Adolescent Psychiatry Unit Research Articles

Psychiatric crises among youth with a history of trauma during COVID-19: A retrospective study of psychiatrically hospitalized children and adolescents

BackgroundYouth hospitalized in inpatient child psychiatry units have a high prevalence of trauma and this population may have been especially affected by the pandemic. ObjectiveThis study examined the clinical and sociodemographic characteristics of hospitalized youth with a history of trauma prior to, during, and after the pandemic. Additionally, youth who reported a trauma history were compared to those who denied having a trauma history. Participants and settingThis retrospective study utilized data gathered from (n = 1101) first admissions to a child and adolescent inpatient psychiatry unit of a New York City hospital during the pandemic. MethodsHospital admission records were reviewed for clinical and sociodemographic variables. Statistical analyses evaluated whether there were significant differences in these variables throughout the pandemic. ResultsThe clinical severity of inpatient youth with trauma increased during the quarantine period compared to pre-pandemic. The percentage of youth admitted for psychosis increased by 3 % (φc = 0.15, p = 0.03), suicide attempt by 14.8 % (φc = 0.15, p = 0.03), and suicidal ideation without suicide attempt decreased by 9.6 % (φc = 0.15, p = 0.03). Clinically, patients with a history of trauma were more likely to have greater comorbidity and clinical severity. Demographically, patients with a history of trauma were more likely to be female or transgender/non-binary (φc = 0.11, p < 0.01), Black or Latinx (φc = 0.14, p < 0.01), and on public insurance (φc = 0.11, p < 0.01). ConclusionsIn an urban area inpatient youth psychiatric unit, the clinical severity of inpatient youth with trauma increased during COVID-19 quarantines. The clinical severity of inpatient youth with trauma was greater than those without during and after COVID-19 and youth with certain minority and marginalized identities were particularly impacted.

Social skills programme for adolescents with depression: initial outcomes of a hospital based study in Sri Lanka

ObjectiveThis quasi-experimental study aimed to describe the outcome of a social skills intervention for adolescents with depression followed up at an outpatient Child and Adolescent Psychiatry Unit. Twenty adolescents with depression attending a tertiary care facility in Colombo, Sri Lanka were recruited, who participated in two social skills training programmes (6 months apart), in addition to pharmacological treatment. Outcome of the programme was measured by a self-administered questionnaire that assessed perceived changes in social skills, before and after the intervention. Wilcoxon Signed Rank test was used to determine the statistical significance of improvement in social skills.ResultsThe sample consisted of 80% (n = 16) female adolescents. Median scores (inter-quartile range) for social skills before and after the first social skills programme were 31.5 (21.0–36.0) and 33.0 (28.25–40.25) respectively, indicating a significant improvement in social skills following intervention (p = 0.011, r = 0.57). A similar improvement was observed after the second programme (n = 10), reporting higher median scores for social skills after intervention (29.5 vs. 37.5, p = 0.005, r = 0.89). A significant improvement was also observed in perceived ability to cope with depressive thoughts after intervention (p = 0.032), indicating that social skills training can be a useful adjunct to pharmacological interventions, in the management of depression in adolescents.

Exploring the internal medicine comorbidities associated with eating disorders: correlation between disease severity and cardiac abnormalities in adolescent patients with anorexia nervosa

ABSTRACT Anorexia Nervosa (AN) is a psychiatric disorder characterized by caloric restriction, weight loss, and fear of gaining weight. Cardiac complications are among the most severe medical consequences. Despite the importance of regular cardiac assessments, there is a lack of standardized protocols for timing and patient selection. This retrospective cohort study has aimed to assess the correlation between AN severity, Body Mass Index, weight loss percentage, and cardiac abnormalities in pediatric patients. A total of 123 patients admitted to a child and adolescent psychiatry unit between January 2019 and March 2022 were included. Data on demographics, clinical characteristics, cardiac evaluations were collected from electronic health records. The study revealed a prevalence of cardiac abnormalities in 57.7% of patients, with bradycardia being the most common (49.5%), followed by QTc prolongation (4%) and pericardial effusion (4%). However, no significant correlation was found between AN severity and cardiac alterations, suggesting that disease severity alone is not a reliable predictor of cardiac risk. The study highlights the need for individualized risk assessment and targeted cardiac evaluations based on specific risk factors rather than disease severity alone. Early diagnosis and comprehensive care contribute to better outcomes, emphasizing the importance of multidisciplinary approaches in managing AN.

