Childhood adversities

The impact of life events as potential risk factor in the development of anxiety disorders has been evaluated in several epidemiological studies, hi almost all studies evidence was found for an association between childhood adversities... 

Kessler RC and Magee WJ. (1993). Childhood adversities and adult depression basic patterns of association in a US national survey. Psychol Med 23 679-690. 

Xie, P, Kranzler, H.R., Poling, J., et al., 2010. Interaction of FKBP5 with childhood adversity on risk for post-traumatic stress disorder. Neuropsychopharmacology 35,1684-1692. 

The proportion of ALL in patients older than age 60 years constitutes between 16% and 31% of all adult leukemias. Treatment of adults largely has followed the conventional chemotherapeutic regimes used in childhood ALL. However, the intensification regimens common in childhood are not suitable for this population because of their associated toxic-ities in older patients. The adverse prognostic factor, the Philadelphia chromosome, occurs in 15% to 30% of adults and thus is more common in the over 60 age group.17 Based on the experience achieved in CML, the use of imatinib, a potent inhibitor of the Ph+-associated BCR-ABL tyrosine kinase, is becoming a common practice for these older adults. Results show that the combination of imatinib with conventional chemotherapy has improved remission rates compared with the use of conventional chemotherapy alone,... 

Lidsky, I.T. and Schneider, J.S., Adverse effects of childhood lead poisoning The clinical neuropsychological perspective, Environmental Research, 100, 284-293, 2006. 

Anda RF, Croft JB, Felitti VJ, Nordenberg D, Giles WH, Williamson DF and Giovino GA (1999). Adverse childhood experiences and smoking during adolescence and adulthood. Journal of the American Medical Association, 282, 1652-1658. 

Parrott AC (2000b). Smoking and adverse childhood experiences. Journal of the American Medical Association, 283, 1959. 

A native of England, Roy Bolbery, forty-two when interviewed, was ill throughout his childhood in London. At age six he had a severe adverse reaction to penicillin. His sleep frequently was interrupted by night terrors. And during the day he would suddenly feel ill for no apparent reason. The outcome of many medical tests was a diagnosis of mild epilepsy. His sister died in childhood of leukemia. His father suffered with tuberculosis. 

In response to the National Childhood Vaccine Injury Act of 1988, which required health workers to report vaccine adverse events, the CDC and the FDA collaborated in 1990 to implement the Vaccine Adverse Event Reporting System (VAERS) to monitor the safety of vaccines in both sectors. Health care professionals and parent or other caretakers are encouraged to report all clinically significant vaccine adverse events. Narrative diagnostic reports are reviewed and assigned standard codes using Coding Symbols for a Thesaurus of Adverse Reaction Terms. The source of the vaccines (public versus private provider) is recorded on the form. 

Susceptibility Factors that can increase or decrease the adverse effects of an agent Developing organism, childhood, genetics... 

Kallen and Robert (2000) found no adverse effects on congenital malformations, childhood cancer, infant mortality, low Apgar score, neonatal jaundice, or neonatal hypothyroidism among infants and children who lived in areas where drinking water was disinfected with chlorine dioxide, compared to controls living in... 

Lack of access to medicines and inappropriate doses result in serious morbidity and mortality, particularly for childhood infections and chronic diseases, such as hypertension, diabetes, epilepsy and mental disorders. Inappropriate use and over-use of medicines waste resources - often out-of-pocket payments by patients - and result in significant patient harm in terms of poor patient outcomes and adverse drug reactions. Furthermore, over-use of antimicrobials is leading to increased antimicrobial resistance and non-sterile injections to the transmission of hepatitis, HIV/AIDS and other blood-borne diseases. Finally, irrational over-use of medicines can stimulate inappropriate patient demand, and lead to reduced access and attendance rates due to medicine stock-outs and loss of patient confidence in the health system. 

