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2.
J Am Acad Child Adolesc Psychiatry ; 38(3): 250-5, 1999 Mar.
Article in English | MEDLINE | ID: mdl-10087685

ABSTRACT

OBJECTIVE: To determine prospectively whether parental receipt of injury prevention education is associated with new action limiting access to lethal means and if so, what action was taken for which means. METHOD: Prospective follow-up of 103 adults whose children made an emergency department visit for mental health assessment or treatment. Record review assessed whether hospital staff provided injury prevention education. Logistic regression was used to determine the likelihood of new caretaker action limiting access to the following potentially lethal means: firearms, alcohol, prescription medications, and over-the-counter medications. RESULTS: Significant associations were found between exposure to injury prevention education and action to limit access (adjusted odds ratio = 3.6, 95% confidence interval = 1.1-12.1, p = .04). Five of 8 adults whose households contained firearms took new action to limit access after injury prevention education, whereas none of the 7 firearm-owning families who did not receive injury prevention education took new action to limit firearm access. Similar patterns were seen for other means. Adults more often chose to lock up rather than dispose of lethal means. CONCLUSIONS: Injury prevention education should be provided to parents during child/adolescent emergency department mental health-related visits. Potential for violence prevention is real because parents do take new action to limit access to lethal means when means restriction education is provided.


Subject(s)
Emergency Service, Hospital , Parents/education , Suicide Prevention , Violence/prevention & control , Adolescent , Adult , Child , Female , Follow-Up Studies , Humans , Male , Outcome and Process Assessment, Health Care , Prospective Studies , Suicide/psychology , Violence/psychology , Wounds and Injuries/prevention & control , Wounds and Injuries/psychology
3.
Am J Emerg Med ; 16(3): 257-61, 1998 May.
Article in English | MEDLINE | ID: mdl-9596427

ABSTRACT

This study evaluated the impact of a mail information campaign on emergency department (ED) professionals' knowledge about the lethal role of firearms in suicide, knowledge of appropriate strategies for warning caregivers of adolescents who have attempted suicide about firearms, and practices with respect to the delivery of such warnings. Responses obtained from physicians and nurses working in ED sites within the targeted city (Chicago) were compared with responses from ED professionals employed in a comparison city (Detroit). In Chicago, the percentage of respondents recommending firearm removal strategies increased from 60% at pretest to 76% at posttest. Individual reports of caregiver warnings per adolescent suicide exposure showed a significant decline in Chicago and a marginally significant decline in Detroit. Gains in knowledge about firearm warning strategies persisted in multivariate analyses controlling for subject demographic characteristics. The pattern of results suggests that the intervention may have effected changes in knowledge while having little impact on behavior. More intensive, interactive educational strategies may be needed to effect behavioral changes among ED professionals.


Subject(s)
Adolescent Behavior , Clinical Competence , Emergency Nursing/education , Emergency Service, Hospital/standards , Firearms , Medical Staff, Hospital/education , Suicide, Attempted/prevention & control , Adolescent , Adult , Chicago , Female , Humans , Male , Michigan , Middle Aged , Multivariate Analysis , Urban Health
4.
Am J Emerg Med ; 15(4): 357-60, 1997 Jul.
Article in English | MEDLINE | ID: mdl-9217524

ABSTRACT

The study objectives were to ascertain whether caretakers of suicidal children and adolescents received emergency department (ED) injury prevention education and to determine if injury prevention education and the medical outcome after a drug overdose are associated with caretakers restricting access to means of suicide. Participants were adult caretakers of children and adolescents who deliberately ingested a drug and received ED evaluation. Information was obtained by poison center chart review and phone interview. Fourteen percent of caretaker reported receiving injury prevention education concerning restriction of access to potential means of suicide at home. ED injury prevention education is significantly associated with caretakers restricting access to suicidal means, even when controlling for medical outcome from the attempt. Because parents are less likely to restrict access to means of suicide without education, injury prevention education about restricting access to means of suicide should be given in the ED.


