title: Psychiatric characterization of children with genetic causes of hyperandrogenism.
abstract: OBJECTIVE
  Very little is known about the mental health status in children with genetic causes of hyperandrogenism. This study sought to characterize psychiatric morbidity in this group.
  
  
  METHODS
  Children (8-18 years) with the diagnosis of classic congenital adrenal hyperplasia (CAH) or familial male precocious puberty (FMPP) underwent a semi-structured psychiatric interview, the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version. According to sex and the literature, incidence of identified psychopathology was compared between the two endocrinological groups. We evaluated 72 patients: 54 CAH (21 females) and 18 FMPP.
  
  
  RESULTS
  Twenty-four (44.4%) CAH patients and 10 (55.6%) FMPP patients met the criteria for at least one lifetime psychiatric diagnosis. Attention-deficit hyperactivity disorder (ADHD) was present in 18.2% of CAH males, 44.4% of FMPP males, and one case (4.8%) in CAH females. A high rate of anxiety disorders was also found in all the three groups (17-21%). Relative to females with CAH, the FMPP patients exhibited higher rates of ADHD. Age at diagnosis and the treatment modalities were not associated with psychopathology. Rates of psychiatric disorder, specifically ADHD and anxiety disorders, were higher than in the general population.
  
  
  CONCLUSIONS
  Although anxiety disorders may occur at an increased rate in children with chronic illness, androgens may contribute to higher risk for psychopathology in pediatric patients with genetic cause of excess androgen. Early diagnosis and treatment of childhood hyperandrogenism is essential for optimal development. The results suggest that assessment for psychiatric disorders should be part of the routine evaluation of these patients.
authors.affiliation: Section of Developmental and Affective Neuroscience, National Institute of Mental Health, NIH, 15K North Drive, Bethesda, Maryland 20892-1932, USA. msven@mail.nih.gov
authors.forename: Sven C
authors.initials: SC
authors.lastname: Mueller
authors.forename: Pamela
authors.initials: P
authors.lastname: Ng
authors.forename: Ninet
authors.initials: N
authors.lastname: Sinaii
authors.forename: Ellen W
authors.initials: EW
authors.lastname: Leschek
authors.forename: Liza
authors.initials: L
authors.lastname: Green-Golan
authors.forename: Carol
authors.initials: C
authors.lastname: VanRyzin
authors.forename: Monique
authors.initials: M
authors.lastname: Ernst
authors.forename: Deborah P
authors.initials: DP
authors.lastname: Merke
mesh_terms: D000293:Adolescent; D000312:Adrenal Hyperplasia, Congenital / Q000175:diagnosis / Q000235:genetics / Q000523:psychology; D001007:Anxiety / Q000175:diagnosis / Q000235:genetics / Q000523:psychology; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000235:genetics / Q000523:psychology; D002648:Child; D005260:Female; D006801:Humans; D017588:Hyperandrogenism / Q000150:complications / Q000175:diagnosis / Q000235:genetics* / Q000523:psychology*; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000235:genetics* / Q000523:psychology*; D011629:Puberty, Precocious / Q000175:diagnosis / Q000235:genetics / Q000523:psychology
references.citation: Arch Dis Child. 1969 Jun;44(235):291-303
references.pmid: 5785179
references.citation: Lancet. 2005 Jun 18-24;365(9477):2125-36
references.pmid: 15964450
references.citation: Helv Paediatr Acta. 1974 Apr;29(1):61-72
references.pmid: 4838166
references.citation: Pediatrics. 2010 Jan;125(1):75-81
references.pmid: 20008426
references.citation: Behav Neurosci. 2008 Apr;122(2):273-81
references.pmid: 18410167
references.citation: Psychoneuroendocrinology. 1997 Oct;22(7):505-15
references.pmid: 9373884
references.citation: Lancet. 2005 Jul 16-22;366(9481):237-48
references.pmid: 16023516
references.citation: J Am Acad Child Adolesc Psychiatry. 1996 Jul;35(7):865-77
references.pmid: 8768346
references.citation: Brain Inj. 2004 Apr;18(4):377-90
references.pmid: 14742151
references.citation: Dev Med Child Neurol. 2003 May;45(5):292-5
references.pmid: 12729141
references.citation: J Clin Psychopharmacol. 1998 Aug;18(4):324-31
