PubMed Health⌕ Search

Biomedical subjects

G A Bernstein

Publications and source records attributed to G A Bernstein.

At least 19 recordsLinked to original sources
PubMed2001

Pharmacokinetic interactions between cyclosporine and bupropion or methylphenidate.

A 10-year-old boy with a history of heart transplantation had a potentially life-threatening decrease in his cyclosporine (CSA) blood levels during administration of bupropion. Subsequently he had an increase in CSA levels while receiving methylphenidate. These occurrences represent potential drug-drug interactions in children not previously documented in the literature. The CSA-bupropion and CSA-methylphenidate interactions merit further investigation, particularly because psychotropic agents are often prescribed in combination with immunosuppressants in transplantation patients of all ages.

Antidepressive Agents, Second-Generation↗
PubMed2001

School refusal in children and adolescents: a review of the past 10 years.

OBJECTIVE: To critically review the past 10 years of research on school refusal in children and adolescents. METHOD: Literature on school refusal published from 1990 onward was reviewed following a systematic search of PsycINFO. The review focuses on definitional issues, epidemiology and school refusal identification, diagnostic considerations, family functioning, assessment, treatment, and follow-up studies. RESULTS: While definitional and conceptual issues are still evident, promising developments have occurred in relation to assessment and treatment practices and understanding of the family context of school refusal. CONCLUSIONS: From a clinical viewpoint, school refusal cases require comprehensive assessment and treatment. Advances have been made in the treatment of school refusal. However, additional controlled studies evaluating interventions for school refusal are needed.

Adolescent↗
PubMed2001

Treatment of school refusal: one-year follow-up.

OBJECTIVE: To conduct a 1-year follow-up of anxious-depressed school-refusing adolescents who participated in an 8-week study of imipramine versus placebo, each in combination with cognitive-behavioral therapy. METHOD: Sixty-five percent (41 of 63) of the randomly assigned subjects returned for follow-up evaluation, which consisted of diagnostic interviews, clinician rating scales for anxiety and depression, family functioning measure, and a questionnaire regarding interim treatments and school programs. RESULTS: From the adolescent and/or parent perspective, 64.1% met criteria for an anxiety disorder and 33.3% met criteria for a depressive disorder. Remission rates and acquisition rates for specific anxiety and depressive disorders were determined. In the follow-up period, 67.5% received at least one psychotropic medication trial and 77.5% had outpatient therapy. Higher level of somatic complaints on the Anxiety Rating for Children-Revised Physiological subscale at baseline predicted more severe depression on the Children's Depression Rating Scale-Revised at follow-up (p = .029). CONCLUSIONS: In this naturalistic follow-up study, there was high utilization of mental health interventions. In addition, a substantial number of subjects met criteria for anxiety and/or depressive disorders 1 year after treatment. Investigation of duration of acute treatments and evaluation of maintenance treatments for school refusal is needed.

Adolescent↗
PubMed2000

Imipramine plus cognitive-behavioral therapy in the treatment of school refusal.

OBJECTIVE: To investigate the efficacy of 8 weeks of imipramine versus placebo in combination with cognitive-behavioral therapy (CBT) for the treatment of school-refusing adolescents with comorbid anxiety and major depressive disorders. METHOD: This was a randomized, double-blind trial with 63 subjects entering the study and 47 completing. Outcome measures were weekly school attendance rates based on percentage of hours attended and anxiety and depression rating scales. RESULTS: Over the course of treatment, school attendance improved significantly for the imipramine group (z = 4.36, p < .001) but not for the placebo group (z = 1.26, not significant). School attendance of the imipramine group improved at a significantly faster rate than did that of the placebo group (z = 2.39, p = .017). Over the 8 weeks of treatment, there was a significant difference between groups on attendance after controlling for baseline attendance; mean attendance rate in the final week was 70.1% +/- 30.6% for the imipramine group and 27.6% +/- 36.1% for the placebo group (p < .001). Defining remission as 75% school attendance, 54.2% of the imipramine group met this criterion after treatment compared with only 16.7% from the placebo group (p = .007). Anxiety and depression rating scales decreased significantly across treatment for both groups, with depression on the Children's Depression Rating Scale-Revised decreasing at a significantly faster rate in the imipramine group compared with the placebo group (z = 2.08, p = .037). CONCLUSIONS: Imipramine plus CBT is significantly more efficacious than placebo plus CBT in improving school attendance and decreasing symptoms of depression in school-refusing adolescents with comorbid anxiety and depression.

