Psychiatric Problems In Adolescents Research Articles

The Use of Problem Solving Therapy in Psychiatric Problems in Adolescents and Psychiatric Nursing Approach

For a healthy development, individuals must have completely completed their own developmental stages in each period. Adolescence, which is one of these developmental periods, is a different and special period, separate from childhood and adulthood, in which many basic developmental characteristics are acquired. It is stated that psychiatric symptoms and disorders seen in adult life begin in early ages and the problem continues over the years. Problem-solving therapy is one of the methods that is increasingly used in the treatment of mental problems in adolescents today. For this reason, it is important in terms of eliminating the negative effects of the problems they encounter in adolescence and facilitating them to cope effectively by increasing their resilience to the problems in question.

Sex differences in the course of autistic and co-occurring psychopathological symptoms in adolescents with and without autism spectrum disorder.

There is an ongoing debate as to whether autism spectrum disorder (ASD) is expressed differently in women than men. Studies on sex differences in autistic symptoms and symptoms of other psychiatric problems present in individuals with autism generally do not include a general population comparison group, making it unclear whether differences are specific to autism or merely reflecting development in the general population. In this study, we compared sex differences in the course of autistic and at the same time present symptoms of other psychiatric problems in adolescents with milder forms of ASD to those in a group of the general population with an equal intelligence quotient (IQ) and socioeconomic status. Data of five assessment moments from ages 11 to 22 years were analyzed using a statistic procedure that allowed us to determine which factors affect the course of symptoms over time. We found that in adolescence, sex differences in the course of psychopathological symptoms specific for autism are confined to the repetitive stereotyped domains. Males had higher scores on the sensory/stereotypic and resistance to change domains, the latter difference disappeared during the course of adolescence due to an increase of these problems in autistic females. Other sex differences, among which an increase over time in mood and anxiety problems in females was the most outstanding, were also observed in females without autism. These sex-specific differences have relevance in the clinical care of autistic men and women, although they are subtle compared to differences between individuals with and without autism.

Do complex mixtures of prenatal environmental and social exposures explain variation in risk for behavioral symptoms in adolescence?

Background and Aim: Prenatal exposure to environmental chemicals is associated with behavioral symptoms of mental health. These symptoms often emerge across adolescence and frequently co-occur, suggesting shared etiologic pathways. Prenatal chemical exposures are often correlated with each other and with social exposures such as maternal demoralization that are also associated with elevated behavioral symptoms. We aimed to identify how complex patterns of prenatal co-exposure to chemicals and social factors are associated with symptoms of psychiatric outcomes common in adolescence, such as attention problems, substance abuse, and psychotic symptoms. Methods: We used exposure and behavioral symptoms data from the Columbia Center for Children’s Environmental Health Mothers and Newborns birth cohort (age 14-21). We use principal components pursuit (PCP) to decompose the exposure matrix into a low-rank matrix to identify consistent exposure patterns and a sparse matrix to isolate unique exposure events. To identify profiles of exposures (N=550), after running PCP, we used principal components analysis (PCA). We use multiple linear regression to test interactions between prenatal exposures and behavioral outcomes in adolescence (age 14-21) in N=253 participants. Results: We observed two subgroups of strong correlation among phthalate exposures and maternal demoralization. We identified similar patterns using PCA on the raw data. Prenatal Polycyclic Aromatic Hydrocarbons (PAH) exposure modified effects of early life stress (ELS) on underage alcohol use (interaction: z=1.95, p=.05). Relative to those with lower exposure, those with higher prenatal PAH and ELS had the highest risk for underage alcohol use. Conclusions: Variability in phthalates and maternal demoralization within the cohort describe unique profiles of exposure. PCP analysis will more precisely identify consistent and interpretable prenatal exposure patterns while dealing with data missingness and outliers. Interactions between prenatal chemical and social exposures increase risk for psychiatric problems in adolescence pointing to modifiable pathways to reduce risk.

Emotion Recognition in Preterm and Full-Term School-Age Children.

