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Ayyash HF, Ogundele MO, Lynn RM, Schumm TS, Ani C. Involvement of community paediatricians in the care of children and young people with mental health difficulties in the UK: implications for case ascertainment by child and adolescent psychiatric, and paediatric surveillance systems. BMJ Paediatr Open 2021; 5:e000713. [PMID: 33614992 PMCID: PMC7871672 DOI: 10.1136/bmjpo-2020-000713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 12/08/2020] [Accepted: 01/09/2021] [Indexed: 12/17/2022] Open
Abstract
Objective To ascertain the extent to which community paediatricians are involved in the care of children with mental health conditions in order to determine which difficulties are appropriate for single or joint surveillance by the British Paediatric Surveillance Unit (BPSU) and Child and Adolescent Psychiatry Surveillance System (CAPSS). Design An online survey of the 1120 members of the British Association of Community Child Health (BACCH) working in 169 Community Child Health (CCH) services in the UK. Results A total of 245 community paediatricians responded to the survey. This represents 22% of members of BACCH but likely to have covered many of the 169 CCH units because participants could respond on behalf of other members in their unit. The survey showed that children and young people (CYP) with neurodevelopmental conditions presented more frequently to paediatrics than to Child and Adolescent Mental Health Services (CAMHS). In addition, a sizeable proportion of CYP with emotional difficulties presented to paediatricians (eg, 29.5% for anxiety/obsessive compulsive disorder (OCD), and 12.8% for depression)-mainly due to difficulty with accessing CAMHS. More than half of the community paediatricians are involved in the care of CYP with anxiety and OCD, while 32.3% are involved in the care of those with depression. Conclusion There is significant involvement of community paediatricians in the care of CYP with mental health conditions. Involvement is highest for neurodevelopmental conditions, but also significant for CYP with emotional difficulties. The implication of the findings for surveillance case ascertainment is that joint BPSU and CAPSS is recommended for surveillance studies of neurodevelopmental conditions. However, for emotional disorders, single or joint surveillance should be made based on the specific research question and the relative trade-offs between case ascertainment, and the additional cost and reporting burden of joint surveillance. Single CAPSS studies remain appropriate for psychosis and bipolar disorder.
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Cognigni M. An Italian paediatric department at the time of Coronavirus: a resident's point of view. Arch Dis Child 2021; 106:206-207. [PMID: 32341011 DOI: 10.1136/archdischild-2020-319299] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2020] [Indexed: 11/03/2022]
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Friend AJ. Attention deficit hyperactivity disorder was associated with increased risk of suicidal behaviour. Arch Dis Child Educ Pract Ed 2021; 106:63. [PMID: 31843940 DOI: 10.1136/archdischild-2019-318308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Skylstad V, Aber H, Bakken V, Dierkes J, Iversen SA, Kisaakye E, Kühl MJ, Nalugya JS, Rayamajhi D, Sebuwufu D, Skar AMS, Skokauskas N, Valeckaite N, Wamani H, S Engebretsen IM, Babirye JN. Child alcohol use disorder in Eastern Uganda: screening, diagnostics, risk factors and management of children drinking alcohol in Uganda (TREAT C-AUD): a mixed-methods research protocol. BMJ Paediatr Open 2021; 5:e001214. [PMID: 34345718 PMCID: PMC8322685 DOI: 10.1136/bmjpo-2021-001214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 07/13/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Following a finding of alcohol use among children aged 5-8 years old in Mbale, Uganda, this project investigates the magnitude of alcohol and substance use among children ged 6-13 years old and related household, community, school, health system and clinical factors. METHODS The project includes four larger work packages (WPs). WP1 comprises management, WP2 and 3 include the scientific components and WP4 includes integration of results, dissemination, policy and implementation advice. This protocol presents the planned research work in WP 2 and 3. WP2 comprises the adaptation and validation of the alcohol use screening tool Car-Relax-Alone-Forget-Family and Friends-Trouble (CRAFFT) to the age group and setting. WP3 comprises four substudies (SS). SS1 is a cross-sectional community household survey with an estimated sample size of 3500 children aged 6-13 years and their caregivers. We apply cluster sampling and systematic sampling within the clusters. Data collection includes a structured questionnaire for caregiver and child, measuring social and demographic factors, mental health status, alcohol and substance use, nutrition history and anthropometry. Urine samples from children will be collected to measure ethyl glucuronide (EtG), a biological marker of alcohol intake. Further, facilitators, barriers and response mechanisms in the health system (SS2) and the school system (SS3) is explored with surveys and qualitative assessments. SS4 includes qualitative interviews with children. Analysis will apply descriptive statistics for the primary outcome of establishing the magnitude of alcohol drinking and substance use, and associated factors will be assessed using appropriate regression models. The substudies will be analysed independently, as well as inform each other through mixed methods strategies at the stages of design, analysis, and dissemination. ETHICS AND DISSEMINATION Data protection and ethical approvals have been obtained in Uganda and Norway, and referral procedures developed. Dissemination comprises peer-reviewed, open access research papers, policy recommendations and intersectoral dialogues.Trial registration numberClinicaltrials.gov 29.10.2020 (NCT04743024).
