Diagnostic outcome of adolescent self-reported suicidal ideation at 8-year follow-up

BACKGROUND: There are few epidemiological data on the outcome of adolescent self-reported suicidal ideation. METHOD: Data from an epidemiological study were used to examine self-reported suicidal ideation in adolescence as a predictor of suicidal ideation and psychiatric diagnoses at 8-year follow-up. RESULTS: Suicidal ideation was reported by 41 (4.5%) of 912 adolescents aged 11-18 and by 19 (2.5%) of 795 young adults aged 19-26. Most parents of adolescents with positive self-report did not report suicidal ideation in their child. Suicidal ideation in adolescents and young adults was associated with other psychiatric problems. Adolescent self-reported suicidal ideation was not a predictor of suicidal ideation or any major psychiatric disorder 8 years later. In males, suicidal ideation in adolescence was associated with specific phobia at follow-up. LIMITATIONS: The sample of adolescents may not be representative of the general population. There were no outcome measures other than DSM-IV diagnoses. Suicidal ideation was assessed by only one item, both at baseline and follow-up. CONCLUSIONS: Adolescents and young adults with self-reported suicidal ideation had high rates of psychiatric problems. Adolescent self-reported suicidal ideation did not predict suicidal ideation or any major psychiatric disorders (i.e. depressive disorders, substance use disorders, or psychotic disorders) at follow-up.     

Measuring psychomotor agitation by use of an actimeter: a pilot study

BACKGROUND: Relatives of early-onset bipolar probands have greater risk for affective disorders than those of adult-onset bipolar probands. METHODS: Relatives of 50 adolescent bipolar I probands and 36 adult-onset bipolar probands (onset > or = 25 years) were assessed using the Family Interview for Genetic Studies (FIGS) by a qualified psychiatrist blind to the proband status. Morbid risk was calculated using Weinberg's method of age correction. RESULTS: Relatives of early-onset probands had significantly greater risk for affective disorders compared to the relatives of adult-onset bipolar probands. CONCLUSIONS: Early-onset bipolar disorder is more familial than the adult bipolar disorder. IMPLICATIONS: Subdivision of bipolar disorder according to age-at-onset may identify homogeneous subtypes useful for genetic studies. LIMITATIONS: Patients were recruited from a major psychiatric hospital. The family history method was used to collect information about relatives.     

First psychiatric hospitalizations in the US military: the National Collaborative Study of Early Psychosis and Suicide (NCSEPS)

BACKGROUND: Military samples provide an excellent context to systematically ascertain hospitalization for severe psychiatric disorders. The National Collaborative Study of Early Psychosis and Suicide (NCSEPS), a collaborative study of psychiatric disorders in the US Armed Forces, estimated rates of first hospitalization in the military for three psychiatric disorders: bipolar disorder (BD), major depressive disorder (MDD) and schizophrenia. METHOD: First hospitalizations for BD, MDD and schizophrenia were ascertained from military records for active duty personnel between 1992 and 1996. Rates were estimated as dynamic incidence (using all military personnel on active duty at the midpoint of each year as the denominator) and cohort incidence (using all military personnel aged 18-25 entering active duty between 1992 and 1996 to estimate person-years at risk). RESULTS: For all three disorders, 8723 hospitalizations were observed in 8,120,136 person-years for a rate of 10.7/10,000 [95% confidence interval (CI) 10.5-11.0]. The rate for BD was 2.0 (95% CI 1.9-2.1), for MDD, 7.2 (95% CI 7.0-7.3), and for schizophrenia, 1.6 (95% CI 1.5-1.7). Rates for BD and MDD were greater in females than in males [for BD, rate ratio (RR) 2.0, 95% CI 1.7-2.2; for MDD, RR 2.9, 95% CI 2.7-3.1], but no sex difference was found for schizophrenia. Blacks had lower rates than whites of BD (RR 0.8, 95% CI 0.7-0.9) and MDD (RR 0.8, 95% CI 0.8-0.9), but a higher rate of schizophrenia (RR 1.5, 95% CI 1.3-1.7). CONCLUSIONS: This study underscores the human and financial burden that psychiatric disorders place on the US Armed Forces.     

