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Hameed RA, Hoel AT, Diseth TH, Bjørnland K, Gjone H. Mental Health, Psychosocial Functioning, and Quality of Life in Adolescents With Hirschsprung Disease. J Pediatr Surg 2024; 59:1037-1043. [PMID: 38369401 DOI: 10.1016/j.jpedsurg.2024.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 01/10/2024] [Accepted: 01/22/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Studies of mental health in adolescents with Hirschsprung disease (HD) are scarce. This cross-sectional study investigates mental health, psychosocial functioning and quality of life in HD adolescents. METHODS Adolescents (12-18 years) treated at the Department of pediatric surgery at Oslo University Hospital were invited for participation. Mental health was assessed by interview; Child Assessment Schedule (CAS) and questionnaires; parental Child Behavior Checklist (CBCL) and adolescent Youth Self-Report (YSR). Psychosocial functioning was rated by Child Global Assessment Scale (cGAS). Adolescent Quality of Life was assessed by Pediatric Quality of Life inventory (PedsQL) and chronic family difficulties (CFD) by interview. Medical records were reviewed for somatic history. RESULTS Thirty-seven adolescents, 28 males, median age 14.3 years, participated. By CAS interview, 8 of 37 (44% of females and 14% of males) fulfilled criteria for psychiatric diagnosis all within emotional and related disorders. Twenty-seven percent had CBCL internalizing scores and 16% had YSR internalizing scores in clinical range indicating emotional problems. By interviewer rated cGAS, 27% were scored in clinical range. By PedsQL 16% reported reduced psychosocial health score. Increased CFD, lower psychosocial functioning and reduced QoL as well as less paternal education were significantly associated with psychiatric diagnosis. Twice as many (4/8) adolescents who either had a stoma or bowel management had a psychiatric diagnosis compared to those who had neither stoma nor bowel management (7/28). CONCLUSION Nearly one in four adolescents with HD fulfilled criteria for psychiatric diagnosis. Mental health problems were associated with reduced psychosocial function and reduced QoL. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Rania Adel Hameed
- Department of Child and Adolescent Mental Health in Hospitals, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway; Department of Child and Adolescent Psychiatry, Innlandet Hospital Trust, Gjøvik, Norway.
| | - Anders Telle Hoel
- Department of Pediatric Surgery, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Trond H Diseth
- Department of Child and Adolescent Mental Health in Hospitals, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kristin Bjørnland
- Department of Pediatric Surgery, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Helene Gjone
- Department of Child and Adolescent Mental Health in Hospitals, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
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Børge M, Yngvild A. User satisfaction with child and adolescent mental health services: the association between user satisfaction and clinical outcomes. BMC Psychiatry 2024; 24:279. [PMID: 38622603 PMCID: PMC11017671 DOI: 10.1186/s12888-024-05715-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 03/25/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND This study aimed to examine the association between user satisfaction and clinical outcomes with child and adolescent mental health services (CAMHS) from the perspective of young people and their parents. The evidence bases for CAMHS user satisfaction measures are limited, with few studies investigating the link between user satisfaction and clinical outcomes. In particular, the perspectives of young people are missing. METHODS The parent and youth versions of the Experience of Service Questionnaire (ESQ), which evaluates the factors of general satisfaction (GS), satisfaction with care (SWC) and satisfaction with environment (SWE), were used to measure user satisfaction. The outcome measures were scores on the Strengths and Difficulties Questionnaire (SDQ), Children's Global Assessment Scale (CGAS), and Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA). Hierarchical regression analysis was conducted on data collected from 233 young people and 495 parents who utilized CAMHS services. RESULTS GS and SWC predicted outcomes for both young people (ΔR2 = 0.08, p <.05) and parents (ΔR2 = 0.01, p <.05), indicating that user satisfaction had a significant impact on clinical outcomes for CAMHS users. In addition, GS and SWC significantly predicted young people-reported outcomes in the interaction model (ΔR2 = 0.10, p <.05), while no significant association was found with parent-reported outcomes (ΔR2 = 0.02, p =.09). CONCLUSION User satisfaction, particularly for young people, has a significant impact on clinical outcomes. The causal relationship between user satisfaction and mental health outcomes requires further study.
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Affiliation(s)
- Mathiassen Børge
- Department of Child and adolescent psychiatry, University Hospital of North Norway, Postboks 43, 9038, Tromsø, Norway.
- Department of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway.
| | - Arnesen Yngvild
- Department of Child and adolescent psychiatry, University Hospital of North Norway, Postboks 43, 9038, Tromsø, Norway
- Department of Psychology, UiT The Arctic University of Norway, Tromsø, Norway
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Grigore B, Peters J, Williams J, Russell G, Coles P, Visintin C, Rogers M, Hayward R, Zhelev Z, Logan S, Hyde C. Screening for Autism Spectrum Disorder in Young Children: Still Not Enough Evidence. J Prim Care Community Health 2024; 15:21501319241263223. [PMID: 39077980 PMCID: PMC11289826 DOI: 10.1177/21501319241263223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 05/16/2024] [Accepted: 06/01/2024] [Indexed: 07/31/2024] Open
Abstract
BACKGROUND Early detection of autism spectrum disorder (ASD) has the potential to significantly reduce the impact of the condition, however previous reviews have found little evidence to support screening programs for ASD in young children. METHODS We conducted a review with the aim of updating evidence on 3 aspects: (a) diagnostic stability of ASD in young children; (b) accuracy of ASD screening tools in young children; and (c) the benefits of early interventions in screen-detected young children with ASD. RESULTS A total of 33 studies were included in our review. Five studies looking at diagnostic stability reported estimates ranging from 71.9% to 100%, however the majority only included a follow-up of 24 months and all studies raised concerns regarding the risk of bias due particularly to lack of blinding, sample size, and patient flow. A total of 25 studies, reported in 26 articles, were identified that reported accuracy data on 11 screening tools. Most of the reports were concerned with versions of M-CHAT, reporting sensitivity estimates from 0.67 to 1.0; however, many of these were deemed to be of high risk of bias due to lack of blinding and follow-up. Four studies reported on early interventions in screen-detected children; however, the majority did not find significant improvements on the relevant outcomes. CONCLUSIONS Overall, the evidence on screening for ASD in young children captured by this review is not conclusive regarding the 3 aspects of screening in this population. Future studies should attempt to ensure blinded diagnostic assessments, include longer follow-up periods and limit attrition.
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Späth Z, Tmava-Berisha A, Fellendorf FT, Stross T, Maget A, Platzer M, Bengesser SA, Häussl A, Zwigl I, Birner A, Queissner R, Stix K, Wels L, Lenger M, Dalkner N, Zelzer S, Herrmann M, Reininghaus EZ. Vitamin D Status in Bipolar Disorder. Nutrients 2023; 15:4752. [PMID: 38004146 PMCID: PMC10674170 DOI: 10.3390/nu15224752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 11/08/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
Vitamin D status may impact acute affective symptomatology and the severity of symptoms in patients with bipolar disorder (BD). Therefore, this cross-sectional study analyzed 25(OH)D, 24,25(OH)2D, and the vitamin D metabolite ratio (VMR) in BD and correlated the results with clinical affective symptomatology and functionality. The inactive precursor 25(OH)D, and its principal catabolite 24,25(OH)2D, were measured simultaneously with a validated liquid chromatography-tandem mass spectrometry method in 170 BD outpatients and 138 healthy controls. VMR was calculated as follows: VMR = 100×(24,25(OH)2D/25(OH)D). The psychometric assessment comprised: Beck Depression Inventory-II, Hamilton Depression Rating Scale, Young Mania Rating Scale, Global Assessment of Functioning, and number of suicide attempts. We did not find a significant difference between patients and controls in the concentrations of 25(OH)D and 24,25(OH)2D. Additionally, the VMR was comparable in both groups. The calculations for the clinical parameters showed a negative correlation between the Young Mania Rating Scale and 24,25(OH)2D (r = -0.154, p = 0.040), as well as the Young Mania Rating Scale and the VMR (r = -0.238, p = 0.015). Based on the small effect size and the predominantly euthymic sample, further exploration in individuals with manic symptoms would be needed to confirm this association. In addition, long-term clinical markers and an assessment in different phases of the disease may provide additional insights.
