Adolescent depression: a placebo-controlled fluoxetine treatment study and follow-up.

Forty patients aged 13 to 18 years participated in a placebo-controlled double-blind study of fluoxetine. Fifteen subjects in each group completed the eight week study. Approximately two-thirds of the patients showed marked or moderate clinical global improvement with both fluoxetine and placebo. Fluoxetine was superior to placebo on all clinical measures except for sleep disorder, but the differences were not statistically significant. Thirty-two of the patients and their parents were interviewed after a mean follow-up interval of 24 months (range: 8-46 months). Mean age at follow-up was 18 years (range: 15-22 years). Both groups had shown further improvement at follow-up but there were no significant group differences. Independent of the study, 19 patients (59%) had received intervening treatment following study termination and nine patients (28%) were still in treatment. Adolescent depression appears to respond to treatment but both mood disturbance and psychosocial adaptation problems persist, requiring active follow-through.

Eating and mood disorders in young children.

This article addresses issues emerging from research and clinical work done with young children who develop eating and mood disorders. A literature review and vignettes of anorexia nervosa in prepubertal children are presented, and research on the relationship between eating disorders and mood disorders is examined. Three cases of prepubertal children with growth problems and features of eating and mood disorders and a developmental model of eating disorders and their relationship to mood disorders are explored. In conclusion, a series of questions and suggestions for research and therapy are posed about young children with eating and mood disorders and the relationship between them.

The child's predicament in families with a mood disorder. Research findings and family interventions.

A family psychiatry approach to mood disorders brings together genetic and family history studies with epidemiologic patterns of individuals at risk to understand the child's predicament. Strands from different areas of research are woven together to argue for the powerful impact of family environment on the developing child. In response to an acute mood episode, family functioning is globally disturbed but may resolve. Family therapy is helpful during the mood episode for both crisis resolution and prevention. Unresolved problems may induce relapse. Dysfunctional family interaction patterns include rigidity, polarizations, and using the child as a go-between. The child's predicament is a cascade of risk factors including exposure to the ill parent, consequences of the illness on family relationships, and the impact on the child's coping capacities. Two common child response patterns are the child who acts as regulator of the family system and the child who opts out of the family. Clinical interventions, adapted to working with mood-disordered families, are illustrated through case vignettes. The need for a broad-based approach is stressed, in which family therapy is part of a package that includes hospitalization, psychopharmacology, and family education.

Grandchildren of survivors: can negative effects of prolonged exposure to excessive stress be observed two generations later?

Some studies have demonstrated negative psychological repercussions on children of parents who experienced extreme, prolonged stress. To determine whether such effects might continue in the third generation, we examined the presenting complaints of patients in a child psychiatry clinic who could be reliably identified as: (i) children whose parents were native born but who had at least one grandparent who was a survivor of the Nazi persecution (Index 1, N = 58); (ii) other children who had at least one parent and one grandparent who was a survivor (Index 2, N = 11); (iii) children of other immigrant grandparents (N = 28); (iv) children with four native born grandparents (N = 30). All other grandparents and parents were native born. All families were of the same ethnic group. Index 2 children manifested more difficulties related to school performance, but the small size of the sample precludes generalization. Although the Index 1 children did not have different types of behavioural disturbances, the size of the Index (1 + 2) group (N = 69) relative to the comparison groups was 300% greater than expected on the basis of community population estimates. Implications of this finding are discussed.

Is there an obsessive psychosis? Aetiological and prognostic factors of an atypical form of obsessive-compulsive neurosis.

The study explores whether an atypical form of obsessional illness can be delineated and separated from the conventional form of obsessive-compulsive neurosis (OCN). From a group of 45 obsessive patients, 8 were selected on the basis of 3 criteria: presence of a severely debilitating main obsessive symptom; bordering on the delusional; no schizophrenic symptoms. Assessment and outcome measures included the Psychiatric Questionnaire, the Leyton Obsessional Inventory, Fear Survey Schedule, and IPAT Self-Analysis Form. Self-assessment forms allowed patients to make social adjustment and neurotic symptom ratings. In a multimodal approach, patients were assigned to behavioural and pharmacological treatments on the basis of severity. Reassessment took place after 50 sessions of therapy. Results of analysis of variance statistics indicated that the atypical group had a more malignant form of illness, with more varied and severe obsessions. A poorer prognosis for the atypical group was indicated by: greater social maladjustment, poor employment records, illness of longer duration showing no remissions despite more courses of treatment, and poor response to treatment throughout. The atypical group manifested fewer characteristic features of OCN (example: fewer precipitating events). On the other hand, schizophrenia was not imputed, although delusion-like experiences in the atypical group suggest a psychotic form of illness. The term "obsessive psychosis" suggested by Strauss and recently investigated by Weiss et al and Robinson et al is proposed for our atypical group. Results are compared with those of other investigators. It is concluded that the delineation of a subgroup of obsessional illness is desirable for research and therapy since a form of atypical obsessional illness or obsessive psychosis can be differentiated on aetiological, phenomenological and prognostic factors.