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Biomedical subjects

Jon A Shaw

Publications and source records attributed to Jon A Shaw.

12 recordsLinked to original sources
PubMed2005

A 10-year prospective study of prodromal patterns for bipolar disorder among Amish youth.

OBJECTIVE: Prospective study of well children at risk of bipolarity to identify the frequency and pattern of potentially prodromal symptoms/behaviors for bipolar disorder type I (BPI) disorder. METHOD: A total of 110 at-risk children with a BPI parent and 112 children with well parents were studied. Ten-year data collection used structured and semistructured annual interviews covering developmental, medical, and behavioral features. Randomized histories for 222 children were submitted blindly for risk rating of bipolarity by a panel of clinicians. RESULTS: Children in the bipolar sample had an overall risk rating of 41% as compared with 16% for control children. Features noted more frequently among the at-risk group were anxious/worried, attention poor/distractable in school, easily excited, hyper alert, mood changes/labile, role impairment in school, somatic complaints, and stubborn/determined. Five additional manic-like behaviors became more evident among at-risk adolescents at the 10-year follow-up: high energy, decreased sleep, problems with thinking/concentration, and excessive and loud talking. CONCLUSIONS: The children of a parent with BPI manifested, episodically, mini clusters of potentially prodromal characteristics more frequently than the children of normal controls. None of these children met any of the sets of diagnostic criteria for prepubertal bipolar disorder.

Adolescent↗
PubMed2005

A pathway to spirituality.

The phenomenology of mystical experiences has been described throughout all the ages and in all religions. All mystical traditions identify some sense of union with the absolute as the ultimate spiritual goal. I assume that the pathway to both theistic and secular spirituality and our readiness to seek a solution in a psychological merger with something beyond the self evolves out of our human experience. Spirituality is one of man's strategies for dealing with the limitations of the life cycle, separation and loss, biological fragility, transience, and non-existence. Spirituality may serve as the affective component to a belief system or myth that is not rooted in scientific evidence but is lived as if it is true. Spirituality may take many forms, but I will suggest that in some instances it may serve as a reparative process in which one creates in the external world, through symbolic form, a nuance or facet of an internalized mental representation which has become lost or is no longer available to the self; or it may represent the continuity of the self-representation after death through a self-object merger. Lastly I will illustrate from the writings of two of our greatest poets, Dante Alighieri and William Wordsworth, how their poetry became interwoven with a profound spirituality. In Dante we will see the elaboration of a religious spirituality, while in the writings of Wordsworth a secular spirituality emerges interwoven with nature and belatedly his identification with "tragic man" as his mythos.

Attitude↗
PubMed2004

Practice parameter for the assessment and treatment of children and adolescents with enuresis.

Enuresis is a symptom that is frequently encountered in child psychiatric evaluations. Careful assessment is required to identify specific urologic, developmental, psychosocial, and sleep-related etiologies. For most children with enuresis, however, a specific etiology cannot be determined. Treatment then involves supportive approaches, conditioning with a urine alarm, or medications--imipramine or desmopressin acetate. The psychosocial consequences of the symptom must be recognized and addressed with sensitivity during the evaluation and treatment of enuresis.

Adolescent↗
PubMed2004

Practice parameter for use of electroconvulsive therapy with adolescents.

Electroconvulsive therapy (ECT) may be an effective treatment for adolescents with severe mood disorders and other Axis I psychiatric disorders when more conservative treatments have been unsuccessful. ECT may be considered when there is a lack of response to two or more trials of pharmacotherapy or when the severity of symptoms precludes waiting for a response to pharmacological treatment. The literature on ECT in adolescents, including studies and case reports, was reviewed and then integrated into clinically relevant guidelines for practitioners. Mood disorders have a high rate of response to ECT (75%-100%), whereas psychotic disorders have a lower response rate (50%-60%). Consent of the adolescent's legal guardian is mandatory, and the patient's consent or assent should be obtained. State legal guidelines and institutional guidelines must be followed. ECT techniques associated with the fewest adverse effects and greatest efficacy should be used. The presence of comorbid psychiatric disorder is not a contraindication. Systematic pretreatment and posttreatment evaluation, including symptom and cognitive assessment, is recommended.

Adolescent↗
PubMed2003

Children exposed to war/terrorism.

This paper reviews the prevalence of psychological morbidities in children who have been exposed to war-related traumas or terrorism as well as the diversity of war-related casualties and their associated psychological responses. The psychological responses to war-related stressors are categorized as (1) little or no reaction, (2) acute emotional and behavioral effects, and (3) long-term effects. Specific categories of war-related casualties discussed include refugee status, traumatic bereavement, effects of parental absence, and child soldiers. Psychological responses associated with terrorism and bioterrorism are presented. Lastly, mediators of the psychological response to war-related stressors are discussed, to include exposure effects, gender effects, parental, family and social factors, and child-specific factors. Children exposed to war-related stressors experience a spectrum of psychological morbidities including posttraumatic stress symptomatology, mood disorders, externalizing and disruptive behaviors, and somatic symptoms determined by exposure dose effect. Specific questions for future research are identified.

