Psychiatric disorders in a community sample of adolescents.

The prevalence of psychiatric disorders diagnosed according to DSM-III in adolescents in the general population is not known. The authors address this issue in a community sample of 150 adolescents 14-16 years of age. Structured interviews as well as other instruments were used to collect data. Twenty-eight (18.7%) of the 150 adolescents were identified as having a psychiatric disorder. These 28 adolescents viewed their parents as less caring, had lower self-esteem, and resolved their conflicts through verbal aggression and physical violence more often than did the adolescents who did not have a psychiatric disorder. The authors make recommendations regarding the use of structured interviews in future research.

Depression, depressive symptoms, and depressed mood among a community sample of adolescents.

Using a structured interview, the authors found that the prevalence of major depression and dysthymic disorder was 4.7% and 3.3%, respectively, in a community sample of 150 adolescents. All of the adolescents who met the criteria for major depression and dysthymic disorder had other psychiatric disorders as well; anxiety was the most frequent accompanying DSM-III diagnosis.

Natural childbirth. A review and analysis.

A review and critique of the literature relating to the effectiveness of psychoprophylaxis (natural childbirth) is made. Based on this review, it is concluded that a variety of methodologic errors have confounded the measurement of treatment effects. An outline of these issues is presented, and it is pointed out that an elucidation of the relationship between treatment and outcome cannot occur until researchers become aware of certain factors that are essential to the validity of their experiments. These factors include the following: 1) the use of a random assignment of subjects to treatment and control groups; 2) the inclusion of a group of controls that receive an attention-placebo treatment; 3) the utilization of obstetricians who are unaware of the type of preparation their patients have received; 4) a careful specification of the details of each treatment procedure; and 5) the utilization of psychologic tests that are appropriate for the purpose of measuring pain and anxiety reduction.

Dysthymic disorder in clinically referred preschool children.

OBJECTIVE: This clinical and descriptive study examined the existence, phenomenology, and frequency of dysthymic disorder in a sample of clinically referred preschool children. In addition, the frequency of DSM-IV symptoms and the alternative research criterion for dysthymic disorder were investigated. METHOD: Three hundred consecutive preschool admissions (aged 2 to 6 years) to a child development unit were given a comprehensive evaluation by a treatment team. Data were collected from multiple informants based on the suitability of each source. RESULTS: The findings indicated that eight children met criteria for dysthymic disorder according to the DSM-IV criteria and the alternative research criterion for dysthymic disorder. CONCLUSIONS: The results support the existence of dysthymic disorder in preschool-age children. Recommendations are made for future versions of DSM as well as the appropriateness and significance of various sources of information, such as the child, parents, teachers, and clinician observations, for the evaluation of symptoms of dysthymic disorder in preschoolers.

Disease and family contributors to adaptation in juvenile rheumatoid arthritis and juvenile diabetes.

OBJECTIVE: Research in the areas of pediatric rheumatology and pediatric chronic illness has emphasized comprehensive models of adaptation involving risk and resistance factors. This study examined adaptation, within this framework, among a large sample of children with chronic illness and children without chronic illness. METHODS: A comprehensive battery of adaptation measures was administered to a sample of 107 children with juvenile rheumatoid arthritis, 114 children with insulin-dependent diabetes mellitus, and 88 healthy controls. RESULTS: Medical diagnosis was associated with mothers' depression and a composite measure of parental (mother and father) distress and passive coping. Children's emotional and behavioral functioning was not related to medical diagnosis, but mothers' depression and parental distress were associated with child behavior problems. CONCLUSION: Because parental distress was associated with child functioning, interventions to ameliorate parental distress may have beneficial effects on the children's behavior and on parents' reactions to their children.

Trajectories of adaptation in pediatric chronic illness: the importance of the individual.

This study used individual growth modeling to examine individual difference and group difference models of adaptation. The adaptation of 27 children with juvenile rheumatoid arthritis (JRA) and 40 children with insulin-dependent diabetes mellitus (IDDM) was tracked for 18 months from diagnosis. A control group of 62 healthy children was followed over the same time period. Clustering procedures indicated that child and family adaptation could be described by a number of distinct adaptation trajectories, independent of diagnostic group membership. In contrast, parental adaptation trajectory was associated with diagnostic group membership and control over disease activity for the JRA group and with diagnostic group membership for healthy controls. The observation of common patterns across trajectory sets, as well as the finding that trajectories were differentially related to a number of variables of interest, support the use of trajectories to represent adaptation to chronic disease.

Factors predictive of panic disorder in cardiology patients with chest pain and no evidence of coronary artery disease: a cross-validation.

Recent data indicate that a substantial number of cardiology patients with chest pain and no clinical evidence of coronary artery disease suffer from panic disorder. Discriminant function analysis reveals that a self-report anxiety measure alone, or in conjunction with minimal demographic information, can predict whether such patients have panic disorder. Predictive accuracy ranges from 69 to 76% correct classification, significantly improving upon chance predictions alone. A 'split-half' design was used in order to cross-validate predictive equations, and the total sample was also analyzed so as to provide the most stable equation. Clinical and future research implications of these findings are discussed.

Dysphoria: a major symptom factor in persons with disability or chronic illness.

Depression frequently is diagnosed in persons with chronic illness or following the onset of disability. The overlap of symptoms of many chronic illnesses and disabling conditions with depression may lead to an overestimation of depression in such populations. Some investigators have proposed revised criteria for diagnosing depression in these conditions without an understanding of the contribution of diagnostic criteria in disabling conditions. This study investigated the nature of depressive symptom criteria constellations by individually factor analyzing the Inventory to Diagnose Depression (based on DSM-III diagnostic criteria) in spinal cord injury (n = 134), rheumatoid arthritis (n = 78), student (n = 140), and community (n = 150) groups. A four-factor solution emerged, with the first factor labeled "dysphoria" being represented by symptoms of negative self-evaluations, depressed affect, and suicidal ideation. The results indicate that a core element of the syndrome of depression is dysphoria, which suggests that the contribution of somatic items may be less important to the identification of the depressive syndrome in chronic illness.

