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Mental Health News & Research

This page lists some useful resources related to children and mental health.

Treatment Update of OCD

Current trends in the treatment of Obsessive-Compulsive Disorder Lisa Bonavita   The Pennsylvania State University – College of Medicine November 2004   DSM-IV Diagnosis of Obsessive-Compulsive Disorder Either Obsessions or Compulsions: Obsessions defined as all of the following: Recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause marked anxiety or distress The thoughts, impulses, or images are not simply excessive worries about real-life problems The person attempts to ignore or suppress such thoughts, impulses, or images or to neutralize them with some other thought or action The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind (not imposed from without as in thought insertion) Compulsions defined as all of the following: Repetitive behaviors (ex. hand washing, checking) or mental acts (ex. praying, counting) that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly The behaviors or mental acts are aimed at preventing or reducing distress of preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive At some point during the course of the disorder, the person has recognized that the obsessions are excessive or unreasonable (this does not apply in children) The obsessions or compulsions cause marked distress, are time consuming (take more than 1 hour/day), or significantly interfere with the person’s normal routine, occupational (or academic) functioning, or usual social...

Pharmacologic Treatment of Obsessive-Compulsive Disorder

Pharmacologic Treatment of Obsessive-Compulsive Disorder  in Children and Adolescents  Amy Bridgeman  The Pennsylvania State University – College of Medicine October 2003   Diagnosis DSM IV criteria for Obsessive-Compulsive Disorder (OCD) (8): Either obsessions or compulsions: Obsessions as defined by: Recurrent and persistent thoughts, impulses, or images that are experienced, at some time during the disturbance, as intrusive and inappropriate and that cause anxiety or distress. The thoughts, impulses, or images are not simply excessive worries about real-life problems. The person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralize them with some other thought or action. The person recognizes that the obsessional thoughts, impulses, or images are a product of his or her own mind. Compulsions as defined by Repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly. The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or are clearly excessive. At some point the person has recognized the compulsions are excessive or unreasonable. (Does not apply to children) The obsessions or compulsions cause marked distress, are time consuming, or significantly interfere with the person’s normal routine, occupational (or academic) functioning, or usual social activities or relationships. If another Axis I disorder is present, the content of the obsessions or compulsions is not restricted to it. The disturbance is not due to the direct physiological...

OCD – A Treatment Review

Obsessive Compulsive Disorder (OCD) is a chronic, waxing and waning, DSM-IV Axis I disorder in which patients have recurrent intrusive thoughts (obsessions) that increase their anxiety level. They usually relieve this anxiety with recurrent standardized behaviors (compulsions). These symptoms are ego-dystonic and cause significant distress in the patients’ lives.

Fighting Anorexia

Fighting Anorexia: No One to Blame Dec. 5, 2005 Newsweek issue – “The age of their youngest patients has slipped to 9 years old, and doctors have begun to research the roots of this disease. Anorexia is probably hard-wired, the new thinking goes, and the best treatment is a family affair.” In summary: “At a National Institute of Mental Health conference last spring, anorexia’s youngest victims were a small part of the official agenda—but they were the only thing anyone talked about in the hallways…” “Six months ago the Eating Disorders Program at Penn State began to treat the youngest ones, too—20 of them so far, some as young as 8.” “Doctors now compare anorexia to alcoholism and depression, potentially fatal diseases that may be set off by environmental factors such as stress or trauma, but have their roots in a complex combination of genes and brain chemistry.” “In a 2000 study published in The American Journal of Psychiatry, researchers at Virginia Commonwealth University studied 2,163 female twins and found that 77 of them suffered from symptoms of anorexia.” “Anorexia is a killer—it has the highest mortality rate of any mental illness, including depression. About half of anorexics get better. About 10 percent of them die. The rest remain chronically ill…” From the report in Newsweek: “Fighting Anorexia: No One to Blame” By Peg Tyre...

