Saliva Testing Predicts Aggression in Boys

A new study indicates that a simple saliva test could be an effective tool in predicting violent behaviour.

The pilot study, led by Cincinnati Children's Hospital Medical Center and published this week online in the journal Psychiatric Quarterly, suggests a link between salivary concentrations of certain hormones and aggression.

Drew Barzman

Researchers, led by Drew Barzman, MD, a child and adolescent forensic psychiatrist at Cincinnati Children's, collected saliva samples from 17 boys ages 7-9 admitted to the hospital for psychiatric care to identify which children were most likely to show aggression and violence.

The samples, collected three times in one day shortly after admission, were tested for levels of three hormones: testosterone, dehydroepiandrosterone (DHEA) and cortisol.

The severity and frequency of aggression correlated with the levels of these hormones.

Barzman's team focused on rapid, real-time assessment of violence among child and adolescent inpatients, a common problem in psychiatric units, but he believes a fast and accurate saliva test could eventually have several other applications.

"We believe salivary hormone testing has the potential to help doctors monitor which treatments are working best for their patients," said Barzman. "And because mental health professionals are far more likely to be assaulted on the job than the average worker, it could offer a quick way to anticipate violent behaviour in child psychiatric units. Eventually, we hope this testing might also provide a tool to help improve safety in schools."

For this study, the saliva test was used in combination with other aggressive behavior tools, including the Brief Rating of Aggression by Children and Adolescents (BRACHA) questionnaire, an assessment tool also developed by Barzman's team to predict aggression and violence in the hospital.

"This study sample, while small, gives us the data we need to move forward," added Barzman. "We have more studies planned before we can reach a definitive conclusion, but developing a new tool to help us anticipate violent behaviour is our ultimate goal."

Reference
The Association Between Salivary Hormone Levels and Children’s Inpatient Aggression: A Pilot Study. Psychiatric Quarterly, 2013; DOI: 10.1007/s11126-013-9260-8

BiPolar Disorder: Cannabis increases neuro-cognitive performance

According to a study published online in the journal Psychiatry Research, individuals with bipolar disorder who used cannabis showed higher neuro-cognitive performance than patients who did not use cannabis.

The Researchers; The Zucker Hillside Hospital in Long Island, NY, in collaboration with a team at the Mount Sinai School of Medicine and the Albert Einstein College of Medicine in New York City.

They examined the difference in cognitive performance among 50 individuals with bipolar disorder who had a history of cannabis use, with 150 bipolar patients who had no history of cannabis use.

Both groups of patients were similar in age at bipolar onset. In addition, the groups did not differ in racial background, age, or highest education level achieved.

The team discovered that patients who used cannabis showed superior neuro-cognitive performance than those who did not. However, patients who used cannabis did not differ considerably on estimates of premorbid IQ.

The researchers explained: "Results from our analysis suggest that subjects with bipolar disorder and history of (cannabis use) demonstrate significantly better neurocognitive performance, particularly on measures of attention, processing speed, and working memory.

These findings are consistent with a previous study that demonstrated that bipolar subjects with history of cannabis use had superior verbal fluency performance as compared to bipolar patients without a history of cannabis use.

Similar results have also been found in schizophrenia in several studies."

They concluded, "The data could be interpreted to suggest that cannabis use may have a beneficial effect on cognitive functioning in patients with severe psychiatric disorders.

However, it is also possible that these findings may be due to the requirement for a certain level of cognitive function and related social skills in the acquisition of illicit drugs."

What is Bipolar Disorder?  
Bipolar disorder, more commonly known in the past as manic depression or manic depressive illness, is a mental disorder in which the patient has mood instability, often severe. In severe cases the illness can be very disabling, psychologically and socially.

An individual with bipolar disorder typically has unusual shifts in mood, energy, and the ability to function - these changes can last for weeks and sometimes months.

The fluctuations present in bipolar disorder are much more severe than the "ups-and-downs" we all go through. The changes are much steeper and last longer.

They can damage relationships, destroy job prospects, and undermine school performance. Some patients find their symptoms so unbearable that they attempt to commit suicide.

The Dyslexia Dilemma – Continued

If dyslexia is a gift, perhaps it does not belong in a manual for diagnosing psychiatric disorders at all. The full title of the DSM is Diagnostic and Statistical Manual of Mental Disorders. 

The book is in essence a psychiatrist’s bible, the ultimate guide on how to figure out and label whatever is wrong mentally or emotionally with the psychiatrist’s patients.

Over-inclusive language and labeling in the DSM has been criticized by many as contributing to over-medication — and over medicalization  - of conditions that may be part of the normal ups and downs of life.

