Events In Adolescents Research Articles

Methylphenidate and the risk of psychosis in adolescents and young adults: a population-based cohort study

SummaryBackgroundThere is a clinical concern that prescribing methylphenidate, the most common pharmacological treatment for attention-deficit hyperactivity disorder (ADHD), might increase the risk of psychotic events, particularly in young people with a history of psychosis. We aimed to determine whether the risk of psychotic events increases immediately after initiation of methylphenidate treatment or, in the longer term, 1 year after treatment initiation in adolescents and young adults with and without a previously diagnosed psychotic disorder.MethodsIn this cohort study, we used population-based observational data from the Swedish Prescribed Drug Register, the National Patient Register, and the Total Population Register, three population-based registers containing data on all individuals in Sweden, to attain data on sex, birth, death, migration, medication use, and psychotic events for all eligible participants. We screened individuals on these registers to identify those receiving methylphenidate treatment, and who were aged 12–30 years at the start of treatment, for their inclusion in the study. We used a within-individual design to compare the incidence of psychotic events in these individuals during the 12-week periods immediately before and after methylphenidate initiation. Longer term risk was assessed by comparing the incidence of psychotic events 12 weeks before methylphenidate initiation and during a 12-week period one calendar year before the initiation of methylphenidate with the incidence of these events during the 12-week period one calendar year after methylphenidate initiation. We estimated the incidence rate ratios (IRR) and 95% CIs of psychotic events after the initation of methylphenidate treatment, relative to the events before treatment, which were defined as any hospital visit (inpatient admission or outpatient attendance, based on data from the National Patient Register) because of psychosis, using the International Classification of Diseases version 10 definition. Analyses were stratified by whether the individual had a history of psychosis.FindingsWe searched the Swedish Prescribed Drug Register to find eligible individuals who had received methylphenidate between Jan 1, 2007 and June 30, 2012. 61 814 individuals were screened, of whom 23 898 (38·7%) individuals were assessed and 37 916 (61·3%) were excluded from the study because they were outside of the age criteria at the start of treatment, they had immigrated, emigrated, or died during the study period, or because they were administered other ADHD medications. The median age at methylphenidate initiation was 17 years, and a history of psychosis was reported in 479 (2·0%) participants. The IRR of psychotic events in the 12-week period after initiation of methylphenidate treatment relative to that in the 12-week period before treatment start was 1·04 (95% CI 0·80–1·34) in adolescents and young adults without a history of psychosis and 0·95 (0·69–1·30) among those with a history of psychosis.InterpretationContrary to clinical concerns, we found no evidence that initiation of methylphenidate treatment increases the risk of psychotic events in adolescents and young adults, including in those individuals with a history of psychosis. Our study should reassure clinicians considering initiating methylphenidate treatment for ADHD in adolescents and young adults, and it challenges the widely held view in clinical practice that methylphenidate should be avoided, or its use restricted, in individuals with a history of psychosis.FundingSwedish Research Council, National Institute of Mental Health, UK National Institute of Health Research Nottingham Biomedical Research Centre.

Diabetes-related events in adolescents and young adults: opportunities for psychosocial interventions

ABSTRACTThis study was conducted to evaluate predictive factors of diabetes-related emergency room (ER) visits and hospitalizations among adolescents and young adults (AYA) with type 1 diabetes (T1D). Baseline demographic, medical, and psychosocial variables were collected for 177 AYA with T1D. Medical records were reviewed to identify ER visits and hospitalizations related to diabetes. Those with diabetes-related events had significantly higher hemoglobin A1c (A1c) values at baseline (p = 0.0001) and during an average 3.36 years of follow-up (p < 0.0001). Participants with events were more likely to have Medicaid or no insurance vs. private insurance (p = 0.0006) and were more likely to be on multiple daily injections vs. insulin pumps (p = 0.0159). Participants with events reported greater diabetes impact on their lives and their parents reported less autonomy in AYA with events (p = 0.0435). These results suggest that when participants were transferring from pediatric to adult care services, factors such as A1c, insurance status and diabetes treatment are associated with diabetes-related events. Further research is needed to elucidate a causative relationship and develop focused interventions to reduce diabetes-related events during this high-risk time. Autonomy should be further explored to determine its role in diabetes-related events during this transition period.

