Adolescent Psychiatric Disorders Research Articles

Associations between childhood trauma and adolescent psychiatric disorders in Brazil: a longitudinal, population-based birth cohort study.

The mental health consequences of exposure to childhood trauma have been little studied among adolescents in low-income and-middle-income countries (LMICs), despite a relatively high burden of trauma in LMIC populations. We investigated associations between trauma and adolescent psychiatric disorders in the 2004 Pelotas Birth Cohort, Brazil. In the 2004 Pelotas Birth Cohort, current psychiatric diagnoses (anxiety, mood, attention-hyperactivity, and conduct-oppositional disorders) were assessed at age 15 years (caregiver-report Development and Well-being Assessment), and age 18 years (self-report Mini-International Neuropsychiatric Interview). Lifetime cumulative trauma was assessed via caregiver report up to age 11 years and combined self-report and caregiver-report thereafter. Exposure to 12 trauma types were assessed (serious accident, fire, other disaster, attack or threat, physical abuse, sexual abuse, witnessed domestic violence, witnessed attack, witnessed accident, heard about attack, heard about accident, and parental death). Due to the high prevalence of trauma exposure in the sample, the number of different types of trauma exposure reported was extracted as a proxy for cumulative trauma load. We assessed both cross-sectional and longitudinal associations between cumulative trauma load and psychiatric disorders during adolescence using logistic regression, adjusting for confounders and pre-existing child psychopathology at 48 months. We also computed population attributable fractions (PAFs) for trauma-mental health associations at age 18 years. 4229 adolescents (51·9% male, 48·1% female) were included in logistic regression analyses based on imputed data. Trauma exposure affected 81·2% of adolescents by age 18 years. At age 15 years, the odds of any disorder (adjusted odds ratio [aOR] 1·19 [95% CI 1·03-1·38]), anxiety disorders (1·45 [1·21-1·75]), and conduct-oppositional disorders (1·60 [1·13-2·27]) increased for each category increase in cumulative trauma, but mood and attention-hyperactivity disorders were not related to cumulative trauma. At age 18 years, the odds of any disorder (1·34 [1·24-1·44]), anxiety disorders (1·23 [1·13-1·34]), mood disorders (1·33 [1·22-1·46]), attention-hyperactivity disorders (1·24 [1·09-1·41]), and conduct-oppositional disorders (1·59 [1·36-1·86]) all increased for each category increase in cumulative trauma. In longitudinal analyses, each category increase in cumulative trauma by age 11 years was associated with an increased odds of any disorder (aOR 1·26 [95% CI 1·11-1·44]), anxiety disorders (1·27 [1·04-1·56]), and conduct-oppositional disorders (1·43 [1·04-1·97]) at 15 years; and trauma up to age 15 years was associated with increased odds of any disorder (1·32 [1·21-1·45]), anxiety disorders (1·27 [1·14-1·40]), mood disorders (1·26 [1·12-1·41]), and conduct-oppositional disorders (1·52 [1·24-1·87]) at age 18 years. Trauma up to age 11 years was not predictive of disorders at age 18 years, and there were no longitudinal associations between trauma and attention-hyperactivity disorders. PAF estimates indicated that trauma exposure accounted for 30·6% (95% CI 21·2-38·7) of psychiatric disorders at age 18 years. Increasing exposure to trauma is associated with mental disorders among Brazilian adolescents. Given the high prevalence of trauma in LMIC populations, strategies to reduce exposure, identify those at greatest risk of mental disorders following trauma, and mitigate the consequences are crucial. Wellcome Trust, WHO, National Support Program for Centers of Excellence, Brazilian National Research Council, Brazilian Ministry of Health, Children's Pastorate, São Paulo Research Foundation, Rio Grande do Sul Research Foundation, L'Oréal-Unesco-ABC Program for Women in Science in Brazil-2020, All for Health Institute, University of Bath, Economic and Social Sciences Research Council. For the Portuguese translation of the abstract see Supplementary Materials section.

