Surgical Repair of an Atraumatic Avulsion of Patellar Tendon at the Tibial Tuberosity in an Adult Patient.

Atraumatic avulsion of the tibial attachment of patellar tendon in adults is a very rare injury with only few published case reports. Here we are sharing the successful management and follow-up of a similar case with a different suture material for repair of the tendon, the FiberWire. We believe that the management we are discussing allows for early return to activity with good functional outcome.

Anxiety in middle adulthood: effects of age and time on the 14-year course of panic disorder, social phobia and generalized anxiety disorder.

BACKGROUND: Much about the long-term course of anxiety disorders is unknown. The present study utilizes a naturalistic, longitudinal, short-interval follow-up design to elucidate the course of anxiety disorders over 14 years in a largely middle-aged adult sample recruited from out-patient psychiatry and primary care facilities. METHOD: The sample consisted of 453 participants with a diagnosis of panic disorder (PD), social phobia (SP) and/or generalized anxiety disorder (GAD). Anxiety symptom ratings were tracked using weekly psychiatric status ratings (PSRs). Controlling for demographic and clinical variables, the course of PD, GAD and SP were examined using longitudinal growth models, with the most severe PSR at each follow-up point as the main outcome variable. RESULTS: PSRs significantly decreased in severity over time in each of the three disorders. In the interaction effects models, age x time had a significant effect on course for PD and GAD, but not for SP, in that older age was associated with lower PSRs over time. CONCLUSIONS: The present findings suggest that the severity of anxiety disorders declines over time, although this decline is modest and depends on the specific disorder being assessed. Older individuals with PD and GAD have a better prognosis than their younger counterparts, as their course is characterized by a steeper decline in severity. The present findings provide important information about the course of anxiety disorders in mid-life.

Sisters, brothers, and delinquency: evaluating social influence during early and middle adolescence.

Although a number of studies have shown that brothers are highly correlated for delinquent behavior, much less research has been conducted on sisters. We propose that sisters, like brothers, show notable similarity for delinquent behavior, and also promote each other's delinquency through direct interaction. We examined these issues in 164 brother and sister pairs studied over a 4-year period (from early to middle adolescence) in a study of intact families in the rural Midwest. Sibling similarity for self-reports of delinquent behavior were highly correlated for both brothers and sisters. Conditional effects of high levels of hostile-coercive sibling relationships and older sibling delinquency predicted younger sibling delinquency in both brother and sister pairs. For brothers, conditional effects were also detected for high levels of warmth-support, in contrast to sisters. The conditional effects of older sibling delinquency and relationship quality were shown to predict change in younger sibling delinquency through adolescence. The results add to a growing literature on sibling effects as well as theoretical models that emphasize the role of social interaction between siblings as a risk factor for the development of delinquent activity in adolescence.

Sibling aggregation for psychopathology in offspring of opiate addicts: effects of parental comorbidity.

Applied a new analytic approach within the high-risk paradigm, the analysis of sibling aggregation, to identify homogeneous subtypes of familial risk for psychopathology and addiction. All sibling pairs participating in a study of offspring of opiate-addicted parents were identified and their aggregation for psychiatric disorders was determined using pairwise odds ratios, an analytic technique used in genetic epidemiology. Sibling aggregation was most notable for depressive and anxiety disorders but only in the presence of comorbid depressive disorders in the parents. Parental comorbid alcoholism did not impact sibling aggregation. We emphasize methodological implications of this approach for addressing issues of phenotypic and etiologic heterogeneity in the study of developmental risk for substance abuse.

Sibling aggregation for psychiatric disorders in offspring at high and low risk for depression: 10-year follow-up.

BACKGROUND: A unique way of determining patterns of parent-offspring transmission of risk to affective disorders is to focus on aggregation within sibling pairs. We attempt to extend our previous finding that sibling aggregation is notable for anxiety disorders in a 10-year follow-up of siblings at high and low risk for depression, by virtue of parental diagnosis. METHODS: The sample, which included 173 unique sibling pairs in the high risk cohort, and 83 pairs in the low risk cohort, had been assessed using semi-structured clinical interviews three times over a 10-year period, spanning from childhood to adulthood. Sibling aggregation was quantified using pairwise odds ratios. RESULTS: Sibling aggregation in the high risk cohort was greater than aggregation in the low risk cohort for anxiety disorders, especially those that emerged in childhood, and later co-morbid disorders, especially major depressive disorder and suicide attempts. CONCLUSIONS: Familial liability to affective disorders may be reflected most strongly by a developmental sequence of anxiety disorders in childhood followed by later depressive and suicidal in adolescence and adulthood.

A new instrument to assess sibling relationships in antisocial youth: the social interaction between siblings (SIBS) interview: a research note.

