designed this study to replicate previous findings which suggest a relationship between the qualities found in family environments and specific eating disorders through the examination of subjects' reports of family environments. We also attempted to refine previous findings of such relationships by adding an additional psychiatric contrast group. Subjects included patients with the following diagnoses: (1) Anorexia nervosa, restrictor type; (2) anorexia nervosa with bulimic features; (3) normal weight bulimia; and, as a psychiatric control population (4) major depression. In contrast to previous findings, subjects in each diagnostic group do not differ statistically either from each other or from a normative population with regard to reported family environments. However, when we grouped subjects by self-reported level of depression, those with a high level of depression described family environments that are significantly different, independent of the severity of illnesses or diagnoses. We discuss the use of self-report instruments in measuring such complex phenomena as family environment.

View details for Web of Science ID A1993LJ73800005

View details for PubMedID 8339098

Abstract

It has been hypothesized that anorexia nervosa is characterized by ineffectiveness, interpersonal distrust, and lack of interoceptive awareness. The Eating Disorder Inventory differentiates patients with anorexia nervosa from weight-preoccupied women on the basis of these subscales. To test further the specificity of these characteristics to anorexia nervosa, the Eating Disorder Inventory scores of 20 adolescent girls diagnosed with anorexia nervosa were compared with those of 21 girls with major depression and 21 girls with both anorexia nervosa and depression. Analyses of variance and discriminant function analysis revealed no significant differences in the scores of the three groups. By 2-year followup, subjects initially diagnosed with only anorexia nervosa showed less psychopathology than those with an additional diagnosis of depression. These findings raise further questions about the overlap between depression and anorexia nervosa and leave open the question of characteristic psychological features in anorexia nervosa.

View details for Web of Science ID A1992JM58400009

View details for PubMedID 1400114

Abstract

Maturity of defense style has been associated with the level of adaptive functioning, but few studies have assessed defense style using self-report questionnaires which can provide ratings with great reliability and objectivity. We compared self-perception of defense style (using Bond's Defense Style Questionnaire) with ratings of adaptation assessed retrospectively by two independent raters (using the DSM III-R Global Assessment of Functioning scale) in a population of 100 adolescent girls diagnosed as having either an eating disorder or depression. There was significant correlation between maturity of defense style and level of adaptation, with greater maturity of defense style being associated with higher levels of adaptive functioning. This effect was independent of diagnosis within this population.

View details for PubMedID 1414355

Abstract

Three cases of adolescents with respiratory stridor of psychiatric etiology are described. All three fulfilled DSM-III-R criteria for diagnoses of somatoform disorders and showed characteristics of repressive defense style. Such patients are likely to undergo extensive medical investigation and treatment if the psychiatric nature of their disorder is not recognized, but few data describing their psychological characteristics or treatment exist. Repressors are typically unaware of emotional arousal and do not recognize the negative affects which lead to their somatic symptoms. They therefore respond poorly to confrontational psychotherapy and are at risk of discontinuing treatment and repeating their maladaptive symptom cycle. Identification of repressive defense style in patients with stridor which has no obvious organic cause may be useful both as a possible "marker" of psychiatric disorder and as a guide to treatment.

View details for PubMedID 1492547

Abstract

Three cases of adolescent females suffering from unexplained weight loss are presented. Differential diagnoses included psychiatric and medical illnesses. We describe how psychometric measures were used in each case to clarify diagnosis.

View details for PubMedID 1492549

Abstract

The hypothesized connection between adaptive style, specifically repressive adaptation, and the family environments of adolescent clinical samples was investigated. Adolescent patients (n = 221) were studied, who were then divided into four groups matched for sex, age, and socioeconomic status (mean age = 15.7 years, SD 2; sex = 14% boys, 86% girls; SES = 2.4). Grouping was based on the Marlowe Crowne Social Desirability Scale and Spielberger's Trait Anxiety Inventory Scores [repressors (n = 43), impression managers (n = 54), high anxious (n = 55) and low anxious (n = 69)]. Results by MANOVA, Scheffe and discriminate function analysis confirmed our hypothesis. Repressors had distinct family environments as measured by the Family Environment Scale (p = 0.0001). Families were characterized by high levels of cohesion, expressiveness, independence, and organization, displaying correspondingly low levels of achievement orientation, conflict, control and incongruence. Repression may be an effort to adapt to an idealized family environment.

View details for PubMedID 1414343

Abstract

We treated four patients with chronic vomiting during childhood in whom a tentative diagnosis of psychogenic vomiting was made after an extensive evaluation. In each case, the diagnosis was reconsidered during the course of treatment, as observations about the patients and their response to interventions accumulated. In three instances, these observations did not fit those expected if the diagnosis of psychogenic vomiting was correct. This led to a reexamination of the organic evaluation and the discovery of an undiagnosed organic contribution to the vomiting. In the fourth patient, gastric emptying studies confirmed that there was a strong psychological contribution to the vomiting, and helped to more carefully define this contribution. Family and individual psychotherapy and treatment were aided by the greater clarity in diagnosis.

