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Biomedical subjects

M A Riddle

Publications and source records attributed to M A Riddle.

At least 73 records · Page 4Linked to original sources
PubMed1990

Fluoxetine treatment of children and adolescents with Tourette's and obsessive compulsive disorders: preliminary clinical experience.

Fluoxetine hydrochloride is the first selective serotonin uptake inhibitor introduced commercially in the United States. This report describes preliminary clinical experience with fluoxetine in 10 children and adolescents, aged 8 to 15 years, with primary obsessive compulsive disorder (OCD) or Tourette's syndrome (TS) plus OCD. In general, fluoxetine, which was administered from 4 to 20 weeks at a dosage of 10 or 40 mg per day, was well tolerated. Adverse effects included behavioral agitation/activation in four patients and mild gastrointestinal symptoms in two patients. No abnormalities were noted in the seven children who had follow-up EKGs. Five of the 10 patients (50%) were considered responders; their obsessive-compulsive symptoms decreased substantially during treatment with fluoxetine. Responder rates were similar in the primary OCD (two of four, 50%) and TS + OCD (three of six, 50%) groups. In conclusion, short-term fluoxetine administration appears to be safe in children and adolescents. Placebo-controlled trials are needed to further assess the efficacy of fluoxetine.

Adolescent↗
PubMed1990

Obsessive compulsive disorder in children and adolescents: phenomenology and family history.

Phenomenology and family history in 21 clinically referred children and adolescents with obsessive compulsive disorder are described. Each child and family participated in a standard clinical psychiatric assessment. The most frequently reported symptoms were repeating rituals, washing, ordering and arranging, checking, and contamination concerns. Controlling behaviors involving other family members were seen in 57% of the patients. Associated psychopathology was common: 38% received an anxiety disorder diagnosis; 29% received a mood disorder diagnosis; tics were observed in 24%. Fifteen (71%) of the children had a parent with either obsessive compulsive disorder (N = 4) or obsessive-compulsive symptoms (N = 11). The clinical and research implications of these findings are discussed.

Adolescent↗
PubMed1990

The role of advanced technology in inpatient child psychiatry: leading edge or useful aid?

New technology has played a catalytic role in advancing understanding of etiology, diagnosis, and treatment in virtually all fields of medicine. Child psychiatry, a relatively new medical specialty, has begun to employ such advanced technology in diagnosis and treatment monitoring. This current study demonstrates that, in an inpatient child psychiatric setting, such advanced technology has a positive diagnostic yield of 5% for new medical diagnoses and a cost of about 0.5% of the hospital bed cost. Other tests, such as psychotropic blood level monitoring and psychometric evaluation of cognitive functioning, have a much higher yield.

Adolescent↗
PubMed1990

Beyond the serotonin hypothesis: a role for dopamine in some forms of obsessive compulsive disorder?

It seems unlikely that a solitary disturbance in serotonin function can fully account for the pathophysiology of obsessive compulsive disorder. The authors propose that some forms of obsessive compulsive disorder, e.g., obsessive compulsive disorder with a history of Tourette's syndrome, may involve a relative or absolute derangement in both brain serotoninergic and dopaminergic systems. A role for dopamine in the pathophysiology of obsessive compulsive disorder is supported by a review of the preclinical and clinical evidence. Additional studies are needed to more directly evaluate dopamine function in patients with obsessive compulsive disorder.

Dopamine↗
PubMed1989

Plasma debrisoquin levels in the assessment of reduction of plasma homovanillic acid. The debrisoquin method.

Plasma concentrations of unconjugated homovanillic acid (pHVA) reflect both central nervous system (CNS) and peripheral dopamine metabolism. Debrisoquin sulfate (DBQ) blocks peripheral, but not CNS, production of HVA from dopamine. Administration of DBQ has been used to decrease the proportion of peripherally produced HVA in pHVA measurements, making such measurements more reflective of CNS turnover of dopamine. We studied the relationships between DBQ dose, plasma DBQ (pDBQ) levels, and changes in pHVA in a group of 21 subjects (9 normal controls and 12 with Tourette's syndrome). DBQ dose was moderately correlated with pDBQ levels (r = 0.63, p = 0.002). Subjects (n = 8) with mean pDBQ levels above 60 ng/ml had a 48% to 66% decrease in mean pHVA levels; this may reflect nearly complete inhibition of peripheral HVA production. Subjects (n = 13) with mean pDBQ levels below 55 ng/ml had decreases in pHVA levels from 10% to 58%. No debrisoquin was detected in cerebrospinal fluid samples. These data suggest that pDBQ levels above 60 ng/ml are sufficient to assure substantial inhibition of peripheral HVA production and that monitoring pDBQ levels may be useful when employing this method for studying CNS metabolism.