This paper presents psychometric information on a new interview (SIBS) designed to examine sibling influences on antisocial behavior. The feasibility of the instrument and internal consistency of the SIBS scales was documented in a sample of 29 children (ages 6-11) with a delinquent older brother. In addition, adequate to excellent test-retest reliability of the SIBS scales was demonstrated in an unselected sample. The potential utility of the SIBS interview for assessing the role of siblings in the development of antisocial behavior is discussed.

Psychiatric disorders in the relatives of depressed probands. I. Comparison of prepubertal, adolescent and early adult onset cases.

Research with adults suggests that early onset of depression is associated with increased rates of depression among relatives. This paper presents results, of a family study that tested the hypothesis that prepubertal depression was associated with a greater familial loading of depression than the postpubertal form, which in turn had a greater familial loading than adult onset depression. Probands were from a child to adult longitudinal study. Psychiatric disorders among relatives were assessed with family interview and family history methods 'blind' to all findings regarding the proband. Contrary to expectation, familial rates of depression did not differ significantly between the groups. However, manic disorders tended to be more common among the relatives of postpubertal depressed cases than among the relatives of adult onset cases. Moreover, relatives of prepubertal depressed subjects had higher rates of criminality and family discord than postpubertal subjects. Prepubertal onset depressive disorders appear to be relatively distinct from postpubertal forms.

Psychiatric disorders in the relatives of depressed probands. II. Familial loading for comorbid non-depressive disorders based upon proband age of onset.

This study examined familial loading for non-depressive disorders in first-degree relatives (FDRs) of early-(< 20 years of age) and adult-onset (> or = 20 years of age) depressed probands. Our previous work, which demonstrated that FDRs of early-onset probands have higher rates of major depression as compared to FDRs of adult-onset probands, has not yet examined risk for non-depressive disorders in FDRs. In this paper, we focus on best-estimate diagnoses of anxiety disorders, alcoholism, and antisocial personality conducted on 639 first-degree relatives. The FDRs of early-onset probands had significantly higher rates of comorbid transmission of alcoholism and depression, and antisocial personality and depression, respectively. Significant co-transmission of anxiety disorders and depression was found in the FDRs of both early- and adult-onset probands. Future genetic studies of depression, especially early-onset depression, should hence broaden their definitions of phenotypes to include comorbid disorders when searching for the etiology of this complex disorder.

Sibling resemblance for psychiatric disorders in offspring at high and low risk for depression.

This study examined sibling resemblance for major depressive disorder, anxiety disorder, and conduct disorder, in offspring at high and low risk for depression by virtue of parental diagnosis. The sample, which ranged in age from 6 to 23 years, included 164 sibling pairs at high risk, and 68 sibling pairs at low risk. Each cohort was assessed at two waves separated by a 2-year period. Sibling resemblance in the high risk cohort was substantially greater than resemblance in the low risk cohort for anxiety disorder (and comorbid conditions including anxiety disorder), but not depression. Discussion focused on the possibility that anxiety disorder may reflect the most pronounced familial influences common to siblings at high risk for depression.

A twin study of competence and problem behavior in childhood and early adolescence.

The Child Behavior Checklist (CBCL) was completed by parents of 181 pairs of same-sex twins ages 7-15 (mean age = 11.0 years). Correlations between scores on the CBCL scales for 99 pairs of monozygotic twins and 82 pairs of dizygotic twins indicated significant genetic influences that varied according to the specific area of competence and problem behavior. Model-fitting estimates derived from multiple regression analyses indicated significant genetic influence on competence in school and on all areas of problem behavior. In addition, significant shared environmental influence was detected for amount and quality of participation in activities, quality of social relationships, performance in school, anxiety/depression, and delinquent behaviour. Implications for future work on the mechanisms underlying these effects are discussed.

Adjustment in middle childhood and early adolescence: links with earlier and contemporary sibling relationships.

The relation of individual differences in internalizing and externalizing behavior in middle childhood and early adolescence to children's concurrent sibling relationships and their mothers' mood, and to their sibling and mother-child relationships in the preschool period was studied. Thirty-nine younger and 39 older siblings observed at home in the preschool period were studied 5 and 7 years later. Differences in adjustment were related to contemporary sibling relationships and maternal mood, and to sibling and mother-child interaction in the preschool period, even when mothers' current mood was taken into account.

Genetic and environmental influences on depressive symptomatology in adolescence: individual differences and extreme scores.

The purpose of the current investigation was to compare the genetic and environmental influences on individual differences in depressive symptomatology (as assessed using the Children's Depression Inventory) to such influences on extreme scores in an unselected sample of adolescents. The sample included 707 pairs of siblings (average ages 14.5 and 12.9 years, respectively) participating in a combined twin- and step-family study. Moderate genetic influence was found for the full range of individual differences in depression; in contrast, there was nonsignificant genetic influence, and significant shared environmental influence, on extreme scores. The results were interpreted using a risk model in which familial influences specific to the high end of the distribution contribute to depressive symptomatology in adolescence.