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Donkor HM, Toxe H, Hurum J, Bjerknes R, Eide GE, Juliusson P, Markestad T. Psychological health in preschool children with underweight, overweight or obesity: a regional cohort study. BMJ Paediatr Open 2021; 5:e000881. [PMID: 33817347 PMCID: PMC7970241 DOI: 10.1136/bmjpo-2020-000881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 02/12/2021] [Accepted: 02/15/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To examine if underweight (UW), overweight (OW) or obesity (OB), or body mass index (BMI) expressed as its SD score (BMI SDS), were associated with psychological difficulties in preschool children. DESIGN Regional cohort study. SETTING Oppland County, Norway. METHODS At the routine school entry health assessment at 5-6 years of age, parents were invited to participate by local public health nurses. The parents completed questionnaires on sociodemographic, health and lifestyle factors of the child and the family, and on the child's neurocognitive development. They assessed psychological health with the Strengths and Difficulties Questionnaire (SDQ). Public health nurses measured weight and height on all eligible children and reported age, sex, height and weight anonymously for the children who declined to participate. PARTICIPANTS We obtained information on 1088 of 1895 (57%) eligible children. The proportion of UW, OW and OB was slightly higher among the children who declined. MAIN OUTCOME MEASURES SDQ subscale and Total Difficulties Scores. RESULTS The mean SDQ scores and proportion of scores ≥the 90th percentile had a curvilinear pattern from UW through normal weight (NW), OW and OB with NW as nadir, but the pattern was only significant for the mean Emotional problems, Peer problems and Total SDQ Scales, and for the Total SDQ Score ≥the 90th percentile (TDS90). After adjusting for relevant social, developmental, health and behavioural characteristics, TDS90 was only significantly associated with UW in multiple logistic regression analyses, and only with the lowest quartile of BMI SDS in a linear spline regression analysis. CONCLUSIONS The study suggests that UW and low BMI, but not OW, OB or higher BMI, are independent risk factors for having psychological symptoms in preschool children.
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Russet F, Humbertclaude V, Davidovic Vrljicak N, Dieleman GC, Dodig-Ćurković K, Franic T, Gerritsen SE, de Girolamo G, Hendrickx G, Kerbage H, McNicholas F, Maras A, Paramala S, Paul M, Schandrin A, Schulze UME, Street C, Tuomainen H, Wolke D, Singh SP, Tremmery S, Purper-Ouakil D. Are Psychiatrists Trained to Address the Mental Health Needs of Young People Transitioning From Child to Adult Services? Insights From a European Survey. Front Psychiatry 2021; 12:768206. [PMID: 35222101 PMCID: PMC8864158 DOI: 10.3389/fpsyt.2021.768206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/29/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In mental health, transition refers to the pathway of young people from child and adolescent to adult services. Training of mental health psychiatrists on transition-related topics offers the opportunity to improve clinical practice and experiences of young people reaching the upper age limit of child and adolescent care. METHODS National psychiatrist's organizations or experts from 21 European countries were surveyed 1/ to describe the status of transition in adult psychiatry (AP) and child and adolescent psychiatry (CAP) postgraduate training in Europe; 2/ to explore the amount of cross-training between both specialties. This survey was a part of the MILESTONE project aiming to study and improve the transition process of young people at the service boundary. RESULTS Transition was a mandatory topic in the AP curriculum of 1/19 countries (5%) and in the CAP curriculum of 4/17 countries (24%). Most topics relevant for transition planning were addressed during AP training in 7/17 countries (41%) to 10/17 countries (59%), and during CAP training in 9/11 countries (82%) to 13/13 countries (100%). Depending on the training models, theoretical education in CAP was mandatory during AP training in 94% (15/16) to 100% of the countries (3/3); and in AP during CAP training in 81% (13/16) to 100% of the countries (3/3). Placements were mandatory in CAP during AP training in 67% (2/3) to 71% of the countries (12/17); and in AP during CAP training in 87% (13/15) to 100% of the countries (3/3). DISCUSSION AND CONCLUSION Specific training about transition is limited during CAP and AP postgraduate training in Europe. Cross-training between both specialties offers a basis for improved communication between child and adult services but efforts should be sustained in practical training. Recommendations are provided to foster further development and meet the specific needs of young people transitioning to adult services.
