Children's mental health during the second year of COVID-19 pandemic in Lithuania: Parents' and children's perspectives

BACKGROUND

Understanding the long-term consequences of the COVID-19 pandemic on children's mental health is needed to deal with it successfully. Our study focuses on the pandemic's impact on children's mental health in the middle of its second year in Lithuania.

AIM

To assess the impact of the pandemic and related restrictions on the mental health of 11-17-year-old children in the second year of the pandemic from the perspectives of children and parents.

METHODS

389 11-17-year-old children and 392 parents/guardians participated in the study. Data were collected from March 9, 2021, to April 30, 2021. A cross-sectional study was conducted with two online questionnaires. Children provided information about changes in emotions and behavior during quarantine, and the influence this had on interpersonal relationships. Parents/guardians answered questions on their children's emotional state, behavior, relationships, and daily life.

RESULTS

Anxiety was the most frequent children's complaint. Girls reported the experience of getting angry more easily, anxiety, stress and tensions, profound tiredness, overall negative changes, and they were more worried about family and friends being infected, while boys were unable to participate in daily activities and were less worried about being infected. Children more frequently than parents reported severe loneliness, sadness, fatigue, impaired concentration, increased sleeping time, improved interpersonal relationships with friends and impaired ones with siblings, and feeling severely worried about family members or friends being infected. Parents more frequently reported children's inability to participate in daily activities, improved children-parent relations, and severe children's anxiety about being infected.

CONCLUSION

In its second year, the pandemic continues to have an extensive negative impact on children's mental health. Significant discrepancies were found between children and parents' perceptions of quarantine consequences on children's mental health, as parents tend to underestimate it. Such undervaluation can be an obstacle to getting mental health services for those children in need of them.

Self-Assessment of Addiction Medicine Core Competencies in Four Year Groups of Psychiatrists in Training: Efficacy of the Addiction Medicine Training Needs Assessment Scale in a Local Training Context

BACKGROUND

In addiction medicine training, self-assessment is increasingly used to support self-regulation learning by identifying standards of excellence, competence gaps, and training needs. To ensure psychiatrists in Lithuania also develop specific addiction competencies, the Lithuanian Health Sciences University faculty in Kaunas developed an addiction psychiatry curriculum.

OBJECTIVES

The aim of this research is to explore the efficacy of the AM-TNA scale to measure individual and group differences in proficiency in the core competencies of addiction medicine. A cross-sectional study and a convenience sample were used.

METHOD

We studied the differences in performance in addiction medicine competencies between 4 successive year groups and analysed the variance to determine the statistical differences between the means of 4 year groups with biases, resulting from repeated measurement statistically corrected-for.

RESULTS

Of the psychiatrists in training, 41% or 59% completed the scale. The assessment of competencies suggested that all but 2 competencies differ significantly (p < 0.05) between the 4 groups. The post hoc analyses indicated that mean scores for 24 of the 30 core competencies differed significantly between the year groups (p < 0.05) and showed a gradual increase in scores of self-assessed competencies over the 4 year groups. We found adequate scale variance and a gradual increase in self-assessed competencies between the 4 year groups, suggesting a positive association between the results of incremental professional training and improved self-assessed substance use disorders (SUD) competency scores.

CONCLUSIONS

This study illustrates the efficacy of the AM-TNA scale as an assessment instrument in a local training context. Future research should aim to have larger sample sizes, be longitudinal in design, assess individual progress, and focus on comparing and combining self-reported competencies with validated objective external assessment and feedback.

COVID-19 pandemic-related aspects and predictors of emotional and behavioural symptoms in youth with pre-existing mental health conditions: results from Georgia, Lithuania, Romania, Serbia, and Turkey

OBJECTIVE

This study evaluated levels of and predictors of emotional and behavioral symptoms in youth with pre-existing mental health conditions over the early phase of the COVID-19 pandemic in 2020 across Georgia, Lithuania, Romania, Serbia, and Turkey.

METHODS

The study included 421 children and adolescents aged 5 - 18 years with pre-existing mental health conditions and corresponding ongoing treatments. We used a parent- and/or child-report, which taps into a broad range of mental health symptoms and contextual factors thought to be particularly pertinent during periods of social restrictions. Data were collected simultaneously across the countries from May 2020 to August 2020.

