Stuart Fine

Sexual Abuse and Psychopathology in Hospitalized Adolescents

Fifty-four consecutive admissions to an inpatient adolescent psychiatric unit were studied within 2 weeks of hospitalization. Of 54 subjects, 17 acknowledged a history of sexual abuse, intra- or extrafamilial (37.9% of girls, 24% of boys). Although the two groups did not differ in age, IQ, or occurrence of parental death, the sexually-abused group was of lower socioeconomic status and had had higher scores on psychosocial stressors in the past year. These patients had significantly greater severity of depressive symptoms, more hallucinations, had more suicide attempts, and were more likely to be referred for long-term inpatient treatment. Compared with the non-sexually victimized patients, the abused group also showed trends toward more conduct symptoms and more often required neuroleptic medication and longer hospital stays for acute management. The authors emphasize the importance of eliciting a history of sexual abuse from disturbed adolescents in an inpatient unit, especially when severe depressive symptoms are noted.

Group Therapy for Adolescent Depressive Disorder: A Comparison of Social Skills and Therapeutic Support

Two forms of short-term group therapy for depressed adolescents are compared. Adolescents were assigned to either a social skills training or therapeutic support group. Treatment outcome was based on self-report and semistructured clinical interviews for depression, measures of self-concept, and cognitive distortions. After treatment, adolescents in the therapeutic support groups showed significantly greater reductions in clinical depression and significant increases in self-concept compared with those in the social skills training group. These group differences were no longer evident at 9-month follow-up, as adolescents in the therapeutic support groups maintained their improvement, and adolescents in the social skills training groups caught up.

Relationship between Depression and Conduct Disorder in Children and Adolescents

Of 60 children and adolescents referred for assessment of depression, 11 cases were found which met diagnostic criteria for both conduct disorder and affective disorder. These 11 subjects could not be distinguished from those with major depression on the basis of psychiatric ratings of depressive symptoms—both diagnostic groups were characterized by multiple depressive symptoms of high severity. Psychiatric ratings also indicated that depressive symptoms were more severe in cases of conduct disorder with depression than in cases of dysthymic disorder. Child and adolescent self-reports of depression were consistent with this pattern of results.

Paraphilias: a double-blind crossover comparison of clomipramine versus desipramine.

A relationship has been suggested between clinical presentation of paraphilias and obsessive-compulsive disorder (OCD) with respect to the unwanted repetitive nature and insight into the irrationality of the paraphiliac behavior. This has led to speculation that paraphiliac disorders might belong to an “obsessive compulsive spectrum.” To address this issue, and because of the striking selective benefit of serotonin reuptake blocking antidepressants (such as clomipramine) in the treatment of OCD, 15 paraphiliacs entered a doubleblind crossover comparison of clomipramine vs. desipramine preceded by a 2-week single-blind placebo period. Four subjects responded to placebo and were dropped from the study. Three others failed to complete the study. Although the study is limited by the small number of patients and the heterogeneity of the paraphilias, the observed benefit from both tricyclics (over the initial placebo) encourages further study. For the 8 subjects completing the protocol, there was no preferential response to the more specific serotonin reuptake inhibitor suggesting a difference in underlying pathophysiology between paraphilia and OCD.

Social problem-solving in depressed, conduct-disordered, and normal adolescents

Although past theory and research implicate social problem- solving deficits in both depression and aggressive disorders, research examining carefully diagnosed groups of adolescent depressed and conduct- disordered groups had not previously been conducted. In the current study three groups of adolescents (major depression, conduct- disordered, and normal) were studied using two social problem- solving measures. Both the Means- Ends Problem- Solving task (MEPS) and the Social Situations Analysis measure (SSA) failed to show social problem- solving problem deficits in the depressed group relative to their normal age peers, but did provide corroborative evidence for social problem- solving deficits in the conduct- disordered sample. Relative to the other two groups, the conduct- disordered adolescents were found to generate fewer means to a social end, to anticipate fewer obstacles in the pursuit of solutions to interpersonal situations, and to generate fewer assertive behavioral solutions to difficult social situations. The results are discussed in relation to other work with depressed and aggressive youth, and directions for future research are given.

Effects of stimulant medication treatment on mothers' and children's attributions for the behavior of children with attention deficit hyperactivity disorder.

Participants were 55 children with attention deficit hyperactivity disorder (ADHD) who were receiving ongoing treatment with stimulant medications and their mothers, and 31 children with ADHD who were beginning stimulant medication and their mothers. Mothers and children offered attributions for child behaviors that occurred when the child was medicated and not medicated. Mothers rated child compliance and prosocial behavior as more global and stable when the child was medicated and rated noncompliance, ADHD symptoms, and oppositional behavior as more externally caused, less global and stable, but more controllable by the child when the child was medicated. Children rated both their compliance and noncompliance as more controllable in the medicated condition. On a forced-choice measure, both mothers and children selected ability, effort, and task attributions for compliance more in the not-medicated condition, and pill-taking attributions more in the medicated condition. This was reversed for noncompliance, which was attributed more to effort, task, or ability in the medicated condition and more to not taking a pill in the not-medicated condition. The potential risks and benefits for parent–child interactions and childrens self-perceptions of these medication-related differences in attributions are discussed.

Drug and placebo side effects in methylphenidate-placebo trial for attention deficit hyperactivity disorder

In a double-blind methylphenidate placebo trial for children with Attention Deficit Hyperactivity Disorder (ADHD), side effects were reported on both placebo and methylphenidate (MPH), and many side effects were similar to the symptoms of ADHD. We suggest that parents and teachers may mistake the symptoms of ADHD for side effects of MPH, and this misconstrual may contribute to the poor acceptance of and compliance with taking MPH.

Factors associated with dropout from group psychotherapy with depressed adolescents

Attempts to determine the characteristics of those individuals who drop out from psychotherapy have yielded few consistent findings. Clinically depressed adolescents who completed a course of brief group therapy were compared with those who failed to complete treatment. Although no differences were found on a number of clinical and demographic variables, those who dropped out were more likely to be one grade behind in school and to have a history of alcohol and/or drug abuse. The implications of these findings for research and practice are discussed.

Psychotic Features in Adolescents with Major Depression

Abstract Psychotic and nonpsychotic depressed adolescent inpatients were compared on demographic features, clinical characteristics, and symptom ratings derived from the Diagnostic Interview Schedule for Children. Their patterns of demographic and clinical characteristics were similar; however, psychotic patients were more likely to have a history of sexual abuse, to be more depressed, and to have more hypomanic symptoms in their recent past than nonpsychotic patients. Those with mood-incongruent features differed from those with mood-congruent features only by the higher frequency of hypomanic episodes in their recent past. These findings suggest that psychotic features are not only a marker for severe depression but also identify mild forms of bipolar disorder. J. Am. Acad. Child Adolesc, Psychiatry , 1988, 27,4:489–493.

Affective disorders in children and adolescents: the dysthymic disorder dilemma.

From 60 patients referred for assessment of their depressive symptomatology, 13 were found to suffer from major affective disorder and 14 from dysthymic disorder. The results from self-rating scales (the Childrens Depression Inventory and the Childrens Depression Scale) were compared with the findings from diagnostic interviews (using DSM-III criteria). The large proportion of dysthymic disorders in this sample is compared to the low reported figure in most other samples and some comments about the possible usefulness of this diagnosis are made.