[Diagnosis and treatment of bipolar disorder in children]. / Diagnostiek en behandeling van bipolaire stoornissen bij kinderen.

In general, bipolar disorder with its classical presentation of regularly recurring manic and depressive episodes can be well diagnosed in adults and adolescents. However, bipolar disorder in children is a controversial issue, difficult to diagnose and to distinguish from other illnesses that frequently occur in childhood. In the US, where the diagnosis of'bipolar disorder' is made relatively often in children, not only its classical presentation but also chronic mood dysregulation and even other mood symptoms may lead to the diagnosis of bipolar disorder. The preferred view is the British one, whereby bipolar disorder is only diagnosed in children if they present with clear manic episodes and euphoric mood. Treatment of bipolar disorder in children consists of pharmacotherapy and of psychoeducation aimed at lifestyle adjustments, including reduction of stress, a stable sleep pattern, and adjustments at school.

[Children of parents with bipolar disorder]. / Kinderen van ouders met een bipolaire stoornis.

BACKGROUND: Bipolar disorder runs in families. The illness is partly genetically determined and develops in conjunction with psychosocial factors. aim To describe what is known about the psychopathology and the functioning of children whose parents suffer from bipolar disorder and to examine the early symptoms and possible predictors of bipolar disorder. METHOD: We describe a prospective study in the Netherlands among 140 children from 86 families in which one parent had bipolar disorder. The results of this study are compared with results that have appeared in the existing literature. results Over a period of five years the children of bipolar parents run a high risk of developing mood disorders and especially bipolar disorder. The onset and course of self-reported affective problems and depression were found to be predictors for the development of bipolar disorders. The General Behavior Inventory was found to be a useful tool for the early detection of bipolar disorder. conclusion It is important that the children of bipolar parents be monitored intensively, particularly if they have from mood swings or depression.

Perceived parental rearing of bipolar offspring.

OBJECTIVE: To explore the impact of growing up with a parent with a bipolar disorder. First, we compared parental rearing behavior perceived by young adult offspring of bipolar parents with parental rearing behavior perceived by same aged young adults from the general population. Secondly, we examined the associations between perceived parental rearing behavior and parental psychopathology and psychopathology in offspring. METHOD: Subjects were 129 offspring of 80 bipolar parents and their spouses and 1122 young adults from the general population. In offspring the Structured Clinical Interview for DSM-IV was used to assess DSM-IV diagnoses and the EMBU was used to assess perceived parental rearing in both groups. RESULTS: In general, offspring growing up in a family with a bipolar parent perceived their mothers as less rejecting, more emotionally warm and less overprotecting and their fathers as less emotionally warm and less overprotecting compared with young adults from the general population. Perceived rejection was related to psychopathology in offspring. CONCLUSION: Overall, parental rearing in families with a parent with a bipolar disorder is not more dysfunctional, as perceived by their offspring, than in families from the general population. Offspring with a bipolar disorder perceive their parents as more rejecting.

Prediction of change in level of problem behavior among children of bipolar parents.

OBJECTIVE: To determine the effects of familial loading, birth weight, and family problems on change in parent-reported problems across a 14-month period among children of bipolar parents. METHOD: Emotional and behavioral problems in a sample of 140 offspring of bipolar parents and familial loading in first- and second-degree relatives were assessed at two measurements. Parents reported the birth weight of their offspring and completed a questionnaire on family problems. Multiple linear regression analyses were performed to assess associations of the three predictors with change in problem scores at follow-up. RESULTS: Familial loading of unipolar disorder was a unique predictor for an increase in problem scores from the first to the second measurement with beta-coefficients ranging from 0.17 to 0.25. Birth weight and family problems were not associated with change in problem scores across the two measurements. CONCLUSION: Familial loading of unipolar disorder predicted an increase in behavioral and emotional problems across the 14-month follow-up.

Prevalence of psychopathology in children of a bipolar parent.

OBJECTIVE: To determine psychopathology in adolescent children of a bipolar parent living in the Netherlands, using multiple sources of information (self-, parent, and teacher reports). METHOD: Problem behavior in 140 offspring (aged 12-21 years) of 86 bipolar parents was assessed with the Child Behavior Checklist (CBCL), the Teacher's Report Form (TRF), and the Youth Self-Report (YSR) between 1997 and 1999. All adolescents, bipolar parents, and their available spouses were interviewed with the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL). RESULTS: Higher problem scores were found for 8 of the 11 CBCL scales for girls and 4 of the 11 CBCL scales for boys, compared with a Dutch normative sample, and 1 Young Adult Self-Report (YASR) scale for girls compared with an American normative sample. Lower problem scores were found on 4 YSR and 4 YASR scales for boys, 1 TRF scale for girls, and 1 TRF scale for boys. The prevalence of current DSM-IV diagnoses in the offspring was 29% and of life-time DSM-IV diagnoses, 44%. CONCLUSIONS: The prevalence of problem behavior and DSM-IV diagnoses found in our sample did not support the notion that the level of psychopathology in children aged 12 to 21 years of bipolar parents is highly elevated. This study, similar to prior studies, suffers from lack of information on the representativeness of the sample and a rather low response rate.