Bereavement↗
PubMed2003

Prospective study of prodromal features for bipolarity in well Amish children.

OBJECTIVE: A prospective study of psychiatrically well Amish children to determine differences in the frequency and pattern of clinical features that may be prodromal for bipolar I disorder. METHOD: Children with a bipolar I parent (n = 100) and children of well parents in a matched control sample (n = 110) were assessed annually for 7 years with semistructured interviews covering medical/developmental features and symptoms/behaviors that are possibly prodromal for bipolarity. Randomized histories of these 210 children were evaluated blindly by 4 clinicians for independent ratings of risk for bipolarity. RESULTS: Thirty-eight percent of the children of bipolar parents were rated as at risk compared with 17% of children in the control sample. Most control sample children with risk ratings had well parents with a bipolar sibling (i.e., family history positive). Children with family histories negative for mental illness rarely received even a low risk rating. Clinical features significantly (p <or=.05) more frequent among children of a bipolar parent included mood lability, low energy, anxious/worried, hyper-alert, attention problems/distractible and school role impairment, easily excited, sensitivity, somatic complaints, and stubborn/determined. CONCLUSION: Mini-clusters of early possible predictors suggest a natural history of episodic prodromal features rather than the chronic symptom pattern sometimes described for children at risk for bipolar disorder.

Adolescent↗
PubMed2002

Practice parameter for the prevention and management of aggressive behavior in child and adolescent psychiatric institutions, with special reference to seclusion and restraint.

This parameter reviews the current state of the prevention and management of child and adolescent aggressive behavior in psychiatric institutions, with particular reference to the indications and use of seclusion and restraint. It also presents guidelines that have been developed in response to professional, regulatory, and public concern about the use of restrictive interventions with aggressive patients with regard to personal safety and patient rights. The literature on the use of seclusion, physical restraint, mechanical restraint, and chemical restraint is reviewed, and procedures for carrying out each of these interventions are described. Clinical and regulatory agency perspectives on these interventions are presented. Effectiveness, indications, contraindications, complications, and adverse effects of seclusion and restraint procedures are addressed. Interventions are presented to provide more opportunities to promote patient independence and satisfaction with treatment while diminishing the necessity of using restrictive procedures.

Adolescent↗
PubMed2002

Practice parameter for the use of stimulant medications in the treatment of children, adolescents, and adults.

This practice parameter describes treatment with stimulant medication. It uses an evidence-based medicine approach derived from a detailed literature review and expert consultation. Stimulant medications in clinical use include methylphenidate, dextroamphetamine, mixed-salts amphetamine, and pemoline. It carries FDA indications for treatment of attention-deficit/hyperactivity disorder and narcolepsy.

Adolescent↗
PubMed2002

Risk factors for psychosocial dysfunction among enrollees in the State Children's Health Insurance Program.

OBJECTIVE: The authors studied enrollees in the State Children's Health Insurance Program (SCHIP) (Title XXI) to characterize risk factors for psychosocial dysfunction among children of the working poor. METHODS: Medical and psychosocial variables were included in a survey completed by 393 parents of children enrolled in SCHIP. Regression analysis was used to examine the relationship between these variables and scores on the Pediatric Symptom Checklist, a measure of psychosocial dysfunction among children. RESULTS: Stepwise multiple regression showed that parental dysphoria, parental history of psychiatric or substance use problems, childhood chronic medical illness, and exposure to traumatic events each contributed independently to variance in psychosocial dysfunction in this population, explaining 34 percent of total variance. CONCLUSIONS: Despite strong progress in implementing SCHIP at the state level, the behavioral health care needs of children of the working poor have not been well defined. This study identified risk factors that can be easily found in the patient's medical record or detected during an interview by the primary care physician. Thus screening to identify children at risk of psychosocial dysfunction is warranted among SCHIP enrollees.

Adolescent↗
PubMed2002

Aggressive adolescents benefit from massage therapy.

Seventeen aggressive adolescents were randomly assigned to a massage therapy group or a relaxation therapy group to receive 20-minute therapy sessions, twice a week for five weeks. The massaged adolescents had lower anxiety after the first and last sessions. By the end of the study, they also reported feeling less hostile and they were perceived by their parents as being less aggressive. Significant differences were not found for the adolescents who were assigned to the relaxation group.

Adolescent↗