One study reported that half of US teens met the criteria for diagnosis of a mental disorder. In that context, a diagnosis opens the doors to prescribing of powerful drugs that may do more harm than good, especially to a a growing child.

Although the goal of inclusion of the term dyslexia into a diagnostic manual is to make it easier for individuals to get recognition and help for their difficulties, the flip side is that the label can come with a stigma, or be used as a barrier.

As long as dyslexia is deemed a “disorder,” educators and employers will continue to look at dyslexics as being less capable and less deserving of advancement.

Perhaps the time has come to recognize that “dyslexia” is a characteristic, not a disease. Because it is common — perhaps impacting as many as 20% of all schoolchildren to some degree — maybe it should be the responsibility of educators to learn how to teach children with dyslexic characteristics within the normal classroom environment.

That is, perhaps parents should be relieved of the educational burden of proving that there is something wrong with their children in order to get specialized services.

The burden should shift to educators to learn to reach and teach all of their students, not just the ones who have “average” or “typical” learning styles.

The need for “diagnosis” only arises because of educational and societal barriers. Within a school context, a child is only referred for “diagnosis” because it is apparent that the child is struggling and falling behind.

But all a dyslexia diagnosis does, especially with the language now proposed by the APA for “Specific Learning Disorder”, is to confirm what the parents and educators already know: that the child is indeed struggling and falling behind.

There is not one word in the current proposed diagnostic standard, with or without the use of the term “dyslexia”, that would shed light on the reasons for the student’s struggle or point the way to a specific path to address the learning difficulties. Instead, it is “diagnosis” that relies entirely on circular reasoning.

A child who has difficulties in acquiring basic academic skills would be referred to a psychologist or psychiatrist, who would then report back that the child indeed has difficulties acquiring basic skills.

Perhaps it is time to dispense with the idea of “diagnosing” a medical condition, and to recognize that “dyslexia” is a legitimate and important way to describe a particular profile of learning strengths and weaknesses.

Perhaps it is time to move beyond blaming the student for what is really a failure of the educational system to address the needs of all learners.

The Dyslexia Dilemma - Redefined

The term dyslexia was coined in 1887 by a German ophthalmologist, Rudolph Berlin. But there exists no standard for diagnosis. The DSM IV defined “Reading Disorder” broadly as “Reading achievement,… substantially below that expected given the person’s chronological age, measured intelligence, and age-appropriate education.” (DSM IV – 315.00)

An early draft of the forthcoming DSM V filled this gap with a simple definition. The term “Dyslexia” was added to be “consistent with international use”. (A 13 Proposed Revision Rationale).

The condition was described broadly as “Difficulties in accuracy or fluency of reading that are not consistent with the person’s chronological age, educational opportunities, or intellectual abilities.”

However, the APA has now retreated from this position, eliminating the term dyslexia from their recommendation entirely: “Learning Disorder has been changed to Specific Learning Disorder, and the previous types of Learning Disorders (Dyslexia, Dyscalculia, and Disorder of Written Expression) are no longer being recommended.”  (See Neurodevelopmental Disorders.)

The text of the newly defined  Specific Learning Disorder will exclude thousands from consideration or diagnosis, by interposing a diagnostic requirement: that “current skill level” be “well-below the average range.”

This means that higher functioning dyslexics will never have the benefit of a diagnosis. As happened with my own son, they will be deemed to be “lazy” despite the hours they put in to attain barely-average functional skill levels.

Those whose skill level is sufficiently depressed to qualify will lose their diagnosis at the moment any form of intervention is successful. It won’t matter how hard they struggle to get there; the moment their reading scores begin to approach “average” their diagnosis will evaporate. It is likely that whatever support or accommodations have enabled their improved skills will also be withdrawn as well.

This is a political determination, not a scientific one — very much at odds with a growing body of brain research showing that dyslexia is neurologically-based.

The APA will allow comments on the new proposal until June 15, 2012.  Anybody can register at the APA web site at www.dsm5.org and post.   

If you are not happy with the proposal, I urge you to take the time in the next few days to do so.

Auditory Hallucinations in Children Suggest Underlying Psychiatric Disorder

Children aged between 11 years to 13 years tend to hear strange voices, according to a new report.

Researchers from the Royal College of Surgeons in Ireland (RCSI) have discovered that auditory hallucinations (hearing voices) can affect up to one-in-five children between the ages of 11 to 13.

"We found that auditory hallucinations were common even in children as young as 11 years old. Auditory hallucinations can vary from hearing an isolated sentence now and then, to hearing "conversations" between two or more people lasting for a several minutes.

It may present like screaming or shouting and other times it could sound like whispers or murmurs. It varies greatly from child to child, and frequency can be once a month to once every day," said Dr Ian Kelleher, professor at the Royal College of Surgeons, in a statement.

