Is coeliac disease prevalent among adolescent psychiatric patients?

UNLABELLED: Coeliac disease (CD) occasionally presents solely with neuropsychiatric symptoms and may predispose to mental and behavioural disorders. This study screened new adolescent psychiatric outpatients (n = 140) in the Department of Adolescent Psychiatry of the Hospital for Children and Adolescents, Helsinki, using immunoglobulin A antibody to tissue transglutaminase. The prevalence rate of CD was found to be 1 in 140. CONCLUSION: The results do not suggest that undetected CD is markedly overrepresented among adolescent psychiatric outpatients.

Defense styles explain psychiatric symptoms: an empirical study.

To examine the relation between psychiatric symptoms and defense mechanisms, we administered two questionnaires, the Symptom Check-list 90 (SCL-90) and the Defense Style Questionnaire (DSQ) to 122 psychiatric out-patients and to a community sample of 337 subjects. Using regression analysis, we found that 51.8% of the variation in subject's Global Severity Index value could be explained by his defense style. Of the three defense styles, the immature style explained most of the variation in the symptoms. We found little overall evidence for specific connections between particular defenses and symptoms. Projection and dissociation were central in most of the symptom dimensions. We compared patients and controls with the same level of general symptom severity and found that patients used significantly more devaluation and splitting, and controls used significantly more altruism and idealization. Whether defenses predispose to certain symptomatology or are one of its aspects is discussed.

Young female survivors of childhood leukaemia do not have increased somatic concerns.

OBJECTIVE: This study examined whether experience of cancer in childhood leaves a hypersensitivity to various somatic symptoms. Further, are self-reported somatic symptoms explained by medical late-effects or a worry of recurrence of the cancer? METHODS: Of the total of 44 female survivors of leukaemia, 42 were compared with 69 age-matched healthy controls. We used a questionnaire to study self reported somatic symptoms and a face-to-face interview to explore worries about recurrence of the illness. Health status and medical late effects were evaluated by a paediatric haematologist. RESULTS: In contrast to our assumptions, young survivors of leukaemia reported fewer somatic symptoms than healthy age-matched comparison subjects (p < 0.001). Late physical sequelae were uncommon except in the survivors of allogeneic bone marrow transplantation. Of the survivors, 52% were afraid of recurrence of the illness. The presence of physical or visible impairment and worry of recurrence were unrelated to frequency of somatic symptoms. CONCLUSIONS: The results suggest that experience of childhood leukaemia and its treatment does not result in increased somatic concerns or hypochondriacal tendencies.

A Finnish validation study of the SCL-90.

The Symptom Check-List-90 (SCL-90) is a widely used psychiatric questionnaire which has not yet been validated in Finland. We investigated the utility of the translated version of the SCL-90 in the Finnish population, and set community norms for it. The internal consistency of the original subscales was checked and found to be good. Discriminant function analysis, based on the nine original subscales, showed that the power of the SCL-90 to discriminate between patients and the community is good. Factor analysis of the items of the questionnaire yielded a very strong unrotated first factor, suggesting that a general factor may be present. This together with the fact that high intercorrelations were found between the nine original subscales suggests that the instrument is not multidimensional. The SCL-90 may be useful in a research setting as an instrument for measuring the change in symptomatic distress, or as a screening instrument. The American community norms should be used with caution, as the Finnish community sample scored consistently higher on all subscales.

Sexuality of young women surviving leukaemia.

This study was designed to assess the sexuality of young women surviving acute leukaemia in childhood or early adolescence. Thirty of 31 survivors were compared with 50 healthy age matched controls. Three methods were used: a self report questionnaire, a face to face interview conducted by a psychiatrist, and a projective psychological test. The age at initiation of dating and sexual activity, the frequency of sexual intercourse, and opinions on sexual behaviour were similar in the two groups. With regard to inner sexuality, however, the survivors differed significantly from the healthy controls. Their images of sexuality were more restrictive, and their attitudes, especially those concerning sexual pleasure, were more negative than those of the controls. Sexual identity among the survivors was less often feminine and more often infantile as compared with the controls. The findings obtained with the three methods of assessment were concordant.

Childhood leukemia and body image: interview reveals impairment not found with a questionnaire.

Twenty-eight adolescent leukemia survivors and 34 healthy controls were examined by means of a self-report questionnaire and a semi-structured face-to-face interview to appraise the quality of their body image. To protect against observer bias a blind-rater was used. The self-report inventory suggested that survivors have a perfectly normal body image, whereas in the interview 36% of the survivors were rated as having an impaired and 36% a diffuse, body image. The survivors' characteristic attitude towards their physical appearance--to evade the difficult issue--because evident when there were no ready answers from which to choose. Thus, in evaluating the impact of cancer on body image the choice of method of inquiry is vital.

