Maturity of defense style has been associated with the level of adaptive functioning, but few stu... more Maturity of defense style has been associated with the level of adaptive functioning, but few studies have assessed defense style using self-report questionnaires which can provide ratings with great reliability and objectivity. We compared self-perception of defense style (using Bond's Defense Style Questionnaire) with ratings of adaptation assessed retrospectively by two independent raters (using the DSM III-R Global Assessment of Functioning scale) in a population of 100 adolescent girls diagnosed as having either an eating disorder or depression. There was significant correlation between maturity of defense style and level of adaptation, with greater maturity of defense style being associated with higher levels of adaptive functioning. This effect was independent of diagnosis within this population.
Die nach der EU-konformen Methode neu berechneten Sozialausgaben betrugen 1995 in Osterreich insg... more Die nach der EU-konformen Methode neu berechneten Sozialausgaben betrugen 1995 in Osterreich insgesamt 694 Mrd. S oder 29,5% des Brutto-Inlandsproduktes. Der Umfang der Sozialausgaben entspricht damit jenem in anderen europaischen Staaten mit ahnlicher Sozial- und Wirtschaftsstruktur. Seit 1980 ist die Sozialquote um 2½ Prozentpunkte gestiegen, im EU-Durchschnitt um 4¼ Prozentpunkte. Nach einer Phase der Konstanz in den achtziger Jahren erhohte sie sich in den fruhen neunziger Jahren durch wesentliche Leistungsausweitungen kraftig. Das Jahr 1995 brachte trotz der Schwache der Konjunktur und der Zunahme der Arbeitslosigkeit eine Stabilisierung der Sozialquote. Diese Tendenz durfte angesichts der Masnahmen im Rahmen der Budgetkonsolidierung anhalten.
Forging Paths toward Reintegration and Rehabilitation, 2007
Several controlled clinical trials of medications in youth make it clear that psychopharmacology ... more Several controlled clinical trials of medications in youth make it clear that psychopharmacology can significantly contribute to rehabilitation and possibly recovery. This chapter summarizes the clinical indications for pharmacological interventions that may help in reducing pathology in this population. The combined knowledge of clinical care, clinical trials, and the recommendations generated by consensus in practice guidelines suggests that the most appropriate approach to using medications in juvenile offenders requires employing a cautious and supportive attitude, and always weighing risks and benefits. The chapter proposes that clinicians should use the integrated provision of services, including medication, to attempt to target the subtype of aggression that may be underpinning the delinquent behaviors of the juvenile. It summarizes the trials where the primary recruitment target was a disorder of aggression, conduct disorder (CD), oppositional-defiant disorder (ODD), and intermittent explosive disorder (IED). In all cases, clinicians should strive to use evidenced-based principles for treatment.
To explore the relationship between PTSD and trauma-spectrum symptoms, including personality and ... more To explore the relationship between PTSD and trauma-spectrum symptoms, including personality and functional correlates, in long term pediatric cancer survivors (N = 40), we assessed these constructs with a structured interview for PTSD, a clinical interview, and self-report questionnaires. Thirty-five out of 40 participants (88%) currently met at least one trauma symptom at a functionally significant level. These survivors demonstrate high levels of restraint and low levels of distress, representative of a repressive adaptive style. After more than 5 years since treatment completion, the relatively high levels of current trauma-spectrum symptoms may reflect the long-term deleterious impact of childhood cancer.
