Adolescent Psychiatry Department Research Articles

The mental distress of our youth in the context of the COVID-19 pandemic.

Epidemiological evidence from population-based surveys suggest that the psychological well-being of adolescents has been severely affected by the COVID-19 pandemic itself, as well as by the safety measures implemented. The rationale of the study was to investigate the influence of the pandemic on psychiatric emergency service use, psychiatric admissions rates, emotional well-being, suicidality and self-harm behaviour in help-seeking children and adolescents. Retrospective cohort study of electronic patient records before and during the COVID-19 pandemic from the emergency out-patient facility of the department of child and adolescent psychiatry and psychotherapy of the Psychiatric University Hospital Zürich. The frequency of all emergency service contacts from 1 January 2019 to 31 June 2021 were described and the frequency of records compared in half-year intervals. Emotional well-being, behavioural problems, suicidality and self-harm were estimated based on the mental state examination notes of electronic patient records from the 1 March to the 30 April for the years 2019, 2020 and 2021. After an initial decline in emergency contacts at the beginning of the first lockdown, the use of the centralised emergency service increased during the subsequent months and has since stabilised at a significantly higher level than before the pandemic. Comparison of emergency contacts in the first half of 2019 with the first half of 2021 shows that the number of emergency phone contacts nearly doubled, emergency outpatient assessments increased by 40%, emergency bridging interventions increased by 230%, and inpatient admissions of minors to adult psychiatric inpatient units more than doubled because of lack of service capacity in child and adolescent psychiatry. The proportion of adolescents who reported suicidal ideation increased significantly by 15%, from 69% to 84%, and the proportion of adolescents who reported self-harm behaviour increased by 17%, from 31% to 48%. We found a significant increase in psychiatric service use, as well as in reported serious mental health symptoms such as suicidality and self-harm behaviour in help-seeking children and adolescents in the course of the pandemic. The child and adolescent psychiatric healthcare system is overburdened and down-referral of adolescents in need of ongoing therapy is becoming increasingly difficult. We recommend prioritising preventive and therapeutic measures to support the mental health of our children and adolescents alongside the somatic management of the COVID-19 pandemic.

Investigation of Adolescents Who Have Internet Addiction Accompanied By Attention Deficit and Hyperactivity Disorder in Terms of Emotion Regulation and Social Cognition.

The aim of this study is to evaluate social cognition and emotion regulation skills in individuals with Internet Addiction (IA) and Internet addiction with comorbid Attention Deficit/Hyperactivity Disorder (IA + ADHD). The sample of the study consist of 30 IA, 30 IA + ADHD patients, 30 healthy controls between the ages of 12-17 who applied to the Child and Adolescent Psychiatry Department, Technology Outpatient Clinic. K-SADS-PL, WISC-R, sociodemographic data form, Internet Addiction Scale (IAS), Addiction Profile Index Internet Addiction Form (APIINT), Beck Depression Inventory, Global Assessment of Functioning Scale, and Difficulties in Emotion Regulation Scale were applied to all participants. Social cognition was evaluated using Faces Test, Reading the Mind in the Eyes Test, The Unexpected Outcomes Test, Faux Paus, Hinting Test and Comprehension Test. In social cognition tests, IA and IA + ADHD groups failed significantly compared to the control group. Emotion regulation difficulties were significantly higher in IA and IA + ADHD groups compared to the control group (p<0.001). Use of the internet for doing homeworks (p<0.001) was found to be higher in the control group than in the IA and IA + ADHD groups Conclusion: It has been found that individuals diagnosed with internet addiction have difficulties in both social cognition and emotion regulation, which is more severe in the presence of comorbid ADHD.

Parenting in the Current COVID-19 Reality – Understanding and Addressing Parental Concerns using a Qualitative Methodology

Background: The COVID-19 pandemic has brought in significant changes in the lifestyles of families worldwide. This study is aimed to look at the parental perspectives and concerns related to the challenges in parenting in the ongoing COVID-19 pandemic through qualitative methodology. Methods: The dataset for the study was the queries raised by parents who participated in a parent training program that addressed concerns related to parenting in the initial phase of the pandemic situation (April 2020). Two training sessions were conducted by one of the authors as part of community outreach activities in the department of child and adolescent psychiatry at a tertiary care academic institute of national importance. Content analysis was used to analyze the dataset manually. Results: The major themes that emerged were concerns related to handling children in home-bound situation, handing siblings of different age groups, caring for children with developmental disorders, managing work-life balance, concerns related to screen time among children, and general parenting-related queries for young children and adolescents. Based on the themes emerged, information pamphlets addressing these specific concerns were prepared for wide dissemination among parents. Conclusion: This study attempted to understand the parental perspectives and experiences related to parenting challenges in the current pandemic situation. Parental narratives highlighted some of the unique challenges pertaining to the “new normal.” Disseminating educational and informational resources during the pandemic are an essential systemic response that will benefit the community in resource-limited settings.

