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A 58 year old woman on long term treatment with chloroquine for systemic lupus erythematosus presented with cardiac conduction disorders and heart failure with hypertrophic cardiomyopathy, which was confirmed by histology to be related to chloroquine toxicity. The heart failure improved on stopping chloroquine treatment.
Family psychology is a new and relatively undeveloped discipline in much of the English-speaking Caribbean, particularly in the U.S. Virgin Islands. Family structure and youth behavior in the region have changed dramatically over the past few decades. Given the family-oriented nature of the culture, it is posited that the use of family psychology as an approach to research and intervention may prove to be a rich method to address this cultural metamorphosis. This article examines the potential effectiveness of interventions at the family level when mental health providers are working with youth with conduct disorder in the Virgin Islands. This article is offered as a microcosm of the global changes in family structure and the youth culture that are occurring particularly in the developing world, in part due to the rapid development of telecommunications. Possible roles of the family psychologist in this global transformation are presented.
BACKGROUND: Despite an expanding epidemiological evidence base, uncertainties remain over key aspects of the epidemiology of the 'antisocial' disorders in childhood and adolescence. METHODS: We used cross-sectional data on a nationally representative sample of 10,438 5-15-year-olds drawn from the 1999 British Child Mental Health Survey to examine age trends, gender ratios and patterns of comorbidity in DSM-IV Conduct Disorder (CD) and Oppositional Defiant Disorder (ODD). RESULTS: CD was significantly more common in boys than girls, and increased in prevalence with age. Among children who met diagnostic criteria for CD, status violations and other non-aggressive conduct problems increased with age, while aggressive symptoms became less common. Gender differences in ODD varied by reporter. Estimates of age trends in ODD depended heavily on treatment of overlaps with CD. Following DSM-IV guidelines (where ODD is not diagnosed in the presence of CD), rates of ODD fell with age; if that constraint was released, clinically significant rates of oppositionality persisted at similar levels from early childhood to middle adolescence. CD and ODD showed high levels of overlap, and both diagnoses showed substantial comorbidity with other non-antisocial disorders. CONCLUSIONS: Results from this large-scale study confirm and extend previous findings in the epidemiology of the disruptive behaviour disorders.
The diagnosis of myocardial ischemia is not confine to the alteration of the RS-T segment and of the T wave. Conduction disorders at any level can be caused by the ischemia itself and contribute to the diagnosis, as well as the ventricular arrhythmias. On the other hand, conduction blocks do not hinder or hide the diagnosis of ischemia. The primary and secondary characteristics of the T wave and RS-T segment are discussed. The relevance of the knowledge of ventricular activation vectors in bundle branch blocks is shown, as well as their alteration in case of associated myocardial infarction. Emphasis is made on the importance of the deductive method in the electrocardiographic interpretation.
The present study employed a multiple-gate screening procedure to identify children at risk for the development of conduct disorder. Measures of cross-setting disruptive behavior and parent discipline practices were administered in sequential fashion to screen a population of 7,231 children attending suburban elementary schools. Convergent validity of the respective gating measures was confirmed by significant correlations with adjustment constructs. Analyses of covariance performed between positive screens, negative screens, and low-risk comparison children on adjustment constructs at each gate supported the discriminative validity of the gating procedure. Hierarchical regression analyses demonstrated that the gating measures were predictive of diagnostic ratings of attention deficit hyperactivity disorder and oppositional defiant disorder that were obtained 18 months following the screening. A stepwise logistic regression analysis indicated that the best predictors of high-risk group membership were variables related to family process, including poor family communication and involvement, poor maternal coping skills, and an external parent locus of control.
An unusually large family of European descent was afflicted over four generations by an automaticity and conduction disorder with an associated dilated cardiomyopathy of variable expression. Ten living members affected with the disorder and three presumed affected but dead members were identified. Typically, the disorder presented as a sinoatrial bradyarrhythmia/tachyarrhythmia syndrome, followed by atrial enlargement and, variably, ventricular enlargement and dysfunction. Three family members required pacemaker implantation. Longevity did not seem to be greatly affected, but the demonstrated potential for embolic cerebrovascular events stresses an associated morbidity. The familial incidence was best explained by autosomal dominant inheritance with incomplete penetrance (greater in males and usually occurring first in adolescence) and variable expressivity. The large size of the family, frequency and profile of disease manifestations and disease tracking through at least four generations are unusual features of the familial disease described.