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Affiliation(s)
- Zita Späth
- Clinical Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria; (Z.S.); (F.T.F.); (T.S.); (A.M.); (M.P.); (S.A.B.); (A.H.); (I.Z.); (A.B.); (R.Q.); (K.S.); (L.W.); (M.L.); (N.D.); (E.Z.R.)
| | - Adelina Tmava-Berisha
- Clinical Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria; (Z.S.); (F.T.F.); (T.S.); (A.M.); (M.P.); (S.A.B.); (A.H.); (I.Z.); (A.B.); (R.Q.); (K.S.); (L.W.); (M.L.); (N.D.); (E.Z.R.)
| | - Frederike T. Fellendorf
- Clinical Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria; (Z.S.); (F.T.F.); (T.S.); (A.M.); (M.P.); (S.A.B.); (A.H.); (I.Z.); (A.B.); (R.Q.); (K.S.); (L.W.); (M.L.); (N.D.); (E.Z.R.)
| | - Tatjana Stross
- Clinical Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria; (Z.S.); (F.T.F.); (T.S.); (A.M.); (M.P.); (S.A.B.); (A.H.); (I.Z.); (A.B.); (R.Q.); (K.S.); (L.W.); (M.L.); (N.D.); (E.Z.R.)
| | - Alexander Maget
- Clinical Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria; (Z.S.); (F.T.F.); (T.S.); (A.M.); (M.P.); (S.A.B.); (A.H.); (I.Z.); (A.B.); (R.Q.); (K.S.); (L.W.); (M.L.); (N.D.); (E.Z.R.)
| | - Martina Platzer
- Clinical Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria; (Z.S.); (F.T.F.); (T.S.); (A.M.); (M.P.); (S.A.B.); (A.H.); (I.Z.); (A.B.); (R.Q.); (K.S.); (L.W.); (M.L.); (N.D.); (E.Z.R.)
| | - Susanne A. Bengesser
- Clinical Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria; (Z.S.); (F.T.F.); (T.S.); (A.M.); (M.P.); (S.A.B.); (A.H.); (I.Z.); (A.B.); (R.Q.); (K.S.); (L.W.); (M.L.); (N.D.); (E.Z.R.)
| | - Alfred Häussl
- Clinical Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria; (Z.S.); (F.T.F.); (T.S.); (A.M.); (M.P.); (S.A.B.); (A.H.); (I.Z.); (A.B.); (R.Q.); (K.S.); (L.W.); (M.L.); (N.D.); (E.Z.R.)
| | - Ina Zwigl
- Clinical Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria; (Z.S.); (F.T.F.); (T.S.); (A.M.); (M.P.); (S.A.B.); (A.H.); (I.Z.); (A.B.); (R.Q.); (K.S.); (L.W.); (M.L.); (N.D.); (E.Z.R.)
| | - Armin Birner
- Clinical Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria; (Z.S.); (F.T.F.); (T.S.); (A.M.); (M.P.); (S.A.B.); (A.H.); (I.Z.); (A.B.); (R.Q.); (K.S.); (L.W.); (M.L.); (N.D.); (E.Z.R.)
| | - Robert Queissner
- Clinical Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria; (Z.S.); (F.T.F.); (T.S.); (A.M.); (M.P.); (S.A.B.); (A.H.); (I.Z.); (A.B.); (R.Q.); (K.S.); (L.W.); (M.L.); (N.D.); (E.Z.R.)
| | - Katharina Stix
- Clinical Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria; (Z.S.); (F.T.F.); (T.S.); (A.M.); (M.P.); (S.A.B.); (A.H.); (I.Z.); (A.B.); (R.Q.); (K.S.); (L.W.); (M.L.); (N.D.); (E.Z.R.)
| | - Linda Wels
- Clinical Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria; (Z.S.); (F.T.F.); (T.S.); (A.M.); (M.P.); (S.A.B.); (A.H.); (I.Z.); (A.B.); (R.Q.); (K.S.); (L.W.); (M.L.); (N.D.); (E.Z.R.)
| | - Melanie Lenger
- Clinical Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria; (Z.S.); (F.T.F.); (T.S.); (A.M.); (M.P.); (S.A.B.); (A.H.); (I.Z.); (A.B.); (R.Q.); (K.S.); (L.W.); (M.L.); (N.D.); (E.Z.R.)
| | - Nina Dalkner
- Clinical Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria; (Z.S.); (F.T.F.); (T.S.); (A.M.); (M.P.); (S.A.B.); (A.H.); (I.Z.); (A.B.); (R.Q.); (K.S.); (L.W.); (M.L.); (N.D.); (E.Z.R.)
| | - Sieglinde Zelzer
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, 8036 Graz, Austria; (S.Z.); (M.H.)
| | - Markus Herrmann
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, 8036 Graz, Austria; (S.Z.); (M.H.)
| | - Eva Z. Reininghaus
- Clinical Department of Psychiatry and Psychotherapeutic Medicine, Medical University Graz, 8036 Graz, Austria; (Z.S.); (F.T.F.); (T.S.); (A.M.); (M.P.); (S.A.B.); (A.H.); (I.Z.); (A.B.); (R.Q.); (K.S.); (L.W.); (M.L.); (N.D.); (E.Z.R.)
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Gezelius CME, Wahlund BA, Wiberg BM. Relation between increasing attachment security and weight gain: a clinical study of adolescents and their parents at an outpatient ward. Eat Weight Disord 2023; 28:82. [PMID: 37816948 PMCID: PMC10564661 DOI: 10.1007/s40519-023-01611-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 09/24/2023] [Indexed: 10/12/2023] Open
Abstract
PURPOSE We wanted to evaluate the impact of a relational focus in the treatment of adolescent ED-patients and their parents at an intensive outpatient ward, based on attachment theory, combined with a family approach and psychodynamic principles. Our aim was to investigate the distribution of different attachment styles among the adolescent ED-patients and their parents, and to find out if they could change by the treatment. METHODS Swedish adolescents (n = 33; 3 boys, 30 girls) and their parents (n = 60; 34 mothers, 26 fathers) participated. MEASURES Attachment Style Questionnaire (ASQ), Body Mass Index (BMI) and Children's Global Assessment Scale (CGAS) before and after treatment. RESULTS The adolescents were high on Need for Approval (ASQ4) of the Insecure/Anxious scale before treatment (in contrast to the parents). The patients had a significant decrease in ASQ4 after treatment, which correlated inversely to the increase in BMI but not to CGAS. The mothers showed features of the Secure/Confident style, fathers of the Insecure/Avoidant with elevated Relationships as Secondary (ASQ2). CONCLUSIONS Treatment with a relational and a family focus has impact on attachment insecurity in adolescent ED-patients and outcomes in terms of BMI. It is important to engage the parents, who need to help the adolescents to separate at that developmental stage. A secure therapeutic context, which enables mentalizations and allows new relational experiences, is essential. The ASQ-instrument is useful in indicating how the treatment of ED-adolescents is proceeding. LEVEL OF EVIDENCE Level IV: evidence obtained from multiple time series with the intervention.
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Affiliation(s)
- Christina M E Gezelius
- Department of Children and Youth Psychiatry, Center for Clinical Research, Falun Hospital, Falun, Sweden
| | - Björn A Wahlund
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- California Institute of Technology, Pasadena, USA
| | - Britt M Wiberg
- Department of Psychology, Umeå University, 90187, Umeå, Sweden.
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Watson M, Filia K, Stevens A, Cotton S, Nelson B, Ratheesh A. A systematic review and meta-analysis of global and social functioning among people at risk of bipolar disorder. J Affect Disord 2023; 321:290-303. [PMID: 36306929 DOI: 10.1016/j.jad.2022.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/04/2022] [Accepted: 10/17/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Functional status could predict development of bipolar disorder (BD) or have clinical significance. The relationship between BD risk and functioning is poorly understood. We undertook a systematic review examining the global and social functioning of those at risk for BD. METHODS We examined observational studies comparing a risk sample with healthy controls or full-threshold BD participants, using measures of global or social functioning. Risk status included family history of BD, meeting risk criteria, or having prodromal symptomatology, or premorbid functioning of persons with BD. Medline, PsycINFO, and Embase were searched. The Newcastle-Ottawa Scale for Cross-Sectional Studies was used to assess quality. Meta-analyses were performed where possible. RESULTS 7215 studies were screened and 40 studies were included (8474 participants). Risk samples had poorer functioning than controls, and superior functioning to participants with BD. Meta-analysis indicated poorer global functioning among persons with familial risk compared to healthy controls (mean global functional difference: 5.92; 95 % confidence interval: 7.90, 3.95; mean premorbid functioning difference: 2.31; 95 % confidence interval: 0.70, 3.92). Studies with higher proportions of female participants had slightly poorer global functioning. High heterogeneity was attributable functional measures and potentially functionally differential subgroups within the risk samples. LIMITATIONS Broader measures of functioning, such as neurocognition and behavioural measures, were excluded. Measures of global functioning are limited by conflating functioning and symptoms. CONCLUSIONS Functioning in the BD risk populations is intermediate to that of healthy controls and persons with BD, indicating their value in definitions of BD risk, in itself a likely heterogeneous state.