Children born preterm (<37 weeks’ gestation) show a specific vulnerability for socio-emotional difficulties, which may lead to an increased likelihood of developing behavioral and psychiatric problems in adolescence and adulthood. The accurate decoding of emotional signals from faces represents a fundamental prerequisite for early social interactions, allowing children to derive information about others’ feelings and intentions. The present study aims to explore possible differences between preterm and full-term children in the ability to detect emotional expressions, as well as possible relationships between this ability and socio-emotional skills and problem behaviors during everyday activities. We assessed 55 school-age children (n = 34 preterm and n = 21 full-term) with a cognitive battery that ensured comparable cognitive abilities between the two groups. Moreover, children were asked to identify emotional expressions from pictures of peers’ faces (Emotion Recognition Task). Finally, children’s emotional, social and behavioral outcomes were assessed with parent-reported questionnaires. The results revealed that preterm children were less accurate than full-term children in detecting positive emotional expressions and they showed poorer social and behavioral outcomes. Notably, correlational analyses showed a relationship between the ability to recognize emotional expressions and socio-emotional functioning. The present study highlights that early difficulties in decoding emotional signals from faces may be critically linked to emotional and behavioral regulation problems, with important implications for the development of social skills and effective interpersonal interactions.

Psychiatric Problems in Adolescence Mediate the Association Between Childhood Learning Disabilities and Later Well-Being

This follow-up study investigated the associations of childhood learning disabilities (LDs) with adult-age anxiety, depression, and unemployment. Psychosocial problems in childhood and psychiatric diagnoses and lack of education in adolescence were studied as potential mediators, and gender and mother’s education were studied as potential moderators of these associations. Data on childhood clinical neuropsychological assessments and lifelong register data on individuals with childhood LD ( n = 430; 301 [70%] males; 20–39 years of age) and matched controls ( n = 2,149) were applied. Mediation analyses were performed using structural equation modeling. Childhood LDs exerted a significant, but relatively small effect on psychiatric diagnoses in adolescence, which predicted adult-age depression and anxiety. Learning disabilities were related to unemployment both directly and via psychiatric diagnoses in adolescence. Examination of differences in the effects on adult-age outcomes of subtypes of LDs revealed mathematical disability to be more strongly associated with psychosocial problems in childhood and psychiatric problems in adolescence and adulthood than reading disability. Our findings show that LD has small and mostly indirect effects on the risk for later well-being problems. The findings emphasize the importance of adolescence in predicting adult-age psychiatric and employment problems and call for more holistic support for individuals with LDs.

Self-Concept, Depression, and Anxiety Levels of Adolescents with Polycystic Ovary Syndrome.

In this study we explored the level and severity of issues related to self-concept, depression, and anxiety in adolescents with polycystic ovary syndrome (PCOS). Cross-sectional and case-control study. The research was conducted in the outpatient Pediatric Endocrinology Clinic of Adiyaman University School of Medicine in Turkey. The study population comprised 153 patients with PCOS and 161 healthy adolescents. The Personal Information Form, State-Trait Anxiety Inventory for Children, Children's Depression Inventory, and Piers-Harris Children's Self-Concept Scale were administered to all of the participants who took part in the study. The Piers-Harris Children's Self-Concept Scale scores were lower in the PCOS group than in the control group (P<.001). In addition, the scores for the Children's Depression Inventory were also significantly higher in the PCOS group (P<.001). The State-Trait Anxiety Inventory for Children scores showed statistically significant higher levels of state anxiety and trait anxiety in the PCOS group (P<.001). Adolescents with PCOS had lower self-concept scores, greater anxiety levels, and increased depressive symptoms than the healthy controls. Future studies are needed to examine the psychiatric problems in adolescents with PCOS.

The emotional and psychiatric problems of adolescents on parole whose parents are substance users: A Brazilian cross-sectional study.

