Anxiety Disorders: Carlson GA

Frazier JA, Carlson GA. · No affiliation provided · J Child Adolesc Psychopharmacol. · Pubmed #16092901 No free full text.

This publication has no abstract.

Potegal M, Carlson GA, Margulies D, Basile J, Gutkovich ZA, Wall M. · Department of Pediatrics, University of Minnesota Medical School, MMC 486, 420 Delaware Street SE, Minneapolis, MN 55455, USA. · Curr Psychiatry Rep. · Pubmed #19302766 No free full text.

Abstract: Angry outbursts, sometimes called rages, are a major impetus for the psychiatric hospitalization of children. In hospitals, such outbursts are a management problem and a diagnostic puzzle. Among 130 4- to 12-year-olds successively admitted to a child psychiatry unit, those having in-hospital outbursts were likely to be younger, have been in special education, have had a preadmission history of outbursts, and to have a longer hospital stay. Three subsets of behaviors, coded as they occurred in 109 outbursts, expressed increasing levels of anger; two other subsets expressed increasing levels of distress. Factor structure, temporal organization, and age trends indicated that outbursts are exacerbations of ordinary childhood tantrums. Diagnostically, children with outbursts were more likely to have language difficulty and a trend toward attention-deficit/hyperactivity disorder. Outbursts of children with anxiety diagnoses showed significantly more distress relative to anger. Outbursts were not especially associated with our small sample of bipolar diagnoses.

Meyer SE, Carlson GA, Youngstrom E, Ronsaville DS, Martinez PE, Gold PW, Hakak R, Radke-Yarrow M. · Division of Child and Adolescent Psychiatry, Cedars-Sinai Medical Center, Los Angeles, CA, United States. · J Affect Disord. · Pubmed #18632161 No free full text.

Abstract: OBJECTIVE: Recent studies have identified a Child Behavior Checklist (CBCL) profile that characterizes children with severe aggression, inattention, and mood instability. This profile has been coined the CBCL-Pediatric Bipolar Disorder (PBD) phenotype, because it is commonly seen among children with bipolar disorder. However, mounting evidence suggests that the CBCL-PBD may be a better tool for identifying children with severe functional impairment and broad-ranging psychiatric comorbidities rather than bipolar disorder itself. No studies have followed individuals with the CBCL-PBD profile through adulthood, so its long-term implications remain unclear. The present authors examined diagnostic and functional trajectories of individuals with the CBCL-PBD profile from early childhood through young adulthood using data from a longitudinal high-risk study. METHOD: Participants (n=101) are part of a 23-year study of youth at risk for major mood disorder who have completed diagnostic and functional assessments at regular intervals. RESULTS: Across development, participants with the CBCL-PBD phenotype exhibited marked psychosocial impairment, increased rates of suicidal thoughts and behaviors and heightened risk for comorbid anxiety, bipolar disorder, cluster B personality disorders and ADHD in young adulthood, compared to participants without this presentation. However, diagnostic accuracy for any one particular disorder was found to be low. CONCLUSIONS: Children with the CBCL-PBD profile are at risk for ongoing, severe, psychiatric symptomatology including behavior and emotional comorbidities in general, and bipolar disorder, anxiety, ADHD, cluster B personality disorders in particular. However, the value of this profile may be in predicting ongoing comorbidity and impairment, rather than any one specific DSM-IV diagnosis.

Mauer MP, Cummings KR, Carlson GA. · Bureau of Occupational Health, New York State Department of Health, Troy, NY, USA. · J Occup Environ Med. · Pubmed #17993923 No free full text.

Abstract: OBJECTIVE: To conduct an evaluation of health effects in New York State personnel who responded to the World Trade Center disaster. METHODS: Data from a medical monitoring program, including questionnaire data, physical examination results, and clinical and laboratory test results were evaluated for 1423 participants. Descriptive statistics were reviewed and data were analyzed using logistic regression. RESULTS: Lower and upper respiratory symptoms were reported by nearly half of the study participants. One third reported a psychological symptom. Some health effects, including respiratory symptoms and symptoms suggestive of posttraumatic stress disorder, were associated with having been caught in the cloud of dust on September 11, 2001. CONCLUSIONS: This cohort probably experienced less overall exposure than other World Trade Center responder cohorts did. Results suggest that being present when the buildings collapsed was associated with reported symptoms.

Jensen PS, Youngstrom EA, Steiner H, Findling RL, Meyer RE, Malone RP, Carlson GA, Coccaro EF, Aman MG, Blair J, Dougherty D, Ferris C, Flynn L, Green E, Hoagwood K, Hutchinson J, Laughren T, Leve LD, Novins DK, Vitiello B. · Center for the Advancement of Children's Mental Health, Columbia University/NYSPI 1051 Riverside Drive, Unit #78, New York, NY 10032, USA. · J Am Acad Child Adolesc Psychiatry. · Pubmed #17314717 No free full text.

