Adolescent Psychiatry Services Research Articles

Assessment of Sleep Habits and Problems in Children Aged 7 to 10: An Observational Study.

IntroductionAppropriate sleep habits play a pivotal role in the physical and psychological development of children. However, sleep deprivation or sleep problems can have a significant impact on children’s mental health and daily functioning. This study investigates the sleep habits and problems in children aged 7 to 10 who attend the Child and Adolescent Psychiatry Service at CHTMAD, Vila Real, Portugal.ObjectivesThe primary objective of this study is to assess the sleep habits and problems in children aged 7 to 10, aiming to establish data that can guide the development, implementation, and reevaluation of future interventions tailored to this age group.MethodsThis study is observational in nature and involved the participation of 21 patients from the Child and Adolescent Psychiatry Service at CHTMAD, Vila Real, Portugal, throughout the year 2022. Questionnaires related to sleep habits were administered to this population. Parents were invited to complete the Children’s Sleep Habit Questionnaire (adapted from the Children’s Sleep Habit Questionnaire by Prof. Owens, 2000), while the children (patients) were asked to fill out the Sleep Self Report-PT (adapted from Owens 2000 Research Version) and the Strengths and Difficulties Questionnaire (SDQ-Por, by Robert Goodman, 2005).ResultsAs of now, the results of this study are still being processed. The data collected from the questionnaires will be analyzed to gain insights into the sleep habits and issues of children aged 7 to 10 years attending the Child and Adolescent Psychiatry Service in Vila Real, Portugal. Findings will be discussed, and any significant observations or trends will be highlighted.ConclusionsThis research aims to provide valuable insights into the sleep patterns and problems experienced by children in the specified age group. By understanding these issues, we can develop and implement targeted interventions to improve sleep quality and overall mental well-being. The conclusions drawn from this study will contribute to the development of evidence-based strategies for enhancing the sleep health of children in the Child and Adolescent Psychiatry Service at CHTMAD, Vila Real, Portugal.Disclosure of InterestNone Declared

Evolution of anhedonia in adolescent depression: An interpretative phenomenological analysis study.

Anhedonia is a symptom complex currently linked to dysfunctional reward processing. Phenomenological studies capture anhedonia as a loss of hedonic and eudemonic pleasure. However, there is a lack of integration between neurobiological understanding and clinical phenomenology. This study used a qualitative method to explore the interplay of sociocultural contexts and individual factors associated with the evolution of dysfunctional reward processing in adolescents with depression and anhedonia. Ten female adolescents with a current or prior diagnosis of major depressive disorder were recruited from a public tertiary care child and adolescent psychiatry service. In-depth interviews were conducted, voice recorded, and transcribed verbatim. The transcripts were analyzed using Interpretative Phenomenological Analysis (IPA). The adolescents hailed from urban families. Educational stress and relational difficulties figured prominently. Amotivation was the most important subdomain of anhedonia affected. An integrated framework for understanding the evolution of anhedonia is presented. Five main patterns of dysfunctional reward processing emerged in our study: an overworked system, erroneous reward valuation, reward-effort imbalance, and diversion of the reward processing system for self-preservation. There is a necessity to build robust theoretical models of the evolution of anhedonia, hence finding homogenous sub-groups, paving the way for person-centric interventions for anhedonia.

23.1 Potential for Prediction of Psychosis and Bipolar Disorder in Child and Adolescent Psychiatry Services: A Longitudinal Register Study of All People Born in Finland in 1987

23.1 Potential for Prediction of Psychosis and Bipolar Disorder in Child and Adolescent Psychiatry Services: A Longitudinal Register Study of All People Born in Finland in 1987

Prevalence, Correlates and Subjective Experience of Emotional Abuse in Adolescents Presenting to Child and Adolescent Psychiatry Services: A Mixed Methods Study

