Patterns of childhood psychiatric disorders in India

Epidemiological studies on the prevalence and patterns of childhood psychiatric disorders in India are practically non-existent. The present study was carried out to systematically analyse the demographic and diagnostic variables relating to the children attending the child guidance clinic over three consecutive years. There was predominance of males, within an age range of 6–14 years. The commonest problem seen was mental retardation (30%) followed by epilepsy (16%). Of the emotional disorders, most frequently encountered was neuroses. Relatively fewer cases were seen of conduct disorder, emotional disorders specific to childhood, hyperkinetic syndrome or specific developmental delays.     

Anxiety and mood disorders in children and adolescents: A practice update

Anxiety and mood disorders are among the most common disorders in children and adolescents. They presage later emotional difficulties and disabilities. An understanding of the disorders’ presentation, common contributing factors and methods of intervention will enable paediatricians and family doctors to provide optimal support to these children and their families. The present paper briefly reviews the epidemiology of anxiety and mood disorders in children and adolescents. Phenomenology is referred to according to the major diagnostic categories for anxiety and depression. Contributing factors, including genetic and environmental components and their possible interaction, are discussed. The management of the disorders, including common strategies for encouraging coping responses, stress reduction and medication, is also described.     

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目的探讨和分析无痛纤维支气管镜术在诊治小儿呼吸道疾病中的应用价值。方法2003年1月至2005年1月,重庆医科大学附属儿童医院对原因不明的肺不张、反复或持续喘息、慢性咳嗽等小儿呼吸道疾病92例,男57例,女35例,年龄2个月至15岁,应用OlympusBF3c-20纤维支气管镜,在异丙酚无痛麻醉下进行病因检查和局部治疗。结果38例肺不张纤支镜术检查显示炎性狭窄、阻塞最多见,为18例(47.4%);经局部灌洗、给药治疗,2周内复张率高达76.3%(29/38)。25例反复或持续喘息患儿,纤支镜术显示炎症所致分泌物阻塞、狭窄14例,气管-支气管软化、狭窄9例,细小异物2例,经局部灌洗给药治疗,获得较满意效果。29例慢性咳嗽中4例为支气管异物,19例为慢性支气管内膜炎,其他6例。92例患儿均采用异丙酚无痛麻醉,术中氧饱和度在0.90以上。结论儿科开展无痛纤维支气管镜术对肺不张、反复或持续喘息性疾病、慢性咳嗽等的病因诊断与治疗十分重要,对支气管细小异物的诊断有独特价值。异丙酚无痛基础麻醉下进行纤维支气管镜检术,使得操作更加容易,减少了风险,增加了安全性。     

Taste disorders in Australian Aboriginal and non-Aboriginal children

Aim: To assess the prevalence and type of taste disorders in Aboriginal and non‐Aboriginal children matched for age, gender and living in the same general and educational environment. Methods: Taste function was assessed in 432 Aboriginal (n = 166) and non‐Aboriginal (n = 266) children aged 8–12 years from six public schools in a rural township using a three‐choice taste identification test and a cross‐sectional design. Results: The prevalence of taste disorders was very high and significantly more common in Aboriginal (20/166; 12.0%) than in non‐Aboriginal (21/266; 7.9%) children. Forty‐one children had quality‐specific disorders, of whom 27 (65.9%) had sweet disorders. Children often had more than one quality disorder. Conclusion: The prevalence of taste disorders in children was high and exceeded the level (4%) designated by the World Health Organisation as requiring immediate action by health authorities. As the cause of the disorders is unknown, there is a need for a wider investigation of the causes and the consequences.     

言语语言障碍儿童执行功能的研究现状

语言是人类交流的工具,与认知功能以及思维的发展有关.执行功能作为人类一种高级认知功能,与学龄前期儿童的语言能力密切联系、协调发展.探讨语言能力与执行功能之间的关系具有广阔的理论前途和应用前景,该文对言语语言障碍儿童执行功能的国内外研究结果进行综述.     

