Child Psychiatry Research Articles

Early maladaptive schemas, depression and anxiety in adolescent psychiatric out-patients.

A growing number of studies among adolescents have reported early maladaptive schemas (EMS) to associate with anxiety and depression within non-clinical samples. However, there is a gap of knowledge concerning clinical populations. The current study's aim was to explore the potential association between EMS domains and anxiety and depressive symptoms within clinical sample of adolescents. The current study included 176 adolescent psychiatry out-patients. The EMS domains were measured with the Young Schema Questionnaire-Short Form 2-Extended (YSQ). Their association with anxiety symptoms (the Overall Anxiety Severity and Impairment Scale) and depressive symptoms (the Beck Depression Inventory II) were analysed with general linear models while controlling for significant confounding factors. Depressive symptoms were associated with three of the four EMS domains: Disconnection and Rejection (η2p=0.047, p=0.005), Impaired Autonomy and Performance (η2p=0.074, p<0.001), and Impaired Limits (η2p=0.053, p=0.003). Anxiety symptoms were associated with two EMS domains: Impaired Autonomy and Performance (η2p=0.046, p=0.005) and Excessive Responsibility and Standards (η2p=0.054, p=0.002). Various EMS domains were associated with depressive and anxiety symptoms among adolescent out-patients. Further studies are needed on the effect of EMSs on the treatment outcomes for depression and anxiety.

‘We tried our best... it wasn’t great’: a qualitative study of clinician experiences on child psychiatry wards at the height of COVID-19

Changing public health and hospital protocols during the height of the COVID-19 pandemic shaped the provision of inpatient mental health care. While a growing body of research explores the challenges of restrictions on adult psychiatric wards, the impact on clinical teams and epidemiological trends in youth mental health, no research has explored inpatient psychiatric hospital services for child and adolescent psychiatry during the pandemic. This study seeks to understand how clinicians in Canada working in child and adolescent mental health wards experienced caring for their patients while navigating pandemic hospital restrictions. Following a qualitative descriptive methodology and also drawing on institutional ethnography we generated data using two methods: 1) an online survey of clinicians across the country asking about experiences providing care and COVID restrictions and 2) in-depth, semi-structured interviews with clinicians. Data from 54 surveys and 14 interviews were analyzed using thematic analysis yielding two major themes. First, clinicians felt that clinical care was compromised with likely impact on patient outcomes. Second, respondents reported that the context of the pandemic provoked tensions and resistance within the clinical teams and the institution. Our findings have important implications not only for future public health crises, but also for rethinking how psychiatric care is provided and prioritized. This study points to the need for 1) mechanisms which support collaborative decision making at the institutional level, to ensure regulations are more flexible and can adapt to the needs of child mental health patients; and 2) that child psychiatry prioritize generating spaces of ethical reflection for clinical teams and institutional decision-makers so that paternalism does not trump principles of primum non-nocere (first, do no harm), autonomy and reciprocity.

Autoimmune Psychosis as a Differential Diagnosis of Primary Schizophreniform Psychosis in Children and Adolescents.

Objective: Autoimmune psychosis (AP), defined as an isolated schizophreniform psychosis with no or only minimal neurological abnormalities stemming from autoantibody-associated cerebral processes, is a very rare and potentially underdiagnosed disorder in children and adolescents. Methods: This article reports the case of a 13-year-old boy who became acutely ill with a psychotic disorder following a respiratory infection. We describe the diagnosis and course of treatment in detail. Results: Following an extensive interdisciplinary workup, a probable glutamic acid decarboxylase (GAD)-associated AP was diagnosed that ultimately remitted completely with treatment. Conclusions: Autoimmune psychoses remain a relatively uncharted territory for the specialty of child and adolescent psychiatry. Good interdisciplinary cooperation is essential for patients with somewhat atypical psychotic symptoms, both in terms of diagnosis and treatment.

