Methylphenidate: between rhetoric and data.
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Central Nervous System Stimulants↗
Biomedical subjects
A Apter
Publications and source records attributed to A Apter.
Psychometric properties of the K-SADS-PL in an Israeli adolescent clinical population.
The main objective of this study was to evaluate the reliability and validity of the Schedule for Affective-Disorders and Schizophrenia for School-Aged Children Lifetime Version (K-SADS-PL) in an Israeli sample. Fifty-seven adolescent admissions to two psychiatric units were evaluated with the Hebrew translation of the K-SADS-PL. Inter-rater and mother-child agreement were evaluated for diagnoses, and 31 affective symptoms. K-SADS diagnoses were also compared with two-month unit evaluation diagnoses as a measure of consensual validity. The reliability of assessing psychosocial functioning was also examined. Reliability and validity of diagnoses were good to excellent. Mother-child agreement fared less well on all measures. The use of semi-structured interviews and DSM-IV criteria in an Israeli adolescent psychiatric setting are discussed.
Adolescent↗
A general hospital study of attempted suicide in adolescence: age and method of attempt.
Attempted suicide in adolescence is a major health problem and recent reports indicate a dramatic increase in the frequency of attempted and completed suicide among adolescents. The aim of this study was to evaluate the characteristics of adolescent admissions with attempted suicide in a large general hospital. The files of all children and adolescents admitted due to a suicide attempt between the years 1984 and 1994 were examined retrospectively, with regard to age, sex, method of attempt, season, year and length of hospitalization. Four hundred and four admissions with attempted suicide were recorded. The majority (83.7%) were females and drug overdose was the most common (92.8%) method used. Thirty patients (7.5%) repeated the attempt during the study period. No specific time of the year was associated with an increase in adolescent suicide attempt admissions. The most remarkable finding was that younger adolescents had a higher probability of performing a violent suicide attempt. Hypotheses for these trends are examined together with possible ramifications for treatment provision.
Adolescent↗
[Adult attention deficit hyperactivity disorder: "there is such a creature"].
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Adult↗
Psychoanalytic perspectives on adolescent suicide.
From the beginning of the twentieth century, youthful suicide has posed both a clinical and a theoretical challenge for psychoanalysis. This paper examines several paradigmatic cases of completed suicide in order to illustrate important psychodynamic aspects of adolescent suicide. The contributions of the developmental psychoanalytic perspective to our understanding of adolescent self-destructiveness are discussed, with particular emphasis on Anna Freud's concept of developmental lines toward self-care and self-regulation. The applications of this developmental psychoanalytic perspective to clinical research on vulnerability to adolescent suicide are reviewed.
Adolescent↗
State and trait anxiety in adolescent suicide attempters.
OBJECTIVE: To examine the relationship between anxiety and suicidal behavior in adolescents. METHOD: Forty-six adolescents who had been hospitalized in an inpatient psychiatric unit after a suicide attempt were compared on measures of anxiety and depression with 72 adolescent psychiatric inpatients who had no history of suicide attempts. RESULTS: The suicide attempters exhibited significantly higher levels of both state and trait anxiety. However, when controlling for depression, the attempters did not differ in their level of state anxiety from the nonattempters, but they still manifested significantly higher levels of trait anxiety than nonattempters. CONCLUSIONS: The results suggest that anxiety, both state and trait, is a risk factor for suicidal behavior in adolescents. Yet, only trait anxiety appears to be relatively independent of depression in its effect on suicidal behavior risk. These findings imply that clinicans should take into account anxiety, both state and trait, for assessment and treatment of adolescents at risk for suicidal behavior.
Adolescent↗
Obsessive-compulsive characteristics: from symptoms to syndrome.
OBJECTIVE: To assess the distribution and severity of obsessions and compulsions in a nonclinical adolescent population. METHOD: During preinduction military screening, 861 sixteen-year-old Israelis completed a questionnaire regarding the lifetime presence of eight obsessive-compulsive (OC) symptoms and three severity measures. The presence or absence of obsessive-compulsive disorder (OCD) or subclinical OCD was ascertained by an independent interview. RESULTS: Although only 8.0% and 6.3% of respondents reported disturbing and intrusive thoughts, respectively, 27% to 72% of subjects endorsed the six remaining OCD symptoms. Twenty percent of subjects regarded the symptoms they endorsed as senseless and 3.5% found them disturbing; 8% reported spending more than an hour daily on symptoms. OCD and subclinical OCD cases differed significantly from non-OCD cases, but not from each other, in distress and mean number of symptoms. Although the distribution of nine of the items differed for noncases, compared with OCD and subclinical OCD cases, the distributions for all items overlapped markedly across the three groups. CONCLUSIONS: OC phenomena appear to be on a continuum with few symptoms and minimal severity at one end and many symptoms and severe impairment on the other. Defining optimal cutoff points for distinguishing between psychiatric disorder and OC phenomena that are common in the general population remains an open question.
