Adolescent Psychiatric Services Research Articles

Dropout rates among patients attending child and adolescent psychiatry services of a tertiary care center: A retrospective study from north India

Background: Little information is available about dropout from treatment for children and adolescents attending the various psychiatric services. Aim: This study aimed to evaluate the drop-out rates of patients attending child and adolescent psychiatry services. Methods: A retrospective review of 2249 case records of all patients aged up to 15 years registered in child and adolescent psychiatry services from 1st January 2017 to 31st December 2018 was carried out. Details regarding socio-demographic data, clinical data and follow up status were extracted from the records. Results: The mean age of the study sample was 11.11(SD: 3.58) years. About two-fifth (n=1003; 43.99 %) did not follow up at all after the first walk-in contact. Additionally, about one-tenth (n=247; 11 %) dropped out by the one month of the first contact, another one-eighth (n=275; 12.2 %) dropped out by 3 months of the first contact with outpatient services and another one-eighth (n=301; 13.4%) dropped out of the follow-up by 6 months of the first contact. Only one-fifth (n=423; 18.8%) of the patients followed up beyond 6 months of the first walk-in contact. No significant difference was noted between those who continued to follow-up and those who dropped out in terms of age group, gender, and the number of diagnoses made at the initial evaluation. Those who dropped out of treatment were less often prescribed medications in the form of antipsychotics or antidepressants. Conclusion: This study shows that there is a high dropout rate from the child and adolescent psychiatric outpatient services. Accordingly, strategies need to be developed to minimize dropout rates.

Slow Cortical Potential Versus Live Z-score Neurofeedback in Children and Adolescents with ADHD: A Multi-arm Pragmatic Randomized Controlled Trial with Active and Passive Comparators

Neurofeedback (NF) as a treatment for Attention Deficit Hyperactivity Disorder (ADHD) has been evaluated in several trials, but the specificity and generalizability of effects remain unclear. This four-arm randomized controlled trial evaluated the efficacy of Slow Cortical Potential (SCP; standard NF protocol) and Live Z-score (LZS; non-standard NF protocol) delivered in high-frequency format (five sessions per week during five weeks), compared to Working-memory training (WMT; active comparator) and Treatment-as-usual (TAU; passive comparator). N = 202 children/adolescents aged 9 to 17 years with ADHD participated. The primary outcome measure was multi-report (self-, teacher-, and parent-report) ADHD core symptoms on the Conners-3, assessed at baseline, posttreatment, and 6-months follow-up. Data were analyzed using a linear mixed model. Between-group differences were scarce and did not show a distinct pattern. Superiority of LZS over TAU at endpoint were observed for teacher-rated measures only, while significant differences between SCP and TAU were restricted to posttreatment measurements. Contrary to our expectations, LZS outperformed SCP at endpoint for teacher-rated hyperactivity (-5.37; 95% CI: -10.14 to -0.60; p = .028; d = -.36) and overall ADHD symptoms (-2.20; -4.18 to -0.22; p = .030; d = -.41). There was no indication that either form of NF was superior to WMT. No severe adverse events were reported during the trial, whereas transient stress-related problems were quite frequent. Overall, the results from this pragmatic trial do not provide convincing support for broad implementation of NF in child and adolescent psychiatric services. Future research should try to clarify for whom and under what circumstances NF might be a viable treatment option.

Perceived impact of the COVID-19 pandemic on child and adolescent psychiatric services after 1 year (February/March 2021): ESCAP CovCAP survey.

In April 2020, the European Society for Child and Adolescent Psychiatry (ESCAP) Research Academy and the ESCAP Board launched the first questionnaire of the CovCAP longitudinal survey to estimate the impact of COVID-19 on child and adolescent psychiatry (CAP) services in Europe. In this brief report, we present the main findings from the second questionnaire of the survey, one year after the COVID-19 pandemic began to hit Europe (i.e., February/March 2021). While service delivery to patients and their families was affected in a major way (reported by 68%) at the beginning of the pandemic, the majority of respondents (59%) in this second survey only reported a minor impact on care delivery. The use of telemedicine remained widespread (91%) but the proportion of CAP services partially closed or transformed to accommodate COVID-19 patients (59% in 2020) dropped to 20%. On the other hand, the perceived impact on the mental health and psychopathology of children and adolescents dramatically increased from “medium” (> 50%) in 2020 to “strong” or “extreme” (80%) in 2021. Four nosographic entities were particularly impacted: suicidal crises, anxiety disorders, eating disorders and major depressive episodes. Accordingly, this was associated with a substantial increase in the number of referrals or requests for assessments (91% reported an increase in 2021 while 61% reported a decrease in 2020). Finally, heads of the CAP departments expressed strong concerns regarding the management of the long-term consequences of this crisis, especially regarding the provision of care in light of the perceived increase in referrals.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00787-021-01851-1.

