Uttom Chowdhury

The Developmental, Dimensional and Diagnostic Interview (3Di): A Novel Computerized Assessment for Autism Spectrum Disorders.

OBJECTIVE Autism is a diagnostic spectrum of variable severity, with significant comorbidity. No existing standardized interview measures autistic features dimensionally. The authors aimed to develop a parental autism interview that could be administered to unselected clinical and general population samples that measures both symptom intensity and comorbidity across the full range of the autistic spectrum. METHOD A computerized procedure was devised for administration by trained interviewers that generates symptom and diagnostic profiles for both autism and non-autistic conditions. Test-retest reliability and interrater reliability were assessed in unselected clinical (n = 50) and nonclinical (n = 30) populations. Concurrent validity (n = 120), discriminant validity (n = 120), and criterion validity (n = 29) were evaluated in autistic spectrum and non-autistic patients. RESULTS Test-retest and interrater reliabilities were excellent (most intraclass correlation coefficients > 0.9). Concurrent validity (agreement with independent clinician formulation) was very good (mean kappa = 0.74). Criterion validity, a comparison with the Autism Diagnostic Interview, was excellent. Discrimination between autistic spectrum versus non-autistic subjects was almost perfect (sensitivity 1.0; specificity > 0.97). CONCLUSIONS The Developmental, Dimensional and Diagnostic Interview (3di) provides an efficient and accurate means of assessing, in dimensional terms, the presence of autistic symptoms in both clinical and normal populations. It offers novel opportunities for those engaged in research and clinical practice.

Clinical Characteristics of Young People Referred to an Obsessive Compulsive Disorder Clinic in the United Kingdom

The Maudsley Hospital childrens OCD clinic is the first clinic in the UK which is specifically set up to cater for the needs of young people with obsessive compulsive disorder (OCD). A retrospective review of case notes was carried out for patients seen between April 1998 and December 1999. Gender, age at assessment, age of onset of symptoms, family history, co-morbid diagnosis, previous treatment and severity of OCD, as measured by the score on the childrens Yale-Brown Obsessive Compulsive Scale, were all measured. The results showed that 57 (74%) of the children referred fulfilled the criteria for OCD. The majority of children who did not have OCD had other neurodevelopmental disorders. Of the children with a diagnosis of OCD, the ratio of males to females was 1.1 to 1. The clinical profile of children seen was similar to profiles seen in other childhood OCD clinics around the world, however, half of the children seen had not received either specific medication or cognitive-behavioural therapy prior to referral.

Needle Phobia in Children: A Discussion of Aetiology and Treatment Options

In this article we review the current literature surrounding needle phobia, concentrating on clinical symptoms, aetiology and treatment options. Clinical symptoms include sudden increase in heart rate and blood pressure on exposure to needles followed by an immediate slowing of the heart and decrease in blood pressure (vasovagal reflex). The various schools of thought surrounding aetiology of this condition include biological, psychological and psychodynamic theories. Treatment options vary from simple education and reassurance to medication and specific behavioural approaches. Consideration should be given to past trauma associated with the phobia and relevant family factors. Careful clinical assessment will not only identify the problem but will also help to indicate appropriate treatment options.

Listening to the patient

Such is the rich diversity of culture in Britain today, that it is likely that most doctors will at some time use the services of an interpreter. It is likely that psychiatry relies most on the effective use of interpreters—after all, language and communication are essential components of a psychiatrists trade. Although the advantages of having an interpreter are obvious, there are also pitfalls. For instance, certain words and sentences in different languages may not bode …

Tourette's syndrome in children.

Tic disorders are common and misunderstood

CLINICAL IMPLICATIONS OF BRAIN IMAGING IN EATING DISORDERS

Imaging studies have greatly improved the understanding of the pathology and physiology of psychiatric disorders, such as schizophrenia, affective disorders, obsessive-compulsive disorder, and Tourette syndrome. In the past few years, several neuroimaging studies have concentrated on patients with eating disorders. Although the number of studies is small compared with studies of other psychiatric disorders, the results are beginning to highlight potential areas in the brain that may lead to a better understanding of these disorders. Much research still is needed, and replication of results across centers is needed. The brain is an extremely complex organ; that eating disorders are a result of abnormalities in one specific area of the brain is unlikely. More likely is that several components of the brain have a role, including cortex and subcortical regions and involvement of several neurochemical pathways and circuits within the brain. Further studies are needed in this exciting development of research about eating disorders.

Focus on Practice: Tourette Syndrome: a Training Day for Teachers

Recent research indicates that Tourette syndrome is more prevalent than was once thought and that teachers in most mainstream schools are likely to encounter pupils displaying the characteristics of Tourette syndrome. Research also indicates that these characteristics, and the range of responses that may be appropriate, are not well understood by school staff. In this article, Dr Uttom Chowdhury, Consultant Child Psychiatrist at the CAMHS Academic Unit in Dunstable and Honorary Child Psychiatrist at the Neurodevelopmental Disorders Clinic at Great Ormond Street Hospital, London, and Dr Deborah Christie, Consultant Clinical Psychologist and Honorary Senior Lecturer at the Department of Child and Adolescent Psychological Services at University College London and Middlesex Hospitals, describe a training day for teachers facilitated by members of the Tic Disorders Clinic at Great Ormond Street Hospital. The day provided a mix of information–giving and discussion of current practice. Uttom Chowdhury and Deborah Christie relate the outcomes of the day to their own professional knowledge and experience and offer an interesting agenda for further developments.

Tourette's syndrome in children: Tic disorders are common and misunderstood

Tic disorders are common and misunderstood

Tourette9s syndrome in children

Tic disorders are common and misunderstood