Adolescent↗
Abnormal psychosocial situations and eating disorders in adolescence.
OBJECTIVE: To assess the relationship between abnormal psychosocial situations and eating disorders in adolescents. METHOD: Twenty girls with eating disorders, 20 girls with major psychiatric conditions, and 20 healthy controls took part in the study. They were interviewed using a semistructured interview designed by the World Health Organization to diagnose the psychosocial situations included in the International Classification of Disease Axis 5 classification for child and adolescent psychiatry. All subjects were also given the Eating Attitudes Test. RESULTS: Many life events and psychosocial adversities differentiated significantly between the patients and controls. Inappropriate parental pressure was specific only for the subjects with eating disorders compared with the other psychiatric patients. In addition, Eating Attitudes Test scores correlated significantly with hostility toward child, sibling disability, parental overprotection, inappropriate parental pressures, and negative changes in family relationships. CONCLUSION: These results support the growing literature on the interrelationship between disordered family relationships and eating disorders. They point the way for developing treatment programs dealing with these issues.
Adolescent↗
Coping styles and suicide risk.
A total of 30 psychiatric in-patients admitted because of suicidal behaviour were compared with 30 non-suicidal psychiatric in-patients and 32 healthy controls on measures of suicide risk and coping styles. The three groups were similar with regard to demographic variables, but the suicidal group scored higher on the suicide risk scale. Suicidal patients were significantly less likely to use the coping styles of minimization and mapping. They were unable to de-emphasize the importance of a perceived problem or source of stress. They also lacked the ability to obtain new information required to resolve stressful life events. Four coping styles correlated negatively with the suicide risk (minimization, replacement, mapping and reversal), while another three (suppression, blame and substitution) correlated positively. These findings may have important implications for therapists and primary prevention workers, and might pave the way towards recognition of the role played by coping styles in predicting suicide and its use for cognitive intervention in these high-risk patients.
Adaptation, Psychological↗
[Anorexia nervosa beginning after the menopause].
Anorexia nervosa (AN) in older patients is not often described. We present a 70-year-old woman with AN which started at the age of 50 after her menopause. We suggest that AN starting after the menopause is a unique disturbance with characteristics different from those in younger age groups. The causes of anorexia in the older patient and its special dynamics should be recognized. It may be necessary to create a different diagnostic system and devise special treatment for AN in post-menopausal women.
Age of Onset↗
Reduction in serotonin 5HT2 receptor binding on platelets of delinquent adolescents.
The possible involvement of serotonin receptors of the 5HT2 type in aggressive behavior was studied in juvenile delinquents. A group of 28 delinquent adolescents (13-18 years old) who had committed violent crimes was compared with a group of age matched controls. Subjects were drug and medication free during the study. 5HT2 receptors were labeled on platelet membranes using tritiated ketanserin. Receptor binding in the delinquent adolescents was significantly lower than in age matched controls. Mean +/- SD of 76 controls was 32.3 +/- 14.2 fm/mg, compared to 16.6 +/- 8.2 fm/mg in 28 delinquents (P < 0.002, Student's t-test). These results support a role for serotonin in general and 5HT2 receptors in particular in human aggressive behavior.
Adolescent↗
Correlation of suicidal and violent behavior in different diagnostic categories in hospitalized adolescent patients.
OBJECTIVE: To determine the relative importance of aggression and depression in adolescent suicide within different diagnostic categories. METHOD: One hundred sixty-three consecutive admissions to an adolescent psychiatric inpatient unit were assessed using a semistructure diagnostic instrument, the Schedule for Affective Disorders and Schizophrenia for School-Age Children. Scores for depression, suicidal behaviors, and violent behaviors were calculated from this assessment. RESULTS: Anorexia nervosa and conduct disorder patients had the highest suicidal behavior scores. In addition, patients with conduct disorder were significantly more violent than patients with major depressive disorder, and scores on the Violent Behavior Scale correlated with suicidal symptoms but not with depressive symptoms. CONCLUSION: Aggression may be as important in some kinds of suicidal behaviors as is depression. Thus it seems that there are hypothetically at least two types of suicidal behaviors during adolescence: a wish to die (depression) and a wish not to be here for a time (impulse control). The first type of suicidal behavior characterizes that seen in disorders with prominent depression such as major depressive disorder and anorexia nervosa, and the second characterizes disorders of impulse control such as conduct disorder.