RESULTS

According to parents, 121 (33.1%) children had deteriorations in the overall quality of mental health over the COVID-19, 156 (43.1%) deteriorations in the quantity of mental health care received, while 82 (25.1%) mental health care received did not meet the needs. For 121 (49.8%) of children, there was worsening in the main presenting psychiatric symptom compared to January 2020, while for 64 (26.3%) there was some improvement. In total, 128 (43.9%) children reported worsened emotional and 118 (40.6%) behavioral symptoms. The COVID-related worry, parental emotional difficulties, and parent-child relationships emerged as the most relevant predictors for higher levels of emotional and behavioral difficulties.

CONCLUSIONS

This study found that the COVID-19 pandemic has considerably changed the daily lives of some children with pre-existing mental health conditions, where almost every second child had deteriorations in overall mental health or worsening of psychiatric symptoms.

Oppel – Kundt illusion manifestation among people with schizophrenia spectrum disorders

Introduction

Various studies have reported differences in early visual processing, gain control and integration for patients with schizophrenia spectrum disorders (SSD). However, Oppel – Kundt (OK) illusion is not studied well enough among subjects affected by SSD. We decided to study the illusion to get more insights in visual perception for individuals with SSD.

Objectives

To investigate the OK illusion manifestation among people with SSD.

Methods

In the prospective study were included 15 patients, who were diagnosed with SSD and 15 matched comparison group (CG) without any mental, neurological diseases or visual impairment. OK figures used in the experiments consisted of three white spots presented horizontally against the black background. We used 3 different types of distractor stimuli – either straight one or two-sided line or circle. Using computerized equipment in OK figures the subjects were asked to adjust the unfilled part of the stimulus to be equal in length to the filled (referential) one. ANOVA, T-test and post hoc Bonferroni correction were used for statistical analysis.

Results

People with SSD tended to make bigger mistakes when evaluating OK figures with the statistical difference which was the most eminent for the subgroup of individuals affected by paranoid schizophrenia. The manifestation of the illusion in the SSD group was contrariwise (respectively to zero point) to the CG group.

Conclusions

OK illusion tended to manifest stronger for patients with SSD, this tendency was mostly expressed for the patients diagnosed with paranoid schizophrenia. The manifestation of OK illusion among persons with SSD was diametrically opposite to that seen for the healthy individuals.

Disclosure

No significant relationships.

Validation of the lithuanian version of the self-evaluation of negative symptoms scale (SNS)

PURPOSE

To validate the Lithuanian version of the Self-Evaluation Negative Symptoms Scale (Lith-SNS).

MATERIALS AND METHODS

A double translation from French to Lithuanian and back was performed. We included patients from in-patient and out-patient settings that had a diagnosis of paranoid schizophrenia according to ICD-10 criteria and were screened as free from acute psychotic symptoms using the Mini International Neuropsychiatric Interview (MINI). Participants were evaluated using the Brief Psychiatric Rating Scale (BRPS) and completed the Lith-SNS scale. We measured internal consistency, convergent validity, and discriminant validity of Lith - SNS comparing its scores with BPRS negative and positive symptom subscores.

RESULTS

A total of 67 participants were evaluated. Cronbach's alpha (α) for all 20 items of Lith-SNS (α = 0.82), and for the five subscores (α = 0.76) showed good internal consistency. Factor analysis showed a 2-factor solution which accounted for 70.12% of the variance with the first factor accounting for 53.3% and the second factor accounting for 16.8% of the variance. Lith-SNS total scores and all five subscores significantly correlated with BPRS negative symptoms subscores showing good convergent validity. There was a correlation between the Positive subscore of BPRS and the alogia subscore of Lith-SNS (r = 0.39, p = 0.001), but no correlations with other subscores or the total Lith-SNS score showing adequate discriminant validity.

CONCLUSIONS

Lithuanian version of SNS is a valuable tool to evaluate negative symptoms of schizophrenia with good internal consistency, convergent, and discriminant validity.

Quality of life assessment in patients with negative symptoms

Introduction

One or more negative symptoms are present in 57,6% of patients with schizophrenia spectrum disorder [Bobes et al, 2010]. These symptoms are responsible for impaired social functioning and have impact on the quality of life. There are no epidemiological studies that analyse the prevalence of negative symptoms and their impact on life quality in Lithuania.