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Hossain MJ, Soma MA, Bari MS, Emran TB, Islam MR. COVID-19 and child marriage in Bangladesh: emergency call to action. BMJ Paediatr Open 2021; 5:e001328. [PMID: 34841091 PMCID: PMC8611234 DOI: 10.1136/bmjpo-2021-001328] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 11/07/2021] [Indexed: 12/22/2022] Open
Abstract
The social burden of Bangladesh's already prevalent child marriage problem has further flared up amid the ongoing COVID-19 pandemic. We aim to briefly report on the current scenario of underage marriage in Bangladesh from available sources and highlight concerns. The prevalence of child marriage has increased by at least 13% due to pandemic-enforced long-term school closure throughout the country, while many cases remain unreported. Exacerbated financial crisis, the prolonged shutdown of educational institutions and social insecurities are the principal triggering factors for such a high pace of child marriages. We urge the government and local administrations to address the current situation through concerted and integrated efforts to combat the early marriage crisis in Bangladesh.
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Wood BL, Woods SB, Sengupta S, Nair T. The Biobehavioral Family Model: An Evidence-Based Approach to Biopsychosocial Research, Residency Training, and Patient Care. Front Psychiatry 2021; 12:725045. [PMID: 34675826 PMCID: PMC8523802 DOI: 10.3389/fpsyt.2021.725045] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 09/08/2021] [Indexed: 11/30/2022] Open
Abstract
Engel's biopsychosocial model, based in systems theory, assumes the reciprocal influence of biological, psychological, and social factors on one another and on mental and physical health. However, the model's application to scientific study is limited by its lack of specificity, thus constraining its implementation in training and healthcare environments. The Biobehavioral Family Model (BBFM) is one model that can facilitate specification and integration of biopsychosocial conceptualization and treatment of illness. The model identifies specific pathways by which family relationships (i.e., family emotional climate) impact disease activity, through psychobiological mechanisms (i.e., biobehavioral reactivity). Furthermore, it is capable of identifying positive and negative effects of family process in the same model, and can be applied across cultural contexts. The BBFM has been applied to the study of child health outcomes, including pediatric asthma, and adult health, including for underserved primary care patients, minoritized samples, and persons with chronic pain, for example. The BBFM also serves as a guide for training and clinical practice; two such applications are presented, including the use of the BBFM in family medicine residency and child and adolescent psychiatry fellowship programs. Specific teaching and clinical approaches derived from the BBFM are described in both contexts, including the use of didactic lecture, patient interview guides, assessment protocol, and family-oriented care. Future directions for the application of the BBFM include incorporating temporal dynamics and developmental trajectories in the model, extending testable theory of family and individual resilience, examining causes of health disparities, and developing family-based prevention and intervention efforts to ameliorate contributing factors to disease. Ultimately, research and successful applications of the BBFM could inform policy to improve the lives of families, and provide additional support for the value of a biopsychosocial approach to medicine.
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Moss D, Majadle G, Milhem J, Waterston T. Mental health impact on children of forcible home invasions in the occupied Palestinian territory. BMJ Paediatr Open 2021; 5:e001062. [PMID: 34604544 PMCID: PMC8449953 DOI: 10.1136/bmjpo-2021-001062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 07/29/2021] [Indexed: 11/13/2022] Open
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Minhas RS, Freeman SJ. Supporting marginalised children with school problems in the COVID-19 pandemic. BMJ Paediatr Open 2021; 5:e000956. [PMID: 34192191 PMCID: PMC7804822 DOI: 10.1136/bmjpo-2020-000956] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 11/30/2022] Open
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Armitage R. Bullying in children: impact on child health. BMJ Paediatr Open 2021; 5:e000939. [PMID: 33782656 PMCID: PMC7957129 DOI: 10.1136/bmjpo-2020-000939] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/24/2021] [Accepted: 03/02/2021] [Indexed: 11/19/2022] Open
Abstract
Bullying in childhood is a major public health problem that increases the risk of poor health, social and educational outcomes in childhood and adolescence. These consequences are felt by all those involved in bullying (bullies, victims and bully-victims) and are now recognised to propagate deep into adulthood. Cyberbullying is a relatively new type of bullying in addition to the traditional forms of direct physical, direct verbal and indirect bullying. Children who are perceived as being 'different' in any way are at greater risk of victimisation, with physical appearance being the most frequent trigger of childhood bullying. Globally, one in three children have been bullied in the past 30 days, although there is substantial regional variation in the prevalence and type of bullying experienced. The consequences of childhood bullying can be categorised into three broad categories: educational consequences during childhood, health consequences during childhood and all consequences during adulthood. Many dose-response relationships exist between the frequency and intensity of bullying experienced and the severity of negative health consequence reported. The majority of victims of cyberbullying are also victims of traditional bullying, meaning cyberbullying creates very few additional victims. Overall, adverse mental health outcomes due to bullying in childhood most severely impact on bully-victims. Bullying prevention is vital for the achievement of the Sustainable Development Goals, with whole-school cooperative learning interventions having the strongest evidence base for successful outcomes. Clear management and referral pathways for health professionals dealing with childhood bullying are lacking in both primary and secondary care, although specialist services are available locally and online.
