Cognitive traits in inpatient adolescents with and without prior suicide attempts and non-suicidal self-injury.

OBJECTIVE: Establishing a psychiatric diagnosis and assessing suicidal tendencies is often a challenging task particularly in the early stages of an illness. Cognitive impairments characterize different psychiatric entities, but there is no known specific cognitive deficit profile that could help the clinician in achieving the diagnostic task. This study's aim was to establish a cognitive profile and test its ability to differentiate psychiatric inpatient subgroups, in terms of suicidal risk and diagnosis. The sample constituted of 76 consecutive admissions to the psychiatric adolescent day-care unit, who were admitted for any diagnosis. Assessment included full psychiatric interview and cognitive evaluation, using the COGNISTAT test. RESULTS: Of the 76 participants, 58% reported having suicidal ideation and 29% reported a prior attempted suicide. Subjects who had a prior suicide attempt had better orientation and attention scores in the COGNISTAT. Other cognitive domains did not differentiate between groups or diagnoses. CONCLUSION: These preliminary results suggest a significant association between specific cognitive characteristics and suicidal behavior in adolescents. Those cognitive characteristics might prove clinically useful in the assessment of suicide risk. Further study is needed to establish this association and generalize the conclusion to different populations.

Perfectionism, narcissism, and depression in suicidal and nonsuicidal adolescent inpatients.

OBJECTIVE: The aim of this study was to investigate the relationship between 2 psychological profiles: (a) the intrapersonal profile, involving self-critical depression, self-oriented perfectionism, and narcissism, and (b) the interpersonal profile, involving dependent depression and socially prescribed perfectionism, and the association of these 2 profiles with suicidal behavior among adolescent inpatients. METHODS: One hundred adolescents, admitted to a university-affiliated psychiatric adolescent inpatient unit in Israel, completed the Depressive Experience Questionnaire for Adolescents, the Child and Adolescent Perfectionism Scale, and the Narcissistic Personality Inventory. The Suicidal Potential Interview was used to evaluate suicidal behavior and separate them into low-risk and high-risk groups. RESULTS: Dependent depression correlated positively and significantly with severity of suicidal behavior. Adolescent inpatients with high levels of suicidal behavior (n = 54) were more dependent in terms of depression and were more inclined to socially prescribed perfectionism compared with adolescent inpatients with low levels of suicidal behavior (n = 45). The components of the intrapersonal profile did not correlate with severity of suicidal behavior; however, low narcissism scores characterized the psychological function that strongly predicted severe suicidal behavior. CONCLUSIONS: The findings indicated that the conceptualization of 2 broad intrapersonal and interpersonal profiles in adolescent inpatients may have some validity in terms of the interpersonal dimension. The components of the interpersonal profile related to severe suicidal behavior and may be important in planning treatment strategy.

Are names of children with attention deficit hyperactivity disorder more 'hyperactive'?

BACKGROUND: The role of the meaning of given names has been noted in psychotherapy as well as in everyday life. This study aimed to investigate the possible association between the nature of given names of children and attention deficit hyperactivity disorder (ADHD) diagnosis. SAMPLING AND METHODS: A total of 134 given names of children and adolescent patients diagnosed as having ADHD were compared with those of an age- and gender-matched randomly chosen control group from the general population. The first names of the two cohorts were compared with regard to the following: the literal meaning of their names, whether the name constitutes a verb, the prevalence of each name and their length (number of syllables). RESULTS: The meaning of first names of children and adolescents with ADHD combined type were rated by referees as expressing significantly more activity and containing less syllables than the names of controls. In addition, the prevalence of their names was significantly lower than that of names used in the general population. All findings remained significant following Bonferroni adjustment. CONCLUSIONS: Our findings demonstrate an intriguing relationship between children's given names and ADHD diagnosis. Given names may serve as a possible predictor of later diagnosis of ADHD. Clinicians should be more attentive to given names in the context of child psychiatric evaluation and therapy.

Late potentials in the signal-averaged electrocardiogram in pre-pubertal children with ADHD, before and after methylphenidate treatment.

