Recidivism in medication-noncompliant serious juvenile offenders with bipolar disorder

OBJECTIVE: To determine whether the recidivism rate varies for adolescent serious juvenile offenders with bipolar disorder in response to compliance with antimanic medication. METHOD: Probation records were reviewed for all adolescents (N = 31) released during a 1-year period (April 1, 1993-March 31, 1994) from a county juvenile corrections treatment facility who had DSM-III-R bipolar disorder, were stabilized on medication, and had agreed to continue treatment at an adolescent psychiatry clinic. New offenses and probation violations committed during the 12-month period after release were tallied. These recidivism records were then compared with medical records to ascertain whether these acts were committed while subjects were on (taking) or off (not taking) medication. RESULTS: The number of serious offenses (felonies and misdemeanors) was significantly reduced while subjects were on medication (4 offenses in 2992 days) versus off medication (39 offenses in 6108 days) (p < .0001). The off-medication rate of offending was 4.8 times higher than the on-medication rate. Probation violations were also significantly reduced while subjects were on medication (p < .001). CONCLUSION: Compliance with prescribed antimanic medication can markedly decrease recidivism in serious juvenile delinquents with bipolar disorder.     

男性青少年罪犯的人格特征比较研究

目的了解男性青少年罪犯的人格基本特征。方法采用自编青少年犯罪行为一般情况调查表和艾森克人格问卷（EPQ）对某未成年犯管教所300名男性青少年犯进行集体测评。结果青少年犯具有典型精神质（P）人格特征的占40.3%,典型神经质（N）的占25.3%,高于一般人群的12.5%;典型外向（E）的占12.0%,掩饰性（L）高分（〉61.5）占8.0%,低于一般人群的12.5%。与全国同龄人群平均水平相比,男性青少年犯的精神质（P）、神经质（N）得分较高,而外向性（E）、掩饰性（L）得分较低,有显著性差异;不同犯罪类型青少年人格特征无显著性差异;青少年罪犯的人格特征城乡无显著性差异。外向性（E）不同的青少年犯,P分、N分有显著性差异。结论男性青少年罪犯的人格多偏离正常;不同犯罪类型、不同地域来源的犯罪青少年人格特征无明显差异;青少年犯群体中人格类型有一定的差异。     

Affective startle potentiation in juvenile offenders: The role of conduct problems and psychopathic traits

Emotion processing difficulties are observed in antisocial individuals exhibiting serious antisocial behavior. This study examined emotion processing in 40 male juvenile offenders (JOs) and 52 male controls by measuring startle reflex responses to aversive sounds during the passive viewing of affective and neutral images. JOs as a group exhibited reduced startle-elicited blinks across all slide categories compared to normal controls. Moreover, within the offender group those with more conduct disorder symptoms and higher levels of psychopathic traits displayed reduced startle amplitudes compared to lower-scoring offenders. The finding that startle magnitudes were inversely related to severity of conduct problems supports a dimensional or continuous approach to understanding externalizing disorders. Reductions in amygdala activity could lead to blunted startle magnitudes. The current findings not only provide further evidence that antisocial children have a general defensive motivational system dysfunction and present with impairments in neural systems that subserve emotion processing, but also show for the first time that those with more severe conduct problems have reduced startle responses compared to those who are less severely affected. The implications of these findings for interventions with JOs are discussed.     

Predicting substance abuse in juvenile offenders: Attention deficit disorder versus aggressivity

The relative predictive significance of attention deficit disorder (ADD) and aggressive behavior for consequent substance abuse was examined in 114 juvenile offenders. ADD, aggressivity, and substance abuse were assessed according to DSM-III criteria. Results from logistic regression indicate thataggressivity, but not an ADD diagnosis, significantly predicts substance abuse. There-fore, previously reported associations between ADD and substance abuse may be confounded by concurrent symptoms of aggression.     

Psychopharmacologic treatment in juvenile offenders

This article first reviews ways to assess children in the justice system who may benefit from psychopharmacologic treatments. Second, it summarizes the emerging understanding of the nature of aggression and violence and the utility of using the schema of reactive ("hot") and proactive ("cold") aggression as a way to consider pharmacologic options. Third, it summarizes the current published studies on the treatment of conduct disorder, which roughly corresponds to the population of children in the juvenile justice system. Finally, it examines the ways that different classes of medications might be considered when approaching juvenile delinquents and the ways that psychopharmacology could be used as part of an overall treatment plan.     