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Holmes H, Darmanthe N, Tee K, Goodchild M. Adverse childhood experiences-household stressors and children's mental health: a single centre retrospective review. BMJ Paediatr Open 2021; 5:e001209. [PMID: 34485707 PMCID: PMC8372878 DOI: 10.1136/bmjpo-2021-001209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 08/05/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE To determine the prevalence of reported 'household stressor' adverse childhood experiences (ACEs) in families of children presenting with neurodevelopmental, behavioural or emotional difficulties and to determine whether family vulnerabilities, individually or cumulatively, were associated with particular clinical symptomatology. DESIGN Retrospective chart review followed by statistical analysis of family stressors and clinical symptomatology. SETTING A community paediatric clinic in Australia. PARTICIPANTS All 267 children who attended an initial paediatric appointment during 2018. RESULTS 162 (60.7%) children had been exposed to one or more household stressor ACEs, including 116 (43.4%) children exposed to parental mental illness. Behavioural disturbance occurred in 144 (53.9%) children and externalising behaviours (other than attention deficit hyperactivity disorder) were more frequent than internalising behaviours. Externalising and internalising behaviours were associated with individual and cumulative household stressor ACEs. Most other symptomatology apart from genetic/neurological conditions, autistic symptoms and some developmental delays appeared to be partially associated with ACEs. CONCLUSION Household stressor ACEs were common, frequently occurred concurrently, and were associated with much of the symptomatology, in this cohort. Parental mental illness was the most prevalent stressor and behavioural disturbance the most prevalent symptomatology. These findings may have implications for clinical practice and service provision.
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Leff RA, Setzer E, Cicero MX, Auerbach M. Changes in pediatric emergency department visits for mental health during the COVID-19 pandemic: A cross-sectional study. Clin Child Psychol Psychiatry 2021; 26:33-38. [PMID: 33183097 DOI: 10.1177/1359104520972453] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Limited early results indicate that the COVID-19 outbreak has had a significant impact on the mental health of children and adolescents. Pediatric emergency departments (PED) play a pivotal role in the identification, treatment, and coordination of care for children with mental health disorders, however, there is a dearth of literature evaluating the effects of the COVID-19 pandemic on mental health care provision in the PED. OBJECTIVES We sought to evaluate whether changes in frequency or patient demographics among children and adolescents presenting to the PED has occurred. METHODS This is a cross-sectional study conducted at the Yale New Haven Children's Hospital (YNHCH) PED. Data representing the early COVID-19 pandemic period was abstracted from the electronic medical record and compared using descriptive statistics to the same time period the year prior. Patient demographics including patient gender, ED disposition, mode of arrival, race-ethnicity, and insurance status were assessed. RESULTS During the pandemic period, 148 patients presented to the YNHCH PED with mental health-related diagnoses, compared to 378 in the pre-pandemic period, a reduction of 60.84%. Compared to white children, black children were 0.55 less likely to present with a mental health condition as compared to the pre-pandemic study period (p = 0.002; 95% CI 0.36-0.85). CONCLUSIONS Children with mental and behavioral health disorders who seek care in PEDs may be at risk for delayed presentations of mental health disorders. African American children may be a particularly vulnerable population to screen for mental health disorders as reopening procedures are initiated and warrants further study.