Subject(s)
Caregivers/education , Emergency Service, Hospital , Poisoning/prevention & control , Suicide, Attempted/prevention & control , Adolescent , Adult , Child , Female , Humans , Male , Poisoning/therapy , Treatment Outcome
5.
J Genet Psychol ; 158(4): 411-26, 1997 Dec.
Article in English | MEDLINE | ID: mdl-9423273

ABSTRACT

Concurrent and longitudinal mother-child attachment qualities were studied in relation to children's ability to postpone gratification at age 6 years. A sample of 32 children (at ages 12 months and 18 months) and their mothers participated in the strange situation procedure. At age 6 years, they were observed in an attachment situation and administered a standard delay of gratification task. The length of time that children were able to delay gratification at age 6 was predicted both by concurrent attachment quality and by a longitudinal attachment measure. Children with secure attachment were able to wait the longest periods of time, whereas those with insecure-disorganized attachment had the most difficulties in waiting. The effects of longitudinal, but not concurrent, attachment quality on children's total waiting time remained significant when other important variables were considered, including gender and children's cognitive functioning. An interactive effect was found between attachment quality and cognitive functioning. Insecure-avoidantly attached children with high cognitive functioning did not differ in their overall waiting times from securely attached children, but insecure-avoidantly attached children with average or low cognitive functioning did have shorter waiting times. The study provides a basis for the further investigation of mother-child attachment quality as a factor that is linked to children's delay behavior.


Subject(s)
Child Development , Impulsive Behavior , Inhibition, Psychological , Mother-Child Relations , Object Attachment , Psychology, Child , Reward , Attention/physiology , Chi-Square Distribution , Child , Child, Preschool , Family Health , Female , Humans , Infant , Longitudinal Studies , Male , Regression Analysis , Sex Factors , Survival Analysis
6.
Psychophysiology ; 33(6): 731-9, 1996 Nov.
Article in English | MEDLINE | ID: mdl-8961795

ABSTRACT

Electrodermal activity and heart rate were recorded during rest, simple tones, and a reaction time task in 43 male and female adolescents and children with obsessive compulsive disorder and 30 male adolescents and children with disruptive behavior disorders who had lumbar cerebrospinal fluid drawn during the same week. Partial correlations controlling for age and sex showed that in the obsessive group metabolites of serotonin and dopamine, but not of norepinephrine, were positively correlated with electrodermal responsivity, most consistently in the reaction time task. This result was not replicated in disruptive boys. Adrenocorticotropic hormone was positively related to electrodermal activity and heart rate throughout the session. The results for the obsessive adolescents suggest that nigrostriatal dopamine turnover and central serotonin turnover affect electrodermal activity, generally confirming and extending conclusions from pharmacological studies. Diagnosis may affect these relationships.


Subject(s)
Autonomic Nervous System/physiopathology , Heart Rate/physiology , Obsessive-Compulsive Disorder/cerebrospinal fluid , Obsessive-Compulsive Disorder/physiopathology , Adolescent , Child , Female , Humans , Male , Reaction Time/physiology
7.
Neuropsychopharmacology ; 14(2): 125-37, 1996 Feb.
Article in English | MEDLINE | ID: mdl-8822535

ABSTRACT

Central dopaminergic activity has been assumed to play a role in the efficacy of stimulant drugs in attention deficit/hyperactivity disorder (ADHD), although supporting evidence has been scant. This study examined baseline cerebrospinal fluid (CSF) of boys with ADHD in relation to response to three different stimulant drugs. Forty five boys with DSM-III-R-diagnosed ADHD had a lumbar puncture before double-blind trials of methylphenidate, dextroamphetamine, and placebo. Sixteen also received pemoline as part of a subsequent open trial. Stepwise linear regressions determined significant predictors of drug response. Our prior report of a positive significant correlation between CSF homovanillic acid (HVA) and ratings of hyperactivity on placebo was replicated in a new sample of 20 boys. After baseline symptom severity, CSF HVA was the best predictor of stimulant drug response, with significant independent contribution to four of the ten measures of hyperactivity that changed significantly with medication. Higher HVA predicted better drug response, and lower HVA was associated with worsening on some measures. This supports the mediating role of central dopaminergic activity in stimulant drug efficacy in childhood hyperactivity.


