ISSN:1044-5463    

DOI:10.1089/cap.1991.1.315

年代:1991

数据来源: MAL

ISSN:1044-5463    

DOI:10.1089/cap.1991.1.319

年代:1991

数据来源: MAL

摘要:

ABSTRACTSelf-injurious behavior (SIB) in the mentally retarded population is a poorly understood and often treatment-refractory problem. The behavior, most often manifested by head banging or self-biting, commonly leads to disfigurement and sensory–neural impairment, and its presence often mandates institutional placement. Serotonergic approaches to the modification of SIB can be supported on theoretical grounds, and serotonergic mechanisms have long been considered in the pathogenesis or treatment of specific syndromes of mental retardation with which SIB is associated. This single case study reviews the rationale for serotonergic treatment of SIB, and reports a trial of the serotonin uptake blocker, fluoxetine, for the treatment of SIB associated with nonsyndromal mental retardation. A 19-year-old individual, with an IQ of approximately 40, was treated with fluoxetine 40 mg daily. A clinically significant therapeutic effect was observed on self injurious and other behavioral symptoms, but the reduced frequency and intensity of SIB were found to endure for only about 60–70 d

ISSN:1044-5463    

DOI:10.1089/cap.1991.1.321

年代:1991

数据来源: MAL

摘要:

ABSTRACTA significant and sustained reduction in self-injurious behavior (SIB) was observed in a 17-year-old male with severe to profound mental retardation who was treated in an open clinical trial with fluoxetine. The 45–55% reduction in SIB was accompanied by improvement in affective stability, motor capacities, and social activity. No adverse effects or diminishing therapeutic effects were observed during 2 years of treatment at 40 mg daily. Twelve weeks before the start of the fluoxetine trial, this adolescent had been found to be unresponsive to the opiate receptor blocker naltrexone in a double-blind placebo-controlled trial following identical methodology. This case raises the possibility that different patients with SIB may respond preferentially to pharmacological treatments that modify either serotonin or endorphin mechanisms. The findings also suggest that some cases of SIB may represent a type of obsessive-compulsive disorder or body grooming disorder. Additional clinical studies are needed before fluoxetine can be considered for routine use in treating SI

ISSN:1044-5463    

DOI:10.1089/cap.1991.1.331

年代:1991

数据来源: MAL

ISSN:1044-5463    

DOI:10.1089/cap.1991.1.341

年代:1991

数据来源: MAL

摘要:

ABSTRACTIndividual symptoms of child psychiatric disorders have rarely been systematically examined to determine which operate best as inclusion criteria (ruling in a disorder by their presence) and which as exclusion criteria (ruling out a disorder by their absence). The past use of sensitivity and specificity statistics to validate the criteria for different diagnoses has been misleading in certain situations. These problems are particularly salient in the classification of disruptive behavior disorders (including ADHD and CD) in DMS-III-R, a polythetic diagnostic system in which any combination of a set of symptoms can be employed for diagnosis as long as the requisite number has been achieved. In this kind of "confirmatory" diagnostic system (the more symptoms, the more likely the diagnosis), symptoms that are most descriptive of a disorder (i.e., many of the children with the disorder have the symptom) may not be most efficient in the diagnosis of that disorder (i.e., many of the children with the symptoms have the disorder). In the case of attention-deficit hyperactivity disorder and conduct disorder, symptoms were identified that were associated with one specific diagnosis, but actually had greater implications for ruling out the other diagnosis. For example, the ADD symptom "doesn't listen" was found to be most useful as an exclusion criterion for a CD diagnosis. Alternatively, the polythetic DSM-III-R system is ideally suited to the application of predictive power methods. Efficient inclusion criteria can be determined from positive predictive power (PPP), and exclusion criteria can be determined by an examination of negative predictive power (NPP) rates. Item analysis of PPP and NPP rates can be used, for example, to establish the efficiency of symptoms in the differential diagnosis of ADD and CD. However, the DSM-III-R criteria for ADHD and CD address only inclusion criteria and make no provision for exclusion criteria. Until clinicians make accommodations for inclusion and exclusion criteria (i.e., until predictive power methods are employed), clinical choices for the child psychopharmacological treatment of disruptive behavior disorders will be based on sensitivity/specificity thinking and limited by our "confirmatory" diagnostic practices.

ISSN:1044-5463    

DOI:10.1089/cap.1991.1.343

年代:1991

数据来源: MAL

摘要:

ABSTRACTAlthough the definition of attention-deficit hyperactivity disorder has changed to some degree over time, there is evidence that genetic factors are important for the concurrent expression of inattention, impulsivity, and hyperactivity. The evidence regarding the hypothesis that genetic factors are important for the expression of this syndrome, and of elements of this syndrome, is reviewed. While genetic factors appear to be important, the specific genetic mode of transmission is not known. Currently available studies on this syndrome, based on research over the last 20 years, focus on varying phenotypic presentations. Further clarification of the definition of the phenotype, both in children and adults, is still needed, so that future research can proceed toward a more complete understanding of the genetic mechanisms.

ISSN:1044-5463    

DOI:10.1089/cap.1991.1.353

年代:1991

数据来源: MAL

摘要:

ABSTRACTβ-Adrenergic blockers appear to be effective in the management of verbal aggression, physical aggression, or self-injurious behavior associated with mental retardation and other developmental disorders. However, methodological limitations of the available studies make it difficult to judge the value of these treatments. Optimal doses for treating patients with mental retardation or developmental disorders appear lower than described in the general psychiatric literature, so low doses of β-blockers may be preferred in such patients with abnormal brain development. Children and adolescents with mental retardation or developmental disorders appear to respond to particularly low doses (e.g., below propranolol 150 mg daily). Propranolol is recommended for central blockade, and nadolol is recommended for peripheral blockade. Most β receptors in the brain (except cerebellum) seem to be β1(cardiac type), but it is not clear that central blockade is required for psychotropic effects. Interim suggestions for empirical trials are offered, and rating scales and other measurement approaches are discussed. Since evidence supporting the efficacy of β-blockers in mental retardation or developmental disorders in children and adolescents is not definitive, the clinician is advised to consider designing an empirical trial for each patient, utilizing pre- and postmedication measures, when conventional treatments have been unsucces

ISSN:1044-5463    

DOI:10.1089/cap.1991.1.361

年代:1991

数据来源: MAL

摘要:

ABSTRACTIf a clinician implements some systematic methods for evaluating and monitoring patients in the course of routine clinical care, a research database within a clinical setting can be a useful means for studying clinical questions and an efficient strategy for integrating research and clinical practice. Certain practical, scientific, and clinical issues must be considered in developing a clinical research database, including the needless collection of clinical data, the impact of adding procedures to the ongoing clinical operations, statistical "fishing expeditions," and overinterpretation of correlational information. Clinical databases have limitations, but can facilitate the testing of clinically based hypotheses, form an important cornerstone in a scientifically based clinical psychopharmacology practice, and improve the quality of care.

ISSN:1044-5463    

DOI:10.1089/cap.1991.1.375

年代:1991

数据来源: MAL

ISSN:1044-5463    

DOI:10.1089/cap.1991.1.381

年代:1991

数据来源: MAL