Utprøving av en tilpasset gruppebehandling for unge voksne

Background: There is a need for special attention to patients in the transition between adolescent and adult psychiatric services. This study investigates effects of a group therapy on depression, anxiety, self-esteem and personal experiences among the youngest patients in an adult outpatient clinic. Method: Patients between 18 and 25 years participated in a 10-week group treatment based on psychoeducation and cognitive therapy. Outcomes were self-reported and both quantitative and qualitative. Results: Of 35 included patients (equal gender distribution, mean age 21 years), 31 completed treatment. Forty-nine percent were diagnosed with depression and 23 % with anxiety. Depressive symptoms and self-esteem improved after treatment, whereas anxiety symptoms did not. Group participation gave new perspectives on own difficulties and a sense of belonging in a safe setting with people they could relate to. Conclusion: Group treatment adapted to young adults may be a suitable and feasible treatment intervention for this vulnerable patient group. Keywords: Depression, anxiety, young adults, cognitive therapy, group therapy, users’ experience.

Emotional Reactivity and Family-Related Factors Associated With Self-Injurious Behavior in Adolescents Presenting to a Child and Adolescent Psychiatric Emergency Service.

Background: Adolescents presenting in a child and adolescent psychiatric emergency service show various psychiatric disturbances, most commonly suicidal ideation, suicide attempts, and non-suicidal self-injury (NSSI). It was postulated that especially disturbed emotion regulation contributes to self-injurious behavior of young people. This study aims to investigate the relevance of emotional reactivity (ER), as part of emotion regulation, during an acute crisis, how it relates to self-injurious behavior reinforcement and how a family as well as peers' history of self-injurious behavior are associated with self-injurious behavior of presenting adolescents. Additionally, crisis-triggering background factors were evaluated from the perspective of patients and their caregivers.Methods: A consecutive sample of 86 adolescents aged 11–18 years presenting to the emergency outpatient department due to self-injurious thoughts and behavior received a pretreatment psychiatric evaluation. Among other psychometric measures and structured clinical interviews, ER was measured via the Emotion Reactivity Scale (ERS). Family-related aspects were collected both through evaluation of history and through questionnaires filled in by custodians or parents.Results: Data analysis revealed that suicidal ideation was significantly related to family history with self-injurious behavior in comparison with a family background without such a history. A significant positive correlation was apparent between the ERS sensitivity score and occurrence of NSSI within the past year. A relationship between the ERS and distinct types of reinforcement as a motivation factor for NSSI was found. Post-hoc tests revealed a significant difference between boys and girls when no positive peers' history is present with boys having lower ERS scores than girls, but no difference when both groups had friends engaging in self-injurious behavior. There was only moderate agreement between parents and their children in naming reasons for the current crisis involving NSSI.Conclusion: Emotional regulation, especially ER, has an influence on patients' acute psychiatric symptomatology and when experiencing an acute crisis should be brought into focus early at psychiatric assessment. A history of self-injurious behavior taken from patient's family members and close circle of friends and agreement on reasons for the crisis should be routinely included in the exploration of a patient presenting with self-injurious behavior.

