Antidepressant treatment of children: clinical relapse is unrelated to tricyclic plasma concentrations

Plasma concentrations of imipramine and amitriptyline and their desmethylated metabolites were measured in 20 children being treated for major depressive illness 2 wk. and 5 to 10 wk. after achieving drug dosages of 2.25 mg/kg body weight. At 2 wk. all children had exhibited clinical improvement, but by 10 wk. 4 of the 10 children treated with imipramine and 5 of the 10 children treated with amitriptyline had experienced clinical relapse of depressive symptoms. Tricyclic antidepressant plasma concentrations and ratios were comparable in the subgroups of children who maintained their clinical improvement and those who relapsed. There was no evidence of a systematic decline in plasma tricyclic antidepressant concentrations in those children who relapsed.     

Infant hypotonia, obesity, hypogenitalism and oligophrenia--new viewpoints on the etiology and symptoms of Prader-Willi syndrome

We present four cases of Prader-Willi syndrome. Two of them have an abnormality of a chromosome 15, the other both show different chromosomal abnormalities. Translocations or deletions were found recently in the bands 15q11/12 in about 60% of the cases of Prader-Willi syndrome. The consequences for diagnosis, symptomatology and genetic counselling of the syndrome are discussed.     

Changes in self-stimulatory behaviors with treatment

For four of six autistic children who underwent intensive behavioral treatment, the nature of their self-stimulatory behavior changed from initial lowlevel motor behaviors (such as rocking, spinning, twirling) to differing kinds of higher-level behaviors (such as lining of objects, echolalic speech, and preoccupation with spelling and numerical values). The children who changed to the highest levels of self-stimulatory behavior also showed the largest gains in treatment (as determined by IQ scores, school placement, etc.). The changes in self-stimulatory behaviors were attributed to the intense teaching of appropriate social behaviors and the explicit therapeutic suppression of low-level, self-stimulatory behaviors. The long-term therapeutic effects of changing from lower-to higher-level forms of self-stimulatory behavior were discussed.This study was supported by a grant from the National Institute of Mental Health (grant MH 11440). We want to express our thanks to the parents who allowed us to study their children. We gratefully acknowledge the assistance of Maria Audero with the design of the weighted measure, and Tracee Parker with the collection of the data.     

PSYCHOLOGY AND HEALTH: CONTRIBUTIONS OF PSYCHOLOGY TO THE IMPROVEMENT OF HEALTH AND HEALTH CARE

Psychology as both a science and a profession has been closely identified with other disciplines in the broad field of health since the turn of the century. Recent advances in health care have reinforced the growing belief that the promotion of health and the prevention and treatment of illness can be greatly enhanced by incorporating the scientific findings and modern technology of psychology into everyday practices. Outlining the contributions of psychology to health care throughout the world is the primary purpose of this report. In this brief survey, only some of the most timely and relevant issues can be mentioned, together with examples of current work in the field. The reader interested in pursuing these psychological contributions more thoroughly is encouraged to review pertinent references from the citations at the end of this report. After an introductory overview, special attention is given to each of the major areas within the broad field of health care where psychological applications have been particularly useful.     

Handedness and dementia

Some researchers have speculated that left-hand dominance is more prevalent among patients suffering from dementia of the Alzheimer's type which began prior to age 65 yr. and that, in those patients, the disease runs a more rapid course. In the present study, seven left-handed dementia patients were matched with seven right-handed dementia patients on the basis of age and years of education and were compared with regard to neuropsychological compromise. While the left-handed group was somewhat more impaired than the right-handed subjects, the difference between the two groups was not statistically significant.     

Separate verbal memory and naming deficits in attention deficit disorder and reading disability

In this study, verbal memory and naming abilities were investigated in reading disabled (RD) and control children who were characterized according to the presence or absence of attention deficit disorder (ADD). Results indicate that deficits in learning and memory for recently acquired information occur as a function of ADD rather than RD while deficits in naming are specific to RD rather than ADD. We conclude that ADD is a major source of additional and separate cognitive morbidity in RD children.     

Mechanisms underlying satiation of feeding behavior of the mollusc Aplysia

Animals filled almost to satiation by nonnutritive bulk do not satiate when they ingest a small amount of seaweed. This suggests that satiation is not triggered by chemostimulation of an anteriorly located "hot spot." Inflation of a balloon placed in the gut of the animal results in satiation as reflected in a number of different parameters of feeding behavior. The suppressive effect of a relatively brief inflation is rapidly and fully reversible, although repeated inflation and deflation appeared to produce slowly reversible or irreversible effects. The parameters of the changes in feeding during gut inflation are comparable to those of normal animals that are slowly fed individual pieces of food. The inflation volume needed to satiate the animal is a function of the rate of inflation--more rapid inflations requiring larger volumes. Cutting of the esophageal nerves results in a significant increase in the volume needed to satiate the animals, but nevertheless they eventually cease feeding and generally do not show a burst gut. The evidence indicates that the satiation that eventually occurs in nerve-sectioned animals, at least in part, is due to depression of feeding following very prolonged sensory stimulation. The data suggest that for a rapidly consumed meal, satiation results primarily due to distension-related gut signals conveyed by the esophageal nerves, whereas for very slowly consumed meals, the former factor interacts with a process associated with sensory stimulation, such as receptor adaptation. The current results indicate that balloon distension can serve as a reasonable stimulus in experiments in simplified preparations in which the nervous system can be studied.