Adolescent depression and suicide: rising problems.

In adolescents, as in adults, most depressive persons are not suicidal, and many suicidal persons are not depressed. However, accurate diagnosis and treatment of depression in adolescent patients is essential to suicide prevention. Unfortunately, depression and suicidality remain widely undiagnosed and untreated in the adolescent population.

Menstrual cycle abnormalities and subclinical eating disorders: a preliminary report.

Menstrual dysfunction is a common concomitant of anorexia nervosa and bulimia. Initial investigations emphasized the role of weight loss and lean/fat ratio in amenorrhea. Subsequent studies suggest a more complex interaction between eating disorders and menstrual status. However, in past investigations, menstrual abnormalities have been confounded with low weight. We conducted two studies to ascertain the prevalence of menstrual abnormalities in a group of women with subclinical eating pathology versus an age-, education-, and weight-matched group of normal controls. In Study I, 93.4% of the subclinical subjects reported a history of menstrual abnormality as compared to 11.7% of the normal controls. In Study II, 100% of the subclinical subjects, versus 15.0% of the controls, reported an abnormal menstrual history. These data suggest that menstrual dysfunction often occurs in women with abnormal eating attitudes but without weight loss or diagnosable eating pathology. Several hypotheses for this finding are proposed.

Recent findings in adolescent depression and suicide.

Adolescent depression and suicide are currently the focus of lively investigation. While diagnostic terminology and prevalence of depression remain unresolved, promising clarification is likely from the new assessment techniques readily available. These range from vigorous history taking and the use of questionnaires to biological tests. Associated depressive spectrum conditions are being defined. Like depression itself, they often respond to the new biological and psychological treatment methods of demonstrated effectiveness. Compounds are under development which may lessen side effects, and plasma antidepressant measurements are of proven value. Even with respect to adolescent suicidal behavior, where similar biological and psychological approaches have yielded less impressive results to date, energetic diagnosis and intervention can be lifesaving.

Body composition changes during recovery from anorexia nervosa: comparison of two dietary regimes.

Twelve patients with anorexia nervosa were studied on the Clinical Research Center for periods of 15 to 58 days. Five patients were fed a diet providing 20% of energy from protein and seven patients were fed a diet with only 10% of energy from protein. These patients had a reduced lean body mass in addition to a loss of body fat, and during recovery about two-thirds of the weight gain was lean tissue. The average energy cost of the weight gain was 5.3 kcal/g. There was no significant difference between the two diets for elemental metabolic balance, changes in anthropometric measures, in weight gain, or in potassium-40 counts; nor was there any difference in the energy cost of weight gain, in the rise in basal metabolic rate, or the change in hematocrit, serum albumin, or cholesterol. However, blood urea nitrogen was higher in those patients who received the high protein diet. Satisfactory nutritional rehabilitation of patients with anorexia nervosa does not require a high protein diet.

Current issues in adolescent psychiatry.

Adolescent psychiatry as a body of knowledge has shown encouraging growth in recent years, as research findings from general psychiatry have been added to new data on adolescent psychological and physical development. The author reviews recent findings on selected topics in adolescent psychopathology, including adaptive disorders, obsessive-compulsive disorders, phobias, attention deficit disorders, depression, manic-depressive illness, suicidal impulses, schizophrenia, anorexia nervosa, and borderline states. He also outlines findings on normal adolescent development and discusses the problems of diagnosing children and adolescents with psychological problems. Studies in anxiety, attention deficit, and conduct disorders, he says, are yielding important new findings by combining biological and psychological insights.

Adolescent suicide and the pediatrician.

The management of adolescent suicidal behavior in the practices of 48 pediatricians from Rochester and Syracuse, New York, was reviewed in the context of a rising local and national incidence. Alternative resources were found to be used much more heavily by suicidal adolescents in the two communities. Few pediatricians ask routinely about suicidal thoughts. The fatality rate is low enough to reinforce present practice, but suicidal symptoms are far more frequent than fatalities. It is hypothesized that avoidance of the issue by the pediatrician results in underutilization of this potentially valuable resource. Asking about the problem may result in a higher contact rate and, it is proposed, a better outcome. Depressive symptoms and appropriate responses to suicidal thinking are discussed.

Emotional complications of adolescent grand mal epilepsy.

Adolescents who have grand mal epilepsy and their parents were interviewed, and the adolescents were evaluated neurologically. Better seizure control and less neurologic disability were unexpectedly associated with less open communication between the adolescents and their families and friends, and with a poorer self-image and poorer expectations for the future. These findings were unrelated to IQ or school performance. This outcome is consistent with other studies of invisible defects and stigmatization, and suggests that youngsters who have relatively mild defects involving social disability may be more troubled than those with more apparent defects, for which denial may be operative. An incidental finding in the study was that a question more predictive of overall family, social, and academic function than the neurologic findings was simply whether or not the youngster was attending the appropriate grade in school for his or her age.