Adolescent Psychiatry Department Research Articles

Sports preferences in children and adolescents in psychiatric care—evaluation of a new questionnaire

IntroductionAs part of an exploratory and hypothesis-generating study, we developed the Sports Preference Questionnaire (SPOQ) to survey the athletic behavior of mentally ill children and adolescents, subjectively assessed physical fitness and perceived psychological effects of physical activity.MethodsIn a department of child and adolescent psychiatry, we classified 313 patients (6–18 years) according to their primary psychiatric diagnosis. The patients or—in the parental version of the questionnaire—their parents reported their sport preferences on the SPOQ. As possibly influential factors, we also assessed the frequency of physical activity, the importance of a trainer, coping with everyday life through physical activity, and subjectively perceived physical fitness.ResultsOne in 3 patients (32.4%) stated that they were not physically active. Patients diagnosed with eating disorders reported, on average, a notably high frequency (median of 3 h/week) and degree of coping with daily life through physical activity (median of 5 on a 6-point Likert scale). Patients with anxiety disorders and depression had the lowest self-perception of physical fitness (mean value of 3.1 or 3.7 on an interval scala from 0 to 9). The presence of a trainer was generally considered not important, except for ADHD patients (median of 3 on a 6-point Likert scale).ConclusionThe SPOQ is sensitive for differential effects of core child and adolescent disorders as well as for main covariates influencing the complex association between physical activity and emotional and behavioral disorders in children and adolescents. Based on this pilot study, we discussed the need for an efficacy study to measure the effects of sports therapy.

Cyber Victimization, Coping Methods, and Attitudes of the Family Toward Internet Use in Adolescents Applying to the Child and Adolescent Psychiatry Department During the Pandemic

Cyber Victimization, Coping Methods, and Attitudes of the Family Toward Internet Use in Adolescents Applying to the Child and Adolescent Psychiatry Department During the Pandemic

Epidemiological Characterization of Patients in the Outpatient Clinic of the Department of Child and Adolescent Psychiatry of a University Hospital in Paraguay: A Three-Year Study

El tema de la salud mental en niños y adolescentes requiere mayor atención. Por lo tanto, este estudio tuvo como objetivo determinar las características de los pacientes de consulta externa de un centro especializado de un hospital universitario paraguayo. Este estudio empleó una serie retrospectiva, no probabilística, de casos consecutivos. Se examinaron las historias clínicas de pacientes de ambos sexos, de entre 2 y 17 años de edad, que solicitaron consulta en el Departamento de Psiquiatría del Niño y del Adolescente del Hospital de Clínicas entre julio de 2021 y julio de 2023, y que fueron diagnosticados con un trastorno mental según la CIE-10. Se recogieron datos demográficos y clínicos de 447 pacientes, representando 1278 consultas. La mayoría de los pacientes eran mujeres (57,7%), con una edad media de 13 ± 3 años. La mayoría de los pacientes (57,3%) procedían del Departamento Central, el 61,5% eran de zonas rurales y el 72% no tenían seguro médico. Los diagnósticos más frecuentes fueron episodios depresivos (F32), otros trastornos de ansiedad (F41), trastornos de conducta (F91) y trastornos específicos de la personalidad (F60). Los resultados de este estudio proporcionan información crucial sobre la salud mental de niños y adolescentes, que es esencial para informar las políticas de salud mental, asignar recursos y formar a los profesionales sanitarios encargados de atender a este grupo de pacientes.

Omega-3 Fatty Acid Supplementation Improves Attention Deficit-Hyperactivity Disorder Symptoms in Children

