The Children's Global Assessment Scale (CGAS) and Global Assessment of Psychosocial Disability (GAPD) in clinical practice--substance and reliability as judged by intraclass correlations.

Studies on the inter-rater reliability on the Children's Global Assessment Scale (CGAS) and the Global Assessment of Psychosocial Disability (GAPD) involving different subgroups of 145 outpatients from 4 to 16 years of age showed fair to substantial intraclass correlations of 0.59 to 0.90. Raters of different training levels participated. Interrater reliability was dependent on number of ratings per rater, training, available data sources and experience. A more detailed description of anchor points resulted in higher inter-rater agreement by psychiatrists training in child and adolescent psychiatry, but did not influence the inter-rater reliability among more (widely) experienced raters. Both the CGAS and the GAPD seem to be sufficiently reliable tools in clinical practice. The CGAS seems to be more sensitive to inter-rater variation than the GAPD.

Micro-hydrovaginoscopy in examining children.

BACKGROUND: The gynecologic evaluation of children is challenging and requires mastery of special examination techniques. TECHNIQUE: small-diameter endoscopic trocar sleeves and endoscopes (2 or 3 mm) were used in conjunction with hydrodistention with normal saline, to view atraumatically the entire vagina and cervix. EXPERIENCE: During the past 3 years we have used micro-hydrovaginoscopy (2-mm trocar sleeve and endoscope, with hydrodistention) for vaginal examination of young girls and in selected cases of young adolescents and virginal adults in whom traditional speculum examination proved difficult or impossible. This technique was effective for (1) confirming diagnosis of cribriform hymen and facilitated hymenotomy; (2) diagnosis of vaginal discharge unresponsive to medical treatment caused by an intravaginal foreign body (color crayon), which was removed under direct endoscopic view; (3) suspected müllerian agenesis and persistent vaginal discharge confirming absence of the cervix and ruling out foreign body in the urogenital portion of the vagina; and (4) a vulvar straddle injury and urinary retention in which vaginal laceration and hematoma were excluded. CONCLUSION: Micro-hydrovaginoscopy is simple, minimally invasive, and effective for vaginal examination in prepubertal girls. It permits precise and complete diagnosis, directs and assists treatment, and has potential for well- tolerated office use in cooperative patients.

Enhancing advanced surgical laparoscopy. Combined, routine use of microlaparoscopes and macrolaparoscopes.

OBJECTIVE: To describe a variety of techniques for using the microlaparoscope in conjunction with a standard-sized laparoscope for simplifying and enhancing advanced laparoscopic surgery. STUDY DESIGN: Descriptive study of microlaparoscopic techniques for enhancing macrolaparoscopic procedures. RESULTS: The microlaparoscope facilitates macrolaparoscopy by permitting: (1) specimen removal and use of 10-mm instruments without secondary, large ports; (2) performance of laparoscopic vaginal hysterectomy with the endoscopic stapler using only one 12-mm port; (3) lysis of difficult pelvic and periumbilical adhesions; (4) enhancement of visual access to difficult operative sites; (5) closure of large umbilical and secondary port sites under direct monitoring; (6) visualization from the left upper quadrant when umbilical adhesions are suspected; and (7) use as the initial entry laparoscope when extensive surgery is not anticipated. CONCLUSION: The routine, combined use of the microlaparoscope and 10-mm laparoscope significantly expands the capabilities of the advanced laparoscopic surgeon. Procedures are simplified, facilitated and made less invasive.

The outcome in children with childhood autism and Asperger syndrome originally diagnosed as psychotic. A 30-year follow-up study of subjects hospitalized as children.

This follow-up study reports data on 18 children fulfilling the ICD-10 criteria for childhood autism (n = 9) and Asperger syndrome (n = 9). In connection with the present study the original child psychiatric records were reassessed according to the ICD-10 criteria. The children were followed over a period of 30 years. The mean age at the time of study was 38 years. The results show that in adulthood the autistic patients had a poorer outcome than children with Asperger syndrome as regards education, employment, autonomy, marriage, reproduction and the need for continuing medical and institutional care. Particular attention is given to pharmacotherapy and the relationship between the childhood disorder and psychiatric morbidity in adult life.

[Placement outside home. 1. Study of the records on 112 children and adolescents placed outside the home in 1990]. / Anbringelse uden for hjemmet. 1. En journalundersøgelse af 112 børn og unge anbragt uden for hjemmet i 1990.

A retrospective study was made of the records of 112 children and adolescents who had been placed outside their homes in 1990 in accordance with Section 66 of the Social Assistance Act. The children had been placed either in foster homes, boarding schools, group homes or youth homes. The aim of the study was to examine the social circumstances relevant to placement of the children. It was found that the parents' marital status, their means of income and the recorded problems of both children and parents, all of which were considered to be contributing factors to placement of the children, corresponded with results from previous studies. However, incest and physical abuse were not recorded as a cause of placement. Only a few children were placed directly from their own homes; most of them were transferred from one form of institution or school to another. In more than 90% of the cases, extensive measures of social support had previously been established in an attempt to avoid the first placement outside the home. Although the children received social support during placement, the support given to the parents is still considered insufficient. This is especially the case for parents of children below school age. Compared to the total sample this group seems to have the highest number of recorded parental problems.

