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Biomedical subjects

A Apter

Publications and source records attributed to A Apter.

At least 37 records · Page 2Linked to original sources
PubMed1998

Bone age in adolescents with schizophrenia and obsessive-compulsive disorder.

The bone age (BA), height and weight of 20 adolescents with schizophrenia and 21 matched adolescents with obsessive-compulsive disorder (COD) were measured. The BA of the schizophrenic patients was significantly higher than their chronological age (CA)(p < 0.05), while the OCD subjects' BA was non-significantly lower than their CA. In addition, the difference between CA and BA (delta ages) in the schizophrenic adolescents was significantly different from the delta ages of the OCD adolescents (p , 0.05). Gender did not significantly affect BA or delta ages. A positive correlation (r = 0.5, p < 0.01) was obtained between CA and delta ages in the schizophrenic patients but not in the OCD patients. Both groups were within the normal range of weight and height percentiles.

Adolescent↗
PubMed1998

Osteoporosis in the corticosteroid-treated patient with asthma.

Osteoporosis affects 40% of white women older than 45 years of age and 15% of white men older than 50 years of age, resulting in approximately 1.5 million annual fractures in the United States. Systemic corticosteroid therapy increases the probability of osteoporosis, even with alternate-day dosing and with dosages sufficiently low so as not to affect the hypothalamic-pituitary-adrenal axis. Inhaled corticosteroid therapy may affect bone density if high-dose therapy is given to select individuals. The potential of increasing osteoporosis with inhaled corticosteroid asthma therapy is a concern because of the availability of more potent inhaled corticosteroid agents and recommendations that inhaled corticosteroid therapy be initiated earlier in the course of asthma. This article provides suggestions, on the basis of the medical literature and consensus of the authors when specific information was not available, for assessing and treating osteoporosis in subjects with asthma. Suggested risk categories are "low risk" (inhaled corticosteroid dosage of < or =800 microg of heclomethasone dipropionate [BDP]/day in adults or < or =400 microg BDP or equivalent in children), "moderate risk" (inhaled BDP >800 microg/day in adults or >400 microg/day in children), and "high risk" (systemic corticosteroid therapy 4 times a year or daily or alternate-day systemic corticosteroid therapy). Dosage of nasal corticosteroid probably should be added to the orally inhaled corticosteroid for total burden of inhaled corticosteroid. Potential treatment strategies based on risk factors and bone density if indicated are offered to assist physicians treating patients with asthma.

Adrenal Cortex Hormones↗
PubMed1998

Parents as the exclusive agents of change in the treatment of childhood obesity.

BACKGROUND: Excessive weight in childhood is a serious public health concern because of its costly health consequences and its increasing prevalence. OBJECTIVE: Our objective was to compare the efficacy of a family-based approach for the treatment of childhood obesity, in which the parents served as the exclusive agents of change, with that of the conventional approach, in which the children served as the agents of change. DESIGN: This study had a randomized, longitudinal prospective design and lasted 1 y. Sixty obese children aged 6-11 y were randomly allocated to the experimental (parents as agents of change) or control (children as agents of change) group. Anthropometric and biochemical measurements were determined at the start and end of the study. A sociodemographic questionnaire and a family eating and activity habits questionnaire were completed by both parents. Hour-long support and educational sessions were conducted by a clinical dietitian: 14 sessions for the parents in the experimental group and 30 sessions for the children in the control group. RESULTS: The dropout rate was nine times greater in the control group (n = 9) than in the experimental group (n = 1). Mean percentile weight reduction was significantly (P < 0.03) higher in children in the experimental group (14.6%) than in the control group (8.1%). CONCLUSIONS: Treatment of childhood obesity with parents as the exclusive agents of change was superior to the conventional approach, as indicated by the dropout rate and the percentage weight loss of the children during the 1-y intervention.

Adult↗
PubMed1998

Association between multiple suicide attempts and negative affects in adolescents.