Evaluating the adverse drug reactions to clozapine in populations of children and adolescents: insights from VigiBase data.

Pharmacovigilance findings have marked clozapine use. Prescribers and package inserts worldwide focus on clozapine-induced neutropenia. The literature on clozapine adverse drug reactions (ADRs) for those under age 18 and their associated fatal outcomes is limited. Reports to the World Health Organization's global pharmacovigilance database (VigiBase) were analyzed among patients under 18 years of age extending from clozapine's introduction to June 1, 2022. There were 2825 reports of clozapine, including 42 fatal outcomes (relative lethality = 1.5% vs. 11.7% in all ages). After 280 cases were excluded (clozapine exposure during pregnancy, accidental exposure or unclear age), 2455 were included with ADRs during therapeutic use. Decreased white blood cell (WBC) count provided the most frequent aggregated ADR, accounting for 934 cases (37% of 2545), with only 1 fatal outcome (0.01%, 1/934). Suicide explained 7 of 27 (26%) non-duplicated fatal outcomes. Next in importance was clozapine-induced gastrointestinal hypomotility (CIGH) with 3 cases (11% of 27) and neuroleptic malignant syndrome with 2 cases (7% of 27). Agranulocytosis, aspiration, myocarditis, myocardiopathy and ventricular arrythmia led to single fatal cases. Based on these new findings and recent literature in all ages, to prevent fatal outcomes, child and adolescent psychiatrists need to shift their focus from severe neutropenia to other ADRs including pneumonia, respiratory aspiration and CIGH. In spite of its potential toxicity during overdoses, clozapine may have specific and strong anti-suicidal effects when compared with other antipsychotics. Child and adolescent psychiatrists need to take extreme precautions to avoid intentional overdoses when prescribing clozapine to patients with suicide risk.

Helping Special Needs Children to Make Friends

Introduction: Children with special needs are often considered to be cursed. They are frequently ostracized from society thus making them feel lonely. This paper aims to help patients, especially children with special needs, find good friends through the review of current studies. Methods: This study used a descriptive quantitative method and data that was retrieved from Child and Adolescence Psychiatric Outpatients Daycare, Dr. Soetomo General Academic Hospital, Surabaya with 80 children with ADHD and 160 children with ASD. Results: A common intervention used in Indonesia is applied behavior analysis (ABA), a method that trains children to have social skills such as how to communicate, interact, and express themselves in social settings. Besides personal intervention, the need for integrated care for children with special needs such as pharmacological therapy, speech and behavioral therapy, occupational therapy, and special education, is needed to support them in helping them make friends. Conclusion: To help children with special needs make friends, we can give support, appreciation, and motivation. However, children with special needs need different treatment from their peers, so special attention and understanding are needed so that children with special needs can socialize and make friends well. Keywords: Children, Special Needs, Friends, Mental Health, Loneliness

Ethical Considerations of Off-Label Prescribing in Disruptive Mood Dysregulation Disorder.

AbstractDisruptive mood dysregulation disorder (DMDD), a relatively new diagnosis in child and adolescent psychiatry that remains without medications approved for its indication, warrants a renewed consideration of the ethics surrounding the off-label use of medications. In the absence of empirical studies, clinicians must work with the best available information regarding treatment, such as case reports demonstrating the success of off-label interventions. Although subject to ethical limitations and the risk-benefit profile of each medication, increased use of this approach in the treatment of DMDD is warranted. A review of the literature was undertaken to identify studies for inclusion in this article. A case history of a 12-year-old girl with DMDD who was treated with amantadine with good response illustrates these ethical considerations within a clinical context. There are significant benefits of off-label uses of medications in the treatment of DMDD. The promising potential of amantadine as an agent for off-label use for pediatric populations with DMDD illustrates this approach. In the absence of approved medications for DMDD, further attempts to use off-label treatments for this disorder are warranted despite ethical constraints and varying risk-benefit profiles for each medication.

