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Rahali M, Fongaro E, Franc N, Nesensohn J, Purper-Ouakil D, Kerbage H. Expected changes in parenting after an online parent training for ADHD. Encephale 2024; 50:59-67. [PMID: 37005192 DOI: 10.1016/j.encep.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 12/26/2022] [Accepted: 01/10/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children and adolescents. Treatments for this population should be multidisciplinary and must be initiated as early as possible. Non-pharmacological interventions for ADHD include psychoeducation, parent behavioural training programs and school interventions and accommodations. In response to the COVID-19 pandemic, we developed an online version of a combined psychoeducation and behavioural training program to facilitate access to mental health treatment and ensure continuity of care. OBJECTIVE The study assessed the acceptability of this online parent training program, among parents and caretakers of children and adolescents with ADHD. METHODS The program consisted of ten online sessions over the course of two consecutive days (five sessions a day). Satisfaction, usefulness and general comments about the program were assessed with open-ended questions and visual-analogous scales. Parents/caretakers' use of strategies to manage behavioural problems was assessed using the Parenting and Family Adjustment Scales. RESULTS A total of 206 parents participated in the online program 175 of whom completed the evaluation. Participants were satisfied with the content of the program. More than half of participants had already started using strategies included in the program. The engagement was high and no major obstacles were identified other than some internet connection issues. DISCUSSION In our survey, online delivery was described as more convenient, and participants were satisfied with the content of the program finding it beneficial for their child. Despite this, some difficulties in implementing new strategies were observed. Online BTP increased access to the BTP programs while being effective on ADHD symptoms and behavioural disturbances. CONCLUSIONS With these measures, we hope to improve engagement in online psychoeducation and behavioural therapy programs. Future research evaluating online behavioural training programs should focus on ways to make them more accessible and adaptable to families' obstacles.
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Affiliation(s)
- M Rahali
- Médecine Psychologique de l'Enfant et de l'Adolescent MPEA1, Hôpital Saint-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34090 Montpellier, France
| | - E Fongaro
- Médecine Psychologique de l'Enfant et de l'Adolescent MPEA1, Hôpital Saint-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34090 Montpellier, France; CESP, Inserm U 1018, UVSQ Psychiatry Development and Trajectories, Villejuif, France.
| | - N Franc
- Médecine Psychologique de l'Enfant et de l'Adolescent MPEA1, Hôpital Saint-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34090 Montpellier, France
| | - J Nesensohn
- Médecine Psychologique de l'Enfant et de l'Adolescent MPEA1, Hôpital Saint-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34090 Montpellier, France
| | - D Purper-Ouakil
- Médecine Psychologique de l'Enfant et de l'Adolescent MPEA1, Hôpital Saint-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34090 Montpellier, France; CESP, Inserm U 1018, UVSQ Psychiatry Development and Trajectories, Villejuif, France
| | - H Kerbage
- Médecine Psychologique de l'Enfant et de l'Adolescent MPEA1, Hôpital Saint-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34090 Montpellier, France; CESP, Inserm U 1018, UVSQ Psychiatry Development and Trajectories, Villejuif, France
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Hervé MJ, Picot MC, Maury M, Kerbage H, Purper-Ouakil D. Adaptation of the working alliance inventory to therapeutic interventions for early-age regulatory and behavioral symptoms: French versions of the infant-toddler WAI for parents and therapists. Encephale 2023; 49:564-571. [PMID: 36253176 DOI: 10.1016/j.encep.2022.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/06/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The therapeutic alliance, an essential component of the therapeutic process, has been investigated in adult and child therapy, but studies in the context of parent-infant or parent-toddler therapeutic interventions are scarce. This monocentric study aims to produce a French cross-cultural adaptation of a therapeutic alliance scale for the context of early consultations in a child and psychiatry department. METHOD Fifty-five young children aged 3 to 30 months consulting for regulation or behavioral disorders and their mothers were included in the study. The working alliance inventory (WAI) was translated into French by two bilingual translators and adapted to early-age consultations in parent and therapist versions. Assessments of the child's symptoms and the parents' anxiety and depression were carried out at the start and end of therapy. We studied the association of the alliance with the initial clinical characteristics and with the outcome of the child and the mother. An exploratory factor analysis was performed considering the items most associated with expected outcomes. RESULTS The alliance coded by the mother was lower in case of child behavioral problems and was associated with the mother and child outcome. Short versions of the infant-toddler WAI were developed based on factor analysis, highlighting four factors: positive goals and tasks, bond with the mother, alliance with the child, negative experience of care relationship. DISCUSSION Results were similar to those found in therapy with adults or older children. The alliance issue in mother-baby therapies was as essential as in other therapy contexts. The short Infant-Toddler WAI resulting from this work must be validated in future studies.
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Affiliation(s)
- M-J Hervé
- Department of Child and Adolescent Psychiatry, CHRU Montpellier, St Eloi University Hospital, 80, avenue Augustin Fliche, 34295 Montpellier cedex 5, France.
| | - M-C Picot
- Clinical research and epidemiology unit (Department of Medical Information), CHRU Montpellier, University of Montpellier, Montpellier, France; Centre de Recherche en Épidémiologie et Santé des Populations (CESP), U1018, INSERM, Université Paris-Saclay, Villejuif, France
| | - M Maury
- Department of Child and Adolescent Psychiatry, CHRU Montpellier, St Eloi University Hospital, 80, avenue Augustin Fliche, 34295 Montpellier cedex 5, France
| | - H Kerbage
- Department of Child and Adolescent Psychiatry, CHRU Montpellier, St Eloi University Hospital, 80, avenue Augustin Fliche, 34295 Montpellier cedex 5, France
| | - D Purper-Ouakil
- Department of Child and Adolescent Psychiatry, CHRU Montpellier, St Eloi University Hospital, 80, avenue Augustin Fliche, 34295 Montpellier cedex 5, France
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Singh SP, Tuomainen H, Bouliotis G, Canaway A, De Girolamo G, Dieleman GC, Franić T, Madan J, Maras A, McNicholas F, Paul M, Purper-Ouakil D, Santosh P, Schulze UME, Street C, Tremmery S, Verhulst FC, Wells P, Wolke D, Warwick J. Effect of managed transition on mental health outcomes for young people at the child-adult mental health service boundary: a randomised clinical trial. Psychol Med 2023; 53:2193-2204. [PMID: 37310306 PMCID: PMC10123823 DOI: 10.1017/s0033291721003901] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/03/2021] [Accepted: 09/03/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Poor transition planning contributes to discontinuity of care at the child-adult mental health service boundary (SB), adversely affecting mental health outcomes in young people (YP). The aim of the study was to determine whether managed transition (MT) improves mental health outcomes of YP reaching the child/adolescent mental health service (CAMHS) boundary compared with usual care (UC). METHODS A two-arm cluster-randomised trial (ISRCTN83240263 and NCT03013595) with clusters allocated 1:2 between MT and UC. Recruitment took place in 40 CAMHS (eight European countries) between October 2015 and December 2016. Eligible participants were CAMHS service users who were receiving treatment or had a diagnosed mental disorder, had an IQ ⩾ 70 and were within 1 year of reaching the SB. MT was a multi-component intervention that included CAMHS training, systematic identification of YP approaching SB, a structured assessment (Transition Readiness and Appropriateness Measure) and sharing of information between CAMHS and adult mental health services. The primary outcome was HoNOSCA (Health of the Nation Outcome Scale for Children and Adolescents) score 15-months post-entry to the trial. RESULTS The mean difference in HoNOSCA scores between the MT and UC arms at 15 months was -1.11 points (95% confidence interval -2.07 to -0.14, p = 0.03). The cost of delivering the intervention was relatively modest (€17-€65 per service user). CONCLUSIONS MT led to improved mental health of YP after the SB but the magnitude of the effect was small. The intervention can be implemented at low cost and form part of planned and purposeful transitional care.
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Affiliation(s)
- S. P. Singh
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
- Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - H. Tuomainen
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - G. Bouliotis
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - A. Canaway
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - G. De Girolamo
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - G. C. Dieleman
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - T. Franić
- Department of Psychiatry, Clinical Hospital Center Split, Split, Croatia
| | - J. Madan
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - A. Maras
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, the Netherlands
- Yulius Academy, Rotterdam, the Netherlands
| | - F. McNicholas
- Department of Child and Adolescent Psychiatry, University College Dublin School of Medicine and Medical Science, Dublin, Republic of Ireland
- Geary Institute, University College Dublin, Dublin, Republic of Ireland
- Department of Child Psychiatry, Our Lady's Hospital for Sick Children, Dublin, Republic of Ireland
- Lucena Clinic SJOG, Dublin, Republic of Ireland
| | - M. Paul
- Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - D. Purper-Ouakil
- Centre Hospitalier Universitaire de Montpellier, Saint Eloi Hospital, Unit of Child and Adolescent Psychiatry (MPEA1), Montpellier, France
| | - P. Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD), National and Specialist Child and Adolescent Mental Health Services, Maudsley Hospital, London, UK
- HealthTracker Ltd, Gillingham, UK
| | - U. M. E. Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - C. Street
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - S. Tremmery
- Department of Neurosciences, Child & Adolescent Psychiatry, University of Leuven, Leuven, Belgium
| | - F. C. Verhulst
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - P. Wells
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - D. Wolke
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
- Department of Psychology, University of Warwick, Coventry, UK
| | - J. Warwick
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
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Fongaro E, Picot MC, Stringaris A, Belloc C, Verissimo AS, Franc N, Purper-Ouakil D. Parent training for the treatment of irritability in children and adolescents: a multisite randomized controlled, 3-parallel-group, evaluator-blinded, superiority trial. BMC Psychol 2022; 10:273. [DOI: 10.1186/s40359-022-00984-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/09/2022] [Indexed: 11/24/2022] Open
Abstract
Abstract
Background
Irritability is common in children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD) and with anxiety/depressive disorders. Although youth irritability is linked with psychiatric morbidity, little is known regarding its non-pharmacological treatments. Developing non-pharmacological treatments for children with severe, chronic irritability is an important target for clinical research. To achieve this goal, we will test the benefits of parent-focused therapies in reducing irritability. The aim of the study is to compare Parent Management Training (PMT) and Non-Violent Resistance Training (NVR) programs with treatment-as-usual (TAU) on the improvement of irritability in children and adolescents with a baseline Parent-rated Affective Reactivity Index of 4 or higher, in the context of ADHD and other emotional and behavioural disorders. Additionally, we will assess (i) improvement of irritability at different times and according to different informants (parents, children, clinicians); (ii) improvement of parental strategies; and (iii) acceptability of the interventions, exploring possible mechanisms of the therapeutic effect.