Researchers had conducted four separate studies on 2,500 children, aged between 11 and 16 years. They found that 20 to 23 percent of younger adults, aged 11 years to 13 had experienced auditory hallucinations. Among them more than 57 percent have mental disorders.

In older adolescents (aged 13-16 years), just 7 percent reported hearing voices. However, among this category, more than 80 percent had psychiatric disorder - showing a clear association between auditory hallucinations and serious mental illness.

In several children, these experiences appear to represent a 'blip' on the radar that does not turn out to signify any underlying or undiagnosed problem.

However, for the other children, these symptoms turned out to be a warning sign of serious underlying psychiatric illness, including clinical depression and behavioural disorders, like attention deficit hyperactivity disorder.

Some older children with auditory hallucinations had two or more disorders.

It is a significant finding which can help the doctors to consider more than one diagnosis, if the child reports auditory hallucinations.

Our study suggests that hearing voices seems to be more common in children than was previously thought. In most cases these experiences resolve with time.

However in some children these experiences persist into older adolescence and this seems to be an indicator that they may have a complex mental health issue and require more in-depth assessment," said Mary Cannon, professor at the Royal College of Surgeons, in a statement.

Antidepressants During Pregnancy: What Are the Risks?

What is a woman struggling with depression supposed to do when she becomes pregnant?

A study published on Monday in the Archives of General Psychiatry tackles the tough decision of deciding to keep taking the medication, or risk harming the fetus.

Roughly six percent of pregnant women are taking antidepressants. The struggle to live with depression or risk your baby's health has plagued women for quite some time.

The latest study included 7,696 pregnant women. Five hundred and seventy of the women suffering from depression were not on medication, and 99 women with depression "were being treated with selective serotonin reuptake inhibitors (SSRIs), a common class of antidepressants."

What this study found is that women going untreated for depression gave birth to babies that had a reduction in total body growth.

This affected the fetal head growth as well. Those women taking prenatal SSRI also had babies that suffered from a reduced growth of the fetal head, but the overall growth of the body during pregnancy was not affected.

What are the risks for the fetus during pregnancy with antidepressants? Mothers taking antidepressants could have preterm babies, who face higher health risks like respiratory and gastrointestinal disorders.

Not only could these children be born preterm, but according to the authors of the study, reduced fetal head-growth can lead to behavioural problems and psychiatric disorders later on.

However, the risks for the mother may outweigh the risks of the pregnancy, if she discontinues antidepressant medication.

Dr. Sudeepta Varma, clinical assistant professor of psychiatry at NYU Langone School of Medicine reported "If we are talking about a woman who can't take care of her health as a result of battling with moderate to severe depression, she faces risks to herself as well as the baby that are associated with untreated depression during pregnancy."

According to Varma, "if you don't take care of the mom, there may be no baby to speak of."

These findings however are inconclusive according to the authors of the study. "More long-term drug safety studies are needed before evidence-based recommendations can be derived," concluded the authors.

Link Between Childbirth and Bipolar Affective Disorder

New research show that risks of developing bipolar affective disorder is increased if a woman experiences a psychiatric episode within the first 30 days after childbirth.

"Childbirth has an important influence on the onset and course of bipolar affective disorder, and studies have shown that episodes of post-partum psychosis are often best considered as presentations of bipolar affective disorder occurring at a time of dramatic psychological and physiological change," the researchers said in the report which was published in Archives of General Psychiatry.

The researchers led by Trine Munk-Olsen, Ph.D., of the National Centre for Register-Based Research, Arhus University in Denmark, collected data on 120,378 women from 1950 to 1991who had a history of a first-time psychiatric contact with any type of psychiatric disorder excluding bipolar affective disorder.

A total of 2,870 of these women had their initial psychiatric contact within the first year after delivery of their first child. During follow-up, 3,062 of the 120,378 women were diagnosed of bipolar affective disorder, of which 132 had their initial psychiatric contact 0 to 12 months post-partum.

Researchers found a significantly higher conversion rate to bipolar affective disorder in women having their initial contact within the first post-partum month. In addition, evidence that the severity of the initial post-partum psychiatric episode may be important, as inpatient admissions were associated with a higher conversion rate than were outpatient contacts, were found.
After fifteen years from initial psychiatric contact, 13.87 percent of women with onset in the immediate post-partum period (0 to 30 days) had converted to bipolar disorder, the study said.

"The present study confirms the well-established link between childbirth and bipolar affective disorder and specifically adds to this field of research by demonstrating that initial psychiatric contact within the first 30 days post-partum significantly predicted conversion to bipolar affective disorder during the follow-up period," the authors conclude.