The Risk of Hospital Admission for an Acute-Onset Psychiatric Disorder in Adolescents and Adults Treated with Isotretinoin: A French, Nationwide, Population-Based, Case-Time-Control Study

Introduction: Oral isotretinoin is the only effective treatment for severe acne without an alternative. Isotretinoin has been linked to the occurrence of acute psychiatric disorders outside suicidal behaviors. There are few large-scale epidemiological studies in this area, and the putative associations are unclear. Our objective was to determine whether adolescents and young adults have an elevated risk of acute-onset psychiatric disorder requiring hospital treatment within 2 months of starting isotretinoin treatment. Methods: Our data source was the French national health insurance database (Système National des Données de Santé, SNDS), 2010–2015. We performed a case-time-control study nested in an exhaustive, nationwide cohort of all French adolescents and young adults aged 10–25 years treated with isotretinoin. The outcome was an acute-onset psychiatric disorder requiring hospitalization (including anxiety, depressive, mood, adjustment, and psychotic disorders). A conditional logistic model was used to estimate odds ratios (ORs) with their 95% confidence interval (CI) for acute psychiatric events. Results: 2,284 acute-onset psychiatric disorder requiring hospitalization were recorded for the study population of 262,786 patients. Among the patients with at least one psychiatric event, 88 had started taking isotretinoin in the risk period (0–2 months before the date of the event), versus 81 in the reference period (2–4 months before the event). A comparison with the 383 and 355 time-trend matched controls who started taking isotretinoin in the risk and reference periods, respectively, yielded a case-time-control OR (95% CI) of 1.01 (0.72–1.41). Conclusion: Psychiatric events managed outside the hospital system were not recorded. Our findings are reassuring for clinicians concerning the risk of severe acute-onset psychiatric events after isotretinoin initiation.

Associations between adolescent psychiatric disorders and adulthood payment problems: a Norwegian register study of complete birth cohorts of 1995–1997

BackgroundPsychiatric disorder diagnoses are linked to long-term socioeconomic ‘shadows’ into adulthood, but little is known about how these diagnoses are associated with adulthood payment problems in Norway and whether these...

Therapists' perspectives on the Maudsley model anorexia nervosa treatment for adolescents and young adults (MANTRa): A qualitative interview study.

A rising incidence of eating disorders in the young population and limited effectiveness of available treatment approaches underscore the need for innovative therapies. This study explores therapists' perspectives regarding a promising new manualized psychotherapeutic treatment (MANTRa) for adolescents and young adults with anorexia nervosa (AN). Semi-structured qualitative interviews were conducted with 10 therapists (nine female) who provided 24-34 sessions of MANTRa per patient. Interview topics included positive and negative experiences with MANTRa in general, with the workbook and other components. Reflexive thematic analysis was used to interpret the data. Furthermore, written notes taken by the therapists after each sessions were analysed. The thematic analysis revealed five overarching themes: (1) Variety of therapeutic tools and content elements included in the workbook; (2) Getting the therapeutic process going; (3) Flexibility in use of the workbook; (4) Impact of the scientific and multidisciplinary framework on quality assurance; (5) Formal design of the workbook. Therapists' case formulation letters to the patients were regarded as powerful tools to strengthen therapeutic alliance and promote recovery. In-depth therapists' training, regular supervision and a multi-professional treatment setting were important factors to ensure high treatment quality. The findings suggest how the MANTRa content (e.g. inclusion of additional therapeutic tools), the therapists' training and the format (e.g. provision of a digital version) can be improved to reach maximum impact. Therapists' formulation letters may be an effective therapeutic tool not only for AN but also across the spectrum of psychiatric disorders in adolescents and young adults.

