Benjamin N. Shain

Alcohol Consumption in Relation to Other Predictors of Suicidality among Adolescent Inpatient Girls

This study of 54 adolescent inpatient girls examined alcohol consumption in relation to depression severity and family dysfunction as predictors of suicidal ideation and behavior. Although alcohol consumption, depression severity, and family dysfunction were intercorrelated, regression analyses revealed their differential importance to the prediction of self-reported suicidal ideation and severity of clinician-documented suicidal ideation or behavior (none, ideation, intent, gesture, attempt). Self-reported ideation was strongly predicted by depression severity and family dysfunction; severity of clinician-documented suicidal ideation or behavior was predicted by alcohol consumption and family dysfunction. Implications for assessment and treatment are discussed.

Chronic depression and hospital course in adolescents

Survival curves were used to analyze the relationship between chronicity of depression and hospital course in 48 adolescents with unipolar major depression. The 25 adolescents with chronic depression (defined as a continuous course of depressive illness for 1 year or more) did not differ from those with acute depression in age, gender, or socioeconomic status. Despite similar admission and discharge Childrens Depression Rating Scale-Revised scores, adolescents with chronic depression had a significantly slower initial rate of improvement. The study suggests that chronicity of depression has predictive validity with regard to acute hospital course in adolescents.

Case Study Capgras Syndrome in Adolescence

Abstract Capgras syndrome, the delusion of substitution, has rarely been reported in adolescents. The etiology is unknown, and intense controversy surrounds the debate over the relative importance of biological versus psychological factors. Presented here are two cases of Capgras syndrome in adolescents and a review of the relevant biological, neuropsychological, and psychodynamic literature. The authors suggest that the psychological processes underlying the Capgras delusion are mediated by neuroanatomical connections between various brain areas and hypothesize that the fundamental lesion in Capgras syndrome may be the patients inability or failure to acknowledge the authenticity of a person they clearly recognize.

Polysomnography and prediction of treatment response in depressed adolescents

To test the hypothesis that an increase in REM latency following initiation of antidepressant treatment will predict favorable outcome, we measured REM latencies of depressed adolescents at medication-free baseline and after two nights of antidepressant treatment. Subjects to date include three adolescents, two with a DSM-III-R diagnosis of dysthymia and one with major depressive episode plus dystbymia. Severity of depression was followed with the Children’s Depression Rating Scale (CDRS). Treatment consisted of amitriptyline or imipramine, 50 mg qHS. Two adolescents eventually responded to antidepressants, whereas one did not. The REM latency of the responders increased an average of 183 minutes, whereas the REM latency of the nonresponder increased only four minutes. Sample size is too small for broad interpretation, but the mean increase in REM latency from the baseline nights to the post-medication nights predicted eventual clinical response (p = .Ol). These findings support several studies of depressed adults and one among depressed children, but clearly require replication with a larger sample. If confirmed, the data suggest that an antidepressant challenge of EEG-monitored sleep may be helpful in predicting clinical response in depressed adolescents.

Natural killer cell suppression in adolescents with major depression

To determine whether depression is associated with immune impairments in adoiescents, we assayed natural killer (NK) cell activity in seven depressed inpatients. ages 13-17, and seven ageand sex-matched normal volunteers. All patients were medication-free and were diagnosed using SADS-RDC as having Major Depressive Disorder. Fresh blood samples from patients and controls were assayed on the same day to control for day-to-day assay variance. Depression severity was measured using the self-rated Children’s Depression Inventory, and the clinician-rated Hamilton Depression Rating Scale and Children’s Depression Rating Scale. We found no significant mean group differences in NK activity when patients were compared with controls. In paired comparisons, however, we observed significantly suppressed (p < .05) NK cell activity in the most severely-depressed patients compared to their matched controls, but only when the self-rated Children’s Depression Inventory was used. These preliminary findings suggest that NK suppression may be present in severely-depressed adolescents, comparable to that reported in some depressed adults, and that severity of depression should be evaluated as a confounding variable in future assessments. Larger samples and longitudinal evaluation using subjects as their own controls during and after treatment are needed to further clarify the relationship between adolescent depression and NK cell suppression.

Effects of depression on performance on neuropsychological tests in adolescents

To determine the effects of depression on cognitive abilities in adolescents, we administered a battery of neuropsychological tests, including Wechsler Intelligence and Memory scales, Category Test, and Buschke Selective Reminding Test to 22 inpatients, ages 13-17. Patients were diagnosed with SADS-RDC criteria. Severity of depression was measured with the clinician-rated Children’s Depression Rating Scale and Hamilton Depression Rating Scale and the self-rated Children’s Depression Inventory and Reynold’s Adolescent Depression Scale. Subjects were classified into high and low depression groups based on a median split of scores from each depression scale. Using the Children’s Depression Rating Scale, patients in the high depression score group were significantly more impaired on select tests of verbal expression, attention, learning, memory, and concept formation (p < .03 or lower on all comparisons). Several visualspatial/motor measures, including Block Design, Object Assembly, and Performance IQ, did not reveal group differences. Measurement methods of depression were found to be important in the analysis, though patients’ age and sex were not. These preliminary findings are consistent with previous studies with depressed adults in that effortful learning and concept formation tests appear to be particularly sensitive to the effects of depression. In contrast to studies of depressed adults, however, we did not find an association between severity of depression and several timed, visual-motor tests.