Self-esteem as a protective factor against adolescent psychopathology in the face of stressful life events

Background: Adolescence is a period of transition, characterized by changing life events. Stressful life events impact the psychological health and quality of life (QoL) of adolescents. It is therefore critical to identify factors that protect adolescents from these stressors to inculcate resilience. The study aimed to explore the nature of life events experienced by adolescents, gender differences in life events, determine their association with psychological health, quality of life, and to investigate the potential protective role of self-esteem. Method: A quantitative, cross-sectional research design was chosen on a sample of 500 higher secondary school students. Life events were measured using the Child and Adolescent Survey of Experiences Scale (CASE). Depression, anxiety, self-esteem, and health related QoL (HRQoL) were assessed using Kutcher’s Adolescent Depression scale, Screen for Child Anxiety Related Disorders, Rosenberg Self-esteem scale, and KIDSCREEN-10 respectively. Results: Adolescents experienced significantly more positive life events. There were no gender differences in the experience of positive or negative life events. Depressed and anxious adolescents experienced significantly more negative life events. Self-esteem was the most significant factor that impacted adolescent QoL and protected against depression and anxiety when compared to life events in multiple regression analysis. Conclusion: Self-esteem is an important factor that buffers the negative effect of stressful life events in adolescence. It can serve as a target for the prevention of negative health outcomes as well as for optimal adolescent development.

Minocycline and the risk of acute psychiatric events in adolescence: A self-controlled case series.

Minocycline has neurological anti-inflammatory properties and has been hypothesised to have antipsychotic effects. The aim of this study was to investigate, using routinely collected United Kingdom primary health care data, whether adolescent men and women are more or less likely to receive an urgent psychiatric referral during treatment for acne with minocycline compared with periods of non-treatment. A self-controlled case series using United Kingdom Clinical Practice Research Datalink to calculate the incidence rate ratio of urgent psychiatric referrals for individuals, comparing periods during which minocycline was prescribed with unexposed periods, adjusted for age. We found 167 individuals who were at the time exposed to minocycline for a mean of 99 days and who received an urgent psychiatric referral. There was no difference in psychiatric referral risk during periods of exposure compared with periods of non-exposure: incidence rate ratio first 6 weeks of exposure 1.96, 95% confidence interval 0.82-4.71, p=0.132; incidence rate ratio remaining exposure period=1.97, 95% confidence interval 0.86-4.47, p=0.107. We found no evidence in support of a protective effect of minocycline against severe psychiatric symptoms in adolescence.

The influence of stressful life events, psychopathy, and their interaction on internalizing and externalizing psychopathology

Exposure to stressful life events increases risk for both internalizing and externalizing psychopathology, but less is known about moderators of the association between stressful life events and psychopathology. The present study examined the influence of stressful life events, psychopathy, and their interaction on internalizing and externalizing psychopathology in 3877 individuals from the community. We hypothesized that (1) exposure to stressful life events would be a transdiagnostic risk factor for psychopathology, (2) primary and secondary psychopathy would be differentially associated with internalizing psychopathology, and (3) primary psychopathy would moderate the association between stressful life events and internalizing psychopathology. Confirming existing findings, our results were consistent with the first and second hypotheses. In contrast to our third hypothesis, primary psychopathy was not associated with stressful life events in childhood, inconsistently associated with stressful life events in adolescence, and did not moderate the association between stressful life events and internalizing psychopathology. Furthermore, stressful life events across development were associated with secondary psychopathy and internalizing and externalizing psychopathology. We also found similar associations between stressful life events, psychopathy, and psychopathology in females and males. Future studies investigating the impact of stressful life events on psychopathology should include psychopathic traits and stress-reactivity.

