Consulting for substance abuse: mental disorders among adolescents and their parents.

Studies conducted outside of Scandinavia indicate that most adolescents with substance misuse problems suffer from co-morbid mental disorders. The present study assessed the mental health of adolescents seeking help for substance misuse problems in a large Swedish city. Parents' mental health was also examined. The sample included 97 girls with their 90 mothers and 52 fathers, and 81 boys with their 72 mothers and 37 fathers. The adolescents completed a diagnostic interview, either the Kiddie-SADs or the Structured Clinical Interview for DSM-IV (SCID) depending on their age. Their parents underwent diagnostic interviews with the SCID. Ninety per cent of the girls and 81% of the boys met criteria for at least one disorder other than substance misuse, and on average, they suffered from three other disorders, most of which had onset before substance misuse began. Almost 80% of the mothers and 67% of the fathers met criteria for at least one mental disorder other than alcohol and drug-related disorders. The findings concur with those reported from studies conducted in North America. The results suggest that in Sweden mental disorders are not being identified and effectively treated among some children and young adolescents who subsequently abuse alcohol and/or illicit drugs. Adolescents who consult for substance abuse problems require assessments and treatment by mental health professionals.

Systematic determination of the serum phenytoin level as an aid in the management of children with epilepsy.

The results from systematic determinations of the serum level of phenytoin in 121 epileptic children are reported. The range 12-25 mg/l is effective in most of the children, responding at all to phenytoin, and causes few and minimal side effects. Practically all children with pure grand mal epilepsy could be kept seizure-free on an optimal dose of phenytoin alone. Possibly the level aimed at should be higher in severe cases than in mild ones. Our initial dose was 10 mg/kg daily; this dose was adjusted according to the serum level until the desired range was reached. Phenytoin produced a lower serum level than the same dose of its sodium salt. Interaction possibly occurs with carbamazepine, which tended to decrease the level, and with acetazolamide, which tended to increase the level. With the help of serum phenytoin determinations an individual dose can be chosen for each patient and phenytoin therapy be rendered safer and more effective.