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Affiliation(s)
- M Watson
- The University of Melbourne, Centre for Youth Mental Health, Parkville 3052, Australia; The University of Melbourne, Melbourne Medical School, Parkville 3052, Australia
| | - K Filia
- Orygen, Parkville 3052, Australia
| | | | - S Cotton
- Orygen, Parkville 3052, Australia
| | - B Nelson
- Orygen, Parkville 3052, Australia
| | - A Ratheesh
- Orygen, Parkville 3052, Australia; The University of Melbourne, Centre for Youth Mental Health, Parkville 3052, Australia.
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Waehre A, Heggeli C, Hald K, Myhre AG, Diseth T. A 15–20-year follow-up of mental health, psychosocial functioning and quality of life in a single center sample of individuals with differences in sex development. Health Psychol Behav Med 2022; 10:837-854. [PMID: 36105256 PMCID: PMC9467622 DOI: 10.1080/21642850.2022.2116329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background: The aim of the study was to present metal health, psychosocial functioning and quality of life (QoL) of children and adolescents with a difference in sex development (DSD) from their first visit in the newly established multidisciplinary team in 2002–2004 in Norway. A secondary aim was to explore mental health, psychosocial functioning and QoL in the same cohort patient’s as for today and finally explore any childhood predictors for these outcomes in adulthood. Methods: The first part of the study took place in 2002–2004 in a mixed cohort of children and adolescents born with a DSD in 1982–2002, compared to a healthy comparison group. This part involved semi-structured interviews and self-reported and proxy-reported questionnaires. The second part of the study is a longitudinal study of the same participants 15–20 years later (2018–2020). Results: The participants at baseline of the study consisted of 33 patients; 24 assigned females (congenital adrenal hyperplasia, androgen insensitivity syndrome, gonadal dysgenesis and ovotesticular DSD) and nine assigned males; all with a hypospadias diagnosis. Significant differences were found for behavioral and emotional problems between groups, 46, XX females with significant higher total scores on YSR (49.43 + 24.17, p = .047); 46, XY females (21.00 + 12.04, p = .032); and higher internalizing problems scores (YSR) in 46, XX females (16.57 + 9.74), compared with the 46, XY females (5.60 + 5.32, p = .047). A positive association between QoL of the participants in adulthood and PedsQL’ social function (r = .657, p = .020) and psychosocial function in childhood (r = .596, p = .041) was found. Conclusions: In summary, this study demonstrated that adolescents assigned females with DSD might have more psychiatric problems and a poorer degree of psychosocial functioning compared to a healthy comparison group. As we do find an association with these problems in adolescence and later adult QoL, it is of great importance to respond to these behaviors in early life.
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Affiliation(s)
- Anne Waehre
- Division of Paediatric and Adolescent Medicine, Department of Child and Adolescent Mental Health in Hospital, Oslo University Hospital, Oslo, Norway
| | | | - Kirsten Hald
- Division of Gynaecology and Obstetrics, Department of Gynaecology, Oslo University Hospital, Oslo, Norway
| | | | - Trond Diseth
- Division of Paediatric and Adolescent Medicine, Department of Child and Adolescent Mental Health in Hospital, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Lorentzen V, Fagermo K, Handegård BH, Neumer SP, Skre I. Long-term effectiveness and trajectories of change after treatment with SMART, a transdiagnostic CBT for adolescents with emotional problems. BMC Psychol 2022; 10:167. [PMID: 35791020 PMCID: PMC9258229 DOI: 10.1186/s40359-022-00872-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 06/27/2022] [Indexed: 11/14/2022] Open
Abstract
Background There is a need for long-term effectiveness trials of transdiagnostic treatments. This study investigates the effectiveness and diagnosis-specific trajectories of change in adolescent patients attending SMART, a 6-week transdiagnostic CBT for anxiety and depression, with 6-month follow-up. Methods A randomized controlled trial with waiting list control (WLC) was performed at three child and adolescent mental health outpatient services (CAMHS) in Norway. Referred adolescents (N = 163, age = 15.72, 90.3% females) scoring 6 or more on the emotional disorders subscale of the Strengths and Difficulties Questionnaire (SDQ) were randomly assigned to treatment or to WLC. Long-term follow-up (N = 83, baseline age = 15.57, 94% females) was performed 6 months after treatment completion (Mean = 7.1 months, SD = 2.5). Linear mixed model analysis was used to assess time by group effects in patients with no diagnosis, probable anxiety, depressive disorder, and combined anxiety and depressive disorder. Results Almost one third (31%) obtained full recovery according to the inclusion criterium (SDQ emotional). There was highly significant change in all outcome variables. Effect sizes (ES) were largest for general functioning, measured with CGAS (ES: d = 2.19), and on emotional problems measured with SDQ (ES: d = 2.10), while CORE-17, BDI-II and CGAS all obtained ES’s close to 1. There were no significant time by diagnostic group interactions for any outcomes, indicating similar trajectories of change, regardless of diagnostic group. Waiting 6 weeks for treatment had no significant impact on long-term treatment effects. Limitations Possible regression to the mean. Attrition from baseline to follow-up. Conclusions Six weeks of transdiagnostic treatment for adolescents with emotional problems showed highly significant change in emotional symptoms and functioning at 6-month follow-up. Patients with anxiety, depression, combined anxiety and depression, and emotional problems with no specific diagnoses, all had similar trajectories of change. Hence this transdiagnostic SMART treatment can be recommended for adolescent patients with symptoms within the broad spectrum of emotional problems. Trial registration: ClinicalTrials.gov Identifier: NCT02150265. First registered May 29, 2014.
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Affiliation(s)
- Veronica Lorentzen
- Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, 9037, Tromsø, Norway. .,Department of Child and Adolescent Psychiatry, Divisions of Child and Adolescent Health, University Hospital of North Norway, P.O. Box 19, 9038, Tromsø, Norway.
| | - Kenneth Fagermo
- Department of Child and Adolescent Psychiatry, Divisions of Child and Adolescent Health, University Hospital of North Norway, P.O. Box 19, 9038, Tromsø, Norway
| | - Bjørn Helge Handegård
- Regional Centre for Child and Youth Mental Health and Child Welfare, UiT The Arctic University of Norway, 9037, Tromsø, Norway
| | - Simon-Peter Neumer
- Regional Centre for Child and Youth Mental Health and Child Welfare, UiT The Arctic University of Norway, 9037, Tromsø, Norway.,Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, 0484, Oslo, Norway
| | - Ingunn Skre
- Department of Psychology, Faculty of Health Sciences, UiT The Arctic University of Norway, 9037, Tromsø, Norway.,Department of General Psychiatry, University Hospital of North-Norway, P.O. Box 6124, 9291, Tromsø, Norway
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Karteczka-Świętek K, Opozda-Suder S, Strojny A. Psychosocial functioning of adolescents with ADHD in the family, school and peer group: A scoping review protocol. PLoS One 2022; 17:e0269495. [PMID: 35714145 PMCID: PMC9205482 DOI: 10.1371/journal.pone.0269495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 05/20/2022] [Indexed: 11/19/2022] Open
Abstract
Objective The objective of this scoping review is to investigate what is known about the psychosocial functioning of adolescents with ADHD. All basic life environments (family, school and peer group) will be considered. Introduction Adolescence is especially critical for people with ADHD–natural maturation may be accompanied by changing symptoms of ADHD. A number of childhood difficulties transform during adolescence and contribute to problems in various areas that comprise psychosocial functioning. The available studies focus on selected domains of psychosocial functioning of adolescents with ADHD, however, to the authors’ best knowledge, there is no comprehensive description of this issue. The lack of such a description is the main rationale for conducting this scoping review. Inclusion criteria Pointing to the PCC elements (population, concept, context), the scoping review will include primary studies on the concept of psychosocial functioning (including functioning in the family, school and peer group). In the included studies, the term "psychosocial functioning" (or related) had to be used explicitly. The population will be adolescents (10 to 19 years old) with a formal diagnosis of ADHD (DSM classification) or Hyperkinetic Syndrome (ICD-9) or Hyperkinetic Disorders (ICD-10). There will be no restrictions on the research context. Methods The methodology of scoping reviews will be applied in accordance with the guidelines of the Joanna Briggs Institute (JBI). The following databases: Academic Search Ultimate, ERIC, MEDLINE, ProQuest Central, PsycInfo, Scopus, and databases under the Web of Science will be searched for primary studies in peer-reviewed journals, written in English and published since 1987. The analyses will be based mainly on frequency counts of the components of psychosocial functioning and population characteristics. The results will be presented in tabular form and supplemented with a descriptive summary. The protocol has been registered on the Open Science Framework: https://doi.org/10.17605/OSF.IO/MS82H [registration DOI].