Phenomenology of panic disorder and major depression in a family study

Family data were used to examine the phenomenology of MDD and panic disorder in relatives with respect to (a) proband diagnoses of PD and MDD, and (b) the occurrence of the disorders comorbidly vs. singly irrespective of family history. PD and MDD do not differ phenomenologically by proband diagnosis. However, PD comorbid with MDD shows more frequent panic attacks and more symptoms than PD without MDD. Endogenous and delusional subtypes and additional comorbidity are more frequent in relatives with MDD plus than in relatives with MDD without PD. The well documented clinical heterogeneities of PD and MDD are not clearly detectable in their phenomenology as a function of whether probands carried both diagnoses or only one. PD and MDD are more severe when they are in the comorbid form compared to when they occur singly.     

The prevalence of major depressive and bipolar disorders in Hungary Results from a national epidemiologic survey

In order to estimate the prevalence of affective disorders in Hungary a sample of the Hungarian adult population (18–64 years) selected at random was interviewed using the Diagnostic Interview Schedule (DIS) which generated DSM-III-R diagnoses. The lifetime rate for Major Depressive Disorder (MDD) was 15.1%, and for Bipolar Disorders (BD) 5.1%. The female-to-male ratio was 2.7 for MDD and nearly equal for BD. The 1-year and 1-month period prevalence rates were 7.1% and 2.6% for MDD and 0.9% and 0.5% for manic episodes. A higher rate of divorced or separated persons was found among individuals with a lifetime diagnosis of MDD. Besides these, the lifetime diagnosis of BD coexisted with higher rates of the never-married state. The highest hazard rate for the development of BD or MDD was in the range 15–19 years but in MDD another peak was also found in the range 45–50 years. The first peak was characteristic of the recurrent, and the other one of the single form of MDD. Insomnia, loss of energy, decreased interest, concentration problems were the most common symptoms during the depressive episode, independent of polarity. Higher rates of lifetime diagnosis of dysthymia and all kinds of anxiety disorder were revealed among persons with MDD. BD was associated with GAD (Generalized Anxiety Disorder), and panic disorder more often than chance.     

Is bipolar II disorder misdiagnosed as major depressive disorder in children?

OBJECTIVES: To estimate the lifetime prevalence of bipolar II disorder in children and adolescents presenting with DSM-IV major depressive disorder (MDD). METHODS: Sixty-one consecutive subjects aged < or =18 years attending the outpatient services of the Child and Adolescent Psychiatric (CAP) services of the National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India with a diagnosis of MDD were evaluated using the Missouri Assessment of Genetics Interview for children (MAGIC). Two psychiatrists, one of whom was a child psychiatrist diagnosed hypomania by consensus. RESULTS: Twelve children had a past episode of hypomania (20%), which was hitherto undiagnosed clinically. LIMITATIONS: We recruited subjects from a psychiatric hospital, thus limiting the generalizability of the finding. Sample size was relatively small and assessments were cross-sectional. CONCLUSIONS:: Our study shows that bipolar II disorder is often misdiagnosed as MDD in children. The study also highlights that the chance of diagnosing bipolarity is enhanced by using semi-structured interview in routine clinical practice.     

Lifetime psychopathology among the offspring of Bipolar I parents

BACKGROUND:

Recent studies have demonstrated high rates of psychopathology in the offspring of parents with bipolar disorder. The aim of this study was to identify psychiatric diagnoses in a sample of children of bipolar parents.

METHOD:

This case series comprised 35 children and adolescents aged 6 to 17 years, with a mean age of 12.5±2.9 years (20 males and 15 females), who had at least one parent with bipolar disorder type I. The subjects were assessed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children – Present and Lifetime version (K-SADS-PL). Family psychiatric history and demographics were also evaluated.

RESULTS:

Of the offspring studied, 71.4% had a lifetime diagnosis of at least one psychiatric disorder (28.6% with a mood disorder, 40% with a disruptive behavior disorder and 20% with an anxiety disorder). Pure mood disorders (11.4%) occurred less frequently than mood disorders comorbid with attention deficit hyperactivity disorder (17.1%). Psychopathology was commonly reported in second-degree relatives of the offspring of parents with bipolar disorder (71.4%).

CONCLUSIONS:

Our results support previous findings of an increased risk for developing psychopathology, predominantly mood and disruptive disorders, in the offspring of bipolar individuals. Prospective studies with larger samples are needed to confirm and expand these results.     