Prediction of Long-term Prognosis of Children with Attention-deficit/Hyperactivity Disorder in Conjunction with Deep Neural Network Regression

Background: Although attention-deficit/hyperactivity disorder (ADHD) symptoms decrease with the factors such as age, many individuals keep suffering from the disorder in adolescence and adulthood. Objective: In this paper, a deep learning algorithm was built to forecast the prognosis of ADHD, using the patient's clinical features, the measurement of their response to treatment, and the degree of improvement seen after six years of follow-up. Participants and Settings: The clinical findings such as socio-demographic data of 433 patients followed by the child and adolescent psychiatry department for an average of 6 years with diagnoses of ADHD, and ADHD sub-type, accompanying oppositional/conduct disorders, other psychiatric and organic disorders, the effectiveness of psychotherapy and medication on attention, academic status, and behavioral problems were used to help predict prognosis. Methods: A deep neural network (DNN) learning-based regressor was used to make a prediction model. Results: The results obtained from the DNN regression model achieved accurate predictions for all outputs. The mean error for all outputs was evaluated as mean-squared error (mse) and 0.0068 mean-absolute error (mae), respectively. The R-value was evaluated as 0.91316. It was proven that the model prediction power was adequate as tested with these metrics. Conclusions: This methodology improves the prediction of ADHD prognosis and provides a robust predictive model. Studies with larger samples may support the results.

Comparison of thyroid-stimulating hormone levels in adolescents with schizophrenia, bipolar disorder, unipolar depression, conduct disorders, and hyperkinetic disorders.

The aim of this study was to retrospectively compare values of thyroid-stimulating hormone (TSH) in adolescent patients diagnosed with schizophrenia, bipolar disorder, unipolar depression (UNI-DEP), conduct disorders (CD), and hyperkinetic disorders.The research involved 1122 patients (718 women, 64%); aged 12 to 18 hospitalized in the Department of Adolescent Psychiatry, Medical University of Lodz. We analyzed TSH levels in the whole study population and compared it between the above-mentioned subgroups of diagnoses.Mean serum TSH concentration in the studied population (n = 1122) was 2.06 μIU/mL. The values of percentiles were as follows: 2.5th – 0.53 μIU/mL, 10th – 0.89 μIU/mL, 25th – 1.31 μIU/mL, 50th – 1.9 μIU/mL, 75th – 2.6 μIU/mL, 90th – 3.43 μIU/mL, 97.5th – 4.72 μIU/mL. TSH values were negatively correlated with patients’ age (P = .00001). Patients with bipolar depression had higher TSH levels than patients with CD (P = .002). Also, when male and female groups were examined separately we found that female patients with UNI-DEP and bipolar disorder had higher TSH levels than female patients with CD (P = .001; P = .001).Our results confirm that there may be a higher prevalence of thyroid dysfunctions in bipolar and UNI-DEP subgroups among adolescents and that it is worthy to consider some kind of interventions regarding thyroid function in depressed individuals.

Transference and Countertransference Dynamics in a Multifamily Group for Transgender Adolescents.

This article is an account of a pioneering multifamily group for transgender adolescents. Meetings were conducted in a Sexual Identity Consultation Service in a Child and Adolescent Psychiatry Department in Paris. In addition to enabling both teenagers and their parents to escape a certain form of isolation, this novel mental health care setting also reinforced the ability of participants to free associate and to cathect substitute objects. The author highlights specific characteristics of transference movements and countertransference reactions of the therapists in this framework. An additional goal is to promote these innovative groups and to recommend similar groups for transgender adolescents and their parents.

Swatantra Clinic: A descriptive study on the specialized child mental health service for children in difficult circumstances at a tertiary care center in India.