Abstract: OBJECTIVE: To determine whether impulsive aggression (IA) is a meaningful clinical construct and to ascertain whether it is sufficiently similar across diagnostic categories, such that parallel studies across disorders might constitute appropriate evidence for pursuing indications. If so, how should IA be assessed, pharmacological studies designed, and ethical issues addressed? METHOD: Experts from key stakeholder communities, including academic clinicians, researchers, practicing clinicians, U.S. Food and Drug Administration, National Institute of Mental Health, industry sponsors, and patient and family advocates, met for a 2-day consensus conference on November 4 and 5, 2004. After evaluating summary presentations on current research evidence, participants were assigned to three workgroups, examined core issues, and generated consensus guidelines in their areas. Workgroup recommendations were discussed by the whole group to reach consensus, and then further iterated and condensed into this report postconference by the authors. RESULTS: Conference participants agreed that IA is a substantial public health and clinical concern, constitutes a key therapeutic target across multiple disorders, and can be measured with sufficient precision that pharmacological studies are warranted. Additional areas of consensus concerned types of measures, optimal study designs, and ethical imperatives. CONCLUSION: Derived from scientific evidence and clinical experience, these consensus-driven recommendations can guide the design of future studies.

Loney J, Carlson GA, Salisbury H, Volpe RJ. · Lodge Associates, LLC, May's Lick, KY 41055, USA. · J Atten Disord. · Pubmed #16110047 No free full text.

Abstract: Short measures of child inattention-overactivity (IO), aggression-defiance (AG), and anxiety-depression or emotionality (EM) derived through a double validation procedure are administered to mothers of 243 clinic-referred suburban New York boys between 6 and 10 years of age. Mother-rated IO is uniquely related to poor performance on cognitive and achievement tests; observed inattentive, hyperactive, and impulsive behaviors in a restricted academic setting; less father education and lower family income; and most mother-reported impairments and treatment use. Mothers of high-IO boys describe themselves and their sons as having similar childhood symptoms. AG is uniquely related to child-reported disruptive behavior and sensation seeking, many measures of family conflict and negative parenting styles, and mother-reported symptom pervasiveness and number of treatments. EM is uniquely related only to poorer cognitive and achievement test performance, living with one parent, parents who considered themselves too busy, and fewer friends. Each dimension also is associated with parallel teacher-rated factors.

Neria Y, Bromet EJ, Carlson GA, Naz B. · Department of Psychiatry, Columbia University and Anxiety Disorder Clinic, New York State Psychiatric Institute, NY 10032, USA. · Acta Psychiatr Scand. · Pubmed #15819732 No free full text.

Abstract: OBJECTIVE: Little is known about the relationship of assaultive trauma to clinical and functional outcome in patients with bipolar disorder. METHOD: We assessed trauma histories in a cohort of 109 first-admission bipolar patients with psychosis using structured interviews and medical records. Assaultive trauma included rape, physical attacks, and physical threats. Outcome was assessed using standardized ratings. RESULTS: Forty percent reported a history of assaultive trauma, mostly in childhood (< or =16 years). Exposed patients were more symptomatic at each follow-up than unexposed. Sixteen percent of exposed patients remitted after one episode compared with 38.5% of the non-exposed. Patients exposed as adults were the most symptomatic at 6 months, while patients exposed in childhood were the most symptomatic at 24 months. CONCLUSION: Our findings supported the salient role of trauma history as a risk factor for poor course in severe bipolar disorder. Given the high prevalence of such exposure, clinical awareness in first-admission psychotic bipolar patients is critical.

Bromet EJ, Finch SJ, Carlson GA, Fochtmann L, Mojtabai R, Craig TJ, Kang S, Ye Q. · Dept. of Psychiatry, Putnam Hall-South Campus, SUNY at Stony Brook, Stony Brook, NY 11794-8790, USA. · Soc Psychiatry Psychiatr Epidemiol. · Pubmed #15685401 No free full text.

Abstract: BACKGROUND: Few studies of the time to remission and first relapse in severe bipolar disorder have been based on epidemiologically defined samples or have examined patient characteristics and time-varying indicators of medication use simultaneously. Using a cohort from the Suffolk County Mental Health Project, we describe these temporal patterns and their relationships with childhood, illness, and treatment characteristics. METHOD: A multi-facility cohort of 123 first-admission inpatients with DSM-IV bipolar disorder with psychotic features was followed for 4 years. Dates of the first complete remission (lasting at least 2 months), subsequent relapses, and use of antimanic (AM),antipsychotic (AP), and antidepressant (AD) medications were recorded. Childhood and illness characteristics were ascertained at baseline using standard instruments. RESULTS: By the 4-year point, 83.7% had achieved a full remission, with 42.3% remitting within 3 months, 63.4% within 6 months, and 74.8% within 1 year. Overall, younger age of onset, history of childhood psychopathology, and higher Brief Psychiatric Rating Scale (BPRS) anxiety/depression scores were significantly associated with longer time to remission. Discontinuing AM, AP and AD (compared to never using) and taking AP and AD (compared to never using) were significantly associated with remission in the multivariate analysis. Of the 103 participants with complete remission, 61.2% suffered a relapse; 24.3 % relapsed within 6 months of remission, and 35.9% within a year. Overall, 32.5% of the 123 participants had a single episode followed by full remission. Childhood internalizing-type problems, higher BPRS anxiety/depression and Hamilton depression scores, and an admission episode not involving mania, but not patterns of medication use, were associated with shorter time to relapse. CONCLUSION: By 4-year follow-up, the majority of severely ill bipolar patients had remitted from their initial episode, but more than half subsequently relapsed. Illness characteristics, especially depressive symptoms, and medication treatment were associated with the early course, although medication use after remission was not associated with relapse.