Dose-response relationship between number of comorbid anxiety disorders in adolescent bipolar/unipolar disorders, and psychosis, suicidality, substance abuse and familiality

OBJECTIVES: To ascertain rates of panic, obsessive-compulsive (OCD) and social phobic disorders among adolescents with bipolar disorder (BP), unipolar major depressive disorder (MDD) and psychiatric comparison patients, to assess their relationships to suicidality, psychosis, comorbidity patterns and familiality. METHODS: The first author (SCD) interviewed 313 Latino adolescents using a structured interview based on the SCID. Family history was ascertained by live interview or interview by proxy. Patients were classified as BP, MDD, or non-affectively ill comparison controls (CC). Data regarding suicidality and psychosis were collected. Regression analysis was used to test associations and control for confounding effects. Positive likelihood ratios were used to measure the dose-response relationships between number of anxiety disorders and measures of severity of illness and familial loading for affective illness. RESULTS: Of the total sample, 36.7% were BP, 44.7% MDD and 18.5% CC. In BP vs. MDD the odds of panic disorder were 4.4, of OCD 5.1, and of social phobia 3.3. MDD, in turn, were more likely to have these disorders than CC. BP (but not MDD) with panic disorder and social phobia, were more likely to have suicidal ideation; among the anxiety disorders, only social phobia was associated with having greater odds of suicide attempts. Among BP and MDD, patients with all three anxiety disorders were more likely to be psychotic. Presence of any mood disorder among first-degree relatives substantially increased the odds of having panic disorder and social phobia. The presence of one comorbid anxiety disorder increased the odds of having another. Finally, there were dose-response relationships between number of anxiety disorders and measures of severity of illness and familial loading for affective illness. LIMITATIONS: Single interviewer using the SCID; cross sectional exploratory study. CONCLUSIONS: BP adolescents have a greater anxiety disorder burden than their MDD counterparts. The results are compatible with the hypothesis that heavy familial-genetic loading for affective illness in juveniles is associated with bipolarity, cumulative anxiety disorder comorbidity, suicidality and psychosis. These observations are in line with pioneering psychopathologic observation in the early 1900s by two French psychiatrists, Gilbert Ballet and Pierre Kahn, who saw common ground between what until then had been considered the distinct categories of the neuroses and cyclothymic (circular) psychoses. This perspective has much in common with current complex genetic models of anxious diatheses in bipolar disorder.     

Multiple dimensions of familial psychopathology affect risk of mood disorder in children of bipolar parents.

The aim of our study was to determine whether familial loading of unipolar disorder, bipolar disorder, and substance use disorder are associated with DSM-IV mood disorders in adolescents at risk for bipolar disorder. One hundred and forty adolescents aged 12-21 years of 86 bipolar parents participated in the study. Lifetime DSM-IV diagnoses of the bipolar offspring were assessed with the Schedule for Affective Disorders and Schizophrenia for School Age Children Kiddie-SADS-Present and Lifetime Version (SADS-PL). Parents were interviewed using the Family History Research Diagnostic Criteria (FH-RDC) which were used to calculate a continuous familial loading score (FL) for unipolar disorder, bipolar disorder, and for substance use disorder in first- and second-degree relatives of the adolescents. FL for unipolar disorder and substance use disorder were strong and independent predictors for lifetime mood disorders in the adolescents. The gender adjusted hazard ratios for mood disorders in the children were 1.5 (95% confidence interval (CI) = 1.2-2.0) for FL of unipolar disorder and 1.8 (95% CI = 1.3-2.4) for FL of substance use disorder. Expression of mood disorders in children of bipolar parents varies with the degree of additional FL of unipolar disorder and substance use disorder in the extended family.     

Morbid risk for psychiatric disorder among the relatives of methamphetamine users with and without psychosis.