Feeding Disorders of Infants and Toddlers

Feeding Disorders of Infants and Toddlers: Infantile Anorexia  Alice Lawrence Penn State College of Medicine 2003   Feeding disorders can occur in infants secondary to many different causes. These disorders can lead to failure to thrive in the infant, and thus associated with significant developmental risks. Failure to thrive is generally defined as a child whose weight is below the 5th percentile for age or whose weight is <80% of the ideal body weight for that age, and is present for at least 1-month duration. It may be caused by a wide variety of disorders, organic and/or non-organic in nature.   DSM-IV Diagnostic Criteria    – Feeding Disorder in Infancy or Early Childhood Feeding disturbance as manifested by persistent failure to eat adequately with significant failure to gain weight or significant loss of weight over at least 1 month. The disturbance is not due to an associated gastrointestinal or other general medical condition (e.g., esophageal reflux). The disturbance is not better accounted for by another developmental disorder (e.g., Rumination Disorder) or by lack of available food. The onset is before the age of 6 years.   The broad scope of the DSM-IV diagnostic criteria does not differentiate between different types of infant/toddler feeding disorders. Three sub classifications of developmental feeding disorders have been described (Chatoor, Schaefer, Dickson, and Egan, 1984): 1) Feeding Disorder of Homeostasis, 2) Feeding Disorder of Attachment, and 3) Infantile Anorexia (Feeding Disorder of Separation).   A Feeding Scale for Research and Clinical Practice to Assess Mother-Infant Interactions in the First Three Years of Life (Article by Chatoor, Getson, Menvielle, Brasseaux, O’Donnell, Rivera, and Mrazek; 1997) The...

Relapse in Anorexia

Approaches to the Reduction of Relapse Rates in Persons with Anorexia Nervosa

Firesetting

Firesetting Behaviors Romberg  The Pennsylvania State University- College of Medicine July 2003   Normal adult fire behavior is the result of appropriate, supervised childhood: Fire interest: 3-5yo Fireplay: 5-9yo Firesetting: >10yo Psychosocial factors such as deficits in emotional function, dysfunctional family environment, and significant life stressors can lead to inappropriate unsupervised fireplay and eventually pathologic firesetting. Pathologic firesetting: >2 fire starts in at least one 6 month period Unsupervised fireplay vs pathologic firesetting   Epidemiology: Nationally compiled fire department statistics from 1998 1/2 to 2/3 of all arsons are set by juveniles 6,215 deaths, 30,800 injuries attributable to fires set by juveniles 100 million dollars in fire fighting and court costs to local government 11 billion dollars in property damage   Profile of a juvenile pathological firesetter Male:female = 10:1 Average age = 8yo Varied socioeconomic background Single parent household or household with marital discord Normal intelligence but higher rate of learning disabilities Likely one parent with at least one psychiatric diagnosis, commonly a mood disorder   Categorization of juvenile firesetters Psychoanalytic model: (Freud 1932) Focuses on firesetting in the context of psychosexual development. Risk of recidivism model: (Kolko and Kazdin 1986) Statistically based, focuses on risk factors for repeat firesetting. Firesetting secondary to antisocial personality d/o or conduct d/o: (Sakheim 1985; Jacobson 1985) Danger hierarchy model: (Pinsonneault 1991) Grouping with focus on therapy Curiosity firesetters Crisis firesetters Delinquent firesetters Pathological firesetters Organic vs. functional causes for firesetting Organic: Klinefelter’s syndrome, epilepsy, CNS malignancies, HIV dementia, metabolic d/o Functional: Conduct d/o, ADHD, Schizophrenia, Mental retardation   Treatment: according to Pinsonneault’s danger hierarchy model Curiosity firesetters: non-punitive fire safety education...

