Acta paedopsychiatrica最新文献

Self-injurious behaviour (SIB) is a frequently occurring and serious problem in autistic and non-autistic retarded children. This paper first summarizes clinical knowledge on SIB. Attention is paid to the Lesch-Nyhan syndrome and Tourette's syndrome as examples of clinical syndromes that are particularly associated with SIB. Then animal models are reviewed that suggest the involvement of dopaminergic, opioidergic and serotonergic mechanisms in the pathophysiology of SIB. The putative biochemical models of SIB in humans are discussed and pharmacological interventions are briefly outlined.

In a prospective longitudinal study the influence of biological and psychosocial risk on early emotional and behaviour problems was investigated in a high-risk sample. Adverse characteristics of temperament and psychosomatic symptoms were assessed in 362 infants aged 3 months by observation of behaviour and parent interview instruments. Results showed cumulative negative effects of nearly equal significance of both biological and psychosocial risk on the severity and number of behavioural disturbances. No sex differences and no interaction of risk factors were found. Detailed analysis revealed that single risk factors were related to different patterns of infant behaviour problems.

Anti-social personalities may be successful in life to a great extent. This is obscured by the tendency to study only those anti-social personalities who are imprisoned, in hospital, or undergoing therapy. We present a case history of Tom, a successful anti-social personality. He was 21 years old when the author lived with him for about 1 year. Tom used his skills to manipulate others and never went to prison nor was he ever ordered into therapy, although he did seek it out voluntarily for a brief period of time. Perhaps what kept him out of trouble with the law was that Tom stole only from friends and acquaintances, and not from strangers. He appeared to be an anti-social personality, but one who was fairly successful at it. Of course, the failure to develop non-manipulative close attachments to others means that the antisocial personality loses out by not having the kind of love, closeness, or stability of friendships that normal people can have.

A random selection was made of 100 adults, diagnosed as suffering from serious affective disorders (DSM-III), who had been cared for in the University Psychiatric Hospital in Geneva. One-third of this adult population (31%) was found to have consulted the child psychiatry service in Geneva (81.4% more than the general population). Patients suffering from manic disorders had consulted this service significantly more often during childhood. Our results showed that patients had a known psychopathology in childhood and adolescence that distinguished them from the control group (P < 0.005): 45% suffered from an affective disorder, in particular manic and hypomanic disorders (29%). The control group was made up of a group of randomly selected adult psychiatric patients, matched for age and sex, who had not been diagnosed as suffering from affective (mood) disorders, and who had also been examined as children or adolescents. Correlations between the childhood pathology and that of the adults were specially for manic disorders. These data are relevant for clinical assessment, treatment and prevention.

The efficacy of dopaminergic antagonists, which are neuroleptics, has been shown in children in varied clinical situations. Five dopaminergic receptors (D1, D2, D3, D4, D5) have thus far been cloned: their existence has thus been confirmed, but their functional significance remains to be determined. This publication reviews their main characteristics. The multiplicity of cerebral dopamine receptors is consistent with the future development of new, more selective and discriminating psychotropic drugs. The diversity of interactions of dopaminergic receptors, among themselves and with receptors for other neurotransmitters, however, explains the difficulty in understanding the mechanism of action of neuroleptics and defining their more rational use in children.

This paper is part of a special section on 'psychopharmacotherapy in children' and deals with facts, controversies and the future of the long-term use of pharmacotherapy in child and adolescent psychiatric disorders. This topic has been little studied because of career disincentives and practical difficulties. Indications for long-term use require evidence of short-term efficacy and safety, a chronic or recurring disorder and continuing proof of effect. Early onset of disorders usually found in adults, such as schizophrenia and bipolar mood disorder, form the clearest indications; but among the child disorders, attention deficit disorder has the most supporting evidence, though medication appears to have little effect on long-term outcome. There is need for further research.

Aggression and self injurious behaviors are associated with some clients with autism and other forms of pervasive developmental disorder. These behaviors are not well understood, and treatment interventions are often ineffective. This article describes these behaviors in terms of the underlying deficits of autism, suggesting that interventions may be more effective if targeted at the underlying causes of the actions. The article presents behaviors and underlying causes within an "iceberg" conceptualization with visible behaviors depicted as occurring "above the water line" and hypothesized causes hidden "below the water line" of the iceberg. Examples of clinical cases are presented to illustrate the usefulness of the conceptualization.

In order to find out if self-injury is associated with the autistic syndrome or at least to specific autistic behaviour patterns, 69 probands were examined and assessed according to the criteria of the Autism Diagnostic Interview according to IQ. We found a high prevalence of self-injurious behaviour among autistic individuals at age 4-5 but no positive correlation between self-injury and the different areas of autistic behaviour. Possible aetiological factors are discussed.

All means of exploring the psychological and environmental antecedents of murder by a child should be used toward preventing lethal outcomes in future. The authors present the case of a ten year old girl who killed her sister with details of the sisters' relationship, the perpetrator's psychological characteristics and the family situation. Sibling-rivalry, family stressors, and the perpetrator's compulsive and narcissistic traits and preoccupation with a violent television fantasy are discussed. A literature review and suggestions for future research are provided.

Total mutism, which is an extremely rare psychiatric disorder, was observed in an 11-year-old boy. He refused to speak a few weeks after starting school. Behavioural analysis showed that learning by model as well as positive and negative reinforcements were involved in the pathogenesis and maintenance of the disorder. The treatment followed principles of behaviour therapy by the use of operant techniques in the sense of contingency management methods. White noise, transmitted by earphones, was utilized to interrupt auditory feedback. It has been suggested that by this method anxiety would be diminished in the case of speech phobia. Within a few months of hospital admission the boy developed speaking behaviour progressing from barely audible breaths to sibilants of normal loudness. Short dialogues were possible after 18 months. The additional conduct disorder improved simultaneously with the increase in verbal and social skills. One year after hospitalization some social uncertainty persisted with tendencies to avoid demands.