Adolescent Psychiatry Department Research Articles

Maternal depression, anxiety, psychoticism and paranoid ideation have effects on developmental delay types of infants: A study with clinical infant-mother dyads

BackgroundDevelopmental delay in infancy includes cognitive-language delay, fine motor delay, gross motor delay, and social-self help delay. Delay in one intellectual domain frequently effects the other areas of development; therefore, determining risk factors are essential. In this study, we evaluated the relationship between maternal psychiatric symptoms and developmental delay types of infants who have not a known risk factor and are expected to show healthy development but have some behavioral and developmental problems. MethodsThe sample consisted of 79 infant–mother (26 girls, 53 boys) dyads who had been admitted to the Department of Child and Adolescent Psychiatry at Gulhane Research and Training Hospital over a one year period. Brief Infant-Toddler Social and Emotional Assessment Scale, Brief Symptom Inventory and Ankara Developmental Screening Inventory were used. ResultsThe most frequent developmental delay types were fine motor and social -self-help delay in this sample. For all developmentally delayed infants, maternal interpersonal sensitivity, and depression scores were higher than healthy developed ones. Logistic regression analyses revealed the risk factors: Higher maternal paranoid ideation increases the language-cognitive delay; maternal hostility and anxiety increase the gross motor delay; maternal psychoticism increases the social and self-help delay, and maternal depression increases the total development delay of infants. ConclusionMaternal depression, anxiety, psychoticism, and paranoid ideation are important risk factors for infants' developmental delay types and should be addressed while evaluating infant-mother dyads in clinical practice.

Frequency and Correlates of Acute Dystonic Reactions After Antipsychotic Initiation in 441 Children and Adolescents.

Objective: To determine the incidence of acute dystonic reactions (ADRs) and risk factors for ADRs in children and adolescents treated with antipsychotics. Methods: This was a retrospective chart review-based cohort study of consecutive patients who attended a university hospital's child and adolescent psychiatry department between 2015 and 2017 and who were treated with antipsychotics and had at least two follow-up visits. Results: Thirty of 441 patients (6.8%) 4-19 years of age who were treated with antipsychotics for conduct disorders (21.5%), attention-deficit/hyperactivity disorder (13.2%) and, irritability and aggression that accompanied intellectual disability (12.9%) and followed for 99.5 ± 223.3 (median: 34) days developed ADRs. ADRs developed in 11/391 patients (2.8%) treated with one antipsychotic and 19/50 patients (38.0%) treated with two antipsychotics (p < 0.001). In patients treated with one antipsychotic that developed ADRs, the time to ADRs was 4.0 ± 4.0 days after antipsychotic initiation and 2.7 ± 2.4 days after an increase in the antipsychotic dose. The time to ADRs in those treated with two antipsychotics was 3.0 ± 2.3 days after the addition of the second antipsychotic and 1.6 ± 0.8 days after a dose increase in the second antipsychotic. The incidence of ADRs during antipsychotic monotherapy was 10.5% with first-generation antipsychotics (FGAs) and 2.2% with second-generation antipsychotics (SGAs; p = 0.037). The antipsychotic was changed due to ADRs in 12/30 (40.0%) of ADR cases. Independent factors associated with ADRs were antipsychotic polypharmacy (p < 0.0001), inpatient treatment (p = 0.013), FGA use (p = 0.015), and diagnoses of schizophrenia (p = 0.039) or bipolar disorder (p < 0.0001). Conclusion: SGAs and low-potency FGA monotherapy in children and adolescents were associated with a relatively low ADR risk, whereas high- and mid-potency FGAs were associated with a high risk. Independent predictors of ADRs were antipsychotic polypharmacy, inpatient treatment, FGAs, and schizophrenia or bipolar disorder diagnoses, which may be related to more aggressive antipsychotic dosing.

Intensive outpatient treatment - a therapy option for all patients in child and adolescent psychiatry or just for a few?

