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Biomedical subjects

J M Rey

Publications and source records attributed to J M Rey.

At least 19 recordsLinked to original sources
PubMed1997

A global scale to measure the quality of the family environment.

BACKGROUND: Simple, reliable measures of the quality of the environment in which a child was reared that can be used in clinical research and practice are lacking. METHOD: The reliability and validity of a global scale to retrospectively appraise the quality of that environment were examined. Fifty-three clinicians from 4 centers in Australia and 1 in Hong Kong, People's Republic of China, used the scale to rate 7 case vignettes; 4 clinicians rated 20 medical records, and 49 rated 211 subjects after clinical interviews. RESULTS: Interrater reliability (intraclass correlation coefficient) was 0.82 (time 1) and 0.84 (time 2) for case vignettes, 0.90 for medical records, and 0.89 for clinical interviews. Consistency in time was high (r = 0.91). Lower ratings, indicative of a less adequate environment, were associated with a clinical diagnosis of oppositional defiant or conduct disorder. CONCLUSIONS: Our simple-to-use scale appears to measure reliably a relevant clinical construct and fills a gap among the instruments available. Ratings may be useful as a cost-effective index to consider in outcome studies, when examining response to treatment, or in other clinical research.

Adolescent↗
PubMed1997

An epidemiological study of the use of ECT in adolescents.

OBJECTIVE: There is little knowledge about the use of electroconvulsive therapy (ECT) in adolescents. Given the prevalence and severity of psychiatric disorders in this age group, it is important to determine the frequency, indications, effectiveness, and side effects of ECT. METHOD: Persons younger than 19 years who received ECT between 1990 and 1996 in the Australian state of New South Wales were identified. Detailed information about diagnosis, treatment, and outcome was then obtained. RESULTS: Forty-two patients aged 14 to 18 years underwent a total of 49 courses comprising 450 ECTs (0.93% of all treatments given to all persons). Marked improvement or resolution of symptoms occurred in half of the completed courses. Mood disorders derived most benefit from ECT. Side effects were transient and minor. Prolonged seizures were observed in 0.4% of treatments. Comorbid personality disorder predicted poorer response, and the anesthetic propofol was associated with shorter seizures. CONCLUSIONS: Although ECT is an effective treatment for some mental disorders in adolescents and has few side effects, it is seldom used. Indications, response, and unwanted effects were similar to those observed in adults. The use of propofol may reduce the risk of prolonged seizures.

Adolescent↗
PubMed1997

Half a century of ECT use in young people.

OBJECTIVE: Pharmacological treatments for certain psychiatric disorders in young people are often ineffective and may cause major side effects; thus, it is important to investigate other treatments. This article reviews the literature on the efficacy and safety of ECT in this age group and examines the evidence for the suggestion that it may be used inappropriately. METHOD: All studies published in English and other languages on the use of ECT in persons 18 years of age or younger were obtained. The reports were systematically reviewed and rated according to the quality of the information in several domains, yielding an overall quality score for each study. Individual cases from each report were then examined and grouped according to diagnosis and response to ECT. RESULTS: Sixty reports describing ECT in 396 patients were identified; most (63%) were single case reports. The overall quality was poor but improved in the more recent studies. There were no controlled trials. Rates of improvement across studies were 63% for depression, 80% for mania, 42% for schizophrenia, and 80% for catatonia. Serious complications were very rare, whereas minor, transient side effects appeared common. CONCLUSIONS: ECT in the young seems similar in effectiveness and side effects to ECT in adults. However, this conclusion is qualified by the lack of systematic evidence. More research and education of professionals and the public are needed. It is suggested that ECT registers be set up, that surveys and controlled trials be conducted, and that seizure thresholds, the optimal anesthetic, effects of concurrent medications, and cognitive consequences of ECT in the young be investigated.

Adolescent↗
PubMed1997

Juvenile obsessive-compulsive disorder.

