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[Psychopath-like equivalents of depression in children and adolescents].

Psychopathlike equivalents of depression in 56 patients aged 10 to 16 years are described. Schizophrenics (50) made up the main group of clinical observations while in six cases, the diagnosis of psychopathlike equivalents of depression associated with diseases of residual-organic nature was made. Individual typical variants of psychopathlike equivalents of depression are described; their psychopathological structure was shown to be dependent on the character of affective disturbances and also on such factors as age-associated and individual reactivity.

Adolescent↗

A culturally patterned depression in a mother after loss of a child.

The phenomenology of clinical psychiatric syndromes is conditioned by the cultural ambience of the patient. This paper describes a reactive depression in an Amerindian woman (Trio group) of Surinam, which followed the form, onset, and outcome prescribed by her tribal tradition.

Adjustment Disorders↗

Reciprocal influences among adrenocortical activation, psychosocial processes, and the behavioral adjustment of clinic-referred children.

The reciprocal effects among cognitive-behavioral, environmental, and biological influences on clinic-referred children's (N = 64; 34 boys; M age 12.71 years) short-term psychological and psychiatric adjustment were studied. At clinic intake and 6 months later, standardized measures of adjustment and control-related beliefs were assessed. Before and after conflict-oriented parent-child interaction tasks the children's saliva was sampled. Adrenocortical responses (i.e., increases in salivary cortisol) to the social conflict task predicted children's internalizing problem behaviors and anxiety disorders at follow-up. Consistently high adrenocortical reactivity at intake and follow-up was associated with deflated social competence over the 6-month period. Also, specific patterns of discontinuity in children's internalizing behavior problems predicted individual differences in their subsequent adrenocortical responsiveness. Specifically, rising behavior problem levels across time predicted higher and declining behavior problem levels predicted lower adrenocortical reactivity at follow-up. Findings are among the first to suggest links among internalizing behavior problems, adrenocortical responsiveness to social challenge, and clinic-referred children's short-term cognitive-behavioral and emotional adjustment.

Adolescent↗

Children in foster care: mental health, service use and costs.

OBJECTIVE: To assess the prevalence of mental health problems in children in foster care, their families' use of services and the associated costs. METHODS: Information on mental health problems, service use and costs was collected, by postal questionnaires and home interviews, on 182 children, their foster carers and teachers from 17 local authorities in Central Scotland. RESULTS: Over 90% of the children had previously been abused or neglected and 60 % had evidence of mental health problems including conduct problems, emotional problems, hyperactivity and problems with peer relations. When compared with 251 children from local schools, the children in foster care had significantly higher symptom scores for Reactive Attachment Disorder. Those children with highest scores for mental health problems were attracting a high level of service support from a wide range of agencies, except Child and Adolescent Mental Health Services (CAMHS). Costs were associated with learning disability, mental health problems, and a history of residential care. CONCLUSIONS: Children in "mainstream" foster care are at greater risk of mental health problems, and are attracting greatest costs, but CAMHS are not successfully targeting these problems. CAMHS may need to develop new models of service delivery.

Adolescent↗

Snake oil, ethics, and the first amendment: what's a profession to do?

This article considers the appropriate legal and ethical response to those whose advocacy of "alternative" or unvalidated therapies places people at risk of harm. What are our professional responsibilities with respect to such advocacy, and what sorts of harm will justify government intervention?

Adolescent↗

Acute-phase protein response is impaired in severely malnourished children.

1. The responses of plasma levels of C-reactive protein and serum amyloid A were assessed in two groups of malnourished children. 2. Sixty-six severely malnourished children were studied at admission. Fifty of these had clinical and/or laboratory evidence of infection. C-reactive protein was not elevated in 23 (46%) and serum amyloid A was not raised in 29 (58%) of these 50 children. 3. Surviving children (n = 62) received two doses of diphtheria-pertussis-tetanus vaccine, to which the C-reactive protein and serum amyloid A responses were measured. The first was given early in recovery, the second after nutritional rehabilitation. Ten mildly malnourished children acted as controls, receiving a single dose of diphtheria-pertussis-tetanus vaccine. 4. The responses of both C-reactive protein and serum amyloid A to diphtheria-pertussis-tetanus vaccine were significantly less in early recovery than after nutritional recovery. The response of the mildly malnourished group was no different from that of the severely malnourished group in early recovery, but was less than their response on discharge. 5. The acute-phase protein response of malnourished children is impaired. This may have prognostic implications as the response plays a central role in promoting healing.