Attitudes and perceptions of parents towards child and adolescent psychiatric consultation, diagnosis and treatment

AimsThe aim of the study was to assess the attitudes and perceptions of parents towards child and adolescent psychiatric consultation, diagnosis and treatment.The hypothesis of the study was there are significant problems in the domains of attitude and perceptions of parents towards child and adolescent psychiatric consultation, diagnosis and treatment.BackgroundParents are an important stake holder in child and adolescent psychiatry and mental health care service models. There is scarce literature from developing countries regarding attitudes and perceptions of parents towards child and adolescent psychiatric consultation, diagnosis and treatment.MethodThis study was conducted at the Child and Adolescent Psychiatry Clinic, Department of Psychiatry at a Tertiary Care Institution. Eligibility criteria comprised of parents of children and adolescents who had come for consultation. The parents were provided information of the study and those willing to participate were included in the study. A convenience sample of 100 parents was considered for the study. The parents were interviewed using a specially designed survey comprising 30 questions with Yes/No response developed by the authors for the purpose of the study. Informed consent and Institutional Ethics Committee Clearance was obtained. Data were analysed using SPSS.ResultWe found that the majority of parents were from urban area (72%) and mothers comprised 68%. We found that 46% of parents did not want a psychiatric diagnosis and 35 % parents felt stigmatized for seeing a psychiatrist for their child. Sixty nine percentage of parents preferred counseling as the first line of treatment and 31% preferred medicines as the first line of treatment. We found that 33 % felt additional psychological tests could be useful and 54% of parents felt brain imaging and blood tests could be useful for their child. Majority of parents expected basic improvement for their child within 1 week(32%) and expected full improvement by 1 month(82%). Fifty three percent of parents had searched online information prior to consulting and found useful information. However, 38% of the parents felt confused after reading online information and 69 % of parents were more worried about giving medications after referring online information.ConclusionOur study provides useful key insights from parent's perspective in child and adolescent psychiatric services. Implications exist for future research as well as policy perspectives on the role, attitudes and expectations of parents as vital stake holders in child and adolescent psychiatry.

If we build it, they will come: Caregiver decision to use an accessible outpatient psychiatric service for children and adolescents in Nigeria

ObjectiveIf child and adolescent psychiatric (CAP) services were accessible in lower-middle-income countries (LMIC) such as Nigeria, what individual and socio-cultural factors would influence caregivers’ willingness to use these services when they are needed? MethodsTo address this question, we conducted structured interviews with a stratified random sampling of 442 adult caregivers of children aged 5 to 19-years who lived within 10 km of an established CAP outpatient service in Ibadan, Nigeria. ResultsBased on structural equation modeling, our cross-sectional findings indicated that caregivers were generally willing to use the accessible outpatient CAP service for a narrow range of overtly disruptive and developmentally atypical child behavior. However, their decisions were not influenced by their recognition of child and adolescent mental health (CAMH) conditions, competing life stressors, caregiver wellness, nor stigma as we had initially hypothesized. Rather caregivers pragmatically considered a range of approaches to address CAMH concerns. Post-hoc hypotheses confirmed that caregivers’ beliefs about etiology and treatment effectiveness for CAMH conditions shaped their help-seeking decisions and stigmatization of CAP services. Specifically, caregivers who attributed CAMH conditions to physical causes regarded biomedical interventions as the most effective treatment while spiritual interventions were deemed to be the least effective. ConclusionsTaken together our results suggested that caregivers were receptive and willing to use outpatient psychiatric services for their children. However, their beliefs about the etiology and treatment effectiveness of CAMH conditions shaped how they intended to engage the services. These findings underscored the importance of scaling up a broader spectrum of accessible complementary CAMH intervention and prevention services in Nigeria that extend beyond indigenous or biomedical models. In doing so caregivers will come.

Identification and prevalence of factors associated with the outcome of psychiatric treatment of youths who refuse to attend school

Objectives To assess the prevalence and investigate factors associated with resumption of school attendance by youths who have previously refused to go to school. Methods Between 2012-2018, a retrospective cross-sectional study measured the baseline situation and outcomes after 3 months of treatment at one tertiary child and adolescent psychiatric service of youths who refused to attend school. Sociodemographic, clinical and family characteristics as well as school environment characteristics and child behavior were used to identify possible correlations with short-term outcomes of youths who had refused to attend school. Results A total of 111 patients age 5-18 displayed a refusal to attend school. Of those, 71 patients who could be followed up for at least 3 months were examined. Of those 71 patients, 22 (31%) resumed regular school attendance and 21 patients (29.6%) resumed attending school occasionally. All subjects had been diagnosed with a psychiatric disorder at baseline, and 32.4% had been diagnosed with at least two psychiatric disorders. Multiple logistic regression revealed that younger age below 14.58 years (p = 0.003), having siblings (p = 0.014), living with biological parents (p = 0.018) and having had negative interactions with teachers or learning (p = 0.029) correlated with favorable outcomes. Conclusions Youth who refuse to attend school have a high incidence of psychiatric disorders. Short-term outcomes of psychiatric treatment are fair. Outcomes of treatment of psychiatric disorders are associated with four factors: age, having siblings, living with biological parents, and having had negative interactions with teachers or learning. However, other outcomes eg., emotional/behavioral symptoms, self-efficacy, social adjustment, well-being of the patient/family and global assessment of functioning should also be considered.