Background: Attention Deficit-Hyperactivity Disorder (ADHD) is one of the most common neuropsychiatric disorders in children. Increasing evidence suggests an association between omega-3 fatty acid and ADHD. We aimed to investigate the effects of 6-month omega- 3 fatty acid supplementation on the fatty-acid profile of erythrocytes and on the clinical severity of ADHD symptoms in children. Methods: Recruitment included 32 children aged 6-14 years diagnosed with ADHD at the Child and Adolescent Psychiatry Department at Ziv Medical Center, Israel. Intervention included refrigerated omega-3 fatty acid supplementation normalized to body weight. Blood samples were taken at baseline, 3 and 6 months after intervention for quantification of fatty acids from erythrocyte membranes. ADHD symptoms were assessed by parents and teachers according to the ADHD Rating-Scale and the Strengths and Difficulties Questionnaire. ADHD severity was additionally assessed by a psychiatrist according to the Clinical Global Impressions Scale. Results: Supplementation of omega-3 fatty acid in children with ADHD raised their omega-3 index statistically significantly from an average of 4.4% omega-3 index at baseline to 11.6% after 6 months and had beneficial effects on ADHD symptoms, as measured by validated questionnaires and in accordance with a pediatric psychiatrist examination. Conclusion: Our pilot study showed that dietary supplementation of omega-3 fatty acid increased the blood omega-3 index levels and improved ADHD symptoms even at the midpoint of 3 months.

Changes in patient care through flexible and integrated treatment programs in German psychiatric hospitals: meta-analyses based on a series of controlled claims-based cohort studies

BackgroundGlobal treatment budgets, i.e. predefined budgets for patients treated in hospital independent of the setting within the hospital, together with flexible and integrated treatment (FIT) have been introduced in some German psychiatric hospitals since 2013. We investigated pooled changes in inpatient, day-care, outpatient treatment, and continuity of care for patients with mental disorders in 12 FIT-hospitals.MethodsWe conducted a series of 12 controlled cohort studies regarding FIT hospitals using anonymized patient claims data from more than 70 German statutory health insurance funds. Each study compared one FIT-hospital to matched patients from equivalent non-FIT-hospitals (routine care). We included only those patients without treatment in the respective hospital within two years prior to first hospital treatment (either FIT or routine care). We contrasted results between the year prior to with the first and second year after patient’s first treatment (treatment continuity: only group comparison) using multivariate multi-level models. To approximate the difference-in-difference effect in the meta-analysis, we used the interaction terms group (FIT hospital vs. routine care) x time (year before vs. first or second patient year after study inclusion) in the Poisson models.ResultsThe 12 studies included 36,069 patients with 2,358 patients from a Department of child and adolescent psychiatry. The pooled effect revealed a 5.1 days lower increase in inpatient treatment in FIT-hospitals during the first patient year compared to routine care. Results were statistically significant for adult care FIT-hospitals but not for child and adolescent FIT-hospitals. Utilization of day-care treatment increased more in most FIT-hospitals during the first year, while outpatient contacts increased in some and decreased in others. The odds of treatment continuity increased by 1.4 in FIT-hospitals compared to non-FIT-hospitals.ConclusionsGlobal treatment budgets lead to the intended changes in mental health care in the majority of FIT-hospitals compared to routine care in this large real-world evidence study from Germany. For child and adolescent psychiatry, more evidence is needed to draw firm conclusions.Trial registrationThis study was registered in the database “Health Services Research Germany” (trial number: VVfD_EVA64_15_003713).

Medical Child Abuse - A Guideline to Detecting this Particular Form of Child Maltreatment

The term Medical Child Abuse (MCA) describes a form of child abuse in which the medical system is "abused" by carrying out unnecessary medical procedures on a child. This abuse of the medical system occurs through misrepresentation, non-disclosure, fabrication, misinterpretation or active causation of symptoms by a parent. In this article, the construct ofmedical child abuse is defined and predisposing and motivational factors are examined. It also provides an overview of terms that are used synonymously or comparably in the literature and discusses the connection between MCA and Munchausen-by-proxy-syndrome.The core of the article is the presentation of an internal guideline, which was created by the interdisciplinary working group on MCA of the Clinics for Paediatric and Adolescent Medicine, the Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, the Child Protection Outpatient Clinic and the Social Services at the Charité. It also outlines possible interventions.

Evaluating the Interrater Reliability of the Icelandic Version of K-SADS-PL DSM-5.

The Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL) is a valuable tool for diagnosing mental disorders in children and adolescents. Previous studies have examined its interrater reliability, but there is limited information on individual disorders, on the updated DSM-5 version. This study aims to analyse the interrater reliability of the Icelandic translation of K-SADS-PL, DSM-5 version. K-SADS-PL was administered to a clinical sample of outpatients from the Icelandic Anxiety Centre for Children, Adolescents, and Young Adults, and The Department of Child and Adolescent Psychiatry at Landspítali, the National University Hospital in Reykjavík, Iceland. In total, 135 patients aged 6-18 were included in this study. We assessed the interrater reliability using Cohen's κ, with results ranging from poor to excellent (0.3-1.0), though most disorders showed excellent reliability (κ > 0.75). The Icelandic translation of the DSM-5 K-SADS-PL is generally reliable when used by properly trained post-graduate students, which supports its use in clinical settings.

Space for youth mental health—coercive measure use before and after architectural innovation at a department of child and adolescent psychiatry

BackgroundInfluence of architectural features in child and adolescent psychiatric wards on coercive measure use has not been investigated so far. We aimed to assess the effect of altering the physical environment of an adolescent psychiatric inpatient unit on the proportion and frequency of adolescents experiencing mechanical coercive measures.MethodIn a naturalistic observational design, coercive measures were compared before and after an architectural intervention facilitated by rebuilding a child and adolescent psychiatric department in October 2020. Age, gender, length of stay, main psychiatric diagnosis and indices of coercion in n = 782 admissions to inpatient child and adolescent psychiatry from April 2019 to April 2022 were extracted. Group comparisons were performed using chi‐squared tests for categorical and Mann–Whitney U‐tests for numerical variables.ResultsAfter structural modernization which included amplifying space and with the newly introduced availability of seclusion rooms, significantly fewer patients were affected by mechanical restraint (8.1% vs. 13.7%, p = .013). Rate of seclusion increased to 5.0% (vs. 0%, p < .001). Rate of seclusion and/or restraint decreased from 13.7% to 11.8% (p = .425). The median cumulative duration of all coercive measures per affected case decreased significantly (2.8 vs. 5.4 h, p = .005), as well as its proportion to length of stay (0.8% vs. 2.8%, p = .006).ConclusionsModernisation and restructuring of buildings hosting psychiatric departments can contribute to a reduction of coercive measures in child and adolescent psychiatric units.

Clinical characteristics of child and adolescent psychiatric outpatients engaging in fireplay or arson: a case–control study

BackgroundFireplay and arson incidents among children and adolescents have gained attention because of their potentially severe consequences and societal impacts. Understanding the underlying psychiatric characteristics of individuals engaging in fireplay or arson is crucial for early identification and targeted intervention. However, there is a lack of research conducted in clinical psychiatric populations in this context. This study compared the clinical characteristics of child and adolescent psychiatric outpatients who engaged in fireplay or arson with those without such behaviors.MethodsA retrospective case–control study was conducted using data collected from patients who visited the Department of Child and Adolescent Psychiatry at Kohnodai Hospital, National Center for Global Health and Medicine in Japan, between April 2014 and March 2022. Medical records were checked to see if the patient had practically committed behaviors that corresponded to fireplay or arson. The case group was identified using this process. After identifying the case and control groups, sex, diagnosis, antisocial behavior, abuse history, and children-to-parent violence were assessed and compared by careful review of medical records.ResultsThe study identified 64 patients who engaged in fireplay or arson, representing approximately 1.1% of the total 5,587 patients (case group). The median age of the patients’ first fire-related behavior was 13 years (range, 6–18 years). In the case group, 14.1% of the cases involved arson, resulting in substantial damage. Of the remaining 5523 patients, 2268 patients had datasets for the first consultation (control group). The most prevalent diagnosis in the case group was attention-deficit hyperactivity disorder (ADHD), present in 57.8% of the cases. The study revealed a significant association between fire-related behaviors and ADHD as well as antisocial behavior. Gender differences were observed, with boys being more likely to engage in fireplay or arson than girls.ConclusionsThis study suggests that clinicians and mental health professionals should closely consider male sex, ADHD, and antisocial behaviors as potential risk factors for fire-related behaviors. Monitoring the case group for the development of psychiatric disorders, including the use of illegal drugs, is recommended to prevent future arson incidents.