View details for Web of Science ID A1991FZ98300026

View details for PubMedID 1858729

Abstract

Comparing mothers' reports of early feeding practices in 18 mothers of anorexics and 25 mothers of normal children by means of a questionnaire, we found that the mothers of anorexics introduced solids earlier and used Schedule rather than Demand feedings more frequently. The mothers of anorexics did not treat patients and control siblings differentially. Our study suggests that differences in early feeding and in infant temperament may be operative in the pathogenesis of anorexia nervosa.

View details for Web of Science ID A1991EZ76300001

View details for PubMedID 2007340

View details for Web of Science ID A1990EG41800009

Abstract

Anorexia nervosa is notoriously difficult to treat, but little is known regarding the relationship of compliance to treatment outcome. We investigated in 41 adolescents who fulfilled DSM-III-R criteria for anorexia nervosa, the relationship between the completion of a standard psychosocial treatment program, subtypes of anorexia nervosa, and outcome as determined by standardized measurements. These adolescents were observed for an average of 32.4 months. Overall, 29 patients (70%) improved considerably, but 10 (24%) were symptomatic, and 2 (5%) remained in poor condition. There were no deaths. Of the 41 patients, 14 (34%) completed our entire treatment program, 15 (37%) received major treatment and failed in the outpatient follow-up phase only, 7 (17%) dropped out of inpatient treatment before its completion, and 5 (12%) refused treatment in our system altogether. Of all the dropouts, 10 received no further treatment. One patient was admitted to hospital elsewhere but again dropped out in the outpatient phase of that program. Seven patients (17%) received further outpatient treatment only, and 9 (22%) received inpatient and outpatient care and seemingly completed their treatment. Treatment completion significantly affected the measures of global clinical functioning and specific psychopathologic features, but only for those patients who completed the initial program. Bulimic patients did considerably worse on follow-up and were less likely to complete treatment. Patients with restricted anorexia nervosa were more likely to complete treatment than those with a bulimic subtype (P = .03). Differential compliance rates in the two subtypes confound the effects of treatment completion and need to be controlled for in future studies. Depression was not associated with noncompliance but, if present, was associated with poor outcome on follow-up and abated in only a third of those in whom it was initially present.

View details for Web of Science ID A1990DU82600001

View details for PubMedID 2219868

Abstract

A patient referred to the authors for evaluation and treatment of depression, behavioral dyscontrol syndrome, and polydipsia is described. The authors reviewed his medical status and, finding damage to his right temporal lobe, conceptualized his symptom constellation as representing interictal syndrome and treated him with carbamazepine. His affective symptoms, but not the polydipsia, improved following treatment with carbamazepine.

View details for Web of Science ID A1990DE38700023

View details for PubMedID 2347849

Abstract

The authors explored the role of Cyclo [His-Pro] (CHP) in 50 adolescents who fulfilled DSM III diagnostic criteria for anorexia nervosa and bulimia. CHP, a relatively new neuro modulator which has a role in inducing satiety, was assayed in serum during routine blood work. CHP levels correlated significantly with weight in restrictor (AN-R) (R = -0.449, P less than 0.05) and bulimic anorexics (AN-B) (R = +0.489, P less than 0.01). There was no significant correlation in normal-weight bulimics (NWB) (R = +0.556, P less than 0.01). It did not correlate with weight in a depressed control group. Longitudinal data on six patients showed a similar relationship between weight, purging and CHP binge/purge activity and/or weight changes of around 2 kilograms correlated with average CHP changes of 42%. Clinical material suggests changes in satiety during CHP changes consistent with a satiety disturbance model of these disorders.

View details for Web of Science ID A1989AW51800006

View details for PubMedID 2615922

Abstract

The effect of desipramine hydrochloride was studied in children who were treated for eating disorders (5), attention deficit disorder (13), or affective disturbance (3). Serial heart rate, blood pressure, ECG, and 24-hour ambulatory monitoring were recorded before treatment and at 4 and 8 weeks during treatment. Maximum dose of desipramine was 5 mg/kg/day, average 4.25. A 21% increase in heart rate and 2.5% increase in QTc at 4 weeks were sustained at 8 weeks. No dysrhythmias or clinically significant changes in blood pressure occurred. Desipramine is safe in children who have normal cardiovascular examinations and ECGs when used within the limits of the study design. The cardiovascular effects of desipramine should be kept in mind and monitored when patients are starting tricyclic antidepressant therapy such as desipramine.