A community child and adolescent psychiatry fellowship for nurse practitioners

A community child and adolescent psychiatry fellowship for nurse practitioners

Child psychiatry: the perception of medical students

Child psychiatry: the perception of medical students

Mental health services in Croatia—current perspectives and future challenges

We examine the current state and challenges of mental health services in the Republic of Croatia, a Central European country with a population of 3.87 million. Croatia’s healthcare system delivers mental health services across primary, secondary, and tertiary levels, largely supported by the Croatian Health Insurance Fund, which administers the country’s universal healthcare system, ensuring wide accessibility. Key policy frameworks include the Strategic Framework for the Development of Mental Health until 2030 and the Action Plan in Addictions. However, challenges persist, including a lack of community-based approaches, underfunding, and workforce shortages, particularly in child and adolescent psychiatry. The paper also highlights the impact of the COVID-19 pandemic and Croatia’s 2020 earthquake on mental health services, emphasizing a transition toward telepsychiatry and mobile psychiatric teams. Additionally, post-traumatic stress disorder (PTSD) is underscored as a significant public health issue in Croatia.

Incidence of avoidant/restrictive food intake disorder in children and adolescents across the UK and Ireland: a BPSU and CAPSS surveillance study

ObjectiveWe aimed to estimate the incidence of avoidant/restrictive food intake disorder (ARFID) in children and adolescents (CA) presenting to secondary care in the UK and Republic of Ireland (ROI).DesignThis observational...

School Refusal and Determinants: Parental Psychopathology, Family Functioning, Attachment and Temperament

ABSTRACTIn the current study investigated the psychopathologies of parents, family functioning, child temperament characteristics, and attachment of kindergarten and primary school‐age children who were brought to the child and adolescent psychiatry outpatient clinic due to school refusal behavior. Fifty‐two children with school refusal and 64 children without school refusal and their parents participated in the current study. School Refusal Assessment Scale, Systemic Family Functionality Scale(SFFS), Family Harmony Scale(FHS), Kerns Secure Attachment Scale(KSAS), Temperament Scale for Children(TSC), and Depression Anxiety Stress Scales(DASS) for parents were used. It was determined that, compared to children without school refusal, the children with school refusal had lower KSAS score(mother)(p = 0.049), higher DASS‐stress and anxiety(mother) scores(p = 0.014 and p = 0.020, respectively), lower TSC‐Responsiveness/Reactivity subscale score (p = 0.005), lower SFFS‐intrafamilial support and SFFS‐intrafamilial connection scores (p = 0.002 and p &lt; 0.001, respectively), and lower FHS‐total score (p = 0.002). It was determined that school refusal was 11 times more common in children who had difficulty adjusting to school in previous years. Each point increase in the SFFS‐intrafamilial connection score reduced school refusal by 30%. In the current study shows that among the interventions required for treatment, the family should also be targeted in addition to the child and adolescent. Therefore, it is essential to identify factors such as parents' psychopathology and their roles in the family, family functioning, and family harmony in school refusal. Because parents play a crucial role in both the development and maintenance of school refusal, using more parent‐targeted strategies or techniques is necessary to improve interventions.

Effects of the COVID-19 Pandemic on Child Psychiatric Consultation

Effects of the COVID-19 Pandemic on Child Psychiatric Consultation

Has Supervision and Training in CAMHS Ireland Improved Following the Maskey Report?

