24 research outputs found
Anxiety Disorders in Children and Adolescents with Bipolar Disorder: A Neglected Comorbidity
Objective: We describe a consecutive clinical sample of children and adolescents with bipolar disorder to define the pattern of comorbid anxiety and externalizing disorders (attention-deficit hyperactivity disorder [ADHD] and conduct disorder [CD]) and to explore the possible influence of such a comorbidity on their cross-sectional and longitudinal clinical characteristics. Methods: The sample comprised 43 outpatients, 26 boys and 17 girls, (mean age 14.9 years, SD 3.1; range 7 to 18), with bipolar disorder type I or II, according to DSM-IV diagnostic criteria. All patients were screened for psychiatric disorders using historical information and a clinical interview, the Diagnostic Interview for Children and Adolescents-Revised (DICA-R). To shed light on the possible influence of age at onset, we compared clinical features of subjects whose bipolar onset was prepubertal or in childhood (< 12 years) with those having adolescent onset. We also compared different subgroups with and without comorbid externalizing and anxiety disorders. Results: Bipolar disorder type I was slightly more represented than type II (55.8% vs 44.2%). Only 11.6% of patients did not have any other psychiatric disorder; importantly, 10 subjects (23.5%) did not show any comorbid anxiety disorder. Comorbid externalizing disorders were present in 12 (27.9%) patients; such comorbidity was related to the childhood onset of bipolar disorder type II. Compared with other subjects, patients with comorbid anxiety disorders more often reported pharmacologic (hypo)mania
Phenomenology and Comorbidity of Dysthymic Disorder in 100 Consecutively Referred Children and Adolescents: Beyond DSM-IV
Objective: Diagnostic criteria and nosological boundaries of juvenile dysthymic disorder (DD) are underresearched. Two different sets of diagnostic criteria are still discussed in the DSM-IV, the first giving major weight to somatic and vegetative symptoms and the second, included in the appendix, to more affective and cognitive symptoms. The aim of this study was to describe prototypical symptomatology and comorbidity of DD, according to DSM-IV criteria, in a consecutive series of referred children and adolescents, as a function of age and sex. Method: One hundred inpatients and outpatients (36 children and 64 adolescents, 57 males, 43 females, age range 7 to 18 years, mean age 13.3 years) received a diagnosis of DD without comorbid major depressive disorder (MDD), using historical information, the Diagnostic Interview for Children and Adolescents-Revised (DICA-R), and symptoms ratings according to the DSM-IV criteria. Results: Irritability, low self-esteem, fatigue or loss of energy, depressed mood, guilt, concentration difficulties, anhedonia, and hopelessness were present in more than 50% of subjects. Differences in symptomatic profile between male and female patients were not significant. Anxiety disorders were commonly comorbid with DD, mainly generalized anxiety disorder, simple phobias, and in prepuberal children, separation anxiety disorder. Externalizing disorders were reported in 35% of the patients, with higher prevalence in male patients. Adolescents showed more suicidal thoughts and anhedonia than children. Conclusions: The clinical picture of early-onset DD we found, based entirely on a pure sample without current and past MDD, is not totally congruent with the diagnostic criteria according to DSM-IV. A more precise definition of the clinical picture may help early diagnosis and prevention of superimposed mental disorders
Developmental language disorder: Early predictors, age for the diagnosis, and diagnostic tools. A scoping review
Background. Developmental Language Disorder (DLD) is frequent in childhood and may have long-term sequelae. By employing an evidence-based approach, this scoping review aims at identifying (a) early predictors of DLD; (b) the optimal age range for the use of screening and diagnostic tools; (c) effective diagnostic tools in preschool children. Methods. We considered systematic reviews, meta-analyses, and primary observational studies with control groups on predictive, sensitivity and specificity values of screening and diagnostic tools and psycholinguistic measures for the assessment of DLD in preschool children. We identified 37 studies, consisting of 10 systematic reviews and 27 primary studies. Results. Delay in gesture production, receptive and/or expressive vocabulary, syntactic comprehension, or word combination up to 30 months emerged as early predictors of DLD, a family history of DLD appeared to be a major risk factor, and low socioeconomic status and environmental input were reported as risk factors with lower predictive power. Optimal time for screening is suggested between age 2 and 3, for diagnosis around age 4. Because of the high variability of sensitivity and specificity values, joint use of standardized and psycholinguistic measures is suggested to increase diagnostic accuracy. Conclusions. Monitoring risk situations and employing caregivers\u2019 reports, clinical assessment and multiple linguistic measures are fundamental for an early identification of DLD and timely interventions
Olanzapine treatment in adolescent with severe conduct disorder
The most severe forms of conduct disorder (CD) are highly stable and disabling
disorders, more likely to persist in time and to evolve into disruptive or
antisocial behaviors. One crucial issue in the prognosis of these forms of CD is
the high resistance to both non-pharmacological and pharmacological treatments,
with antipsychotic drugs being frequently used in refractory cases. Aim of this
study was: (1) to explore efficacy and tolerability of olanzapine treatment in
adolescents with severe CD; (2) to identify predictors of olanzapine treatment
outcome. This was a retrospective study, based on clinical records of the first
23 adolescents diagnosed as having a CD, diagnosed with a clinical interview
(K-SADS), either pure or with comorbid diagnoses, and treated with olanzapine.