The aim of this study is to evaluate the associations between having parents with substance use problems, and having suffered neglect within the family, and behavioral problems (psychological and drug use) among adolescents. All the participants were enrolled on the socio-educational parole scheme, 'Assisted Freedom'. In this cross-sectional study, 150 adolescents were interviewed using the Drug Abuse Screening Test, Teen Addiction Severity Index, and Childhood Trauma Questionnaire. Ninety-five percent of the participants were male (n = 143), aged 13-17. Thirty percent of adolescents had a parent who used substances and had experienced neglect from their families. Those adolescents who were living with both parents (odds ratio adjusted (ORA) = 2.7, 95% confidence interval (CI) = 1.13-6.37), from a low-income family (ORA = 6.7, 95% CI = 1.85-24.22), experienced hallucinations (ORA = 2.8, 95% CI = 1.25-6.14), had problems controlling violent behavior (ORA = 2.6, 95% CI = 1.12-5.87), and were physically neglected (ORA = 3.0, 95% CI = 1.24-7.49) were more likely to have parents who used substances and to have experienced parental neglect. This article concludes that adolescents, who are on parole, come from families with high level of psychosocial vulnerabilities, including substance use, experience neglect by their families leading to adverse emotional and psychological states.

Effectiveness of trauma-focused treatment for adolescents with major depressive disorder

ABSTRACT Background: Major Depressive Disorder (MDD) in adolescence has a high prevalence and risk of disability, but current treatments show limited effectiveness and high drop-out and relapse rates. Although the role of distressing experiences that relate to the development and maintenance of MDD has been recognized for decades, the efficacy of a trauma-focused treatment approach for MDD has hardly been studied. Objective: To determine the effectiveness of eye movement desensitization and reprocessing (EMDR) therapy as a stand-alone intervention in adolescents diagnosed with MDD. We hypothesized that reprocessing core memories related to the onset and maintenance of MDD using EMDR therapy would be associated with a significant decrease in depressive and comorbid symptoms. Method: We recruited 32 adolescents (12–18 years) fulfilling DSM-IV criteria for mild to moderate-severe MDD from an outpatient youth mental health care unit. Treatment consisted of six weekly 60-min individual sessions. Presence or absence of MDD classification (ADIS-C), symptoms of depression (CDI), symptoms of posttraumatic stress (UCLA), anxiety (SCARED), somatic complaints (CSI), and overall social-emotional functioning (SDQ) were assessed pre and post-treatment and 3 months after treatment. Results: 60.9% of the adolescents completing treatment no longer met DSM-IV criteria for MDD after treatment anymore, and 69.8% at follow-up. Multilevel analyses demonstrated significant posttreatment reductions of depressive symptoms (CDI: Cohen’s d = 0.72), comorbid posttraumatic stress, anxiety and somatic complaints, while overall social-emotional functioning improved. These gains were maintained at 3-month follow-up (Cohen’s d = 1.11). Severity of posttraumatic stress reactions significantly predicted the posttreatment outcome; however, duration of MDD, number of comorbid disorders, or having a history of emotional abuse, emotional neglect or physical neglect were not predictive for outcome. Conclusions: This is the first study suggesting that EMDR therapy is associated with a significant reduction of depressive symptoms and comorbid psychiatric problems in adolescents with mild to moderate-severe MDD.

Prevalence of psychiatric problems in school going adolescents (10-19 years)

Background: The period of adolescence is of immense importance in life of an individual. Adolescents are exceedingly vulnerable to psychiatric disorders. This study intended to explore prevalence and decoration of psychiatric problem in adolescents. Aims and Objective: The objective of this research was to study encumbrance and nature of psychiatric problems in school going adolescents in defined geographical area and their psychological correlates. Material &amp; Method: A school based cross sectional study was conducted in month of July-August, 2018 in north India. In this study 1025 students in age group of 10-19 years from ten schools of north India participated. Screening was done by childhood psychopathological measurement schedule (CPMS) followed by detailed evaluation by ICD-10 criteria. Statistical analysis was done by chi-square test and percentage. Result: CPMS score ≥10 were observed in 289 (28.2%) students, with more common in mid adolescence and lower socioeconomic strata, working mother, single parents. Prevalence of psychiatric problems in adolescents according to ICD-10 criteria was found to be 20.8%. Conclusion: The alarming numbers of our adolescents suffer from psychiatric problems. There is need to raise public awareness about the prevalence of these often-hidden psychopathy in Indian adolescents

The Effects of Tobacco Smoking, and Prenatal Tobacco Smoke Exposure, on Risk of Schizophrenia: A Systematic Review and Meta-Analysis.