Test–Retest Reliability of Deep Learning Analysis of Brain Volumes in Adolescent Brain

Magnetic resonance imaging (MRI) is essential for studying brain development and psychiatric disorders in adolescents. However, the imaging consistency remains challenging, highlighting the need for advanced methodologies to improve the diagnostic and research reliability in this unique developmental period. Adolescence is marked by significant neuroanatomical changes, distinguishing adolescent brains from those of adults and making age-specific imaging research crucial for understanding the neuropsychiatric conditions in youth. This study examines the test–retest reliability of anatomical brain MRI scans in adolescents diagnosed with depressive disorders, emphasizing a developmental perspective on neuropsychiatric disorders. Using a sample of 42 adolescents, we assessed the consistency of structural imaging metrics across 95 brain regions with deep learning-based neuroimaging analysis pipelines. The results demonstrated moderate to excellent reliability, with the intraclass correlation coefficients (ICC) ranging from 0.57 to 0.99 across regions. Notably, regions such as the pallidum, amygdala, entorhinal cortex, and white matter hypointensities showed moderate reliability, likely reflecting the challenges in the segmentation or inherent anatomical variability unique to this age group. This study highlights the necessity of integrating advanced imaging technologies to enhance the accuracy and reliability of the neuroimaging data specific to adolescents. Addressing the regional variability and strengthening the methodological rigor are essential for advancing the understanding of brain development and psychiatric disorders in this distinct developmental stage. Future research should focus on larger, more diverse samples, multi-site studies, and emerging imaging techniques to further validate the neuroimaging biomarkers. Such advancements could improve the clinical outcomes and deepen our understanding of the neuropsychiatric conditions unique to adolescence.

The journey of therapists diagnosed with psychiatric disorders in adolescence

AbstractBackgroundAlthough psychotherapists' motivations in choosing the profession have been investigated, there is not enough information in the literature about how personal motivations affect their choice of becoming a psychotherapist. For this reason, this study aimed to reveal the reasons why therapists who received a psychiatric diagnosis during adolescence chose this profession and their relationship with the disease.MethodsTo explore this, semi‐structured interviews were conducted with five female psychotherapists in Turkey who had a psychiatric diagnosis between the ages of 12 and 18 years and had at least a clinical master's degree and practical experience. Interpretative phenomenological analysis (IPA) was used in the research.FindingsThree superordinate themes and nine subthemes depending on these superordinate themes were created: the first theme, ‘Identity’, has three subthemes; the second theme, ‘Why I chose this profession and what I found’, has five subthemes; and the final theme, ‘Being a diagnostic psychotherapist’, has two subthemes.ConclusionThis study suggests that incorporating therapists' personal experiences into supervision may contribute to improved professional skills, patient interactions and the overall effectiveness of therapy.

Empowering primary care physicians in child and adolescent psychiatry: a needs assessment on collaborative care in Dubai.

Child and adolescent psychiatric disorders pose significant public health concerns necessitating prompt intervention. Primary care physicians (PCPs) play a critical role as initial points of contact, facilitating early detection, management, and referral of these conditions. In Dubai, integrating mental health services into primary care faces unique challenges, highlighting the need for systemic reforms and enhanced PCP training. This study investigated perceptions, barriers, and systemic challenges encountered by PCPs in managing child and adolescent psychiatric conditions in Dubai's primary care setting. It also assessed family physicians' involvement and preparedness in this domain. Using a mixed-methods approach, we conducted a survey among family physicians in Dubai Health facilities and analyzed patient data from family medicine clinics. The survey evaluated formal training, preparedness, encounter frequency, and referral patterns for psychiatric care in young patients. Qualitative insights from open-ended survey questions provided additional understanding of specific challenges. Findings revealed significant gaps in formal training, with only 33.3% of respondents trained in child and adolescent psychiatry during medical education, and 21.1% participating in Continuing Medical Education (CME). A majority (54.4%) of PCPs felt unprepared to manage psychiatric care in young patients. Patient data analysis showed a predominance of male patients (59.9%) and identified Autism Spectrum Disorder (43.1%) as the most common condition, emphasizing the reliance on specialized care through a high referral rate (63.1%). Major barriers included time constraints, limited psychiatric knowledge, resistance to mental health services, systemic and structural issues, communication challenges, and resource shortages. Enhanced training and systemic reforms are urgently needed to integrate mental health services effectively into Dubai's primary care. Implementing structured collaborative care models, fostering interdisciplinary collaboration, and addressing systemic barriers are crucial for improving child and adolescent psychiatric condition management. These initiatives promise better patient outcomes and more efficient healthcare resource utilization.

