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Biomedical subjects

Boris Birmaher

Publications and source records attributed to Boris Birmaher.

At least 73 records · Page 4Linked to original sources
PubMed2004

Suicidality and its relationship to treatment outcome in depressed adolescents.

This study investigates the impact of suicidality on treatment outcome in 107 depressed adolescents who participated in a clinical trial, and received either cognitive-behavioral (CBT), systemic-behavioral-family (SBFT), or non-directive-supportive therapy (NST). Suicidal depressed adolescents had a higher dropout rate and were more likely to be depressed at the end of treatment, in large part due to the particularly poor response of suicidal patients to NST. The relationship between suicidality and treatment response was mediated by severity of depression and hopelessness at intake. Hopelessness should be specifically targeted early in treatment. Suicidal depressed adolescents should not receive NST but a specific treatment like CBT.

Adolescent↗
PubMed2004

Recurrent abdominal pain, anxiety, and depression in primary care.

OBJECTIVE: The prevalence of psychiatric disorder in children and adolescents with functional recurrent abdominal pain (RAP) is unknown. Our aim was to determine whether RAP is associated with psychiatric symptoms and disorders, anxious temperament, and functional impairment in pediatric primary care. METHODS: Children and adolescents who were 8 to 15 years of age, inclusive, and presented with RAP (N = 42) or for routine care in the absence of recurrent pain (N = 38) were identified by a screening procedure in pediatric primary care office waiting rooms and recruited to participate in a case-control study. Outcome measures were psychiatric diagnoses generated by standardized psychiatric interview administered blind to subject status and self, parent, and clinician ratings of child psychiatric symptoms, temperamental traits, and functional status. RESULTS: RAP patients were significantly more likely to receive a diagnosis of a psychiatric disorder, with a categorical anxiety disorder in 33 (79%) and a depressive disorder in 18 patients (43%), and higher levels of anxiety and depressive symptoms, temperamental harm avoidance, and functional impairment than control subjects. Anxiety disorders (mean age of onset: 6.25 [standard deviation: 2.17] years) were significantly more likely to precede RAP (mean age of onset: 9.17 [standard deviation: 2.75] years) in patients with associated anxiety. CONCLUSIONS: Youths who present with RAP in primary care deserve careful assessment for anxiety and depressive disorders. Future studies should examine treatments that are proved to be efficacious for pediatric anxiety and/or depressive disorders as potential interventions for RAP. Longitudinal, family, and psychobiological studies are needed to illuminate the nature of observed associations among RAP, anxiety, and depression.

Abdominal Pain↗
PubMed2004

Lifetime history of sexual abuse, clinical presentation, and outcome in a clinical trial for adolescent depression.

OBJECTIVE: To investigate the impact of sexual abuse on clinical presentation and treatment outcome in depressed adolescents. METHOD: 107 adolescent outpatients, 13 to 18 years old, with DSM-III-R major depression were randomly assigned to cognitive-behavioral therapy (CBT), systemic behavioral family therapy (SBFT), or nondirective supportive therapy (NST) from Oct. 1, 1991 through May 31, 1995. Subjects were classified on the basis of the presence or absence of lifetime history of sexual abuse. Since only 1 subject assigned to SBFT had a history of sexual abuse, we restricted our analyses to those 72 subjects assigned to either CBT or NST. The impact of lifetime history of sexual abuse on service use, depression, and treatment outcome was examined. RESULTS: Depressed adolescents with a past history of sexual abuse were more likely, at 2-year follow-up, to have had a psychiatric hospitalization and have a depressive relapse, even controlling for maternal depression, source of referral, race, and treatment assignment. CBT was more efficacious than NST in absence of sexual abuse but was not better than NST in those with a history of sexual abuse. CONCLUSION: Sexual abuse is a negative predictor of long-term outcome in adolescent depression. CBT for depression may not be as efficacious for those depressed adolescents with a history of sexual abuse. These findings suggest that a history of sexual abuse should be assessed not only in clinical practice, but also in research studies of depressive outcome. Further work is indicated to understand the relationship between sexual abuse and poor outcome in order to help restore these high-risk youths to an optimal developmental trajectory.

Adolescent↗
PubMed2004

Clinical characteristics of depressive symptoms in children and adolescents with major depressive disorder.