The association between cigarette smoking and schizophrenia is well established. However, up to 90% of people with schizophrenia begin smoking before the onset of their illness; thus, smoking could be an independent risk factor for schizophrenia. Prenatal exposure to maternal cigarette smoke is also associated with psychiatric problems in adolescence. Therefore, our aim was to undertake a systematic review and meta-analysis to explore the effect of smoking, and prenatal smoke exposure, on risk of schizophrenia. We systematically searched Medline, EMBASE, PsychInfo, Maternity and Infant Care, and Web of Science (from inception to February 2018) to identify comparative observational studies of the risk of schizophrenia in relation to smoking status. Measures of relative risk (RR) were pooled in a meta-analysis with 95% confidence intervals (CI), using random effects model. Twelve studies (9 cohort, 3 case-control) were included. Odds ratios (OR) and hazard ratios (HR) were pooled together to estimate pooled relative risks and estimates combined in a meta-analysis on an assumption of constant risk over time. Smokers had a significantly increased risk of schizophrenia compared with nonsmokers (RR = 1.99, 95% CI = 1.10% to 3.61%, I2 = 97%, 5 studies). Exposure to prenatal smoke increased the risk of schizophrenia by 29% (95% CI = 1.10% to 1.51%, I2 = 71%, 7 studies). Sensitivity analyses identified no significant differences between the results from studies reporting OR and hazard ratio. Our findings suggest smoking, and prenatal smoke exposure, may be an independent risk factor for schizophrenia. Care should be taken when inferring causation, given the observational nature of the studies. In this meta-analysis of 12 studies, smokers had a significantly increased risk of schizophrenia compared with nonsmokers. Exposure to prenatal tobacco smoke also increased the risk of schizophrenia by 29% compared with those with no exposure to prenatal tobacco smoke. Our findings suggest that smoking, and prenatal tobacco smoke exposure, may be independent risk factors for schizophrenia. These results may have important public health implications for decreasing the incidence of schizophrenia. The possibility of a causal link between smoking and schizophrenia warrants further investigation.

Reliability and Validity of the Early Trauma Inventory Self Report-Short Form among Korean Adolescents.

Objectives:Experiencing early childhood trauma is related to multiple psychiatric problems in adolescents and adulthood. This study aimed to examine the reliability and validity of the Korean version of the Early Trauma Inventory Self Report-Short Form (ETISR-SF) among Korean adolescents.Methods:A total of 86 adolescents aged 12–17 years (mean age 14.50±1.35 years, range 12–17) were assessed using the ETISR-SF. Other instruments, including the Children’s Depression Inventory (CDI), the revised Children’s Manifest Anxiety Scale (RCMAS), and the List of Threatening Experiences Questionnaire (LTE-Q), were used to assess clinical symptoms. After 2 months, 51 of the 86 participants were evaluated using the ETISR-SF to assess test-retest reliability.Results:The Cronbach’s coefficient alpha for the ETISR-SF was high (0.803). Adolescents with depressive disorder showed higher ETISR-SF scores compared to healthy controls. The ETISR-SF scores were correlated higher with the scores on the LTE-Q (r=0.485) than with the scores on the CDI or RCMAS (r=0.165 and 0.347, respectively).Conclusion:The ETISR-SF was temporally stable, showing acceptable reliability (r=0.776). These findings suggest that the Korean version of the ETISR-SF appears to be a reliable and valid instrument for the measurement of reported childhood trauma.