Methods
Two hundred and seventy participants between 6 and 15 years with ADHD and other emotional and behavioural disorders will be recruited and randomly assigned with their parents to the PMT, NVR, and TAU groups. PMT and NVR programs have 10 online sessions and two booster sessions at 1 and at 3 months. The primary outcome measure is the change from baseline at 3 months after completion of the program of the Clinician-rated Affective Rating Scale (CL-ARI) assessed by a blind evaluator. Secondary outcome measures include the change from baseline from those scales: the CL-ARI, the Clinical Global Impression Improvement scale, the Parenting and Familial Adjustment Scales, the Child-rated Cranky thermometers and the Parent-rated ARI. We will assess the parent’s expressed emotions and reflexivity during the online five-minute speech sample, clinical dimensions through the Child Behavior Checklist 6–18 and the Inventory of Callous Unemotional traits. Evaluations will be done remotely at baseline and at 1- and 3-months follow-up visits.
Discussion
We expect a benefit in controlling irritability in the treatment groups. This will constitute an important achievement in promoting parental support programs in the treatment of irritability in the context of emotional and behavioural disorders.
Clinicaltrials.gov. Number: NCT05528926. Registered on the 2nd of September, 2022.
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Vacher C, Romo L, Dereure M, Soler M, Picot MC, Purper-Ouakil D. Efficacy of cognitive behavioral therapy on aggressive behavior in children with attention deficit hyperactivity disorder and emotion dysregulation: study protocol of a randomized controlled trial. Trials 2022; 23:124. [PMID: 35130934 PMCID: PMC8819925 DOI: 10.1186/s13063-022-05996-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) is frequently associated with emotional dysregulation (ED). ED is characterized by excessive and inappropriate emotional reactions compared to social norms, uncontrolled and rapid shifts in emotion, and attention focused on emotional stimuli. Few studies have evaluated non-pharmacological interventions to improve ED in children with ADHD. The current randomized controlled trial assesses the efficacy of a cognitive behavioral therapy (CBT) intervention compared with a theater-based intervention (TBI) in children with ADHD and ED. METHODS Sixty-eight 7- to 13-year-old children with ADHD and ED will be recruited and randomly assigned to the CBT or TBI group. CBT aims to reduce ED by teaching anger management strategies. TBI seeks to reduce ED by improving emotion understanding and expression through mimics and movement. In both groups, children participate in 15 1-h sessions, and parents participate in 8 sessions of a parent management program. The primary outcome measure is the change in the "Aggression" sub-score of the Child Behavior Checklist (CBCL). Secondary outcome measures include overall impairment (Children's Global Assessment Scale, Strengths and Difficulties Questionnaire), personality profile (Hierarchical Personality Inventory for Children), executive function (Behavioral Rating Inventory of Executive Function), quality of life (Kidscreen-27), parental stress (Parenting Stress Index, 4th edition), parental depression (Beck Depression Inventory-II), and impact of child disorders on the quality of the family life (Parental Quality of Life and Developmental Disorder). DISCUSSION Children with ADHD and ED are at risk of functional impairment and poor outcomes and have specific therapeutic needs. This randomized controlled trial wants to assess non-pharmacological treatment options for this population. TRIAL REGISTRATION Clinicaltrials.gov. NCT03176108 . Registered on June 5, 2017.
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Affiliation(s)
- C Vacher
- Centre Hospitalo-Universitaire de Montpellier, Service Médecine Psychologique de l'Enfant et de l'Adolescent, Montpellier, Hérault, France. .,CLIPSYD EA-4430, UFR Sciences Psychologiques et Sciences de l'Education, Université de Nanterre, Nanterre, Hauts de Seine, France. .,INSERM U 1018, CESP, Psychiatrie du développement - Evaluer et traiter les troubles émotionnels et du neurodéveloppement (ETE-ND), Montpellier, France.
| | - L Romo
- CLIPSYD EA-4430, UFR Sciences Psychologiques et Sciences de l'Education, Université de Nanterre, Nanterre, Hauts de Seine, France.,Service de Pathologies professionnelles et de l'environnement, Assistance Publique des Hôpitaux de Paris, Hôpital Universitaire Raymond Poincaré, Garches, France
| | - M Dereure
- Unité de Recherche Clinique et Epidémiologie, Département de l'Information Médicale, Centre Hospitalo-Universitaire de Montpellier, Montpellier, Hérault, France
| | - M Soler
- Unité de Recherche Clinique et Epidémiologie, Département de l'Information Médicale, Centre Hospitalo-Universitaire de Montpellier, Montpellier, Hérault, France
| | - M C Picot
- Unité de Recherche Clinique et Epidémiologie, Département de l'Information Médicale, Centre Hospitalo-Universitaire de Montpellier, Montpellier, Hérault, France.,Centre d'Investigation Clinique, Hôpital Saint Eloi, Centre Hospitalo-Universitaire de Montpellier, Montpellier, Hérault, France
| | - D Purper-Ouakil
- Centre Hospitalo-Universitaire de Montpellier, Service Médecine Psychologique de l'Enfant et de l'Adolescent, Montpellier, Hérault, France.,INSERM U 1018, CESP, Psychiatrie du développement - Evaluer et traiter les troubles émotionnels et du neurodéveloppement (ETE-ND), Montpellier, France
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6
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Bobo E, Fongaro E, Lin L, Gétin C, Gamon L, Picot MC, Purper-Ouakil D. Mental Health of Children With Attention Deficit and Hyperactivity Disorder and Their Parents During the COVID-19 Lockdown: A National Cross-Sectional Study. Front Psychiatry 2022; 13:902245. [PMID: 35770061 PMCID: PMC9234728 DOI: 10.3389/fpsyt.2022.902245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/19/2022] [Indexed: 11/16/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has caused a real disruption of children's lives. Children with neurodevelopmental disorders and their parents seem to be particularly vulnerable to adverse mental health effects due to lockdown policies. This study explores the psychological state of children with Attention Deficit Hyperactivity Disorder (ADHD) and their parents during the first lockdown in France. A national prospective cross-sectional parent-reported study was conducted using an online survey disseminated through different social networks of French ADHD associations during the first lockdown. The survey consisted of open-ended, multiple-choice questions and standardized questionnaires such as the Strengths and Difficulties Questionnaire (SDQ), the coping self-report questionnaire (Brief COPE) and the Patient Health Questionnaire-2 (PHQ-2). A total of 538 parents completed the online survey between the 6th and the 15th of April 2020. These results suggest that most children (65.29%) did not experience a worsening of their behavior but still had pathological levels of hyperactivity (56.47%) and behavioral (57.60%) symptoms at the time of the first lockdown. In addition, some parents (26.27%) showed responses indicating possible major depressive disorder. Positive parental coping strategies were associated with both improved child behavior and fewer parental depressive symptoms. Strengthening parents' coping strategies may be an effective intervention to protect both parents and children with ADHD from the negative psychological effects of lockdown. In times of pandemic, psychological care modalities must evolve to provide quality online interventions for families of children with ADHD.
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Affiliation(s)
- E Bobo
- CHU Montpellier, Saint Eloi Hospital, Unit for Child and Adolescent Psychiatry (MPEA1), Montpellier, France
| | - E Fongaro
- CHU Montpellier, Saint Eloi Hospital, Unit for Child and Adolescent Psychiatry (MPEA1), Montpellier, France.,Center for Research in Epidemiology and Population Health (CESP), INSERM U 1018, Paris-Saclay University, Villejuif, France
| | - L Lin
- Clinical Research and Epidemiology Unit, Department of Medical Information, University Hospital Medical Center, Montpellier, France
| | - C Gétin
- Hyper-Super, TDAH France, Paris, France
| | - L Gamon
- Clinical Research and Epidemiology Unit, Department of Medical Information, University Hospital Medical Center, Montpellier, France
| | - M-C Picot
- Center for Research in Epidemiology and Population Health (CESP), INSERM U 1018, Paris-Saclay University, Villejuif, France.,Clinical Research and Epidemiology Unit, Department of Medical Information, University Hospital Medical Center, Montpellier, France
| | - D Purper-Ouakil
- CHU Montpellier, Saint Eloi Hospital, Unit for Child and Adolescent Psychiatry (MPEA1), Montpellier, France.,Center for Research in Epidemiology and Population Health (CESP), INSERM U 1018, Paris-Saclay University, Villejuif, France.,Hyper-Super, TDAH France, Paris, France
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7
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Gerritsen SE, van Bodegom LS, Dieleman GC, Overbeek MM, Verhulst FC, Wolke D, Rizopoulos D, Appleton R, van Amelsvoort TAMJ, Bodier Rethore C, Bonnet-Brilhault F, Charvin I, Da Fonseca D, Davidović N, Dodig-Ćurković K, Ferrari A, Fiori F, Franić T, Gatherer C, de Girolamo G, Heaney N, Hendrickx G, Jardri R, Kolozsvari A, Lida-Pulik H, Lievesley K, Madan J, Mastroianni M, Maurice V, McNicholas F, Nacinovich R, Parenti A, Paul M, Purper-Ouakil D, Rivolta L, de Roeck V, Russet F, Saam MC, Sagar-Ouriaghli I, Santosh PJ, Sartor A, Schulze UME, Scocco P, Signorini G, Singh SP, Singh J, Speranza M, Stagi P, Stagni P, Street C, Tah P, Tanase E, Tremmery S, Tuffrey A, Tuomainen H, Walker L, Wilson A, Maras A. Demographic, clinical, and service-use characteristics related to the clinician's recommendation to transition from child to adult mental health services. Soc Psychiatry Psychiatr Epidemiol 2022; 57:973-991. [PMID: 35146551 PMCID: PMC9042957 DOI: 10.1007/s00127-022-02238-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 01/22/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE The service configuration with distinct child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) may be a barrier to continuity of care. Because of a lack of transition policy, CAMHS clinicians have to decide whether and when a young person should transition to AMHS. This study describes which characteristics are associated with the clinicians' advice to continue treatment at AMHS. METHODS Demographic, family, clinical, treatment, and service-use characteristics of the MILESTONE cohort of 763 young people from 39 CAMHS in Europe were assessed using multi-informant and standardized assessment tools. Logistic mixed models were fitted to assess the relationship between these characteristics and clinicians' transition recommendations. RESULTS Young people with higher clinician-rated severity of psychopathology scores, with self- and parent-reported need for ongoing treatment, with lower everyday functional skills and without self-reported psychotic experiences were more likely to be recommended to continue treatment. Among those who had been recommended to continue treatment, young people who used psychotropic medication, who had been in CAMHS for more than a year, and for whom appropriate AMHS were available were more likely to be recommended to continue treatment at AMHS. Young people whose parents indicated a need for ongoing treatment were more likely to be recommended to stay in CAMHS. CONCLUSION Although the decision regarding continuity of treatment was mostly determined by a small set of clinical characteristics, the recommendation to continue treatment at AMHS was mostly affected by service-use related characteristics, such as the availability of appropriate services.