Adult↗
PubMed1989

Research on a children's psychiatric inpatient service.

It is widely recognized that child psychiatry needs to expand its research enterprise. Psychiatric inpatient units that serve children and adolescents should serve important roles in clinical research in child psychiatry. This paper reviews the need for research on the nature and treatment of psychiatric disorders on children's psychiatric inpatient services and discusses the resources necessary for a productive inpatient research program. The intrinsic relationship between clinical care and clinical study is emphasized.

Child↗
PubMed1989

The Yale Global Tic Severity Scale: initial testing of a clinician-rated scale of tic severity.

Despite the overt nature of most motor and phonic tic phenomena, the development of valid and reliable scales to rate tic severity has been an elusive goal. The Yale Global Tic Severity Scale (YGTSS) is a new clinical rating instrument that was designed for use in studies of Tourette's syndrome and other tic disorders. The YGTSS provides an evaluation of the number, frequency, intensity, complexity, and interference of motor and phonic symptoms. Data from 105 subjects, aged 5 to 51 years, support the construct, convergent, and discriminant validity of the instrument. These results indicate that the YGTSS is a promising instrument for the assessment of tic severity in children, adolescents and adults.

Adolescent↗
PubMed1989

Fluoxetine overdose in an adolescent.

The response to and management of an acute ingestion of a large quantity of fluoxetine hydrochloride in a 13-year-old boy with Tourette's syndrome and obsessive compulsive disorder is described. The patient's symptomatic course following the ingestion included a grand mal seizure, depressed ST segments on EKG, nausea, dizziness, and headache. In general, the fluoxetine was well tolerated: all of the symptoms and signs remitted spontaneously.

Adolescent↗
PubMed1989

Childhood comorbidity of anxiety/affective disorders and behavior disorders.

Considerable data have been reported concerning comorbidity of various individual psychiatric disorders in children within the diagnostic supradomains of affect/anxiety disorders and behavior disorders as well as between these supradomains. To further examine such comorbidity, 35 psychiatrically hospitalized children were studied in terms of the prevalence of comorbidity, demographic and cognitive characteristics, adaptive functioning and maladaptive behaviors. The prevalence of comorbid behavior + affect/anxiety disorders exceeded 50% of the samples. Children with such comorbidity were similar to children with Behavior only diagnoses in terms of demographic and cognitive characteristics but differed in terms of adaptive functioning and maladaptive behaviors.

Anxiety Disorders↗
PubMed1988

Plasma MHPG: within- and across-day stability in children and adults with Tourette's syndrome.

Within- and across-day stability of unconjugated plasma 3-methoxy-4-hydroxyphenethyleneglycol (pMHPG, the major metabolite of norepinephrine) levels were assessed in several subgroups of 47 primarily child and adolescent subjects with Tourette's syndrome (TS). Mean morning pMHPG levels remained stable over a 20-min period from 8:30 to 8:50 AM at 3.5 +/- 0.8 ng/ml. However, the mean intraindividual fluctuation in pMHPG levels over 20 min was +/- 12%. Mean pMHPG levels remained stable in the morning from 8:00-8:30 AM to noon. However, an 11% decrease (p less than 0.01) in mean pMHPG levels was observed in the afternoon between noon and 3:00-4:00 PM. Monitored on consecutive days, mean morning pMHPG levels fell 12% (p less than 0.002). The afternoon and across-day falls in pMHPG levels observed in this study of primarily children and adolescents with TS have not been observed in studies of adult control subjects. The results suggest that the design of research protocols involving children and adolescents that use pMHPG should take into consideration the effects of time, both within- and across-day, in pMHPG levels.

Adolescent↗
PubMed1988

Elevated CSF dynorphin A [1-8] in Tourette's syndrome.