Anxiety-anger relationship in hyperandrogenemia: a comparative study with polycystic ovary syndrome (PCOS) and healthy control adolescents

Objective: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders. It is well established that adult women with PCOS suffer from reduced quality of life, depression, and anxiety. But psychiatric problems of adolescents with PCOS are not adequately addressed in studies although the potential role of hyperandrogenemia and high levels of testosterone in inducing anger and anxiety are known. In this study, we aimed to examine the relationship between anger and anxiety in adolescents with PCOS compared to the healthy controls. Methods: 28 adolescents with PCOS and 16 healthy adolescents were recruited to the study. The State-Trait Anxiety Inventory (STAI I-II) and The Trait Anger and Anger Expressions Scale were administered to all adolescents. Results: Our results indicated that anxiety and anger types, except for internalized anger, were higher and anger control was lower in adolescents with PCOS than controls. Also state and trait anxiety were negatively associated with anger control in adolescents with PCOS, while there were no such associations in healthy controls. Conclusions: In this present study, we demonstrated that, there was a unique relationship between anxiety and anger in adolescents with PCOS than controls. This could be a consequence of chronic hyperandrogenemia and both medical and psychiatric treatment could prevent adolescents with PCOS from anxiety.

A cross-sectional study on depression among school going adolescent girls in Barabanki district, Uttar Pradesh, India

Background: Depression is one of the common and ignorant psychiatric problems in adolescents now days. It has profound adverse effect on their physical as well as mental health. The objective of this study was to study the prevalence of depression among school going adolescent girls.Methods: A cross sectional study was conducted among 336 school going adolescent girls in Barabanki district from June 2016 to September 2016. Multistage sampling was used to enroll the study subjects. Bio-social parameters such as age, socioeconomic status etc. were assessed by direct interview of adolescent girl as well as its confirmation with school records. Six items KADS (Kutcher Adolescent Depression Scale) was used for assessment of depression among adolescent girl.Results: Out of 336 adolescent girls screened 18.7% were found positive for depression. Lower socio-economic status was found as one of the independent predictor of depression. Girls belonging to lower socioeconomic groups (odds ratio ([OR] 2.08; 95% confidence interval [CI] 1.18-3.21; p = 0.03) were more susceptible for depression. However on multiple logistic regression no statistical association was observed between depression with respect to age group, class, religion, caste and mothers education, and type of family (p&gt;0.05).Conclusions: The study highlights need for timely diagnosis and treatment of problem through school based periodic screening programmes. There is also need of increasing awareness among teachers and parents about depression.

Early-Term Birth in Single-Ventricle Congenital Heart Disease After the Fontan Procedure: Neurodevelopmental and Psychiatric Outcomes

To investigate the long-term impact of early-term birth (37-38 weeks' gestation) relative to full-term birth (≥39 weeks' gestation) on neurodevelopmental and psychiatric outcomes in adolescents with single-ventricle congenital heart disease (CHD). This cross-sectional cohort study analyzed retrospective medical records from full term adolescents with single-ventricle CHD who underwent the Fontan procedure. Participants underwent neurodevelopmental and psychiatric evaluations, as well as structural brain magnetic resonance imaging. Early-term born adolescents were compared with full-term born adolescents using regression models with adjustments for family social status, birth weight, and genetic abnormality status. Medical and demographic risk factors were examined as well. Compared with the full-term group (n = 100), adolescents born early term (n = 33) scored significantly worse on daily-life executive functions, as measured by the Behavior Rating Inventory of Executive Function parent-report (mean scores: early term, 62.0 ± 10.9; full-term, 55.6 ± 12.2; P = .009) and self-report (P = .02) composites. Adolescents born early term were more likely than those born full term to have a lifetime attention-deficit/hyperactivity disorder (ADHD) diagnosis (early term, 55%; full term, 26%; P = .001). The early-term group also displayed greater psychiatric symptom severity, as indicated by the clinician-reported Brief Psychiatric Rating Scale (mean score: early term, 16.1 ± 8.6; full-term, 12.5 ± 8.2; P = .007). Early-term birth is associated with greater prevalence of executive dysfunction, ADHD diagnosis, and psychiatric problems in adolescents with single-ventricle CHD. Early-term birth should be included as a potential risk factor in the algorithm for closer developmental surveillance in CHD.

