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Biomedical subjects

H A Schreier

Publications and source records attributed to H A Schreier.

At least 19 recordsLinked to original sources
PubMed1998

Risperidone for young children with mood disorders and aggressive behavior.

Open clinical treatment with risperidone was administered to a clinically heterogeneous group of 11 children and adolescents (age range 5.5-16 years, mean 9.8 years) with concurrent presentation of affective symptoms (mostly suggestive of bipolar disorder), aggressive and violent behavior, and marked management problems. These patients had responded inadequately to several mood-stabilizing medications. In this outpatient sample, 8 of 11 children (73%) appeared to have therapeutic responses to risperidone. Risperidone doses were low (0.75-2.5 mg daily) and clinical responses were observed at times within days of receiving the medication. Improvement was clinically judged to be moderate to marked in 7 of 8 children. In addition, the treatment of 2 children was stopped because of drowsiness; one also experienced a weight gain of 6 kg (13 lbs). An additional child with autism and aggressive behavior who lacked affective symptoms did not respond to risperidone. None of the children showed behavioral deterioration. Seven of the 8 responders were taking concurrent medications; including 4 on mood-stabilizing medications (either lithium, carbamazepine, or valproic acid) in subtherapeutic doses. Even in combination with other medications, side effects at these doses were minimal and limited to mild sedation and, at times, troubling weight gain. Pending controlled studies, these preliminary findings suggest that risperidone--alone or in combination with mood stabilizers--may be of value in treating children and adolescents with mood disorders (especially subthreshold bipolar disorder) and aggressive behavior.

Adolescent↗
PubMed1998

Auditory hallucinations in nonpsychotic children with affective syndromes and migraines: report of 13 cases.

This report describes the discovery of a possible association between auditory hallucinations, migraine, and affective/anxiety disorders in nonpsychotic children. The cases were culled by a review of all consultations in an outpatient practice in an 8-month period. Thirteen cases of nonpsychotic children who experienced hallucinations (auditory in 12) were found. All but one suffered from a variety of major affective or anxiety/panic disorders and migraine headaches. The family histories were strongly positive for affective/anxiety disorders and migraine, and four of the parents also had a history of hearing voices. The age of onset of the auditory hallucinations, where known (8 cases), was between 4 and 8 years. In only two cases did the voices accompany the migraine attacks, and these two children also heard voices at other times. Although a strong association between migraine and anxiety, panic, and affective syndromes in adults has been repeatedly found in epidemiologic study, no such association has been studied in children, and this is the first known report of a possible association between migraine, affective/anxiety disorders, and auditory hallucinations in nonpsychotic children. It suggests the need for epidemiologic study.

Adolescent↗
PubMed1996

Repeated false allegations of sexual abuse presenting to sheriffs: when is it Munchausen by Proxy?

Munchausen by proxy syndrome, wherein a caretaker (most often a mother) simulates or fabricates illness in a child in order to assume the sick role through another has now been described involving a variety of psychiatric problems and false allegations of sexual abuse. Given that a proposed dynamic appears to be a need in a dependent and/or hostile relationship with powerful transferential people from the past, it was expected that professionals (school psychologists, social workers, lawyers) other than doctors would be involved. A case involving law enforcement agents as a primary "target" is described and its significance discussed.

Child Abuse, Sexual↗
PubMed1994

Munchausen by proxy syndrome: a modern pediatric challenge.

Munchausen by proxy syndrome is a condition in which a mother pretends her infant or child is ill or causes the infant or child to be ill in order to engage in an intensely ambivalent but often destructive relationships with a physician. Despite appearances to the contrary, evidence indicates that the infant serves as little more than an object to regulate this relationship. The harming of the child takes place in a fully conscious nonpsychotic state and is a by-product of the dynamics of this relationship. We see the mother's actions as an example of imposturing good mothering. Physicians are susceptible to these mothers in ways that lead them to delays in uncovering these dynamics that can have disastrous consequences for the infant. Social and interpersonal forces that contribute to the unfolding of this syndrome are worthy of our study.

Female↗
PubMed1993

Munchausen syndrome by proxy: diagnosis and prevalence.

A review of the literature and a survey of pediatric neurologists and gastroenterologists yield data indicating that the prevalence of Munchausen syndrome by proxy is greater than is generally estimated. This possibility is further supported by follow-up data on siblings of victims, together with wide variability among practitioners in case identification.

Child↗
PubMed1992

The perversion of mothering: Munchausen syndrome by proxy.

Munchausen syndrome by proxy, in which a seemingly caring and concerned mother is simultaneously harming her child, can best be understood in terms of the mother's need for a relationship with a physician that is rooted in a profound sense of early abandonment. This understanding broadens the definition of perversions. The infant in this sadomasochistic interaction is dehumanized and is used as a fetishistic object to control the relationship. The author's literature review and case report provide the basis for his exploration of the historical, cultural, and psychological factors that both contribute to the development of the syndrome and conspire to deny its reality.

Adult↗