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Turgoose DP, Kerr S, De Coppi P, Blackburn S, Wilkinson S, Rooney N, Martin R, Gray S, Hudson LD. Prevalence of traumatic psychological stress reactions in children and parents following paediatric surgery: a systematic review and meta-analysis. BMJ Paediatr Open 2021; 5:e001147. [PMID: 34337164 PMCID: PMC8287603 DOI: 10.1136/bmjpo-2021-001147] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/07/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Children undergoing surgery and their parents are at risk of developing post-traumatic stress reactions. We systematically reviewed the literature to understand the prevalence of this issue, as well as potential risk factors. METHODS We conducted a systematic review and meta-analysis, using PubMed, PsycInfo, Web of Science and Google Scholar, with searches conducted in February 2021. Papers were included if they measured post-traumatic stress in children and/or parents following paediatric surgery and were excluded if they did not use a validated measure of post-traumatic stress. Data were extracted from published reports. FINDINGS Our search yielded a total of 1672 papers, of which 16 met our inclusion criteria. In meta-analysis, pooled studies of children estimated an overall prevalence of 16% meeting criteria for post-traumatic stress disorder post surgery (N=187, 95% CI 5% to 31%, I2=80%). After pooling studies of parents, overall prevalence was estimated at 23% (N=1444, 95% CI 16% to 31%, I2=91%). Prevalence rates were higher than those reported in the general population. Risk factors reported within studies included length of stay, level of social support and parental mental health. INTERPRETATION There is consistent evidence of traumatic stress following surgery in childhood which warrants further investigation. Those delivering surgical care to children would benefit from a raised awareness of the potential for post-traumatic stress in their patients and their families, including offering screening and support.
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Zhang M, Vallabhajosyula R, Fung D. Emotional Bias Modification for Individuals With Attention Deficit Hyperactivity Disorder: Protocol for a Co-Design Study. JMIR Res Protoc 2020; 9:e24078. [PMID: 33355536 PMCID: PMC7787886 DOI: 10.2196/24078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/21/2020] [Accepted: 11/24/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with a worldwide prevalence rate of 5%. Individuals with ADHD often tend to have difficulties with emotional regulation. The advances in experimental psychology have led to the discovery of emotional biases. Targeting emotional biases could potentially help improve the core symptoms of irritability and short-temperedness among these individuals. Emotional biases refer to the preferential allocation of attention toward emotional stimuli. A recent study reported the presence of emotional biases among individuals with ADHD when they compared individuals with ADHD with those without. Gamification technologies have been explored to help diminish the repetitiveness of the task and increase the intrinsic motivation to train. These inconsistent findings of the impact of gaming on the effectiveness of mobile interventions call for further work to better understand the needs of patients (users) and health care professionals. OBJECTIVE The aim of this research study is to collate health care professionals' perspectives on the limitations of the existing task, and to determine if gamification elements could be incorporated, to refine the conventional intervention. METHODS A qualitative research approach, that of a focus group, will be used. Health care professionals from the Department of Development Psychiatry, Institute of Mental Health, Singapore will be invited to participate in this qualitative research. During the focus group, participants are to comment on the limitations of the existing emotional bias intervention; recommend strategies to improve the intervention; and provide their perspectives pertaining to the use of gamification to improve the intervention. RESULTS We expect that the study will be completed in 12 months from the publication of this protocol. CONCLUSIONS To our best knowledge, this is perhaps one of the only few studies that have attempted to explore emotional biases among adolescents with ADHD. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/24078.
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Tatsiopoulou P, Porfyri GN, Bonti E, Diakogiannis I. School Failure in a Girl with Specific Learning Difficulties, Suffering from Childhood Depression: Interdisciplinary Therapeutic Approach. Brain Sci 2020; 10:E992. [PMID: 33339175 PMCID: PMC7765623 DOI: 10.3390/brainsci10120992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/07/2020] [Accepted: 12/14/2020] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Recent studies confirm the association of literacy difficulties with higher risk of both childhood behavioral and mental disorders. When co-morbid problems occur, it is likely that each will require separate treatment. The management of major depressive disorder (MDD) for a 9.5 years old girl with specific learning difficulties (SLD), a protracted clinical course, and a family history of affective disorders, was challenging for the interdisciplinary team of our clinic, dealing with learning disabilities. AIM The research and examination of the first-onset major depressive disorder (MDD) in a child with specific learning disabilities and its impact on school performance. This case report examines the potential contributory factors, but also the recent evidence on the co-morbidity between literacy difficulties and mental illnesses in children. METHOD Reporting a two years follow-up of a 9.5 years old child with SLD suffering from childhood depression. RESULTS A 9.5 years old child with no history of affective disorders, but with a family history of first-degree and second-degree relative suffering from childhood-onset, recurrent, bipolar or psychotic depression. The child was assessed by a child psychiatrist during a period of 2 years, with an average of follow-ups between 1 or 2 weeks. The discussion highlights diagnostic and treatment pitfalls, as well as developmental issues. Practical interventions are suggested. CONCLUSION A psychiatrically charged familial environment, including a mother suffering from anxiety disorder and behavioral disorder, contribute significantly to the development of depression in early age. An early medical intervention would be the key for successful treatment. The combination of psychotherapy and antidepressants (mostly selective serotonin reuptake inhibitors (SSRIs)) is the suggested therapy for childhood MDD.