Subject(s)
Attention Deficit Disorder with Hyperactivity/cerebrospinal fluid , Attention Deficit Disorder with Hyperactivity/drug therapy , Behavior/drug effects , Central Nervous System Stimulants/therapeutic use , Homovanillic Acid/cerebrospinal fluid , Attention Deficit Disorder with Hyperactivity/psychology , Biogenic Monoamines/cerebrospinal fluid , Child , Cross-Over Studies , Dextroamphetamine/therapeutic use , Double-Blind Method , Humans , Male , Methylphenidate/therapeutic use , Pemoline/therapeutic use , Psychiatric Status Rating Scales , Regression Analysis
8.
Neurology ; 45(12): 2199-202, 1995 Dec.
Article in English | MEDLINE | ID: mdl-8848193

ABSTRACT

Analysis of cerebral magnetic resonance images of 24 subjects with Sydenham's chorea and 48 age-, height-, weight-, gender-, and handedness-matched controls demonstrated increased sizes of the caudate, putamen, and globus pallidus in the Sydenham's chorea group. In contrast, neither total cerebral, prefrontal, or midfrontal volumes or thalamic area were increased. These results indicate the selective involvement of the basal ganglia in Sydenham's chorea.


Subject(s)
Basal Ganglia/pathology , Chorea/diagnosis , Magnetic Resonance Imaging , Adolescent , Child , Female , Humans , Male , Reference Values
10.
Psychiatry Res ; 54(2): 199-210, 1994 Nov.
Article in English | MEDLINE | ID: mdl-7761553

ABSTRACT

Levels of calcium in plasma, red blood cells, and mononuclear blood cells, levels of calcium in plasma, and the plasma calcium-to-magnesium ratio were measured at baseline and after 3 weeks of each drug phase of a double-blind, placebo-controlled study of methylphenidate and dextroamphetamine in hyperactive boys. Levels of magnesium in plasma were significantly higher after 3 weeks of dextroamphetamine treatment, and the calcium-to-magnesium ratio was significantly lower after 3 weeks of either drug compared with the baseline or placebo condition. There was no change in magnesium levels in red blood cells or mononuclear blood cells. These measures were obtained 30 minutes before the morning dose and at 9 a.m., 9:30 a.m., 10:30 a.m., 11:00 a.m., and noon on the last day of each 3-week phase. Analysis of variance revealed a drug effect on plasma magnesium and on the calcium-to-magnesium ratio but no drug x time interaction. Although these changes were not correlated with the time course of acute symptomatic response to stimulant therapy, the decrease in the ratio may be relevant to side effects and treatment resistance associated with stimulant use.


Subject(s)
Attention Deficit Disorder with Hyperactivity/drug therapy , Calcium/blood , Calcium/metabolism , Dextroamphetamine/pharmacology , Dextroamphetamine/therapeutic use , Magnesium/blood , Magnesium/metabolism , Methylphenidate/pharmacology , Methylphenidate/therapeutic use , Body Weight , Calcium/urine , Child , Circadian Rhythm , Dextroamphetamine/administration & dosage , Epinephrine/metabolism , Epinephrine/urine , Erythrocyte Count/drug effects , Humans , Magnesium/urine , Male , Methylphenidate/administration & dosage , Placebos
11.
Psychiatry Res ; 52(3): 305-16, 1994 Jun.
Article in English | MEDLINE | ID: mdl-7527565