In India, children in difficult circumstances, like institutionalized children have higher mental health morbidity and complex psychosocial concerns than the non-institutionalized children. To cater to the complex needs of these children referred by the Juvenile Justice System, a specialized service called 'Swatantra Clinic' was initiated by the Department of Child and Adolescent Psychiatry at the National Institute of Mental Health and Neurosciences, India. This article thereby aims to describe the psychosocial characteristics of these children, along with the array of specialized interventions provided during the first year of its inception in June 2018. It was found that majority of these children were girls and were from lower socio-economic, urban background, primarily referred for externalizing or internalizing concerns. The majority of them reported experiences of physical and verbal abuse along with family stressors and almost half of them had a diagnosable psychiatric condition. The nature of the psychosocial services rendered at the clinic mostly comprised of brief, individual and family counseling along with liaison work with various governmental agencies for rehabilitation services. These form the key components of a comprehensive, collaborative, time-bound and holistic care model to cater to the distinct psychosocial issues of this vulnerable population of children in low - middle resource settings. Policy implications are discussed.

Evaluation of a flexible and integrative psychiatric care model in a department of child and adolescent psychiatry in T\xfcbingen, Germany: study protocol (EVA_TIBAS)

BackgroundModel projects for flexible and integrated treatment (FIT) in Germany aim at advancing the quality of care for people with mental disorders. A new FIT model project was established in 2017 at the Department of child and adolescent psychiatry (KJP) of the University Hospital Tübingen (Universitätsklinikum Tübingen, UKT). The study design of EVA_TIBAS presented here describes the evaluation of the FIT model project at the KJP of the UKT. This evaluation aims at quantifying the anticipated FIT model project changes, which are to improve patients’ cross-sectoral care at the same maximum cost as standard care.MethodsEVA_TIBAS is a controlled cohort study using a mix of quantitative and qualitative methods. The FIT evaluation consists of three modules. In Module A, anonymized claims data of a statutory health insurance fund will be used to compare outcomes (duration of inpatient and day care psychiatric treatment, inpatient and day care psychiatric length of stay, outpatient psychiatric treatment in hospital, inpatient hospital readmission, emergency admission rate, direct medical costs) of patients treated in the model hospital with patients treated in structurally comparable control hospitals (estimated sample size = ca. 600 patients). In Module B, patient-reported outcomes (health related quality of life, symptom burden, return to psychosocial relationships (e.g. school, friends, hobbies), treatment satisfaction, societal costs) will be assessed quantitatively using validated questionnaires for the model and two control hospitals (estimated sample size = ca. 300 patients). A subsequent health economic evaluation will be based on cost-effectiveness analyses from both the insurance fund’s and the societal perspective. In Module C, about 30 semi-structured interviews will examine the quality of offer, effects and benefits of the service offered by the social service of the AOK Baden-Württemberg (for stabilizing the overall situation of care in the family) in the model hospital. A focus group discussion will address the quality of cooperation between employees of the university hospital and the social services.DiscussionThe results of this evaluation will be used to inform policy makers whether this FIT model project or aspects of it should be implemented into standard care.Trial registrationThis study was registered at ClinicalTrials.gov PRS (ID: NCT04727359, date: 27 January 2021).

Parent-Child Treatment in Child and Adolescent Psychiatry: Models and Clinical Implementation Using the Example of a Modular Parent-Child Ward

The joint treatment of mentally ill children and their parents represents a special treatment concept in child and adolescent psychiatry. A study conducted by the Working Group (BAG) "Early Childhood" shows the current situation of care and possible models of child and adolescent psychiatric parent-child treatment in Germany. Using the parent-child ward of the Child and Adolescent Psychiatry Department in Magdeburg as an example, the combined treatment of mentally ill children and their parents is presented. The treatment approach consists of a three-week diagnostic phase, after which families are discharged again to their home environment followed by a five-week therapy block, for which the families have to be readmitted to the ward. With a focus on the parent-child relationship, the treatment concept - in contrast to regular child psychiatric treatments - is dynamically adapted to the quality of the parent-child interaction and not primarily related to the disorder of the children. First studies indicate the effectiveness of the special treatment setting and illustrate the efficiency of a joint treatment of parents and child, which, however, is associated with increased economic costs. Based on these results, the chances and limitations of parent-child wards are discussed and conclusions for parent-child treatment are drawn.