Psychoanalysis was intended by Freud to be "a foundation for a truly dynamic psychology"... more Psychoanalysis was intended by Freud to be "a foundation for a truly dynamic psychology" [1, vol. 3, p. 287] and as such it was to be part of the "natural sciences" [2, vol. 20, p. 57]. Its status as a science has been repeatedly and seriously questioned for 70 years [3-9] and at the same time vigorously affirmed [10-17]. Psychoanalytic theory has beenjudged "unscientific" [5, p. 241], "inadequate," and "misleading" [6]; or, per contra, "powerful and original" [18, p. 549]. One is bewildered by such an array of opinions. The present situation is truly paradoxical: While clinicians in many training centers rely heavily on Freudian theories, another group of clinicians is equally convinced of the worthlessness of psychoanalysis. This paradox is even more evident in the opinions of two groups of researchers. After their respective reviews of the available experimental and clinical evidence for Freudian theories, Fisher and Greenberg conclude that "the quantity of research data pertinent to it [psychoanalysis] that has accumulated in the literature grossly exceeds that available for most other personality or developmental theories . . ." [16]. They were unable to find "a single systematic psychological theory that has been so frequently evaluated scientifically as have Freud's concepts" [16, chap. 10]. On the other hand, Eysenk says, "In view of the great interest aroused by psychoanalytic notions in the years from 1930 to 1960, it seems odd that very little was done experimentally to put these views to the test" [19, p. xi]. Several questions arise. Why was psychoanalysis not integrated into science, despite the pronounced intentions of its founder? Was it because of its subject matter and its concepts, as some would have it? Is
CD and ODD present unique challenges in both the diagnostic and treatment arenas. The complex net... more CD and ODD present unique challenges in both the diagnostic and treatment arenas. The complex network of causes leading to disruptive disorders makes it necessary to structure treatment in a multifaceted manner. The earlier that adolescents are identified as exhibiting disruptive behavior disorders, the better the opportunity to intervene. While early-onset CD is very difficult to treat effectively, the disorder is far more difficult to correct if left untreated and can ultimately lead to ASPD in adulthood. When physicians are presented with behavioral complaints, they must fully assess the adolescent to determine what, if any, referrals and treatments are needed.
Journal of the American Academy of Child & Adolescent Psychiatry, 1999
This Special Section is part of the violence prevention initiative of the Academy. It is our firm... more This Special Section is part of the violence prevention initiative of the Academy. It is our firm belief that the m ental health sc iences and the developmental approach have much to contribute to our efforts to understand the origins and offset the effects of violen ce and related psychopathology. Approaching the pr obl em s associated with violence from such a perspective will do much to help tho se invol ved in the problem, victim and perpetrator alike, and will sh ift the tendency to blame and count er with blame. This Special Section presents art icles reflecting our current knowledge abo ut intervention s. Our goal is to stimulate interest and close the gap between wh at is known to be effect ive and what is being done in the field. It is our hope th at such edu cation will en courage practit ioners to get involved with the prevention and treatment of violen ce. An increase in violence to all members of society is a major public health issue. Violen ce occurs within every segment of our population, regardless of race, erhniciry, religion, or socioeconomic status. Two phenomena have become prominent in an analysi s of our social structure: an increasing exper ience of interperson al alienation , and an increase in the impact on our civilizing and social-
Children who participated in school extracurricular activities were less likely to drop out or to... more Children who participated in school extracurricular activities were less likely to drop out or to have been arrested Mahoney JL. School extracurricular activity participation as a moderator in the development of antisocial patterns.
Objective. Since the clinical observations published by Janz in 1957, the presence of personality... more Objective. Since the clinical observations published by Janz in 1957, the presence of personality irregularities in patients with juvenile myoclonic epilepsy (JME) has been described repeatedly, but never quantified using standardized assessments. The aim of the present study was to investigate whether juveniles with a short history of JME exhibit psychopathological symptoms and/or personality irregularities. Method. We used standardized assessments, the Youth Self Report (YSR) and the Weinberger Adjustment Inventory (WAI). Results. Of 38 patients who fulfilled the study entry criteria, 25 agreed to participate and completed all surveys. On the YSR, our sample exhibited twice the amount of psychiatric symptoms than age-matched norms. Furthermore, psychopathological symptoms increased with duration of JME. According to WAI results, JME significantly affected self-restraint: patients with longer disease duration showed less self-control. Conclusion. Adolescents with JME present not only with neurological abnormalities but also with significant psychopathology and personality irregularities. Our data suggest that psychological and behavioral changes are dynamic processes dependent on the progression of the disease.