Thapar, A., Harold, G., and McGuffin, P. (1998). Life events and depressive symptoms in childhood—shared genes or shared adversity A research note. / Child Psychol Psychiatry 39 1153-1158. 

Effects of early environmental adversity on HPA mediation of neurodevelopment have also been demonstrated in non-human primates (Coplan et al., 1995). Corticotropin-releasing hormone (CRH) intracerebro-ventricular administration in rhesus monkeys that had been separated from their mothers produced behavioral inhibition and increases in ACTH and cortisol. Coplan et al (1995) presented evidence for persistently elevated cerebrospinal fluid concentrations of corticotropin-releasing factor (CRF) in grown macaques that had been reared by mothers in unpredictable environmental conditions. Further studies in adversely reared adult monkeys demonstrated an inverse relationship between mean CRF concentrations and GH response to clonidine (Coplan et al., 2000). In light of evidence that reduced GH response to clonidine has been shown in other anxiety disorders (Charney and Bremner, 1999), Coplan et al. (2000) hypothesize that GH response to clonidine may inversely reflect trait-like increases of central nervous system CRF activity. Data linking childhood anxiety to growth deficits are consistent with this view (Pine et al., 1996). Activity, of the HPA axis, as related to early environmental... 

Adverse early environmental stress has also been investigated in human populations. Observations of the effects of early childhood experience of environmental adversity have led investigators to propose a stress vulnerability mediated by changes in stress-responsive CRF systems implicated in both mood and anxiety disorders (Heim and Nemeroff, 1999). Granger et al. (1996) measured children s adrenocortical reactions to a conflict-oriented mother-child interaction task and found that children s pretask cortisol scores were negatively associated with anxiety symptoms. 

Anda, R.E, Croft, J.B., Felitti, V.J., Nordenberg, D., Giles, W.H., Williamson, D.E, and Giovino, G.A. (1999) Adverse childhood experiences and smoking duing adolescence and adulthood. 

Inhibition of the MAO-A enzyme for the treatment of depression is appealing because MAO-A is specifically responsible for the degradation of serotonin and norepinephrine. There was initial interest in clorgyline for treatment of adult depression and childhood ADHD (Potter et ah, 1982 Zametkin et ah, 1985). Clorgyline was found to be beneficial in a small, double-blind, crossover study for the treatment of ADHD in children, but adverse events associated with irreversibility resulted in the lack of an industry sponsor for further trials (Zametkin et ah, 1985). 

Tourette s syndrome consists of tics (i.e., rapid, purposeless movements), noises (e.g., grunts, squeals, barks), and sometimes coarse speech, usually with an onset in childhood. It is inherited by an autosomal dominant mechanism. In some cases, drug treatment is not required, and simply explaining the neurological basis of the condition to the parent and child is often reassuring. In some cases, enduring the tics is less of a burden than suffering from the dysphoric adverse effects of antipsychotics. 

Nevertheless, this condition is responsive to treatment with dopamine-2 receptor antagonists. Hence, this condition is one of the clearest childhood indications for treatment with these medications. In theory, any dopamine-2 blocking receptor antagonist could be used. Haloperidoi has been the most extensively tested and used medication for this condition (167). The typical dose for children aged 3 to 12 years old is 0.2 mg/kg per day. More recently, in a double-blind study of 36 boys with Tourette s syndrome, risperidone was effective in reducing tics in 88% versus 60% for haloperidol (197), perhaps making risperidone a better option than a neuroleptic in terms of neurological adverse effects. 

Heerema NA, Nachman JB, Sather HN et al. Hypodiploidy with less than 45 chromosomes confers adverse risk in childhood acute lymphoblastic leukemia a report from the Childrens Cancer Group. Blood 1999 94 4036-4045. 

Gajjar A, Harrison PL, Sandlund JT et al. Traumatic lumbar puncture at diagnosis adversely affects outcome in childhood acute lymphoblastic leukemia. B/oorf2000 96 3381-3384. 

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