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Depression in Adolescents: Clinical Outcome in Early Adulthood
NEW
RESEARCH
The following abstracts were among the highest rated new research posterspresented at the October 1993 Annual Meeting of the American Academy of Child and Adolescent Psychiatry. The outstanding quality of these submissions underscores the ever-improving quality of research in our field. These abstracts are published here to hasten the availability of new research findings to the professional community at large and to recognize the high quality of research presented at the Annual Meeting.
Predictors ofAntidepressant Response to Sleep Deprivation in Depressed Adolescents. M. W. Naylor, M.D., K. Kaminski, B.A.; C. A. King, Ph.D.; N. Ghaziuddin, M.D.; ]. E. Shipley, M.D.; ]. F. Greden, M.D. Total sleep deprivation (TSD) has a transient antidepressant effect in many depressed adolescents. We undertook this study to determine whether baseline polysomnographic sleep variables, severity of depression, or endogenous subtype predict which adolescents have an antidepressant response to TSD. Subjects were 22 depressed adolescents with a Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present Episode/Research Diagnostic Criteria (K-SADS-P/RDC) affective disorder diagnosis (rn = 5, f = 17; 15.6 ± 1.3 years). Baseline polysomnography was obtained on 14 subjects. Depression severity was measured at baseline, during sleep deprivation, and after recovery sleep. It was found that responders, defined as showing 30% improvement in depression rating scores, were significantly more depressed as measured by the Hamilton Rating Scale for Depression (19.2 ± 3.6 vs. 10.6 ± 3.8; t{20] = 5.2, P < .0001), were more likely to have the endogenous subtype of depression (X 2 with continuity correction = 9.6, P ~ .002), and to have shorter rapid eye movement (REM) latency (75.4 ± 14.2 vs. 118.6 ± 31.0 minutes; t{12] = - 3.4, P < .006) than nonresponders . The conclusion is that, as in adults, severely depressed adolescents with the endogenous subtype and short REM latency respond to TSD. These data suggest similarities in the pathophysiology of depression across the life cycle. Depression in Adolescents: Clinical Outcome in Early Adulthood. U. Rao, M.D., N. D. Ryan, M.D.; R. E. Dahl, M.D.; B. Birmaher, M.D.; D. E. Williamson, B.A. This report describes preliminary outcome data for a sample of 31 adolescent subjects with major depressive disorder (MOD) and 35 normal controls in their early adulthood. This sample is unique in having careful diagnostic and multidimensional psychobiological assessments in their adolescence. Follow-up assessments were conducted 5 to 8 years after the initial assessment in 26 (84%) MOD subjects and 32 (89%) normal controls in their early adulthood. These
assessments were made "blind" to the original diagnostic and psychobiological status. Psychiatric and psychosocial assessments were done using the Schedule for Affective Disorders-Lifetime Version, the Structured Clinical Interview for DSM-III-R Personality Disorders , Multi-dimensional Personality Questionnaire, Lifetime Suicide and Aggression History Interview, Lifetime Drinking History, Lifetime Drug Use History, and Longitudinal Interval Follow-up Evaluation Base Psychosocial Schedule. The MOD group was at a significantly increased risk for recurrence of MOD episodes, bipolar disorder, anxiety disorder, suicidal ideation and/or attempts, psychiatric treatment, psychiatric hospitalizations, and impairment in psychosocial functioning when compared to the normal control group. Psychopathology in Children of Late versus Early Onset Bipolar Probands. G. Sachs, M.D., A. Conklin, Ed.M.; B. Lafer, M.D .; A. Thibault, B.A.; ]. Biederman, M.D.; ]. Rosenbaum, M.D. This study presents lifetime prevalence ofpsychopathology in the first 20 bipolar probands and their 32 biological children enrolled in an ongoing study of children at risk for bipolar illness. Rates of psychopathology are compared for probands and their children based on the proband's age at onset of his or her first major affective episode. Overall, early-onset probands (EOP) met criteria for significantly more cornorbid diagnoses (mean 4.58 ± 2.9) than lateonset probands (mean 0.65 ± 0.9), with a 2.44 times higher risk for anxiety disorders (p < .02). Among probands, the EOP group accounted for all observed cases of alcohol abuse, drug abuse, separation anxiety, social phobia, generalized anxiety disorder, overanxious disorder, attention-deficit hyperactivity disorder (ADHD), conduct disorder, and enuresis. Children of EOPs were significantly more likely to receive at least one diagnosis (p < .02). These children had a 4.2 times higher risk for anxiety disorders (p < .05). All observed cases of separation anxiety, simple phobia, social phobi a, obsessive-compulsive disorder, overanxious disorder, and enuresis were in children ofEOPs. The risk ofdepression and ADHD in children was nearly the same in both groups. The data suggest that children of an EOP parent are at increased risk for nonaffective psychopathology. The appearance of such early symptomatology may be a marker for the later development of bipolar illness. Peripheral Serotonergic Measures Correlate with Aggression and Impulsivity in Juvenile Offenders. A. S. Unis, E. Cook, M.D.; j. Vincent , M.D. ; D. Gjerde, Ph.D.; B. Perry, M.D ., Ph.D. ; ] . Mitchell, M.D . Dysregulation of serotonin (5-HT) has been associated with aggression in several stud ies involving children, adoles-
J. AM . ACAD . CHILD ADOLESC. PSYCHIATRY , 33:6, JULY/AUGUST 1994
917
RESEARCH
The following abstracts were among the highest rated new research posterspresented at the October 1993 Annual Meeting of the American Academy of Child and Adolescent Psychiatry. The outstanding quality of these submissions underscores the ever-improving quality of research in our field. These abstracts are published here to hasten the availability of new research findings to the professional community at large and to recognize the high quality of research presented at the Annual Meeting.