Intensive outpatient treatment - a therapy option for all patients in child and adolescent psychiatry or just for a few? Abstract. Objective: "Child and adolescent psychiatric ward-equivalent treatment" (= stationsäquivalente Behandlung, StäB) is an intensive daily home treatment that has now become available in Germany. Conditions for StäB services were negotiated were negotiated, authorized and came into force by German healthcare commissioners and hospitals on 1 January 2018. However, to date few hospitals in Germany offer StäB, and its feasibility has been questioned. This study evaluates the first 58 cases of StäB in the Department of Child and Adolescent Psychiatry, ZfP Südwürttemberg (2018-2019). Method: All patients admitted consecutively to StäB from 1 January 2018 to 15 August 2019 were included and evaluated solely using descriptive analyses in SPSS.25. Results: The average length of stay in StäB was 37.95 days (SD 15.35). 86.2 % of the families completed treatment, with 3 patients discontinuing treatment and 5 patients needing inpatient admission. Unlike in the literature, internalising disorders predominated (70.7 %), whereas externalizing disorders were diagnosed in only 27.8 % of the patients. The cost of treatment in StäB was on average 8779.25 €. Conclusions: StäB is a viable and well-accepted new treatment alternative for patients requiring inpatient admission. The multiprofessionality of treatment as well as daily contacts are required. Feasibility under the conditions set is given. The average length of stay is slightly longer, but the costs are lower than those of inpatient treatment.

Psychotropic Drug Use in Children with Autism Spectrum Disorder Admitted to a Training and Research Hospital Outpatient Clinic: A Retrospective Cross-Sectional Study

AbstractThis study aimed to examine demographic and clinical variables, psychiatric comorbidities, the prevalence of psychotropic drug use, relationships between drug use, demographic and clinical variables, and predictors of drug use in children with autism spectrum disorder (ASD) admitted to a training and research hospital outpatient clinic. Four hundred and eleven children with ASD admitted to the Department of Child and Adolescent Psychiatry, Dr. Sami Ulus Maternity and Children's Health and Diseases Training and Research Hospital, between October 1, 2019 and December 31, 2019, were retrospectively reviewed. Demographic and clinical variables, psychiatric comorbidities, and characteristics of drug use for the cases were recorded. Psychotropic drug use was found in 34.3% (n = 141) of the cases. Our results revealed male sex and psychiatric comorbidity as predictors of psychotropic drug use. Antipsychotics were the most prescribed drugs, and the most common psychiatric comorbidity was conduct disorder. Also, children with ASD who had been toilet-trained, and could express sentences but were illiterate, were using psychotropic drugs more often than others. Future multicentered, large clinic-based studies from training and research hospitals should focus on trends of treatment in psychiatric comorbidities accompanying ASD, and constitute a systematic approach for the psychopharmacological treatment of these cases.

Sleep problems in children and adolescents with β-thalassemia major

Purpose: The aim of this study was to compare the sleep problems between children and adolescents with β-thalassemia major and healthy controls.Materials and Methods: This study was a case-control survey of children and adolescents with β-thalassemia major. The sample consisted of 76 children and adolescents in the patient group and 68 healthy children and adolescents in the control group, with an age range of 8-16 years. Subjects were recruited from the Department of Child and Adolescent Psychiatry in Hatay State Hospital between January and December 2018. Children and adolescents with β-thalassemia major were consulted from the Department of Pediatric Hematology. The Children’s Sleep Habits Questionnaire (CSHQ) was used to evaluate sleep problems between the groups. Results: Mean age of the patient group was 11.66 (SD = 3.22) years, and 47.4% (N = 36) were males. Control group had a mean age of 12.84 (SD = 3.12) years, and 47.1% (N = 32) were males. Total score, night waking and sleep disordered breathing subscores of CSHQ were significantly higher in children with β-thalassemia major than healthy children.Conclusion: As there are more sleep problems in children and adolescents with β-thalassemia major than in healthy children, detailed studies are needed.

