Progesterone: its possible role in the biosynthesis of cardenolides in Digitalis lanata.

The incorporation of progestrone-7alpha-(3)H and pregnenolone-7alpha-(3)H into digitoxigenin, gitoxigenin, and digoxigenin in isolated, surviving leaves of Digitalis lanata was demonstrated. In addition, the conversion of pregnenolone to progesterone in the same system was proved. The results tend to indicate that progesterone is as good a precursor of cardenolides as pregnenolone It is suggested that the biosynthesis of cardenolides might proceed through the intermediacy of progesterone.

Medical histories of female delinquents. Clinical and epidemiologic findings.

The medical histories (based on hospital records) of matched samples of nonincarcerated delinquent girls, incarcerated delinquent girls, and nondelinquent girls were compared. Numbers of visits, timing of visits, services used, and reasons for hospital contacts were compared for the three groups. Delinquent girls in general had significantly more adverse medical histories than nondelinquent girls; they made significantly more hospital visits and had significantly more accidents and injuries through age 21 years. Perinatal difficulties did not distinguish these two groups. Although incarcerated and nonincarcerated delinquent girls made similar numbers of hospital visits, their histories differed qualitatively. Accidents and injuries, head and face injuries, perinatal difficulties, neurologic abnormalities, and child abuse were found more frequently in the histories of incarcerated girls. These findings have etiologic importance to the development of seriously delinquent behavior.

"Sociopathy" and its synonyms: inappropriate diagnoses in child psychiatry.

The use of the diagnosis "sociopathy" and its synonyms hinders the search for other kinds of symptomatology, the recognition of which might lead to appropriate therapeutic intervention. The authors therefore suggest that the terms "sociopathic personality," "antisocial personality," and "acting out aggressive reaction of childhood or adolescence" be eliminated as primary diagnoses from the psychiatric nomenclature for children or adolescents. Two case reports are presented to emphasize the damage these diagnoses can cause.

Delinquency, psychomotor epileptic symptoms and paranoid ideation: a triad.

In a retrospective chart-review study, the author found psychomotor epileptic symptoms in 6% (N=18) of children referred to a juvenile court over a 2-year period. Abnormalities appeared in 11 of the 14 available EEGs, but temporal lobe foci were noted in only 3 cases. Of these 18 children, 16 experienced paranoid symptoms that led to aggressive behavior. The incidence of offenses against persons was 50% in this sample, compared to 2--3% in the population of children referred to the juvenile court. The author suggests that psychomotor epilepsy may be far more common among delinquent children than has been reported previously and should therefore be included in the differential diagnosis of court-referred children.

Medical histories of delinquent and nondelinquent children: an epidemiological study.

The authors studies the hospital records of 109 delinquent children and a matched comparison group of 109 nondelinquent children. The number, reasons for, and timing of hospital contacts significantly differentiated the delinquent from the nondelinquent children; perinatal difficulties did not. The authors hypothesize that an interaction of developmental factors and parental inadequacies accounts for the clustering of hospital contacts before age 4 and between ages 14 and 16 in the delinquent sample. They discuss the implications of their findings for prevention.

The use of a correctional setting for follow-up care of psychiatrically disturbed adolescents.

The authors studied the first 88 adolescents boys who were placed on the secure unit of a correctional school during an 18-month period and found that 52 (59.1%) of the boys had previously received psychiatric residential treatment or psychiatric hospitalization. The authors hypothesize that many of these boys may have been transferred from a psychiatric setting to a correctional facility during adolescence when long-standing aberrant behaviors became more threatening to staff. At present the number of psychiatric hospital beds is decreasing and the criteria for hospitalization of children are becoming more stringent. The data indicate that correctional facilities are now expected to function as psychiatric treatment centers for disturbed adolescents no longer welcome in therapeutic settings.

Juvenile court versus child guidance referral: psychosocial and parental factors.

The authors compared the psychiatric symptoms, socioeconomic status, family structure, family size, and occurrence of treated parental mental illness in 136 children referred to a juvenile court and 82 children referred to a child guidance clinic. The prevalence of psychiatric and organic symptoms and treated parental psychopathology in both groups of children did not differ significantly. Juvenile court clinic children, however, tended to come from larger families and to lack a biological mother in the home. The authors explore explanations for the routing of sick children to the juvenile court rather than to a treatment facility.

Mortality in a group of formerly incarcerated juvenile delinquents.