Drabick DA, Gadow KD, Carlson GA, Bromet EJ. · Department of Psychology, Temple University, Philadelphia, PA 19122-6085, USA. · J Am Acad Child Adolesc Psychiatry. · Pubmed #15167090 No free full text.

Abstract: OBJECTIVE: To examine potential external validators for oppositional defiant disorder (ODD) and attention-deficient/hyperactive disorder (ADHD) symptoms in a Ukrainian community-based sample of 600 children age 10 to 12 years old and evaluate the nature of co-occurring ODD and ADHD symptoms using mother- and teacher-defined groups. METHOD: In 1997, parents, children, and teachers participated in extensive clinical assessments using standard Western measures. Four areas of functioning were assessed: child mental health, parent-child interactions, parental well-being, and school/cognitive performance. RESULTS: Mother-defined ODD versus ADHD symptom groups were differentiated by a history of overactivity and tantrums, behavior in school, and maternal anxiety and hostility. Teacher-defined groups were differentiated by conduct problems, internalizing symptoms, mother-child interactions, and paternal alcohol use. The effects of co-occurring ODD and ADHD symptoms were greater than would be expected based on their separate effects for conduct problems, internalizing symptoms, social problems, academic performance, parent-child relations, and marital discord. CONCLUSIONS: Children with ODD versus ADHD symptoms were not significantly different from each other for the majority of variables examined, and group differences were dependent on the rater used to define symptom groups.

Gadow KD, Sprafkin J, Carlson GA, Schneider J, Nolan EE, Mattison RE, Rundberg-Rivera V. · Department of Psychiatry, State University of New York, Stony Brook 11794-8790, USA. · J Am Acad Child Adolesc Psychiatry. · Pubmed #12049441 No free full text.

Abstract: OBJECTIVE: To examine the reliability and validity of the Youth's Inventory-4 (YI-4), a DSM-IV-referenced self-report rating scale. METHOD: Youths (N = 239) aged between 11 and 18 years who were clinically evaluated between 1996 and 1999 completed the YI-4, and 79% completed at least one additional self-report. Parents and teachers completed a companion measure. A second sample (N = 47) was retested 2 weeks after an initial evaluation. RESULTS: The YI-4 demonstrated satisfactory internal consistency (alpha values = .66-.87) and test-retest reliability (r values = 0.54-0.92), convergent and to lesser extent divergent validity with other self-report measures, and discriminant validity by differentiating children with and without diagnosed attention-deficit/hyperactivity disorder, conduct disorder, substance use, generalized anxiety disorder, or major depressive disorder. Youth-parent (r values = 0.05-0.50) and youth-teacher (r values < 0.18) agreement was generally modest. CONCLUSIONS: These findings provide preliminary support for the clinical utility of the YI-4 for symptom assessment in referred youths.

Carlson GA, Loney J, Salisbury H, Kramer JR, Arthur C. · Division of Child and Adolescent Psychiatry, State University of New York at Stony Brook, 11794-8790, USA. · J Child Adolesc Psychopharmacol. · Pubmed #11052407 No free full text.

Abstract: This study used data from a completed longitudinal study to examine the effects of methylphenidate on 6-12-year-old boys presumably at risk for bipolar disorder. Of 75 boys referred, diagnosed with hyperkinetic reaction of childhood (minimal brain dysfunction), treated clinically with methylphenidate, and followed as young adults, 23% (the maximorbid or MAX group) had childhood symptoms of irritability and emulated DSM-IV diagnoses of attention deficit hyperactivity disorder (ADHD), plus oppositional defiant or conduct disorder (ODD/CD) and anxiety or depression or both. The remaining boys (the minimorbid or MIN group) had fewer symptoms and disorders. MAX and MIN groups did not differ in rated response to methylphenidate, duration of treatment, clinically determined maintenance doses, concurrent or subsequent treatment with other medications, or other aspects of medication experience. At ages 21-23, individuals with bipolar-related lifetime diagnoses (adult mania, hypomania, or cyclothymia) did not differ from those without bipolar-related diagnoses in any aspect of early methylphenidate treatment history. These findings indicate that ADHD boys with symptoms suggesting childhood mania do not respond differently to methylphenidate than boys without such symptoms, and there is no evidence here that methylphenidate precipitates young adult bipolar disorders in susceptible individuals.