Sample Of Inpatient Adolescents Research Articles

Early Onset Schizo-Obsessive Disorder: A Case Series of 7 Inpatient Children

IntroductionSchizo-obsessive disorder (SOD) is a complex psychiatric condition characterized by exhibiting symptoms of schizophrenia and obsessive-compulsive disorder (OCD)(Schirmbeck et al. Front Pharmacol. 2013 Aug 9;4:99). Some researchers prefer to describe this condition as a spectrum called “schizo-obsessive spectrum” and state that clinical represantations such as OCD with poor insight, OCD with schizotypal personality disorder, schizophrenia with obsessive-compulsive symptoms and schizophrenia with OCD are included in this spectrum(Poyurovsky et al. J Psychiatr Res. 2005 Jul;39(4):399-408). There is limited literature available on early on-set schizo-obsessive disorder in child and adolescent sample.ObjectivesThis case series aimed to describe the clinical characteristics, phenomenology, diagnostic process and treatment response of SOD in a sample of inpatient adolescents and illuminate the intricate symptomatology between schizophrenic and obsessive-compulsive features.Methods A retrospective review was conducted of 7 adolescent patients who met DSM-V criteria for both schizophrenia and OCD in our inpatient clinic over the past year. Data were collected from medical records, including demographic information, clinical presentation, treatment history and response to treatment. All data were anonymized to maintain patient confidentiality.ResultsThe sample consisted of 5 females and 2 males, with a mean age of 15,4 years. All patients presented with a mixed symptomatology of hallucinations, delusions and obsessive-compulsive symptoms. Many common points observed about clinical characteristics and psychiatric history of the patients. In most of the patients, the first psychiatric complaints started with obsessive-compulsive symptoms. It was observed that obsessions evolved into over-valued ideas and delusions in the course of time. Patients responded late and inadequately to pharmacological treatment, multiple drug use was necessary. Hospitalization lasted longer, the average time was 53 days. Most of the patients required augmentation with cognitive-behavioral therapy due to partial response or intolerable side effects. Unfortunately, no patient experienced full remission or returned to premorbid functioning.ConclusionsThis case series underscores the complexity of diagnosing and treating schizo-obsessive disorder in a pediatric population. It appears that a combined approach using both pharmacotherapy and psychotherapy may yield the most beneficial results. However, given the small sample size and retrospective design, these findings need to be interpreted with caution. Further research are crucial to corroborate our findings and refine treatment strategies.Disclosure of InterestNone Declared

The OPD-CA-2 axis interpersonal relations: A helpful tool for treatment planning? Relationship patterns of adolescent patients with persistent intrapsychic conflicts, structural deficits and trauma sequelae disorders

The axis interpersonal relations of the Operationalized Psychodynamic Diagnosis in Childhood and Adolescence (OPD-CA-2; OPD-CA-2 Task Force, OPD-CA-2. Operationalized Psychodynamic Diagnosis in Childhood and Adolescence. Theoretical Basis and User Manual. Hogrefe, 2017) allows to describe how children and adolescents handle relationships both with relevant attachment figures (e.g., parents) and with the examiner in a standardized way. In the current study, the axis interpersonal relations was used in an inpatient adolescent sample. The aim of the study was to identify typical relationship patterns depending on the patients’ structural level. By inspecting the relationship patterns of all ratings, we identified three groups of patients: The first group included patients with a limited structural level and clearly recognizable intrapsychic conflict dynamics (“focus: conflict”), the second group included patients with a low structural level (“focus: structure”), and the third group included patients who had been exposed to severe traumatic experiences with relevant attachment figures (“focus: trauma”). The relationship characteristics of these three groups were described and illustrated by prototypical cases. Conclusions for clinical practice were discussed as well.