Child and adolescent psychiatric disorders and ICD-11.

An important change in ICD-11 is the lifespan approach, whereby previous child and adolescent disorders have been amalgamated with adult disorders. There have been changes in the definition/descriptions of neurodevelopmental and disruptive disorders, some of which may have an impact on service development.

EMDR–Teens–cPTSD: Efficacy of Eye Movement Desensitization and Reprocessing in Adolescents with Complex PTSD Secondary to Childhood Abuse: A Case Series

Background: Mental healthcare for children and adolescents with a history of childhood abuse constitutes a major public health issue. Indeed, abuse exposes children to severe and complex post-traumatic stress disorder (cPTSD) but also to neurodevelopmental and psychological repercussions impacting the developmental trajectory. Trauma-focused care is essential to avoid the chronicization of symptoms and disorders. Objective: The aim of this prospective case series study was to investigate the efficacy of eye movement desensitization and reprocessing (EMDR) on complex post-traumatic symptoms and associated psychiatric disorders in adolescents with a history of abuse. Method: Twenty-two adolescents, aged 12 to 17, who had been abused during childhood were included. All adolescents met ICD-11 criteria for complex PTSD. Subjective measures of PTSD and associated psychiatric disorders were taken before (T0) and after 3 months of EMDR therapy (T1). Results: The average PTSD symptom score on the CPTS-RI significantly decreased from 40.2 to 34.4 after EMDR, indicating improvement in post-traumatic symptoms. A significant decrease in the average depression score (CDI from 18.2 at T0 to 10.6 at T1), anxiety score (R–CMAS from 21.3 at T0 to 13.3 at T1), emotional regulation score (ALS from 29 at T0 to 10.8 at T1), insomnia score (ISI from 18.5 at T0 to T1 of 9.2 at T1), and harmful use of alcohol and drugs score (ADOSPA from 2.3 at T0 to 0.3 at T1) was observed after EMDR therapy, as well as an increase in quality of life (CBCL 4–16 score from 57.9 at T0 to 77.4 at T1). Conclusions: The results of this study are encouraging and suggest that EMDR may be effective in the symptom management reducing post-traumatic symptoms and certain comorbid disorders frequently seen in adolescents who have experienced childhood abuse. Further research is needed on adolescent populations suffering from cPTSD (e.g., randomized controlled trials with control groups and other therapies or evaluating the action of the different phases of the study).

Violence in contact and custody proceedings-Acase of child endangerment in the family court-Where are efficient child protection measures?

Against the background of 30years of discussion in medicine and law about unfounded accusations and the existence of reasonable suspicion of intra-family violence in contact and custody proceedings, this article emphasises the importance of focusing on child protection by all professionals.Based on acase report in connection with the Federal Ministry of Justice's handout "Dealing with violence in custody and contact proceedings", the article describes the relevance of child protection in Austrian case law and the means by which it is undermined. In the name of science, ideological diagnoses are used instead of evidence-based treatment diagnoses [1]. "Professionals from the healthcare system, youth welfare, justice and education should cooperate in child protection with the aim of recognising, identifying and ending child abuse, maltreatment and/or neglect as such (cf. §3 KKG) [2]."In legal practice, however, practitioners in the psychosocial, psychosomatic and psychotherapeutic fields are often not recognised as witnesses because of the assumption they are influenced by parents or patients themselves. In Austria, the evaluation of evidence is the responsibility of the judge and it is often assumed that practitioners cannot take an objective position towards their patients and their relatives. Specialist medical or psychological experts are therefore of crucial importance. When taking their oath, they have committed themselves to objectivity and impartiality in the recording of findings and orientation towards scientific principles and standards ("state of the art") and their application, as well as to continuous further training and education in the preparation of expert opinions [3].The specific case in question is achild with adiagnosis of post-traumatic stress disorder following suspected sexualised violence, enuresis and enkopresis in connection with the traumatic experiences.The connection between violent situations and child and adolescent psychiatric disorders and the course of the custody and contact proceedings are described. Relevant legal interests such as the will of the child, the best interests of the child, attachment tolerance and protection against violence are addressed and put up for discussion. Topics such as domestic, psychological, sexualised, institutional violence and intimate terror are presented.The case report is an example of how child psychiatrists deal with points relevant to the Federal Ministry of Justice's handbook "Dealing with violence in custody and contact proceedings", which was published in January 2024. It represents aguideline for the area of court proceedings, assessment and treatment.