ABSTRACT

Cerebrospinal fluid (CSF), plasma, and urinary monoamine metabolites were determined for 29 boys, aged 6-12, with attention-deficit hyperactivity disorder (ADHD). Levels of CSF 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA), and 3-methoxy-4-hydroxyphenylglycol (MHPG), the metabolites of serotonin, dopamine, and norepinephrine, respectively, correlated significantly with behavioral measures of aggression and impulsivity/hyperactivity. However, these correlations were in the unexpected direction; for example, CSF 5-HIAA correlated positively with the Brown-Goodwin Lifetime History of Aggression Scale. HVA in CSF was positively correlated with several measures of hyperactivity. The replicability of these findings, as well as possible socioenvironmental effects, and the predictive value of CSF monoamines in prepubertal hyperactivity are the subjects of ongoing study.


Subject(s)
Attention Deficit Disorder with Hyperactivity/cerebrospinal fluid , Neurotransmitter Agents/cerebrospinal fluid , Aggression/drug effects , Aggression/physiology , Aggression/psychology , Attention/drug effects , Attention/physiology , Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/drug therapy , Attention Deficit Disorder with Hyperactivity/psychology , Child , Dextroamphetamine/therapeutic use , Double-Blind Method , Homovanillic Acid/cerebrospinal fluid , Humans , Hydroxyindoleacetic Acid/cerebrospinal fluid , Impulsive Behavior/cerebrospinal fluid , Impulsive Behavior/diagnosis , Impulsive Behavior/drug therapy , Impulsive Behavior/psychology , Male , Methoxyhydroxyphenylglycol/cerebrospinal fluid , Methylphenidate/therapeutic use , Motor Activity/drug effects , Motor Activity/physiology
12.
Psychophysiology ; 30(6): 605-14, 1993 Nov.
Article in English | MEDLINE | ID: mdl-8248452

ABSTRACT

Skin conductance (SC) and heart rate (HR) were measured during rest, a series of tones, and a reaction time task in 34 boys with disruptive behavior disorder to ascertain (a) if this broadly defined group differed from control boys (n = 33) and (b) if there were differences within the spectrum related to component diagnoses or to target behaviors. Disruptive boys had higher resting HR than controls, due largely to those without a subdiagnosis of conduct disorder. Disruptive boys showed a smaller increment in SC response frequency for task instructions. They did not show a general deficit in phasic SC reactivity but habituated to signal stimuli at a faster rate than did controls. However, their SC response latencies were shorter despite slower motor reaction time. Responsivity variables were similar in boys with and without a subdiagnosis of conduct disorder. The data are not compatible with the hypothesis of low autonomic nervous system (ANS) baselines in disruptive boys but partially suggest low ANS reactivity. They generally support the validity of the disruptive behavior disorder spectrum. Correlations with measures of aggression and impulsivity suggest that individual differences within the spectrum might be more fruitfully described by behavior dimensions than by conventional subdiagnosis.


Subject(s)
Arousal/physiology , Attention/physiology , Autonomic Nervous System/physiopathology , Child Behavior Disorders/physiopathology , Adolescent , Aggression/physiology , Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/physiopathology , Child , Child Behavior Disorders/diagnosis , Galvanic Skin Response/physiology , Humans , Impulsive Behavior/diagnosis , Impulsive Behavior/physiopathology , Male , Psychophysiology
13.
Am J Orthopsychiatry ; 63(1): 103-12, 1993 Jan.
Article in English | MEDLINE | ID: mdl-8427300

ABSTRACT

In order to examine their relationship to Expressed Emotion, family environment and marital relationships were measured in the parents of disruptive, obsessive-compulsive, and normal children. Satisfactory family and martial environment were found to be related to low Expressed Emotion, while achievement orientation in mothers and greater family conflict were found to be significantly related to high Expressed Emotion.