Clinico-Demographic Profile of Children and Adolescents with Attention Deficit Hyperactivity Disorder Presenting to a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children. ADHD leads to significant impairment in overall functioning of the child. There is limited information concerning the clinical scenario of ADHD within Nepal. The study aims to determine the clinico-demographic profile and pattern of medication use in the treatment of ADHD. This study retrospectively examines the records of children diagnosed with ADHD at the Child and Adolescent Psychiatry (CAP) Unit, Kanti Children's Hospital (KCH), Nepal. Approval for the study was granted by KCH's Institutional Review Board. The analysis focused on data extracted from hospital records of ADHD patients spanning from 1 January 2021 to 30 June 2023 encompassing two and a half years. A total of 585 children were diagnosed with ADHD, with a mean age 7±3.04 years. The majority 501 (85.64%) were male, and 377 (64.44%) were from the school going age group (6 to 11 years). The prevalent psychiatric comorbidities included Autism Spectrum Disorder (ASD) at 102 (17.43%), Intellectual Disability (ID) at 93(15.89%), and Oppositional Defiant Disorder (ODD) at 36 (6.15%). The commonly used medication was Clonidine 165 (28.20%) followed by Atomoxetine 154 (26.32%) and Risperidone 65 (11.11%). The study indicates that ADHD is highly prevalent in Nepal. Comorbidities like ASD and ID are frequently seen which further necessitates the need for structured assessments and multidisciplinary approaches to address ADHD. In our context with limited treatment options, the management of ADHD is extremely challenging.

Mental telehealth in a public child and adolescent psychiatry unit during the pandemic: a qualitative implementation study.

The COVID-19 pandemic led to a prompt implementation of remote care, especially in mental health care. The evidence supporting this modality of care is still emerging, with few qualitative studies describing its implementation in Latin American countries. This study aims to understand the perspectives of therapists and patients regarding the use of telehealth in a child and adolescent mental health unit of a Chilean public service. This is a qualitative study. Two focus groups were defined with 14 professionals, and 16 in-depth interviews were conducted with users of an outpatient child and adolescent psychiatry unit. The data were analyzed using the grounded theory model. In the group of therapists, four main categories emerged: background of mental telehealth, implementation, mental telehealth from the therapist's position, and projections. Three main categories emerged in the patient's group: implementation, evaluation of mental telehealth users, and projections. There are elements in common between the opinions of patients and therapists. Something to note within the patient's group is that, despite accepting remote care and recognizing its positive aspects, aside from the pandemic context, they prefer face-to-face or mixed care.

Implementing patient-reported outcome measures on an adolescent inpatient psychiatry unit: A feasibility study.

This article examines the feasibility of implementing patient-reported outcome (PRO) measures with adolescents on an inpatient psychiatry service. During the study period (March 8, 2021, to June 7, 2022), a total of 154 patient encounters were recorded for adolescents between 12 and 17 years of age. PROs were piloted during the first 3 months of the study period, with a focus on technical implementation. In the 12 months from June 8, 2021, through June 7, 2022, the PRO project moved to full implementation across all patient encounters. Fisher's exact test and independent t tests were conducted to examine the differences between patients who completed the PROs and patients who did not complete them to determine the representativeness of the sample receiving them. During the 3-month pilot period, 31.8% of patients completed the PROs at admission and discharge, while during the 12-month full implementation, 74.5% of patients completed them at both time points. Statistical tests showed no significant diagnostic, sex, or race/ethnicity differences between patients who received and did not receive the outcome measures. Even without funding, small inpatient psychiatry services for adolescents can feasibly implement PROs with completion rates similar to other published studies and capture the majority of the patients served. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Factors Influencing Despair, Self-blame, and Acceptance Among Parents of Children with Autism Spectrum Disorder (ASD): A Malaysian Perspective.