All these patients did not respond satisfactorily to non-pharmacological
intervention and to adequate dosages of mood stabilizers (lithium and/or
valproate). The sample consisted of 16 males and seven females, 16 inpatients and
seven outpatients (mean age 13.6 +/- 1.9 years, range 11-17.2 years), followed-up
for a period ranging from 6 to 12 months (mean 8.8 +/- 2.7 months). Outcome
measures included the Modified Overt Aggression Scale (MOAS), Clinical Global
Impression-Improvement (CGI-I) and Children Global Assessment Scale (CGAS).
During the follow-up, all patients were involved in non-pharmacological
treatments (psychotherapy, family therapy, or day-hospital group treatments).
Based on both an improvement of at least 50% at MOAS and a score 1 or 2 at CGI-I,
14 out of 23 patients (60.9%) were classified as responders at the end of the
follow-up. Significant improvement at the last observation was found in MOAS (P <
0.001) and CGAS (P < 0.001) scores. Olanzapine dosage was 8 +/- 3.2 mg/day (range
5-20 mg/day). Mean weight gain at the end of the follow-up was 4.6 +/- 3 kg. The
predictors of a positive treatment response was an impulsive-affective versus
controlled-predatory type of aggression. Age at onset of CD and comorbid
disorders did not affect treatment response. These preliminary findings suggest
that olanzapine may improve behavior in adolescents with severe and
treatment-refractory CD and impulsive aggression
Aripiprazole monotherapy in children and young adolescents with pervasive developmental disorders: a retrospective study
BACKGROUND: Pervasive developmental disorders (PDDs) are severe psychiatric
disorders characterized by impairment in social interactions, in verbal and
non-verbal communication, and by restricted and stereotyped patterns of interest
and behaviour, with onset in the first 3 years of life. The appropriate use of
pharmacotherapy can improve some aberrant symptoms and behaviours and increase
the person's response to non-pharmacological interventions.
OBJECTIVE: To describe clinical outcomes, or symptom changes, and adverse effects
during naturalistic treatment with aripiprazole monotherapy in children with PDDs
and severe behavioural disorders (such as aggression against self and/or others,
hostility, hyperactivity, severe impulsiveness).
METHOD: This retrospective naturalistic study included 34 patients (23 males and
11 females, age range 4.5-15 years, mean age 10.2 +/- 3.3 years), admitted during
2006-2007, diagnosed according to DSM-IV criteria and followed up for 4-12 months
(mean 7.0 +/- 3.6 months). Outcome measures were three global measures of
clinical and functional impairment and improvement from baseline: the Clinical
Global Impression-Severity (CGI-S) and CGI-Improvement (CGI-I) scales; the
Children's Global Assessment Scale (C-GAS); and the Childhood Autism Rating Scale
(CARS), a specific measure of PDD symptoms.
RESULTS: The mean baseline CGI-S was 5.7 +/- 0.8 (markedly ill/severely ill). The
mean final dosage of aripiprazole was 8.1 +/- 4.9 mg/day. At the endpoint, 11
patients (32.4%) were 'much improved' or 'very much improved' (CGI-I score of 1
or 2), 12 patients (35.3%) were 'minimally improved' (CGI-I score of 3) and 10
(29.4%) were 'unchanged' or 'worsened' (CGI-I score of 4 or 5). C-GAS and CARS
scores significantly improved (p < 0.0001, effect sizes 0.59 and 0.62,
respectively). Nine patients (26.5%) experienced moderate to severe agitation,
which was associated with self-injurious behaviours in five of these patients,
and five patients presented with sleep disorders. Twelve patients (35.3%)
discontinued medication during the follow-up because of lack of efficacy or
adverse effects.
CONCLUSIONS: In these severely impaired children with PDDs, aripiprazole
monotherapy was associated with a significant improvement in maladaptive
behaviours in one-third of patients. Agitation and insomnia were the most
frequent adverse effects. Further controlled studies in larger samples to explore
possible predictors of efficacy are warranted