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Affiliation(s)
- Kinga Karteczka-Świętek
- Institute of Education, Faculty of Philosophy, Jagiellonian University in Kraków, Kraków, Poland
- * E-mail:
| | - Sylwia Opozda-Suder
- Institute of Education, Faculty of Philosophy, Jagiellonian University in Kraków, Kraków, Poland
| | - Agnieszka Strojny
- Institute of Applied Psychology, Faculty of Management and Social Communication, Jagiellonian University in Kraków, Kraków, Poland
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10
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Haukeli K, Edlund K. Two-year longitudinal case study of intensive exposure treatment in an adolescent girl with social anxiety disorder. Clin Case Rep 2022; 10:e05588. [PMID: 35340635 PMCID: PMC8931300 DOI: 10.1002/ccr3.5588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/23/2022] [Accepted: 02/25/2022] [Indexed: 11/24/2022] Open
Abstract
The purpose was to adapt the "Bergen 4-Day Treatment" for severe social anxiety disorder and to study the 28 months follow-up effects for a 16-year-old girl. It was delivered over three full days. At post-treatment, 48% reduction in symptoms, she no longer met the diagnostic criteria for SAD.
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Affiliation(s)
- Kristine Haukeli
- Child and Adolescent PsychiatryUppsala University HospitalUppsalaSweden
| | - Klara Edlund
- Musculoskeletal & Sports Injury Epidemiology CenterDepartment of Health Promotion ScienceSophiahemmet UniversityStockholmSweden
- Unit of Intervention and Implementation Research for Worker HealthInstitute of Environmental MedicineKarolinska InstitutetStockholmSweden
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11
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Gromark C, Hesselmark E, Djupedal IG, Silverberg M, Horne A, Harris RA, Serlachius E, Mataix-Cols D. A Two-to-Five Year Follow-Up of a Pediatric Acute-Onset Neuropsychiatric Syndrome Cohort. Child Psychiatry Hum Dev 2022; 53:354-364. [PMID: 33559023 PMCID: PMC7870456 DOI: 10.1007/s10578-021-01135-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2021] [Indexed: 11/28/2022]
Abstract
Little is known about the long-term prognosis of children with pediatric acute-onset neuropsychiatric syndrome (PANS). Out of the 46 eligible patients from the Karolinska PANS cohort, 34 consented to participate in a follow-up (median 3.3 years). Participants underwent a thorough clinical evaluation and were classified according to their clinical course. Resulting groups were compared on clinical characteristics and laboratory test results. We observed significant reductions in clinician-rated PANS symptom severity and improved general function. Two patients were classified as remitted, 20 as relapsing-remitting, and 12 as having a chronic-static/progressive course. The latter group had an earlier onset, greater impairment and received more pharmacological and psychological treatments. Although remission was rare, the majority of children with PANS were significantly improved over the follow-up period but a non-negligible minority of patients displayed a chronic-static/progressive course and required additional treatments. The proposed definitions of flare and clinical course may be useful in future clinical trials.
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Affiliation(s)
- Caroline Gromark
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. .,Centre for Psychiatry Research, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden. .,Centre for Psychiatry Research, Child and Adolescent Psychiatry Research Center, Gävlegatan 22, 113 30, Stockholm, Sweden.
| | - Eva Hesselmark
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden ,Centre for Psychiatry Research, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Ida Gebel Djupedal
- Centre for Psychiatry Research, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Maria Silverberg
- Centre for Psychiatry Research, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - AnnaCarin Horne
- Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden ,Division of Pediatric Rheumatology, Karolinska University Hospital, Stockholm, Sweden
| | - Robert A. Harris
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Eva Serlachius
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden ,Centre for Psychiatry Research, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - David Mataix-Cols
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden ,Centre for Psychiatry Research, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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12
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Bourvis N, Aouidad A, Spodenkiewicz M, Palestra G, Aigrain J, Baptista A, Benoliel JJ, Chetouani M, Cohen D. Adolescents with borderline personality disorder show a higher response to stress but a lack of self-perception: Evidence through affective computing. Prog Neuropsychopharmacol Biol Psychiatry 2021; 111:110095. [PMID: 32896602 DOI: 10.1016/j.pnpbp.2020.110095] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/18/2020] [Accepted: 08/30/2020] [Indexed: 10/23/2022]
Abstract
Stress reactivity is a complex phenomenon associated with multiple and multimodal expressions and functions. Herein, we hypothesized that compared with healthy controls (HCs), adolescents with borderline personality disorder (BPD) would exhibit a stronger response to stressors and a deficit in self-perception of stress due to their lack of insight. Twenty adolescents with BPD and 20 matched HCs performed a socially evaluated mental arithmetic test to induce stress. We assessed self- and heteroperception using both human ratings and affective computing-based methods for the automatic extraction of 39 behavioral features (2D + 3D video recording) and 62 physiological features (Nexus-10 recording). Predictions were made using machine learning. In addition, salivary cortisol was measured. Human ratings showed that adolescents with BPD experienced more stress than HCs. Human ratings and automated machine learning indicated opposite results regarding self- and heteroperceived stress in adolescents with BPD compared to HCs. Adolescents with BPD had higher levels of heteroperceived stress than self-perceived stress. Similarly, affective computing achieved better classification for heteroperceived stress. HCs had an opposite profile; they had higher levels of self-perceived stress, and affective computing reached a better classification for self-perceived stress. We conclude that adolescents with BPD are more sensitive to stress and show a lack of self-perception (or insight). In terms of clinical implications, our affective computing measures may help distinguish hetero- vs. self-perceptions of stress in natural settings and may offer external feedback during therapeutic interaction.
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Affiliation(s)
- Nadège Bourvis
- Pôle de Psychiatrie Infanto-Juvénile, Centre Hospitalier Intercommunal de Toulon - La Seyne-sur-Mer, France; Institut des Systèmes Intelligents et de Robotique, Sorbonne Université, CNRS UMR, Paris 7222, France
| | - Aveline Aouidad
- Institut des Systèmes Intelligents et de Robotique, Sorbonne Université, CNRS UMR, Paris 7222, France; Département de Psychiatrie de l'Enfant et de l'Adolescent, AP-HP. Sorbonne Université, GH Pitié-Salpêtrière, Paris, France; Inserm-CEA U1000, Imagerie en psychiatrie, Orsay, France
| | - Michel Spodenkiewicz
- Unité de Pédopsychiatrie de Liaison, Pôle de Santé Mentale, CHU Sud Réunion, Université de la Réunion, CEPOI EA 7388, Saint-Pierre, France
| | - Giuseppe Palestra
- Institut des Systèmes Intelligents et de Robotique, Sorbonne Université, CNRS UMR, Paris 7222, France
| | - Jonathan Aigrain
- Institut des Systèmes Intelligents et de Robotique, Sorbonne Université, CNRS UMR, Paris 7222, France
| | - Axel Baptista
- Pôle de Psychiatrie Infanto-Juvénile, Centre Hospitalier Intercommunal de Toulon - La Seyne-sur-Mer, France; Institut Jean Nicot, Ecole Normale Supérieure, Paris, France
| | - Jean-Jacques Benoliel
- Service de Biochimie Endocrinienne et Oncologique, AP-HP. Sorbonne Université, GH Pitié-Salpêtrière, et INSERM UMR_S1130 CNRS UMR8246, Pathophysiology of Psychiatric Disorders, Paris, France
| | - Mohamed Chetouani
- Institut des Systèmes Intelligents et de Robotique, Sorbonne Université, CNRS UMR, Paris 7222, France
| | - David Cohen
- Institut des Systèmes Intelligents et de Robotique, Sorbonne Université, CNRS UMR, Paris 7222, France; Inserm-CEA U1000, Imagerie en psychiatrie, Orsay, France.