The preschool behavior history and a history of abuse or neglect were compared between emotionally disturbed boys with and without conduct disorder (CD), and between boys with high and low plasma dopamine-beta-hydroxylase (D beta H) activities and CD. Boys with CD had the expected increase in preschool behaviors associated with attention deficit disorder (ADD) and CD as well as more reports of abuse or neglect. A higher percentage of boys with low D beta H were reported to have preschool behaviors associated with ADD. In contrast, more high D beta H subjects were reported as abused or neglected.
The behavior of conduct disordered (CD) children was compared with normal control (NC) children in interaction with normal peers. Dyads consisting of a) a CD child and a normal peer and b) an NC child and the same normal peer as in a) were observed. CD boys were less able than NC boys to neutralize incipient conflicts. Hitherto most behavioral studies of CD boys have concentrated on their tendency to escalate conflicts but have paid very little attention to their difficulty in neutralizing conflicts.
Aggressive and prosocial behaviours and responses to prosocial acts were examined in groups of conduct-disordered and normal children. The observations were repeated following therapeutic intervention. Before treatment, the clinic groups displayed greater levels of peer-directed aggression and responded inappropriately to social overtures. Following intervention, both clinic groups showed improved responsiveness to their peers' social overtures and the older clinic children reduced their aggression while the younger children did not. Independent evaluations of each child's medical file and case disposition revealed that the observational data served as a sensitive index of the status of the two clinic groups.
Clustering techniques were used to identify a subsample of young adopted and nonadopted children in the Colorado Adoption Project at risk for conduct disorder. Although data from both boys and girls were analyzed, a cluster of girls large enough for subsequent statistical analysis could not be identified; therefore, results are reported for boys only. Identifying measures were selected based on the DSM-III-R diagnostic criteria. Cluster analyses confirmed the existence of a small group of boys who appeared to be significantly at risk. Subsequent parental and teacher ratings of these children verified the stability over time of the classification. The poor conduct group was significantly associated with difficult temperament in infancy, with poor conduct on the part of parents when they were youths, and with high achievement orientation in the home environment.
An ontogenetic framework for elucidating the etiology of substance use disorders (SUD) requires identifying how individual traits and family contexts combine to increase risk for SUD outcomes. In this study, we examine individual traits in family context to identify processes that account for the relationship between fathers' SUD + status and sons' externalizing behaviors. Results obtained from SUD + (n = 89) and SUD - (n = 139) families show that fathers' abusive propensities toward their sons mediated the relationship between fathers' SUD + status and sons' externalizing behavior scale (EBS) scores 2 years later. Moreover, individual traits, family contextual variables and deviant peer affiliations accounted for 58% of the variance on sons' EBS scores. Also, high risk cluster (HRC) and low risk cluster (LRC) memberships were derived from cluster analyses of the continuous risk factor scores that predicted sons' EBS scores. Preliminary relative risk ratios show that sons classified into the HRC at age 10-12 were at greater risk for DSM-III-R conduct disorder and SUD outcomes at age 16 than sons assigned to the LRC, SUD + or SUD - groups. Implications for selected family-based prevention initiatives are presented.
Binding characteristics of tritiated imipramine on blood platelets were determined in daytime hospitalized prepubertal children who had mixed diagnoses of conduct disorder (CD) plus attention deficit disorder hyperactivity (ADDH) and in inpatient adolescents who had a history of aggressive behavior. The number of (3H)-imipramine maximal binding sites (Bmax) was significantly lower in the prepubertal patient group of CD plus ADDH; the dissociation constant (Kd) was not significantly different. There were significant negative correlations between Bmax and the Externalizing or Aggressive factors of the Child Behavior Checklist when the CD plus ADDH prepubertal patients were combined with their matched controls and within the adolescent inpatient group. We propose that a decreased platelet imipramine binding Bmax value, as an index of disturbed presynaptic serotonergic activity, is not specific to depression and may be used as a biologic marker for the lack of behavioral constraint in heterogeneous. populations of psychiatric patients.
A series of 15 sinus of Valsalva aneurysms (SVA) admitted between 1961 and 1981 was reviewed to analyse associated conduction defects. It comprised 11 men and 4 women; the mean age was 31 years (range 16 to 53). The diagnosis of SVA was made at the time of rupture (4 cases), during investigation of associated cardiac disease (8 cases), at surgery (1 case) and during advanced conduction disorders (2 cases). All patients underwent catheterisation and angiography. Endocavitary electrophysiological studies were performed in 3 patients. Eight out of 15 patients had conduction defects which comprised: incomplete right bundle branch block (2 cases), atrioventricular block (AVB) (6 cases). Endocavitary investigation of 3 of the 6 AVB showed conduction defects at several levels: sino atrial, suprahisien, intrahisian and infrahisian blocks (1 case); transient complete AVB with 1 degree and 2 degree intrahisian block (1 case); complete AVB, six years after correction of SVA, due to infrahisian block (1 case). Thirteen of the 15 patients underwent surgery; none of the 9 cases of SVA without conduction defects before surgery developed conduction defects. Four of the 6 cases of AVB required permanent pacing; there was 1 postoperative death. One patient was not operated. These conduction defects were caused by the close relationship of the SVA to the intracardiac conduction pathways. The right anterior was the most commonly affected sinus. The investigation of AV conduction should be systematic in cases of SVA, and, conversely, the finding of AVB in young patients should alert the physician to the possibility of a SVA.
