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Using a nationwide psychiatric case register covering a background population of 5.1 million inhabitants, 39 children (23 boys, 16 girls) were identified who got the diagnosis of manic-depressive psychosis between 1970 and 1986 before the age of 15. The frequency of manic-depressive psychosis in this child psychiatric population was 1.2%. The mean age for first-time admission with this diagnosis was 12.7 years. There was no sex difference. Twenty-six of the children got the diagnosis of manic-depressive psychosis during their first admission. Survival analysis was used to describe the prognosis and the diagnostic development of the group. As a whole, the group had a poor prognosis with many readmissions. The most common differential diagnoses were other types of psychosis in boys and oppositional and emotional disorders in girls.

Some borderline cases of obsessive-compulsive disorder (OCD), schizophrenia, and manic-depressive disorder in whom the diagnosis had been difficult to assess in adolescence are presented. The records of 27 OCD patients with admission both in adolescence and adulthood were compared to a group of manic-depressive and schizophrenic patients with an admission in adolescence where the OCD diagnosis had been given. Some differential diagnostic considerations and difficulties in the borderline area between OCD, manic-depressive psychosis and schizophrenia at the time of the first manifestation in adolescence are described. The symptomatology in the three groups of patients as it was presented in adolescence only showed a few differences, and the patients offered differential diagnostic difficulties to the clinicians.

Organic aspects of obsessive-compulsive disorder (OCD) have previously been described and hypotheses of biological etiology have been suggested. Sixty-one patients, 8-17 years of age, who fulfilled the DSM-III criteria for OCD in a review of the records were compared with 117 matched control patients for organic features. The indicators chosen for an organic concept were neurological signs, more than mild electroencephalographic abnormality, specific developmental disorder and attention deficit, and their defining property of an organic concept was confirmed by latent class analysis. Neurological signs was the most sensitive and specific indicator. Significantly fewer OCD children than control patients were assigned to the organic class. Almost all the types of obsessive-compulsive symptoms were more related to the non-organic class. Such extroverted symptoms as behavioral problems and loss of temper were significantly more frequent in patients assigned to the latent organic class, whereas symptoms of phobia and depressive mood were more often present in patients belonging to the nonorganic class. No difference was found between OCD patients and controls as to frequency of birth complications. The findings do not support the evidence of OCD having signs of major cerebral disturbance found by conventional neuropediatric methods.

At follow-up, 29 young adults treated previously (ages 7-14 years) for nocturnal enuresis by means of conditioning, mostly with a bed alarm, showed no excess of mental abnormalities, including psychosomatic symptoms. Most of the probands recollected the treatment as positive and effective. It is concluded that conditioning is effective in the treatment of nocturnal enuresis and that it does not seem to leave any undesirable after-effects. Nothing seems to indicate that omission of more intensive, conflict-solving psychotherapy has implied any disadvantage for the patient. Thus, the bed alarm method can still be recommended as the treatment of first choice.

To find children and adolescents with obsessive-compulsive disorder (OCD), a review was made of all the charts of the 4594 nonretarded, nonpsychotic patients treated at the Children's Psychiatric Hospital in Risskov, Denmark, as in- or outpatients from 1970 to 1986. Sixty-one children and adolescents (37 boys and 24 girls) fulfilled the DSM-III criteria for OCD. The frequency of OCD in a child psychiatric clientele was 1.33%, which supports earlier findings. Only 8 of the 61 children were actually discharged with a diagnosis of OCD (ICD-8 diagnosis). Most children were diagnosed as neurosis infantilis and about one fifth received a diagnosis of maladjustment. The possible reasons for this are discussed. It is concluded that it is hardly a matter of underdiagnosing OCD, but more likely an attempt to look upon the obsessive-compulsive symptoms as transient phenomena and perhaps an unwillingness among clinicians to use the diagnosis of OCD, which is often connected with a bad prognosis. Boys and girls with OCD did not differ significantly on important demographic items.

