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Biomedical subjects

L Scahill

Publications and source records attributed to L Scahill.

At least 55 records · Page 3Linked to original sources
PubMed1995

Tourette syndrome: update and review.

Tourette Syndrome is a movement disorder of childhood onset, characterized by multiple motor and phonic tics. In addition to tics, some children exhibit repetitive habits and recurring thoughts, and others may manifest problems of inattention, impulsiveness, and hyperactivity. Over the past two decades there has been increased interest in Tourette Syndrome, because it provides a useful model for examining the interaction of genes and environment, as well as neurobiology and behavior. This article provides school nurses and nurses working in school-based clinics with a general review of Tourette Syndrome and associated disorders.

Child↗
PubMed1994

Enhanced stress responsivity of Tourette syndrome patients undergoing lumbar puncture.

Tourette's syndrome (TS) is a complex inherited neuropsychiatric disorder that is characterized by multiple motor and phonic tics. Stress-related fluctuations in symptom severity and medication responsiveness are common, and patients often report that tics are worsened by fatigue, emotional trauma, and anxiety. We examined the effects of lumbar puncture (LP) stress on plasma adrenocorticotropin (ACTH) and cortisol, urinary catecholamines, and self- and clinician ratings of anxiety in 13 medication-free TS patients and 10 normal controls, ages 17 to 41 years. The TS patients secreted significantly more ACTH than the normal controls in response to the stress of the lumbar puncture. Compared to the controls the TS patients had significantly greater postLP mean and postLP peak ACTH levels. The TS patients also excreted significantly more norepinephrine in the 20 hr preceding the lumbar puncture and reported higher levels of anxiety before and during the procedure than the controls. In addition, urinary norepinephrine excretion of the TS patients was significantly correlated with clinician ratings of tic severity. The results were not related to current levels of depression and anxiety. Taken together, these findings suggest that a subset of TS patients may be characterized by heightened reactivity of the hypothalamic-pituitary-adrenal axis and related noradrenergic sympathetic systems.

Adrenocorticotropic Hormone↗
PubMed1994

Education survey.

Explore the source record for details and available documents.

Curriculum↗
PubMed1994

Steroid hormones and Tourette's syndrome: early experience with antiandrogen therapy.

We report here the first use in Tourette's syndrome of the nonsteroidal androgen receptor blocking agent flutamide. One man and one woman underwent open trials of the medication, and a second man participated in a placebo-controlled, double-blind crossover trial. Improvement in tic symptoms ranged from 45 to 60%. The improvement was sustained in the woman during daily flutamide use and in one man during its intermittent use. One man's symptoms became refractory to treatment after 5 weeks of flutamide use, whereas the woman became depressed and had protracted diarrhea during her treatment.

Adult↗
PubMed1993

Tourette's syndrome, Part I: Definition and diagnosis.

Tourette's syndrome (TS) is a neuropsychiatric disorder characterized by a changing repertoire of motor and phonic tics that typically begin in childhood and exhibit a fluctuating course. Obsessive-compulsive symptoms and problems of inattention, overactivity, and impulsiveness are present in some cases. Historically, TS has been viewed as a severe disorder. However, data from epidemiologic and family-genetic studies indicate that it shows a wide range of severity. This article, the first of two parts, examines the current notions concerning the origin, pathophysiology, and diagnosis of TS. The second article will present three cases and describe contemporary approaches to treatment.

Adolescent↗
PubMed1993

Tourette's syndrome, Part II: Contemporary approaches to assessment and treatment.

Clinical assessment of a child with Tourette's syndrome (TS) includes a careful review of motor and phonic tics. In addition, commonly associated problems of such as obsessive-compulsive symptoms, or symptoms of attention deficit hyperactivity disorder (inattention, impulsiveness, and overactivity) should also be evaluated. Treatment almost always includes education of the child, family, and school personnel concerning the natural history and behavioral boundaries of the disorder. Other treatment interventions depend to a great extent on the primary source of impairment. This article, the second of two parts, presents three illustrative cases and reviews current treatment interventions for children and adolescents with TS.

