Norman E. Alessi

Psychiatric Disturbance in Serious Delinquents

Psychiatric disturbance, and its relationship to delinquent behavior, was investigated in 71 incarcerated seriously delinquent adolescents (40 male, 31 female) using structured diagnostic instruments (SADA-DSM-III) and a definition of delinquency based on adjudicated felonies. A wide range of psychopathology was identified, with all subjects receiving multiple psychiatric diagnoses. Substance abuse/alcoholism, borderline personality disorder, and major/minor affective disorders were the most common diagnoses. Measures associated with severity of delinquency and adult antisocial outcome were most clearly associated with borderline personality disorder and substance/alcohol abuse. Results are discussed with regard to future studies and treatment implications.

Ontogeny of opioid and related peptides in the rat CNS and pituitary: An immunocytochemical study

The development of proopiomelanocortin (POMC) derived peptides was compared to that of leucine-enkephalin ([Leu]ENK) and dynorphin A (DYN-A) immunoreactivity (i.r.) in the rat CNS and pituitary gland. POMC i.r. appeared first in hypothalamic neurons on embryonic day E12, in pituitary anterior lobe (AL) cells on E15, in pituitary intermediate lobe (IL) cells on E16, and in perikarya of the nucleus tractus solitarius on E17. In the fetal stages (E19-22), all POMC systems appeared adult-like; however, peak i.r. occurred between postnatal days P21-28. The development of alpha-MSH (a-MSH) i.r. was dissimilar to that of other POMC peptides including beta-endorphin (B-End). In contrast, both [Leu]ENK and DYN-A i.r. appeared in later embryonic stages (E16-17), and their maturation lagged behind that of POMC peptides. Peak i.r. for these latter peptides also occurred between P21-28.

Life events and depression in children with pervasive developmental disorders

To determine the role of life events in the occurrence of depression in children with pervasive developmental disorders (PDD), we compared 11 patients (DSM-III-R; 9 male; 2 female; Mage: 11.0 years; Mfull-scale IQ: 75.3) with PDD and depression, with an age- and sex- matched control group of patients with PDD without depression (DSM-III-R; 9 male; 2 female; Mage: 9.8 years; Mfull-scale IQ: 60.6). Information was collected about the occurrence of unpleasant life events in the 12 months prior to the onset of depression. Depressed children experienced significantly more life events in the 12 months prior to the onset of depression. Exit events such as bereavement were more common in the depressed group. Findings suggest that, as in the general population, significant life events, particularly those with a negative impact, may contribute to the occurrence of depression in children with PDD. Future studies should explore the role of both biologic factors and environmental Stressors in the onset of depression in this population.

Update on Lithium Carbonate Therapy in Children and Adolescents

The use of lithium to treat child and adolescent psychiatric disorders is becoming more common. Since the publication of the report of The Committee on Biological Aspects of Child Psychiatry of the American Academy of Child Psychiatry in 1978, a considerable body of literature has accumulated on the efficacy of lithium in treating adolescent bipolar disorders, childhood aggression, and behavioral disorders associated with mental retardation and developmental disorders. Efforts to understand lithiums mechanism(s) and refinements in psychiatric diagnosis have contributed to its growing use.

Treatment of adolescents with major depression: implications of the DST and the melancholic clinical subtype

Of 38 adolescents hospitalized with major depression, 47% of those receiving psychosocial treatment alone responded. Of the non-responders then treated with combined tricyclic antidepressants and psychosocial treatment, 92% responded. The melancholic subtype and dexamethasone suppression test non-suppression were associated with failure to respond to psychosocial treatment alone. Implications for controlled studies are discussed.

Stress induces supersensitivity of a cholinergic system in rats

Cholinergic system supersensitivity may be involved in the pathophysiology of depressive disorders (Janowsky et al. 1972; Dilsaver and Greden 1984; Dilsaver 1986). Associations between stressful events and onset of depressive (Lloyd 1980) and manic (Kennedy et al. 1983) episodes are documented. Janowsky et al. (1983) proposed that stress increases the sensitivity of central cholinergic mechanisms and that the latter mediates some neurobiological effects of stress. Despite these points, animal models linking the physiologies of depression, mania, stress, and cholinergic systems are not available. Thermoregulation is subject to muscarinic cholinergic control at the hypothalamic level (Lomax et al. 1964). Lomax and Jenden (1966) reported that oxotremorine produces dose-dependent hypothermia in rats. We utilized this fact to evaluate the effect of stress on a central muscarinic receptor mechanism.

