Acta paedopsychiatrica最新文献

The neurobiological rationale for an opiate antagonist pharmacotherapy of autism is presented. Naltrexone efficacy in decreasing autistic behaviour and in increasing social-affiliative behaviour was explored in a 5-year-old autistic boy. Naltrexone (0.5 mg/kg 3 times peer week) was effective in immediately decreasing gross motor activity and stereotyped behaviour and caused a delayed increase of crying, smiling and rough-and-tumble play. This single case presents preliminary evidence that a therapeutically valuable rebound reaction is possible and that the human opioid system modulates social-affective processes. The possibility of psychological factors being instrumental in achieving this effect is discussed as being suitable for future clinical trials.

An analysis is reported of drawings of pregnancy by children of both sexes, with the hypothesis that it would be possible to determine sex-related characteristics of the drawings. Clear sexual differentiation in male and female children's representations of pregnancy was revealed by to features: the location of the baby inside the body of the mother and the tendency in some of the boys to "masculinize" the figure, of the expectant mother.

In Japan, school refusal began to attract the attention of psychiatrists from about 1960, and has been one of the main focuses of contemporary child and adolescent psychiatry because of the increase in the number of patients. It is now one of the most popular diagnosis in the clinical practice of child and adolescent psychiatry in this country. School refusal, however, is not listed as a diagnostic classification of a syndrome or disease in such international classifications of psychiatry as the ICD-9, ICD-10 draft, DSM-III, or DSM-III-R. It is an important task for child and adolescent psychiatry in Japan to determine the position of school refusal in relation to the international diagnostic standards. In this paper, (1) We described the actual conditions of school refusal in Japan. (2) We argued that it was reasonable and clinically useful to retain the concept of school refusal as a clinical entity unique to Japan.

A special technique is described, to be used at the beginning or in the course of psychotherapy, designed to gain access to inhibited, silent or depressive patients. For this purpose, the client is presented with an assortment of natural stones, feathers or pieces of wood (driftwood) in a rich variety of colours and forms and invited to choose and handle whatever object most attracts him/her. In the resulting interaction with the therapist, the concrete object acts as a mediator and "transitional object" in the literal sense of the term, namely as a "third object" between the patient and the therapist. This real object (stone, feather or piece of wood), which the patient can feel and handle, helps to enlarge the "playing field" of the dyadic patient-therapist relationship and to reduce anxiety in inhibited and depressive clients. Feeling the object helps the patient to evoke memories and associations and to perceive and address inner emotions hitherto pent up inside him/her. With the help of three case studies the technique of using such natural materials is described.

Three cases of adolescents with respiratory stridor of psychiatric etiology are described. All three fulfilled DSM-III-R criteria for diagnoses of somatoform disorders and showed characteristics of repressive defense style. Such patients are likely to undergo extensive medical investigation and treatment if the psychiatric nature of their disorder is not recognized, but few data describing their psychological characteristics or treatment exist. Repressors are typically unaware of emotional arousal and do not recognize the negative affects which lead to their somatic symptoms. They therefore respond poorly to confrontational psychotherapy and are at risk of discontinuing treatment and repeating their maladaptive symptom cycle. Identification of repressive defense style in patients with stridor which has no obvious organic cause may be useful both as a possible "marker" of psychiatric disorder and as a guide to treatment.

The aim of this study was to assess the differences in the behaviour of help seeking teenagers at the time of consultation. The younger urban and female adolescents were more need of than older rural males.

The study reported here compared the gaze behavior of infants with Down syndrome (DS) and nondelayed infants during interactions with their mothers. The subjects were 10 DS infants and 11 nondelayed infants. Five of the DS infants and 6 of the nondelayed infants were 4 months old; the rest were 9 months old. The results support the expectation that infants with DS gazed at their mothers longer than did nondelayed infants during face-to-face play, and also indicate that all the infants visually attended to their mothers less at 9 months than at 4 months of age. It is conjectured that the increased gaze of the infants with DS may well facilitate attachment in the 1st year of life.

Recent findings have suggested that the simultaneous occurrence of neurofibromatosis and childhood psychosis might be more than a coincidence. In this study of 341 children with infantile autism and other types of childhood psychosis seen as inpatients in two university clinics of child psychiatry in a 25-year period, only one case (0.3%) of concomitant occurrence of the disorders was found, which is a frequency no higher than expected by chance.

Most research on hopelessness has focused on adult populations. However, with the recent publication of Kazdin's Hopelessness Scale for Children, there has been increasing attention directed toward hopelessness in children. This report reviews research on hopelessness, and in both adults and children, emphasizes findings which support Beck's cognitive trial view of depression. Also discussed is the neglected topic of hopelessness within the academic setting, including attributions, motivation and delayed gratification. This report suggests ways to prevent and treat hopelessness in the school-aged child, focusing primarily on cognitive-behavioral techniques.

The social impairments of autism, which are especially salient in autism of the Asperger type, have been attributed to a failure of affective processing, and more recently to a failure to develop a "theory of mind". Recent research evidence bearing on these theories is reviewed and a new hypothesis is put forward, based on research in progress, which posits a developmentally earlier abnormality of the "social gaze response": the inherent tendency of the normal infant to focus gaze and attention on social cues and, later, on objects in the environment as indicated by the gesture of gaze of others. Weakness or absence of the social gaze response is enough, it is argued, to account for many of the typical symptoms of autism, including the failure to acquire a theory of mind.