Reports on sudden cardiac death (SCD) of children and adolescents treated with stimulant agents have raised concerns regarding the need for cardiovascular monitoring and risk stratification schedules. Cardiac ventricular late potentials (LPs) represent delayed ventricular activation that might predispose to fatal ventricular arrhythmias and SCD in cardiac patients. LPs have not previously been measured in children with attention deficit/hyperactivity disorder (ADHD). LPs were measured in 18 physically healthy ADHD children (5 girls and 13 boys, age 11.9 ± 2.5 years, treatment duration 2.6 ± 1.9 years) before and 2 h after oral methylphenidate administration. No significant changes were detected and LPs were found to be within normal ranges. In conclusion, this preliminary small-scale study suggests that methylphenidate in physically healthy children with ADHD was not associated with cardiac ventricular LPs, suggesting the safety of the agent in this age group.

Suicidal behavior and related traits among inpatient adolescents with first-episode schizophrenia.

PURPOSE: Suicide is a major cause of death in adolescents with first-episode schizophrenia (FES). The aim of this pilot study was to compare suicide-related traits between subjects with FES and those with other psychopathologies to evaluate risk factors for suicidal behavior. METHOD: Twenty-five inpatient adolescents with FES and a control group of 28 psychiatric inpatients matched for sex and age were assessed for depression, anger, criminal behavior, aggression, and suicidal ideation, risk, and potential. RESULTS: The adolescents with FES had significantly lower depression (P = .003), anger (P = .025), and criminal behavior (P = .022) than did the controls. However, although suicide ideation was greater in the subjects with FES (P = .003), suicide risk was significantly lower than that in controls (P = .004). CONCLUSION: Decreased levels of both depression and anger as part of affective constriction in the group with schizophrenia could explain why the increased suicide ideation did not lead to a higher suicide risk in these inpatients. This study highlights the importance of distinguishing between suicidal ideation and actual suicide risk. We demonstrated that thoughts of suicide do not necessarily translate into an actual risk of suicidal behavior in adolescents with schizophrenia.

Alterations in QT dispersion in the surface electrocardiogram of female adolescent inpatients diagnosed with bulimia nervosa.

Increased QT dispersion (QTd) reflects cardiac autonomic imbalance and indicates elevated risk for cardiac arrhythmias. In the present study, we assessed heart rate, QT and corrected QT intervals, and QTd in 20 acutely ill bulimia nervosa adolescent inpatients on admission and discharge. A significant decrease in QTd was found between admission and discharge (67 +/- 13 milliseconds vs 55 +/- 12 milliseconds, respectively; P = .0005). The decrease in QTd values correlated significantly with the decrease in the frequency of bingeing/purging behaviors (r = 0.51, P = .022). No significant correlations were found between the electrocardiographic indices and other clinical and laboratory measures. The elevated QTd in malnourished bulimia nervosa patients might indicate a cardiac autonomic imbalance that is most likely corrected after symptomatic improvement.

Alterations in QT dispersion in the surface electrocardiogram of female adolescents diagnosed with restricting-type anorexia nervosa.

OBJECTIVE: QT dispersion (QTd), defined as the difference between the longest interval and the shortest interval in the 12-lead electrocardiogram (ECG), is a measure of myocardial repolarization inhomogeneity. We assessed QTd in malnourished anorexia nervosa (AN) inpatients and following weight restoration. METHODS: QTd analysis, anthropometric evaluations, and laboratory tests were carried out in 30 malnourished female adolescent AN restricting-type (AN-R) inpatients and following weight restoration. RESULTS: A significant increase was found in weight/height ratio and body mass index from malnourished stage to weight restoration, paralleled by a significant decrease in QTd (70+/-16 vs. 47+/-16 ms; P<.0001). No correlations were found between ECG indices and anthropometric and laboratory measures. CONCLUSION: Elevated QTd in malnourished AN-R inpatients may indicate possible cardiac autonomic imbalance and/or myocardial damage, likely corrected following weight restoration.

QT interval and dispersion in very young children treated with antipsychotic drugs: a retrospective chart review.