A 7-year follow-up study of formerly incarcerated delinquents revealed an extremely high mortality rate. Of 118 male and female subjects, seven had died before their 25th birthdays, making the mortality rate of the sample approximately 58 times the national average for individuals in their age group. All died violent deaths, making the violent death rate of the sample approximately 76 times the national average for that age group. Differences in mortality rates according to the race and sex of the subjects are reported, and possible clinical predictors of early death are explored.

Sexually assaultive male juveniles: a follow-up.

OBJECTIVE: The purpose of this study was to investigate the adult outcome of a group of male juveniles who committed sexual assault. METHOD: Nineteen sexually assaultive male juveniles and a comparison group of 58 violent juveniles were studied over an 8-year period through use of criminal records and clinical interviews. RESULTS: Although in adolescence the two groups were similarly violent, on follow-up those who had committed sexual assault were significantly more likely to commit adult sexual offenses. They also committed significantly more violent nonsexual offenses. Childhood sexual abuse, especially by females, was associated with adult sexual offenses. CONCLUSIONS: Sexually assaultive delinquents are at particularly high risk for subsequent violence. Hence, special efforts must be made to treat these delinquents in adolescence. Prevention of violent sexual behavior must include improved methods of detecting sexual abuse, especially that perpetrated by older females.

Perinatal difficulties, head and face trauma, and child abuse in the medical histories of seriously delinquent children.

The authors compared the medical histories of incarcerated and nonincarcerated delinquent children. Incarcerated delinquent children were significantly more likely than nonincarcerated delinquents to have sustained severe head and face injury. Differences were evident by age 2. Perinatal difficulties and psychiatric impairment were also significantly more prevalent in the histories of incarcerated delinquents. Especially violent incarcerated children had more perinatal difficulties, accidents, injuries, and ward admissions than did their less violent incarcerated peers. The authors suggest that the combination of early CNS trauma, parental psychopathology, and social deprivation is responsible for the serious, often violent, delinquency that is now prevalent.

Juvenile male sexual assaulters.

This study compares the psychiatric, neurological, and psychoeducational status of sexually assaultive male juveniles and other violent juveniles. The authors found that juvenile sexual assaulters suffered from neuropsychiatric problems similar to those of other violent juveniles, had committed violent acts other than sexual assault, and had had seriously aberrant behavior since early childhood. The findings contradict prevailing assumptions that sexual assaults by juveniles are rare occurrences and that juvenile sex offenders have low rates of recidivism. Theoretical and treatment implications are discussed.

Parental criminality and medical histories of delinquent children.

In clinical practice the authors observed that many of the delinquent children of psychiatrically impaired and/or criminal parents had remarkably adverse health histories. To test their clinical impression they systematically compared the medical histories of 20 delinquent children with criminal parents and 85 delinquent children with less obviously maladapted parents. They found a strong association between paternal criminality and serious medical problems in these delinquent children. On the basis of this finding the authors suggest that the behavioral manifestations resulting from such physical illness or neglect, although they appear genetic in nature, may reflect the physical and psychological consequences of parental neglect and/or battering.

The treatment of adopted versus neglected delinquent children in the court: a problem of reciprocal attachment?

The authors investigated the discrepant treatment by a juvenile court of adopted versus neglected delinquents. Adopted delinquents received harsher dispositions in spite of the fact that neglected delinquents often faced more serious charges. The two groups are compared in terms of family structure and the criminal and psychiartic histories of their parents; none of these seems to account for the adoptees' harsher treatment. The authors hypothesize that an interplay of late adoption intrinsic vulnerabilities in the children, and weakness of parental bonds accounts for the differential outcomes.

Conduct disorder and its synonyms: diagnoses of dubious validity and usefulness.

Psychiatrically hospitalized adolescents from city and voluntary services who had been diagnosed as having conduct disorder were compared with psychiatrically hospitalized adolescents who had never been so diagnosed. There were no significant symptomatic differences. The major factor distinguishing adolescents ever diagnosed as having conduct disorder was violence, regardless of other symptoms. The most common discharge diagnosis of those who had formerly been diagnosed as having conduct disorder was schizophrenia. However, even violence did not distinguish those discharged with a diagnosis of conduct disorder from those whose diagnoses were subsequently changed. With its focus on manifest behaviors and its lack of clear exclusionary criteria, the conduct disorder diagnosis obfuscates other potentially treatable neuropsychiatric disorders.

