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Anti-vimentin staining in muscle pathology.

The intermediate filaments of immature muscle fibres contain desmin and vimentin; vimentin is lacking in mature fibres. Regenerating fibres react with anti-vimentin antibodies and more intensely for desmin than mature fibres. The aim of the present study was to evaluate anti-vimentin staining for muscle pathology. Anti-vimentin-reactive fibres were found in 40 of 89 biopsies assessed. Fifteen patients with progressive destructive myopathy, infantile spinal muscular atrophy, clinically suspected Leigh's disease or unclassifiable congenital myopathy had between 1% and 95% vimentin-positive fibres. Less than 1% positive fibres were found in 25 patients with neuropathy with secondary myopathy or chronic myopathic conditions. Vimentin-positive fibres were lacking in 20 normal biopsies, in eight biopsies with neuropathic and in 21 biopsies with mild or non-destructive myopathic changes. We conclude that staining with anti-vimentin antibodies is a useful indicator for muscle fibre regeneration; it may help establish the diagnosis in infantile spinal muscular atrophy when the histopathology is non-characteristic. The high incidence of reactive fibres in some congenital or early-onset disorders may indicate developmental arrest.

Adolescent↗

Occupational assault among community care workers.

The author presents the findings of a study that attempted to analyze the frequency, trend, and pattern of workplace assaults among community care workers who provide care for severely emotionally and behaviorally disturbed children in a state government agency in Australia between 1997 and 2000. He identifies the high risk groups and discusses activities for prevention opportunities.

Adolescent↗

Stress and the major psychiatric illnesses.

Sixty patients who had a major psychiatric breakdown following stress were studied. The mode of presentation of one group led to the suspicion of a reactive psychosis and comparison with the other group showed that in terms of the actual or threatened loss of an emotionally significant person, the temporal relationship between stress and illness and the distribution of vulnerable personalities, there was a significant difference between the groups. The sex ratio and frequency distribution for age were also suggestive. In view of the above and the known clinical course of the illness and comparison with the work of major workers in this field, it seems reasonable to believe that grounds exist for accepting the diagnosis of reactive psychoses in Sri Lanka.

Adolescent↗

Correlates of stress reactivity in patients with bipolar disorder.

OBJECTIVE: The authors examined individual differences in stress reactivity as well as whether features of the illness itself or psychological characteristics differentiate between patients with bipolar disorder who are highly stress reactive and those who are not. METHOD: They assessed stressors and bipolar episodes in 58 patients with bipolar disorder followed for at least 1 year. RESULTS: Not only did stress level predict relapse, so did personality variables such as introversion and obsessionality and their interaction with stress. Number of previous episodes of bipolar illness, however, did not affect stress response. CONCLUSIONS: These results are not consistent with the view that episodes of bipolar disorder become increasingly independent of stressors after initial episodes. However, psychological traits may affect reactivity to stressors.

Adolescent↗

An adoption study of depressive disorders and substance abuse.

Registered psychiatric illness was studied in the biologic and adoptive parents of 115 adoptees with affective disorders or histories of substance abuse. The parents of these patients were compared with those of 115 control subjects who were pairwise matched for demographic and social variables and who had no psychiatric illness. Psychiatric patients had a fivefold excess of adoptive fathers who had psychiatric illness compared with fathers of their matched controls. This was due to an excess of affective disorders in adoptive fathers regardless of the sex or diagnosis of the adopted child. Biologic mothers of female patients had a threefold increase in psychiatric illness compared with mothers of their matched controls and a fourfold increase compared with mothers of male adoptees. However there was no significant concordance between specific diagnoses in biologic parents and their adopted-away children. Subdivision of depressive patients according to psychotic-nonpsychotic and reactive-nonreactive dichotomies did not yield subgroups with distinct family histories.

Adolescent↗

Clinical effects and adverse reactions of off-label use of aripiprazole in children and adolescents with developmental disabilities.

OBJECTIVE: The aim of this study was to report on the clinical efficacy and side effects of aripiprazole in treating behavioral symptoms of children with a developmental disability (DDs). DESIGN/METHODS: A retrospective chart review of the first 32 children treated with aripiprazole at an urban clinic for children with DD was conducted. RESULTS: Ages ranged from 5 to 19 years; 9 (28%) were female. Twenty four had diagnoses within the autistic spectrum and 18 had mental retardation (MR). Other disorders included: attention-deficit/hyperactivity disorder/disruptive behavior disorders (n = 13), mood disorders (n = 7), reactive attachment (n = 2), and sleep disorders (n = 2). Target symptoms included aggression, hyperactivity, impulsivity and, self-injurious behaviors. Twenty eight of the children were switched from another antipsychotic. The mean daily aripiprazole starting dose was 7.1 +/- 0.32 mg (0.17 mg/kg/day) and the mean daily maintenance dose was 10.55 +/- 6.9 mg (0.27 mg/kg/day). Aripiprazole had been used for a period between 6 and 15 months. Improvement in target symptoms was found in 56%. When treating a child with MR, the concomitant presence of an autistic spectrum diagnosis predicted a worse outcome. Side effects were reported in 16 (50%), with the most frequent being sleepiness (n = 6). Mean body mass index (BMI) rose from 22.5 to 24.1 (p = 0.003) over the follow up period, with changes in the BMI z scores. These changes were more pronounced in children younger than 12 years. CONCLUSIONS: These results with aripiprazole in this difficult-to-treat population suggest that this medication warrants controlled studies of its effectiveness and safety.