Between “Yesterday and Today”. A description of group therapy in the Department of Child and Adolescent Psychiatry, Jagiellonian University Medical College, Krakow.

The following article is an attempt to present the model of group interaction conducted in the Department of Child and Adolescent Psychiatry of the University Hospital in Krakow. It describes both the beginnings of group interaction conducted by the team of Prof. M. Orwid, Prof. J. Bomba and dr W. Badure- Madej as well as the model developed by the current team of the clinic. The structure and setting of group interaction conducted in the stationary ward, the therapeutic framework, supervision process, and the method of conducting group therapy are described. The article describes the changes in the understanding and conduct of group therapy that have taken place over the years.

From editors

Dear Readers Between Yestarday and Today ...With this words we open the autumn issue of Archives of Psychiatry and Psychotherapy. This is also the opening phrase of the first paper prepared by the Krakow team of Klaudiusz Kudła et al, prepared under the supervision of Maciej Pilecki. The article describes the transition of the model of group interaction conducted in the Department of Child and Adolescent Psychiatry of the University Hospital in Krakow, Poland - from its beginnings conducted by Prof. M. Orwid, Prof. J. Bomba and dr W. Badure-Madej throughout the changes that have taken place over the years.

Likelihood of identifying autistic traits with the autism spectrum quotient (AQ) in male juveniles with autism spectrum disorder (ASD) and severe behavioral problems (SBPs)

BackgroundWhen screening for autism spectrum disorders (ASD), the Autism Spectrum Quotient (AQ) is generally considered to be useful. Whether the AQ is also a suitable screener for ASD in juveniles with severe behavioral problems (SBPs) is unknown. Due to the overlap of symptoms between ASD and SBPs, particularly in juveniles low on empathy, the screening capacity of the AQ might be constrained. The aim of the present study was to investigate whether (comorbid) SBPs affect the screening capacity of the AQ. The hypothesis is that male juveniles with SBPs - but without a diagnosis of ASD - will score higher than male juveniles without both SBPs and ASD.MethodThe AQ was completed by 216 male juveniles aged 15–18 years treated at an outpatient department of child and adolescent psychiatry. The 216 participants were categorized into four groups according to a clinical diagnosis of ASD and SBPs (defined as disruptive behavior disorder and/or delinquent behavior). Using multinomial logistic regression, we investigated whether the four identified groups, based on a diagnosis of ASD and SBPs, scored differently for the total score and subscales of the AQ.ResultsParticipants in the group with ASD (ASD+) but without SBPs (SBP-) were more likely to report higher levels of autistic traits than the reference group without both ASD and SBPs (ASD-SBP-), except for the subscale on attention to detail (ASD+SBP- OR = 1.04; 95%CI = 0.98–1.11). Participants in the group with both ASD and SBPs were more likely to report higher levels for the total AQ score (ASD+SBP+ OR = 1.03; 95%CI = 1.00–1.05) and the communication subscale of the AQ (ASD+SBP+ OR = 1.18; 95%CI = 1.07–1.31) than the reference group without both ASD and SBPs.ConclusionIn outpatient male juveniles, SBPs do not affect the screening capacity of the AQ for autistic traits. In spite of the well-known overlap of symptoms between ASD and SBPs, male juveniles with SBPs but without a diagnosis of ASD do not score higher on the AQ than male juveniles without SBPs and without a diagnosis of ASD.

Identifying major predictors for parenting stress in a caregiver of autism spectrum disorder using machine learning models.