Introduction: The burden and impact of childhood emotional abuse (CEA) among children and adolescents utilizing psychiatry services is a less studied area, especially in the Indian context. This study aims to study the prevalence and correlates of CEA in adolescents attending psychiatry services and to understand the subjective experience of emotional abuse (EA) in this population. Methods: Adolescents aged between 12 and 18 years attending child and adolescent psychiatry (CAP) services were recruited for the study. The prevalence of CEA was assessed using ICAST-C (ISPCAN Child Abuse Screening Tool), temperament was assessed using the Malhotra Temperament Scale, and psychosocial adversities were assessed with the Parent Interview Schedule (PIS). From those reporting CEA, a few of them were interviewed to get narratives of subjective experiences of CEA, and this was analyzed using thematic analysis. Results: In total, 81 adolescents were recruited for the study, and among them, 82.7% ( n = 67) reported at least 1 form of EA in the last year, and 93.8% ( n = 76) of them reported a lifetime history of at least 1 form of EA. The frequency of other psychosocial adversities like abnormal intrafamilial relationships ( n = 33; 40.7%) and inadequate or distorted intrafamilial communications ( n = 49; 60.5%) was high in this sample. There was a significant association between the presence of EA in the last year and physical abuse ( p = .00) and neglect ( p = .01) in the last year. Narratives for qualitative analysis were collected from 21 adolescents. The most common themes in the context of CEA were related to academics ( n = 10) and emotional and behavioral problems in the child ( n = 7). Conclusions: There is a high prevalence of EA among adolescents attending CAP services. There is a high co-occurrence of other forms of abuse and other psychosocial adversities with EA. As adverse childhood experiences (ACEs) pose a high risk for future physical and mental health sequelae, this needs to be identified early and intervened with.

Sensory integration in a department of child and adolescent psychiatry

IntroductionThe area of Sensory Integration has its origin in the 1960s, developed by the neuroscientist and occupational therapist Jean Ayres. Although the first studies focused on the relationship between learning problems and atypical sensory processing, today there are new applications in clinical practice.Sensory integration is defined as the neurological process responsible for organizing the sensations that one receives from one’s own body and from the environment, in order to respond and function adequately in relation to environmental demands.ObjectivesThis work has several objectives. On the one hand, review the concept of sensory integration, the definition and theoretical basis as well as the scientific evidence of this theory. On the other hand, review the use of sensory integration in psychiatric practice from the 1960s to the present day. Also, explain the experience of a child and adolescent psychiatry unit with the use of sensory integration as part of the treatment. Finally, new challenges, approaches and needs of psychiatry services will be considered for the implementation or improvement of this new work tool in a multidisciplinary team.MethodsA bibliographic search has been carried out in the main sources of medical information such as pubmed, uptodate as well as in national and international journals. Likewise, the knowledge and clinical experience of the team has been reviewed.ResultsIn our clinical experience, the child and adolescent psychiatry device for intensive outpatient treatment where patients between 12 and 17 years of age with severe mental disorders attend, initially passed the sensory profile by occupational therapy to patients who presented behavioral or emotional symptoms. not consistent with the psychopathological examination. In view of the results and magnificent progress, this intervention began to be carried out systematically to the boys who joined the device.We present the case of a 15-year-old patient who attended the device due to emotional dysregulation and suicidal risk. During evolution, possible difficulties were seen in sensory integration that made it difficult for the patient to improve with psychiatric or psychological therapy alone. The patient was evaluated and treated by the team’s occupational therapist, specifically trained in sensory integration. It was evaluated with the sensory profile, with the results having a sensory sensitivity profile and auditory and tactile avoidance. The specific measures that were carried out were: sensory diet and environmental modifications.ConclusionsSensory integration is a therapy with sufficient clinical evidence to implement it in child and adolescent psychiatry services. Therapy should be performed by suitably trained and validated occupational therapists. This therapy must be included in a multidisciplinary approach to the patient and specific modifications that can be developed at home and at school are provided.Disclosure of InterestNone Declared

Clinical and sociodemographic characteristics of patients hospitalized in a child and adolescent psychiatry inpatient unit