Psychiatric symptoms in traumatized Syrian refugee children settled in Hatay

Aim: After the beginning of the Syrian civil war in 2011, its cruelty and violence forced about millions to leave their homes. These experiences might create serious mental problems, especially in children and adolescents who might have an increased risk of developing post-traumatic stress disorder (PTSD) and depression. In this study, we aimed to investigate the mental health status of Syrian refugee children who exposed to a variety of traumatic events.Method: The sample consisted of 1518 drug-naive Syrian refugee children and adolescents aged between 8 and 16 years who were admitted to the Child and Adolescent Psychiatry Department in Hatay State Hospital between June 2016 and December 2018. The CRIES-13 (Children's Revised Impact of Event Scale-13) was used to evaluate PTSD symptoms and CDI (Children's Depression Inventory) was used to examine depressive symptoms. The sample was divided into three groups according to the type of trauma and the CRIES-13 and CDI scores were compared between the groups.Results: The mean age of the children was 12.4 ± 3.1. 46.9% of the children were male and 53.1% were female. The total score and intrusion and arousal subscores of CRIES-13 were significantly different between the three groups. The total CDI score was also significantly different between the three groups. The likelihood rates of PTSD and depression differed significantly between the groups.Conclusion: Traumatized Syrian refugee children may present PTSD symptoms more likely than depressive symptoms. War-related traumatic experiences may have more adverse effects on Syrian children’s psychology than other traumas.

Pédopsychiatrie et pharmacogénétique : pharmacorésistance aux psychotropes et duplication du cytochrome P450 2D6, à propos de trois cas cliniques

Severe mental health diseases in children and adolescents–such as schizophrenia, bipolar disorder or depression–are chronic impairing diseases representing a major public health issue. Despite adequate pharmacological treatment, some patients will present pharmacoresistant disease and in consequences psychotropic poly-therapy. Those patients are at more important risk to present adverse advents as well as longer in- our outpatient treatment. Psychotropics are predominantly metabolised at hepatic level, and for a high number of them by cytochrome P450 and its CYP2D6 subunit. A functional abnormality of this subunit induces a dysfunctioning of metabolisation of these treatments (inefficiency or adverse events). Several studies demonstrated a link between pharmacogenetics and treatment efficiency. This clinical presentation describes three pharmacoresistant patients aged between 13 and 16 years. All presented psychiatric disease since several years and requiring one or several full-time hospitalisation in a child and adolescent psychiatry department. Psychotropic treatments with market authorization or frequently used in our speciality had been without clinical efficiency for the symptomatology of these adolescents. As a consequence, clinical management implicated poly-therapy, adverse events and repeated hospitalisation with a high impact on social, family and school functioning. In this context of pharmacoresistance, pharmacogenetic testing has been realised. Two patients presented functional pharmacogenetic anomalies of cytochrome P450 2D6 and were ultrarapid metaboliser for CYP2D6. Accordingly, treatment decisions had been revised using psychotropics not metabolized by CYP2D6 as well as non-pharmacological approaches. This readjustement was followed by clinical improvement and psychosocial rehabilitation. The third patient we describe did not present a pharmacogenetic abnormality of CYP2D6, thus illustrating the complex mechanism of pharmacoresistance, not only explained by CYP2D6 dysfunctioning. This clinical case also allows questioning about our clinical practices.

13.5 THE WONDER OF IT ALL: EARLY CHILDHOOD DIGITAL HEALTH

We will: 1) describe the WonderLab, a digital health initiative within the New York University Langone Health Department of Child and Adolescent Psychiatry; 2) introduce When to Wonder: Picky Eating, which is the WonderLab’s first early childhood mental health digital study; and 3) present preliminary data from this study. Our first objective is to demonstrate how smartphone-based tools developed to assess children in their homes and the use of advanced data analytics can transform how, when, and where we assess young children’s development and mental health. Our second objective is to share how our multidisciplinary team and agile development methodology enable us to build and launch a consumer-facing pediatric health app within an academic medical center.

Adolescence: Contemporary issues in the clinic and beyond.

This article reports on a Continuing Medical Education Programme (CME), organized by the Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, in March 2019. The theme, Adolescence: contemporary issues in the clinic and beyond, aimed to cover 'lesser understood and challenging' areas in adolescent mental health. The CME was attended by over 200 professionals from various fields - clinicians, post-graduate students in psychiatry, psychology and psychiatric social work, school counsellors, and members of non-governmental organisations working in the areas of childcare and law. The article covers key messages from the 8 sessions in this CME.

