Biomedical subjects
Publications and source records attributed to C A King.
One hundred fifty adolescent inpatients with major depression were systematically assessed for demographic and clinical differences between psychotic and nonpsychotic depression. Delusions and/or hallucinations were present in 10% of the subjects. The psychotic group had significantly more frequent and severe suicidal ideation. Posttraumatic stress disorder was also more frequent in the psychotic group.
The diagnostic Interview Schedule for Children (DISC-2.3) was studied in a sample of 265 adolescent inpatients to determine type and concurrent validity of depressive symptoms and depressive disorder diagnoses for different DISC-2.3 informants (parent, adolescent, both). The Children's Depression Rating Scale--Revised, Reynolds Adolescent Depression Scale (RADS), Suicide Ideation Questionnaire--Junior, Spectrum of Suicide Behavior Scale, and clinical consensus diagnoses were used to assess concurrent validity. Results indicated that (1) parents, compared to adolescents, reported a higher prevalence of all depressive symptoms with the exception of weight change; (2) DISC-2.3 depressive and suicidality symptoms were related positively to independent validating criteria for all informant conditions, suggesting good concurrent validity; (3) the DISC-2.3 both informant condition correctly identified the most depressive disorders; and (4) the parent, but not the adolescent, DISC-2.3 Informant condition contributed to the prediction of clinical consensus diagnoses of depression after taking into account RADS scores.
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This study compared the ability of listeners with normal hearing and listeners with moderate to moderately-severe sensorineural hearing loss to use fundamental frequency differences (delta F0) in the identification of monotically presented simultaneous vowels. Two psychophysical procedures, double vowel identification and masked vowel identification, were used to measure identification performance as a function of delta F0 (0 through 8 semitones) between simultaneous vowels. Performance in the double vowel identification task was measured by the percentage of trials in which listeners correctly identified both vowels in a double vowel. The masked vowel identification task yielded thresholds representing signal-to-noise ratios at which listeners could just identify target vowels in the presence of a masking vowel. In the double vowel identification task, both listeners with normal hearing and listeners with hearing loss showed significant delta F0 benefit: Between 0 and 2 semitones, listeners with normal hearing showed an 18.5% average increase in performance; listeners with hearing loss showed a 16.5% average increase. In the masked vowel identification task, both groups showed significant delta F0 benefit. However, the mean benefit associated with delta F0 differences in the masked vowel task was more than twice as large in listeners with normal hearing (9.4 dB) when compared to listeners with hearing loss (4.4 dB), suggesting less delta F0 benefit in listeners with hearing loss. In both tasks, overall performance of listeners with hearing loss was significantly worse than performance of listeners with normal hearing. Possible reasons for reduced delta F0 benefit and decreased overall performance in listeners with hearing loss include reduced audibility of vowel sounds and deficits in spectro-temporal processing.
OBJECTIVE: To help determine optimal strategies for treating suicidal adolescents, the authors studied family predictors of compliance with recommended psychotropic medication monitoring, individual therapy, and parent guidance/family therapy sessions. METHOD: Sixty-six hospitalized, suicidal adolescents participated in a comprehensive diagnostic evaluation and depression/suicidality assessment. Family/parental assessment measures were the Family Assessment Device, Social Adjustment Inventory for Children and Adolescents (parent-adolescent subscales), Symptom Checklist-90-Revised, and Social Adjustment Scale-Self Report. Follow-up evaluation, 6 months posthospitalization, consisted of structured telephone interviews assessing treatment follow-through. RESULTS: Compliance with recommended medication follow-up (66.7%) and individual therapy (50.8%) was better than compliance with parent guidance/family therapy (33.3%) sessions. The most dysfunctional families and those with the least involved/affectionate father-adolescent relationships had the poorest follow-through with parent guidance/family therapy. Mothers' depressive and paranoid symptoms were linked with less adolescent individual therapy and family therapy follow-through. Mothers' hostility was associated with less medication follow-up. CONCLUSIONS: Follow-through was best for medication and individual therapy. Multiple family/parental predictors of poor follow-through suggest the need for alternative or supplemental treatment strategies.