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Affiliation(s)
- S E Gerritsen
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
| | - L S van Bodegom
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
- Yulius Academy, Yulius Mental Health Organization, Dordrecht, The Netherlands
| | - G C Dieleman
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands.
| | - M M Overbeek
- Yulius Academy, Yulius Mental Health Organization, Dordrecht, The Netherlands
- Clinical Child and Family Studies, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - F C Verhulst
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - D Wolke
- Department of Psychology, University of Warwick, Coventry, UK
| | - D Rizopoulos
- Department of Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - R Appleton
- NIHR Mental Health Policy Research Unit, Division of Psychiatry, University College London, London, UK
| | - T A M J van Amelsvoort
- Department of Psychiatry and Neuropsychology, University of Maastricht, Maastricht, The Netherlands
- Mondriaan Mental Health Care, Heerlen, The Netherlands
| | | | | | - I Charvin
- Centre Hospitalier Universitaire de Marseille, Marseille, France
| | - D Da Fonseca
- Centre Hospitalier Universitaire de Marseille, Marseille, France
| | - N Davidović
- University Hospital Split, Split, Croatia
- School of Medicine, University of Split, Split, Croatia
| | - K Dodig-Ćurković
- Faculty for Dental Care and Health, Osijek, Croatia
- University Health Center Osijek, Osijek, Croatia
- Unit for Child and Adolescent Psychiatry, Osijek, Croatia
| | - A Ferrari
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
- DISM, ULSS 16, SOPROXI Onlus, Padua, Italy
| | - F Fiori
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK
- HealthTracker Ltd, Kent, UK
| | - T Franić
- University Hospital Split, Split, Croatia
- School of Medicine, University of Split, Split, Croatia
| | - C Gatherer
- Warwick Medical School, University of Warwick, Coventry, UK
| | - G de Girolamo
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - N Heaney
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - G Hendrickx
- Department of Neurosciences, Centre for Clinical Psychiatry, KU Leuven, Leuven, Belgium
| | - R Jardri
- Lille Neurosciences and Cognitions, Plasticity and Subjectivity Team, CURE Platform, Université de Lille, INSERM (U-1172), Fontan Hospital, CHU Lille, Lille, France
| | | | | | - K Lievesley
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - J Madan
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - M Mastroianni
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK
| | - V Maurice
- Centre Hospitalier Universitaire de Montpellier, Saint Eloi Hospital, Montpellier, France
| | - F McNicholas
- School of Medicine & Medical Science, University College Dublin, Dublin, Republic of Ireland
- Lucena CAMHS, SJOG, Dublin, Republic of Ireland
| | - R Nacinovich
- Child and Adolescent Neuropsychiatry Unit, ASST Monza, Monza, Italy
- Università Degli Studi Milano Bicocca, Milan, Italy
| | - A Parenti
- Centre Hospitalier Universitaire de Lille, Lille, France
| | - M Paul
- Warwick Medical School, University of Warwick, Coventry, UK
- Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - D Purper-Ouakil
- Centre Hospitalier Universitaire de Montpellier, Saint Eloi Hospital, Montpellier, France
- INSERM, CESP U1018, PsyDev, University Paris Saclay, UVSQ, Versailles, France
| | - L Rivolta
- Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Center, Brescia, Italy
- Department of Mental Health, Psychiatry Unit, San Gerardo Hospital, Monza, Monza Brianza, Italy
| | - V de Roeck
- Department of Neurosciences, KU Leuven, Leuven, Belgium
- Child and Youth Studies, Campus Social School, University Colleges Leuven Limburg, Heverlee, Belgium
| | - F Russet
- Centre Hospitalier Universitaire de Montpellier, Saint Eloi Hospital, Montpellier, France
| | - M C Saam
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - I Sagar-Ouriaghli
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - P J Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK
- HealthTracker Ltd, Kent, UK
| | - A Sartor
- Josefinum Augsburg, Klinik für Kinder- und Jugenspsychiatrie und Psychotherapie, Augsburg, Germany
| | - U M E Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - P Scocco
- Department of Mental Health, ULSS 6 Euganea, Padua, Italy
- SOPROXI Onlus, Padua, Italy
| | - G Signorini
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - S P Singh
- Warwick Medical School, University of Warwick, Coventry, UK
| | - J Singh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK
| | - M Speranza
- INSERM, CESP U1018, PsyDev, University Paris Saclay, UVSQ, Versailles, France
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Centre Hospitalier de Versailles, Versailles, France
| | - P Stagi
- Child and Adolescent Neuropsychiatry Unit, AUSL Modena, Modena, Italy
| | - P Stagni
- IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
- Child and Adolescent Neuropsychiatry, Department of Mental Health, Modena, Italy
| | - C Street
- Warwick Medical School, University of Warwick, Coventry, UK
| | - P Tah
- Warwick Medical School, University of Warwick, Coventry, UK
| | - E Tanase
- Abteilung für Psychiatrie und Psychotherapie des Kindes-und Jugendalters Weissenau, ZfP Südwürttemberg, Ravensburg, Germany
| | - S Tremmery
- Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - A Tuffrey
- Warwick Medical School, University of Warwick, Coventry, UK
| | - H Tuomainen
- Warwick Medical School, University of Warwick, Coventry, UK
| | - L Walker
- Warwick Medical School, University of Warwick, Coventry, UK
| | - A Wilson
- Warwick Medical School, University of Warwick, Coventry, UK
| | - A Maras
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, P.O. Box 2060, 3000 CB, Rotterdam, The Netherlands
- Yulius Academy, Yulius Mental Health Organization, Dordrecht, The Netherlands
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Hervé MJ, Maurice V, Gamon L, Rusconi Serpa S, Trojan D, Guedeney N, Tereno S, Guedeney A, Myquel M, Fernandez A, Raynaud JP, Poinso F, Maury M, Purper-Ouakil D, Picot MC. Predictive factors for the outcome of emotional and/or behavioural disorders in 18- to 48-month-old children after parent-child psychotherapy: Protocol of a European prospective cohort study. Encephale 2022; 49:254-260. [DOI: 10.1016/j.encep.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 10/09/2021] [Accepted: 10/19/2021] [Indexed: 10/19/2022]
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9
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Maurice V, Didillon A, Purper-Ouakil D, Kerbage H. Adapting a parent training program to the COVID-19 crisis in a mental health care setting in France. Encephale 2021; 48:354-358. [PMID: 34649712 PMCID: PMC8504859 DOI: 10.1016/j.encep.2021.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/28/2021] [Accepted: 06/12/2021] [Indexed: 11/02/2022]
Affiliation(s)
- V Maurice
- Centre hospitalier universitaire de Montpellier, Saint Eloi Hospital, 80, avenue Augustin Fliche, 34195 Montpellier, France.
| | - A Didillon
- Centre hospitalier universitaire de Montpellier, Saint Eloi Hospital, 80, avenue Augustin Fliche, 34195 Montpellier, France
| | - D Purper-Ouakil
- Centre hospitalier universitaire de Montpellier, Saint Eloi Hospital, 80, avenue Augustin Fliche, 34195 Montpellier, France; Inserm U 1018, CESP, psychiatry, development and trajectories, Paris, France
| | - H Kerbage
- Centre hospitalier universitaire de Montpellier, Saint Eloi Hospital, 80, avenue Augustin Fliche, 34195 Montpellier, France
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10
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Fond G, Franc N, Sarfati Y, Purper-Ouakil D, Boyer L. [Psychological development of children born by medically assisted procreation]. Encephale 2021; 46:167-168. [PMID: 32546294 DOI: 10.1016/j.encep.2020.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- G Fond
- Marseille Univ, faculté de médecine - secteur Timone, EA 3279 : CEReSS - Centre d'étude et de recherche sur les services de santé et la qualité de vie, hôpital La Conception, Assistance publique des Hôpitaux de Marseille, Marseille, France.
| | - N Franc
- Service universitaire de pédopsychiatrie, CHU Montpellier, Montpellier, France
| | - Y Sarfati
- Service universitaire de pédopsychiatrie, CHU Montpellier, Montpellier, France
| | - D Purper-Ouakil
- Service universitaire de pédopsychiatrie, CHU Montpellier, Montpellier, France
| | - L Boyer
- Marseille Univ, faculté de médecine - secteur Timone, EA 3279 : CEReSS - Centre d'étude et de recherche sur les services de santé et la qualité de vie, hôpital La Conception, Assistance publique des Hôpitaux de Marseille, Marseille, France
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11
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Santosh P, Adams L, Fiori F, Davidović N, de Girolamo G, Dieleman GC, Franić T, Heaney N, Lievesley K, Madan J, Maras A, Mastroianni M, McNicholas F, Paul M, Purper-Ouakil D, Sagar-Ouriaghli I, Schulze U, Signorini G, Street C, Tah P, Tremmery S, Tuomainen H, Verhulst FC, Warwick J, Wolke D, Singh J, Singh SP. Protocol for the development and validation procedure of the managing the link and strengthening transition from child to adult mental health care (MILESTONE) suite of measures. BMC Pediatr 2020; 20:167. [PMID: 32299401 PMCID: PMC7161143 DOI: 10.1186/s12887-020-02079-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 04/13/2020] [Indexed: 02/06/2023] Open
Abstract
Background Mental health disorders in the child and adolescent population are a pressing public health concern. Despite the high prevalence of psychopathology in this vulnerable population, the transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) has many obstacles such as deficiencies in planning, organisational readiness and policy gaps. All these factors contribute to an inadequate and suboptimal transition process. A suite of measures is required that would allow young people to be assessed in a structured and standardised way to determine the on-going need for care and to improve communication across clinicians at CAMHS and AMHS. This will have the potential to reduce the overall health economic burden and could also improve the quality of life for patients travelling across the transition boundary. The MILESTONE (Managing the Link and Strengthening Transition from Child to Adult Mental Health Care) project aims to address the significant socioeconomic and societal challenge related to the transition process. This protocol paper describes the development of two MILESTONE transition-related measures: The Transition Readiness and Appropriateness Measure (TRAM), designed to be a decision-making aide for clinicians, and the Transition Related Outcome Measure (TROM), for examining the outcome of transition. Methods The TRAM and TROM have been developed and were validated following the US FDA Guidance for Patient-reported Outcome Measures which follows an incremental stepwise framework. The study gathers information from service users, parents, families and mental health care professionals who have experience working with young people undergoing the transition process from eight European countries. Discussion There is an urgent need for comprehensive measures that can assess transition across the CAMHS/AMHS boundary. This study protocol describes the process of development of two new transition measures: the TRAM and TROM. The TRAM has the potential to nurture better transitions as the findings can be summarised and provided to clinicians as a clinician-decision making support tool for identifying cases who need to transition and the TROM can be used to examine the outcomes of the transition process. Trial registration MILESTONE study registration: ISRCTN83240263 Registered 23-July-2015 - ClinicalTrials.gov NCT03013595 Registered 6 January 2017.