references.pmid: 9690699
references.citation: J Am Acad Child Adolesc Psychiatry. 1997 Jul;36(7):980-8
references.pmid: 9204677
references.citation: Neuroreport. 1999 May 14;10(7):1589-92
references.pmid: 10380986
references.citation: Am J Med Genet B Neuropsychiatr Genet. 2010 Apr 5;153B(3):837-45
references.pmid: 19927307
references.citation: J Am Acad Child Adolesc Psychiatry. 2000 Nov;39(11):1446-51
references.pmid: 11068901
references.citation: J Child Psychol Psychiatry. 2008 Dec;49(12):1287-95
references.pmid: 18673405
references.citation: J Child Psychol Psychiatry. 2007 Dec;48(12):1251-8
references.pmid: 18093031
references.citation: Proc Natl Acad Sci U S A. 2004 May 25;101(21):8174-9
references.pmid: 15148381
references.citation: Pediatrics. 1987 May;79(5):805-13
references.pmid: 2952939
references.citation: Nature. 1993 Oct 14;365(6447):652-4
references.pmid: 7692306
references.citation: J Pediatr. 2004 Jun;144(6):741-6
references.pmid: 15192620
references.citation: Arch Sex Behav. 2006 Dec;35(6):667-84
references.pmid: 16902816
references.citation: Psychoneuroendocrinology. 1990;15(5-6):401-20
references.pmid: 2101963
references.citation: Neuroscience. 2009 Dec 15;164(3):887-95
references.pmid: 19761818
references.citation: Endocrinology. 2009 Aug;150(8):3690-8
references.pmid: 19423759
references.citation: J Clin Endocrinol Metab. 1995 Aug;80(8):2490-4
references.pmid: 7629248
references.citation: Diabetes Care. 1997 Jan;20(1):36-44
references.pmid: 9028691
references.citation: J Clin Endocrinol Metab. 2003 Apr;88(4):1760-5
references.pmid: 12679470
references.citation: Arch Gen Psychiatry. 1984 Oct;41(10):959-67
references.pmid: 6332591
references.citation: Psychol Sci. 2009 Feb;20(2):144-8
references.pmid: 19175758
references.citation: J Am Acad Child Adolesc Psychiatry. 2003 Oct;42(10):1203-11
references.pmid: 14560170
references.citation: Annu Rev Clin Psychol. 2008;4:275-303
references.pmid: 18370618
references.citation: Horm Behav. 2006 Jun;50(1):148-53
references.pmid: 16624315
references.citation: Int J Neurosci. 1988 Sep;42(1-2):121-5
references.pmid: 3145253
references.citation: Diabetes Care. 1993 Dec;16(12):1579-87
references.pmid: 8299453
references.citation: J Pediatr. 2003 Oct;143(4 Suppl):S35-45
references.pmid: 14597912
references.citation: Horm Behav. 2009 Feb;55(2):285-91
references.pmid: 19100266
references.citation: Psychoneuroendocrinology. 1992 Nov;17(6):553-63
references.pmid: 1287677
references.citation: Psychol Med. 2006 May;36(5):699-710
references.pmid: 16438742
references.citation: Science. 2005 Nov 4;310(5749):819-23
references.pmid: 16272115
references.citation: JAMA. 2002 Oct 9;288(14):1740-8
references.pmid: 12365958
references.citation: Brain Res. 2000 Apr 10;861(2):288-95
references.pmid: 10760490
references.citation: Vital Health Stat 10. 2008 Jul;(237):1-14
references.pmid: 18998276
references.citation: J Endocrinol. 1999 Jan;160(1):1-12
references.pmid: 9854171
references.citation: N Engl J Med. 1989 Feb 23;320(8):496-502
references.pmid: 2492636
references.citation: Arch Gen Psychiatry. 2003 Aug;60(8):837-44
references.pmid: 12912767
references.citation: Int J Dermatol. 2008 Nov;47(11):1118-20
references.pmid: 18986440
references.citation: Pharmacol Biochem Behav. 2008 May;89(3):314-23
references.pmid: 18275993
references.citation: Neurosci Biobehav Rev. 2003 Aug;27(5):413-36
references.pmid: 14505684
references.citation: N Engl J Med. 1990 Jun 7;322(23):1674
references.pmid: 2342531
references.citation: Arch Gen Psychiatry. 1988 Jan;45(1):64-8
references.pmid: 3257379
references.citation: QJM. 1996 Jul;89(7):543-51
references.pmid: 8759496
references.citation: Horm Behav. 2007 Sep;52(3):368-74
references.pmid: 17673215
references.citation: Arch Gen Psychiatry. 1984 Oct;41(10):949-58
references.pmid: 6332590
references.citation: Cereb Cortex. 2009 Feb;19(2):464-73
references.pmid: 18550597
references.citation: Am J Psychiatry. 1996 Aug;153(8):974-84
references.pmid: 8678193
references.citation: Horm Behav. 2010 Jan;57(1):63-75
references.pmid: 19703457
references.citation: AJNR Am J Neuroradiol. 2007 Mar;28(3):543-7
references.pmid: 17353333