Assessment of criterion validity of personality disorder diagnosis in adolescents and relations between attachment style and personality disorder diagnosis.

Assessment of criterion validity and temporal stability of personality disorder diagnosis in adolescents and relationships between attachment styles and personality disorder diagnosis. 50 adolescents (46 girls and 4 boys, aged 15-17) hospitalized at the department of child and adolescent psychiatry were assessed with the Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II) and the Inventory of Parent and Peer Attachment (IPPA). After one year, adolescents meeting the criteria for apersonality disorder (PD) diagnosis were reassessed with the SCID-II. In the first stage of assessment, diagnostic criteriafor different types of personality disorders were met by 41 adolescents (82%) (mean number of criteria = 5.9). Criteria were met most often for borderline personality disorder (BPD) (n = 26; mean number of criteria = 7.9). In the second stage of assessment, the interview was re-administered to 21 (51%) adolescents; the mean number of criteria was = 6.6. A statistically significant relationship between the number of PD diagnostic criteria in assessment one and the number of criteria in assessment two was obtained (r = 0.58; p < 0.01). 82% of the participants with PD were insecurely attached to their mothers. In the borderline group, 83% of the participants reported anxious-avoidant attachment style. PD traits in adolescence, specifically BPD, are stable across one year.

Subjective experiences of dissociative and conversion disorders among adolescents in India.

Dissociative/conversion disorders affect almost 31% of children and adolescents in a clinical setting. These children experience significant impairments in their academics, and daily functioning, with high chances of developing other psychiatric comorbidities such as anxiety and depression. However, there are no studies that explore the experiences of suffering from dissociative/conversion disorders from perspective of the sufferer. Therefore, the paper has aimed at exploring the subjective experiences of dissociative and conversion disorders among adolescents in the Indian context by examining their understanding about the illness and the reason they ascribe to the cause of their illness. The study used a qualitative semi-structured interview to understand their illness. In total, 10 adolescents of age group between 12 and 16 years participated. Eight out of the 10 participants were female and the mean age was 12 years. All of them were in-patients in the department of Child and Adolescent Psychiatry, NIMHANS, which is the tertiary mental health care Institute India and pioneer Institute of mental health in Asia. All participants have had at least one or more consultation history either with a traditional healer or/and physician. Thematic analysis identified vital themes such as (1) Adolescents' attributing factors of the illness, (2) Cognitive and emotional appraisal of stressful situation/s, (3) Adolescents' appraisal of different explanatory model, (4) Living with the Impact of the illness. This analysis about dissociative/conversion disorders from adolescents' perspective has a major contribution in enhancing the clinical knowledge and practice in planning and managing children/adolescents diagnosed with dissociative/conversion disorders.

Current use of attention-deficit hyperactivity disorder (ADHD) medications and clinical characteristics of child and adolescent psychiatric outpatients prescribed multiple ADHD medications in Japan.

Patients with attention-deficit hyperactivity disorder (ADHD) manifest symptoms of hyperactivity, impulsivity, and/or inattention. ADHD medications available in Japan are limited compared with those in Western countries. Prescribing status has not been sufficiently evaluated in clinical settings in Japan. This study investigated the current use of ADHD medications and characteristics of patients who received multiple ADHD medications in a clinical setting in Japan. Study participants were those who visited the Department of Child and Adolescent Psychiatry, Kohnodai Hospital between April 2015 and March 2020. We investigated patients who received osmotic-controlled release oral delivery system methylphenidate, atomoxetine, or guanfacine. A retrospective case-control design was used to evaluate the characteristics of patients who received multiple ADHD medications. Patients who were given three ADHD medications were defined as the case group. Randomly sampled sex- and age-matched patients diagnosed with ADHD were defined as the control group. We compared data for child-to-parent violence, antisocial behavior, suicide attempt or self-harm, abuse history, refusal to attend school, and two psychological rating scales (the ADHD-Rating Scale and Tokyo Autistic Behavior Scale). Among the 878 patients who were prescribed any ADHD medications, 43 (4.9%) received three ADHD medications. Logistic regression revealed that children with severe ADHD symptoms, autistic characteristics, or tendency of child-to-parent violence were more likely to have been prescribed three medications during their treatment. Our findings suggest the approach to prevent the use of multiple ADHD medications. A prospective study to investigate the causality between prescribing status and clinical characteristics is warranted.

