Heidi Splete

HOUSTON – In the age of 24-hour technology, bullying no longer stops at the playground border.

Cyber bullying is a form of harassment using text messages, e-mail, and Web sites. This high-tech approach allows children and adolescents to engage in bullying not only at school, but at home, at all hours of the day and night.

A bully can post a disparaging comment on the Internet or in an e-mail message and send it to 3 people, 30 people, or 300 people, said Richard Sarles, M.D., at the annual meeting of the American Society for Adolescent Psychiatry. In addition, the insult is there for the victim and recipients of the message to read over and over again–which makes this kind of aggression even more insidious, said Dr. Sarles, professor of psychiatry and pediatrics at the University of Maryland, Baltimore. The anonymous nature of cyberspace creates additional problems, because the bully need not face the victim and may be unknown.

Any sort of bullying is a significant clinical problem, Dr. Sarles said at the meeting, cosponsored by the University of Texas Southwestern Medical Center at Dallas. In fact, bullying, the most common form of aggression experienced by children and teens, is more problematic for this population than is racism, or pressure to use drugs or alcohol, or to have sex, he said. Bullying that is considered traditional can be either physical or verbal. Dr. Sarles said boys tend to be more direct–and aggressive–than girls. Boys are more likely to intimidate their victims by engaging in name calling, malicious teasing, and obnoxious gestures.

Girls who bully tend to use more passive approaches. They are more likely to employ rumor spreading, malicious gossip, and sexual innuendo. In addition, girls are less likely to use physical bullying. Instead, they are more drawn to relational bullying, which is meant to cause social isolation. Their goals are to damage reputations and relationships.

Cyber bullying in the hands of girls can be particularly devastating. After all, this is a time in which peer group acceptance and the need for belonging are highly sought. “Girls share so much information when they are friends that they never run out of ammunition if they turn on one another,” he said.

Several theories exist about the etiology of bullying. The person-centered theory involves the characteristics of the bully, victim, and onlookers, and the way in which they predispose children to bullying or being bullied.

“We know that bullies are impulsive; they often have characteristics of oppositional defiant disorder, often have a hard time following school rules, and derive satisfaction from inflicting harm and intimidating others,” Dr. Sarles said. They tend to be nonempathetic and domineering. These children or teens may have conduct disorder and antisocial personality disorder as well.

The victims of bullies tend to be quiet, socially awkward, and sometimes labeled “nerds,” or “weirdos.” They tend to be nonassertive and have few friends and low self-esteem, and have poor social skills. In other words, victims tend “not to fit in,” which is a stronger predictor of being the victim of a bully than physical characteristics such as height and weight, Dr. Sarles noted. Bullies are more likely to pick on socially awkward children than those with obvious physical abnormalities or disabilities.

“Bully-victims are a group that we don't know much about,” Dr. Sarles said. These children or adolescents are usually victims first, and then they become bullies, and they are overrepresented as perpetrators in instances of school shootings.

The onlookers represent the largest group of adolescents. This group doesn't present with symptoms, so are not treated for anything from a clinical psychiatrist's point of view. But they are extremely important in discussions of intervention, because they provide an audience and tacit approval for the behavior to continue. “Bullies like a crowd,” Dr. Sarles said. The onlookers could stop the bullying but may fear retaliation.

The dominance theory of bullying involves a hierarchy based on access to and control of resources. When transitioning from elementary school to middle school, children need to reassert their dominance. Research has shown that the most common time for bullying behavior is in middle school, when children both redefine their identities and adjust to the onset of puberty, Dr. Sarles said. Their surging hormones allow for variation in size and development that can foster bullying behavior.

The ecologic theory goes beyond the bully-victim dyad. This theory includes all factors that allow bullying to develop and persist. This theory suggests that school and playground designs may foster unsupervised spaces where children and adolescents are vulnerable to bullies, and that inaction on the part of adults in authority allows bullying to continue. “If you can't change community attitudes and the school environment, you won't be able to prevent bullying,” Dr. Sarles said. A successful intervention involves parents and school personnel developing a consensus on prevention programs. (See sidebar.)

Physicians may recognize bullying before the parents do. Clear links exist between bullying and other antisocial behaviors for example. Dr. Sarles cited one study in which 40% of people who reported being bullies as children or adolescents had criminal convictions at age 24 years.

Children and adolescents who are victims may present to clinicians with symptoms of anxiety. These children often do not want to go to school, feign illness, and have unexplained cuts and bruises. Belongings often end up missing for victims.

After the bullying stops, the symptoms tend to disappear in the absence of a genuine comorbid condition, he said.

Some Interventions Begin at School

Most bullying, even cyber bullying, begins at school–where children meet and spend much of their time. Many interventions against bullying start at school as well.

“You have to get people to agree that bullying is not for kids,” by encouraging parents to go to their children's schools and advocate for a no-tolerance policy, Dr. Sarles said.

School-based strategies include:

▸ Increasing adult supervision of children in public spaces during lunch and recess.

▸ Elimination of unsupervised places where children might be bullied.

▸ Use of classroom-based antibullying programs in an effort to teach that bullying is wrong and should be reported.

▸ Use of a “bully box” near the school counselor's office that allows children to anonymously report bullying episodes.

▸ Role playing and assertiveness training.

▸ Use of video cameras on school buses, on school property, and in buildings to record instances of bullying and to act as a deterrent.

▸ Establishment and enforcement of a zero-tolerance bullying policy that includes all school personnel, from teachers to cafeteria workers, coaches, and janitors.

▸ Switching schools. If the school and the community fail to cooperate, the child must simply change schools to get out of an abusive environment.

The federal government has jumped on the bully bandwagon. Its Web site,

http://stopbullyingnow.hrsa.gov

The attention given to bullying among girls in recent years has sparked several books and movies. A Web site,

www.meangirls.com

The bottom line is to create a safe environment for the child, because children who feel intimidated in school can't learn, Dr. Sarles said.

HOUSTON – In the age of 24-hour technology, bullying no longer stops at the playground border.

Cyber bullying is a form of harassment using text messages, e-mail, and Web sites. This high-tech approach allows children and adolescents to engage in bullying not only at school, but at home, at all hours of the day and night.

A bully can post a disparaging comment on the Internet or in an e-mail message and send it to 3 people, 30 people, or 300 people, said Richard Sarles, M.D., at the annual meeting of the American Society for Adolescent Psychiatry. In addition, the insult is there for the victim and recipients of the message to read over and over again–which makes this kind of aggression even more insidious, said Dr. Sarles, professor of psychiatry and pediatrics at the University of Maryland, Baltimore. The anonymous nature of cyberspace creates additional problems, because the bully need not face the victim and may be unknown.

Any sort of bullying is a significant clinical problem, Dr. Sarles said at the meeting, cosponsored by the University of Texas Southwestern Medical Center at Dallas. In fact, bullying, the most common form of aggression experienced by children and teens, is more problematic for this population than is racism, or pressure to use drugs or alcohol, or to have sex, he said. Bullying that is considered traditional can be either physical or verbal. Dr. Sarles said boys tend to be more direct–and aggressive–than girls. Boys are more likely to intimidate their victims by engaging in name calling, malicious teasing, and obnoxious gestures.

Girls who bully tend to use more passive approaches. They are more likely to employ rumor spreading, malicious gossip, and sexual innuendo. In addition, girls are less likely to use physical bullying. Instead, they are more drawn to relational bullying, which is meant to cause social isolation. Their goals are to damage reputations and relationships.

Cyber bullying in the hands of girls can be particularly devastating. After all, this is a time in which peer group acceptance and the need for belonging are highly sought. “Girls share so much information when they are friends that they never run out of ammunition if they turn on one another,” he said.

Several theories exist about the etiology of bullying. The person-centered theory involves the characteristics of the bully, victim, and onlookers, and the way in which they predispose children to bullying or being bullied.

“We know that bullies are impulsive; they often have characteristics of oppositional defiant disorder, often have a hard time following school rules, and derive satisfaction from inflicting harm and intimidating others,” Dr. Sarles said. They tend to be nonempathetic and domineering. These children or teens may have conduct disorder and antisocial personality disorder as well.

The victims of bullies tend to be quiet, socially awkward, and sometimes labeled “nerds,” or “weirdos.” They tend to be nonassertive and have few friends and low self-esteem, and have poor social skills. In other words, victims tend “not to fit in,” which is a stronger predictor of being the victim of a bully than physical characteristics such as height and weight, Dr. Sarles noted. Bullies are more likely to pick on socially awkward children than those with obvious physical abnormalities or disabilities.

“Bully-victims are a group that we don't know much about,” Dr. Sarles said. These children or adolescents are usually victims first, and then they become bullies, and they are overrepresented as perpetrators in instances of school shootings.

The onlookers represent the largest group of adolescents. This group doesn't present with symptoms, so are not treated for anything from a clinical psychiatrist's point of view. But they are extremely important in discussions of intervention, because they provide an audience and tacit approval for the behavior to continue. “Bullies like a crowd,” Dr. Sarles said. The onlookers could stop the bullying but may fear retaliation.

The dominance theory of bullying involves a hierarchy based on access to and control of resources. When transitioning from elementary school to middle school, children need to reassert their dominance. Research has shown that the most common time for bullying behavior is in middle school, when children both redefine their identities and adjust to the onset of puberty, Dr. Sarles said. Their surging hormones allow for variation in size and development that can foster bullying behavior.

The ecologic theory goes beyond the bully-victim dyad. This theory includes all factors that allow bullying to develop and persist. This theory suggests that school and playground designs may foster unsupervised spaces where children and adolescents are vulnerable to bullies, and that inaction on the part of adults in authority allows bullying to continue. “If you can't change community attitudes and the school environment, you won't be able to prevent bullying,” Dr. Sarles said. A successful intervention involves parents and school personnel developing a consensus on prevention programs. (See sidebar.)

Physicians may recognize bullying before the parents do. Clear links exist between bullying and other antisocial behaviors for example. Dr. Sarles cited one study in which 40% of people who reported being bullies as children or adolescents had criminal convictions at age 24 years.

Children and adolescents who are victims may present to clinicians with symptoms of anxiety. These children often do not want to go to school, feign illness, and have unexplained cuts and bruises. Belongings often end up missing for victims.

After the bullying stops, the symptoms tend to disappear in the absence of a genuine comorbid condition, he said.

Some Interventions Begin at School

Most bullying, even cyber bullying, begins at school–where children meet and spend much of their time. Many interventions against bullying start at school as well.

“You have to get people to agree that bullying is not for kids,” by encouraging parents to go to their children's schools and advocate for a no-tolerance policy, Dr. Sarles said.

School-based strategies include:

▸ Increasing adult supervision of children in public spaces during lunch and recess.

▸ Elimination of unsupervised places where children might be bullied.

▸ Use of classroom-based antibullying programs in an effort to teach that bullying is wrong and should be reported.

▸ Use of a “bully box” near the school counselor's office that allows children to anonymously report bullying episodes.

▸ Role playing and assertiveness training.

