Proton magnetic resonance spectroscopy (MRS) and neuropsychological testing were conducted on 8 children with attention-deficit/hyperactivity disorder (ADHD-H), with no learning disabilities or comorbidities and 8 controls. Magnetic resonance spectroscopy revealed increased Glutamate/Glutamine in both frontal areas, and increased N-acetyl aspartate and Choline in the right frontal area of the ADHD-H subjects. Neuropsychological testing revealed few within- and between-group differences. Findings related to frontal lobe dysfunction in ADHD-H subjects were noted. N-acetylasparte/creatine (NAA/Creatine) in the right frontal region, and myoinositol/creatine (Myo inositol/Creatine) in the right and left frontal regions appear to be highly associated with the regulation of sensorimotor, language, and memory and learning functioning in children with ADHD-H.
The diagnosis of childhood psychosis raises a host of unresolved problems, despite the Diagnostic and Statistical Manual Of Mental Disorders, 4th edition, Text Revision (DSM-IV-TR) giving identical symptoms and definitions for children, adolescents, and adults. The fantasy lives of children, and issues of developing language and cognition (including retardation), all impair diagnostic accuracy, particularly when differentiating between childhood-onset schizophrenia (COS) (≤12 years), bipolar affective disorder, major depressive disorder, and even obsessive-compulsive disorder and attention-deficit/hyperactivity disorder: the catch-all classification, psychosis not otherwise specified (PNOS), is always available for conundra that prove unsolvable. Typical if nonpathognomonic features include neurocognitive difficulties. Multiple screening instruments and specialized versions of semistructured diagnostic interviews are available. Although smooth-pursuit eye-tracking movements may prove a genetic marker for COS, etiologies are likely to be oligogenetic rather than related to a single gene. No specific biological markers or neuroimages have been identified. As such, psychoses may be indicative of a more general pattern of brain dysfunction. Drug treatments are largely based on the adult literature because of a dearth of controlled data below age 18. There are still no rigorous studies of psychosocial treatments and psychotherapy specific to childhood psychosis.
The atypical antipsychotics have been recognized to induce diabetes mellitus and ketoacidosis in the adult psychiatric population. This report notes the onset of weight gain, diabetes, and apparent ketosis in a prepubertal boy diagnosed with bipolar disorder and treated with olanzapine. The hyperglycemia rapidly normalized after discontinuation of the olanzapine. Within 2 years, the diabetes recurred. In spite of the normalization of blood-glucose levels, urine ketone tests remained positive and were explained by the fact that patients taking valproic acid may have a false-positive urine test for ketones. Regular monitoring of glucose should be considered in children and adolescents who gain weight while treated with atypical antipsychotics.
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