Is there stress eating in children and adolescents? A first validation of the Dutch version of the Salzburg Stress Eating Scale

The recently developed Salzburg Stress Eating Scale (SSES) is the first to specifically address the relationship of stress experiences and coping failure on the one hand and increases or decreases in food intake on the other hand. The SSES demonstrated good psychometric properties in English and German speaking adult samples. However, it has not been applied to younger age groups, which may differ in their expression and reporting of stress related eating behavior. Therefore, the current study evaluated the psychometric properties and correlates of the SSES in a Dutch speaking community sample of adolescents (study 1; N = 244, 9–18 years, adjusted BMI range = 71–189%, M = 103%) and in an inpatient sample of adolescents with obesity (study 2; N = 100, 9–16 years, adjusted BMI range = 151–310%, M = 194.5%). Factor analysis confirmed the original one factor structure in both studies. Internal consistency was 0.85 in study 1 and 0.90 in study 2 (Cronbach's alpha). In both the obesity and community sample, SSES scores were positively correlated with other eating-related measures (e.g., emotional eating, external eating), and uncorrelated with non-eating-related wellbeing measures (e.g., perceived stress, depressive symptoms). Unexpectedly, however, no association with adjusted BMI was found in the community sample, obesity sample, or combined sample. The scores of the obesity sample were also compared to the community sample in an age and sex-matched subsample of study 1. Against our hypothesis, the obesity sample did not report higher SSES scores than the community sample. The good internal consistency and the evidence for convergent and discriminant validity indicate that the Dutch version of the SSES seems useful in examining this clinically important eating behavior in adolescents. However, validity with regard to stress eating and BMI remains to be further explored.

Refinement of the Reflective Function Questionnaire for Youth (RFQY) Scale B Using Item Response Theory.

We conducted item response theory analyses to refine the Reflective Function Questionnaire for Youth (RFQY) Scale B. Data from a non-clinical sample of young people (n = 737; aged 18-25 years) was used to derive a shortened version of the RFQY. Results were replicated in a clinical sample of inpatient adolescents (n = 467; aged 12-17 year), resulting in a five-item measure, thereafter named the RFQY-5. The RFQY-5 item set was then scrutinized for construct validity against the original 23-item RFQY item set in a randomly selected sample of 100 inpatient adolescents not included in the item response theory replication, and 186 healthy adolescents drawn from the community. Results showed that the RFQY-5 performed similarly as the long version in terms of associations with criterion variables, and outperformed the longer version in discriminating between inpatient and community-dwelling adolescents who differed in their levels of borderline traits. The study provides evidence in support of the use of the RFQY-5 in research and clinical settings.

The Impact of Adverse Childhood Experiences (ACEs) on Suicidal Ideation and Suicide Attempts in an Inpatient Adolescent Sample

Background: Suicidal ideation (SI) and suicide attempts (SAs) among adolescents are a significant public health concern worldwide. The current study extends previous research by exploring the association between adverse childhood experiences (ACEs) and SI and SAs in a sample of inpatient adolescents as well as identifying specific predictors for increased risk of SI and SAs. Methods: Associations between ACE scores and self-reported SI and SAs were explored in a sample of 154 inpatient adolescents via clinical interview and by analyzing the association between cumulative ACE scores and scores on the Suicidal Tendency scale of a larger personality measure. We also tested for independent relationships between 19 ACEs and SI and SAs to determine unique predictors for suicidality. Results: One-way ANOVA analyses revealed that those who attempted suicide reported significantly more ACEs compared to those who did not attempt suicide. Witnessing violence in the home, school, or neighborhood and experiences of discrimination increased one’s likelihood to attempt suicide by two to threefold, while sexual abuse, neglect, and physical abuse increased this likelihood by three-to-fourfold. Stepwise linear regression analyses demonstrated that emotional abuse, living with someone who had mental health problems or attempted suicide were most associated with elevated Suicidal Tendency scores on a personality measure. Conclusions: Early identification, education and intervention are imperative to limit or eliminate ACEs from occurring. The impact of cumulative as well as specific ACEs on suicide risk should be closely considered as areas for such intervention. Areas for future research include extending to include more diverse populations such as the LGBTQ community as well as more ethnically and racially diverse populations.

Multiple Substance Abuse as a Form of High Risk Behavior in Adolescence

Multiple Substance Abuse as a Form of High Risk Behavior in Adolescence We identify multiple substance abuse as a form of high risk behavior in adolescence based on a sample of in-patient adolescents. 43 adolescents were treated for substance abuse over the course of 20 months. 70 % reported the use of three or more different drugs, with an average of 5,35 consumed substances. The most commonly abused substance was cannabis, followed by synthetic drugs such as cocaine or ecstasy. We observed a high rate of non-suicidal self-injury as a comorbidity of multiple substance abuse in our sample. 73,3 % of adolescents with high risk, multiple substance abuse fulfilled diagnostic criteria for non-suicidal self-injury.

