Clinical Correlates of Alcohol Abuse among Adolescent Psychiatric Inpatients in Israel.

BACKGROUND: Recent epidemiological studies have reported a world-wide increase in the rates of alcohol use among adolescents. Research has shown a strong link between alcohol abuse and psychiatric disorders. This study explored the clinical and demographic correlates of adolescents with a history of alcohol abuse (AA) compared to adolescents with no history of alcohol abuse (NAA) among a group of adolescent psychiatric inpatients in Israel. METHOD: Two hundred and thirty-eight subjects were screened, all were patients consecutively admitted to an adolescent inpatient unit at a university-affiliated mental health center in Israel during a 4-year period RESULT: Patients in the AA group were more prone to have a history of suicide attempts and self-injury compared to patients in the NAA group. Prevalence of attentiondeficit disruptive behavior disorders was more common in the AA group, and these patients were more prone to have a history of criminal activity and drug use. Median length of hospitalization was greater in the NAA group. LIMITATIONS: Limitations concerning attribution of causality due to the cross-sectional nature of this study. CONCLUSION: Higher prevalence of criminal behavior, selfinjury and suicide attempts associated with alcohol abuse may be related to higher levels of impulsivity, indicated by higher prevalence of attention-deficit disruptive behavior disorders. Alcohol-related disorders should be carefully screened and addressed in adolescent psychiatric units and in consequent ambulatory treatment settings.

Can computerized cognitive tests assist in the clinical diagnosis of attention-deficit hyperactivity disorder?

A group of 34 children and adolescents suspected of having attention-deficit hyperactivity disorder were referred for a computerized evaluation that included sustained attention, working memory, planning, and set-shifting. Although only sustained attention had reasonable specificity, all tests had questionable contribution to the diagnostic evaluation.

Understanding and knowledge of psychiatric treatment among adolescents and adults.

We evaluated the level of adolescent psychiatric patients' knowledge and understanding of their treatment in light of their competency to participate in decision-making processes related to their receiving treatment, and compared the adolescents' levels of understanding and knowledge to those of adult psychiatric patients. The study group consisted of 30 adolescents and 30 adults who were randomly selected from the inpatients of our mental health center. Consenting participants were interviewed and their objective knowledge of psychiatric treatments was evaluated by a specially designed questionnaire. Adolescents knew significantly more about adverse effects of treatment and showed a higher level of comprehensive general knowledge. These data indicate that adolescents are no less knowledgeable than adults and should be regarded as competent partners in the process of therapeutic decision making.

Reasons for referral for electroconvulsive therapy: a comparison between adolescents and adults.

OBJECTIVE: In order to improve our understanding of the use of electroconvulsive therapy (ECT) in adolescent patients, we aimed to evaluate the reasons for referral for ECT in different age groups. METHOD: We compared the reasons for adolescent and adult referrals by a retrospective file review of 13 consecutive adolescents and 56 consecutive adults treated in our ECT unit during a 5-year period. RESULTS: There was a significant association between age group and reason for referral. Non-response to pharmacotherapy was a significantly more common reason among adults. Adolescents were mainly referred due to catatonia and suicidal behaviour. CONCLUSION: Our results support the need to study reasons for referral to ECT, beyond non-response to pharmacotherapy, especially in adolescent patients.

Repetitive transcranial magnetic stimulation in the treatment of depression in adolescents: an open-label study.

OBJECTIVE: This open-label pilot study examined repetitive transcranial magnetic stimulation as a possible treatment of adolescent resistant depression. METHOD: Nine adolescents (aged 16-18 years) with severe resistant depression (determined by SCID) were recruited, and their depression, suicidality, and cognitive functions were evaluated before, during, and after a course of twenty 10-Hz, 2-second trains (intertrain intervals of 58 seconds) given over 20 min/d over 14 working days. RESULTS: Lower levels of depression with progression in therapy were recorded by both the Beck Depression Inventory and Child Depression Rating Scale measures (F1.7,14.01 = 4.52, P < 0.05; F4,32 = 6.645, P < 0.01, respectively). Three patients reached the primary outcome measure of less than 30% reduction in their Child Depression Rating Scale. The effect on suicidality was not significant. Side effects were considered mild. CONCLUSIONS: Repetitive transcranial magnetic stimulation might be a possible therapy for adolescent depression. Our preliminary findings warrant double-blind, controlled studies.