Adolescent↗
PubMed2000

Imipramine compliance in adolescents.

OBJECTIVE: To investigate side effects, medication compliance, and assumption of medication assignment in adolescents taking imipramine versus placebo in a clinical trial. METHOD: Sixty-three anxious-depressed adolescents in an 8-week double-blind study of imipramine versus placebo, each in combination with cognitive-behavioral therapy for school refusal, were evaluated. Measures of side effects, global improvement, family functioning, medication compliance based on pill counts, and guesses of drug assignment (imipramine versus placebo) were analyzed. RESULTS: Mean side effects ratings were significantly higher for the imipramine group compared with the placebo group (p = .001). Side effects were not associated with noncompliance or with dropping out. Oppositional defiant disorder (ODD) in the adolescents was significantly associated with medication noncompliance (p = .036). On the Family Adaptability and Cohesion Evaluation Scale II (FACES II), low family adaptability (i.e., rigidity), low family cohesion (i.e., disengagement), and extreme family type were significantly associated with greater noncompliance with medications. Accuracy rates for guessing medication assignment (imipramine versus placebo) were 66% for subjects, 62.5% for mothers, and 79.5% for the psychiatrist. Logistic regression demonstrated that side effects (p = .005) and global improvement scores (p = .06) predicted the psychiatrist's guesses of drug assignment. CONCLUSIONS: Side effects were not associated with noncompliance. Nonadherence with taking medications was associated with ODD in the adolescents and problematic family functioning on FACES II. The psychiatrist, who was blind to treatment condition, guessed the subjects' medication assignments with high accuracy. Thus, because of expectancy bias, the data support the use of blind independent evaluators for rating changes in medication trials.

Adolescent↗
PubMed1999

Anxiolytics, adrenergic agents, and naltrexone.

OBJECTIVE: To review extant data on the efficacy and safety of anxiolytic medications (benzodiazepines, buspirone, and other serotonin 1A agonists), adrenergic agents (beta-blockers and alpha 2-adrenergic agonists clonidine and guanfacine), and the opiate antagonist naltrexone that have been used to treat various psychopathologies in children and adolescents. To identify critical gaps in our current knowledge about these agents and needs for further research. METHOD: All available controlled trials of these medications in children and adolescents published in English through 1997 were reviewed. In addition, selected uncontrolled studies are included. RESULTS: The major finding, that there are virtually no controlled data that support the efficacy of most of these drugs for the treatment of psychiatric disorders in children and adolescents, is both surprising and unfortunate. For some drugs, e.g., buspirone and guanfacine, this is because no controlled studies have been carried out in children and/or adolescents. For other drugs, e.g., clonidine and naltrexone, most of the placebo-controlled studies have failed to demonstrate efficacy. CONCLUSIONS: The strongest recommendations for controlled studies of safety and efficacy in children and adolescents can be given for the following drugs: benzodiazepines for acute anxiety; buspirone (and newer serotonin 1A agonists as they become available) for anxiety and depression; beta-blockers for aggressive dyscontrol; guanfacine for attention-deficit/hyperactivity disorder; and naltrexone for hyperactivity, inattention, and aggression in autistic disorder.

Adolescent↗
PubMed1998

Caffeine withdrawal in normal school-age children.

OBJECTIVE: Caffeine is widely consumed by children around the world. The purpose of this study was to determine whether children manifest withdrawal effects after cessation of caffeine intake. METHOD: Thirty normal children completed the single-blind, within-subjects, repeated-measures study with weekly sessions. Subjects were tested four times: (1) baseline (on regular caffeine diet); (2) on caffeine (approximately 120 to 145 mg/day); (3) during withdrawal (24 hours after discontinuation of caffeine taken for 13 consecutive days); and (4) at return to baseline. Subjects were evaluated with self-report measures of symptoms and objective measures of attention, motor performance, processing speed, and memory. RESULTS: During caffeine withdrawal, there was a significant deterioration on response time of a visual continuous performance test of attention. This finding is consistent with caffeine withdrawal. The deterioration in response time appeared to persist for 1 week. CONCLUSIONS: Twenty-four hours after children discontinued caffeine, there was a decrease in performance on reaction time of a task requiring sustained attention. Further work is indicated to determine whether children manifest caffeine withdrawal effects after cessation of caffeine intake.