Hemostatic parameters and platelet activation marker expression in cyanotic and acyanotic pediatric patients undergoing cardiac surgery in the presence of tranexamic acid.

We have investigated hemostatic parameters including platelet activation in 56 pediatric patients with or without cyanosis undergoing cardiopulmonary bypass (CPB) and cardiac surgery to repair congenital defects. Patients were participants in a study assessing the effects of tranexamic acid on surgery-related blood loss. Parameters monitored included blood loss, prothrombin F1.2, thrombin-antithrombin complexes, t-PA, PAI-1, plasminogen, fibrin D-dimer, and plasma factor XIII. Additionally, flow cytometry monitored platelet degranulation (P-selectin or CD63), as well as surface-bound fibrinogen, von Willebrand factor and factor XIIIa. Cyanotic patients had evidence of supranormal coagulation activation as both fibrin D-dimer and PAI-1 levels were elevated prior to surgery. While the extent of expression of P-selectin or CD63 was not informative, platelet-associated factor XIIIa was elevated in cyanotic patients at baseline. In both patient groups, CPB altered platelet activation state and coagulation status irrespective of the use of tranexamic acid.

Bipolar disorder in children and adolecents: a clinical reality?

The appearance, the differential diagnosis and the prevalence of bipolar disorder in children and adolescents is discussed. Among adolescents bipolar disorder appears to have a similar prevalence in the US and The Netherlands. However, among children it is frequently diagnosed in the US and hardly in The Netherlands. It is concluded that bipolar disorder tends to start earlier in the US than in the Netherlands. It is hypothesized that this may be related to a higher use of stimulants and antidepressants by US children diagnosed as ADHD or depression, respectively.

Prevalence of psychopathology in children of bipolar parents.

The purpose of this study was to determine psychopathology in a large sample of adolescent children (N = 140) of parents (N = 86) with bipolar disorders, using multiple sources of information (child, parent, teacher). The main aims of the study were: 1) to compare parent, teacher and self reported problem behavior ratings of children of bipolar parents with those of children from the general population, and 2) to determine the prevalence of DSM-IV diagnoses in offspring of bipolar parents, and 3) to examine the possible association between gender of the bipolar parent and psychopathology among the offspring.

Use of cell culture and a rapid diagnostic assay for Chlamydia trachomatis screening.

OBJECTIVE: To compare a rapid, office-based test with standard cell culture for screening of women for Chlamydia trachomatis infections. DESIGN AND SETTINGS: An 8-month prospective crossover trial used alternating screening protocols in two Baltimore (Md) sexually transmitted disease clinics from January 2 through August 14, 1991. PARTICIPANTS: Consecutive women attending the two clinics who had no indication for administration of antichlamydial antibiotic therapy (eg, history of recent sexual contact with a partner with a sexually transmitted disease, mucopurulent cervicitis, pelvic inflammatory disease, known gonorrhea, or previously diagnosed Chlamydia infections). INTERVENTIONS: Chlamydia screening was offered according to one of two protocols. Use of the two screening protocols was alternated between clinics each month. In the "rapid test clinic," eligible women were screened with both a 30-minute enzyme immunoassay test and tissue culture. Patients screened with the rapid test were asked to remain in the clinic until their rapid assay results were available so that, if positive, the patients could be treated. In the "routine screening clinic," eligible women were screened for Chlamydia by cell culture. Women identified as being infected with Chlamydia by screening culture were later confidentially notified of their test results by health department disease intervention specialists and referred for therapy. MAIN OUTCOME MEASURES: Performance of screening tests for bringing infected patients to therapy; time intervals between initial clinic visits and therapy; and pelvic inflammatory disease occurring between initial visits and therapy. RESULTS: Chlamydia cultures were positive in 100 (6.6%) of 1526 women screened with the solid-phase immunoassay, 47 of which were detected and treated on the basis of rapid test results. In contrast, 93 (74%) of 126 women with positive screening cultures returned to the clinic and received therapy. The median interval between testing and therapy for women with positive screening cultures was 14 days, and three (3.2%) developed pelvic inflammatory disease in the interval between testing and return for therapy. CONCLUSIONS: Neither cell culture nor a rapid diagnostic test performed well for ensuring therapy of women with Chlamydia infections. The sensitivity of the rapid diagnostic test was low, and nearly one fourth of the women with positive screening cultures did not return for therapy. Evaluation of screening for Chlamydia should consider the utility of strategies for bringing patients to treatment, as well as the more usual measures of test performance, such as sensitivity, specificity, and predictive values.

