Adolescent Psychiatry Services Research Articles

Conséquences psychiatriques de la pandémie de la Covid 19 chez l’enfant et l’adolescent

The objective of this article is to present a literature review concerning the psychiatric consequences associated with the Covid 19 pandemic, in the pediatric population. This review is realized with Pubmed Database, using Covid 19, Coronavirus, child, children, adolescent, mental health, psychiatric or psychological consequences as keywords. We propose to present an inventory of current research based on three factors: fear linked to the pandemic, the consequences of the stay-at-home confinement, and the risks of cumulative trauma. We will present three clinical vignettes of children who were followed during the health crisis following the development of symptoms related to the health situation. We will end with some perspectives on the management of the health crisis by child and adolescent psychiatry services.

Overcoming traps and challenges in child and adolescent psychiatry

Appropriate healthcare and psychological support for children and adolescents is essential for the successful development and good mental health. Unfortunately, this is often a neglected element in the healthcare systems around the world. It is known that approximately half of all adult psychiatric disorders start under the age of 14 and that the prevalence of child and adolescent-onset psychiatric conditions is increasing. The real reason for this increase remains unclear, but it demands our attention as does the care of affected children, adolescents, and their families. Transitions between different age groups need to be made easily navigable for the patients and their families. Many challenges in child and adolescent psychiatry are present, especially in developing countries such as Serbia. A possible solution for overcoming these challenges is uniting the child and adolescent professional societies from all over the world. These societies should work together to develop unified strategies for diagnosis, treatment and support of children affected by psychiatric conditions. By working closely with pediatricians, family physicians, psychologists, nurses, and other professionals, child and adolescent psychiatry can use knowledge and skills to support practice while teaching other professionals how to optimize the utilization of child and adolescent psychiatry services.

Covid-19 Pandemic may have Unique Effects on Emergency Admissions for Pediatric Psychopathology: A Single-Center Study

Objective: In December 2019, a new coronavirus was identified that caused an epidemic across China and a worldwide pandemic (COVID-19). We aimed to examine the admissions of the children to the emergency service with psychiatric symptoms by comparing retrospectively in terms of sociodemographic variables, diagnoses, psychiatric symptoms, and psychiatric treatments during and before the Covid-19 Pandemic. Method: In our study, the first group consisted of the 170 patients who were consulted to child and adolescent psychiatry emergency service department between 11.03.2019 and 30.09.2019 and the second group consisted of the 102 patients who have consulted in the same period previously. The statistical analysis of the study was performed by using SPSS 23. The significant level was accepted as a p-value 0.05). The diagnosis of depression and anxiety disorders were found to be the most common diagnosis in both two groups (48.8%;42%, respectively). We observed an increase in diagnoses of post-traumatic stress disorder, eating disorders, and obsessive-compulsive disorders and a decrease in neurodevelopmental disorders among the children who applied to the emergency department during the Covid-19 Pandemic. Conclusion: Our results contribute the knowledge about the features of emergency administrations of children during the pandemic. Further research is crucial to ensure that child and adolescent psychiatry services are prepared in extraordinary situations such as epidemics.

