Spinal Cord Stimulation for Complex Regional Pain Syndrome I [RSD]: a Retrospective Multicenter Experience from 1995 to 1998 of 101 Patients.

Objective. To evaluate effectiveness of spinal cord stimulation (SCS) applied to complex regional pain syndrome I (CRPS I). To analyze trends to focus the design of a multicenter prospective study. Design. Retrospective multicenter series, 3 years. Outcome measures. We collected visual analog scales for pain and patient satisfaction data on n= 101 patients. Patients were divided into two groups: Group I had single-lead quadrapolar systems, Group II had dual-lead octapolar systems. Results. Mean pain scores decreased in both groups with a significantly greater decrease in Group II (p < 0.0001). 74.6% of Group II patients preferred multiple programming arrays with 15.5% requiring frequencies > 250Hz.; overall satisfaction scores were 70% in Group I and 91% in Group II (p < 0.05). Conclusions. SCS is an effective treatment of pain in CRPS I. Frequencies > 250Hz were necessary in some patients to maintain or re-establish pain control. Bilateral multielectrode leads appear superior with application of multiple arrays, permitting paresthesia steering without need for surgical revision. A multicenter, prospective design is needed applying dual-lead multichannel systems with high frequency capabilities in the treatment of CRPS I.

Aggression classification and treatment response.

This preliminary study investigated whether the aggression subtypes derived from the Aggression Questionnaire (AQ) are related to treatment response. The subjects were 28 aggressive conduct-disordered children (25 males, 3 females), ranging in age from 9.8 to 17.0 years (mean age = 12.69 years), who participated in a double-blind, placebo-controlled study of lithium as a treatment for reducing aggression. We used the Predatory-Affective Index of the AQ to classify subjects into "predatory" (planned) or "affective" (explosive) subtypes of aggression and then related this classification to treatment response. This index did not differentiate placebo baseline responders from nonresponders. However, the Index did significantly differentiate responders and nonresponders during the experimental treatment period, regardless of whether they received lithium or placebo. Treatment response was associated with a more affective and less predatory subtype of aggression. To the best of our knowledge, this is the first study in children to show an association between the aggression subtype and treatment response.

Relationship of Beck Depression Inventory factors to depression among adolescents.

Beck Depression Inventory (BDI) scores of 328 adolescents referred to a depression clinic were factor analyzed to test the discriminant validity of each factor. Three of the four factors (Negative Self Attitude. Performance Difficulty, and Somatic Symptoms) discriminated depressed adolescents from those with a behavior disorder or no diagnosis; the Negative Self Attitude and Performance Difficulty factors also discriminated depressed from anxious adolescents. The fourth factor, Physical Worry, failed to discriminate diagnostic groups. Diagnostic efficiency statistics are reported for both the BDI and for items comprising the 13-item BDI Short Form. Results indicate the BDI is a valid screening tool for adolescent depression in a clinical setting, regardless of the presence of comorbid conditions.

Daughter and mother report of individual symptoms on the Children's Depression Inventory.

PURPOSE: To examine differences between early adolescent girls' and their mothers' perceptions of girls' depressive symptoms. METHODS: 313 daughter-mother dyads completed the Children's Depression Inventory. RESULTS: Low to modest agreement was found for most symptoms, although higher agreement was found for symptoms relating to school performance. The hypothesis that girls would report more ideational symptoms and mothers more behavioral symptoms of depression was tested; girls generally reported more ideational and behavioral symptoms when differences occurred. However, several specific ideational symptoms (feeling like crying; feeling sad; guilt; worrying) tended to be more frequently endorsed by girls and had particularly poor daughter-mother agreement. Examining third variables associated with daughter-mother agreement, girls scoring high on social desirability tended to have smaller daughter-minus-mother difference scores for ideational, but not for behavioral items; therefore, social desirability may be associated with girls underreporting ideational symptoms. CONCLUSIONS: Mothers appear to be reliable raters of symptoms related to school functioning, but may be less aware of certain covert depressive symptoms in their early adolescent daughters.

Parent acceptability and feasibility of ADHD interventions: assessment, correlates, and predictive validity.

Examined variables related to parents' stated willingness to pursue treatment, and their actual adherence to treatment recommendations, for children with attention deficit-hyperactivity disorder (ADHD). Parents (87 mothers; 63 fathers) of 91 patients seen for evaluation at an outpatient ADHD clinic completed the ADHD Knowledge and Opinions Survey-Revised (AKOS-R). A factor analysis of the AKOS-R revealed three relevant factors: Counseling Acceptability, Medication Acceptability, and Counseling Feasibility. Externalizing problems were positively related to parents' Counseling Acceptability ratings, while parents' ADHD knowledge was positively related to their Medication Acceptability ratings. However, Counseling Acceptability, Counseling Feasibility, and Medication Acceptability scores at intake failed to predict parents' pursual of recommended counseling and medication at follow-up. Association between treatment acceptability and adherence might be enhanced by assessing treatment acceptability at multiple points during the assessment and treatment process.

The acceptability of interventions for attention-deficit hyperactivity disorder among elementary and middle school teachers.

The acceptability of behavioral and pharmacological interventions for children with attention-deficit hyperactivity disorder (ADHD) among elementary and middle school teachers was examined. Teachers (n = 147) from four suburban school districts read vignettes depicting the use of two behavioral interventions (i.e., daily report and a response cost procedure) and the use of psychostimulant medication in the treatment of ADHD and then rated the acceptability of each. Teachers' ratings of acceptability were examined as a function of knowledge of ADHD and level of teaching experience. Results demonstrated that elementary and middle school teachers each rated daily report as significantly more acceptable than response cost and stimulant medication. Also, teachers rated medication as more acceptable when used in combination with behavioral interventions than when used in isolation. Knowledge of ADHD and years of teaching experience generally were unrelated to ratings of acceptability. Cluster analyses demonstrated that teachers can be differentiated into several profile types with regard to their perceptions of treatment acceptability.

Depression among children with chronic medical problems: a meta-analysis.

Reviewed 60 studies of depressive symptoms among children and adolescents with chronic medical problems. Findings indicate that children with a chronic medical problem are at slightly elevated risk for depressive symptoms but that most are not clinically depressed. Although great variability in depressive symptoms was found across children with the same disorder, children with certain disorders (e.g., asthma, recurrent abdominal pain, sickle cell anemia) may be at greater risk than children with other disorders (e.g., cancer, cystic fibrosis, diabetes mellitus). Disorder severity was inconsistently related to depressive symptoms, while time since diagnosis, gender, and age were generally unrelated to symptoms. Parent (vs. child) ratings and the use of community (vs. normative) control groups were associated with higher ratings of depressive symptoms among children with a chronic medical problem.