Challenges of Covid-19 on Adolescent Psychiatric Service Provision in an Independent Inpatient and Outpatient Setting

Background: COVID-19 is one of the most challenging and devastating public health emergencies we have experienced in our lifetimes. There is a growing concern that the pandemic and its imposed public health restrictions may be harming a generation of young people. This article concerns child and adolescent psychiatry as there is already a mismatch between resources and demand. Method: This paper will outline the day to day working challenges encountered by the SPMHS adolescent service, staff, and patients in the initial months of the COVID-19 crisis and some of the strategies implemented to deal with these. Discussion: In St. Patrick’s University Hospital in Ireland, significant challenges in the adolescent service were encountered in the initial months of the COVID-19 crisis. These included the cessation of face-to-face patient interactions, therapeutic leave and visiting restrictions, school closure, social restrictions, difficulties in organizing medical appointments and investigations, family stress and increased workload for staff. Strategies including telepsychiatry have enabled the delivery of an efficient and accessible adolescent service during this crisis. Conclusion: Future research is required to analyse how best we can support children and adolescents during COVID-19, particularly those with existing mental illness is crucial.

Changes in referral patterns to outpatient child and adolescent psychiatric services from 2005–2018

Introduction There has been a steep increase in referrals to child and adolescent psychiatric (CAP) services across Western countries. To fit CAP services to the increasing demand, it is important to gain more knowledge about the background for the increase in referrals and to investigate changes in referral patterns over time. Methods Cross-sectional observational study comparing referrals to outpatient CAP services from 2005, 2010 and 2018 to the only CAP center in the North Denmark Region. Results There was a 3.9 times increase in referrals from 2005 to 2018. Referrals for disorders with onset in early childhood (primarily autism and ADHD/ADD) increased from 2005 to 2010 but decreased from 2010 to 2018. There was an increase in the proportion of referrals for emotional disorders from 2010 to 2018. The proportion of girls referred for disorders with onset in early childhood increased from 2005 to 2018. The referral age for these disorders remained relatively high, and this was most pronounced for girls. Conclusions There has been significant changes in the referral pattern to outpatient CAP services. The increasing referral rates for girls for disorders with onset in early childhood could indicate improved ability in primary settings to recognize these symptoms in girls. However, late referral to CAP services for these disorders remains an issue. Educational services play an increasing role in referring children for these disorders, and it is important to ensure that they have the competences to identify children in need of assessment by CAP services.

A Retrospective Evaluation of a Pilot Youth Community Assessment and Treatment Service

Targeted, highly accessible early intervention for youths with emerging and complex psychiatric presentations is increasingly needed. The Youth Community Assessment and Treatment Team (YCATT) multidisciplinary service was established to provide intensive intervention for youths in Perth, Australia. The authors conducted a retrospective evaluation to examine YCATT's impact on emergency department (ED) visits, psychiatric inpatient admissions, and provision of care for youths in the transition period between adolescent and adult psychiatric services. Demographic, clinical, and service utilization data for all referrals over the pilot period (2016-2017) were collected and analyzed with descriptive statistics. During the pilot period, 308 referrals were accepted. All referred youths had a trauma history and presented with acute or complex conditions, and most (66%) were between 16 and 18 years old. The admission rate to a psychiatric inpatient unit was <7%. Of 61 youths specifically referred to YCATT as an alternative to psychiatric admission, 90% were successfully diverted from psychiatric or ED admission. After discharge from YCATT, youths had improved scores on the Health of the Nations Outcome Scale and 10-item Kessler Psychological Distress Scale. These findings suggest that YCATT is an accessible and effective service for the population of transition-age youths. It appears that YCATT, in collaboration with other community services, contributed to diverting psychiatric inpatient admissions, facilitated outpatient treatment, and enabled continuity of care for vulnerable youths. The results underscore the need for more accessible, individualized treatment approaches for youths who transition to adulthood.