The role of behavioral inhibition, perceived parental rearing, and adverse life events in adolescents and young adults with incident obsessive-compulsive disorder

The role of behavioral inhibition (BI), parental rearing, and adverse life events in the development of obsessive–compulsive disorder (OCD) is unresolved. We prospectively examined whether BI and perceived parental rearing predicted the subsequent first onset of OCD and whether BI moderated the association between perceived parental rearing/adverse life events and the first onset of OCD. Data come from a prospective-longitudinal study among community adolescents and young adults (aged 14–24) who were followed up over 10 years (N = 2210). OCD and adverse life events were assessed with the DSM-IV/M-CIDI. BI and parental rearing were assessed by self-report. In adjusted logistic regressions, BI (risk ratio, RR = 8.8,95% confidence interval, CI,[3.3,23.2]), both the social (RR = 2.6,95%CI[1.04,6.3]) and nonsocial fear (RR = 4.5,95%CI[2.3,8.6]) components, and paternal rejection (RR = 3.9,95%CI[1.6,9.7]) predicted OCD. Social BI moderated the association of adverse life event (RR = 11.98,95%CI[1.8,82.1]) and paternal overprotection (RR = 5.5,95%CI[2.1,14.8]) with OCD. Nonsocial fear BI moderated the association between paternal emotional warmth (RR = 0.37,95%CI[0.1,0.99]) and OCD. BI and paternal rejection were associated with an increased risk of first onset of OCD. Individuals with high social BI who experienced paternal overprotection or any adverse life events may profit from early targeted prevention. Emotional warmth may buffer the association between nonsocial fear BI and OCD.

"A change in perspective": Exploring the experiences of adolescents with hereditary tumor predisposition.

Hereditary tumor predisposition syndromes (HTPSs) are being recognized more frequently in the etiology of pediatric cancer. Previous research indicates that disclosure of tumor susceptibility is a significant event in adolescents' lives. Insight into adolescents' adjustment to knowledge of their syndromes can guide healthcare delivery, particularly genetic counseling. This study explored the experiences of adolescents with hereditary tumor predisposition and their perceptions of living at risk. Seven adolescents, ages 14 to 17, representing six different childhood-onset HTPSs, were purposively sampled and interviewed using a study-specific semistructured interview guide. We explored the disclosure process, support systems, and the perceived benefits and harms of knowledge of hereditary tumor susceptibility. Interview transcripts were analyzed via interpretive description. Three major themes emerged from the data: (1) The benefits of knowledge outweigh the harms; (2) context surrounding genetic testing must be recognized; and (3) self-concept is influenced but not defined by tumor risk. We conclude that adolescents recognize the challenges associated with awareness of tumor predisposition but may also identify positive aspects in their experiences, reflecting a changed life perspective. Results of this exploratory study suggest strategies that can guide pretest and posttest genetic counseling of adolescents for HTPSs, facilitating the adaptive incorporation of genetic information into an adolescent's self-concept.

The Role of Electroencephalography in Differentiating Epileptic and Non-Epileptic Events in Adolescents: 3-Year Experience in One Pediatric Neurology Center

The Role of Electroencephalography in Differentiating Epileptic and Non-Epileptic Events in Adolescents: 3-Year Experience in One Pediatric Neurology Center

Validity of Administrative Data in Identifying Cancer-related Events in Adolescents and Young Adults