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Windsor RB, Sierra M, Zappitelli M, McDaniel M. Beyond Amitriptyline: A Pediatric and Adolescent Oriented Narrative Review of the Analgesic Properties of Psychotropic Medications for the Treatment of Complex Pain and Headache Disorders. CHILDREN-BASEL 2020; 7:children7120268. [PMID: 33276542 PMCID: PMC7761583 DOI: 10.3390/children7120268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 12/12/2022]
Abstract
Children and adolescents with recurrent or chronic pain and headache are a complex and heterogenous population. Patients are best served by multi-specialty, multidisciplinary teams to assess and create tailored, individualized pain treatment and rehabilitation plans. Due to the complex nature of pain, generalizing pharmacologic treatment recommendations in children with recurrent or chronic pains is challenging. This is particularly true of complicated patients with co-existing painful and psychiatric conditions. There is an unfortunate dearth of evidence to support many pharmacologic therapies to treat children with chronic pain and headache. This narrative review hopes to supplement the available treatment options for this complex population by reviewing the pediatric and adult literature for analgesic properties of medications that also have psychiatric indication. The medications reviewed belong to medication classes typically described as antidepressants, alpha 2 delta ligands, mood stabilizers, anti-psychotics, anti-sympathetic agents, and stimulants.
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Gkouliama A, Samakouri M, Serdari A. School bullying and minority identity as a menace to mental well-being of students in Greece. BJPsych Int 2020; 18:60-63. [PMID: 34382951 PMCID: PMC8314986 DOI: 10.1192/bji.2020.51] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/11/2020] [Accepted: 09/15/2020] [Indexed: 11/24/2022] Open
Abstract
Increasing migration and the resultant multiculturalism in Greek society has highlighted the importance of studying the role of school ethnic composition in bullying and peer victimisation, not least because ethnic minority students involved in bullying behaviours seem to experience high levels of internalising and externalising problems. It is imperative that schools work towards ensuring a safe environment for all students. This can be achieved through the implementation of policies that facilitate positive social interactions and address issues of bias-based bullying, thus contributing to social justice. This article examines school bullying and related policies in Greece in the context of increasing diversity and reviews their evolution in the past decade.
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Ang YS, Frontero N, Belleau E, Pizzagalli DA. Disentangling vulnerability, state and trait features of neurocognitive impairments in depression. Brain 2020; 143:3865-3877. [PMID: 33176359 PMCID: PMC7805803 DOI: 10.1093/brain/awaa314] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/15/2020] [Accepted: 07/31/2020] [Indexed: 12/15/2022] Open
Abstract
Depression is a debilitating disorder that often starts manifesting in early childhood and peaks in onset during adolescence. Neurocognitive impairments have emerged as clinically important characteristics of depression, but it remains controversial which domains specifically index pre-existing vulnerability, state-related or trait-related markers. Here, we disentangled these effects by analysing the Adolescent Brain Cognitive Development dataset (n = 4626). Using information of participants' current and past mental disorders, as well as family mental health history, we identified low-risk healthy (n = 2100), high-risk healthy (n = 2023), remitted depressed (n = 401) and currently depressed children (n = 102). Factor analysis of 11 cognitive variables was performed to elucidate latent structure and canonical correlation analyses conducted to probe regional brain volumes reliably associated with the cognitive factors. Bayesian model comparison of various a priori hypotheses differing in how low-risk healthy, high-risk healthy, remitted depressed and currently depressed children performed in various cognitive domains was performed. Factor analysis revealed three domains: language and reasoning, cognitive flexibility and memory recall. Deficits in language and reasoning ability, as well as in volumes of associated regions such as the middle temporal and superior frontal gyrus, represented state- and trait-related markers of depression but not pre-existing vulnerability. In contrast, there was no compelling evidence of impairments in other domains. These findings-although cross-sectional and specific to 9-10-year-old children-might have important clinical implications, suggesting that cognitive dysfunction may not be useful targets of preventive interventions. Depressed patients, even after remission, might also benefit from less commonly used treatments such as cognitive remediation therapy.