Predictors of dropout among adolescents with borderline personality disorder attending mentalization-based group treatment

Background: Premature termination from treatment or dropout is prevalent among patients with borderline personality disorder (BPD). To our knowledge, no studies have examined which factors predisposes dropout from therapy among adolescents with BPD. The current study examined sociodemographic, clinical and psychological predictors of dropout among adolescents who attended a one-year treatment program with mentalization-based group treatment (MBT-G). Methods: Participants were 89 female adolescent patients aged 14–18 years who attended MBT-G in a Danish child and adolescent psychiatric service and 56 matched controls who received non-manualized individual sessions (treatment as usual). Forty (45%) dropped out and 49 (55%) completed treatment in MBT-G. Pretreatment predictors included (1) sociodemographic variables such as age, schooling, relationship status and after-school job, (2) clinical measures of self-reported adolescent borderline personality features, depression, self-harm, internalizing and externalizing symptoms, and (3) psychological measures on self-reported reflective functioning (i.e., mentalizing) and attachment to peers and parents. Results: Binary logistic regression analyses revealed that lower reflective functioning was the only significant predictor of dropout in MBT-G. No sociodemographic or clinical variables predicted dropout. No significant predictors of dropout were identified among participants who received treatment as usual. Conclusions: Adolescents with BPD who report low reflective functioning are at increased risk of dropping out of MBT-G treatment but not treatment as usual. These findings highlight that clinicians need to consider level of reflective functioning among adolescents with BPD in MBT or in group therapy and adapt psychotherapy to the needs of the patient in order to reduce dropout.

A longitudinal study of adolescents engaged in Non-Suicidal Self Injury (NSSI): clinical follow-up from adolescence to young adulthood

The main aim of the current study is to examine the demographic and clinical factors that predict a continuity of the use of Mental Health Services (MHS) in adulthood by subjects who have engaged in non-suicidal-self-injury behaviors (NSSI) and have been followed in MHS in their teen years. A cohort of 147 participants was selected from an original sample of 267 adolescent patients recruited from the Child and Adolescent Outpatient Psychiatric Services. Patients were divided into two groups: those who had engaged in NSSI (NSSI-group), and those who had not (non-NSSI-group). Rate of use of MHS in adulthood was calculated for both groups and univariate analyses and binary logistic regression analysis were applied. In the NSSI-group, two factors appeared to influence a continuity of the use of MHS in adulthood. Prosocial behavior was associated with a greater use of MHS in adulthood whereas behavioral problems were associated with less use. Only prosocial behavior was maintained in the regression model as a predictor. Our findings could have implications for clinical practice with NSSI patients and highlight the importance of working on specific areas that could prevent treatment abandonment in the transition from adolescence to adulthood.

When parents and clinicians disagree: Consequences for high-risk youth receiving in-home family-based psychiatric treatment

Children, parents and clinicians often disagree about how children are doing at the outset of psychotherapy. Besides complicating the formal diagnostic process, such disagreements are conspicuous indicators of distance between individuals whose ability to form constructive working relationship is crucial to ensure good treatment outcomes. No studies to date have investigated the impact of parent-clinician disagreements on child outcomes in intensive in-home psychiatric treatment. The present study used multiple regression modeling to analyze data from 7845 high-risk adolescents participating in a manualized, 6-month family-based intervention (Intensive In-Home Child and Adolescent Psychiatric Service (IICAPS). Parent-clinician disagreement on child functioning, but not symptom severity, predicted worse treatment outcomes for adolescents. Youth whose parents thought they were doing much worse than clinicians, had almost no effect of treatment at the group level whereas youth whose parents thought they were doing better than clinicians experienced clinically significant change on average. This finding lends empirical support to the notion that parent-clinician disagreements at the outset of youth psychotherapy may jeopardize not only diagnostic validity, but treatment outcomes for high-risk adolescents.

