Benzodiazepine use and quality of sleep in the community-dwelling elderly population

Background: About 50% of the elderly population report being dissatisfied with their sleep. Although benzodiazepines are the most prescribed drugs to treat sleep complaints, the effectiveness of their use on the quality of sleep is not well documented.

Objectives: This study aimed to assess the association between benzodiazepine use and global sleep quality, as well as six components of sleep quality.

Methods: Data from the cross-sectional Quebec Survey on Seniors’ Health (n = 2798) conducted in 2005–2006 were used. Quality of sleep was self-reported and use of benzodiazepines was assessed during the previous year.

Results: Benzodiazepine users reported poorer quality of sleep than non-users. The association between benzodiazepine use and each of the six quality of sleep components studied were similar except for the daytime dysfunction component.

Conclusion: The results suggest that there is no evidence that using benzodiazepines is associated with better quality of sleep than non-users in the elderly population. Future longitudinal population-based studies are needed to assess improvements in quality of sleep in the elderly associated with the use of benzodiazepines.     

Hoarding in Children and Adolescents: A Review

The diagnostic conceptualization of hoarding has recently changed, and yet the application of these changes to hoarding in youth remains to be clarified. In this review we examine the literature on hoarding in youth. We discuss issues related to the assessment of pediatric hoarding, and the nature of hoarding in youth. We consider evidence for hoarding disorder as a distinct diagnosis in youth, and review the relationship between pediatric hoarding and other psychiatric disorders. Finally, we describe preliminary models of treatment for pediatric hoarding. We conclude that there is support for hoarding disorder as a distinct diagnosis in youth. However, more precise and developmentally appropriate assessment tools are needed to provide stronger evidence for this claim and to further our knowledge of prevalence and associated clinical characteristics. Although there is no evidence-based treatment for pediatric hoarding, preliminary evidence from case studies suggests that cognitive and behavioral methods may have promise.     

A Crossover Study of Risperidone in Children, Adolescents and Adults with Mental Retardation

Risperidone has shown safety and efficacy for aggressive and destructive behaviors in short-term studies. This longer-duration study includes a broad sample. Forty subjects, aged 8–56 years (mean=22), all with mental retardation and 36 with autism spectrum disorders participated in this 22-week crossover study, with 24 weeks of open maintenance thereafter. Of 40 subjects, 23 (57.5%) responded fully (50% decrease in Aberrant Behavior Checklist-Community Irritability subscale score), while 35 subjects (87.5%) showed a 25% decrease. Gender, mood disorder, and antiseizure medications did not alter response. Increased appetite and weight gain were common. Low dose risperidone was effective for aggressive behavior in persons with MR. More long-term studies are needed, incorporating weight control interventions.     

Somatoform Disorders in Children and Adolescents: A Comparison with Other Internalizing Disorders

A chart review of children and adolescents attending a university-based psychiatric outpatient clinic over a 1-year period was done. Nineteen consecutive patients with somatoform disorders were compared with 26 consecutive patients with other internalizing disorders, i.e., depressive disorders and/or anxiety disorders without disruptive behavior problems. Mean age, sex distribution, cognitive level, and duration of symptoms were not different between groups. Self- and parent-reported levels of psychopathology, including depression, anxiety, suicidal ideation, and deliberate self-harm, differentiated between somatoform disorders and other internalizing disorders at the group level. Levels of adaptive functioning and functional somatic symptoms did not. High levels of medically unexplained symptoms should prompt the clinician for assessing depressive symptoms and anxiety. Findings also support the use of DSM-IV criteria in pediatric patients to differentiate somatoform disorders from other internalizing disorders.     

Social Anxiety in High-functioning Children and Adolescents with Autism and Asperger Syndrome

We examined social anxiety and internalizing symptoms using the Social Phobia and Anxiety Inventory for Children (SPAI-C), the Social Anxiety Scale for Children -Revised (SASC-R), and the Child Behavior Checklist (CBCL) in a sample of fifty-four high-functioning subjects with autism or Asperger syndrome (HFA/AS) (M = 11.2 ± 1.7 years) and 305 community subjects (M = 12.2 ± 2.2 years). Children and adolescents completed the SPAI-C and SASC-R, and their parents completed the CBCL Internalizing scale. Adolescents with HFA/AS scored higher than the community sample on all measures. Behavioural avoidance and evaluative social anxiety increased by age within the HFA/AS group, whereas behavioural avoidance decreased by age in control participants. Data support that HFA/AS in adolescents may be associated with clinically relevant social anxiety symptoms.     

Benzodiazepine effects on flicker sensitivity: Role of stimulus frequency and size

Maddock Richard J., Evanne J. Casson, Lori A. Lott, Cameron S. Carter, and Chris A. Johnson: Benzodiazepine effects on flicker sensitivity: Role of stimulus frequency and size. Prog. Neuro-Psychopharmacol. & Biol. Psychiat. 1993, 17(6): 955–970.

1. 1. Benzodiazepines (BZDs) impair sensitivity to temporally modulated visual stimuli (flicker). Critical flicker-fusion frequency (CFF) is commonly used as a measure of this effect, but it only measures sensitivity to a narrow range of frequencies, usually above 25 Hz. Are other frequencies more sensitive to the effects of BZDs?