OBJECTIVE: To compare the level of negative emotions-anxiety, depression, aggression, and impulsivity-in hospitalized adolescents with a history of either a single or multiple suicide attempts. METHOD: Thirty-two adolescents hospitalized for a first suicide attempt, 19 hospitalized for a repeated attempt (fifth or more), 109 nonsuicidal psychiatric inpatients, and 85 community controls were assessed for level of depression, anxiety, aggression, and impulsivity with the Beck Depression Inventory, the State-Trait Anxiety Inventory, the Multidimensional Anger Inventory, and the Suicide Potential Scale. RESULTS: Both suicidal groups demonstrated higher levels of most of the negative emotions than both the normal controls and the nonsuicidal inpatients. When the first attempters were compared with the multiple attempters, similarly high levels were noted for most dimensions of anxiety and depression. A trend toward increased aggression was noted among the multiple suicide attempters on all parameters evaluated; some of these differences were significant. CONCLUSION: In already highly anxious and depressed suicidal inpatients, a high level of aggression might significantly increase the risk of recidivism.

Adolescent↗
PubMed1998

Death concepts in suicidal adolescents.

OBJECTIVE: To investigate the relationship between components of death concept (preoccupation with death, death as a pleasant state, and death as final) and suicidal behavior in adolescents. METHOD: The death concepts of 51 suicidal inpatients, 102 nonsuicidal inpatients, 36 emergency room suicidal subjects, and 81 normal controls were compared using Pfeffer's Child Suicide Potential Scale. In addition, the IQ level as well as emotions that potentially influence the death concept were measured. RESULTS: Both groups of suicidal adolescents evaluated death as more pleasant than the nonsuicidal groups. All the study groups equally perceived death as a final state. Suicidal inpatients were more preoccupied with death than nonsuicidal inpatients, but surprisingly among all study groups, including normal controls, the emergency room suicidal subjects were the least preoccupied with death. Partialing out depression, anxiety, and aggression specifically augmented the association between preoccupation with death and suicidality. Thus the relationship between death concept and suicidality appears to be a direct one. No correlation was found between suicidality and intelligence level. CONCLUSIONS: Elements of death concept distinguish suicidal from nonsuicidal as well as between hospitalized versus nonhospitalized suicidal adolescents. Thus the death concept evaluation is potentially valuable in the assessment of adolescents with a high risk for suicide.

Adolescent↗
PubMed1998

The child suicide potential scale: inter-rater reliability and validity in Israeli in-patient adolescents.

The objective of this study was to evaluate the psychometric properties of the Hebrew version of the Child Suicide Potential Scale for use with psychiatrically hospitalized adolescents. The criterion validity, the parallel validity, the internal consistency, the inter-rater reliability and the test-retest reliability were assessed. One hundred eighty-five adolescent in-patients, consecutive admissions to a locked adolescent unit, were interviewed by a single interviewer. The subjects filled out a series of self report questionnaires and were also rated on an observational measure by the ward staff. In addition, 30 adolescents were interviewed by two raters simultaneously, in order to check the inter-rater reliability of this semi-structured interview. Twenty-three of the interviewees were re-interviewed after 6-12 months in order to assess the test-retest reliability. The majority of the Pearson correlation coefficients between the Child Suicide Potential Scale and parallel self report measures were also statistically significant. The internal consistencies of sections in the scale were high. The scale was found to have good parallel validity, by differentiating between suicidal and non-suicidal patients. The Pearson Correlation Coefficients between the two raters were markedly significant. The test-retest reliability was low. These results indicate that the Child Suicide Potential Scale is a reliable and fairly valid tool for the assessment of suicidal behavior in adolescent in-patients in Israel.

Adolescent↗
PubMed1998

Aggression and sexual offense in Asperger's syndrome.