Pediatric and psychiatric illness can combine in complex patterns, which have implications for di... more Pediatric and psychiatric illness can combine in complex patterns, which have implications for diagnosis, treatment, and outcome. The knowledge base in pediatric psychiatry (child psychiatry as it applies to pediatric practice) has expanded considerably in the past two decades. The careful documentation of the epidemiology of comorbidity in cross-sectional and longitudinal studies in clinical and population-based samples is enabling us to shift our attention to the examination of developmental pathways and predictable patterns of relationships between pediatric and psychiatric illness. We describe a pragmatically based model for the clinician who works in the primary care setting. The model is based on the biopsychosocial model of disease. We enrich our perspective by adding the theoretical framework of developmental psychopathology, as it informs child psychiatric practice. Context, complexity, and continuity are concepts that can be easily accommodated within the synthetic framewo...
Comparing mothers' reports of early feeding practices in 18 mothers of anorexics and 25 m... more Comparing mothers' reports of early feeding practices in 18 mothers of anorexics and 25 mothers of normal children by means of a questionnaire, we found that the mothers of anorexics introduced solids earlier and used Schedule rather than Demand feedings more frequently. The mothers of anorexics did not treat patients and control siblings differentially. Our study suggests that differences in early feeding and in infant temperament may be operative in the pathogenesis of anorexia nervosa.
Although previous research has investigated the stress response in acutely anorexic patients, the... more Although previous research has investigated the stress response in acutely anorexic patients, there is currently little research addressing this response in recovering adolescent anorexic girls. Therefore, this study investigated partially and fully weight-restored anorexic adolescent girls' psychological and physiological response to a standardized stressor. We measured the heart rate and affect of 17 adolescent recovering anorexic patients and 40 healthy age-matched controls during two conditions of the Stress Induced Speech Task (SIST): Free Association and Stress Task. Recovering patients were either partially or fully weight-restored. Compared to the controls, the recovering anorexic girls reported greater overall habitual psychological distress and higher levels of negative affect during the standardized stressor. However, recovering patients did not show a muted heart rate response during the stressor. Neither recovering anorexics nor controls demonstrated a correspondence between heart rate and positive or negative affect. Although the physiological stress response of recovering adolescent anorexic patients was similar to controls, the psychological response of partially and fully weight-restored anorexic adolescents appears similar to that of acutely anorexic adolescents. Treatment implications are discussed in terms of the persistence of negative affect and treatment resistance.
Children of parents with bipolar disorder (bipolar offspring) represent a rich cohort for study w... more Children of parents with bipolar disorder (bipolar offspring) represent a rich cohort for study with potential for illumination of prodromal forms of bipolar disorder. Due to their high-risk nature, bipolar offspring may present phenomenological, temperamental, and biological clues to early presentations of bipolar disorder. This article reviews the evidence for establishing bipolar offspring as a high-risk cohort, the studies which point to possible prodromal states in bipolar offspring, biological findings in bipolar offspring which may be indicators of even higher risk for bipolar disorder, initial attempts at early intervention in prodromal pediatric bipolar disorder, and implications for future research.
Archives of Pediatrics & Adolescent Medicine, 1986
Bulimia is a serious and prevalent eating disorder in the adolescent population. The pediatrician... more Bulimia is a serious and prevalent eating disorder in the adolescent population. The pediatrician is often in a position to make the initial diagnosis of bulimia but must suspect the disorder in light of subtle physical evidence. Denial and embarrassment reduce the likelihood of self-report of symptoms. Hand lesions resulting from self-induced emesis have a distinctive configuration and appearance. Noting these characteristic lesions during a physical examination should alert a physician to the diagnosis of bulimia or to an exacerbation of symptoms in a patient whose condition was previously diagnosed.