Despite the importance of estimating population level cancer outcomes, most registries do not collect critical events such as relapse. Attempts to use health administrative data to identify these events have focused on older adults and have been mostly unsuccessful. We developed and tested administrative data-based algorithms in a population-based cohort of adolescents and young adults with cancer. We identified all Ontario adolescents and young adults 15-21 years old diagnosed with leukemia, lymphoma, sarcoma, or testicular cancer between 1992-2012. Chart abstraction determined the end of initial treatment (EOIT) date and subsequent cancer-related events (progression, relapse, second cancer). Linkage to population-based administrative databases identified fee and procedure codes indicating cancer treatment or palliative care. Algorithms determining EOIT based on a time interval free of treatment-associated codes, and new cancer-related events based on billing codes, were compared with chart-abstracted data. The cohort comprised 1404 patients. Time periods free of treatment-associated codes did not validly identify EOIT dates; using subsequent codes to identify new cancer events was thus associated with low sensitivity (56.2%). However, using administrative data codes that occurred after the EOIT date based on chart abstraction, the first cancer-related event was identified with excellent validity (sensitivity, 87.0%; specificity, 93.3%; positive predictive value, 81.5%; negative predictive value, 95.5%). Although administrative data alone did not validly identify cancer-related events, administrative data in combination with chart collected EOIT dates was associated with excellent validity. The collection of EOIT dates by cancer registries would significantly expand the potential of administrative data linkage to assess cancer outcomes.

The role of identity commitments in depressive symptoms and stressful life events in adolescence and young adulthood.

The formation of a stable identity, consisting of a strong set of commitments, is a key developmental task in adolescence and young adulthood. Not resolving this task and lacking strong identity commitments is related to difficulties like depressive symptoms and stressful life events. However, the exact role of identity commitments in these negative experiences has remained unclear. In two longitudinal studies in the Netherlands spanning 8 and 6 years, respectively, we examined the associations between career and interpersonal commitments, depressive symptoms, and the number of experienced stressful life events over time. Study 1 included 683 adolescents (11 to 15 years at T1) and 268 adolescents and young adults (16 to 20 years at T1). Study 2 included 960 adolescents (12 to 17 years at T1) and 944 young adults (18 to 24 years at T1). Both studies indicated that stronger identity commitments predicted relative decreases in negative experiences. In Study 2, stronger interpersonal commitments predicted relative decreases in depressive symptoms. In both studies, stronger career commitments predicted a relative decrease in stressful life events. Furthermore, only career commitments weakened after negative experiences. Interpersonal commitments did not weaken after negative experiences, possibly because of the importance of interpersonal relationships during difficult times. Moreover, identity commitments did not buffer the effect of stressful life events on depressive symptoms in either study. These findings underscore the importance of identity commitments in adolescence and young adulthood, but provide crucial nuances regarding their role in different life domains. (PsycINFO Database Record

Contraceptive Methods After an Obstetrical Event in Adolescents: An Observational and Retrospective Study

Contraceptive Methods After an Obstetrical Event in Adolescents: An Observational and Retrospective Study

Exposure to violence: associations with psychiatric disorders in Brazilian youth.

Objective:The effects of exposure to violent events in adolescence have not been sufficiently studied in middle-income countries such as Brazil. The aims of this study are to investigate the prevalence of psychiatric disorders among 12-year-olds in two neighborhoods with different socioeconomic status (SES) levels in São Paulo and to examine the influence of previous violent events and SES on the prevalence of psychiatric disorders.Methods:Students from nine public schools in two neighborhoods of São Paulo were recruited. Students and parents answered questions about demographic characteristics, SES, urbanicity and violent experiences. All participants completed the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) to obtain DSM-IV diagnoses. The data were analyzed using weighted logistic regression with neighborhood stratification after adjusting for neighborhood characteristics, gender, SES and previous traumatic events.Results:The sample included 180 individuals, of whom 61.3% were from low SES and 39.3% had experienced a traumatic event. The weighted prevalence of psychiatric disorders was 21.7%. Having experienced a traumatic event and having low SES were associated with having an internalizing (adjusted OR = 5.46; 2.17-13.74) or externalizing disorder (adjusted OR = 4.33; 1.85-10.15).Conclusions:Investment in reducing SES inequalities and preventing violent events during childhood may improve the mental health of youths from low SES backgrounds.