Trastorno del vínculo en niños con trastorno del espectro alcohólico fetal

Introducción: El síndrome alcohólico fetal y los trastornos del espectro alcohólico fetal (TEAF) resultan de la exposición intrauterina al alcohol, y son las causas no heredables más comunes de discapacidad intelectual. Entre personas diagnosticadas de TEAF se ha identificado una mayor prevalencia de alteraciones físicas, cognitivas y conductuales, y mayor psicopatología en el niño, afectando a variables del temperamento que dificultan la creación de un vínculo seguro. Los niños con trastorno del vínculo presentan alteraciones conductuales, emocionales y de interacción social que aparecen asociados a la exposición de un patrón de cuidado caracterizado por negligencia, carencia social o maltrato durante la primera infancia. Objetivo: El objetivo del presente trabajo es aportar información sobre los trastornos del vínculo en población diagnosticada de un TEAF, a través de la revisión de la literatura existente y la presentación de dos casos clínicos. Por último, discutiremos sobre la intervención psicoterapéutica en este perfil clínico. Método: Estudio de casos clínicos, de dos niños con diagnóstico de TEAF y Trastorno del vínculo, atendidos en nuestro servicio de Psiquiatría y Psicología infanto-juvenil del Hospital Clínic de Barcelona. Resultado: Se expondrán las características clínicas y la evolución de los casos durante el tratamiento. Conclusiones: Se propone un diagnóstico temprano y una intervención centrada en el vínculo que garantice un cuidador constante y sensible, involucrado emocionalmente y afectivamente disponible, y a partir de esta intervención, trabajar la sintomatología comórbida. No es posible generalizar los resultados debido a las limitaciones en la revisión y el número de casos.

COVID-19 pandemic: An opportunity in disguise for Child and Adolescent Psychiatry!

Globally COVID-19 pandemic has hit the child and adolescent population hard; though the virus remains asymptomatic or causes mild symptoms in the majority of children; but the psychological impact is tremendous. As in any disaster, adult lives gain prominence at the cost of child well-being. Maternal and child healthcare services are diverted towards COVID care facilities. Routine child and adolescent mental health facilities are suspended impairing the mental health of children. The already precarious child and adolescent psychiatry services have suffered a severe blow.

The Feasibility and Outcomes of Genetic Testing for Autism and Neurodevelopmental Disorders on an Inpatient Child and Adolescent Psychiatry Service.

Diagnostic genetic testing is recommended for children with autism spectrum disorder 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. We provided medical genetics education to CAP fellows and retrospectively compared the genetic testing rates and diagnostic yield pre- and post-education. We compared demographics to similar patients who received testing on other clinical services and assessed rates of outpatient genetics follow-up post-discharge. The genetic testing rate on the inpatient CAP service was 1.6% before the educational intervention and 10.7% afterward. Genetic risk factors were identified in 4.3% of inpatients. However, 34.8% had variants of unknown significance. 39.1% of patients who received genetic testing while inpatients were underrepresented minorities, compared to 7.7% of inpatients who received genetic testing from other clinical services. 43.5% of patients were lost to outpatient genetics follow-up. We have demonstrated that it is feasible to provide medical genetics education to CAP fellows on an inpatient service, which may improve genetic testing rates. This preliminary evidence also suggests that genetic testing for inpatients may identify variants of unknown significance instead of well-known neurodevelopmental disorder risk variants. Genetic testing on an inpatient CAP service may also improve access to genetic services for underrepresented minorities, but assuring outpatient follow-up can be challenging. LAY SUMMARY: Genetic testing is recommended for children with autism and related developmental conditions. We provided genetic testing to a group of these children who were in a psychiatric hospital by teaching their doctors how it can be helpful. We identified a genetic risk factor in a small percentage of children and a possible genetic risk factor in a large percentage of children. However, many children did not end up receiving their genetic test results once they left the hospital. These results tell us that the psychiatric hospital may be a good place for children with autism and behavioral problems to get genetic testing, but that it is really important that doctors assure follow-up is feasible for all patients to receive their genetic test results once they leave the hospital. Autism Res 2020, 13: 1450-1464. © 2020 International Society for Autism Research, Wiley Periodicals, Inc.

Electroconvulsive Therapy for the Treatment of Severe Mood Disorders During Adolescence: A Retrospective Chart Review.

