Elizabeth B. Weller

Children's Interview for Psychiatric Syndromes (ChIPS)

OBJECTIVEnTo describe the development and summarize the psychometric properties of the Childrens Interview for Psychiatric Syndromes (ChIPS).nnnMETHODnChIPS is a highly structured interview designed for use by trained lay interviewers in children aged 6-18 years. It screens for 20 Axis I disorders as well as psychosocial stressors. Questions use simple language and short sentence structure to enhance subject comprehension and cooperation. The interview is based on DSM-IV and results are presented in a concise, easy-to-interpret manner. There are both child and parent versions. The psychometric properties of each version were studied.nnnRESULTSnA series of 5 studies has demonstrated the validity of the DSM-III, DSM-III-R, and DSM-IV versions of the ChIPS as well as the validity of the P-ChIPS (parent version). Administration time is relatively brief, averaging 49 minutes for inpatients, 30 minutes for outpatients, and 21 minutes for a community-based sample.nnnCONCLUSIONSnChIPS can be used as a screening instrument to maximize a clinicians efficiency, as a diagnostic instrument in clinical research, and as a training instrument to help mental health professionals learn psychiatric diagnosis. It can also be used in epidemiological research.

Depression in adolescents growing pains or true morbidity

This review discusses the prevalence and characteristics of depression in childhood and adolescence. Depression in this age group is a major public health concern, but is often under-recognised and dismissed as growing pains. Interviewing the patient and their parents is essential for accurate diagnosis and structured interviews may be helpful. Prevalence increases with age. Risk of recurrence is high and is influenced by family conflict. Childhood onset depression has a 60-70% risk of continuing into adulthood and 20-40% develop bipolar disorder within 5 years. The nature of the disorder is affected by family history and symptoms vary with age. Comorbidity is common and influences treatment choice and long-term outcome. It is hoped that complications such as poor academic performance, impaired social functioning, and substance abuse may be prevented by early intervention.

Suicide-bereaved children and adolescents: a controlled longitudinal examination.

OBJECTIVEnThe current study examined emotional and behavioral sequelae in children who have experienced parental suicide by completing a secondary analysis of data from the Grief Research Study, a longitudinal study of childhood bereavement.nnnMETHODnTwenty-six suicide-bereaved (SB) children, aged 5 to 17 years, were compared with 332 children bereaved from parental death not caused by suicide (NSB) in interviews 1, 6, 13, and 25 months after the death. Childrens emotional reactions to the death, psychiatric symptomatology, and psychosocial functioning after the parents death were determined.nnnRESULTSnGrief emotions were common in both groups. SB children were more likely to experience anxiety, anger, and shame than NSB children. SB children were more likely to have preexisting behavioral problems and more behavioral and anxiety symptoms throughout the first 2 years compared with NSB children. Indices of depression, suicidality, and psychosocial functioning differed minimally between groups.nnnCONCLUSIONSnSB children experience some common elements of bereavement. In addition, they demonstrate some lifetime risk factors as well as subsequent pathology that suggests a negative behavioral trajectory. As these cohorts have not yet passed through the age of risk, long-term follow-up is critical.

A rose is a rose is a rose.

This young man presented initially and repeatedly over a period of twenty years with symptoms of irritability, depressed and withdrawn mood, impulsivity, out-of-control behavior, and suicidal ideation and behavior. These symptoms occurred with disabling intensity at ages 3 year, 6 1/2 years, and 8 1/2 years, when he had not yet been adequately diagnosed and treated with appropriate psychopharmacology. Symptoms re-occurred in early adulthood after medication had been discontinued by the patient. While he had symptoms characteristic of ADHD before age seven, these were present episodically and only in the context of significant mood disturbance and behavior disruption, which were more characteristic of mood disorder than oppositional behavior associated with ADHD. His reaction to stimulants alone was significant. His response to Ritalin suggested dysphoria and/or neurovegetative slowing. On Dexedrine, he developed frank visual hallucinations. Both reactions can be typically seen in youths with underlying mood or psychotic disorders. This patients symptoms and their repeated occurrence, in the face of significant family history of mood disorder, demonstrate the utility of DSM-IV criteria and longitudinal history taking in making the diagnosis of bipolar disorder in prepubertal children.

Affective disorders and other psychiatric diagnoses in children and adolescents with 22q11.2 Deletion Syndrome.

BACKGROUNDn22q11.2 Deletion Syndrome (22qDS) is a common chromosome deletion syndrome that has been associated with severe psychopathology, including bipolar disorder and schizophrenia, in adults. Assessment of psychiatric diagnoses in children and adolescents with 22qDS is in the early stages of investigation.nnnMETHODSn24 children and adolescents with 22qDS established by chromosomal analysis were randomly selected from a 22qDS clinic. Children and their parents were interviewed by trained psychometricians with a standardized structured diagnostic interview. A diagnosis was considered present if DSM-IV diagnostic criteria were met on either the parent or the child interview.nnnRESULTSn24 22qDS subjects (mean age 9.7+/-3.3 years) had a mean of two DSM-IV psychiatric disorders. 79% met criteria for at least one DSM-IV psychiatric disorder and over one third had three or more diagnoses. 12.5% met criteria for major depression but none had bipolar disorder. Anxiety disorders (54%), attention-deficit/hyperactivity disorder (38%), and oppositional defiant disorder (38%) were common. Although 29% reported at least one psychotic-like symptom, none met criteria for a psychotic disorder.nnnLIMITATIONSnSmall sample size may have obscured significant associations. Other limitations included non-blinded interviewers and lack of a simultaneously studied control group.nnnCONCLUSIONnAffective, anxiety, attentional, and behavioral disorders were relatively common in this randomly selected group of children and adolescents with 22qDS. No child met criteria for bipolar disorder or schizophrenia. Prospective, longitudinal study is needed to determine whether early psychiatric symptomatology in children with 22qDS predicts continuing or more severe psychopathology later in life. Early psychiatric screening and monitoring appears warranted in 22qDS patients.

