Organic psychosis without anemia or spinal cord symptoms in patients with vitamin B12 deficiency.

The authors describe two patients with organic psychosis who had vitamin B12 deficiency and no hematologic or spinal cord abnormalities. They review the literature that supports a causal relationship between B12 deficiency and cerebral dysfunction, as measured by the EEG, and consequent organic mental changes. The authors cite evidence that these EEG and organic mental changes are reversible with B12 replacement. They emphasize that psychiatric manifestations may be the first symptoms of vitamin B12 deficiency and thus antedate anemia and spinal cord disease. They recommend consideration of B12 deficiency and serum B12 determinations in all patients with organic mental symptoms.

Self-reported depressive symptoms in first-grade children: developmentally transient phenomena?

The question of whether self-reported depressive symptoms in young children represent more than transient developmental phenomena was examined in an epidemiologically defined sample of 1,313 first graders. Children's reports of depressive symptoms were relatively stable over a 4-month interval. The level of stability was particularly impressive for children initially in the highest quartile of depression, of all whom remained in the highest quartile at retest, 4 months later. In addition, depressive symptoms were significantly related to the negotiation of a number of salient developmental tasks at entrance to first grade, including academic achievement, peer relations, and attention/concentration in the classroom. Moreover, the relationships between depressive symptoms and the various indices of social and academic functioning remained stable over the 4-month test-retest interval.

The significance of self-reported anxious symptoms in first-grade children.

It is generally believed that prior to the middle to late elementary school years children's reports of anxious symptoms represent nothing more than transient developmental phenomena. In light of the limited empirical study of this issue and its import to the allocation of mental health resources, the present study seeks to provide empirical evidence of the significance of anxious symptoms in children younger than 7. Specifically, utilizing an epidemiologically defined population of 1197 first-grade children, followed longitudinally from the fall to spring of first grade, we examine the stability, prevalence and caseness of children's self-reports of anxious symptoms. Self-reported anxious symptoms proved relatively stable over 4-month test-retest interval. In addition, they appeared to have a significant impact on academic functioning in terms of reading achievement. These findings on stability, caseness, and prevalence suggest children's self-reported anxious symptoms in the early elementary school years may have clinical significance. However, further study is necessary before firm conclusions can be drawn.

The course of aggression in first-grade children with and without comorbid anxious symptoms.

We studied the course of aggressive behavior in an epidemiologically defined sample of first graders with and without comorbid anxious symptoms. Our primary purpose in doing so was to understand whether the stability of aggression in young children was attenuated or strengthened in the presence of comorbid anxiety. Previous studies of older children and adolescents had produced equivocal findings in this regard. Data on anxious symptoms were obtained through an interview of the children, whereas aggressive behavior was assessed through the use of a teacher interview and peer nominations. Assessments were performed in the fall and spring of first grade. In contrast to children classified as aggressive alone in the fall of first grade, boys and girls classified as aggressive and anxious in the fall of first grade were significantly more likely to be classified as aggressive in the spring in terms of teacher ratings and/or peer nominations of aggression. Thus our findings suggest that the link between early and later aggression may be strengthened in the presence of comorbid anxious symptoms, rather than attenuated. Future studies are needed to identify the mechanisms by which the course of aggression is influenced by the presence of comorbid anxiety.

Conflicting needs and interests of researchers and service providers in child sexual abuse cases.

A child sexual abuse research project was designed which was dependent on referrals from local departments of social services. Significant differences in needs and goals existed between the referral sources and the research team. Modifications of project designs were necessary in the areas of subject recruitment, allocation of project resources, design and measurement, and analysis and reporting. These modifications resulted in a beneficial blend of service and research and produced a useful service in the setting of competent research.

Maternal support following disclosure of incest.

The level of maternal support to incest victims following disclosure was found to be more closely related to perpetrator than to child characteristics. Lack of maternal support was significantly associated with foster placement and higher psychopathology scores in a clinical interview. Evidence is presented challenging the validity of maternal behavioral reports in assessments of incest victims.

Civil commitment: a range of patient attitudes.