儿童凝血功能障碍性疾病137例临床分析

目的 总结凝血功能障碍性疾病(coagulation disorders,CD)患儿的病因、治疗及预后情况.方法 137例患儿经过凝血5项或弥散性血管内凝血检查确诊为CD,并进一步进行特异凝血因子测定、骨髓形态学检测及肝肾功能等相关检查以查找病因及原发病.结果 137例患儿中,43例为遗传性CD,其中29例为血友病A,4例为血友病B,10例为血管性血友病;94例为获得性CD,其中15例源于维生素K依赖性凝血因子缺乏症,22例源于肝源性凝血障碍,30例源于弥散性血管内凝血,26例源于特殊治疗药物,1例源于血栓性血小板减少性紫癜.遗传性CD以凝血因子替代治疗为主,减少并发症,其中1例死亡原因为颅内出血.获得性CD在治疗原发病基础上,给予短期、特异、必要的输血及血液制品输注,其中死亡11例,7例为原发病所致肝功能衰竭,4例为晚期白血病及淋巴瘤.结论 儿童CD分为遗传性及获得性,临床上以获得性为主,遗传性CD需要特异性凝血因子的终生替代治疗,预后取决于凝血因子缺乏的程度;而获得性CD则需针对原发病进行治疗,血液支持为短期替代,预后取决于原发病的治疗效果.     

儿童骨髓增生异常/骨髓增殖性疾病临床及生物学特征分析

目的探讨儿童骨髓增生异常/骨髓增殖性疾病(MDS/MPD)的临床及生物学特征。方法对我科收治的28例MDS/NPD临床资料进行分析总结。结果临床主要以贫血、出血为首发症状,部分可见肝脾肿大;血常规示两系以上血细胞减少,骨髓中可见病态造血,幼稚细胞比例增高;染色体异常多见,可见毒-7、+8等特异性染色体核型异常。结论儿童MDS/MPD非常少见,占儿童血液系统恶性肿瘤的2%,具有与成人MDS不同的临床表现和生物学特征。     

Pharmacotherapy for anxiety disorders in children and adolescents

Anxiety disorders comprise the most prevalent mental health disorders among children and adults. Psychotherapy and pharmacotherapy are effective in improving clinical impairments from anxiety disorders and maintaining these improvements. This article discusses how to obtain a suitable diagnosis for anxiety disorders in youth for implementing appropriate treatments, focusing on the evidence base for pharmacologic treatment. Clinical guidelines are discussed, including Food and Drug Administration indications and off-label use of medications, and considerations for special populations and youth with comorbidities are highlighted. Findings suggest moderate effectiveness of medication, particularly selective serotonin reuptake inhibitors, in the treatment of anxiety disorders in youth.     

Diffusion-weighted and diffusion tensor imaging for pediatric musculoskeletal disorders

Diffusion-weighted imaging (DWI) is a powerful tool that has recently been applied to evaluate several pediatric musculoskeletal disorders. DWI probes abnormalities of tissue structure by detecting microscopic changes in water mobility that develop when disease alters the organization of normal tissue. DWI provides tissue characterization at a cellular level beyond what is available with other imaging techniques, and can sometimes identify pathology before gross anatomic alterations manifest. These features of early detection and tissue characterization make DWI particularly appealing for probing diseases that affect the musculoskeletal system. This article focuses on the current and future applications of DWI in the musculoskeletal system, with particular attention paid to pediatric disorders. Although most of the applications are experimental, we have emphasized the current state of knowledge and the main research questions that need to be investigated.     

Socio-demographic and psychopathologic correlates of enuresis in urban Ethiopian children

AIM: To examine the association between enuresis and psychopathology in urban Ethiopian children. METHODS: A two-stage mental health survey of 5000 urban children found enuresis to be by far the most common disorder. Logistic regression modelling was carried out to determine the independent associations of a number of socio-demographic and psychopathological characteristics with enuresis. RESULTS: Male sex, younger age and lower achieved educational grade of the child were all independently associated with childhood enuresis. The odds of having enuresis were significantly higher for children in families with significant financial worries and in children from homes where parents were separated. Children with DSMIII-R anxiety disorders, especially simple phobia, or disruptive behaviour disorders were found to have significantly higher odds of having enuresis. CONCLUSION: Psychopathology, both anxiety and behavioural disorders, as well as family stressors in urban Ethiopian children were found to be risk factors for enuresis. Although a cause-effect relationship could not be ascertained, the findings of higher association of psychopathology with enuresis in this and other studies indicate that there is a need for evaluating children with enuresis for the presence of concurrent psychopathology, especially in traditional societies where undetected psychopathology may be more common.     