CYP2D6 and Antipsychotic Treatment Outcomes in Children and Youth: A Systematic Review.

Objective: To systematically review the impact of CYP2D6 genetic variation on antipsychotic pharmacokinetics, efficacy, and adverse drug reactions among children and youth. Method: The published literature was systematically searched in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations and critically evaluated using standardized tools and consensus criteria. Results: A total of 20 eligible studies comprising 1078 children and youth were evaluated. The included studies were of fair to moderate quality and included mostly males, individuals of European ancestry, and those treated with risperidone. CYP2D6 poor metabolizers (PMs) were consistently shown to have increased concentrations of risperidone relative to normal metabolizers (NMs). PMs were also consistently shown to have a greater propensity to experience antipsychotic (primarily risperidone) associated adverse drug reactions relative to NMs. However, robust evidence for an association between CYP2D6 and efficacy was less apparent. Conclusion and Clinical Significance: The current knowledge base suggests that CYP2D6 genetic variation has an appreciable impact on antipsychotic pharmacokinetics and the propensity for adverse drug reactions, particularly among children receiving risperidone treatment. However, several limitations with the current literature (e.g., sample sizes, study design, sample heterogeneity) should be addressed in future studies. Assuming that future studies support the link between CYP2D6 genetic variation and antipsychotic outcomes, we would anticipate an increase in the implementation of CYP2D6-guided antipsychotic drug selection and dose optimization in child and adolescent psychiatric services.

Young Women’s Mental Illness and (In-)visible Social Media Practices of Control and Emotional Recognition

What “counts” as a mental illness–related image matters. Most research attention has focused on distressing or recognizable mental illness–related visual practices, yet this offers partial insight into youth mental health. Using visibility and practice theories, I share an in-depth case study exploring the social media practices of four young women, aged 14–17 years, engaged with an Australian adolescent psychiatric service. They describe how being visible to others on social media potentially produces anxiety and burdens them to respond to others’ questions or unhelpful support. In response, they engage in practices of control to manage the vulnerability of mental illness and burdensome sociality. Their mental illness–related media practices are often invisible; they rework mental illness through ambiguous, supportive or humorous practices or, through imagined intimacy, engage with images that feel relatable to them even if the images do not depict recognizable mental illness content or employ recognizable hashtags or titles. These insights complicate “what counts” as mental illness–related content or practices on social media and challenge researchers and practitioners to consider the sociotechnical contexts that shape young people’s mental health.

Psychiatric care utilization among children in refugee families – a Swedish population-based study

Abstract Background Previous studies have demonstrated a high prevalence of mental health problems, in particular depression, anxiety, and posttraumatic stress disorder (PTSD), among individuals with experiences of war, persecution, and torture. Mental health problems can affect parenting and the well-being of the children. However, few large-scale studies have investigated the intergenerational effects of psychological trauma on children in refugee families. Methods Register data on all children living in Stockholm, Sweden, in 2016 (&amp;gt;90 000) were used to investigate utilization of child and adolescent psychiatric care in relation to parental PTSD, in foreign-born and Swedish-born refugee children compared to non-refugee children. Results In total, 13% of children in refugee families had a parent who had been treated for PTSD. Preliminary results showed an increased risk of psychiatric care use among foreign-born refugee children (HR: 2.68, 95% CI: 2.08-3.44) and in Swedish-born children in refugee families (HR: 1.86, 95% C.I: 1.43-2.41), whose mothers had been treated for PTSD. No association was observed in relation to PTSD diagnoses in fathers. Conclusions The findings indicate that refugee children with experience of PTSD of the mother were more than twice as likely to have been in contact with child and adolescent psychiatric services. This underlines the importance of making mental health care available so that adequate support and treatment is offered to refugees and their children. Key messages This study contributes with important information on the intergenerational effects of psychological trauma in refugee families. In order to prevent mental health problems in refugee children, Public health interventions for their parents with PTSD are crucial.

Implementation of Key Components of Evidence-Based Family Therapy for Eating Disorders in Child and Adolescent Psychiatric Outpatient Care.