Objectives

To evaluate the impact of negative symptoms on quality of life in patients with schizophrenia spectrum disorder.

Methods

Participants were 48 adults with schizophrenia (n=36) or schizoaffective disorders (n=12). All participants provided informed consent. All participants were administered a sociodemographic data form, Brief Psychiatric Rating Scale (BPRS), Mini-International Neuropsychiatric Interview (MINI). Negative symptoms were assessed by the Self-evaluation of Negative Symptoms (SNS). The Short-Form Health Survey (SF-36) was used to measure health-related quality of life.

Results

The results of SF-36 scales significantly correlated with SNS subscales. All SNS subscales correlated with general health result, vitality, social functioning and emotional well-being as well as in overal quality of life. Signifficant correlations were observed between the total scores of SNS and physical activity (r=-0,404, p=0,004), general health (r=-0,626, p<0,001), vitality (r=-0,683, p=0,004), social functioning (r=-0,53, p<0,001), role limitations (r=0,354, p=0,014), emotional well-being (r=-0,662, p<0,001) in SF-36 scales.

Conclusions

Negative symptoms of schizophrenia such as social withdrawal, diminished emotional range, alogia, avolition and anhedonia are associated with impaired quality of life. We found a strong relation between negative symptoms and quality of life, however further studies can support this point of view.

ADHD-Related Mental Health Issues of Young Adult Male Prisoners in Pravieniškės Correction House-Open Colony (Lithuania)

The aim of this study was to evaluate mental health issues related to attention-deficit/hyperactivity disorder (ADHD) in young adult male prisoners.

The study was performed in the Pravieniškės Correction House-Open Prison Colony and represents the first study on adult ADHD in Lithuania. The sample consisted of 100 young males imprisoned for mild to moderate crimes. ADHD symptoms were assessed using the Adult Self-Report Scale v1.1 (ASRS v1.1) and Wender Utah Rating Scale (WURS) self-rating scales. Related mental health issues were evaluated using the DSM-5 Level 1 Cross-Cutting Symptom Measure, the Personality Inventory for DSM-5, and data from both medical files and offenses-incentives lists.

Clinically significant ADHD symptoms were found in 17% of the respondents. Prisoners with ADHD were younger and had shorter incentives lists. Personality traits of negative affect, antagonism, disinhibition, and psychoticism with increased personality dysfunction were more prevalent in the respondents with ADHD. Medical files of prisoners with ADHD more frequently included data on substance abuse, psychiatric diagnoses, and psychopharmacological treatment. None of the respondents had been diagnosed or treated for this disorder.

Clinically significant ADHD symptoms were highly prevalent among imprisoned males, but ADHD was not diagnosed or treated correctly. These findings show that the problem of ADHD in young male adults with increased risk for criminal behavior needs recognition by the politicians and professionals responsible for health care in Lithuania in order to better care for prisoners with this psychopathology.

Changes over time in Lithuanian schoolchildren's attitudes toward addictive behaviors: Promoting and preventing factors

Background

Concern is growing about the high prevalence of traditional and new forms of addictive behaviors among young people due to the health risks and a better understanding of the factors causing these behaviors is needed.

Aim

To evaluate tendencies in the attitudes of Lithuanian schoolchildren toward addictive behaviors over a three year period and to ascertain the promoting and preventing factors of such behaviors.

Methods

The researchers developed a survey which was conducted twice over a three year period. The sample consisted of pupils in the 5^th, 9^th and 12^th grades (N = 1590, age range 11–19 years) from both urban and rural areas.

Results

Both the recognition of and involvement in addictive behaviors significantly increased with age. Motivation to abstain due to internal factors decreased with age and increased among pupils already involved in addictive behaviors. Time- and age-related differences were found regarding substance abuse and behavioral addictions. Whilst betting adverts were increasingly noticed over time, smoking adverts were decreasingly noticed over the three year period and it was concomitant with inconsistent changes in self-reported involvement in these behaviors.

Conclusions

Most significant changes in the attitudes of Lithuanian pupils toward addictive behaviors occur between the ages of 11 and 15 years. However, age-related changes differ for the pupils’ attitudes toward substance abuse and behavioral addictions. Increasing awareness of the potential risk of addictive behaviors does not prevent their increasing prevalence with age. Increased risk of involvement in addictive behavior correlates with decreased internal motivation to abstain from addictive behavior and decreased recognition of its potential risks. No clear correlation was found between significant changes in noticing adverts and involvement in addictive behaviors.