Occurrence of affective disorders compared to other psychiatric disorders in children and adolescents with 22q11.2 deletion syndrome

BACKGROUNDn22q11.2 deletion syndrome (22qDS) is a common genetic disorder with highly variable clinical manifestations that may include depression, bipolar disorder and schizophrenia. Studies of psychiatric disorders in youth with 22qDS often had methodological limitations. This study reviewed clinical studies with the currently best available methodology to determine the occurrence of affective disorders compared to other psychiatric disorders in youth with 22qDS.nnnMETHODnA PubMed search was performed to identify psychiatric studies published from 2000 through 2009 of children and adolescents with genetically confirmed 22qDS who underwent systematic psychiatric assessments. Studies that met defined inclusion/exclusion criteria were selected for further analysis.nnnRESULTSnSeven studies with a total of 323 children and adolescents with 22qDS (mean age=10.8 years) met the defined inclusion/exclusion criteria. Depressive disorders, but not bipolar spectrum disorders, were increased compared to community-based rates in youth without 22qDS. Anxiety disorders and attention-deficit/hyperactivity disorder were the most frequent disorders. Although psychotic-like phenomena and schizotypical traits were reported, only two adolescents (<1%) had a psychotic disorder.nnnLIMITATIONSnUnknown selection and assessment factors may have impacted on occurrence rates.nnnCONCLUSIONnThe elevated occurrence of depressive, anxiety, and attention disorders in children with 22qDS, compared to community-based rates in children without 22qDS, suggest that psychiatric screening is needed. Longitudinal study is needed to determine if these childhood psychiatric disorders will resolve, continue into adulthood, or develop into more serious psychopathology.

Treatment options in the management of adolescent depression.

Treatment for depression in children and adolescents often requires pharmacotherapy with tricyclic antidepressants (TCAs) or selective serotonin reuptake inhibitors (SSRIs), followed by psychotherapy. Most studies have not found the TCAs to be more effective than placebo in the treatment of depression in children and adolescents. Initial reports, however, have found the SSRIs to be more effective and better tolerated. In the small proportion of children who have treatment-resistant depression, TCAs plus lithium, monoamine oxidase inhibitors (MAOIs) or electroconvulsive therapy (ECT) may be useful. More studies on the treatment of depression in children and adolescents are needed, as adult data cannot simply be extrapolated.

Somatic treatment of bipolar disorder in children and adolescents.

The currently available data from randomized, controlled trials and a considerable amount of open clinical data suggest that adolescent-onset bipolar disorder probably responds to the same agents as adult-onset bipolar disorder. Research examining psychopharmacologic treatment approaches in the early-onset bipolar disorder is limited, however. Methodologic problems include small sample sizes, lack of comparison groups, retrospective designs, and lack of standardized measures. In addition, sometimes no clear differentiation is made between mania and bipolar disorder, the latter term being used broadly in the literature. Often the studies show that symptoms improve because of treatment, but the functioning of the patients does not improve significantly. More research is clearly needed in all aspects of this disorder but especially in examining the efficacy of various types of treatment, its longitudinal course, and diagnostic issues. The indications for, and the overall duration of, long-term maintenance therapy need further study. Many adolescents and children with bipolar disorder do not respond to any of the first-line pharmacologic treatments; therefore, studies with novel agents should be extended to patients in this age range. Furthermore, physicians will probably continue to use combination therapies when confronted by either lack of efficacy or delayed onset of efficacy with a single agent. Thus, such resultant drug-drug interactions also should also be systematically studied [97].

The Role of Ritual in Children's Bereavement

Three hundred and eighteen parent-bereaved children aged 5–17 recruited from the community and their surviving parents were interviewed at 1, 6, 13, and 25 months post-parental death about their participation in funeral related rituals and subsequent adjustment following the death. Nearly all the children attended their parents visitation, funeral, and burial. Children from families who did not have such rituals fare less well over time. Children who reported internalizing or externalizing behavior at rituals were more likely to experience some increased problems in the first two years post-death. Children who were withdrawn or quiet during the rituals had fewer subsequent problems than children who acted out during these rituals. Visitation attendance was associated with better outcome one and two years later. The symbolism of rituals (e.g., playing a favorite song) often brings comfort to child survivors. Cremation does not appear to have any negative effect on childrens outcome.

Somatic treatment of bipolar disorder in children and adolescents

The currently available data from randomized, controlled trials and a considerable amount of open clinical data suggest that adolescent-onset bipolar disorder probably responds to the same agents as adult-onset bipolar disorder. Research examining psychopharmacologic treatment approaches in the early-onset bipolar disorder is limited, however. Methodologic problems include small sample sizes, lack of comparison groups, retrospective designs,and lack of standardized measures. In addition, sometimes no clear differentiation is made between mania and bipolar disorder, the latter term being used broadly in the literature. Often the studies show that symptoms improve because of treatment, but the functioning of the patients does not improve significantly. More research is clearly needed in all aspects of this disorder but especially in examining the efficacy of various types of treatment, its longitudinal course, and diagnostic issues. The indications for, and the overall duration of, long-term maintenance therapy need further study.Many adolescents and children with bipolar disorder do not respond to any of the first-line pharmacologic treatments; therefore, studies with novel agents should be extended to patients in this age range. Furthermore, physicians will probably continue to use combination therapies when confronted by either lack of efficacy or delayed onset of efficacy with a single agent. Thus, such resultant drug-drug interactions also should also be systematically studied [97].