Maturity of defense style has been associated with the level of adaptive functioning, but few stu... more Maturity of defense style has been associated with the level of adaptive functioning, but few studies have assessed defense style using self-report questionnaires which can provide ratings with great reliability and objectivity. We compared self-perception of defense style (using Bond's Defense Style Questionnaire) with ratings of adaptation assessed retrospectively by two independent raters (using the DSM III-R Global Assessment of Functioning scale) in a population of 100 adolescent girls diagnosed as having either an eating disorder or depression. There was significant correlation between maturity of defense style and level of adaptation, with greater maturity of defense style being associated with higher levels of adaptive functioning. This effect was independent of diagnosis within this population.
Die nach der EU-konformen Methode neu berechneten Sozialausgaben betrugen 1995 in Osterreich insg... more Die nach der EU-konformen Methode neu berechneten Sozialausgaben betrugen 1995 in Osterreich insgesamt 694 Mrd. S oder 29,5% des Brutto-Inlandsproduktes. Der Umfang der Sozialausgaben entspricht damit jenem in anderen europaischen Staaten mit ahnlicher Sozial- und Wirtschaftsstruktur. Seit 1980 ist die Sozialquote um 2½ Prozentpunkte gestiegen, im EU-Durchschnitt um 4¼ Prozentpunkte. Nach einer Phase der Konstanz in den achtziger Jahren erhohte sie sich in den fruhen neunziger Jahren durch wesentliche Leistungsausweitungen kraftig. Das Jahr 1995 brachte trotz der Schwache der Konjunktur und der Zunahme der Arbeitslosigkeit eine Stabilisierung der Sozialquote. Diese Tendenz durfte angesichts der Masnahmen im Rahmen der Budgetkonsolidierung anhalten.
Forging Paths toward Reintegration and Rehabilitation, 2007
Several controlled clinical trials of medications in youth make it clear that psychopharmacology ... more Several controlled clinical trials of medications in youth make it clear that psychopharmacology can significantly contribute to rehabilitation and possibly recovery. This chapter summarizes the clinical indications for pharmacological interventions that may help in reducing pathology in this population. The combined knowledge of clinical care, clinical trials, and the recommendations generated by consensus in practice guidelines suggests that the most appropriate approach to using medications in juvenile offenders requires employing a cautious and supportive attitude, and always weighing risks and benefits. The chapter proposes that clinicians should use the integrated provision of services, including medication, to attempt to target the subtype of aggression that may be underpinning the delinquent behaviors of the juvenile. It summarizes the trials where the primary recruitment target was a disorder of aggression, conduct disorder (CD), oppositional-defiant disorder (ODD), and intermittent explosive disorder (IED). In all cases, clinicians should strive to use evidenced-based principles for treatment.
To explore the relationship between PTSD and trauma-spectrum symptoms, including personality and ... more To explore the relationship between PTSD and trauma-spectrum symptoms, including personality and functional correlates, in long term pediatric cancer survivors (N = 40), we assessed these constructs with a structured interview for PTSD, a clinical interview, and self-report questionnaires. Thirty-five out of 40 participants (88%) currently met at least one trauma symptom at a functionally significant level. These survivors demonstrate high levels of restraint and low levels of distress, representative of a repressive adaptive style. After more than 5 years since treatment completion, the relatively high levels of current trauma-spectrum symptoms may reflect the long-term deleterious impact of childhood cancer.
