A dramatic increase in the number of children who are diagnosed with an autistic disorder has given rise to a deluge of articles on autism in the professional as well as the popular literature. This review of the current literature summarizes and synthesizes recent information on the causes and manifestations of autism; the trends in screening, diagnosis, and assessment; and the salient features of different treatment programs. It provides an overview of the advances and controversial issues that are of special interest to practicing clinical psychologists. SUSAN KABOT received her MEd in 1973 from Boston College and an MS in Speech and Language Pathology in 1992 from Nova Southeastern University. She is the director of the Autism Consortium at the Mailman Segal Institute for Early Childhood Studies at Nova Southeastern University, which develops educational programming for students with autism. WENDY MASI received her PhD in developmental psychology from Nova University in 1977. She is the dean of the Mailman Segal Institute for Early Childhood Studies at Nova Southeastern University, where she designs and implements programs for families with young children, preschool programs, and early childhood and family support training programs. MARILYN SEGAL received her PhD in the psychology of behavioral change in 1970 from Nova University.
Lithium is an important medication in the treatment of mood disorders. However, clinicians are hesitant to use lithium in older adults for fear of its medical effects, particularly kidney disease. This review describes the current understanding of the epidemiology and mechanisms underlying chronic kidney disease (CKD) in older lithium users, with recommendations for using lithium safely in late life. Prevalence estimates of CKD in older lithium users range from 42-50%, which does not differ greatly from the 37.8% rates seen in community-dwelling non-lithium using, non-psychiatric populations. Clinical and pre-clinical data suggest a variety of synergistic mechanisms contributing to CKD in older lithium users, including aging, cardiovascular factors, oxidative stress, inflammation, nephrogenic diabetes insipidus, acute kidney injury, and medication interactions. With regards to CKD, lithium can be used safely in many older adults with mood disorders. Compared to patients with pre-existing CKD, those with an estimated glomerular filtration rate >60 mL/min/1.73 m(2) are probably not as susceptible to lithium-associated renal decline. Using lithium concentrations <0.8 mmol/L; monitoring lithium concentrations and renal function every 3-6 months; being vigilant about concurrent medication use (e.g., diuretics, anti-inflammatories); as well as preventing/treating acute kidney injury, nephrogenic diabetes insipidus, diabetes mellitus, hypertension, smoking, and coronary artery disease can all help prevent CKD and further renal decline in older lithium users.
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