OBJECTIVE: Very few studies have compared the symptoms of major depressive disorder (MDD) and rates of comorbid psychiatric disorders between depressed children and adolescents. The aim of this study was to reproduce and extend these findings. METHOD: The Kiddie Schedule for Affective Disorders and Schizophrenia, present version (KSADS-P) was administered to parents (about their children) and in face-to-face interviews with 916 subjects aged 5.6 to 17.9 years with MDD (DSM criteria) (715 adolescents and 201 children; 348 male and 568 female). The subjects were consecutive referrals to an outpatient mood and anxiety disorders clinic. RESULTS: Depressed adolescents had significantly more hopelessness/helplessness, lack of energy/tiredness, hypersomnia, weight loss, and suicidality compared with children (p values < or = .001). In comparison with children, adolescents had significantly more substance abuse and less comorbid separation anxiety disorder and attention-deficit/hyperactivity disorder (p values < or = .001). Depressed female adolescents had significantly more suicidality than depressed male adolescents (p < or = .001). There were no other sex differences between males and females. The symptoms of depressed adolescents grouped into 3 factors (endogenous, negative cognitions/suicidality, and appetite/weight), whereas the symptoms in children grouped into 2 factors (endogenous/negative cognitions/suicidality and appetite/weight). CONCLUSIONS: These results provide further evidence for the continuity of MDD from childhood to adolescence.

Adolescent↗
PubMed2003

The stressful life events schedule for children and adolescents: development and validation.

The development and psychometric properties of the Stressful Life Events Schedule (SLES), an interview instrument to assess stressors in children and adolescents, are described. Children (< or =12 years) and adolescents (>12 years) with psychopathology (n=30) and non-psychiatric controls (n=30) were interviewed with the SLES about the occurrence of stressful life events during the prior year. To examine concurrent validity of the SLES, all subjects also completed the self-report Life Events Checklist (LEC) and half the sample completed the Life Events and Difficulties Schedule (LEDS). To examine informant validity, the parent/guardian also reported on stressful life events occurring to their child during the year prior to interview. Test-retest reliability of the SLES was examined by re-assessing all children approximately one week after the initial interview. Subjects rated subjectively how stressful an event was on a 4-point scale. Additionally, panel ratings of objective stress and behavior-dependence/independence were made on 4-point scales. The SLES was found to have substantial inter-rater consensus reliability for objective threat (kappa=0.67) and almost perfect reliability for event behavior-dependence/independence (kappa=0.84). Similarly, the test-retest reliability of the SLES was also found to be substantial at the level of specific event comparisons (kappa=0.68). The SLES discriminated between children with and without psychopathology on all measures of stressful life events. Total stressful life events assessed with the SLES concurred well with those assessed by the LEC (ICC=0.83) and the LEDS (kappa=0.77) although, as expected, examination of specific events showed much smaller overlap between the SLES and the LEC (kappa=0.26). Child-parent agreement for the occurrence of severe events was substantial (kappa=0.73) but tended to be only moderate when all events were examined (kappa=0.48). The results of this study indicate that the SLES has good psychometric properties. The SLES is a useful, cost-effective tool for assessing stressful life events in children and adolescents.

Adolescent↗
PubMed2003

The prevalence and impact of large sudden improvements during adolescent therapy for depression: a comparison across cognitive-behavioral, family, and supportive therapy.

This study assessed the treatment specificity and impact on outcome of large, abrupt symptomatic improvements occurring prior to and during cognitive-behavioral, family, and supportive therapy. Eighty-seven depressed adolescents receiving at least 8 therapy sessions were included. Abrupt large decreases in depressive symptoms were identified by changes in weekly Beck Depression Inventory scores. Overall, 28% experienced a pretreatment gain and 39% a sudden within-treatment gain. Both types of gains were associated with superior outcome on self-report and interviewer ratings of depression. Among those participants failing to experience a pretreatment or sudden within-treatment gain, cognitive-behavioral therapy produced the superior outcomes. These findings suggest pretreatment and sudden within-treatment gains are important therapeutic events worthy of further investigation.

Adolescent↗
PubMed2003

Measuring mood and complex behavior in natural environments: use of ecological momentary assessment in pediatric affective disorders.

This article describes the theoretical background and methodology of ecological momentary assessment (EMA) and reports results from a pilot study using EMA techniques in 16 children and adolescents with affective disorders and 5 subjects who were healthy and at low risk to develop future affective disorders. Multiple daily assessments of the subjects' mood, thoughts, and behaviors were performed in their natural environments using brief interviews on cellular phone calls by the study staff and by wrist actigraphy. The pilot results demonstrated that the EMA methodology is feasible in this population, as 17 of 21 subjects were able to complete the entire 8-week protocol. The potential usefulness of the EMA methodology is illustrated by specific case reports. Potential applications of the EMA methodology to the study of neurobehavioral systems and the pathophysiology of pediatric affective disorders are discussed.