The authors interviewed adult civil commitment excandidates about their perceptions of commitment six months after discharge. Scales were developed for the following constructs: perceived need of commitment, perceived personal consequences of commitment, view of medication, view of primary hospital physician, and view of hospital experience. Excandidates had a mixed view of commitment. The majority reported positive views, but a substantial minority endorsed negative descriptors.

A further look at the prognostic power of young children's reports of depressed mood and feelings.

A primary objective of the present study was to determine the validity of first graders' self-reports of depressed mood and feelings. To that end, the prognostic power of first grade self-reports of depressed mood and feelings was examined with respect to later psychopathology and adaptive functioning in a population of urban school children (N = 946). First grade self-reports of depressed mood predicted later child academic functioning, the need for and use of mental health services, suicidal ideation, and a diagnosis of major depressive disorder by age 14. The prognostic power of these early self-reports suggests that children as young as 5 or 6 years of age are capable of providing valid reports of depressed mood and feelings.

The significance of self-reported anxious symptoms in first grade children: prediction to anxious symptoms and adaptive functioning in fifth grade.

In an earlier study of an epidemiologically defined sample of first grade children, primarily between the ages of 5 and 6, self-reported anxious symptoms proved relatively stable and were significantly related to adaptive functioning. In the present study we follow that cohort of first graders longitudinally and assess the prognostic value of self-reports of anxious symptoms in first grade with respect to anxious symptoms and adaptive functioning in the late elementary school years or at about age 10. First grade anxious symptoms were found to have significant prognostic value in terms of levels of anxious symptoms and adaptive functioning in fifth grade.

Impact of legal intervention on sexually abused children.

OBJECTIVE: Examining the psychologic risks of court and related interventions on child sexual abuse victims. DESIGN: A prospective cohort study with follow-up at 5 months. SETTING: Eleven county social service departments in central North Carolina. SUBJECTS: 100 sexually abused children, ages 6 to 17 years, were recruited from consecutive referrals by social service departments; 75 completed the study. MEASUREMENTS AND RESULTS: Using a structured psychiatric inventory, the Child Assessment Schedule, we found a high degree of distress at referral. The level of distress fell by 26% over the next 5 months (p less than 0.001). The 33 children not involved in criminal proceedings improved 30%, in comparison with a 17% improvement in the 22 children waiting for the proceedings (p = 0.042). The 12 children who had testified in juvenile court improved 42% on the Anxiety subscale, in comparison with a 17% improvement in all other subjects (p less than 0.01). With mathematical modeling that controlled for the factors of vaginal or anal penetration, the relationship to the perpetrator, an estimate of verbal IQ, duration of abuse, and whether counseling was received, it was estimated that children waiting for court proceedings at the follow-up examination were only one twelfth as likely to have improved by one standard deviation on the Depression subscale (p less than 0.05). A second model revealed that children who testified in juvenile court were 20.11 times more likely to improve by one standard deviation on the CAS Anxiety subscale (p less than 0.05). CONCLUSIONS: Testimony in juvenile court may be beneficial for the child, whereas protracted criminal proceedings may have an adverse effect on the mental health of the victim.

Developmental epidemiologically based preventive trials: baseline modeling of early target behaviors and depressive symptoms.

Describes a conceptual framework for identifying and targeting developmental antecedents in early childhood that have been shown in previous work to predict delinquency and violent behavior, heavy drug use, depression, and other psychiatric symptoms and possibly disorders in late adolescence and into adulthood. Criteria are described that guided choices of targets for two epidemiologically based, randomized preventive trials carried out in 19 elementary schools in the eastern half of Baltimore, involving more than 2,400 first-grade children over the course of first and second grades. Baseline models derived from the first of two cohorts show the evolving patterns of concurrence among the target antecedents. The central role of concentration problems emerged. From Fall to Spring in first grade, concentration problems led to shy and aggressive behavior and poor achievement in both genders and to depressive symptoms among girls. There was evidence for reciprocal relationships in girls. For example, depressive symptoms led to poor achievement in both girls and boys, whereas poor achievement led to depressive symptoms in girls but not boys, at least over the first-grade year. These results provide important epidemiological data relevant to the developmental paths leading to the problem outcomes and suggest preventive trials.