Objective: In this study, it was aimed to examine the clinical and sociodemographic characteristics of patients hospitalized in Ankara City Hospital Child and Adolescent Psychiatry Inpatient Unit during the pandemic period. Material and Methods: Medical records of children and adolescents who were hospitalized in Ankara City Hospital Child and Adolescent Psychiatry Inpatient Unit between March 2021 and March 2022 were retrospectively analyzed. Patients were evaluated in terms of sociodemographic characteristics, clinical diagnosis and treatment, duration of hospitalization, and Clinical Global Impression Scale (CGI) scores at admission and discharge. Results: In our study, the mean age of 132 cases (86 girls, 46 boys) was found 15.1±1.8 years. The main diagnoses of the subjects were 30.3% (n=40) major depressive disorder, 25% (n=33) psychotic disorder, 14.4% (n=19) eating disorders, and the remaining 30.3% (n=40) were other disorders. Comorbidity was found in 63.6% (n=84) of the cases. The presence of eating disorders, comorbidity and antidepressant use were found significantly higher in females. There was a significant differences in major depressive disorder (MDD), bipolar disorder (BD), psychotic disorder, eating disorder, conduct disorder, and post-traumatic stress disorder (PTSD) between admission and discharge CGI-Severity (CGI-S) scores. In addition, there was a significant difference between admission and discharge CGI side effects scores only for BD. Conclusion: In our study, major depressive disorder, psychotic disorder, and eating disorder were the most common diagnoses of cases hospitalized in inpatient unit. There was a comorbidity accompanying two out of every three cases. There are few child and adolescent psychiatry services in our country, and studies on this subject are scarce. It is thought that our study will contribute to the literature on child and adolescent psychiatry inpatient units.

Finnish Population Study Yields New Way to Identify Youth at Risk for Serious Mental Illness

Finnish Population Study Yields New Way to Identify Youth at Risk for Serious Mental Illness

Increasing important roles of child and adolescent psychiatrists in the treatment of gaming disorder: Current status in Japan.

Digital gaming is the most common leisure activity among children and adolescents in Japan, especially in males. Playing online gaming has become more common among school-age children over the years. As a result, excessive online gaming in younger children has become a significant social problem in Japan. Previous studies have demonstrated that excessive online gaming could cause various mental health issues in children and adolescents. At medical institutions having child and adolescent psychiatry services, there is an increasing number of children and adolescents with various problems related to excessive gaming. The aim of this study was to investigate the current practice of gaming disorder (GD) in clinical settings in Japan. The subjects of this study were all of 414 child and adolescent psychiatrists certified by the Japanese Society for Child and Adolescent Psychiatry (JSCAP). The study questionnaire was mailed to all subjects from the official secretariat of JSCAP. Study subjects were requested to answer the questionnaire anonymously. The survey contained three types of responses: open responses; single and multiple-choice responses; and, responses on a five-point Likert scale. The questionnaire consisted of 14 questions regarding GD. We received 159 responses. The most common reason for a visit to child and adolescent psychiatry service which results in a subsequent diagnosis of GD was school refusal/absenteeism followed by disruption of sleep-awake rhythm. The most common specialized treatment for GD currently offered at child and adolescent psychiatry service is individual psychotherapy. The two most frequently experienced difficulties in the treatment of GD were low motivation to achieve recovery and a large variety of combined problems other than excessive gaming itself. With regard to the three most common psychiatric comorbidities of GD, they were autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and depression. The results of our survey revealed that although GD is a behavioral addiction, many children and adolescents with GD first visit child and adolescent psychiatry clinics rather than specialized clinics for addiction which are usually designed and staffed for adult patients. Because it is known that GD is more prevalent among young males, including junior high and high school students, GD has become one of the most important clinical issues in child and adolescent psychiatry today. The important roles of child and adolescent psychiatrists in the treatment of GD has been increasing.

Cognitive behavioral treatment for disordered gaming and problem gambling in adolescents: a pilot feasibility study.

BackgroundDisordered gaming and problem gambling (DG/PG) are associated with a range of functional impairments as well as psychiatric comorbidity. With the proliferation of digital gaming apps aimed at children and adolescents, which involve in-game purchases, there is increasing evidence that DG/PG are on the rise in this age range. The behavior can be detected in youth presenting at school-based health clinics and community psychiatric clinics. Cognitive behavioral therapy (CBT) is one of several recommended treatments for adults, but little evidence is available for the efficacy of this approach in adolescents with DG/PG.AimTo evaluate the acceptability and feasibility of a CBT-based intervention developed for adolescents with DG/PG, which can be delivered in routine psychiatric care facilities.MethodsAdolescents who were patients at a child and adolescent psychiatry service were screened for DG/PG. Those aged 12–17 years with pronounced symptoms were invited to participate in a 7-week CBT program called Relapse Prevention. Nine adolescents agreed to participate and five consented to repeated assessments of outcome (pre-, post-treatment, and 6-month follow-up). In addition to acceptability and satisfaction with treatment, symptoms of DG were assessed with standardized interview and self-report measures.ResultsThere were no dropouts from the treatment. Participants who completed treatment and all outcome assessments reported satisfaction with the treatment. The participants showed fewer symptoms of DG after treatment, and the proportion who met criteria for computer game addiction decreased from 56 to 0%. There was no reduction in the number of participants who met criteria for PG.ConclusionThis study provides preliminary evidence for the acceptability and feasibility of a CBT-based intervention for DG/PG in adolescents. Preliminary data suggest that the treatment may be effective for DG but not PG. Further studies are needed to evaluate the efficacy of this approach for both conditions.

