Prevalence of anxiety disorders in a clinic-based sample of pediatric asthma patients.

Psychosocial variables may affect the clinical course of childhood asthma. In this study, 37 children with asthma were assessed for DSM-III-R anxiety disorders with the Schedule for Affective Disorders and Schizophrenia for School-Age Children and intrafamilial stress with the Index of Family Relations. When compared with a healthy control group, the asthma group had significantly more total anxiety disorders, past school problems, past psychiatric illnesses, and intrafamilial stress. There was also more family history of emotional problems in the asthma group. The implications of these findings for clinical management of this population are discussed.

Therapists' attitudes about treating patients with eating disorders.

The attitudes of 90 therapists toward patients with an eating disorder were explored by questionnaire. Topics included therapist's treatment desires, countertransference, treatment approaches, and prognosis. Twenty-eight respondents (31%) desired not to treat such patients. Analysis of those who did not desire to treat these patients showed that (1) more of them were male, (2) individual therapy as the sole treatment method was more common, (3) feelings of empathy were less common, and (4) more of them believed the prognosis for anorexia nervosa with bulimia to be poor. Overall, therapists considered cognitive behavioral therapy to be the preferred treatment method, though subjects who desired to treat these individuals tended to use more diverse (dynamic, supportive, interpersonal, eclectic) approaches. Twenty-nine percent of both groups believed female therapists were preferred. Therapist frustration, treatment resistance, and comorbid conditions were found problematic. This study revealed several factors that distinguish therapists by desire to treat individuals with eating disorders.

Adolescent psychopathy in relation to delinquent behaviors, conduct disorder, and personality disorders.

The purpose of this study was to explore the relationship between psychopathy as measured by The Revised Psychopathy Checklist (PCL-R) and delinquent behaviors, conduct disorder, and personality disorders in psychiatrically hospitalized adolescents. Thirty adolescent inpatients were assessed for psychopathy, delinquent behaviors, DSM-III-R Axis I disorders, and personality disorders using the Revised Psychopathy Checklist (PCL-R), the Diagnostic Interview for Children and Adolescents (DICA-R), and the Structured Interview for DSM-III-R Personality Disorders (SIDP-R). Significant relationships were noted between elevated PCL-R psychopathy scores and delinquent behaviors, conduct disorder, and narcissistic personality disorder. The validity of the PCL-R as a measure of psychopathy in adolescence was supported. Longitudinal studies are needed to clarify the clinical application of the PCL-R to adolescent populations.

Axis I and personality comorbidity in adolescents with conduct disorder.

This study was undertaken to investigate psychiatric comorbidity in male and female adolescents with conduct disorder diagnoses. Twenty-five hospitalized adolescents (11 females, 14 males) with conduct disorder were evaluated using structured diagnostic interviews for Axis I and personality disorders. The most common Axis I comorbid diagnoses were: depressive disorders (major depression and/or dysthymia), 64 percent; anxiety disorders (separation anxiety disorder, overanxious disorder, panic disorder, obsessive-compulsive disorder, phobias, and/or posttraumatic stress disorder), 52 percent; substance abuse, 48 percent; and attention-deficit hyperactivity disorder, 28 percent. Common Axis II disorders included passive-aggressive personality disorder, 56 percent, and borderline personality disorder, 32 percent. When compared with the male subjects, the females had significantly more total Axis I disorders and a trend toward more total personality disorders, anxiety disorders, depression, and borderline personality disorders. These findings support conduct disorder as a complex illness with extensive Axis I and II involvement as well as some gender differences in presentation.

Pediatricians' perceptions of child psychiatry consultations.

To ascertain pediatrician's expectations of child psychiatric consultants at our facility, a self-report questionnaire was sent to the 135 members of the Department of Pediatrics, The University of Florida Health Science Center, in 1991. The 73 respondents (54%) reported high rates of emotional problems and adverse family situations in their patients, and a majority said they used psychiatric consultation sometimes or often. Adolescents were the patient group most frequently referred, and behavioral problems were the most frequent reasons for consultation requests. Pediatricians most valued a timely response and accessibility from consultants. These results are discussed with reference to the further development of a consultation-liaison service within a child and adolescent psychiatry training program.

Factors predicting reluctance to seek treatment in patients with eating disorders.

Eating disorders, including anorexia nervosa and bulimia nervosa, are common problems in young women, yet many delay or never seek treatment for them. A semistructured telephone interview that addressed various eating problems was conducted with 78 consecutive patients referred to a university hospital eating disorders clinic. It was hypothesized that individuals who subsequently followed through with treatment would differ in some easily recognizable characteristics from those who did not. No significant differences were found in variables, including duration of eating problems, frequency of binge eating or vomiting, history of previous treatment, or presence of associated physical problems. However, individuals who abused laxatives, those with depression, and those who were least satisfied with their current weight tended to avoid coming to the clinic for treatment. These findings suggest that individuals with more severe eating problems may be the most reluctant to seek treatment.