Distress-Related Internalizing Symptoms Interact With Externalizing Symptoms to Predict Alcohol Problems in an Inpatient Adolescent Sample.

Previous research has yielded equivocal findings regarding whether internalizing symptoms are risk factors for adolescent hazardous alcohol use (AU), specifically in the presence of externalizing symptoms. This may be due to the type of internalizing symptoms examined (ie, distress vs fear), and the use of primarily normative rather than clinical samples. Thus, we tested internalizing and externalizing symptom interactions as they relate to adolescent hazardous AU in a high-risk, clinical sample of adolescents. Adolescents (N = 101; 66% female; Mage = 15) were recruited from an inpatient psychiatric unit and assessed for current symptoms. Hypotheses were tested by running a series of moderation models regressing hazardous AU on a set of internalizing symptoms (ie, depression, generalized anxiety disorder [GAD], social anxiety, separation anxiety, school avoidance, and panic), each interacting with externalizing symptoms. We observed significant interactions between several internalizing symptoms (depression, GAD, and panic symptoms) and externalizing symptoms predicting hazardous AU. These internalizing symptoms were unrelated to AU at low and average levels of externalizing symptoms, but were positively related to AU at high levels of externalizing symptoms. In this clinical sample, distress-related internalizing symptomatology was associated with risk for, and not protection against, hazardous AU, but only when accompanied by high externalizing symptoms. Findings suggest that whether or not internalizing symptoms operate synergistically with externalizing symptoms to predict hazardous AU depends on the subdomain of internalizing symptoms (distress vs fear) and perhaps the type of sample (ie, clinical vs community). (Am J Addict 2019:00:00-00).

The Basic Empathy Scale: Factor structure and validity in a sample of inpatient adolescents.

The Basic Empathy Scale (BES) is used widely to measure empathy in adolescents. Despite this wide use, there has been no examination of the measure's factor structure or its validity in an American or severe clinical sample. The present study addressed this gap by evaluating factor structure and construct validity in an inpatient sample of 652 adolescents (63% female). Results indicated that a bifactor model, with a general empathy factor and specific factors of affective and cognitive processes, provided the best fit of the data. After examining factor loadings for both the general and specific factors and calculating model-based reliability estimates, we conclude that the two specific factors represent measurement-specific error due to wording and the confounding construct of emotion recognition, respectively, and that BES total scores should be used in scoring and interpretation to capture the construct of empathy. BES total scores were positively associated with prosocial behavior, negatively associated with affective components of psychopathy (unemotionality, callousness, and uncaringness), and significantly higher for girls than for boys further bolstering the conclusion that the BES total score is a valid measure of empathy in adolescents with severe psychopathology. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Attentional bias, craving and cannabis use in an inpatient sample of adolescents and young adults diagnosed with cannabis use disorder: The moderating role of cognitive control

Motivational processes like attentional bias and craving have been related to substance use. However, results are inconclusive. The present cross-sectional study was designed to replicate and extend previous research by investigating the relationships between attentional bias, craving, cognitive control and (severity of) cannabis use in a sample of inpatient adolescents and young adults (aged 18–30) diagnosed with CUD according to DSM-5. Contrary to expectations, our sample did not show attentional bias for cannabis words, neither did attentional bias correlate with craving, cognitive control or (severity of) cannabis use. In line with our hypotheses, however, increased session-induced craving was correlated to more daily cannabis use and reduced cognitive control. Furthermore, participants who displayed reduced cognitive control used more cannabis per day. A bootstrapped hierarchical regression model showed that, contrary to expectations, cognitive control did not modulate the relationships between attentional bias, craving and cannabis use. This study highlights the unique role of craving in relation to cannabis use and extends previous findings that cognitive control appears to have no moderating role regarding cannabis use disorder. Based on our results, it might well be that the underlying mechanisms of cannabis use disorder differ from those in other substance use disorders.

Exposure to Parental Threatening Behaviors and Internalizing Psychopathology in a Trauma-Exposed Inpatient Adolescent Sample: The Role of Difficulties With Goal-Directed Behaviors.