Based on a review of the charts of child and adolescent psychiatric patients, a group of patients with obsessive-compulsive symptoms and a control group were identified. Obsessive-compulsive symptoms described in the charts were classified according to form using the checklist of Khanna et al. By use of latent trait models, a 6-item obsessive-compulsive rating scale was established revealing a dimensional rather than a categorical distribution of obsessive-compulsive symptoms. The correlation with other clinical features was investigated.

The charts of 61 children and adolescents admitted to the Psychiatric Hospital for Children in Aarhus, Denmark, in the period 1970-1986 fulfilling the DSM-III criteria for obsessive-compulsive disorder were reviewed for obsessive/compulsive symptoms. The symptoms were divided into form and content. The most common form of compulsion was rituals seen in 39 of the patients, and the most common compulsive content was washing. The most frequent obsessive content was thoughts about dirt and contamination followed by concern about death, illness and harm. The phenomenological feature of boys and girls was very similar, and only a few significant differences between boys and girls were found. One quarter of the boys and 12.5% of the girls had only obsession, whereas 27.0% of the boys and 37.5% of the girls had only compulsion and no obsession. The number of obsessive/compulsive symptoms was not found to correlate with the time spent each day on the symptom. It is concluded that there do not seem to be any intercultural differences between Denmark, India, and Japan as to the content of obsessional thoughts and compulsive behaviour in children and adolescents.

At follow-up, 29 young adults treated previously (ages 7-14 years) for nocturnal enuresis by means of conditioning, mostly with a bed alarm, had shown no excess of mental abnormalities, including psychosomatic symptoms. To investigate whether the probands displayed personality traits that could be related to the former enuresis and its treatment, they were asked to answer a mailed questionnaire that attempts to find deviations of personality, the Karolinska Scales of Personality. The scores were compared with those of a group drawn from the general population in the same geographical area and matched for sex and age. The enuresis group was found to have moderately (but significantly) lower scores on socialization and higher scores on suspicion. Possible causes for these findings are discussed. It is concluded that conditioning therapy, which is usually successful in rapidly alleviating enuresis, can also be regarded as a safe treatment. According to this study, it does not seem to leave unwanted aftereffects that could be interpreted as expressions of persisting psychological conflicts.

The present article describes experience with admissions for observation for limited periods in the Psyciatric Hospital for Children in Risskov. Admissions of this type were introduced in 1984 in Risskov and this is hitherto the only place in Denmark where this is done. The case records of 75 children admitted during the period 1.1.1984-31.12.1986 were reviewed as regards the pattern of referral, the problems on admission and placing on discharge. The durations of these admissions were 4-5 weeks and the structure of these admissions for limited periods is described in this article. The value of this form of hospitalization is emphasized. Maintenance of the child's relationships to the home and school, efficiency of the working routine and improved sorting out of children for long-term hospitalization are emphasized as important arguments. Finally, it is recommended that all departments for child psychiatry with residential units should have the possibility of admitting children for limited periods as part of extended outpatient investigation.

A register-based study of 485 children (0-15 years of age) admitted to a child psychiatric hospital from January 1, 1970 to December 31, 1972 who were followed up on December 31, 1986 showed higher rates of admission to psychiatric hospital in late adolescence or young adulthood (i.e. greater than or equal to 16 years of age) than found in an age-standardized general population. Patients with the childhood diagnosis neurosis (ICD-8 300 + 308.00) were found to have higher rates of admission with personality disorders (ICD-8 301.09-301.39 + 301.82-301.99) but not of other diagnoses including neurotic disorders. Patients with the childhood diagnosis of conduct disorder (ICD-8 301.09-301.99 + 308.01) had a higher risk of admission in adulthood with the diagnosis of personality disorders and drug or alcohol abuse. Girls with adjustment disorder (ICD-8 307 + 308.02-308.06) had higher risks of admission in young adulthood with diagnosis of personality disorders and psychosis. No connection was found between the age at first referral and the incidence of admission after the age of 15 years.