Gay and lesbian issues in child and adolescent psychiatry training as reported by training directors.

OBJECTIVE: Although increased evidence of disproportionate psychosocial risk and other health problems encountered by lesbian, gay male, and bisexual (LGB) youths has emerged, no study has described how the topic of homosexuality is addressed within child and adolescent residency psychiatry training. METHOD: Residency training directors in U.S. child and adolescent psychiatry programs were asked questions about instruction on the topic of homosexuality and the care of LGB patients, the department's view of whether homosexuality represents a pathological condition, the director's awareness of LGB colleagues and residents, and the director's opinion of LGB residents' disclosure of their homosexuality to their patients and patients' families. Asking similar questions facilitated a comparison of survey results with those of an earlier study of general psychiatry training directors. RESULTS: The reported departmental attitudes about whether homosexuality represents a pathological condition were essentially equivalent in general and child programs. Child and adolescent training directors were, however, less likely to have a favorable view of disclosure of sexual orientation to patients, less likely to know LGB residents or faculty, and less likely to report LGB residents an asset to their departments. CONCLUSIONS: The prediction that the majority of child and adolescent training programs would reflect a heightened awareness of the vulnerability of LGB youths was not confirmed.

Infant with mos45,x/46,XY/47,XYY/48,XYYY: genetic and clinical findings.

We describe an infant with mos45,X/46,XY/47,XYY/48,XYYY who presented with ambiguous genitalia. Her phenotype was also remarkable for minor ear and eye anomalies and coarctation of the aorta with bicuspid aortic valve. Laparoscopy revealed bilateral Fallopian tubes and a left infantile testis with epididymis. Chromosomal analyses of blood, skin, aorta, right Fallopian tube, and left gonadal tissue showed mos45,X/46,XY/47,XYY/48,XYYY. The 46,XY cell line was identified with routine trypsin-Giemsa banding only in cultured cells from an aortic biopsy. Fluorescence in-situ hybridization (FISH) was utilized to identify the presence of 46,XY cells in other tissues. The clinical manifestations of this patient are discussed and compared with those of similar cases of Y chromosome aneuploidy. To our knowledge, this is the first report of a patient with this unusual karyotype.

Cross-gender behavior and psychopathology in boy psychiatric outpatients.

One hundred 5- to 12-year-old boys referred for outpatient psychiatric evaluation were assessed for cross-gender behavior using the Child Behavior and Attitude Questionnaire (CBAQ) and the Child Game Participation Questionnaire (CGPQ), and for possible associated psychopathology using the Child Behavior Checklist (CBCL) and clinical psychiatric (DSM-III) diagnoses. On the two feminine scales of the CBAQ and CGPQ, 30 to 50% scored within defined clinical ranges. High feminine scale scorers did not have higher Total CBCL scores than lower feminine scale scorers, and scores on the feminine scales correlated minimally with scores on the CBCL broad and narrow-band behavior problem scales, except for a significant positive correlation with the Delinquent subscale. No particular clinical psychiatric diagnoses were significantly associated with high feminine scorers: however, high feminine behavior scorers tended to have more conduct problems and mixed adjustment disorders and less anxious and depressive psychopathology. Clinicians were not alert to the degree of cross-gender behavior found, perhaps due to the concomitant externalizing psychopathology and masculine behavior in these same patients.

Molindone hydrochloride treatment of hospitalized children with conduct disorder.

Treatment-emergent symptoms and behavioral changes were assessed during an 8-week double-blind study comparing molindone and thioridazine in 31 aggressive hospitalized children (ages 6-11). Molindone was found to be as effective as thioridazine in this sample. Adverse effects differed (nonsignificantly) for the two groups, with more sedation in the thioridazine-treated children. Clinical records from 6 adolescent inpatients treated with molindone were reviewed as a comparison group. Molindone is a relatively safe neuroleptic for child and adolescent inpatients because of its short half-life and minimal prolonged tissue accumulation. Additional studies on different child populations are necessary before the proper indications for molindone usage in the pediatric group can be established.