OBJECTIVE: To describe the characteristics of a series of children and adolescents with obsessive-compulsive disorder (OCD) and evaluate the outcome of treatment. METHOD: Type of symptoms, severity before and after treatment and factors associated with outcome were examined in a large group (n = 82) of consecutive OCD cases referred for treatment. RESULTS: Most children (95%) had both obsessions and compulsions. Symptoms had been present for 2 years on average. Seventy-one per cent (n = 57) of all eligible patients completed a combined behavioural and pharmacological protocol. Among these, there was a 68% remission rate and a 60% decrease of symptoms at 4 weeks. Comorbidity with oppositional defiant disorder and high aggression scores were associated with poor outcome. CONCLUSIONS: Juvenile OCD can be treated effectively in a standard clinical setting. Treatment programs of the kind described are accepted by young people. It remains to be seen whether in this age group a combined treatment produces better results than medication alone or cognitive-behaviour therapy alone.

Adolescent↗
PubMed1997

Referred adolescents as young adults: the relationship between psychosocial functioning and personality disorder.

OBJECTIVE: To examine the functioning of young adults who had been referred for psychiatric treatment during adolescence. METHOD: A group of 145 adolescents referred at a mean age of 14 years were interviewed at a mean age of 20 years to ascertain their functioning and whether they suffered from a personality disorder. RESULTS: Having a personality disorder was associated with poor functioning at follow-up independently of adolescent diagnosis. Antisocial personalities were typified by problems with the law, a poor work record and early cohabitation, while other personality disorders were characterised by social isolation and problems in interpersonal relationships. Poor quality of the family environment and having received treatment during the follow-up period were the only developmental variables associated with poor functioning. CONCLUSIONS: Developing a personality disorder and having a poor family environment, rather than having an adolescent disorder, appear to be the factors that result in poor functioning in young adults.

Adolescent↗
PubMed1995

Perceptions of poor maternal care are associated with adolescent depression.

This study sought to ascertain if depressed adolescents perceived their parents as less caring and more controlling than patients with other diagnoses, as reported for adults. Associations between perceptions of parenting, as measured by the Parental Bonding Instrument, and diagnosis were studied using groups of referred adolescents with major depression (n = 19), dysthymia (n = 41), oppositional disorder (n = 51), conduct disorder (n = 122), attention deficit disorder with hyperactivity (n = 55), separation anxiety (n = 38) and other anxiety disorders (n = 36). When the effects of other variables were statistically controlled, only adolescents with major depression showed an association with low maternal care.

Adolescent↗
PubMed1995

Functional enuresis: is desmopressin the answer?

OBJECTIVE: The efficacy of desmopressin in the treatment of functional enuresis, known for 15 years, has received very little attention in the psychiatric literature. This review seeks to remedy this and to asses critically its effectiveness, risks and side effects, as well as the implications for the understanding and management of enuresis. METHOD: Treatment trials, reports of unwanted effects, and literature on mechanisms of action were reviewed. RESULTS: Desmopressin is more effective than placebo in controlled trials, but only one quarter of patients become "dry." Individuals who wet the bed 4 nights per week or more can expect a one-third reduction in their wet nights with a single intranasal dose of desmopressin before bedtime. Relapse rates upon cessation of treatment are very high, while side effects appear to be few. However, there are increasing reports of hyponatremic seizures. There is a group of patients in which bed-wetting appears to be the result of insufficient nocturnal secretion of vasopressin. CONCLUSIONS: Desmopressin is a simple-to-use and effective drug for the treatment of nocturnal enuresis; it has opened important new avenues of inquiry, but more information is required about its long-term effectiveness and unwanted side effects.

Child↗
PubMed1995

Bedwetting and psychopathology in adolescents.