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13
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Becker-Hebly I, Fahrenkrug S, Campion F, Richter-Appelt H, Schulte-Markwort M, Barkmann C. Psychosocial health in adolescents and young adults with gender dysphoria before and after gender-affirming medical interventions: a descriptive study from the Hamburg Gender Identity Service. Eur Child Adolesc Psychiatry 2021; 30:1755-1767. [PMID: 32990772 DOI: 10.1007/s00787-020-01640-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 09/02/2020] [Indexed: 12/11/2022]
Abstract
Empirical evidence concerning the psychosocial health outcomes after puberty suppression and gender-affirming (GA) medical interventions of adolescents with gender dysphoria (GD) is scarce. The aim of the present study was to describe how dimensions of psychosocial health were distributed among different intervention groups of adolescents with a GD diagnosis from the Hamburg Gender Identity Service before and after treatment. Participants included n = 75 adolescents and young adults from a clinical cohort sample, measured at their initial intake and on average 2 years later (M treatment duration = 21.4 months). All cases were divided into four different intervention groups, three of which received medical interventions. At baseline, both psychological functioning and quality of life scores were significantly below the norm mean for all intervention groups. At follow-up, adolescents in the gender-affirming hormone (GAH) and surgery (GAS) group reported emotional and behavioral problems and physical quality of life scores similar to the German norm mean. However, some of the psychosocial health outcome scores were still significantly different from the norm. Because this study did not test for statistically significant differences between the four intervention groups or before and after treatment, the findings cannot be generalized to other samples of transgender adolescents. However, GA interventions may help to improve psychosocial health outcomes in this sample of German adolescents. Long-term treatment decisions during adolescence warrant careful evaluation and informed, participatory decision-making by a multidisciplinary team and should include both medical interventions and psychosocial support. The present study highlights the urgent need for further ongoing longitudinal research.
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Affiliation(s)
- Inga Becker-Hebly
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. .,Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Saskia Fahrenkrug
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Florentien Campion
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hertha Richter-Appelt
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Schulte-Markwort
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Claus Barkmann
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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14
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De Visscher C, Hesselmark E, Rautio D, Djupedal IG, Silverberg M, Nordström SI, Serlachius E, Mataix-Cols D. Measuring clinical outcomes in children with pediatric acute-onset neuropsychiatric syndrome: data from a 2-5 year follow-up study. BMC Psychiatry 2021; 21:484. [PMID: 34607588 PMCID: PMC8488538 DOI: 10.1186/s12888-021-03450-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/26/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND It is unclear how to best measure the complex symptom presentation of pediatric acute-onset neuropsychiatric syndrome (PANS). METHODS Well-characterized participants of a 2-5 year follow-up study (n = 34; 56% male) underwent clinical evaluations and completed scales assessing global symptom severity, functional impairment and specific psychiatric symptoms. We explored inter-correlations between the measures and used intraclass correlation coefficients to evaluate the agreement between clinician-, parent- and child ratings of the same constructs. RESULTS Ratings on symptom-specific measures varied largely between participants. Agreement between informants was excellent on functional scales, fair-to-moderate on global severity scales and mixed on symptom-specific scales. Clinician-rated global and functional measures had stronger inter-correlations with parent- and child-rated functional measures than with symptom-specific measures. CONCLUSIONS General instruments assessing global severity and functioning are well suited for the assessment and follow-up of PANS, but should be complemented by symptom-specific scales representative of core symptoms.
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Affiliation(s)
- Caroline De Visscher
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. .,Stockholm Health Care Services, Region Stockholm, CAP Research Center, Gävlegatan 22, SE-113 30, Stockholm, Sweden. .,Moment Psykologi, Drottninggatan 99, 113 60, Stockholm, Sweden.
| | - Eva Hesselmark
- grid.4714.60000 0004 1937 0626Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden ,grid.467087.a0000 0004 0442 1056Stockholm Health Care Services, Region Stockholm, CAP Research Center, Gävlegatan 22, SE-113 30, Stockholm, Sweden
| | - Daniel Rautio
- grid.4714.60000 0004 1937 0626Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden ,grid.467087.a0000 0004 0442 1056Stockholm Health Care Services, Region Stockholm, CAP Research Center, Gävlegatan 22, SE-113 30, Stockholm, Sweden
| | - Ida Gebel Djupedal
- grid.467087.a0000 0004 0442 1056Stockholm Health Care Services, Region Stockholm, CAP Research Center, Gävlegatan 22, SE-113 30, Stockholm, Sweden
| | - Maria Silverberg
- grid.467087.a0000 0004 0442 1056Stockholm Health Care Services, Region Stockholm, CAP Research Center, Gävlegatan 22, SE-113 30, Stockholm, Sweden
| | - Selma Idring Nordström
- grid.4714.60000 0004 1937 0626Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden ,grid.467087.a0000 0004 0442 1056Stockholm Health Care Services, Region Stockholm, CAP Research Center, Gävlegatan 22, SE-113 30, Stockholm, Sweden
| | - Eva Serlachius
- grid.4714.60000 0004 1937 0626Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden ,grid.467087.a0000 0004 0442 1056Stockholm Health Care Services, Region Stockholm, CAP Research Center, Gävlegatan 22, SE-113 30, Stockholm, Sweden
| | - David Mataix-Cols
- grid.4714.60000 0004 1937 0626Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden ,grid.467087.a0000 0004 0442 1056Stockholm Health Care Services, Region Stockholm, CAP Research Center, Gävlegatan 22, SE-113 30, Stockholm, Sweden
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15
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Åsberg Johnels J, Yngvesson P, Billstedt E, Gillberg C, Halldner L, Råstam M, Gustafsson P, Selinus EN, Lichtenstein P, Hellner C, Anckarsäter H, Lundström S. The relationship between intelligence and global adaptive functioning in young people with or without neurodevelopmental disorders. Psychiatry Res 2021; 303:114076. [PMID: 34247062 DOI: 10.1016/j.psychres.2021.114076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 06/10/2021] [Accepted: 06/22/2021] [Indexed: 11/18/2022]
Abstract
Previous studies have shown an association between IQ and adaptive global functioning, i.e. how well a person is functioning in different domains of life. However, it is unclear to what extent such an association applies in children with neurodevelopmental disorders (NDDs). The study group consisted of 550 population-screened children assessed with the K-SADS, WISC-IV, and the C-GAS. Approximately half of the sample had been diagnosed with one or several NDDs (ADHD, autism, language disorder and tic disorder). A factorial ANOVA with IQ level and the presence of NDD was conducted, with C-GAS score as the dependent variable. Results revealed a significant interaction effect between IQ-group and NDD-status. In the non-NDD group (49% girls), higher IQ scores were clearly linked with better global adaptive functioning. Among children with NDDs (35% girls), however, higher IQ scores were not clearly associated with better functioning. Thus, the association between IQ and adaptive functioning were found to differ depending on the presence of NDD. These results have implications for the interpretation of IQ test results in neurodevelopmental assessments and point towards the importance of providing support based on an assessment of needs and functioning rather than scores from IQ tests.
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Affiliation(s)
| | - Paul Yngvesson
- Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden
| | - Eva Billstedt
- Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden
| | | | - Linda Halldner
- Department of Clinical Science, Child and Adolescent Psychiatry, Umeå University, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Maria Råstam
- Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden; Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Peik Gustafsson
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Eva Norén Selinus
- Centre for Clinical Research, County of Västmanland, Uppsala University, Västerås, Sweden; Centre for Psychiatry Research, Stockholm, Sweden; The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Clara Hellner
- Centre for Ethics Law and Mental Health, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Anckarsäter
- Centre for Ethics Law and Mental Health, University of Gothenburg, Gothenburg, Sweden
| | - Sebastian Lundström
- Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden; Centre for Ethics Law and Mental Health, University of Gothenburg, Gothenburg, Sweden.
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16
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Janssen H, Maat A, Slot MIE, Scheepers F. Efficacy of psychological interventions in young individuals at ultra-high risk for psychosis: A naturalistic study. Early Interv Psychiatry 2021; 15:1019-1027. [PMID: 32945145 DOI: 10.1111/eip.13048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 08/02/2020] [Accepted: 08/30/2020] [Indexed: 11/28/2022]
Abstract
AIM Early detection and intervention in individuals at risk for developing psychosis have become a priority for many clinical services around the world. Limited naturalistic evidence is available on whether detection and intervention for ultra-high risk (UHR) is effective by means of reducing psychosis risk and improving functioning. METHODS We compared functioning scores over 5.9 (±7.7) months of time between UHR individuals (n = 61) and help-seeking adolescents without a specific UHR profile (general adolescent help-seeking population [HSP]; n = 82) aged 12 to 25 years receiving psychological interventions at a specialized UHR service in the Netherlands. Attenuated psychotic symptoms (APS) were evaluated over time within the UHR group. In addition, the impact of duration of treatment, <7 sessions, 8 to 21 sessions and >20 sessions, as well as treatment type, that is, cognitive behavioural therapy (CBT) and CBT + add on treatment, were evaluated. RESULTS Both UHR and HSP showed an increase in functioning over time (P < .001), with no difference between these groups. The UHR group showed a reduction of APS over time (P < .001). More than 20 treatment sessions was more effective than 1 to 6 treatment sessions (P < .01, partial eta squared = .08) and CBT was equally effective as CBT-add on in improving functioning. CONCLUSIONS The findings of this study suggest that psychological treatment is just as effective in improving functioning in UHR as in HSP. Moreover, it decreases APS in UHR. Improvement in functioning is not affected by treatment type, but positively affected by the duration of treatment.
