Adolescent Psychiatric Outpatient Clinics Research Articles

Characteristics of Patients Attending the Child and Adolescent Psychiatric Outpatient Clinic of a Tertiary Care Hospital in North India

Background: The psychiatric morbidity profile of children and adolescents is very different from that of adults. Failure of early identification and timely intervention of psychiatric disorders adversely affects the developmental trajectory of children to becoming a healthy adult. Objectives: To study the clinico-demographic profile of patients attending the child & adolescent psychiatric OPD and to estimate the frequency of various psychiatric disorders among them. Methodology: In this retrospective file review study, all patients attending the child and adolescent psychiatry clinic of a tertiary care hospital between Jan 2018- June 2022 were taken. Data collection was done using a semi-structured proforma and ICD-10 was used to make psychiatric diagnoses. Statistical analysis was done by using SPSS 16 (Version 25.0). Results: The total number of cases visiting child psychiatry OPD during the study period was 1199 with an average of 240 cases per year. The mean age was found to be 12 years, with gender distribution revealing male preponderance (58.4%). Around 64% of the participants were 63.8%) were in the age range 10 to 15 years. Most subjects (59.4%) were Hindu by religion and hailed from urban areas (52.4%). Epilepsy (23.9%) was the most prevalent psychiatric disorder, followed by intellectual disability (16.8%), anxiety disorder (14.1%), hyperkinetic and conduct disorder (8.8%), and schizophrenia & other psychotic disorders (10.3%). Conclusion: This study is one of the few ones conducted in a tertiary care hospital in North India. Children in poor nations receive less mental health and psychiatric care than adults do. Our research indicates that Indian clinics may need to improve their offerings for conditions like depression, specific learning disorders, communication disorders, and hyperkinetic disorders. The study also emphasizes the need for more child psychologists special educators, and strengthened counseling services in schools

Is the Conners’ continuous performance test helpful for assessing attention deficit hyperactivity disorder in a clinical setting?

Background Despite lacking validation for Norwegian populations, the Conners Continuous Performance Test II (CCPT-II) is applied to almost one-third of children receiving an ADHD diagnosis. However, evidence of the CCPT-II’s ability to differentiate between children with and without ADHD is contradictory. Thus, this study examines how CCPT-II results correlate with ADHD symptoms reported by mothers and teachers in a sample representing ordinary child and adolescent mental health services and explores the extent to which the CCPT-II influences the diagnostic result. Methods Correlations between CCPT-II results and ADHD Rating Scale scores and a clinical diagnosis of ADHD were analysed in children aged 6–15 years (N = 69) referred to a child and adolescent psychiatric outpatient clinic. Results Total ADHD symptom scores rated by mothers correlated with hit reaction time (HRT) block change (.260), HRT inter-stimulus interval (ISI) change (.264) and CCPT-II overall index (.263), while hyperactivity subscale scores correlated with omissions (.285), HRT (.414) and variability (.400). In teachers’ ratings, total ADHD and both subscale scores correlated with commissions (.280–.382), while hyperactivity scores correlated with variability (.265). A higher number of commissions was the only significant difference in CCPT-II performance between children diagnosed with and children without ADHD. Conclusions Correlations between CCPT-II results and ADHD symptoms were all small to moderate. As such, CCPT-II results should be interpreted with caution, because they correspond to a limited degree with other sources of information.

Effect of Nursing Intervention Program for Parents Caring of Children with Autism Regarding to their Daily Activities