OBJECTIVE: To ascertain whether nocturnal enuresis in adolescents is associated with depression, hyperactivity, oppositionality, conduct and peer problems. METHODOLOGY: This was investigated cross-sectionally in adolescents aged 12-16 years from a community sample (n = 528) and a clinically referred cohort (n = 2325) using parents' reports. RESULTS: Referred adolescents were 7 times more likely to wet the bed than their community counterparts. There was a small but significant association between nocturnal enuresis and hyperactivity. Depressed adolescents were half as likely to wet the bed as those without depression. Bedwetters had more problems relating to peers but were not disliked more often. There was no association between bedwetting, oppositionality, conduct problems and gender. Gender differences disappeared when the effect of hyperactivity was controlled. CONCLUSIONS: Clinicians need to inquire about symptoms of attention deficit hyperactivity disorder in adolescents who present with enuresis and vice versa.

Adolescent↗
PubMed1995

Inter-rater reliability of global assessment of functioning in a clinical setting.

Four studies on the inter-rater reliability of a proposed Axis V version for DSM-IV and of the CGAS involving 162 child and adolescent patients and 20 clinicians showed moderate agreement (intraclass correlation: 0.53-0.66). This was comparable to previous versions of Axis V, but lower than that reported for the CGAS. More detailed description of anchor points did not increase reliability nor there were differences in agreement when rating current or previous functioning.

Achievement↗
PubMed1995

Continuities between psychiatric disorders in adolescents and personality disorders in young adults.

OBJECTIVE: Personality disorders are a major mental health problem, but little information about their etiology and natural history is available. This study examined continuities between axis I disorders in adolescents and personality disorders in young adults. METHOD: The authors interviewed 145 young adults (mean age, 19.6 years) who had been diagnosed with a variety of DSM-III emotional and disruptive disorders during adolescence (mean age, 13.7 years). The Personality Disorder Examination was used to establish whether the subjects currently suffered from personality disorders. RESULTS: Subjects who had had disruptive disorders during adolescence showed high rates of all types of personality disorders (40% had a personality disorder at follow-up), while subjects who had had emotional disorders had a lower rate of personality disorders (12%). Men were more likely to have cluster A personality disorders, and women were more likely to have cluster C personality disorders. Disruptive diagnoses were associated with cluster B personality disorders, but emotional disorders did not show an association with cluster C personality disorders. Oppositional disorder did not increase the likelihood of passive-aggressive personality disorder. There was an association between attention deficit disorder with hyperactivity and borderline personality disorder. CONCLUSIONS: The rate of personality disorders was lower among young adults who had had emotional disorders during adolescence than among those who had had disruptive disorders, suggesting either that treatment for emotional disorders is more effective or that the personality psychopathology in these adolescents is not as severe as that in adolescents with disruptive disorders.

Adolescent↗
PubMed1994

Comorbidity between disruptive disorders and depression in referred adolescents.

Parent questionnaires from large Australian (N = 2093) and American (N = 500) clinic cohorts of adolescents were used to diagnose depression, attention deficit disorder with hyperactivity, and oppositional and conduct disorders. Co-occurrence of diagnoses was very high. Comorbidity between depression and conduct disorder was not higher than that expected for any psychiatric disorder (odds ratios = 1.20 and 1.45 respectively for each cohort) while comorbidity between attention deficit disorder with hyperactivity and oppositional disorder was higher than expected (odds ratios = 7.03 and 9.02) but comparable to that between conduct and oppositional disorder (odds ratios = 7.35 and 6.14). Co-occurrence of depression with other disorders did not increase the likelihood of comorbid conduct disorder.

Adolescent↗
PubMed1994

Child and adolescent psychiatric services: case audit and patient satisfaction.

A system for the monitoring and review of a large number of cases seen for assessment and outpatient treatment by a multidisciplinary child and adolescent psychiatric service is described. The system permits monitoring of all cases to closure, and clinical review of treatment for those cases whose outcomes are judged unsatisfactory by the treating clinician. It also allows monitoring of those cases in which there was patient dissatisfaction with the service, as expressed in a patient satisfaction questionnaire. The system of review has gained the acceptance of the clinical team, who are involved in its continued improvement.