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Affiliation(s)
- P Santosh
- Department of Child and Adolescent Psychiatry, King's College London, London, UK. .,Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK. .,HealthTracker Ltd, Gillingham, Kent, UK.
| | - L Adams
- School of Psychology, Plymouth University, Plymouth, UK
| | - F Fiori
- Department of Child and Adolescent Psychiatry, King's College London, London, UK.,Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK.,HealthTracker Ltd, Gillingham, Kent, UK
| | - N Davidović
- Department of Psychiatry, Clinical Hospital Center Split, Split, Croatia
| | - G de Girolamo
- Unità di Psichiatria Epidemiologica e Valutativa, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - G C Dieleman
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - T Franić
- Department of Psychiatry, Clinical Hospital Center Split, Split, Croatia
| | - N Heaney
- Department of Child and Adolescent Psychiatry, King's College London, London, UK
| | - K Lievesley
- Department of Child and Adolescent Psychiatry, King's College London, London, UK
| | - J Madan
- Warwick Clinical Trials Unit, Warwick Medical School, Warwick Medical School, Coventry, UK
| | - A Maras
- Yulius Academy, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - M Mastroianni
- Department of Child and Adolescent Psychiatry, King's College London, London, UK
| | - F McNicholas
- Department of Child and Adolescent Psychiatry, University College Dublin School of Medicine and Medical Science, Dublin, Republic of Ireland.,Geary Institute, University College Dublin, Dublin, Republic of Ireland.,Department of Child Psychiatry, Our Lady's Hospital for Sick Children, Dublin, Republic of Ireland.,Lucena Clinic, SJOG, Dublin, Republic of Ireland
| | - M Paul
- Centre for Mental Health and Wellbeing Research, Warwick Medical School, University of Warwick, Coventry, UK.,Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - D Purper-Ouakil
- CHU Montpellier / University of Montpellier; Saint Eloi Hospital, Médecine Psychlogique de l'enfant et de adolescent (MPEA1), Montpellier, France
| | - I Sagar-Ouriaghli
- Department of Child and Adolescent Psychiatry, King's College London, London, UK
| | - U Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - G Signorini
- Unità di Psichiatria Epidemiologica e Valutativa, IRCCS Istituto Centro San Giovanni di Dio Fatebenefratelli, Brescia, Italy
| | - C Street
- Centre for Mental Health and Wellbeing Research, Warwick Medical School, University of Warwick, Coventry, UK
| | - P Tah
- Centre for Mental Health and Wellbeing Research, Warwick Medical School, University of Warwick, Coventry, UK
| | - S Tremmery
- Department of Neurosciences, Child & Adolescent Psychiatry, University of Leuven, Leuven, Belgium.,Department of Child & Adolescent Psychiatry, University Hospitals Leuven, Leuven, Belgium
| | - H Tuomainen
- Centre for Mental Health and Wellbeing Research, Warwick Medical School, University of Warwick, Coventry, UK
| | - F C Verhulst
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - J Warwick
- Warwick Clinical Trials Unit, Warwick Medical School, Warwick Medical School, Coventry, UK
| | - D Wolke
- Centre for Mental Health and Wellbeing Research, Warwick Medical School, University of Warwick, Coventry, UK.,Department of Psychology, University of Warwick, Coventry, UK
| | - J Singh
- Department of Child and Adolescent Psychiatry, King's College London, London, UK.,Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, South London and Maudsley NHS Foundation Trust, London, UK
| | - S P Singh
- Centre for Mental Health and Wellbeing Research, Warwick Medical School, University of Warwick, Coventry, UK.,Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
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12
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Carballo JJ, Llorente C, Kehrmann L, Flamarique I, Zuddas A, Purper-Ouakil D, Hoekstra PJ, Coghill D, Schulze UME, Dittmann RW, Buitelaar JK, Castro-Fornieles J, Lievesley K, Santosh P, Arango C. Psychosocial risk factors for suicidality in children and adolescents. Eur Child Adolesc Psychiatry 2020; 29:759-776. [PMID: 30684089 PMCID: PMC7305074 DOI: 10.1007/s00787-018-01270-9] [Citation(s) in RCA: 142] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/20/2018] [Indexed: 12/28/2022]
Abstract
Suicidality in childhood and adolescence is of increasing concern. The aim of this paper was to review the published literature identifying key psychosocial risk factors for suicidality in the paediatric population. A systematic two-step search was carried out following the PRISMA statement guidelines, using the terms 'suicidality, suicide, and self-harm' combined with terms 'infant, child, adolescent' according to the US National Library of Medicine and the National Institutes of Health classification of ages. Forty-four studies were included in the qualitative synthesis. The review identified three main factors that appear to increase the risk of suicidality: psychological factors (depression, anxiety, previous suicide attempt, drug and alcohol use, and other comorbid psychiatric disorders); stressful life events (family problems and peer conflicts); and personality traits (such as neuroticism and impulsivity). The evidence highlights the complexity of suicidality and points towards an interaction of factors contributing to suicidal behaviour. More information is needed to understand the complex relationship between risk factors for suicidality. Prospective studies with adequate sample sizes are needed to investigate these multiple variables of risk concurrently and over time.
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Affiliation(s)
- J. J. Carballo
- grid.4795.f0000 0001 2157 7667Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, CIBERSAM, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Madrid, Spain
| | - C. Llorente
- grid.4795.f0000 0001 2157 7667Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, CIBERSAM, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Madrid, Spain
| | - L. Kehrmann
- grid.4795.f0000 0001 2157 7667Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, CIBERSAM, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Madrid, Spain
| | - I. Flamarique
- grid.410458.c0000 0000 9635 9413Child and Adolescent Psychiatry and Psychology Department, 2014SGR489, Institute Clinic of Neurosciences, Hospital Clinic of Barcelona, CIBERSAM, Barcelona, Spain
| | - A. Zuddas
- grid.7763.50000 0004 1755 3242Child and Adolescent Neuropsychiatry Unit, Department of Biomedical Sciences, University of Cagliari, and “A. Cao” Paediatric Hospital, “G. Brotzu” Hospital Trust, Cagliari University Hospital, Cagliari, Italy
| | - D. Purper-Ouakil
- grid.414352.5CHRU Montpellier, Hôpital Saint Eloi, Médecine Psychologique de l’Enfant et de l’Adolescent, Montpellier, France
| | - P. J. Hoekstra
- grid.4494.d0000 0000 9558 4598Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - D. Coghill
- grid.1008.90000 0001 2179 088XDepartment of Paediatrics, School of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia ,grid.1008.90000 0001 2179 088XDepartment of Psychiatry, School of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia ,grid.1058.c0000 0000 9442 535XMurdoch Children’s Research Institute, Melbourne, Australia ,grid.8241.f0000 0004 0397 2876Division of Neuroscience, School of Medicine, University of Dundee, Dundee, UK
| | - U. M. E. Schulze
- grid.6582.90000 0004 1936 9748Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - R. W. Dittmann
- grid.7700.00000 0001 2190 4373Paediatric Psychopharmacology, Department of Child and Adolescent Psychiatry, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - J. K. Buitelaar
- grid.10417.330000 0004 0444 9382Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, and Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
| | - J. Castro-Fornieles
- grid.410458.c0000 0000 9635 9413Child and Adolescent Psychiatry and Psychology Department, 2014SGR489, Institute Clinic of Neurosciences, Hospital Clinic of Barcelona, CIBERSAM, Barcelona, Spain ,grid.418264.d0000 0004 1762 4012Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Barcelona, Spain ,grid.5841.80000 0004 1937 0247Department of Psychiatry and Clinical Psychology, University of Barcelona, Barcelona, Spain
| | - K. Lievesley
- grid.13097.3c0000 0001 2322 6764Department of Child and Adolescent Psychiatry, Institute of Psychology, Psychiatry and Neuroscience, King’s College London, London, UK ,grid.37640.360000 0000 9439 0839Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD), South London and Maudsley NHS Foundation Trust, London, UK ,HealthTracker Ltd, Gillingham, Kent UK
| | - Paramala Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychology, Psychiatry and Neuroscience, King's College London, London, UK. .,Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD), South London and Maudsley NHS Foundation Trust, London, UK. .,HealthTracker Ltd, Gillingham, Kent, UK.
| | - C. Arango
- grid.4795.f0000 0001 2157 7667Child and Adolescent Psychiatry Department, Hospital General Universitario Gregorio Marañón, CIBERSAM, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), School of Medicine, Universidad Complutense, Madrid, Spain
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13
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Tuomainen H, Schulze U, Warwick J, Paul M, Dieleman G, Franić T, Madan J, Maras A, McNicholas F, Purper-Ouakil D, Santosh P, Signorini G, Street C, Tremmery S, Verhulst F, Wolke D, Singh SP. Managing the link and strengthening transition from child to adult mental health Care in Europe (MILESTONE): background, rationale and methodology. BMC Psychiatry 2018; 18:167. [PMID: 29866202 PMCID: PMC5987458 DOI: 10.1186/s12888-018-1758-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 05/22/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Transition from distinct Child and Adolescent Mental Health (CAMHS) to Adult Mental Health Services (AMHS) is beset with multitude of problems affecting continuity of care for young people with mental health needs. Transition-related discontinuity of care is a major health, socioeconomic and societal challenge globally. The overall aim of the Managing the Link and Strengthening Transition from Child to Adult Mental Health Care in Europe (MILESTONE) project (2014-19) is to improve transition from CAMHS to AMHS in diverse healthcare settings across Europe. MILESTONE focuses on current service provision in Europe, new transition-related measures, long term outcomes of young people leaving CAMHS, improving transitional care through 'managed transition', ethics of transitioning and the training of health care professionals. METHODS Data will be collected via systematic literature reviews, pan-European surveys, and focus groups with service providers, users and carers, and members of youth advocacy and mental health advocacy groups. A prospective cohort study will be conducted with a nested cluster randomised controlled trial in eight European Union (EU) countries (Belgium, Croatia, France, Germany, Ireland, Italy, Netherlands, UK) involving over 1000 CAMHS users, their carers, and clinicians. DISCUSSION Improving transitional care can facilitate not only recovery but also mental health promotion and mental illness prevention for young people. MILESTONE will provide evidence of the organisational structures and processes influencing transition at the service interface across differing healthcare models in Europe and longitudinal outcomes for young people leaving CAMHS, solutions for improving transitional care in a cost-effective manner, training modules for clinicians, and commissioning and policy guidelines for service providers and policy makers. TRIAL REGISTRATION "MILESTONE study" registration: ISRCTN ISRCTN83240263 Registered 23 July 2015; ClinicalTrials.gov NCT03013595 Registered 6 January 2017.