Diagnosis evolution to adulthood in a group of ADHD pediatric patients from “Prof. Dr. Alex. Obregia” Psychiatry Hospital

Background. Even though until recently it was believed that ADHD is a primarily childhood condition, once the adult diagnostic criteria was introduced in DSM 5, the clinical interest for this disorder increased, and it's nowadays recognized that adults continue to experience high levels of clinically significant symptoms. Methods. In this observational, retrospective study we investigated the evolution of psychiatric diagnosis to adulthood in a group of patients that received an ADHD diagnosis before turning 18. In the study it's been used the information data base of „Prof. Dr. Alex. Obregia” Psychiatry Hospital. In the period January 2009-December 2018 in Child and Adolescent Psychiatry Department there were assessed 2.628 children/ adolescents that met the criteria for an ADHD diagnosis. 58 patients returned to the same hospital after turning 18 years of age. Results. ADHD diagnosis was maintained in 5 out of the 58 patients. 61.40% of the adult patients had a Personality Disorder. 25% of the patients had behavioral disorders secondary to drug use, and 73.33% of subjects with chronic substance abuse had comorbid a personality disorder. Regarding the Affective Disorders, 65% of the patients presented episodes of unipolar Depression, while 35% had Affective Bipolar Disorder. Conclusions. The obtained data are consistent with those in the literature. The highlighted results demonstrate that there is a need for increased awareness in terms of continuity of ADHD diagnosis in adulthood, because this disorder is still underdiagnosed and less treated in adult life.

Emergency Psychiatrists Issue Guidelines for Treating Youth With Agitation

Emergency Psychiatrists Issue Guidelines for Treating Youth With Agitation

Empathy in Youths with Conduct Disorder and Callous-Unemotional Traits.

Previous studies indicated that a lack of empathy could be considered the core feature of callous-unemotional (CU) traits in children and adolescents. The present study is aimed at exploring relationships among CU traits, cognitive and emotional dimensions of empathy, emotion recognition (basic, social, and complex emotions), and history of maltreatment in a sample of youths with conduct disorder diagnosis. The sample consisted of 60 Italian male patients (age range 11-17 years, mean age 13.27 ± 1.90 years) referred to the Department of Child and Adolescent Psychiatry (Pisa, Italy). In the whole sample, the levels of CU traits were significantly negatively associated with both cognitive and emotional dimensions of empathy; in addition, the CD patients with high levels of CU traits show significantly lower levels of empathic concern compared to those with low levels of CU traits. Clinical implications of the findings are discussed.

Influence of Psychopharmacotherapy on the Quality of Life of Children with Attention-Deficit/Hyperactivity Disorder.

Objective: Attention-deficit/hyperactivity disorder (ADHD) may have a lasting effect on the quality of life (QoL) of children and their parents. Children with ADHD as well as their parents report a lower QoL compared with healthy children and children with chronic diseases such as bronchial asthma. The primary objective of this study was to investigate the changes of QoL of children with ADHD and their parents' subjective well-being before and after starting pharmacotherapy. We used the appropriate KINDL questionnaire for assessing the children's QoL and the World Health Organization (WHO) Big Five Questionnaire for assessing parental well-being. Methods: We assessed the QoL and the parental well-being in 60 children and adolescents with ADHD between the ages of 6 and 12 years [mean age 8.7 years, (standard deviation = 1.8)], treated at the Department of Child and Adolescent Psychiatry of the Medical University of Vienna. QoL was rated using the KINDL questionnaires, and parental well-being was assessed using the WHO Big Five Questionnaire (WHO-5) before and after starting pharmacotherapy. We used t-tests and three-way GLM-ANOVA (SPSS, version 22; IBM Corp.) for evaluating the statistical significance of pre-post differences. Results: The QoL of the children with ADHD and the subjective well-being of the parents improved significantly after introducing pharmacotherapy. Conclusions: Pharmacotherapy is recommended in children with clinically significant ADHD not only because it helps to improve the symptoms of ADHD, but also their QoL and the well-being of their parents.

Temperament and Character Profiles Associated with Internalizing and Externalizing Problems in Children with Attention Deficit Hyperactivity Disorder.

