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Pharmacologic and cognitive behavioral therapies have been advocated in the treatment of bulimia nervosa (BN). Brofaromine, a selective and reversible inhibitor of monoamine oxidase-A was selected for a double-blind, placebo-controlled evaluation because of previous demonstrated monoamine oxidase inhibitor efficacy in BN and because of its safer adverse reaction profile. Thirty-six female patients who met DSM-III-R criteria for BN were randomly assigned to the drug group (N = 19) or to the placebo group (N = 17) for an 8-week outpatient trial. Brofaromine produced a significant effect in decreasing episodes of vomiting throughout the trial, although comparable reductions in episodes of binge eating were found in both groups. Also, there were no advantages of drug over placebo on improvements in attitudinal measures and shape or on self-report ratings of depression and anxiety. However, a significant proportion of the subjects on brofaromine lost weight when compared with the placebo group. Methodologic issues including subjective assessment measures, placebo response rates, and the elucidation of responder subgroups are discussed. (J Clin Psychopharmacol 1993;13:415–422)

In this article, the author comments on the magnetic resonance imaging (MRI) study conducted by researchers from the Massachusetts General Hospital, which evaluated the temperament of 18-year-old patients. He mentions that researchers provided a hypothesis for the observed structural differences in adult orbital and ventromedial prefrontal cortex. He believes that the lack of MRI data from infancy makes it hard to determine whether the findings at 18 years old reflect genetic factors.

An abstract of the article "Are There Placebo Effects in the Medication Treatment of Children With Attention-Deficit Hyperactivity Disorder?," by D. A. Wachsbusch and colleagues is presented.

The article presents a study on the efficacy of an Internet-based depression prevention program for adolescents in the U.S. The program is specifically intended to assist adolescents with tendencies of having depression and those who are depressed. The physicians convince adolescents of the advantages of pursuing an intervention and motivational phone calls from social workers.

In this article the author comments on the issue regarding the implication of diagnosing bipolar disorder in children in the U.S. The author presents questions addressed for all health professionals who care for children. The author also indicates that bipolar disorder in children is determined first during the age range 15-24 years.

The article presents information on a study led by David Brent and his colleagues on the benefit of different interventions among depressed adolescents with or without selective serotonin reuptake inhibitor (SSRI) antidepressant. The study showed that cognitive-behavioral (CBT) combined with either SSRI or serotonin and norepinephrine reuptake inhibitor (SNRI) was better than taken solely. According to the article, no medication was superior to any other and there is no dissimilarity among treatments in terms of frequency of unfavorable events.

The article discusses research on the greeting behavior in routine clinical practice. It references a study by G. Makoul and colleagues published in the June 11, 2007 issue of "Archives of Internal Medicine." A computer-assisted telephone survey of 415 adults in the 48 contiguous U.S. was conducted. Results revealed that 50 % of respondents wanted doctors to call them by their first name. It suggests that respect, sensitivity and anxiolysis are required in doctor-patient relationship.

The article discusses research on weight gain and metabolic effects of antipsychotic drugs and mood stabilizers in pediatric bipolar disorder. It references a study by C. U. Correll that was published in the June 2007 issue of the "Journal of the American Academy of Child & Adolescent Psychiatry." The study suggested that while mood stabilizing drugs are recommedned as first-line treatments in clinical practice guidelines for pediatric bipolar disorder, there is a paucity of data regarding their ricsks from high-quality research.

The article discusses a study on methylphenidate use among children living in single-parent households in Canada. The study tests the impact of divorce as a stressful event. Accordingly, the National Longitudinal Study of Children and Youth was used. It says that three percent of children whose parents remained married and 6.1% of children whose parents separated by 2000 were on methylphenidate.

The article discusses research being done on identifying the young people at risk for depression. It references a study by Z. N. Mannie et al. published in the April 2007 issue of "American Journal of Psychiatry." The researchers examined whether salivary cortisol hypersecretion can be a marker in identifying at risk young people. They observed that salivary cortisol levels were elevated in subjects with a family history of depression.

The article discusses research being done on the impact of the publicity of pediatric suicidality on the practice patterns of U.S. psychiatrists. It references a study by C. B. Nemeroff et al. published in the April 2007 issue of "Archives of General Psychiatry." The researchers used a physician drug and diagnosis audit to determine the changes in the prescription of antidepressants in the country. They found that the prescription rates for people below 18 years old from 2000 to 2005 fell by 23%.

The article deals with the essay published by Doctor Jerome Groopman, Chief of Experimental Medicine at Beth Israel Deaconess Medical Center, in the April 9, 2007 issue of "The New Yorker" about diagnosing bipolar disorder in children. Based on the article, the diagnosis of the disorder remains a clinical one and no biological markers were identified to prove that the condition is real. In his essay, Groopman claims that cultural phenomena may amplify diagnosis.