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Affiliation(s)
- Hella Janssen
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands.,GGzE, Institute for Mental Health Care Eindhoven and De Kempen, Eindhoven, The Netherlands
| | - Arija Maat
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Margot I E Slot
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Floortje Scheepers
- Department of Psychiatry, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
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Yurtbasi MK, Melvin G, Pavlou C, Gordon M. Nurse and patient factors: Predicting seclusion in adolescent psychiatric units. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2021; 34:112-119. [PMID: 33393691 DOI: 10.1111/jcap.12306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/13/2020] [Indexed: 11/30/2022]
Abstract
PROBLEM Seclusion is considered a necessity when alternatives have failed. There is a consensus that seclusion has no therapeutic benefit, which justifies efforts to reduce the practice. This study aimed to identify nurse and patient variables that are predictive of seclusion on a large adolescent inpatient unit. METHODS Nested case controls were used to compare 72 afternoon shifts on which seclusion occurred to 216 afternoon shifts on which no seclusion occurred, between 2010 and 2013, at an Adolescent Psychiatric Inpatient Unit. FINDINGS Increased seclusion was predicted by a lower nurse to patient ratio, more male nurses on shift, fewer female nurses on shift, the presence of agency/temporary nurses on shift, greater combined years of mental health experience, and lower total HoNOSCA behavior subscale score. Unique predictors that increased risk of seclusion included greater number of male nurses and the presence of agency/temporary nurses, while a greater number of female nurses decreased risk of seclusion. CONCLUSIONS Nurses play a unique role in seclusion outcomes that are separate to patient-factors and act as both protective and risk factors for seclusion. Changes can be made to staffing to reduce seclusion and future research should investigate why these nurse-factors contribute to seclusion.
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Affiliation(s)
- Miriam K Yurtbasi
- Department of Psychiatry, Centre for Developmental Psychiatry and Psychology, School of Clinical Sciences, Monash University, Clayton, Australia
| | - Glenn Melvin
- School of Psychology, Faculty of Health, Deakin University, Burwood, Australia
| | - Christine Pavlou
- Psychiatric Services at Monash Health, Early in Life Mental Health Service, Monash Children's Hospital, Clayton, Australia
| | - Michael Gordon
- Department of Psychiatry, Centre for Developmental Psychiatry and Psychology, School of Clinical Sciences, Monash University, Clayton, Australia.,Psychiatric Services at Monash Health, Early in Life Mental Health Service, Monash Children's Hospital, Clayton, Australia
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A comprehensive mapping of outcomes following psychotherapy for adolescent depression: The perspectives of young people, their parents and therapists. Eur Child Adolesc Psychiatry 2021; 30:1779-1791. [PMID: 33006003 PMCID: PMC8558204 DOI: 10.1007/s00787-020-01648-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 09/13/2020] [Indexed: 12/19/2022]
Abstract
As mental health systems move towards person-centred care, outcome measurement in clinical research and practice should track changes that matter to young people and their families. This study mapped the types of change described by three key stakeholder groups following psychotherapy for depression, and compared the salience of these outcomes with the frequency of their measurement in recent quantitative treatment effectiveness studies for adolescent depression.Using qualitative content analysis, this study identified and categorized outcomes across 102 semi-structured interviews that were conducted with depressed adolescents, their parents, and therapists, as part of a randomized superiority trial. Adolescents had been allocated to Cognitive-Behavioral Therapy, Short-Term Psychoanalytic Psychotherapy, or a Brief Psychosocial Intervention.The study mapped seven high-level outcome domains and 29 outcome categories. On average, participants discussed change in four domains and six outcome categories. The most frequently discussed outcome was an improvement in mood and affect (i.e., core depressive symptoms), but close to half of the participants also described changes in family functioning, coping and resilience, academic functioning, or social functioning. Coping had specific importance for adolescents, while parents and therapists showed particular interest in academic functioning. There was some variation in the outcomes discussed beyond these core themes, across stakeholder groups and treatment arms.Of the outcomes that were frequently discussed in stakeholder narratives, only symptomatic change has been commonly reported in recent treatment studies for adolescent depression. A shift towards considering multiple outcome domains and perspectives is needed to reflect stakeholder priorities and enable more nuanced insights into change processes.
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19
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Ekbäck E, Granåsen G, Svärling R, Blomqvist I, Henje E. Clinical Effectiveness of Training for Awareness Resilience and Action Online Compared to Standard Treatment for Adolescents and Young Adults With Depression: Study Protocol and Analysis Plan for a Pragmatic, Multi-Center Randomized Controlled Superiority Trial. Front Psychiatry 2021; 12:674583. [PMID: 34707516 PMCID: PMC8542661 DOI: 10.3389/fpsyt.2021.674583] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 09/10/2021] [Indexed: 01/21/2023] Open
Abstract
Depression in adolescents and young adults is an increasing global health concern. Available treatments are not sufficiently effective and relapse rates remain high. The novel group-treatment program "Training for Awareness, Resilience and Action" (TARA) targets specific mechanisms based on neuroscientific findings in adolescent depression. TARA is framed within the National Institute of Mental Health's Research Domain Criteria and has documented feasibility and preliminary efficacy in the treatment of adolescent depression. Since neurodevelopment continues well into the mid-twenties, age-adapted treatments are warranted also for young adults. Patients 15-22 years old, with either major depressive disorder (MDD) or persistent depressive disorder (PDD) according to the DSM-IV/5 or a rating >40 on the clinician rating scale Children's Depression Rating Scale-Revised (CDRS-R), will be recruited from specialized Child and Adolescent Psychiatry and local Youth-Clinics and randomized to either TARA or standard treatment, including but not limited to antidepressant medication and/or psychotherapy. Outcome measures will be obtained before randomization (T0), after 3 months of treatment (T1) and at 6-months- (T2) and 24-months- (T3) follow-up. Additionally, dose-response measures will be obtained weekly in the TARA-arm and measures for mediation-analysis will be obtained halfway through treatment (T0.5). Primary outcome measure is Reynolds Adolescent Depression Scale (RADS-2) score at T1. Secondary outcome measures include RADS-2 score at T2, Multidimensional Anxiety Scale for Children at T1 and T2, and CDRS-R at T1. Additional outcome measures include self-report measures of depression-associated symptoms, systemic bio-indicators of depression from blood and hair, heartrate variability, brain magnetic resonance imaging, as well as three-axial accelerometry for sleep-objectivization. Qualitative data will be gathered to reach a more comprehensive understanding of the factors affecting adolescents and young adults with depression and the extent to which the different treatments address these factors. In summary, this article describes the design, methods and statistical analysis plan for pragmatically evaluating the clinical effectiveness of TARA. This will be the first RCT to examine the effects of TARA compared to standard treatment for adolescents and young adults with MDD or PDD. We argue that this study will extend the current knowledgebase regarding the treatment of depression. NCT Registration: identifier [NCT04747340].
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Affiliation(s)
- Erik Ekbäck
- Department of Clinical Science, Umeå University, Umeå, Sweden
| | - Gabriel Granåsen
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Rachel Svärling
- Department of Clinical Science, Umeå University, Umeå, Sweden
| | - Ida Blomqvist
- Department of Clinical Science, Umeå University, Umeå, Sweden
| | - Eva Henje
- Department of Clinical Science, Umeå University, Umeå, Sweden
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Goto R, Matsuda N, Nonaka M, Hamamoto Y, Eriguchi Y, Fujiwara M, Suzuki A, Yokoyama Y, Kano Y. The Gilles de la Tourette Syndrome-Quality of Life Scale (GTS-QOL): A Validation in Japanese Patients. Front Psychiatry 2021; 12:797037. [PMID: 35046856 PMCID: PMC8761978 DOI: 10.3389/fpsyt.2021.797037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 11/30/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Though Gilles de la Tourette's syndrome (GTS) has significant impact on the quality of life of its patients, measures of health-related quality of life (HR-QOL) specific to adolescents and adults with GTS were not developed until recently. The present study provides evidence on the validity of the Gilles de la Tourette Syndrome-Quality of Life Scale (GTS-QOL), the first disease-specific HR-QOL instrument for GTS patients, for the first time in an East Asian sample. Methods: One hundred and two Japanese individuals aged 13 and above with GTS were included in our study. Internal consistency was evaluated using Cronbach's alpha. The 4-factor structure of the GTS-QOL was assessed using confirmatory factor analysis, using goodness of fit indices, factor loadings of each questionnaire item, and covariances between factors. Validity was assessed using interscale correlations. Convergent and discriminate construct validity was evaluated using correlations with other scales such as the 28-item General Health Questionnaire, the Yale Global Tic Severity Scale, and the short version of the Padua Inventory. Results: Scaling assumptions were met. Internal consistency reliability was high, with a Cronbach's alpha of 0.96. Confirmatory factor analysis revealed sufficient factor loadings and goodness of fit. All measures of goodness of fit corroborated the fit of the 4-factor model. Standardized covariances between factors in the confirmatory factor analysis were >0.8. There were significant correlations with other well-validated scales, and thus convergent and discriminate construct validity was sufficient. Conclusion: The GTS-QOL is a valid and reliable instrument to measure disease-specific HR-QOL of GTS patients in Japan.