Adolescent↗

Early life experiences and psychiatric disorders: an adoptee study.

The aim of this study was to investigate whether there is any correlation between negative experiences in early infancy and the later occurrence of psychiatric disorders. The subjects in this study were a cohort of 2,215 adoptees born 1930-1949. Information about the probands' early experiences has been obtained from the files of the Child Welfare Office, which include age at time of placement in the adoptive home and type of care before placement. 136 of the probands had been treated in a psychiatric department or mental hospital. From the case records a uniform classification of diagnoses was made. The analyses have been carried out in two steps; first as repeated univariate analyses and secondly as series of discriminant function analyses. Reactive neurotic depression was significantly correlated with placement at the age of 6-12 months, but with this sole exception there was no support for the hypothesis of a correlation between psychiatric disorders and early experiences.

Adjustment Disorders↗

[The status of adaptive-compensatory mechanisms after the brain concussion in children].

80 children of preschool age were observed after concussion of the brain. In follow-up from 6 months 3 years clinical-anamnestic and neuropsychologic methods were used. The functions of autonomic nervous system were evaluated according to the results of estimation of initial autonomic tonus, autonomic reactivity, autonomic maintenance of the activity and the data of cardiointervalography. The state of nonspecific systems of the brain was studied with day time polygraphic research with a visual EEG evaluation, construction of histogramms by Fora method, estimation of speed and order of the fading of the components of a rough response. Psychovegetative stress was the ground for neurologic disorders in posttraumatic period. The disorders of adaptive regulation were manifested in exhausting of ergotropic systems with compensatory overstrain of trophotropic mechanisms, resulted in predominance of inhibiting influences with an inadequate response of synchronization on EEG during functional loads. Severity of clinical manifestations and disorders of adaptive regulation were more pronounced in children 1-3 year-old and with hypoxic-traumatic damages of the brain in anamnesis. Disintegration of cerebral activity correlated with the remote period. In the first 6-12 months after the concussion of the brain changes of vegetative reactivity prevailed, after 18 months the alterations in vegetative maintenance progressed.

Brain Concussion↗

Proactive and reactive aggression in referred children and adolescents.

Investigating different types of aggression is important to facilitate a better understanding of excessive maladaptive aggression in referred youth. Using regression analysis, the authors investigated demographic, historical, diagnostic, and treatment correlates of proactive aggression and reactive aggression in a heterogeneous population (N = 323) of psychiatrically referred youths. Ratings of proactive and reactive aggression significantly correlated with more established measures of aggression. Results suggest the importance of hyperactive/impulsive behavior, disruptive behavior disorders, and self-reported hostility in youths with both reactive and proactive aggression. Substance use disorders, a family history of substance abuse, and family violence were specifically associated with proactive aggression. Younger age and a history of abuse were correlated with reactive aggression. Implications for clinical interventions and future research are discussed.

Adolescent↗

Domestic violence and vagal reactivity to peer provocation.

This paper examined whether individual differences in children's vagal reactivity to peer provocation were related to domestic violence within the family. It also examined the question of whether conduct-problem children who show vagal augmentation to peer provocation come from families with high levels of domestic violence. During the peer provocation, children were expecting to interact with a difficult peer while vagal reactivity was assessed. Groups were divided into children who showed vagal augmentation and vagal suppression to the stressful peer interaction. Findings indicated that conduct-problem children who showed vagal augmentation to interpersonal challenge came from families with the highest levels of domestic violence. Vagal augmentation was also associated with a greater number of conduct-related problems for those children exposed to high levels of domestic violence. Discussion highlights the role of individual differences in physiological reactivity in understanding children's behavior problems in relation to domestic violence.

Child↗

The varied adult psychopathologies of children's behavior disorders.

Thirteen percent of the general population show the traits of emotional over-reactivity, emotional lability and impulsiveness that appear to be genetically transmitted. The troublesome manifestation of these traits can often be medically controlled, thereby reducing their costs to society.

Adolescent↗

Interleukin-1 blockade by anakinra improves clinical symptoms in patients with neonatal-onset multisystem inflammatory disease.

