Adolescent cancer patient and physician responses to a questionnaire on patient concerns.

In order to help physicians provide informational support to young patients with cancer, 63 adolescent cancer patients and 53 physicians completed self-administered questionnaires; 30 disease-related information items were included on the questionnaire. Although physicians and patients agreed on one-half of the items, they differed significantly on the others. Physician responses were not significantly related to the physicians' level of training, suggesting that education programs on this topic should be required at all levels of medical training. Psychiatrists may have a role to play in designing these programs.

Clinical needs assessment of middle and high school students following the 1995 Oklahoma City bombing.

OBJECTIVE: This clinical assessment was designed to identify middle and high school students in need of formal evaluation for posttraumatic response symptoms following the 1995 bombing of the Alfred P. Murrah Federal Building in Oklahoma City. METHOD: A clinical needs assessment instrument was developed and administered to grade 6 through 12 students 7 weeks after the bombing (N = 3,218). RESULTS: More than 40% of the students reported knowing someone injured, and more than one-third reported knowing someone killed in the blast. Posttraumatic stress symptoms at 7 weeks significantly correlated with gender, exposure through knowing someone injured or killed, and bomb-related television viewing. CONCLUSIONS: This study documents the intensity of community exposure to the bombing and the lingering symptoms of stress. The assessment was used in planning for clinical service delivery, training professional responders, and supporting funding requests.

Stages in pediatric bone marrow transplantation.

Bone marrow transplantation is a relatively new and aggressive procedure that is being used in the treatment of leukemia and aplastic anemia. We observed approximately 30 children and their families at the UCLA Medical Center throughout the procedure. Various psychological responses during the treatment are outlined. Eleven stages are identified, including the patient's and family's first awareness of this procedure, the preadmission evaluation and psychosocial assessment, the introduction into isolation, the donor's hospitalization, the transplantation itself, and the various reactions and interactions of the patient, family, and staff throughout these stages.

Two cases of benzodiazepine toxicity in children.

While benzodiazepines have been widely used in adult populations, their role in the treatment of anxiety disorders in children and adolescents has not been well established. The authors report on two cases in which benzodiazepine use resulted in psychotic symptoms. The importance of eliciting a careful history as well as being familiar with drugs' side effects and withdrawal effects is stressed.

Posttraumatic stress disorder in children: a review of the past 10 years.

OBJECTIVE: To review current knowledge about the clinical presentation, assessment, and treatment of posttraumatic stress disorder (PTSD) in children. METHOD: The literature on PTSD in children is examined. RESULTS: Over the past 10 years, PTSD has been described in children exposed to a variety of traumatic experiences. Little is known about the epidemiology of the disorder in children. Partial symptomatology and comorbidity are common. A variety of factors influence response to trauma and affect recovery. They include characteristics of the stressor and exposure to it; individual factors such as gender, age and developmental level, and psychiatric history; family characteristics; and cultural factors. Since the condition is likely to occur after disaster situations, much of the literature describes the child's response to disaster and interventions tend to include efforts within schools and/or communities. A number of clinical approaches have been used to treat the condition. CONCLUSIONS: While assessment has been studied extensively, the longitudinal course of PTSD and treatment effectiveness have not been. Biological correlates of the condition also warrant greater attention.

The influence of culture on pain in Anglo and Hispanic children with cancer.

This study sought to determine if cultural heritage and acculturation influence the perception and expression of pain and anxiety. The study was based on self-report and observation of Anglo and Hispanic children with cancer undergoing invasive procedures. Seventy-eight children between the ages of 3 and 15 participated. Thirty-five were Anglo and 43 were Hispanic. A significant inverse relationship between age and observed and reported distress was noted in both ethnic groups. The Anglo and Hispanic children had remarkably similar behavioral responses. Hispanic parents, however, reported significantly higher levels of anxiety than Anglo parents.

Pharmacological management of pain in children.

This article examines the use of analgesics and psychopharmacological adjuvants in children experiencing pain. Peripheral analgesics are effective for mild to moderate pain. Narcotics are effective but may produce dependence and tolerance as well as untoward side effects. Major tranquilizers, minor tranquilizers, tricyclic antidepressants, and stimulants have all been used as adjuvants in pain management. Major tranquilizers are now discouraged because of potential serious adverse effects. Benzodiazepines are relatively safe and decrease anxiety accompanying pain. Tricyclics may be used with caution. Stimulants have received little attention but may be useful in treating both pain and depression in the physically ill.

Monoamine oxidase inhibitor toxicity.