The impact of SARS-CoV-2 pandemic on suicidal ideation admissions: a single adolescent and young adult psychiatry center experience

IntroductionThe COVID-19 pandemic and the lockdown brought about a sense of fear and anxiety around the globe. This phenomenon led to both short and long term psychosocial and mental health implications for children and adolescents.ObjectivesTo evaluate the effect of COVID-19 pandemic on hospital admissions for suicidal ideation in a Portuguese adolescent and young adult psychiatry service.MethodsWe conducted a single-center, retrospective study including adolescent and young adult patients (15-25 years old) admitted to our service with suicidal ideation within a year before and a year after the declaration date of SARS-CoV-2 disease as a pandemic. Patients were divided in two groups: Group A - patients admitted before the pandemic (March 11, 2019 and March 11, 2020) and Group B – patients admitted after the pandemic declaration (March 12, 2020 and March 12, 2021). The groups characteristics and outcomes were assessed and compared.ResultsA total of 647 admissions were assessed (Group A, n= 372 and Group B, n=275). Demographic characteristics were similar between groups. 75 patients (vs 25 patients) were admitted with suicidal ideation in the year before the pandemic. There was a lower proportion of patients admitted with suicidal ideation during the year after the pandemic year - OR 0.374 (95% CI 0.228-0.614, P<0.001).ConclusionsOur study showed a decrease in admissions for suicidal ideation in this service in the year after the pandemic. More studies are needed to understand the factors that may justify this decline and evaluate the longer effects of this pandemic in mental health.DisclosureNo significant relationships.

Suicidal Behavior in Emergency Child and Adolescent Psychiatric Service Users Before and During the 16 Months of the COVID-19 Pandemic.

BackgroundSlovenia is among the countries with the highest suicide rates in the world. The COVID-19 pandemic has had a significant impact on the mental health of children and adolescents. Our hypothesis is that the school closure during the pandemic with a gradual transfer to virtual schooling had an important impact on children's and adolescents' suicidal behavior. Therefore, we aimed to determine possible changes in the frequency of assessments as well as frequency and severity of suicidal behavior in the population of Slovene children and adolescents seeking emergency psychiatric help in correlation with the progression of the pandemic and online schooling.MethodsWe performed a retrospective observational analysis of medical records of all children and adolescents referred to the only 24-h emergency in- and outpatient child and adolescent psychiatry service in Slovenia from March 2019 through the end of July 2021. We extracted number of assessments, number of patients with suicidal ideation and with attempted suicide. A comparison between the same periods prior to the pandemic and during the pandemic was made. The months of school closure due to the COVID-19 restriction measures and the months without closures were also compared.ResultsDuring this period, 1966 children and adolescents were assessed. There was no statistically significant difference in the observed frequency of emergency visits when we compared all the months with to all the months without school closures, or when individual corresponding months with and without school closures were compared. However, there were statistically significantly more patients with suicidal ideation [t(16) = −2.739, p = 0.015; W = 25.0, p = 0.016] and patients who had attempted suicide [t(16)= −3.412, p= 0.004; W = 14.5, p =0.006] during the pandemic as individually compared to the corresponding pre-pandemic months.ConclusionsOur results show that the number of Slovene children and adolescents who required emergency psychiatric help with suicidality and attempted suicide increased during the COVID-19 pandemic. The increase was shown only after the first year of the pandemic. The observed increase did not appear to directly correspond to the school closures, but was more likely related to the duration of the pandemic.