Neonatal-onset multisystem inflammatory disease (NOMID) is a rare, childhood-onset disease that is characterized by chronic, systemic inflammation. The purpose of this report is to describe the effects of interleukin-1 (IL-1) blockade on the clinical symptoms of 2 patients with NOMID. At the time of this report, the patients had been treated with anakinra (Kineret), a recombinant human IL-1 receptor antagonist, for 1.5 and 2 years, respectively. Both patients demonstrated rapid improvement in clinical symptoms and laboratory markers of inflammation. The use of anakinra in these patients seemed to be effective, without any safety concerns. These observations suggest that IL-1 plays a critical role in the pathogenesis of this inflammatory disease, and that blockade with anakinra should be further studied as a treatment for patients with NOMID and related disorders.

Adolescent↗

The differential diagnosis of impaired reciprocal social interaction in children: a review of disorders.

Impairment in reciprocal social interaction in children that is less severe than autism can be difficult to diagnose due to the variety of developmental pathways that may lead to this problem. Seven childhood disorders are reviewed that include impaired reciprocal interaction: multisystem developmental disorder, nonverbal learning disability syndrome, semantic-pragmatic disorder, attachment disorders (including a developmental theory of limbic system damage), multiplex developmental disorder, schizoid personality disorder, and pervasive developmental disorder not otherwise specified. Clarification is needed for most of the disorders in the areas of operationalized criteria, assessment tools, and documenting causal relationships.

Child↗

Urinary retinol excretion and kidney function in children with shigellosis.

BACKGROUND: Acute infections, including diarrhea, are associated with an increased risk of vitamin A deficiency. Urinary retinol excretion during such infections may contribute to this risk. The mechanism accounting for urinary retinol loss has not been clearly defined. OBJECTIVE: This study attempted to determine whether urinary retinol loss in children with acute infection is associated with impaired kidney function, particularly impaired tubular protein reabsorption. DESIGN: Urinary retinol excretion and kidney function were examined in 66 hospitalized children 5 mo to 5 y of age with acute Shigella dysentery. RESULTS: Urinary retinol loss occurred in 59% of children and was substantial (>0.1 micromol/d) in 8% of them. Children with more severe disease excreted higher concentrations of urinary retinol; those with a body temperature > or =40 degrees C excreted a mean of 0.10 +/- 0.18 micromol/d compared with 0.005 +/- 0.008 micromol/d for other children (P < 0.0001). Children with more severe disease also had impaired tubular reabsorption of low-molecular-weight proteins beta2-microglobulin and retinol binding protein (RBP)], although other measures of tubular and glomerular function were not similarly impaired. In multiple regression analysis, severity of disease indicators were the best predictors of tubular reabsorption of beta2-microglobulin (R2 = 0.53) whereas tubular reabsorption of beta2-microglobulin and RBP were found to be the best predictors of urinary retinol loss (R2 = 0.69). CONCLUSIONS: A significant amount of retinol was excreted in the urine in children with shigellosis: 8% excreted >0.10 micromol/d (15% of the daily metabolic requirement). Impaired tubular reabsorption of low-molecular-weight proteins, such as RBP transporting retinol, appeared to be the cause of this urinary retinol loss.

C-Reactive Protein↗

Psychopathology of sexual abuse in young people with intellectual disability.

The present study addressed two issues using a sample of child and adolescent victims and perpetrators of sexual abuse: (1) the extent of post-traumatic stress disorder (PTSD) in the sample; and (2) the possible distinction between perpetrators whose motivations were sexually impulsive, and those who were controlling and abuse-reactive. Retrospective case material from 43 cases (21 victims only, and 22 perpetrators, of whom 16 were also victims) provided the data. Post-traumatic symptomatology was not common. Only one case of PTSD was found. Perpetrators could be distinguished by whether they had suffered sexual abuse alone, sexual and physical abuse, or neither. The proposed distinction between perpetrators received support. Sexual abuse directed at younger victims was associated with earlier experience of multiple forms of abuse. The present data does not support the view that post-traumatic symptoms following victimization are a mediator of sexual abuse perpetration. It is argued that an elaboration of the Williams & New developmental model of perpetration better fits the data.

Adolescent↗

Psychiatric consultations for 112 pediatric inpatients.

The investigator, a child psychiatry consultant for a pediatric service, studied 112 consecutive consultations, categorizing the presenting psychiatric problems, mental status, psychiatric diagnoses, final physical diagnoses, and psychiatric recommendations. The 112 patients represented 3.4% of all pediatric patients in the same age range admitted to the hospital. Girls comprised 59% of the sample studied. The most common presenting problems were unexplained physical symptoms, while the most frequent physical diagnoses were seizure disorder and diabetes. Psychiatric diagnoses were made for 82% of the patients seen; the most common diagnosis was "reactive" disorder. Specific recommendations for either inpatient or outpatient psychiatric care were made for 42 patients, of whom 23 were known to have followed through with the recommendations. However, most recommendations involved technics that could be applied by the primary care physician, eg, advice to parents, counseling the child, liaison with schools, direction of hospital staff.

Adolescent↗