Psychoanalysis was intended by Freud to be "a foundation for a truly dynamic psychology"... more Psychoanalysis was intended by Freud to be "a foundation for a truly dynamic psychology" [1, vol. 3, p. 287] and as such it was to be part of the "natural sciences" [2, vol. 20, p. 57]. Its status as a science has been repeatedly and seriously questioned for 70 years [3-9] and at the same time vigorously affirmed [10-17]. Psychoanalytic theory has beenjudged "unscientific" [5, p. 241], "inadequate," and "misleading" [6]; or, per contra, "powerful and original" [18, p. 549]. One is bewildered by such an array of opinions. The present situation is truly paradoxical: While clinicians in many training centers rely heavily on Freudian theories, another group of clinicians is equally convinced of the worthlessness of psychoanalysis. This paradox is even more evident in the opinions of two groups of researchers. After their respective reviews of the available experimental and clinical evidence for Freudian theories, Fisher and Greenberg conclude that "the quantity of research data pertinent to it [psychoanalysis] that has accumulated in the literature grossly exceeds that available for most other personality or developmental theories . . ." [16]. They were unable to find "a single systematic psychological theory that has been so frequently evaluated scientifically as have Freud's concepts" [16, chap. 10]. On the other hand, Eysenk says, "In view of the great interest aroused by psychoanalytic notions in the years from 1930 to 1960, it seems odd that very little was done experimentally to put these views to the test" [19, p. xi]. Several questions arise. Why was psychoanalysis not integrated into science, despite the pronounced intentions of its founder? Was it because of its subject matter and its concepts, as some would have it? Is
CD and ODD present unique challenges in both the diagnostic and treatment arenas. The complex net... more CD and ODD present unique challenges in both the diagnostic and treatment arenas. The complex network of causes leading to disruptive disorders makes it necessary to structure treatment in a multifaceted manner. The earlier that adolescents are identified as exhibiting disruptive behavior disorders, the better the opportunity to intervene. While early-onset CD is very difficult to treat effectively, the disorder is far more difficult to correct if left untreated and can ultimately lead to ASPD in adulthood. When physicians are presented with behavioral complaints, they must fully assess the adolescent to determine what, if any, referrals and treatments are needed.
Journal of the American Academy of Child & Adolescent Psychiatry, 1999
This Special Section is part of the violence prevention initiative of the Academy. It is our firm... more This Special Section is part of the violence prevention initiative of the Academy. It is our firm belief that the m ental health sc iences and the developmental approach have much to contribute to our efforts to understand the origins and offset the effects of violen ce and related psychopathology. Approaching the pr obl em s associated with violence from such a perspective will do much to help tho se invol ved in the problem, victim and perpetrator alike, and will sh ift the tendency to blame and count er with blame. This Special Section presents art icles reflecting our current knowledge abo ut intervention s. Our goal is to stimulate interest and close the gap between wh at is known to be effect ive and what is being done in the field. It is our hope th at such edu cation will en courage practit ioners to get involved with the prevention and treatment of violen ce. An increase in violence to all members of society is a major public health issue. Violen ce occurs within every segment of our population, regardless of race, erhniciry, religion, or socioeconomic status. Two phenomena have become prominent in an analysi s of our social structure: an increasing exper ience of interperson al alienation , and an increase in the impact on our civilizing and social-
Children who participated in school extracurricular activities were less likely to drop out or to... more Children who participated in school extracurricular activities were less likely to drop out or to have been arrested Mahoney JL. School extracurricular activity participation as a moderator in the development of antisocial patterns.
Objective. Since the clinical observations published by Janz in 1957, the presence of personality... more Objective. Since the clinical observations published by Janz in 1957, the presence of personality irregularities in patients with juvenile myoclonic epilepsy (JME) has been described repeatedly, but never quantified using standardized assessments. The aim of the present study was to investigate whether juveniles with a short history of JME exhibit psychopathological symptoms and/or personality irregularities. Method. We used standardized assessments, the Youth Self Report (YSR) and the Weinberger Adjustment Inventory (WAI). Results. Of 38 patients who fulfilled the study entry criteria, 25 agreed to participate and completed all surveys. On the YSR, our sample exhibited twice the amount of psychiatric symptoms than age-matched norms. Furthermore, psychopathological symptoms increased with duration of JME. According to WAI results, JME significantly affected self-restraint: patients with longer disease duration showed less self-control. Conclusion. Adolescents with JME present not only with neurological abnormalities but also with significant psychopathology and personality irregularities. Our data suggest that psychological and behavioral changes are dynamic processes dependent on the progression of the disease.