Adolescent↗
PubMed1993

Severe disturbances in speech, swallowing, and gait following stereotactic infrathalamic lesions in Gilles de la Tourette's syndrome.

A 40-year-old man with severe Gilles de la Tourette's syndrome characterized by forceful self-injurious motor tics, coprolalia, and obsessive-compulsive disorder had bilateral anterior cingulotomies and bilateral infrathalamic lesions placed stereotactically during two neurosurgical procedures. During the second procedure, the patient acutely developed a marked dysarthria. Postoperatively, he manifested a severe gait disturbance with postural instability, bradykinesia, axial rigidity, micrographia, and a profound swallowing disorder. MRI showed asymmetric (left > right) low-density areas in an infrathalamic region as well as low-density areas bilaterally in the anterior cingulate gyri. Although the patient's tic and obsessive-compulsive symptoms improved, the self-injurious motor tics along with other motor and phonic tics have recurred. The patient's speech remains largely unintelligible 8 months following the last surgical procedure, and the other neurologic deficits remain unchanged.

Adult↗
PubMed1992

Steroid hormones and CNS sexual dimorphisms modulate symptom expression in Tourette's syndrome.

We present our hypothesis that various steroid hormones play an important role in the symptom expression of Gilles de la Tourette's syndrome (TS) and that androgenic hormones, in particular, are likely to exacerbate symptoms of the disorder. We review the clinical evidence supporting our hypothesis. Sex steroids establish brain sexual dimorphisms early in CNS development, and we suggest mechanisms whereby androgenic and other hormonal changes later in human development might act at dimorphic brain regions to influence the natural history of TS. Finally, we discuss the various ways in which neuroendocrine studies might assist in genetic and neurobiologic research programs in TS.

Adolescent↗
PubMed1992

Behavioral treatment of children and adolescents with trichotillomania.

Trichotillomania is a behavior disorder with onset generally in childhood, characterized by repetitive, compulsive pulling out of hair from the scalp, eyebrows, or other parts of the body, often leading to disfigurement. Trichotillomania tends to be persistent and is often resistant to counselling and standard psychiatric care. A systematic behavioral treatment program for children and adolescents and pilot findings with three patients are described. Methodological issues in relation to compliance and assessment are discussed. The relative safety and potential effectiveness of behavioral techniques suggest a useful role for this approach, perhaps in conjunction with pharmacological, family, and other treatment modalities.

Adolescent↗
PubMed1992

Double-blind, crossover trial of fluoxetine and placebo in children and adolescents with obsessive-compulsive disorder.

Rigorously designed clinical trials have demonstrated the efficacy and safety of fluoxetine in adults with major depressive disorder and obsessive-compulsive disorder (OCD) but not in patients below 18 years old. This report describes a randomized, double-blind, placebo-controlled, fixed-dose (20 mg qd) trial of fluoxetine in 14 children and adolescents with OCD, ages 8 to 15 years old; the study was 20 weeks long with crossover at 8 weeks. Obsessive-compulsive symptom severity was measured on the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) and the Clinician's Global Impression-Obsessive Compulsive Disorder scale (CGI-OCD). The CY-BOCS total score decreased 44% (N = 7, p = .003) after the initial 8 weeks of fluoxetine treatment, compared with a 27% decrease (N = 6, p = .13) after placebo. During the initial 8 weeks, the magnitude of improvement for the fluoxetine group significantly exceeded that for the placebo group as measured by the CGI-OCD (p = .01) but not by the CY-BOCS (p = .17). The most common drug side effects were generally well tolerated. The results suggest that fluoxetine is a generally safe and effective short-term treatment for children with OCD.

Adolescent↗
PubMed1991

Screening child psychiatric inpatients for communication disorders: a pilot study.

This study was part of a project concerned with speech and language disorders among child psychiatric inpatients. Twenty-two consecutively admitted children were screened and 10 were positive. Of these, nine were diagnosed with a speech or language delay, prevalence = 40.9 (9 of 22). A chart review of the preceding 2-year period showed that 27 of 128 admissions had been referred to the speech clinic and that 25 had positive findings, for a prevalence of 19.5% (25 of 128). The difference in the observed prevalence in these two studies was significant (chi 2 = 4.89, rho = .03). Standard clinical practice may miss some children with communication disorders (estimated sensitivity = 39%), while the new screening method shows promise (estimated sensitivity = 82%).

