Depressive states in 11 psychiatrically hospitalized preschoolers: investigation and review.
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Biomedical subjects
Publications and source records attributed to P A Rosenthal.
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The association between depressive symptomatology and failure of cortisol suppression following dexamethasone administration is explored in a preschool age tertiary care psychiatric population. Clinical research investigation of 16 preschoolers, including 13 inpatients and three outpatients, indicates that a broad range of DSM-III depressive symptomatology can be identified in this population. Seven patients had a serum cortisol value greater than 5 micrograms/dl following 1 mg dexamethasone and six of these had diagnoses within the depressive spectrum. The appropriateness of DSM-III criteria in this age group is discussed and the usefulness of the Preschool Depression Scale as an interview guide is reviewed. Difficulties in interpreting the biological findings are also reviewed, in addition to possible genetic or environmental influences from the family psychiatric history.
The authors explored the depressive symptomatology in 9 hospitalized preschool children with suicidal thoughts and behaviors and compared them with 16 suicidal and 16 behavior-disordered outpatient preschoolers. Results indicate that suicidal preschool-age inpatients show significantly more morbid ideas, depressed mood, weepiness, and parental psychopathology than the suicidal and behavior-disordered preschool outpatients. Two of the children did not suppress cortisol post-dexamethasone.
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Sixteen suicidal preschoolers age 21/2 to 5 years who were referred to a university child psychiatry outpatient clinic were compared with 16 behaviorally disordered preschoolers matched by age, sex, race, and parental marital and socioeconomic status. The suicidal group showed significantly more nonsuicidal self-directed aggression, loss of interest, morbid ideas, depression (according to the Weinberg criteria, but not DSM-III), impulsivity and hyperactivity, and running away behavior. They also showed significantly less pain and crying after injury; more of the children were unwanted and abused or neglected by parents. Four subgroups of suicidal motivation are identified and discussed.
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This paper describes the use of short-term family therapy as a new modality for resolution of pathological grief with young children and adolescents. These families' experience with other modalities of therapy had been disappointing. The unusual cohesiveness of the family was evidenced by resistance to actual or threatened separation. Such activities as entering individual therapy or going to school, camp, boarding school, or residential treatment wer hard to accomplish because of the difficulty with earlier grieving processes and the associated failure of decathexis of the lost person.
This case report aims to make psychiatrists aware of the need for a "psychohistorical" approach to the diagnosis and treatment of patients who are the third generation of the holocaust, and identify the nature of the multigenerational processes within such a family.
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