Analysis of Variance↗
PubMed1997

Somatic symptoms in anxious-depressed school refusers.

OBJECTIVE: To identify the most common physical complaints in a sample of adolescent school refusers with comorbid anxiety and depressive disorders. Whether somatic symptoms are more likely to be associated with high levels of anxiety or high levels of depression was also explored. METHOD: Forty-four adolescents in a treatment study were evaluated at baseline with structured psychiatric interviews and measures of anxiety, depression, and somatization. RESULTS: The most common somatic complaints were in the autonomic and gastrointestinal categories. In simple regression analyses, anxiety level as measured with the Revised Children's Manifest Anxiety Scale and depression level as measured with the Beck Depression Inventory each significantly predicted the severity of somatic symptoms. The correlation between percentage of days absent from school and severity of somatic symptoms approached significance (r = .27, p = .074). CONCLUSIONS: Knowledge that somatic complaints are commonly an expression of underlying anxiety and depression may facilitate more rapid referral for psychiatric assessment and treatment and thereby help avoid unnecessary medical workups and sequelae from school refusal.

Adolescent↗
PubMed1997

Practice parameters for the assessment and treatment of children and adolescents with anxiety disorders. American Academy of Child and Adolescent Psychiatry.

Anxiety disorders comprise one of the most prevalent categories of psychopathology in children and adolescents. These revised practice parameters highlight the DSM-IV changes for anxiety disorders and review the literature related to the assessment and treatment of anxiety disorders in children and adolescents. Up-to-date information on longitudinal outcome data, assessment of anxiety, parent-child interventions, and use of selective serotonin reuptake inhibitors has been added to the previous parameters, published in September 1993. Recommendations for evaluation and multimodal approaches to treatment are presented.

Anxiety Disorders↗
PubMed1996

Management of blood-drawing fears in adolescents with comorbid anxiety and depressive disorders.

As more pharmacologic treatment and research on child and adolescent psychiatric patients are conducted, the common problem of blood-drawing fears will need to be addressed. Avoidance of blood-drawing could jeopardize an individual's physical and mental health, and inhibit the collection of data aimed at furthering the study of psychiatric disorders in youth. This report describes the naturalistic application of specific techniques for managing severe blood-drawing fears in adolescent subjects undergoing a clinical trial. The adolescents (ages 12-18) were 44 consecutive school refusers with comorbid anxiety and major depressive disorders. Of the school-refusing adolescents, 27% (12 of 44) were observed to have a severe fear of blood-drawing. A management strategy comprised of providing information, distraction, supportive reassurance, and exposure appeared successful in managing the fears of blood-drawing in all of the adolescents, except two. These 2 adolescents refused to enter the treatment study due to a marked fear of blood-drawing. All 10 subjects who exhibited a fear of blood-drawing and were able to complete the initial blood test, using the interventions noted, were able to obtain subsequent venipunctures with minimal or no avoidance behavior. These preliminary findings suggest that blood-drawing fears can be effectively managed in most cases, though controlled studies of these interventions are needed.

Adolescent↗
PubMed1996

Anxiety disorders in children and adolescents: a review of the past 10 years.

OBJECTIVE: To critically review the research on anxiety disorders in children and adolescents, focusing on new developments in the past 10 years. METHOD: This review includes recent articles which contribute to the conceptualization, assessment, and treatment of childhood anxiety disorders. RESULTS: Information was organized into a developmental framework. Anxiety disorders research has shown steady progress. CONCLUSIONS: More research is needed, particularly in the areas of neurobiological basis of anxiety disorders, longitudinal studies, and treatment.

Adolescent↗
PubMed1996

Psychiatric diagnoses in children with alopecia areata.

