Nasreen Roberts

Clinical, Cognitive, and Neurophysiological Effects of Alprazolam in Children and Adolescents with Overanxious and Avoidant Disorders

In a double-blind, placebo-controlled study, the efficacy and safety of alprazolam was investigated in childhood and adolescent anxiety disorders. Thirty patients (mean, 12.6 years) diagnosed with overanxious or avoidant disorders participated in the study. Evaluations included clinical, laboratory, cognitive, and qualitative EEG measurements. On a clinical global rating, there was no statistical difference between alprazolam and placebo. Relative to baseline EEG, acute alprazolam administration increased beta power in the right occipital lead, and chronic administration increased beta power in both leads. Alprazolam was well tolerated, and adverse effects were few, mild, and transient.

Response to Desipramine Treatment in Adolescent Depression: A Fixed-Dose, Placebo-Controlled Trial

OBJECTIVE To determine the efficacy and tolerability of the tricyclic antidepressant desipramine (DMI) in the treatment of DSM-III-R-diagnosed major depressive disorder in adolescents. METHOD Sixty adolescents (42 female, 18 male; aged 15 to 19 years) diagnosed with major depressive disorder using clinical interview and Schedule for Affective Disorders and Schizophrenia for School-Age Children were randomized to receive either DMI (200 mg daily in divided doses) or placebo for six consecutive weeks following a 1-week placebo period. Treatment outcome was determined using the Hamilton Depression Rating Scale and the Beck Depression Inventory. Tolerability was determined using a symptom side effects scale. In addition, a variety of laboratory and cardiovascular monitoring was performed. RESULTS No significant differences in treatment outcome between DMI- and placebo-treated groups were determined. Neither DMI, nor its metabolite 2-hydroxy-DMI, nor their ratio, was positively correlated to treatment outcome. The DMI group endorsed more side effects but there were no significant between-group differences in any laboratory, electrocardiographic, or other cardiovascular parameters apart from heart rate, which was increased in the DMI-treated group (p = .03). CONCLUSIONS Given the findings of this study and our review of previously published reports of tricyclic antidepressant treatment in this population, the routine use of short-term (6 weeks) DMI in the treatment of adolescent depression is not supported by the data on hand. Further investigations into what constitutes optimal psychopharmacological treatment of adolescent depression are warranted.

Concordance Among Sources of Information for Ratings of Anxiety and Depression in Children

The efficacy of the assessment of psychopathology in children by a multirater approach has been questioned by research considtently indicating a relative lack of agreement among ratings from different sources, especially for symptoms of an introspective nature such as anxiety and depression. The present study examines the degree of concordance among self, parent, and clinician ratings of anxiety and depression as a function of diagnosis, age, sex, and status. The results support previous research findings of low to moderate agreement among rating sources, but they indicate that the source and nature of the discrepancy very depending on the unit of analysis. Possible sources for the observed discrepancies are discussed with reference to the present findings and those of other investigators in this area.

Immigrant child and adolescent psychiatric referrals : a five-year retrospective study of Asian and Caucasian families

Objective Referrals to the Bradford (England) Child and Family Psychiatric Clinic were studied over a five-year period with the purpose of comparing native Caucasian and immigrant groups. Punjabi Moslems of Pakistani descent formed a majority of immigrant referrals. Method This immigrant sample was compared with native Caucasians matched for age and sex. Results Differences between these groups were found in the rates and sources of referral, together with family composition, diagnosis and adherence to treatment. Conclusion These results are discussed in terms of the influence of cultural background and gender socialization. This report makes suggestions with respect to service provision and the assessment of individuals from linguistically unassimilated ethnic minorities.

Pilot study of anxiety and depression in prepubertal children

Early detection of anxiety and depression is important because of the relationship between these disorders, suicide and other problems (i.e. social, phobias, learning problems). This study screened prepubertal students in a school setting for symptoms of anxiety and depression using self-report measures (Revised Childrens Manifest Anxiety Scale and the Childrens Depression Inventory). Controls and children who scored high on measures of anxiety or depression or both were interviewed with their parents and were tested using the Diagnostic Interview for Children and Adolescents (computer version) and the Peabody Individual Achievement Test. Initial results indicated that anxiety is more prevalent in prepubertal children than depression. The correlation between different diagnostic measurements used in this project was calculated. A correlation was found between low scores of self-esteem and high scores of anxiety and depression on self-reports. It is concluded that self-report measures are good screening tools.

The relationship between anxiety and depression in children: rating scales and clinical variables

The present study examined the relationship between anxiety and depression in children in the context of proposed adult models. The results support the qualitative distinction between anxious and depressed patient groups on subsets of rating scale measures and clinical variables. In contrast to anxious children who were younger, (day patients) had been ill for longer than one year, presented with behavioral problems, and were low on observer ratings of depressive symptoms; depressed children were older, (inpatients) had been ill for less than one year, presented with emotional problems and were high on observer ratings of both anxious and depressive symptoms. The finding that the older depressed children were concurrently anxious while the younger anxious children were not concurrently depressed is discussed from the viewpoint of a hypothesized temporal sequence between anxiety and depression. The implication of this and other related findings are discussed in regard to their importance for differential diagnosis and prognosis.