▸ Use of video cameras on school buses, on school property, and in buildings to record instances of bullying and to act as a deterrent.

▸ Establishment and enforcement of a zero-tolerance bullying policy that includes all school personnel, from teachers to cafeteria workers, coaches, and janitors.

▸ Switching schools. If the school and the community fail to cooperate, the child must simply change schools to get out of an abusive environment.

The federal government has jumped on the bully bandwagon. Its Web site,

http://stopbullyingnow.hrsa.gov

The attention given to bullying among girls in recent years has sparked several books and movies. A Web site,

www.meangirls.com

The bottom line is to create a safe environment for the child, because children who feel intimidated in school can't learn, Dr. Sarles said.

HOUSTON – In the age of 24-hour technology, bullying no longer stops at the playground border.

Cyber bullying is a form of harassment using text messages, e-mail, and Web sites. This high-tech approach allows children and adolescents to engage in bullying not only at school, but at home, at all hours of the day and night.

A bully can post a disparaging comment on the Internet or in an e-mail message and send it to 3 people, 30 people, or 300 people, said Richard Sarles, M.D., at the annual meeting of the American Society for Adolescent Psychiatry. In addition, the insult is there for the victim and recipients of the message to read over and over again–which makes this kind of aggression even more insidious, said Dr. Sarles, professor of psychiatry and pediatrics at the University of Maryland, Baltimore. The anonymous nature of cyberspace creates additional problems, because the bully need not face the victim and may be unknown.

Any sort of bullying is a significant clinical problem, Dr. Sarles said at the meeting, cosponsored by the University of Texas Southwestern Medical Center at Dallas. In fact, bullying, the most common form of aggression experienced by children and teens, is more problematic for this population than is racism, or pressure to use drugs or alcohol, or to have sex, he said. Bullying that is considered traditional can be either physical or verbal. Dr. Sarles said boys tend to be more direct–and aggressive–than girls. Boys are more likely to intimidate their victims by engaging in name calling, malicious teasing, and obnoxious gestures.

Girls who bully tend to use more passive approaches. They are more likely to employ rumor spreading, malicious gossip, and sexual innuendo. In addition, girls are less likely to use physical bullying. Instead, they are more drawn to relational bullying, which is meant to cause social isolation. Their goals are to damage reputations and relationships.

Cyber bullying in the hands of girls can be particularly devastating. After all, this is a time in which peer group acceptance and the need for belonging are highly sought. “Girls share so much information when they are friends that they never run out of ammunition if they turn on one another,” he said.

Several theories exist about the etiology of bullying. The person-centered theory involves the characteristics of the bully, victim, and onlookers, and the way in which they predispose children to bullying or being bullied.

“We know that bullies are impulsive; they often have characteristics of oppositional defiant disorder, often have a hard time following school rules, and derive satisfaction from inflicting harm and intimidating others,” Dr. Sarles said. They tend to be nonempathetic and domineering. These children or teens may have conduct disorder and antisocial personality disorder as well.

The victims of bullies tend to be quiet, socially awkward, and sometimes labeled “nerds,” or “weirdos.” They tend to be nonassertive and have few friends and low self-esteem, and have poor social skills. In other words, victims tend “not to fit in,” which is a stronger predictor of being the victim of a bully than physical characteristics such as height and weight, Dr. Sarles noted. Bullies are more likely to pick on socially awkward children than those with obvious physical abnormalities or disabilities.

“Bully-victims are a group that we don't know much about,” Dr. Sarles said. These children or adolescents are usually victims first, and then they become bullies, and they are overrepresented as perpetrators in instances of school shootings.

The onlookers represent the largest group of adolescents. This group doesn't present with symptoms, so are not treated for anything from a clinical psychiatrist's point of view. But they are extremely important in discussions of intervention, because they provide an audience and tacit approval for the behavior to continue. “Bullies like a crowd,” Dr. Sarles said. The onlookers could stop the bullying but may fear retaliation.

The dominance theory of bullying involves a hierarchy based on access to and control of resources. When transitioning from elementary school to middle school, children need to reassert their dominance. Research has shown that the most common time for bullying behavior is in middle school, when children both redefine their identities and adjust to the onset of puberty, Dr. Sarles said. Their surging hormones allow for variation in size and development that can foster bullying behavior.

The ecologic theory goes beyond the bully-victim dyad. This theory includes all factors that allow bullying to develop and persist. This theory suggests that school and playground designs may foster unsupervised spaces where children and adolescents are vulnerable to bullies, and that inaction on the part of adults in authority allows bullying to continue. “If you can't change community attitudes and the school environment, you won't be able to prevent bullying,” Dr. Sarles said. A successful intervention involves parents and school personnel developing a consensus on prevention programs. (See sidebar.)

Physicians may recognize bullying before the parents do. Clear links exist between bullying and other antisocial behaviors for example. Dr. Sarles cited one study in which 40% of people who reported being bullies as children or adolescents had criminal convictions at age 24 years.

Children and adolescents who are victims may present to clinicians with symptoms of anxiety. These children often do not want to go to school, feign illness, and have unexplained cuts and bruises. Belongings often end up missing for victims.

After the bullying stops, the symptoms tend to disappear in the absence of a genuine comorbid condition, he said.

Some Interventions Begin at School

Most bullying, even cyber bullying, begins at school–where children meet and spend much of their time. Many interventions against bullying start at school as well.

“You have to get people to agree that bullying is not for kids,” by encouraging parents to go to their children's schools and advocate for a no-tolerance policy, Dr. Sarles said.

School-based strategies include:

▸ Increasing adult supervision of children in public spaces during lunch and recess.

▸ Elimination of unsupervised places where children might be bullied.

▸ Use of classroom-based antibullying programs in an effort to teach that bullying is wrong and should be reported.

▸ Use of a “bully box” near the school counselor's office that allows children to anonymously report bullying episodes.

▸ Role playing and assertiveness training.

▸ Use of video cameras on school buses, on school property, and in buildings to record instances of bullying and to act as a deterrent.

▸ Establishment and enforcement of a zero-tolerance bullying policy that includes all school personnel, from teachers to cafeteria workers, coaches, and janitors.

▸ Switching schools. If the school and the community fail to cooperate, the child must simply change schools to get out of an abusive environment.

The federal government has jumped on the bully bandwagon. Its Web site,

http://stopbullyingnow.hrsa.gov

The attention given to bullying among girls in recent years has sparked several books and movies. A Web site,

www.meangirls.com

The bottom line is to create a safe environment for the child, because children who feel intimidated in school can't learn, Dr. Sarles said.

HOUSTON – Psychiatrists can become part of a child's diabetes treatment team and provide guidance when barriers to compliance arise, Scot G. McAfee, M.D., said at the annual meeting of the American Society for Adolescent Psychiatry.

They can also stay alert to signs of depression–which is three times more likely to strike diabetics as nondiabetics, said Dr. McAfee, who has lived with diabetes since his youth.

Diabetes is considered to be one of the most demanding of all chronic illnesses, mostly because 95% of diabetes management is conducted by the patient. Some children as young as 7 or 8 with diabetes understand how to manage the disease effectively.

But when children with diabetes reach puberty or are diagnosed in adolescence, they might develop compliance issues because of feelings of rebellion and desires to be like their peers, said Dr. McAfee, a psychiatrist at St. Vincent's Hospital, New York.

Children and adolescents with diabetes who learn about their condition immediately and learn to monitor themselves have a better chance of avoiding complications. But some children think it is too difficult to figure out insulin doses and don't want to stand out at the lunch table. “So they eat whatever everyone else is eating,” Dr. McAfee noted at the meeting, cosponsored by the University of Texas Southwestern Medical Center at Dallas.

In addition to managing their illness, adolescents with diabetes must face the daily traumas of teenage life. For example, anxiety and stress about a test or about a relationship with a friend can increase blood sugar levels. And diabetic adolescents who exercise during a gym class or an after-school sports practice require additional carbohydrates.

Adolescents require guidance in learning to compromise and achieve a livable balance between the demands of diabetes, the life stresses that all adolescents endure, and a desire for a normal lifestyle, he said.

“If an adolescent with diabetes enters a psychiatric hospital after a suicide attempt with [his or her] diabetes medications, I recommend finding someone with experience in adolescent diabetes to talk with the patient and verify that this was in fact a suicide attempt and not an attempt at overly close diabetes management,” Dr. McAfee added.

A diabetic child or adolescent puts stress on the family unit as well. “Adjustments to a diagnosis of diabetes can take 6 months for children and 9 months for parents,” Dr. McAfee said. Family issues include social stigma, possible economic burdens, and marital strife, especially when one parent wants to be more coddling of the diabetic child. Health care providers should reassess the families' knowledge of diabetes and coping strategies every 2 years, he said.

Dr. McAfee is a consultant to Janssen and Otsuka, and is a member of the speakers' bureau of AstraZeneca.

HOUSTON – Psychiatrists can become part of a child's diabetes treatment team and provide guidance when barriers to compliance arise, Scot G. McAfee, M.D., said at the annual meeting of the American Society for Adolescent Psychiatry.

They can also stay alert to signs of depression–which is three times more likely to strike diabetics as nondiabetics, said Dr. McAfee, who has lived with diabetes since his youth.

Diabetes is considered to be one of the most demanding of all chronic illnesses, mostly because 95% of diabetes management is conducted by the patient. Some children as young as 7 or 8 with diabetes understand how to manage the disease effectively.

But when children with diabetes reach puberty or are diagnosed in adolescence, they might develop compliance issues because of feelings of rebellion and desires to be like their peers, said Dr. McAfee, a psychiatrist at St. Vincent's Hospital, New York.

Children and adolescents with diabetes who learn about their condition immediately and learn to monitor themselves have a better chance of avoiding complications. But some children think it is too difficult to figure out insulin doses and don't want to stand out at the lunch table. “So they eat whatever everyone else is eating,” Dr. McAfee noted at the meeting, cosponsored by the University of Texas Southwestern Medical Center at Dallas.

In addition to managing their illness, adolescents with diabetes must face the daily traumas of teenage life. For example, anxiety and stress about a test or about a relationship with a friend can increase blood sugar levels. And diabetic adolescents who exercise during a gym class or an after-school sports practice require additional carbohydrates.

Adolescents require guidance in learning to compromise and achieve a livable balance between the demands of diabetes, the life stresses that all adolescents endure, and a desire for a normal lifestyle, he said.

“If an adolescent with diabetes enters a psychiatric hospital after a suicide attempt with [his or her] diabetes medications, I recommend finding someone with experience in adolescent diabetes to talk with the patient and verify that this was in fact a suicide attempt and not an attempt at overly close diabetes management,” Dr. McAfee added.

A diabetic child or adolescent puts stress on the family unit as well. “Adjustments to a diagnosis of diabetes can take 6 months for children and 9 months for parents,” Dr. McAfee said. Family issues include social stigma, possible economic burdens, and marital strife, especially when one parent wants to be more coddling of the diabetic child. Health care providers should reassess the families' knowledge of diabetes and coping strategies every 2 years, he said.