ObjectiveThis study aimed to identify temperament and character profiles associated with internalizing and externalizing problems in children with attention deficit hyperactivity disorder (ADHD). MethodsChildren with ADHD (n=114, 8.51±1.87 years) were selected from the Department of Child and Adolescent Psychiatry at Jeju National University Hospital. They were diagnosed by Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Version and evaluated using the Advanced Test of Attention and Korean Wechsler Intelligence Scale for Children-Fourth Edition. Their parents completed the ADHD Rating Scale, Korean-Child Behavioral Checklist, and Junior Temperament and Character Inventory. ResultsThe participants with both internalizing and externalizing problem had more severe ADHD symptoms and significantly higher novelty seeking, harm avoidance, and self-transcendence, as well as lower self-directedness and cooperativeness than those who had not comorbid problems. Harm avoidance was correlated with their level of internalizing problems regardless of severity of ADHD symptoms. In addition, novelty seeking and sex (male) were being associated with the level of externalizing problems. ConclusionDifferences were observed in the temperament and character profiles of children with ADHD according to their comorbid psychopathology. Results suggested that temperament and character profiles may affect the comorbid psychopathology in children with ADHD regardless of ADHD symptom severity.

Favourable short-term course and outcome of pediatric anxiety spectrum disorders: a prospective study from India

BackgroundAlthough anxiety disorders are the most prevalent psychiatric disorders among children and adolescents, there is a paucity of research on the course and outcome of anxiety spectrum disorders in low and middle-income countries.Methods60 children and adolescents aged 6–16 years with anxiety spectrum disorders attending the child and adolescent psychiatry department in a tertiary care center from India were included after taking written informed consent and assent in this prospective study conducted between April 2012 to May 2014. Assessments were done at baseline, 12 weeks and 24 weeks using pediatric anxiety rating scale, clinical global impression-severity, clinical global assessment scale and pediatric quality of life scale; MINI-KID (version 6.0) was used to examine remission status.ResultsMean age of children was 12.68 years and mean duration of illness was 34.52 months. Follow-up rate at 24 weeks was 80% with a remission rate of 64.6%. Socio-demographic factors did not affect the baseline severity or course and outcome measures. Children with greater baseline severity and social phobia had a less favorable outcome at 24 weeks. Improvements made in the initial 12 weeks were maintained at 24 weeks follow up. These findings are in line with earlier studies from high-income countries.LimitationsSmall sample size, attrition, rater bias.ConclusionThe study has shown a favorable outcome in children and adolescents with anxiety spectrum disorders receiving treatment-as-usual in a tertiary care setting. Adolescents who present with greater severity, comorbid with other anxiety disorders and depression at baseline require intensive intervention, and long-term follow up. There is a need for interventional research with specific focus on universal preventive programs for anxiety spectrum disorders that are feasible for delivery in low and middle-income countries.

Transcultural differences of psychologically traumatised children and adolescents.

SummaryBackgroundThe symptoms following a traumatic event as well as the coping strategies can be culture specific. The objective of the present study was to analyse the transcultural differences of psychologically traumatized children and adolescents with and without migration background.MethodsThe medical files of 199 psychologically traumatized children and adolescents (99 native Austrian, 100 Turkish-speaking) who were treated at the Department of Child and Adolescent Psychiatry in Vienna were retrospectively analysed.ResultsThe most frequently observed causes of trauma in patients with Turkish migration background were intra-familial conflicts, forced separation from parent(s), and conforming to a new environment. In native Austrian patients, forced separation from parent(s) and divorce or separation of parents were the leading causes of trauma. Trauma-related symptoms like changed mood, cognitive and perceptual disturbance, social withdrawal, sleeping problems, somatisation and behavioural problems were similarly observed in both groups; “sleeping problems” were more often observed in Austrian patients, and “behavioural problems” were more often observed in Turkish patients. More Austrian patients (32.7%) obtained psychiatric and psychotherapeutic treatment. Turkish-speaking patients mostly obtained psychiatric treatment only. Patients with migration background were more compliant compared to indigenous patients.ConclusionsBoth study groups differed in type, causes and symptoms of trauma, and in preferred therapy. Turkish-speaking patients were more compliant with therapy, as they received culture and language-sensitive medical advice and treatment in their mother tongue. Considering the cultural background of patients can optimize service delivery and therapy outcomes among children and adolescents with stressful and traumatic experiences.

