Naturalistic experience with the use of divalproex sodium on an in-patient unit for adolescent psychiatric patients.

This paper focuses on the importance of data collected not only from controlled clinical trials, but also from naturalistic treatment experience. In particular we examine the use of divalproex sodium either as monotherapy or as part of combined therapy on an in-patient ward for adolescents aged 13-18 years. All admissions in which divalproex sodium use was attempted (n=36) were analysed over a 1-year period. The most common use was in patients with a mixed-presentation bipolar disorder (n=16), followed by patients with major depression (n=7), mania (n=4) or psychoses not otherwise specified (n=4). Divalproex sodium use was evaluated in the control of mania, psychosis, agitation, mood swings, aggression and/or anxiety. Overall, the use of divalproex sodium was associated with a marked improvement along all psychopathological variables in the vast majority of patients. Few side-effects or medical complications were noted. We believe that divalproex sodium is a potentially useful drug in adolescent patients with varying forms of psychopathology.

Molecular analysis of HLA class I (HLA-A and -B) and HLA class II (HLA-DRB1) genes in Japanese patients with multiple sclerosis (Western type and Asian type).

The types of HLA-A, -B and -DRB1 genes were studied in 146 Japanese patients with multiple sclerosis (MS) using polymerase chain reaction-sequence-specific oligonucleotide probe analysis. Fifty-seven patients who displayed selective clinical involvement of the optic nerve and spinal cord were classified as having Asian type MS. The other 89 patients had disseminated central nervous system involvement and were classified as having Western type MS. The frequency of HLA-B*5101 was increased in both types of MS patients compared with controls. The frequency of HLA-DRB1*1501 was increased in Western type MS and the frequency of HLA-DRB1*0802 was increased in Asian type MS compared to controls. After correction of P values, the association of Western type MS patients with HLA-DRB1*1501 was statistically significant (Pc=0.0003) whereas other HLA alleles showed no significant association. These results suggest that HLA class I (HLA-A and -B) alleles may not contribute to a strong susceptibility to MS in Japanese compared to HLA class II (HLA-DRB1) alleles.

Subclassifications in eating disorders and obesity: a comparative study of an Italian sample.

The purpose of this study is to examine differences between eating disorder subgroups, including obese patients, in a large Italian sample seen at a specialist clinic. All patients (n=263) who consecutively contacted the University Eating Disorder Outpatient Clinic of Padua were divided into subgroups according to the literature. Different subgroups were compared according to clinical features, SCL-90, EAT and TFEQ scores. The study confirms the importance of purging, which is associated with more severe psychiatric symptoms than bingeing; a direct correlation between severity of psychiatric symptoms and duration of eating disorder was found. Among obese patients the bingers are distinguished from the nonbingers by a higher degree of eating and psychological distress and a greater number of dieting attempts.

Psychotherapy of adults with attention-deficit disorder.

The multimodal treatment of adults with attention-deficit disorder (ADD) is described as consisting of a sequence of overlapping therapeutic measures. The initial objective is symptom amelioration through adequate pharmacotherapy. Once this has been accomplished, a period of psychoeducational therapy is recommended to teach the individual to live successfully with a chronic disorder. These two aspects of treatment may suffice for some ADD adults, but many others may require an additional course of psychotherapy to deal with dysfunctional personality characteristics resulting from having grown up with ADD. Among these are modes of defenses against painful affects, resistances to treatment, and inaccurate estimations and expectations of the self and others.