Background: Caring for children with Autism spectrum disorder regarding their daily activities is challenging for parents. Aim: This study aimed to assess the effect of nursing intervention program for parents caring of children with autism regarding to their daily activities. Design: A quasi-experimental design used in the present study one group (pre\ posttest). Setting: The study was carried out in Children and Adolescent Psychiatric Outpatient Clinics in Suez Canal University Hospital (SCUH) & Outpatient Clinic for children psychiatric treatment at Abbasia Mental Health Hospital affiliated to General Secretariat of Mental Health and Addiction in Cairo governorate. Subjects: Study subjects included all available (50) parents have autistic children from the mentioned settings. Tool: A Structured Interview questionnaire included three parts; Part 1: Socio-demographic characteristics of parents, Part 2: Characteristics of the studied children with autism, Part 3: Assessment of parents’ knowledge & Part 4: Assessing the parents’ reported practice regarding to self-reliance during their children daily activities. Results: revealed that more than two thirds, (68%) of parents were mothers. More than two thirds (78%) of father's age was ranged from 30-50 years. More than two thirds (88%) of studied parents’ identification of autism, causes, predictors and symptoms of autism and management of autism post program implementation compared to preprogram Conclusion: there was a statistically significant improvement in total knowledge about autism of the parents caring of children with autism pre and post program implementation. Recommendations: Replication of the same study on larger probability sample at different geographical locations for data generalizability.

Sub-threshold or full-syndrome borderline personality disorder in adolescents with recurrent self-harm – distinctly or dimensionally different?

BackgroundBorderline personality disorder (BPD) is a severe mental disorder frequently seen in individuals with recurrent self-harm behaviour. To what extent there are distinguishing characteristics between self-harming adolescents who meet the criteria for a full diagnosis of BPD, a sub-threshold number of BPD criteria and those who don’t have BPD, with respect to clinical characteristics, is still uncertain and could have important clinical implications.MethodsData from 103 adolescents with recurrent self-harm behaviour recruited from child and adolescent psychiatric outpatient clinics were collected through clinical interviews and self-reports. Bivariate analyses comparing participants with or without a diagnosis of BPD were performed. Group differences based on the number of BPD criteria fulfilled (few-if-any BPD: 0–2 criteria, sub-threshold BPD: 3–4 criteria, full-syndrome BPD: 5 or more criteria) were tested and regression analyses performed.ResultsAdolescents with a diagnosis of BPD (28.2%) had significantly higher numbers of co-morbid DSM-5 disorders, suicide attempts and self-harm methods. They also reported significantly higher levels of suicidal ideation, depression, anxiety and impulsivity, compared with adolescents without BPD. Adolescents with sub-threshold BPD (20.4%) place themselves in the intermediate position between participants with full-syndrome BPD and participants with few-if-any BPD, in terms of these symptoms. Higher levels of emotional regulation difficulties and a lower level of global functioning were significantly associated with fulfilling a higher number of BPD criteria.ConclusionAdolescents with recurrent self-harm who meet diagnostic criteria for a full-syndrome BPD or sub-threshold BPD seem to have difficulties within the same spectrum. They seem dimensionally, but not categorically, different with respect to the severity of their difficulties. These adolescents need interventions aimed at their dysfunctional self-harm behaviour, emotional regulation difficulties and BPD symptoms at an earlier, rather than at a later stage of symptom development.

COVID-19, DEHB'li çocuk ve ergenlerin ruh sağlığı ve yaşam kalitesini etkiledi mi?

Aim: COVID-19 pandemic has had negative effects on the lives of many children and adolescents with psychiatric disorders. This research aims to investigate the effects on the mental status and quality of life of children with ADHD during the COVID-19 pandemic. Material and Method: This study was conducted at the child and adolescent psychiatric outpatient clinic of a university hospital, between April and May 2020. The research group consisted of 113 children and adolescents with ADHD, and the control group consisted of 45 children and adolescents. The depression and anxiety symptoms of the children were assessed using the Child Depression Inventory (CDI) and the Screen for Child Anxiety-Related Emotional Disorders (SCARED), respectively. Child-reported and parent-reported Pediatric Quality of Life Inventories (PedsQL) were used to evaluate the health-related quality of life of the children. Result: Depressive symptoms and anxiety levels were found to be statistically higher in the ADHD group. According to PedsQL-P scale, psychosocial and scale total scores were statistically significantly lower. According to the regression analysis, the SCARED scores predicted negative physical, psychosocial, and total scores of the PEDsQL-C scale. The CDI scores, however, predicted negative physical, psychosocial, and total scores of the PEDsQL-P scale. Conclusion: This study revealed that in the COVID-19 pandemic, children with ADHD are more affected in terms of depression, anxiety and quality of life than children without any psychiatric disease. The study findings suggest that further studies are needed to better understand the psychological conditions and difficulties that children with ADHD experience during the COVID-19 pandemic.