Pharmacorésistance aux psychotropes et anomalies pharmacogénétiques du cytochrome P450 2D6 : vers une médecine personnalisée en pédopsychiatrie, présentation d’un protocole de recherche

BackgroundPsychotropic drugs such as antipsychotics (AP) and antidepressant (AD) are frequently used in children and adolescents for the treatment of psychiatric diseases, with a constantly increasing prescription rate for atypical AP. Nevertheless, in France, only two atypical AP have marketing authorization in children, and 5 in adolescents. Consequently, a significant part of AP prescriptions in the pediatric population is off-label and depends on the experience of each clinician. In addition, some patients are pharmaco-resistant inducing exposure to several psychotropic molecules, long and/or repeated hospitalizations, relapses, and sometimes interruption of care pathways. Many psychotropic treatments are metabolized at the hepatic level by cytochrome P450 and in particular its subunit CYP2D6. In child psychiatry, most commonly prescribed AP and AD drugs are metabolized by CYP2D6, e.g., risperidone, aripiprazole and fluoxetine. Duplication of the CYP2D6 gene is linked to very rapid metabolizer phenotype and thus typically to clinical inefficiency of treatment. The frequency of this pharmacogenetic anomaly is up to 10 % in the general population in Southern Europe. MethodsWe describe the implementation of a biomedical study, whose main objective is to describe the prevalence of duplication or polymorphisms of CYP2D6 gene associated with very rapid metabolizer phenotype, in the pediatric population pharmaco-resistant to CYP2D6-mebtalized psychotropic drugs (AP or AD). Secondary objectives are to study the associations between the presence of functional anomalies of CYP2D6 gene and the characteristics related to patient and mental health disease. This study will include 22 children or adolescents patients from 4 child and adolescent psychiatry (CAP) departments. CYP2D6 genotyping will be realized from salivary sampling. FindingsThe expected results on the main judgment criterion might highlight a link between pharmacoresistance and duplication of CYP2D6 in our patient population. The results on secondary endpoints should help to better characterize the population of drug-resistant patients and mental health diseases in CAP. PerspectivesThe demonstration of a link between drug resistance and duplication of the CYP2D6 gene should help to develop treatment strategies using molecules not metabolized by CYP2D6 and/or having a very restrictive marketing authorization earlier in the evolution of psychiatric illness, as well as the intensification of non-pharmacological treatment strategies in such patients. Overall, many links between CYP2D6 and psychiatry remain to be studied, and highlighting functional genetic anomalies of CYP2D6 in psychotropic drug-resistant children and adolescents should participate to the development of personalized medicine in CAP, and thus improve the quality of life and the prognosis of our patients.

Programme de Remédiation cognitive NEAR (Neuropsychological Educational Approach to Cognitive Remediation) chez des adolescents présentant un Trouble Déficit de l’Attention/Hyperactivité et/ou un Trouble du spectre Autistique