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Gerritsen SE, Dieleman GC, Beltman MAC, Tangenbergh AAM, Maras A, van Amelsvoort TAMJ, van Staa A. Transitional psychiatry in the Netherlands: Experiences and views of mental health professionals. Early Interv Psychiatry 2020; 14:684-690. [PMID: 31747718 PMCID: PMC7687088 DOI: 10.1111/eip.12890] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 09/26/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND The majority of psychopathology emerges in late adolescence and continues into adulthood. Continuity of care must be guaranteed in this life phase. The current service configuration, with a distinction between child/adolescent and adult mental health services (CAMHS and AMHS), impedes continuity of care. AIM To map professionals' experiences with and attitudes towards young people's transition from CAMHS to AMHS and the problems they encounter. METHODS An online questionnaire distributed among professionals providing mental health care to young people (15-25 years old) with psychiatric disorders. RESULTS Five hundred and eighteen professionals completed the questionnaire. Decision-making regarding transition is generally based on the professional's own deliberations. The preparation was limited to discussing changes with the adolescent and parents. Most transition-related problems are experienced in CAMHS, primarily with regard to collaboration with AMHS. Respondents report that the developmental age should be leading in the transition-decision making process and that developmentally appropriate services are important in bridging the gap. CONCLUSION Professionals in CAMHS and AMHS experience problems in the preparation of, and the collaboration during transition. The problems are related to coordination, communication and rules and regulations. Professionals attach importance to improvement through an increase in flexibility and more specialist services for youth.
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146
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Davies V. A model for specific goals for in-patient treatment linked to resources and limitations in out-patient treatment. BJPsych Bull 2020; 44:275-276. [PMID: 32327004 PMCID: PMC7684771 DOI: 10.1192/bjb.2020.31] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
The author reflects on the Norwegian inpatient service descriptions contained in Wilkinson's article, considering the challenges laid out in his piece from the perspective of a child and adolescent psychiatrist working in a hospital crisis setting, as well as within the context of child and adolescent mental healthcare staffing across the UK.
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[Comparison of Inpatients in Child Psychiatry in Rostock Between 1960 and 2015]. Prax Kinderpsychol Kinderpsychiatr 2020; 69:737-748. [PMID: 33245032 DOI: 10.13109/prkk.2020.69.8.737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Comparison of Inpatients in Child Psychiatry in Rostock Between 1960 and 2015 Since its beginnings, child psychiatry has been subject to permanent change due to social changes and thus different expectations of the field, developments in diagnostics, therapy and the respective classification systems. After 1949 Child and Adolescent Psychiatry in the German Democratic Republic (GDR) underwent an independent and somatically oriented development. Although assumed that there was systematic injustice in inpatient facilities of child psychiatry in the GDR, no study from this period has been published to our knowledge up to now. The work presented here begins to close this gap by comparing data from 1960 with current data (2015) of the Child and Adolescent Psychiatry Department at the Rostock Medical Center. Significant differences between results from 1960 and 2015 indicate a currently higher number of admissions, only half the length of stay, an alignment in the gender ratio, a trend towards adolescent patients, a shift away from the 1960 dominant intelligence impairment towards behavioural and emotional disorders, a higher proportion of children and adolescents treated with drugs, and more specialist follow-up treatments after the inpatient stay in 2015. We found no evidence of forced medication in 1960. The discussion also addresses the danger of a solitary development of child psychiatry away from a medical to a more social psychiatric, educational and therapeutic subject.