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Affiliation(s)
- Ryunosuke Goto
- Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan
| | - Natsumi Matsuda
- Department of Child Psychiatry, The University of Tokyo Hospital, Tokyo, Japan.,Department of Developmental Psychology, Faculty of Human Studies, Shirayuri University, Tokyo, Japan
| | - Maiko Nonaka
- Department of Child Psychiatry, The University of Tokyo Hospital, Tokyo, Japan.,Graduate School of Education, The University of Tokyo, Tokyo, Japan
| | - Yu Hamamoto
- Department of Child Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yosuke Eriguchi
- Department of Child Psychiatry, The University of Tokyo Hospital, Tokyo, Japan.,Department of Child Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mayu Fujiwara
- Department of Child Psychiatry, The University of Tokyo Hospital, Tokyo, Japan
| | - Akane Suzuki
- Department of Child Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukari Yokoyama
- Department of Social Welfare, Faculty of Social Welfare, Nihon Fukushi University, Mihama, Japan
| | - Yukiko Kano
- Department of Child Psychiatry, The University of Tokyo Hospital, Tokyo, Japan.,Department of Child Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Li YH, Li DS, Wang MQ, Zhao K, Gao BL. Modified hemispherectomy for infantile hemiparesis and epilepsy. Transl Neurosci 2020; 11:380-390. [PMID: 33335778 PMCID: PMC7718624 DOI: 10.1515/tnsci-2020-0145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 09/17/2020] [Accepted: 09/28/2020] [Indexed: 11/15/2022] Open
Abstract
Objective To investigate the effect and medical imaging of modified hemispherectomy on patients with infantile hemiparesis and medically refractory epilepsy. Patients and methods Forty-three patients with infantile hemiparesis and refractory epilepsy who underwent hemispherectomy were enrolled. The treatment effect and medical imaging were analyzed. Results Anatomical hemispherectomy was successfully performed in all patients (100%). In all patients, the muscular tension decreased and the contracted limbs relaxed. In the pathological examination of the resected brain tissue, secondary cicatricial gyri with concomitant cortical dysplasia was present in 36 cases and polycerebellar gyrus malformation and porencephalia in the other 7 cases. Followed up for 7-15 years (mean 11.3), all patients were alive without a long-term sequela. Epilepsy was satisfactorily controlled, with complete seizure relief in 39 cases (91%) classified as Engel I and basic control in the other 4 (9%) defined as Engel II. The posthemispherectomy medical imaging demonstrated that the intracranial space on the operative side shrank, and the healthy cerebral hemisphere shifted markedly toward the hemispherectomy side, with expanded lateral ventricle on the healthy side and thickened skull and enlarged frontal sinus on the operative side. After 4-5 years, the intracranial space on the operative side disappeared in 75% of the patients, demonstrating enlarged cerebral peduncle on the healthy side. Conclusion Further modified hemispherectomy in patients with infantile hemiparesis and medically refractory epilepsy demonstrated markedly ameliorated effects on epilepsy control and the prevention of superficial cerebral hemosiderosis in the long-term follow-up.
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Affiliation(s)
- Yu-Hui Li
- Department of Neurosurgery, Shijiazhuang People's Hospital, Xian Jiaotong University, 365 South Jianhua Street, Shijiazhuang, Hebei Province 050030, China
| | - Dong-Sheng Li
- Department of Neurosurgery, Shijiazhuang People's Hospital, Xian Jiaotong University, 365 South Jianhua Street, Shijiazhuang, Hebei Province 050030, China
| | - Mei-Qing Wang
- Department of Neurosurgery, Shijiazhuang People's Hospital, Xian Jiaotong University, 365 South Jianhua Street, Shijiazhuang, Hebei Province 050030, China
| | - Kai Zhao
- Department of Neurosurgery, Shijiazhuang People's Hospital, Xian Jiaotong University, 365 South Jianhua Street, Shijiazhuang, Hebei Province 050030, China
| | - Bu-Lang Gao
- Department of Neurosurgery, Shijiazhuang People's Hospital, Xian Jiaotong University, 365 South Jianhua Street, Shijiazhuang, Hebei Province 050030, China
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Mundal I, Gråwe RW, Hafstad H, De Las Cuevas C, Lara-Cabrera ML. Effects of a peer co-facilitated educational programme for parents of children with ADHD: a feasibility randomised controlled trial protocol. BMJ Open 2020; 10:e039852. [PMID: 33268416 PMCID: PMC7713204 DOI: 10.1136/bmjopen-2020-039852] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION Significant numbers of children with attention deficit hyperactivity disorder (ADHD) display problems that cause multiple disabilities, deficits and handicaps that interfere with social relationships, development and school achievement. They may have multiple problems, which strain family dynamics and influence the child's treatment. Parent activation, described as parents' knowledge, skills and confidence in dealing with their child's health and healthcare, has been shown to be an important factor in improving health outcomes. Research suggests that parents need edification to learn skills crucial to the treatment and management of their children's healthcare. Promoting positive parenting techniques may reduce negative parenting factors in families. This study aims to assess the acceptability, feasibility and estimated sample size of a randomised controlled trial (RCT) comparing an ADHD peer co-led educational programme added to treatment as usual (TAU). METHODS AND ANALYSIS Using a randomised waitlist controlled trial, parents of children aged 6-12 years newly diagnosed with ADHD, and referred to a child mental health outpatient clinic in Mid-Norway, will receive TAU concomitant with a peer co-facilitated parental engagement educational programme (n=25). Parents in the control group will receive TAU, and the educational programme treatment within a waitlist period of 3-6 months (n=25). Parent activation, satisfaction, well-being, quality of life and treatment adherence, will be assessed at baseline (T0), 2 weeks (T1) pre-post intervention (T2, T3) and at 3 months follow-up (T4). Shared decision making, parents preferred role in health-related decisions and involvement, parent-reported symptoms of ADHD and child's overall level of functioning will be assessed at T0 and T4. Such data will be used to calculate the required sample size for a full-scale RCT. ETHICS AND DISSEMINATION Approval was obtained from the Regional Committee for Medicine and Health Research Ethics in Mid-Norway (ref: 2018/1196). The findings of this study are expected to provide valuable knowledge about how to optimise family education and management of ADHD and will be disseminated through presentations at conferences and publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT04010851.
