Epidemiology of child psychiatric disorder: Methodological issues and some substantive findings

Key conceptual and substantive issues in child psychiatric epidemiology are reviewed using mainly European studies in terms of methodological problems and causal mechanisms. Attention is paid to issues in the measurement and categorization of disorder, case definition, case identification and classification. Research into causal processes is discussed in relation to organic brain dysfunction, temperamental risk, parental mental disorder and stress associated with multiple hospital admission.Department of Child and Adolescent Psychiatry Institute of Psychiatry     

Practitioner Review: Routes from Research to Clinical Practice in Child Psychiatry: Retrospect and Prospect

The last 40 years has seen a virtual revolution in both medical research and medical practice. Child psychiatry has been part of that revolution. The situation in the 1950s is briefly noted and seven examples are used to illustrate how causal research in the past has led to changes in clinical practice. The areas used as examples comprise: autism, hyperactivity/attention deficit syndromes, conduct disorders, depressive conditions, genetic research, organic brain dysfunction, and psychosocial risk processes. Prospects for the future with respect to the impact of research on clinical practice are discussed in relation to molecular genetics, environmental risks, cognitive and affective processing of experiences, links across the lifespan, and functional brain imaging. Attention is drawn to implications for training as well as for practice.     

Role of routine investigations in children presenting with their first febrile convulsion.

To assess the role of routine investigations in children presenting with their first febrile convulsion, the results of investigations carried out in 328 children over a 2-year period were reviewed. Lumber puncture was performed in 96% of cases and resulted in the detection of 4 cases of unsuspected meningitis, one of which was bacterial. 2 children had normal lumbar punctures on admission but developed meningococcal meningitis within 48 hours. Sugar, calcium, urea, and electrolyte estimations, and blood counts were commonly performed but were unhelpful. We suggest that lumbar puncture in those children presenting with their first febrile convulsion under the age of 18 months is the only useful routine investigation.     

The assessment and treatment of pre-school autistic childrent

In recent years there has been an Increasing emphasis on the early diagnosis and treatment of the autistic child. This paper considers the principles upon which a service for pre-school autistic children should be established and outlines the organizational requirements. Although autism is an uncommon and complex condition, it is argued that there are serious drawbacks to regional assessment centres for autistic children. A broad-based appraisal, including developmental evaluation, behavioral assessment, medical investigation and environmental study, is required. This necessitates access to a wide range of skills, but there must be one person who has the responsibility of coordinating care. Assessment and treatment are inextricably linked, and both must be viewed from a developmental perspective with reevaluation as the children change with age. Treatment should be mainly focussed on aiding social and linguistic development and reducing the tendency to develop rigid stereotyped patterns. A home-based approach founded upon developmental and behavioral principles is appropriate in this connection. In-patient care is of only limited usefulness and is unnecessary for most children. One assessment clinic for a child population of 80,000 (i.e. a total population of 400,000-500,000) should be adequate, and approximately two full-time therapists would be needed to cope with the treatment needs of autistic children from the same population.     

Bias resulting from missing information: some epidemiological findings.

The biases resulting from missing information were examined in three psychiatric epidemiological studies. In each study, cases with missing information could be compared with the main sample because data were available from several sources or at several points in time through a longitudinal study. In almost all instances, cases with missing data differed systematically in terms of variables crucial to the questions being studied. In general, they tended to include a higher proportion with problems of various kinds--such as, behavioural deviance, reading backwardness, child or adult psychiatric disorder, and marital discord. The characteristics or circumstances of those giving information were generally more strongly associated with co-operation in testing or interviewing than the characteristics of those about whom information was sought. In some situations, the nature and degree of distortion resulting from missing information could lead to biased results.     

Synergism between Trichuris suis and the microbial flora of the large intestine causing dysentery in pigs.

The role of the microbial flora of the large intestine in experimental Trichuris suis infection was studied by comparing the clinical syndrome in conventionally reared (CR) pigs, specific pathogen-free pigs, and gnotobiotic pigs. Thedisease in CR pigs was characterized by a severe mucohemorrhagic enteritis; in contrast, a mild catarrhal enteritis was observed in specific pathogen-free and gnotobiotic pigs.Spirochaetes and vibrio-like organisms were observed only in CR pigs and increased during the clinical phase of the disease. The clinical syndrome was not transmitted by oral administration of intestinal or fecal material from infected CR pigs to CR pigs free of T. suis. Smaller numbers of T. suis produced diarrhea in CR pigs and significantly reduced the growth rates of infected animals; clinical signs and the reduction in growth rate was prevented by incorporating an antibacterial substance (dimetridazole) in the food. Although clinical trichuriasis closely resembles swin dysentery, the two syndromes seem to be distinct. The present results suggest that a microbial component acts synergistically with T. suis to produce the severe clinical syndrome in CR pigs, but identification of the microbial component and the mechanism by which clinical signs are produced await further studies of the bacterial flora of the large intestine of pigs.     

A comparative study of infantile autism and specific developmental receptive language disorders III. Discriminant function analysis

A psychometric, observational, and interview study was undertaken with 47 boys, aged 4 1/2 to 10 years, with nonverbal IQs of 70+ and a severe developmental disorder of language comprehension. Separate discriminant function analyses, based on behavioral, language, or cognitive features, showed little overlap between clinically defined autistic and dysphasic subgroups. Moreover, the discrimination could be made as clearly on language or cognitive characteristics as on social or behavioral criteria. Language abnormalities and behavioral features also intercorrelated within the autistic subgroup. It is concluded that autism and dysphasia differ in important ways and that a cognitive deficit is an essential part of the syndrome of autism.This study was supported in part by grants from the Department of Education and Science and the Bethlem-Maudsley Hospital Research Fund. We are very grateful to the Directors and staff of the Units from which cases were selected for their ready cooperation in allowing us to examine children in each Unit. All went out of their way to provide help throughout the investigation. We are especially grateful to the parents of the children for their forbearance in allowing us to interview them at considerable length and for their exceptional kindness to individual investigators. We are also very grateful to Mr. B. S. Everitt of the Biometrics Department, Institute of Psychiatry, for statistical advice.     

Chromosomal assignments of human genes for serine proteases trypsin,chymotrypsin B,and elastase

The genes for the serine proteases trypsin, chymotrypsin B, and elastase were chromosomally assigned in man using cDNA probes that have been isolated from a rat pancreatic cDNA library. DNA from human × rodent somatic cell hybrids was cleaved with BamHI or EcoRI and analyzed by Southern filter hybridization methods for the segregation of the genes for trypsin-1 (TRY1), chymotrypsin B (CTRB), and elastase-1 (ELA1). TRY1 was assigned to human chromosome 7q22qter, CTRB to chromosome 16, and ELA1 to chromosome 12. Although the three genes are members of the same gene family, they are dispersed over different chromosomes.Preliminary chromosome assignments of chymotrypsin B (1) and of trypsin and elastase (2) have been made in abstract.