Prediction of response to fluoxetine and placebo in children and adolescents with major depression: a hypothesis generating study.

BACKGROUND: The results of multivariate analyses to identify potential predictors of response to fluoxetine or placebo separately in 96 child and adolescent outpatients with major depressive disorder from a recent controlled trial are presented. METHODS: A variety of clinical, demographic and laboratory factors were examined as possible predictors of response to fluoxetine or placebo using logistic regression models. RESULTS: No single variable or combination of variables strongly predicted response to fluoxetine. For the placebo group, a younger age, a shorter duration of depressive episode, and a lower socioeconomic status predicted response with an overall predictive power of 81%. CONCLUSIONS: This study is limited by the small sample size and should be considered hypothesis generating rather than confirming.

The effects of extended evaluation on depressive symptoms in children and adolescents.

A sample of 137 child and adolescent outpatients with major depressive disorder were examined to identify baseline clinical characteristics that predicted symptom severity at the end of a 3-week evaluation period and to determine whether change in symptom severity between week 1 and week 2 predicted symptom severity at week three. Subjects underwent three consecutive weekly evaluations prior to being considered for entry into a double-blind, placebo-controlled treatment trial of fluoxetine. Results indicated that the combination of age, social functioning, family history, Children's Depressive Rating Scale-Revised (CDRS-R) (Poznanski et al. (1985) Psychopharmacol. Bull. 21, 979-989) total score at visit one, and percent change in symptom severity between visit one and visit two were predictors of symptom severity at visit three. These findings suggest that (1) subjects should not be excluded from randomized controlled clinical treatment trials based solely on improvement of symptom severity between visits and (2) an extended evaluation period is warranted, especially for adolescents whose symptom severity tends to fluctuate from week to week.

Sleep EEG features of adolescents with major depression.

A substantial body of research in adults has established that certain sleep polysomnographic abnormalities are commonly found in depressed patients, including sleep continuity disturbances, reduced slow-wave sleep, shortened rapid eye movement (REM) latency and increased REM density. To date the findings in depressed adolescents are equivocal. Three consecutive nights of polysomnographic recordings were obtained in 31 hospitalized depressed adolescents and 17 age-matched normal controls. The depressed adolescents had a shorter REM latency, shorter sleep latency, more REM sleep, and less stage 3 nonREM (NREM) sleep. There was a trend for melancholic and suicidal patients to have a shorter REM latency.

Depressive symptoms by self-report in adolescence: phase I of the development of a questionnaire for depression by self-report.

As the first step in validating a criteria-based, self-report depression questionnaire specifically for children and adolescents and to determine the prevalence of self-reported depressive symptoms, we studied 3,294 high school students of mixed ethnic background in a large urban school district. They completed the Weinberg Screening Affective Scale. The 21-item Beck Depression Inventory was also completed to allow comparison with a previous study. The prevalence of clinically significant depressive symptoms suggesting depression by self-report ranged from 18% on the Beck Depression Inventory to 13% on the Weinberg Screening Affective Scale. Hispanic females had the highest scores, while white males had the lowest. Being behind in school, female, and nonwhite predicted more self-reported depressive symptoms.

Children with major depression show reduced rapid eye movement latencies.

A substantial body of research in adults has established that certain sleep polysomnographic abnormalities are commonly found in depressed patients, including sleep continuity disturbances, reduced slow-wave sleep, shortened rapid eye movement (REM) latency, and increased REM density. To date, these abnormalities have not been documented in depressed children compared with age-matched controls. Three consecutive nights of polysomnographic recordings were obtained in 25 hospitalized depressed children and 20 age-matched healthy controls. The depressed patients had reduced REM latencies. The shortest single-night REM latency of each individual was the most sensitive discriminating value between depressed subjects and controls. The influence of different scoring criteria in distinguishing depressed children from healthy children is discussed. In addition, depressed children had an increased sleep latency and increased REM time but did not have stage 4 differences.

Comparison of paragraph comprehension test scores with reading versus listening-reading and multiple-choice versus nominal recall administration techniques: justification for the bypass approach.

Eight groups of learning disabled children (N = 100), categorized by the clinical Lexical Paradigm as good readers or poor readers, were individually administered the Gilmore Oral Reading Test, Form D, by one of four input/retrieval methods: (1) the standardized method of administration in which the child reads each paragraph aloud and then answers five questions relating to the paragraph [read/recall method]; (2) the child reads each paragraph aloud and then for each question selects the correct answer from among three choices read by the examiner [read/choice method]; (3) the examiner reads each paragraph aloud and reads each of the five questions to the child to answer [listen/recall method]; and (4) the examiner reads each paragraph aloud and then for each question reads three multiple-choice answers from which the child selects the correct answer [listen/choice method]. The major difference in scores was between the groups tested by the recall versus the orally read multiple-choice methods. This study indicated that poor readers who listened to the material and were tested by orally read multiple-choice format could perform as well as good readers. The performance of good readers was not affected by listening or by the method of testing. The multiple-choice testing improved the performance of poor readers independent of the input method. This supports the arguments made previously that a "bypass approach" to education of poor readers in which testing is accomplished using an orally read multiple-choice format can enhance the child's school performance on reading-related tasks. Using a listening while reading input method may further enhance performance.

Comparison of nominal recall (standard) and multiple-choice methods for administration of WISC-R information subtest: a preliminary study indicating a learning effect of multiple-choice testing.

The Wechsler Intelligence Scale for Children--Revised (WISC--R) Information subtest was administered to learning disabled children using two methods of administration, the standard (recall) method and a multiple-choice format. Those children who were tested first with the multiple-choice format and subsequently with the standard format did better on the standard format than expected. This preliminary study suggests a learning effect of such multiple-choice testing and the desirability of further research being undertaken.

Depression, learning disability, and school behavior problems.

It is possible that recurrent depression (primary affective illness) is the most significant variable related to school problems of a behavioral nature in children manifesting developmental specific learning disabilities. The association of school problems and depression was investigated at a private school for children with developmental specific learning disabilities. These children were of normal intelligence and were free of primary conduct or thought disturbances. Prior to entering school, 95% of the students fulfilled criteria for developmental specific learning disabilities and 64% for depression with or without hyperactivity. Students manifesting no diagnosable behavioral condition prior to entrance continued to be relatively free of behavioral problems during their stay at school. Students with both depression and hyperactivity showed the most problematic behavior followed by students with depression without hyperactivity.