Parental threatening behaviors have emerged as a subset of negative parental behaviors strongly related to internalizing symptoms among youth, yet the underlying mechanisms in this association have remained unexplored. The current investigation examined the role of difficulties engaging in goal-directed behavior while emotionally distressed in the association between exposure to maternal threatening behaviors and internalizing symptoms among trauma-exposed inpatient psychiatric youth. Participants (N = 50; mean [SD] age, 15.1 [0.51] years; age range, 12-17 years) completed measures of emotion dysregulation, exposure to maternal threatening behaviors, depression, anxiety, and posttraumatic stress disorder symptoms, as well as trauma-related functional impairment. Results revealed that inability to engage in goal-directed behavior while distressed significantly explained associations between exposure to maternal threatening behaviors and each of the three symptom classes, but not the association between exposure to maternal threatening behaviors and trauma-related functional impairment. These novel findings underscore the need for interventions that target the capacity for goal-directed behavior in the context of emotional distress, especially among trauma-exposed youth who have experienced parental threatening behaviors.

Use of self-report outcome measures in an acute inpatient CAMHS setting.

Outcome measures are increasingly being used to index change in service users' presentation. However, within Child and Adolescent Mental Health Services (CAMHS), these raise questions around what should be measured, who should be asked to rate outcome and what constitutes progress. This study sought to audit the value of two self-report measures within the inpatient adolescent setting. An admission sample of 67 young people completed the Revised Child Anxiety and Depression Scale (RCADS) and Young Person's Clinical Outcomes in Routine Evaluation (YP CORE), with clinicians completing the Children's Global Assessment Scale (CGAS) and Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA). A follow-up dataset consisted of 20 young people who completed the measures on two occasions, with clinician ratings completed on admission and discharge. The RCADS and YP CORE measures showed discriminant and convergent reliability and appeared to index change in the current inpatient sample of adolescents. Self-report of symptoms and general functioning were closely related. There was little relationship between self-report and clinician ratings, emphasising the importance of collating self-report in addition to clinician ratings.

The relations between self- and caregiver- focused reflective function and theory of mind in the context of borderline pathology in adolescence

Theory of mind (ToM) development is fostered by parent-child interactions characterized by accurate reflection on the child's mental states, or reflective function (RF), by the caregiver. Therefore, attachment-based RF is the foundation upon which children learn to reason about minds outside the attachment context (domain-general ToM). However, it is not known to what extent attachment-based RF of the self versus caregivers uniquely relates to domain-general ToM. Additionally, it is likely that for psychopathology associated with maladaptive parent-child dynamics (i.e., borderline pathology), domain-general ToM impairments are more strongly related to attachment-based RF disturbances. Therefore, the aim of the current study was to evaluate associations between domain-general ToM and attachment-based RF to determine whether RF of the self versus caregivers has unique relations to domain-general ToM. Second, we tested whether borderline pathology would moderate this relation. Among a sample of inpatient adolescents (N = 330 adolescents; Mage = 15.40, SD = 1.44), findings suggest that RF of the self uniquely relates to domain-general ToM and that this relation is strongest among adolescents with high levels of borderline pathology. Therefore, evidence supports theory regarding the association between attachment-based RF and domain-general ToM. Additionally, interpersonal disturbance observed in borderline pathology, even in adolescence, is related to attachment-based social-cognition.

The role of maternal care in borderline personality disorder and dependent life stress

BackgroundBorderline Personality Disorder (BPD) affects 0.9%–3.2% of adolescents, and more than 20% of inpatient adolescents. Life stress has been linked to BPD across the lifespan, and previous research in adults has linked BPD to dependent stress (i.e., stress induced by the individual). However, prior research has not examined dependent stress alongside BPD in adolescents. Additionally, the potential protective effect of maternal care has not been considered in this relation. This study tested a moderation model expecting that (1) BPD would be positively associated with dependent life stress, (2) maternal care would be negatively associated with BPD, and (3) maternal care would moderate the relation between BPD and dependent life stress.MethodThe sample consisted of 184 adolescents recruited from an inpatient psychiatric facility serving a diverse population in the Southwestern United States. Dependent life stress, BPD, and maternal care were measured using the UCLA Life Stress Interview, DSM-IV Childhood Interview for BPD, and Kerns Security Scale, respectively.ResultsResults supported the first two hypotheses; BPD diagnosis was significantly, positively associated with dependent life stress, and negatively associated with maternal availability and dependability. Contrary to the third hypothesis, no significant evidence that maternal care acts as a buffer in the relation between BPD and dependent life stress was found.ConclusionsAlthough maternal care was not found to moderate the association between BPD and dependent life stress, results supported previously found relations between BPD, dependent life stress, and maternal care, and did so within a diverse inpatient adolescent sample.