Introduction: A look back review of South Kerry CAMHS in Ireland, known as the ‘Maskey report’ (MR) highlighted several key contributory factors including an absence of formal supervision, inadequate prescribing knowledge, and a lack of contractual requirements to engage in professional education to develop skills pertaining to child psychiatry.Aim: To investigate child and adolescent psychiatrists’ perceptions concerning supervision levels before and after the MR, their prescribing knowledge and practices, and professional education. Methods: The study utilized a cross-sectional, mixed-methods observational approach, distributing a study-specific questionnaire electronically to 160 CAP. Demographic details and participants’ perspectives on training, supervision, and CPD activities were collected. Statistical analysis, including chi-square tests, was conducted to explore associations with thematic analysis applied to free text responses for qualitative insights. Results: From the 160 eligible respondents, 102 child and adolescent psychiatrists participated in the study giving a response rate of 63.8%. More than a third of non-consultant hospital doctors (NCHDs) reported less than weekly supervision (n = 11, 34.4%). Fifty-two respondents (51.0%) felt that psychotropic medication training for trainees was below adequate, and this was higher in NCHDs (χ2 (2, n = 102) = 12.192, p = .002) and in those working in public settings (χ2 (2, n = 102) = 10.098, p = .006). A third of respondents reported access to CPD activity as inadequate (n = 32, 31.4%) and this was also higher in NCHDs (χ² (1, n = 102) = 7.515, p = 0.006). Discussion: Given the suboptimal frequency of supervision, perceived inadequacy of psychotropic medication training and lack of access to CPD activities, further research to establish effective strategies for enhancing supervision and training of child and adolescent psychiatrists is warranted.

Anxiety depression levels, anxiety sensitivity, and quality of life in children with chronic spontaneous urticaria: A cross-sectional study

Existing literature offers some insights into the prevalence of anxiety and depression in children with chronic spontaneous urticaria (CSU). However, the literature on anxiety sensitivity (AS) and quality of life (QoL) in these children remains poorly understood. This study aimed to evaluate psychiatric diagnoses, anxiety and depression levels, AS, and QoL in children with CSU compared to healthy controls. The CSU group consisted of 44 children aged 8 to 17 years who were diagnosed with CSU, while the control group consisted of 44 healthy children. A child psychiatrist conducted the psychiatric assessment of the children. The Revised Child Anxiety and Depression Scales (RCADS), the Childhood Anxiety Sensitivity Index (CASI), and the Children’s Dermatology Life Quality Index (CDLQI) were administered. Multiple linear regression analysis was conducted to identify independent predictors of QoL, considering several potential factors, including the urticaria activity score, duration of urticaria, presence of a psychiatric diagnosis, scores on the RCADS major depression disorder, RCADS-total anxiety, and total CASI. A significantly higher prevalence of psychiatric diagnoses and anxiety disorders was observed in the CSU group (P &lt; .05). In the CSU group with a psychiatric diagnosis, CASI-total (0.011), CASI-physical (0.049), CASI-social (0.022), and CDLQI scores (P &lt; .001) were significantly higher than those without a psychiatric diagnosis. In the multiple linear regression analysis, only the presence of a psychiatric diagnosis was found to be a significant predictor of CDLQI scores (OR, 5.918; 95% CI, 2.505–9.330; P: .001). This study indicated that children with CSU exhibited a higher prevalence of psychiatric diagnoses than controls. Additionally, children with psychopathology in the CSU group demonstrated higher AS and greater impairment of QoL than those without psychiatric diagnoses. Furthermore, the most significant predictor of a decline in QoL was the presence of a psychiatric diagnosis.

Comparisons between obsessive-compulsive disorder and trichotillomania in terms of autistic traits and repetitive behaviors in adolescents