Subject(s)
Child Behavior Disorders/psychology , Child of Impaired Parents/psychology , Emotions , Obsessive-Compulsive Disorder/psychology , Parent-Child Relations , Adaptation, Psychological , Adolescent , Child , Child Behavior Disorders/therapy , Female , Humans , Male , Marriage/psychology , Obsessive-Compulsive Disorder/therapy , Personality Assessment , Personality Development , Social Environment , Verbal Behavior
14.
Arch Sex Behav ; 21(6): 587-93, 1992 Dec.
Article in English | MEDLINE | ID: mdl-1482282

ABSTRACT

A relationship has been suggested between clinical presentation of paraphilias and obsessive-compulsive disorder (OCD) with respect to the unwanted repetitive nature and insight into the irrationality of the paraphiliac behavior. This has led to speculation that paraphiliac disorders might belong to an "obsessive compulsive spectrum." To address this issue, and because of the striking selective benefit of serotonin reuptake blocking antidepressants (such as clomipramine) in the treatment of OCD, 15 paraphiliacs entered a double-blind crossover comparison of clomipramine vs. desipramine preceded by a 2-week single-blind placebo period. Four subjects responded to placebo and were dropped from the study. Three others failed to complete the study. Although the study is limited by the small number of patients and the heterogeneity of the paraphilias, the observed benefit from both tricyclics (over the initial placebo) encourages further study. For the 8 subjects completing the protocol, there was no preferential response to the more specific serotonin reuptake inhibitor suggesting a difference in underlying pathophysiology between paraphilia and OCD.


Subject(s)
Clomipramine/therapeutic use , Desipramine/therapeutic use , Paraphilic Disorders/drug therapy , Adult , Double-Blind Method , Humans , Male , Middle Aged , Treatment Outcome
15.
Brain ; 115 ( Pt 5): 1249-73, 1992 Oct.
Article in English | MEDLINE | ID: mdl-1422788

ABSTRACT

Neurological dysfunction, seizures and brain atrophy occur in a broad spectrum of acute and chronic neurological diseases. In certain instances, over-stimulation of N-methyl-D-aspartate receptors has been implicated. Quinolinic acid (QUIN) is an endogenous N-methyl-D-aspartate receptor agonist synthesized from L-tryptophan via the kynurenine pathway and thereby has the potential of mediating N-methyl-D-aspartate neuronal damage and dysfunction. Conversely, the related metabolite, kynurenic acid, is an antagonist of N-methyl-D-aspartate receptors and could modulate the neurotoxic effects of QUIN as well as disrupt excitatory amino acid neurotransmission. In the present study, markedly increased concentrations of QUIN were found in both lumbar cerebrospinal fluid (CSF) and post-mortem brain tissue of patients with inflammatory diseases (bacterial, viral, fungal and parasitic infections, meningitis, autoimmune diseases and septicaemia) independent of breakdown of the blood-brain barrier. The concentrations of kynurenic acid were also increased, but generally to a lesser degree than the increases in QUIN. In contrast, no increases in CSF QUIN were found in chronic neurodegenerative disorders, depression or myoclonic seizure disorders, while CSF kynurenic acid concentrations were significantly lower in Huntington's disease and Alzheimer's disease. In inflammatory disease patients, proportional increases in CSF L-kynurenine and reduced L-tryptophan accompanied the increases in CSF QUIN and kynurenic acid. These responses are consistent with induction of indoleamine-2,3-dioxygenase, the first enzyme of the kynurenine pathway which converts L-tryptophan to kynurenic acid and QUIN. Indeed, increases in both indoleamine-2,3-dioxygenase activity and QUIN concentrations were observed in the cerebral cortex of macaques infected with retrovirus, particularly those with local inflammatory lesions. Correlations between CSF QUIN, kynurenic acid and L-kynurenine with markers of immune stimulation (neopterin, white blood cell counts and IgG levels) indicate a relationship between accelerated kynurenine pathway metabolism and the degree of intracerebral immune stimulation. We conclude that inflammatory diseases are associated with accumulation of QUIN, kynurenic acid and L-kynurenine within the central nervous system, but that the available data do not support a role for QUIN in the aetiology of Huntington's disease or Alzheimer's disease. In conjunction with our previous reports that CSF QUIN concentrations are correlated to objective measures of neuropsychological deficits in HIV-1-infected patients, we hypothesize that QUIN and kynurenic acid are mediators of neuronal dysfunction and nerve cell death in inflammatory diseases. Therefore, strategies to attenuate the neurological effects of kynurenine pathway metabolites or attenuate the rate of their synthesis offer new approaches to therapy.