Neuropsychological Assessment of Seriously Delinquent Adolescents

Neuropsychological tests (the Luria-Nebraska Battery) were administered to 64 male and female offenders in residential settings. Subjects were selected according to the seriousness of their offenses and the extent of their recidivism within the juvenile justice system. Pervasive abnormalities in the delinquent population are documented. Evidence documenting neuropsychological abnormalities in delinquent adolescents is cited and reviewed. Methodological issues and questions of interpretation are explored.

The characterization of depressive disorders in serious juvenile offenders

The authors systematically evaluated a selected population of juvenile offenders for the prevalence of affective disorders. Seventy-one (40 male, 31 female) serious juvenile offenders were interviewed using the Schedule for Affective Disorders and Schizophrenia (SADS). They were then diagnosed using the Research Diagnostic Criteria (RDC) and the DSM-III. The Hamilton Rating Scales (HRS), Carroll Self-Rating Scale (CSRS), and Global Rating Scale for Depression (GRS) were also obtained for each subject. Eleven (15%) subjects were diagnosed as having an active major depressive disorder (MDDa), 6 (8%) subjects were diagnosed as having a major depressive disorder in remission (MDDr), and 9 (13%) as having a minor depressive disorder (mDD). The HRS, CSRS, and GRS differentiated the MDDa from the other three groups including MDDr, mDD and all other psychiatric diagnoses. RDC subtypes of depressive disorders were identified in those juvenile offenders with active major depressive disorders (MDDa) and compared to a population of hospitalized adolescents with major depressive disorders. There were significant differences in the distribution of the subtypes identified. Secondary, agitated and endogenous subtypes occurred significantly more often. The diagnostic, prognostic and therapeutic significance of these findings are discussed.

Acute and chronic administration of trazodone in the treatment of disruptive behavior disorders in children

We report the results of an open trial of trazodone in the treatment of severe behavioral disturbances in a sample of 22 hospitalized children previously found to be unresponsive to other treatments. Response to treatment was assessed by overall clinical criteria and improvements in individual symptom dimensions during the inpatient hospitalization. Thirteen children (67%) were found to benefit from the introduction of trazodone. Aggressive, impulsive behaviors were symptoms most frequently improved by this agent. Three of those found to be nonresponders actually worsened in symptomatology. A follow-up interview of the parents was conducted 3-14 months after discharge from the inpatient unit, for those children who initially responded to trazodone administration. The results of this interview suggest that the effect of trazodone was persistent for a prolonged period of time after the initial inpatient trial. Trazodone appears to be of value in the management of severe behavioral disturbances in children. The possible mechanism of action of trazodone is discussed.

Panic and depressive disorders among psychiatrically hospitalized adolescents

Sixty-one adolescents hospitalized on an inpatient psychiatric unit were evaluated to determine whether they met criteria for panic and affective disorders according to Research Diagnostic Criteria. Ten (16%) and 15 (24%) met criteria for definite or possible panic disorder. Fifteen (24.5%) had major depressive disorder (MDD) endogenous subtype, 10 (16%) had MDD nonendogenous subtype, 8 (13%) had minor depressive disorder (mDD), and 27 (44%) had no diagnosable mood disorder. Four adolescents with definite panic disorders were diagnosed as having MDD endogenous subtype, three MDD, two mDD, and one had no diagnosable depressive disorder. The mean total score on the Hamilton Rating Scale for Depression (HRSD) was significantly higher among those subjects with definite panic attacks compared with those with either possible or no panic. Patients with definite panic disorder showed significant increases on the HRSD items of guilt, decreased work and interest, psychological and somatic anxiety, and weight loss compared to these samples.