Background Our study aims to reveal the relationship between autistic traits and repetitive behaviors in adolescents diagnosed with obsessive-compulsive disorder and trichotillomania and to compare them to healthy controls. Method A total of 100 adolescents, 33 of whom were diagnosed with obsessive-compulsive disorder, 32 of whom were diagnosed with trichotillomania and 35 healthy controls, aged 11-18 years, who applied to a Child and Adolescent Psychiatry Outpatient Clinic between February 2023 and July 2023, were included in the study. Participants were evaluated with the Autism Spectrum Quotient (AQ)-Adolescent, Repetitive Behavior Scale-Revised (RBS-R), Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS), and Clinical Global Impression Scale-Severity (CGI-S). SPSS 25.0 program was used in the analysis. p < 0.05 was accepted as the significance level. Results It was found that adolescents diagnosed with obsessive-compulsive disorder and trichotillomania had higher autistic trait levels compared to healthy controls, while there was no significant difference between the obsessive-compulsive disorder and trichotillomania groups. While stereotypic, routine, sameness, and restricted repetitive behaviors were more common in the obsessive-compulsive disorder and trichotillomania groups as opposed to healthy controls, it was found that compulsive behavior was more common in the obsessive-compulsive disorder group, and self-injurious behavior was more common in the trichotillomania group compared to healthy controls. Conclusion The findings of our study indicate that adolescents diagnosed with trichotillomania, similar to those with obsessive-compulsive disorder, have a higher level of autistic traits and repetitive behaviors. The authors believe it is crucial to focus on the social skill difficulties these adolescents may be experiencing.

Leo Kanner: The Physician and Pioneer of Autism.

Dr. Chaskel Leib (Leo) Kanner is widely regarded as the father of child psychiatry in the United States. He was a pioneering figure in autism research who paved the way for child psychiatry and our modern-day understanding of autism. His monumental efforts distinguished autism as a distinct neurodevelopmental condition, contributing to the establishment of specific diagnostic criteria that helped shape our current perception of autism. Kanner's observations and theories recognized autism as an inherent condition, and his lasting contributions continue to influence diagnostic approaches while propelling ongoing, cutting-edge research.

Perception of Internalized Stigma in Parents of Children With Autism Spectrum Disorder: Investigating the Effects of Depression, Anxiety, and Family Functioning.

Introduction Autism spectrum disorder (ASD) is a pervasive neurodevelopmental disorder that impacts communication, behavior, and social interaction. It is well-documented that parents of children with ASD often experience psychiatric conditions like anxiety and depression. Nevertheless, research on the perception of internalized stigma, family functioning, and their interconnections is scarce. The main objective of our study was to analyze the internalized stigma perceptions, depression, anxiety, and family functioning among parents or caregivers of children diagnosed with ASD. Methods This study was conducted on 102 cases and 101 healthy controls in a cross-sectional case-control study involving patients aged 3-12 years. The research was carried out at the Child Psychiatry Clinic of Adana City Training and Research Hospital and three Family Health Centers in Adana from October 15 to December 15, 2022. Sociodemographic data, family history, families' knowledge levels about autism, and information about their social lives were collected using a face-to-face structured questionnaire. The Internalized Stigma of Mental Illness (ISMI), Hospital Anxiety and Depression (HAD), and Family APGAR scales were administered. Results The mean ISMI score of the case group was 67.31±8.91. According to the HAD Anxiety scale score, 60.8% of the case group and 14.9% of the control group were at high risk (p<0.001). According to the HAD Depression Scale, 52% of the case group participants and 25.7% of the control group were at high risk (p<0.001). The rate of severe familial dysfunction was 18.6% in the case group and 3.0% in the control group (p<0.001). Conclusion Stigma, anxiety, depression, and family functioning in parents of children diagnosed with ASD lead to various adverse outcomes. Further studies are necessary to prevent these negative experiences for families of children with ASD and to facilitate the integration of these children into society.

Identifying predictors of persistent post-earthquake dizziness among adolescents after the 2023 earthquakes in Türkiye: A cross-sectional, multicenter study