Objective: Electroconvulsive therapy (ECT) is a well-recognized treatment of refractory mood disorders in adults. However, relatively little is known about its use for similar conditions in adolescents. Based on a chart review, we describe its use and outcome in a sample of adolescents with severe, refractory mood disorders (unipolar or bipolar disorder) hospitalized in an academic medical center. Methods: The sample was drawn from referrals to an adolescent psychiatry service. After obtaining approval from the ethics board, medical records of 54 adolescents with refractory mood disorder were examined. Participants (males 24, females 30; mean age 15.8 ± 1.5 years) had received their first course of ECT before the age of 18 years during the period 1996-2010. Response to treatment was examined after the initial treatment and during a 1-year follow-up. Results: Following the index course of ECT (mean number of treatments = 13.7 ± 6.3), a 52.8% response rate (defined as a Clinical Global Impressions [CGI] score ≤2) was noted, while 15.1% achieved remission (CGI = 1). The response rate was 82.4% after a 1-year follow-up with a remission rate of 23.5%. The Children's Depression Rating scores declined significantly from pre-ECT to the end of the index course (70.7 ± 16.4 to 52.5 ± 18; p ≤ 0.00). A reduction in suicidal ideation and self-injurious behaviors along with increased school attendance was noted. Cognition, monitored by the Mini-Mental State Examination, did not decline significantly. Minor side effects were limited to the day of the treatment. Prolonged seizures (>2 minutes) were common during ECT (74% of subjects experienced one or more). The only side effect noted at the 1-year follow-up was self-reported memory loss involving events during and around the index treatment course. Conclusions: In this severely impaired sample of adolescents, ECT was found to decrease suicidal behavior, reduce depressive symptoms, and improve overall functioning, as indexed by school attendance at follow-up after 1 year. Prospective studies using large samples are needed to determine its effectiveness and safety in refractory mood disorders in adolescents.

Development of an early intervention programme for adolescents with emotion dysregulation and their families: Actions for the treatment of adolescent personality (ATraPA).

Borderline personality disorder and severe emotion dysregulation in adolescence is a major public health concern. Dialectical Behaviour Therapy is a promising treatment for suicidality in adolescents. The aim of this work is to present an adaptation of this intervention to the Spanish national health system, Actions for the Treatment of Adolescent Personality (ATraPA). Data consists of a description of the different ATraPA subprogrammes, including interventions for adolescents aged 13 to 17 and their families. Participants were referred to ATraPA from different hospitals within the region of Madrid, Spain. ATraPA has been developed as an intensive outpatient treatment and it comprises different subprogrammes. ATraPA-TAI is an intensive outpatient treatment, including a skills-based group, individual therapy and email therapy. ATraPA-FAL is a psychoeducational intervention for families, including emotion regulation strategies for parents themselves. Finally, the Alternatives Group is offered to adolescents during the hospital admission, with the aim of promoting alternative coping skills. The group of therapists provides a support network to the professionals involved in ATraPA. ATraPA has been successfully implemented in a Child and Adolescent Psychiatry Service within the Spanish national health system. Future studies should address the efficacy of ATraPA using a controlled design.

Can the Child Behavior Checklist (CBCL) help characterize the types of psychopathologic conditions driving child psychiatry referrals?

Background:Little is known about the scope of problems driving referrals to child and adolescent psychiatry services. Identifying the full range of mental disorders affecting a particular child can help triage the child to a clinician with the appropriate level of expertise. The Child Behavior Checklist (CBCL) is an easy-to-use assessment tool that may provide invaluable information regarding the severity of the presenting complaints and also aid in the referral process.Objective:To assess the utility of the CBCL to gain insights into the type of clinical problems driving referrals of youth to an outpatient pediatric psychiatry clinic.Method:The sample consisted of 418 newly referred youth 4-18 years of age of both sexes. Parents completed the CBCL assessing psychopathology and competence. Rates of patients with elevated T-scores on each scale were calculated for the whole group and stratified by sex and age (≤12 versus >12).Results:The CBCL identified high rates of psychopathology affecting referred youth. It also provided information on the type of suspected disorders affecting a particular child as well as their severity, critical information to guide likely differing clinical needs and therapeutic approaches. It also helped identify a high number of youth affected with multiple psychopathological conditions, likely to require a high level of clinical attention. Overall, males were significantly more impaired than females but there were no major differences between children and adolescents.Conclusions:The CBCL can aid in the identification of individual and comorbid mental disorders affecting youth seeking mental health services by providing specific information about the presence and the severity of specific suspected disorder. These findings have implications for prioritizing scarce resources in child mental health and for improved consideration of the complexity of clinical presentations to pediatric psychiatry programs of any type.