Evaluating sleep and sleep disorders in the pediatric primary care setting

Sleep is a vital physiologic function. Asking parents about their children's sleep should be part of every routine physical examination. Evaluating infants requires an understanding of changes in sleep associated with developmental stage. Problems with sleep associations may begin in late infancy and become a major issue for toddlers. Good sleep is crucial for success in learning for all children. Daytime behaviors in children may be symptoms of nighttime problems. Adolescents are often chronically sleep-deprived. Educating parents and their children about the importance of sleep is an important intervention that over time can help children lead happier, more productive lives.     

Specificity of putative psychosocial risk factors for psychiatric disorders in children and adolescents

BACKGROUND: Most psychosocial risk factors appear to have general rather than specific patterns of association with common childhood and adolescence disorders. However, previous research has typically failed to 1) control for comorbidity among disorders, 2) include a wide range of risk factors, and 3) examine sex by developmental stage effects on risk factor-disorder associations. This study tests the specificity of putative psychosocial risk factors while addressing these criticisms. METHODS: Eight waves of data from the Great Smoky Mountains Study (N = 1,420) were used, covering children in the community age 9-16 years old. Youth and one parent were interviewed up to seven times using the Child and Adolescent Psychiatric Assessment, providing a total of 6,674 pairs of interviews. A wide range of putative neighborhood, school, peer, family, and child risk factors, and common and comorbid youth disorders were assessed. RESULTS: The majority of putative risk factors were specific to one disorder or one disorder domain. A unique or 'signature set' of putative risk factors was identified for each disorder. Several putative risk factors were associated with a disorder in preadolescent males, preadolescent females, adolescent males, or adolescent females only. CONCLUSIONS: Our findings support the need to define risk factors and disorders narrowly, to control comorbidity and other risk factors, and to consider developmental patterns of specificity by sex.     

The persistence and stability of psychiatric problems in adolescents with autism spectrum disorders

Background: Psychiatric problems are common in autism spectrum disorders (ASDs), but the reasons are poorly understood. We use a longitudinal population‐representative cohort to examine for the first time the persistence of psychiatric problems and to identify risk factors for their occurrence and stability. Methods: Eighty‐one 16‐year olds (75 male, six female), initially seen at 12 years, were re‐assessed using the parent‐report Strengths and Difficulties Questionnaire (SDQ). Child, family and contextual characteristics from age 12 were tested as risk factors for psychopathology. Results: Prevalence rates varied depending on whether general population or ASD‐specific SDQ cut‐offs were used. While the former suggested a decrease in psychiatric problems over time, the ASD‐specific cut‐offs showed no significant differences. With the exception of ADHD, the ASD‐specific cut‐offs identified a smaller proportion of individuals as ‘affected’ than did the general population cut‐offs. There was longitudinal domain specificity, with parent correlations ranging from 0.50 to 0.58 and teacher SDQ reports at age 12 correlating 0.33–0.53 with parent reports at 16 years. In examining the role of risk factors, lower IQ and adaptive functioning predicted higher hyperactivity and total difficulties scores. Greater emotional problems at 16 were predicted by poorer maternal mental health, family‐based deprivation and lower social class. Improvement from 12 to 16 years in conduct problems was predicted by greater neighbourhood deprivation and special school attendance. Conclusions: This is the first longitudinal study of other psychiatric symptoms in ASD. Additional psychiatric problems in ASD are persistent and domain‐specific from childhood to adolescence. The finding that age‐related reduction in SDQ symptoms does not apply when ASD‐specific cut‐offs are used requires further evaluation using diagnostic measures. Only a few of the expected risk factor‐psychopathology predictions expected from general population studies were found, raising the possibility that the causes of psychopathology in ASD differ from those in the general population.     