Health care costs and changes in subjective health-related quality of life among Finnish adolescents referred to secondary psychiatric out-patient services: a one-year follow-up study.

There has been growing interest in economic evidence regarding treatment of mental disorders. The purpose of this one-year follow-up study was to evaluate the secondary health care costs and changes in health-related quality of life (HRQoL) in three common adolescent psychiatric disorder groups. Further, HRQoL of patients was compared to that of population controls. Twelve- to fourteen-year-old adolescents with behavioral and emotional disorders (n = 37), mood disorders (n = 35), and anxiety disorders (n = 34), completed the 16D HRQoL questionnaire when they entered the adolescent psychiatric outpatient clinics (baseline) and at follow-up. The direct secondary health care costs were calculated using a clinical patient administration system. Population controls included 373 same-aged pupils from randomly selected 13 comprehensive schools. The direct secondary health care costs did not differ significantly between the three patient groups. However, in adolescents with mood disorders, this investment generated a significant and clinically important improvement in HRQoL, which was not observed in the other two patient groups. The costs of health care alone do not necessarily reflect its quality.

Undersupply of child and adolescent psychiatric outpatient clinics in Austria that can meet minimum requirements

This article is intended to provide an overview of the supply situation with independent outpatient clinics and dislocated Hospital ambulances for Child and Adolescent Psychiatry, taking into account minimum professional standards. The level of care, the mandate to provide care, requirements, structural quality criteria and implementation recommendations are described. 13outpatient clinics and dislocated Hospital ambulances are described in a data matrix.Acomprehensive Austria-wide survey of the staffing and care offerings identified 13 outpatient clinics and outpatient clinics that meet minimum standards. This proves a difference between the current situation and the number of outpatient clinics required nationwide of 26 to 36 (depending on the assessment 1/350k or 1/250k)Thus, the findings provided here, lead us to the conclusion that the patient care in Austria's child and adolescent psychiatric outpatient clinics is not sufficiently guaranteed due to the largely tolerated but technically incorrect interpretation of the legally valid minimum standards.If the current deficiencies are retained, acentral child and adolescent psychiatric care level remains with an effectiveness of less than 50% of the Austrian health structure plan (OSG).

Emotional Reactivity in Adolescents With Non-suicidal Self-injury and Its Predictors: A Longitudinal Study.

BackgroundThe management of emergency presentations at child and adolescent psychiatric outpatient clinics, by children and adolescents with self-injurious thoughts and behaviors, represents very responsible tasks but also offers the opportunity for immediate interventions. The stability and degree of emotional reactivity (ER) is a significant psychopathological symptom for development and maintenance of self-injurious behavior, differentiating between those who have continued to injure themselves and those who have not. In general, the relationship between ER and self-injurious behavior has been shown to be bidirectional. However, the stability of ER over time, as well as important predictors for ER itself have not been investigated so far. Therefore, this present study aimed at investigating the stability of ER over time and the relationship between non-suicidal self-injury (NSSI) and ER. Reinforcement functions and several variables of psychological functioning were considered as possible influencing factors.MethodsAs part of a longitudinal study, 97 adolescents aged 11–18 years who presented due to self-injurious thoughts or behaviors underwent standardized emergency management. This included a specified detailed psychiatric assessment at baseline (including the Emotion Reactivity Scale, ERS, and the Self-Injurious Thoughts and Behaviors Interview, SITBI) and treatment recommendations. These were followed by a catamnestic examination with two follow-up appointments. Changes over time in ER, NSSI, reinforcement functions of NSSI and general indicators of psychological functioning (General Severity Index, GSI) were examined and significant correlations were followed up by a linear-mixed effect model predicting the ERS score over time.ResultsData analysis revealed a statistically significant decrease in ERS scores and GSI over time. However, reinforcement functions for and the symptomatology of NSSI did not change. Furthermore, no predictive relationship from ER to NSSI could be identified. A linear-mixed effect model predicting the ERS identified the GSI, automatic positive reinforcement (as a reinforcement function for NSSI) and age as the only significant predictors.ConclusionResults demonstrate the importance of NSSI reinforcement functions for heightened emotional reactivity and emphasize their role as a point for therapeutic intervention by providing alternatives to NSSI and thereby possibly reducing emotional reactivity.

