Andrea M. Hegedus

Traumas and Other Adverse Life Events in Adolescents With Alcohol Abuse and Dependence

OBJECTIVE Clinical observation suggests that adolescents with alcohol use disorders often have complex histories that include childhood maltreatment and other traumas. The aim of this study was to determine the relationships among adolescent alcohol use disorders and a broad range of traumas and adverse life events. METHOD The subjects were 132 adolescents with alcohol dependence, 51 adolescents with alcohol abuse, and 73 adolescents recruited from the community as a control group. Trauma history was assessed by a semistructured interview and other adverse life events by questionnaire. RESULTS Traumatic events reflecting interpersonal violence had occurred in many of the adolescents with alcohol dependence and abuse and few of the control adolescents. Adolescents with alcohol abuse or dependence, compared with control subjects, were 6 to 12 times more likely to have a physical abuse history and 18 to 21 times more likely to have a sexual abuse history. Sexual abuse was more common in females, and victimization by other violent acts was more common in males. Many other adverse life events were also significantly more common in the alcohol use disorder groups than in the control group, including having a close friend die, arguments within the family, and legal difficulties. CONCLUSIONS These results demonstrate that trauma and other adverse life events are strongly associated with alcohol use disorders in adolescents. Clinical screening of adolescents with alcohol use disorders for a range of traumatic events is recommended.

Nonalcoholic Cirrhosis Associated With Neuropsychological Dysfunction in the Absence of Overt Evidence of Hepatic Encephalopathy

Although much is known about the neuropsychological functioning of cirrhotic individuals with Laennecs (alcohol associated) cirrhosis, little is known about the neuropsychological functioning of individuals with nonalcoholic cirrhosis. In the present investigation, we have determined that individuals suffering from chronic nonalcoholic cirrhosis, despite the absence of clinical signs of hepatic encephalopathy, are impaired on neuropsychological tests that measure visuopractic capacity, visual scanning, and perceptual-motor speed. In contrast, intellectual, language, memory, attentional, motor, and learning abilities are intact. In comparison with a chronically ill control group of patients suffering from Crohns disease, individuals with advanced nonalcoholic cirrhosis exhibit less emotional disturbance, but are more impaired in their daily activities. These findings indicate that individuals with nonalcoholic cirrhosis, even in the absence of overt clinical signs of encephalopathy, manifest neuropsychological impairments and experience significant disruption in the routines of everyday living.

Neuropsychological, Personality, and Familial Characteristics of Physically Abused Delinquents

Juvenile delinquents who were physically abused as children are more likely than nonabused delinquents to commit violent offenses, have alcoholic and criminal parents, and be sexually abused. Physically abused delinquents are also cognitively impaired relative to nonabused delinquents, but do not differ on measures of psychopathology. The manifest cognitive deficits were most noteworthy on tasks involving language capacities, leading the authors to hypothesize that an impairment in self-regulation, due to poor internal language mediation, may be associated with a violent pattern of delinquency.

Cognitive Capacities of Juvenile Violent, Nonviolent, and Sexual Offenders

Juvenile violent, nonviolent, and sexual offenders were compared across a broad range of intellectual, neuropsychological, and psychoeducational measures. No systematic group differences were noted, nor was cognitive status related to the severity of violent behavior. These findings cast doubt on the generalizability of previous investigations implicating cerebral dysfunction in juvenile delinquents.

Prevalence of behavior problems and mental health utilization among encopretic children: implications for behavioral pediatrics.

The psychiatric literature traditionally has viewed encopretic children as having severe and characteristic behavior problems. Current psychiatric views as expressed in the Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition (DSM-III), and in the pediatric literature, however, tend to regard the behavior problems of encopretic children as being rather mild or secondary to the consequences of the encopresis itself. Using a behavioral checklist with empirically derived factors (the Child Behavior Checklist), 55 children presenting for medical treatment of their encopresis have been assessed. Numerous behavior problems are reported on parental ratings, but the overall severity of behavior problems in this group of children falls below that found in children with behavior problems who are referred for mental health services. Most children presenting for medical management of encopresis have not been seen or evaluated by mental health services. Encopresis is a disorder in which psychological evaluation and intervention by the pediatrician may be advisable. J Dev Behav Pediatr 7:293-297, 1986.

Neurobehavioral correlates of cholestatic and hepatocellular disease: differentiation according to disease specific characteristics and severity of the identified cerebral dysfunction.

Subjects with three different types of hepatic cirrhosis were compared on a battery of neuropsychological tests to determine if cerebral dysfunction varied according to the type of liver disease. It was found that the manifest cognitive impairments varied according to the type and etiology of the liver disease. These findings underscore the sensitivity of neuropsychological tests in the detection of hepatic encephalopathy, particularly in cases where there are no overt clinical signs or symptoms of neurologic disturbance. They also suggest that the nature and severity of the measurable neuropsychological abnormalities may vary within patient populations depending upon the etiology of the individuals liver disease and the specific pathophysiological mechanisms involved in its progression.

Neuropsychiatry Sequelae of Portal-Systemic Encephalopathy: A Review

Portal-systemic encephalopathy (PSE) is a common condition affecting individuals with chronic hepatic dysfunction. The clinical presentation of PSE often mimics a number of psychiatric disorders and, as discussed in the text, complicates the treatment of persons who suffer from both liver dysfunction and psychiatric illness. This review of the literature addresses the etiology, natural history and treatment of PSE. Special attention is devoted to clarifying the cognitive and affective manifestations of chronic low grade PSE.

Intellectual Profiles and Violent Behavior in Juvenile Delinquents

Hemispheric laterality, measured by the Wechsler Verbal IQ-Performance IQ differential score, in a large group of delinquents (N = 101) was not associated with violent-nonviolent behavior. Delinquents were, however, likely to be relatively more impaired on verbal than on nonverbal intellectual capacities.

Neuropsychiatric Characteristics Associated with Primary Biliary Cirrhosis

Patients suffering from primary biliary cirrhosis and a control group of patients with Crohns disease were compared with respect to neuropsychological, psychiatric and psychosocial functioning. While the two groups did not differ on tests of intelligence, the primary biliary cirrhosis patients evidenced significant deficits on certain measures of functional neuropsychological capacity, including attentional, visuospatial and perceptual-motor abilities. These patients also reported several behavioral impairments consequential to their illness, although their emotional and psychiatric status were relatively unimpaired. In addition, the similarities in neuropsychological functioning of primary biliary cirrhosis patients and individuals suffering from chronic alcoholic cirrhosis are discussed. The results of this investigation underscore the importance of a neuropsychiatric evaluation as part of a comprehensive diagnostic workup and medical management program for patients with chronic liver disease.

The Pittsburgh Initial Neuropsychological Testing System (PINTS): A neuropsychological screening battery for psychiatric patients

This paper presents a new neuropsychological screening battery for psychiatric patients. It takes 1.5 to 2 hr to administer and briefly assesses general level of performance, memory, language skills, attention, and spatial-constructional abilities. Scoring and profiling are computerized. Initial validation based on discriminant analysis of a group of brain-damaged and non-brain-damaged psychiatric patients yielded a diagnostic accuracy level of 84.51%. Cross-validation on a different population led to a substantial attrition of classificatory accuracy, but cross-validation based on a comparison between two samples drawn from a homogeneous population yielded substantially less attrition. It was concluded that while the battery discriminates accurately in a homogeneous population, it is necessary to develop separate norms for populations varying in level of impairment.