Pediatric and adolescent anterior shoulder instability: clinical management of first-time dislocators.

The purpose of this review is to discuss the epidemiology, pathoanatomy, diagnosis, and clinical management of pediatric and adolescent patients following a first-time shoulder dislocation. Shoulder instability is becoming increasingly common as pediatric and adolescent patients engage in earlier organized sports competition. Recommended treatment following a first-time glenohumeral dislocation event in adolescents depends on several factors, but surgical stabilization is becoming more frequently performed. Surgical indications include bony Bankart lesion, ALPSA lesion, bipolar injury (e.g. Hill-Sachs humeral head depression fracture) or off-season injury in an overhead or throwing athlete. Complications following surgical treatment are rare but most commonly are associated with recurrent instability. Young children (eg. open proximal humerus growth plate), individuals averse to surgery, or in-season athletes who accept the risk of redislocation may complete an accelerated rehabilitation program for expedited return to play in the absence of the structural abnormalities listed above. Following a first-time dislocation event in pediatric and adolescent patients, a detailed discussion of the risks and benefits of nonoperative versus operative management is critical to match the recommended treatment with the patient's injury pattern, risk factors, and activity goals.

STRESSFUL EVENTS AND EXECUTIVE FUNCTIONING, WORKING MEMORY AND ACADEMIC PERFORMANCE IN ADOLESCENTS

A number of studies have investigated the association between psychiatric disorders and alterations in cognitive development, academic performance and learning ability. However, few studies have explored the relationship between stressful events and grade repetition. Therefore, the main goal of the present study was to compare the frequency of exposure to stressful events, academic performance, executive functioning and performance on working memory tasks between adolescents with and without a history of grade repetition. This was a cross-sectional correlational study. The sample was composed of 83 adolescents, divided into two groups: (1) individuals with a history of grade repetition (n=39) and (2) participants who had never repeated a grade (n=44). Participants were administered tests to assess executive functions, intelligence, exposure to stressful events and academic performance. Individuals with a history of grade repetition reported to experiencing a higher number of stressful events in adolescence, had worse academic performance, and obtained lower scores on executive functioning and working memory tasks than non-repeaters. Results also showed that individuals who had lower executive function scores had experienced a greater number of stressful events. In conclusion, the study demonstrated that exposure to stressful events and impaired executive functioning may contribute significantly to worse academic performance.

Supplemental Material for The Role of Identity Commitments in Depressive Symptoms and Stressful Life Events in Adolescence and Young Adulthood

Supplemental Material for The Role of Identity Commitments in Depressive Symptoms and Stressful Life Events in Adolescence and Young Adulthood

45.0 Suicide Prevention and Resilience at Children’s (SPARC) Program: An Innovative Program Aimed to Reduce Suicide Events in Adolescents With Suicidal Behaviors

45.0 Suicide Prevention and Resilience at Children’s (SPARC) Program: An Innovative Program Aimed to Reduce Suicide Events in Adolescents With Suicidal Behaviors

Life Happens When You Are Young: Reminiscence Bump in Cultural Life Scripts Regardless of Number of Events Elicited

Cultural life scripts are representations of a prototypical life course within a culture, consisting of a shared understanding of culturally important transitional events and their timing. Cultural life scripts contain a “bump” for events in adolescence and early adulthood, mirroring the reminiscence bump in autobiographical memory. However, the bump in the cultural life script might be due to the typical methodology used, namely generating only the seven most important events in a prototypical life, thus prioritizing early events. Here, we tested whether expanding the number of events would level the bump in the cultural life script. Four groups of 100 participants each generated a cultural life script with four, seven, 15 or 25 events. Across groups, there was a clear bump in adolescence and early adulthood, showing that the bump in cultural life scripts is highly robust and not an artefact of methodology.