Dr. McAfee is a consultant to Janssen and Otsuka, and is a member of the speakers' bureau of AstraZeneca.

HOUSTON – Psychiatrists can become part of a child's diabetes treatment team and provide guidance when barriers to compliance arise, Scot G. McAfee, M.D., said at the annual meeting of the American Society for Adolescent Psychiatry.

They can also stay alert to signs of depression–which is three times more likely to strike diabetics as nondiabetics, said Dr. McAfee, who has lived with diabetes since his youth.

Diabetes is considered to be one of the most demanding of all chronic illnesses, mostly because 95% of diabetes management is conducted by the patient. Some children as young as 7 or 8 with diabetes understand how to manage the disease effectively.

But when children with diabetes reach puberty or are diagnosed in adolescence, they might develop compliance issues because of feelings of rebellion and desires to be like their peers, said Dr. McAfee, a psychiatrist at St. Vincent's Hospital, New York.

Children and adolescents with diabetes who learn about their condition immediately and learn to monitor themselves have a better chance of avoiding complications. But some children think it is too difficult to figure out insulin doses and don't want to stand out at the lunch table. “So they eat whatever everyone else is eating,” Dr. McAfee noted at the meeting, cosponsored by the University of Texas Southwestern Medical Center at Dallas.

In addition to managing their illness, adolescents with diabetes must face the daily traumas of teenage life. For example, anxiety and stress about a test or about a relationship with a friend can increase blood sugar levels. And diabetic adolescents who exercise during a gym class or an after-school sports practice require additional carbohydrates.

Adolescents require guidance in learning to compromise and achieve a livable balance between the demands of diabetes, the life stresses that all adolescents endure, and a desire for a normal lifestyle, he said.

“If an adolescent with diabetes enters a psychiatric hospital after a suicide attempt with [his or her] diabetes medications, I recommend finding someone with experience in adolescent diabetes to talk with the patient and verify that this was in fact a suicide attempt and not an attempt at overly close diabetes management,” Dr. McAfee added.

A diabetic child or adolescent puts stress on the family unit as well. “Adjustments to a diagnosis of diabetes can take 6 months for children and 9 months for parents,” Dr. McAfee said. Family issues include social stigma, possible economic burdens, and marital strife, especially when one parent wants to be more coddling of the diabetic child. Health care providers should reassess the families' knowledge of diabetes and coping strategies every 2 years, he said.

Dr. McAfee is a consultant to Janssen and Otsuka, and is a member of the speakers' bureau of AstraZeneca.

HOUSTON – Most adolescents with gender identity issues initially are treated for comorbid conditions such as depression, Flynn O'Malley, Ph.D., said at the annual meeting of the American Society for Adolescent Psychiatry.

Considerations for managing adolescents with gender issues include treating the comorbid conditions (if any) first, and then educating the patient about the realities of a sex change.

The clinician can assist the adolescent in developing a plan for life as a person of the opposite gender after his/her sex change treatment, and can assess family support and encourage discussion of the family's discomfort with the adolescent's transgendered feelings. A patient who expresses a desire for a sex change must be thoroughly assessed to determine whether he or she meets the DSM-IV criteria for Gender Identity Disorder (GID) and shows commitment to the sex change process.

The problems inherent in gender identity issues among adolescents include the personal struggles of the patient with his or her identity; fears of rejection, attack, or humiliation; desires to keep gender preference a secret; concerns about parental reaction; problems in school and community settings; and the range of differences in professional attitudes and opinions about treatment, said Dr. O'Malley of Baylor College of Medicine, Houston. Dr. O'Malley, also of the Menninger Clinic, an inpatient facility in Houston for adolescents with unremitting psychiatric problems, reported no conflicts of interest related to his talk.

“People come to the Menninger Clinic after multiple hospital admissions and with multiple diagnoses–several of which have changed over time,” Dr. O'Malley said. Many patients with gender issues also have mood disorders and substance abuse disorders, and a history of multiple suicide attempts. They often have serious family problems. In addition, many patients have a history of failure to improve or to regress after some improvement.

Suicidality, self-harm, and thought disorders may all occur in the context of gender dysphoria, Dr. O'Malley noted. Some patients reveal the gender dysphoria as part of their psychiatric treatment course; many report a history of sexual abuse. It is tempting to link gender dysphoria to sexual abuse, but the etiology of gender dysphoria is extremely complex.

“If gender dysphoria started early, whatever sexual experiences teenagers have had have been awkward and confusing for them,” Dr. O'Malley said at the meeting, cosponsored by the University of Texas Southwestern Medical Center at Dallas.

Adolescents come to the Menninger Clinic in varying stages of intervention. Some have not identified their gender issues; others are already taking hormones. “There is enormous controversy when we admit someone with these difficulties, and discussion of what to do with them,” he added.

Some adolescents with gender dysphoria are confused about their gender problems, while others are adamant that they are transsexuals and insist on treatment that would facilitate a sex change. They often suffer enormous humiliation, especially in cases where they have revealed the problems to others.

A controversy persists between those professionals who support psychodynamic therapy and those who back sex reassignment for these patients, Dr. O'Malley said. The psychodynamic supporters ask how one can possibly think about changing the anatomy when the discontent is rooted in psychopathology. Supporters of sex reassignment, on the other hand, recognize that the condition is usually permanent and that people denied a change might become suicidal, he noted.

Careful diagnosis is important. Intersex conditions such as chromosomal abnormalities, pseudohermaphroditism, and enzyme deficiencies should not be confused with gender identity disorders. Intersex conditions, which arise from developmental problems with sexual differentiation, have clear physiologic and biologic aspects. People with those conditions may or may not suffer from psychiatric problems. In contrast, transgender patients do not have ambiguous genitalia or physical inconsistencies related to sex at birth.

Criteria for a GID diagnosis include a persistent, strong identification with the opposite gender, persistent discomfort with one's sex, and feelings of inappropriateness in the gender role for one's sex. To meet the GID diagnosis, these characteristics must not be concurrent with an intersex condition and must cause significant distress and impairment in important areas of everyday life.

Subcriteria for a GID diagnosis in children include repudiation of the genitals among young boys and preference for a penis among young girls. GID is categorized in the DSM-IV under Sexual and Gender Identity Disorders, rather than Psychosexual Disorders, which suggests something about the etiology of the disorders, Dr. O'Malley noted.

Transvestitism differs from gender dysphoria because it involves a feeling of sexual arousal created by putting on the clothes of the opposite sex.

Some relationship appears to exist between childhood gender identity disorder and adolescent transsexuality. However, many children who cross-dress and exhibit gender issues at an early age do not become adolescent gender dysphoric patients or undergo sex change procedures, Dr. O'Malley said. Most children who meet the diagnosis for GID become transsexuals, and early cross-gender behavior often leads to homosexuality.

Steps to Take When Decision Is Made

If and when an adolescent makes the choice to change his or her sex, the steps toward sex and gender reassignment should begin with a thorough psychiatric assessment and discussion of plans for the future. Among the steps:

▸ A clinician determines whether the adolescent meets the DSM-IV criteria for Gender Identity Disorder (GID), and assesses his or her personal and social stability and levels of support from family and friends.

▸ If he or she meets the assessment criteria, the adolescent starts to live in a cross-gender role and initiates reversible hormone treatments. The fully reversible hormones suppress estrogen and testosterone and delay the physical changes of puberty. Reversible hormone treatments usually do not begin unless the adolescent is aged at least 16 years. Many experts also believe that the adolescent should be in at least Tanner stage 2 of development before initiating hormones.

▸ If he/she still desires change, the adolescent continues living in a cross-gender role and proceeds to partly reversible hormone treatment, which takes about 1 year for females working to become male and 1.5 years for males working to become female.

The difference in duration reflects the sense that it is more difficult for males who want to be females to pass as women than it is for women to pass as men. In fact, many adolescent girls can start to look like males relatively quickly.

Most physicians recommend that the adolescent wait until age 18 to receive the partly reversible hormone treatment, since these hormones masculinize or feminize the body and could lead to surgery to reverse the results, such as breast development in males.

▸ The final step is a continuation of hormones and a referral for sex change surgery.

Source: Dr. O'Malley

HOUSTON – Most adolescents with gender identity issues initially are treated for comorbid conditions such as depression, Flynn O'Malley, Ph.D., said at the annual meeting of the American Society for Adolescent Psychiatry.

Considerations for managing adolescents with gender issues include treating the comorbid conditions (if any) first, and then educating the patient about the realities of a sex change.

The clinician can assist the adolescent in developing a plan for life as a person of the opposite gender after his/her sex change treatment, and can assess family support and encourage discussion of the family's discomfort with the adolescent's transgendered feelings. A patient who expresses a desire for a sex change must be thoroughly assessed to determine whether he or she meets the DSM-IV criteria for Gender Identity Disorder (GID) and shows commitment to the sex change process.

The problems inherent in gender identity issues among adolescents include the personal struggles of the patient with his or her identity; fears of rejection, attack, or humiliation; desires to keep gender preference a secret; concerns about parental reaction; problems in school and community settings; and the range of differences in professional attitudes and opinions about treatment, said Dr. O'Malley of Baylor College of Medicine, Houston. Dr. O'Malley, also of the Menninger Clinic, an inpatient facility in Houston for adolescents with unremitting psychiatric problems, reported no conflicts of interest related to his talk.

“People come to the Menninger Clinic after multiple hospital admissions and with multiple diagnoses–several of which have changed over time,” Dr. O'Malley said. Many patients with gender issues also have mood disorders and substance abuse disorders, and a history of multiple suicide attempts. They often have serious family problems. In addition, many patients have a history of failure to improve or to regress after some improvement.

Suicidality, self-harm, and thought disorders may all occur in the context of gender dysphoria, Dr. O'Malley noted. Some patients reveal the gender dysphoria as part of their psychiatric treatment course; many report a history of sexual abuse. It is tempting to link gender dysphoria to sexual abuse, but the etiology of gender dysphoria is extremely complex.

“If gender dysphoria started early, whatever sexual experiences teenagers have had have been awkward and confusing for them,” Dr. O'Malley said at the meeting, cosponsored by the University of Texas Southwestern Medical Center at Dallas.

Adolescents come to the Menninger Clinic in varying stages of intervention. Some have not identified their gender issues; others are already taking hormones. “There is enormous controversy when we admit someone with these difficulties, and discussion of what to do with them,” he added.

Some adolescents with gender dysphoria are confused about their gender problems, while others are adamant that they are transsexuals and insist on treatment that would facilitate a sex change. They often suffer enormous humiliation, especially in cases where they have revealed the problems to others.

A controversy persists between those professionals who support psychodynamic therapy and those who back sex reassignment for these patients, Dr. O'Malley said. The psychodynamic supporters ask how one can possibly think about changing the anatomy when the discontent is rooted in psychopathology. Supporters of sex reassignment, on the other hand, recognize that the condition is usually permanent and that people denied a change might become suicidal, he noted.