Çocuk ve ergen psikiyatrisi polikliniğine başvuran hastaların başvuru biçimi, şikayet, tanı ve eştanı dağılımları

Amaç: Çocuk ve ergen psikiyatrisine aile, genç kendi isteğiyle veya başka birimlerin yönlendirmesiyle başvurabilir. Bu çalışmada çocuk ve ergen psikiyatrisi başvurularının, tanı ile eştanının birden çok başvuru şikayetine göre değerlendirilmesi amaçlanmıştır. Gereç ve Yöntemler: Nisan 2017-Mart 2018 tarihlerinde Kırıkkale Üniversitesi Çocuk ve Ergen Psikiyatrisi polikliniğine ayaktan başvuruların dosyası geriye dönük olarak incelenmiştir. Bulgular: %63,5’i erkek, yaş ortalaması 9,2±4,0 yıl olan 1079 hastanın dosyasından okul çağında erkeklerin, ergenlikte kızların daha fazla başvurduğu; okulun erkekleri, pediatrinin kızları daha sık yönlendirdiği; ergen kızların kendi isteğiyle başvurabildiği saptanmıştır. Okul tarafından dışa vurum şikayetleri; pediatri tarafından nörogelişimsel sorunlar ve somatik belirtiler belirtilmiştir. Erkeklerde hareketlilik, sinirlilik/laf dinlememe, konuşma/telaffuz sorunları, konuşmama/geç konuşma; kızlarda somatik yakınmalar, mutsuzluk/kolay ağlama, kendine zarar verme davranışı/intihar girişimi daha fazladır. Birden fazla şikayet erkeklerde daha fazladır. %75,3’ü en az bir tanı almıştır. Erkeklerde Dikkat Eksikliği Hiperaktivite Bozukluğu (DEHB), iletişim bozuklukları, otizm spektrum bozukluğu; kızlarda depresyon, ayrılık anksiyetesi bozukluğu daha fazladır (p<0,05). Erkeklerin %17,7’si, kızların %12,7’si eştanı almıştır (p<0,05). Eştanı sıklığı okul öncesinde %5,2, okul çağında %19,2, ergenlikte %19,5 şeklindedir. İkinci şikayet belirtenlerin %86,5’i eştanı almıştır (p<0,05). En fazla eştanı DEHB ve zihinsel yetersizlikte saptanmıştır. Sonuç: Bulgular literatürle uyumludur. Bu çalışmanın çocuk ve ergen psikiyatrisinde hasta profilinin oluşturulmasına, koruyucu ve tedavi edici hizmetlerin planlanmasına katkı sağlayacağı düşünülmektedir. Yapılandırılmış ölçeklerle epidemiyolojik verilerin toplanması önerilmektedir.

Child and adolescent psychiatry training and services in the Middle East region: a current status assessment.

Mental health is a key component of health, yet appropriate care is limited. Evidence concerning child and adolescent mental health has predominantly come from western countries, while the Middle East region, with a large youth population, has reported very little on it. This original, cross-sectional study of child and adolescent psychiatry in the Middle East provides an assessment of current postgraduate programs, services and what is needed to build workforce capacity. Academic psychiatrists from 16 Middle East countries were invited to form a Consortium to map current postgraduate training as one of thedeterminants of available child and adolescent psychiatry services, identify gaps in the distribution of child and adolescent psychiatrists, and propose potential steps to improve access to child and adolescent mental health care. The study collected data from 15 of the 16 countries invited (no data provided from Yemen). The study revealed underdeveloped child and adolescent psychiatry academic systems throughout the region. Despite recognition of the specialty in a majority of the countries (11/15), only six countries had established a designated child and adolescent psychiatry training program. The overall shortage of child and adolescent mental health specialists varied, yet all Consortium members reported a need for additional child and adolescent psychiatry specialists and allied professionals. Lack of child and adolescent psychiatry specialized programs in place throughout the region has evidently contributed to the shortage of qualified child and adolescent mental health workforce in the Middle East.

