ISSN:1044-5463    

DOI:10.1089/cap.1994.4.1

年代:1994

数据来源: MAL

ISSN:1044-5463    

DOI:10.1089/cap.1994.4.5

年代:1994

数据来源: MAL

ISSN:1044-5463    

DOI:10.1089/cap.1994.4.7

年代:1994

数据来源: MAL

ISSN:1044-5463    

DOI:10.1089/cap.1994.4.9

年代:1994

数据来源: MAL

摘要:

A retrospective study of 36 adolescents with schizophrenia treated in open clinical trials with clozapine, following treatment failure on at least 2 conventional neuroleptic medications, demonstrated that 75% (27 of 36) showed notable symptomatic improvement. Four adolescents (11%) showed an essentially complete remission of symptoms. The majority of patients became able to participate in a comprehensive rehabilitation program. Positive symptoms of schizophrenia were more responsive to clozapine than were negative symptoms, but certain negative symptoms showed some modest improvement. Three patients (8%) did not respond to clozapine, and six patients (17%) required discontinuation of treatment due to adverse effects, so a total of 25% of these adolescents did not respond to clozapine treatment. Leukopenia (without agranulocytosis) was observed in 8% (three patients), which is consistent with findings in adults. Unexpectedly, some extrapyramidal symptoms were observed. Mean dose was 330 mg daily (range, 50-800 mg daily), and the mean duration of these open clinical trials was 154 days. In prior treatments with typical neuroleptic agents, these 36 adolescents with schizophrenia had shown nonresponse, worsening of symptoms, or significant adverse effects. Although controlled research protocols are needed to evaluate this medication in adolescents, these clinical data suggest that clozapine may enrich the range of possible therapeutic interventions for adolescents with schizophrenia that is resistant to typical neuroleptic treatment. However, the safety of this treatment in adolescents requires considerably greater study, especially in view of the extrapyramidal side effects observed in some adolescents.

ISSN:1044-5463    

DOI:10.1089/cap.1994.4.31

年代:1994

数据来源: MAL

摘要:

This article examines the relationship of dexamethasone nonsuppression to both categorical (i.e., diagnostic categories) and dimensional (i.e., quantitative, multivariate) measures of depression in children. Sixty inpatients, ages 5-13 years, were administered the dexamethasone suppression test (DST). Categorical measures were the diagnoses of major depression or dysthymic disorder obtained from semi-structured interviews of child and parent. Dimensional measures of depression were the Short Child Depression Inventory (which is a child's self-report instrument) and the Child Behavior Checklist (which gave parent-rated quantitative scores for depression, aggression, hyperactivity, internalizing behaviors, and externalizing behaviors). Cortisol nonsuppression was associated with both dimensional and categorical measures of depression, but not with ratings of aggression or hyperactivity or with the diagnoses of dysthymic disorder or disruptive behavior disorder. Children with major depression had a higher rate of nonsuppression (69%) than children with either dysthymic disorder (29%) or disruptive behavior disorders (36%). Abnormal DST findings and postdexamethasone cortisol levels appeared significantly associated with higher scores on both dimensional measures of depression, but not with measures of internalizing or externalizing behavior, aggression, or hyperactivity. The total variance in dexamethasone suppression accounted for by dimensional ratings of depression was relatively modest (<20%). Although the potentially confounding roles of comorbid anxiety disorders and psychosocial Stressors remain to be investigated, it appears that biological studies of mood disorders in children may be advanced by the use of both dimensional and categorical approaches to the assessment of depression.

ISSN:1044-5463    

DOI:10.1089/cap.1994.4.43

年代:1994

数据来源: MAL

摘要:

This article reports the appearance of complex partial seizures during the course of successful use of the atypical neuroleptic clozapine in a 15 year old with neuroleptic-resistant schizophrenia. After 7 months of clozapine treatment, and 1 week after a gradual increase in dose to 550 mg, the adolescent began to develop periods of nausea and a "spacey feeling" that lasted for several minutes to hours at a time. A diagnosis of absence status was confirmed by electroencephalography (EEG). It was treated effectively by dose reduction (to 400 mg daily) without the use of anticonvulsant medications. A 3-year follow-up showed the generally sustained efficacy of this treatment, without recurrence of absence status seizures. This appears to be the first report of an absence seizure apparently associated with clozapine treatment. Published reports on 80 adolescents suggest an estimated prevalence of clozapineinduced seizures at about 4% (compared to 1-5% in adults, depending on dose), whereas 60% developed mild to marked EEG abnormalities. The current data on the safety and efficacy of clozapine for treating adolescents with schizophrenia remain preliminary. These data support the clinical recommendation that an EEG be obtained before adolescents are started on treatment with clozapine.

ISSN:1044-5463    

DOI:10.1089/cap.1994.4.53

年代:1994

数据来源: MAL

摘要:

This case study describes some problems encountered in treating a child with ADHD symptoms through parent training when the parent also meets criteria for ADHD. The mother's ADHD symptoms affected her parenting by reducing consistency, impeding monitoring, and preventing her from keeping accurate records. Her ADHD symptoms also negatively affected her relationships with others, comprehension of spoken and written language, and her social and academic life in childhood. The mother reported that her son's behavior problems were severe and dangerous, and this resulted in his hospitalization. On discovering the mother's history of ADHD and her inability to benefit from parent training, the focus of treatment shifted from the child's disruptive behavior to the mother's dysfunctional behaviors. Subsequent outpatient treatment focused on behavioral parent training to improve the mother's ability to manage the child's behavior. Following psychostimulant treatment of the mother (conducted as a double-blind, placebo-controlled outpatient trial), her parenting behaviors improved and she reported improvements in her son's behavior, even though he had never been treated with medication. In the absence of direct observations of the child's behavior, it is speculated that the mother's reports of changes in the child's behavior after the mother's stimulant treatment were due to a change in the mother's behavior or to a change in the mother's perception and evaluation of her son's behavior, or both. In cases in which both a parent and child have an ADHD diagnosis, clinicians might consider the alternative treatment strategy of deferring medication treatment of a child with mild ADHD until after the parent's medication trial.

ISSN:1044-5463    

DOI:10.1089/cap.1994.4.63

年代:1994

数据来源: MAL