Mothers' reactions to prenatal diagnostic procedures and dexamethasone treatment of congenital adrenal hyperplasia.

A retrospective survey of mothers' attitudes toward and experiences of chorionic villus sampling, amniocentesis and dexamethasone (DEX) treatment was conducted in 38 women who underwent a prenatal diagnostic procedure for congenital adrenal hyperplasia because of a previously affected child (n = 37) or because the mother herself was affected (n = 1). Both diagnostic procedures were well tolerated and almost every woman said that the anxiety or discomfort associated with the procedure was far outweighed by the value of knowing whether or not her fetus was affected. The earlier diagnostic information provided by chorionic villus sampling was highly valued. Maternal side-effects of DEX were common (75%) and more than one-third of the women rated one or more side-effects as "severe' (weight gain, fatigue, stomach pain, irritability, facial hair growth). Many women expressed anxiety about possible short- and long-term side-effects of DEX on their unborn children and themselves but all said they would undergo DEX treatment again to prevent virilization.

Seasonal rhythm of platelet [3H]imipramine binding in adolescents who attempted suicide.

OBJECTIVE: This study was designed to determine the seasonality of serotonin functions among adolescents who attempt suicide. METHOD: Platelet [3H]imipramine binding was assessed over a period of 18 months in 98 adolescents who attempted suicide and a comparison group of 23 never-suicidal youths with conduct disorder. RESULTS: [3H]Imipramine (Bmax) was uncorrelated with age, but showed considerable seasonal variability over time in those who had attempted suicide. CONCLUSIONS: [3H]Imipramine binding density in adolescents who attempted suicide exhibited significant seasonality, reaching a nadir in late winter/early spring.

Effects of early prenatal dexamethasone on the cognitive and behavioral development of young children: results of a pilot study.

The effect of early prenatal dexamethasone (DEX) exposure on cognitive and behavioral development, behavior problems, and temperament were examined in 26 consecutively identified children aged 6 mo to 5 1/2 years, whose mothers had been DEX-treated during pregnancy because their offspring was at risk for congenital adrenal hyperplasia (CAH), and compared with 14 children from untreated CAH-risk pregnancies. Three children in each group were CAH-affected. Assessments were performed by way of mother-completed standard questionnaires. No significant differences in cognitive abilities or behavior problems were identified. On temperament questionnaires, DEX-exposed children showed more Shyness (p < .004), greater Emotionality (p < .03), less Sociability (p < .04), and a trend for greater Avoiddance (p < .07) than unexposed children. DEX-exposed children also had significantly higher Internalizing (p < .002) and Total Problem scores (p < .05) on the behavior problem measure for 2-3 year olds. The results should be considered preliminary until they have been replicated by the study of a larger sample and direct examination of the children.

Are adolescent suicide attempters noncompliant with outpatient care?

The outpatient clinic attendance patterns of 115 consecutively referred 10- to 18-year-old suicide attempters and of 110 nonattempters were compared. The two groups did not differ in number of appointments scheduled or missed, but attempters kept significantly fewer appointments than did nonattempters. Seventy-seven percent of each group dropped out of treatment, but attempters dropped out significantly faster. Attendance and dropout were unrelated to age, reason for referral, or previous attempts. Girls missed more appointments than did boys, and Hispanic patients kept a smaller percentage of scheduled appointments than did other ethnic groups. We conclude that adolescent attempters are not more likely to drop out of treatment but keep fewer appointments and remain in care more briefly than do other outpatients. Recommendations for triage and brief case management are made.

Psychiatric diagnoses in minority female adolescent suicide attempters.

Psychiatric diagnoses were examined using the Schedule for Affective Disorders and Schizophrenia for School-Aged Children semistructured interview among three groups of minority adolescent females aged 12 to 17:61 suicide attempters, 31 psychiatrically disturbed nonattempters, and 23 nonattempting, nondisturbed girls. Major or minor depressive disorder was found in 42% of the suicide attempters; conduct disorder in 46%; multiple diagnoses in 38%, no diagnosis in 13%. These rates were very similar to those found in disturbed nonattempters. Only one symptom, suicidal ideation, distinguished attempters from disturbed nonattempters, while many symptoms distinguished these two groups from nondisturbed nonattempters.

Cognitive style and pleasant activities among female adolescent suicide attempters.

Cognitive style and pleasant activities of 77 suicide-attempting female minority adolescents were compared with those of 2 groups of non-suicide-attempting female minority adolescents, 39 who were psychiatrically disturbed and 23 who were nondisturbed. Suicide attempters differed from other groups, even when depression and IQ were statistically controlled. They reported significantly fewer alternatives for solving interpersonal problems, were significantly more focused on problems, and were more likely to report a wishful thinking style of coping in stressful situations than were members of the nondisturbed comparison group. Across groups, depression was associated with significantly more dysfunctional attributions. Interpersonal problem-solving ability and attributional style best distinguished the suicide attempters. Results suggest using different cognitive-behavioral interventions with depressed and nondepressed minority female adolescent suicide attempters.

Pediatric management of suicidal behavior.

Emergency evaluation of the adolescent suicide attempter presents the pediatrician with a complex challenge. The attempter is acutely ill, in a psychosocial crisis, and may have one or more major mental disorders and a highly disturbed family. The adolescent rarely has planned the attempt for more than a few minutes, and usually does not know the dangerousness of the chosen method. Suicide attempts are quite common among adolescents and suicide quite rare, yet the risk of later death among attempters is substantial. Suicide is associated with a variety of problems and diagnoses, and in most ways attempters do not differ from other emotionally troubled adolescents. Suicide attempters and their families are often quite resistant to treatment, and this resistance seems to increase with the number of problems identified. How should the clinician proceed? We have stressed the importance of rapid evaluation of parent and adolescent to identify individual and family risk factors (Table 1). As the number of risk factors increases, greater caution should be exercised. A short hospitalization can allow a more thorough evaluation of complicated cases. Brief, problem-oriented therapy (Table 2) is most likely to be accepted by the family and can result in rapid improvement. A smaller number of adolescents will require long term care.

Prediction of intellectual deficits in children with acute lymphoblastic leukemia.

Possible predictors of reported lower cognitive functioning in irradiated children with acute lymphoblastic leukemia (ALL) were investigated. Thirty-four subjects, 5-14 years old, with ALL in continuous complete remission and without evidence of current or past central nervous system disease, were examined 9-110 months after diagnosis, using standard measures of intelligence and academic achievement. Subjects with a history of post-irradiation somnolence syndrome were significantly older at diagnosis than nonsomnolent subjects. Intelligence (IQ) was found to be unrelated to history of somnolence syndrome. IQ and achievement were unrelated to age at irradiation, irradiation-examination interval, and radiation dosages. The strongest predictor of IQ by far is parental social class. The importance of controlling for social class differences when searching for treatment effects on IQ and achievement is stressed.