Perceived Parenting Styles and Parental Bonding among a Sample of Adolescents Attending Adolescents’ Psychiatry Clinic at Ain Shams University Hospital

Abstract Background Although family history of mental disorders is one of the most consistent and potent risk factors for mental disorders in offspring, both familial and non-familial environmental factors are thought to play a role in etiology. Many aspects of parenting, ranging from daily interactions to potentially traumatic experiences such as abuse and inter-parental conflict, may be not only mechanisms through which parental disorders confer increased risk to offspring but also independent risk factors for mental disorders. Aim of the Work Our study aimed to study perceived parenting styles among adolescents with different psychiatric disorders compared to adolescents without psychiatric disorder, study both maternal and paternal bonding among adolescents with different psychiatric disorders compared to adolescents without psychiatric disorder. Patients and Methods Our study was conducted in Ain Shams university hospital, precisely in the outpatient clinic of Okasha institute of psychiatry. We compared 50 adolescents diagnosed with different psychiatric disorders to 50 healthy adolescents. Participants were recruited from the outpatient clinic while a matched group of adolescents without psychiatric disorders was recruited from adolescents of employee working in Okasha institute of psychiatry. Results adolescents with different psychiatric disorders perceived their parents as more authoritarian, less authoritative. they also perceived their mothers as less permissive, while there was no significant difference between both groups regarding father's permissiveness. Low level of care and high level of overprotection were significantly correlated with all psychiatric disorders in the study group. Conclusion Pathogenic parenting styles characterized by high level of control and overprotection and low level of care are associated with wide range of psychiatric disorders in adolescents, while parenting styles characterized by high level of care seem to be protective against psychiatric disorders in adolescents.

Risk factor patterns define social anxiety subtypes in adolescents with brain and clinical feature differences.

Social anxiety disorder (SAD) is one of the most common psychiatric disorders in adolescents. The heterogeneity of both symptoms and etiology is an essential source of difficulties in the treatment and prevention of SAD. The study aimed to identify subtypes of adolescent SAD based on etiology-related phenotype dimensions and examine symptom and brain associations of the subtypes. We used a deeply phenotyped sample (47 phenotype subscales from 13 measures) of adolescents with SAD (n = 196) and healthy controls (n = 109) to extract etiology-relevant risk factors, based on which we identified subtypes of SAD. We compared the subtypes on clinical characteristics and brain morphometrics and functional connectivity, and examined subtype-specific links between risk factors, brain aberrance, and clinical characteristics. We identified six etiology-relevant risk factors and two subtypes of adolescent SAD. One subtype showed mainly elevated negative emotionality trait and coping style and diminished positive emotionality trait and coping style, while the other additionally had significantly high environmental risk factors, more severe impairments in social functioning, and significant abnormalities in brain structure and function. There were subtype-specific links between the risk factor profiles, brain aberrance, and clinical characteristics. The finding suggests two etiology-based subtypes of adolescent SAD, providing novel insights to the diversity of pathological pathways and precise intervention strategies.