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Fibert P, Relton C. What families in the UK use to manage attention-deficit/hyperactivity disorder (ADHD): a survey of resource use. BMJ Paediatr Open 2020; 4:e000771. [PMID: 33294627 PMCID: PMC7689584 DOI: 10.1136/bmjpo-2020-000771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 10/13/2020] [Accepted: 10/15/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE To identify interventions being used to manage attention-deficit/hyperactivity disorder (ADHD) in the UK. DESIGN A survey within the Sheffield Treatments for ADHD Research project. A convenience sample of participants in the UK who consented to join an observational cohort were asked closed questions about medication, behavioural change programmes and service use, and an open-ended question about what else they used. SETTING A broad variety of non-National Health Service, non-treatment seeking settings throughout the UK, including local authority organisations, schools, ADHD and autism spectrum condition support groups and social media. PARTICIPANTS Families of children aged 5-18 with carer reported ADHD and Conners Global Index (CGI) T scores of 55+. RESULTS Responses from 175 families were analysed. The mean age of the children was 10.21 (2.44), and two-thirds (n=114) had additional diagnoses. The majority used medications to manage ADHD (n=120) and had participated in a parenting class (n=130). Just over a quarter (28%, n=49) did not use ADHD medications, and used sleep medications. Just under half had consulted psychologists (n=83), and 32 had participated in other talking therapies such as psychotherapy, counselling and cognitive-behavioural therapy. A few used aids such as reward charts or fiddle toys (n=17) and participated in activities (mostly physical) (n=14). A substantial minority (78/175) had used non-mainstream treatments, the most popular being homoeopathy (n=32), nutritional interventions (n=21) and bodywork such as massage or cranial osteopathy (n=9). CONCLUSIONS Families reported use of a wide variety of treatments to help with management of their children with ADHD in addition to their use of mainstream treatments.
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Winarizal AS, Horvath A, Sawyer SM. Measuring functional recovery in somatic symptom and related disorders: a scoping review. Arch Dis Child 2020; 105:1086-1092. [PMID: 32398323 DOI: 10.1136/archdischild-2020-318955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/21/2020] [Accepted: 04/09/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Somatic symptom and related disorders (SSRDs) are prevalent, heterogenous conditions that have the potential to profoundly affect normative function in children and adolescents. Yet there is little understanding of pathways to recovery. This study aimed to systematically scope how functional recovery has been measured in children and adolescents with SSRD . DESIGN Scoping review of primary studies. METHOD Medline (Ovid) and PsychInfo were systematically searched for publications from January 1998 to April 2019. Primary studies in English that reported functional outcomes of children and adolescents with SSRD were included. Case reports and population studies were excluded. Within the tools and clinician notes, the core domains of functional outcome were identified. RESULTS Sixteen studies were identified that used 11 different functional outcome tools. The domains assessed within these functional outcome tools, together with the domains noted by clinicians, included physical and mental health symptoms, as well as school attendance and academic outcomes, recreational participation, impact on family and service utilisation. There was no evidence of a preferred outcome measure as only two of the tools were used in more than one study. CONCLUSIONS The variability of tools and domains used to measure functional recovery in children and adolescents with SSRD suggests lack of conceptual agreement about what constitutes functional recovery. Continued focus on symptom measurement or mental health comorbidities risks limiting research to single types of disorder (eg, functional neurological disability) or interventions, which threatens a much needed wider research agenda around appropriate treatment, including of complex and persistent disorders.
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Bettencourt AF, Plesko CM. A Systematic Review of the Methods Used to Evaluate Child Psychiatry Access Programs. Acad Pediatr 2020; 20:1071-1082. [PMID: 32673763 DOI: 10.1016/j.acap.2020.07.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 06/12/2020] [Accepted: 07/12/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is a well-documented gap between the need for and availability of mental health services for children nationwide. To address this gap, over 30 regional Child Psychiatry Access Programs (CPAPs) provide psychiatric consultation and other services to primary care providers. OBJECTIVE Summarize the methods used to evaluate CPAPs in the United States. DATA SOURCES PubMed, PsychInfo, CINAHL, and reference checking. STUDY APPRAISAL METHODS A systematic literature review was conducted searching 3 databases. The search produced 307 unique articles, 278 were excluded for irrelevance, leaving 29 for data extraction. Data extracted included author(s), publication year, provider types, CPAP formats, study sample, design, outcomes examined, results, and limitations. Articles were also appraised for quality using the Johns Hopkins Nursing Evidence-Based Practice Evidence Level and Quality Guide. RESULTS The 29 articles evaluated 13 unique CPAPs. Most evaluations used nonexperimental observational designs (68.9%), 6.9% used quasi-experimental designs, and none used true experimental designs. Evaluations examined the following outcomes: usage of program services (82.8%), provider satisfaction (48.3%), provider comfort/confidence with managing mental health concerns (31.0%), provider practice change (24.1%), patient outcomes (13.7%), and family satisfaction (6.9%). Outcomes were measured using surveys, qualitative interviews, or insurance claims data. LIMITATIONS Review was limited to articles published in English in 3 databases or identified by reference checking. CONCLUSIONS Evaluations of CPAPs have largely been descriptive in nature, focusing primarily on program usage and provider satisfaction. Few studies have examined the impact of CPAPs on patients, families, or health systems. Future studies should evaluate the broader impacts of CPAPs.
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