It is not clear why some methamphetamine (MAMP) abusers develop psychotic symptoms, while others use MAMP regularly over long periods and remain unscathed. We tested the hypotheses that those users who develop MAMP-induced psychosis (MIP) have greater familial loading for psychotic disorders than users with no psychosis. Four hundred forty-five MAMP users were recruited from a psychiatric hospital and a detention center in Taipei, and were assessed with the Diagnostic Interview for genetic studies (DIGS-C) and the Family Interview for genetic study (FIGS-C). Morbid risk (MR) for psychiatric disorders in first-degree relatives was compared between those MAMP users with a lifetime diagnosis of MAMP psychosis and those without. The relatives of MAMP users with a lifetime diagnosis of MAMP psychosis had a significantly higher MR for schizophrenia (OR = 5.4, 95% CI: 2.0-14.7, P < 0.001) than the relatives of those probands who never became psychotic. Furthermore, the MR for schizophrenia in the relatives of the subjects with a prolonged MAMP psychosis (MIP-P) was higher than in the relatives of those users with a brief MAMP psychosis (MIP-B) (OR = 2.8, 95% CI: 1.0-8.0, P = 0.042). The greater his or her familial loading for schizophrenia, the more likely a MAMP user is to develop psychosis, and the longer that psychosis is likely to last.     

Comorbidity between asthma attacks and internalizing disorders among Puerto Rican children at one-year follow-up

Authors examined the association between internalizing disorders and asthma attacks at 1-year follow-up among a community sample of 1,789 children and adolescents ages 5-18 years living on the island of Puerto Rico. The Diagnostic Interview Schedule for Children was administered to assess DSM-IV internalizing disorders during the past year. Children with a lifetime history of asthma attacks at baseline had greater odds of having an internalizing disorder at 1-year follow-up, independent of socio-demographic measures. However, an association was not found between asthma attacks and persistence of internalizing disorders. These findings show that the association between internalizing disorders and asthma attacks was replicated 1 year later in the same sample.     

Course and outcome of major depressive disorder in non-referred adolescents

BACKGROUND: Although major depressive disorder (MDD) is one of the most common disorders in adolescence, little is known about its course and outcome in non-referred adolescents. Therefore, the aims of this article were to examine the course and outcome of MDD in non-referred adolescents, and to examine factors related to its stability. METHODS: Five hundred and twenty-three adolescents were interviewed twice at an interval of about 15 months using the computerized Munich version of the Composite International Diagnostic Interview. RESULTS: Of the 90 adolescents who met the diagnosis of MDD at T1, 22 (24.4%) still met the same diagnosis at T2. Sixty-eight (75.6%) of them no longer met the diagnosis of MDD at T2, and in some of these cases, their depression was replaced by several other disorders; 44 adolescents received no diagnostic criteria for any DSM-IV disorders. The factors that were significantly associated with the stability of MDD included the presence of substance use disorders and parental alcohol problems, negative life events and negative coping, past suicidal attempt, suicidal thought, and concrete suicidal plan at the T1-interview. Adolescents with "chronic" (T1 and T2) compared to "transient" (only T1) MDD and those without any disorders were significantly more impaired in various life domains. LIMITATIONS: This study was based on a small number of adolescents with a chronic MDD. CONCLUSIONS: The course and outcome of MDD in majority of the adolescents seemed to have a favourable course, whereas in some adolescents, it tended to have a heterogeneous pattern.     

Recurrent brief depressive disorder reinvestigated: a community sample of adolescents and young adults

BACKGROUND: This article presents prospective lower bound estimations of findings on prevalence, incidence, clinical correlates, severity markers, co-morbidity and course stability of threshold and subthreshold recurrent brief depressive disorder (RBD) and other mood disorders in a community sample of 3021 adolescents. METHOD: Data were collected at baseline (age 14-17) and at two follow-up interviews within an observation period of 42 months. Diagnostic assessment was based on the Munich Composite International Diagnostic Interview (M-CIDI). RESULTS: Our data suggest that RBD is a prevalent (2.6%) clinical condition among depressive disorders (21.3%) being at least as prevalent as dysthymia (2.3%) in young adults over lifetime. Furthermore, RBD is associated with significant clinical impairment sharing many features with major depressive disorder (MDD). Suicide attempts were reported in 7.8% of RBD patients, which was similar to MDD (11.9%). However, other features, like gender distribution or co-morbidity patterns, differ essentially from MDD. Furthermore, the lifetime co-occurrence of MDD and RBD or combined depression represents a severe psychiatric condition. CONCLUSIONS: This study provides further independent support for RBD as a clinically significant syndrome that could not be significantly explained as a prodrome or residual of major affective disorders.     