OBJECTIVES AND BACKGROUND: QT dispersion (QTd) is a measure of interlead variations of the surface 12-lead electrocardiogram (ECG). Increased QTd, found in various cardiac diseases, reflects cardiac instability and risk for lethal cardiac arrhythmias. Research suggests a link between psychotropic treatment, ECG abnormalities (QT prolongation), and increased sudden cardiac mortality rates. Reports of sudden death in children treated with psychotropic drugs have raised concerns about cardiovascular monitoring and risk stratification. QTd analysis has not been investigated in very young children treated with antipsychotic drugs. In the present retrospective chart review study, we calculated QT interval, QTd, and their rate-corrected values in very young children treated with antipsychotics. METHODS: The charts of 12 children (ages 5.8 +/- 0.98 yr; 4 girls, 8 boys) were examined before initiation of antipsychotic treatment [risperidone (n = 7), clotinapine (n = 1), and propericiazine (n = 4)] and during the maintenance period after achieving a positive clinical response. Three children were concomitantly maintained on methylphenidate. QT interval, QTd, and their rate-corrected values were calculated. RESULTS: QT interval, QTd, and their rate-corrected values were all within normal values both before and after successful drug treatment. CONCLUSIONS: This preliminary, naturalistic, small-scale study suggests that antipsychotic treatment, with or without methylphenidate, in very young children is not commonly associated with significant alterations of QT interval and dispersion, suggesting the relative safety of these agents in this unique age group.

The use of illicit substances in adolescent schizophrenia inpatients.

Illicit substance use is a common co-morbidity in adolescent-onset schizophrenia/ schizoaffective patients. This study aimed to evaluate the rates of substance use among adolescent schizophrenia inpatients as compared to the general adolescent population. A total of 188 inpatients consecutively admitted to psychiatric adolescent inpatient unit were compared to a representative sample of 26,543 control adolescents screened for substance use by the Israel Anti-Drug Authority during the same time period. All illicit substances, except for opiates, were used in significantly higher rates by the inpatient sample. The distribution of the used psychoactive substances was different in the inpatient setting. Specific prevention and treatment programs must be developed in order to cope with this crucial clinical issue in these high-risk patients.

Dimensional complexity of the neuronal activity in a rat model of depression.

The Flinders sensitive line of rats is a widely accepted and validated model of depression. These rats demonstrate abnormalities in limbic dopamine neurotransmission, suggesting disturbed neuronal activity in the ventral tegmental area. Interspike interval time-series were recorded from the ventral tegmental area of control Sprague-Dawley and Flinder sensitive line rats. These data were analyzed using standard measures (mean firing rate, bursting activity and spectral analysis) as well as the pointwise correlation dimension, a nonlinear measurement characterizing the complexity degree of dynamic systems. Pointwise correlation dimension, but not standard analysis revealed a significant difference between the animal lines. Our results suggest that nonlinear analyses can detect dysregulation of the mesolimbic dopaminergic system and shed light on the pathophysiology of depression.

Alterations in QT dispersion in medicated schizophrenia patients following electroconvulsive therapy.

QT dispersion (QTd) is a measure of interlead variations of the surface 12-lead electrocardiogram (ECG). Increased QTd, found in various cardiac diseases, reflects cardiac instability and is associated with increased risk for cardiac death. Research suggests a link between antipsychotics, ECG abnormalities (QT prolongation) and increased sudden cardiac mortality rates. However, QTd analysis has been scarcely investigated in schizophrenia patients. We calculated QTd in 20 medicated psychotic inpatients with schizophrenia, before and 3 days after electroconvulsive therapy (ECT), concomitantly with Brief Psychiatric Rating Scale (BPRS) assessment. QT interval and the rate-corrected QT (QTc) were abnormally prolonged before ECT. However, although QT was significantly shortened, QTc showed only a marginal decrease after ECT. QTd, the rate-corrected QTd, as well as BPRS, showed a significant decrease after ECT. Further large-scale studies are warranted to determine if QTd can serve as a marker for response to ECT, and if it is a risk factor for sudden cardiac death in schizophrenia patients.

DRD4 exon III polymorphism and response to risperidone in Israeli adolescents with schizophrenia: a pilot pharmacogenetic study.

This study examined the possible association between the polymorphism in the dopamine receptor DRD4 gene and response to risperidone among 24 Israeli Jewish adolescent inpatients with first-episode schizophrenia. Response was categorically determined by a change of >40% on the Brief Psychiatric Rating Scale (BPRS). No significant association was found between the DRD4 genotype and clinical response, although carriers of <7 repeat alleles demonstrated higher response rate (10/20 vs. 0/4, P=0.11). Studies in larger groups of adolescent schizophrenia patients are warranted to clarify the possible association between DRD4 exon III repeat alleles and the response to risperidone.

QT dispersion in patients with social phobia.

