Journal of the American Academy of Child Psychiatry最新文献

The relationship of environmental stress to biobehavioral factors has gained recognition in the adult disorders of essential hypertension and coronary artery disease. The pathogenetic dissection of these cardiovascular diseases indicates an interrelationship of multiple biologic factors. It is now recognized that the process evolving into essential hypertension has its onset in the young. The paper discusses the interaction of biologic and psychosocial factors on the cardiovascular system in the young. The patterns of cardiovascular response to various central nervous system stressors in the young with established cardiac risk factors provide insight to the pathogenesis of essential hypertension and also establish a framework from which to develop future interventions.

Reports of eating-disordered symptoms in high risk populations suggest an increasing incidence of both anorexia nervosa and bulimia. To investigate the magnitude of this problem in a “high risk” but nonclinical population, we surveyed upper-middle-class female adolescents from two private girls' schools (one boarding, one day). Of the boarding school population, 18.1% reported at least one symptom of an eating disorder, while the figure for the day school population was 18.6%. Although clinical interviews are a prerequisite to a DSM-III diagnosis of Eating Disorder, this study indicates that many of the students are likely to have a diagnosable clinical syndrome. Discussion includes the early onset of symptoms (prepuberty) suggesting the need for educational, preventative programs.

The perceptions of anxiety and the family climate (family environment scale, FES) among 20 pairs of parents of LD boys were compared with 20 sets of parents of non-LD hoys. The LD parents were more anxious than the control group, and the LD family climate reflected greater emphasis on organization and control within the family system. More ambition and more striving for personal achievement were expected, while free expression of feelings was not encouraged by LD parents. Differences shown by non-LD parents were not found between LD fathers and mothers. Although not different from control fathers, LD fathers did not seem to play a unique male role in the family. With respect to interrelations between expressions of anxiety and FES measures, fathers were more concerned about conflicts within the family system, and this measure was related to their elevated anxiety. On the other hand, the mothers' anxiety was related to greater emphasis on achievement. The results clearly suggest the need for mental-health professionals to consider parent counseling as a significant part of LD intervention programs, with special attention given to anxiety and role definitions within the family system.

Eight children with Attention Deficit Disorder with Hyperactivity were treated with methylphenidate and promethazine in an open crossover design study. No improvement occurred with promethazine, while behavioral deterioration in four subjects necessitated discontinuation of the drug in two cases.

A 16-year-old female adolescent who met DSM-III criteria for bipolar disorder, mixed with psychotic features, showed a clinical response to lithium carbonate, but experienced repeated deterioration in function whenever she entered the premenstrual phase of her menstrual cycle. This exacerbation in her affective psychosis coincided with a progressive fall in serum lithium concentration despite a constant oral regimen with which the patient was compliant. If the oral dose was prophylactically increased during the patient's luteal phase in order to compensate for the anticipated decline in serum concentration, and if the concentration could thereby be maintained at or above 1.1 mEq/L, then the premenstrual deterioration could be prevented.