Asperger's Syndrome is one of the diagnostic subcategories of pervasive developmental disorders. It is characterized by a defect in reciprocal social interaction, lack of empathy for others and poor non-verbal communication. Antisocial acts, including aggression and sexual offense, are not considered to be common in this disorder. We describe an adolescent with Asperger's Syndrome whose main problems are his violence and sexual offenses. We assume that these symptoms are secondary to his diagnosis of Asperger's as a manifestation of his difficulties with the "theory of mind" of others. This atypical case report is in contrast with the low prevalence of aggression and sexual offense in Asperger's, as reported in the literature. We discuss the reasons for this low prevalence. Our conclusions are based on one case history and a literature review. We call for further research in this field.

Adolescent↗
PubMed1997

Measurement of aggression in psychiatric patients.

This article analyzes, describes, and characterizes the methods used for measuring aggression in studies on psychiatric patients. The authors reviewed all studies published between 1985 and 1994 in seven major psychiatric journals and found 103 studies on adult aggression and 43 on childhood and adolescent aggression. Almost half (44.7%) of the adult studies and 23.3% of the child and adolescent studies did not use any structured instrument; the remainder used a total of 52 different instruments, indicating that the methodology in this area is not well established. The methods used for measuring aggression were mainly of three types: observational measures; self-report questionnaires; and structured chart reviews. Each of these tools is described herein, with special focus on reliability and validity. Overall the reliability of the various scales is high, but the empirical validity is rather poor. In choosing a suitable method for measuring aggression, researchers should take into account the direction of investigation (e.g. state vs. trait aggression, dynamic or biological aspects of aggression) and the target population. Practical suggestions in this regard are offered.

Adolescent↗
PubMed1997

Suicidal adolescents and ego defense mechanisms.

OBJECTIVES: To identify defense mechanisms that characterize adolescents with a range of suicidal behaviors and to differentiate them from nonsuicidal adolescents. METHODS: Fifty-five suicidal adolescent inpatients admitted for a definite suicide attempt were compared with 87 adolescent inpatients who had no history of suicide attempt or ideation and 81 nonpatients. Defense mechanisms were assessed by the Ego Defense Scale (EDS) which is part of a larger semistructured interview, the Child Suicide Potential Scale (CSPS), and by a self-report questionnaire, the Life Style Index (LSI). The CSPS was also used to quantity violent and suicidal behaviors. RESULTS: On the LSI suicidal adolescent patients scored higher on denial, displacement, repression, and total defenses than the nonpatients. On the EDS they scored higher on regression, denial, projection, introjection, repression, and total defenses and lower on sublimation. LSI scores on displacement (higher) and on compensation (lower) distinguished suicidal from nonsuicidal inpatients. Denial and regression correlated positively and sublimation correlated negatively with both suicidal and violent behaviors. Introjection and repression correlated with suicidal behavior only. CONCLUSIONS: Overuse of displacement is connected with increased risk for suicidal and aggressive behaviors, while sublimation is probably a protective factor. In addition, several immature ego defenses possibly amplify aggression, which then is directed against the self by the maladaptive overuse of introjection, displacement, and repression.

Adolescent↗
PubMed1997

A cross-cultural comparison of behavior disturbance and suicidal behavior among psychiatrically hospitalized adolescents in Israel and the United States.

American adolescent psychiatric patients had significantly higher levels of suicidal behavior (49% vs. 19%) and a higher percentage of depression diagnoses (78% vs. 24%) than Israeli psychiatric inpatients. After controlling for the diagnosis of depression, American male patients obtained significantly higher scores on the Obsessive-Compulsive, Aggression, and Hyperactive subscales of the Child Behavior Checklist (CBCL) than the Israeli males. American females scored higher on the Depression subscale than Israeli females. Differences may be attributed to less tolerance or differing perceptions of deviant behavior in America, clinical practice, and/or the CBCL's greater applicability to American inpatient samples.

Adolescent↗
PubMed1997

Anger, impulsivity and suicide risk.