BACKGROUND: QT dispersion (QTd) is the maximal interlead difference in QT interval on the surface 12-lead electrocardiogram (ECG). An increase in QTd is found in various cardiac diseases and reflects cardiac autonomic imbalance. It has recently been associated with increased anxiety levels, thereby predisposing affected individuals to fatal heart disease. This is the first study to assess QTd in social phobia, as a marker of anxiety-induced cardiac dysregulation. METHODS: QTd and rate-corrected QTd were measured in 16 physically healthy and non-depressed outpatients with long-term (mean 28+/-12.2 years; age 37.9+/-9.6 years) social phobia (SP) and in 15 physically and mentally healthy age- and gender-matched controls. The Liebowitz Social Anxiety Scale (LSAS) was scored concomitantly. The intra- and inter-observer reproducibilities of QTd were highly correlated (r=0.96, P<0.001; r=0.74, P=0.002, respectively). RESULTS: QTd and rate-corrected QTd were significantly higher in the patients with SP compared to the controls (70+/-21 versus 43+/-10 ms, P<0.001 and 75+/-23 versus 46+/-10 ms, P<0.001, respectively), and highly correlated with the two LSAS subscores. CONCLUSIONS: Prolonged SP is associated with an increase in QTd. This association may result from prolonged anxiety and, in turn, a decrease in vagal modulation and/or increase in sympathetic modulation. Further large-scale epidemiological studies are needed to determine if increased QTd can serve as a trait/state marker, and if it is a risk factor for sudden cardiac death in patients with SP.

Heart rate variability increases in elderly depressed patients who respond to electroconvulsive therapy.

OBJECTIVES: To evaluate the parasympathetic modulation in elderly inpatients with major depressive disorder (MDD) before and after electroconvulsive therapy (ECT) using both linear and nonlinear methods of heart rate variability (HRV) analysis. METHOD: A measure of local dimensional complexity (pointwise correlation dimension, PD2), as well as spectral analysis measures (LF, low-frequency range; HF, high-frequency range) were calculated for the heart rate time series of 10 elderly inpatients with MDD (70+/-7 years) before and after ECT. Hamilton Depression Rating Scale (HAM-D) was evaluated concomitantly. RESULTS: Only the responders to ECT (n=7; >or=50% reduction in HAM-D) exhibited a significant increase in PD2 (P=.0035), which showed a tendency towards a correlation with symptom improvement (r=.73, P=.06). Spectral analysis measures did not show a significant difference after ECT. CONCLUSION: Elderly patients with MDD, who respond to ECT, might show increased vagal modulation. Since nonlinear HRV measures have been shown to be reduced by aging, similar to cholinergic deficit, they might shed light on the increased risk for cardiac mortality in depression.

Attention patterns in children with attention deficit disorder with or without hyperactivity.

The objective of this study was to differentiate the attention patterns associated with attention deficit disorder with or without hyperactivity using continuous performance test (CPT). The diagnoses were based on the DSM-III, III-R, and IV criteria and of the 39 children who participated in the study, 14 had attention deficit disorder with hyperactivity (ADDH) and 11 had attention deficit disorder without hyperactivity (ADDWO), while 14 normal children served as a control group. Attention patterns were examined according to the performance of subjects on the CPT and parental scores on the ADHD Rating Scale, the Child Attention Profile, and the Conners Rating Scale. CPT performances were assessed before and after administration of 10 mg methylphenidate. We found as hypothesized that the CPT differentiated between the ADDH and ADDWO groups. However, contrary to our expectations, the ADDH children made more omission errors than the ADDWO children; they also showed more hyperactivity and impulsivity. The performance of both groups improved to an equal degree after the administration of methylphenidate. It is concluded that different subtypes of the attention deficit disorders are characterized by different attention profiles and that methylphenidate improves scores on test of continuous performance.

Atypical neuroleptic malignant syndrome associated with risperidone treatment in two adolescents.

Neuroleptic Malignant Syndrome (NMS) is a known, life threatening, side effect of classical antipsychotic drugs. We report two cases of 16 and 17 year old males, who suffered life-threatening "NMS-Like" syndromes in association with Risperidone treatment. Further controlled studies are needed.

Effectiveness and safety of citalopram in hospitalized adolescents with major depression: a preliminary, 8-week, fixed-dose, open-label, prospective study.