Previous studies have investigated predictive factors for parenting stress in caregivers of autism spectrum disorder (ASD) patients using traditional statistical approaches, but their study settings and results were inconsistent. Herein, this study aimed to identify major predictors for parenting stress in this population by developing explainable machine learning models. Study participants were collected from the Department of Child and Adolescent Psychiatry, Severance Hospital, Yonsei University College of Medicine, Seoul, the Republic of Korea between March 2016 and October 2020. A total of 36 model features were used, which include subscales of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) for caregivers' psychopathology, Social Responsiveness Scale-2 for core symptoms, and Child Behavior Checklist (CBCL) for behavioral problems. Machine learning classifiers [eXtreme Gradient Boosting (XGBoost), random forest (RF), logistic regression, and support vector machine (SVM) classifier] were generated to predict severe total parenting stress and its subscales (parental distress, parent-child dysfunctional interaction, and difficult child). Model performance was assessed by area under the receiver operating curve (AUC), sensitivity, specificity, accuracy, positive predictive value, and negative predictive value. We utilized the SHapley Additive exPlanations tree explainer to investigate major predictors. A total of 496 participants were included [mean age of ASD patients 6.39 (SD 2.24); 413 men (83.3%)]. The best-performing models achieved an AUC of 0.831 (RF model; 95% CI 0.740-0.910) for parental distress, 0.814 (SVM model; 95% CI 0.720-0.896) for parent-child dysfunctional interaction, 0.813 (RF model; 95% CI 0.724-0.891) for difficult child, and 0.862 (RF model; 95% CI 0.783-0.930) for total parenting stress on the test set. For the total parenting stress, ASD patients' aggressive behavior and anxious/depressed, and caregivers' depression, social introversion, and psychasthenia were the top 5 leading predictors. By using explainable machine learning models (XGBoost and RF), we investigated major predictors for each subscale of the parenting stress index in caregivers of ASD patients. Identified predictors for parenting stress in this population might help alert clinicians whether a caregiver is at a high risk of experiencing severe parenting stress and if so, providing timely interventions, which could eventually improve the treatment outcome for ASD patients.

The Effect of Mobile Neurofeedback Training in Children with Attention Deficit Hyperactivity Disorder: A Randomized Controlled Trial.

: To examine the effect of mobile neurofeedback training on the clinical symptoms, attention abilities, and execution functions of children with attention deficit hyperactivity disorder (ADHD). : The participants were 74 children with ADHD aged 8-15 years who visited the Department of Child and Adolescent Psychiatry at Seoul National University Children's Hospital. The participants were randomly assigned to the mobile neurofeedback (n = 35) or control (sham; n = 39) group. Neurofeedback training was administered using a mobile app (equipped with a headset with a 2-channel electroencephalogram [EEG] sensor) for 30 min/day, 3 days/week, for 3 months. Children with ADHD were individually administered various neuropsychological tests, including the continuous performance test, Children's Color Trails Test-1 and 2, and Stroop Color and Word Tests. The effects of mobile neurofeedback were evaluated at baseline and at 3 and 6 months after treatment initiation. : Following treatment, both mobile neurofeedback-only and sham-only groups showed significant improvements in attention and response inhibition. In the visual continuous performance test, omission errors decreased to the normal range in the mobile neurofeedback-only group after training, suggesting that mobile neurofeedback effectively reduced inattention in children with ADHD. In the advanced test of attention, auditory response times decreased in the mobile neurofeedback + medication group after training, but increased in the sham+medication group. Overall, there were no significant between-group differences in other performance outcomes. : Mobile neurofeedback may have potential as an additional therapeutic option alongside medication for children with ADHD.

Neurocognitive Profile in Children with Attention Deficit/Hyperactivity Disorder and Dyslexia

Objective: The current study aimed to examine the neurocognitive deficits of children with ADHD and/or Developmental Dyslexia (DD) using neurocognitive tests. Material and Methods: The participants of the study consisted of children diagnosed with Dyslexia (N=33), ADHD (N=32), and DD+ADHD (N=37) who applied to the Department of Child and Adolescent Psychiatry, Faculty of Medicine, Ankara University. The control group consists of 30 primary school children aged 7-11 with similar sociodemographic data. K-SADS-PL is used for the DSM-5 diagnoses of the patients and the control group. Stroop Test, Trail Making Test, Verbal Cancellation Test, and Wechsler Intelligence Scale for Children-Revised (WISC-R) were used to evaluate the cognitive functions of the groups in detail. Results: Children with ADHD and/or Dyslexia were evaluated to have significant deficits in all neurocognitive measures such as reaction inhibition, selective attention, sustained attention, shifting attention, and visuospatial short-term memory compared to the healthy control group (p<0.001). Children with ADHD-only revealed the most significant weaknesses in reaction inhibition, and visuospatial short-term memory measures (p<0.001). The comorbid group exhibited significant weakness on almost all neurocognitive measures compared with the control group, but did not perform significantly lower than the ADHD-only and Dislexia-only groups. Conclusion: It has been shown that children with ADHD and/or Dyslexia have multiple neurocognitive deficits, and our study supports the multiple cognitive deficit hypothesis.

