Depression in an adolescent delinquent population.

One hundred and twenty adolescents aged 13, 14, and 15 were given a structured psychiatric interview within 48 hours of their admission to a correctional facility. The interview assessed demography, social and delinquent history, family history, and drug and alcohol use and related problems. The interview issued diagnoses based on the Research Diagnostic Criteria. The adolescents were followed up with self-rated and observer-rated instruments. Twenty-three percent of the population met criteria for a major affective disorder. Observer blind ratings significantly identified the depressed group at 15 days. Self-ratings of depression did not separate the two groups. No pattern of antisocial or "acting-out" behavior differentiated the depressed group, although the depressed group did relate more of their problems to drug and alcohol abuse. A depressed or alcoholic family member significantly predicted for depression. Some possible unique cognitive aspects of depression in younger adolescents are explored, and implications for further research with delinquents are discussed.

Depression, hopelessness, and suicidal behavior in Chinese and American psychiatric patients.

The authors compared 37 patients in the People's Republic of China and 46 patients in the United States who were having difficulty with suicidal thinking or behavior. Hopelessness, reasons for living, and suicidal efficacy showed none of the expected relationships with suicidal intent among the Chinese patients, but the two groups were similar on many variables theoretically related to suicidality. Chinese patients were less likely to communicate suicidal intent and rated suicide as less effective at solving problems. The authors examine such variations in the light of possibly different cultural approaches to suicidal behavior.

The Texas Medication Algorithm Project (TMAP) schizophrenia algorithms.

BACKGROUND: In the Texas Medication Algorithm Project (TMAP), detailed guidelines for medication management of schizophrenia and related disorders, bipolar disorders, and major depressive disorders have been developed and implemented. DISCUSSION: This article describes the algorithms developed for medication treatment of schizophrenia and related disorders. The guidelines recommend a sequence of medications and discuss dosing, duration, and switch-over tactics. They also specify response criteria at each stage of the algorithm for both positive and negative symptoms. The rationale and evidence for each aspect of the algorithms are presented.

Medication treatment for the severely and persistently mentally ill: the Texas Medication Algorithm Project.

This article provides an overview of the issues involved in developing, using, and evaluating specific medication guidelines for patients with psychiatric disorders. The potential advantages and disadvantages, as well as the essential elements in the structure of algorithms, are illustrated by experience to date with the Texas Medication Algorithm Project, a public-academic collaboration. Phase 1 entailed assembling research findings on the efficacy of medications for schizophrenic, bipolar, and major depressive disorders. This knowledge was evaluated for its quality and relevance, integrated with expert clinical judgment as well as input by practicing clinicians, family advocates, and patients. Phase 1 (the design and development of the algorithms) was followed by a feasibility test (Phase 2). Phase 3 is an ongoing evaluation comparing the clinical and economic effects of using specific medication guidelines (algorithms) versus treatment as usual in public sector patients with severe and persistent mental illnesses.

Intermittent medication for schizophrenic outpatients: who is eligible?

The Medication Clinic of a large, urban Mental Health Center was screened for schizophrenic patients eligible for an intermittent medication approach. A total of 112 patients were evaluated, and 39, or 34.8 percent of the sample, met our basic inclusion criteria. No sex or age differences were found for eligibility. Sufficient eligible patients were found to make the intermittent medication approach a useful part of a comprehensive psychopharmacological program for schizophrenia, if the efficacy of the approach is demonstrated in clinical trials.

Implementing effectiveness research and improving care for schizophrenia in real-world settings.

OBJECTIVE: To review recent advances in medication practices and standards of care in the treatment of schizophrenia and examine the disparity between the knowledge base and clinical practice. DATA SOURCES: Key literature on medication practices, novel pharmacotherapies, and the evolution of practice guidelines for schizophrenia were reviewed. DISCUSSION: Emerging data demonstrate a lack of consistent application of current knowledge and best practices, in part due to major structural inconsistencies in the public mental health system. Implementation of results from effectiveness research as well as the incorporation of practice guidelines may help bridge this gap. CONCLUSION: As standards of care for schizophrenia are developed, the following issues will need particular attention: coordination with the criminal justice system, comprehensive treatment of comorbid illnesses, outcomes based on symptoms in all domains, and continuous and integrated collection of data to produce rational cost justification.

The Texas Medication Algorithm Project: development and implementation of the schizophrenia algorithm.

The Texas Medication Algorithm Project is a program designed to improve the quality of care of persons with serious mental disorders across sites in the Texas public mental health system and to create a uniform clinical environment from which cost estimates can be made. This paper describes the process of developing a pharmacological treatment algorithm for schizophrenia that addresses use of antipsychotics as well as other medications for side effects and co-existing symptoms. Input from clinicians, consultants, and consumers informed development of the algorithm, which was based on existing expert consensus guidelines. Information about the project can be found on the Internet at www.mhmr.state.tx.us/meds/tmap.htm. The authors present and describe the original and current versions of the algorithm, outline the feedback process by which it will be refined, and discuss how new medications will be incorporated as they enter the market.

The 24 hours before hospitalization: factors related to suicide attempting.

Fifty-nine psychiatric inpatients were interviewed concerning the psychological and environmental events that occurred in the 24 hours prior to their hospitalization. Independent raters then performed a content evaluation of these accounts, allowing for comparisons among patients admitted for a suicide attempt, suicide ideation, or non-suicide-related complaints. Results showed that suicide attempters were more likely to have used alcohol or marijuana and less likely to have contacted a health care professional than suicide ideators, even when past history of suicide behavior was controlled for. Suicide ideators were more likely to have contacted a mental health professional. Implications for suicide risk assessment and intervention are discussed.

Behavioral manifestations of the Kleine-Levin syndrome.

The authors present a case of the Kleine-Levin syndrome, and review the literature to assess the various ways this illness can appear. Psychiatric manifestations not only obscure the diagnosis, but may lead to inappropriate treatment.

Electrophysiological changes during episodes of the Kleine-Levin syndrome.

Diurnal EEGs of a 17 year old male with the Kleine-Levin syndrome revealed moderate diffuse abnormalities and stage REM at sleep onset during attacks. Overnight, stages 3, 4, and REM of sleep were decreased, but sleep onset REM stage was not seen. These records returned to normal between attacks.