OBJECTIVE: Citalopram is widely used in adolescents with major depressive disorder (MDD) and anxiety; however, data on efficacy and safety are still limited and inconsistent. The aim of this study was to evaluate both the efficacy and the safety of citalopram for treatment of MDD and anxiety symptoms in adolescent inpatients. METHODS: An open-label, prospective design of an 8-week trial with a fixed dose of 20 mg/d of citalopram was performed in 10 hospitalized adolescents. Clinical state was assessed by Hamilton Depression (HAM-D 17) and Hamilton Anxiety scales, Beck Depression Inventory (BDI), and the Clinical Global Impression-Severity Scale for depression. Suicidal risk was assessed by the Suicide Risk Scale. A 30% improvement in the rating scales was considered as being a response to the treatment. RESULTS: After 8 weeks, depression levels as measured by the HAM-D 17 (P = 0.002), the BDI (P = 0.011), and the Clinical Global Impression-Severity Scale (P = 0.002) showed significant improvement. So did anxiety levels, as measured by the Hamilton Anxiety (P = 0.026) at end point. Subjective depression level (BDI) decreased significantly between week 2 and 4 (Z = -2.36, P = 0.018), whereas objective depression level (HAM-D 17) decreased significantly between week 4 and 6 (Z = -2.53, P = 0.012). Suicide risk, as assessed by the Suicide Risk Scale, however, increased significantly after 8 weeks (P = 0.011). CONCLUSIONS: This pilot small-scale trial found that citalopram was effective for both depressive and anxiety symptoms in adolescents with MDD and that response started as early as the second week. However, suicidal risk was elevated for some of the subjects. Larger randomized placebo-controlled trials are needed.

Late potentials in the signal-averaged electrocardiogram in schizophrenia patients maintained on antipsychotic agents: a preliminary naturalistic study.

In the present, preliminary, naturalistic study, cardiac ventricular late potentials (LPs), were measured in 33 physically healthy schizophrenia patients (13 - females and 26 - males, age - 45.5+/-8.8years) maintained on typical and atypical antipsychotic agents. These LPs represent delayed ventricular activation that might predispose to fatal ventricular arrhythmias and sudden cardiac death (SCD) in cardiac patients. Sixteen of the 33 patients ( approximately 48%) were found to be positive for LPs (compared to 3.7-6% in the general population). No association was found with any of the following: drug type, anti-cholinergic burden, daily dose of antipsychotic agents, age, gender, disease duration, QT(c) interval and QT dispersion. Further large-scale longitudinal prospective studies are warranted to substantiate our findings and to clarify their impact on the excess cardiac morbidity and mortality in schizophrenia patients.

Early repolarization in young children with attention-deficit/hyperactivity disorder versus normal controls: a retrospective preliminary chart review study.

OBJECTIVE AND BACKGROUND: Early repolarization (ER), considered a common and benign electrocardiographic pattern on the surface 12-lead electrocardiogram (ECG), was recently found to be prevalent among patients with idiopathic ventricular fibrillation. It is also highly predominant in physically active young males. Reports on sudden cardiac death (SCD) of children and adolescents treated with psychotropic agents have raised concerns regarding the need for cardiovascular monitoring and risk stratification schedules. The rate of ER pattern has not been estimated in children with attention deficit/hyperactivity disorder (ADHD). Thus, in the present retrospective chart review study, we estimated the rate of ER pattern, as well as RR, QT, and QTc intervals, from ECG tracings of physically healthy children with ADHD versus physically and mentally healthy controls. METHODS: The ECG tracings of 50 children (aged 8.7 +/- 1.4 years; 12 girls, 44 boys) diagnosed as suffering from ADHD were compared to 55 physically and mentally healthy controls (aged 8.25 +/- 2.1 years; 20 girls, 35 boys). ER was defined as an elevation of the QRS-ST junction (J point) of at least 0.1 mV from baseline with slurring or notching of the QRS complex, and assessed separately by two senior cardiologists who were blind to all other data relating to the study participants. RESULTS: The rate of ER pattern was significantly higher in ADHD children compared to normal controls (32% vs. 13%, respectively, P = 0.012; relative risk [RR] = 1.68, 95% confidence interval [CI] 1.16-2.44), irrespective of stimulant treatment or gender. All other standard ECG measures (heart rate, QT and QTc intervals) were within normal range. CONCLUSION: The rate of ER in children with ADHD is significantly higher than in normal controls. Its clinical significance awaits further research.