Validation of a violence risk screening for youth in psychiatric inpatient care-a pilot study of V-RISK-Y.

The reason for this study was the void of validated risk assessment screening tools for violence in adolescence psychiatry. Our aims were to test the predictive validity and feasibility of a pilot version of the Violence Risk Screening for Youth (V-RISK-Y). The V-RISK-Y was based on a violence risk screen for adults, the V-RISK-10, and adapted to adolescents, resulting in 12 risk items that are scored for (a) presence and (b) relevance for future violence. In this naturalistic, prospective observational study, the V-RISK-Y was scored at admission and compared with recorded episodes of violent acts and threats during hospital stay. The target population was all 92 patients admitted to the emergency department of adolescent psychiatry at Oslo University Hospital for 1 year, of which 67 patients were scored with the V-RISK-Y at admission and constituted the study sample. The predictive validity of the V-RISK-Y for violent behavior showed an AUC of 0.762 (p = 0.006). Staff approved the screener and found it to be equally or better usable than the V-RISK-10, which was previously used in the department. Still, a high proportion of raters failed to follow the scoring instructions of relevance scores, reducing feasibility. The results must be interpreted within the limits of a pilot study and low power. We conclude that results suggest changes of certain parts of the V-RISK-Y and provide a basis for testing a revised edition of the screener in a more comprehensive study, preferably with a multicenter design.

Sports Preferences in children and adolescents in psychiatric care – evaluation of a new Questionnaire (SPOQ)

Background: As part of an exploratory and hypothesis-generating study, the Sports Preference Questionnaire (SPOQ) was developed to survey the athletic behavior of mentally ill children and adolescents, subjectively assessing physical fitness and the perceived psychological effects of physical activity. Methods: In a department of child and adolescent psychiatry, 313 patients (6 years - 18 years) were classified according to their primary psychiatric diagnosis. The patients or - in the parental version of the questionnaire - their parents reported their sports preferences on the SPOQ. As possibly influential factors, also the frequency of physical activity, the importance of a trainer, coping with everyday life through physical activity, and subjectively perceived physical fitness were assessed. Results: One in 3 patients stated that they were not physically active. Patients diagnosed with eating disorders reported, on average, a notably high frequency and degree of coping with daily life through physical activity. Patients with anxiety disorders and depression had the lowest self-perception of physical fitness. The presence of a trainer was generally considered very unimportant, but not in Attention Deficit Hyperactivity Disorder (ADHD) patients. Conclusion: The SPOQ is sensitive to differential effects of core child and adolescent disorders as well as to main covariates influencing the complex association between physical activity and emotional and behavioral disorders in children and adolescents. Based on this pilot study, the need for an efficacy study to measure the effects of sports therapy was discussed.

Evaluation of Disability Health Committee Reports of Patients Applying to the Child and Adolescent Psychiatry Unit of a University Hospital

Objective: The aim was to investigate the reasons for admission, sociodemographic background, psychiatric diagnoses, additional physical diseases and special needs levels of children and adolescents who applied to Kocaeli University Faculty of Medicine disability health committee for a special needs report in order to expand the literature on individuals with special needs. Methods: Between 1st August 2021 and 31st August 2022, the data of 616 patients aged 0-18 years who applied for a special needs report to the Department of Child and Adolescent Psychiatry was retrospectively examined. Results: The mean age of the group was 7.74±3.64 years, with most cases being between 7-12 years of age and male. The most common diagnosis was "delayed milestone in childhood (ICD R 62.0)" in 45.3% (n=279). The most commonly reported special needs level was "Requires Special Needs" in 33.5% (n=206), and the most common reason for application was to renew the report, in 40.4% (n=249). In this cohort, 34.6% had an additional medical disease, most commonly genetic diseases, including Down, Fragile X, and Angelman syndromes. Conclusion: Special needs report evaluation in children and adolescents is commonly encountered in a Psychiatry outpatient clinic. It is important that both patients and their families can benefit from their existing rights and that patients with special educational needs can be identified as early as possible to begin educational interventions promptly. Thus, child psychiatrists should be informed of the demographics and clinical presentation in this patient group.