Subject(s)
Kynurenine/metabolism , Nervous System Diseases/metabolism , Neuritis/metabolism , Quinolinic Acid/metabolism , Aged , Animals , Brain Diseases/metabolism , Encephalitis/metabolism , Female , HIV Infections/cerebrospinal fluid , HIV Infections/metabolism , Humans , Kynurenic Acid/cerebrospinal fluid , Kynurenic Acid/metabolism , Kynurenine/cerebrospinal fluid , Macaca , Male , Middle Aged , Nervous System Diseases/cerebrospinal fluid , Neuritis/cerebrospinal fluid , Neuritis/etiology , Neuritis/veterinary , Quinolinic Acid/cerebrospinal fluid , Simian Acquired Immunodeficiency Syndrome/complications
16.
Arch Gen Psychiatry ; 49(6): 429-35, 1992 Jun.
Article in English | MEDLINE | ID: mdl-1376104

ABSTRACT

A 2-year prospective follow-up study of 100% (N = 29) of a sample of children and adolescents with disruptive behavior disorders found that the baseline lumbar cerebrospinal fluid monoamine metabolite concentration and autonomic nervous system activity predicted some subsequent outcomes. The 5-hydroxyindoleacetic acid concentration significantly predicted severity of physical aggression during follow-up. The skin conductance level significantly predicted institutionalization. Correlations were in predicted directions with lower cerebrospinal fluid 5-hydroxyindoleacetic acid concentrations and autonomic activity correlated with poor outcome. Moreover, in multivariate analyses, which included nonlaboratory measures as predictors, cerebrospinal fluid and autonomic measures still contributed significantly to the prediction. However, hypothesized predictions of cerebrospinal fluid 5-hydroxyindoleacetic acid concentrations for suicide attempts and of low autonomic nervous system activity for arrests were not supported thus far. Patients are still at risk; consequently, these results must be considered preliminary. Nonetheless, the results suggest that further investigation of relationships between biological factors and outcome of children with disruptive behavior disorders is warranted.


Subject(s)
Child Behavior Disorders/diagnosis , Adolescent , Aggression/psychology , Attention Deficit Disorder with Hyperactivity/cerebrospinal fluid , Attention Deficit Disorder with Hyperactivity/diagnosis , Child , Child Behavior Disorders/cerebrospinal fluid , Female , Follow-Up Studies , Galvanic Skin Response , Homovanillic Acid/cerebrospinal fluid , Humans , Hydroxyindoleacetic Acid/cerebrospinal fluid , Institutionalization , Male , Multivariate Analysis , Probability , Prospective Studies , Severity of Illness Index
17.
Arch Gen Psychiatry ; 49(1): 29-36, 1992 Jan.
Article in English | MEDLINE | ID: mdl-1370197