Ninety-six psychiatrically ill adolescents admitted to an adolescent inpatient service were systematically assessed to determine the morbidity of conduct disorder (CD), with other Axis I psychiatric disorders. Twenty-six (27%) met DSM-111 criteria for CD in addition to other Axis I disorders. A CD diagnosis was significantly associated with substance abuse, and attention deficit disorder with hyperactivity. Although CD was found in 21% of depressives it was more commonly found in patients with psychotic disorders (25%) and bipolar (42%) disorders. These findings suggest that CD may be commonly found in a variety of adolescent psychiatric disorders. The implications of this finding for pharmacologic treatment of CD, the clinical assessment of the CD patient, and possible relationships between CD and adolescent psychiatric disorders are discussed.
To assess condition of the heart in polymyositis (PM) and dermatomyositis (DM) in terms of defects in the rhythm and conductivity, we carried out ECG, 24-hour ECG monitoring, EIA measurements of KPK MB-fraction and myoglobin, echocardiography and Doppler echocardiography. Maximal frequency of arrhythmia presenting as supraventricular and ventricular extrasystole occurred in patients with acute PM/DM. Blockade of the bundle of His left anterior branch was detected most frequently in patients with acute and subacute PM-DM and in those with high serum levels of KPK MB-faction and myoglobin. Frequency of rhythmic and conductivity disorders seems unrelated to the disease duration. We registered no alterations at rest either in intracardiac hemodynamics or myocardial contractility. The study of these parameters under exercise test may provide objective information on early defects in myocardial contractility.
A structural equation model designed to estimate the contributions of trait, method and error variance to maternal and teacher and child ratings of conduct disorder is presented. This model was fitted to data collected on a birth cohort of New Zealand children studied over a 3 yr period. On the basis of the fitted model it was estimated that between 28% and 40% of the variance in maternal and teacher ratings was ascribable to variations in the child's generalized behavioural tendencies and the remaining variance to either method-specific factors or random errors of measurement. The implications of these results are discussed.
Ten subjects completed an open pilot study of carbamazepine in hospitalized aggressive and explosive children diagnosed as having conduct disorder. The subjects (9 boys, 1 girl) ranged in age from 5.25 to 10.92 years (mean = 8.27). Ratings were done at the end of a 1-week baseline period and after 3 weeks of treatment with carbamazepine. Ratings were carried out by multiple raters in several settings, using various rating instruments. The optimal daily doses of carbamazepine ranged from 600 to 800 mg (mean = 630); plasma levels at post-treatment rating ranged from 4.8 to 10.4 micrograms/mL (mean = 6.2). Administration of carbamazepine was associated with clinically and statistically significant declines in the target symptoms of aggressiveness and explosiveness. These results are promising and suggest that a critical assessment of the efficacy and safety of carbamazepine is warranted under double-blind and placebo-controlled conditions in this population.
OBJECTIVES: This study aimed to evaluate the effectiveness of a 12-week intervention programme for conduct-disordered boys aged 10-16 years. DESIGN: A descriptive study comparing a group of boys who participated in an intervention programme with a non-participant group. SETTING: All the participants were resident in Khayelitsha and the programme was conducted at Empilweni, a community mental health project in Site C, Khayelitsha. SUBJECTS: Nine of the 15 boys who were referred to Empilweni for serious conduct problems participated in the intervention; the remaining 6 were non-participants. OUTCOME MEASURES: The New York Teacher Rating Scale (NYTRS) and selected modules of the Diagnostic Interview Schedule for Children (DISC) were administered before and immediately after the treatment programme, and again after a 6-month interval. RESULTS: Six months after the intervention, the treatment group showed a significant reduction in defiance, physical and delinquent aggression, as well as additional conduct problems. The non-treatment group only showed a significant reduction in defiance. CONCLUSIONS: The study results suggest that short-term community-based group therapy may be effective in treating delinquent behaviour among boys in an informal settlement. The feasibility of promoting such interventions as part of national violence prevention programmes requires serious consideration.