OBJECTIVE: To identify individual, parent/family, and treatment follow-through predictors of outcome for adolescent psychiatric inpatients 6 months after hospital discharge. METHOD: Eighty-nine adolescents participated in a comprehensive baseline evaluation during psychiatric hospitalization. Baseline measures included the Diagnostic Interview Schedule for Children, Social Adjustment Inventory for Children and Adolescents, Reynolds Adolescent Depression Scale (RADS), and Suicidal Ideation Questionnaire-Junior (SIQ-Jr). Structured telephone follow-up interviews assessed treatment follow-through, suicidal behaviors, rehospitalizations, living changes, and social adaptive functioning. The RADS and SIQ-Jr were also readministered. RESULTS: Baseline indices of adolescent functioning emerged as the strongest predictors of outcomes. Hierarchical multiple regression analyses indicated that baseline depression severity, a cluster of parent/family indices, and medication follow-through were significant predictors of outcome depression severity. Baseline social adaptive functioning, presence/absence of conduct disorder, and medication follow-through were significant predictors of outcome social adaptive functioning. CONCLUSIONS: The nature and course of adolescent psychopathology was difficult to disrupt, with baseline characteristics as the strongest predictors of outcome. Nevertheless, the significance of medication follow-through as a predictor suggests that treatment-related gains are possible.
Despite the dramatic increase in Mexican-American immigration over the past two decades, the acculturative experience and its relationship to suicide risk have received little attention within the field of suicidology. This paper summarizes findings from community-based studies that have explored suicide and risk factors among immigrant and Mexican-American groups, and suggests directions for future research. Most of these studies have been epidemiologic, and relatively few have addressed risk and protective factors within well-defined acculturating groups. Further study of the full continuum of suicidal thoughts and behaviors that examines precise cultural risk factors, and uses methodologies that combine quantitative and qualitative data, may improve our understanding of suicide risk among acculturating Mexican Americans.
The effectiveness and safety of ECT in pharmacotherapy-refractory depression was examined in 11 hospitalized adolescents (ages 16.3 +/- 1.7 years, 10 females) with a primary DSM-III-R diagnosis of mood disorder, which had failed to respond to three or more adequate trials of antidepressant pharmacotherapy. After a thorough diagnostic evaluation, patients received a course of ECT involving 11.2 +/- 2.0 (range 8-15) administrations. ECT was commenced with bilateral treatment in 2 adolescents and nondominant right electrode placement in 9 patients; 5 of the 9 patients were subsequently changed to bilateral treatment. All 11 patients improved to a clinically significant degree. Significant improvements were noted in scores on the Children Depression Rating Scale-Revised (CDSR-R) and the Global Assessment of Functioning Scale (GAF) (p < 0.05). Euthymia, defined as CDRS-R score < or = 40, was achieved by 64% (7/11) of patients. The Mini-Mental State Examination showed no significant decline in cognitive functioning. Neuropsychological testing completed in 5 subjects both before ECT and 1-5 days after the last treatment, indicated a significant decline in attention, concentration, and long-term memory search. Minor side effects, experienced within the first 12 hours of treatment, were headache (80% of patients) and nausea/vomiting (64%). The potentially serious complication of tardive seizure (after full recovery of consciousness) occurred in 1 adolescent. Prolonged seizures (> 2.5 minutes) were noted in 7 of the 11 patients (9.6% of the 135 ECT administrations). Pending further research on ECT in youth, it is recommended that ECT should only be administered to youth in hospital settings, that all regularly administered psychotropic medications (including antidepressants) be discontinued before ECT and restarted after the final administration of ECT, and that physicians be aware that 12 treatments are usually sufficient, but that 15 treatments may occasionally be necessary for treating depressed adolescents. With the understanding that scientific evaluation of ECT in youth is lacking, it appears that ECT can be an effective and relatively safe treatment for depressed adolescents who have failed to respond to antidepressant pharmacotherapy.
