Biomedical subjects

G Moritz

Publications and source records attributed to G Moritz.

At least 19 recordsLinked to original sources

PubMed2001

A pilot longitudinal study of hippocampal volumes in pediatric maltreatment-related posttraumatic stress disorder.

BACKGROUND: Adult posttraumatic stress disorder (PTSD) is associated with decreased hippocampal volumes; however, decreased hippocampal volumes were not seen in pediatric maltreatment-related PTSD. We examined hippocampal volumes longitudinally to determine if a history of childhood traumatic stress alters hippocampal growth during puberty. METHODS: Magnetic resonance imaging was used to measure temporal lobes, amygdala, and hippocampal volumes in nine prepubertal maltreated subjects with pediatric maltreatment-related PTSD and nine sociodemographically matched healthy nonmaltreated yoked control subjects at baseline and after at least 2 years follow-up (during the later stages of pubertal development) using identical equipment and measurement methodology. RESULTS: Temporal lobe, amygdala and hippocampal volumes did not differ between groups at baseline, follow-up, or across time. CONCLUSIONS: Whereas these data are from a small sample, the results do not support hippocampal changes in pediatric maltreatment-related PTSD.

Amygdala↗

PubMed2001

Psychiatric co-morbidity in caregivers and children involved in maltreatment: a pilot research study with policy implications.

OBJECTIVE: The purpose of this study was to determine the lifetime incidence of mental disorders in caregivers involved in maltreatment and in their maltreated child. METHODS: Lifetime DSM-III-R and IV psychiatric diagnoses were obtained for 53 maltreating families, including at least one primary caregiver and one proband maltreated child or adolescent subject (28 males, 25 females), and for a comparison group of 46 sociodemographically, similar nonmaltreating families, including one proband healthy child and adolescent subject (22 males, 22 females). RESULTS: Mothers of maltreated children exhibited a significantly greater lifetime incidence of anxiety disorders (especially post-traumatic stress disorder), mood disorders, alcohol and/or substance abuse or dependence disorder, suicide attempts, and comorbidity of two or more psychiatric disorders, compared to control mothers. Natural fathers or mothers' live-in mates involved in maltreatment exhibited a significantly greater lifetime incidence of an alcohol and/or substance abuse or dependence disorder compared to controls. The majority of maltreated children and adolescents reported anxiety disorders, especially post-traumatic stress disorder (from witnessing domestic violence and/or sexual abuse), mood disorders, suicidal ideation and attempts, and disruptive disorders. Most maltreated children (72%) suffered from comorbidity involving both emotional and behavioral regulation disorders. CONCLUSIONS: Families involved in maltreatment manifest significant histories of psychiatric comorbidity. Policies which target identification and treatment of comorbidity may contribute to breaking the intergenerational transmission of maltreatment.

Adolescent↗

PubMed1996

Long-term impact of exposure to suicide: a three-year controlled follow-up.

OBJECTIVE: To determine the long-term impact of exposure to suicide on the friends of adolescent suicide victims. METHOD: One hundred sixty-six friends of suicide victims and unexposed community controls were followed up at periodic intervals up to 3 years after the suicide, using the Schedule for Affective Disorders and Schizophrenia for School-Age Children, Epidemiologic and Present Episode versions, to assess current and incident psychopathology. RESULTS: The incidence of suicide attempts was comparable between groups over the entire follow-up period, despite higher rates of baseline and incident psychopathology in the exposed group. An increased incidence of depression and anxiety was found in friends that was most marked in the first 6 months of follow-up. An increased incidence of posttraumatic stress disorder (PTSD) in those exposed was seen in the early as well as the later periods of follow-up. Those exposed youths who knew the suicide plans of the suicide victim were at the greatest risk for incident depression and PTSD over the entire course of follow-up. CONCLUSION: Exposure to suicide does not result in an increased risk of suicidal behavior among friends and acquaintances, but it has a relatively long impact in terms of increased incidence of depression, anxiety, and PTSD.

Adolescent↗

PubMed1996

The impact of adolescent suicide on siblings and parents: a longitudinal follow-up.

