Selection of subjects for study of depression in adolescents.
Explore the source record for details and available documents.
Adolescent↗
Biomedical subjects
B Geller
Publications and source records attributed to B Geller.
Prospective study of scheduled withdrawal from nortriptyline in children and adolescents.
Thirty 6- to 16-year-old subjects were gradually tapered from their maintenance dose of nortriptyline while being monitored for withdrawal effects. Five subjects had brief gastrointestinal distress that did not require the administration of an extra dose. The results of this open study suggest that scheduled tapering of nortriptyline will preclude withdrawal symptoms in most pediatric patients.
Adolescent↗
Child and adolescent nortriptyline single dose pharmacokinetic parameters: final report.
This is the final report of a study of single dose pharmacokinetic parameters of nortriptyline in children and adolescents 5 to 16 years old (N = 64). The data were analyzed separately for the 5- to 12-year-olds (N = 41) and for the 13- to 16-year-olds (N = 32). The results confirm the preliminary findings of the similarity of the pharmacology of nortriptyline between the pediatric and adult age groups with respect to a logarithmically linear rate of elimination and a wide interindividual rate of metabolism. The 5- to 12-year-olds had a significantly shorter mean half-life and a significantly greater mean apparent oral clearance than the 13- to 16-year-olds. The mean half-life in the 5- to 12-year-olds was 20.8 +/- 7.2 (range, 11.2 to 42.5) hours and in the 13- to 16-year-olds was 31.1 +/- 19.8 (range, 14.2 to 89.4) hours. A twice a day dosage regimen is recommended for the entire 5- to 16-year-old group based on their range of half-lives.
Adolescent↗
Preliminary data on the relationship between nortriptyline plasma level and response in depressed children.
Twenty-two subjects 6-12 years old who met Research Diagnostic Criteria and DSM-III criteria for major depressive disorder received a fixed daily dose of nortriptyline during an 8-week protocol. Weekly plasma levels were measured; the raters performing behavioral assessments were blind to these levels. There was a highly significant difference between the mean steady-state plasma levels and the milligram-per-kilogram doses of the responders and nonresponders. The data suggest that the lower limit of the therapeutic range of nortriptyline in children (over 60 ng/ml) is similar to that reported for adults. The disadvantages of the use of a milligram-per-kilogram dose rather than a pharmacokinetic approach are discussed.
Age Factors↗
Components of the design of psychopharmacology studies.
Explore the source record for details and available documents.
Humans↗
Dose and plasma levels of nortriptyline and chlorpromazine in delusionally depressed adolescents and of nortriptyline in nondelusionally depressed adolescents.
Eight adolescents with major depressive disorder were treated with nortriptyline and six adolescents with delusional depression were treated with combined nortriptyline and chlorpromazine. Dose and plasma levels of nortriptyline for the two groups were compared. The delusional group receiving combined drug treatment needed significantly less nortriptyline than did the nondelusional group receiving only nortriptyline to obtain similar mean steady state plasma levels of the drug. The mean plasma chlorpromazine levels were quite low.
Adolescent↗
Preliminary data on DSM-III associated features of major depressive disorder in children and adolescents.
Fifty-nine subjects 5-16 years old with major depressive disorder were assessed for the presence of separation anxiety and antisocial behavior, mentioned in DSM-III as associated features of the disorder in children and adolescents. The findings of the study support the existence of these associated features.
Age Factors↗
Serial ECG measurements at controlled plasma levels of nortriptyline in depressed children.
The authors investigated ECG measurements in 21 children with major depressive disorder treated with nortriptyline at plasma levels of 50-100 ng/ml. P-R and QRS intervals and heart rate measured at baseline and once a week during treatment remained within guidelines.
Age Factors↗
Child and adolescent nortriptyline single dose kinetics predict steady state plasma levels and suggested dose: preliminary data.
The use of nortriptyline single dose kinetics to predict steady state plasma levels and suggested dose was investigated in 33 pediatric subjects who were diagnosed as having major depressive disorder. The data were analyzed separately for the 11 subjects 5 to 9 years old who received a single dose of 25 mg and a fixed daily dose of 20 mg of nortriptyline, and for the 22 subjects 10 to 16 years old who received a single dose of 50 mg and a fixed daily dose of 50 mg of nortriptyline (N = 17) or a fixed daily dose of 20 mg (N = 5) because of a very slow rate of metabolism of the drug. Correlations within the group of 5 to 9 years olds between the steady state plasma levels and the five sampling points after the single dose were all highly significant. Correlations between the steady state plasma levels within the group of 10 to 16 year olds and the five sampling points after the single dose and a fixed daily dose of 50 mg (N = 17) were also highly significant. Similar correlations for the total group of 10 to 16 year olds (N = 22) were performed (prorating the steady state plasma levels of the slow metabolizers), and these too were highly significant. Suggested dose schedules for each age group were developed from the regression equations of nortriptyline steady state plasma levels versus 24-hour nortriptyline plasma levels after the single dose. The regression equation for the group of 5 to 9 year olds was highly significant.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Serial monitoring and achievement of steady state nortriptyline plasma levels in depressed children and adolescents: preliminary data.
