Autism and Asperger's syndrome.

Knowledge about the spectrum of autistic disorders, including Asperger's syndrome, has grown significantly. Diagnoses can be made more reliably and there is better characterization of elements within the spectrum than ever before. A clearer picture of the cognitive limitations displayed by persons with conditions in the autistic spectrum is emerging. Deficits in manipulating abstract meanings, translating principles across contexts, and attending to contextual meanings can be seen in lower and higher functioning individuals. Links between "executive function," "theory of mind," and findings from functional imaging are becoming apparent. There are consistent indications that frontal and temporal regions play a crucial role in these disorders. Associations with specific genetic defects has been suggested, but methods capable of discovering the complex interplay of several genes will be needed before generalized conclusions can be reached.

Clozapine for early developmental delays with childhood-onset schizophrenia: protocol and 15-month outcome.

This paper reports on the pharmacotherapy and long-term follow-up of a child treated with clozapine. It is one of the earliest American experiences with this agent in children to date. Clozapine was relatively effective and safe in this patient. Additional features of the case are the early social and developmental delays preceding schizophrenia, the response of symptoms of childhood-onset schizophrenia to clozapine, and the reduction in tardive dyskinesia symptoms while taking clozapine. Compared to recommendations for dosing adults, a slower rate of increasing clozapine doses was important for this child. For future reference, the protocol and consent form used for this course of treatment are included.

Conceptualizing "borderline syndrome of childhood" and "childhood schizophrenia" as a developmental disorder.

OBJECTIVE: This is the first attempt to define and validate criteria for an early onset, chronic syndrome of disturbances in affect modulation, social relatedness, and thinking. This study formulates and tests five hypotheses that follow from conceptualizing this syndrome as a developmental disorder. The advantages of viewing this syndrome as a developmental disorder are discussed and compared with alternative formulations such as childhood schizophrenia or borderline syndrome of childhood. METHOD: An inpatient cohort (26 boys, 4 girls) was ascertained using specific, defined criteria. Using standardized measures on retrospective chart reviews, these subjects were compared with two different inpatient samples: one diagnosed with dysthymic disorder, the other with conduct disorder. RESULTS: The criteria readily distinguished between developmentally disordered children and comparison groups. Findings also supported the hypotheses in the predicted directions; index subjects had earlier onset of symptoms, poorer social and overall adjustment, longer hospitalizations, and poorer outcomes. CONCLUSIONS: Findings support the validity of this developmental concept for a multiple complex developmental disorder and give preliminary, "first-cut" validity to these specified criteria.

Obsessive compulsive disorder in children and adolescents: phenomenology and family history.

Phenomenology and family history in 21 clinically referred children and adolescents with obsessive compulsive disorder are described. Each child and family participated in a standard clinical psychiatric assessment. The most frequently reported symptoms were repeating rituals, washing, ordering and arranging, checking, and contamination concerns. Controlling behaviors involving other family members were seen in 57% of the patients. Associated psychopathology was common: 38% received an anxiety disorder diagnosis; 29% received a mood disorder diagnosis; tics were observed in 24%. Fifteen (71%) of the children had a parent with either obsessive compulsive disorder (N = 4) or obsessive-compulsive symptoms (N = 11). The clinical and research implications of these findings are discussed.

Drug treatment of obsessive-compulsive disorder: a review of findings in the light of diagnostic and metric limitations.

Nearly every category of psychotropic drug has been investigated in an attempt to find a pharmacologic treatment for obsessive compulsive disorder (OCD). This study reviews published trials from the English literature in which tricyclic antidepressants, monoamine oxidase inhibitors, neuroleptics, benzodiazepines, and other agents were employed for treatment of OCD. Weaknesses in the current methodology including diagnosis, measurement of severity and criteria for improvement have contributed to invalid conclusions about drug treatment and efficacy. It appears that OCD is an etiologically heterogeneous disorder with a complex differential diagnosis. For the clinician, a major conclusion drawn from this review is that no agent emerges as a drug of choice. Although clorimipramine, the most actively investigated agent, shows some promise, it has not been conclusively demonstrated that other, more readily available heterocyclic agents are less effective. Furthermore, when other disorders co-exist, such as panic disorder, alternative agents may prove as effective.

Gilles de la Tourette's syndrome and obsessive-compulsive disorder. Evidence supporting a genetic relationship.

Previous studies have suggested that obsessive-compulsive symptoms frequently occur among patients with Gilles de la Tourette's syndrome (TS). To examine the relationship between TS and obsessive-compulsive disorder (OCD), data from all first-degree relatives of TS probands were obtained with a semistructured interview designed to collect information on the presence of TS, other tic disorders, and neuropsychiatric illnesses during the lifetime of the individual. The rate of OCD among first-degree relatives was significantly increased over estimates from the general population and a control sample of adoptive relatives. The rates of TS, OCD, and chronic multiple tics (CMT) were virtually the same in families of probands with OCD (TS +/- OCD) when compared with families of probands without OCD (TS - OCD). Finally, the frequency of OCD without TS or CMT among first-degree relatives was significantly elevated in families of both TS + OCD and TS - OCD probands, suggesting that some forms of OCD may represent an alternative expression of the factors responsible for TS and/or CMT.