Pharmacotherapy of Autism Spectrum Disorder: Results from the Randomized BAART Clinical Trial.

The objective of this trial, Biomarkers in Autism of Aripiprazole and Risperidone Treatment (BAART), was to provide support and guidance for an evidence-based approach for the selection and monitoring of initial pharmacotherapy in patients with autism by assessing predictors of efficacy, tolerability, and safety. This randomized double-blind parallel-group study was conducted in three academic medical centers and a single private pediatric practice. Eighty children or adolescents (aged 6-17 yrs) with autistic disorder were enrolled, and 61 patients were randomized to the study drug.

Does conduct disorder mediate the development of substance use disorders in adolescents with bipolar disorder? A case-control family study.

Background: Recent work has highlighted important relationships among conduct disorder (CD), substance use disorders (SUD), and bipolar disorder in youth. However, because bipolar disorder and CD are frequently comorbid in the young, the impact of CD in mediating SUD in bipolar disorder youth remains unclear.

Method: 105 adolescents with DSM-IV bipolar disorder (mean +/- SD age = 13.

Healthy choices through family history: a community approach to family history awareness.

Background: The importance of family health history data in health care is widely acknowledged. Few individuals report having collected this information from their own family.

Methods: This project implemented a community-based approach to design and pilot a linguistically and culturally appropriate family health history collection toolkit for two minority populations in Harrisburg, Pa.

A pilot study of the effects of atomoxetine on driving performance in adults with ADHD.

Objective: There is a high risk of vehicular crashes, traffic citations, and poorer driving performance in adults with ADHD. This pilot study examines the value of a new nonstimulant (atomoxetine) for improving the driving performance of adults with ADHD.

Method: Atomoxetine (1.

Reduced temporal lobe volume in early onset conduct disorder.

Regional brain volumes derived from magnetic resonance imaging (MRI) scans from 10 youths with early onset conduct disorder and 10 healthy controls matched for age, sex and handedness were compared to determine whether prefrontal or temporal lobe brain volumes differed in the two groups. Right temporal lobe and right temporal gray matter volumes were significantly reduced in subjects with conduct disorder compared with controls. Prefrontal volumes in subjects with conduct disorder were 16% smaller than in controls, but the difference did not reach statistical significance.

Cigarette smoking and psychiatric comorbidity in children and adolescents.

Objective: To review the current state of knowledge of psychiatric comorbidity in adolescent cigarette smokers.

Method: assisted literature search was conducted and seminal articles were cross-referenced for comprehensiveness of the search. For each disorder, a synopsis of knowledge in adults is provided and compared with the knowledge in adolescents.

Hippocampal pathology in two mentally ill paraphiliacs.

Paraphilias or disorders of sexual behavior have markedly increased in prevalence during the last decade. Until now no published neuropathological studies on paraphilia have appeared in the medical literature. A computerized search was done on all available medical and autopsy records of a large urban hospital (St.

Children's ability to delay gratification: longitudinal relations to mother-child attachment.

Concurrent and longitudinal mother-child attachment qualities were studied in relation to children's ability to postpone gratification at age 6 years. A sample of 32 children (at ages 12 months and 18 months) and their mothers participated in the strange situation procedure. At age 6 years, they were observed in an attachment situation and administered a standard delay of gratification task.

Autonomic activity in relation to cerebrospinal fluid neurochemistry in obsessive and disruptive children and adolescents.

Electrodermal activity and heart rate were recorded during rest, simple tones, and a reaction time task in 43 male and female adolescents and children with obsessive compulsive disorder and 30 male adolescents and children with disruptive behavior disorders who had lumbar cerebrospinal fluid drawn during the same week. Partial correlations controlling for age and sex showed that in the obsessive group metabolites of serotonin and dopamine, but not of norepinephrine, were positively correlated with electrodermal responsivity, most consistently in the reaction time task. This result was not replicated in disruptive boys.

Cerebrospinal fluid homovanillic acid predicts behavioral response to stimulants in 45 boys with attention deficit/hyperactivity disorder.