Borderline personality disorder associates with violent criminality in women: A population based follow-up study of adolescent psychiatric inpatients in Northern Finland

Various psychiatric problems in adolescence and early adulthood have been shown to associate with criminal behaviour. In this study the association of personality disorders (PDs) with criminal behaviour was examined in adolescents treated in psychiatric hospitals.The study sample consisted of 508 adolescents (age 13–17) admitted to acute psychiatric impatient care between April 2001 and March 2006. Crime data was obtained from the Finnish Legal Register Centre on September 2013. The Schedule for Affective Disorder and Schizophrenia for School-Age Children Present and Lifetime (K-SADS-PL) was used to assess psychiatric diagnoses in adolescence. The information on PDs in early adulthood was based on follow-up information on psychiatric treatments in either out- or inpatient settings until the end of 2012, and was extracted from the National Care Register for Health Care provided by the Finnish National Institute for Health and Welfare.A total of 22 (39%) of the 57 subjects with PD had committed a crime. In women, the likelihood for violent criminality was significantly increased in those with Borderline PD (OR 6.09, CI 1.24–29.84, p=0.009) and was also associated with conduct disorder (OR 4.26, CI 1.38–13.19, p=0.012), child welfare placement (OR 11.82, CI 3.61–38.76, p<0.001) and parent's substance use disorder (OR 7.74, CI 2.30–26.10, p=0.001). In men, no association was observed between PD and any kind of criminal behaviour. Significant predictors for violent criminality in males were conduct disorder (OR 4.05, CI 1.75–9.38, p=0.001), substance use disorder (OR 2.51, CI 1.22–5.17, p=0.012) and special services at school (OR 2.58, CI 1.16–5.76, p=0.021).Females with Borderline PD showed an increased risk for violent offending. This suggests Borderline PD as a potential explanatory factor for violent assaults by females and highlights the importance of recognizing the risk for violence in young women with a Borderline PD.

The Validity of the Health-Relevant Personality Inventory (HP5i) and the Junior Temperament and Character Inventory (JTCI) Among Adolescents Referred for a Substance Misuse Problem

The aim was to study the validity of 2 personality instruments, the Health-Relevant Personality Inventory (HP5i) and the Junior Temperament and Character Inventory (JTCI), among adolescents with a substance use problem. Clinical interviews were completed with 180 adolescents and followed up after 12 months. Discriminant validity was demonstrated in the lack of correlation to intelligence in both instruments’ scales. Two findings were in support of convergent validity: Negative affectivity (HP5i) and harm avoidance (JTCI) were correlated to internalizing symptoms, and impulsivity (HP5i) and novelty seeking (JTCI) were correlated to externalizing symptoms. The predictive validity of JTCI was partly supported. When psychiatric symptoms at baseline were controlled for, cooperativeness predicted conduct disorder after 12 months. Summarizing, both instruments can be used in adolescent clinical samples to tailor treatment efforts, although some scales need further investigation. It is important to include personality assessment when evaluating psychiatric problems in adolescents.

The persistence and stability of psychiatric problems in adolescents with autism spectrum disorders

