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Effect of vitamin D and calcium on bone mineral density in children with CP and epilepsy in full-time care.

Atraumatic fractures are often seen in children and adolescents with cerebral palsy (CP) and epilepsy in full-time care. Increased bone fragility was postulated to be due to osteopenia resulting from a combination of factors including immobilization and antiepileptic treatment. The aim of this study was to determine the effect of vitamin D and calcium substitution on bone mineral density (BMD) in a group of children with CP in full-time care. Twenty children with the most severe form of CP (spastic quadriplegia) who had been treated with antiepileptic drugs for a relatively long period of time were included in the study. Physical examination and laboratory analyses excluded other possible causes of osteopenia. BMD was measured by dual X-ray absorptiometry. Thirteen patients were treated for 9 months with 1,25-dihydroxy-cholecalciferol vitamin D (0.25 mcg daily) and with calcium (500 mg daily). Seven control children were used for observation only. BMD greatly increased in the treated group, while children with CP in full-time care who did not receive vitamin D and calcium substitution continued to lose their bone mass. It can be concluded that the addition of vitamin D and calcium increases BMD in children with the most severe form of CP, who are receiving antiepileptic drugs.

Absorptiometry, Photon↗

Mental health and juvenile justice: moving toward more effective systems of care.

This issue brief discusses the mental health needs of youth who are involved with the juvenile justice system, how they come into contact with the system, and the evidence of the availability and quality of mental health services for such youth. The paper also explores public policy options for avoiding dependence on the juvenile justice system as a last resort for treating youth with mental disorders.

Adolescent↗

[The adolescent and the asylum].

For reasons often multiple, it can happen that the adolescent finds himself/herself hospitalised in an asylum. Ever since Pinel, the asylum strives if not towards curing at least towards resocialization. This resocialization is carried out in a very particular way: Desire Orthopaedics. Such orthopaedics is responsible for chronification and only through a listening process could it be curative.

Adolescent↗

Dental caries experience and periodontal status of handicapped institutionalised black high school pupils in Soshanguve, Pretoria.

This study compares the oral health status, as reflected by caries experience and periodontal status, of 3 cohorts of institutionalised handicapped pupils. The 3 groups of impairments studied were physical, visual and aural disability. 267 institutionalised handicapped high school pupils were examined. 163 (61 per cent) were physically, 84 (31.5 per cent) visually, and 20 (7.5 per cent) aurally handicapped. 34 per cent of the study population was caries-free with a mean DMFT of 2.63. There was no statistically significant difference (p greater than 0.05) between the caries experience of the three handicapped groups. Similarly no significant difference (p greater than 0.05) was observed between males and females. More than half of the calculus accumulation occurred among the physically disabled. At the 90 per cent confidence interval there was no significant difference in bleeding and shallow pocketing among the three groups. However, there was a significant difference for the presence of calculus. The physically disabled pupils consistently indicated the highest proportion of bleeding, calculus accumulation and shallow pocketing.

Adolescent↗

[Therapeutic methods used in psychiatric departments and homes for children and adolescents in Norway].

In November 1988 a point prevalence questionnaire study was carried out to evaluate which methods of treatment were given to child and adolescent psychiatric inpatients in Norway. Special emphasis was laid on to what extent psychotropic drugs are prescribed. All child and adolescent psychiatric institutions participated in the study and completed questionnaires on every inpatient on one particular day, 295 patients in all. The study confirms the family-oriented approach within child psychiatry and discredits the notion that children are drugged by psychiatrists. The study raises the question of how the chain of treatment should be organized to optimalize the available resources, and how methods should be differentiated in regard to the different diagnostic groups. It also emphasizes the need for continuous evaluation of the therapeutic activity.

Adolescent↗

[Evaluation of the institutional setting on psychotic adolescents. Psychoanalytic approach].

Based on a statistical check of how certain teenage psychotics have changed, these changes, even mutative effects on these kinds of problems because of steps taken in the institutional setting, were examined. Within the framework of the mental-health facility, through compulsive repetition, a process implicating both patient and healer in their interrelationship and the possibility of talking about family problems are developed. In the same way, such a setting allows a patient's virtualities to come out and be used because of the objective, transitional and narcissistic aspects that these various opportunities bring into play. Several clinical examples are given, regarding dialectic articulation, with their theory highlighted. The idea of accepting one's own exaggerated narcissism turns out to be fundamental in realizing a teenager's psychotic problems as much as different diachronic and synchronic ways of action, so that, without playing with language, we can qualify the setting as therapeutic.

Adolescent↗

[Narcissism vs narcissism. An attempt to analyze an institutional sequence].

A institution has its own psychic apparatus, its own narcissism which it is important to recognize and try to analyse to the extent that they condition the therapeutic capabilities of the treatment team. Taking psychotics in at an institution allows them to re-live "crises", which can be revealing echoes of what is being played out on the level of family narcissism. In this article, this kind of session is suggested because analyzing it shows how the appearance and resolution of such crises can turn out to be beneficial to the progress of psychotic teenagers.

Adolescent↗