Psychomotor epileptic symptoms in six patients with bipolar mood disorders.

Of 12 consecutive patients with bipolar mood disorders satisfying DSM-III criteria, six were discovered to have five or more psychomotor epileptic symptoms. All of the six had olfactory hallucinations, metamorphopsias, and multiple déjà vu or mystical experiences. Each of them responded to lithium carbonate and had a first-degree relative with a bipolar disorder. The authors suggest that psychomotor symptoms may be more prevalent in bipolar patients than has hitherto been recognized.

Homicidally aggressive young children: neuropsychiatric and experiential correlates.

Of 55 children admitted to a children's psychiatric service, 21 were homicidally aggressive. Psychiatric symptoms and diagnoses did not distinguish these children from the nonhomicidal children, but the homicidally aggressive children were significantly more likely to 1) have a father who behaved violently, often homicidally, 2) have had a seizure, 3) have attempted suicide, and 4) have a mother who had been hospitalized for a psychiatric disorder. The authors explore explanations for the contribution of these factors to juvenile violence.

Race bias in the diagnosis and disposition of violent adolescents.

The authors compared psychiatric symptoms, violent behaviors, and medical histories of an entire one-year sample of adolescents from the same community who were sent either to the correctional school or the only state hospital adolescent psychiatric unit serving the area. The initial hypothesis that the incarcerated group would be equally disturbed but more violent than the hospitalized group was contradicted. Violence as well as severe psychiatric symptomatology was equally prominent in the two groups. The most powerful variables distinguishing the groups were race, accidents, and injuries (especially head injury), and sex. The medical and social implications of the findings are discussed.

Psychiatric, neurological, and psychoeducational characteristics of 15 death row inmates in the United States.

The authors present the results of clinical evaluations of 15 death row inmates, chosen for examination because of the imminence of their executions and not for evidence of neuropsychopathology. All had histories of severe head injury, five had major neurological impairment, and seven others had other, less serious neurological problems (e.g., blackouts, soft signs). Psychoeducational testing provided further evidence of CNS dysfunction. Six subjects had schizophreniform psychoses antedating incarceration and two others were manic-depressive. The authors conclude that many condemned individuals probably suffer unrecognized severe psychiatric, neurological, and cognitive disorders relevant to considerations of mitigation.

Objective documentation of child abuse and dissociation in 12 murderers with dissociative identity disorder.

OBJECTIVE: The skepticism regarding the existence of dissociative identity disorder as well as the abuse that engenders it persists for lack of objective documentation. This is doubly so for the disorder in murderers because of issues of suspected malingering. This article presents objective verification of both dissociative symptoms and severe abuse during childhood in a series of adult murderers with dissociative identity disorder. METHOD: This study consisted of a review of the clinical records of 11 men and one woman with DSM-IV-defined dissociative identity disorder who had committed murder. Data were gathered from medical, psychiatric, social service, school, military, and prison records and from records of interviews with subjects' family members and others. Handwriting samples were also examined. Data were analyzed qualitatively. RESULTS: Signs and symptoms of dissociative identity disorder in childhood and adulthood were corroborated independently and from several sources in all 12 cases; objective evidence of severe abuse was obtained in 11 cases. The subjects had amnesia for most of the abuse and underreported it. Marked changes in writing style and/or signatures were documented in 10 cases. CONCLUSIONS: This study establishes, once and for all, the linkage between early severe abuse and dissociative identity disorder. Further, the data demonstrate that the disorder can be distinguished from malingering and from other disorders. The study shows that it is possible, with great effort, to obtain objective evidence of both the symptoms of dissociative identity disorder and the abuse that engenders it.

A comparison of delinquent and nondelinquent adolescent psychiatric inpatients.

The psychopathology of 29 delinquent and 25 nondelinquent psychiatrically hospitalized adolescent boys was similarly severe. Similar proportions had hallucinations, delusions, learning disabilities, and evidence of neurological impairment, and over half in each group had been diagnosed as being psychotic. Fire-setting, enuresis, and cruelty to animals did not distinguish the two groups. Significantly more of the delinquents had been psychiatrically hospitalized previously, and significantly more of the delinquents had engaged in violently aggressive acts. The household composition of both groups was similar, but more mothers of delinquents than of nondelinquents had been psychiatrically hospitalized. The authors discuss the issue of the treatment of psychiatrically ill violent adolescents.