Adolescent↗
PubMed1993

Enzymatic activities of Dermatophilus congolensis measured by API ZYM.

API ZYM kit was used to test enzymatic activities on eighteen strains of Dermatophilus congolensis. All strains produced lipase and acid phosphatase, which act on lipids, and leucine arylamidase which act on proteins. Another 10 exoenzymes were present in at least one of the strains.

Actinomycetales↗
PubMed1993

Parental evaluation of treatment outcome and satisfaction with an inpatient program for eating disorders.

This study is concerned with the service provided to adolescent patients with eating disorders admitted to a private hospital. The patients' parents were asked to evaluate the service. Parental satisfaction was assessed by means of a questionnaire devised for this purpose and comments were elicited as to how the service could be improved. Parents of a consecutive series of 56 patients were asked to complete the questionnaire 6 months after admission; 82% (N = 46) responded. Most parents were pleased with the service provided but nevertheless many made some criticisms (35%) or suggestions for improvement (37%). The parental responses were discussed with the staff involved in treatment, resulting in changes to the service.

Adolescent↗
PubMed1993

Are oppositional and conduct disorders of adolescents separate conditions?

This study explores the factor structure of behaviours that correspond to symptoms of DSM-III-R oppositional defiant (OD) and conduct disorder (CD). It also seeks to clarify how those hypothetical factors may relate to diagnoses of OD and CD. Using exploratory factor analysis and cluster analysis of parent questionnaire data from a group of referred adolescents (N = 528) diagnosed according to DSM-III criteria the authors extracted four factors. One of them corresponded closely to DSM-III-R OD, while the others comprised different aspects of the CD construct. The findings suggest there are subtypes of conduct problems in adolescents, and give some support to the distinction between conduct and oppositional disorders.

Adolescent↗
PubMed1993

Effects of gender, age and diagnosis on perceived parental care and protection in adolescents.

To assess whether perceived parental care and protection varied according to age and gender of the child and whether they were associated with psychiatric diagnoses, these constructs were measured with the Parental Bonding Instrument in a cohort of non-referred adolescents (n = 762), in a clinically referred cohort (n = 1299), and in a group of adolescents from the referred cohort (n = 365) for whom DSM-III diagnoses were available. Significant differences in parental care and protection according to clinical status, age, gender and diagnosis were found. However, perceived parental affectionless control was not associated with emotional disorders in adolescents, contrary to reports in adult subjects, but with clinical status.

Adolescent↗
PubMed1993

Oppositional defiant disorder.

OBJECTIVE: Oppositional defiant disorder is a common clinical diagnosis that has attracted little research interest, and doubts about its validity as a distinct category remain. However, it underwent substantial changes from DSM-III to DSM-III-R, and more are proposed for DSM-IV. The objective of this study was to review the literature on this condition to establish its place in the psychiatric nosology. METHOD: The terms used in computerized searches of the literature included "oppositional disorder," "oppositional defiant disorder," and "oppositional behavior." Publications found by these searches were supplemented with references in articles, searches in the epidemiological literature, and noncomputerized searches. RESULTS: Findings of studies in which multivariate analyses were used support a distinction between oppositional defiant disorder and conduct disorder. In these studies, one-third of all community-based children with any psychiatric condition had a diagnosis of oppositional defiant disorder and used mental health services often. Symptoms of oppositional defiant disorder appear to be stable over time and to have a developmental profile and sex distribution different from those of conduct disorder. The reliability of the diagnosis is low. CONCLUSIONS: There is some support for oppositional defiant disorder as a category that reflects an oppositional-aggressive psychological dimension, which is different from a delinquent dimension. There is little evidence for making oppositional defiant disorder a part of the construct of conduct disorder and for making "lying" a criterion for it. Considerable impairment should be required for the diagnosis. A more detailed description of symptoms, including a threshold for considering them present, may increase reliability of the diagnosis.

Aggression↗