On the Relation Between General Intelligence and Psychopathic Traits: An Examination of Inpatient Adolescents.

A substantial literature has investigated relations between intelligence and psychopathic traits. At the construct level, findings have been mixed, with a small negative relation found. At the facet level however, a positive relation between verbal intelligence and the interpersonal facet of psychopathy, and a negative relation between verbal intelligence and the lifestyle factor of psychopathy emerge. To date, this research has largely neglected adolescents and prior research has focused on clinical and incarcerated populations, while failing to control for psychopathology. The current study sought to address these limitations by examining the relation between intelligence and psychopathy at the construct, facet, and trait level in a sample of inpatient adolescents. At the bivariate level, verbal intelligence was related to dishonest charm, unemotionality, impulsiveness, and manipulation. In regression analyses, however, verbal intelligence lost significance as a predictor of all but impulsiveness. Gender and severity of psychopathology accounted for most significant relations.

Specific coping strategies moderate the link between emotion expression deficits and nonsuicidal self-injury in an inpatient sample of adolescents

BackgroundNon-suicidal self-injury (NSSI) is a behavior of increasing prevalence in adolescents with links to various negative mental health and adjustment outcomes. Poor emotion expression has been linked with NSSI use, whereas the use of adaptive coping strategies has been identified as a protective factor against NSSI. The current study examined whether specific coping strategies moderate the relation between poor emotion expression and NSSI, and whether moderation is conditional on adolescent gender.MethodsNinety-five adolescents hospitalized on an acute care inpatient psychiatric unit completed questionnaires measuring NSSI, emotion expression and use of specific coping strategies (i.e., problem-focused coping, positive reframing coping, support seeking, avoidance, and distraction).ResultsResults indicated that poor emotion expression was positively associated with NSSI. Positive reframing and support seeking emerged as significant moderators of the poor emotion expression—NSSI link. This result was not conditional upon adolescent gender. Problem-focused coping, avoidance, and distraction did not emerge as significant moderators.ConclusionsEncouraging youth to use particular coping strategies might protect against the negative impact of emotion expression deficits for both boys and girls.

Trauma and Aggression: Investigating the Mediating Role of Mentalizing in Female and Male Inpatient Adolescents.

High rates of posttraumatic stress disorder (PTSD) symptoms and elevated levels of aggression are common among youth in inpatient psychiatric settings. Several models link trauma exposure to aggression through anomalous mental state reasoning. Some theoretical frameworks linking trauma to aggression specify that the over-attribution of hostile mental states contributes to the development of aggressive behavior whereas other theories suggest that an inhibition of mental state reasoning leads to aggressive behavior. Using a sample of inpatient adolescents, the current study examined relations between PTSD symptoms and four forms of aggression, exploring the role of both over- and under-mentalizing (i.e., hypo- and hypermentalizing) as mediators and gender as a moderator. The results suggest that hypermentalizing, but not hypomentalizing, mediates the relation between trauma and aggression, extending prior research related to inpatient adolescents for the first time. Evidence of moderated mediation was noted, such that this mediational relation was evident for females but not males. The current study offers support for differential underlying causes of aggression among males and females with PTSD symptoms.

Social cognition, psychopathological symptoms, and family functioning in a sample of inpatient adolescents using variable-centered and person-centered approaches

The process of diagnosis and treatment planning for adolescents requires clinicians to integrate information about various domains of functioning especially: clinical signs and symptoms, social cognition and family functioning. In the current study we applied an integrative analytic approach to mirror case conceptualization by clinicians. Our analyses were performed on the data gathered from the 328 inpatient adolescents. We used a broad range of measures of social-cognitive constructs, family functioning and parent-and self-reported psychopathology. Using a combination of variable-based (PCA) and person-centered (LCA) analyses we determined class membership of adolescents based on variation in social cognition, psychopathology, and family functioning. We identified five latent classes: two internalizing groups, two externalizing groups and a severe psychopathology group. Patterns of general hyperfunctioning (characterized by hypermentalizing and hypervigilance to emotional stimuli) and hypofunctioning (manifested in undermentalizing and under-reactivity to emotional stimuli), can be observed in these groups.

