Biomedical subjects
Publications and source records attributed to B Pfefferbaum.
Children are often required to testify in court about physical and sexual abuse. This article examines the literature related to their testifying and reports the experiences of children who were interviewed regarding those experiences. In general, the children did not appear to be unduly traumatized by their court experiences.
A number of factors associated with teen suicide have been elucidated in recent years. Relevant clinical and research issues are reviewed: victim characteristics including psychopathology and warning signs; social influences including the effects of music and the media, the role of imitation and access to firearms; prevention programs; and implications for practice including professional education, primary care interventions, response to threats, commitment, and post-intervention.
PURPOSE: This self-report study of college students sought to examine the relationship between risk-taking and delinquent behavior, to develop reliable measures of impulsiveness and attraction to thrill-seeking and risk-taking, and to measure the relationships among conventional correlates of delinquent behavior, personality factors, and delinquent behavior itself. METHODS: A sample of 296 undergraduate college students completed questionnaires pertaining to delinquent behavior and other activities, identification with educational goals and behavior, and attraction to thrill-seeking and risk-taking behavior, as well as items from the Self-Control and Socialization scales of the California Personality Inventory. RESULTS: Males who measured high in thrill-seeking behavior and low in self-control reported significantly more property delinquency. Interpersonal delinquency was most influenced by a lack of self-control. There was a negative correlation between substance abuse and socialization. The reasons most often given for property and substance delinquency were "fun/thrills" while those most often given for interpersonal delinquency involved "anger/revenge." CONCLUSION: Variables representing conventional sociological theories have often been treated as the immediate causal factors in juvenile delinquency, but their impact may be mediated through factors such as impulsiveness and an attraction to thrill-seeking and risk-taking.
This article examines the use of analgesics and psychopharmacological adjuvants in children experiencing pain. Peripheral analgesics are effective for mild to moderate pain. Narcotics are effective but may produce dependence and tolerance as well as untoward side effects. Major tranquilizers, minor tranquilizers, tricyclic antidepressants, and stimulants have all been used as adjuvants in pain management. Major tranquilizers are now discouraged because of potential serious adverse effects. Benzodiazepines are relatively safe and decrease anxiety accompanying pain. Tricyclics may be used with caution. Stimulants have received little attention but may be useful in treating both pain and depression in the physically ill.
This study sought to determine if cultural heritage and acculturation influence the perception and expression of pain and anxiety. The study was based on self-report and observation of Anglo and Hispanic children with cancer undergoing invasive procedures. Seventy-eight children between the ages of 3 and 15 participated. Thirty-five were Anglo and 43 were Hispanic. A significant inverse relationship between age and observed and reported distress was noted in both ethnic groups. The Anglo and Hispanic children had remarkably similar behavioral responses. Hispanic parents, however, reported significantly higher levels of anxiety than Anglo parents.
Stimulants once used to treat depression have been overshadowed by tricyclic antidepressants and monoamine oxidase inhibitors. Recently, their use has been reported in the treatment of depression in medically ill adults in whom tricyclics are contraindicated, or for whom a rapid response is critical. This report documents the successful use of methylphenidate in a depressed adolescent with AIDS.
Monoamine oxidase inhibitor (MAOI) drugs are used in the treatment of depressive and anxiety disorders in adults. MAOIs are also used in high doses for the treatment of lymphomas and of central nervous system (CNS) tumors in children. Toxic effects resulted when procarbazine, a drug of this class, was used in treating a child with a CNS tumor. Psychotic reaction in the child may have been triggered by any of several factors, but arguments are for an organic cause. The implication of the MAOI procarbazine must be seriously considered. The case highlights potential serious problems associated with MAOIs and the interaction of this agent with other drugs.
Upon admission to a hospital treatment program, clinically depressed and nondepressed children (aged 9-17 years) were assessed on measures of attributional style, hopelessness, depression, life stress, and child temperament. The depressed group tended to attribute positive events to specific and unstable factors when compared with the nondepressed sample. Group differences also were found on child temperament measures. However, no differences were reported between the diagnostic groups on self-reported depression, hopelessness, or life stress. The findings suggested that there may not be a unique constellation of cognitive characteristics in depressed children when compared with a nondepressed clinical sample. For both depressed and nondepressed groups, treatment did appear to affect self-reported depression and overall ratings of depressogenic attributional style.
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To enhance communications between physicians and adolescents, 600 middle school students and 99 physicians completed written questionnaires assessing the importance of 45 items from seven subscales: smoking; physical fitness; weight control; self-actualization; comparison with others; peer opinion; and communications. Adolescents rated the importance of knowing about items from each scale. Physicians rated how much importance they attached to each scale and their perception of the adolescents' ratings. Physicians placed more importance on each scale than did the adolescents, and they did not accurately judge the importance adolescents placed on the items. Physicians and adolescents differed significantly in the ratings of all but one scale, weight. With the exception of one scale (peer opinion), physicians estimated that adolescents would place less importance on the items in each scale than the adolescents actually reported. Our results suggest the need to concurrently consider adolescent-physician views when seeking to meet adolescents' health needs.
Projective testing may provide the clinician with a valuable context in which childhood borderline conditions may be investigated. The purpose of this study was to determine if Rorschach scores could be useful in diagnosing borderline disorders. Rorschach scores from a group of 13 borderline children and 10 conduct disorder children were compared using a step-down discriminate analysis. The results indicated that children in these two groups could be correctly classified beyond chance levels using Rorschach scores. Three variable, content analysis, human movement, and animal movement were the strongest contributors in separating the two groups. The Rorschach measure of form quality (i.e., adequacy of perception) was notable in that it failed to produce any independent discriminatory power in this analysis. As in the case of adult borderline testing using the Rorschach, novel scoring procedures, used in conjunction with standard scoring procedures may lead to further clarification of childhood borderline disorders.
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While benzodiazepines have been widely used in adult populations, their role in the treatment of anxiety disorders in children and adolescents has not been well established. The authors report on two cases in which benzodiazepine use resulted in psychotic symptoms. The importance of eliciting a careful history as well as being familiar with drugs' side effects and withdrawal effects is stressed.
The utility of the Brief Psychiatric Rating Scale for Children (BPRS-C) for transcribing narrative medical records into standard quantitative form for research purposes is examined. Three clinicians independently read and rated the records of 40 child and adolescent patients. Interrater reliabilities were adequate in most major domains of psychopathology, the one notable exception being symptoms in the anxiety domain. On the basis of these results, the BPRS-C appears appropriate for use in administrative and audit reviews, as well as in epidemiological and program evaluation research in which medical records are the primary sources of information.
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A follow-up study was made of the prevalence of the use of unproven treatment methods by families of children being treated for cancer at UT M.D. Anderson Hospital. Information was also obtained about parental attitudes toward conventional and alternative treatments and their understanding of them, as well as the physicians' awareness of the use of alternative treatments. Cross-cultural comparisons were made to assess the differences between Hispanics and Anglos in their perceptions of treatment. Sixty-six parents responded to questionnaires (34 Anglo, 30 Hispanic, and two others), and the results in terms of prevalence of use were comparable to those obtained in an earlier study (less than 10%) at the same institution, as well as to those recently reported by investigators at another institution in northwestern U.S. No parents reported the use of Laetrile. Significant differences were found between the Anglos and Hispanics in their perceptions of the treatment administered at the hospital. A significant number of parents expressed a desire for more information from their physicians about all types of treatment. This study serves as a pilot project for a nationwide, multihospital study to be conducted in 1982.