Effectiveness of clozapine and a social learning program for severely disabled psychiatric inpatients.

OBJECTIVE: This study examined the combined effectiveness of clozapine and a comprehensive inpatient psychosocial rehabilitation program on the clinical functioning and aggressive behaviors of patients with chronic schizophrenia. METHODS: Two groups of 11 subjects each were selected from among patients being treated in the social learning program at Fulton (Mo.) State Hospital. Group 1 subjects were placed on clozapine at various times after the introduction of the program, while group 2 subjects remained on traditional antipsychotics throughout the study period. Group 1 and group 2 subjects were matched on clinical functioning as measured by the Time-Sample Behavioral Checklist (TSBC). For each subject, scores on six TSBC subscales were examined at five time points. Data were analyzed using repeated-measures multiple analysis of variance and univariate analyses of variance. Data on frequency of aggressive behaviors were aggregated into three six-month time periods and were analyzed using Wilcoxon signed-rank tests. RESULTS: Both groups demonstrated significant improvement on several measures. However, the addition of clozapine resulted in accelerated improvement for group 1 subjects, especially in aggressive behaviors. CONCLUSIONS: Comprehensive psychosocial treatment programming resulted in significant improvements in clinical functioning for many inpatients. Clozapine may enhance responsiveness to such programming for some patients.

Prediction of discharges against medical advice from an alcohol and drug misuse treatment program.

A discriminant function method of data analysis revealed that statistically significant predictions could be made regarding AMA discharge, and that certain variables emerge consistently as predictors: a diagnosis involving personality disorder, admission after regular hours, age 20-29, intoxicated on admission, and less likely to have been referred by relatives or legal authorities.

Social-learning procedures for increasing attention and improving basic skills in severely regressed institutionalized patients.

Seven severely debilitated and chronically institutionalized forensic psychiatric patients were enrolled in intensive shaping classes as part of a comprehensive social-learning treatment program. Results compiled over 1 year reveal that six of these patients demonstrated marked improvements in their ability to attend to basic academic tasks and five also showed consistently high rates of successful task completion or increased rates over time. Evidence for the generalization of these effects comes from the fact that all four of the residents who went on to regular academic classes demonstrated consistently high rates of successful task completion. Recommendations are made for further applications of intensive shaping procedures for such severely impaired subgroups.

Risperidone in the management of violent, treatment-resistant schizophrenics hospitalized in a maximum security forensic facility.

This study examines the effectiveness of risperidone compared with traditional neuroleptic medications in the areas of clinical functioning and aggressive behaviors in a sample of inpatients diagnosed with chronic schizophrenia. Similar to the methodology of Menditto et al. (Psychiatr Serv 47:46-51, 1996), two groups of 10 patients were selected from those being treated in a comprehensive psychosocial rehabilitation program. Group 1 subjects were placed on risperidone at various times during their treatment. Group 2 subjects, who were matched with Group 1 subjects on pre-study levels of clinical functioning as measured by the Time-Sample Behavioral Checklist (TSBC), remained on traditional neuroleptics throughout the study period. For each subject, scores on six TSBC subscales were examined at four time points; data were analyzed with repeated-measures multivariate analyses of variance and univariate analyses of variance. Frequency counts of aggressive behaviors (threats and assaults) were compiled into two six-month time periods and analyzed with nonparametric techniques. The risperidone group did not differ from the traditional neuroleptic group on measures of clinical functioning and aggressiveness measured over time. Both groups evidenced improvements in bizarre motor behaviors over the study period. The risperidone group evidenced some deterioration in measures of appropriate interpersonal interaction over time. No differences in aggressive behaviors were noted for either group. The study concludes that for forensic patients with chronic schizophrenia, risperidone failed to produce therapeutic effects in overall clinical functioning and aggressive behaviors that were significantly different from traditional neuroleptics. Descriptive comparisons are made between the receptor-binding profiles and clinical effectiveness of risperidone and clozapine in an attempt to explain these findings.

Preparation for childbirth and contemporary research on pain, anxiety, and stress reduction: a review and critique.

The literature on psychoprophylaxis (prepared childbirth) manifests little interface with contemporary psychosomatic research, despite the fact that psychosomatic variables are intimately involved in the treatment process. Comments are made regarding the application of research on pain and anxiety reduction to labor preparation, and the employment of this knowledge in the development of more efficacious treatment methods. In addition, an examination of studies designed to evaluate the therapeutic efficacy of psychoprophylaxis reveals that a variety of methodological errors have confounded the measurement of treatment effects. It is concluded that preparation for labor is a valid and desirable subject of inquiry for psychosomatic medicine, with particular relevance for researchers engaged in a study of the cognitive, behavioral, or psychophysiological manifestations of pain, anxiety, or stress.

Predictors of psychopathology in children of patients with major affective disorders.

The present study reports on variables associated with psychopathology in children of patients hospitalized with major affective disorders. The primary instrument used in this investigation was a structured diagnostic interview that was completed by a child psychiatrist. Univariate and multivariate statistical analyses of these data suggest that severity of parental psychopathology (as measured by a higher score on the SCL-90 and a longer stay in the hospital) and the report of child abuse were associated with general childhood psychopathology. The significance of these and other findings are discussed.