Anxiety and depressive disorders in attention deficit disorder with hyperactivity: new findings.

OBJECTIVE: The authors examined the discriminant validity of the diagnosis of attention deficit disorder with hyperactivity. METHOD: They used standardized rating scales of life stresses and child and family functioning to assess psychosocial and family risk factors in 47 children who had the diagnosis of attention deficit disorder with hyperactivity, a matched group of 47 children in the community, and a matched group of 47 children seen in a psychiatric clinic. RESULTS: Children who had the diagnosis of attention deficit disorder and children in the psychiatric clinic reported significantly more depression and anxiety than did the children in the community; furthermore, children diagnosed as having attention deficit disorder with hyperactivity had more externalizing symptoms than did children in the psychiatric clinic. Children diagnosed as having attention deficit disorder with hyperactivity plus a comorbid anxiety or depressive disorder had higher levels of coexisting life stresses and parental symptoms than did children who had the single diagnosis of attention deficit disorder with hyperactivity. CONCLUSIONS: These results underscore the need for future studies to carefully assess children diagnosed as having attention deficit disorder with hyperactivity for concurrent psychiatric disorders as well as family and psychosocial stressors that may contribute to childhood symptoms. Such information is essential because different subtypes of attention deficit disorder with comorbid disorders may arise from different etiologic pathways, may require varying treatment options, and may foreshadow different eventual outcomes.

Father absence: effects on child and maternal psychopathology.

The effects of fathers' absences during the previous year on 213 military children were examined, using multiple measures of children's functioning and psychiatric symptoms. Children whose fathers had been absent 1 or more months during the previous 12 months experienced significantly higher self-reported depression and anxiety, but these symptoms were not apparent to adult observers (parents and teachers). These effects were not demonstrated when maternal psychiatric symptoms and intercurrent family stressors were controlled. Thus, the effects of father absence under routine conditions in relatively healthy samples may exert no significant effects independent of intervening family stressors or maternal psychopathology. Clinic referrals of children during times of father absence may partly be due to an effect of additional stressors impacting on the mother during the absence of the father.

Data-gathering tools for "real world" clinical settings: a multisite feasibility study.

OBJECTIVE: To determine the mental health needs and optimal treatments for children and families in "real world" settings, data-gathering strategies are needed that can be easily implemented across a variety of clinical settings. To address this need, the authors developed and piloted a "clinician-friendly" questionnaire that includes demographic, psychosocial, medical, and family history variables, such as those routinely gathered in standard clinical evaluations. METHOD: Optical scanning technology was used to encode data from more than 1,900 children, including 1,458 consecutive referrals in four military child psychiatry clinics, 285 consecutive admissions to a civilian psychiatric state hospital, 71 pediatric patients, and a community sample of 113 children. RESULTS: Despite geographic and logistic obstacles, clinical data were reliably obtained across multiple settings. Data analyses revealed meaningful differences across samples in subjects' presenting complaints, and a range of psychosocial, demographic, and background variables. Data were characterized by an apparently high degree of accuracy and completeness. CONCLUSIONS: Findings illustrate the importance and feasibility of standardized data-gathering approaches in routine clinical settings and clarify the hazards as well as the opportunities afforded by these research approaches. Such data-gathering tools appear to have significant merit and deserve further implementation and testing across a range of clinical and research settings.

Influence of diet form on the hyperphagia-promoting effect of polysaccharide in rats.

Adult female rats were fed chow only, or chow plus the polysaccharide Polycose presented as a solution (32% w/v), as a powder, or as a powder mixed into the chow diet. The rats fed the Polycose solution overate and gained three times as much weight as did the control rats in the 30-day test period. The rats fed the Polycose powder or mixed diet, on the other hand, did not differ from controls in food intake or weight gain. The solution-fed rats consumed more Polycose than did the powder-fed rats, but the two groups were equivalent in their chow intake. The absolute and percent body fat of the solution-fed rats exceeded that of control rats, as well as that of powder and mixed-diet animals. The percent body fat of the powder and mixed-diet groups exceeded that of the control animals. The findings demonstrate that the form of diet presentation has a major impact on the rat's feeding and body weight responses to polysaccharide diets.

Sucrose and polysaccharide induced obesity in the rat.

Adult male rats were fed, in addition to chow and water, solutions (32%) of either sucrose, Polycose (a bland-tasting polysaccharide), or Polycose sweetened with 0.2% saccharin. The solutions were available for two 30-day periods when the rats were 90-120, and 180-210 days of age. A control group received only chow and water during these periods. During the second 30-day test the Polycose and Saccharin- Polycose groups were hyperphagic and gained as much excess weight as did the Sucrose group. The sucrose-fed rats, however, did not overeat relative to the control animals. Adding saccharin to the Polycose failed to increase total caloric intake or weight gain, but did increase Polycose intake and percent carbohydrate intake. The intakes of both Polycose solutions were greater than that of the sucrose solution, although in brief two-bottle preference tests the sucrose solution was preferred over the Polycose and saccharin- Polycose solutions. A similar pattern of results was obtained during the first test period, but the group differences were less pronounced. The findings demonstrate that carbohydrate-induced obesity is not unique to sweet-tasting sugars, but can also be produced by bland-tasting polysaccharides. Sweet taste does increase polysaccharide preference and intake, however.

The effects of pimozide on the consumption of a palatable saccharin-glucose solution in the rat.