Adolescents With Non-Suicidal Self-Harm—Who Among Them Has Attempted Suicide?

We aimed to determine differences between adolescents with non-suicidal self-harm with and without a history of suicide attempt (SA). Sixty-eight adolescents with a mean age of 15.6 years (SD = 1.5) attending child and adolescent psychiatric outpatient clinics for repeated self-harm in Oslo, Norway, were included. A battery of instruments was used to assess sociodemographic information and psychopathology such as Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnoses, emotional and behavioral problems, borderline symptoms, depression, hopelessness, suicidal ideation, and history of SA. Twenty-six participants (38.2%) reported a lifetime history of SA. Compared to the participants without a history of SA, those with an SA history had used a higher number of methods of self-harm and methods with higher lethality and had higher degrees of emotional and behavioral problems. They also scored higher in depressive symptoms, borderline pathology, emotional dysregulation, hopelessness, and suicidal ideation. History of SA was independently associated with perceived moderate to high risk of death on the most severe episode of self-harm (adjusted odds ratio [aOR], 15.93; 95% confidence interval [CI], 1.96–129.66), a longer duration (months) since self-harm debut (aOR, 1.07; 95% CI, 1.01–1.13), and suicidal ideation severity (aOR, 1.05; 95% CI, 1.01–1.11). Parental report of behavioral problems associated with SA suggested a strong association with externalizing problems. A combination of having a high level of psychopathology, externalizing problems, an extended history of self-harm behavior and use of more lethal self-harm methods seems to entail a significantly increased risk for making SAs among adolescents with non-suicidal self-harm. HIGHLIGHTS Non-suicidal self-harm (NSSH) with suicide attempt may be distinctive from NSSH without suicide attempt. Adolescents with NSSH with suicide attempt had relatively greater psychopathology. Protracted/lethal self-harm methods and externalizing problems indicate comorbidity.

Retrospective Review of Forensic Cases Referred to the Child and Adolescent Psychiatric Outpatient Clinic

Background: The aim of this study is to explore the cause of forensic report orders, socio-demographic characteristics and comorbid mental disorders in children and adolescents passed to court for any reason and referred to a child and adolescent psychiatry outpatient clinical by judicial authority in Şanlıurfa province. Materials and Methods: In this study, we retrospectively reviewed files of 64 cases which referred to a child and adolescent psychiatry outpatient clinic for forensic psychiatric assessment between December, 2018 and December, 2020. The socio-demographic characteristics, the event underlying referral, coverage of question asked by judicial authority, smoking or alcohol and substance abuse, intelligence level, comorbid mental disorders and socio-demographic characteristic of parents were reviewed in children referred by judicial authorities. We used the Chi-square test to compare socio-demographic characteristics and comorbid psychiatric diagnoses and The Mann Whitney U test to compare numerical variables. Results: It was found that 46.9% of the children were referred due to juvenile delinquents while 12.5% due to being subjected to abuse and 25.0% due to early marriage. Of the juvenile delinquents, 90% were boys with median age of 15 years while 62.5% of victims were girls with median age of 13.5 years. The findings show that 63.3% of juvenile delinquents and 62.5% of victims were not attending to school. The incidence of psychiatric diagnosis was 53.3% among juvenile delinquents while it was 50% among victims. All of the children presented with request of early marriage were girls with median age of 16 years. The results show that 43.8% of cases were pregnant at presentation and 93.8% did not receive education appropriate for their age. Conclusions: It was found that more than one-half of juvenile delinquents and victims were not attending school in that study. In addition, it was found that male gender preponderance was observed among juvenile delinquents. There is a need for further studies to determine groups of under risk.

Is age of self-harm onset associated with increased frequency of non-suicidal self-injury and suicide attempts in adolescent outpatients?