Antibacterial activities of OPC-17116, ofloxacin, and ciprofloxacin against 200 isolates of Neisseria gonorrhoeae.

OPC-17116 is a new fluoroquinolone with potent activity against aerobic and anaerobic organisms. We evaluated the susceptibilities of 200 clinical gonococcal isolates including organisms with plasmid and chromosomally mediated resistance to beta-lactams and tetracycline. The antibiotics studied included OPC-17116, ofloxacin, ciprofloxacin, penicillin, tetracycline, erythromycin, azithromycin, and ceftriaxone. All isolates tested were susceptible to the quinolone class of antibiotics. The MICs of ciprofloxacin, ofloxacin, and OPC-17116 for 90% of isolates tested were 0.004, 0.03, and 0.004 micrograms/ml, respectively. For organisms with chromosomally mediated resistance to penicillin and tetracycline, geometric mean MICs of all antibiotics including the quinolones were increased.

Comparative behavioral epidemiology of gonococcal and chlamydial infections among patients attending a Baltimore, Maryland, sexually transmitted disease clinic.

Between April 1988 and May 1989, 400 males and 400 females attending a Baltimore, Maryland, sexually transmitted disease clinic were enrolled in a study evaluating and comparing behaviors associated with culture-proven gonococcal or chlamydial infection. The subjects were enrolled consecutively, and were all seen by the same clinician. Among participants of each sex, gonorrhea but not chlamydia was associated with increasing numbers of recent (the past 30 days) sexual partners. Compared with males with neither infection, factors independently associated with increased risk of gonorrhea included age less than 20 years (odds ratio (OR) = 1.93), the presence of genitourinary symptoms (OR = 8.07), and recent exposure to a new sexual partner (OR = 2.78); risk for chlamydial infection in males was associated with genitourinary symptoms (OR = 2.83) and was significantly reduced in those reporting multiple recent (OR = 0.19) or new (OR = 0.07) sexual partners. Among females, age less than 20 years was independently associated with gonococcal (OR = 1.86) and chlamydial (OR = 7.79) infections in comparison with females with neither infection. No other behavioral factors were associated with chlamydial infection for females in this study; however, having a regular sexual partner was associated with significantly elevated risk of gonorrhea (OR = 3.85), while the presence of genital tract symptoms was associated with diminished risk (OR = 0.29) for gonorrhea. These data suggest that there are differences in the behaviors associated with gonorrheal and chlamydial infections and that different strategies may be useful in efforts to control these infections.

Temporal trends in gonococcal antibiotic resistance in Baltimore.

Each month from August 1986 through July 1990, clinical and laboratory data were evaluated for the first 25 urethral isolates of Neisseria gonorrhoeae from men attending a Baltimore sexually transmitted disease (STD) clinic as part of an effort to understand factors that contribute to changes in gonococcal antimicrobial susceptibility. During the 48-month study period, 1193 gonococcal isolates were evaluated; the proportion of penicillinase-producing N. gonorrhoeae (PPNG) isolates steadily increased, the prevalence of tetracycline-resistant N. gonorrhoeae (TRNG) remained relatively stable, and chromosomally mediated penicillin resistance increased steadily during the first 5 6-month intervals, then decreased, only to increase again during the final 2 6-month intervals. Changes in antibiotic treatment regimens for gonorrhea were associated with changes in the prevalence of chromosomally mediated penicillin resistance. In a supplementary study to characterize patterns of antibiotic use among men and women attending the STD clinics, 9% of patients reported antibiotic use in the 2 weeks prior to clinic visit. Antibiotics were taken prior to clinic attendance by 65% of patients reporting antibiotic use, because of concerns regarding possible STD or STD exposure. These patients were significantly less likely to be culture positive for N. gonorrhoeae when compared with patients who did not report antibiotic use. Temporal trends in N. gonorrhoeae antibiotic resistance appear to be influenced by many factors, including treatment regimens and self medication.

Prevalence and patterns of condom use among patients attending a sexually transmitted disease clinic.

