Prefrontal synaptic markers of cocaine addiction-like behavior in rats.

Defining the drug-induced neuroadaptations specifically associated with the behavioral manifestation of addiction is a daunting task. To address this issue, we used a behavioral model that differentiates rats controlling their drug use (Non-Addict-like) from rats undergoing transition to addiction (Addict-like). Dysfunctions in prefrontal cortex (PFC) synaptic circuits are thought to be responsible for the loss of control over drug taking that characterizes addicted individuals. Here, we studied the synaptic alterations in prelimbic PFC (pPFC) circuits associated with transition to addiction. We discovered that some of the changes induced by cocaine self-administration (SA), such as the impairment of the endocannabinoid-mediated long-term synaptic depression (eCB-LTD) was similarly abolished in Non-Addict- and Addict-like rats and thus unrelated to transition to addiction. In contrast, metabotropic glutamate receptor 2/3-mediated LTD (mGluR2/3-LTD) was specifically suppressed in Addict-like rats, which also show a concomitant postsynaptic plasticity expressed as a change in the relative contribution of AMPAR and NMDAR to basal glutamate-mediated synaptic transmission. Addiction-associated synaptic alterations in the pPFC were not fully developed at early stages of cocaine SA, when addiction-like behaviors are still absent, suggesting that pathological behaviors appear once the pPFC is compromised. These data identify specific synaptic impairments in the pPFC associated with addiction and support the idea that alterations of synaptic plasticity are core markers of drug dependence.

Working with avoidant children: a clinical challenge.

Clinicians have become increasingly aware of the difficulty inherent in interviewing avoidant children for possible maltreatment. Evaluations of avoidant children in cases involving multiple risk factors for maltreatment are often the most complex. The dilemma lies in balancing forensic standards while ensuring that every effort is made to enable children to relate their experiences. It is incumbent upon the evaluator to be aware of the reasons children may resist sharing their experiences. Initial stages of the interview process are discussed, including techniques for dealing with avoidant children.

Children's perceptions of genital examinations during sexual abuse evaluations.

Children's reactions to the medical evaluation of sexual abuse and the methods that enhance their coping ability have not been well addressed in the literature. For many children, a genital examination can be highly stressful, and may even trigger memories of the sexual abuse itself. Stress can be reduced by preparing the child for the examination, by giving the child greater control, and by debriefing the child (and parents) afterward. Research is needed to develop the most effective techniques for reducing children's stress during a genital examination.

Harmful genital care practices in children. A type of child abuse.

Little attention has been paid in the literature to children's genital hygiene in recent years. We describe harmful genital care practices that produce physical and/or psychoemotional abnormalities in children. These practices comprise unusual and ritualistic handling and inspection of the child's genitals. Abnormalities produced include chronic and varied somatic complaints and behavioral anomalies, changes in genital anatomy, unnecessary medical diagnostic and therapeutic interventions, and, sometimes, overt sexual abuse. The practices need to be recognized as harmful to children, and effective intervention must be sought.

Association of coexisting vaginal infections and multiple abusers in female children with genital warts.

All 11 girls less than 12 years of age presenting to the pediatric clinic between 1980 and 1986 with genital warts were evaluated by the Child Protection Team for possible sexual abuse. Nine of the 11 girls had condylomata acuminata, and two had verruca vulgaris. Ten of the 11 had historical and/or physical evidence other than the warts that confirmed sexual abuse. Six girls had coexisting vaginal infections such as bacterial vaginosis and infections due to various pathogens including Neisseria gonorrhoeae, Trichomonas vaginalis, Ureaplasma urealyticum, and Mycoplasma hominis. These six girls were known (three) or suspected (three) of being abused by multiple perpetrators. None of the five girls with a known or suspected single abuser had coexisting vaginal infections (P = less than 0.02, Fisher's exact test). We conclude that almost all genital warts in girls are sexually transmitted and that girls presenting with anogenital warts should be evaluated for other genito-vaginal infections and sexual abuse. Multiple vaginal infections in childhood, with organisms that are sexually transmitted or associated with sexual activity, may be a marker for abuse by multiple perpetrators.