Behavioral Problems and Fetal Alcohol Exposure

Behavioral Problems Associated with Fetal Alcohol Exposure Laura Arensmeyer April 2004   Introduction Ethanol crosses the placenta and causes CNS cell death by apoptosis, and reduces neural cell genesis. Fetal Alcohol Syndrome (FAS) Prenatal or postnatal growth retardation. CNS dysfunction. Syndrome-specific craniofacial abnormalities. Fetal Alcohol Effects (FAE) Fulfilling only two of the above three criteria. Alcohol-Related Neurodevelopmental Disorder (ARND) Signs of persistent cognitive difficulties and subsequent learning problems. Growth retardation and typical facies are usually absent. Cost to society. Prevalence of FAS is estimated at 1 to 1.5 cases per 1000 live births. Annual cost estimates for FAS range from $74.6 million to $9.7 billion per year. Lifetime cost of care per case in excess of $1.4 million. Association of Prenatal Alcohol Exposure with Behavioral and Learning Problems in Early Adolescence. Recruitment 1529 women interviewed during 5th month. 250 infants of social drinkers vs. 250 infants of infrequent drinkers/abstainers selected at birth. At 14 years, neuropsychological and psychosocial testing by single examiner with no knowledge of history. Assessment of Alcohol exposure By maternal report, average social drinker has 2-2.5 drinks per occasion before pregnancy, about 2 drinks per occasion by mid pregnancy. Assessment of Adolescent Learning and Behavior Adolescent self-report. Parental Interview. Examiner report. Conclusions Increasing levels of alcohol intake correspond to subtle impairment in learning and behavior in adolescence. a) Impairment occurs even when alcohol consumption is mild. b) Highest risk is early in pregnancy and binge drinking.   No alcohol related growth deficiencies or facial dysmorphology were seen, but disturbances in function were present in adolescence. Common behavior problems included: Antisocial behavior, substance use, school difficulties, and...

ParentsMedGuide.org Resource

Coalition Launches ParentsMedGuide.org: “Helping Parents Help Their Kids” Tuesday, Feb. 1, 2005 Washington, D.C. – Today a large coalition of medical and family/patient advocacy organizations launched ParentsMedGuide.org, a new resource center for parents of children and adolescents with depression. A focal point of the Web site is a fact sheet called “The Use of Medication in Treating Childhood and Adolescent Depression: Information for Patients and Families” – practical advice for parents that has been endorsed by more than a dozen national organizations, including: • American Academy of Child and Adolescent Psychiatry • American Psychiatric Association The guides and the site will be updated on an ongoing basis with the latest scientific and medical research. They are being launched as new data suggest the number of children receiving treatment that includes antidepressant medication continues to decline. “The evidence clearly suggests that the FDA’s action regarding the black box warning is already having a dramatic effect on prescribing patterns across the country,” said Dr. Fassler. “As a result, many children are losing access to effective and appropriate treatment.” The ParentsMedGuide.org coalition convened for the first time in November 2004 as a work group sponsored by the American Psychiatric Association and the American Academy of Child and Adolescent Psychiatry. The Parent Guide can be found on the Web at www.parentsmedguide.org/parentsmedguide.htm. The Physician Guide is at...

FDA and Antidepressants in Children

FDA Statement on Recommendations of the Psychopharmacologic Drugs and Pediatric Advisory Committees September 16, 2004 – The Food and Drug Administration (FDA) generally supports the recommendations that were recently made to the agency by the Psychopharmacologic Drugs and Pediatric Advisory Committees regarding reports of an increased risk of suicidality (suicidal thoughts and actions) associated with the use of certain antidepressants in pediatric patients. FDA has begun working expeditiously to adopt new labeling to enhance the warnings associated with the use of antidepressants and to bolster the information provided to patients when these drugs are dispensed. In summary, the members of the advisory committees: endorsed FDA’s approach to classifying and analyzing the suicidal events and behaviors observed in controlled clinical trials and expressed their view that the new analyses increased their confidence in the results; concluded that the finding of an increased risk of suicidality in pediatric patients applied to all the drugs studied (Prozac, Zoloft, Remeron, Paxil, Effexor, Celexa Wellbutrin, Luvox and Serzone) in controlled clinical trials; recommended that any warning related to an increased risk of suicidality in pediatric patients should be applied to all antidepressant drugs, including those that have not been studied in controlled clinical trials in pediatric patients, since the available data are not adequate to exclude any single medication from an increased risk; reached a split decision (15-yes, 8-no) regarding recommending a “black-box” warning related to an increased risk for suicidality in pediatric patients for all antidepressant drugs; endorsed a patient information sheet (“Medication Guide”) for this class of drugs to be provided to the patient or their caregiver with every prescription; recommended that...
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