Adolescent↗
PubMed2003

Gastrointestinal distress to serotonergic challenge: a risk marker for emotional disorder?

OBJECTIVE: Serotonin is an important mediator of gut sensation and motility. The authors' aim was to determine whether inadvertent gastrointestinal (GI) distress to serotonergic challenge predicted future major depressive and/or anxiety disorders in exposed children. METHOD: l-5-hydroxytryptophan was administered to 119 prepubertal children free of psychiatric disorder as part of a psychobiological cohort study initially designed to examine familial loading for mood disorder as the exposure of interest. Subjects were followed longitudinally with standardized psychiatric interviews to identify new-onset mood and anxiety disorders over 90.3 +/- 29.2 months, with the average assessment interval being 16.6 +/- 6.2 months. Reports of GI distress in a subgroup during serotonergic challenge led the authors to examine GI distress to infusion as an exposure post hoc and to perform survival analysis using major depressive and/or anxiety disorders as the outcomes of interest. RESULTS: GI distress to serotonergic challenge was experienced by 23 subjects, with 7 (30.4%) developing an emotional disorder during follow-up in comparison to 12 (10.4%) of 96 nondistressed subjects. The distressed group was at significantly greater risk of subsequent major depression and/or anxiety (p =.026), even after controlling for family history of psychiatric disorder. CONCLUSIONS: GI distress to serotonergic challenge in childhood is associated with heightened risk for subsequent major depressive and/or anxiety disorders. Studies of serotonergic neurotransmission may aid our understanding of nonrandom associations between functional GI symptoms and emotional symptoms and disorders.

5-Hydroxytryptophan↗
PubMed2003

Fluoxetine for the treatment of childhood anxiety disorders.

OBJECTIVE: To assess the efficacy and tolerability of fluoxetine for the acute treatment of children and adolescents with generalized anxiety disorder, separation anxiety disorder, and/or social phobia. METHOD: Anxious youths (7-17 years old) who had significant functional impairment were randomized to fluoxetine (20 mg/day) (n = 37) or placebo (n = 37) for 12 weeks. RESULTS: Fluoxetine was effective in reducing the anxiety symptoms and improving functioning in all measures. Using intent-to-treat analysis, 61% of patients taking fluoxetine and 35% taking placebo showed much to very much improvement. Despite this improvement, a substantial group of patients remained symptomatic. Fluoxetine was well tolerated except for mild and transient headaches and gastrointestinal side effects. Youths with social phobia and generalized anxiety disorder responded better to fluoxetine than placebo, but only social phobia moderated the clinical and functional response. Severity of the anxiety at intake and positive family history for anxiety predicted poorer functioning at the end of the study. CONCLUSIONS: Fluoxetine is useful and well tolerated for the acute treatment of anxious youths. Investigations regarding the optimization of treatment to obtain full anxiety remission and the length of treatment necessary to prevent recurrences are warranted.

Adolescent↗
PubMed2003

Major depressive disorder in adolescents exposed to a friend's suicide.

OBJECTIVE: To evaluate whether the risk of DSM-III major depressive disorder (MDD) is uniform across the 6 months after adolescent exposure to a friend's suicide, and to examine potential moderating or mediating processes that may influence the risk of new-onset MDD. METHOD: One-month incidence rates of MDD were compared between 129 adolescents who were exposed to a friend's suicide between December 1988 and March 1991 and 145 similar-aged, unexposed community controls participating in the Youth Exposed to Suicide study. Clinical, family, and social factors that antedated the exposure were examined as predictors of new-onset MDD within 1 month of the suicide. RESULTS: Exposed adolescents had a markedly increased risk of developing new-onset MDD that was restricted to a narrow period of time, within 1 month after exposure. In contrast, there were no differences in the incidence of MDD between the groups in months 2 to 6. Past history of alcohol abuse increased the risk of exposure to suicide, which subsequently increased the risk of new-onset MDD within 1 month of exposure. Exposed youths who had both a family history of MDD and feelings of accountability for the death were at considerably increased risk of new-onset MDD. CONCLUSIONS: For adolescents exposed to a friend's suicide, events surrounding the death interact with family history of MDD to greatly increase the risk for new-onset MDD.

Adolescent↗
PubMed2003

Peripubertal suicide attempts in offspring of suicide attempters with siblings concordant for suicidal behavior.