Careful diagnosis is important. Intersex conditions such as chromosomal abnormalities, pseudohermaphroditism, and enzyme deficiencies should not be confused with gender identity disorders. Intersex conditions, which arise from developmental problems with sexual differentiation, have clear physiologic and biologic aspects. People with those conditions may or may not suffer from psychiatric problems. In contrast, transgender patients do not have ambiguous genitalia or physical inconsistencies related to sex at birth.

Criteria for a GID diagnosis include a persistent, strong identification with the opposite gender, persistent discomfort with one's sex, and feelings of inappropriateness in the gender role for one's sex. To meet the GID diagnosis, these characteristics must not be concurrent with an intersex condition and must cause significant distress and impairment in important areas of everyday life.

Subcriteria for a GID diagnosis in children include repudiation of the genitals among young boys and preference for a penis among young girls. GID is categorized in the DSM-IV under Sexual and Gender Identity Disorders, rather than Psychosexual Disorders, which suggests something about the etiology of the disorders, Dr. O'Malley noted.

Transvestitism differs from gender dysphoria because it involves a feeling of sexual arousal created by putting on the clothes of the opposite sex.

Some relationship appears to exist between childhood gender identity disorder and adolescent transsexuality. However, many children who cross-dress and exhibit gender issues at an early age do not become adolescent gender dysphoric patients or undergo sex change procedures, Dr. O'Malley said. Most children who meet the diagnosis for GID become transsexuals, and early cross-gender behavior often leads to homosexuality.

Steps to Take When Decision Is Made

If and when an adolescent makes the choice to change his or her sex, the steps toward sex and gender reassignment should begin with a thorough psychiatric assessment and discussion of plans for the future. Among the steps:

▸ A clinician determines whether the adolescent meets the DSM-IV criteria for Gender Identity Disorder (GID), and assesses his or her personal and social stability and levels of support from family and friends.

▸ If he or she meets the assessment criteria, the adolescent starts to live in a cross-gender role and initiates reversible hormone treatments. The fully reversible hormones suppress estrogen and testosterone and delay the physical changes of puberty. Reversible hormone treatments usually do not begin unless the adolescent is aged at least 16 years. Many experts also believe that the adolescent should be in at least Tanner stage 2 of development before initiating hormones.

▸ If he/she still desires change, the adolescent continues living in a cross-gender role and proceeds to partly reversible hormone treatment, which takes about 1 year for females working to become male and 1.5 years for males working to become female.

The difference in duration reflects the sense that it is more difficult for males who want to be females to pass as women than it is for women to pass as men. In fact, many adolescent girls can start to look like males relatively quickly.

Most physicians recommend that the adolescent wait until age 18 to receive the partly reversible hormone treatment, since these hormones masculinize or feminize the body and could lead to surgery to reverse the results, such as breast development in males.

▸ The final step is a continuation of hormones and a referral for sex change surgery.

Source: Dr. O'Malley

HOUSTON – Most adolescents with gender identity issues initially are treated for comorbid conditions such as depression, Flynn O'Malley, Ph.D., said at the annual meeting of the American Society for Adolescent Psychiatry.

Considerations for managing adolescents with gender issues include treating the comorbid conditions (if any) first, and then educating the patient about the realities of a sex change.

The clinician can assist the adolescent in developing a plan for life as a person of the opposite gender after his/her sex change treatment, and can assess family support and encourage discussion of the family's discomfort with the adolescent's transgendered feelings. A patient who expresses a desire for a sex change must be thoroughly assessed to determine whether he or she meets the DSM-IV criteria for Gender Identity Disorder (GID) and shows commitment to the sex change process.

The problems inherent in gender identity issues among adolescents include the personal struggles of the patient with his or her identity; fears of rejection, attack, or humiliation; desires to keep gender preference a secret; concerns about parental reaction; problems in school and community settings; and the range of differences in professional attitudes and opinions about treatment, said Dr. O'Malley of Baylor College of Medicine, Houston. Dr. O'Malley, also of the Menninger Clinic, an inpatient facility in Houston for adolescents with unremitting psychiatric problems, reported no conflicts of interest related to his talk.

“People come to the Menninger Clinic after multiple hospital admissions and with multiple diagnoses–several of which have changed over time,” Dr. O'Malley said. Many patients with gender issues also have mood disorders and substance abuse disorders, and a history of multiple suicide attempts. They often have serious family problems. In addition, many patients have a history of failure to improve or to regress after some improvement.

Suicidality, self-harm, and thought disorders may all occur in the context of gender dysphoria, Dr. O'Malley noted. Some patients reveal the gender dysphoria as part of their psychiatric treatment course; many report a history of sexual abuse. It is tempting to link gender dysphoria to sexual abuse, but the etiology of gender dysphoria is extremely complex.

“If gender dysphoria started early, whatever sexual experiences teenagers have had have been awkward and confusing for them,” Dr. O'Malley said at the meeting, cosponsored by the University of Texas Southwestern Medical Center at Dallas.

Adolescents come to the Menninger Clinic in varying stages of intervention. Some have not identified their gender issues; others are already taking hormones. “There is enormous controversy when we admit someone with these difficulties, and discussion of what to do with them,” he added.

Some adolescents with gender dysphoria are confused about their gender problems, while others are adamant that they are transsexuals and insist on treatment that would facilitate a sex change. They often suffer enormous humiliation, especially in cases where they have revealed the problems to others.

A controversy persists between those professionals who support psychodynamic therapy and those who back sex reassignment for these patients, Dr. O'Malley said. The psychodynamic supporters ask how one can possibly think about changing the anatomy when the discontent is rooted in psychopathology. Supporters of sex reassignment, on the other hand, recognize that the condition is usually permanent and that people denied a change might become suicidal, he noted.

Careful diagnosis is important. Intersex conditions such as chromosomal abnormalities, pseudohermaphroditism, and enzyme deficiencies should not be confused with gender identity disorders. Intersex conditions, which arise from developmental problems with sexual differentiation, have clear physiologic and biologic aspects. People with those conditions may or may not suffer from psychiatric problems. In contrast, transgender patients do not have ambiguous genitalia or physical inconsistencies related to sex at birth.

Criteria for a GID diagnosis include a persistent, strong identification with the opposite gender, persistent discomfort with one's sex, and feelings of inappropriateness in the gender role for one's sex. To meet the GID diagnosis, these characteristics must not be concurrent with an intersex condition and must cause significant distress and impairment in important areas of everyday life.

Subcriteria for a GID diagnosis in children include repudiation of the genitals among young boys and preference for a penis among young girls. GID is categorized in the DSM-IV under Sexual and Gender Identity Disorders, rather than Psychosexual Disorders, which suggests something about the etiology of the disorders, Dr. O'Malley noted.

Transvestitism differs from gender dysphoria because it involves a feeling of sexual arousal created by putting on the clothes of the opposite sex.

Some relationship appears to exist between childhood gender identity disorder and adolescent transsexuality. However, many children who cross-dress and exhibit gender issues at an early age do not become adolescent gender dysphoric patients or undergo sex change procedures, Dr. O'Malley said. Most children who meet the diagnosis for GID become transsexuals, and early cross-gender behavior often leads to homosexuality.

Steps to Take When Decision Is Made

If and when an adolescent makes the choice to change his or her sex, the steps toward sex and gender reassignment should begin with a thorough psychiatric assessment and discussion of plans for the future. Among the steps:

▸ A clinician determines whether the adolescent meets the DSM-IV criteria for Gender Identity Disorder (GID), and assesses his or her personal and social stability and levels of support from family and friends.

▸ If he or she meets the assessment criteria, the adolescent starts to live in a cross-gender role and initiates reversible hormone treatments. The fully reversible hormones suppress estrogen and testosterone and delay the physical changes of puberty. Reversible hormone treatments usually do not begin unless the adolescent is aged at least 16 years. Many experts also believe that the adolescent should be in at least Tanner stage 2 of development before initiating hormones.

▸ If he/she still desires change, the adolescent continues living in a cross-gender role and proceeds to partly reversible hormone treatment, which takes about 1 year for females working to become male and 1.5 years for males working to become female.

The difference in duration reflects the sense that it is more difficult for males who want to be females to pass as women than it is for women to pass as men. In fact, many adolescent girls can start to look like males relatively quickly.

Most physicians recommend that the adolescent wait until age 18 to receive the partly reversible hormone treatment, since these hormones masculinize or feminize the body and could lead to surgery to reverse the results, such as breast development in males.

▸ The final step is a continuation of hormones and a referral for sex change surgery.

Source: Dr. O'Malley

Parent's HIV Death Affects Teen Stress

Depression and self-destructive behavior are more common among adolescents with HIV-infected parents prior to the parent's death than in the year after the parent's death, reported Mary Jane Rotheram-Borus, Ph.D., and her colleagues at the University of California, Los Angeles.

The investigators studied 414 adolescents who lived with a parent with HIV (PWH) for more than a year before the parent's death and followed them for at least 1 year after the parent's death for a total average observation period of 6 years. Compared with nonbereaved adolescents, the bereaved adolescents scored significantly higher on subscales of the Brief Symptom Inventory including hostility, interpersonal sensitivity, paranoid ideation, somatization, psychoticism, and global distress prior to the parent's death (J. Consult. Clin. Psychol. 2005;73:221-8).

In the year after the parent's death, however, their scores were not significantly different from those of nonbereaved children. PWH adolescents scored significantly higher on the BSI subscale for depression and on coping style of passive problem solving in the year immediately after a parent's death, but these scores returned to baseline in another year.

Adolescents Favor Oral Sex

In a longitudinal study of 580 ethnically diverse ninth-graders in California public schools, 19.6% reported having oral sex, compared with 13.5% who reported having vaginal sex, said Bonnie L. Halpern-Felsher, Ph.D., and her colleagues at the University of California, San Francisco.

The teens completed in-school surveys about oral sex. Overall, significantly more students reported an intention to engage in oral sex in the next 6 months, compared with vaginal sex (31.5% vs. 26.3%).

Although oral sex alleviates the risk of pregnancy, it remains a potential method for spreading herpes, hepatitis, gonorrhea, chlamydia, syphilis, and HIV. The adolescents correctly recognized that the risk of disease is significantly less likely from oral sex, but 14% responded that there was zero chance of contracting chlamydia and 13% responded that there was zero chance of contracting HIV from oral sex (Pediatrics 2005;115:845-51).

Atomoxetine Improves ADHD, ODD

A daily 1.8-mg/kg dose of atomoxetine (Strattera) significantly improved attention-deficit hyperactivity disorder symptoms in children and adolescents aged 8-18 years after 8 weeks of treatment compared with a placebo, said Jeffrey H. Newcorn, M.D., of Mount Sinai School of Medicine, New York, and his associates.

In a randomized, double-blind study, 115 patients with ADHD and oppositional defiant disorder (ODD) and 178 patients with ADHD but not ODD received one of three fixed daily doses: 0.5 mg/kg, 1.2 mg/kg, or 1.8 mg/kg (J. Am. Acad. Child Adolesc. Psychiatry 2005;44:240-8).