The psychiatric sequelae of loss of a family member to suicide were evaluated in parents and siblings of adolescent suicide victims and controls, who were followed up to 3 years after the suicide. Siblings did not show an increased risk for the development of depression, posttraumatic stress disorder (PTSD), or other conditions over the course of follow-up, despite showing a prolonged elevated level of grief symptomatology. Mothers showed an increased rate of recurrence of depression over follow-up, whereas fathers did not show an increased incidence of disorder compared to fathers of controls. The interrelationship of bereavement and depression for siblings, parents, and others exposed to suicide is discussed.

Adolescent↗

PubMed1996

Patterns of nitric oxide synthase expression in the developing superior colliculus.

Nitric oxide (NO) is synthesized in cells of both the central and peripheral nervous system and has been implicated in several forms of synaptic plasticity. The enzyme that produces NO, nitric oxide synthase (NOS), can be visualized in the brain by the reduced nicotinamide adenine dinucleotide phosphate diaphorase histochemistry technique (NADPH-d). We have used NADPH-d activity to detect the presence of NOS-positive cells in the developing rat superior colliculus. Our results showed that NOS is present in cells and neuropil in the developing and adult rat superior colliculus. The first NOS-positive cells appeared at postnatal day 7 and were weakly stained. The number and intensity of the NOS-positive cells increased progressively during the following days reaching a maximum at postnatal day 15. By the end of the third postnatal week, both the number and intensity of stained cells showed an adult-like pattern. The NOS-positive cells showed a Golgi-like morphology and we have found that all cell types present in the superior colliculus express the enzyme. The expression of NOS by tectal cells parallels the functional development of the retino-collicular and cortico-tectal projections and suggest that nitric oxide synthase-positive cells might be involved in this process. In this review we highlighted some of the recent descriptions of the expression of NOS in the mammalian visual system with emphasis in the superior colliculus and correlate these findings with several developmental events taking place in this structure.

Animals↗

PubMed1995

Posttraumatic stress disorder in peers of adolescent suicide victims: predisposing factors and phenomenology.

OBJECTIVE: To examine the factors predisposing to posttraumatic stress disorder (PTSD) in peers of adolescent suicide victims. METHOD: One hundred forty-six adolescents who were the friends of 26 suicide victims were studied. Five percent (n = 8) developed PTSD after exposure to suicide. These 8 subjects with PTSD were compared to the remainder of the exposed subjects (n = 138). RESULTS: Subjects with PTSD were more likely than those without PTSD to have had a history of substance abuse, agoraphobia, and suicide attempts. Subjects who developed PTSD were more likely to have developed a new-onset depression, to have more severe grief, and to have been closer to the suicide victim. Subjects with PTSD tended to have more severe exposure to suicide and came from discordant households with a history of disruptions in key relationships. The 8 subjects who developed PTSD were compared to 38 subjects who developed new-onset depression but not PTSD. Those with PTSD were more likely to have had past substance abuse, prior suicide attempts, family history of panic disorder, a history of parent-child disruption, and a history of loss. Symptoms of intrusive visual images, hypervigilance, and avoidance of reminders discriminated subjects who had PTSD from new-onset depressives without PTSD. CONCLUSIONS: PTSD is an expectable outcome in youth exposed to suicide. Further work is required to differentiate symptoms of depression from PTSD.

Adolescent↗

PubMed1994

Suicide in affectively ill adolescents: a case-control study.

Sixty-three adolescent suicide victims with a history of affective illness were compared to 23 adolescent community controls with a lifetime history of affective illness, using a case-control design. Suicide victims were more likely to have had major depression, comorbid substance abuse, a past suicide attempt, family history of major depression, treatment with a tricyclic antidepressant, history of legal problems, and a handgun available in the home. There was a non-significant trend for bipolar depression to convey a higher risk for completed suicide than unipolar depression. Recommendations for the prevention of suicide among those with early onset affective illness are discussed in light of these findings.

