Hallucinogens

This article describes the various hallucinogens with which adolescents may come in contact. Perspective is provided as to the importance of the various hallucinogens and to their effects on adolescent users.

Methylphenidate and cognitive therapy with ADD children: a methodological reconsideration

The present double-blind study examined the effects of methylphenidate, cognitive therapy, and their combination in attention deficit-disordered (ADD) children. Four treatment groups were compared on measures of attentional deployment and cognitive style, tests of academic achievement, and behavioral rating scales. In contrast to a previous study conducted in this laboratory, children in this study were not receiving medication during post-testing. Results were interpreted to suggest that measurable effects of stimulant medication dissipate rapidly upon discontinuation of pharmacotherapy. The combination of methylphenidate and cognitive therapy was not found to be any more efficacious than either of the treatments studied alone. Discussion suggests that medication status at follow-up is an essential feature of research design.

Insulin-induced hypotension and neurogenic orthostatic hypotension

Insulin-induced hypoglycemia induced a fall in blood pressure (BP) in patients with idiopathic orthostatic hypotension (IOH) and multiple system atrophy (MSA), but not in control subjects. Only in IOH was there a correlation between plasma norepinephrine (NE) levels and maintenance of BP during the test. The hypotension was not affected by pretreatment with propranolol. Hypotension during insulin-induced hypoglycemia is manifested in patients who lack an adequate NE response. The hypotension, however, may be due to a central action of insulin because not all MSA patients with impaired NE release become hypotensive.

Methylphenidate and cognitive therapy in children with attention deficit disorder: a double-blind trial

Stimulant medications have been the treatment of choice for children with Attention Deficit Disorder (ADD), yet long-term benefits have not been found. The present study examined the ability of an adjunctive cognitive behavioral self-control therapy program to improve upon these long-term results. Findings only partially supported the efficacy of the cognitive therapy, as demonstrated on the Matching Familiar Figures Test of impulsivity. However, this improvement did not persist over time. Results are discussed in terms of the need for pediatricians to consider individual differences in therapeutic response across patients.

The performance of attention-deficit-disordered and normal children on conservation tasks

The present study was designed to investigate whether a specific subgroup of learning-disabled children (attention-deficit-disordered, ADD) differed from their normal counterparts on Piagetian tasks of conservation. The subjects were 34 third-and fourth-grade children. Seventeen children had been diagnosed as ADD; the remaining half were designated as normal. The two groups were equivalent in chronological age, mental age, and intelligence. The results indicated significant differences between the two groups on tasks tapping conservation of substance and number. These results may support the theory of a lag in the development of conservation in children with specific learning disabilities (ADD). Implications of the present research for therapeutic and remedial programs that serve ADD children are also discussed.

Radiographic-pathologic correlation in cerebral amyloid angiopathy. A review of 12 patients

Twelve patients with pathologically proven cerebral amyloid angiopathy (CAA), causing intracerebral hemorrhage, were reviewed to determine the clinical and radiographic features. All 12 patients were 62 years of age or older and presented with acute neurological syndromes. The computed tomographic scan (CT) in each showed a relatively large intracerebral lobar hemorrhage located in a cortical and subcortical area. The finding of a lobar intracerebral hematoma in an elderly patient should suggest CAA as a cause.

Iron status of adolescent female athletes

To determine whether or not adolescent female athletes were more in need of routine dietary iron supplements than their nonathlete peers, the iron status of 32 athletes and 31 nonathletes was assessed. The athletes were track-team members in the middle of their season. Hemoglobin, transferrin saturation, and serum ferritin were evaluated, as well as the amount of dietary iron intake. Athletes had significantly lower serum ferritin levels and transferrin saturation (less than 16%) than did nonathletes. Black girls were significantly lower than whites on all three values. There were also a greater number of black girls deficient in serum ferritin. We conclude that athletes may be at greater risk for iron deficiency and, therefore, for iron deficiency anemia; and black adolescents may have an increased prevalence of iron deficiency, with black female athletes being at potentially greater risk for iron deficiency and its possible consequences. We recommend a more sensitive assessment of iron status in female athletes.

