Ethics for the Society of Biological Psychiatry.
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Biological Psychiatry↗
Biomedical subjects
R A Weller
Publications and source records attributed to R A Weller.
Bipolar disorder in children: misdiagnosis, underdiagnosis, and future directions.
Bipolar disorder has not been well studied in prepubertal children, despite its potentially debilitating effects on growth and development. However, there have been case reports of mania in this age group dating back to Esquirol in the mid-19th century. Despite anecdotal case reports, explicit criteria to diagnose mania in children were not used until 1960. Since 1980 the DSM-III/DSM-III-R criteria have indicated adult criteria can be used to diagnose childhood mania, with some modifications to adjust for age differences. Bipolar disorder has not been frequently considered in the psychiatric differential diagnosis of children. However, if a diagnosis of mania is made, clinical rating scales can be used to rate the severity of manic symptoms and to monitor treatment. A manic child should be treated using a biopsychosocial approach. To date, lithium carbonate has been the most commonly used psychopharmacological treatment, but results have been variable. Additional research is needed, including double-blind, placebo-controlled studies to document the beneficial effects of mood-stabilizing medications. Also, diagnostic instruments should be refined to improve their utility. Finally, children at high risk for developing mania should be studied to identify predictors of bipolar disorder in children.
Adolescent↗
Untoward effects of lithium treatment in children aged four through six years.
OBJECTIVE: To explore the relationship between lithium dose and serum lithium level on the occurrence of untoward or toxic effects of lithium in the treatment of 20 hospitalized aggressive and/or mood-disordered children aged 4 through 6 years. METHOD: Clinical and research records of 20 children treated with lithium according to an established inpatient protocol were reviewed. Side effects as reported by psychiatric staff were categorized by organ system affected and severity. RESULTS: During the initial 2 weeks of lithium treatment, 60% of the children manifested one or more types of side effects, most commonly central nervous system effects. Side effects were seen at doses of 25.6 to 52.1 mg/kg per day and at serum levels from 0.65 to 1.37 mEq/L. In general, adverse effects were associated with higher lithium doses and lithium levels and were most common during the first week of treatment. A potential interaction between concurrent infection and more severe side effects was seen. CONCLUSIONS: Side effects occur frequently in children aged 6 years and younger during the initiation phase of lithium treatment; are related to higher milligram per kilogram doses, higher serum lithium levels, and phase of treatment; and may be related to concurrent medical illness.
Aggression↗
The Mania Rating Scale (MRS): further reliability and validity studies with children.
Empirical studies of prepubertal mania are scarce and are limited by a lack of assessment instruments. This study extended previous research on the Mania Rating Scale (MRS) in children. Psychometric properties of the MRS were examined in three new groups of prepubertal subjects: (1) 10 inpatients with bipolar disorder, (2) 10 inpatients with attention deficit hyperactivity disorder (ADHD), and (3) 10 outpatients with ADHD. Subjects were administered the MRS and other standard depression and hyperactivity measures. The MRS had adequate internal consistency (alpha = .80), convergent validity (r = .83, p < .0001), and divergent validity (no significant correlations with depression and hyperactivity ratings). Items assessing "classic" manic symptoms (e.g., elevated mood, increased sexual interest, pressured speech, racing thoughts) effectively discriminated the bipolar group from both comparison groups, while items assessing increased activity level and irritability did not. Results suggest that the MRS can be used with children.
Attention Deficit Disorder with Hyperactivity↗
Psychopathology in families of children with major depressive disorders.
Family psychiatric histories of 63 inpatient children with major depressive disorder (MDD) and 63 matched inpatient psychiatric controls were compared. MDD, anxiety disorders, somatization disorder and antisocial personality disorder (ASP) were significantly more common (P < 0.05) in the family histories of MDD probands. When family histories of depressed/anxious (D/A) versus depressed/behavior disordered (D/B) children were compared, the D/B group had more alcohol abuse (P < 0.05) and antisocial personality disorder (P < 0.08) than the D/A group. This report supports findings from earlier studies and suggests mood and anxiety disorders are increased in families of children with MDD.
Child↗
Anxiety in acutely bereaved prepubertal children.
Anxiety symptoms present immediately following parental death and approximately 8 weeks following the death were evaluated in 38 prepubertal children. Comparison groups included 38 hospitalized depressed children and 19 normal children. Bereaved children and parents were administered the Grief Interview and all were administered standard diagnostic interviews (DICA-C/P). While no bereaved children met DSM-III-R criteria for any anxiety disorder, anxiety regarding other family members dying was reported in 55% of bereaved children immediately after death and in 63% approximately 8 weeks later. When DSM-III-R anxiety symptoms were assessed, bereaved children did not report significantly more anxiety symptoms in the approximate 8-week interval post-parental death than normal comparison children, and had significantly fewer anxiety symptoms than depressed children (p < 0.0001). Bereaved children who had the most anxiety symptoms were also likely to have a depressive disorder (p < 0.002). Age and sex of child, sex of surviving parent, anticipation of death, and family history of anxiety or depressive disorders were not significantly associated with increased anxiety.
Adaptation, Psychological↗
Psychosocial functioning in children after the death of a parent.
Eight weeks after the death of a parent, children from stable families (N = 38) were compared to depressed inpatients (N = 38) and normal children (N = 19). School behavior, interest in school, peer involvement, peer enjoyment, and self-esteem were similar for bereaved and normal children. Bereaved children functioned significantly better than depressed inpatients. As a group, the bereaved children from stable families did not experience significant, acute psychosocial dysfunction.
Adaptation, Psychological↗
Depression and learning disabilities in children.