Nonsuicidal self-injury: a condition for further study.

Nonsuicidal self-injury: a condition for further study.

The Ottawa Self-Injury Inventory: Evaluation of an assessment measure of nonsuicidal self-injury in an inpatient sample of adolescents.

BackgroundThe Ottawa Self-Injury Inventory (OSI) is a self-report measure that offers a comprehensive assessment of nonsuicidal self-injury (NSSI), including measurement of its functions and addictive features. In a preliminary investigation of self injuring college students who completed the OSI, exploratory analysis revealed four function factors (Internal Emotion Regulation, Social Influence, External Emotion Regulation and Sensation Seeking) and a single Addictive Features factor. Rates of NSSI are particularly high in inpatient psychiatry youth. The OSI can assistin both standardizing assessment regarding functions and potential addictive features and aid case formulation leading to informed treatment planning. This report will describe a confirmatory factor analysis (CFA) of the OSI on youth hospitalized in a psychiatric unit in southwestern Ontario.MethodsDemographic and self-report data were collected from all youth consecutively admitted to an adolescent in-patient unit who provided consent or assent.ResultsThe mean age of the sample was 15.71 years (SD = 1.5) and 76 (81 %) were female. The CFA proved the same four function factors relevant, as in the previous study on college students (χ2(183) = 231.98, p = .008; χ2/df = 1.27; CFI = .91; RMSEA = .05). The model yielded significant correlations between factors (rs = .44-.90, p < .001). Higher NSSI frequency was related to higher scores on each function factor (rs = .24-.29, p < .05), except the External Emotion Regulation factor (r = .11, p > .05). The factor structure of the Addictive Features function was also confirmed (χ2(14) = 21.96, p > .05; χ2/df = 1.57; CFI = .96; RMSEA = .08). All the items had significant path estimates (.52 to .80). Cronbach’s alpha for the Addictive Features scale was .84 with a mean score of 16.22 (SD = 6.90). Higher Addictive Features scores were related to more frequent NSSI (r = .48, p < .001).ConclusionsResults show further support for the OSI as a valid and reliable assessment tool in adolescents, in this case in a clinical setting, where results can inform case conceptualization and treatment planning.Electronic supplementary materialThe online version of this article (doi:10.1186/s13034-015-0056-5) contains supplementary material, which is available to authorized users.

Screening efficiency of the self-report version of the Multidimensional Anxiety Scale for Children in a highly comorbid inpatient sample

Background: The Multidimensional Anxiety Scale for Children (MASC) is a widely used self-report questionnaire for the assessment of anxiety symptoms in children and adolescents with well documented predictive validity of the total score and subscales in internalizing and mixed clinical samples. However, no data exist on the screening efficiency in an inpatient sample of adolescents. Aim: To examine the psychometric properties and screening efficiency of the MASC in a high comorbid inpatient sample. Method: The current study used receiver operating characteristic (ROC) analyses to investigate the predictive value of the MASC total and subscale scores for the Schedule for Affective Disorders and Schizophrenia for School-age children—Present and Lifetime version (K-SADS-PL), DSM-IV diagnoses of generalized anxiety disorder (GAD), separation anxiety disorder (SAD) and social phobia (SoP) in a highly comorbid inpatient sample of adolescents (11–18 years). Results: The MASC total score predicted any anxiety disorder (AD) and GAD moderately well. Physical symptoms predicted GAD moderately well. Social anxiety and separation anxiety/panic did not predict SoP or SAD, respectively. Physical symptoms and harm avoidance also predicted the presence of major depressive disorder. Conclusions: The findings support the utility of the MASC total score to predict the presence of any AD and GAD. However, the utility of the social anxiety and separation anxiety/panic subscales showed limited utility to predict the presence of SAD and SoP, respectively. The MASC has probably a more limited function in screening for AD among a highly comorbid inpatient sample of severely affected adolescents. Our results should be interpreted in the light of a small, mixed sample of inpatient adolescents.