OBJECTIVE: To identify psychiatric diagnoses in a sample of 12 children with alopecia areata (AA), to assess the possible relationship between life stressors and AA and to correlate any consistent physical findings to psychiatric data. METHOD: Twelve children with AA completed systematic psychiatric evaluations. The assessments included structured and semistructured interviews, rating scales, and parent checklists. Children had previously undergone immunological and endocrinological blood testing. RESULTS: Seven of the 12 subjects met criteria for anxiety disorders (including simple phobia) on structured interviews. An additional subject met criteria for dysthymia. Self-esteem measures indicated a high positive self-concept, and rating scales measuring anxiety and depression were within normal limits. No significant difference was found between mean number of positive or negative life events of children with AA compared with a normative sample. CONCLUSIONS: Although structured interviews revealed a higher than expected rate of anxiety or depressive disorders in this small clinical sample, self-report rating scales and semistructured interviews did not support the conclusion that significant psychopathology was present.

Adolescent↗
PubMed1995

Comorbid disorders in hospitalized bipolar adolescents compared with unipolar depressed adolescents.

This study examined comorbid psychiatric disorders in adolescents with bipolar disorder. Hospitalized bipolar adolescents (N = 10) were compared to hospitalized adolescents with unipolar depression (N = 33), and to adolescents with nonaffective psychiatric disorders (N = 11). Results showed conduct disorder, attention-deficit hyperactivity disorder, psychosis, and having any DSM-III-R psychoactive substance use disorder were all significantly more common in the bipolar group than the unipolar depressed group. Comorbid anxiety disorder was present in 40-45% of the subjects in the unipolar and bipolar groups, but in none of the control group subjects.

Adolescent↗
PubMed1995

Psychopathology in the families of inpatient affective disordered adolescents.

The purpose of this study was to examine the rates of psychiatric disorders in the parents of affective disordered adolescent inpatients, and to examine characteristics of the adolescent patients' illnesses and hospital stays for effects of having a concurrently depressed mother. Twenty-three percent of the depressed probands (N = 33), 20% of the bipolar group (N = 10), and 9% of the psychiatric control group (N = 11) had mothers who reported major depression (MD) at the time of hospitalization. Concurrent maternal depression did not have prominent effects on the course of the adolescents' hospitalizations.

Adolescent↗
PubMed1994

A comparison of inpatient and outpatient school refusers.

This study describes children and adolescents with school refusal who were hospitalized and compares them to a matched group with school refusal who were treated as outpatients in order to examine the use of hospitalization in the treatment of this symptom presentation. The results showed the inpatient group had significantly more depressive disorder, a greater number of diagnoses, more severe symptoms, were more likely to reside in single-parent homes, and were more likely to have been physically abused.

Adolescent↗
PubMed1992

Clinical characteristics and psychiatric comorbidity in children with trichotillomania.

Ten children with trichotillomania (hair pulling) were systematically evaluated with structured psychiatric interviews and rating scales assessing anxiety, depression, life events, self-esteem, and family functioning. Six of the subjects met diagnostic criteria for overanxious disorder on the Diagnostic Interview for Children and Adolescents--Revised--Child or Adolescent Version and/or Diagnostic Interview for Children and Adolescents--Revised--Parent Version. Two met the criteria for dysthymia, including one of the subjects with overanxious disorder. No children reported associated obsessions or compulsions. Only one subject experienced tension before hair pulling and relief associated with hair pulling. The DSM-III-R criteria for trichotillomania, which currently require an increasing sense of tension before hair pulling and gratification with hair pulling, may be overly restrictive and in need of redefinition. Additional research with increased sample size is necessary to define diagnostic criteria for trichotillomania and clarify its relationship with other psychiatric diagnoses.

Adolescent↗
PubMed1992

Patterns of utilization of outpatient mental health services by children and adolescents.

Although as many as one-fifth of children and adolescents may meet DSM-III criteria for at least one psychiatric diagnosis, data from the Minnesota Department of Human Services for 1988 show that only 20 to 38 percent of children and adolescents in the state who are eligible for medical assistance and who are potentially in need of psychiatric care are referred for or seek treatment. A study of publicly funded mental health care for youths under 18 found that in 1988 the average cost for state-supported psychiatric services per outpatient case was $520, compared with $8,556 per inpatient case. However, overall cost of state-supported mental health services for youths under 18 increased by 28 percent between 1987 and 1988, primarily due to increases in payments for inpatient care of patients with dual diagnoses of mental illness and chemical dependency.

Adolescent↗