OBJECTIVE: To determine the nature of comorbid psychopathology and suicidality associated with a history of sexual abuse in depressed adolescents. METHOD: Twenty-four depressed adolescent inpatients with a history of sexual abuse were compared with a matched control group of 24 depressed adolescent inpatients on measures of depression, suicidal ideation and behavior, and posttraumatic stress disorder (PTSD) symptoms. RESULTS: Depressed adolescents with a history of sexual abuse had a higher prevalence of comorbid PTSD than did those without such a history. Chronicity and severity of abuse were significant contributors to a PTSD diagnosis. No differences were found in depression severity, specific depressive symptoms, or suicidal behavior. CONCLUSION: Comorbidity of depressive disorders and PTSD are common among adolescent inpatients with a history of chronic sexual abuse. The need for thorough assessment of depression and PTSD with appropriate interventions for sexually abused adolescents is clear.
OBJECTIVE: To identify clinical profiles discriminating depressed adolescents on the basis of comorbid alcohol/substance use disorders and to determine whether or not profiles with high predictive power are gender-specific. METHOD: One hundred three adolescent inpatients with major depression (65 girls, 38 boys) participated in a comprehensive diagnostic evaluation. Independent assessments of depression, suicidality, and psychosocial adjustment were conducted using well-validated instruments. RESULTS: Gender-specific clinical profiles were identified that predicted alcohol/substance abuse in depressed adolescents with high levels of sensitivity (90%). The significant discriminant function for depressed girls included the following predictors: longer depressive episodes, more conduct problems and psychosocial impairment, and more active involvement in relationships with boys. The significant discriminant function for depressed boys included conduct disorder, older age, and schoolwork problems. These profiles correctly identified most depressed adolescents with comorbid alcohol/substance abuse. CONCLUSIONS: Given that alcohol abuse and depression are associated with highly impaired social functioning and increased risk of self-harm, sensitivity in case identification is critical. Clinicians should conduct comprehensive assessments of alcohol/substance abuse in depressed adolescents with the identified clinical profiles.
OBJECTIVE: (1) To determine the relationship between acculturative stress, depressive symptoms, and suicidal ideation in a sample of immigrant and second-generation Latino-American adolescents, and (2) to determine the best predictors of acculturative stress and depressive symptoms. METHOD: Subjects were 40 female and 30 male students from a bilingual program in a southern California high school. Measures used were the Short Acculturation Scale for Hispanics, the SAFE acculturative stress measure, the Family Assessment Device, the Reynolds Adolescent Depression Scale, the Suicidal Ideation Questionnaire-Junior, and an open-ended question measuring individual attitudes and expectations toward the future. A cross-sectional design was used. RESULTS: One fourth of the adolescents reported critical levels of depression and suicidal ideation, which were positively correlated with acculturative stress. Multiple regression analyses revealed that perceived family dysfunction and nonpositive "expectations for the future" were significant predictors of acculturative stress and depression. CONCLUSIONS: Results suggest that some acculturating Latino adolescents experience high levels of acculturative stress. These adolescents are also "at risk" for experiencing critical levels of depression and suicidal ideation. Findings highlight the importance of assessing the treating the depressed and potentially suicidal acculturating adolescent within a cultural context.
A convenience sample of 499 perioperative nurses was surveyed to determine what they perceive to be the most pressing ethical issues. Staffing patterns, informed consent, allocation of resources, and occupational risk were ranked as most important. Also surveyed were subjects' knowledge and application of the American Nurses Association (ANA) Code for Nurses with Interpretive Statements--Explications for Perioperative Nursing (ANA Code in AORN: Standards and Recommended Practices. Denver, CO, 1994.
This study examined psychiatrically disturbed adolescents' history of exposure to suicide attempts, completions, and other deaths in relation to attitudes about life and death. A primary goal of the study was to study the mediating processes involved in the impact of loss on suicidality. Adolescents who experienced the suicide of a friend or immediate family member reported a weaker attraction to life and stronger attraction to death than adolescents lacking this experience. Exposure to attempted suicide resulted in attitudes indicating a stronger attraction to death and repulsion by life. We conclude that a comprehensive history of loss and assessment of current attitudes toward death are important aspects of evaluation and subsequent treatment of at-risk adolescents.