BackgroundSelf-harm in adolescents is an increasing public health concern and an important risk factor for suicide. We aimed to examine how age of self-harm onset in adolescents was associated with frequency of subsequent suicidal and non-suicidal self-harm (NSSI) episodes, and how age of onset and duration of self-harm may influence the frequency of self-harm.MethodsData from 103 adolescents with recurrent self-harm recruited from child and adolescent psychiatric outpatient clinics were collected through clinical interviews and self-reports, and analysed with negative binomial and hurdle models.ResultsA lower age of self-harm onset and a longer duration of self-harm were both significantly associated with increased frequency of subsequent episodes of NSSI and risk of a first suicide attempt. There was an increase in repeated suicide attempts when the age of onset of self-harm decreased and the duration increased, and dramatically more for long duration of NSSI before first suicide attempt.ConclusionInitiating self-harm behaviour at the youngest age had the highest risk of increased frequency of NSSI and suicide attempts. Longer duration of self-harm behaviour increased this risk. This underlines the importance of early identification of self-harm behaviour in adolescents, and the use of effective interventions.

6.22 The Combination of Kampo and Western Antipsychotic Drugs Were Effective for 20 Cases in Child Psychiatric Outpatients

Kampo is the Japanese herbal traditional medicine formula, with a root from ancient China, that is used for irritation, mood swing, and agitation in Japan. Ninety percent of Japanese doctors have an experience of prescribing Kampo, and 80% of doctors have combined Kampo and a Western antipsychotic drug (WAD). The indication of atypical WAD is for the irritability and agitation with autism spectrum disorder (ASD), and Kampo is used for peripheral symptoms in the child and adolescent psychiatric patient. For now, risperidone and aripiprazole are the only choices under the Japanese health insurance system to treat children with ASD. This retrospective case series report was conducted in 20 children who received Kampo and a WAD, from April 1, 2017 to December 31, 2020, at our child and adolescent psychiatric outpatient clinic. Their ages ranged from 7 to 19 years. Their age, gender, IQ test (Wechsler Intelligence Scale for Children–Fourth Edition [WISC-4], Tanaka-Binet-5 test, Kyoto Scale of Psychological Development), the severity that DSM-5 defines on the initial examination and the end of this research (none = Level 0, mild = Level 1, moderate = Level 2, severe = Level 3), dropouts, side effects, and the number of medications were surveyed. The average age was 12.2 years (7-19). The ratio of males to females was 19:1. The average IQ was 69.4 (22-143). There were no side effects from Kampo. Seven children had a blood test, and their average serum potassium level was 4.0 mEq/l (3.5-4.4). In addition, 0.5 (25%) of them had any type of drug and food allergies, 6 (30%) had febrile convulsion, abnormality of EEG, and epilepsy, and 3 (15%) had any severe physical disabilities. The initial diagnosis (maximum 2) was 11 (55%) with pervasive developmental disorder and ASD, 9 (45%) with ADHD, 2 (10%) with ODD, 12 (60%) with intellectual disability containing below average IQ (BAIQ), 14 (70%) had continued combined medicine, 5 (25%) had dropped out of the child and adolescent psychiatric outpatient clinic, 6 (30%) had taken multiple WADs. The average Kampo dose per day was 4.6 g (1 package is 2.5 g). The average administration duration was 14.4 month (2-41). The price of a risperidone tablet (2 mg) is $0.40 USD, aripiprazole (3 mg) is $0.60 USD, and Kampo is $0.34 to $0.16 USD per 1 package. The average severity level according to the DSM-5 on the initial examination was 1.95 (1-3). The average severity at the end of this research was 1.17 (0-3). The combination of Kampo and WADs might alleviate the severity of children in the child and adolescent psychiatric outpatient.

Child Maltreatment: Adolescents' Psychiatric Sequels In The Light Of Oxytocin Receptor Gene SNP rs2254298 And Global DNA Methylation: A Case Control Study