Monoamine oxidase inhibitor (MAOI) drugs are used in the treatment of depressive and anxiety disorders in adults. MAOIs are also used in high doses for the treatment of lymphomas and of central nervous system (CNS) tumors in children. Toxic effects resulted when procarbazine, a drug of this class, was used in treating a child with a CNS tumor. Psychotic reaction in the child may have been triggered by any of several factors, but arguments are for an organic cause. The implication of the MAOI procarbazine must be seriously considered. The case highlights potential serious problems associated with MAOIs and the interaction of this agent with other drugs.

Posttraumatic stress responses in bereaved children after the Oklahoma City bombing.

OBJECTIVE: To investigate the responses of middle and high school students exposed to the 1995 Oklahoma City bombing across a spectrum of loss. METHOD: A questionnaire measuring exposure, personal consequences, initial response, and current posttraumatic stress and other symptoms was administered to 3,218 students 7 weeks after the explosion. RESULTS: More than one third of the sample knew someone killed in the explosion. Bereaved youths were more likely than nonbereaved peers to report immediate symptoms of arousal and fear, changes in their home and school environment, and posttraumatic stress symptoms. Retrospective measures of initial arousal and fear predicted posttraumatic stress symptoms at 7 weeks. CONCLUSIONS: The results support the literature addressing the role of initial response in posttraumatic stress symptom development. The study raises concern about the impact of television, and traumatized youths' reactivity to it, in the aftermath of disaster.

Management of acute psychologic problems in pediatric oncology.

Several psychologic issues in pediatric oncology are addressed and case illustrations of psychologic intervention for selected problems are offered. Psychologic intervention must take into account the patient's perception of his illness, the patient's developmental level, the parents' coping mechanisms, the dynamics of the child's emotional and behavioral responses, the staff's perception of the problems, and the community's capacity for reintegration of the patient. Each of these issues is addressed by use of case examples to demonstrate important aspects of psychosocial intervention.

Brief psychiatric rating scale for children: quantitative scoring of medical records.

The utility of the Brief Psychiatric Rating Scale for Children (BPRS-C) for transcribing narrative medical records into standard quantitative form for research purposes is examined. Three clinicians independently read and rated the records of 40 child and adolescent patients. Interrater reliabilities were adequate in most major domains of psychopathology, the one notable exception being symptoms in the anxiety domain. On the basis of these results, the BPRS-C appears appropriate for use in administrative and audit reviews, as well as in epidemiological and program evaluation research in which medical records are the primary sources of information.

Self-report study of impulsive and delinquent behavior in college students.

PURPOSE: This self-report study of college students sought to examine the relationship between risk-taking and delinquent behavior, to develop reliable measures of impulsiveness and attraction to thrill-seeking and risk-taking, and to measure the relationships among conventional correlates of delinquent behavior, personality factors, and delinquent behavior itself. METHODS: A sample of 296 undergraduate college students completed questionnaires pertaining to delinquent behavior and other activities, identification with educational goals and behavior, and attraction to thrill-seeking and risk-taking behavior, as well as items from the Self-Control and Socialization scales of the California Personality Inventory. RESULTS: Males who measured high in thrill-seeking behavior and low in self-control reported significantly more property delinquency. Interpersonal delinquency was most influenced by a lack of self-control. There was a negative correlation between substance abuse and socialization. The reasons most often given for property and substance delinquency were "fun/thrills" while those most often given for interpersonal delinquency involved "anger/revenge." CONCLUSION: Variables representing conventional sociological theories have often been treated as the immediate causal factors in juvenile delinquency, but their impact may be mediated through factors such as impulsiveness and an attraction to thrill-seeking and risk-taking.

Assessing adolescent health needs: a factor analytic approach.

Advances in technology are rapidly expanding health educators' resources for presenting information tailored to meet individual health needs and interests. A self-administered questionnaire was given to 510 youths in grades 6 through 9 to ascertain adolescents' health concerns and thus develop more appropriate educational programs. Smoking, diet and weight control, physical fitness, and general health items were included. Factor analysis methods identified ten concerns; smoking, weight control, exercise effects, peer approval of appearance, preparatory health behaviors, planning and maintaining a personal health program, feeling good about oneself, communication issues, comparisons with others, and resistance to negative peer influences. Sex and grade were significantly associated with particular responses. Recommendations include the value of addressing each area of the content domain as it relates to health lessons to ensure that information is relevant to the needs and interests of individual adolescents.

Lessons from the first two years of Project Heartland, Oklahoma's mental health response to the 1995 bombing.