Health status of juvenile offenders. A survey of young offenders appearing before the juvenile courts

This paper reports on the health needs of a sample of juvenile offenders appearing before a Manchester Court during the month of August 1992. Of the 192 subjects interviewed (74% of those listed), 19% had significant medical problems, 42% a history of substance abuse and 7% psychiatric problems requiring further treatment. Substantial numbers (26%) engaged in a variety of dangerous behaviours. Custodial remands were common (21%), particularly in those with multiple psychosocial difficulties.     

Learning disabilities in juvenile offenders

The article briefly reviews the literature on the association between learning disabilities and conduct problems across correctional communities and clinical settings. It first reviews the literature on the prevalence of learning deficiencies among criminal offenders. It then discusses a number of relevant points from studies of the association between low academic achievement and conduct problems in nonincarcerated population samples. Third, it discusses studies of postrelease academic profiles of juvenile offenders. The article closes with a comment on possible future directions of the research linking reduced levels of academic achievement and delinquency.     

A family study of juvenile obsessive-compulsive disorder.

OBJECTIVES: To determine whether juvenile obsessive-compulsive disorder (OCD) is familial and whether the rate of Tourette syndrome (TS) and tic disorders is higher among relatives of patients with OCD than among relatives of controls subjects. METHOD: We assessed first-degree relatives of 35 juvenile OCD probands (aged 16 years or less) and 34 matched, psychiatrically unaffected control subjects, using the Diagnostic Interview for Children and Adolescents-Revised (DICA-R) (unpublished), a Questionnaire for tic disorders, the Children's Version of Leyton's Obsessional Inventory (CV-LOI), and the Children's Version of the Yale-Brown Obsessive Compulsive Scale (CY-BOCS). Similarly, we assessed adult relatives, using the Schedule for Clinical Assessment in Neuropsychiatry (SCAN), Leyton's Obsessional Inventory (LOI), the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), and a Questionnaire for tic disorders. The diagnoses were determined by consensus, using DSM-III-R criteria. We calculated age-corrected morbid risk, using Weinberg's method. RESULTS: The morbid risk for OCD among the relatives of OCD probands was 4.96%, while none of the relatives of unaffected control subjects had OCD. We did not diagnose TS in any of the relatives of either OCD probands or control subjects. We diagnosed chronic motor tic disorders in only 1 of the relatives of OCD probands, while none of the relatives of control subjects had any tic disorder. CONCLUSION: Most juvenile cases of OCD are nonfamilial and unrelated to tic disorders, while only a few are familial. There is a need to re-examine the issue of familiality in cases of OCD, as well as its relation to TS, using larger community samples to better understand the hypotheses of familial transmission and comorbidity with tic disorders.     

A preliminary typology of young sex offenders

Data concerning all young (15-20 years, n = 56) sex offenders (YSOs) subjected to forensic psychiatric investigation in Sweden during 1988-1995 were used in an attempt to construct and validate an introductory YSO typology based solely on offence characteristics. A 5-cluster solution received optimal support from cluster analysis of 15 offence-related variables. A few historical and clinical characteristics varied across clusters. Survival analyses revealed that the clusters differed with respect to sexual but not to violent or general reconviction rates.     

A review of mood disorders among juvenile offenders

OBJECTIVES: This article provides an overview of what is known about the prevalence, diagnosis, and effective treatment of mood disorders among youths, particularly among juvenile offenders, and discusses the unique problems that arise for the delivery of treatment services. The relationship between mood disorders and disruptive or delinquent behaviors as well as the particular importance of proper diagnosis and treatment of mood disorders in this population are discussed. METHODS: A search was conducted of the MEDLINE and PsycINFO databases for articles that had been published since 1980 on mood disorders in the juvenile offender population as well as articles on adolescent mood disorders. RESULTS: The studies on the prevalence of mood disorders among juvenile offenders varied significantly in the methodology used and in the rates of prevalence found, although all studies showed that this population had high rates of mood disorders. The identification and effective treatment of mood disorders is critical because these disorders are a leading cause of suicide among adolescents and because mood disorders may contribute to or exacerbate delinquent and disruptive behaviors. CONCLUSIONS: Juvenile detainees have a constitutional right to needed mental health treatment. More comprehensive mental health services are required to ensure that juvenile offenders with mental illness are identified and cared for appropriately. Doing so not only will alleviate painful symptoms but may also contribute significantly to improvements in psychosocial functioning, interpersonal relations, and school performance and to decreases in delinquent, disruptive, and suicidal behaviors.     

