Barbara Fish

Lithium and chlorpromazine: A controlled crossover study of hyperactive severely disturbed young children

A controlled crossover study of lithium and chlorpromazine involving 10 severely disturbed children, 3 to 6 years of age, of which 6 were schizophrenic and 1 autistic, is reported in detail. Patients were matched for motor activity (hyper- and hypoactivity) and prognosis. More symptoms diminished on chlorpromazine than on lithium. However, improvements were only slight on both, except in one child whose autoaggressiveness and explosiveness practically ceased on lithium (nonblind evaluations). Blind ratings indicated no statistically significant difference between the two drugs as well as absence of statistically significant change from baseline to treatment with either. Lithium diminished the severity of individual symptoms, though not statistically significant, such as explosiveness, hyperactivity, aggressiveness, and psychotic speech. Its effect in adult schizophrenia is compared to responses of schizophrenic children. Also discussed is the relationship of EEG to clinical improvement and toxicity, and effect of lithium on hyperactivity and aggressiveness. It is suggested that lithium may prove of some value in treatment of severe psychiatric disorders in childhood involving aggressiveness, explosive affect and hyperactivity.

Response to Triiodothyronine and Dextroamphetamine: A Study of Preschool Schizophrenic Children.

A controlled study of triiodothyronine (T3), a hormone with CNS effects and stimulating properties, is reported in detail and discussed. Twelve of the 16 subjects (13 boys and 3 girls ranging in age from 3 to 6 years) were psychotic (10 schizophrenic and 2 autistic), 2 had chronic organic brain syndromes (Turners and Klinefelters, both with withdrawing reaction) and 2 were nonpsychotic (withdrawing and hyperkinetic reactions). Optimal daily doses of T3 ranged from 12.5 to 75 mcg, while those of dextroamphetamine, used as control, from 1.25 to 10 mg. Nonblind evaluations indicated marked improvement on T3 in 11 children, slight in 3, and deterioration in one. Blind ratings indicated statistically significant improvement in overall symptomatology (p⩽0.01). While dextroamphetamine yielded poor responses in all diagnostic categories, T3 had antipsychotic and stimulating effects. T3 is viewed as an agent that is potentially effective in the treatment of childhood schizophrenia.

Drug therapy in child psychiatry: Pharmacological aspects

Summary The deviations in development of disturbed children can provide an objective guide to the severity of the initial psychopathology and the degree of change following treatment. The group of children was divided into categories of severity, the divisions being based on the deviation of psychomotor development of these children from the norm. The actions of several drugs were studied, comparing their ability to correct the critical deviations occurring in the different clinical categories. This developmental approach makes it possible to define more specific indications for using various drugs with disturbed children.

IMITATION AND ECHOING IN YOUNG SCHIZOPHRENIC CHILDREN

By the beginning of the fourth year of life most children have attained sufficient language skills to comprehend and speak their native tongue. While the capacity for language development is partly dependent on the maturation of inborn structures, the acquisition of specific speech patterns is molded by the language community into which the child is born. Thus, competence in language is differentiated by the egos continuing impact with experience. Imitation of native speakers is one of the important means by which a child utilizes his experience to differentiate and expand his functional command of language. Imitation has been used to describe a wide range of copying behaviors. Verbal imitative responses may range from rigid echoing (parroting) to imitations which use the words heard in newly generated creative forms used to convey meaning (Thorpe and Zangwill, 1956; Chomsky, 1965; Piaget, 1928).

Imipramine in preschool autistic and schizophrenic children

Imipramine was studied in 10 autistic and schizophrenic children 2 to 6 years of age, whose intellectual functioning ranged from low average and mild to severe mental retardation. The purpose of this pilot study was to explore the effects of imipramine in this patient population. Imipramine showed a mixture of stimulating, tranquilizing, and disorganizing effects. Three children improved markedly, 3 slightly, and 5 became worse (nonblind evaluations). Only 2 were rated improved by the “blind” psychiatrist. In general, this was not a good drug for this group of children. The overall effect was infrequently therapeutic and usually outweighed by the toxic effects. Epileptogenic effect, effect on psychosis, as well as possible mechanisms of action of imipramine are discussed. It is suggested that this drug merits further exploration in the most retarded, mute, anergic children, and in those with only borderline or little psychotic symptomatology.

A METHOD TO STUDY LANGUAGE DEVIATION AS AN ASPECT OF EGO ORGANIZATION IN YOUNG SCHIZOPHRENIC CHILDREN

Language holds a unique position among the functions of the ego because its development and operation depend upon the synthesis of mental schematization, motor control, affective responses, and environmental stimulation. Moreover, language is a structural organization like the ego itself, and may be studied effectively through the vehicle of speech. Thus, it may be said that speech offers a window to ego organization and higher integrative functions subsumed under the central nervous system. The developing deviant speech of schizophrenic children provides an opportunity to observe and measure one aspect of the integrative defect or fragmentation of the ego in this disorder. Deviations in language were a prominent part of the earliest clinical descriptions of childhood schizophrenia and early infantile autism (Lutz, 1937; Despert, 1938; Bradley, 1941; Kanner, 1943; Bender, 1947). Some schizophrenic children have such grossly reo

THE MATURATION OF AROUSAL AND ATTENTION IN THE FIRST MONTHS OF LIFE: A STUDY OF VARIATIONS IN EGO DEVELOPMENT

The study of individual variations in ego development requires the application of quantitative methods to very complex clinical phenomena. Most quantitative studies of individual differences in infants have been limited to the newborn period. Such studies have demonstrated differences among newborn infants in autonomic response patterns (Bridger & Reiser, 1959; Grossman & Greenberg, 1957; Richmond & Lipton, 1959), activity level (Fries, 1944), and sensory responsiveness (Birns, 1961; Graham, 1956). However, it is more difficult to demonstrate that any of these variations persist into later infancy or childhood. It is still more complicated to show how they affect personality development. Fries (1944) found some longitudinal consistency in individual activity type and described relationships between the extreme variations and certain personality characteristics in later life. Graham (1962) found no clear correlation between increased

Drug therapy in child psychiatry: psychological aspects.

Summary Drug therapy was found to be a safe and useful addition to psychological measures in the outpatient treatment of children whose disorders ranged from severe schizophrenia to mild behavior disorders. Although the underlying pathology was not removed, the quantitative reduction of disorganizing anxiety helped the forces in the child which were striving for re-integration and active mastery. Drugs also promoted more mature patterns of motility, impulse control and attention. These effects enabled many of the children to learn more constructive ways of coping with their interpersonal problems, and to make better use of their schooling. Drug therapy thus facilitated the psychological aspects of treatment, and accelerated the therapy of many of the children. It also provided some help for children who were too disturbed to be candidates for traditional psychotherapy, or who could not participate in such therapy in the absence of drugs. Drugs were generally accepted by parents and children as simply another way in which the doctor was trying to help the child. The physiological effects of drugs did not interfere with the therapeutic relationships between doctor, child and parent. The regulation of medication introduced additional practical problems and transference complications into these interpersonal relationships, but the management of such problems was no different in principle from the similar problems encountered in the absence of, drugs. To this observer, the added problems seemed amply justified by the ability of medication to increase the help available to seriously disturbed children and to accelerate the treatment of many others.