ABSTRACT

Cerebrospinal fluid hormones, monoaminergic metabolites, and dynorphin A (1-8 sequence) were examined in 43 children with severe, primary obsessive-compulsive disorder. Cerebrospinal fluid levels of 5-hydroxyindoleacetic acid were positively correlated with one of eight obsessive-compulsive disorder severity ratings and three of seven measures of improvement following 5 weeks of treatment with clomipramine hydrochloride. Arginine vasopressin concentration was significantly and negatively correlated with several ratings of obsessive-compulsive disorder symptom severity, while oxytocin concentration was positively correlated with depressive symptoms. The ratio of arginine vasopressin to oxytocin was also negatively correlated with obsessive-compulsive disorder and depressive symptoms. Comorbid affective disorder was associated with decreased arginine vasopressin concentrations, while concomitant anxiety disorder was associated with increased oxytocin. Dynorphin A (1-8 sequence), homovanillic acid, corticotropin, 3-methoxy-4-hydroxyphenylglycol, and corticotropin releasing hormone were not significantly related to obsessive-compulsive disorder symptoms. These results seem to indicate that arginine vasopressin may be related to obsessive-compulsive disorder symptom severity, while 5-hydroxyindoleacetic acid might be associated with drug response.


Subject(s)
Neuropeptides/cerebrospinal fluid , Obsessive-Compulsive Disorder/cerebrospinal fluid , Adolescent , Adrenocorticotropic Hormone/cerebrospinal fluid , Adult , Arginine Vasopressin/cerebrospinal fluid , Child , Clomipramine/therapeutic use , Corticotropin-Releasing Hormone/cerebrospinal fluid , Dynorphins/cerebrospinal fluid , Female , Homovanillic Acid/cerebrospinal fluid , Humans , Hydroxyindoleacetic Acid/cerebrospinal fluid , Male , Methoxyhydroxyphenylglycol/cerebrospinal fluid , Obsessive-Compulsive Disorder/drug therapy , Obsessive-Compulsive Disorder/psychology , Oxytocin/cerebrospinal fluid , Peptide Fragments/cerebrospinal fluid , Severity of Illness Index
18.
J Clin Endocrinol Metab ; 73(6): 1224-34, 1991 Dec.
Article in English | MEDLINE | ID: mdl-1659582

ABSTRACT

Chronic fatigue syndrome is characterized by persistent or relapsing debilitating fatigue for at least 6 months in the absence of a medical diagnosis that would explain the clinical presentation. Because primary glucocorticoid deficiency states and affective disorders putatively associated with a deficiency of the arousal-producing neuropeptide CRH can be associated with similar symptoms, we report here a study of the functional integrity of the various components of the hypothalamic-pituitary-adrenal axis in patients meeting research case criteria for chronic fatigue syndrome. Thirty patients and 72 normal volunteers were studied. Basal activity of the hypothalamic-pituitary-adrenal axis was estimated by determinations of 24-h urinary free cortisol-excretion, evening basal plasma total and free cortisol concentrations, and the cortisol binding globulin-binding capacity. The adrenal cortex was evaluated indirectly by cortisol responses during ovine CRH (oCRH) stimulation testing and directly by cortisol responses to graded submaximal doses of ACTH. Plasma ACTH and cortisol responses to oCRH were employed as a direct measure of the functional integrity of the pituitary corticotroph cell. Central CRH secretion was assessed by measuring its level in cerebrospinal fluid. Compared to normal subjects, patients demonstrated significantly reduced basal evening glucocorticoid levels (89.0 +/- 8.7 vs. 148.4 +/- 20.3 nmol/L; P less than 0.01) and low 24-h urinary free cortisol excretion (122.7 +/- 8.9 vs. 203.1 +/- 10.7 nmol/24 h; P less than 0.0002), but elevated basal evening ACTH concentrations. There was increased adrenocortical sensitivity to ACTH, but a reduced maximal response [F(3.26, 65.16) = 5.50; P = 0.0015). Patients showed attenuated net integrated ACTH responses to oCRH (128.0 +/- 26.4 vs. 225.4 +/- 34.5 pmol/L.min, P less than 0.04). Cerebrospinal fluid CRH levels in patients were no different from control values (8.4 +/- 0.6 vs. 7.7 +/- 0.5 pmol/L; P = NS). Although we cannot definitively account for the etiology of the mild glucocorticoid deficiency seen in chronic fatigue syndrome patients, the enhanced adrenocortical sensitivity to exogenous ACTH and blunted ACTH responses to oCRH are incompatible with a primary adrenal insufficiency. A pituitary source is also unlikely, since basal evening plasma ACTH concentrations were elevated. Hence, the data are most compatible with a mild central adrenal insufficiency secondary to either a deficiency of CRH or some other central stimulus to the pituitary-adrenal axis. Whether a mild glucocorticoid deficiency or a putative deficiency of an arousal-producing neuropeptide such as CRH is related to the clinical symptomatology of the chronic fatigue syndrome remains to be determined.