Genes, environment, and addictive behavior: etiology of individual differences and extreme cases.

There is considerable interest in assessing the role of genetic factors in the aetiology of addiction. This paper reviews the possible contribution of a new quantitative technique, termed DF analysis after its originators DeFries & Fulker. DF analysis provides a way of examining whether aetiological factors relating to addiction as a discrete disorder (manifest as extreme scores on a diagnostic instrument) are similar to or different from those that relate to it as a continuum. For example, it is possible to estimate the contribution of familial factors to the development of a clinical condition defined in terms of an extreme score on an instrument by examining the extent of regression towards the unselected population mean of siblings' scores on that instrument. At the same time it is possible to estimate familial influences on the full range of values by examining the correlation between the scores of siblings. Insofar as the two methods produce different estimates, it is possible to infer different levels of involvement of familial factors for extreme cases than for the continuum as a whole. Information provided by such analyses could be critical when constructing models of addictive disorders and help direct more specific studies isolating particular mechanisms.

Longitudinal relations between temperament traits and behavioral syndromes in middle childhood.

OBJECTIVE: This study tested Graham and Stevenson's 1987 hypothesis specifying links between EAS (emotionality-activity-sociability) temperament traits and behavioral syndromes of depression, hyperactivity, and delinquency in an unselected sample of 164 children in infancy and early childhood. METHOD: Mothers completed the Colorado Child Temperament Inventory. Each mother also used the Child Behavior Checklist (CBCL) to report on her child's behavior problems after the child's completion of first grade. Scores on three CBCL scales, anxiety/depression, attention problems, and delinquent behavior, were examined in relation to the EAS traits. RESULTS: For boys, high emotionality in infancy and early childhood was associated with high scores on both the anxiety/depression and attention problem scales. For girls, both high emotionality and low sociability predicted high scores on the anxiety/depression scale. There were no associations between EAS traits and attention problems for girls. There was little evidence for links between EAS traits and delinquent behavior for either boys or girls. CONCLUSIONS: The results are discussed with respect to temperamental traits as risk factors for the emergence of behavior problems in childhood.

Child and parent perceptions of the upsettingness of major life events.

An adaptation of the Coddington Social Readjustment Rating Scale for use with first-grade children was administered to 164 first-graders and their parents. Parents indicated whether each event occurred and both parents and their children rated the upsettingness to the child. Parent ratings of stress are significantly higher than child ratings for specific events and a composite stress measure. Parent and child composite scores correlated 0.21 when the number of events was controlled. Implications for research on life events and childhood stress are discussed.

Who discovered the twin method?

The twin method is usually credited to Francis Galton's 1875 article on twins. However, Galton did not propose the comparison between identical and fraternal twin resemblance which is the essence of the twin method. Although the twin method was "in the air" in the mid-1920s, the first descriptions of the method appeared in an article by Curtis Merriman and in a book by Hermann Siemens, both in 1924, 50 years after Galton's paper.

Facial perception in autism.

Disturbances in gaze and patterns of facial interaction are prominent aspects of social dysfunction in autism; the nature of this disturbance has up to the present been unclear. This study examined the ability of autistic subjects to use the human face as a source of information. Autistic and age- and MA-matched retarded control subjects assembled a series of puzzles displaying photographs of human faces; puzzles differed in complexity, familiarity of the faces and configuration (normal vs scrambled faces). Significant effects of all three factors, but not of diagnostic group, were observed. The autistic subjects did not exhibit specific deficits in perception of faces.

Phenomenology and classification of the childhood psychoses.

Two hundred and twenty-eight cases of children with final clinical diagnoses of childhood psychosis were reviewed using a standard coding scheme; cases were grouped in three broad categories on the basis of clinical diagnosis (autistic, atypical and schizophreniform). These three groups differed significantly in many respects, although the 'atypical' group more closely resembled the autistic group. While it was possible meaningfully to differentiate diagnostic groups using DSM-III criteria, some cases were difficult to classify. Childhood schizophrenia, as strictly defined, was far less common than childhood autism. The development of diagnostic schemes for those children whose disorders are difficult to classify is an important topic for future research.

Arthrography in the diagnosis of fractures of the distal end of the humerus in infants.

Single-contrast arthrography was performed in six infants who had an injury to the elbow because the exact nature of the injury was uncertain from interpretation of the plain radiographs and clinical findings. A correct diagnosis was made in all six patients, and it significantly altered the treatment in five. Four lesions were a Salter-Harris Type-I fracture and two were a Salter-Harris Type-II fracture. Three patients had a closed reduction, two required no reduction, and one had an open reduction. Child abuse of two infants was confirmed, and it was suspected in another two.