6.51 Improving Access to Child and Adolescent Psychiatry Through Econsultations

Wait times to access child and adolescent psychiatry services are long throughout Canada, and access to such services is also limited by geography. The Champlain LHIN eConsult service allows primary care practitioners (PCP) to submit clinical questions to a pediatric psychiatrist via a secure platform and to receive a response within a week. It was hypothesized that the eConsult service would avert some referrals from tertiary care, would help build PCP capacity for treating pediatric mental health problems, and would support PCPs in implementing, continuing, or expanding recommended courses of action.

Professioner, makt och samverkan mellan myndigheter

Professions, power and collaboration between authorities: Social Services, schools, and Child and Adolescent Psychiatry Services working with adolescents who do not go to school School non-attendance is often a sign of a complex combination of dierent kinds of problems, which means that these children and young people are often in need of composite help from several dierent types of professions within various authorities. e purpose of the study was to examine how school authorities, the Social Services and Child and Adolescent Psychiatry (BUP) collaborate in their work with young people who do not go to school. e study comprised a thematic analysis of qualitative interviews with managerial representatives of the respective autho- rities. e empirical material consisted of 12 qualitative interviews with heads of units at BUP (5 individuals), section managers from Social Services (3 individuals) and principals from compul- sory schools (4 individuals) in three municipalities in western Sweden. According to the results, it seems problematic to manage the positions of power that may arise in collaboration between the parties. A position of power thus implies the right to make a decision as a profession as well as acti- vities that are related to each other. e right to make a decision means the mandate to determine which measures should be put in place for the young people and their families. is study also shows that the parties should develop a common knowledge base that is a combination of educa- tional, social and psychological perspectives. e common knowledge base can reduce the risk of power imbalance between the parties.

58.5 Shared Experience of Developing Pediatric Consultation Liaison Psychiatry in Singapore

In Singapore, the development of Pediatric Consultation Liaison Psychiatry (PCLP) has historically been limited by the health organizational structure and availability of child and adolescent psychiatry services. This study explores the mental health needs of children and adolescents admitted into the country’s largest pediatric hospital, Kerbang Kerbau Women’s and Children’s Hospital (KKWCH), and the development of a child and adolescent mental wellness service (CAMWS) since 2010.

Trouble de personnalité limite à l’adolescence : quelle réalité clinique ?

AimsTo better describe the population of adolescents diagnosed with “borderline personality disorder”, by identifying some distinct clinical profiles based on their psychopathology. Material and methodsThis retrospective study included both adolescents hospitalized between January 2013 and December 2014 in the adolescent inpatient psychiatry service of the University Hospital of Tours, and adolescents followed up between January 2014 and December 2014 in the adolescent outpatient psychiatry service of Chinon. After identification of the patients diagnosed with “borderline personality disorder” (screening using ICD-10 diagnoses codes and confirmation or invalidation of the diagnosis by the clinician in charge of the patient), we assessed for each of these patients their sociodemographic characteristics, their psychopathological characteristics, and the other psychiatric comorbidities (comorbid ICD-10 diagnoses). We identified different clusters of patients using ascending hierarchical classification, and compared them using univariate statistics. ResultsAmong the 823 eligible adolescents, 14.2% (n=117) had a borderline personality disorder, including two third of female (n=79) and one third of male (n=38), with a mean age of 15.5 years. Prevalence for borderline personality disorder was 9.0% for outpatients and 19.4% for inpatients. Cluster analysis identified three distinct groups of patients. The first group (called confirmed borderline personality disorder; 17.1%) included patients with higher symptom severity, intrapsychic symptoms and social isolation. The second group (called borderline crisis at adolescence; 35%) included patients that had lower symptom severity, and lower impulsivity. The third group (called expressive borderline disorder; 47.9%) included patients that were more oftenly female, and that had higher prevalence for behavioural manifestations but lower alexithymia and better social adjustment. ConclusionWe identified three distinct clinical profiles in patients diagnosed with a borderline personality disorder: confirmed borderline personality disorder, borderline crisis at adolescence and expressive borderline disorder.