Acute manic state with psychotic features in a teenager with autoimmune encephalitis: a case report

IntroductionAutoimmune disorders have become increasingly acknowledged as having a more causative role in encephalitis than previously assumed. Anti-N-methyl-d-aspartate receptor encephalitis seems to be the most prevalent disorder. Symptoms of the neuropsychiatric phase in children and adolescents include abnormal behavior, seizures, and neurologic symptoms. We present a report on a teenage girl with predominantly psychiatric symptoms, highlighting the need for awareness of the disease and multidisciplinary collaboration.Case presentationOur patient, a 17-year-old girl of Middle Eastern origin, had no earlier medical history, but a family history of autoimmune disease. One morning, she could not recognize her mother and soon developed increased energy and pressured speech. The condition worsened, with paranoid delusions. In the emergency unit, she ran around speaking incoherently. The condition was interpreted as a full-scale mania. After pediatric clearance, the patient was admitted to the Department of Child and Adolescent Psychiatry. Mood-stabilizing treatment was initiated with second-generation psychotics and lithium, but this brought no improvement. A multidisciplinary discussion was held with physicians from psychiatry and neurology. A lumbar puncture showed N-methyl-d-aspartate receptor antibodies, and autoimmune treatment was initiated. Computed tomography thorax/abdomen revealed a right-sided ovarian tumor. After salpingo-oophorectomy, our patient’s mental status gradually improved, as demonstrated by repeated testing. Seven months post discharge she was in a stable relationship and performing well in school.ConclusionThis case underlines the importance of collaboration between child and adolescent psychiatry and pediatrics, and gives pointers for timely diagnosis. Manic adolescents who do not respond to mood-stabilizing treatment should be subjected to further consultations and investigations. Psychiatrists and neurologists should develop an integrated approach to the management of brain disorders.

Characteristics of Child and Adolescent Psychiatry Consultations at a University Hospital and Accuracy Rates of Recognition of Childhood Psychiatric Diseases by Nonpsychiatry Specialists

Objective: Physical and mental health are closely related. Psychiatric problems increase in the presence of a physical illness. Consultation liaison psychiatry provides a combination of medical treatment, psychiatric treatment, and psychosocial care to patients when necessary. In this study, we aimed to examine the consultation-liaison services provided by the child and adolescent psychiatry department of a university hospital within two years and to examine the accuracy rates of recognition of childhood psychiatric diseases nonpsychiatry specialists.Methods: Consultations for pediatric patients from other clinics were screened retrospectively at Gaziantep University Hospital between January 1st, 2018, and December 31st, 2019. Data relating to the departments requesting a consultation, reasons for consultation, diagnoses made by children and adolescent psychiatrists, and psychiatric treatments were evaluated.Results: A child and adolescent psychiatry consultations were requested for 290 children over a two-year period. The average age of the cases for whom consultation was requested was 12.1, and 61% of the cases were female. The most common reason for consultation was suicide attempts (26.6%). The most common mental disorder was depression (19%), while the most common intervention was psychoeducation (48.9%). The disorders with the highest diagnostic accuracy were delirium (100%), autism (100%), substance use disorders (80%), and mental disability (70%), while the disorders with the lowest diagnostic accuracy were psychotic disorder (0%), depression (%18,2) and anxiety disorder (22.2%).Conclusion: Mental disorders are common in children with physical illnesses, but the rate of correct recognition of childhood mental disorders by other physicians is low. The high rates of psychiatric disorders highlight the importance of educating physicians that work with children about childhood mental problems and cooperation between child psychiatrists and other physicians.

Deuxième vague : quid des patients atteints d’anorexie mentale hospitalisés en pédopsychiatrie ?