Decreased sympathetic neuronal uptake in idiopathic orthostatic hypotension

The disappearance rates from plasma of intravenously administered levo-norepinephrine (l-NE), dextro-norepinephrine (d-NE), and isoproterenol (ISO) were measured in normal subjects and in patients with either multiple-system atrophy (MSA) or idiopathic orthostatic hypotension (IOH). The two isomers, l-NE and d-NE, were removed at similar rates in all groups. In normal subjects, the d and l isomers of norepinephrine were cleared more rapidly than ISO. In patients with IOH, the initial rates of disappearance of the NE isomers from plasma were slower than normal and similar to the rate for ISO disappearance. Plasma NE levels, NE clearance, and the apparent release rate of NE into plasma from sympathetic neurons were significantly lower in patients with IOH than in normal subjects. Only the apparent NE secretion rate was related to the baseline plasma NE level. Sympathetic neuronal dysfunction in IOH is attended by a reduction in the clearance of NE. The very low plasma NE levels, in association with the striking reduction in NE clearance, suggest that in IOH there is a marked decrease in NE release. NE clearance and apparent NE secretion rate are normal in MSA, consistent with a central nervous system dysfunction in regulating the sympathetic nervous system. Neuronal uptake of NE in humans does not appear to be stereoselective.

Methylphenidate and cognitive therapy: a comparison of treatment approaches with hyperactive boys

This study of hyperactive boys evaluated the effects of three modes of treatment in relation to an untreated group. The treatments were administered over a 3-month period and included cognitive training, stimulant drug therapy (methylphenidate), and the two treatments combined. A follow-up assessment was conducted approximately 3 months after contact between the training staff and the child had ceased. Analyses of attentional deployment and cognitive style measures, tests of academic achievement, and behavioral ratings showed that only those children in the two medication treatment conditions demonstrated improvement in attentional deployment and behavioral ratings. In the cognitive therapy condition, there were changes only on measures of attentional deployment. The data did not provide evidence indicating that the combined medication and cognitive therapy condition was any more effective than that condition involving medication alone. Discussion provides future guidelines for evaluation of the relative effectiveness of stimulant drug therapy and other psychological treatment modalities.

Developing ambulatory and in-patient services for adolescents

Adolescents require specialized health care because of their unique developmental needs. The medical or surgical treatment of a disorder may be straightforward and little different from that of a child or adult; but, because of cognitive, physical, and psychosocial stages of development, consideration of these attributes assumes great importance if optimal results are to be achieved. Establishing outpatient and inpatient facilities for adolescents requires meticulous planning and continuing commitment, careful selection of professional staff, elimination of barriers to health care, respect for privacy and confidentiality, and knowledge of laws affecting consent for care. Teenagers are often unsure of themselves, have difficulty relating to adults, and their actions often belie their true feelings. It is necessary to establish rapport and trust with patients and other professionals.

Attention deficit disorder and the effect of methylphenidate on attention, behavioral, and cardiovascular functioning

The effect of a 0.3 mg/kg dose of methylphenidate on attentional, behavioral, and cardiovascular measures in boys with attention deficit disorder (ADD) was examined. The results of double-blind clinical trials demonstrated a significant improvement in sustained attention and impulse control, as well as in ratings of social behavior by both teachers and parents. Consistent with previous research, cardiovascular functioning did not significantly increase as a function of methylphenidate. Due to the large intraindividual variability in cardiovascular response, careful monitoring of each patient's response is recommended.

Determination of urinary 4-hydroxy-3-methoxyphenylethylene glycol in man by high performance liquid chromatography with electrochemical detection

A reverse phase high performance liquid chromatographic method for determining levels of 4-hydroxy-3- methoxyphenylethylene glycol (MHPG) in human urine that is virtually free of all interfering peaks has been developed. After addition of a homologous internal standard, enzymatic hydrolysis is performed. Samples are then placed onto columns containing AG1-X8, and the MHPG is collected in a phosphate buffer wash of the column. After ethyl acetate extraction and evaporation of the organic solvent, the dry residue is redissolved in mobile phase, and injected onto a reverse phase column. Results obtained with this assay were almost identical (101+/-5.6%, mean+/-SD, n=6) with those obtained using a gas chromatography - mass spectrometry (GCMS) assay.

How much stimulant medication is appropriate for hyperactive school children?

This research tested the hypothesis that a relatively modest dose of stimulant medication would produce optimal effects on cognitive and impulse control performance when compared to three other dosage levels in hyperactive school children. The efficacy of the medication was measured using a school-like visual search and matching task tapping concentration and impulse control that previously has been shown to be sensitive to stimulant drug effects. Task performance was found to be optimal at the predicted dose level, supporting the original hypothesis. The importance of school health personnel involvement in the adjusting of dosage levels of stimulant medication was stressed. A role for school health personnel in facilitating communication between physicians and teachers was suggested.

