Comparative effects of methylphenidate and mixed salts amphetamine on height and weight in children with attention-deficit/hyperactivity disorder.

OBJECTIVE: To determine whether methylphenidate (MPH) and mixed salts amphetamine (MSA) have different effects on growth in children with attention-deficit/hyperactivity disorder. METHOD: Patients treated for at least 1 year with MPH or MSA were identified. A linear regression was performed to determine the effect of stimulant type, patient gender, cumulative stimulant dose, and length of time in treatment on change in Z scores for height. A subset of patients was identified who had 3 years of consistent stimulant treatment on either MSA or MPH. Repeated-measures analyses of variance were performed to examine the effects of time and medication type on Z scores for weight, height, and body mass index. RESULTS: The linear regression showed no effect of stimulant type, drug holidays, or length of time of treatment on change in height Z score. Cumulative dose of stimulant had a small (-0.26) relationship to change in height Z scores. For patients treated for 3 years, there were no effects of stimulant or time on height Z scores. MSA produced more decrease in weight and body mass index Z scores than MPH; all of the subjects were heavier than average at baseline. CONCLUSION: MSA and MPH did not differ in their effects on height. MSA had more of an effect on weight than MPH, although the effect was modest in magnitude and may be of limited clinical significance.

Children's turn-arounds in psychotherapy: the doctor's gesture.

UNLABELLED: Over the past year, a number of us have been examining the organizing principles behind dramatic turning points in the psychotherapies of children. We wondered whether any particular techniques or occurrences in therapy promoted childhood change. METHOD: One of us (L. T) asked the health care professionals on the UCSF child psychiatry grand rounds email list and 50 colleagues across the United States and Canada to select key "moments," or turning points, in their treatments of young people. No organizing principles were suggested in the request letters. Over 3 months, 21 vignettes telling of major changes in children and adolescents arrived in San Francisco. Some of them came from psychotherapies-others, from consultations or very brief therapies. Eleven are included in this paper. RESULTS: Gestures from the psychotherapist were shown to effect dramatic turn-arounds in some young people. These shifts in the doctor's emphasis or behavior included: (1) making an entirely unexpected statement; (2) advocating strongly for the youngster; (3) confessing personal flaws and/or frustrations to the patient; (4) feeding or rewarding the young patient; and (5) inquiring deeply into something personal with the child. A gesture never given--in this instance, an undelivered inquiry into incest--is shown to have left an adolescent patient unchanged. The young people described in this report suffered from anxiety, trauma, neglect, cancer; anorexia, bulimia, and personality disorders. Two were institutionalized at the time of their dramatic changes. One had been previously hospitalized 4 times. Another small child had suffered a double amputation. These children came with a far broader spectrum of problems than the relatively mild disorders for which child-psychodynamic psychotherapy was originally tailored. Although we were not primarily concerned with the "ground" on which the doctor's gesture fell, in 5 of our cases there had been little to no therapeutic relationship prior to the gesture; in 4, the relationship had been primarily positive; and, in 2, it had been negative. CONCLUSIONS: Doctors' gestures are usually given on impulse and unexpectedly during psychotherapy. To the child, these gestures appear counter-intuitive and surprising. From the therapist's perspective, they first generate a brief sense of confusion in the patient, and then a strong sense of connection between the young person and the adult. In the cases we report, the physicians'gestures created a new alliance. The tone of the therapy switched, leading to a noticeable psychic shift in the child. SUMMARY: A doctor's gesture may elicit a dramatic turn-around in a young patient. This therapeutic climax is implicitly understood between the two parties and then may be converted to consciousness and worked with explicitly. Therapeutic "moments" occur in a broad range of disorders, that in many cases are also being treated simultaneously with medications, and with family or institutional counseling.

Improving recruitment and funding in psychiatry by teaching college undergraduates.

OBJECTIVE: To explore attitudes among leaders in psychiatric training about the usefulness of teaching college undergraduates about psychiatry and to assess benefits in recruitment and funding. METHOD: A survey of current practices and beliefs was sent to most adult and child psychiatry residency training directors (RTDs) and Chairs of academic departments of psychiatry in the U.S.). A follow-up survey was then sent to RTDs at responding programs that teach undergraduates. Interviews were also conducted with education experts to learn about the potential financial benefits of teaching undergraduates. RESULTS: Of the 289 (64%) respondents to the first survey, 237 (82%) expressed that teaching undergraduates might or would lead to increased recruitment. All RTDs at responding programs that offered courses answered the second survey, and four reported that undergraduate teaching brings in revenue. Experts confirmed the financial feasibility of these courses. CONCLUSION: Undergraduate psychiatry courses may increase overall recruitment and provide financial benefits for the departments that offer such courses.

Case series: acute mood symptoms associated with posterior fossa lesions in children.

Nineteen children were acutely dysphoric, inattentive, irritable, and sometimes mute following midline posterior fossa neoplasm resection and arteriovenous malformation hemorrhage. These symptoms represent an acute manifestation of the cerebellar cognitive affective syndrome. The authors aimed to describe the acute psychiatric changes in mood and behavior in children with posterior fossa lesions and to evaluate the relationship of posterior fossa syndrome to cerebellar cognitive affective syndrome.

The delirium rating scale in children and adolescents.

The study of delirium has been neglected in pediatric patients, and there are no diagnostic criteria or rating scales adapted for use in this age group. The Delirium Rating Scale is widely used to diagnose and rate the severity of delirium in adults. It was retrospectively administered to 84 children and adolescents diagnosed with delirium to evaluate its applicability in pediatric patients. Delirium Rating Scale scores were comparable to those reported for delirium in adults, although single cross-sectional Delirium Rating Scale scores did not predict length of hospital stay or mortality outcome. Therefore, the Delirium Rating Scale can be used to evaluate delirium in the pediatric population.