Retrospective Evaluation of Adolescent Patients Presenting to the Emergency Department with Suicidal Attempt

Objective: Suicide attempts among adolescents are a major public health problem. It is important to understand the prevalence of suicide attempts in the adolescent population and the risk factors underlying the attempts so that the necessary precautions can be taken by health authorities. We therefore aimed to retrospectively evaluate the demographic and clinical characteristics of adolescent patients presented to the emergency department due to suicide attempts. Materials and Methods: This retrospective observational study included adolescent patients aged 10-19 years who presented to the emergency department for suicide attempt between August 01, 2018 and July 31, 2023. Ethics committee approval was obtained and data were collected from the hospital automation system through ICD codes. Demographic data, clinical characteristics, intervention methods, treatment processes and outcomes of the patients were analysed in detail. Results: Of the 126 patients included in the study, 80.2% were female, 19.8% were male, and the mean age was 184 months. 97.6% of the patients attempted suicide by ingestion of drugs or substances, and the rest of the patients preferred methods such as jumping from a height, firearm and sharp instrument use. Depression was the most common comorbid psychiatric disorder and was identified in 73.7% of the adolescents in the study. 42.1% of the patients presented to the emergency department with other complaints along with the suicide attempt. Treatments such as gastric lavage and activated charcoal were administered in the majority of admissions. Conclusions: This study reveals that suicide attempts are an important public health problem in the adolescent population and psychiatric disorders, especially depression, play a role in these attempts. It was observed that suicide attempts were more common among adolescent females. The findings emphasise the importance of early screening and interventions for the prevention and management of suicide attempts in adolescents. The findings of the study shed light on efforts to review and improve current management strategies and demonstrate the need for large-scale community-based studies.

Perceived parenting styles and bonding among adolescents with mental illness: Okasha Institute of Psychiatry experience

BackgroundWorldwide, at least 10% of adolescents have a documented mental illness, which is a leading source of morbidity, mortality, and functional impairment. Among individuals aged between 10 and 24 years, psychiatric disorders account for 45% of all years lived with disability. Parenting discipline styles are fundamental in shaping adolescents’ emotional integrity, cognitive capabilities, and behavioral patterns.To compare parenting styles and parental bonding dimensions in adolescents with different psychiatric disorders versus a group of healthy adolescents matched for age and sex.Patients and methodsA case–control study conducted at Okasha Institute of Psychiatry, Ain Shams University Hospitals, involved 50 participants of adolescents diagnosed with variable psychiatric disorders and 50 matched healthy controls.ResultsAuthoritarian parenting style was evident in mentally ill adolescents, while authoritative parenting style was prevalent in healthy controls. In terms of parental bonding, mentally ill adolescents experienced a low level of care and a high level of overprotection from both parents.ConclusionThe results of the study demonstrated that parenting styles may serve as predictors and predisposing factors for psychiatric disorders in adolescents. Adolescents with psychiatric disorders perceived both parents as more authoritarian, less authoritative. They also received a low level of care and a high level of overprotection from both parents.

Discriminant diagnostic validity of paediatric bipolar disorder screening tests: A systematic review and meta-analysis.

Bipolar disorders (BD) are among the most significantly impairing of childhood and adolescent psychiatric disorders. Although BD symptoms may begin in adolescence, they are frequently not diagnosed until adulthood, and accordingly BD scales could aid diagnostic assessment in paediatric populations. This review aims to synthesis the evidence for the accuracy of BD symptom index tests for discriminating BD from non-BD (other diagnoses or healthy controls) in paediatric population. Additionally, several theoretically relevant moderators of diagnostic accuracy were evaluated. A systematic search across three databases were conducted from 1980 to 2022, augmented by grey literature database searches, citation chaining and contacting authors. Data from eligible studies were synthesized using meta-analysis. A multilevel model was fitted to account for nested effect sizes, with 31 potential moderators examined in univariate and multivariate models. Twenty-Eight studies were eligible, yielding 115 effect sizes for analysis. Meta-analytic modelling indicated BD symptom index tests have a high diagnostic accuracy (g = 1.300; 95% CI: 0.982 - 1.619; p < .001) in paediatric population. Accuracy was relative to the type of comparison group, index test content, index test informant and index test's scale or subscale. Screening tests based on mania content, caregiver report and non-healthy comparison groups have clinical utility in identifying paediatric BD. Other informant-and-content combination may not accurately identify paediatric BD. Unlike healthy controls, tests derived from studies using non-healthy comparison groups, represent BD symptom non-specificity and BD symptom overlap with other disorders, providing external validity and clinical utility.