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Affiliation(s)
- H. Tuomainen
- Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - U. Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - J. Warwick
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - M. Paul
- Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | - G.C. Dieleman
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, Netherlands
| | - T. Franić
- Department of Psychiatry, Clinical Hospital Center Split, Split, Croatia
| | - J. Madan
- Warwick Medical School, University of Warwick, Coventry, UK
| | - A. Maras
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, Netherlands
- Yulius Academy, Yulius Mental Health Organization, Barendrecht, Netherlands
| | - F. McNicholas
- Department of Child and Adolescent Psychiatry, University College Dublin School of Medicine and Medical Science, Dublin, Republic of Ireland
- Geary Institute, University College Dublin, Dublin, Republic of Ireland
- Department of Child Psychiatry, Our Lady’s Hospital for Sick Children, Dublin, Republic of Ireland
- Lucena Clinic SJOG, Dublin, Republic of Ireland
| | - D. Purper-Ouakil
- Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - P. Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- HealthTracker Ltd, Gillingham, UK
- Centre for Interventional Paediatric Psychopharmacology and Rare Diseases (CIPPRD), National and Specialist Child and Adolescent Mental Health Services, Maudsley Hospital, London, UK
| | - G. Signorini
- Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Center, Brescia, Italy
| | - C. Street
- Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - S. Tremmery
- Department of Neurosciences, Child & Adolescent Psychiatry, University of Leuven, Leuven, Belgium
- Department of Child & Adolescent Psychiatry, University Hospitals Leuven, Leuven, Belgium
| | - F.C. Verhulst
- Department of Child and Adolescent Psychiatry and Psychology, Erasmus Medical Center, Rotterdam, Netherlands
| | - D. Wolke
- Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
- Department of Psychology, University of Warwick, Coventry, UK
| | - S. P. Singh
- Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
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Bousquet E, Franc N, Ha C, Purper-Ouakil D. Troubles disruptifs intrafamiliaux : données actuelles et perspectives de traitement. Encephale 2018; 44:176-182. [DOI: 10.1016/j.encep.2017.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/17/2017] [Accepted: 09/06/2017] [Indexed: 11/29/2022]
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Arns M, Batail JM, Bioulac S, Congedo M, Daudet C, Drapier D, Fovet T, Jardri R, Le-Van-Quyen M, Lotte F, Mehler D, Micoulaud-Franchi JA, Purper-Ouakil D, Vialatte F. Neurofeedback: One of today's techniques in psychiatry? Encephale 2017; 43:135-145. [DOI: 10.1016/j.encep.2016.11.003] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/20/2016] [Accepted: 11/21/2016] [Indexed: 11/15/2022]
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Purper-Ouakil D, Porfirio MC, Le Strat Y, Falissard B, Gorwood P, Masi G. What do childhood attention deficit/hyperactivity symptoms in depressed adults tell us about the bipolar spectrum? Psychiatry Res 2017; 249:244-251. [PMID: 28126580 DOI: 10.1016/j.psychres.2016.12.055] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Revised: 06/15/2016] [Accepted: 12/31/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND This study aims to establish if adult patients with major depressive disorder (MDD) and childhood Attention Deficit/Hyperactivity disorder (ADHD) symptoms would be more frequently within the bipolar spectrum than depressed patients without childhood ADHD. METHODS This study was carried out in outpatients recruited by psychiatrists in private practice, with 3963 participants being included in the final sample. Clinicians filled out questionnaires about current depressive symptoms in their patients, lifetime bipolar symptoms, global assessment of functioning and parental history of both major depression and bipolar disorder. Patients assessed current level of anxiety and depressive symptoms and antecedents of childhood ADHD symptoms. RESULTS Depressed adults with significant childhood ADHD symptoms had a specific pattern of their major depressive episode compared to depressed patients without such symptoms. Subjects with childhood ADHD symptoms were more likely to report lifetime symptoms of mania/hypomania and to have a parent with type I or II bipolar disorder. The developmental trajectories of familial risk for lifetime bipolar symptoms showed that parental bipolar disorder influenced lifetime bipolar symptoms both through a direct pathway and an indirect pathway involving childhood ADHD symptoms. Childhood ADHD and number of depressive symptoms both made direct contributions to lifetime bipolar symptoms.
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Affiliation(s)
- D Purper-Ouakil
- Unit of Child and Adolescent Psychiatry (MPEA1), CHU Montpellier-Saint Eloi Hospital, Montpellier, France.
| | - M C Porfirio
- Unit of Child Neurology and Psychiatry of "Tor Vergata", University of Rome, Italy
| | - Y Le Strat
- AP-HP Hôpital Louis Mourier, 178 Rue des Renouillers, 92700 Colombes, France; INSERM U894 Centre Psychiatrie et Neurosciences, Paris, France
| | - B Falissard
- INSERM U1178, Maison de Solenn, Paris, France
| | - P Gorwood
- INSERM U894 Centre Psychiatrie et Neurosciences, Paris, France; CMME Saint Anne Hospital, Hôpital Sainte-Anne (Paris-Descartes University), France
| | - G Masi
- Stella Maris Scientific Institute of Child Neurology and Psychiatry, Calambrone, Pisa, Italy
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Flamarique I, Santosh P, Zuddas A, Arango C, Purper-Ouakil D, Hoekstra PJ, Coghill D, Schulze U, Dittmann RW, Buitelaar JK, Lievesley K, Frongia R, Llorente C, Méndez I, Sala R, Fiori F, Castro-Fornieles J. Development and psychometric properties of the Suicidality: Treatment Occurring in Paediatrics (STOP) Suicidality Assessment Scale (STOP-SAS) in children and adolescents. BMC Pediatr 2016; 16:213. [PMID: 27964729 PMCID: PMC5155380 DOI: 10.1186/s12887-016-0751-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 12/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To create a self-reported, internet-based questionnaire for the assessment of suicide risk in children and adolescents. METHODS As part of the EU project 'Suicidality: Treatment Occurring in Paediatrics' (STOP project), we developed web-based Patient Reported Outcome Measures (PROMs) for children and adolescents and for proxy reports by parents and clinicians in order to assess suicidality. Based on a literature review, expert panels and focus groups of patients, we developed the items of the STOP Suicidality Assessment Scale (STOP-SAS) in Spanish and English, translated it into four more languages, and optimized it for web-based presentation using the HealthTrackerTM platform. Of the total 19 questions developed for the STOP-SAS, four questions that assess low-level suicidality were identified as screening questions (three of them for use with children, and all four for use with adolescents, parents and clinicians). A total of 395 adolescents, 110 children, 637 parents and 716 clinicians completed the questionnaire using the HealthTrackerTM, allowing us to evaluate the internal consistency and convergent validity of the STOP-SAS with the clinician-rated Columbia Suicide Severity Rating Scale (C-SSRS). Validity was also assessed with the receiver operating characteristic (ROC) area of the STOP-SAS with the C-SSRS. RESULTS The STOP-SAS comprises 19 items in its adolescent, parent, and clinician versions, and 14 items in its children's version. Good internal consistency was found for adolescents (Cronbach's alpha: 0.965), children (Cronbach's alpha: 0.922), parents (Cronbach's alpha: 0.951) and clinicians (Cronbach's alpha: 0.955) versions. A strong correlation was found between the STOP-SAS and the C-SSRS for adolescents (r:0.670), parents (r:0.548), clinicians (r:0.863) and children (r:0.654). The ROC area was good for clinicians' (0.917), adolescents' (0.834) and parents' (0.756) versions but only fair (0.683) for children's version. CONCLUSIONS The STOP-SAS is a comprehensive, web-based PROM developed on the HealthTrackerTM platform, and co-designed for use by adolescents, children, parents and clinicians. It allows the evaluation of aspects of suicidality and shows good reliability and validity.
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Affiliation(s)
- I Flamarique
- Department of Child and Adolescent Psychiatry and Psychology, SGR1119, Institut Clinic de Neurociències, Hospital Clínic Universitari of Barcelona, Fundació Clínic per la Recerca Biomèdica, C/Villarroel, 170, Barcelona, 08036, Spain. .,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.
| | - P Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK.,Centre for Interventional Paediatric Psychopharmacology, South London and Maudsley NHS Foundation Trust, London, UK
| | - A Zuddas
- Department of Biomedical Sciences, Cagliari University Hospital, University of Cagliari, Cagliari, Italy
| | - C Arango
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - D Purper-Ouakil
- CHRU Montpellier, Hôpital Saint Eloi, Médecine Psychologique de l'Enfant et de l'Adolescent, Montpellier, France.,INSERM U894-Team 1. Center of Psychiatry and Neurosciences, Paris, France
| | - P J Hoekstra
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - U Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - R W Dittmann
- Paediatric Psychopharmacology, Department of Child and Adolescent Psychiatry, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - J K Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Medical Centre, and Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands
| | - K Lievesley
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - R Frongia
- Department of Biomedical Sciences, Cagliari University Hospital, University of Cagliari, Cagliari, Italy
| | - C Llorente
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - I Méndez
- Department of Child and Adolescent Psychiatry and Psychology, SGR1119, Institut Clinic de Neurociències, Hospital Clínic Universitari of Barcelona, Fundació Clínic per la Recerca Biomèdica, C/Villarroel, 170, Barcelona, 08036, Spain
| | - R Sala
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - F Fiori
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - J Castro-Fornieles
- Department of Child and Adolescent Psychiatry and Psychology, SGR1119, Institut Clinic de Neurociències, Hospital Clínic Universitari of Barcelona, Fundació Clínic per la Recerca Biomèdica, C/Villarroel, 170, Barcelona, 08036, Spain.,Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.,Department of Psychiatry and Clinical Psychology, University of Barcelona, Barcelona, Spain.,Institut d'Investigació Biomèdica August Pi i Sunyer, IDIBAPS, Barcelona, Spain
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Jeanne G, Purper-Ouakil D, Rigole H, Franc N. [New patterns of substance use and abuse among French adolescents, a knowledge synthesis]. Encephale 2016; 43:346-353. [PMID: 27720453 DOI: 10.1016/j.encep.2016.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 05/23/2016] [Accepted: 05/25/2016] [Indexed: 10/20/2022]
Abstract
AIM There have been significant changes in adolescent consumption habits over the past fifteen years. New molecules have been synthesized, new devices created and a number of products have increased in popularity; and as a result clinicians sometimes lack information. We chose to focus on this population because of its vulnerability, as adolescents show low sensitivity to long-term outcomes of their actions and may be easily influenced by peers as regards experimentation of new drugs. The most consumed products by adolescents in France are tobacco, alcohol and cannabis with the physiological effects and consumption patterns of these drugs well documented. The purpose of this review is to identify and describe other products that are frequently used by adolescents to get high, to increase performance, for purposes of self-medication or because of peer pressure. We summarized the current scientific evidence regarding drug availability, physical and chemical properties, pharmacodynamics and adverse effects. METHOD A literature review was conducted from 2000 to 2015 based on Pudmed, Google Scholar and governmental websites, using the following keyword alone or in combination: "adolescent", "new", "misuse", "abuse", "toxicity", "pharmacology" "cocaine", "MDMA", "inhalant", "poppers", "magic mushroom", "psilocybin", "designer drug", "legal high", "smart drug", "cathinone", "mephedrone", "cannabinoid", "prescription drug", "codeine", "opioid", "methylphenidate", "cough syrup", "purple drank". RESULTS New products, including synthetic cannabis, cathinone or purple drank seem to be the most dangerous. They are easily accessible and may lead to short-term severe or lethal complications. Other substances do not pose a major short-term health risk by themselves. However, their consumption may be an indication of other unhealthy risk behaviors, such as prescription drug use, which may be related to psychiatric comorbidity. Unfortunately, we do not have enough data to determine the long-term consequences of the use of these substances. Moreover, these products have a strong addictive potential and may be a risk factor for other addictions. For this reason, increased supervision is justified, both for surveillance and reduction of harm. CONCLUSION Taking care of an adolescent with substance abuse can be difficult. Updated information regarding these new substances and the particular danger they pose to adolescent health is needed. Informed clinicians can provide up to date and accurate information to the patient and family, assess potential risk factors and comorbidities, and provide appropriate support. Furthermore, because of the high prevalence of substance abuse in the adolescent population, systematic screening of adolescent consumption habit is useful to avoid or anticipate complications. Often, problematic substance consumption behaviors are signs of more complicated psychological or psychiatric issues. Substance abuse behaviors will often disappear over time but they can also become a major problem as the adolescent moves into adulthood. If problems persist, consultation with an addiction specialist may be warranted.
