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Children with Sydenham's chorea may develop psychological symptoms such as obsessive-compulsive disorder. Sydenham's chorea is a self-limited disorder of early life that is characterized by involuntary movements that gradually become severe. Eleven children between four and 12 years old with Sydenham's chorea were evaluated physically and psychologically. All of the children had different types of psychological symptoms. Nine had symptoms of obsessive-compulsive disorder, and four fit the diagnostic criteria for this disorder. The severity of psychological symptoms correlated with the severity of the children's motor impairment. Other psychological symptoms observed in the children included increased emotional instability, hyperactivity, irritability, distractibility and regressive behavior. Sydenham's chorea was called St. Vitus dance when it was first described in the 1600s., Eleven children with Sydenham's chorea (8 girls and 3 boys, mean age = 8.4 [+ or -] 2.2 [SD] years) underwent comprehensive physical, neuropsychologic, and psychiatric examination. The chorea was manifested as dysarthria, gait disturbances, and frequent adventitious movements of the face, neck, trunk, and extremities. Antineuronal antibodies were present in 10 of 11 children. All children exhibited concomitant psychologic dysfunction, specifically obsessive-compulsive symptomatology, increased emotional lability, motoric hyperactivity, irritability, distractibility, and age-regressed behavior. Obsessive-compulsive symptoms were observed in 9 (82%) children, 4 of whom met diagnostic criteria for obsessive-compulsive disorder. These behavioral symptoms began several days to weeks before the chorea was observed, and they waxed and waned in severity along with the motoric abnormalities. These results suggest that psychologic, particularly obsessive-compulsive, symptoms are accompanying manifestations of Sydenham's chorea which may require medical attention. Pediatrics 1993; 91:706-713; Sydenham's chorea, movement disorders, obsessive-compulsive disorder, attention deficit hyperactivity disorder, neuropsychology.

Suicide ranks third as a cause of death among teenagers and young adults aged 15 to 24 years. The number of suicide attempts is 40 to 220 times greater than that of successful suicides, however. Factors that increase the risk of suicide are classified into psychiatric disorders, personality traits, family influences, biological causes, and psychosocial conditions. Suicide attempts may be triggered by a stressful event such as the break-up of a relationship, humiliation, sexual abuse, or impending punishment. Teenagers who attempt suicide may perceive that their present life is chaotic, and that they are alone and without the support of family or friends. Many adolescents have similar experiences but do not attempt suicide, and thus certain risk factors may be more significant in predicting the likelihood that a teenager will attempt suicide. The contributions of psychiatric, familial, psychosocial, and environmental risk factors to adolescent suicide attempts were assessed. The study involved 21 adolescents who had attempted suicide, 34 normal adolescent control subjects, and 15 adolescents who had never attempted suicide but had the risk factors for attempted suicide. The subjects were interviewed and asked to fill out a questionnaire. Teenagers who had attempted suicide differed from control subjects with regard to substance abuse, depression, self-image, relationships with other people, ways of communicating, family support, and behavior difficulties. Teenagers who attempted suicide and high-risk teenagers differed on tests assessing sense of hopelessness and distress, as well as in experience with thinking about and planning suicide (suicidal ideation). Analysis of the results indicated that detection of hopelessness and suicidal ideation helped to identify 93 percent of subjects who actually attempted suicide. (Consumer Summary produced by Reliance Medical Information, Inc.)

background: Although the increase in treatment of children and adolescents with antipsychotic medications has been well documented, much less is known about the factors related to the use of these agents and how closely the treatment follows best practice recommendations. methods: Prescribers of each antipsychotic medication prescription issued for a Medicaid-insured child in Vermont aged <18 years were sent a prior authorization survey that assessed several domains including the clinical indication, other treatments, metabolic monitoring, prescriber specialty, and prescription origin. These variables were combined to categorize prescriptions as following indications approved by the US Food and Drug Administration (FDA) and best practice guidelines. results: The response rate of the survey was 80%, with 677 surveys from 147 prescribers available for analysis; more than one-half of the respondents were primary care clinicians. Overall, the clinical indication for an antipsychotic prescription followed best practice guidelines 91.7% of the time, with overall best practice guidelines followed at a rate of 50.1%. An FDA indication was followed in 27.2% of cases. Psychiatrists were significantly more likely to follow best practice guidelines than nonpsychiatrists. Antipsychotic medications were typically used only after other pharmacologic and nonpharmacologic treatments were ineffective, although previous treatment with cognitive-behavioral therapy was uncommon (15.5%). Metabolic monitoring that included serial laboratory tests was reported in 57.2% of cases. conclusions: Current prescribing patterns of antipsychotic medications for children and adolescents follow best practice guidelines approximately one-half of the time, with nonadherence often related to lack of metabolic monitoring. [ABSTRACT FROM AUTHOR]

Objective: Characterize the prevalence of chronic physical illness types and mental illness and their comorbidity among adolescents and young adults (AYA) and assess the association of comorbidity on hospital utilization., Methods: This study features a population-level sample of 61 339 insurance-eligible AYA with an analytic sample of 49 089 AYA (aged 12-21) in Vermont's 2018 all-payer database. We used multiple logistic regressions to examine the associations between physical illness types and comorbid mental illness and emergency department (ED) use and inpatient hospitalization., Results: The analytic sample was 50% female, 63% Medicaid, and 43% had ≥1 chronic illness. Mental illness was common (31%) and highly comorbid with multiple physical illnesses. Among AYA with pulmonary illness, those with comorbid mental illness had 1.74-times greater odds (95% confidence interval [CI]: 1.49-2.05, P ≤.0005) of ED use and 2.9-times greater odds (95% CI: 2.05-4.00, P ≤.0005) of hospitalization than those without mental illness. Similarly, comorbid endocrine and mental illness had 1.84-times greater odds of ED use (95% CI: 1.39-2.44, P ≤.0005) and 2.1-times greater odds of hospitalization (95% CI: 1.28-3.46, P = .003), comorbid neurologic and mental illness had 1.36-times greater odds of ED use (95% CI: 1.18-1.56, P ≤.0005) and 2.4-times greater odds of hospitalization (95% CI: 1.73-3.29, P ≤.0005), and comorbid musculoskeletal and mental illness had 1.38-times greater odds of ED use (95% CI: 1.02-1.86, P = .04) and 2.1-times greater odds of hospitalization (95% CI: 1.20-3.52, P = .01)., Conclusions: Comorbid physical and mental illness was common. Having a comorbid mental illness was associated with greater ED and inpatient hospital utilization across multiple physical illness types., (Copyright © 2023 by the American Academy of Pediatrics.)