Recently, child maltreatment was connected with long term consequences in childhood, adolescents and adulthood among them psychiatric disorders. The present work aimed at determining the association between psychiatric consequences and types of child maltreatment among adolescents between 12-18 years, exploring the role of Oxytocin Receptor Gene Polymorphism (rs2254298) in the relation between types of child maltreatment and psychiatric consequences and to examine the relation between childhood abuse and global DNA methylation. A case-control study was performed on 90 children aged 12- 18 years divided equally into; cases suffering from psychiatric illness and attending child and adolescent psychiatric outpatient clinics at Al-Hadara University Hospital in Alexandria, Egypt and controls recruited from different outpatient clinics at Alexandria University Hospitals. Significant difference was detected between cases and controls regarding physical, sexual and emotional abuse and neglect. Significant positive correlation was detected between these four types and depressive symptoms detected by children depression inventory (CDI) and total scale of child behavior checklist (CBCL). Non- significant interaction between OXTR gene SNP rs2254298 and child maltreatment in prediction of depressive symptoms and total scale of CDI and CBCL respectively. Significant negative correlation was detected between means of global DNA methylation and physical, emotional abuse and neglect.

Assessment of Knowledge, Strains and Coping of the Family Care Givers Having Autistic Children

Background: Autism is a lifelong disability and, a broad spectrum disorder of unknown cause appears during the first three years of life. Aim: The present study aimed to assess the knowledge, strains and coping of the family caregivers having autistic children (descriptive study). Setting: The study was conducted in Children & Adolescent Psychiatric Outpatient Clinic in Suez Canal University Hospital, El-Terbia El-Fekria, El-Salam El-Engelia, Gamal El-Din El-Afghani and Ard El-Mashtl Primary Schools, Wyana Institution for Integration and Rehabilitation, El-Aml Center for Children with Special Needs, El-Tathkief El-Fekri Institution and the Psychiatric Measures Clinic at Ismalia city. Sample: Included 36 caregivers and 36 autistic children. Data were obtained through an interview with the studied caregivers using three tools: structured interview questionnaire, caregiver strain questionnaire-short form and brief cope scale. Results: Revealed that 44.4% of the studied caregivers had unsatisfactory total knowledge regarding autism, 77.8% of the studied caregivers' total strains mean scores were high and the 97.2% of the studied caregivers had high total coping mean scores.Conclusion: The studied caregivers had unsatisfactory total knowledge mean score (regarding autism, strains and coping), had high total strains mean scores and had high total coping mean scores. Recommendation: Emphasize the importance of carrying out educational programs to improve knowledge of autistic children's care givers regarding their autistic children's needs and care. Also regular assessment and monitoring of the studied family care givers' strains and coping is recommended.

Gaining the courage to see and accept oneself: Group-based compassion-focussed therapy as experienced by adolescent girls.

Shame and self-stigmatisation are common in adolescents with mental health problems, and can hinder their recovery. Compassion-focussed therapy (CFT) help people address challenging experiences and emotions with courage, wisdom, and care. However, no previous studies have examined whether CFT is helpful for adolescents with mental health problems. The present study aimed to describe lived experiences regarding group-based CFT based on the perspectives of a sample of adolescent girls who were recruited from a child and adolescent psychiatric outpatient clinic in Sweden. In-depth interviews were conducted with six girls, aged 15 to 17, using a reflective lifeworld research approach. The results showed that participating in group-based CFT means gaining the courage to see and accept oneself through meeting with peers who are experiencing similar difficulties. When sharing experiences in a group, new perspectives and an acknowledgement that mental and emotional struggle are normal arise, and a sense of inner peace and belonging emerges. Instead of hiding from society, it is possible to participate in everyday life, ask for help, and asserting oneself. CFT can provide a promising method for empowering young people with mental health problems, helping them feel connected with others, and fostering in them the strength to show their true personalities.

An exploration of group-based compassion-focused therapy for adolescents and their parents.