Predictors ofAntidepressant Response to Sleep Deprivation in Depressed Adolescents. M. W. Naylor, M.D., K. Kaminski, B.A.; C. A. King, Ph.D.; N. Ghaziuddin, M.D.; ]. E. Shipley, M.D.; ]. F. Greden, M.D. Total sleep deprivation (TSD) has a transient antidepressant effect in many depressed adolescents. We undertook this study to determine whether baseline polysomnographic sleep variables, severity of depression, or endogenous subtype predict which adolescents have an antidepressant response to TSD. Subjects were 22 depressed adolescents with a Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present Episode/Research Diagnostic Criteria (K-SADS-P/RDC) affective disorder diagnosis (rn = 5, f = 17; 15.6 ± 1.3 years). Baseline polysomnography was obtained on 14 subjects. Depression severity was measured at baseline, during sleep deprivation, and after recovery sleep. It was found that responders, defined as showing 30% improvement in depression rating scores, were significantly more depressed as measured by the Hamilton Rating Scale for Depression (19.2 ± 3.6 vs. 10.6 ± 3.8; t{20] = 5.2, P < .0001), were more likely to have the endogenous subtype of depression (X 2 with continuity correction = 9.6, P ~ .002), and to have shorter rapid eye movement (REM) latency (75.4 ± 14.2 vs. 118.6 ± 31.0 minutes; t{12] = - 3.4, P < .006) than nonresponders . The conclusion is that, as in adults, severely depressed adolescents with the endogenous subtype and short REM latency respond to TSD. These data suggest similarities in the pathophysiology of depression across the life cycle. Depression in Adolescents: Clinical Outcome in Early Adulthood. U. Rao, M.D., N. D. Ryan, M.D.; R. E. Dahl, M.D.; B. Birmaher, M.D.; D. E. Williamson, B.A. This report describes preliminary outcome data for a sample of 31 adolescent subjects with major depressive disorder (MOD) and 35 normal controls in their early adulthood. This sample is unique in having careful diagnostic and multidimensional psychobiological assessments in their adolescence. Follow-up assessments were conducted 5 to 8 years after the initial assessment in 26 (84%) MOD subjects and 32 (89%) normal controls in their early adulthood. These
assessments were made "blind" to the original diagnostic and psychobiological status. Psychiatric and psychosocial assessments were done using the Schedule for Affective Disorders-Lifetime Version, the Structured Clinical Interview for DSM-III-R Personality Disorders , Multi-dimensional Personality Questionnaire, Lifetime Suicide and Aggression History Interview, Lifetime Drinking History, Lifetime Drug Use History, and Longitudinal Interval Follow-up Evaluation Base Psychosocial Schedule. The MOD group was at a significantly increased risk for recurrence of MOD episodes, bipolar disorder, anxiety disorder, suicidal ideation and/or attempts, psychiatric treatment, psychiatric hospitalizations, and impairment in psychosocial functioning when compared to the normal control group. Psychopathology in Children of Late versus Early Onset Bipolar Probands. G. Sachs, M.D., A. Conklin, Ed.M.; B. Lafer, M.D .; A. Thibault, B.A.; ]. Biederman, M.D.; ]. Rosenbaum, M.D. This study presents lifetime prevalence ofpsychopathology in the first 20 bipolar probands and their 32 biological children enrolled in an ongoing study of children at risk for bipolar illness. Rates of psychopathology are compared for probands and their children based on the proband's age at onset of his or her first major affective episode. Overall, early-onset probands (EOP) met criteria for significantly more cornorbid diagnoses (mean 4.58 ± 2.9) than lateonset probands (mean 0.65 ± 0.9), with a 2.44 times higher risk for anxiety disorders (p < .02). Among probands, the EOP group accounted for all observed cases of alcohol abuse, drug abuse, separation anxiety, social phobia, generalized anxiety disorder, overanxious disorder, attention-deficit hyperactivity disorder (ADHD), conduct disorder, and enuresis. Children of EOPs were significantly more likely to receive at least one diagnosis (p < .02). These children had a 4.2 times higher risk for anxiety disorders (p < .05). All observed cases of separation anxiety, simple phobia, social phobi a, obsessive-compulsive disorder, overanxious disorder, and enuresis were in children ofEOPs. The risk ofdepression and ADHD in children was nearly the same in both groups. The data suggest that children of an EOP parent are at increased risk for nonaffective psychopathology. The appearance of such early symptomatology may be a marker for the later development of bipolar illness. Peripheral Serotonergic Measures Correlate with Aggression and Impulsivity in Juvenile Offenders. A. S. Unis, E. Cook, M.D.; j. Vincent , M.D. ; D. Gjerde, Ph.D.; B. Perry, M.D ., Ph.D. ; ] . Mitchell, M.D . Dysregulation of serotonin (5-HT) has been associated with aggression in several stud ies involving children, adoles-
J. AM . ACAD . CHILD ADOLESC. PSYCHIATRY , 33:6, JULY/AUGUST 1994
917