Those with both ADHD and ODD showed significant improvement on the Conners' Parent Rating Scale-Revised Short Form Oppositional subscale with daily doses of 0.5 mg/kg or 1.8 mg/kg. Those without comorbid ODD showed improvement in symptoms at daily doses of 1.2 mg/kg and 1.8 mg/kg but no incremental benefit at a dose of 0.5 mg/kg. Eli Lilly & Co. sponsored the study.

Gender Influences Suicide Attempts

Antisocial behavior is more prevalent among inpatient adolescents who attempt suicide than those who do not, regardless of gender, said Silvana Fennig, M.D., of Tel Aviv University and her associates (Compr. Psychiatry 2005;46:90-7).

A cohort of 404 consecutive adolescents aged 12-21 years in an inpatient facility was divided into four groups: male (76) and female (143) suicide attempters and males (103) and females (82) with psychopathology but no history of suicide.

Depression and anxiety were more common among the suicide attempters, and males were more depressed and anxious than were females. Among nonattempters, depression and anxiety were significantly more prevalent in females.

Antipsychotic Use in Young Children

Nearly one-fourth of insurance claims in 2001 for atypical antipsychotics in youth aged 19 years and younger were for children aged 9 years and younger, said Lesley H. Curtis, Ph.D., of Duke University Medical Center in Durham, N.C., and colleagues.

The investigators reviewed the administrative claims database of AdvancePCS, a large pharmaceutical benefits manager, for claims from January through December 2001 and evaluated claims for five drugs: clozapine (Clozaril), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), and ziprasidone (Geodon) (Arch. Pediatr. Adolesc. Med. 2005;159:362-6). Of 16,599 claims reported for patients aged 19 years and younger, 3,830 were for children aged 9 years and younger, and 80% of those 9 years and younger were boys.

Parent's HIV Death Affects Teen Stress

Depression and self-destructive behavior are more common among adolescents with HIV-infected parents prior to the parent's death than in the year after the parent's death, reported Mary Jane Rotheram-Borus, Ph.D., and her colleagues at the University of California, Los Angeles.

The investigators studied 414 adolescents who lived with a parent with HIV (PWH) for more than a year before the parent's death and followed them for at least 1 year after the parent's death for a total average observation period of 6 years. Compared with nonbereaved adolescents, the bereaved adolescents scored significantly higher on subscales of the Brief Symptom Inventory including hostility, interpersonal sensitivity, paranoid ideation, somatization, psychoticism, and global distress prior to the parent's death (J. Consult. Clin. Psychol. 2005;73:221-8).

In the year after the parent's death, however, their scores were not significantly different from those of nonbereaved children. PWH adolescents scored significantly higher on the BSI subscale for depression and on coping style of passive problem solving in the year immediately after a parent's death, but these scores returned to baseline in another year.

Adolescents Favor Oral Sex

In a longitudinal study of 580 ethnically diverse ninth-graders in California public schools, 19.6% reported having oral sex, compared with 13.5% who reported having vaginal sex, said Bonnie L. Halpern-Felsher, Ph.D., and her colleagues at the University of California, San Francisco.

The teens completed in-school surveys about oral sex. Overall, significantly more students reported an intention to engage in oral sex in the next 6 months, compared with vaginal sex (31.5% vs. 26.3%).

Although oral sex alleviates the risk of pregnancy, it remains a potential method for spreading herpes, hepatitis, gonorrhea, chlamydia, syphilis, and HIV. The adolescents correctly recognized that the risk of disease is significantly less likely from oral sex, but 14% responded that there was zero chance of contracting chlamydia and 13% responded that there was zero chance of contracting HIV from oral sex (Pediatrics 2005;115:845-51).

Atomoxetine Improves ADHD, ODD

A daily 1.8-mg/kg dose of atomoxetine (Strattera) significantly improved attention-deficit hyperactivity disorder symptoms in children and adolescents aged 8-18 years after 8 weeks of treatment compared with a placebo, said Jeffrey H. Newcorn, M.D., of Mount Sinai School of Medicine, New York, and his associates.

In a randomized, double-blind study, 115 patients with ADHD and oppositional defiant disorder (ODD) and 178 patients with ADHD but not ODD received one of three fixed daily doses: 0.5 mg/kg, 1.2 mg/kg, or 1.8 mg/kg (J. Am. Acad. Child Adolesc. Psychiatry 2005;44:240-8).

Those with both ADHD and ODD showed significant improvement on the Conners' Parent Rating Scale-Revised Short Form Oppositional subscale with daily doses of 0.5 mg/kg or 1.8 mg/kg. Those without comorbid ODD showed improvement in symptoms at daily doses of 1.2 mg/kg and 1.8 mg/kg but no incremental benefit at a dose of 0.5 mg/kg. Eli Lilly & Co. sponsored the study.

Gender Influences Suicide Attempts

Antisocial behavior is more prevalent among inpatient adolescents who attempt suicide than those who do not, regardless of gender, said Silvana Fennig, M.D., of Tel Aviv University and her associates (Compr. Psychiatry 2005;46:90-7).

A cohort of 404 consecutive adolescents aged 12-21 years in an inpatient facility was divided into four groups: male (76) and female (143) suicide attempters and males (103) and females (82) with psychopathology but no history of suicide.

Depression and anxiety were more common among the suicide attempters, and males were more depressed and anxious than were females. Among nonattempters, depression and anxiety were significantly more prevalent in females.

Antipsychotic Use in Young Children

Nearly one-fourth of insurance claims in 2001 for atypical antipsychotics in youth aged 19 years and younger were for children aged 9 years and younger, said Lesley H. Curtis, Ph.D., of Duke University Medical Center in Durham, N.C., and colleagues.

The investigators reviewed the administrative claims database of AdvancePCS, a large pharmaceutical benefits manager, for claims from January through December 2001 and evaluated claims for five drugs: clozapine (Clozaril), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), and ziprasidone (Geodon) (Arch. Pediatr. Adolesc. Med. 2005;159:362-6). Of 16,599 claims reported for patients aged 19 years and younger, 3,830 were for children aged 9 years and younger, and 80% of those 9 years and younger were boys.

Parent's HIV Death Affects Teen Stress

Depression and self-destructive behavior are more common among adolescents with HIV-infected parents prior to the parent's death than in the year after the parent's death, reported Mary Jane Rotheram-Borus, Ph.D., and her colleagues at the University of California, Los Angeles.

The investigators studied 414 adolescents who lived with a parent with HIV (PWH) for more than a year before the parent's death and followed them for at least 1 year after the parent's death for a total average observation period of 6 years. Compared with nonbereaved adolescents, the bereaved adolescents scored significantly higher on subscales of the Brief Symptom Inventory including hostility, interpersonal sensitivity, paranoid ideation, somatization, psychoticism, and global distress prior to the parent's death (J. Consult. Clin. Psychol. 2005;73:221-8).

In the year after the parent's death, however, their scores were not significantly different from those of nonbereaved children. PWH adolescents scored significantly higher on the BSI subscale for depression and on coping style of passive problem solving in the year immediately after a parent's death, but these scores returned to baseline in another year.

Adolescents Favor Oral Sex

In a longitudinal study of 580 ethnically diverse ninth-graders in California public schools, 19.6% reported having oral sex, compared with 13.5% who reported having vaginal sex, said Bonnie L. Halpern-Felsher, Ph.D., and her colleagues at the University of California, San Francisco.

The teens completed in-school surveys about oral sex. Overall, significantly more students reported an intention to engage in oral sex in the next 6 months, compared with vaginal sex (31.5% vs. 26.3%).

Although oral sex alleviates the risk of pregnancy, it remains a potential method for spreading herpes, hepatitis, gonorrhea, chlamydia, syphilis, and HIV. The adolescents correctly recognized that the risk of disease is significantly less likely from oral sex, but 14% responded that there was zero chance of contracting chlamydia and 13% responded that there was zero chance of contracting HIV from oral sex (Pediatrics 2005;115:845-51).

Atomoxetine Improves ADHD, ODD

A daily 1.8-mg/kg dose of atomoxetine (Strattera) significantly improved attention-deficit hyperactivity disorder symptoms in children and adolescents aged 8-18 years after 8 weeks of treatment compared with a placebo, said Jeffrey H. Newcorn, M.D., of Mount Sinai School of Medicine, New York, and his associates.

In a randomized, double-blind study, 115 patients with ADHD and oppositional defiant disorder (ODD) and 178 patients with ADHD but not ODD received one of three fixed daily doses: 0.5 mg/kg, 1.2 mg/kg, or 1.8 mg/kg (J. Am. Acad. Child Adolesc. Psychiatry 2005;44:240-8).

Those with both ADHD and ODD showed significant improvement on the Conners' Parent Rating Scale-Revised Short Form Oppositional subscale with daily doses of 0.5 mg/kg or 1.8 mg/kg. Those without comorbid ODD showed improvement in symptoms at daily doses of 1.2 mg/kg and 1.8 mg/kg but no incremental benefit at a dose of 0.5 mg/kg. Eli Lilly & Co. sponsored the study.

Gender Influences Suicide Attempts

Antisocial behavior is more prevalent among inpatient adolescents who attempt suicide than those who do not, regardless of gender, said Silvana Fennig, M.D., of Tel Aviv University and her associates (Compr. Psychiatry 2005;46:90-7).

A cohort of 404 consecutive adolescents aged 12-21 years in an inpatient facility was divided into four groups: male (76) and female (143) suicide attempters and males (103) and females (82) with psychopathology but no history of suicide.

Depression and anxiety were more common among the suicide attempters, and males were more depressed and anxious than were females. Among nonattempters, depression and anxiety were significantly more prevalent in females.

Antipsychotic Use in Young Children

Nearly one-fourth of insurance claims in 2001 for atypical antipsychotics in youth aged 19 years and younger were for children aged 9 years and younger, said Lesley H. Curtis, Ph.D., of Duke University Medical Center in Durham, N.C., and colleagues.

The investigators reviewed the administrative claims database of AdvancePCS, a large pharmaceutical benefits manager, for claims from January through December 2001 and evaluated claims for five drugs: clozapine (Clozaril), olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), and ziprasidone (Geodon) (Arch. Pediatr. Adolesc. Med. 2005;159:362-6). Of 16,599 claims reported for patients aged 19 years and younger, 3,830 were for children aged 9 years and younger, and 80% of those 9 years and younger were boys.

Women who feel chronic anxiety or who suppress anxiety in daily life are more likely to be traumatized by a diagnosis of breast cancer, compared with women who are generally less anxious, reported Yumi Iwamitsu, Ph.D., of Kitasato University, Kanagawa, Japan, and colleagues.

The investigators examined the differences in emotional responses among 21 women who had received a diagnosis of breast cancer and 72 women who had benign tumors. Their mean age was 46 years.