Assessing suicide management skills of emergency medical services providers before and after suicide intervention/prevention training with Lithuanian version of suicide intervention response inventory

BACKGROUND

Effective suicide management skills of emergency medical services (EMS) providers are crucially important in Lithuania, which has the highest suicide rates in Europe.

METHODS

Respondents were 268 EMS providers, doctors (n=78) and nurses (n=190), who agreed to participate in suicide prevention/intervention training and completed the survey twice. Study was conducted in five steps: adaptation of Lithuanian version of Suicide Intervention Response Inventory (SIRI-LT); initial assessment of suicide counseling skills of the EMS providers using SIRI-LT; suicide prevention/intervention training; second assessment of suicide counseling skills using SIRI-LT 6 months after training; data analysis evaluating the skills and effectiveness of the training among different groups of EMS providers (doctors vs nurses, age groups).

RESULTS

SIRI-LT showed good internal consistency: Cronbach's alpha score of 0.85 (pretest) and 0.73 (posttest). The value of Kaiser-Meyer-Olkin measure of sampling adequacy was 0.849. A four-factor solution was forced and accounted for 40.8% of the variance. The SIRI-LT mean total scores before suicide prevention/intervention training were significantly higher for doctors than for nurses (13.01±5.24 vs 11.36±5.14, respectively; P=0.031). Younger respondents with a shorter period of employment and heavier workload were significantly more effective at suicide management than older respondents with a longer period of employment and lower workload. After suicide prevention/intervention training, SIRI-LT mean total scores decreased for doctors (13.0±5.24 vs 11.02±4.76; P=0.031) and significantly increased in older (≥55 age) respondents (11.85±3.82 vs 9.28±4.44; P=0.022).

CONCLUSION

SIRI-LT has good internal consistency and can be considered a good instrument for assessing suicide management skills of EMS providers. Our results suggest that ability to find appropriate responses to suicide situations may be multidimensional, related to cultural setting and influenced by age, education, motivation, engagement, and emotional distraction. Particular attention should be paid to active listening and empathic communication skills when developing suicide prevention/intervention training for EMS providers.

Factors influencing the suicide intervention skills of emergency medical services providers

BACKGROUND

Lithuania currently has the highest suicide rate in Europe and the fifth highest worldwide.

AIMS

To identify the factors that influence the suicide intervention skills of emergency medical services (EMS) providers (doctors, nurses, paramedics).

METHOD

Two hundred and sixty-eight EMS providers participated in the research. The EMS providers were surveyed both prior to their training in suicide intervention and six months later. The questionnaire used for the survey assessed their socio-demographic characteristics, suicide intervention skills, attitudes towards suicide prevention, general mental health, strategies for coping with stress, and likelihood of burnout.

RESULTS

Better suicide intervention skills were more prevalent among EMS providers with a higher level of education, heavier workload, more positive attitudes towards suicide prevention, better methods of coping with stress, and those of a younger age. Six months after the non-continuous training in suicide intervention, the providers' ability to assess suicide risk factors had improved, although there was no change in their suicide intervention skills.

CONCLUSIONS

In order to improve the suicide intervention skills of EMS providers, particular attention should be paid to attitudes towards suicide prevention, skills for coping with stress, and continuous training in suicide intervention.

ABBREVIATIONS

EMS: Emergency medical services; SIRI: Suicide intervention response inventory.

Attitudes of Lithuanian secondary school children toward addictive behaviors, their promoting and preventive factors with regard to the age