2. 2. Flicker sensitivity at 1, 2, 4, 8, 16, and 32 Hz was measured for 1° and 5° stimuli before and 50 to 100 minutes after triazolam (0.25 mg), lorazepam (1.0 mg) and placebo. Drug effects on CFF were also measured.

3. 3. Both BZDs significantly impaired overall flicker sensitivity. Triazolam produced 50% more impairment than lorazepam. CFF was significantly impaired by triazolam. BZD effects did not vary with stimulus size.

4. 4. Significantly greater BZD-induced impairment of flicker sensitivity occurred at 16 Hz than at 1, 2, 4, or 32 Hz.

5. 5. The magnitude of BZD effects on flicker sensitivity vary with the temporal frequency of the stimulus. BZD effects are greatest for 8–16 Hz stimuli.

Serum cholesterol and aggressive behavior in psychiatrically hospitalized children

The relationship between serum cholesterol and a number of measures of impulsiveness and aggression was examined in 38 prepubertal, psychiatrically hospitalized children. Although care was taken to use reports and direct observations of both variables within 2 weeks of admission and 8 weeks later, no consistent relationship was found. The reasons for these findings are discussed.     

Early Onset Dysthymic Disorder in Children and Adolescents: Clinical Implications and Future Directions

Early onset dysthymic disorder (EODD) is a serious psychiatric disorder that is associated with impaired social and relationship functioning, comorbid psychiatric conditions, a chronic course and increased risk for adult affective disorders. Unlike major depressive disorder (MDD) in childhood, which has been the focus of ongoing research, EODD has been relatively neglected in clinical practice and research. This paper reviews and evaluates EODD research findings and outlines pertinent clinical and research implications.     

Measurement of violence during in-patient treatment and association with psychopathology

OBJECTIVE: Four available instruments for the measurement of violence were compared. The association between psychopathological status at admission and violence during in-patient treatment was examined. METHOD: In 199 consecutively admitted patients (143 with schizophrenia or schizoaffective disorder, 56 with non-psychotic disorders), the PANSS was recorded at the time of admission. Violent behaviour against self and others was assessed for the total period of in-patient treatment using the scales MOAS, SDAS, SOAS and VS. RESULTS: The sumscores of the scales correlated highly (r between 0.78 and 0.91), but the scales differed in sensibility and inter-rater reliability. There was a strong association between thought disorders and violent behaviour during in-patient treatment in psychotic patients (beta = 0.34; P<0.001). CONCLUSION: Although constructed to measure different aspects of violence, all investigated instruments correlated highly. The psychopathological status at admission is associated with violent behaviour during in-patient treatment.     

Cognitive Behavioural Therapy for Anxiety Disorders in Children and Adolescents: A Meta-Analysis

We conducted a meta-analysis using 20 randomised controlled studies of cognitive behavioural therapy (CBT) for anxiety disorders in children and adolescents. The mean pre-post effect size was d  = 0.94, which was maintained at follow-up. The mean effect size when comparing the CBT and control group was d  = 0.61. Within the CBT group, the mean effect size of university clinics ( d  = 0.77) was larger than that of other clinics ( d  = 0.37). The difference in effect sizes was hardly noticeable when comparing CBT with family or parents and CBT with child only ( d  = 0.03). Further studies are required to examine the effectiveness of family CBT versus child CBT.     

Sociodemographic Characteristics,Risk Factors,and Prevalence of Comorbidity among Children and Adolescents with Intellectual Disability: A Cross-sectional Study

ABSTRACT

Introduction: Intellectual disability (ID) is characterized by limitations in cognitive and adaptive functioning. The aim of this study is to examine sociodemographic characteristics, perinatal and childhood risk factors, and prevalence of psychiatric and biomedical comorbidities in children with ID.

Methods: 260 patients with ID were included in the study (mean age: 8.42 ± 3.59, 61% male, 75% mild ID). The Ankara Developmental Screening Inventory, the Wechsler Intelligence Scale for Children–Revised, and the Porteus Maze Test were used to assess the intelligence of the participants. An additional questionnaire was used to investigate their sociodemographic characteristics and birth, developmental, and medical histories.

Results: Adverse perinatal/neonatal events (p < .001), biomedical comorbidities (p < .001) and seizure/convulsion history (p < .001) were strongly associated with the moderate-severe ID. The children with mild ID had more emotional-social deprivation (p = .022). Low socioeconomic situation, parental education, and teenage parenthood were risk factors for stimulus deficiency. While internalizing disorders were more common in those with mild ID and among girls, externalizing disorders were more common in those with moderate-severe ID and among boys.

Conclusion: Interventions to perinatal/neonatal events may reduce the rate of moderate-severe ID. Evaluation of psychiatric and medical comorbidities and elimination of emotional-social deprivation should be fundamental components of the services offered to children with ID.     

Relationships between mental disorders in childhood and adulthood

Research findings on continuities and discontinuities in psychopathology between childhood and adult life are reviewed with respect to major depressive disorders, anxiety states, obsessional conditions, anorexia nervosa, conduct disorders, hyperkinetic disorders, autism, specific developmental disorders of language and schizophrenia. The findings are used to consider both the conceptual issues and possible mediating mechanisms.