BackgroundIn child and adolescent psychiatry departments, the number of hospitalizations for anorexia nervosa (AN) has been increasing in recent years. In the phase of severe undernutrition, these patients may exhibit disturbances in their immune functions. Based on this observation, many French practitioners had chosen to avoid long hospitalizations during the first wave of COVID-19. They had in mind a risk of contagion between adolescents, in which infections can be frequently asymptomatic. Fear of an increased risk of a severe form of COVID-19 in AN patients has led to early returns home, where they would probably be safer than in our departments. Is this strategy still relevant for the second wave? Has an increased risk of a severe form been identified in the adolescent AN patients? MethodWe have recalled the French recommendations on the subject. Then we carried out a review of the international literature via Medline, Google Scholar as well as data from the American organization Center for Disease Control and Prevention. ResultsThe evolution of knowledge about the pandemic has clearly established a lower risk of infection in adolescents than in adults. It seems that the virus spares this population, most of them remaining asymptomatic or paucisymptomatic. Reassuringly, AN or low body weight has not been shown to pose a risk for the severe form of COVID-19. Conversely, the literature reports that lockdown worsens the symptoms of AN (food restriction, hyperactivity) in at least a third of these patients. Most of the patients expressed a high level of anxiety during the first lockdown. It may even have been difficult for these patients to continue to access care when they were confined. ConclusionIn the end, it seems wise not to reproduce the strategy of early return home in adolescents with AN. Current data support the need for continuity of care, as well as the continuation of hospital care when necessary, while a too rapid discharge runs the risk of destabilizing the patient in an already long and difficult course of care in the usual time.

Pica and attention deficit hyperactivity disorder: is there a link? Comorbidity and treatment outcomes with methylphenidate

Introduction: Pica is the persistent ingestion of non-nutritive substances. It is common during childhood and may be related to nutritional deficits, intellectual disability, stress, and psychosis. However, no causative biological condition is identified in most cases and there is limited evidence to support pharmacological intervention. As several authors describe pica as an impulse control disorder and impulsive symptoms are a core aspect of the diagnostic criteria of attention deficit hyperactivity disorder (ADHD), this study reviews literature data on pica, ADHD, and treatment response during childhood and adolescence and adds two case reports to this body of evidence. Methods: Systematic literature review using the key terms “pica”, “attention deficit”, “hyperactivity”, “child”, and “adolescent”. A retrospective analysis of clinical data of two patients with pica and ADHD followed at the Child and Adolescent Psychiatry Department of Hospital Pediatrico was also conducted. Results: As far as the authors are aware, only three cases are currently reported in the literature describing comorbid pica and ADHD in children. Of these, two reported complete pica symptom remission after methylphenidate treatment. Two other cases of children with pica and ADHD observed at the Child and Adolescent Psychiatry Department of our institution were reported in this study, one of which had complete symptom remission after psychostimulant treatment optimization. Discussion: The suggested association between pica and ADHD may have underlying etiology in poor impulse control and dopaminergic system dysfunctions. Therefore, a pharmacological approach capable of improving dopaminergic functioning may be an alternative treatment for pica. Psychostimulants may improve pica by eliciting an increase in brain dopamine levels and a decrease in impulsivity.

Screening for adult attention deficit and hyperactivity disorder among military parents: A pilot study

IntroductionThe prevalence of adult Attention Deficit and Hyperactivity Disorder (ADHD) has been investigated in the general population by multiple studies. However, few studies have focused on identifying its prevalence in the military population, particularly among military parents of children with ADHD.ObjectivesThe aim of our study was to screen for adult ADHD among military parents of ADHD children followed-up at the child and adolescent psychiatry department in the Military Hospital of Instruction of Tunis, Tunisia.MethodsThis prospective study was carried among military parents (one or both parents belonging to the national army) of ADHD children. Children were diagnosed with ADHD based on the 5th Diagnostic and Statistical Manual ADHD criteria and the Conners Comprehensive Behavior Rating Scale. Whereas adult ADHD was screened for using the Adult ADHD Self-Report Scale-V1.1.ResultsFifteen children and twenty-nine parents were included in the study: sixteen of the parents were military members and thirteen were civilian spouses. Eight (50%) of the sixteen military parents, and four (30,7%) of the civilian spouses were screened positive for ADHD. Whereas 73% of these children had at least one parent screened positive for ADHD, and 53% had at least one military parent screened positive for ADHD. These results suggest a high prevalence of adult ADHD among this population.ConclusionsADHD occurs in childhood and may persist into adulthood. The findings of this study indicate that ADHD symptoms are not limited to the youth and are common in military population. Implications on screening, management, preventive measures and research should be discussed.