Adolescent↗

PubMed1994

Major depression or uncomplicated bereavement? A follow-up of youth exposed to suicide.

OBJECTIVE: To determine whether the depressive reactions experienced by youth exposed to suicide were uncomplicated bereavement or major depression by examining the longitudinal risk of recurrent major depression. METHOD: The 121 friends and acquaintances of 26 adolescent suicide victims were followed up 1 to 18 months after an initial interview that took place around 6 months after the death of the suicide victim. A demographically similar group of 138 unexposed controls was also followed up. RESULTS: The median duration of depression in the 37 subjects who became depressed after exposure was 8 months. The exposed group, compared with controls, had a higher rate of incident depression (RR = 1.7, 95% Cl = 1.0-2.8) during the follow-up period, even after adjustment for previous history of depression and other risk factors for depression. Within the group of exposed subjects, the rate of depression on follow-up was highest in those who developed a depressive disorder before exposure to suicide, intermediate in those who developed depression after exposure, and lowest in those who were not depressed at the first interview after exposure. There was no evidence of an increased incidence of suicide attempts in the exposed group relative to the unexposed controls on follow-up. CONCLUSIONS: The depressive reactions observed in youth exposed to suicide are most consistent with major depressive episodes on the basis of course and risk of recurrence. Exposure to suicide was associated with an increased risk of recurrent depression but not with an increased long-term risk of suicidal behavior.

Adjustment Disorders↗

PubMed1994

Familial risk factors for adolescent suicide: a case-control study.

Sixty-seven adolescent suicide victims and 67 demographically matched living controls were compared as to family constellation, familial stressors and familial loading for psychopathology. Suicide victims were less likely to have lived with both biological parents, were more likely to be exposed to stressors such as parent-child discord, physical abuse and residential instability and showed greater familial loading for depression and substance abuse. Multivariate analyses showed that family history of both depression and substance abuse and lifetime history of parent-child discord were most closely associated with adolescent suicide. Children who are the offspring of parents with depression or substance abuse should be psychiatrically screened. Family interventions to decrease discord may also be helpful in decreasing the risk of adolescent suicide.

Adolescent↗

PubMed1993

Firearms and adolescent suicide. A community case-control study.

OBJECTIVE: To assess the association between firearms in the home and adolescent suicide. RESEARCH DESIGN: Matched, case-control. SETTING: Population-based community sample. SUBJECTS: Sixty-seven adolescent suicide victims and a demographically matched group of 67 living community controls. SELECTION PROCEDURE: The series of adolescent suicide victims was consecutive, with an overall participation rate of 74% (67/91). MEASUREMENTS AND RESULTS: The presence, type (hand-gun vs long-gun), number, and method of storage (locked vs unlocked, loaded vs unloaded) of firearms in the home were compared between the suicide victims and controls. Even after adjusting for differences in rates of psychiatric disorders between suicide victims and controls, the association between suicide and both any gun (odds ratio [OR] = 4.4, 95% confidence interval [CI] = 1.1 to 17.5) and handguns (OR = 9.4, 95% CI = 1.7 to 53.9) in the home were both highly significant. Long-guns in the home were associated with suicide only in rural areas, whereas handguns were more closely associated with suicide in urban areas. Handguns (OR = 12.9, 95% CI = 1.5 to 110.9) and loaded guns (OR = 32.3, 95% CI = 2.5 to 413.4) in the home were particularly significant risk factors for suicide in those with no apparent psychiatric disorder. CONCLUSIONS: When pediatricians are faced with a suicidal adolescent, they should insist on the removal of firearms from the home. Pediatricians should also inform parents that the presence of firearms may be associated with adolescent suicide even in the absence of clear psychiatric illness.

Adolescent↗

PubMed1993

Psychiatric impact of the loss of an adolescent sibling to suicide.

Twenty-five adolescent siblings of 20 adolescent suicide victims were psychiatrically assessed 6 months after the suicide, and compared to 25 demographically matched controls. Siblings were much more likely to show a new-onset major depression subsequent to exposure to suicide. New-onset depression was associated with previous psychiatric disorder, family history of any psychiatric disorder, and family history of major depression. Mothers of suicide victims, compared to the mothers of controls, were also more likely to be depressed 6 months after the suicide of their child. The development of a family-based intervention for families of adolescent suicides is recommended.