BACKGROUND: To examine the relationship between anger, impulsivity and suicidality. METHODS: Thirty psychiatric inpatients admitted for suicidal behavior were compared with 30 nonsuicidal psychiatric inpatients and 32 healthy controls on measures of anger, impulsivity and suicide risk. RESULTS: The three groups were similar on demographic variables, but the suicidal group scored higher on the suicide risk scale, impulsivity scale and anger scale. Anger and impulsivity correlated significantly with suicide risk. High anger and impulsivity contributed synergistically to the suicide risk. Whereas anger was specific to both psychiatric groups, suicidals and nonsuicidals, only impulsivity was specific to the suicidal group. CONCLUSIONS: These findings may have important implications for therapists and primary prevention workers, and may pave the way for the recognition of risk factors and for effective intervention in patients with a high suicide risk.

Adult↗
PubMed1997

Obsessive-compulsive disorder with and without tics in an epidemiological sample of adolescents.

OBJECTIVE: This study was undertaken to discriminate subtypes of obsessive-compulsive disorder in adolescents. METHOD: Forty individuals with obsessive-compulsive spectrum disorders were ascertained from an epidemiological sample of 861 adolescents. Interviews were conducted by child psychiatrists using semistructured diagnostic interviews, including a clinician-rated Yale-Brown Obsessive Compulsive Scale. Discriminant analysis was performed to compare the scores on the Yale-Brown scale of groups with and without comorbid tics and to compare boys and girls. RESULTS: Adolescents with tics were more prone to aggressive and sexual images and obsessions than were adolescents without tics; these differences could not be wholly attributed to sex differences. CONCLUSIONS: The subtypes among unreferred adolescents are similar to those of adult patients with obsessive-compulsive disorder with and without Gilles de la Tourette syndrome. Subtypes evident in adulthood may be established relatively early in the natural course of obsessive-compulsive disorder.

Adolescent↗
PubMed1997

Psychometric properties of the K-SADS-PL in an Israeli adolescent clinical population.

The main objective of this study was to evaluate the reliability and validity of the Schedule for Affective-Disorders and Schizophrenia for School-Aged Children Lifetime Version (K-SADS-PL) in an Israeli sample. Fifty-seven adolescent admissions to two psychiatric units were evaluated with the Hebrew translation of the K-SADS-PL. Inter-rater and mother-child agreement were evaluated for diagnoses, and 31 affective symptoms. K-SADS diagnoses were also compared with two-month unit evaluation diagnoses as a measure of consensual validity. The reliability of assessing psychosocial functioning was also examined. Reliability and validity of diagnoses were good to excellent. Mother-child agreement fared less well on all measures. The use of semi-structured interviews and DSM-IV criteria in an Israeli adolescent psychiatric setting are discussed.

Adolescent↗
PubMed1997

A general hospital study of attempted suicide in adolescence: age and method of attempt.

Attempted suicide in adolescence is a major health problem and recent reports indicate a dramatic increase in the frequency of attempted and completed suicide among adolescents. The aim of this study was to evaluate the characteristics of adolescent admissions with attempted suicide in a large general hospital. The files of all children and adolescents admitted due to a suicide attempt between the years 1984 and 1994 were examined retrospectively, with regard to age, sex, method of attempt, season, year and length of hospitalization. Four hundred and four admissions with attempted suicide were recorded. The majority (83.7%) were females and drug overdose was the most common (92.8%) method used. Thirty patients (7.5%) repeated the attempt during the study period. No specific time of the year was associated with an increase in adolescent suicide attempt admissions. The most remarkable finding was that younger adolescents had a higher probability of performing a violent suicide attempt. Hypotheses for these trends are examined together with possible ramifications for treatment provision.

Adolescent↗
PubMed1996

Psychoanalytic perspectives on adolescent suicide.

From the beginning of the twentieth century, youthful suicide has posed both a clinical and a theoretical challenge for psychoanalysis. This paper examines several paradigmatic cases of completed suicide in order to illustrate important psychodynamic aspects of adolescent suicide. The contributions of the developmental psychoanalytic perspective to our understanding of adolescent self-destructiveness are discussed, with particular emphasis on Anna Freud's concept of developmental lines toward self-care and self-regulation. The applications of this developmental psychoanalytic perspective to clinical research on vulnerability to adolescent suicide are reviewed.

Adolescent↗