The gender distribution of psychopathological disorders at a child and adolescent psychiatry department: About 577 cases

Introduction The evaluation of the distribution of pathologies according to gender in child and adolescent psychiatry remains an interesting question both for epidemiological and etiopathogenic research.ObjectivesThe objective of our work was to study the influence of gender on the psychopathological expression of disorders in children and adolescents.MethodsA retrospective study was conducted at the outpatient child psychiatry department at the Tahar Sfar University Hospital in Mahdia, Tunisia, among patients who consulted for the first time during the period from January 2015 to December 2017. To carry out this work, we used a pre-established form evaluating the sociodemographic and clinical information. We opted for grouping diagnoses according to axis I of the DSM IV- TR.Results We collected 577 cases: 231 girls, and 346 boys. The analysis of the results showed a male predominance (60% of our sample were boys). A significant difference in diagnosis relating to gender was found (p = 0.02). In fact, boys were more likely to have pervasive developmental disorders, mental retardation and externalizing disorders, while girls were more likely to develop sleep and eating disorders and internalizing disorders such as mood disorders.ConclusionsDemonstrating the existence of a significant gender distribution of pathologies in adolescent and child psychiatry is certainly of real importance in the context of epidemiological, clinical and etiopathogenic research. However, it would be more efficient to further investigate other epidemiological and socio-cultural data in order to better specify the involvement of each of these factors in the emergence of psychopathology.

Inflammatory cytokines dysfunction in autism spectrum disorder

IntroductionAutism spectrum disorder (ASD) is a common neurodevelopmental disorder. Its underlying causes and pathophysiologies remain unclear. Recent data support the potential involvement of neuroinflammation in the onset of this disorder.ObjectivesThe aim of our study was to investigate the potential link between ASD and inflammatory mediators.MethodsThis descriptive study was conducted among ASD outpatients followed-up at the child and adolescent psychiatry department in the Military Hospital of Instruction of Tunis. Blood samples were collected for inflammatory cytokines dosage, notably the interleukin 1β (IL-1β), interleukin 6 (IL-6) and the Tumor Necrosis Factor α (TNF-α) immunodosage.ResultsTwenty-four patients were included in this study, aged between four and ten years old (mean age= 6,55 years; minimum=4; maximum=10 years). Our sample was mainly represented by male patients (95,6%). TNF-α plasmatic levels were high (&gt;5pg/mL) among all of our sample with a mean of 11,6 pg/mL (minimum= 6,87; maximum=17,7 pg/mL; standard deviation= 3,52 pg/mL), suggesting abnormal peripheral blood mononuclear cells response. However, IL-1β and IL-6 plasmatic levels were relatively normal.ConclusionsAn immune response dysregulation was detected in our sample. Multiple clinical and experimental studies investigated the implication of inflammatory cytokines in neurodevelopmental disruption. Their results, however, remain controversial and limited by small samples. Further studies need to be done in order to investigate the neuroimmunological factors linked with ASD.

Protransition – an online-course for professionals to optimize the health care service for young people with mental illness in transition from adolescence to adulthood

IntroductionAdolescent transitions to adulthood are a vulnerable phase for the development of mental illnesses. Additionally, there are often disruptions in psychiatric care delivery during the transition phase, potentially leading to a considerable treatment delay with a high risk of early chronification. Thus, the health care system and professionals in both child and adolescent psychiatry and adult psychiatry should be given greater consideration to the transition phase.ObjectivesThe aim of the project ProTransition is the development of an online course for health care professionals to give in-depth knowledge of “transition psychiatry”, practical guidance and to sensitize them for the special challenges and needs of young adults with mental illness.MethodsThe online-course is being developed at the Department of Child and Adolescent Psychiatry/ Psychotherapy, Ulm and is expected to start in May 2021. It comprises e.g. special psychopathology of emerging adulthood, clinical interventions for adolescents with mental illness or legal aspects. An innovative and multi-didactical approach with specialized texts, case-studies, online-chats and interviews with experts and young people is applied. Additionally, user satisfaction with the online course will be evaluated.ResultsOn the basis of the gained experiences, ideas for new transition-psychiatric treatment models will be derived. The accompanying research will point out the status quo and the course-related increasing knowledge of health care professionals regarding transition psychiatry. First results are expected in November 2021.ConclusionsAs transition psychiatry is facing great difficulties and challenges, professionals should be adequately educated. E-Learning offers a flexible and low-level approach to reach a broad target group.