BackgroundRestrictive eating disorders with pronounced starvation are serious psychiatric conditions that often begin during childhood or adolescence. An early and efficient intervention is crucial to minimize the risk of the illness becoming longstanding and to limit the consequences. There is good evidence that weight gain during the first month of treatment provides a better prognosis. Only a limited amount of young people suffering from severe restrictive eating disorder receive an evidence-based treatment at present in Sweden. The ROCKETLAUNCH project intends to implement key components of the evidence-based family therapy during the first month of treatment in child and adolescent psychiatric outpatient care.MethodsFrom the southern part of Sweden, 12 local child and adolescent psychiatric outpatient services will take part. All patients with a restrictive eating disorder and pronounced starvation together with their families will be asked to take part in the study. We expect that one hundred 50 patients will be assessed every year. The patients and their families will receive 1 month of intense manualized treatment. Body weight, days in inpatient care, eating disorder, and other psychopathology-related symptoms, will be evaluated after one month and at 12-month follow-up. Economic evaluation of ROCKETLAUNCH will also be carried out alongside the intervention. At each outpatient clinic, data from the 10 previous patients will be gathered to compare the treatment provided at ROCKETLAUNCH with the standard treatment in Sweden.DiscussionWe expect that by implementing the key components of the evidence-based family therapy during the first month of treatment, the prognosis of young newly diagnosed patients with severe restrictive eating disorders, primarily anorexia nervosa will improve, which, in turn, will reduce the need for psychiatric inpatient care.Clinical Trial Registrationwww.ClinicalTrials.gov, identifier NCT04060433.

Prevalence of mental illness among adolescents (15–18 years) treated at Federal Neurospsychiatric Hospital, Enugu Nigeria, from 2004 to 2013

PurposeThe aim of this study was to investigate the prevalence of mental illness among adolescents treated at Federal Neurospsychiatric Hospital, Enugu Nigeria. MethodsA retrospective descriptive design was used to assess 1255 adolescents within the age of 15–18 years diagnosed with mental illness from 2004 to 2013. A proforma designed by the researchers was used to document information on prevalence, type, and relationship with age and gender. ResultsThe prevalence of mental illness within the 10 year period was 9.9%. Schizophrenia spectrum and other psychotic disorders 869 (69.2%) were the commonest conditions recorded. Higher prevalence of mental illness was seen among males 752 (59.9%) compared to females 503 (40.1%). Schizophrenia spectrum and other psychotic disorders 384 (76.3%); depressive disorders 20 (4.0%) were more common among female adolescents while substance-related and addictive disorders 84(11.2%) and neurodevelopmental disorders 48(6.8%) were more common among male adolescents. The prevalence of mental illness increased with age, being highest at 18 years and lowest at 15 years while prevalence of drug induced psychosis was 90 (7.2%). ConclusionsThe study highlights the need to focus on the mental health of adolescents by planning preventive programs and creating awareness on mental health promoting strategies, and to introduce child and adolescent psychiatric health services in the study setting.

The SDQ dysregulation profile is associated with self-injurious thoughts and behaviors in adolescents evaluated at a clinical setting

IntroductionSuicidal ideation, suicidal behavior, and non-suicidal self-injury behavior are serious public health problems among adolescents. A significant proportion of adolescents evaluated in clinical settings meet criteria for the dysregulation profile (DP). DP is characterized by restlessness, irritability, “affective storms‿, mood instability, and aggression in a disproportionate grade to the situation. This DP might be related to increased risk of self-injurious thoughts and behaviors. MethodsTwo hundred and thirty-nine adolescents from the Child and Adolescent Outpatient Psychiatric Services of the Jimenez Diaz Foundation, Madrid, were assessed with the Strengths and Difficulties Questionnaire-Dysregulation Profile, the Self-Injurious Thoughts and Behaviors Interview and socio-demographic questionnaires. ResultsLogistic regression showed that DP adolescents were at increased risk for suicide plans, gestures, and suicide attempts. They also tended to present more self-injurious behaviors than adolescents without DP. ConclusionsOur results point to the role of self-regulatory problems in the presence of suicide plans, suicide gestures, suicide attempts, and in non-suicidal self-injury behavior. Longitudinal studies are needed to confirm the relationship between the Strengths and Difficulties Questionnaire-Dysregulation Profile and self-injurious thoughts and behaviors.