Changes in the psychosocial and clinical profiles of anorexia nervosa patients during the pandemic.

The COVID-19 pandemic and related control measures have increased the prevalence of anorexia nervosa (AN), and recent studies demonstrated that approximately 70% of individuals diagnosed with AN experienced deterioration in symptoms. This study aimed to examine the psychosocial and clinical impacts on patients with AN during the COVID-19 pandemic. This cross-sectional study involved 35 female AN adolescents who were being treated at Ege University Child and Adolescent Psychiatry Department. To assess pre-pandemic symptom levels and daily life routines, a retrospective form utilizing the visual analog scale (VAS) was employed. Body mass index (BMI) and Clinical Global Impression (CGI) data were recorded by an interviewer for all 35 patients who gave consent to participate in the study. Fifteen patients completed all the forms [VAS, the Children's Depression Inventory (CDI), the Screen for Child Anxiety Related Disorders Scale (SCARED), the Eating Attitudes Test, the Quality-of-Life Scale (QoLS), the Autism Spectrum Screening Questionnaire, and the Turgay DSM-4 Based Screening and Evaluation Scale for Behavioral Disorders in Children and Adolescents] online in 2022. Clinical diagnosis and progress were assessed retrospectively using The Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS). The duration of the follow-up period and the number of psychiatric visits were obtained retrospectively from patient files. Retrospective data on pre-pandemic symptom levels and daily life routines were collected using the VAS. The mean age of AN patients was 16.67 ± 1.63 years. Comorbid diseases were present in 73.33% of patients, and major depressive disorder (MDD) was the most common (46.66%). Mean scores indicated moderate levels of anxiety (SCARED score: 37.23 ± 12.67) and depression (CDI score: 17.23 ± 10.85). QoLS scores were negatively correlated with eating attitudes (r = -0.601, p = 0.039). Obsession level, exercise level, and screen time increased during the pandemic, while social activity, quality of education, and perception of learning decreased. BMI increased in all patients. Patients who completed the forms had a higher number of psychiatric visits compared to those who did not complete the forms (p = 0.033). The mean number of clinic visits was 26.27 ± 20.33. The results show that the COVID-19 pandemic had adverse effects on AN patients and disrupted their daily routines. These patients experienced high rates of comorbidities. The patients showed improvement in BMI scores, indicating the positive impact of treatment. These findings emphasize the need for comprehensive psychiatric care and targeted interventions for AN patients during crises such as the COVID-19 pandemic.

Investigation of Sociodemographic and Clinical Characteristics of Forensic Cases Admitted to a Child and Adolescent Psychiatry Outpatient Clinic in Şanlıurfa

Objective: In this study, we aimed to evaluate the sociodemographic and clinical characteristics of children and adolescents for whom forensic reports were requested by judicial authorities for various reasons. Materials-Methods: The records of 110 cases referred to our hospital’s Child and Adolescent Psychiatry Department for forensic psychiatric evaluation between January 2022 and December 2022 were evaluated retrospectively. Sociodemographic data of the cases, clinical diagnoses, contents of forensic events, and forensic report decisions were included in the analyses. Results: The mean age of the 110 patients participating in the study was 14.5 ± 2.9 years and 68.2% (n=75) of the cases were male. The judicial authorities directed the cases most frequently (n=53) for evaluating discrimination under the Turkish Penal Code 31/2, and it was determined that crime against property (41.5%) was committed most frequently. Considering the distribution of perpetrator and victim status by gender, a significant difference was found between the two genders (p<0.001). Conclusion: Determining regional differences regarding individual and familial characteristics of child and adolescent forensic cases may contribute to the determination of factors that may adversely affect children's mental health and to the development of preventive mental interventions.