Accepting and adapting to the child's diagnosis of Autism Spectrum Disorder (ASD) can be challenging for parents. We aimed to assess domains of parental adjustment namely despair, self-blame, and acceptance among parents whose children were diagnosed with ASD. A cross-sectional study was conducted among 111 parents of children with autism who attended Child and Adolescent Psychiatry Unit (CAPU), in a university teaching hospital in Kuala Lumpur, Malaysia. Sociodemographic profiles of both parents and children were gathered. Parental adjustment focusing on parental self-blame, despair and acceptance were assessed using self-reported questionnaires namely Adjustment to the Diagnosis of Autism (ADA). Higher level of despair was associated with parents who have medical illness (β = 0.214, p = 0.016) and children who received antipsychotic medications (β = 0.329, p < 0.001). Parents with tertiary education (β = -0.207, p = 0.023) and those with autistic child attended school (β = -0.200, p = 0.037) have lower level of despair. Parents with medical illness (β = 0.245, p = 0.008), child receiving antipsychotic medications (β = 0.251, p = 0.005), Chinese ethnicity (β = 0.185, p = 0.04), and child's gender (β = 0.283, p = 0.003) were significantly associated with higher level of self-blame. Lower acceptance was found among Chinese parents (β = -0.264, p = 0.005) while married parents had higher acceptance levels (β = 0.215, p = 0.022). Parental adjustment involving domains of despair, self-blame, and acceptance were significantly associated with ethnicity of parents, educational level, parents' marital status and medical illness, as well as the ASD children's schooling status and type of medications used.

Relapse prevention therapy for internet gaming disorder in Swedish child and adolescent psychiatric clinics: a randomized controlled trial

ObjectivesTo evaluate the effectiveness of relapse prevention (RP) as a treatment for internet gaming disorder (IGD).DesignRandomized controlled trial.SettingThree child and adolescent psychiatry (CAP) units in Region Skåne, Sweden.ParticipantsChildren aged 13–18 years, coming for their first visit to CAP during 2022, were screened for gaming behavior. Those who met the proposed DSM-5 criteria for IGD were offered participation in the trial, if they had the capacity to provide written informed consent and if they spoke Swedish. A total of 111 CAP patients agreed to participate. Out of those, 11 patients were excluded due to incorrect inclusion such as young age (n = 1), or due to the absence of responses to follow-up measures (n = 9). After exclusion, 102 participants remained (intervention = 47, control = 55).InterventionsThe intervention, RP, is based on cognitive behavioral treatment (CBT) and was provided individually, comprising of five to seven 45-min sessions over a period of 5 to 7 weeks versus treatment as usual.Outcome measuresParticipants were assessed with Game Addiction Scale for Adolescents pre-treatment (GASA) (baseline), post-treatment (treatment group only), and 3 months after baseline (follow-up).ResultsThe repeated measures ANOVA showed a significant interaction effect between treatment and time. Both the control group and treatment group lowered their mean GASA score from baseline to follow-up significantly, but the improvement was greater in the treatment group (mean difference in control group −5.1, p &amp;lt; 0.001, 95% CI = − 3.390 to −6.755, mean difference in treatment group −9.9, p &amp;lt; 0.001, 95% CI = −11.746 to −8.105).ConclusionRP was found to be superior to treatment as usual in terms of reduction of IGD symptoms. Future research should address which aspects within a given treatment are effective, who benefits from treatment, in what aspects, and why.Trial registration numberClinicalTrials.gov, NCT05506384 https://clinicaltrials.gov/ct2/show/NCT05506384.

6.45 A Qualitative Study of Trends in Restraints and Seclusions by Patient Race and Ethnicity on an Adolescent Inpatient Psychiatry Unit

6.45 A Qualitative Study of Trends in Restraints and Seclusions by Patient Race and Ethnicity on an Adolescent Inpatient Psychiatry Unit

COVID-19 pandemic impact among adolescents with eating disorders referred to Italian psychiatric unit.

The COVID-19 pandemic has triggered or exacerbated eating disorders (EDs), especially in adolescents. This study examined the prevalence of admissions of patients with EDs at the Child and Adolescent Psychiatry Unit from the pre-COVID-19 pandemic to March 2023 and explored the differences in dimensions of ED's symptomatology according to the year of access. We included 174 children and adolescents, 94.3% females and 5.7% males, with a diagnosis of ED (Mage = 14.87; SD = 1.72). The Eating Disorder Inventory-3 (EDI-3), the Body Uneasiness Test (BUT) and Youth Self Report ASEBA (YSR) were assessed. A one-way analysis of variance test was performed. EDs' hospitalization prevalence was higher in the years 2020 and 2021 compared to pre-COVID-19 and the year 2022. Considering the ED psychopathology (EDI-3), findings showed a higher score in the dimension of the push to thinness, body dissatisfaction, asceticism, and fear of maturity in the year 2021 compared to pre-pandemic. Regarding the discomfort related to the image of one's own body (BUT), results showed an increase in the global severity index in the year 2022 compared to pre-pandemic and in weight phobia in the year 2021 compared to the year 2020. Concerning the internalizing symptoms (YSR), a tendency was found for withdrawal/depression, with higher levels in the year 2022 compared to the year 2020. Our study highlighted the increase of different types of EDs symptomatology related to concerns about weight, especially 2 and 3 years after the outbreak of the pandemic, on which the literature is still scarce, especially in the Italian context.