The article focuses on a study which compares a short course and a long course of manual-based family therapy in adolescents with anorexia nervosa four years after the treatment conducted by researchers from Stanford University in California. It enumerates the phases of treatment such as helping the parents return control of normal eating to the adolescent. It found that there were no further advantages given by the longer course of family therapy at the end of four years.

The impact of exposure among preschool children to violence in the home, particularly to violence involving harm to the mother or primary caregiver is expressed across several domains of childhood functioning. This study, a randomized controlled trial, examined the efficacy of Child-Parent Psychotherapy (CPP), a treatment based on the premise that early mental health problems should be addressed in the context of the child's primary attachment relationships. CPP involved weekly hour-long sessions with mother and child together for a year. Thirty-six boys and 39 girls ages 3-5 from ethnically diverse backgrounds were referred because of clinical concerns over the child or mother's behavior after the child had witnessed or overheard marital violence. They were randomized as dyads to either CPP or monthly case management plus referral to community mental health clinics for one year. Measures of childhood behavior, maternal functioning and traumatic stress were administered. The attrition rate was less than 15% in both groups over the year. The CPP group had a significant reduction in traumatic stress scores and improvement in childhood behavior, whereas the comparator group did not. The authors also reported on the clinical as well as statistical significance of their findings, looking only at the subgroups of children who surpassed the threshold at baseline for a diagnosis of traumatic stress disorder. Once again, the CPP proved effective in moving children out of the range of diagnostic categorization. A trend favouring CPP was also seen in maternal measures [ABSTRACT FROM AUTHOR]

While clinicians increasingly recognize the presence of Asperger syndrome (AS) in children with socio-emotional difficulties, there is a paucity of evidence-based interventions for this population. Elevated rates of anxiety disorder and worry have been documented among AS children. Cognitive behavioural therapy (CBT) is well-established as the psychotherapeutic treatment of choice for anxiety disorders in adults and children. In children, there is evidence that group CBT involving both children and their parents is superior to child-only treatment. This Australian study involved 71 AS children age 10-12 years who had comorbid anxiety as reflected by parental report and objective measures. They were randomly assigned to either group CBT in small groups of three children, group CBT involving small groups of three children plus parent groups and a waiting list control. The CBT program was designed to be "highly structured, informative and entertaining". It consisted of 6 two-hour sessions exploring both positive and negative emotions as well as coping strategies, conceptualized as a toolbox. Multiple outcome measures for parents and children were used at baseline, after the last session and 6 weeks later. The results show therapeutic superiority of both interventions over sitting on a waiting list and further benefit to the parent-child intervention over the child-alone CBT. This benefit was seen not only with regard to anxiety symptoms but also in terms of parental reports of social worries in their children. Further, using a novel brief scenario called "James and the Maths Test", where children were asked to generate positive coping strategies for an anxious child to whom AS children could easily relate, the group that received parent-child CBT generated significantly more strategies at both follow-up measurement points. [ABSTRACT FROM AUTHOR]

In both adults and children, screening for depression is complicated by the presence of physical symptoms which can reflect both non-psychiatric and psychiatric disorder. The use of screening and self-report measures has been advocated to improve the detection of disorders that are common and impair quality of life in a "two-tier" approach. First, the healthcare provider asks targeted questions to identify possible cases. Then, self-report questionnaires may provide secondary elucidation of "caseness". This approach has been endorsed by the American Academy of Pediatrics. In this study, (Mount Sinai Medical Center, New York, NY) the diagnostic accuracy of the Children's Depression Inventory (CDI) was evaluated in medically ill children who were suspected of having an emotional problem by their pediatricians. The CDI is a 27-item self-report questionnaire that has been validated and used extensively. The CDI was compared with other established measures for depression in children, as well as a "best estimate" diagnostic procedure that incorporated both clinician input and structured evaluation. Patients were consecutive referrals, from pediatricians and subspecialists in a variety of services in New York, of children suspected of having an emotional problem. These patients underwent extensive evaluation with a battery of diagnostic instruments and 81 children ages 8-19 years completed the study. The CDI proved to be significantly associated with, and could be used as a predictor of the existence of either a major depressive disorder or any depressive disorder in this group of suspected but not previously diagnosed medically ill children. This study validates the two-tier approach of initial clinical suspicion followed by targeted screening with a self-report instrument. The anhedonia scale of the CDI was most highly associated with the diagnosis of depression in this group and is least confounded by physical symptoms such as fatigue in the medically ill. It was a more clinically important indicator of depression in this group than low self-esteem. [ABSTRACT FROM AUTHOR]

In this article, the author comments on a study of all live births in Sweden from 1978-2004 on the roles of risk factors for sudden infant death syndrome (SIDS). The study sought to determine the influence of environmental factors in higher risk SIDS associated with parental mental illness. According to the author, this study demonstrates that a national campaign of health promotion can have an effect on the population.