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目的比较3岁前有无睡眠障碍孤独症儿童临床症状及发展特点。方法对1999—2006年在北京星星雨教育研究所接受特殊教育的275例孤独症学生进行儿童期孤独症评定量表(CARS)、克氏行为量表(CABS)测量。结果总体上3岁前有过睡眠障碍者症状严重于无睡眠障碍者。2~4岁时,有过睡眠障碍者比无睡眠障碍者病情严重,如有过睡眠障碍者情感、感觉、行为、社交问题均比无睡眠障碍者严重;5~8岁时,两者病情严重程度却比较接近,且有过睡眠障碍患儿情感反应优于无睡眠障碍患儿。结论3岁前有过睡眠障碍者与无睡眠障碍者有着不同的病情发展模式。前者起始症状严重,随后病情进展缓慢;后者起始症状虽然较轻,但病情进展迅速,以至于两类患者在学龄初期时病情严重程度基本相当。     

Ten-year follow-up of adolescent-onset anorexia nervosa: psychiatric disorders and overall functioning scales

The aim of this study was to assess prospectively the long-term outcome in a representative sample of teenage-onset anorexia nervosa (AN) in respect of psychiatric disorders and overall outcome. Fifty-one AN cases, recruited by community screening, with a mean age of onset of 14 years, was contrasted with 51 matched comparison cases at a mean age of 24 years (10 years after AN onset). All 102 cases had been examined at ages 16 and 21 years. At 24 years all probands were interviewed regarding psychiatric disorders (SCID-I) and overall outcome (Morgan-Russell assessment schedule, the GAF). There were no deaths at 10-year follow-up. One in four in the AN group had a persisting eating disorder (ED), including three who still had anorexia nervosa. Lifetime diagnoses of affective disorders and obsessive-compulsive disorder were over-represented in the AN group. Outcome according to Morgan-Russell was poor in 27%, intermediate in 29%, and good in 43%. According to the GAF, half the AN group had a poor psychosocial functioning. These were subjects with either a persisting ED or lifelong problems with social interaction or obsessive-compulsive behaviour. Ten-year outcome of teenage-onset AN is favourable in the majority of cases; most individuals have recovered from their ED and have no other axis I disorder. However, half the AN group reported poor psychosocial outcome, in most cases explained by a persisting ED or chronic obsessive-compulsive behaviour/social interaction problems.     

Prevalence of child and adolescent mental disorders in Chile: a community epidemiological study

Background: In Latin America, there is limited research on the prevalence of mental disorders in children and adolescents. This Chilean survey is the first national representative survey in the Latin American region to examine the prevalence of Diagnostic and Statistical Manual-IV (DSM-IV) psychiatric disorders in the region in children and adolescents. Methods: Subjects aged 4-18 were selected using a stratified multistage design. The Diagnostic Interview Schedule for Children version IV (DISC-IV) was used to obtain 12-month DSM-IV diagnoses of affective, anxiety, conduct and substance use disorders, and supplemented with questionnaires examining family risk factors, family income, and service utilization. The parent or the primary caretaker was interviewed for children, aged 4-11, using the DISC-IV; however, adolescents, aged 12-18, were directly interviewed. Results: A sample of 1558 children and adolescents was evaluated. Using the most stringent DISC-IV impairment algorithm, the prevalence rate for any psychiatric disorders was 22.5% (19.3% for boys and 25.8% for girls). The prevalence rate was higher among the children, aged 4-11, in comparison with adolescents, aged 12-18 (27.8% and 16.5%, respectively). Less than half of the subjects in need of services sought some form of assistance. Nearly a quarter of those using services did not present with a psychiatric diagnosis in the past year. Comorbidity was found in 24.8% of those with a disorder, but only 6.3% had three or more diagnoses. Conclusions: The prevalence of psychiatric disorders in Chile is high among children and adolescents. This study highlights the increasing need to reevaluate mental health services provided to children and adolescents in Latin America.     

褪黑素治疗孤独症谱系障碍儿童睡眠障碍有效性的荟萃分析

目的 探讨褪黑素治疗孤独症谱系障碍(autism spectrum disorder,ASD)儿童睡眠障碍的有效性.方法 采用计算机检索与ASD睡眠障碍和褪黑素相关的文献,检索时间从建库起至2018年10月31日.纳入标准:随机对照试验(randomized controlled trials,RCT);研究对象为AS...     

神经心理发育障碍儿童静态眼睛照片深度学习的病例对照初步研究

背景 目前对儿童神经心理发育障碍的诊断主要靠临床表现,尚缺乏客观的生物学指标,一些神经心理发育障碍儿童的眼睛特征可能具有重要的临床价值.目的 评价静态眼睛图像是否可以作为儿童神经心理发育障碍的一个潜在的筛查测试.设计病例对照研究.方法 双眼图像采集应用Google人脸图片搜索引擎进行图片搜索,以"autism and ...