Occurrence of learning disabilities was determined in 30 inpatient children aged 6-12 with major depressive disorder (MDD). Learning disabilities (LD) occurred seven times more often compared to community base rates (33% v 4.7%). While rates of comorbid diagnoses, severity of depression, and children's and parents' reports (DICA-C, DICA-P) did not differ between groups, teachers' reports (TRS, TRF) indicated increased classroom problems and poorer adaptive functioning in MDD/LD subjects (P < 0.0001).
Child↗
The Mania Rating Scale: can it be used in children? A preliminary report.
The Mania Rating Scale (MRS) was evaluated for use in prepubertal children. Eleven manic and 11 matched controls with attention-deficit hyperactivity disorder were examined. MRS scores were significantly higher in manic versus ADHD children (p less than 0.0001), while scores on hyperactivity rating scales (Conners-Parent and Teacher Forms) did not differ between groups. Most individual MRS item scores differed significantly between groups (p less than 0.05). MRS scores correlated significantly with severity of mania (Clinical Global Impression--Mania, r = 0.84; p less than 0.0001). Age, race, and sex were not correlated with MRS scores. The MRS may be useful in differentiating mania from ADHD and determining the severity of mania in prepubertal children.
Attention Deficit Disorder with Hyperactivity↗
Comparison of fluorescent polarization immunoassay and radioimmunoassay in measuring cortisol levels in prepubertal depressed children.
Cortisol levels of 21 hospitalized prepubertal depressed children given the dexamethasone suppression test (DST) were measured by radioimmunoassay and by fluorescent polarization immunoassay, a new assay method. Correlation analyses demonstrated a highly significant linear relationship between the two methods of measuring cortisol. Thus, it may be possible to use fluorescent polarization immunoassay to measure cortisol levels in children undergoing the DST.
Age Factors↗
Depression in recently bereaved prepubertal children.
OBJECTIVE: The purpose of this study was to ascertain depressive symptoms in recently bereaved prepubertal children and compare these symptoms with those of depressed prepubertal children. METHOD: The subjects were 38 children who had recently experienced the death of one but not both of their parents. They had to meet strict inclusion criteria so that the effects of bereavement per se, rather than other significant stressors, could be assessed. The comparison group consisted of 38 hospitalized, depressed children individually matched to each bereaved subject for age, sex, and socioeconomic status. All of the children underwent systematic and comprehensive evaluation. They and their parents were independently evaluated by trained interviewers using the parent and child versions of the Diagnostic Interview for Children and Adolescents. Family histories and basic demographic information were also obtained. RESULTS: The recently bereaved children endorsed many depressive symptoms. Thirty-seven percent of them met the DSM-III-R criteria for a major depressive episode. The depressed children, however, had more depressive symptoms on average than the bereaved children. The factors associated with increased depressive symptoms in the bereaved children were 1) the mother as the surviving parent, 2) preexisting untreated psychiatric disorder in the child, 3) family history of depression, and 4) high socioeconomic status. CONCLUSIONS: A considerable number of the bereaved children developed the clinical symptoms of a major depressive episode immediately after the death of a parent. The relation of these symptoms to the subsequent course of grief and to major depressive disorder remains unknown and should be studied further.
Adult↗
Dexamethasone suppression test and depressive symptoms in bereaved children: a preliminary report.
Eighteen bereaved children and adolescents were assessed using the dexamethasone suppression test (DST) and the Diagnostic Interview for Children and Adolescents 4 weeks following parental death. Thirty-nine percent had a positive (nonsuppressed) DST. DST-positive subjects reported more DSM-III-R depressive symptoms (6.3 +/- 2.9 vs. 3.9 +/- 2.7, means +/- SD) than DST-negative subjects. Most frequently reported symptoms included dysphoria, loss of interest, sleep disturbance, appetite disturbance, psychomotor disturbance, and morbid and suicidal ideation. Post-dexamethasone cortisol levels were significantly correlated with the total number of depressive symptoms and suicidal ideation.
Adolescent↗
DST status and blood chemistries in prepubertal children.
Cholesterol, sodium, potassium, and serum glucose were examined to determine if they could predict status on the dexamethasone suppression test (DST) in 59 depressed prepubertal psychiatric inpatients and 21 nondepressed psychiatric inpatients. Multivariate analyses found that none of these variables, alone or combined, were predictive of DST results.
Adolescent↗
Plasma levels of imipramine and metabolites in 68 hospitalized children.
Steady-state plasma imipramine levels were measured in 68 hospitalized children. Interindividual variability (imipramine 12-fold; desipramine 72-fold; 2 hydroxyimipramine 33-fold; 2 hydroxydesipramine 3-fold) was not correlated with clinical or demographic variables. However, intraindividual levels were reproducible and were linearly correlated with dose (r = 0.76; p less than 0.005). Clinicians, by using plasma level monitoring, can rationally adjust dosages so that all patients will be in the optimum range, ensuring an adequate trial while avoiding supratherapeutic levels associated with cognitive toxicity.
Adolescent↗
Imipramine treatment of trichotillomania and coexisting depression in a seven-year-old.
Trichotillomania is seen in normal children with a variety of psychiatric conditions (Krishnan, 1985). Although an association between depression and trichotillomania has been suggested in adults and adolescents (Krishnan, 1985), its association with DSM-III-R major depressive disorder in a prepubertal child has not been reported. Such a case of trichotillomania occurring with major depressive disorder is reported in this paper. In this prepubertal child, imipramine therapy led to remission of both disorders.
Child↗
Pediatric management of depression.
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Adolescent↗
Lymphocyte subclasses and depression.
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Adolescent↗
Should children attend their parent's funeral?
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Adult↗