Psychostimulants in preschool children with attention-deficit/hyperactivity disorder: clinical evidence from a developmental disorders institution.

OBJECTIVE: To examine psychostimulant response in preschool children with attention-deficit/hyperactivity disorder (ADHD) in an outpatient child psychiatry clinic (housed within a developmental disorders institution) over 3, 12, and 24 months of treatment. METHOD: A systematic retrospective chart review was conducted for 27 preschool children with ADHD who were started on psychostimulants between the ages of 3 and 5 years, inclusive. Two child and adolescent psychiatrists reviewed each chart independently, using the Clinical Global Impressions (CGI) scale to rate the severity of illness and global improvement and the Side Effects Rating Form to rate side effects. RESULTS: Over 24 months, psychostimulants were stopped in three children (11%) because of side effects and concomitant psychotropic medications were added in seven children (26%). The CGI severity-of-illness ratings showed a significant effect of time over 3, 12, and 24 months of psychostimulant treatment (all p values < .0001). Rate of response was 74% at 3 months and 70% at 12 and 24 months. Side effects were mostly mild and occurred in 63% of the children at 3 months, 41% at 12 months, and 29% at 24 months. CONCLUSIONS: The findings suggest that preschool children with developmental disorders respond to psychostimulants but need close monitoring because of frequent side effects. Inasmuch as the study participants were recruited from a child psychiatry clinic housed within a developmental disorders institution and had a high rate of developmental disorders, the findings may not generalize to other preschool children with ADHD.

Demographic and clinical characteristics of emotionally disturbed children being raised by grandparents.

Among 233 youths treated at a community mental health center, 51 were living with their grandparents. Youths who lived with grandparents were more likely to be male, African American, and younger. Frequent psychiatric diagnoses included oppositional defiant disorder, depressive disorders, and anxiety disorders. Common reasons for youths' placement with grandparents included parents' absence, substance abuse, or incarceration; abuse by parents; and death of parents. Caregivers were most often maternal grandmothers, and more than one-third of the grandmothers were age 62 or older. The findings highlight the need to develop treatment interventions for youths who are living with their grandparents and to create public policies to support grandparent caregivers.

Psychosocial functioning of youth receiving mental health services in the schools versus community mental health centers.

Evaluated psychosocial differences between youth receiving mental health services in Community Mental Health Centers (CMHCs; n = 79) as compared to youth receiving services from a program operating in 10 Baltimore schools (n = 186). Racial and gender differences were shown, with more African American youth and females in the School than CMHC sample. Multivariate analyses that controlled for these racial and gender differences failed to reveal significant effects, indicating comparable functioning on measures of life stress, violence exposure, family support, self-concept, and emotional/behavioral problems for youth from the two samples. However, particularly for those with internalizing disturbances, youth in the School sample were less likely to have received prior mental health services than youth from the CMHCs. Findings support the conclusion that school-based mental health programs are reaching youth who need mental health services, who otherwise may not receive them.

Delta-hepatitis.

Investigations were conducted for serological evidence of hepatitis B virus (HBV) and hepatitis D virus (HDV) infections in children suffering from acute viral hepatitis. A total of 52 serum samples were analysed by enzyme immunoassay. Of these, 18 (24%) were positive for hepatitis B virus markers and 34 (65.4%) were negative. Delta virus infection was detected in 6/18 (33%) hepatitis B patients. A significant finding was, that of the 34 patients negative for hepatitis B, 4 (12%) were positive only for HDV although the latter can only occur as a coexistent infection with hepatitis B virus. From the present study it may be inferred that delta virus infection is prevalent in children and absence of HBV markers does not rule out hepatitis D.

Prevalence of hepatitis A, B, C & D in Ludhiana.

172 sera were tested for serological markers of hepatitis A, hepatitis B, hepatitis C and hepatitis D to define the aetiology of acute viral hepatitis by Enzyme immunoassays. The viral aetiology could be decided in 60.5% (104/ 172) of patients. Hepatitis B infection was present in 34.9%, hepatitis A in 10.5%, hepatitis C in 9.3% and hepatitis D in 5.8% of cases. Delta hepatitis associated with HBsAg positive hepatitis was detected in 10% (6/60) of the patients. The aetiology remained undecided in 39.5% of patients.

Shigella isolates in stool.

A total of 447 Shigella strains were isolated from stool samples during 1989-1991. Of these 270 (60%) were from children. Among the different species and serotypes Sh. flexneri 60 (13.4%) and Sh. sonnei Phage 139 (65%) were the most frequently isolated strains. 154 (34.4%) strains were resistant to three and 179 (40%) to more than three antibiotics. Some strains of Shigella were found to be resistant to furazolidine and neomycin.

Acinetobacter meningitis.

10,468 CSF samples from cases of meningitis in different age groups were cultured during 1988-1991. Acinetobacter calcoaceticus was isolated in 12 (5.6%) of 211 positive cultures. The strain were 100% resistant to ampicillin, cotrimoxazole and tetracycline 50% resistant to cephazolin gentamicin and kanamycin but 100% susceptible to chloramphenicol.

Acute delta hepatitis without hepatitis B surface antigen detectable in the blood.

The case is described of a 42-year-old man suffering from acute delta hepatitis without hepatitis B surface antigen (HBsAg) being detectable in his blood. Tests on the patient's blood were negative for anti-HBcIgM and HBeAg but positive for anti-HBs, anti-HBe, HDAg and anti-DIgM. It is well known that the delta antigen-antibody system is detectable only in HBsAg carriers except rarely in persons recently recovered from acute hepatitis B virus (HBV) and delta infection. We report one of the rare cases in which the circulating HBsAg as well as anti-HBcIgM and HBeAg were not found in the patient's serum, thus indicating the absence of recent infection with HBV.

Variables predictive of the need for placement in a long-term structured setting for adolescents.

A retrospective study of 113 adolescent patients admitted to a short-term unit revealed that family history of drug abuse, behavior problems in females, history of previous inpatient hospitalization diagnosed under a DSM-III category of disorders usually first evident in childhood or adolescence, grade level, symptom of drug experimentation, elopement, and family involvement in treatment were significant variables distinguishing the patients who returned to the community at the end of short-term stay versus those who required continued treatment in a structured residential setting.

The psychiatric uses of cold wet sheet packs.

The cold wet sheet pack is a treatment that is seldom discussed anymore. The authors present results of a national survey which demonstrated that this treatment is rarely used in modern American psychiatry. They retrospectively review its recent use for 46 hospitalized psychiatric patients and conclude that the treatment is safe and has interesting and useful effects that go beyond the concept of simple restraint. Further study of treatment with cold wet sheet packs is recommended before it disappears altogether.

Three group psychotherapy settings with long-term adolescent inpatients: advantages and disadvantages.

The authors describe three types of group psychotherapy settings on an adolescent service. The group setting which included all patients on the unit and employed multiple therapists and several nursing staff provided better communication, cohesiveness, and greater opportunity for staff training. Small groups provided comparatively more time for patient participation, less distraction, and better disclosure. Mixing patients from different units resulted in objective and keener observations by patients, but hall meetings became increasingly necessary to work out interpersonal issues among patients from the same unit. These observations by staff were confirmed by a patient questionnaire.