Each of the women completed the Profile of Mood States (POMS), the Courtauld Emotional Control Scale, and the Manifest Anxiety Scale during a first visit to an outpatient clinic for a breast biopsy (Psychosomatics 2005;46:19-24). The women completed the POMS again after a second visit at which they learned the biopsy results.

Both the breast cancer patients and the benign tumor patients were assigned to either low anxiety or high anxiety subgroups based on the Manifest Anxiety Scale scores, and either negative emotion suppression or negative emotion expression groups based on the Courtauld Emotional Control Scale scores. The researchers compared the POMS scores before and after the biopsy results among the eight subgroups.

Among the women with breast cancer, the total mood disturbance scores were significantly higher among those in the high anxiety subgroup than in the low anxiety subgroup. Those scores were higher in the negative emotion suppression group than in the negative emotion expression group.

Among women with benign tumors, those in the high anxiety subgroup showed higher overall total mood disturbance scores at the first visit, compared with women in the low anxiety subgroup. In addition, the total mood disturbance scores in the negative emotion expression group were not significantly different between the first and second clinic visits, regardless of the diagnosis.

Women who feel chronic anxiety or who suppress anxiety in daily life are more likely to be traumatized by a diagnosis of breast cancer, compared with women who are generally less anxious, reported Yumi Iwamitsu, Ph.D., of Kitasato University, Kanagawa, Japan, and colleagues.

The investigators examined the differences in emotional responses among 21 women who had received a diagnosis of breast cancer and 72 women who had benign tumors. Their mean age was 46 years.

Each of the women completed the Profile of Mood States (POMS), the Courtauld Emotional Control Scale, and the Manifest Anxiety Scale during a first visit to an outpatient clinic for a breast biopsy (Psychosomatics 2005;46:19-24). The women completed the POMS again after a second visit at which they learned the biopsy results.

Both the breast cancer patients and the benign tumor patients were assigned to either low anxiety or high anxiety subgroups based on the Manifest Anxiety Scale scores, and either negative emotion suppression or negative emotion expression groups based on the Courtauld Emotional Control Scale scores. The researchers compared the POMS scores before and after the biopsy results among the eight subgroups.

Among the women with breast cancer, the total mood disturbance scores were significantly higher among those in the high anxiety subgroup than in the low anxiety subgroup. Those scores were higher in the negative emotion suppression group than in the negative emotion expression group.

Among women with benign tumors, those in the high anxiety subgroup showed higher overall total mood disturbance scores at the first visit, compared with women in the low anxiety subgroup. In addition, the total mood disturbance scores in the negative emotion expression group were not significantly different between the first and second clinic visits, regardless of the diagnosis.

Women who feel chronic anxiety or who suppress anxiety in daily life are more likely to be traumatized by a diagnosis of breast cancer, compared with women who are generally less anxious, reported Yumi Iwamitsu, Ph.D., of Kitasato University, Kanagawa, Japan, and colleagues.

The investigators examined the differences in emotional responses among 21 women who had received a diagnosis of breast cancer and 72 women who had benign tumors. Their mean age was 46 years.

Each of the women completed the Profile of Mood States (POMS), the Courtauld Emotional Control Scale, and the Manifest Anxiety Scale during a first visit to an outpatient clinic for a breast biopsy (Psychosomatics 2005;46:19-24). The women completed the POMS again after a second visit at which they learned the biopsy results.

Both the breast cancer patients and the benign tumor patients were assigned to either low anxiety or high anxiety subgroups based on the Manifest Anxiety Scale scores, and either negative emotion suppression or negative emotion expression groups based on the Courtauld Emotional Control Scale scores. The researchers compared the POMS scores before and after the biopsy results among the eight subgroups.

Among the women with breast cancer, the total mood disturbance scores were significantly higher among those in the high anxiety subgroup than in the low anxiety subgroup. Those scores were higher in the negative emotion suppression group than in the negative emotion expression group.

Among women with benign tumors, those in the high anxiety subgroup showed higher overall total mood disturbance scores at the first visit, compared with women in the low anxiety subgroup. In addition, the total mood disturbance scores in the negative emotion expression group were not significantly different between the first and second clinic visits, regardless of the diagnosis.

WASHINGTON — Foreign-born women living in the United States were significantly less likely to have had a Pap test within the past 3 years, compared with American-born women, Xu Wang, M.D., and colleagues reported in a poster presented at the annual meeting of the American College of Preventive Medicine.

Immigration status was associated with lower Pap test use independently of poverty, lack of insurance, and lack of a regular source of medical care, noted Dr. Wang and associates of Meharry Medical College in Nashville, Tennessee.

The logistic regression analysis included data on 16,505 women taken from the 2000 National Health Interview Survey. Overall, the age-adjusted percentage of women who had Pap tests within the past 3 years increased the longer they lived in the United States. Only 47% of women who immigrated less than 5 years ago had undergone Pap tests, compared with 58% of women who immigrated 5-9 years ago, and 78% of American-born women.

Compared with the American-born women, the foreign-born women in the survey were more likely to be younger, impoverished, uninsured, educated at less than high school level, and lacking a regular source of health care.

WASHINGTON — Foreign-born women living in the United States were significantly less likely to have had a Pap test within the past 3 years, compared with American-born women, Xu Wang, M.D., and colleagues reported in a poster presented at the annual meeting of the American College of Preventive Medicine.

Immigration status was associated with lower Pap test use independently of poverty, lack of insurance, and lack of a regular source of medical care, noted Dr. Wang and associates of Meharry Medical College in Nashville, Tennessee.

The logistic regression analysis included data on 16,505 women taken from the 2000 National Health Interview Survey. Overall, the age-adjusted percentage of women who had Pap tests within the past 3 years increased the longer they lived in the United States. Only 47% of women who immigrated less than 5 years ago had undergone Pap tests, compared with 58% of women who immigrated 5-9 years ago, and 78% of American-born women.

Compared with the American-born women, the foreign-born women in the survey were more likely to be younger, impoverished, uninsured, educated at less than high school level, and lacking a regular source of health care.

WASHINGTON — Foreign-born women living in the United States were significantly less likely to have had a Pap test within the past 3 years, compared with American-born women, Xu Wang, M.D., and colleagues reported in a poster presented at the annual meeting of the American College of Preventive Medicine.

Immigration status was associated with lower Pap test use independently of poverty, lack of insurance, and lack of a regular source of medical care, noted Dr. Wang and associates of Meharry Medical College in Nashville, Tennessee.

The logistic regression analysis included data on 16,505 women taken from the 2000 National Health Interview Survey. Overall, the age-adjusted percentage of women who had Pap tests within the past 3 years increased the longer they lived in the United States. Only 47% of women who immigrated less than 5 years ago had undergone Pap tests, compared with 58% of women who immigrated 5-9 years ago, and 78% of American-born women.

Compared with the American-born women, the foreign-born women in the survey were more likely to be younger, impoverished, uninsured, educated at less than high school level, and lacking a regular source of health care.

BETHESDA, MD. — Large fibroids appear to grow faster than smaller fibroids, but symptoms, rather than growth rate, spur women to surgery.

A preliminary analysis of data from 120 women in the Fibroid Growth Study suggests that large fibroids (greater than 50 cm3) and medium fibroids (7 to 50 cm3), showed a significantly greater increase in size over 1 year, compared with small fibroids (less than 7 cm3).

“Most women have fibroids, but there is a subset of women that are symptomatic,” Barbara J. Davis, Ph.D., said at an international conference on uterine leiomyoma research sponsored by the National Institutes of Health.

Data on the factors that cause fibroids to grow and become clinically symptomatic are limited. “Our hypothesis was that fibroids are heterogenous and that growing tumors will have different cellular and molecular characteristics than nongrowing tumors,” said Dr. Davis, formerly chief of the Laboratory of Women's Health at the National Institute of Environmental Health Sciences and now a principal scientist at AstraZeneca.

She and her associates sought to compare leiomyoma growth over time as a function of the number and location of the tumors.

To describe relationships between growth, clinical symptoms, and outcome, the investigators studied women at high risk for hysterectomy or myectomy.

The study results also indicated that intramural fibroids appeared to grow more slowly than did submucosal fibroids, fibroid growth might depend on the accumulation of fibrous tissue, and race had no effect on growth rate.

The study, funded by the National Institute of Environmental Health Sciences and the National Center on Minority Health and Health Disparities, included clinically symptomatic, premenopausal women with large uteri—the size of 12 weeks' gestation—who had tumors of at least 2 cm in diameter, confirmed by ultrasound at baseline. Approximately 48% of the women were black and 41% were white.

The women had MRIs at baseline, 3 months, 6 months, and 1 year. They also underwent physicals, completed extensive medical history forms, donated blood and urine, and participated in monthly questionnaires via a 20-minute phone interview.

Women who opted for surgery donated their fibroid tissues to the study investigators and had a presurgical MRI to map the tumors for the surgeon so they could be identified by type and location.

A total of 31 women had either a hysterectomy or myomectomy during the course of the study. The average age of the surgery patients was slightly younger than the overall average (37.8 years vs. 39 years).

Overall, 1,076 fibroid volumes were calculated, including data from 52 women who completed all four MRIs—16 women who had surgery and 36 women who did not have surgery. The investigators used a computer program to overlay MRI images at different times and determine the growth rates.

In this preliminary analysis growth rate, defined by a change in volume, was mostly a function of location and other factors.

“We were surprised that there were not significant differences in the rate of growth between women of different race or ethnicity,” Dr. Davis said. The difference in the prevalence of fibroids between blacks and whites appears not to be caused by tumors growing faster in blacks.

“We did find that size was a factor in determining rates of growth,” she noted. The investigators were surprised that large and medium fibroids grew at a faster rate than small ones. “We thought that small tumors would be the fast-growing ones, and we thought we might find some that shrank, but we didn't,” Dr. Davis said. In fact, all the fibroids grew to some extent.

Intramural fibroid growth was slower than that of subserosal fibroids. However, growth rates between intramural vs. submucosal and between submucosal vs. subserosal were not significantly different.

As for the impact of growth rates on clinical outcomes, there were no significant differences between patients who had surgery and those who did not. “That was a surprise to us,” Dr. Davis said. “We wondered why the women were going to surgery.”

The answer is their symptoms. Symptom severity scores related to bleeding in surgery patients were almost double those of nonsurgery patients. Similarly, there was a significant difference in reported pain before and after surgery among surgery patients, compared with pain scores of nonsurgery patients.

Although the clinical symptomology differed between women who chose surgery and those who did not, the fibroid growth rates appeared similar in both groups. Dr. Davis noted the investigators have yet to review the impact of number of tumors on outcome. The total number of fibroids per woman ranged from 1 to 11.

The most common reasons for choosing surgery were to reduce heavy bleeding (40%) and to attempt pregnancy (20%).

The investigators found a greater proportion of fibrous tissues, compared with smooth tissues, in the large tumors than in smaller tumors. The large tumors were the fastest growing, suggesting that connective tissue contributes to tumor growth rather than regression. The vascularity varied as well—the fibroids had fewer blood vessels compared with normal tissue, but the fibroid tissue bled more. Larger fibroids had a larger total area of vascularity, but the smaller fibroids had a larger cross-section of blood vessels.