A recent neuropathological study has reported decreased levels of dynorphin A immunoreactivity in striato-pallidal fibers in the brain of a patient with severe Gilles de la Tourette's syndrome (TS). This observation, taken with the neuroanatomic distribution of dynorphin and its broad range of motor and behavioral effects, has led to speculation concerning its role in the pathobiology of TS. We report on the presence of elevated concentrations of dynorphin A [1-8] in the CSF of 7 TS patients, aged 20 to 45 years. The increase in CSF dynorphin was found to be associated with the severity of the obsessive compulsive symptoms but not with tic severity in these patients. Although CSF studies lack the precision necessary to address questions of selective involvement of neuronal system in specific CNS locations, these findings suggest that endogenous opioids are involved in the pathobiology of TS and related disorders. Tourette's syndrome (TS) is a chronic neuropsychiatric disorder of childhood onset that is characterized by multiple motor and phonic tics that wax and wane in severity and an array of behavioral problems including some forms of obsessive compulsive disorder (OCD) (1). Once thought to be a rare condition, the prevalence of TS is now estimated to be one case per 1,000 boys and one case per 10,000 girls, and milder variants of the syndrome are likely to occur in a sizeable percentage of the population (2). Although the etiology of TS remains unknown, the vertical transmission of TS within families follows a pattern consistent with an autosomal dominant form of inheritance (3,4). Neurobiologic and pharmacological data have implicated central monoaminergic and neuropeptidergic systems in the pathophysiology of TS, and basal ganglia structures remain the prime candidates as the neuroanatomical origin for TS and related conditions (1). Endogenous opioids, including dynorphin and met-enkephalin are concentrated in structures of the basal ganglia (5), are known to interact with central dopaminergic neurons (6, 7), and may play an important role in the control of motor functions (8). Post-mortem brain studies have directly implicated opioids in the pathophysiology of Parkinson's disease (9), Huntington's disease (10), and most recently in TS (11). The neuropathological study of Haber et al. (11) reported decreased levels of dynorphin A [1-17] immunoreactivity in striatal fibers projecting to the globus pallidus in the brain of a patient with severe TS. This ovservation, taken with the neuroanatomic distribution of dynorphin and its broad range of motor and behavioral effects, has led to speculation concerning its role in the pathobiology of TS.(ABSTRACT TRUNCATED AT 400 WORDS)

Dynorphins↗
PubMed1988

The ontogeny of 3,4-dihydroxyphenylacetic acid in human cerebrospinal fluid.

Measurement of cerebrospinal fluid (CSF) levels of the minor dopamine metabolite 3,4-dihydroxyphenylacetic acid in neonates and children indicates that a rapid decline (approximately 90%) occurs in the first 2 years of life. The much less rapid ontogenetic decline seen for the predominant dopamine metabolite, homovanillic acid (HVA), indicates that differing factors affect CSF levels of the two acid metabolites. Further study is required to determine which compound more closely reflects ontogenetic changes in dopamine functioning.

3,4-Dihydroxyphenylacetic Acid↗
PubMed1987

Plasma-free homovanillic acid: within- and across-day stability in children and adults with Tourette's syndrome.

Within- and across-day stability of plasma-free homovanillic acid (pHVA) was assessed in children and adults with Tourette's syndrome. A diurnal fall in pHVA was observed in 13 of 15 subjects. There was a small but significant (p less than .0001) decrease (8%) in mean morning pHVA levels obtained just 20 minutes apart (8:30 A.M. and 8:50 A.M.). A substantial and significant (p less than .001) mean decrease in pHVA (25%) was observed when samples obtained between 8:00 and 8:30 A.M. were compared with samples obtained at 12:00 noon. Changes in pHVA levels observed during the afternoon (between 12:00 noon and 4:00 P.M.) were small, nondirectional, and nonsignificant. Repeated measurement of morning pHVA in the same individual after 24 or more hours revealed marked increases or decreases in many individuals, suggesting that morning pHVA is not a stable measure. The results of this and previous studies suggest that pHVA obtained at 12:00 noon or later in the day may be a more reliable measure of centrally produced HVA. Further studies are needed regarding the stability of pHVA over time.

Adolescent↗