Acta paedopsychiatrica最新文献

Three cases of adolescent females suffering from unexplained weight loss are presented. Differential diagnoses included psychiatric and medical illnesses. We describe how psychometric measures were used in each case to clarify diagnosis.

To date, in publications on hamartomas, precocious puberty and laughing seizures have been discussed, but behavioural and cognitive abnormalities have been neglected. Therefore, we report a 14-year-old girl with a proven hamartoma, in which abnormalities of behaviour and cognition played an important role within the somatopsychic complex. In our patient, urinary incontinence during the seizures and psychiatric symptoms, such as eating disorder with obesity, school phobia, antisocial behaviour, withdrawal and cognitive problems (e.g. general slowness, deficiency of cognitive flexibility) came to the fore. The girl had not attended school regularly for almost 2 years, had stayed at home and was overtaxed psychosocially. The seizures and the urinary incontinence improved with drug treatment, but psychiatric difficulties increased and remained untreated until the girl came to a child psychiatric inpatient clinic where drug treatment and behavioural therapy were combined. During well-coordinated neurological and psychiatric treatment the laughing seizures (spontaneous, event-related, psychogenic) decreased and a considerable improvement in psychiatric and psychosocial problems was attained. Consequently, we recommend a close and timely integration of the psychiatric aspects in the treatment of children with hamartomas.

To evaluate the long-lasting effects of excessive life changes during childhood, a group of children sent during the war years 1939-1945 from Finland to Sweden was examined. Their physical and mental health were compared with those of a control group. Information was gathered by postal questionnaire and from various official records both in Finland and Sweden. A clinical interview enhanced the findings of the study. The groups did not differ greatly from each other. Somatically the control group suffered from chronic illnesses more than the group of war children. This particularly applied to cardiovascular diseases; the control group also received more medication free of charge, i.e. medication for chronic diseases, the expenses of which are covered by Public Health Care. As regards mental illnesses the groups were similar. The group of war children was more capable than the control group at recognizing and expressing their feelings.

First borns tend to be different, some of the time, than children born into the other birth orders. This seems due to parental treatment. Parents are often overly anxious about their first child, and may be more restrictive with the first child than with later children. It may be that this is especially true if the first child is female, given the tendency of parents to be more protective of females than of males. Also, the first child has more time alone with the parents than subsequent children, by virtue of having no siblings until the second child is born. From the above factors, it appears that first borns grow up more fearful than later born children but also more intellectually oriented. These are only tendencies and would not be absolutely true in every instance. But, the birth order does seem to initiate a tendency for things to be as stated. As a result, first borns achieve much more than the other birth orders, perhaps due to early adult-oriented styles learned when they had only the parents and no other siblings. If this speculation is correct, the same finding should hold for only children as well. The greater anxiety, achievement, and creativity of some first borns means their lives may be very different as a result of having been the first born child in the family.

Improvements in neonatal care and medical intervention have dramatically increased the number of seriously health-impaired and physically disabled children who now survive to enroll in elementary and secondary schools. Investigation into the post-secondary status of those populations reveals that few of them are employed or living independently. Some researchers have recently found that the disappointing status of these individuals correlates more significantly with psychosocial factors than with intelligence or severity of the disability. This paper describes the circumstances which typically surround children with serious chronic illness or physical disability in the context of Erikson's stages of psychosocial development and suggests strategies for educators regarding the social development of such individuals during the elementary and secondary school years.

The author discusses in detail the operations of a prison treatment program for youthful offenders. Although a model program and an exception to the typical prison, the treatment program had problems. One is the inherent difficulty of working with anti-social people. The other, analyzed in detail, is the unpleasant nature of many of the prison staff, several of whom were unqualified to work in a treatment setting. Suggestions are made for humanizing the staff.

The purpose of exchange and development therapies (EDT) is to reduce the behavioural problems which are the expression of psychophysiological dysfunction. The aim of this study was to reveal the most disturbed psychophysiological functions and their evolution during the course of EDT in 42 children divided into three groups; group I--15 children with pure autism (A); group II--16 children with autism associated with neurological disorders (AA); and group III--11 children with pervasive developmental disorders (PDD). Among the 12 functions analysed, groups AA, A and APDD had respectively 8, 6 and 4 functions in which the score was high (> 2.5), indicating serious disorders (maximum 4). All the dysfunctions improved during EDT. However, each group had certain areas which were more susceptible to treatment. Further analysis of behaviour problems led to a more precise definition of the objectives and to the adaptation of the therapeutic methods to obtain greater effectiveness.

The paper presents the results of an investigation into some psychological aspects of shame and guilt of a group of school children aged fourteen. The research, which involved forty seven children, showed that majority of them, and girls in particular, treat guilt as distinctly different from shame. Guilt seems to be as a more intensive, longer-lasting experience, usually accompanied by a feeling of bad or wrong behaviour, with a general tendency to be coped with in privacy and rather consciously. In the case of the feeling of guilt, it is the individual in question who is his/her own judge (inner source), whereas in the case of shame judgement seems to come from the outside (i.e. other people). The paper proposes ways in which children can be protected from these two emotions.

The immediate effects of relaxation therapy (RT) were assessed in 40 hospitalized children and adolescents with diagnoses of adjustment disorder and depression. These effects were assessed using a within subjects pre-test/post-test design and by comparison with a control group of 20 depressed and adjustment disorder patients who watched a 1-h relaxing videotape. The 1-h RT class consisted of yoga exercise, a brief massage and progressive muscle relaxation. Decreases were noted in both self-reported anxiety and in anxious behavior and fidgeting as well as increases in positive affect in the RT but not the video group. In addition, adjustment disorder patients and a third of the depressed patients showed decreases in cortisol levels following RT, while no changes were noted in the video group. Thus, both diagnostic groups appeared to benefit from the RT class.

As part of a prospective study on the neuropsychiatric development of children born at varying degrees of organic and psychosocial risk, the effect of marital discord on the cognitive and social-emotional development of 315 first-born children into two parent households was investigated. Both the children and the quality of the parental relationship were evaluated when the children were 3 months and 2 years of age. The findings show that marital discord at 3 months does not affect child performance at 3 months, or at 24 months. Marital discord at 2 years does affect the emotional well-being of the 2 year olds, i.e. it is accompanied by a significant rise in psychopathological symptoms. When the effect of the stability of marital strife from the first assessment to the second was studied, a significant increase of behaviour problems and decrease in cognitive performance was found in the group of children whose parents' marital situation had deteriorated and failed in the meantime but surprisingly not in the group with chronic discordant relationships. Conversely, poor child performance and emotional adjustment improved with a positive change in the parental relationships. Analysis shows that negative marital change goes hand in hand with a decrease in parenting skills which affect children more adversely than their counterparts whose parents had a history of marriage and child-rearing problems. Further study of the course of marital relationships and child development at the next research waves (4.5 and 8 years) will show which results are of long-term versus short-term relevance.