[Placement outside the home. 2. Interviews with children and adolescents and their parents about placement outside the home]. / Anbringelse uden for hjemmet. 2. Interview med børn og unge samt deres foroeldre om anbringelsen uden for hjemmet.

An interview study of 11 children and their parents was carried out in connection with a more comprehensive retrospective review of the records concerning children who in 1990 had been placed outside their homes. The aim of the study was to describe how children and parents experience the process of placement in order to adjust placement criteria if necessary. At the time of interview the age of the children was 12-19 years (mean 16.2 years), there were five boys and six girls. Five of the children were still placed outside the home. All the children had an intellectual understanding of the reason why they did not live at home. However, none of them had reached a corresponding emotional understanding and clarification. It was found that there were two different ways of managing separation. Those children who experienced attuned separation seemed to manage best. In these cases the problems of separation were worked through by parents and children. Some of these parents also expressed the view that their child was not really placed outside the home, but was still implicitly a member of the family. The opposite was true in non-attuned separations. The authors recommend a revision of the criteria on which the social authorities base their evaluation as to where and when a placement should be made--especially concerning children exposed to non-attuned separation.

Psychological aspects of precocious puberty. An overview.

During the last three decades the psychological consequences of precocious puberty have received considerable attention. The nature and shortcomings of relevant studies are described. It is emphasized that specialized counselling and guidance of families with children who have to cope with precocious puberty is important, since it often contributes to an appropriate behaviour adjustment without the development of psychiatric symptomatology. Guidelines for medical service and psychological management are provided.

A 30-year follow-up study of a child psychiatric clientele. II. Psychiatric morbidity.

Psychiatric morbidity, expressed as hospital admissions during a 30-year follow-up period, was studied among 322 former child psychiatric patients, who were admitted from 1949-1951, and who were followed up as of December 31, 1980. A total of 115 patients (36%)--55 boys (29%) and 60 girls (45%)--had been admitted to an adult psychiatric department, with 50 patients having only one admission. The mean age at the time of the study was 39 years. The former child psychiatric patients were admitted to adult psychiatric hospitals 50 times more often than comparable age groups from the general population. At all times women had a higher prevalence of admission. The cumulative percentage of first admissions of men was almost unchanged during the last 10 years of the follow-up period, and the figure for women was gradually increasing. The longitudinal course of mental disorders in the sample, measured as psychiatric admissions, was studied in relation to age at the time of admission to the child psychiatric department. The results consistently showed that older age of admission as a child meant fewer psychiatric admissions as an adult during the follow-up period. A total of 39 of the psychiatrically admitted patients (34%) had been granted a disability pension. A total of 7 patients (6%) died during the study period, including 2 patients who committed suicide. By the variables employed, 37% of the sample were judged to have had a good overall outcome, with diagnosis being an inconsistent predictor of outcome.(ABSTRACT TRUNCATED AT 250 WORDS)

A 30-year follow-up study of a child psychiatric clientele. I. Demographic description.

A register investigation was carried out as of December 31, 1980, with the aim of giving a broad description of a child psychiatric clientele 30 years after admission to hospital. The material consists of 322 patients--189 boys (59%) and 133 girls (41%)--who were admitted during the period 1949-1951 to the only 2 child psychiatric departments at that time in Denmark. We succeeded in identifying 93% of the patients. The mean age at the time of analysis was 38.6 years (range 32-46). The material was compared with the age-related Danish population by marital status, vocational education, and socioeconomic class. A total of 115 patients (36%) had been admitted to an adult psychiatric department, and 50 patients only once. A total of 95 patients (30%) had committed criminal offences and 12 had only committed traffic offences. A total of 60 patients (19%) had obtained disability pensions. During the 30-year follow-up period, 19 patients (6%) had died. A statistically significant extra mortality was found only for women. Four patients had committed suicide. By logistic regression analysis, a statistically significant correlation was found between criminal record and admission to psychiatric department and the variables: divorce, no vocational education, and lowest socioeconomic class. About 54% had managed well, judging by the variables employed.

Zimeldine versus amitriptyline in endogenous depression. A double-blind study with special reference to effects on liver function.

In a double-blind comparison of 21 inpatients with endogenous depression 225 mg zimeldine demonstrated the same degree of antidepressive efficacy as 150 mg amitriptyline after 4 weeks of treatment. Only "sleep disturbances" on the Hamilton Rating Scale for Depression (HRS) showed significant (P less than 0.05) improvement with amitriptyline. Only small differences in the frequency of side effects were seen. In the zimeldine group, increased sweating and headache were more pronounced, while the amitriptyline patients more often reported dry mouth and constipation. Body weight was not significantly changed by either treatment. In the zimeldine group, treatment had to be interrupted in three patients due to hypersensitivity reactions in the form of drug fever. Three other patients in the zimeldine group showed clinically significant elevation of liver enzymes. Hypersensitivity reactions and abnormal blood chemistry were both reversible. The adverse reactions are discussed, the cause of the occurrence remaining unknown.