The aim of this study was to evaluate the attitudes of Lithuanian secondary school children toward addictive behaviors, their promoting and preventive factors with regard to the age. MATERIAL AND METHODS. The study sample consisted of all 5th-, 9th-, and 12th-grade schoolchildren of 6 secondary schools in Kaunas and Šakiai (N=856). Schoolchildren were surveyed with a questionnaire consisting of the questions about their attitudes and experience regarding addictive behaviors and factors promoting and preventing such behaviors. RESULTS. Smoking (82.8%), use of illegal drugs (81.0%), and consumption of strong alcoholic beverages (80.6%) were most often indicated as addictive behaviors. Consumption of light alcoholic beverages and computer gaming were least often indicated as addictive behaviors: by 67.2% and 57.1% of respondents, respectively. Less than one-third (32.7%) of respondents answered that they had one or more of potentially addictive behaviors: computer gaming (27.8%), consumption of light alcoholic beverages (24.6%), smoking (16.3%), and consumption of strong alcoholic beverages (12.1%). The most significant difference was observed between the answers of schoolchildren of 5th and 9th grades. Friends (38.4%), TV (37.9%), and Internet (24.6%) were most often mentioned as influencing a wish to try and abstain from addictive behaviors. Fear for one's health (74.4%) and possible impediment for the life (71.4%) were the most frequently mentioned reasons for abstaining from addictive behaviors. CONCLUSIONS. Involvement in potentially addictive behaviors and acknowledgement of their risks were found to increase with the age of schoolchildren, most significantly from 5th to 9th grades. Consumption of light alcoholic beverages was the second most prevalent behavior among respondents, highly noticed in advertising, but least often acknowledged as addictive behavior. TV and Internet were most often mentioned by respondents as mass media influencing their wish to try or abstain from trying addictive behaviors. Reasons for abstaining from addictive behaviors differed with regard to the age but fears for health and life impediment were most prevalent in all grades.

Diagnosis and treatment of conduct disorder related to frontal lobe syndrome in a 16-year-old girl

Conduct disorders are the most frequent psychiatric diagnosis in the pediatric and adolescent population, with different etiology and difficult to treat. Delinquent, aggressive, and impulsive behavior, lack of empathy and inability to predict possible consequences of the behavior lead to significant desadaptation and danger for these patients. In clinical practice, focus is usually given on social and psychological causes of conduct disorders ignoring possible biological factors in etiology and pathophysiology. A clinical case described in this article shows the linkage between frontal brain dysfunction and behavioral symptoms. The first clues of organic brain disorder were multiple and severe symptoms of disinhibition resistant to treatment with dopaminergic drugs and the results of neuropsychological testing. Computed tomography, magnetic resonance imagining, and single-photon emission computed tomography findings were minor and not supported by associated neurological symptoms. However, the location of alterations of brain structure and perfusion significantly correlated with psychopathology. Clarification of the organic cause of the conduct disorder allowed choosing an effective strategy of psychopharmacologic treatment. A positive clinical effect was achieved after switching the treatment from dopaminergic antipsychotic drugs to carbamazepine, which modulates the GABAergic system. Presenting this clinical case, we intended to emphasize the importance of careful attention to the findings of neurovisual and neuropsychological testing diagnosing conduct disorders and individually choosing the most effective psychopharmacologic treatment.

Associations of quality of sleep with lifestyle factors and profile of studies among Lithuanian students

The objective of the study was to analyze associations among quality of sleep, profile of the studies, and lifestyle factors among the students of three different study profiles (medicine, economics, and law).

MATERIAL AND METHODS

A total of 405 randomly selected students from the first and fourth years of studies from 4 different universities in Lithuania answered the standardized questionnaires consisting of two parts: 1) the Pittsburgh Sleep Quality Index (PSQI) for subjective evaluation of sleep quality; 2) the questionnaire about sleep and lifestyle habits and impact of poor sleep on the quality of life developed by the researchers.

RESULTS

More than half (59.4%) of the students scored higher than 5 on the PSQI, which allowed suspecting sleep disorders. A significant difference in the frequency of poor sleepers was found regarding the profile of studies (P<0.05) showing the highest frequency of sleep disturbances among medical students. There was a significant correlation between quality of sleep and subjective evaluation of quality of life (P<0.01). Medical students experienced the highest impact of poor sleep on the quality of life (P=0.008). Students studying before going to sleep, spending more time studying, and having less leisure time had worse quality of sleep (P<0.01). A significant difference was found among three profiles of studies regarding the anxiety about studies (P<0.0005) and subjective estimation of success in studies (χ²=27.9, P<0.0005), showing the highest anxiety and worst satisfaction among students of medicine.