ObjectivesCognitive Remediation is a therapeutic approach based on the notion of brain plasticity. It aims to improve certain cognitive function deficits through the repetition of specific exercises and to promote the metacognitive dimension (the awareness and reflection of an individual on his cognitions, his behaviors and the strategies he uses to solve a problem). Several programs have already been validated in adult patients with schizophrenia and have shown improvements in cognitive performance and functioning. Some of the programs were later applied to other pathologies such as anorexia nervosa or autism spectrum disorders (ASD). Remedial programs have also been developed for children and adolescents because the early symptomatic expression of certain disorders such as Attention Deficit Hyperactivity Disorder (ADHD) or ASD makes one suspect a neurodevelopmental origin and all have in common an alteration of the executive functions. There are programs of cognitive stimulation or cognitive training, particularly in the context of ADHD. Although the results do show benefits in terms of visual and verbal working memory, the effects of cognitive training seem to be difficult to generalize to other everyday learning and have only limited effects on the symptoms. The objective of this study is to assess the feasibility and acceptability of the Neuropsychological Educational Approach to Cognitive Remediation for Adolescents (NEAR). Patients or materials and methodsThe Department of Child and adolescent Psychopathology of the Sainte-Anne Hospital (Paris), part of the reference center for remediation and psychosocial rehabilitation (C3RP), used NEAR, originally developed for adult schizophrenic patients, with four preadolescents and adolescents aged 11 to 15 years with either ADHD or ASD. The IQ ranged from 80 to 112 and none was under medication. This method combines cognitive exercises and Cognitive-Behavioral Therapy groups. The interest is in working simultaneously on cognitive functions such as memory, executive functions, attention, visuospatial abilities and the metacognitive dimension by building “bridges” between what has been worked on in the sessions and examples from daily life. One of the main focuses in the NEAR method is the principle of encouraging intrinsic motivation. The method also aims to restore confidence in the ability to acquire skills, to overcome certain failures regularly encountered by these adolescents in their schooling and to encourage the generalization and transfer of learning to other situations or contexts from daily life. ResultsThe first observations show that this program is applicable and adapted to preadolescents and adolescents as well as to the pathologies targeted in this group. The participants reported improvement in memory. They also emphasized the benefits in attention and planning. Moreover, the adolescents report that the majority of learning has been transferable to the school environment. The commonest example was the use of techniques to improve their memory such as making a list, verbalizing (stating either aloud or mentally the subject matter of a course) or organizing information. Others have used attentional strategies learned during the group such as condensing information, pausing, using verbalization, or reducing sensory distractors. Another positive aspect of the group reported by all teenagers was the pleasure of seeing each other again every week, the perceived support and the development of self-help skills. ConclusionCognitive Remediation is now an additional therapeutic tool, which can empower other therapeutic approaches with no significant side effects. The development and evaluation of programs targeting a wider range of neuropsychological deficits than the NEAR program seems to us to be a future direction because children do not all have the same neuropsychological profile and they are often affected by several neuropsychological deficits. The first application of this program in adolescents is taking place within the Department of Child and Adolescent Psychiatry of the Sainte-Anne Hospital Centre. Neuropsychological and functional evaluations on a larger sample are underway.

Acute poisoning among children and adolescents in southern Norway.

Self-inflicted poisoning is common in adolescents and is a risk factor for suicide. The aim of this study was to survey the circumstances surrounding hospitalisations due to acute poisoning in patients aged up to 18 years. All hospitalisations in the Departments of Paediatric and Adolescent Medicine, Sørlandet Hospital Trust (Arendal and Kristiansand) due to acute poisoning in the period 1 August 2014-31July 2015 were prospectively recorded with the aid of a form completed during the admission. There were 88 hospitalisations distributed among 68 adolescents (mean age 15.5 years, SD 1.5) and 13 children (mean age 2.8 years, SD 2.8). The poisoning was categorised as self-harm behaviour in 32 (47%) of the adolescents, and as substance misuse-related in 35 (52%). In total, 37 (54%) of the adolescents had been or were under treatment at the Department of Child and Adolescent Psychiatry. Fifteen (22%) of the adolescents were deemed to be suicidal. Thirty (94%) of the adolescents who reported self-harm as the intention behind their poisoning were offered further follow-up at the Department of Child and Adolescent Psychiatry, along with 7 (20%) of the group with substance misuse-related poisoning. Adolescents who reported self-harm as their intention were usually offered further follow-up, whereas adolescents with substance misuse-related poisoning were rarely offered follow-up.

The effects of methylphenidate on weight, height, and body mass index in Turkish children and adolescents with ADHD

Objective: The pathophysiological mechanisms underlying the effects of psychostimulants (methylphenidate) treatment on growth still remain controversial. We examined the long term effects of methylphenidate on height, weight and body mass index in Turkish children and adolescents with attention deficit hyperactivity disorder (ADHD). Methods: Participants (6-18 years, 330 boys, 103 girls) diagnosed with ADHD who received treatment with methyl-phenidate for at least 1 year at the Department of Child and Adolescent Psychiatry at Dokuz Eylul University Medical School were included in a retrospective study. Weight, height, and BMI z scores were converted to age- and gender- corrected z scores using norms from the Turkish population at baseline and last follow-up. Results: Height and weight standard deviation score (SDS) were reduced by treatment (baseline height-SDS [SDS]: 0.74±1.43, follow-up height-SDS [SDS]: -0.67±4.35, t-test p