Psychiatric admissions of Asian Canadians to an adolescent inpatient unit

Objective: To compare the psychiatric diagnoses for Asian Canadians admitted to an adolescent inpatient unit with those of their white Canadian peers. Method: A literature review was first completed and then followed by a hospital file review of the Asian Canadians admitted over a 5-year period to the adolescent inpatient psychiatric unit. The data extracted (relating to psychiatric diagnosis, age, length of stay, referral source, family type, and gender) were then compared with a random sample of white Canadians admitted to the same unit during the same 5-year time frame. Results: There were far fewer Asian Canadians admitted than would be expected based on Calgarys demographics. There was equal gender representation among those who were admitted, and they tended to be older and to have a greater preponderance of severe psychiatric symptomatology than their white Canadian peers. Conclusions: This paper adds to previous research in emphasizing that ethnocultural factors play a significant role in the utilization of psychiatric services by immigrant populations.

Anorexia nervosa: two cases of male-female dizygotic adolescent twins.

The dose was increased gradually to 6 mg/day and was kept at that level for 16 weeks. Although, there was no improvement of her psychotic symptoms, there was a definite worsening of her hoarding. She foraged in the rubbish bins for discarded fruits, ransacked the lockers of fellow patients, and hoarded a variety of other items like toothbrushes, slippers, magazines, sweet wrappers, and soiled tissue papers. She would be agitated when thwarted and tried to hide the items in various places in the ward. After 16 weeks, risperidone was discontinued. The intensity of her hoarding reduced over the next 2 weeks to the same level as it was before risperidone was added. There was no improvement of her psychotic symptoms.

Problems with crystallizing phenomenology and nosology in adolescent psychiatry.

At baseline cognitive assessment following entry into PEPP, the patient scored at or above average on measures of intellectual functioning, working memory, immediate and delayed auditory memory, delayed visual memory, and mental flexibility. Weakness (that is, a score 1 or more standard deviations below average) was demonstrated in immediate visual memory, concept formation, attention, and processing speed. The patient was not willing or able to tolerate the demands of testing again until 41 months after entering the program. At that time, he had been taking clozapine 400 mg daily for approximately 14 months. He showed significant improvement in positive and negative symptoms of psychosis. Significant gains in concept formation and attention were seen. Most notably, the patient demonstrated an improvement in speeded information processing, rising from over 2 standard deviations below average to 0.5 standard deviations below average (a gain of 31 points). Although he did not complete his PhD, he is now employed full-time in his field of study.

Book Review: Child and Adolescent Psychiatry: The Depressed Child and Adolescent. 2nd Ed.The Depressed Child and Adolescent. 2nd ed.GoodyerIan M, editor. Cambridge (UK): Cambridge University Press; 2001. 388 p. US

This ex cel lent text is based on the most re cent con cep tual, clini cal, theo reti cal, and re search data in the field of child and ado les cent de pres sion. The edi tor is inter na tion ally well known in child and ado les cent psy chia try for his schol arly book on the study of life ex pe ri ences and their im pact on the de vel op ment of child psy cho pa thol ogy. He has col labo rated with sev eral con tribu tors in this vol ume, choos ing wellestablished and proven ex perts to con trib ute chap ters on their par ticu lar area of clini cal and aca demic re search. This vol ume bears wit ness to the rapid ad vances tak ing place in our un der stand ing of de pres sion in chil dren and ado les cents, spe cifi cally, in the realms of psy cho phar ma col ogy, psy chothera pies, and ge net ics. Our un der standing of the in ter play be tween the biopsychosexualsocial fac tors is crys tal liz ing: we are gain ing bet ter un derstand ing of the way in which each com po nent im pacts on the other. Gone are the days of po lar ized camps of dynamic vs be hav iour ist vs bio logic theo rists. This book com prises 13 chap ters. It be gins with a chap ter on the his tori cal as pects of mood dis or ders in young peo ple, taken from the first edi tion as a trib ute to its author, the late Pro fes sor Wil liam Parry Jones. This is an ex cel lent and fas ci nat ing re view of the con cep tu ali za tion of mood dis tur bances over the cen tu ries. It is in ter est ing that as early as 1621 ref er ence was made to the im pact of extremes of child rear ing and dis ci pli nary prac tices on the emo tional wellbeing of chil dren. Es pe cially in ter est ing is the sec tion on theo ries of cau sa tion, which lo cates the nidus for pres ent day think ing in early, ru di men tary theo ries.