Anxiety and intrafamilial stress in children with hemophilia after the HIV crisis.

OBJECTIVE: The 12-month prevalence of DSM-III-R anxiety disorders and intrafamilial stress ratings were determined in 23 children with hemophilia, 37 children with asthma, and 31 healthy children. METHOD: Diagnoses were made using the parent and child versions of the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS), and intrafamilial stress ratings were obtained using the Index of Family Relations (IFR). RESULTS: HIV-positive boys with hemophilia had significantly higher rates of anxiety disorders than did the other comparison groups (p = 0.05), mainly owing to a high rate of separation anxiety disorder. Intrafamilial stress ratings were highest in the asthma group, where 29.7% of the children and 24.3% of the parents reached clinically significant scores. CONCLUSIONS: Anxiety disorders appear to be common in HIV-positive children with hemophilia; however, they report little intrafamilial stress.

Conduct disorder and personality disorders in hospitalized adolescents.

BACKGROUND: The purpose of this study was to investigate the differences between DSM-III-R Axis I and II psychiatric diagnoses in hospitalized adolescents with and without conduct disorder. The spectrum of psychopathology associated with conduct disorder, especially personality disorder symptoms and diagnoses, remains largely unexplored. METHOD: Twenty-five inpatients were evaluated using the Diagnostic Interview for Children and Adolescents, Adolescent Version (DICA-R-A); the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Epidemiologic Version (K-SADS-E) (panic disorder and agoraphobia only); and the Structured Interview for DSM-III-R Personality Disorders (SIDP-R). RESULTS: Fifty-two percent met criteria for conduct disorder, and the majority of these had comorbid substance abuse, attention-deficit hyperactivity disorder, and major depression. The diagnosis of conduct disorder was also associated with fulfilling criteria for multiple Axis II personality disorders, particularly passive aggressive and histrionic. Nearly three personality disorders per subject were found in those with conduct disorder, while those without conduct disorder averaged just over one personality disorder. There was a trend for female subjects with conduct disorders to have more frequent and varied personality disorder diagnoses. For the entire sample, males were significantly more likely to have conduct disorder, and females were significantly more likely to have borderline personality disorder. CONCLUSION: These findings support conduct disorder as a multifaceted illness composed of diverse Axis I and II characteristics. Long-term follow-up studies are needed to determine the outcome of personality disorder diagnoses made in adolescents with and without conduct disorder.

A review of the pharmacotherapy of aggression in children and adolescents.

Aggressive behavior in children and adolescents is a heterogeneous phenomenon occurring in a wide variety of illnesses. No single etiologic model seems adequate to explain this phenomenon. In many cases, pharmacotherapy may prove to be a useful adjunct to treatment. Potentially useful medications are described in reference to psychiatric diagnosis. Pharmacological treatment can be helpful in the management of the aggressive youth when judiciously applied in the context of a comprehensive treatment plan.

DSM-III diagnoses and offenses in committed female juvenile delinquents.

The relationship between juvenile delinquency and psychiatric disorders remains poorly understood. However, it is becoming more apparent that the spectrum of psychiatric illness present in juvenile delinquents is broader than once believed. Fifteen female juvenile delinquents committed to a residential treatment program were assessed for DSM-III diagnoses, using a structured diagnostic interview, the Diagnostic Interview for Children and Adolescents (DICA). A search of the literature revealed no other reports using the DICA in female juvenile delinquents. A broad spectrum of current and past diagnoses was discovered, including conduct disorder (100%), substance abuse/dependence (87%), major depression (67%), and anxiety disorders (47%). The average number of lifetime diagnoses per subject was 4.7; current diagnoses averaged 3.4 per subject. Additionally, criminal and status offense records were obtained for each subject. No significant relationship was noted between diagnoses and categories of offense. These results add further evidence for the presence of frequent and severe psychiatric disturbances in this population, and the need for increased clinical and research efforts by the psychiatric community.

Eating attitudes, behaviors, and disorders in female juvenile delinquents.

Forty-one female juvenile delinquents completed a self-report questionnaire designed to assess their eating attitudes and behaviors. Responses were analyzed using DSM-III-R criteria to determine the presence of clinically significant eating disorders. Aberrant eating behaviors were very common, and 22% of respondents had probable eating disorders. Significant eating problems may exist in this delinquent population.

Pelvic calcification and autoamputation of the uterine adnexa in an adolescent.

An adolescent with pelvic calcification, autoamputation of the right uterine adnexa, and surface endometriosis of the left ovary is presented. The differential diagnosis of pelvic calcifications in adolescent females is discussed.

Eating disorders in American black men.

Eating disorders are rare in the black population, particularly in black men. A case of an atypical eating disorder in a black male adolescent is described. The clinical characteristics of this case are compared with others in the literature.