Two experiments investigated the role of dopamine in reward mechanisms by examining the effects of the specific dopamine receptor blocker pimozide on drinking behavior in the rat. In Experiment 1, the effects of pimozide on the consumption of a palatable saccharin-glucose solution were compared to the effects of quinine adulteration of the same solution. Pimozide and quinine both reduced 30 min/day consumption, decreased lick rate early in the drinking session and reduced lick efficiency in a dose related manner. In Experiment 2, the effects of pimozide on the consumption of a saccharin-glucose solution and water were compared in thirsty and nonthirsty rats. Pimozide suppressed the consumption of both water and the saccharin-glucose solution in a dose related manner. However, saccharin-glucose solution intake was suppressed more than water intake, and this effect was independent of thirst drive. The drug also decreased lick rate early in the drinking session and lick efficiency. The results are discussed in terms of the reward and sensory-motor deficits produced by dopamine receptor blocking agents.

The dopaminergic mediation of a sweet reward in normal and VMH hyperphagic rats.

The role of dopamine in mediating the rewarding quality of a sweet saccharin-glucose (SG) solution was investigated by comparing the effects of the dopamine receptor blocker pimozide, the bitter adulterant quinine, and solution dilution on the consummatory response to the solution in normal and VMH rats. Experiments 1 and 2 demonstrated that pimozide and quinine caused a dose/concentration dependent dependent reduction in the intake of and the licking response to a SG solution. Pimozide treatment caused an equivalent suppression in the intake of the normal and VMH rats, in both the dynamic and static phases, whereas quinine adulteration caused a greater suppression in the intake of the VMH rats. The effects of pimozide and quinine on initial lick rate were also different. Experiment 3 demonstrated that dilution of a SG solution produced a concentration related decrease in intake and licking response. Dilution of the SG solution, like pimozide treatment, affected the intake of the normal and VMH rats in an equivalent manner. The effects of solution dilution and pimozide treatment on the licking response were also similar. The results suggest that the mechanisms by which pimozide and quinine reduce the hedonic quality of natural rewards are functionally dissimilar. The similarity between pimozide treatment and solution dilution suggests that pimozide reduces the positive affective quality of natural reinforcers. The results are discussed in terms of the dopamine theory of reward, the role of dopamine in hypothalamic hyperphagia, and VMH finickiness.

Consultation in the aftermath of an air tragedy.

In the early morning hours of December 12, 1985, a chartered jet airliner carrying 248 soldiers crashed shortly after takeoff, killing all aboard. The day after, the authors were designated as a consultation team to the mental health staff at Fort Campbell who were providing services in the aftermath of the crash. This report describes and analyzes the experiences of this consultation on disaster management. Our consulting experience has been one of the most profound and demanding events of our professional lives. Salient lessons of the consultation include: (a) the need to clarify leadership roles among the local mental health care team; (b) the need to help the local team establish clear roles among team members; (c) the value of enabling the local team to mourn the loss of their fellow soldiers and community members; and (d) the value of establishing a clear plan of mental health services for both short-term and long-term management.

Group psychotherapy in the treatment of adolescent and preadolescent military dependents with recurrent diabetic ketoacidosis.

The adolescent military dependent with recurrent diabetic ketoacidosis (DKA) is a difficult management problem. Career relocations and an absentee sponsor frequently preclude family-oriented interventions. We recently treated four patients with recurrent DKA who had failed to improve following intensive medical and educational programs. They were enrolled into weekly outpatient group psychotherapy in addition to routine medical management. Three out of the four patients improved in compliance and had a decrease in the frequency or severity of DKA. This approach may be effective when individual psychotherapy or lengthy hospitalization are either too far removed or too costly.

Telemedicine improved diabetic management.

Effective control of diabetes is known to delay or prevent the end-organ complications of this disease. Can telemedicine improve a patient's ability to self-manage diabetes? Twenty-eight patients entered a study comparing home telemedicine consultation with standard outpatient care. A nurse case manager contacted the telemedicine group once a week under the direction of a primary care physician, who contacted the telemedicine group once a month. Laboratory studies and total body weight were measured at the beginning and at the end of the 3-month study. The hemoglobin A1c (HbA1c) and total body weight improved significantly in the intervention (telemedicine) group, as shown by a 16% reduction in mean HbA1c level (from 9.5 to 8.2%) and a 4% mean weight reduction (from 214.3 to 206.7 pounds). Based on our experience, we present a functionally based telemedicine classification system to improve the application of electronic medicine in future studies.

Atropine fails to block the overconsumption of sugar solutions by hypothalamic hyperphagic rats.

Adult female rats given bilateral parasagittal knife cuts in the medial hypothalamus (VMH group) were hyperphagic and became obese on a chow diet, compared with sham-operated controls. The VMH rats also overconsumed, relative to controls, sucrose and glucose solutions during 30 min/day tests. Pretreating the VMH and control rats with atropine methyl nitrate (1.0, 5.0, or 10.0 mg/kg) reduced their intake of the sugar solutions in three out of five experiments, and in all experiments it suppressed their 24-hr chow intake. However, the VMH rats continued to drink more of the sugar solutions than did the controls after all atropine treatments, and in three out of four experiments their hyperphagia on the chow diet was not blocked by the atropine. The results do not support the hypothesis that vagally stimulated insulin release or other cholinergically mediated cephalic responses of digestion are essential for the expression of hypothalamic hyperphagia and finickiness.