Subject(s)
Fatigue Syndrome, Chronic/physiopathology , Hypothalamo-Hypophyseal System/physiopathology , Pituitary-Adrenal System/physiopathology , Adrenal Cortex/physiopathology , Adrenocorticotropic Hormone/cerebrospinal fluid , Adrenocorticotropic Hormone/pharmacology , Adult , Animals , Behavior , Corticotropin-Releasing Hormone/cerebrospinal fluid , Corticotropin-Releasing Hormone/pharmacology , Dose-Response Relationship, Drug , Fatigue Syndrome, Chronic/cerebrospinal fluid , Fatigue Syndrome, Chronic/psychology , Female , Humans , Male , Medical Records , Mental Health , Sheep
19.
J Child Psychol Psychiatry ; 32(5): 757-70, 1991 Jul.
Article in English | MEDLINE | ID: mdl-1918226

ABSTRACT

Both high expressed emotion (EE) and psychiatric disorders were frequent in the parents of children and adolescents with disruptive behavior disorder (DBD, N = 34) and obsessive compulsive disorder (OCD, N = 49) compared to normal controls (NC, N = 41). Parental psychiatric diagnosis was significantly related to high-EE in fathers (p = .0002) and mothers (p = .0001) of all groups combined, and in parents of the ill groups (p = .03). Absence of diagnosis was associated with low-EE in fathers (p = .0006) and mothers (p = .04) of the controls. Psychiatric diagnosis was the only significant predictor for high-EE in fathers, while for mothers child's diagnosis was a stronger predictor.


Subject(s)
Child Behavior Disorders/psychology , Emotions , Hostility , Obsessive-Compulsive Disorder/psychology , Parent-Child Relations , Personality Development , Social Environment , Adolescent , Child , Child of Impaired Parents/psychology , Female , Humans , Male , Risk Factors , Socioeconomic Factors
20.
J Abnorm Child Psychol ; 19(2): 233-52, 1991 Apr.
Article in English | MEDLINE | ID: mdl-2056165

ABSTRACT

Boys with diagnoses in the disruptive behavior disorder (DBD) spectrum and normal controls were tested in two reaction time (RT) experiments. In Experiment I simple warned RT was measured and the length and regularity of the preparatory intervals were varied in order to study sustained attention in the sense of preparation. With age and IQ controlled, DBD boys had slower and more variable RT overall than controls and showed generally more pronounced effects of variations in the length and sequence of the preparatory intervals. The results suggest that DBD boys are subject to lapses of attention which are increased by a relatively long preparatory interval, and that they have a particular problem with temporal uncertainty. In Experiment II some aspects of selective attention were studied in a paradigm in which stimulus modality uncertainty and response selection were varied. DBD boys showed greater effects of modality uncertainty but not response selection than controls. No differences between subdiagnoses within the DBD spectrum could be demonstrated.


Subject(s)
Attention Deficit Disorder with Hyperactivity/psychology , Attention , Child Behavior Disorders/psychology , Reaction Time , Attention Deficit Disorder with Hyperactivity/diagnosis , Child , Child Behavior Disorders/diagnosis , Choice Behavior , Discrimination Learning , Humans , Male , Psychomotor Performance
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