OBJECTIVE: The authors sought to determine 1) whether the risk for familial transmission of suicidal behavior is greater with increased family loading for suicide attempts, and 2) whether the transmission of suicidal behavior is mediated by impulsive aggression. METHOD: A reanalysis of a high-risk study compared the offspring of three mood disorder proband groups: suicide attempters with a sibling who also attempted suicide (N=19), suicide attempters whose siblings never made a suicide attempt (N=73), and nonsuicidal probands whose siblings also never engaged in suicidal behavior (N=73). Probands and offspring were assessed with respect to psychopathology, suicide attempt history, impulsive aggression, and exposure to familial adversity. RESULTS: Offspring of suicide attempters with siblings concordant for suicidal behavior showed a higher risk of suicide attempt than did offspring of nonsuicidal probands and had an earlier age at onset of suicidal behavior than offspring of suicide attempters with siblings discordant for suicidal behavior. Probands from sibling pairs concordant for suicidal behavior and their offspring reported greater lifetime impulsive aggression compared with each of the other two proband/offspring groups. In the offspring, impulsive aggression was the most powerful predictor of early age at first suicide attempt. CONCLUSIONS: Familial loading for suicide attempts may affect rates of transmission as well as age at onset of suicidal behavior, and its effect may be mediated by the familial transmission of impulsive aggression.

Adolescent↗
PubMed2002

Superior temporal gyrus volumes in pediatric generalized anxiety disorder.

BACKGROUND: The essential symptoms of generalized anxiety disorder (GAD) are intrusive worry about everyday life circumstances and social competence, and associated autonomic hyperarousal. The amygdala, a brain region involved in fear and fear-related behaviors in animals, and its projections to the superior temporal gyrus (STG), thalamus, and to the prefrontal cortex are thought to comprise the neural basis of our abilities to interpret social behaviors. Larger amygdala volumes were previously reported in pediatric GAD; however, the brain regions involved in social intelligence were not examined in this pilot study. METHODS: Magnetic resonance imaging (MRI) was used to measure the STG, thalamus, and prefrontal volumes in 13 medically healthy child and adolescent subjects with generalized anxiety disorder (GAD) and 98 comparison subjects, who were at low familial risk for mood and psychotic disorders. Groups were similar in age, gender, height, weight, handedness, socioeconomic status, and full-scale IQ. RESULTS: The total, white matter, and gray matter STG volumes were significantly larger in GAD subjects compared with control subjects. Thalamus and prefrontal lobe volumes did not differ between groups. Findings of significant side-by-diagnosis interactions for STG and STG white matter volumes suggest that there is a more pronounced right > left asymmetry in total and STG white matter volumes in pediatric GAD subjects compared with control subjects. A significant correlation between the STG white matter percent asymmetry index with the child report of the Screen for Child Anxiety Related Emotional Disorders Scale was seen. CONCLUSIONS: These data agree with previous work implicating posterior right-hemispheric regions in anxiety disorders and may suggest developmental alterations in pediatric GAD.

Adolescent↗
PubMed2002

Familial pathways to early-onset suicide attempt: risk for suicidal behavior in offspring of mood-disordered suicide attempters.

BACKGROUND: Although adoption, twin, and family studies have shown that suicidal behavior is familial, the risk factors for familial transmission from parent to child remain unclear. METHODS: A high-risk family study was conducted comparing the offspring of 2 mood-disordered groups: suicide attempters and nonattempters. Recruited from 2 sites, probands were 81 attempters and 55 nonattempters, with 183 and 116 offspring, respectively. Offspring were assessed by investigators masked to proband status. Probands and offspring were assessed with respect to psychopathologic findings, suicide attempt history, impulsive aggression, and exposure to familial environmental stressors. RESULTS: Offspring of attempters had a 6-fold increased risk of suicide attempts relative to offspring of nonattempters. Familial transmission of suicide attempt was more likely if (1) probands had a history of sexual abuse and (2) offspring were female and had a mood disorder, substance abuse disorder, increased impulsive aggression, and a history of sexual abuse. CONCLUSIONS: The offspring of mood-disordered suicide attempters are at markedly increased risk for suicide attempts themselves. Familial transmission of suicidal behavior in families with mood disorders almost always requires transmission of a mood disorder and is also related to the offspring's impulsive aggression and the familial transmission of sexual abuse. Early treatment of mood disorders and targeting impulsive aggression and sexual trauma may be helpful in the prevention and treatment of suicidal behavior in families with mood disorders.

Adolescent↗
PubMed2002

Heterogeneity in EEG sleep findings in adolescent depression: unipolar versus bipolar clinical course.