Cognition in young schizophrenia outpatients: comparison of first-episode with multiepisode patients.

Cognitive impairments are recognized as a central feature of schizophrenia (SZ), largely independent of other symptoms, and a major cause of poor functioning. Studies indicate cognitive deterioration in the first years after the onset of SZ. These studies, however, have been criticized for using a small sample size, for having limited monitoring of confounding variables, and for the inclusion of cohorts of different ages. The current study compared the cognitive profile of first-episode schizophrenia patients, multi-episode schizophrenia patients and healthy controls (n = 44, n = 39, and n = 44; respectively). The study focused on the early stages of the disorder, recruiting only young patients. All subjects underwent an extensively validated computerized cognitive assessment (Cambridge Neuropsychological Test Automated Battery). The results revealed widespread cognitive impairments in SZ patients, compared with healthy control subjects. The multiepisode SZ patients were significantly more impaired than the first-episode ones, with deficits mainly related to psychomotor speed, pattern memory, and executive functioning. The functioning in other cognitive domains (ie, attention and spatial memory) was deficient even at an early stage of the disorder. These findings can help clarify the course of cognitive decline in young-aged SZ patients and aid in the development of phase-appropriate interventions.

How many pins? A case report of a girl who swallowed more than 50 straight pins in a suicide attempt.

A 14-year-old girl was admitted after attempting suicide by swallowing over 50 pins. On admission, she complained of abdominal pain. A flat abdominal X-ray revealed numerous needle-like objects in the large intestine. After a period of observation we were able to diagnose her as suffering from a major depressive episode with psychotic features, post-traumatic stress disorder, physical abuse, neglect and inhalant abuse. Medically, the pins were spontaneously evacuated with her stools without any intervention. The mode of the suicide attempt was an important clue to raise suspicion of a psychotic episode. Two issues are discussed: 1) A "psychiatric" issue: the way in which an attempt is made should be considered as a factor not just for the evaluation of the suicidal risk, but also for the psychopathology. This case demonstrates that a bizarre attempt should raise the suspicion of a psychotic disorder. 2) A "general medical" issue: our experience with this patient was in accordance with common medical expectant management for patients who have swallowed multiple sharp objects once they have reached the large intestine. We conclude: 1) In the preliminary psychiatric evaluation, more emphasis should be placed on how bizarre the means of the suicide attempt as a possible sign of a psychotic psychopathology. 2) Treatment for adolescents who swallow numerous sharp objects should consist of expectant management once those objects reach the large intestine.

Learned irrelevance is disrupted in first-episode but not chronic schizophrenia patients.

Learned irrelevance (LIrr) is a pre-exposure effect in which uncorrelated presentations of a conditioned stimulus (CS) and an unconditioned stimulus (US) retard subsequent CS-US association. LIrr is closely related to the phenomenon of latent inhibition (LI). LI refers to the retarding effects of inconsequential stimulus pre-exposure on subsequent conditioning to that stimulus, and is considered to reflect the organism's capacity to ignore irrelevant stimuli. LI is disrupted in schizophrenia patients, due to faster learning of the association between the preexposed CS and the US. A new within-subject target-recognition LIrr procedure was applied. The target was either cued by a priming signal or appeared at random, and priming signals were novel or preexposed cues. Schizophrenia patients were compared to age- and sex-matched control subjects. Normal subjects (n = 24) have shown robust LIrr, namely, faster cue-target associations of novel compared to preexposed cues. Schizophrenia patients at the early stages of their first episode (n = 7) showed LIrr disruption, namely, cue-target associations to preexposed cues were as fast as for novel cues. Chronic patients during an acute phase (n = 18) did not show LIrr as they failed to learn the cue-target association. In addition to the LIrr paradigm the same subjects were tested in a covert-orientation task. No differences were observed between the groups on this task. The possible advantages of the new LIrr paradigm are discussed.