Background:The long-term negative consequences of mental health problems during adolescence highlight the need for effective treatments. Compassion-focused therapy (CFT) aims to help individuals to enhance their ability to support and care for themselves and to alleviate shame and self-stigmatization.Objective:This non-randomized controlled trial examined the effectiveness of group-based CFT on perceived stress and the extent of self-compassion in a clinical sample of adolescents receiving psychiatric care for complex mental health difficulties and their parents.Method:The participants were 43 adolescents (ages 14–17; 83.7 % female) under treatment at a child and adolescent psychiatric outpatient clinic in Sweden and their parents (n = 77; 61 % female). The adolescents volunteered for group-based CFT (n = 19); if they did not want to participate, they were asked to join the control group receiving treatment as usual (TAU, n = 24). The CFT parents were given the same treatment as their children in parallel parent groups. The participants completed questionnaires measuring self-compassion and perceived stress before and after treatment. Paired samples t-tests and independent samples t-tests assessed the within-group and between-group differences via change scores.Results:The fathers scored highest on self-compassion and had less perceived stress at both times than the adolescents or mothers. There were no significant differences between the CFT and TAU groups in self-compassion or perceived stress at either time, and the effect sizes were small (g ≤ 0.25). The TAU mother group was the only group with a significantly changed mean self-compassion score post-treatment.Conclusions:Some patients seem to benefit from group-based CFT in ways similar to the benefits of specialized therapeutic approaches. Further research into the utility of CFT for adolescents with MH problems and their parents, as well as the long-term clinical effects of CFT for this group is needed.

Mentalization-based treatment in groups for adolescents with borderline personality disorder: a randomized controlled trial.

Borderline personality disorder (BPD) typically onsets in adolescence and predicts later functional disability in adulthood. Highly structured evidence-based psychotherapeutic programs, including mentalization-based treatment (MBT), are first choice treatment. The efficacy of MBT for BPD has mainly been tested with adults, and no RCT has examined the effectiveness of MBT in groups (MBT-G) for adolescent BPD. A total of 112 adolescents (111 females) with BPD (106) or BPD symptoms ≥4 DSM-5 criteria (5) referred to child and adolescent psychiatric outpatient clinics were randomized to a 1-year MBT-G, consisting of three introductory, psychoeducative sessions, 37 weekly group sessions, five individual case formulation sessions, and six group sessions for caregivers, or treatment as usual (TAU) with at least 12 monthly individual sessions. The primary outcome was the score on the borderline personality features scale for children (BPFS-C); secondary outcomes included self-harm, depression, externalizing and internalizing symptoms (all self-report), caregiver reports, social functioning, and borderline symptoms rated by blinded clinicians. Outcome assessments were made at baseline, after 10, 20, and 30weeks, and at end of treatment (EOT). The ClinicalTrials.gov identifier is NCT02068326. At EOT, the primary outcome was 71.3 (SD=15.0) in the MBT-G group and 71.3 (SD=15.2) in the TAU group (adjusted mean difference 0.4 BPFS-C units in favor of MBT-G, 95% confidence interval -6.3 to 7.1, p=.91). No significant group differences were found in the secondary outcomes. 29% in both groups remitted. 29% of the MBT group completed less than half of the sessions compared with 7% of the control group. There is no indication for superiority of either therapy method. The low remission rate points to the importance of continued research into early intervention. Specifically, retention problems need to be addressed.

Reliability and validation of Swedish translation of Beliefs about Medication Specific (BMQ-Specific) and Brief Illness Perception Questionnaire (B-IPQ) for use in adolescents with attention-deficit hyperactivity disorder

Objectives: The purpose of this study was to assess the reliability and validity of Swedish translations of the Beliefs about Medicines Questionnaire-Specific (BMQ-Specific) and Brief Illness Perception Questionnaire (B-IPQ) for use in adolescents with ADHD.Methods: Forward and backward translations of the BMQ-Specific and B-IPQ scales to Swedish were conducted and reviewed by adolescents with ADHD and professionals. The validity and reliability of both questionnaires were investigated in a cross-sectional study of 101 adolescents (13–17 years) on a long-term prescription of ADHD medication recruited from two child and adolescent psychiatric outpatient clinics in Sweden.Results: Regarding the BMQ-Specific, principal component analysis (PCA) loadings confirmed the previously defined components of Specific-Necessity and Specific-Concern. The PCA for B-IPQ revealed two components, the first one, B-IPQ Consequences, captured questions regarding perceptions of the implication of having ADHD (items 1, 2, 5, 6 and 8) and the second one, B-IPQ-Control, the perceptions of the capability to manage the ADHD disorder (items 3, 4 and 7). The Cronbach alpha coefficients for BMQ-Specific-Necessity scale was α = 0.80, for BMQ-Specific-Concern scale α = 0.75, B-IPQ Consequences α = 0.74 and for B-IPQ-Control α = 0.44.Conclusions: The present results prove the Swedish translation of BMQ-Specific and B-IPQ to be valid and reliable for utilization in adolescents with ADHD. The PCA confirmed the original components for BMQ-Specific and the recent findings of two main B-IPQ components describing emotional and cognitive implications versus the capability for self-care maintenance of ADHD.