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Affiliation(s)
- G Jeanne
- Service de médecine psychologique pour l'enfant et l'adolescent (MPEA), CHU Saint-Éloi, 80, avenue Augustin-Fliche, 34090 Montpellier, France.
| | - D Purper-Ouakil
- Service de médecine psychologique pour l'enfant et l'adolescent (MPEA), CHU Saint-Éloi, 80, avenue Augustin-Fliche, 34090 Montpellier, France
| | - H Rigole
- Service de médecine interne et addictologie, CHU Saint-Éloi, 80, avenue Augustin-Fliche, 34090 Montpellier, France
| | - N Franc
- Service de médecine psychologique pour l'enfant et l'adolescent (MPEA), CHU Saint-Éloi, 80, avenue Augustin-Fliche, 34090 Montpellier, France.
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Purper-Ouakil D, Didillon A. [Psychopathology related to women pubertal precocity]. Encephale 2016; 42:453-457. [PMID: 27198075 DOI: 10.1016/j.encep.2015.06.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 05/17/2015] [Accepted: 06/22/2015] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Puberty is a developmental process characterized by hormonal and physical changes leading to the ability of reproduction. Precocious puberty, especially in girls, has been associated with an increased incidence of emotional and behavioral problems. Adolescence is a life stage influenced both by the biological changes of puberty and the emergence of new social challenges. In individuals facing these developmental issues at a younger age than expected, the exposure to internal and external stress factors may be greater than in other young people. METHODS This narrative review provides an overview of psychopathology associated with precocious puberty in order to raise awareness of clinicians dealing with adolescents at risk for adverse behavioral and emotional outcomes. Developmental challenges of standard puberty and adolescence will be outlined before a more detailed description of recent findings from clinical and epidemiological studies. Putative mechanisms underlying the association between precocious puberty and psychopathology will also be discussed. RESULTS Epidemiological studies have shown that an early onset of puberty in girls is associated with an earlier onset of sexuality, an earlier age of first birth and a lesser professional qualification regardless of cognitive abilities and socio-economic status. In both population studies and clinical cohorts, girls with an early age of puberty or in treatment for precocious puberty have more disruptive behavior disorders such as conduct disorders, more substance abuse disorders and delinquent behavior compared to their standard developing peers. Precocious puberty and behavioral problems may have common genetic and environmental risk factors. In young people with conduct disorders and early puberty, findings have emphasized the role of non-shared environmental factors. Low birth weight, obesity, exposure to endocrine-disrupting chemicals and adoption are potentially shared between both conditions. Early puberty in girls is also associated with psychosocial stressors and at-risk environments. The early development of secondary sexual characteristics in girls attracts older and more deviant peers, raising probability of sexual contacts but also of drug use and of a disengagement in school activities. Adolescence is the life stage during which prevalence of depressive disorders rises significantly, especially in girls. Hormonal changes and increase of the Body Mass Index leading to dissatisfaction with body image, have been put forward to explain this trend. Psychosocial challenges (emerging sexuality, instability of identity and social role) are other sources of stress at this particular period of life characterized by emotional hyper-reactivity. These stressors may have greater impact in young people showing a discrepancy between physical and affective maturation. Follow-up studies have shown that emotional and behavioral problems tend to lessen with time. Nevertheless, a heightened risk of depressive disorder remains in girls having had an early onset of puberty when other risk factors co-exist. CONCLUSION Early puberty, especially in girls, has been associated with a number of emotional and behavioral symptoms and difficulties in adaptive functioning. Even though these adverse outcomes seem to lessen with time, heightened risk for depression and negative impact on socio-professional outcomes persist in subjects with other risk factors. The impact of treatment of precocious puberty on psycho-behavioral outcomes is currently unknown. However, clinicians should be aware that the social and emotional challenges these adolescents with atypical pubertal development have to face put them at risk for psychopathology and are potentially accessible to preventive actions.
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Affiliation(s)
- D Purper-Ouakil
- Service de médecine psychologique de l'enfant et de l'adolescent, CHRU de Montpellier, hôpital Saint-Éloi, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France.
| | - A Didillon
- Service de médecine psychologique de l'enfant et de l'adolescent, CHRU de Montpellier, hôpital Saint-Éloi, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France
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Purper-Ouakil D, Cohen D, Flament MF. Les antidépresseurs chez l’enfant et l’adolescent : mise au point des données d’efficacité et de tolérance. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.neurenf.2011.03.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Purper-Ouakil D, Franc N. [Emotional dysfunctions in attention deficit hyperactivity disorder]. Arch Pediatr 2011; 18:679-85. [PMID: 21497072 DOI: 10.1016/j.arcped.2011.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Revised: 01/23/2011] [Accepted: 03/06/2011] [Indexed: 10/18/2022]
Abstract
Inattention, motor instability, and impulsivity, associated in varying degrees of severity depending on the clinical subtype, constitute the key symptoms of attention deficit/hyperactivity disorder (ADHD). However, emotional symptoms are frequent in patients with ADHD and may, in some cases, be responsible for a major part of the negative impact on functioning and outcome. Emotional problems have been described in ADHD even in the absence of characterized comorbid conditions such as depressive or anxiety disorders. They can manifest acutely in the form of severe tantrums and aggressive behaviour, generally in reaction to an environmental trigger, or show a more chronic course of irritable or labile mood. Symptoms of emotional undercontrol seem to occur more frequently when ADHD is associated with oppositional defiant behaviour, but they are not specific and may contribute to difficulties in making a differential diagnosis, especially with bipolar disorder and prodromal symptoms of personality disorders. The frequency and negative impact of emotional symptoms and the need to differentiate them from bipolar disorder has led some authors to the description of a novel clinical entity called "severe mood dysregulation" or "temper dysregulation with dysphoria." This article aims to review the recent literature on emotional symptoms associated with ADHD and to discuss relevant clinical and biological issues. Current research highlights the links between emotional self-regulation and executive functions and possible involvement of motivational systems. The role of environmental factors in the development of emotional regulation and self-control is another important issue, especially because environmental modification is the major focus of current preventive and therapeutic interventions.
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Affiliation(s)
- D Purper-Ouakil
- Service de psychopathologie de l'enfant et de l'adolescent, AP-HP, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France.
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Asch M, Cortese S, Perez Diaz F, Pelissolo A, Aubron V, Orejarena S, Acquaviva E, Mouren MC, Michel G, Gorwood P, Purper-Ouakil D. Psychometric properties of a French version of the junior temperament and character inventory. Eur Child Adolesc Psychiatry 2009; 18:144-53. [PMID: 19198924 DOI: 10.1007/s00787-008-0713-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Accepted: 06/18/2008] [Indexed: 11/24/2022]
Abstract
The junior temperament and character inventory (JTCI) has been developed for the assessment of temperament and character dimensions in childhood based on Cloninger's model of personality. We evaluated the psychometric proprieties of a French child and parent-rated version of the JTCI based on a previous German version, and assessed the correlations between the JTCI dimension scores and the scores on the child behavior checklist (CBCL) in a community sample of French children and adolescents aged 10-16 years. We used data from 452 child-rated and 233 -parent-rated JCTI. The psychometric properties (internal consistency and external validity in relation to the emotionality activity sociability (EAS) questionnaire) of the French JTCI were adequate in the parent-rated version. The parent-rated JTCI had overall better psychometric qualities than the child-rated version, but for both versions of the JTCI the confirmatory factor analysis showed low fit between the observed data and the original model. Dimensions of the EAS model were significantly correlated with the temperament scales of the JTCI. Further studies are required to improve the psychometric properties of the child-rated JTCI, and to provide insight about lacking fit of our data with the theoretical model.
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Affiliation(s)
- M Asch
- AP-HP, Service de Psychopathologie de l'Enfant et de l'Adolescent, Hôpital Robert Debré, Paris, France
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Wohl M, Boni C, Asch M, Cortese S, Orejarena S, Mouren MC, Gorwood P, Purper-Ouakil D. Lack of association of the dopamine transporter gene in a French ADHD sample. Am J Med Genet B Neuropsychiatr Genet 2008; 147B:1509-10. [PMID: 18214864 DOI: 10.1002/ajmg.b.30695] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Discrepancies in the role of the 40 bp VNTR polymorphism of the dopamine transporter gene (DAT1) in attention-deficit hyperactivity disorder (ADHD) could be due to various sources of genetic or phenotypical heterogeneity. We therefore analyzed a sample of 146 ADHD children and their parents, with a transmission disequilibrium test (TDT) design, assessing age, inattention, and hyperactivity dimensions and total score of the ADHD Rating Scale, the number of errors and the total score at Stroop Color-Word test, and the total score at the Trail Making Test. The TDT for 10-repeat (10-R) allele shows a perfect lack of transmission bias (Mc Nemar chi(2) = 0) and PBAT analyses showed no role of this polymorphism for any of the studied endophenotypes. Lack of statistical power is always a possibility, but with a sample size above the average of the majority of previous studies, and an odds ratio (number of transmitted versus untransmitted 10-R allele) of 1.00 exactly, this possibility may be considered as not very likely.