CONCLUSIONS

The incidence of sleep problems is high among students in Lithuania, reaching 59.4%. Medical students have worse quality of sleep and worse impact of poor sleep on the quality of life compared to students of law and economics. A significant difference was found between medical students and their peers in other profiles of studies regarding their attitudes and habits related to studies: medical students spent more time for studying, were more anxious about studies and less satisfied with the results, studied more often before going to sleep.

Distinctions of bipolar disorder symptoms in adolescence

Bipolar disorder in adolescents is a serious mental illness with problematic diagnosis that adversely affects social, academic, emotional, and family functioning. The objective of this study was to analyze features of premorbid and clinical symptoms, comorbidity, and course of bipolar disorder in adolescence. Data for analysis were collected from all case histories (N=6) of 14-18-year-old patients, hospitalized with diagnosis of bipolar disorder in the Unit of Children's and Adolescents' Psychiatry, Department of Psychiatry, Hospital of Kaunas University of Medicine, during the period from 2000 to 2005. Analysis of bipolar disorder course showed that five patients previously had been diagnosed with an episode of depression. The most frequent symptoms typical to bipolar disorder were disobedience and impulsive behavior, rapid changes of mood. The most common premorbid features were frequent changes of mood, being active in communication, hyperactive behavior. Adolescence-onset bipolar disorder was frequently comorbid with emotionally instable personality disorder, borderline type. Findings of the study confirm the notion that oppositional or impulsive behavior, rapid changes of mood without any reason, dysphoric mood and euphoric mood episodes with increased energy were cardinal symptoms of bipolar disorder with mania in adolescents. Most frequent premorbid features of these patients were quite similar to attention-deficit/hyperactivity disorder making differential diagnosis problematic.

[Study of the prevalence of disturbance of activity and attention and co-morbid psychiatric disorders in the sample of Kaunas city primary school pupils]

Aim of the study was to evaluate the prevalence of disturbance of activity and attention and co-morbid psychiatric disorders among the primary school children in Kaunas city. Parents and teachers of all pupils of 12 randomly selected primary schools (N=2942) were asked to fill the scales on the presence of disturbance of activity and attention symptoms in their children. Disturbance of activity and attention was diagnosed if at least 6 symptoms of hyperactivity and/or 6 symptoms of inattention were present for at least 6 months according parents reports in DuPaul-IV scale and the result of teachers CAP scale exceeded the norms for age and gender. Both scales were obtained for 2298 pupils--1096 girls and 1202 boys 6-12 years of age. Disturbance of activity and attention was diagnosed for 5.2% of primary school pupils. It was 1.9 times more frequent among boys than among girls. Prevalence of co-morbid psychiatric disorders was estimated individually interviewing suspected children and their parents using M.I.N.I. Kid questionnaire. Out of all disturbance of activity and attention diagnosed children, 52.5% were also diagnosed co-morbid psychiatric disorders, most frequently oppositional defiant disorder (31.3%) and different types of anxiety disorders (18.0%). Prevalent type of disturbance of activity and attention and co-morbid disorders was related with the age of the pupils. Symptoms of hyperactivity and co-morbid psychiatric disorders had influenced motivation of parents to seek treatment for their children. Forty percent of the parents of children, who were diagnosed disturbance of activity and attention, have applied to the mental health care professionals; most of them evaluated the help they received as partly useful (57.9%) or not useful at all (26.3%).

[Relationship between the suicidal attempts of adolescent girls and risk factors in the family]

The same factors in the family are described as risk factors for the suicidal behavior of adolescents by some authors and as risk factors for the development of depression by others. The goal of the study is to learn, if incomplete family, parental alcohol abuse, mentally ill member of the family, suicidal behavior in the family, sexual, physical or emotional abuse experienced in the family are directly related with the suicidal attempts of adolescent girls or relates to it just by causing depression. The results of the study suggest that 57.4% of the female adolescent suicide attempters and 9.3% of their non-suicidal peers in the comparison group were diagnosed clinical depression. Incomplete family, parental alcohol abuse, suicidal behavior in the family, sexual, physical or emotional abuse experienced in the family were statistically more frequent among the depressed and not depressed suicide attempters than among their non-suicidal peers. This allows the conclusion, that these risk factors in the family have a relationship with the suicide attempts of adolescent girls independently from clinical depression and require attention of the specialists, involved in the treatment and prevention of adolescents suicidal behavior.