Adaptation, Psychological↗

PubMed1993

Adolescent psychiatric inpatients' risk of suicide attempt at 6-month follow-up.

Adolescent inpatients (of whom 48 were admitted for a suicide attempt, 33 were admitted for suicidal ideation, and 53 had no history of clinically significant suicidal ideation or attempt), were interviewed while in the hospital and then followed up 6 months later. Of the 134 patients followed up, 13 (9.7%) had made a suicide attempt. The vast majority of those who attempted suicide had been suicidal while in the hospital (12/13 or 92.3%). Other risk factors for suicidal behavior include major depression at intake, affective disorder with nonaffective comorbidity, a depressive disorder that continued through follow-up, death of a relative, and family financial problems. Suicidal inpatients, particularly those with chronic and recurrent affective illness, are at substantial risk for making a suicide attempt within 6 months of discharge. At follow-up, an even higher proportion showed attempts or suicidal ideation with a plan (N = 36 or 26.8%), with risk factors similar to those noted above. More intense outpatient or partial hospital interventions as a transition from the inpatient environment may be necessary to reduce the rate of recidivism among suicidal adolescents.

Adolescent↗

PubMed1993

Suicide in adolescents with no apparent psychopathology.

OBJECTIVE: To delineate the characteristics of adolescent suicide victims with no apparent psychiatric disorder. METHOD: Seven adolescent suicide victims with no apparent disorder were compared with 60 suicide victims with definite or probable psychiatric disorder, and with 38 community controls with no psychiatric disorder. RESULTS: Suicide victims without psychiatric disorder, compared with the remainder of suicides showed lower rates of past psychiatric treatment, previous suicide attempt, family history of affective illness, total life stressors over the previous 12 months, and a greater prevalence of the availability of a loaded gun in the home. The seven suicide victims compared with the 38 psychiatrically normal community controls, showed a higher rate of familial psychiatric disorder, past suicidal ideation or behavior, legal or disciplinary problems in the past year, and firearms in the home, particularly those that were loaded. CONCLUSION: Even suicide victims without apparent psychiatric disorder still show some evidence of psychiatric risk factors compared with community controls. However, prevention of suicide in this group is probably best achieved by restriction of the availability of firearms, particularly loaded ones. The clinician should pay particular attention to suicidal risk in youth who are confronting legal or serious disciplinary crises and should take suicidal ideation seriously even in the absence of clear psychopathology.

Adolescent↗

PubMed1993

Psychiatric sequelae to the loss of an adolescent peer to suicide.

OBJECTIVE: This study was designed to learn whether friends and acquaintances of suicide victims were at increased risk for depression, post-traumatic stress disorder, and suicidal behavior after exposure to suicide. METHOD: The social networks of 26 adolescent suicide victims, consisting of 146 adolescents, were interviewed 7 months after the death of the suicide victim and compared with 146 matched, unexposed controls. RESULTS: The rates of these disorders that had onset after exposure were elevated in the exposed group vs. controls: major depression, post-traumatic stress disorder, suicidal ideation with a plan or an attempt, but not suicidal attempts. Almost all of those exposed youth who developed new-onset suicidality did so in the context of a new-onset depressive episode. The majority of these new-onset depressive disorders began within 1 month of exposure. CONCLUSION: Postvention programs not only should focus on the prevention of imitation of suicidal behavior, but also should provide longer term follow-up for potentially bereaved and depressed youth exposed to suicide.

Adolescent↗

PubMed1993

Psychiatric risk factors for adolescent suicide: a case-control study.