Svak skår på deltesten Tallhukommelse i WISC-V – en indikasjon på språklige vansker?

Background: WISC-V is the first Wechsler intelligence test that measures both the visual working memory and the auditory working memory. Both tests contribute to a combined Working Memory Index, but much of the research suggests that sensory modality plays an important role. Children with impaired phonological capacity and resulting reading, writing or language difficulties, often struggle with Digit Span without necessarily having problems with Picture Span. Psychologists are often more concerned with possible attention deficits than modality-specific problems, and may suspect ADHD in cases of impaired Digit Span. Method: In the project, 62 test protocols from children in the Child and Adolescent Psychiatry Unit at Vestfold Hospital Trust were analysed. They were assessed using Digit Span and Picture Span, and Conners CPT 3 was used to test attention deficit, in addition to the Norwegian test Språk 6-16 and Children’s Communication Checklist-2 to measure possible language-related problems. Results: Beyond shared variance between Digit Span and Picture Span, regression analyses showed that Digit Span was associated with language-related problems and not attention deficit problems, while Picture Span was associated with attention deficit. Implications: The clinical recommendation is to not interpret Digit Span or the Working Memory Index in isolation before considering modality differences. Impaired Digit Span should prompt clinicians to consider language-related problems, while impaired Picture Span may raise suspicion of more general attention deficits. Keywords: WISC-V, Digit Span, Working Memory, ADHD, language-related problems

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

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

Concordance between admission and discharge diagnosis of a child and adolescent psychiatry inpatient unit.

Psychiatry is arguably the most medical practice that is affected by culture. The pediatric literature is sparse with respect to the differences between child psychiatric units in different cultures and different countries. In this study, we aim to investigate the discordance between admission diagnosis and discharge diagnosis for child psychiatric disorders. A retrospective analysis was conducted on 206 patients admitted to a university hospital inpatient child and adolescent psychiatry unit in Ontario, Canada. The data extracted from electronic charts were age, gender, DSM-IV-based diagnosis at admission, living arrangement before admission, length of stay (minimum one day), post-discharge diagnosis, and post-discharge outcomes. There was 75% agreement with the discharge diagnosis. We found strong negative and positive associations between conduct disorder at discharge and the prescription of antipsychotics (+), antidepressants (-), and stimulants (-), and there was a strong association between a conduct disorder (CD) diagnosis and medication-free status. The powerful effect size of stimulant medication was specific to the association between a primary diagnosis of ADHD (vs. not-ADHD) and stimulant medication (c2=127.5, df=1, phi=0.79, P<0.0001). We have found a significant agreement between admission and discharge diagnosis. It is suggested that the inpatient stay helped to refine the formulation and to improve the child's well-being.