Violent Radicalization and Post-traumatic Dissociation: Clinical Case of a Young Adolescent Girl Radicalized.

IntroductionSince 2014, the profiles of radicalized individuals have changed with the appearance of radical groups composed of a large proportion of adolescents. Various individual, relational, and social vulnerabilities have been identified as being involved in the radicalization process of adolescents. Among these factors, it appears that early and repeated history of personal and/or family psychotraumatism may constitute factors of vulnerability to violent radicalization.Material and MethodsThe clinical situation of a 17-year-old woman convicted of “links with a terrorist group (DAECH)” was recruited from the 130 radicalized young people followed by the teams of the Maison des Adolescents and the Child and Adolescent Psychiatry Service of the University Hospitals of Strasbourg since May 2015. Based on the analysis of this clinical case, we present the hypothesis that post-traumatic antecedents can constitute vulnerability factors to violent radicalization, and that post-traumatic symptoms can be “used” by recruiters of radical movements at different moments of the radicalization process by reactivating post-traumatic psychic mechanisms, but also, for a smaller number of subjects, by the induction of the trauma (viewing of propaganda videos).ResultsWe show a possible link between violent radicalization and complex psycho-traumatism with an impact of the reactivation of post-traumatic mechanisms such as (i) the activation of the autonomic nervous system and emotional dysregulation on violent acts, (ii) the activation of dissociation mechanisms (psychic sideration and post-traumatic amnesia) on indoctrination and violent acts, (iii) the activation of control mechanisms on the search for a strict framework of life and a radical ideology and (iv) relational avoidance on the processes of relational rupture and radical socialization. Thus, we highlight that the radicalization process can respond to the needs and psychic functioning of psycho-traumatized individuals (channeling tensions, being recognized and active in one's life).DiscussionWe discuss the central role of propaganda videos in the activation of the ANS and dissociation, and the self-perpetuating process between these two posttraumatic mechanisms. We also discuss clinical and therapeutic perspectives (therapies targeting complex psychotrauma).ConclusionPsychotrauma can promote radicalization due to vulnerability mechanisms. Treatments targeting psychotrauma may be one of the ways to get these young people out of violent radicalization.

Révéler des violences sexuelles subies dans l’enfance à un professionnel de santé : une métasynthèse

ObjectiveChild sexual abuse is a major public health issue, and disclosure of such abuse to a healthcare professional could mitigate its impact on the survivor's life. Qualitative studies are relevant in this context, focusing as they do on the lived experience of the stakeholders, victims and professionals. We aimed to conduct a metasynthesis, i.e. a systematic review and analysis of qualitative studies, exploring the qualitative literature about the lived experience of child's sexual abuse disclosure. Method and data sourcesFour databases and two journals were screened (Medline, PsycINFO, EMBASE, SSCI, Journal of Sexual Abuse and Child Abuse and Neglect) so as to identify studies concerning the lived experience of child sexual abuse disclosure from the point of view of survivors or healthcare professionals or both. We used the “Critical Appraisal Skills Program” to assess the methodological quality of each article and performed a thematic analysis of the data extracted to identify key themes and synthesize them. ResultsTwenty-six articles were included, covering data from 673 participants (333 survivors, adult at the time of the study; 122 survivors still minor at the time of the study and 218 health professionals). Data analysis produced three themes: (1) to reveal or not to reveal, (2) the narrative of the disclosure by the participants, (3) positive and negative outcomes of the disclosure. Our results show that, on the one hand, health professionals and minor survivors both have a negative experience of disclosure that could impede the process. On the other hand, some adult survivors underlined the importance and the positive impact of such disclosure to a healthcare professional. ConclusionWe identified a gap in the literature regarding disclosure of such abuse within child and adolescent psychiatry services and drew research perspectives. Concrete clinical implications can also be drawn from our results, especially the involvement of adult survivors within the training of concerned healthcare professionals so as to raise awareness among them and help them better cope with the disclosure process.

An Exploration of the Possibilities of Current Mental Health Services to Tackle Transgenerational Effects of Parental Mental Illnesses on Offspring Adjustment in Lithuania.