Separation of DSM-III attention deficit disorder and conduct disorder: evidence from a family-genetic study of American child psychiatric patients

Using family study methodology and assessments by blind raters, this study tested hypotheses about patterns of familial association between DSM-III attention deficit disorder (ADD) and antisocial disorders (childhood conduct (CD) and oppositional disorder (OPD) and adult antisocial personality disorder) among 457 first-degree relatives of clinically referred children and adolescents with ADD (73 probands, 264 relatives), psychiatric (26 probands, 101 relatives) and normal controls (26 probands, 92 relatives). Among the 73 ADD probands, 33 (45%) met criteria for OPD, 24 (33%) met criteria for CD, and 16 (22%) had no antisocial diagnosis. After stratifying the ADD sample into those with CD (ADD + CD), those with OPD (ADD + OPD) and those with neither (ADD) familial risk analysis revealed the following: (1) relatives of each ADD proband subgroup were at significantly greater risk for ADD than relatives of both psychiatric and normal controls: (2) the morbidity risk for ADD was highest among relatives of ADD + CD probands (38%), moderate among relatives of ADD + OPD (17%) and ADD probands (24%) and lowest among relatives of psychiatric and normal controls (5% for both); (3) the risk for any antisocial disorder was highest among relatives of ADD + CD (34%) and ADD + OPD (24%) which were significantly greater than the risk to relatives of ADD probands (11%), psychiatric (7%) and normal controls (4%); and (4) both ADD and antisocial disorders occurred in the same relatives more often than expected by chance alone. Although these findings suggest that ADD with and without antisocial disorders may be aetiologically distinct disorders, they are also consistent with a multifactorial hypothesis in which ADD, ADD + OPD and ADD + CD fall along a continuum of increasing levels of familial aetiological factors and, correspondingly, severity of illness.     

Latent class typology of nicotine withdrawal: genetic contributions and association with failed smoking cessation and psychiatric disorders

BACKGROUND: Nicotine withdrawal is associated with failed smoking cessation and thus contributes to continuance of the habit and increases risk of smoking-related illnesses. Withdrawal is also associated with psychiatric disorders such as depression and alcoholism. However, relatively little is known about how to characterize the severity of withdrawal, including whether withdrawal subtypes exist in male smokers. If so, do these subtypes represent quantitative or qualitative differences? METHOD: Smoking and withdrawal data were obtained from 4112 male-male twin pairs of the Vietnam Era Twin Registry during a 1992 administration of the Diagnostic Interview Schedule. Latent Class Analysis (LCA) was used to derive significantly different nicotine withdrawal profiles, and their association with psychiatric disorders was assessed. Genetic and environmental contributions and the correlation between these contributions were evaluated using bivariate biometrical modeling of the withdrawal phenotype and failed smoking cessation. RESULTS: The LCA model which best fit the data was a four-class severity continuum. Psychiatric disorders were significantly associated with more severe classes and the magnitude of the association increased as withdrawal severity increased. Genetics accounted for 31% and 51% of the variance in risk for withdrawal and failed cessation, respectively. The genetic contributions were significantly correlated (r = 0.37). CONCLUSIONS: Nicotine withdrawal classes are characterized by quantitative differences. The strong association between psychiatric disorders and withdrawal severity and the significant genetic correlation between withdrawal and cessation highlight the importance of withdrawal severity. Further refinement of the DSM definition of withdrawal to incorporate severity ratings may be warranted.     

Effects of borderline personality disorder features and a family history of alcohol or drug dependence on P300 in adolescents.

Decrements in P300 amplitude have been associated with familial risk for alcoholism as well as several other psychiatric disorders characterized by disinhibited behavior. The present study examined the P300 in relation to Borderline Personality Disorder (BPD) features in adolescents with a paternal history of alcohol or drug dependence. One hundred and seventy-five males and females, aged 14-20, were assigned to groups based on BPD features (BPD+ vs. BPD-), family history of substance dependence (negative FH-, alcohol FHA, drug FHD) and gender. BPD features were assessed using the Structured Clinical Interview for the DSM-III-R questionnaire. P300 ERPs were recorded while each subject performed the Stroop color-word compatibility test. Repeated measures analyses, which included Conduct Disorder and Depression symptoms as covariates, indicated a significant reduction in P300 amplitude in the BPD+ group. There were no significant effects of FH or gender on P300 amplitude. These results document the presence of neurophysiological abnormalities associated with BPD features in an adolescent sample. This effect appeared to be independent of a family history of alcohol or substance dependence. These findings suggest that BPD symptoms during adolescence are relevant to the examination of the physiological antecedents of those forms of adult psychopathology characterized by behavioral disinhibition, including alcohol and drug dependence.     

