Borderline Traits Tracked in Teens
Borderline personality disorder appears to encompass a much broader range of psychopathology in adolescent inpatients than in hospitalized adults, reported Dr. Daniel F. Becker of the University of California, San Francisco, and his colleagues.
The investigators interviewed 123 adolescent inpatients, aged 13–18 years, who were a mean age of 15.9 years. Most (104) were white; 67 (54%) were boys (Compr. Psychiatry 2006;47:99–105).
Based on interviews, borderline personality disorder (BPD) was diagnosed in 65 adolescents–45% of boys and 65% of girls–and four factors associated with BPD presentation accounted for 67% of the overall variance.
Factor 1 reflected negative or self-deprecating aspects of BPD presentation, such as suicidal threats and gestures, and feelings of emptiness or boredom. Factor 2 covered affective dysregulation or irritability, including uncontrolled anger. Factor 3 reflected interpersonal problems, such as unstable relationships. Factor 4 reflected impulsiveness.
These factors suggest that BPD in teens may be associated with Axis I disorders, and more research is needed on the heterogeneity of BPD, the investigators noted.
The existence of the four BPD factors that appear to differ from those reported for similar studies in adults raises “the question whether BPD is different in its nature and underlying structure in adolescents,” the authors wrote.
Methylphenidate and Cell Abnormalities
Methylphenidate is associated with significant increases in cell abnormalities when given to children at therapeutic levels, reported Dr. Randa A. El-Zein of the University of Texas M.D. Anderson Cancer Center, Houston, and colleagues.
Data from 12 children showed significant increases in several genotoxic end points after 3 months of daily treatment with methylphenidate. The children, whose average age was 9 years, received doses ranging from 20 mg/day to 54 mg/day (Cancer Letters 2005;230:284–91).
Peripheral blood lymphocyte samples were collected from the children at baseline and after 3 months of treatment and evaluated for cell abnormalities.
Compared with baseline values, the children demonstrated a threefold increase in the mean number of chromosomal abnormalities, from 1.7 per 50 cells to 5.1 per 50 cells. They also showed a 4.3-fold increase in the mean number of sister chromatid exchanges (the number of crossover events in a chromosome pair), from 6.1 to 26.3, and a 2.4-fold increase in micronuclei frequencies per 1,000 cells, from 3.6 to 8.5.
Despite the small sample size, the investigators said, their study was “remarkable in the consistency of the increase of every type of cytogenetic end point monitored, in every child receiving the drug.” The study opens the door for further larger studies that address these issues in order to establish the safety of methylphenidate, as well as possible replacement drugs, for treating ADHD, they said.
Psychosocial Support, Pregnant Teens
Pregnant adolescents who receive interdisciplinary prenatal and postpartum care and psychosocial support have lower rates of rapid pregnancy recurrence, Amanda Melhado reported at the annual meeting of the Society for Adolescent Medicine.
In a prospective study of a “global care” model, Ms. Melhado, Dr. Maria José Carvalho Sant'Anna, and Dr. Verônica Coates of Faculdade de Ciências Médicas da Santa Casa in São Paolo, Brazil, compared the outcomes of 30 adolescents who received specialized prenatal medical care and psychoeducational support with those of 39 age-matched adolescents who received standard prenatal care only. All of the young women in the study were 18 years old or younger at the time of conception and gave birth in the maternity ward of the same hospital between July 1, 2004, and June 30, 2005.
No significant differences were found between the two groups with respect to marital status or relationship with the babies' fathers, Ms. Melhado said. More than half of the young women in both groups were not married at the time of the study.
The psychoeducational support component included group and individual sessions with a team of providers–including mental health professionals, obstetricians, and pediatricians–focusing on such topics as self-esteem, contraception, relationships, and infant development.
As of March 2006, the rate of pregnancy recurrence among the young women who received the intervention was 3%, compared with 15% in the standard care group.