Child↗
PubMed1991

Emergence of self-destructive phenomena in children and adolescents during fluoxetine treatment.

Self-injurious ideation or behavior appeared de novo or intensified during fluoxetine treatment of obsessive-compulsive disorder in six patients, age 10 to 17 years old, who were among 42 young patients receiving fluoxetine for obsessive-compulsive disorder at a university clinical research center. These symptoms required the hospitalization of four patients. Before receiving fluoxetine, four patients had major risk factors for self-destructive behavior including depression or prior suicidal ideation or self-injury. Three hypotheses concerning the apparent association between fluoxetine and these self-injurious phenomena are discussed: (1) coincidence; (2) disorganization of vulnerable individuals secondary to drug-induced activation; and (3) a specific serotonergic-mediated effect on the regulation of aggression.

Adolescent↗
PubMed1991

Nursing diagnosis vs goal-oriented treatment planning in inpatient child psychiatry.

The sharp rise in acute psychiatric beds for children and youth has opened up practice opportunities for child psychiatric nurses. But there is pressure from third party payers to reduce the length of stay on these services which increases demand for effective and efficient care. Timely evaluation, stabilization and discharge of children requires multidisciplinary teamwork. This paper considers the merit of nursing diagnosis in this setting and compares it to a method of multidisciplinary goal setting. The use of nursing diagnoses in child inpatient psychiatry carries some risk of creating parallel systems of care and isolating nurses from the treatment team.

Adolescent↗
PubMed1991

Exacerbation of Gilles de la Tourette's syndrome associated with thermal stress: a family study.

Gilles de la Tourette's syndrome (TS) is a familial disorder that is often exacerbated by stress or fatigue. Here we present a family of a TS proband that has several members with obsessive-compulsive symptoms, a bleeding disorder, and an unusual sensitivity to heat. The proband, who is affected by all of these traits, was challenged with heat or exercise in climate-controlled conditions and showed a marked increase in the frequency of tics.

Adolescent↗
PubMed1990

Fluoxetine treatment of children and adolescents with Tourette's and obsessive compulsive disorders: preliminary clinical experience.

Fluoxetine hydrochloride is the first selective serotonin uptake inhibitor introduced commercially in the United States. This report describes preliminary clinical experience with fluoxetine in 10 children and adolescents, aged 8 to 15 years, with primary obsessive compulsive disorder (OCD) or Tourette's syndrome (TS) plus OCD. In general, fluoxetine, which was administered from 4 to 20 weeks at a dosage of 10 or 40 mg per day, was well tolerated. Adverse effects included behavioral agitation/activation in four patients and mild gastrointestinal symptoms in two patients. No abnormalities were noted in the seven children who had follow-up EKGs. Five of the 10 patients (50%) were considered responders; their obsessive-compulsive symptoms decreased substantially during treatment with fluoxetine. Responder rates were similar in the primary OCD (two of four, 50%) and TS + OCD (three of six, 50%) groups. In conclusion, short-term fluoxetine administration appears to be safe in children and adolescents. Placebo-controlled trials are needed to further assess the efficacy of fluoxetine.

Adolescent↗
PubMed1990

Obsessive compulsive disorder in children and adolescents: phenomenology and family history.

Phenomenology and family history in 21 clinically referred children and adolescents with obsessive compulsive disorder are described. Each child and family participated in a standard clinical psychiatric assessment. The most frequently reported symptoms were repeating rituals, washing, ordering and arranging, checking, and contamination concerns. Controlling behaviors involving other family members were seen in 57% of the patients. Associated psychopathology was common: 38% received an anxiety disorder diagnosis; 29% received a mood disorder diagnosis; tics were observed in 24%. Fifteen (71%) of the children had a parent with either obsessive compulsive disorder (N = 4) or obsessive-compulsive symptoms (N = 11). The clinical and research implications of these findings are discussed.

Adolescent↗