An analysis of attentional components in hyperactive and normal boys

Attentional performance was examined in hyperactive and normal 10 and 14 yearold boys. The children participating in the present study were administered a series of measures hypothesized to test three components of attention: coming to attention, decision making, and sustaining attention to a task over time. Multivariate analyses followed by univariate tests indicated that both age groups of normal children were superior to hyperactive children in attentional performance while hyperactive adolescents demonstrated significant improvement with age only in the area of coming to attention. Findings were interpreted to suggest that while activity levels of hyperactive children may diminish at adolescence, hyperactive adolescents still continue to be impulsive and impaired in attention. Correlational analyses yielded low but statistically significant relationships among the attentional measures, but no significant relationships between IQ and the attention test scores. Findings were consistent with the interpretation that the three hypothesized components of attention are independent of intelligence.

Ameliorating attentional deficits and concomitant academic deficiencies in learning disabled children through cognitive training

The present study investigated the efficacy of a package of cognitive self-control procedures for ameliorating the attentional deficits of 12-year-old learning disabled children. It was hypothesized that a package of self-control procedures would improve academic performance on a number of measures in which learning disabled children generally perform poorly due to faulty attentional processes. Performance on measures of reading, attention, and inhibitory control was improved in these children as a function of the cognitive self-instructional training. The improvement continued to sustain even three months after the training had ceased. Implications are discussed for adapting the techniques utilized in the present study for classes which serve learning disabled children.

A developmental analysis of visual and auditory sustained attention and reflection-impulsivity in hyperactive and normal children

Sustained attention to visual and auditory stimuli and reflection-impulsivity were examined in hyperactive and normal 9- and 14-year-old boys. Multivariate analyses, followed by univariate tests, indicated that the normal children increased in sustained attention efficiency with age to both visual and auditory stimuli. Hyperactive children increased in sustained attention efficiency with age to auditory but not visual stimuli. Both groups increased with age in reflection-impulsivity as measured by Kagan's Matching Familiar Figures Test (MFFT). Correlations between the sustained attention scores and the MFFT error and latency scores were not significant for hyperactive children. Recommendations were made for training programs that offer hyperactive children remediation in developing sustained attention efficiency to visual information.

Adjunctive behavior in children on fixed interval food reinforcement schedules

Four female children (4 to 6 years of age) were tested on fixed interval (FI) 30-sec and 60-sec food schedule with M & M candy reinforcers. All four subjects displayed increased movement on the FI schedules as compared to appropriate FR 1 baseline conditions. Increased drinking was shown by three subjects, and increased vocalization by two subjects. These results clearly demonstrated schedule-induced behaviors in children with food reinforcement schedules which are typically used in animal experiments.U

Costochondritis in adolescents

One hundred adolescent clinic patients who complained of chest or upper abdominal pain were evaluated. Seventy-nine were found to have only tender costal cartilages. Costochondritis pain originates in the anterior chest wall and may radiate into the chest, back, or abdomen. It is reproducible by palpating the affected costal cartilage. Costochondritis was more often unilateral than bilateral (P = 0.001), and in unilaterally affected patients (P less than 0.005), is involved the left side more than the right. The left fourth sternocostal cartilage was involved most frequently. A simple program of mild analgesics and reassurances was sufficient treatment in all cases. These findings suggest that chest pain and upper abdominal pain in adolescents rarely arise from serious problems. Adolescents are normally hypersensitive about physical symptoms, but they can be effectively reassured and an expensive diagnostic and treatment program can be avoided.

Time course of peripheral heterothermy in a homeotherm

The integrity of the peripheral heterothermic response was monitored in adult Sprague-Dawley rats during cold acclimation. Subcutaneous peripheral temperature gradients were simultaneously recorded in the hindlimbs. One limb was exposed to room temperature (22 +/- 2 degrees C) while the contralateral limb was gradually cooled to 0 +/- 1 degrees C. Noncontrols were acclimated at 5 +/- 1 degrees C for periods up to 35 days. Controls responded to the cooling regimen (25 to 0 degrees C at 0.5 degrees C . min-1) in a "poikilothermic" manner indicating local cold-induced vasoconstriction (CIVC). CIVC was not released until tissue temperatures reached 22,3 +/- 2.5 degrees C whereupon nonpatterned limb temperature fluctuations, Lewis' hunting response, were often initiated. The hunting response occurred synchronously in the contralateral warmed limb despite its elevated temperature. The experiments revealed a progressive decrease in the intensity of heterothermy indicative of an earlier onset of cold-induced vasodilation as well as increased resistance to tissue cooling with increasing acclimation time. Following 21 days at 5 degrees C, limb exposure to 0 degrees C resulted in a 2-4 degrees C drop in tissue temperature. The time course of the diminution in peripheral heterothermy is discussed. In addition, evidence supporting the hypothesis of a central component in the regulation of the hunting response is presented.