Trends in Mental Disorders in Children and Adolescents Receiving Treatment in the State Mental Health System

To examine recent trends in clinical diagnoses of children and adolescents receiving treatment in publicly funded mental health treatment services in the United States. Data on children and adolescents (≤17 years) receiving treatment from publicly funded mental health treatment services recorded in Mental Health Client-Level Data 2013-2021 (total number of records= 13,684,154) were used to examine temporal trends in the proportion of different child and adolescent psychiatric disorders. Trends were examined overall and in age, sex, racial/ethnic, and service strata focusing on community-based programs. The analyses revealed increases in the proportion of anxiety disorders from 9.6% in 2013 to 19.2% in 2021 (adjusted odds ratio [AOR] 2.17, 95% CI 1.85-2.55, p< .001), trauma- and stressor-related disorders from 22.7% to 27.4% (AOR 1.31, 95% CI 1.09-1.57, p= .004), and depressive disorders from 13.4% to 17.0% (AOR 1.20, 95% CI 1.03-1.41, p= .04). During this same period, the proportion of bipolar disorders declined almost 8-fold from 10.0% to 1.3% (AOR 0.07, 95% CI 0.06-0.09, p< .001). The proportion of conduct disorder and oppositional defiant disorder also declined from 9.7% to 4.4% (AOR 0.42, 95% CI 0.32-0.55, p< .001) and from 11.1% to 7.8% (AOR 0.79, 95% CI 0.65-0.98, p= .03), respectively. Trends varied across sex, age, and racial/ethnic strata. The composition of childhood psychiatric diagnoses in patients within publicly funded mental health treatment settings changed over the past decade. While some of the trends may reflect changes in diagnostic practices of clinicians, increases in anxiety and depressive disorders parallel trends in the prevalence of these conditions in the general population and highlight a growing need for identifying and treating these conditions in this age group.

The child and adolescent patient’s profiles and usefulness of instant collaborative video consultations of tele-psychiatrists with primary care doctors

Background: The Tele-Medicine Center at the National Institute of Mental Health and Neurosciences, Bengaluru, organized module-based capacity-building training courses for in-service primary care doctors (PCDs) with MBBS degree. The objective was to bolster the coverage of the National Mental Health Program services and diminish the treatment gap in the region. As part of this training, an instant collaborative video consultation (i-CVC) module allowed PCDs to engage in live, real-time video consultations with tele-psychiatrists at NIMHANS to discuss their patients’ cases. Approximately 7% of the i-CVC cases focused on child and adolescent psychiatric disorders. Aim: Aim of this study is understand the profiles of child and adolescent patients and usefulness of instant collaborative video consultations of tele-psychiatrists with primary care doctors. Materials and Methods: This study delved into data from 41 children and adolescents’ (aged 10–17 years) i-CVC module case proformas. It examined six predefined learning themes highlighted by PCDs and evaluated patientprofiles, along with diagnostic agreement between PCDs and tele-psychiatrists. Results: Among the 41 patients, there were 19 males (46.3%) and 22 females (53.7%), aged between 10 and 17 years. The study identified six key learning themes: clinical assessment, identification and diagnosis, counseling for children and parents, pharmacotherapy, and legal aspects. Emotional disorders were noted in 12 patients (29.3%), developmental disorders in eight patients (19.5%), psychotic disorders in eight patients (19.5%), and behavioral disorders in three patients (7.3%). Pharmacotherapy was initiated for five patients (12.2%), while 23 patients (56.1%) received counseling, and 13 patients (31.7%) received both treatments. Conclusion: Diagnostic agreement between PCDs and tele-psychiatrists was observed in 25 cases (61%). This study represents the first evaluation of the collaborative i-CVC module aimed at training PCDs in child and adolescent psychiatry in India. The 61% diagnostic agreement suggests the feasibility of PCD training. These findings underscore the pressing need for an Indianized, point-of-care manual in child and adolescent psychiatry to train PCDs throughout India.