Ultimately, these results and future analyses might help physicians develop a model that they can use to predict fibroid growth over time, Dr. Davis noted.

BETHESDA, MD. — Large fibroids appear to grow faster than smaller fibroids, but symptoms, rather than growth rate, spur women to surgery.

A preliminary analysis of data from 120 women in the Fibroid Growth Study suggests that large fibroids (greater than 50 cm3) and medium fibroids (7 to 50 cm3), showed a significantly greater increase in size over 1 year, compared with small fibroids (less than 7 cm3).

“Most women have fibroids, but there is a subset of women that are symptomatic,” Barbara J. Davis, Ph.D., said at an international conference on uterine leiomyoma research sponsored by the National Institutes of Health.

Data on the factors that cause fibroids to grow and become clinically symptomatic are limited. “Our hypothesis was that fibroids are heterogenous and that growing tumors will have different cellular and molecular characteristics than nongrowing tumors,” said Dr. Davis, formerly chief of the Laboratory of Women's Health at the National Institute of Environmental Health Sciences and now a principal scientist at AstraZeneca.

She and her associates sought to compare leiomyoma growth over time as a function of the number and location of the tumors.

To describe relationships between growth, clinical symptoms, and outcome, the investigators studied women at high risk for hysterectomy or myectomy.

The study results also indicated that intramural fibroids appeared to grow more slowly than did submucosal fibroids, fibroid growth might depend on the accumulation of fibrous tissue, and race had no effect on growth rate.

The study, funded by the National Institute of Environmental Health Sciences and the National Center on Minority Health and Health Disparities, included clinically symptomatic, premenopausal women with large uteri—the size of 12 weeks' gestation—who had tumors of at least 2 cm in diameter, confirmed by ultrasound at baseline. Approximately 48% of the women were black and 41% were white.

The women had MRIs at baseline, 3 months, 6 months, and 1 year. They also underwent physicals, completed extensive medical history forms, donated blood and urine, and participated in monthly questionnaires via a 20-minute phone interview.

Women who opted for surgery donated their fibroid tissues to the study investigators and had a presurgical MRI to map the tumors for the surgeon so they could be identified by type and location.

A total of 31 women had either a hysterectomy or myomectomy during the course of the study. The average age of the surgery patients was slightly younger than the overall average (37.8 years vs. 39 years).

Overall, 1,076 fibroid volumes were calculated, including data from 52 women who completed all four MRIs—16 women who had surgery and 36 women who did not have surgery. The investigators used a computer program to overlay MRI images at different times and determine the growth rates.

In this preliminary analysis growth rate, defined by a change in volume, was mostly a function of location and other factors.

“We were surprised that there were not significant differences in the rate of growth between women of different race or ethnicity,” Dr. Davis said. The difference in the prevalence of fibroids between blacks and whites appears not to be caused by tumors growing faster in blacks.

“We did find that size was a factor in determining rates of growth,” she noted. The investigators were surprised that large and medium fibroids grew at a faster rate than small ones. “We thought that small tumors would be the fast-growing ones, and we thought we might find some that shrank, but we didn't,” Dr. Davis said. In fact, all the fibroids grew to some extent.

Intramural fibroid growth was slower than that of subserosal fibroids. However, growth rates between intramural vs. submucosal and between submucosal vs. subserosal were not significantly different.

As for the impact of growth rates on clinical outcomes, there were no significant differences between patients who had surgery and those who did not. “That was a surprise to us,” Dr. Davis said. “We wondered why the women were going to surgery.”

The answer is their symptoms. Symptom severity scores related to bleeding in surgery patients were almost double those of nonsurgery patients. Similarly, there was a significant difference in reported pain before and after surgery among surgery patients, compared with pain scores of nonsurgery patients.

Although the clinical symptomology differed between women who chose surgery and those who did not, the fibroid growth rates appeared similar in both groups. Dr. Davis noted the investigators have yet to review the impact of number of tumors on outcome. The total number of fibroids per woman ranged from 1 to 11.

The most common reasons for choosing surgery were to reduce heavy bleeding (40%) and to attempt pregnancy (20%).

The investigators found a greater proportion of fibrous tissues, compared with smooth tissues, in the large tumors than in smaller tumors. The large tumors were the fastest growing, suggesting that connective tissue contributes to tumor growth rather than regression. The vascularity varied as well—the fibroids had fewer blood vessels compared with normal tissue, but the fibroid tissue bled more. Larger fibroids had a larger total area of vascularity, but the smaller fibroids had a larger cross-section of blood vessels.

Ultimately, these results and future analyses might help physicians develop a model that they can use to predict fibroid growth over time, Dr. Davis noted.

BETHESDA, MD. — Large fibroids appear to grow faster than smaller fibroids, but symptoms, rather than growth rate, spur women to surgery.

A preliminary analysis of data from 120 women in the Fibroid Growth Study suggests that large fibroids (greater than 50 cm3) and medium fibroids (7 to 50 cm3), showed a significantly greater increase in size over 1 year, compared with small fibroids (less than 7 cm3).

“Most women have fibroids, but there is a subset of women that are symptomatic,” Barbara J. Davis, Ph.D., said at an international conference on uterine leiomyoma research sponsored by the National Institutes of Health.

Data on the factors that cause fibroids to grow and become clinically symptomatic are limited. “Our hypothesis was that fibroids are heterogenous and that growing tumors will have different cellular and molecular characteristics than nongrowing tumors,” said Dr. Davis, formerly chief of the Laboratory of Women's Health at the National Institute of Environmental Health Sciences and now a principal scientist at AstraZeneca.

She and her associates sought to compare leiomyoma growth over time as a function of the number and location of the tumors.

To describe relationships between growth, clinical symptoms, and outcome, the investigators studied women at high risk for hysterectomy or myectomy.

The study results also indicated that intramural fibroids appeared to grow more slowly than did submucosal fibroids, fibroid growth might depend on the accumulation of fibrous tissue, and race had no effect on growth rate.

The study, funded by the National Institute of Environmental Health Sciences and the National Center on Minority Health and Health Disparities, included clinically symptomatic, premenopausal women with large uteri—the size of 12 weeks' gestation—who had tumors of at least 2 cm in diameter, confirmed by ultrasound at baseline. Approximately 48% of the women were black and 41% were white.

The women had MRIs at baseline, 3 months, 6 months, and 1 year. They also underwent physicals, completed extensive medical history forms, donated blood and urine, and participated in monthly questionnaires via a 20-minute phone interview.

Women who opted for surgery donated their fibroid tissues to the study investigators and had a presurgical MRI to map the tumors for the surgeon so they could be identified by type and location.

A total of 31 women had either a hysterectomy or myomectomy during the course of the study. The average age of the surgery patients was slightly younger than the overall average (37.8 years vs. 39 years).

Overall, 1,076 fibroid volumes were calculated, including data from 52 women who completed all four MRIs—16 women who had surgery and 36 women who did not have surgery. The investigators used a computer program to overlay MRI images at different times and determine the growth rates.

In this preliminary analysis growth rate, defined by a change in volume, was mostly a function of location and other factors.

“We were surprised that there were not significant differences in the rate of growth between women of different race or ethnicity,” Dr. Davis said. The difference in the prevalence of fibroids between blacks and whites appears not to be caused by tumors growing faster in blacks.

“We did find that size was a factor in determining rates of growth,” she noted. The investigators were surprised that large and medium fibroids grew at a faster rate than small ones. “We thought that small tumors would be the fast-growing ones, and we thought we might find some that shrank, but we didn't,” Dr. Davis said. In fact, all the fibroids grew to some extent.

Intramural fibroid growth was slower than that of subserosal fibroids. However, growth rates between intramural vs. submucosal and between submucosal vs. subserosal were not significantly different.

As for the impact of growth rates on clinical outcomes, there were no significant differences between patients who had surgery and those who did not. “That was a surprise to us,” Dr. Davis said. “We wondered why the women were going to surgery.”

The answer is their symptoms. Symptom severity scores related to bleeding in surgery patients were almost double those of nonsurgery patients. Similarly, there was a significant difference in reported pain before and after surgery among surgery patients, compared with pain scores of nonsurgery patients.

Although the clinical symptomology differed between women who chose surgery and those who did not, the fibroid growth rates appeared similar in both groups. Dr. Davis noted the investigators have yet to review the impact of number of tumors on outcome. The total number of fibroids per woman ranged from 1 to 11.

The most common reasons for choosing surgery were to reduce heavy bleeding (40%) and to attempt pregnancy (20%).

The investigators found a greater proportion of fibrous tissues, compared with smooth tissues, in the large tumors than in smaller tumors. The large tumors were the fastest growing, suggesting that connective tissue contributes to tumor growth rather than regression. The vascularity varied as well—the fibroids had fewer blood vessels compared with normal tissue, but the fibroid tissue bled more. Larger fibroids had a larger total area of vascularity, but the smaller fibroids had a larger cross-section of blood vessels.

Ultimately, these results and future analyses might help physicians develop a model that they can use to predict fibroid growth over time, Dr. Davis noted.

WASHINGTON — Women who experienced hyperemesis gravidarum had a significantly increased risk of preeclampsia, compared with controls, wrote Michele Soltis, M.D., and colleagues in a poster presented at the annual meeting of the American College of Preventive Medicine.

Hyperemesis gravidarum was associated with several obstetric complications in a retrospective study of singleton pregnancies, reported Dr. Soltis of Madigan Army Medical Center in Tacoma, Washington, and her associates.

In this retrospective study, the investigators compared 4,808 women hospitalized for hyperemesis gravidarum with 9,616 controls and calculated the relative risks for certain obstetric outcomes.

Women with hyperemesis gravidarum had relative risks of 1.3 for preeclampsia, 1.3 for infant birth weight less than 2,500 g, and 2.1 for premature deliveries before 28 weeks' gestation. The relative risk of premature delivery at 28-32 weeks or at 33-36 weeks was 1.5.

In addition, hyperemesis gravidarum was associated with a longer hospital stay after both vaginal and cesarean deliveries.

WASHINGTON — Women who experienced hyperemesis gravidarum had a significantly increased risk of preeclampsia, compared with controls, wrote Michele Soltis, M.D., and colleagues in a poster presented at the annual meeting of the American College of Preventive Medicine.

Hyperemesis gravidarum was associated with several obstetric complications in a retrospective study of singleton pregnancies, reported Dr. Soltis of Madigan Army Medical Center in Tacoma, Washington, and her associates.

In this retrospective study, the investigators compared 4,808 women hospitalized for hyperemesis gravidarum with 9,616 controls and calculated the relative risks for certain obstetric outcomes.

Women with hyperemesis gravidarum had relative risks of 1.3 for preeclampsia, 1.3 for infant birth weight less than 2,500 g, and 2.1 for premature deliveries before 28 weeks' gestation. The relative risk of premature delivery at 28-32 weeks or at 33-36 weeks was 1.5.