Acute Disease↗

Mentalizing language development in a longitudinal attachment sample: implications for alexithymia.

BACKGROUND: The construct of alexithymia implies a deficit in symbolization for emotional, somatic, and mental states. However, the etiologic factors for alexithymia have not yet been fully elucidated. The present study investigated the use of mentalizing language, i.e. the utterance of internal states, from a developmental perspective according to attachment organization and disorganization. METHODS: A longitudinal design across 4 time points was applied to a volunteer sample of 42 children. At 12 months, children were tested with the strange situation procedure, the standard measure of attachment at the optimal age, and attachment classifications were taken of videotapes. At ages 17, 23, 30 and 36 months, mother and child were observed in simplified separation episodes of 30 min duration. Transcripts of the sessions were subject to coding of internal state words. RESULTS: During the investigated span, securely attached children rapidly acquired emotion, physiology, cognition and emotion-regulatory language, whereas insecurely attached and disorganized children either completely lacked internal state language or displayed a considerable time lag in the use of emotion and cognition vocabulary. CONCLUSION: The results raise the possibility that alexithymia might be a consequence of deficits in the development of internal state language in the context of insecure or disorganized childhood attachment relationships.

Affective Symptoms↗

Little orphan Anastasia. The analysis of an adopted Russian girl.

It is becoming commonplace for analysts to hear about or encounter in their clinical work adopted children from Korea, China, Eastern Europe, or Russia. There is wide variation in the orphanage experience from one area to another and also in the manner in which the transitional phase from orphanage to adoptive parents is carried out. Not surprisingly, the experience of being an orphan carries with it lifelong implications and repercussions, particularly in the area of self/object relations. Some of the problems of being an orphan are obvious at the time of adoption. Others unfold only in the course of subsequent development. We are increasingly called upon to assist adoptive families whose children are struggling amid much pain and confusion with the aftermath of the threefold experience of becoming an orphan, being raised in an orphanage, and joining a family of another culture. This essay describes in some detail the infancy and early childhood of "Little Orphan Anastasia" as she picks through the emotional rubble of her infancy and samples the embarrassment of rich nurture in her current life with her adoptive parents, the Carters. This is followed by a description of the opening phase of her analysis, in which I sketch some of her attempts to fashion an adapted identity that is more congruent with her life before and after her adoption.

Adoption↗

Stromal keratitis and anterior uveitis due to herpes simplex virus-2 in a young child.

BACKGROUND: An uncommon case of stromal keratitis and anterior uveitis due to herpes simplex virus type 2 (HSV-2) is reported. CASE: The patient was a 3-year-old boy admitted for conjunctival injection of the right eye of unknown cause, accompanied by corneal opacity and anterior uveitis. OBSERVATIONS: High titers of antibodies against HSV and Epstein-Barr virus (EBV) were found in blood samples. Polymerase chain reaction (PCR) for the detection of HSV-1, -2, and EBV genome fragments was carried out using an anterior chamber sample as a template. An HSV-2 genome fragment was amplified by PCR. Administration of acyclovir and betamethasone was started, with the consequent elimination of corneal opacity, inflammatory cells, and keratic precipitates. CONCLUSION: PCR clearly showed that HSV-2 was the causative pathogen of the stromal keratitis and anterior uveitis in this young patient. Systemic EVB infection may induce systemic immunocompromised conditions that can lead to reactivation of HSV-2 followed by ocular disorders.

Acyclovir↗

The relationship between serum levels of interleukin-6 and thyroid hormone in children with acute respiratory infection.