The validity of algorithms using health administrative data in identifying cancer-related events in adolescents and young adults: A population-based study using the IMPACT cohort.

e18168 Background: Despite the importance of estimating population level cancer outcomes, most registries do not collect critical events such as relapse and progression. Attempts to use health administrative data to identify these events have focused on older adults and have been mostly unsuccessful. We developed and tested administrative data-based algorithms in a population-based cohort of adolescents and young adults (AYA) with cancer. Methods: We identified all Ontario AYA 15-21 years of age diagnosed with leukemia, lymphoma, sarcoma, or testicular cancer between 1992 and 2012. Chart abstraction was used to determine the end of initial treatment (EOIT) date and subsequent cancer-related events (progression, relapse, second cancer). Linkage to population-based administrative databases identified fee and procedure codes indicating cancer treatment or palliative care. Algorithms that determined EOIT based a time interval free of treatment-associated codes, and new cancer-related events based on billing codes, were compared to chart abstracted data. Results: The cohort comprised 1,404 patients. Time periods free of treatment-associated codes did not validly identify EOIT dates; using subsequent codes to identify new cancer events was thus associated with low sensitivity (56.2%). However, using administrative data codes that occurred after the EOIT date based on chart abstraction, the first cancer-related event was identified with excellent validity (sensitivity 87.0%, specificity 93.3%, PPV 81.5%, negative predictive value 95.5%). Conclusions: While administrative data alone did not validly identify cancer-related events, using administrative data in combination with chart collected EOIT dates was associated with excellent validity. The collection of EOIT dates by cancer registries would significantly expand the potential of administrative data linkage to assess cancer outcomes.

Genetic and environmental correlations between subjective wellbeing and experience of life events in adolescence

Some life events appear heritable due to the genetic influence on related behaviours. Shared genetic influence between negative behaviours and negative life events has previously been established. This study investigated whether subjective wellbeing and positive life events were genetically associated. Participants in the Twins Early Development Study (aged 16.32 ± .68 years) completed subjective wellbeing and life events assessments via two separate studies (overlapping N for wellbeing and life events measures ranged from 3527 to 9350). We conducted bivariate twin models between both positive and negative life events with subjective wellbeing and related positive psychological traits including subjective happiness, life satisfaction, optimism, hopefulness and gratitude measured at 16 years. Results suggested that the heritability of life events can partially be explained by shared genetic influences with the wellbeing indicators. Wellbeing traits were positively genetically correlated with positive life events and negatively correlated with negative life events (except curiosity where there was no correlation). Those positive traits that drive behaviour (grit and ambition) showed the highest genetic correlation with life events, whereas the reflective trait gratitude was less correlated. This suggests that gene–environment correlations might explain the observed genetic association between life events and wellbeing. Inheriting propensity for positive traits might cause you to seek environments that lead to positive life events and avoid environments which make negative life events more likely.

Effects of companion support on insulin pump therapy in adolescents with type 1 diabetes

Objective To explore the effects of companion support on insulin pump therapy in adolescents with type 1 diabetes. Methods A total of 60 patients were randomly divided into experimental group and control group, 30 cases respectively. Patients in control group were given routine education, while patients in experimental group received additional intervention of companion support. Changes of blood glucose, the occurrence of negative events during the use of insulin pump and standardized usage of insulin pump were compared between two groups. Blood glucose before sleep in one random day was recorded and the fluctuation of blood glucose was compared between two groups. Results After six months, fasting and postprandial blood glucose, glycated hemoglobin and the occurrence of negative events during the use of insulin pump in experimental group were significantly lower than those in control group (P<0.05) . The waveform stability at one random day before sleep of experimental group was better than that of control group. Conclusions Companion support plays curial roles in controlling blood glucose, improves the standardization of insulin pump operation and effectively reduces the negative events in adolescents with type 1 diabetes undergoing temporary insulin pump therapy. Key words: Diabetes, type 1; Insulin infusion system; Adolescents; Companion support