Early-onset schizophrenia: an adolescent case report

IntroductionThis is the case of a girl, aged 13, starting on 2021 with a first psychotic episode. Before this episode, her psychiatric history was an adjustment disorder because of scholar bullying, fully recovered before the onset of the current symptoms.ObjectivesTo describe an interesting case of early-onset psychosis.MethodsWe have used the interviews with the patient and her profile in Diraya (the medical database software in Andalucía).ResultsThe first symptoms started 6 months before the first hospitalization, and consisted in mild behavioural disorders, with disobedience and rudenesses, which represented a significant change compared with the previous personality of the patient. 3 weeks before the first admission she abruptly started to experience disconnection, unmotivated laughs, decreaded academic performance and incoherent speech. Also, she showed motor symptoms, consisting in oral and right-hand stereotypies. Then, she was hospitalized in a Pediatric unit, in order to rule out organicity. The nuclear magnetic resonance showed an image suggestive of venous development anomaly, with no acute injuries. Her cerebral spinal fluid was widely studied, and all the results were negative, including: the technique of PCR for many virus and bacteria that can cause meningitis or encephalitis; a bacterial culture; a biochemical study; antineuronal antibodies; and a limbic encephalitis antibodies study. Besides, the blood count, the biochemistry, the gasometry and serology were also negative. No drugs were detected in the urinalysis. Once the organicity was ruled out, she was treated with Olanzapine and Diazepam, and destinated to my child and adolescent psychiatry unit. During the first hospitalization we observed that she looked very often to the mirror, showed soliloquies and took leaps. During the interviews she was desinhibited. She initiated a delusional speech, focused in sexual topics. She said that she’s had a baby in the future with his father, and talked a lot about things she had already made in the future. During this admission, we changed the treatment to Quetiapine and Valproate.The second hospitalization was was done due to a lack of efficacy with the previous treatment and the presence of autolytic thoughts. We switched from Quetiapine to Aripiprazole. After a few days, she showed again a desinhibited behaviour, and kept the delusional speech, that now was more complex, refering that she had more than 20 babies, with many different men. After this we tried Lurasidone and suspended Aripiprazole, she showed a clinical improvement, at the cost of many side effects, though. So we finally changed to Clozapine, in combination with Gabapentin. Since she got clinical levels of clozapine, the delusions have been encapsulated.ConclusionsThe differential diagnosis is set with an early-onset schizophrenia and a schizoaffective disorder. Obviously, the evolution of the sypmptoms in the following months and years will have the last word.Disclosure of InterestNone Declared

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

The medical consequences of eating disorders: the correlation between the severity of the disease and the degree of the cardiological changes in paediatric patients with anorexia nervosa

IntroductionAnorexia nervosa (AN) is associated with several medical complications. The cardiac changes represent the most severe complications and are associated with higher mortality. For this reason, periodic evaluation is necessary, by ECG and echocardiography. Moreover, there is not a protocol that defines the timelines or how to select higher risk patients that must be evaluated more frequently.ObjectivesThis single-center, retrospective, observational and epidemiological study aims to analyze the prevalence of cardiac changes and their correlation with disease severity, in patients admitted to the Child and Adolescent Psychiatry Unit, AOU Meyer, Florence.MethodsThe study population consisted of 123 children between the ages of 7 and 18 years old admitted to inpatient or intensive day hospital, with a diagnosis of AN, between January 1, 2019, to March 31, 2022. Data were collected by retrospectively consulting clinical reports. The correlation between BMI, percentage of weight loss since the onset of symptoms and HR, QTc interval values and pericardial effusion was evaluated. Furthermore, the correlation between cardiac changes and the intake of antidepressant and antipsychotic medications was analyzed.ResultsThe overall prevalence of cardiac changes was 57.7%. In our analysis BMI showed a significant positive correlation whit HR. QTc prolongation was significantly related only to psychotropic drug intake. Pericardial effusion was evidenced exclusively in patients diagnosed with severe or extreme AN. After six months from the hospitalization and the beginning of treatment the prevalence of cardiovascular complications was reduced.ConclusionsThe present study identifies criteria able to select patients with AN at higher risk of developing cardiac changes and underlines the importance of performing more frequent and targeted cardiologic evaluations in this subgroup of patients. This suggests the importance of establishing a common protocol for all clinicians.Disclosure of InterestNone Declared

Human-Animal Bond Generated in a Brief Animal-Assisted Therapy Intervention in Adolescents with Mental Health Disorders.

The human-animal bond is crucial for the proper development of animal-assisted therapy (AAT) sessions. However, in specific cases such as in AAT focused on psychiatric patients who are admitted to acute units, there is only a short period of time available to establish this bond. To assess the degree of HAB generated after two AAT sessions in adolescents admitted to acute psychiatry units. A prospective multicenter cohort study aimed at adolescents aged 13 to 17 years admitted to the acute child and adolescent psychiatry unit of three hospitals. Two weekly 1 h group sessions of AAT with therapy dogs. The Center for the Study of Animal Wellness Pet Bonding Scale Survey (CSAWPB). One hundred and fourteen adolescents participated. A positive perception of the dog was generated, achieving a good level of bonding and attachment. The results obtained make it possible to affirm that a short period of time is enough to establish a good HAB between patients and therapy dogs. This study aims to contribute to the study of non-pharmacological interventions as a complement to pharmacological treatments in adolescents with mental health disorders.

Functional tic-like behaviours during the COVID-19 pandemic: Follow-up over 12 months.