Malignancy of recurrent,early‐onset major depression: A family study

Coordinated efforts to identify susceptibility genes for unipolar major depressive disorder (MDD) and related disorders are now underway. These studies have focused on recurrent, early‐onset MDD (RE‐MDD), the most heritable form of this disorder. The goal of this study was to characterize the burden of MDD and other mood disorders, comorbid mental disorders, and excess mortality in RE‐MDD families. A total of 81 families were identified through probands over the age of 18, who met criteria for recurrent (≥ 2 episodes), early‐onset (≤ 25 years), nonpsychotic, unipolar MDD (RE‐MDD), and included 407 first‐degree relatives and 835 extended relatives. Psychiatric diagnoses for probands and their family members who provided blood samples were formulated from structured personal interviews, structured family history assessments, and available medical records. The remaining family members who participated and those who were deceased were evaluated through the family history method augmented by available medical records. Best estimate diagnoses were made during a consensus conference according to established diagnostic criteria. Approximately half of the first‐degree relatives and a quarter of extended relatives of RE‐MDD probands suffered from at least one mood disorder, typically MDD. As commonly observed for other oligogenic, multifactorial disorders, the severity of MDD reflected by age at onset and number of episodes attenuated with increasing familial/genetic distance from the proband. A substantial fraction of RE‐MDD probands and their first‐degree relatives met diagnostic criteria for additional psychiatric disorders that include prominent disturbances of mood. The deceased relatives of RE‐MDD probands died at a median age that was 8 years earlier than for the local population; over 40% died before reaching age 65. These differences in mortality statistics resulted from a shift toward younger ages at death across the lifespan, including a fivefold increase in the proportion of individuals who died in the first year of life. Several‐fold increases in the proportion of deaths by suicide, homicide, and liver disease were observed among the relatives of RE‐MDD probands. However, the rank order of the three most common causes of death—heart disease, cancer, and stroke—remained unchanged and differences in the proportions of deaths from the remaining causes were small. RE‐MDD is a strongly familial condition with a high rate of psychiatric comorbidity, whose malignant effects have a significant negative impact on the health and longevity of patients and their family members. © 2001 Wiley‐Liss, Inc.     

A family study of bipolar I disorder in adolescence. Early onset of symptoms linked to increased familial loading and lithium resistance

Lifetime rates of psychiatric illness were compared in relatives of adolescent probands with bipolar I disorder and in relatives of age-matched schizophrenic controls. Familial aggregation of major affective disorders was observed in bipolar probands, the rate of bipolar I disorder greatly exceeding that reported in relatives of adult bipolar probands. Adolescent probands with childhood onset of psychiatric disturbance were distinguished from probands who had no premorbid childhood psychiatric abnormality in two ways: (1) significantly increased aggregation of bipolar I disorder in first-degree relatives; and (2) poorer antimanic response to lithium carbonate. These data underscore important heterogeneity in adolescent-onset bipolar disorder.     

Substance use disorders in an adolescent inpatient psychiatric population.

This study examined the comorbidity of substance use disorders and other psychiatric disorders in adolescent populations. The study population was comprised of 100 consecutive admissions, ages 13 to 17, to an acute care adolescent psychiatric inpatient unit for substance use disorders. Patients were assessed using the Personal Experience Screening Questionnaire (PESQ) and the substance-use disorder portion of the Structured Clinical Interview for DSM III-R (SCID-R). Thirty-three (33%) patients were identified as having a substance abuse or dependence diagnosis. There was no significant difference in the age between substance users and nonsubstance users. There were significantly more whites in the substance-using group. Sixty percent of all adolescents interviewed had histories of sexual or physical trauma, with trauma being significantly more common in the substance-using group. There were no significant differences in the number or type of other Axis I or Axis II diagnoses between the two groups. While substance users and nonsubstance users had no significant difference in the number of past psychiatric hospitalizations, nonsubstance users had significantly more past medical hospitalizations. These results indicate that high rates of comorbid substance abuse and psychiatric disorders exist in adolescents, and more in-depth study of comorbidity among adolescents is warranted.