Children and adolescents 6 to 16 years old (N = 25), who were diagnosed as having major depressive disorder, received a fixed daily dose of nortriptyline during an 8-week period. Nortriptyline plasma levels were drawn and assayed weekly. Data were analyzed for the total sample (N = 25) and separately for the subgroup of 6 to 9 year olds (N = 9) and for the subsample of 10 to 16 year olds (N = 16). There were no significant differences between the day 7 (week 1) plasma levels and the means of weeks 2 to 8 or between the means of weeks 1 to 4 and 5 to 8 within the total sample or within either subgroup. These findings suggest that nortriptyline steady state plasma levels within the pediatric age range are achieved by day 7 (week 1) and that nortriptyline (during the pediatric years) does not induce its own metabolism during an 8-week period. The achievement of steady state by day 7 is similar to that found in adults. The mean coefficients of variation were calculated for the total sample and for each subsample and were 13.7 +/- 4.0% (range, 8 to 20%) for the 6 to 9 year olds; 13.8 +/- 3.2% (range, 10 to 21%) for the 10 to 16 year olds; and 13.8 +/- 3.4% (range, 8 to 21%) for the total sample. These coefficients of variation are similar to the 10 to 20% range reported in adult subjects.(ABSTRACT TRUNCATED AT 250 WORDS)
Adolescent↗
Nortriptyline pharmacokinetic parameters in depressed children and adolescents: preliminary data.
The pharmacokinetic parameters of nortriptyline in the pediatric age group following oral administration of a single dose of 25 or 50 mg were investigated from nortriptyline plasma level assays at 12, 18, 24, 36, and 48 hours postdose. Data were analyzed separately for the nine prepubertal and 11 postpubertal subjects, all of whom were diagnosed major depressive disorder. These data were compared with studies in the literature of nortriptyline pharmacokinetics from adult and geriatric normal and depressed populations. Similar to adults, the elimination of nortriptyline in children and adolescents is apparently first order kinetics with a logarithmically linear rate of disappearance. The prepubertals had a shorter mean half-life (17.6 +/- 3.7 hours) than some adult groups and twice a day dosage would, therefore, be more appropriate for many children. Although the mean half-life (27.1 +/- 17.1 hours) for the adolescent group suggested that once a day dosage would be sufficient, some adolescents would need twice a day dosage for optimum plasma level control because there was a wide range (14.1 to 76.2 hours). The almost twofold variation in half-life in prepubertals and fivefold variation in postpubertals were similar to differences in adult groups and emphasize the value of plasma level monitoring in the clinical use of nortriptyline.
Adolescent↗
Preliminary data on the dexamethasone suppression test in children with major depressive disorder.
The authors administered the dexamethasone suppression test to 14 children aged 5-12 years who met the Research Diagnostic Criteria and DSM-III criteria for major depressive disorder. The dexamethasone dose used was 20 micrograms/kg; 2 subjects were nonsuppressors.
Age Factors↗
Aggression in adolescents. Aspects of pathogenesis.
The violent adolescent presents considerable difficulty to society and to health care professionals. Thus, this discussion overviews some theories of pathogenesis regarding aggression in adolescence. There is special emphasis on related concepts of neuroanatomy and neurobiochemistry, as well as hormonal influences and the associated psychosocial environment. Literature about the importance of drug abuse and the media is also reviewed. In addition, studies relating aggression to epilepsy and electroencephalographic changes are considered. It is hoped that this paper will aid the interested clinician discern the vast and multidisciplinary literature describing aggression in adolescence. Future investigative endeavors will provide, it is hoped, more definitive biologic and social measurements to enable specific prevention and intervention strategies.
Adolescent↗
Coexistence of childhood onset pervasive developmental disorder and attention deficit disorder with hyperactivity.
Explore the source record for details and available documents.
Attention Deficit Disorder with Hyperactivity↗
Masturbation; historic perspective.
Explore the source record for details and available documents.
Adolescent↗
Psychological management of acute paraplegia in adolescence.
Important management principles regarding emotional needs of the teenager with acute paraplegia during early hospitalization are discussed. One illustrative case is presented. Mourning reaction of the patient and family to this severe loss of bodily function is reviewed. Reaction of medical caretakers to this catastrophe is also discussed. It is emphasized that these concepts be applied by pediatricians in managing adolescent paraplegics.
Adolescent↗
Haloperidol-induced comatose state with hyperthermia and rigidity in adolescence: two case reports with a literature review.
Two adolescents who developed severe extrapyramidal and hypothalamic reactions due to haloperidol therapy are describe. This is a rarely reported result of utilizing this medication in children and youth, and caution is urged in its use. Prolonged reactions have occurred.
Adolescent↗
Minor physical anomalies in young psychotic children.
The authors examined three groups of children for minor physical anomalies: 52 autistic children, 34 nonautistic siblings of these patients, and 29 normal controls. The total number of anomalies and the weighted score were significantly higher in the autistic children. The formation of these anomalies in the first three months of fetal life may concur with the developmental deviation of the central nervous system in some of these individuals.
Abnormalities, Multiple↗