A follow-up study of juvenile obsessive-compulsive disorder from India

Objective: To study the long‐term course and outcome of juvenile obsessive–compulsive disorder (OCD). Method: Two to 9‐year follow‐up of largely self‐referred, drug‐naïve subjects (n = 58) by employing catch‐up longitudinal design. Results: The mean follow‐up period was 5 years. Nearly three‐fourth of the sample was adequately treated with medications. Only 21% of the subjects had clinical OCD at follow‐up and 48% were in true remission (no OCD and not on treatment). Earlier age‐at‐onset was associated with better course and outcome. Conclusion: Juvenile OCD has favorable outcome. Our findings are applicable to psychiatric hospital settings in India and perhaps to the general psychiatric settings in the Western countries. Whether the better outcome in this sample is the result of differing clinical characteristics or because of true cross‐cultural variation in the course needs further exploration. It is speculated that early onset OCD could be a subtype of juvenile OCD with better outcome.     

Affective disorder: the new imperium

Eugen Bleuler formulated schizophrenia as a disjunctive category based on universal, dimensional phenomena that were regarded as pathognomonic of the disorder. In consequence, schizophrenia came to dominate diagnostic practice in American psychiatry. This report suggests that affective disorder has been formulated in a similar way, and with a similar result. The nature of disjunctive categories is examined and their replacement by conjunctive categories for schizophrenia and affective disorder is anticipated.     

A preliminary study of sleep-disordered breathing in major depressive disorder

BACKGROUND AND PURPOSE: Individuals with obstructive sleep-disordered breathing (OSDB) commonly report symptoms of depression; however, the percentage of individuals with major depressive disorder (MDD) who experience OSDB is less clear. This study aimed to examine OSDB in a sample of individuals with MDD, unselected for sleep-related complaints, along a continuum of ventilatory and hypoxic abnormalities. PATIENTS AND METHODS: The overnight sleep-related breathing of 19 individuals with MDD and 15 non-depressed controls was recorded using an unattended nasal pressure-based home sleep monitoring device. The device recorded nasal airflow, breathing effort, heart rate, oxygen saturation, and body position. RESULTS: The two groups varied significantly on three sleep-related breathing variables: major flow-limitation events, major flow-limitation events accompanied by a desaturation, and average saturation throughout the evening; and these groups approached significance on minor flow-limitation events accompanied by a desaturation and average number of desaturations throughout the evening. Sleep-related breathing variables predicted accurate grouping in 81.3% of those with MDD and 80.6% of the non-depressed participants. CONCLUSIONS: These results suggest that OSDB may play a more important role in MDD than previously recognized. OSDB may contribute to or exacerbate the condition of someone predisposed to MDD, and the treatment of OSDB may ameliorate or possibly prevent depressive symptoms.     

Affective disorder in adolescence: issues in misdiagnosis

This case report describes a young adolescent female with bipolar manic-depressive illness, (MDI), whose behavioral symptomatology was originally attributed to non-affective forms of psychopathology. We review her entire clinical course to date and elucidate several factors that may account for diagnostic error.     

Affective disorder in an adolescent

A case of bipolar disorder presenting in an adolescent girl is presented. Differential diagnosis and treatment is discussed. A number of aspects of this case are outlined including the difficulties of diagnostic accuracy in major disorders of childhood and adolescence, the existence of biological markers, the implication of environmental stressors and cultural-familial factors. An unusual situation of reversal of index case identification is noted.     

Six years on: a prospective cohort study of male juvenile offenders in secure care

Longitudinal studies are helpful in understanding developmental trajectories and recognising opportunities for early intervention. This paper describes the long-term needs and mental health of an initial sample of male juvenile offenders, now adults 6?years after their index admission to secure care. In this prospective cohort study of 97 male juvenile offenders admitted to secure, offenders were assessed initially on admission, 2 and 6?years later. Interviews were conducted with 54 offenders at the 6-year follow-up and included an assessment of psychosocial need, mental health and psychopathy. Outcome data on offending behaviour were collected on a total of 71 offenders. Persistent offenders have needs in multiple domains as they transition into adulthood. The majority of offenders were single and about a half were in neither employment nor training. Almost nine out of ten offenders had a substance misuse disorder and a similar number met the criteria for a diagnosis of antisocial personality disorder. Substance misuse in adolescence was strongly correlated with later substance misuse in adulthood, emphasising the importance of early intervention. A diagnosis of antisocial personality disorder and living with friends and family were both significantly associated with persistent offending behaviour. Many offenders continued to reoffend despite receiving offence-related interventions and custodial care. Interventions currently aimed at reducing recidivism in more severe offenders appear to be ineffective. Persistent offenders would benefit from a multi-modal approach based on individual needs, rather than receiving generic interventions.