Adaptation de la thérapie comportementale dialectique aux adolescents francophones, une expérience pilote auprès d’adolescentes avec dépression et trouble de personnalité limite

BackgroundDialectical behavioral therapy (DBT) has been developed by Linehan and further adapted to adolescents by Miller (DBT-A). Current literature supports the efficacy of DBT for youth with suicidal/self-harming behaviours. However, no study has been published on the feasibility and clinical validity of DBT-A when used with francophone adolescents. MethodWe followed a two-step plan: (1) a feasibility study exploring the requirements for implementing DBT-A in French child & adolescent psychiatry services and the impact of DBT-A on the team functioning; (2) a pilot evaluation study with a 12-week pre/post-design including the standardised assessment of mental disorders encompassing borderline personality disorder (BPD), suicidal behaviors (SB), borderline phenomenology as well as the DBT-trained skills: mindfulness, emotion regulation and tolerance to distress. ResultsMost of the feasibility objectives were achieved. Regular team meetings helped building a common view on the appropriate multimodal treatment plan for self-harmers, integrating psychodynamic, dialectical behavioral, systemic and pharmacological perspectives. Efficient connection with the referring practician eased the implementation and monitoring of DBT-A for each participant. The pre/post-test study included six female adolescents (mean age: 14.5) with major depressive disorder (MDD) and BPD who committed at least two suicidal attempts prior to the admission in DBT-A. Over the 12-week post-test, a suicidal attempt (SA) was reported for one adolescent. At 1-year follow-up, SB was reported for 2/6 adolescents. Borderline symptoms significantly decreased over the 12-week DBT-A program (P<0.05). With respect to the DBT-trained skills, significant improvement was observed in emotion regulation (P<0.05). ConclusionWithin an integrated therapy framework, implementing DBT-A in French child and adolescent psychiatry services is feasible. Given our results DBT-A for female adolescents with MDD and BPD is worth considering.

Erratum zu: Traumatisierung bei unbegleiteten minderjährigen Flüchtlingen

Almost 70,000 unaccompanied children and adolescents have sought refuge in Germany since the beginning of the current migration crisis. The majority originate from Afghanistan, Syria, Eritrea, Iraq and Somalia. Many of the unaccompanied minor refugees (UMR) are severely affected by the difficult experiences in their home countries and on their perilous trek to Europe and regularly present with symptoms of posttraumatic stress, depression and or anxiety. Since 2012, the 24-h emergency department at the kbo-Heckscher Clinic, a large public hospital providing child and adolescent psychiatry, psychosomatic care and psychotherapy services for the region of Upper Bavaria, has been seeing steadily increasing numbers of UMR. In addition to coping with peaking utilization rates, the emergency department has had to develop new UMR-specific intervention strategies and treatment programs in order to appropriately serve this new, very challenging clientele. Retrospectively collected and evaluated data for 151 UMR patients treated in 2015 on the acute wards are presented. The high rate of emergencies and crisis interventions recorded reflects the severe psychological stress and pressure most of the UMR have endured and the severity of the psychiatric conditions.

Are There Other Options?

