Substance abuse: an overview.

Substance abuse continues to be a major adolescent health risk. Despite encouraging trends toward decreased drug use in the late 1980s, an increase in use occurred in the early 1990s and only now is beginning to level off. A brief update on the status of the most commonly abused substances is provided. A discussion of current research is given in support of viewing drug addiction as a medical condition, i.e., a "brain disease." Reasons are suggested to explain why adolescents use and abuse drugs and why trends occur in their use. Two aspects of diagnosis are reviewed: psychiatric and medical comorbidity and drug screening and laboratory assessment of the adolescent. Prevention and early intervention are presented with an emphasis on drug education, behavioral wellness, family communication, doctor-patient discussion and assessment, and referral. Commentary is made on the ethics of care; issues of confidentiality and the right to privacy with regard to drug testing and sharing of information are explored. A review of various policy statements of the American Academy of Pediatrics and other medical organizations is presented.

Threats to chronically ill adolescents. Challenges for physicians as we approach the next millennium.

The frequency of all forms of juvenile arthritis, including juvenile rheumatoid arthritis, other major connective tissue diseases, and other rheumatic diagnoses, is estimated to be approximately 160,000-190,000 U.S. children under 15 years of age. The author suggests that the legitimization of alternative medicine and the corporatization of U.S. health care are undermining the quality of care that chronically ill adolescents receive.

Efforts by the American Academy of Pediatrics to prevent and reduce violence and its effects on children and adolescents.

The American Academy of Pediatrics (AAP) is an organization of 53,000 pediatricians committed to the attainment of optimal physical, mental, and social health for all infants, children, adolescents, and young adults. Recognizing the major impact that violence has on children and youth, the AAP has been working to prevent and reduce violence and its effects on the pediatric population. This article will describe AAP efforts intended to help pediatricians, other professionals, and the public to combat the problem.

Medical complications of anorexia nervosa and bulimia nervosa.

The internist plays a critical role in the care of eating disorder patients, especially in the management of the life-threatening medical complications of these conditions. In anorexia nervosa, the immediate danger is related to the effects of voluntary starvation, including hypophosphatemia, bone marrow failure, cardiac decompensation, and shock. Patients with bulimia nervosa more often experience severe fluid and electrolyte abnormalities resulting in hypovolemia, secondary hyperaldosteronism, depletion of total body potassium, and cardiac arrhythmias. Immediate management of medical complication and correction of nutritional deficits are necessary before patients can benefit from psychotherapy. The need for continued involvement of the internist in the ongoing care of the eating disorder patient is stressed. The high mortality and the likelihood of chronicity without early intervention underscore the need for early recognition and skilled management of eating disorders.

Bromocriptine-unresponsive prolactin macroadenoma in a prepubertal female.

Macroprolactinomas occur rarely in prepubertal children. A prepubertal 11 10/12-year-old female with a macroprolactinoma presented with a diagnosis of anorexia nervosa. Findings included severe headaches, anorexia, weight loss, and growth failure. The initial serum prolactin level was 2,916 ng/ml. This value fell after beginning treatment with bromocriptine, but later rose despite a doubling of the dose. Transsphenoidal surgical resection was performed and postoperative radiation given. The use of bromocriptine, surgical resection, and radiation therapy in the treatment of macroprolactinomas are discussed.

Cardiac output and regional myocardial contraction in anorexia nervosa.

The study measured cardiac output and assessed regional myocardial contraction in 14 patients with anorexia nervosa, some of whom also had bulimia, and in 15 controls. The experimental and control groups were not significantly different in age or body surface area (p = greater than 0.05). To evaluate regional myocardial contraction, 12 of 14 anorexia nervosa-bulimia (ANB) patients were studied in the acute phase and once serially at a mean interval of 1.5 years by assessing the movement of each left ventricular wall segment toward the center of the ventricle as imaged in the precordial short axis. Cardiac output was measured in the ascending aorta by pulsed Doppler for control subjects and for 13 ANB patients. Regional myocardial contraction was normal for all controls, but eight of 14 ANB patients showed regional myocardial contraction abnormalities. Between studies, four of these eight demonstrated improved regional myocardial contraction, three remained unchanged, and one was worse. Mean cardiac output was markedly reduced in ANB patients (2.6 L/min) compared to controls (4.5 L/min) (p = less than 0.001). The low cardiac output in ANB patients was reflected as reduced mean ascending aortic velocity/second (18.5 cm/s) compared to a mean of 22.8 cm/s for controls (p = less than 0.02). Mean ascending aortic area was slightly smaller for ANP patients. Mean peak ascending aortic velocity was significantly lower in ANB patients than in controls (p = less than 0.02). Mitral valve prolapse was seen during at least one examination in seven of 14 ANB patients (0/15 controls) and disappeared in two of three patients following hydration.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent medicine education in pediatric residency programs following the 1978 Task Force on Pediatric Education report.

In 1982, the Society for Adolescent Medicine initiated a survey of all pediatric residencies in the United States and Canada to determine: if there had been an increase in the amount and quality of adolescent medicine training since the 1978 report by the Task Force on Pediatric Education; if pediatric departments were assuming responsibility for the care of adolescents; and the curriculum objectives for adolescent medicine (AM), the educational methods used, and whether program graduates (PGs) felt competent to care for adolescents. One hundred directors and 72 recent graduates completed an initial questionnaire. A follow-up telephone survey of program directors (PDs) who did not respond resulted in 109 completed interviews. The survey results suggest a favorable trend in AM training. Evidence of this favorable trend includes: a 10% increase (p less than 0.05) in the number of AM wards, and a 33% increase (p less than 0.01) in clinics; a 29% increase (p less than 0.01) in programs having a block of time devoted to AM; increased time spent caring for adolescents at all resident levels; and an increase in adolescent inpatients of 32% and outpatients of 45% (p less than 0.01). An increase in the number of and time for mastery of curriculum objectives and educational methods was reported by PDs.

Symptoms associated with menstruation.

Symptoms associated with menstruation during the teenage and young adult years may represent a spectrum of possibilities varying from a relatively benign deviation from normal to a serious life-threatening disease. Nevertheless, even for the young woman found to be without serious disease, menstrual problems have special meaning associated with the fear of being different from peers, concern about being less than complete or wholesome, and anxiety regarding future functioning as a normal woman. The physician must be aware of the adolescent's sensitivity in this area. Her apprehension should influence the manner in which the various abnormalities of menstruation are evaluated and managed. The physician must understand and appreciate the potential for profound emotional effects and psychological implications of menstrual conditions. The manner in which we care for the adolescent with menstrual symptoms will determine to a significant degree how successfully the patient will cope with abnormalities of menstruation.