The purpose of this study is to evaluate prevalence and patterns of condom use among patients attending a sexually transmitted disease (STD) clinic, who are at increased risk of developing STDs. Interviews of 800 patients attending a Baltimore STD clinic were conducted. The prevalence of condom use was dependent on the measure of use employed. For example, 9 out of 10 patients reported ever having used condoms, slightly less than one-third of the patients reported having used condoms in the past 30 days, and only 17% of the patients reported using a condom at last sex. Use also varied somewhat by type of sexual partner, and within any given relationship, from first to last sexual encounter. The most significant factor corresponding to condom use in the 30 days prior to the interview was number of sexual partners (lifetime and in the last month). Multivariate analyses revealed number of lifetime partners to be the most significant predictor of condom use for men, whereas age was the most significant variable for women. These findings suggest that interventions should focus not only on the individual, but the couple.

PIP: This study evaluated the prevalence and patterns of condom use among patients attending a sexually transmitted disease (STD) clinic who are at increased risk for developing STDs. Interviews were conducted with 800 patients attending a Baltimore STD clinic. The prevalence of condom use was dependent on the measure of use employed; e.g., 9 of 10 patients reported ever having used condoms, slightly less than 1/3 of the patients reported having used condoms in the past 30 days, and only 17% of the patients reported using a condom at last sexual encounter. Use also varied somewhat by type of sexual partner, and within any given relationship, from 1st to last sexual encounter. The most significant factor corresponding to condom use in the 30 days prior to the interview was the number of sexual partners (lifetime and in the last month). Multivariate analyses revealed the number of lifetime partners to be the most significant predictor of condom use for men, whereas age was the most significant variable for women. These findings suggest that interventions should focus not only on the individual but on the couple.

Disease prevalence among women attending a sexually transmitted disease clinic varies with reason for visit.

Prevalence of sexually transmitted diseases (STD) and selected behavioral and demographic variables were evaluated in 279 women attending a Baltimore STD clinic, using a standardized questionnaire and cultures for Neisseria gonorrhoeae, Chlamydia trachomatis, and Trichomonas vaginalis. Stratified by reason for clinic visit, 102 (37%) of 279 women attending the clinic stated that they were recent contacts to men with STDs with the majority (59 out of 102, or 58%) reporting gonorrhea contact as their reason for visit. Another 124 women (44%) came to the clinic for symptom evaluation, and 53 (19%) for other reasons. Prevalence of STDs was higher among those attending as contacts than among noncontacts: 35% versus 15% for N. gonorrhoeae; 26% versus 16% for C. trachomatis; and 27% versus 15% for T. vaginalis (P less than 0.05 for each). Furthermore, multiple infections were found in 23% of those attending as contacts but only in 10% of noncontacts (P less than 0.001). In general, patients reporting contact with an infected person were also less likely to report symptoms (43% versus 34%, P less than 0.001), despite increased disease prevalence. These data suggest that multiple STDs are often present in women attending STD clinics, irrespective of reason for visit. Merely treating women for reported exposure without further evaluation will fail to identify a substantial number of women coinfected with other organisms.

Effect of HIV posttest counseling on STD incidence.

OBJECTIVE: To evaluate the effectiveness of human immunodeficiency virus (HIV) testing and posttest counseling in reducing subsequent high-risk behavior. METHODS: The incidence of sexually transmitted diseases (STDs) in the Baltimore, Md, public STD clinic population after HIV testing and counseling was determined by chart review and was compared in two groups, 868 HIV-seropositive patients and 1104 HIV-seronegative patients, matched by age, sex, and month in which HIV test was conducted. Patients were observed for incident STDs at intervals of 6 through 23 months. Patients with incident STDs were classified hierarchically after being notified of the HIV test result and receiving posttest counseling. RESULTS: Of HIV-seropositive patients, 615 (71%) returned for their test results and received posttest counseling; 694 HIV-seronegative patients (63%) returned. Of all those who returned for results and posttest counseling, 60 (9.7%) of 615 HIV-seropositive patients and 61 (8.8%) of 694 HIV-seronegative patients were diagnosed at least once with definite STD (syphilis, gonorrhea, or trichomoniasis) (P, not significant). Twenty-four HIV-seropositive patients (3.9%) and 71 HIV-seronegative patients (10.2%) returned with probable STD (nongonococcal urethritis or pelvic inflammatory disease) (P less than .001). Nine HIV-seropositive patients (1.5%) and 23 HIV-seronegative patients (3.3%) returned having had an STD-infected sexual partner (P less than .03). Age, sexual orientation, and drug use behavior did not predict return with STD. CONCLUSIONS: Both HIV-seropositive and HIV-seronegative patients showed high rates of repeat STDs after posttest counseling, an important public health challenge in creating effective high-risk behavior prevention strategies.