This study compared University of Missouri child and adolescent telepsychiatry services patients’ specific zip codes to child and adolescent psychiatrists’ practice locations to learn if telehealth was an appropriate option for this group of patients. In demographically and geographically diverse state such as Missouri, patients in rural areas may have limited or no access to timely, affordable and quality care. Many large urban health-care institutions have turned to telehealth as a means of providing equal access to care for all population, no matter where they choose to live. The management analyst system Cognos/Analyzer was used as a data source. Patient- and provider-specific zip codes were processed using GeoKettle software, and ArcGIS explorer was used for map visualization. While patients utilizing child and adolescent telepsychiatry services come from various parts of the state, providers are mostly clustered in urban locations along the Interstate 70. This greatly limits access to specialty care for rural and other vulnerable populations. Telehealth provides adequate and timely access to child and adolescent psychiatry services for the youth that may otherwise not be able to get needed care. Barriers such as mental health crisis and access to care for rural population have been more or less successfully addressed by telehealth for several decades now. However, the shortage of specialty physicians adds an additional layer of complexity to this issue. Health-care organizations with informatics tools such as telemedicine need to focus their efforts on maximizing usage to allow more access for the underserved population.

Childhood adversities and emergency room visits

IntroductionInstitutionalized children and adolescents who reside in foster centres are a subgroup of population that use mental health resources. This group of population has an increased risk of physical and psychopathology health problems. That translates into a greater number of emergency visits. This is the same perception presented by different professionals.ObjectivesThe aim of the study is to analyse visits to emergency child and adolescent psychiatry service from a pediatric hospital. Also ask for a point of view of the professionals about it.MethodsWe select all the patients attended the emergency psychiatry child and adolescent care that were institutionalized. The sample was collected for 4 months in a pediatric hospital.Resultsn = 66 (51.5% male; mean age 14.09 ± 1.95 years old), 31.8% was the first time at the emergency room, 31.8% had consulted between 2–4 times and 36.4% over 4 times. The main reason for consultation was aggressiveness (66.7%). The three main discharge diagnoses were conduct disorder (50%), adjustment disorder (25.7%) and TDAH (7.5%) The 45.5% had a history of drug use and the 24.2% of self-harm. Asking professionals 80% responded perception of increased emergency consultations and the 90% think inadequate value between 50–70% of queries.ConclusionsThe boys institutionalized perform a high use of paediatric and psychiatric emergencies. There are a significant number of re-consultations. Professionals have the perception that their emergency visits are increasing. Since patients are at high risk of suffering mental disorders and high use of emergency would be interesting to develop specific protocols for emergency care for these groups.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Psychosocial predictors in adolescent's non-suicidal self-injury: Preliminary results

Introduction Non-suicidal self-injury (NSSI) have their typical onset during adolescence. Although a growing body of research has been dedicated to this subject, little is known about the relation between psychosocial factors (PF) and NSSI in adolescence. Objectives To identify the main PF associated with the occurrence of NSSI in adolescence and potential relations between them. Methods The authors used a convenience sample of 50 outpatient adolescents from Coimbra's Child and Adolescent Psychiatry Service, with identified history of NSSI. Each patient was evaluated regarding the presence/absence of the PF contemplated in the Axis V (Associated Abnormal Psychosocial Situations) of the Multiaxial Classification of Child and Adolescent Psychiatric Disorders, (ICD-10, WHO). Results Sixty-seven factors were evaluated within this sample, with 50% of the subjects showing the 3 most prevalent PF (the 5 most prevalent PF are displayed on Table 1). Statistical significance between pairs or triads of PF (selected within the 10 most prevalent PF) was evaluated, with results showing 14 significant correlations between pairs and 20 significant correlations between selected triads among the most prevalent PF. Conclusions PF are highly prevalent within adolescents with NSSI. Identification of specific associations of PF may be useful to identify high-risk patients and promote early intervention and prevention programs.