Impaired body image of young female survivors of childhood leukemia.

The purpose of this study was to assess the body image of young female survivors of leukemia. Young female survivors of leukemia (n = 42) were compared with healthy age-matched control subjects (n = 69). The study included a semistructured face-to-face interview and a psychological test. The data were separated into three distinct evaluations of each subject's body image: 1) the subject's self-assessment, 2) evaluation by a psychiatrist, and 3) the Rorschach test. The body images of the survivors were inferior to those of the control subjects in all three evaluations (P < 0.001). The preceding leukemia was assessed still as extremely threatening in 26% of the survivors.

Quality of life in pre-adolescence: a 17-dimensional health-related measure (17D).

Although interest in the health-related quality of life (HRQOL) of children has increased in the last years, validated methods for assessing the HRQOL- and especially the perceived HRQOL-of children have been missing. We introduced a 17-dimensional, illustrated, generic measure of perceived HRQOL (17D) for pre-adolescents, and demonstrated its application to three populations of children aged 8-11 years: (1) 244 normal schoolchildren; (2) 22 patients surviving organ transplantation and (3) 10 patients with genetic skeletal dysplasias. The HRQOL scores and profiles of the patients differed significantly according to the diagnosis, giving support to its construct validity. The reliability of the measure was high: its repeatability coefficient was 95%. As a structured interview of 20-30 minutes, the measurement burden is reasonable. We conclude that the assessment of quality of life of pre-adolescents can and should be based on data collected from the children themselves. Our initial experience indicates that 17D is comprehensive, reliable, and valid.

Psychological defenses and psychiatric symptoms in adults with pediatric spinal cord injuries.

The psychological defenses and psychiatric morbidity of 30 adults with pediatric spinal cord injury and of 235 community controls were compared several years after the occurence of the injury. The patient group did not report more symptoms when measured with the Symptom Checklist-90 than the control group, but there were some characteristic features in their use of defenses as measured with the Defense Style Questionnaire. The adaptation process seems to follow a pattern: the greater the length of time since the injury, the less likely were the immature defenses omnipotence-devaluation and regression and the higher were the scores on the mature defense anticipation. It appears that the same result-symptom free adaptation-is first achieved by more immature means but as the adaptation process evolves, the psychological equilibrium can be maintained by mature defenses which do not distort reality. Furthermore, the results that patients with pediatric spinal cord injury scored higher on fantasy (daydreaming) and passive aggression (silent resistance) suggest that being injured very young may leave some faint, yet permanent psychodynamic traces.

Comparing two self-report measures of coping--the Sense of Coherence Scale and the Defense Style Questionnaire.

Antonovsky's Sense of Coherence Scale (SOC) and Bond's Defense Style Questionnaire (DSQ) were compared in a sample of 334 community controls and 122 psychiatric outpatients. The major question was, whether the two coping inventories with different theoretical backgrounds-stress research vs. psycho-analysis-tap similar phenomena. The affinity of the two coping measures was evident: in multiple regression analysis defenses explained 68% of the variance in sense of coherence. Not surprisingly, the SOC scale-emerging out of the salutogenic orientation-showed more expertise in measuring how people manage when they do well, whereas the DSQ-with its theoretical roots deep in psychopathology-was most sensitive to how people manage when they do rather poorly.

Quality of life in early adolescence: a sixteen-dimensional health-related measure (16D).

While data on the health-related quality of life (HRQOL) of adults are accumulating, very little is known about the HRQOL--and especially the perceived HRQOL--of children. In our study we introduced a 16-dimensional, generic self-assessment measure of HRQOL (16D) for early adolescents, and demonstrated its use with four populations of children aged 12-15: (1) 239 normal schoolchildren, (2) patients waiting for organ transplantation (n = 5), (3) patients with genetic skeletal dysplasias (n = 19), and (4) patients with epilepsy (n = 32). The HRQOL profiles of the patients differed significantly according to the diagnosis, giving support to its construct validity. The reliability of the measure was high: its repeatability coefficient was 91%. The quality of life ratings of the healthy boys and their parents differed on the dimensions of distress, vitality, speech, mental function, and discomfort and symptoms (p < 0.05). In addition, there were significant differences in the health-related valuations between the girls, boys and their parents. We conclude that the assessment of quality of life of adolescents should be based on data collected from the adolescents themselves. Further, the 16D is so far the only generic HRQOL measure designed specifically for this purpose. It is capable of differentiating the HRQOL of healthy adolescents as well as patients with various diagnoses. Our experience also indicates that it is easy to use, yet it seems comprehensive, reliable, and valid.