In addition, hyperemesis gravidarum was associated with a longer hospital stay after both vaginal and cesarean deliveries.

WASHINGTON — Women who experienced hyperemesis gravidarum had a significantly increased risk of preeclampsia, compared with controls, wrote Michele Soltis, M.D., and colleagues in a poster presented at the annual meeting of the American College of Preventive Medicine.

Hyperemesis gravidarum was associated with several obstetric complications in a retrospective study of singleton pregnancies, reported Dr. Soltis of Madigan Army Medical Center in Tacoma, Washington, and her associates.

In this retrospective study, the investigators compared 4,808 women hospitalized for hyperemesis gravidarum with 9,616 controls and calculated the relative risks for certain obstetric outcomes.

Women with hyperemesis gravidarum had relative risks of 1.3 for preeclampsia, 1.3 for infant birth weight less than 2,500 g, and 2.1 for premature deliveries before 28 weeks' gestation. The relative risk of premature delivery at 28-32 weeks or at 33-36 weeks was 1.5.

In addition, hyperemesis gravidarum was associated with a longer hospital stay after both vaginal and cesarean deliveries.

Women who feel chronic anxiety or who suppress anxiety in daily life are more likely to be traumatized by a diagnosis of breast cancer, compared with women who are generally less anxious, reported Yumi Iwamitsu, Ph.D., of Kitasato University, Kanagawa, Japan, and colleagues.

They examined the differences in emotional responses among 21 women who had received a diagnosis of breast cancer and 72 women who had benign tumors. Their mean age was 46 years.

Each of the women completed the Profile of Mood States (POMS), the Courtauld Emotional Control Scale, and the Manifest Anxiety Scale during a first visit to an outpatient clinic for a breast biopsy (Psychosomatics 2005;46:19-24). The women completed the POMS again after a second visit at which they learned the biopsy results.

Both the breast cancer patients and the benign tumor patients were assigned to either low anxiety or high anxiety subgroups based on the Manifest Anxiety Scale scores, and either negative emotion suppression or negative emotion expression groups based on the Courtauld Emotional Control Scale scores. The researchers compared the POMS scores before and after the biopsy results among the eight subgroups.

Among the women with breast cancer, the total mood disturbance scores were significantly higher among those in the high anxiety subgroup than in the low anxiety subgroup. Those scores were higher in the negative emotion suppression group than in the negative emotion expression group.

Among women with benign tumors, those in the high anxiety subgroup showed higher overall total mood disturbance scores at the first visit, compared with women in the low anxiety subgroup. The total mood disturbance scores in the negative emotion expression group were not significantly different between the first and second clinic visits, regardless of diagnosis.

Women who feel chronic anxiety or who suppress anxiety in daily life are more likely to be traumatized by a diagnosis of breast cancer, compared with women who are generally less anxious, reported Yumi Iwamitsu, Ph.D., of Kitasato University, Kanagawa, Japan, and colleagues.

They examined the differences in emotional responses among 21 women who had received a diagnosis of breast cancer and 72 women who had benign tumors. Their mean age was 46 years.

Each of the women completed the Profile of Mood States (POMS), the Courtauld Emotional Control Scale, and the Manifest Anxiety Scale during a first visit to an outpatient clinic for a breast biopsy (Psychosomatics 2005;46:19-24). The women completed the POMS again after a second visit at which they learned the biopsy results.

Both the breast cancer patients and the benign tumor patients were assigned to either low anxiety or high anxiety subgroups based on the Manifest Anxiety Scale scores, and either negative emotion suppression or negative emotion expression groups based on the Courtauld Emotional Control Scale scores. The researchers compared the POMS scores before and after the biopsy results among the eight subgroups.

Among the women with breast cancer, the total mood disturbance scores were significantly higher among those in the high anxiety subgroup than in the low anxiety subgroup. Those scores were higher in the negative emotion suppression group than in the negative emotion expression group.

Among women with benign tumors, those in the high anxiety subgroup showed higher overall total mood disturbance scores at the first visit, compared with women in the low anxiety subgroup. The total mood disturbance scores in the negative emotion expression group were not significantly different between the first and second clinic visits, regardless of diagnosis.

Women who feel chronic anxiety or who suppress anxiety in daily life are more likely to be traumatized by a diagnosis of breast cancer, compared with women who are generally less anxious, reported Yumi Iwamitsu, Ph.D., of Kitasato University, Kanagawa, Japan, and colleagues.

They examined the differences in emotional responses among 21 women who had received a diagnosis of breast cancer and 72 women who had benign tumors. Their mean age was 46 years.

Each of the women completed the Profile of Mood States (POMS), the Courtauld Emotional Control Scale, and the Manifest Anxiety Scale during a first visit to an outpatient clinic for a breast biopsy (Psychosomatics 2005;46:19-24). The women completed the POMS again after a second visit at which they learned the biopsy results.

Both the breast cancer patients and the benign tumor patients were assigned to either low anxiety or high anxiety subgroups based on the Manifest Anxiety Scale scores, and either negative emotion suppression or negative emotion expression groups based on the Courtauld Emotional Control Scale scores. The researchers compared the POMS scores before and after the biopsy results among the eight subgroups.

Among the women with breast cancer, the total mood disturbance scores were significantly higher among those in the high anxiety subgroup than in the low anxiety subgroup. Those scores were higher in the negative emotion suppression group than in the negative emotion expression group.

Among women with benign tumors, those in the high anxiety subgroup showed higher overall total mood disturbance scores at the first visit, compared with women in the low anxiety subgroup. The total mood disturbance scores in the negative emotion expression group were not significantly different between the first and second clinic visits, regardless of diagnosis.

WASHINGTON — Women's perceptions that they gain weight when taking hormonal contraceptives do not reflect reality.

Data from a pair of posters presented at the annual meeting of the Association of Reproductive Health Professionals refuted the long-held association between weight gain and using hormonal contraceptives in the form of a pill, ring, or patch.

Concerns about weight gain may lead women to discontinue hormonal contraception, according to Lauren Osborne, a graduate student, and colleagues at Columbia University, New York. No significant weight changes occurred from baseline among women who used either oral contraceptives or the vaginal ring in their randomized study of 201 subjects.

Overall, 167 of the 201 women completed three menstrual cycles using the oral contraceptive Ortho TriCyclen Lo (ethinyl estradiol and norgestimate) or a ring (ethinyl estradiol and etonogestrel). The study was supported by a grant from Organon Pharmaceuticals Inc., maker of the NuvaRing vaginal ring.

On average, the women gained 2.8 pounds, regardless of baseline weight or BMI and type of contraceptive used. The 34 women who reported a “bad change” in weight at the study's end had gained an average of 4.4 pounds, while the 112 women who reported “no change” had gained 2.2 pounds, and the 14 women who reported a “good change” had gained 3.3 pounds.

The mean weight of all the women studied was 146 pounds, and included women with BMIs in the healthy (less than 25), overweight (from 25 to 30), and obese (greater than 30) range.

In a second poster, Dr. Katharine O'Connell and Dr. Carolyn Westhoff of Columbia University reviewed data from 130 observational studies of combined hormonal contraception and weight gain dating from 1966 to 2003. These studies excluded progestin-only contraception, and most (118 of 130) included an oral contraceptive.

Regardless of what type of contraceptive was used, the investigators concluded that all weight gains described during hormonal contraception use were not significantly different from weight changes in the general United States population over the same period.

WASHINGTON — Women's perceptions that they gain weight when taking hormonal contraceptives do not reflect reality.

Data from a pair of posters presented at the annual meeting of the Association of Reproductive Health Professionals refuted the long-held association between weight gain and using hormonal contraceptives in the form of a pill, ring, or patch.

Concerns about weight gain may lead women to discontinue hormonal contraception, according to Lauren Osborne, a graduate student, and colleagues at Columbia University, New York. No significant weight changes occurred from baseline among women who used either oral contraceptives or the vaginal ring in their randomized study of 201 subjects.

Overall, 167 of the 201 women completed three menstrual cycles using the oral contraceptive Ortho TriCyclen Lo (ethinyl estradiol and norgestimate) or a ring (ethinyl estradiol and etonogestrel). The study was supported by a grant from Organon Pharmaceuticals Inc., maker of the NuvaRing vaginal ring.

On average, the women gained 2.8 pounds, regardless of baseline weight or BMI and type of contraceptive used. The 34 women who reported a “bad change” in weight at the study's end had gained an average of 4.4 pounds, while the 112 women who reported “no change” had gained 2.2 pounds, and the 14 women who reported a “good change” had gained 3.3 pounds.

The mean weight of all the women studied was 146 pounds, and included women with BMIs in the healthy (less than 25), overweight (from 25 to 30), and obese (greater than 30) range.

In a second poster, Dr. Katharine O'Connell and Dr. Carolyn Westhoff of Columbia University reviewed data from 130 observational studies of combined hormonal contraception and weight gain dating from 1966 to 2003. These studies excluded progestin-only contraception, and most (118 of 130) included an oral contraceptive.

Regardless of what type of contraceptive was used, the investigators concluded that all weight gains described during hormonal contraception use were not significantly different from weight changes in the general United States population over the same period.

WASHINGTON — Women's perceptions that they gain weight when taking hormonal contraceptives do not reflect reality.

Data from a pair of posters presented at the annual meeting of the Association of Reproductive Health Professionals refuted the long-held association between weight gain and using hormonal contraceptives in the form of a pill, ring, or patch.

Concerns about weight gain may lead women to discontinue hormonal contraception, according to Lauren Osborne, a graduate student, and colleagues at Columbia University, New York. No significant weight changes occurred from baseline among women who used either oral contraceptives or the vaginal ring in their randomized study of 201 subjects.

Overall, 167 of the 201 women completed three menstrual cycles using the oral contraceptive Ortho TriCyclen Lo (ethinyl estradiol and norgestimate) or a ring (ethinyl estradiol and etonogestrel). The study was supported by a grant from Organon Pharmaceuticals Inc., maker of the NuvaRing vaginal ring.

On average, the women gained 2.8 pounds, regardless of baseline weight or BMI and type of contraceptive used. The 34 women who reported a “bad change” in weight at the study's end had gained an average of 4.4 pounds, while the 112 women who reported “no change” had gained 2.2 pounds, and the 14 women who reported a “good change” had gained 3.3 pounds.

The mean weight of all the women studied was 146 pounds, and included women with BMIs in the healthy (less than 25), overweight (from 25 to 30), and obese (greater than 30) range.

In a second poster, Dr. Katharine O'Connell and Dr. Carolyn Westhoff of Columbia University reviewed data from 130 observational studies of combined hormonal contraception and weight gain dating from 1966 to 2003. These studies excluded progestin-only contraception, and most (118 of 130) included an oral contraceptive.

Regardless of what type of contraceptive was used, the investigators concluded that all weight gains described during hormonal contraception use were not significantly different from weight changes in the general United States population over the same period.