Venlafaxine in the treatment of children and adolescents with major depression.

Major depression is commonly found in the child and adolescent population. Venlafaxine, a new antidepressant, has been used successfully in adults; however, its use in children and adolescents has been very limited. This study evaluated the efficacy and side effect profile of venlafaxine in the treatment of depression in children and adolescents. In a double-blind, placebo-controlled, 6-week study, 33 subjects between the ages of 8 and 17, who met DSM-IV criteria for major depression, were treated with either venlafaxine and therapy or placebo and therapy. Patient progress data were obtained by weekly rating assessments. Data on side effects were also obtained weekly. The statistical analysis indicated a significant improvement over time, but it could not be attributed to venlafaxine drug therapy. These findings are consistent with other studies where the efficacy of antidepressants in the treatment of major depression in this age population remains unproven. Low dosage and short length of treatment may account for the lack of efficacy. The findings did, however, suggest a low side-effect profile. Further studies are recommended to assess efficacy and to corroborate its safety in children and adolescents.

Clonidine therapy for comorbid attention deficit hyperactivity disorder and conduct disorder: preliminary findings in a children's inpatient unit.

This retrospective study examined the clinical course of 18 prepubertal boys (aged 6 to 12) who had dual diagnoses of attention deficit hyperactivity disorder and conduct disorder and who received clonidine on an inpatient basis after failed trials of conventional drug therapy, consisting predominantly of psychostimulants. The effects of clonidine were assessed during inpatient treatment and after discharge at intervals of 1 to 2 months. Eleven (61%) of the children had marked improvement as measured by clinical impression. Transient sedation lasting 2 to 3 days occurred after initial administration or dosage increase; otherwise, clonidine was well tolerated. Our findings suggest that clonidine may prove to be an alternative treatment of comorbid attention deficit hyperactivity disorder and conduct disorder.

A psychiatric population of prenatally cocaine-exposed children.

The backgrounds and behaviour of 40 prenatally cocaine exposed children referred to the child psychiatry program of an inner-city teaching hospital are explored. The population described is unique to the literature in these ways: (1) Most of the children were not detected as cocaine-exposed at birth, and were disclosed as cocaine-exposed by historical account. (2) Most of the children had lived within drug-dominated home environments for varying lengths of time. Findings indicated that the children receiving intervention early in life, whether detected as cocaine-exposed at birth or by historical account, fared much better socially and emotionally as measured by rate of abuse and severity of psychiatric symptoms. It is concluded that instances of prenatal cocaine exposure should be ascertained at the earliest possible point to intervene in potentially deleterious environmental outcome and associated psychiatric morbidity. Four illustrative cases are presented.

Evaluation and treatment of rage in children and adolescents.

Rage is characterized by an unpredictable and primitive display of violence that is out of proportion to the provoking event and often threatens serious self-injury or harm to others. New insight into the pathogenesis of unpredictable violent behavior has been gained largely as a result of neurochemical, neuropsychological and brain imaging studies. This article examines episodic rage from a neuropsychiatric perspective. Three cases illustrating the evaluation and treatment of rage in childhood and adolescence are presented.

Subcategories of attention deficit hyperactivity disorder.

It is estimated that as many as 20% of school-aged children have an attention deficit hyperactivity disorder (ADHD). Hyperactivity is recognized as a common symptom of a variety of childhood disorders. In many instances the symptoms of ADHD signal the onset of severe psychopathology and indicate comorbidity. Because a significant number of children exhibiting symptoms of ADHD are unresponsive to stimulants or have side effects, the use of such drugs is contraindicated. In this article we describe ADHD according to subcategories in an effort to distinguish diverse groups of children with ADHD and to identify those responding best to psychopharmacologic agents other than stimulants. Further understanding of the neurobiology of ADHD is needed to more clearly define and treat this condition.

A review of Klinefelter's syndrome in children and adolescents.

Klinefelter's syndrome (XXY syndrome) has been defined as the spectrum of phenotypic features resulting from a sex chromosome complement that includes two or more X chromosomes and one or more Y chromosomes. Cytogenetic surveys conducted across the world have identified a sizable population of XXY males, who have been studied extensively from the newborn period through adolescence. The longitudinal studies of these boys have produced an accurate and reliable account of the growth and development of the XXY male. There now exists a growing body of knowledge that suggests that XXY boys often experience language deficits, neuromaturational lag, academic difficulties, and psychological distress, which may be reduced or ameliorated by early identification, anticipatory guidance, and proper medical management.

Klinefelter syndrome: the need for early identification and treatment.

A 14-year-old boy presented with severe academic difficulties, emotional disturbance, borderline mental retardation, tall stature, delayed sexual development, small testes, and gynecomastia. Chromosomal analysis revealed an additional X chromosome compatible with the diagnosis of 47, XXY Klinefelter Syndrome. This case retrospectively follows the progression of learning and behavioral problems occurring in the primary grades prior to the diagnosis of Klinefelter Syndrome and reports the effects of psychiatric treatment, modified educational placement, testosterone supplementation, and corrective surgery in adolescence. The early identification of Klinefelter Syndrome is vital to the XXY male in that many of the developmental, behavioral and emotional problems associated with an additional X chromosome are amenable to treatment.