Inpatient intervention for chronic functional encopresis in psychiatrically disturbed children

Twelve children referred for short-term inpatient psychiatric treatment also received intervention for Functional Encopresis. Treatment consisted of an initial regimen of cathartic medication (CATH MED) followed by prompted toileting trips after meals for bowel retraining (TRIPS). Maintenance medications were given throughout both conditions. Staff records were used to document the integrity and impact of treatment. Compared to baseline, CATH MED was associated with an increase in independent toileting but no reduction in accidents. Significant improvements were obtained on both of these measures during the subsequent TRIPS condition. Some association among demographic, integrity, and outcome measures was detected. There was modest evidence for maintenance of improvements at one-year follow-up. Implications for the delivery and evaluation of inpatient treatment for encopretic children are discussed.     

Differentiating psychiatrically disturbed children on the basis of a structured interview

A structured psychiatric interview designed for both clinical assessment and data collection was given to 50 pairs of well-matched pediatrie and psychiatric clinic children and their mothers. The two groups were shown to be dearly distinguished on the basis of numbers of symptoms. Behavior and school symptoms gave the sharpest distinction between the two groups. Neurotic and somatic symptoms were the poorest discriminators. The psychiatric children showed significantly more antisocial symptoms than their matched pediatrie peers. Age differences showed the expected trends with the widest divergence in the number of symptoms being in the oldest age group.This study was supported in part by NIMH Grant 05938.     

Perfectionism and depression symptom severity in major depressive disorder.

In recent years it has been recognized that perfectionism is a multidimensional construct and two Multidimensional Perfectionism Scales have been developed and investigated in relative isolation [Frost, R.O., Marten, P., Lahart, C., & Rosenblate, R. (1990). The dimensions of perfectionism. Cognitive Therapy and Research, 14, 449-468; Hewitt, P.L., & Flett, G.L. (1991). Perfectionism in the self and social contexts: Conceptualization, assessment and association with psychopathology. Journal of Personality and Social Psychology, 60, 456-470]. The present study sought to evaluate the association between various dimensions of perfectionism, higher-order personality dimensions, and self and observer rated depressive symptoms in a group of 145 patients with major depressive disorder. Only three of ten perfectionism dimensions (socially prescribed perfectionism, concern over mistakes and self-criticism) displayed medium to large correlations with depressive symptoms, especially self-report symptoms reflecting depressive cognitive distortions. The results are discussed in relation to the specificity of perfectionism dimensions to depression, adaptive versus maladaptive aspects of perfectionism, and in the context of previous research, much of which has relied on college student samples.     

Prevalence and correlates of self-reported depressive mood among seriously emotionally disturbed adolescents.

This study examined self-reported depression on the Reynolds Adolescent Depression Scale among 45 seriously emotionally disturbed adolescents. Scores of one-third of the sample exceeded the cut-off score, which indicated the need for further diagnostic study to assess the possible presence of depression. Significant positive correlations included an association with school attendance, a relationship with scores on the Revised Children's Manifest Anxiety Scale, and an association with teachers' ratings on two subscales of the Revised Behavior Problem Checklist. Also, the Depression scale's negative association with the Lie subscale of the Manifest Anxiety Scale is interpreted as indicative of seriously emotionally disturbed adolescents' response style on self-reported measures of depression.     

Problem-solving deficits and depressive symptoms among children

Depressive symptoms among 40 fourth- and fifth-grade students as measured by the Children's Depression Inventory, correlated highly with impaired problem solving at block designs (r = .64) and anagrams (r = .67). Similar impairments have been found among depressed adults, suggesting that depression among children may be continuous with depression among adults.     

Correlates of loneliness in nonreferred and psychiatrically hospitalized children

We investigated psychosocial correlates of loneliness using self- and caretaker-reports in 6–12 year old nonreferred and psychiatrically hospitalized children. In Phase 1, 109 nonreferred children completed self-report measures of internalizing problems, mothers completed the Child Behavior Checklist (CBCL), and teachers completed the CBCL-Teacher's Report Form. In Phase 2, a similar assessment battery was completed for 109 psychiatrically hospitalized children. Results indicated a moderate to strong relationship between loneliness and self-reported depression, hopelessness, low self-esteem, and anxiety. Children reporting high and low levels of loneliness were not differentiated by parent or teacher reports. Lonely children had lower IQs than their non-lonely peers.     

Hopelessness depression as a distinct dimension of depressive symptoms among clinical and non-clinical samples

Subtyping depression has been an interest of theorists and clinicians for at least four centuries. In this paper, we examined the validity of the symptom cluster component of the hopelessness theory of depression. We used structural equation modeling analyses on large samples of psychiatric outpatients (N=1604, 844, and 680) and Air Force cadets (N=1404) who completed the items of the Beck Depression Inventory (BDI). Findings were supportive of the hopelessness depression cluster as a distinct depressive syndrome. Implications for the nosology of depression and for depression theory were discussed.     

Negative mood,depressive symptoms,and major depression after smoking cessation treatment in smokers with a history of major depressive disorder

Negative mood, depressive symptoms, and major depressive episodes (MDEs) were examined in 179 smokers with a history of major depression in a trial comparing standard smoking cessation treatment to treatment incorporating cognitive-behavioral therapy for depression (CBT-D). Early lapses were associated with relatively large increases in negative mood on quit date. Mood improved in the 2 weeks after quit date among those returning to regular smoking but not among those smoking moderately. Continuous abstinence was associated with short- and long-term reductions in depressive symptoms. MDE incidence during follow-up was 15.3% and was not associated with abstinence. Unexpected was that CBT-D was associated with greater negative mood and depressive symptoms and increased MDE risk. Results suggest complex bidirectional associations between affect and smoking outcomes.     