View details for Web of Science ID A1989U609000012

View details for PubMedID 2661525

View details for Web of Science ID A1988N956700002

View details for PubMedID 3402259

Abstract

The purpose of this study was to test the relationship between social environment and the activity of the HPA axis in adolescents. Ten elective admissions to Children's Hospital at Stanford were assessed by standard psychiatric interview. Five fulfilled criteria for a DSM-III diagnosis, five others did not. The groups were comparable in age, height, weight, SES, and number of previous hospitalizations. All subjects and their families completed the Family Environment Scale. All subjects had plasma cortisol concentrations determined on days 1, 3, and 5 of hospitalization and at the time of discharge. Samples were drawn under standardized conditions, after a brief interview during which potentially stressful events of the day were discussed. Results revealed that the five individuals with poor coping skills, as defined by the presence of a DSM-III diagnosis, had significantly higher peak concentrations of plasma cortisol, than the five psychiatrically normal subjects. Peak cortisol elevations occurred upon discharge from the hospital. Family environment in the two groups differed significantly on the dimensions of cohesion, conflict, control, and incongruence of perception of the environment among family members themselves. The findings support the hypothesis that social environmental characteristics are associated with psychiatric and physiological measures of coping.

View details for Web of Science ID A1988Q222900005

View details for PubMedID 3227090

Abstract

Approximately 15% of patients with bronchial asthma are unable to sense marked changes in airway obstruction. We have investigated the hypothesis that inability to sense changes in the severity of bronchial asthma varies with insensitivity to emotional arousal, which in turn is associated with repressive defense styles. Nine asthmatic patients were studied comparing actual changes in peak flow rate using a coded peak flow meter and in arousal during a stress-inducing psycholinguistic protocol with perceived changes. Our hypotheses were confirmed. Ability to perceive changes in asthma could be predicted from performance on the psycholinguistic stress test (Spearman's rho = +0.733, p less than 0.01). Repressors performed significantly worse on the asthma perception task (Spearman's rho = -0.650, p less than 0.05). The results suggest a role for defense pathology in the psychomaintenance of asthma.

View details for Web of Science ID A1987F961800003

View details for PubMedID 3823349

Abstract

Bulimia is a serious and prevalent eating disorder in the adolescent population. The pediatrician is often in a position to make the initial diagnosis of bulimia but must suspect the disorder in light of subtle physical evidence. Denial and embarrassment reduce the likelihood of self-report of symptoms. Hand lesions resulting from self-induced emesis have a distinctive configuration and appearance. Noting these characteristic lesions during a physical examination should alert a physician to the diagnosis of bulimia or to an exacerbation of symptoms in a patient whose condition was previously diagnosed.

View details for Web of Science ID A1986AXF5200023

View details for PubMedID 3455790

View details for Web of Science ID A1984TW58500004

View details for PubMedID 6510030

View details for Web of Science ID A1983AUZ9000001

View details for PubMedID 6678710

View details for Web of Science ID A1982QN37200001

View details for PubMedID 7182114

View details for Web of Science ID A1982QC06800008

View details for PubMedID 7118812

Abstract

The authors evaluated six acute short-stay admission wards in a community mental health center using the sociometric Ward Atmosphere Scale. There was an attempt to run three of the six wards as therapeutic communities. No differences were found on Ward Atmosphere Scale dimensions between the therapeutic communities and other types of programs, nor did the therapeutic communities conform to an empirically derived therapeutic community program dimension profile. Possible reasons for this failure and its implications for community mental health centers are discussed.

View details for Web of Science ID A1982NW07200010

View details for PubMedID 7091407

Abstract

With many asthmatic children for whom emotional factors are significant, joint pediatric and psychiatric management is essential. A three-level model of collaboration is presented, including (1) pediatric care, (2) psychiatric consultation, and (3) inpatient psychosomatic treatment. The organization, professional roles, and treatment protocol of the psychosomatic inpatient service are described. A review of the first 16 asthmatic children who received inpatient care in the program suggests that such a model may present a viable alternative to long-term residential care.

View details for Web of Science ID A1981MT91700003

View details for PubMedID 7307410

Abstract

The psychiatric complications occurring in a group of adult burn patients were correlated with pertinent data in the literature and a classification constructed, based on the three stages of the acute grief response to injury: psychiatric complications occur when the process of mourning is arrested in a regressive episode. Thirty-five adult patients with burns of greater than 7% body surface area were studied. It was found that Body Surface Area burned, the presence of a Premorbid Psychiatric Diagnosis, and Age are all significantly correlated with the occurrence of psychiatric complications following burn injuries and account for 61% of the variance in the sample. The implications of these findings and possibilities for further research are discussed.

View details for Web of Science ID A1977DA91600008

View details for PubMedID 846020

View details for Web of Science ID A1977DR72900004

View details for PubMedID 331232