On April 19, 1995, a terrorist bombing in Oklahoma City killed 168 people and injured 853 others. The Oklahoma Department of Mental Health and Substance Abuse Services was the lead agency in crafting a community mental health response to reduce impairment of those affected. The Project Heartland program, which opened on May 15, 1995, was the first community mental health program in the U.S. designed to intervene in the short to medium term with survivors of a major terrorist event. The authors describe lessons learned in the areas of planning and service delivery, as well as the types and extent of services provided in the project's first two years.

Mental health services for children in the first two years after the 1995 Oklahoma City terrorist bombing.

Nineteen infants and children were killed in the 1995 terrorist bombing in Oklahoma City, and many were injured. More than 200 children lost one or both parents. These casualties focused attention on children in the disaster response efforts. This paper describes the development and implementation of a school-based mental health program that provided accessible services to children affected by the bombing, with an emphasis on normalization. A clinical needs assessment of all children in the Oklahoma City public school system was carried out, and clinicians provided emergency and crisis services, counseling, and support groups.

Traumatic reactions as predictors of posttraumatic stress six months after the Oklahoma City bombing.

OBJECTIVE: This study attempted to identify remembered reactions of Oklahoma City residents at the time of the April 1995 terrorist bombing that predicted later development of posttraumatic stress symptoms. METHODS: Eighty-six adults who sought help for distress related to the bombing six months after it occurred completed a survey about demographic characteristics, level of exposure to the event, symptoms of grief, retrospective reports of reactions at the time of the trauma, current posttraumatic stress symptoms, and coping strategies. To identify immediate bombing reactions predictive of later distress, retrospective reports of reactions to the trauma were correlated with current posttraumatic stress symptoms. Multiple regression analysis was used to determine which reactions predicted the emergence of posttraumatic stress symptoms. RESULTS: Reactions of being nervous and being upset by how other people acted when the bombing occurred accounted for about one-third of the total variation in posttraumatic stress symptom scores and thus were major predictors of posttraumatic stress. CONCLUSIONS: These results differ from those of other studies in which peritraumatic dissociation, or dissociation at the time of the event, was more predictive than anxiety for developing later distress. The results suggest that persons who experience significant anxiety at the time of the traumatic event may continue to experience distress. Those who are overly concerned about others' actions may be showing diminished interpersonal trust, evidence of terrorism's ability to erode social harmony.

Posttraumatic stress among young children after the death of a friend or acquaintance in a terrorist bombing.

The effects of traumatic loss on children who reported a friend or acquaintance killed in the 1995 Oklahoma City bombing of a federal office building were examined. Twenty-seven children who lost a friend or acquaintance and 27 demographically matched controls were assessed eight to ten months after the bombing. All but three of the children continued to experience posttraumatic stress symptoms. Those who lost a friend watched significantly more bombing-related television coverage than those without losses. Those who lost a friend had significantly more posttraumatic stress symptoms at the time of the assessment than those who lost an acquaintance. Parents and those working with children should be alert to the impact of loss even when it involves nonrelatives.

The use of methylphenidate in a depressed adolescent with AIDS.

Stimulants once used to treat depression have been overshadowed by tricyclic antidepressants and monoamine oxidase inhibitors. Recently, their use has been reported in the treatment of depression in medically ill adults in whom tricyclics are contraindicated, or for whom a rapid response is critical. This report documents the successful use of methylphenidate in a depressed adolescent with AIDS.

A comparison of depressed and nondepressed disturbed children on measures of attributional style, hopelessness, life stress, and temperament.

Upon admission to a hospital treatment program, clinically depressed and nondepressed children (aged 9-17 years) were assessed on measures of attributional style, hopelessness, depression, life stress, and child temperament. The depressed group tended to attribute positive events to specific and unstable factors when compared with the nondepressed sample. Group differences also were found on child temperament measures. However, no differences were reported between the diagnostic groups on self-reported depression, hopelessness, or life stress. The findings suggested that there may not be a unique constellation of cognitive characteristics in depressed children when compared with a nondepressed clinical sample. For both depressed and nondepressed groups, treatment did appear to affect self-reported depression and overall ratings of depressogenic attributional style.

Caring for children affected by disaster.

The child and adolescent psychiatrist must play an essential role in the wake of disaster. The focus of the community and the world understandably turns to the physical devastation wrought, and emergency and medical efforts take center stage. Physical evidence of the past may be lost, but the child psychiatrist is able to maintain focus on what cannot be seen. He or she may be the only one to advocate the child's emotional needs. It may be too difficult for others who lack the specialized expertise of mental health training to attend to both the child's physical and emotional needs, and it may be impossible for those without medical training to impress on medical personnel the importance of emotional issues. The child and adolescent psychiatrist, with his or her understanding of medical, mental health, and developmental concerns, is well positioned to support the child, the child's community, and the helpers whose own responses may complicate recovery.