Gender differences in electroconvulsive therapy: a retrospective chart review.

BACKGROUND: There is a growing interest in gender differences of different psychiatric disorders, especially major depression. We sought a possible gender difference related to electroconvulsive therapy (ECT). METHODS: This retrospective study compared 20 male and 23 female depressed adult patients treated by ECT. We compared their findings on gender differences to those of 12 female and 4 male bipolar patients and 11 male and 19 female schizophrenic patients, all treated in the same ECT setting. RESULTS: Depressed female patients underwent significantly fewer antidepressant drug trials than males before being referred to ECT (t41=2.09, P<0.05). A similar gender difference was found in the treatment of patients suffering from schizophrenia: female patients underwent fewer pharmacological antipsychotic trials than males before being referred to ECT (t28=3.11, P<0.01). ECT was significantly more effective in female patients than in male patients suffering from schizophrenia (U=38, P<0.05). LIMITATIONS: This is a retrospective pilot study whose results are based on subjective evaluations. CONCLUSION: The findings of this study may support a gender difference both in referral and in the outcome of ECT. CLINICAL RELEVANCE: there might be a need to consider lowering the number of pre-ECT drug trials for depressed males and to consider ECT as a viable therapeutic option for schizophrenic females.

Use of topical application of lidocaine-prilocaine cream to reduce injection-site pain of depot antipsychotics.

This study took place in Israel and examined the use of a local topical anesthetic cream to ameliorate the pain at the injection site caused by depot antipsychotic medications. Fifteen consecutive outpatients who had schizophrenia and who were under treatment with depot antipsychotic medications were enrolled in this randomized, double-blind, placebo-controlled crossover study. The patients received either lidocaine-prilocaine cream or a placebo one hour before the injection. The degree of pain at the injection site was quantified by the patients' use of a visual analogue scale five minutes after the injection. The application of the lidocaine-prilocaine cream led to a significant reduction of pain compared with the placebo.

Hyperglycemia from olanzapine treatment in adolescents.

The increasing use of olanzapine for treating adolescent patients has brought with it greater awareness of the recognized side effects of this medication, especially weight gain. Of the reports of glucose dysregulation related to olanzapine therapy, only a few pertain to adolescents. We present five cases: two youths who consequently suffered from overt diabetes and three who responded with glucose dysregulation. According to the Naranjo probability scale, the relation of this phenomenon to olanzapine therapy is "probable." We consider the findings of the presented case series as justification for regular metabolic follow-up for apparently healthy adolescents receiving olanzapine therapy.

Obsessive-compulsive disorder in adolescent schizophrenia patients.

OBJECTIVE: The co-occurrence of obsessive-compulsive disorder (OCD) in adult patients with schizophrenia has been increasingly recognized. However, the rate of OCD comorbidity in adolescent schizophrenia patients has yet to be systematically evaluated. METHOD: The rate of DSM-IV OCD was evaluated in 50 adolescent inpatients with schizophrenia or schizoaffective disorder. The severity of schizophrenia and OCD symptoms was assessed with the Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms (SANS), and Yale-Brown Obsessive Compulsive Scale. RESULTS: Thirteen schizophrenia patients (26.0%) also met the DSM-IV criteria for OCD. This subgroup scored significantly higher on the SANS subscale for affective flattening or blunting. The total SANS score positively correlated with the total Yale-Brown Obsessive Compulsive Scale score. CONCLUSIONS: A substantial proportion of adolescent schizophrenia inpatients have concomitant OCD. A prospective study is needed to evaluate the clinical course, response to treatment, and prognosis for this complex disorder.