Defense style in personality disorders. An empirical study.

Do patients with DSM-III-R axis II diagnoses use defenses thought to be specific to personality disorders, such as omnipotence, devaluation, splitting, and projective identification? Thirty-one psychiatric outpatients with personality disorders, 42 neurotic outpatients, and 353 community controls completed the 88-item Defense Style Questionnaire. Factor analysis yielded four factors (defense styles). One of them consisted of omnipotence, devaluation, splitting, denial, isolation, and projective identification, defenses considered as typically "borderline" (Cronbach's alpha = .72). The personality disorder group scored significantly higher on the borderline defense style than did the other two groups. The other defense styles (mature, immature, and neurotic) did not differentiate between the patient groups, but the mature and immature styles did distinguish between patients and healthy controls.

Does defense style vary with severity of mental disorder? An empirical assessment.

Bond's Defense Style Questionnaire was administered to control subjects from the general population (n = 50) and to psychiatric outpatients with neurosis (n = 42), high-level personality disorder (n = 37) and low-level personality disorder (n = 22). Factor analysis yielded 4 defense styles ranging on a continuum from immature to mature; the reliabilities of the subscales as measured with Cronbach's alpha were adequate. Three of the styles - the mature, neurotic and immature - were similar to the styles in Bond's original study, but the fourth style consisted of items reflecting inhibition instead of omnipotence as in the original study. The level of defense maturity varied with severity of disorder. The construct and criterion validity of the measure are discussed.

Reflections of testicular damage on psychosexual development in adolescent males who survived childhood malignancies.

We studied testicular growth and psychosexual development in 41 young males who had survived malignancies in childhood. The focus of the study was evaluation of the connection between the possible pathologies of these two phenomena. The size of the testicles was measured in millilitres and compared with reference values. The psychosexual development was evaluated using three approaches: the interviewer's evaluation, the patient's subjective assessment and information gained by specific questions. On the basis of the developmental theory of adolescence described by Blos, the appropriate development in each criterion was defined. Our results indicated that both psychosexual and somatic development were impaired. A significant relationship existed between testicular size and three criteria assessed by the patients: the patients who felt that their pubertal development was different from that of their peers, those who felt that their developmental failures were related to their personal medical histories, and those who did not feel that they had the ability to have sexual intercourse and/or children. The last group had significantly smaller testicles than the others. We speculate that the perception of the small size of testicles may trigger the psychological experiences of failed development, leading to narcissistic problems in adolescent development. In order to prevent these harmful consequences it will be necessary for different specialists to work together with the families and patients.

Prolactinemia in adolescent males surviving malignancies in childhood: impaired dating activity.

A relationship appears to exist between prolactin metabolism and psychosexual development. We studied pubertal stage, testicular size, and serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, thyroxine, thyroid-stimulating hormone (TSH), and prolactin concentrations in 94 adolescent males who had survived malignancies in childhood. Of the patients, 22% had elevated serum prolactin, > 300 mU/L. In multivariate analysis, the only therapeutic agents or treatments found to be independently associated with prolactin concentration were cisplatin and cytosine arabinose. Administration of cisplatin was associated with an increase of 55 m U/L (p < 0.01) and that of cytosine arabinoside with an increase of 23 mU/L (p < 0.01) in serum prolactin concentration. Serum prolactin concentration correlated with serum FSH (r = 0.26, p = 0.16) and LH (r = 0.30, p = 0.005). In 45 of the patients 10 criteria of psychosexual development were evaluated using a personal, semi-structured, and psychodynamically-oriented interview. A significant inverse relation existed between serum prolactin concentration and dating with the opposite sex (p = 0.008); none of the patients with elevated serum prolactin were dating. We conclude that even a slight elevation of serum prolactin above normal is associated with or may be reflected in the psychosexual development of adolescent males who have survived malignancies in childhood.

Psychosexual problems in male childhood malignancy survivors.

We studied the development of psychosexuality and object relationships in 58 young males who had survived malignancies in childhood. Using a psychodynamically oriented, semistructured psychiatric interview, we formed 13 criteria for comparisons between patients over and under 18 years of age. Of these 13 criteria, 12 showed that development was equally problematic for the older and younger patients. Our findings indicate that, in many patients, the adolescent process remains problematic during development, with obvious difficulties in establishing the final sexual organization, separating from internalized primary objects, and making contacts with same-sex and opposite-sex peers.