To determine whether monocyte-derived humoral factors such as tumor necrosis factor-alpha (TNF alpha), interleukin-1 beta (IL-1 beta), and IL-6 modulate serum thyroid hormone levels in infectious disorders, we measured serum levels of these monocyte-derived products, T3, T4, and C-reactive protein (CRP) in 59 out-patients with acute respiratory infection, aged 5 months to 15 yr (mean +/- SD, 5.7 +/- 4.2 yr). To minimize individual variation in their clinical and nutritional conditions, we selected out-patients with fever lasting for at least 3 days who had no severe disturbance of food intake. Serum T3 concentrations tended to be low in these subjects; 3 (5.1%) had levels below 1.2 nmol/L, L, and 13 (22.0%) had levels below 1.5 nmol/L. Serum T3 levels in 22 patients with elevated IL-6 (> 15 pg/mL) were significantly lower than those in 19 patients with normal IL-6 (< or = 5 pg/mL; T3, 1.7 +/- 0.4 vs. 2.2 +/- 0.6 nmol/L; P < 0.05). The serum IL-6 concentration was correlated inversely with the serum T3 level (r = -0.324; P = 0.012) as well as the T3/T4 ratio (r = -0.279; P = 0.032). Furthermore, a significant negative correlation was observed between CRP (induced mainly by IL-6) and T3 (r = -0.408; P = 0.001) or the T3/T4 ratio (r = 0.302; P = 0.020). On the other hand, TNF alpha was measurable in only 9 of 59 patients, and there was no correlation between TNF alpha and levels of thyroid hormone, CRP, or IL-6. Serum IL-1 beta was weakly detected in only 1 patient. On follow-up study of 10 of these patients, the serum T3 and T3/T4 ratio increased significantly with a reciprocal decrease in IL-6 and CRP during convalescence. No remarkable change in the serum T4 level was observed in our study. Our data suggest that the euthyroid sick syndrome is relatively common in children with acute respiratory infection, and IL-6 appears to mediate this syndrome in infectious disorders.

Acute Disease↗

Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children.

BACKGROUND: We investigated a consecutive series of children with chronic enterocolitis and regressive developmental disorder. METHODS: 12 children (mean age 6 years [range 3-10], 11 boys) were referred to a paediatric gastroenterology unit with a history of normal development followed by loss of acquired skills, including language, together with diarrhoea and abdominal pain. Children underwent gastroenterological, neurological, and developmental assessment and review of developmental records. Ileocolonoscopy and biopsy sampling, magnetic-resonance imaging (MRI), electroencephalography (EEG), and lumbar puncture were done under sedation. Barium follow-through radiography was done where possible. Biochemical, haematological, and immunological profiles were examined. FINDINGS: Onset of behavioural symptoms was associated, by the parents, with measles, mumps, and rubella vaccination in eight of the 12 children, with measles infection in one child, and otitis media in another. All 12 children had intestinal abnormalities, ranging from lymphoid nodular hyperplasia to aphthoid ulceration. Histology showed patchy chronic inflammation in the colon in 11 children and reactive ileal lymphoid hyperplasia in seven, but no granulomas. Behavioural disorders included autism (nine), disintegrative psychosis (one), and possible postviral or vaccinal encephalitis (two). There were no focal neurological abnormalities and MRI and EEG tests were normal. Abnormal laboratory results were significantly raised urinary methylmalonic acid compared with age-matched controls (p=0.003), low haemoglobin in four children, and a low serum IgA in four children. INTERPRETATION: We identified associated gastrointestinal disease and developmental regression in a group of previously normal children, which was generally associated in time with possible environmental triggers.

Child↗

Changes in nitric oxide levels and antioxidant enzyme activities may have a role in the pathophysiological mechanisms involved in autism.

BACKGROUND: There is evidence that oxygen free radicals play an important role in the pathophysiology of many neuropsychiatric disorders. Although it has not been investigated yet, several recent studies proposed that nitric oxide (NO) and other parameters related to oxidative stress may have a pathophysiological role in autism. METHODS: We assessed the changes in superoxide dismutase (SOD), glutathione peroxidase (GSH-Px) activities and thiobarbituric acid-reactive substances (TBARS) levels in plasma as well as NO levels in red blood cells (RBC) in patients with autism (n=27) compared to age- and sex-matched normal controls (n=30). RESULTS: In the autistic group, increased RBC NO levels (p<0.0001) and plasma GSH-Px activity (p<0.0001) and unchanged plasma TBARS levels and SOD activity were detected. CONCLUSIONS: These findings indicate a possible role of increased oxidative stress and altered enzymatic antioxidants, both of which may be relevant to the pathophysiology of autism.

Autistic Disorder↗