Treatment Of Adult Disorders Research Articles

Pediatric indications for deep brain stimulation

Based on the success of deep brain stimulation (DBS) in the treatment of adult disorders, it is reasonable to assume that the application of DBS in the pediatric population is an emerging area worthy of study. The purpose of this paper is to outline the current movement disorder indications for DBS in the pediatric population, and to describe areas of investigation, including possible medically refractory psychiatric indications. We performed a structured review of the English language literature from 1990 to 2011 related to studies of DBS in pediatrics using Medline and PubMed search results. Twenty-four reports of DBS in the pediatric population were found. Based on published data on the use of DBS for pediatric indications, there is a spectrum of clinical evidence for the use of DBS to treat different disorders. Dystonia, a disease associated with a low rate of remission and significant disability, is routinely treated with DBS and is currently the most promising pediatric application of DBS. We caution the application of DBS to conditions associated with a high remission rate later in adulthood, like obsessive-compulsive disorder and Tourette's syndrome. Moreover, epilepsy and obesity are currently being investigated as indications for DBS in the adult population; however, both are associated with significant morbidity in pediatrics. While currently dystonia is the most promising application of DBS in the pediatric population, multiple conditions currently being investigated in adults also afflict children and adolescents, and thus warrant further research.

Laser-Assisted Management of Congenital and Acquired Pediatric Airway Disorders: Case Reports and Review of the Literature

As laser surgery advances are made in the treatment of adult disorders, lasers are likewise increasingly being used in the treatment of pediatric otolaryngologic disorders. We evaluated outcomes of laser surgery in a group of infants and children with congenital and acquired airway disorders. The medical charts of infants and children who were treated for airway disorders between July 2005 and January 2007 at a tertiary care children's hospital were reviewed. Data included relevant history and physical examination, diagnostic work-up, management, and follow-up assessment. Seven patients who had laser surgery for airway lesions were identified. Two infants aged 3-12 wk had laryngomalacia, failure to thrive, and apnea. In one infant, CO(2) laser-assisted supraglottoplasty, in combination with microlaryngeal scissors, resulted in continuing weight gain in one infant at 15 mo after surgery, and no apnea episodes at 4 wk in the other infant. A 2-month-old infant underwent laser-assisted laryngeal cleft repair. Two patients diagnosed with recurrent respiratory papillomatosis at age 6-15 mo underwent multiple CO(2) and KTP laser ablations of laryngotracheal papillomas. Microdebrider removal of papillomas was initiated due to the large size of the papillomas. Two patients aged 5-11 y were burn victims with stridor, hoarseness, or difficulty breathing. After CO(2) ablation of subglottic stenosis and posterior glottic webs, voice and breathing improved and stridor resolved. Congenital and acquired airway lesions in ;infants and children can be treated with the laser. A combined approach with other techniques may be considered to decrease the duration of the procedure when applicable.

Review of Treating Attachment Pathology.

JON MILLS Treating Attachment Pathology Lanham, MD: Jason Aronson, 2005, 388 pages (ISBN 0-7657-0132-4, CDN$40.02 Paper, 0-7657-0130-8, CDN$89.31 Cloth) Reviewed by TREVOR R. OLSON and MICHAEL Wm. MACGREGOR Many books written on attachment pathology focus on the assessment and treatment of children, and provide very little information on attachment difficulties found in adults and adolescents. Jon Mills' Treating Attachment Pathology addresses this neglected area by exploring attachment disorders and psychopathology in adults. As such, Mills' work is a welcome addition to the literature. It goes beyond simply linking adult psychopathology to early attachment difficulties. Mills' work provides a theoretical framework for understanding attachment from a psychodynamic/psychoanalytic perspective and then uses this theoretical framework to discuss the aetiology and treatment of adult disorders. Mills aims to make Treating Attachment Pathology accessible to the expert and novice alike. He does this by extensively reviewing the literature for the expert (e.g., conceptualizations of the self, borderline conditions, etc.), and by making the literature accessible to the novice by providing case examples. Mills himself, however, acknowledges that at times the literature and language is and esoteric. To counteract this Mills makes extensive use of case examples and thereby makes complex and theoretically dense concepts accessible. This is one of the real strengths of Mills' book and it is done with great skill. Mills divides Treating Attachment Pathology into three sections: Theoretical and Diagnostic Considerations, where he introduces psychodynamic, psychoanalytic, and attachment theory and research (pp. 3-92); Treatment Perspectives where he examines specific aspects of psychodynamic/psychoanalytic psychotherapy for attachment disordered patients (pp. 95-276); and Extended Case Studies, where the reader is given an opportunity to consider the previously presented information in lengthy case examples (pp. 279-339). The first section of Treating Attachment Pathology begins with an exploration of the unconscious and prelanguage origins of attachment. Mills also explores issues such as early attachment classification, biological and emotional components of attachment, relationality, and intersubjectivity. Mills' philosophical background is clearly evident in Chapter One as he takes the reader through a review of past and present attachment conceptualizations and classifications. Although the material is at times philosophical and dense, this chapter provides a foundation upon which Mills builds his conceptualization of attachment pathology and how it relates to adult psychopathology. For example, Mills discusses how attachment pathology results in structural deficit of the self due to the incorporation of toxic introjects. Mills continues to lay the foundation for his understanding of attachment pathology in Chapter Two, where he discusses his theory of the infantile mind. In this chapter, Mills provides an excellent summary of his theory of the infantile mind (pp. 42-43). He also addresses the defensive evolvement of the infant and highlights the works of Object Relations psychologists such as Klein, Bion, and Fairbairn. Through the use of case examples, Mills helps the reader better understand the material presented. This is one of the strengths found throughout Mills' book and as indicated above, helps makes the material accessible to the novice. In the third chapter, Mills cogently argues that attachment pathology often results in personality organization at the borderline level. He further goes on to argue that this borderline organization helps account for the polysymptomatic presentation seen in patients with attachment pathology (i.e., dysregulated affect, complaints directed towards others, interpersonal difficulties, disturbed self-representations, impulsive behaviours, confusion over interpreting inner experiential states, developmental histories marked by absence and loss). …

COGNITIVELY ENHANCED PARENT TRAINING

Parent training is one of the most effective interventions for behaviour problems in young children. Most models of parent training are largely behavioural in content and have been developed from social learning theory. As with developments in treatments for adult disorders, it is proposed that parent training implementation and parental engagement may be improved by the introduction of a cognitive component. In particular, the use of the “thoughts, feelings, behaviour cycle” throughout parent training is proposed as a tool for challenging parental beliefs and attributions regarding children's behaviour and increasing parental uptake of the behavioural strategies that are taught. Preliminary findings are discussed with reference to clinical implications and future research.

Pharmacotherapy of School Refusal

This paper reviews the role and indications for pharmacotherapy of children with school refusal. The psychopharmacological treatment of school refusal is based mainly on evidence of the effectiveness of certain drugs in the treatment of adult disorders. There is some evidence that tricyclic antidepressants and benzobiazepines may be specifically useful in the treatment of school refusal, but further research is warranted. Potentially serious side effects mean that drugs are best confined to cases where psychological treatments have not been effective or where drugs are used briefly as an adjunct to a broader psychological treatment plan. Drugs may also have a role in the specific treatment of comorbid conditions associated with school refusal. Any use of drugs should involve regular reviews to monitor response, compliance, and side effects.