Pediatric and psychiatric illness can combine in complex patterns, which have implications for di... more Pediatric and psychiatric illness can combine in complex patterns, which have implications for diagnosis, treatment, and outcome. The knowledge base in pediatric psychiatry (child psychiatry as it applies to pediatric practice) has expanded considerably in the past two decades. The careful documentation of the epidemiology of comorbidity in cross-sectional and longitudinal studies in clinical and population-based samples is enabling us to shift our attention to the examination of developmental pathways and predictable patterns of relationships between pediatric and psychiatric illness. We describe a pragmatically based model for the clinician who works in the primary care setting. The model is based on the biopsychosocial model of disease. We enrich our perspective by adding the theoretical framework of developmental psychopathology, as it informs child psychiatric practice. Context, complexity, and continuity are concepts that can be easily accommodated within the synthetic framewo...
Comparing mothers' reports of early feeding practices in 18 mothers of anorexics and 25 m... more Comparing mothers' reports of early feeding practices in 18 mothers of anorexics and 25 mothers of normal children by means of a questionnaire, we found that the mothers of anorexics introduced solids earlier and used Schedule rather than Demand feedings more frequently. The mothers of anorexics did not treat patients and control siblings differentially. Our study suggests that differences in early feeding and in infant temperament may be operative in the pathogenesis of anorexia nervosa.
Although previous research has investigated the stress response in acutely anorexic patients, the... more Although previous research has investigated the stress response in acutely anorexic patients, there is currently little research addressing this response in recovering adolescent anorexic girls. Therefore, this study investigated partially and fully weight-restored anorexic adolescent girls' psychological and physiological response to a standardized stressor. We measured the heart rate and affect of 17 adolescent recovering anorexic patients and 40 healthy age-matched controls during two conditions of the Stress Induced Speech Task (SIST): Free Association and Stress Task. Recovering patients were either partially or fully weight-restored. Compared to the controls, the recovering anorexic girls reported greater overall habitual psychological distress and higher levels of negative affect during the standardized stressor. However, recovering patients did not show a muted heart rate response during the stressor. Neither recovering anorexics nor controls demonstrated a correspondence between heart rate and positive or negative affect. Although the physiological stress response of recovering adolescent anorexic patients was similar to controls, the psychological response of partially and fully weight-restored anorexic adolescents appears similar to that of acutely anorexic adolescents. Treatment implications are discussed in terms of the persistence of negative affect and treatment resistance.
Children of parents with bipolar disorder (bipolar offspring) represent a rich cohort for study w... more Children of parents with bipolar disorder (bipolar offspring) represent a rich cohort for study with potential for illumination of prodromal forms of bipolar disorder. Due to their high-risk nature, bipolar offspring may present phenomenological, temperamental, and biological clues to early presentations of bipolar disorder. This article reviews the evidence for establishing bipolar offspring as a high-risk cohort, the studies which point to possible prodromal states in bipolar offspring, biological findings in bipolar offspring which may be indicators of even higher risk for bipolar disorder, initial attempts at early intervention in prodromal pediatric bipolar disorder, and implications for future research.
Archives of Pediatrics & Adolescent Medicine, 1986
Bulimia is a serious and prevalent eating disorder in the adolescent population. The pediatrician... more Bulimia is a serious and prevalent eating disorder in the adolescent population. The pediatrician is often in a position to make the initial diagnosis of bulimia but must suspect the disorder in light of subtle physical evidence. Denial and embarrassment reduce the likelihood of self-report of symptoms. Hand lesions resulting from self-induced emesis have a distinctive configuration and appearance. Noting these characteristic lesions during a physical examination should alert a physician to the diagnosis of bulimia or to an exacerbation of symptoms in a patient whose condition was previously diagnosed.
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