The topic of mental health and mental disorders is very sensitive and delicate in families and the society. Stigma is one of the main reasons for little help-seeking for mental disorders. Transgenerational effects of mental disorders is the utmost sensitive theme that brings difficulties for service organization and research. By emphasizing the importance of the effects of parental mental illnesses on the health of offspring and their adjustment, together with sharing the international experience between professionals, both the administration of services and society could provide opportunities for further positive change in this little-studied but utmost actual field. There is still a lack of appropriate long term systematic programs and ways to overcome complex organizational challenges. Sharing international experience and research could help find ways that best fit the situations in each country. After a descriptive analysis of the current system of mental health services in Lithuania, opportunities were sought to meet the needs of children and adolescents whose parents have mental disorders by ensuring their healthy psychosocial development. Child and adolescent psychiatry services are a more favorable and less stigmatized area in Lithuania than adult psychiatry, so assistance and specialized programs for children of parents with mental health problems could be organized using the country's relatively well-developed network of child and adolescent psychiatric and pediatric services. For such a small country with limited resources, there could be a possibility to use and strengthen the existing network of services together with finding opportunities for mixed models of financing and cooperation with non-governmental initiatives and organizations. A unique network of primary mental health outpatient centers that provide services for adults and children/adolescents could serve as a reasonable basis for the systematic implementation of specialized programs and initiatives in this field. This network is still not adequately used in the organization of mental health prevention, early intervention, and complex treatment services for the children of parents with mental illness.

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.

16.1 GENETIC TESTING IN AN INPATIENT CHILD AND ADOLESCENT PSYCHIATRY SETTING

Diagnostic genetic testing is recommended for children with autism spectrum disorder (ASD) and other neurodevelopmental disorders. One approach to improve access to genetic testing is to offer it on the inpatient child and adolescent psychiatry (CAP) service. However, many CAP trainees and attending physicians have limited training in medical genetics.

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.

Collaborative Care in the Identification and Management of Psychosis in Adolescents and Young Adults.

Pediatricians are often the first physicians to encounter adolescents and young adults presenting with psychotic symptoms. Although pediatricians would ideally be able to refer these patients immediately into psychiatric care, the shortage of child and adolescent psychiatry services may sometimes require pediatricians to make an initial assessment or continue care after recommendations are made by a specialist. Knowing how to identify and further evaluate these symptoms in pediatric patients and how to collaborate with and refer to specialty care is critical in helping to minimize the duration of untreated psychosis and to optimize outcomes. Because not all patients presenting with psychotic-like symptoms will convert to a psychotic disorder, pediatricians should avoid prematurely assigning a diagnosis when possible. Other contributing factors, such as co-occurring substance abuse or trauma, should also be considered. This clinical report describes psychotic and psychotic-like symptoms in the pediatric age group as well as etiology, risk factors, and recommendations for pediatricians, who may be among the first health care providers to identify youth at risk.

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.

ESCAP CovCAP survey of heads of academic departments to assess the perceived initial (April/May 2020) impact of the COVID-19 pandemic on child and adolescent psychiatry services

In April 2020, the European Society for Child and Adolescent Psychiatry (ESCAP) Research Academy and the ESCAP Board launched the first of three scheduled surveys to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on child and adolescent psychiatry (CAP) services in Europe and to assess the abilities of CAP centers to meet the new challenges brought on by the crisis. The survey was a self-report questionnaire, using a multistage process, which was sent to 168 heads of academic CAP services in 24 European countries. Eighty-two responses (56 complete) from 20 countries, representing the subjective judgement of heads of CAP centers, were received between mid-April and mid-May 2020. Most respondents judged the impact of the crisis on the mental health of their patients as medium (52%) or strong (33%). A large majority of CAP services reported no COVID-19 positive cases among their inpatients and most respondents declared no or limited sick leaves in their team due to COVID-19. Outpatient, daycare, and inpatient units experienced closures or reductions in the number of treated patients throughout Europe. In addition, a lower referral rate was observed in most countries. Respondents considered that they were well equipped to handle COVID-19 patients despite a lack of protective equipment. Telemedicine was adopted by almost every team despite its sparse use prior to the crisis. Overall, these first results were surprisingly homogeneous, showing a substantially reduced patient load and a moderate effect of the COVID-19 crisis on psychopathology. The effect on the organization of CAP services appears profound. COVID-19 crisis has accelerated the adoption of new technologies, including telepsychiatry.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00787-020-01699-x.