Vitamin B12 and folate deficiencies, elevated homocysteine and their roles in the biochemical basis of neuropsychiatric diseases in children and adolescents: Case series, review and recommendations

Objective: Vitamin B12 and folate deficiencies can be frequently seen in children and adolescents and may manifest with neuropsychiatric symptoms. Vitamin B12 and folate deficiencies and the associated increase in homocysteine are related to one-carbon metabolism (OCM) and may play a role in the pathogenesis of childhood and adolescent psychiatric disorders. Therefore, a case series and review on OCM will be presented here. Method: Twelve cases with vitamin B12 and folate deficiency and increased homocysteine among those admitted to the child and adolescent psychiatry clinic were retrospectively examined. Results: It was found that vitamin B12 and folate deficiency and increased homocysteine may cause depressive symptoms, anxiety disorders, obsessive compulsive disorder, anger control problems, self-harming behaviors, suicidal thoughts, and attempts in children and adolescents. Conclusion: According to these data, vitamin B12 and folate deficiency and the resulting increase in homocysteine may cause psychiatric symptoms in some children and adolescents. In addition, literature on OCM has been reviewed. The diagnosis and treatment methods for vitamin B12 and folate deficiencies are summarized for clinicians.

Cannabidiol for Treatment of Child and Adolescent Psychiatric Disorders

Parents and patients have inquired about the safety and efficacy of cannabidiol (CBD) in treating child and adolescent mental health conditions. This review examines the current literature regarding CBD containing less than 0.3% tetrahydrocannabinol (THC) in treatment of childhood psychiatric disorders for youth 20 years and younger. Although there are several areas of growing interest for potential use of CBD, such as social anxiety disorder and autism spectrum disorder, the evidence base remains limited. Large-scale controlled trials are needed to determine the efficacy of CBD for treatment of child and adolescent psychiatric disorders. [ Psychiatr Ann . 2024;54(6):e186–e192.]

Unraveling Multimodal Brain Signatures: Deciphering Transdiagnostic Dimensions of Psychopathology in Adolescents

Adolescent psychiatric disorders arise from intricate interactions of clinical histories and disruptions in brain development. While connections between psychopathology and brain functional connectivity are studied, the use of deep learning to elucidate overlapping neural mechanisms through multimodal brain images remains nascent. Utilizing two adolescent datasets—the Philadelphia Neurodevelopmental Cohort (PNC, n = 1100) and the Adolescent Brain Cognitive Development (ABCD, n = 7536)—this study employs interpretable neural networks and demonstrates that incorporating brain morphology, along with functional and structural networks, augments traditional clinical characteristics (age, gender, race, parental education, medical history, and trauma exposure). Predictive accuracy reaches 0.37–0.464 between real and predicted general psychopathology and four psychopathology dimensions (externalizing, psychosis, anxiety, and fear). The brain morphology and connectivities within the frontoparietal, default mode network, and visual associate networks are recurrent across general psychopathology and four psychopathology dimensions. Unique structural and functional pathways originating from the cerebellum, amygdala, and visual‐sensorimotor cortex are linked with these individual dimensions. Consistent findings across both PNC and ABCD affirm the generalizability. The results underscore the potential of diverse sensory inputs in steering executive processes tied to psychopathology dimensions in adolescents, hinting at neural avenues for targeted therapeutic interventions and preventive strategies.