Adolescent↗
An epidemiological study of trichotillomania in Israeli adolescents.
OBJECTIVE: To determine the prevalence of trichotillomania and comorbid psychopathology in nonreferred adolescents. METHOD: Using a questionnaire and interview, 794 Israeli 17-year-olds were screened for current and past hair-pulling and comorbid psychopathology. RESULTS: Eight current or past hair-pullers (5 male, 3 female) were identified, yielding a lifetime prevalence of hair-pulling of 1%. Four subjects reported current hair-pulling (point prevalence of 0.5%). None of these reported alopecia, distress, or tension before pulling; only two reported relief after pulling. Thus, none met the full DSM-III-R criteria for trichotillomania. Four subjects reported past but not current hair-pulling, with bald spots in two cases. Three of the four current hair-pullers had significant obsessive-compulsive symptoms, a significantly elevated rate compared to the entire screened population. Two subjects with obsessive-compulsive disorder also had generalized anxiety disorder and, in one case, chronic simple vocal tics. Hair-pullers did not differ significantly from non-hair-pullers in IQ, physical fitness, and overall competency, or prevalence of other comorbid disorders. CONCLUSIONS: In a community adolescent sample, only 25% of hair-pullers reported resulting bare spots and none endorsed both rising tension and subsequent relief. The prevalence of obsessive-compulsive symptoms was significantly elevated in these nonreferred hair-pullers.
Adolescent↗
Defense mechanisms in severe adolescent anorexia nervosa.
OBJECTIVE: To compare ego defense mechanisms in adolescents with anorexia nervosa and other major psychiatric disorders, to defenses in healthy adolescents. METHOD: Thirty-seven patients with anorexia nervosa, 30 with major depressive disorder, 20 with obsessive-compulsive disorder, 53 with borderline personality disorder, 60 with schizophrenia, and 81 healthy controls were assessed with Pfeffer's Ego Defense Scale. RESULTS: Regression, denial, projection, repression, introjection, and total defenses were common to all psychiatric patients and distinguished them from normal adolescents. In addition to these defenses, anorectic patients also used intellectualization more frequently than normal adolescents and psychiatric patients. They used sublimation more than other psychiatric patients. Patients with disorders, apart from obsessive-compulsive disorder, that are considered to be often comorbid with anorexia did not have different defense than schizophrenic patients. CONCLUSIONS: Anorectic adolescents overutilize relatively more mature defenses than do psychiatrically ill adolescents, and they overutilize immature defenses compared with normal adolescents. This combination of mature and immature defenses may be related to the uniquely heterogeneous ego functioning seen in anorectic patients, and it may provide insight into the nature of the psychopathology of anorexia nervosa. It also could have important psychotherapeutic and prognostic value.
Adolescent↗
Verbal and nonverbal expressions of central deficits in schizophrenia.
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Adolescent↗
Life events and severe anorexia nervosa in adolescence.
The purpose of the study was to study the influence of life events on adolescent patients suffering from anorexia nervosa. Twenty one hospitalized adolescent inpatients with severe anorexia nervosa were compared with 79 adolescent nonanorectic psychiatric inpatients and 40 healthy adolescents for stressful life events throughout their lives. The nonanorectic patients suffered from schizophrenia, affective disorders, anxiety disorders, borderline personality disorder or conduct disorder. The assessment of the contribution of life events to the development of anorexia and the control mental disorders was based on semistructured interviewing of the patients, their parents and the patients' therapists. The instrument used was that developed by Pfeffer. The anorectic patients showed significantly higher negative life event scores than healthy controls in all the areas of life events examined. In addition, they showed significantly more negative life events concerning parents than patients in the other psychiatric diagnostic categories. These findings have relevance for the growing literature on the association between eating disorders and certain forms of child abuse.
Adolescent↗
The sociocultural theory in the development of anorexia nervosa.
The relationship between anorexia nervosa (AN) and sociocultural factors is examined. Anorexia nervosa was first described in the West and was reported as particularly rare or absent in Eastern cultures. However, the frequency of its presentation has increased worldwide over the past two decades, probably as a consequence of changes in cultural norms and concepts of feminine beauty and an increasing inflow of Western values into other countries. Sociocultural factors are important in the development of AN in psychologically vulnerable young females, although other factors may also be implicated.
Adolescent↗