Diagnostic validity of the MINI-KID disorder classifications in specialized child and adolescent psychiatric outpatient clinics in Sweden

BackgroundMissing diagnostic information often results poor accuracy of the clinical diagnostic decision process. The Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) is a short standardized diagnostic interview and covers a rather broad range of diagnoses applicable to children and adolescents. MINI-KID disorder classifications have shown test-retest reliability and validity comparable to other standardized diagnostic interviews and is claimed to be a useful tool for diagnostic screening in Child and Adolescent Psychiatric care. The concordance between the Swedish language version of the MINI-KID Interview and LEAD (Longitudinal, Expert, All Data) research diagnoses was studied in secondary child and adolescent psychiatric outpatient care.MethodsMINI-KID interviews were performed for 101 patients, boys n = 50, girls n = 51, aged 4 to 18 years. The duration of the interview was on average 46 min, the child/adolescent participating together with the parent(s) in most cases. The seven most prevalent diagnoses were included in the analyses.ResultsThe average overall percent agreement (OPA) between MINI-KID and LEAD was 79.5%, the average percent positive agreement (PPA) 35.4 and the average percent negative agreement (NPA) 92.7. OPA was highest for Obsessive-Compulsive Disorder (OCD) (0.89), Tic disorders (0.88) and Pervasive developmental disorders (0.81). There were similar results in diagnostic agreement comparing the two versions: the standard MINI-KID and MINI-KID for parents. The specific screening questions in MINI-KID resulted in additional preliminary diagnoses compared with the regular initial clinical assessment.ConclusionsOverall, there was an acceptable agreement between MINI-KID disorder classifications and research diagnoses according to LEAD. The standardized interview MINI-KID could be considered as a tool with the possibility to give valuable information in the diagnostic process in child and adolescent care which is similar to the setting in the present study.

Characteristics of patients attending the child and adolescent psychiatric outpatient clinic in Erbil city.

BackgroundThe Erbil psychiatric hospital is the major governmental psychiatric facility in the governorate of Erbil, the capital of the Kurdistan region in Iraq, providing services for the diagnosis, treatment and follow-up of patients from the city and its surrounding areas. The child and adolescent outpatient clinic in the hospital is for patients younger than 18 years. The objectives of this study were to explore the sociodemographic, pregnancy and birth characteristics, as well as the clinical profiles, of patients who presented to the child and adolescent psychiatric outpatient clinic to statistically estimate the frequency of various psychiatric disorders among the attendees and to test hypotheses of the association of these psychiatric disorders with sociodemographic and birth and pregnancy characteristics as reported by many previous studies but with inconsistent results.MethodsA descriptive consecutive cross-sectional study was conducted from October 2017 to February 2018 in the Child and Adolescent Psychiatric Outpatient Clinic in Erbil province of Iraq’s Kurdistan region. The diagnostic criteria of the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition) were implemented. Chi-square tests were used to test the hypothesized associations.ResultsOf a total of 207 patients, 142 were males and 65 were females, and most lived in low socioeconomic status. Most of the patients’ fathers were school educated, and most mothers were illiterate. Consanguinity was found in 41% of the parents, 26.6% of the patients were born by caesarean section(C/S), 62.8% were nurtured exclusively by breastfeeding in their first six months after birth, 42.5% of them visited faith healers before consulting a psychiatrist, 43% had neurodevelopmental disorders, 26.6% had intellectual disabilities with behavioral and emotional comorbidities and 30.4% had other mental/behavioral disorders.ConclusionThis study revealed that the child and adolescent psychiatric disorders in Erbil city are versatile and that many factors are significantly associated with them. Cultural concepts are still influential in the region in a way that can interfere with children’s well-being, a situation that calls for more concern and attention.