Functional tics are included in the wide spectrum of functional movement disorders (FMDs). Their distinction from organic tics is challenging because they both phenomenologically present common features. During the COVID-19 pandemic, there has been an increase in functional tic-like behaviours in vulnerable children and adolescents after social media exposure. This study explores the phenomenology and course of a cohort of newly diagnosed functional tic-like behaviors. We analysed clinical data of 243 patients affected by tic disorders collected at outpatient Tourette Clinic, Child and Adolescent Neurology and Psychiatry Unit, Catania University. Among the clinical cohort with functional tic-like behaviors, we evaluated the clinical course of symptoms at follow-up visits after 6 and 12 months. Among the cohort of 243 patients referred for evaluation at our centre, 11 were diagnosed with functional tic-like behaviours. The majority of participants with functional tic-like behaviours were female with a mean age of 15 years old and presented an explosive symptom's onset. At follow-up visit after 12 months, patients with functional tic-like behaviors showed a significant variation in the severity of tics and anxiety symptoms. Conversely, depressive, and obsessive-compulsive symptoms did not significantly differ during the follow-up. Our data suggest that several characteristics in clinical course and their phenomenology can help clinicians to distinguish functional tic-like behaviours from organic tics. Our results also suggest a better outcome for tics and anxiety symptoms respect on other comorbidities. A prompt diagnosis and management not only of tics but also comorbidities are recommended, as generally conventional pharmacotherapy for tics does not have positive effects on these patients.

Psychopathology and mental health service use among youth in foster care admitted to a psychiatric inpatient unit: a 4-year retrospective controlled study.

Youth in foster care (FC) are at increased risk of poor psychosocial outcomes. The aim of this study was to assess psychopathology and mental health service use among youth living in FC who require psychiatric hospitalisation. All individuals admitted to our Children and Adolescent Inpatient Psychiatry Unit between 2014 and 2017 who were in FC were systematically reviewed. The control group was defined as all youth living with their immediate family and hospitalised in our unit throughout 2016. We identified 89 patients placed in FC and 247 controls. Socio-demographic and clinicaldata were retrospectively collected from computerised charts. A survival analysis of emergency department visits and readmission to the hospital was conducted. Compared to controls, the FC group presented significantly higher rates of conduct disorder (78.7% vs 14.6%; p < 0.001) and substance use disorder (49.4% vs 27.5%; p < 0.001), mainly cannabis use (34.8% vs 16.6%; p < 0.001); higher rates of comorbidity (96.6% vs 55.9%; p < 0.001) and mean number of comorbid diagnoses (3.3 ± 1.1 vs 2.3 ± 0.5; p < 0.001). The FC group had a higher number of emergency room visits before and after admission than controls. FC youth were also 2.77 times more likely to visit the emergency department after discharge, and in a shorter time period, than controls (p = 0.004). Disruptive behaviours, substance use disorder, and comorbid psychopathology were all more prevalent among FC youth than controls. Specific strategies are needed to optimize community mental health resources and address the increased use of emergency services by these youth before and after hospitalisation.

Autism Spectrum and Neurodevelopmental Disorders in Early Childhood: Experience of the Child and Adolescent Psychiatry Unit of Casablanca

Since 2012, when the juvenile psychiatry unit of Casablanca was created, children and adolescents in psychological distress or suffering from psychiatric disorders are cared for by a multidisciplinary team. The Early Childhood Unit (ECU) receives children from 0 to 6 years old, requiring a diagnostic assessment and/or therapeutic care. Objective: The aim of our study was to describe the profile of patients with a diagnosis of neurodevelopmental disorder (NDD); autism spectrum disorder (ASD) among others. Patients and Methods: We conducted a descriptive study including all children hospitalized at the ECU, in the child psychiatry department of the University Hospital of Casablanca, from January 1, 2012 to December 31, 2019. A descriptive analysis of sociodemographic, clinical and care arrangements have been made. Results: A total of 135 children were included in the study, 83% of them were boys. The mean age during hospitalization was 3.4 years. Consanguinity was found in 8.7% of cases. All the children were admitted on a part-time basis: day hospital, with an average of 71 days. The period between the parents' first concerns and the beginning of follow-up was 10 months, and the average age at diagnosis was 44 months. The main diagnoses made were autism spectrum disorder (ASD) 55.5% and Global Developmental Delay (GDD) 20.1%. Our descriptive results are comparable to those of the literature, and are preliminary to future studies on the involvement of certain risk factors in the occurrence of NDDs.