In this article, the author comments on the randomized controlled trial for the treatment of childhood obesity through retraining eating pattern conducted at the Royal Hospital for Children in Bristol, England. The author offers insights on the use of Mandometer, which was developed by the Karolinska Institute in Sweden, in the study. The author believes that the intervention using Mandometer is beneficial for the respondents of the study because it guides them toward normal eating habits.

The article focuses on the study conducted by Massachusetts General Hospital and State University of New York regarding the possible role of stimulants in protecting youth with attention deficit hyperactivity disorder (ADHD) against psychiatric disorders. On a follow up study, it was believed that stimulant-treated subjects were less likely to develop psychiatric disorders. According to the author, stimulant treatment may interrupt its pathogenic trajectory leading to other disorders.

The article reports on a study conducted by researchers at Vanderbilt University on the effectiveness of group cognitive-behavioral (CB) prevention for depression in adolescents. The researchers found that the CB group was associated with a lower rate of new depressive episodes at follow-up than those in usual care. In addition, self-reported depressive symptoms were lower in the experimental intervention.

The article offers information on a study regarding the blood alcohol concentration (BAC) in children conducted by the University of Pittsburgh Medical Center in Pittsburgh, Pennsylvania. Specifically, the study aims to improve the determination of drinking behavior deemed risky in children and adolescents in the 9 to 17 age bracket. As per results of the study, lowering the definition of binge drinking for the said age group was suggested.

The article presents a commentary on the study about children's stigmatization of childhood depression and attention-deficit hyperactivity disorder (ADHD). The author renders his views on the magnitude and demographic variation in a national sample and comments on the stigma that comes with ADHD. According to the author, health professionals should think about our language and behaviors when it comes to common human problems such as the ADHD.

The article discusses a randomized, controlled trial of fluoxetine alone and fluoxetine coupled with individual cognitive-behavioral therapy (CBT) for depressed adolescents conducted by Ian Goodyer and colleagues at Cambridge University in England. The trial involving 211 subjects took 28 weeks and revealed that 61% of those on drug alone and 53% of those on drug plus CBT were much or very much improved. Worsening of symptoms and no response were reported in 17% on drug alone and 25% on drug plus CBT.

The article discusses research on the use of atypical antipsychotics for patients under 18 years old in Canada. It references a study by T. Doey and others in the June 2007 issue of the "Canadian Journal of Psychiatry." The study found that the most common indications for prescribing the drugs were pervasive developmental disorder, affective dysregulation and bipolar disorder. The research suggested that the prescribing of the drugs is common among child psychiatrists and developmental pediatricians.

The author comments on a study which evaluated the efficacy and cost-effectiveness of family therapy and cognitive behavior therapy in adolescents with bulimia nervosa. He states that the study provides support for the use of guided self-help for bulimic adolescents. He cites that such study is an alternative to grafting therapeutic solutions from adults onto an adolescent population.

The article focuses on a study which evaluates the efficacy of paroxetine treatment versus placebo in children and adolescents with major depressive disorder conducted in the U.S. and Canada. It found that the rate of serious adverse events was higher in the paroxetine group. It cites that the incidence of suicidal behaviour during the treatment was 1.92% in the paroxetine group compared to 0.98% in the placebo group.

Incidental findings of abnormalities on magnetic resonance brain imaging research on healthy volunteers pose ethical and clinical challenges. This study, from the Long Island Jewish Medical Center, is a retrospective look at 60 children and adolescents who participated as healthy volunteers in comparison with adolescents suffering early-onset schizophrenia. Incidental MRI abnormalities were found in 8 (13%) of the healthy controls. All of these abnormalities were communicated back to the child or adolescent, their parent and the primary care physician. In three subjects, the clinical neuroradiologist noted abnormalities that required further evaluation over the next two years, including magnetic resonance angiography. None proved to be clinically significant. However, the generation of anxiety in the children and parents was not insignificant. The authors consider various ethical, clinical, practical and medico-legal challenges related to the detection and management of incidental findings in healthy participants in research protocols. These include forewarning of the possibility of incidental findings in informed consent, the low likelihood of successful "trolling" for clinically significant abnormalities, the routine involvement of a clinical neuroradiologist and the risks of subsequent investigation and the generation of anxiety. [ABSTRACT FROM AUTHOR]