Idiotypic immunoglobulin expressed by a B cell tumor presents a clear tumor antigen which could be attacked by vaccination of the host. Vaccination with idiotypic protein has been shown to induce protective immunity against lymphoma, but application to patients is limited by the requirement of "personal" vaccines for each patient. A genetic approach enables V-region sequences encoding idiotypic antigen to be rescued from tumor biopsies, and to be assembled as scFv fragments. These can be expressed in bacteria to produce recombinant protein, or used directly as naked DNA vaccines. Intramuscular injection of idiotypic DNA from a mouse B cell lymphoma induces low levels of syngeneic anti-idiotypic antibody in serum. Response can be stimulated by co-injection of DNA plasmids encoding either IL-2 or GM-CSF, and T cells which proliferate in response to idiotypic IgM are generated. However, protection against tumor appears to be blocked by continuing secretion of idiotypic antigen from the persisting vaccine vector, which forms immune complexes with serum antibody. Methods for regulating the level of scFv to engage the immune system, but not to block the effector arm are being investigated. Similar control will be applicable to the cytokine vectors, which can deliver encoded cytokines designed to activate immune pathways for tumor destruction. Experience gained in lymphoma may be extended to other tumors with defined tumor antigens.
Parents' marital functioning and adolescent psychopathology were investigated in 2 studies. The first study compared parents' marital satisfaction, conflict over childrearing, affective communication, and traditional role orientation in matched samples of psychiatric inpatient and control-group adolescents. The second study examined associations between specific dimensions of marital functioning and adolescent depression severity, suicidal ideation, and social adjustment in a larger sample of adolescent inpatients. In Study 1, parents of inpatients reported less marital satisfaction and more conflicts over childrearing than parents of control-group adolescents. In Study 2, marital conflicts over childrearing were associated with a less active or involved father-adolescent relationship and more severe school behavior and spare time problems. Marital functioning was not associated with depression severity or suicidal ideation.
Idiotypic antigens are clearly defined tumor-associated protein antigens, which can induce protective immunity against lymphoma. Because each patient requires an individual vaccine, idiotypic antigens also provide ideal candidates for exploring the feasibility of replacing protein antigens by DNA vaccines. Component idiotypic variable region genes can be identified in patients' tumor biopsies and rapidly assembled as scFv sequences. These can be used to produce recombinant scFv protein in bacteria, or as direct naked DNA vaccines. A preliminary small trial of DNA vaccines for chemotherapy-resistant patients with lymphoma has begun. Intramuscular idiotypic DNA vaccination in a mouse model induces low levels of anti-idiotypic antibody in serum. Levels can be increased dramatically by coinjection of DNA plasmids encoding either IL-2 or GM-CSF, and specific proliferative anti-idiotypic T cells are induced. However protective immunity remains to be demonstrated, and a possible reason for this may lie in the continued secretion of idiotypic scFv antigen which blocks antibody activity by formation of immune complexes. Methods for regulating secretion of antigen are required before this category of tumor antigen can be fully exploited as a vaccine. The power of DNA technology should allow analysis and manipulation of pathways of antigen presentation to induce maximal therapeutic attack on neoplastic B cells. In addition, lymphoma presents a model for application of DNA technology to the wide range of human tumors known to harbor potential tumor antigens.
Forty-two severely emotionally disturbed adolescents discharged after a brief hospitalization for an acute psychiatric episode were assigned to two groups--one for whom clinicians recommended continued intensive treatment in an inpatient, residential, or day treatment setting, even though such services were not available, and the other for whom clinicians recommended only outpatient treatment. The two groups were compared on rates of rehospitalization, self-harmful actions, and suicide attempts and on severity of problems with peers during the six months after discharge. The two groups showed significant differences only in the extent of their problems with peers.