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Affiliation(s)
- M Wohl
- INSERM U 675, University Xavier Bichat (IFR02), Paris, France
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Purper-Ouakil D, Wohl M, Orejarena S, Cortese S, Boni C, Asch M, Mouren MC, Gorwood P. Pharmacogenetics of methylphenidate response in attention deficit/hyperactivity disorder: association with the dopamine transporter gene (SLC6A3). Am J Med Genet B Neuropsychiatr Genet 2008; 147B:1425-30. [PMID: 18563707 DOI: 10.1002/ajmg.b.30809] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Pharmacogenetic studies investigating the 40-bp VNTR polymorphism at SLC6A3 and methylphenidate response have shown conflicting results and large differences in study design and efficacy endpoints. Our objective was to investigate the relation between the 3'-VNTR at SLC6A3 and variability in methylphenidate response in a sample of 141 ADHD children and adolescents, assessed before and after methylphenidate treatment with both clinical and neuropsychological outcome measures. 10-R homozygotes were significantly overrepresented in the low response group, but no genotype effect was shown in cognitive variables improvement. A meta-analysis of pharmacogenetic studies with comparable data (responders vs. non-responders) on a total of 475 subjects showed a significant association between the 10-10 genotype and low rates of methylphenidate response (mean Odds Ratio = 0.46; 95% CI [0.28-0.76]). Heterogeneity between these studies did not reach a significant level but, as publications with different endpoints were excluded from this meta-analysis, our results do not rule out a possible influence of study design.
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Abstract
The need for specific psychopharmacology trials in the pediatric population has been recognized and promoted by clinicians and regulatory instances. There are indeed specificities in symptom expression and pharmacological characteristics in this population, and recent studies showed that extrapolation from adult data is not always possible. Available results are insufficient to provide effective guidance for prescription and long-term evaluation of risk/benefit ratio in most indications. The aim of this article is to give an overview of efficacy and safety data in pediatric psychopharmacology.
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Affiliation(s)
- D Purper-Ouakil
- Service de psychopathologie de l'enfant et de l'adolescent, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France.
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Delaunay E, Purper-Ouakil D, Mouren MC. Troubles oppositionnels de l’enfant et tyrannie intrafamiliale : vers l’individualisation de types cliniques. Annales Médico-psychologiques, revue psychiatrique 2008. [DOI: 10.1016/j.amp.2005.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Purper-Ouakil D, Cortese S, Wohl M, Asch M, Acquaviva E, Falissard B, Michel G, Gorwood P, Mouren MC. Predictors of diagnostic delay in a clinical sample of French children with attention-deficit/hyperactivity disorder. Eur Child Adolesc Psychiatry 2007; 16:505-9. [PMID: 17876509 DOI: 10.1007/s00787-007-0627-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2007] [Indexed: 11/29/2022]
Abstract
BACKGROUND Early recognition of attention-deficit/hyperactivity disorder (ADHD) may improve the educational and psychosocial outcome of most affected children. To date, factors associated with diagnostic delay of ADHD have not specifically been addressed. Aims of this study were to evaluate the mean diagnostic delay (time between first consultation and definite diagnosis) in a clinical sample of French children with ADHD referred to an outpatient university clinic, and to determine associated factors. METHOD A total of 129 consecutively referred ADHD patients aged 6-16 years. A detailed history of the children was obtained from their parents. The Kiddie-SADS-PL, the ADHD-Rating Scale, and the Clinical Global Impression Scale were used for clinical assessment. RESULTS Mean diagnostic delay was 32.89 months. A previous suspicion of ADHD by any health care professional, therapist or teacher was significantly associated with a reduced diagnostic delay. Co-morbidity with anxiety/depressive disorders and previous contact with a mental health professional were associated with a significant delay in diagnosis. CONCLUSION Delay in diagnosis of ADHD in France is among the longest reported. Children with co-morbid anxiety or depressive disorders are particularly at risk of having a significant delay in the diagnosis. Health professionals, therapists and teachers may play a relevant role to accelerate the diagnostic procedure.
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Purper-Ouakil D, Fourneret P, Wohl M, Rénéric JP. [Atomoxetine: a new treatment for Attention Deficit/Hyperactivity Disorder (ADHD) in children and adolescents]. Encephale 2005; 31:337-48. [PMID: 16142049 DOI: 10.1016/s0013-7006(05)82399-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This paper provides a review of safety and efficacy data as well as of pharmacological characteristics of atomoxetine, a new drug treatment for the Attention Deficit/Hyperactivity Disorder (ADHD). To date, the only pharmacological treatment available in France for children and adolescents diagnosed with ADHD is methylphenidate, a psychostimulant drug. However, the clinical response to methylphenidate may be absent or insufficient in about 20-30% drug-treated children while the occurrence of adverse effects with methylphenidate (sleep disturbances, loss of appetite, tics increase...) may sometimes require a dose reduction or even the discontinuation of the treatment. Atomoxetine is an alternative candidate drug for the treatment of ADHD. The drug has been developed with respect to the actual standards of investigation of drugs intended to a -pediatric use. Atomoxetine has been recently licensed in the USA for the treatment of ADHD. Atomoxetine is a potent inhibitor of the norepinephrine transporter that shows only mini-mal affinity for other neurotransmitter systems. Although pharmacokinetics of atomoxetine is influenced by the polymorphism of the CYP2D6 metabolic pathway, safety and -tolerability data reported during clinical trials did not show any difference in poor versus extensive metabolizers. In addition, atomoxetine does not inhibit nor induce the CYP2D6 enzymatic function. The major metabolite of atomoxetine is 4-hydroxyatomoxetine, a pharmacologically active metabolic found in very low plasma concentrations in pediatric patients, suggesting that it plays only a minor role in the norepinephrine reuptake inhibition. Preliminary studies were aimed to assess the effective dose range of atomoxetine and to evaluate its safety and efficacy on the reduction of ADHD symptoms in adults and children diagnosed with ADHD. Main data on the child and adolescent population were obtained in four double-blind, randomized, placebo-controlled trials: two identical pivotal trials, a multiple dose study, a once-daily dose study. The first two pivotal trials were carried out in ADHD children aged 7-13 years, treated with atomoxetine vs placebo for a duration of 9 weeks. Patients presenting comorbidities (ie conduct disorder, -anxiety, depression) as well as a history of previous treatment with methylphenidate were also eligible to participate. The primary outcome was the reduction of the score on the ADHD rating scale, ADHD-RS ; secondary criteria included the responder's rate (patients with an ADHD-RS score reduction of 25% or above), the Clinical Global Impression Scale and the Conners Parent Rating Scale. With a mean dose of 1.5 mg/kg/day, atomoxetine showed a significant reduction of mean ADHD-RS scores at endpoint (ANOVA, p<0.001) (table II). Yet, the clinical significance of both studies is limited since efficacy was scored only in a social/familial setting and not in classroom conditions. In addition, intermediate results from baseline to endpoint were not presented in the publication. The multiple dose trial showed a significant reduction of the symptom score at the 1.2 and 1.8 mg/kg/day doses. The objective of the last study was to assess the efficacy of a single daily dose of atomoxetine versus placebo during a 6 week-treatment. Patients were evaluated by parents, investigators, as well as by teachers. The superiority of atomoxetine was demonstrated as compared to the placebo and the effect size of the daily dosing was similar to that reported with multiple doses. Preliminary data on ADHD patients presenting comorbidities showed that atomoxetine alone signi-ficantly reduced the symptom scores of anxiety and depression and similarly to atomoxetine associated with fluoxetine. In ADHD children with the oppositional defiant disorder, oppositional symptoms were reduced in the group receiving atomoxetine 1.8 mg/kg/day. Preliminary results in children with ADHD and chronic tics or Tourette syndrome showed a significant reduction of ADHD symptoms and a tendency to the decrease of tics. Tolerance and safety data pooled from the child and adolescent trials were acceptable. Study discontinuations due to adverse events in the four registration studies were only 2.8%. The most frequent adverse effects reported were gastrointestinal symptoms and decreased appetite. Weight loss reported early in clinical studies tended to stabilize during the open-label extension phases lasting up to 9 months. A retrospective comparison showed that the adverse event profile of poor metabolizers was similar to that of extensive metabolizers. In summary, data presented suggest that atomoxetine is a safe and effective drug for the treatment of ADHD in children and adolescents. Further studies are expected to accurately define the place of atomoxetine in the treatment strategy of ADHD, a chronic and invalidating disorder affecting 3 to 7% of school-aged children.
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Affiliation(s)
- D Purper-Ouakil
- Service de Psychopathologie de l'Enfant et de l'Adolescent, Hôpital Robert Debré, boulevard Sérurier, 75019 Paris
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Abstract
Attention-deficit hyperactivity disorder (ADHD) is a common behavioral disorder observed during childhood, detected in 3% to 5% of school-age children. The disorder is characterised by marked inattention, hyperactivity, and impulsiveness. In most cases, symptoms can be treated by catecholamine-releasing drugs, such as methylphenidate. Children with ADHD are at higher risk for substance abuse and oppositional, conduct and mood disorders. Familial and adoption studies shed light on the genetic vulnerability of ADHD. Twin studies estimated the broad heritability to range between 40% and 90%. The mode of transmission is yet unknown, but is likely polygenic. Molecular genetic studies in ADHD should contribute to a greater understanding of the pathophysiology of the disorder (genetics of the vulnerability), and could help to select a more rational type of treatment (pharmacogenetic). Family-based association studies already performed are reviewed in this manuscript. Association studies, using haplotype relative risk (HRR) or transmission disequilibrium test (TDT) have focused on candidate genes which code for proteins potentially involved in the etiopathogenesis of the disorder. Genes involved in dopamine, serotonin, and noradrenalin systems have thus been assessed for their role in core features of ADHD, such as motor overactivity, inattention, and impulsiveness. According to a meta-analysis, the DAT1 gene, an obvious candidate gene in ADHD vulnerability, does not appear to be involved (OR = 1.13, p = 0.21). On the other hand, DRD4 (OR = 1.26, p = 0.01) and DRD5 (OR = 1.4, p = 0.01) are significantly associated to ADHD according to the present meta-analysis, confirming previous ones. Recent studies showed a trend for an association between one allele of the 5-HTT (considering case-control studies) and DBH (OR = 1.27, p = 0.06) genes and ADHD, but these positive findings have to be replicated. ADHD is a complex disorder with potentially many different risk factors. Genetic and phenotypic heterogeneity could explain why some association studies are positive, whereas others are negative. For instance, different developmental pathways are likely to lead to similar clinical outcomes. More clear-cut phenotypes, such as ADHD with conduct disorder, or ADHD with bipolar disorder, could be more homogenous, the genes involved being therefore more easy to detect. These phenotypes are beginning to be specifically studied in molecular genetics. In addition, the development of pharmacogenetics could help to identify predictors of clinical response for a specific type of treatment, which would be clearly helpful in clinical practice.