Psychiatric problems are common in autism spectrum disorders (ASDs), but the reasons are poorly understood. We use a longitudinal population-representative cohort to examine for the first time the persistence of psychiatric problems and to identify risk factors for their occurrence and stability. Eighty-one 16-year olds (75 male, six female), initially seen at 12 years, were re-assessed using the parent-report Strengths and Difficulties Questionnaire (SDQ). Child, family and contextual characteristics from age 12 were tested as risk factors for psychopathology. Prevalence rates varied depending on whether general population or ASD-specific SDQ cut-offs were used. While the former suggested a decrease in psychiatric problems over time, the ASD-specific cut-offs showed no significant differences. With the exception of ADHD, the ASD-specific cut-offs identified a smaller proportion of individuals as 'affected' than did the general population cut-offs. There was longitudinal domain specificity, with parent correlations ranging from 0.50 to 0.58 and teacher SDQ reports at age 12 correlating 0.33-0.53 with parent reports at 16 years. In examining the role of risk factors, lower IQ and adaptive functioning predicted higher hyperactivity and total difficulties scores. Greater emotional problems at 16 were predicted by poorer maternal mental health, family-based deprivation and lower social class. Improvement from 12 to 16 years in conduct problems was predicted by greater neighbourhood deprivation and special school attendance. This is the first longitudinal study of other psychiatric symptoms in ASD. Additional psychiatric problems in ASD are persistent and domain-specific from childhood to adolescence. The finding that age-related reduction in SDQ symptoms does not apply when ASD-specific cut-offs are used requires further evaluation using diagnostic measures. Only a few of the expected risk factor-psychopathology predictions expected from general population studies were found, raising the possibility that the causes of psychopathology in ASD differ from those in the general population.

Assessment and intervention of psychiatric problems in adolescents experiencing Typhoon Morakot

Assessment and intervention of psychiatric problems in adolescents experiencing Typhoon Morakot

Multi-informant reports of psychiatric symptoms among high-functioning adolescents with Asperger syndrome or autism

The aim of the study was to examine psychiatric symptoms in high-functioning adolescents with autism spectrum disorders reported by multiple informants. Forty-three 11- to 17-year-old adolescents with Asperger syndrome (AS) or high-functioning autism (HFA) and 217 typically developed adolescents completed the Youth Self-Report (YSR), while their parents completed the Child Behavior Checklist (CBCL). Teachers of adolescents with AS/HFA completed the Teacher Report Form (TRF). The informants reported significantly more psychiatric symptoms, especially withdrawn, anxious/depressed, social and attention problems, in adolescents with AS/HFA than in controls. In contrast to findings in the general population, the psychiatric problems of adolescents with AS/HFA are well acknowledged by multiple informants, including self-reports. However, anxiety and depressive symptoms were more commonly reported by adolescents with AS/HFA and their teachers than their parents, indicating that some emotional distress may be hidden from their parents.

Psychiatric manifestations revealing inborn errors of metabolism in adolescents and adults

Inborn errors of metabolism (IEMs) may present in adolescence or adulthood as a psychiatric disorder. In some instances, an IEM is suspected because of informative family history or because psychiatric symptoms form part of a more diffuse clinical picture with systemic, cognitive or motor neurological signs. However, in some cases, psychiatric signs may be apparently isolated. We propose a schematic classification of IEMs into three groups according to the type of psychiatric signs at onset. Group 1 represents emergencies, in which disorders can present with acute and recurrent attacks of confusion, sometimes misdiagnosed as acute psychosis. Diseases in this group include urea cycle defects, homocysteine remethylation defects and porphyrias. Group 2 includes diseases with chronic psychiatric symptoms arising in adolescence or adulthood. Catatonia, visual hallucinations, and aggravation with treatments are often observed. This group includes homocystinurias, Wilson disease, adrenoleukodystrophy and some lysosomal disorders. Group 3 is characterized by mild mental retardation and late-onset behavioural or personality changes. This includes homocystinurias, cerebrotendinous xanthomatosis, nonketotic hyperglycinaemia, monoamine oxidase A deficiency, succinic semialdehyde dehydrogenase deficiency, creatine transporter deficiency, and alpha and beta mannosidosis. Because specific treatments should be more effective at the 'psychiatric stage' before the occurrence of irreversible neurological lesions, clinicians should be aware of atypical psychiatric symptoms or subtle organic signs that are suggestive of an IEM. Here we present an overview of IEMs potentially revealed by psychiatric problems in adolescence or adulthood and provide a diagnostic strategy to guide metabolic investigations.