OBJECTIVE: The objective of this study was to determine the psychiatric risk factors for adolescent suicide. METHOD: Sixty-seven adolescent suicide victims were compared with 67 demographically matched community controls. Psychiatric disorder was assessed in suicide victims using a psychological autopsy protocol and in controls using similar semistructured psychiatric interviews. Risk factors were quantified by use of the odds ratio (OR), that is, the relative frequency of the occurrence of a given condition in the suicides compared with the controls. RESULTS: The most significant psychiatric risk factors associated with adolescent suicide were major depression (OR = 27.0), bipolar mixed state (OR = 9.0), substance abuse (OR = 8.5), and conduct disorder (OR = 6.0). Substance abuse was a more significant risk factor when comorbid with affective illness than when alone (OR = 17.0 versus 3.3). The majority of depressed suicide victims had a primary affective disorder (82%). A significant minority (31%) of depressed suicide victims had been depressed less than 3 months. Previous suicide attempts, suicidal ideation, and homicidal ideation also were associated with adolescent suicide. CONCLUSIONS: The development of effective treatments for youth who fit the above-noted risk profiles should be given high priority.

Adolescent↗

PubMed1993

Adolescent witnesses to a peer suicide.

OBJECTIVE: This case-control study attempts to evaluate the psychological impact of witnessing a suicide on high school students. METHOD: Twenty-eight high school students witnessed a firearms suicide and the serious injury of another student while riding a school bus. They were assessed 2 months after the event, and their responses were compared with 28 demographically similar adolescents from another community who had not been exposed to suicide. RESULTS: The exposed students, when compared with the controls, had higher rates of new-onset anxiety disorder and a trend for increased rates of new-onset post-traumatic stress disorder (PTSD). Within the exposed group, measures of the closeness of the relationship to both the suicide victim and the student who was injured were correlated with the severity of PTSD symptomatology. Within the exposed group, other factors that predisposed to new-onset disorder included family history of affective illness, family history of suicide attempt, and stressful life events occurring in the year before exposure. CONCLUSIONS: In combination with the extant literature, this study demonstrates that adolescents who witness a traumatic suicidal death are at risk for the development of psychopathology, specifically, anxiety disorders and PTSD.

Adolescent↗

PubMed1993

Bereavement or depression? The impact of the loss of a friend to suicide.

OBJECTIVE: To determine whether the depressive reactions experienced by youth exposed to suicide were uncomplicated bereavement or bona fide major depression. METHOD: In a sample of 146 friends and acquaintances of 26 adolescent suicide victims, 43 (29%) developed a depressive episode subsequent to exposure to suicide, 18 were depressed before exposure, and 85 were never depressed. The three groups were compared. RESULTS: Those who became depressed after exposure were similar to those who were depressed before exposure. Both depressed groups differed from the nondepressed exposed group with respect to functional impairment, depressive symptom pattern and severity, convergent validity with other measures of depression, personal and family history of depression, and stressful life events. Previous depressives showed greater comorbidity with nonaffective disorders than those who became depressed after exposure. Those who became depressed after exposure compared with both the previous and nondepressive had a closer relationship with the suicide victims, showed more severe grief, and showed more intense exposure to the suicide. CONCLUSIONS: Depressive reactions occurring after exposure to suicide appear to be bona fide major depression, occurring as a complication of bereavement. Youth exposed to suicide should be carefully screened and followed up. Should a symptomatic picture of depression and functional impairment ensue, such exposed youth should be treated accordingly for a major depressive episode.

Adolescent↗

PubMed1993

The validity of diagnoses obtained through the psychological autopsy procedure in adolescent suicide victims: use of family history.

A test of validity of the psychiatric diagnoses obtained by the psychological autopsy procedure is described in a consecutive series of 67 adolescent suicide victims. Family history of mental illness in first-degree relatives of subjects was obtained blind to subject diagnosis using the family history method. It was hypothesized that subjects with a given diagnosis, compared with subjects without this diagnosis, would show an increased rate of this disorder among first-degree relatives. This hypothesis was supported insofar as specific associations between subject diagnosis and familial rates of illness were demonstrated for major depression, bipolar illness, conduct and antisocial disorder and substance abuse. These results provide further support for the validity of diagnoses obtained through the psychological autopsy procedure.

Adolescent↗