Facets of loneliness and depression among Chinese children and adolescents

The authors examined the relation among different facets of loneliness and depression in a sample of 6,356 Chinese children and adolescents from Grades 4-9. Loneliness and depression were closely related among the primary (Grades 4-6) and secondary (Grades 7-9) students, both boys and girls. Although the different facets of loneliness were predictive of the various facets of depression, peer-related loneliness and aloneness were more predictive of depression in both groups than was parent-related loneliness. The students in Grades 5 and 6 scored lower for loneliness but a little higher for depression than did the students in Grade 4. The students in Grades 8 and 9 scored higher than the students in Grade 7 for loneliness and depression. The primary boys scored higher than the primary girls for both loneliness and depression. Among the secondary students, there was no difference between the scores of the boys and those of the girls for loneliness, but the boys scored lower than the girls for depression.     

The Children's Firesetting Interview with psychiatrically referred and nonreferred children

This study evaluated the Children's Firesetting Interview (CFI). The measure was developed to operationalize multiple domains of functioning derived from a riskfactor model of firesetting. The model poses that child, parent, and family characteristics promote firesetting and continuation of a pattern of firesetting. Major factors include curiosity about fire, involvement in and exposure to firerelated activities, and knowledge about first safety The CFI, consisting of 46 questions reflecting six a prioridimensions, was administered to 519 children (ages 6–13) recruited from nonpatient, outpatient, and inpatient samples. Internal consistency and testretest reliability of the measure were satisfactory. Criterion validity was supported by the findings that firesetters showed greater curiosity about fire, involvement in firerelated activities, exposure to models/materials, and knowledge about things that burn than did nonfiresetters. These findings did not vary as a function of the child's patient status or level of antisocial behavior. Implications for the evaluation of firesetting risk are discussed.This study was supported by grant MH-39976 from the Antisocial and Violent Behavior Branch of the National Institute of Mental Health and by a Research Scientist Development Award (MH00353) from the National Institute of Mental Health. The authors acknowledge the constructive suggestions of two anonymous reviewers.     

Gender differences in major depressive disorder and bipolar disorder

This paper reviews the literature on gender differences in major depressive disorder (MDD) and bipolar disorder (BPD). Beginning in adolescence, women are at a higher risk than men of becoming depressed. Avenues of investigation that might ultimately help to explain this phenomenon include studies of gender differences in the processing of emotional stimuli, the psychotropic effects of gonadal steroids, and environment/gene interactions in men and women. With the exception of the elevated suicide rate among men, consistent gender differences in the course and symptoms of MDD have not been found. In BPD, women are more likely than men to develop a rapid-cycling course. Gender differences in treatment response, particularly in regard to mood stabilizing medications, warrant further study.     

Factor analytic evaluation of differences between black and caucasian emotionally disturbed children on the children's depression inventory

Scores on the Children's Depression Inventory (CDI) for 392 Caucasian and 159 black psychiatric inpatients between 6 and 18 years of age were subjected to principal-components factor extraction with Varimax rotation. Factors not contributing to variance were eliminated using the scree test (Cattell, 1966) and the degree of variance accounted for by remaining factors for both groups was examined through respective squared multiple correlations. A comparison of CDI factors for blacks and Caucasians indicated some differences, with blacks be ing less suicidal yet higher on other behavioral dimensions, such as oppositionality, and Caucasians higher on affective dimensions, such as sadness. The results support research on black-Caucasian differences and suggest the need to validate further the CDI with minority populations.     

Use of mental health services among severely emotionally disturbed children and adolescents in San Francisco

This study examined the mental health services available to severely emotionally disturbed children and adolescents in San Francisco. Social, familial, developmental, and clinical data—as well as service use histories—on 192 youths were collected. Results indicated high levels of family dysfunction, physical and sexual abuse, and neglect in the total study population. The study also identified case history and demographic factors that were associated with repeated psychiatric inpatient hospitalizationand high annual rates of change in residential placement. These factors included being male, older, non-English-speaking, and having a history of physical and sexual abuse. The impact of the service system on the lives and course of illness of these youth is discussed and future directions for research are suggested.     

The patterning of agonistic behaviors among friends and acquaintances in programs for emotionally disturbed children

Peer conflicts in two age groups (toddler and preschool) of emotionally disturbed children were examined for developmental trends and for changes over time in an intervention program. Children were observed in their peer groups six times over the course of a year. Prosocial and agonistic social behaviors were coded in a continuous coding observational procedure. Friendship pairs were identified from the observational records and validated by teacher reports. It was hypothesized that agonistic responses to both prosocial and agonistic bids would decrease over time and that friendships would facilitate conflict resolution and conflict avoidance in the emotionally disturbed children. Agonistic responses to agonistic bids decreased over time for all children. Older acquaintances responded to prosocial bids with agonistic responses. Friendship relationships facilitated conflict resolution and avoidance skills in preschool-age but not toddler-age friends. The results are discussed in terms of their implications for intervention.