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Affiliation(s)
- M Wohl
- CHU Robert-Debré (AP-HP, Paris VII), 75019 Paris
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Abstract
Attention-deficit hyperactivity (ADHD) is a common disorder in school-aged children and is associated with significant impairment in social and academic functioning. Its recognition is based on congruent information from different sources, because most ADHD children and adolescents are not completely aware of impairments caused by inattention and/or hyperactivity/impulsivity. Fluctuations in symptom expression may complicate the diagnosis: during clinical examination or tests sessions, ADHD symptoms may be less severe than usual or completely absent. This review examines variations in ADHD symptoms due to environmental context, internal state, circadian factors, development, psychiatric comorbidity and discusses their clinical relevance. Generally, ADHD symptoms are pervasive and identified in different areas of functioning. Despite their chronicity, they show a relative context-dependency. An unfamiliar environment or situation may lessen symptoms. The same happens in dual relations or in calm settings, when the child receives attention and positive reinforcement from the adult. On the contrary, the classroom situation with its high stimulation level (noise, visual distractors, large class size) is likely to reveal or accentuate instability, impulsivity and inattention. Independently from objective symptom fluctuations, the impact of ADHD symptoms, and their consequences on self-esteem may also vary with the degree of environmental mismatch. Recent research in experimental psychology also draws attention to the motivational state of ADHD children: preference for immediate gratification and delay aversion may explain why most of them show satisfactory attentional capacities in certain activities (for instance video games or TV), while showing impairment in school work or in other effortful tasks. The diagnosis of the full ADHD syndrome requires significant impact on functioning in at least two areas. Some children with "situational" ADHD are impaired either in school setting or exclusively at home. Manuzza et al. report long-term outcome of "situational" versus "pervasive" ADHD. School-ADHD, in opposition to home-ADHD shows similarities with the full blown syndrome, as regards proportion of anti-social personality disorder, psycho-social functioning and academic/professional achievements. Moderate seasonal variations have also been identified with less ADHD symptoms in August. This result is likely to reflect a better fit between individual characteristics and environmental demands during school holidays rather than neurobiological changes, as there are no convincing arguments for seasonal fluctuations of serotoninergic tone in ADHD. Another cause for variations in ADHD symptom expression may be the co-occurrence of a mood disorder. Relationships between early-onset mania and ADHD are discussed. The appropriate definition of prepubertal mania is still in debate; its recognition is hindered by symptom overlap and high level of comorbid conditions. Chronic emotional dysregulation with irritability and frequent temper tantrums, sometimes viewed as characteristics of early-onset mania, might reflect a--possibly severe--sub-type of ADHD rather than a prodrome of bipolarity. A marked cyclicity of symptoms, with periodic accentuation of ADHD and mood symptoms, requires careful monitoring and systematic analysis of comorbid conditions. Clarification of the complex interrelations between ADHD and bipolar disorder will be obtained from long-term studies.
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Affiliation(s)
- D Purper-Ouakil
- Psychiatre Attachée, Service de Psychopathologie de l'Enfant et de l'Adolescent, Hôpital Robert Debré, 48 boulevard Sérurier, 75019 Paris, France
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Purper-Ouakil D, Wohl M, Mouren MC, Verpillat P, Adès J, Gorwood P. Meta-analysis of family-based association studies between the dopamine transporter gene and attention deficit hyperactivity disorder. Psychiatr Genet 2005; 15:53-9. [PMID: 15722958 DOI: 10.1097/00041444-200503000-00009] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Molecular genetic research has mainly focused on the D4 dopamine receptor (DRD4) and the dopamine transporter (DAT) genes in attention-deficit hyperactivity disorder (ADHD). A recent meta-analysis showed that the DRD4 gene has a significant role in the vulnerability to ADHD. OBJECTIVES With an equal number of positive and negative association studies between the 10-repeat of the DAT gene and ADHD, a meta-analysis is required for this other candidate gene. METHODS We re-analysed the 13 published family-based association studies between ADHD and the DAT gene. Following recent recommendations, different biases were specifically assessed, such as the sample-size effect and the time effect. RESULTS The meta-analysis showed no significant association between ADHD and the DAT gene (P = 0.21), but an important between-samples heterogeneity (P = 0.0009). Odds ratios above 1 are mostly observed in studies with a small number of informative transmissions, and decrease with larger sample size. CONCLUSIONS Contrary to what was found for the DRD4 gene, the 10-repeat allele of the DAT gene has at most a minor role in the genetic susceptibility of ADHD. The different biases detected herein probably explain the initial impression of a significant impact of the DAT gene on hyperactivity.
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Michel G, Le Heuzey MF, Purper-Ouakil D, Mouren-Siméoni MC. [Novelty seeking and risk taking behavior in adolescents]. Rev Infirm 2004:31-4. [PMID: 15984732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Affiliation(s)
- G Michel
- UPRES 2114, Université François-Rabelais, Tours
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Purper-Ouakil D, Michel G, Perez-Diaz F. Influence des traits de tempérament et du contextesur le choix des stratégies de coping dans une populationd'étudiants. Annales Médico-psychologiques, revue psychiatrique 2004. [DOI: 10.1016/j.amp.2004.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Michel G, Purper-Ouakil D, Leheuzey M, Mouren-Simeoni M. Pratiques sportives et corrélats psychopathologiques chez l’enfant et l’adolescent. ACTA ACUST UNITED AC 2003. [DOI: 10.1016/s0222-9617(03)00049-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Gasman L, Purper-Ouakil D, Michel G, Mouren-Siméoni MC, Bouvard M, Perez-Diaz F, Jouvent R. Cross-cultural assessment of childhood temperament. A confirmatory factor analysis of the French Emotionality Activity and Sociability (EAS) questionnaire. Eur Child Adolesc Psychiatry 2002; 11:101-7. [PMID: 12369768 DOI: 10.1007/s00787-002-0248-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The Emotionality Activity Sociability (EAS) questionnaire focuses on heritable individual differences in reactivity and behavior which are often referred to in developmental temperament research. Psychometric properties of the French version of EAS were examined in a sample of 197 school-children aged six to 12 years. Parents, teachers and children aged nine years and more completed parallel forms of the EAS questionnaire. Confirmatory factor analysis was used to examine the fit between the original factors and the data. Internal consistency of each subscale, inter-rater and external validity were also examined. Children-rated EAS showed the best indices of fit between the four hypothesized factors and the data, but internal consistency was generally lower than in adult-rated questionnaires. Shyness and sociability showed significant overlap in both parent and teacher-rated EAS. The low concordance between child and adult-ratings indicates that temperament evaluation and interpretation of items may be influenced by subjective and/or developmental factors. Results are discussed in the perspective of validity versus cross-cultural comparability of temperament measurement. The theoretical four-factor structure was not completely replicable in our sample.
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Affiliation(s)
- L Gasman
- Service de Psychopathologie de l'Enfant et de l'Adolescent, H6ĵital Robert Debré, Paris, France
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Purper-Ouakil D. Empirical guidelines for the use of antidepressants in childhood depressive disorders. Eur Psychiatry 2002. [DOI: 10.1016/s0924-9338(02)80341-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Purper-Ouakil D, Michel G, Mouren-Siméoni MC. [Vulnerability to depression in children and adolescents: update and perspectives]. Encephale 2002; 28:234-40. [PMID: 12091784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
Abstract
Depression in children and adolescents is associated with poor psychosocial functioning, high psychiatric comorbidity, risk of recurrent episodes or onset of bipolar disorder. These findings emphasize the importance of early identification of children and adolescents having elevated risk for future depression and further development, evaluation and greater availability of prevention strategies. Our review aims an update about depressive vulnerability in children and adolescents in the perspective of better identification of at-risk populations and targeting of prevention programs. Psychopathology, in particular anxiety and disruptive disorders are well identified risk-factors for later depression. Subclinical depressive symptomatology, also termed "demoralization", also identifies high-risk populations, likely to become incident cases of depression. It is still unclear whether this condition is prodromal depression, a specific clinical entity or the expression of biological and/or cognitive vulnerability. Familial risk for depressive disorders involves both genetic and psychosocial factors. Marital discord, poor communication and dysfunctional parenting practices are often present in families with affective disorders and can be implicated in increased depressive vulnerability in the offspring. Research on individual vulnerability in children and adolescents has focused on temperamental and cognitive characteristics. Temperament traits describe individual differences in reactivity and behavior. High emotionality, defined as the tendency to become upset easily and intensely has been associated with an increased risk for subsequent major depression. However, as the majority of high scorers will not become depressive cases, emotionality should not be the only criterion for selection of at-risk populations. Cognitive style including poor self esteem, low social competence and negative attributions are also associated with increased likelihood of depressive symptoms, but their predictive value for the onset of clinical depressive episodes needs further investigation. Familial and individual vulnerability is likely to heighten the depressogenic impact of life events and psycho-social adversity. Prevention interventions have been developed in the United States for children and adolescents at-risk for depression. In France, clinicians witness growing demands from families with affective illness concerned with risk of parent-child transmission of depressive vulnerability, prevention and early identification of symptoms. To meet this kind of emerging needs and to prevent family dysfunction, a preventive program targets offspring of depressed parents and uses clinician-based family approaches. Family and individual sessions aim a better understanding of illness experience and encourage the parents to identify and foster resilience in their children. Another type of preventive intervention focuses on children and adolescents with subclinical depressive symptoms, eventually associated with behavioral problems ou high level of parental conflict, recruited in school settings. These school-based interventions combine cognitive and social problem-solving techniques. Both familial and school-based preventive interventions have proven applicable and promising in high-risk children and adolescents. Perspectives are more systematic identification of risk groups, including youngsters with past or current non affective symptoms who might benefit from depression prevention, long-term evaluation and cross-cultural applications of prevention programs.
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Affiliation(s)
- D Purper-Ouakil
- CCA, Service de Psychopathologie de l'Enfant et de l'Adolescent, Hôpital Robert Debré, 75019 Paris, France
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Michel G, Le Heuzey M, Purper-Ouakil D, Mouren-Siméoni M. Recherche de sensations et conduites à risque chez l’adolescent. Annales Médico-psychologiques, revue psychiatrique 2001. [DOI: 10.1016/s0003-4487(01)00123-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Blondiaux I, Castro D, Hugonot-Diener L, Lebowitz J, Petot JM, Purper-Ouakil D, Rolland JP, Waintraud L, Waintraub M, Allilaire JF, Flament M, Guelfi JD, Hanin B, Nollet D, Pelissolo A, Thomas J. Lectures. Eur Psychiatry 2000; 15:35-38. [PMID: 11861136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
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