Joaquim Puig-Antich

Retrospective Assessment of Prepubertal Major Depression with the Kiddie-SADS-E

The Kiddie-SADS-E is a structured psychiatric interview designed to elicit and record past episodes of child and adolescent psychiatric disorder. In order to test the accuracy of retrospective diagnoses made with this instrument, a blind interviewer reassessed 17 children. The children had been initially evaluated with a parallel instrument, the K-SADS-P (present episode), between 6 months and 2 years prior to reassessment. Diagnostic agreement between the two different assessments of the same episode of disorder was high. Although this is only a pilot study, it does suggest that the retrospective assessment of child psychopathology based on interviews with parent and child may be a technique capable of yielding reliable information.

Major Depression and Conduct Disorder in Prepuberty

This paper reports a set of unexpected clinical observations made during the course of a study of the possible effectiveness of imipramine (IMI) in a prepubertal major depressive disorder. Stated briefly, it was found that one-third of the boys fitting RDS criteria for major depressive disorder also fit DSM-III criteria for conduct disorder. Clinical observations of this subsample during the 5-week IMI protocol, and during open IMI treatment and follow up thereafter, indicated that successful outcome of their mood disorder was followed by abatement of conduct disorder behaviors in the majority of the patients. The possible theoretical and practical implications of these findings will be reviewed and a set of hypotheses will be formulated with the aim to stimulate further research on this difficult area. Journal of the American Academy of Child Psychiatry , 21, 2:118–128, 1982.

The Psychosocial Functioning and Family Environment of Depressed Adolescents

OBJECTIVE This study examined measures of functional impairment and family relations in a sample of 62 adolescents with major depressive disorder (MDD) and 38 normal controls with no history of psychiatric illness. METHOD Ratings of the following domains were obtained: mother-child relations, father-child relations, spousal relations, sibling relations, peer relations, and school performance. Ratings of each domain for the 3-month period preceding the assessment were derived from information obtained using a semistructured interview administered independently to the adolescents and one of their parents. RESULTS Adolescents with MDD were found to have severe difficulties in all areas. Ninety percent of the depressed adolescents had scores greater than 2 SD above the mean of the normal controls on one or more of the domain ratings. In addition, adolescents with difficulties in parent-child relations were more likely than those adolescents without problems in family relations to have difficulties in peer relations and school performance. CONCLUSIONS The authors discuss the importance of systematically examining psychosocial variables in future studies of the etiology, course, and treatment of MDD in adolescents.

24-hour cortisol measures in adolescents with major depression : a controlled study

Plasma cortisol levels were determined every 20 min for 24 hr in depressed adolescents (n = 27) meeting research diagnostic criteria (RDC) for major depressive disorder (MDD) and normal controls (n = 32). All subjects were between 12 and 18 years of age, at least Tanner Stage III of sexual development, medically healthy, and medication free at the time of the studies. The results showed that cortisol secretory patterns were very similar between the two groups with the exception that the depressed adolescents showed significantly elevated cortisol levels around sleep onset (a period when cortisol is usually suppressed). Subgroup analyses showed that most of these differences were contributed by the suicidal/inpatient depressed adolescents. The cause of the elevated cortisol during the normally quiescent period warrants further investigation and may be related to other biological disturbances around sleep onset (difficulty initiating sleep, reduced rapid eye movement (REM) latency, and alterations in sleep-stimulated growth hormone secretion).

Prepubertal Major Depressive Disorder: A Pilot Study

Abstract A group of 13 prepubertal children fitting unmodified Research Diagnostic Criteria for major depressive disorder in adults was identified. The clinical characteristics of the group are described as well as the results of an open trial of imipramine. Pilot data from this study point to the possibility that adult and prepubertal major depressive disorders are basically the same illness occurring at different points in development.

EEG sleep in adolescents with major depression: the role of suicidality and inpatient status

All night sleep EEG recordings were performed for three consecutive nights in 27 adolescents with a diagnosis of major depressive disorder (MDD) and 30 normal adolescent controls. Group comparisons between the entire MDD group and the normal controls revealed no significant diagnostic group differences for any of the major sleep variables. Analyses within subgroups of MDD adolescents, however, revealed heterogeneity of EEG sleep findings in association with suicidality and inpatient status. The findings of this study suggest that the discrepancies among the EEG sleep studies in adolescent MDD may be accounted for by the relative proportions of inpatients, suicidality, or bipolarity within the MDD sample being studied.

A Secular Increase in Child and Adolescent Onset Affective Disorder

Both longitudinal and cross-sectional studies utilizing population and family study samples have found evidence for a secular increase in major affective disorders in adults. Applying techniques used in cross-sectional studies in adults to family study data of children and adolescents, the authors demonstrate evidence of a parallel secular increase for child and adolescent onset affective disorders. Normal and depressed prepubertal probands were identified. All full siblings were directly interviewed for lifetime episodes of affective disorder. Analysis of the siblings (probands not further analyzed in this article) by the Cox proportional hazards model demonstrates that the risk for affective disorder is higher in siblings born more recently.

Imipramine in adolescent major depression: plasma level and clinical response

ABSTRACT Thirty‐four adolescents with mean age 14.25 years who met RDC criteria for major depressive disorder as assessed with the K‐SADS, were treated for 6 weeks on a fixed schedule of imipramine hydrochloride titrated to a dosage of 5.0 mg/kg/day except as limited by side effects. Mean dose was 246 mg/day (4.5 mg/kg/day). In spite of good indications of compliance with treatment only 44% of the adolescents improved to the level of no or only slight depressed mood or anhedonia, though most had less depressive symptomatology at the end of treatment. There was neither a linear nor curvilinear relationship between total plasma level of IMI plus DMI and clinical response, despite a wide range of both plasma level (77 ng/ml to 986 ng/ml) and outcome. Adolescents with associated separation anxiety had significantly poorer response to treatment of their depressive disorder than those with major depression alone. Poor response was also weakly associated with being female, having endogenous subtype of depression, and having higher plasma IMI (but not DMI) level. In the context of similar studies of IMI on depression in other age groups, it is hypothesized that high levels of sex hormones during adolescence and young adulthood may interfere with IMIs antidepressant effects. It is concluded that other types of antidepressants should be tested in adolescents with major depression.

Plasma Levels of Imipramine (IMI) and Desmethylimipramine (DMI) and Clinical Response in Prepubertal Major Depressive Disorder: A Preliminary Report

Abstract A study is in progress to examine the relationship between clinical response to imipramine (IMI) of prepubertal major depressive disorder at 5 weeks and plasma levels of IMI and its metabolite desmethylimipramine (DMI). Data are presented on the first 13 children in the study. A strong correlation is emerging in nondelusional subjects between total plasma level and clinical response. A total plasma level of 146 ng/ml separates respondent from nonresponders. These data parallel those previously reported in adult major depressive disorder by several investigators.

Lithium Antidepressant Augmentation in TCA-refractory Depression in Adolescents

Abstract The few existing studies on the pharmacological treatment of major depression in adolescents indicate that most patients respond partially or not at all to a tricyclic antidepressant (TCA). Information from a retrospective chart review of 14 adolescents diagnosed with nonbipolar depression who were treated openly with a TCA/lithium combination after an inadequate response to a TCA alone is presented here. The clinical course, including TCA choice and dosage, lithium dosage and serum levels, clinical response, and side effects, is detailed. Six of the 14 patients achieved a good response on this combination. All patients tolerated the TCA/lithium combination well. Results are contrasted with those presented in the adult literature, which is reviewed.