BACKGROUND: EEG sleep measures in child and adolescent subjects with depression have shown considerable variability regarding group differences between depressed and control subjects. This investigation was designed to assess whether some of the observed variability is related to undifferentiated unipolar and bipolar disorders in a sample that was reported previously. METHODS: Twenty-eight adolescents who met criteria for unipolar major depression and 35 controls with no lifetime psychiatric disorder participated in a cross-sectional sleep polysomnography study. Approximately 7 years later, follow-up clinical evaluations were conducted in 94% of the original cohort. Clinical course during the interval period was assessed without knowledge of subjects' initial diagnostic and psychobiological status. Re-analysis of the original sleep data were performed with the added information of longitudinal clinical course. RESULTS: Depressed subjects who had a unipolar course showed reduced REM latency, higher REM density, and more REM sleep (specifically in the early part of the night) compared with depressed adolescents who converted to bipolar disorder and controls who remained free from psychopathology at follow-up. In contrast to the unipolar group, depressed subjects who would later switch to bipolar disorder had demonstrated more stage 1 sleep and diminished stage 4 sleep. CONCLUSIONS: These preliminary results indicate that some of the observed variability in EEG sleep measures in adolescent depression appear to be confounded by latent bipolar illness. The findings also suggest that sleep regulatory changes associated with unipolar versus bipolar mood disorders may be different.

Adolescent↗
PubMed2002

Course and outcome of child and adolescent major depressive disorder.

Major depressive disorder (MDD) is a familial recurrent illness that significantly interferes with the child's normal development and is associated with increased risk for suicidal behaviors and psychiatric and psychosocial morbidity. Although most children and adolescents recover from their first depressive episode, 30-70%, in particular those with familial history of MDD, comorbid psychiatric disorders, dysthymia, subsyndromal symptoms of depression, anxiety, negative cognitive style, and exposure to negative life events (e.g., family conflicts and abuse) will experience one or more depressive recurrences during their childhood, adolescence, and adulthood. Depressed youth who present with psychosis, psychomotor retardation, pharmacological induced hypomania/mania, and/or family history of bipolar disorder are at high risk to develop bipolar disorder.

Adolescent↗
PubMed2002

Sertraline pharmacokinetics and dynamics in adolescents.

OBJECTIVE: To determine the pharmacokinetics of sertraline in adolescents and assess its effect on a surrogate marker of serotonin transport. METHOD: Pharmacokinetic parameters of a single 50-mg dose of sertraline were determined in 10 adolescents. Steady-state withdrawal kinetics were determined in 12 adolescents taking 50 mg/day and in 6 adolescents taking 100 to 150 mg/day. Platelet serotonin reuptake was measured before and after 2 weeks of daily 50-mg dosing. RESULTS: The mean steady-state half-life of 50 mg was significantly shorter (15.3 +/- 3.5 hours) than the single-dose half-life (26.7 +/- 5.2 hours; t = 6.4, p < .001) and the steady-state half-life at 100 to 150 mg/day (20.4 +/- 3.4 hours; t = 2.9, p = .01). Platelet serotonin reuptake was inhibited by 61 +/- 15% after approximately 2 weeks of sertraline 50 mg/day. CONCLUSIONS: The half-life of sertraline 50 mg becomes significantly shorter from the initial dose to steady-state, and many adolescents may benefit from twice-per-day dosing. The steady-state half-life increases as the dose increases. The moderate levels of platelet reuptake inhibition at 50 mg/day indicate that most adolescents may need sertraline doses higher than 50 mg/day to attain a therapeutic response.

Adolescent↗
PubMed2002

Oppositional defiant disorder and conduct disorder: a review of the past 10 years, part II.

OBJECTIVE: To review empirical findings on oppositional defiant disorder (ODD) and conduct disorder (CD). METHOD: Selected summaries of the literature over the past decade are presented. RESULTS: Research on ODD and CD during the past decade has addressed the complexity involved in identifying the primary risk factors and developmental pathways to disruptive behavior disorders (DBD). In some domains, research is entering an entirely new phase because of the availability of new technologies. In others, larger data sets and more complicated methodological and statistical techniques are testing increasingly complex models. Yet questions remain regarding the most useful subtyping systems, the identification of the most significant risk factors, and the relationships between risk factors from multiple domains. CONCLUSIONS: Convincing evidence of causal linkages remains elusive. Research has questioned the notion that CD is intractable, especially when multiple domains of risk and impairment are the targets of intervention. It is apparent that there is not one single causative factor; thus it is not likely that one single modality will suffice to treat CD. Future steps will involve the restructuring of diagnostic criteria to capture adequate subtypes and indicators, clarification of the neurological underpinnings of the disorder, and refinement in the models available to explain the varied pathways to DBD.

Achievement↗