Central dopaminergic activity has been assumed to play a role in the efficacy of stimulant drugs in attention deficit/hyperactivity disorder (ADHD), although supporting evidence has been scant. This study examined baseline cerebrospinal fluid (CSF) of boys with ADHD in relation to response to three different stimulant drugs. Forty five boys with DSM-III-R-diagnosed ADHD had a lumbar puncture before double-blind trials of methylphenidate, dextroamphetamine, and placebo.

Multiple sclerosis and bipolar disorder: a case report with autopsy findings.

An 81-year-old woman with postmenopausal onset of a bipolar disorder had multiple individual manic and depressive episodes over the span of 31 years. Autopsy disclosed widespread periventricular demyelinated plaques. Although the late age at onset of bipolar symptoms suggested an underlying organic disorder, the multiple affective episodes and lack of additional neurological manifestations make the case atypical.

Sydenham's chorea: magnetic resonance imaging of the basal ganglia.

Analysis of cerebral magnetic resonance images of 24 subjects with Sydenham's chorea and 48 age-, height-, weight-, gender-, and handedness-matched controls demonstrated increased sizes of the caudate, putamen, and globus pallidus in the Sydenham's chorea group. In contrast, neither total cerebral, prefrontal, or midfrontal volumes or thalamic area were increased. These results indicate the selective involvement of the basal ganglia in Sydenham's chorea.

Ethical issues in biological psychiatric research with children and adolescents.

Objective: This article reviews, discusses, and elaborates considerations and recommendations summarized by the biological research working group at the May 1993 NIMH conference on ethical issues in mental health research on children and adolescents.

Method: Notes from the conference were summarized and supplemented by a computer search of relevant literature. Drafts were circulated for comment to national and international experts, some of whom joined as coauthors.

Sydenham's chorea and schizophrenia: a case report.

The following is a case report of a patient with Sydenham's chorea who later developed schizophrenia. Autopsy examination of this patient revealed mineral deposits in the basal ganglia. The deposition of minerals, especially iron, within subcortical brain structures has been associated with dopaminergic abnormalities, schizophreniform symptoms, and abnormal movement disorders.

Effect of dextroamphetamine and methylphenidate on calcium and magnesium concentration in hyperactive boys.

Levels of calcium in plasma, red blood cells, and mononuclear blood cells, levels of calcium in plasma, and the plasma calcium-to-magnesium ratio were measured at baseline and after 3 weeks of each drug phase of a double-blind, placebo-controlled study of methylphenidate and dextroamphetamine in hyperactive boys. Levels of magnesium in plasma were significantly higher after 3 weeks of dextroamphetamine treatment, and the calcium-to-magnesium ratio was significantly lower after 3 weeks of either drug compared with the baseline or placebo condition. There was no change in magnesium levels in red blood cells or mononuclear blood cells.

Cerebrospinal fluid monoamine metabolites in boys with attention-deficit hyperactivity disorder.

Cerebrospinal fluid (CSF), plasma, and urinary monoamine metabolites were determined for 29 boys, aged 6-12, with attention-deficit hyperactivity disorder (ADHD). Levels of CSF 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA), and 3-methoxy-4-hydroxyphenylglycol (MHPG), the metabolites of serotonin, dopamine, and norepinephrine, respectively, correlated significantly with behavioral measures of aggression and impulsivity/hyperactivity. However, these correlations were in the unexpected direction; for example, CSF 5-HIAA correlated positively with the Brown-Goodwin Lifetime History of Aggression Scale.

Autonomic activity in boys with disruptive behavior disorders.

Skin conductance (SC) and heart rate (HR) were measured during rest, a series of tones, and a reaction time task in 34 boys with disruptive behavior disorder to ascertain (a) if this broadly defined group differed from control boys (n = 33) and (b) if there were differences within the spectrum related to component diagnoses or to target behaviors. Disruptive boys had higher resting HR than controls, due largely to those without a subdiagnosis of conduct disorder. Disruptive boys showed a smaller increment in SC response frequency for task instructions.