ObjectiveThe impacts of earthquakes on the mental health of individuals have been well-documented. Additionally, individuals frequently report experiencing dizziness akin to seasickness or carsickness. This phenomenon, termed “post-earthquake dizziness syndrome” (PEDS), has garnered increasing attention due to its unclear etiology. This study investigates the prevalence and predictors of ongoing PEDS within an adolescent population more than one year after the 2023 Kahramanmaraş earthquakes. MethodsThis cross-sectional study was conducted between April 2024 and June 2024 across five cities officially designated as an “earthquake zone” by relevant authorities. The sample comprised 551 adolescents aged 11 to 18 years who were recruited from child psychiatry outpatient clinics within these cities. Results402 participants (73.0 %) reported experiencing PEDS following the earthquake, while 105 (19.1 %) reported ongoing PEDS. Multivariate logistic regression analysis revealed that higher trait anxiety and post-traumatic stress disorder (PTSD) symptoms, as well as being located on a higher floor during the earthquake, were positively correlated with the persistence of PEDS symptoms. ConclusionsThe findings underscore the potential association between PEDS and psychiatric disorders, such as anxiety and PTSD. However, the underlying mechanisms of PEDS remain elusive, requiring further research to elucidate the links between PEDS and psychiatric conditions for more effective treatment strategies.

Surveying Child and Adolescent Inpatient Psychiatric Units: Demographics, Policies, and Practice

ABSTRACT Background The increasing demand for acute inpatient psychiatric unit (IPU) treatment for children and adolescents in recent years has put significant pressure on hospital systems to provide efficient and effective care. However, there is a gap in the literature regarding the characteristics of IPU care for children and adolescents in the US, making it difficult for institutions to benchmark their performance against nationwide standards or understand generalizability of existing research. Objective To address this gap in the literature by beginning to collect descriptive data on significant variables for youth care from a geographically and institutionally diverse group of on Child and Adolescent IPUs. Method A multi-institutional research team conducted a nationwide (US) survey of child and adolescent IPU clinicians using snowball sampling. Recruitment e-mails were sent to IPU groups in the American Psychological Association and the American Academy Child and Adolescent Psychiatry. Results The study yielded data from 12 institutions with a total of 20 IPUs, representing over 23,000 admissions in the years 2019 and 2020. The results of the survey show wide variability in institutional definitions of key variables (such as readmissions and safety events) as well as large ranges in length of stay, restraints, seclusions, and safety events. Conclusion This study reveals the importance of IPU clinical researchers taking steps to build a robust evidence base for IPU care, including developing consensus definitions of key variables and conceptualizing why high degrees of variability exist in important variables of IPU care. The survey results provide valuable insights for hospital systems, policymakers, and clinicians in the field of child and adolescent psychiatry.

Delayed drug-induced catatonia in an adolescent girl—clinical implications: a case report

BackgroundCatatonia is a potentially life-threatening condition that is characterized by psychiatric and motor disturbances, such as negativism, hypomotility, bradykinesia, and unusual movements. The diagnosis is based on clinical examination and occurs in both pediatric and adult patients and is associated with an increased mortality. Catatonia is associated with psychiatric illnesses such as schizophrenia, major depression, encephalitis, and bipolar disorder. The physiopathology of catatonia is complex and not fully understood. There is an ongoing debate in the medical community whether catatonia is an independent syndrome, or secondary to other mental illnesses. This case presentation is unique, as there are few reports describing cases of isolated catatonic syndrome in the absence of any other psychiatric or medical condition with a delayed onset caused by recreational drug abuse.Case presentationWe present the case of a 17-year-old Caucasian athletic girl with no previous contact with child and adolescent psychiatry, nor any previous drug abuse. After recreational intake of drugs, there was a delay of approximately 7 days, before the patient searched care with symptoms that were at a later stage recognized as catatonia. Treatment with a high dose of lorazepam in combination with memantine and lithium resulted in a regression of the symptoms. After 6 weeks the patient could be discharged from the hospital almost fully recovered.ConclusionsAn acute onset of psychomotor symptoms without any previous history of mental illnesses must be addressed early as a potential catatonic syndrome. Delayed onset of catatonic symptoms after intake of drugs should not be overlooked, and we here suggest that mephedrone might be capable of inducing delayed catatonia. It is feasible to use memantine as an adjuvant to the treatment of catatonia in adolescents.