Faculty Bibliography

OBJECTIVE: The purpose of this study was to investigate the adult outcome of a group of male juveniles who committed sexual assault. METHOD: Nineteen sexually assaultive male juveniles and a comparison group of 58 violent juveniles were studied over an 8-year period through use of criminal records and clinical interviews. RESULTS: Although in adolescence the two groups were similarly violent, on follow-up those who had committed sexual assault were significantly more likely to commit adult sexual offenses. They also committed significantly more violent nonsexual offenses. Childhood sexual abuse, especially by females, was associated with adult sexual offenses. CONCLUSIONS: Sexually assaultive delinquents are at particularly high risk for subsequent violence. Hence, special efforts must be made to treat these delinquents in adolescence. Prevention of violent sexual behavior must include improved methods of detecting sexual abuse, especially that perpetrated by older females

A total of 2250 subjects from psychiatric and geriatric settings was examined for abnormal involuntary movements by the same team of trained raters employing a standard examination technique and rating scale. 'Spontaneous' dyskinesia rates were 1.3% among 400 healthy elderly people surveyed at senior citizens centers, 4.8% among medical geriatric inpatients and ranged from 0 to 2% among psychiatric patients never exposed to neuroleptics. For samples of neuroleptic-treated patients, prevalence rates ranged from 13.3% among patients at a voluntary psychiatric hospital to 36.1% among state hospital patients. Logistic regression analyses revealed a large effect of age on tardive dyskinesia prevalence and an interaction of age with sex. Among younger subjects, men had higher rates; among subjects over age 40, rates were higher for women. Edentulousness and presence of other neurological disorders were possible contributors to high rates for the elderly. Even with control for age, sex and duration of neuroleptic exposure, prevalence differed markedly across study site

Preclinical and clinical observations suggest that enhancement of prostaglandin activity inhibits catecholamine release and may have antidyskinetic effects. A double-blind therapeutic trial with prostaglandin precursor essential fatty acids was conducted in 16 patients with tardive dyskinesia. No beneficial effects were seen

Twenty-five schizophrenic outpatient subjects in a depot neuroleptic discontinuation study received an amphetamine challenge approximately 6 weeks after their last dose. Only five of these showed greater than three-point increases in positive symptoms on the BPRS, and all five relapsed within 30 days of the challenge. The 20 with less than three-point increases in positive symptoms showed extremely variable stability, relapsing from 20- greater than 600 days after the challenge. Thus, increase in positive symptoms after amphetamine may identify a group at risk for rapid relapse after neuroleptic discontinuation, but lack of such a response gives little prognostic information

In stable schizophrenic outpatients with predominantly 'defect state' symptomatology amphetamine caused a reduction in negative symptoms that was statistically significant but not complete (i.e. these symptoms remained clinically discernible). The possibility that dopaminergic hypofunction contributes some elements to the schizophrenic defect state is presented, along with some limited data compatible with this concept. These findings are compared to prior studies in recently hospitalized schizophrenic subjects, and discussed with respect to recent theoretical concepts regarding the role of dopamine in schizophrenic psychopathology

The age of onset of affective illness as measured by the initial psychiatric consultation for four affective subtypes was evaluated. Bipolar I (mean age = 28.00) and cyclothymics (mean age = 27.58) sought psychiatric consultation for their affective symptoms significantly earlier than unipolar patients (mean age = 34.69). Bipolar II patients (mean age = 31.54) sought psychiatric consultation at an age intermediate between bipolar I and unipolar patients. Male bipolar II patients sought psychiatric treatment significantly later than female bipolar II patients and there was a nonsignificant trend toward male cyclothymics initially seeking treatment later than female cyclothymics. In all, the range of age of onset for the four affective subtypes was quite wide suggesting that a patient was at risk for developing an affective disorder at any time from adolescence to the geriatric age range