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Affiliation(s)
- Ingunn Mundal
- Department of Mental Health, Faculty of medicine and health sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Faculty of Health and Social Sciences, Molde University College, Molde, Norway
- Division of Psychiatry, Kristiansund Community Mental Health Centre, Møre og Romsdal Hospital Trust, Kristiansund, Norway
| | - Rolf W Gråwe
- Department of Mental Health, Faculty of medicine and health sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Division of Psychiatry, Nidaros Community Mental Health Centre, St Olav's University Hospital, Trondheim, Norway
| | - Hege Hafstad
- Division of Mid-Norway, Vårres Regional User Involvement Centre, Trondheim, Norway
| | - Carlos De Las Cuevas
- Department of Internal Medicine, Dermatology and Psychiatry, Universidad de La Laguna, San Cristóbal de La Laguna, Tenerife, Spain
- Instituto Universitario de Neurociencia (IUNE), Universidad de La Laguna, San Cristóbal deLa Laguna, Tenerife, Spain
| | - Mariela Loreto Lara-Cabrera
- Department of Mental Health, Faculty of medicine and health sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Division of Psychiatry, Tiller Community Mental Health Centre, St Olav's University Hospital, Trondheim, Norway
- Department of Research and Development, Division of Mental Health, St Olav's University Hospital, Trondheim, Norway
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Bussing R, Gagnon JC, Garvan CW, Ribuffo-Duggan C, Houchins D. Psychometric Properties of the Vanderbilt ADHD Diagnostic Rating Scale Completed by Juvenile Corrections Staff. J Atten Disord 2020; 24:1521-1529. [PMID: 28164727 DOI: 10.1177/1087054717690811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: This research tests the psychometric performance of the Vanderbilt ADHD Diagnostic Teacher Rating Scale (VADTRS) completed by juvenile corrections (JC) staff. Method: With institutional review board (IRB) approval and appropriate consents/assents, data were collected from case managers (n = 18), teachers (n = 9), youth (n = 261), and an administrative database. Separate psychometric analyses were conducted for case managers and teachers. Results: For both respondent groups, 2-week retest reliability and internal consistency were high for all four VADTRS subscales, and confirmatory factor analysis suggested fit with previously reported VADTRS subscale structure. Significant correlations of VADTRS with respective Revised Behavior Problem Checklist subscale scores indicated good concurrent validity. Discriminative validity was strong for ADHD, but not for conduct subscales. Interrater agreement was poor, similar as reported in other settings. Conclusion: Acceptable VADTRS psychometric performance among two JC staff groups supports guideline-consistent practice of obtaining standardized rating scale information from JC staff to enhance the quality of ADHD treatment.
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The Course of Neurocognitive Functioning and Prediction of Behavioral Outcome of ADHD Affected and Unaffected Siblings. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 47:405-419. [PMID: 30079436 PMCID: PMC6397140 DOI: 10.1007/s10802-018-0449-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Longitudinal studies on the course of neurocognitive functioning of children with ADHD and their unaffected siblings are scarce. Also, it is unclear to what extent that course is related to ADHD outcomes. A carefully phenotyped large sample of 838 Caucasian participants (ADHD-combined type: n = 339, unaffected siblings: n = 271, controls: n = 228; mean age at baseline = 11.4 years, mean age at follow-up = 17.3 years, SD = 3.2) was used to investigate differences in the course of neurocognitive functioning of ADHD affected and unaffected siblings versus controls, and to investigate the relationship between neurocognitive change and ADHD outcomes. At baseline, an aggregated measure of overall neurocognitive functioning and eight neurocognitive measures of working memory, timing (speed/variability), motor control, and intelligence were investigated. Outcomes at follow-up were dimensional measures of ADHD symptom severity and the Kiddie-Global Assessment Scale (K-GAS) for overall functioning. At follow up, affected and unaffected siblings trended to, or fully caught up with performance levels of controls on four (44.4%) and five (55.6%) of the nine dependent variables, respectively. In contrast, performance in remaining key neurocognitive measures (i.e. verbal working memory, variability in responding) remained impaired at follow-up. Change in neurocognitive functioning was not related to ADHD outcomes. Our results question the etiological link between neurocognitive deficits and ADHD outcomes in adolescents and young adults.
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Hamdani SU, Huma ZE, Wissow L, Rahman A, Gladstone M. Measuring functional disability in children with developmental disorders in low-resource settings: validation of Developmental Disorders-Children Disability Assessment Schedule (DD-CDAS) in rural Pakistan. Glob Ment Health (Camb) 2020; 7:e17. [PMID: 32913656 PMCID: PMC7443609 DOI: 10.1017/gmh.2020.10] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 05/12/2020] [Accepted: 05/22/2020] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Developmental disorders (DDs) in children are a priority condition and guidelines have been developed for their management within low-resource community settings. However, a key obstacle is lack of open access, reliable and valid tools that lay health workers can use to evaluate the impact of such programmes on child outcomes. We adapted and validated the World Health Organization's Disability Assessment Schedule for children (WHODAS-Child), a lay health worker-administered functioning-related tool, for children with DDs in Pakistan. METHODS Lay health workers administered a version of the WHODAS-Child to parents of children with DDs (N = 400) and without DDs (N = 400), aged 2-12 years, after it was adapted using qualitative study. Factor analysis, validity, reliability and sensitivity to change analyses were conducted to evaluate the psychometric properties of the adapted outcome measure. RESULTS Among 800 children, 58% of children were male [mean (s.d.) age 6.68 (s.d. = 2.89)]. Confirmatory Factor Analysis showed a robust factor structure [χ2/df 2.86, RMSEA 0.068 (90% CI 0.064-0.073); Tucker-Lewis Index (TLI) 0.92; Comparative Fit Index (CFI) 0.93; Incremental Fit Index (IFI) 0.93]. The tool demonstrated high internal consistency (α 0.82-0.94), test-retest [Intra-class Correlation Coefficient (ICC) 0.71-0.98] and inter-data collector (ICC 0.97-0.99) reliabilities; good criterion (r -0.71), convergent (r -0.35 to 0.71) and discriminative [M (s.d.) 52.00 (s.d. = 21.97) v. 2.14 (s.d. = 4.00); 95% CI -52.05 to -47.67] validities; and adequate sensitivity to change over time (ES 0.19-0.23). CONCLUSIONS The lay health worker administrated version of adapted WHODAS-Child is a reliable, valid and sensitive-to-change measure of functional disability in children aged 2-12 years with DDs in rural community settings of Pakistan.
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Key Words
- AMOS, Analysis of Moment Structure
- Autism
- CFA, Confirmatory Factor Analysis
- CFI, Comparative Fit Index
- CGAS, Children-Global Assessment of Functioning
- DD-CDAS, Developmental Disorders-Children Disability Assessment Schedule
- DD-CGAS, Developmental Disorders Children-Global Assessment of Functioning
- Developmental Disabilities Children's Global Assessment Scale (DD-CGAS)
- Developmental Disorders-Children Disability Assessment Schedule (DD-CDAS)
- ICC, Interclass Correlation
- ICF, International Classification of Functioning
- ICF-CY, International Classification of Functioning-Children and Youth
- IFI, Incremental Fit Index
- International Classification of Functioning-Children and Youth (ICF-CY)
- LHWs, Lady Health Workers.
- RMSEA, Root Mean Square Error of Approximation
- SDGs, Sustainable Development Goals
- TLI, Tucker–Lewis Index
- TQS, Ten Questions Screen
- VABS, Vineland Adaptive Behavior Scales
- WHO Disability Assessment Schedule (WHODAS 2.0)
- WHO mhGAP, World Health Organization Mental Health Gap Action Programme
- childhood disability
- developmental disorders/disabilities
- functional disability
- intellectual disability
- low-resource settings
- non-specialists
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Affiliation(s)
- Syed Usman Hamdani
- University of Liverpool, Liverpool, UK
- Human Development Research Foundation, Islamabad, Pakistan
| | - Zill-e Huma
- University of Liverpool, Liverpool, UK
- Human Development Research Foundation, Islamabad, Pakistan
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The Global Assessment of School Functioning (GASF): Criterion validity and interrater reliability. PSYCHOLOGY IN THE SCHOOLS 2020. [DOI: 10.1002/pits.22365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Liang ZW, Ong SH, Xie YH, Lim CG, Fung D. The Effects of a Traditional Chinese Medication on Children with Attention-Deficit/Hyperactivity Disorder. J Altern Complement Med 2020; 26:473-481. [PMID: 32407137 DOI: 10.1089/acm.2020.0009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Objective: This feasibility study examined the effects of a particular Traditional Chinese Medicine (TCM) herbal formula on attention-deficit/hyperactivity disorder (ADHD) and related problem behaviors. Design: A total of 79 participants aging 6-12 years consumed a granulated TCM herbal formula twice daily over a period of 3 months and underwent assessments at months 0, 3, and 6. Changes in ADHD symptoms and related behaviors were measured using the ADHD rating scale-IV (ADHD-RS-IV), child behavior checklist (CBCL), children's global sssessment scale (CGAS), as well as the clinical global impressions-severity (CGI-S) and improvement (CGI-I) scales. Results: Repeated measures mixed model analyses revealed significant differences in scores across time on all ADHD-RS-IV and CBCL subscales as well as on the CGAS, CGI-S, and CGI-I scales. Pairwise comparisons between months 0 and 3 as well as months 0 and 6 indicated significant improvements in scores. Scores also did not differ significantly between months 3 and 6. The results may suggest that this particular TCM formula possesses potential therapeutic qualities in the treatment of ADHD. Furthermore, changes in ADHD symptoms generally appear to be stable 3 months after discontinuation. However, these findings could also be attributed to placebo effects as well as reporting biases. Conclusion: This particular TCM formula may prove to be a useful adjunctive treatment for children with ADHD, and randomized controlled trials need to be conducted to evaluate its efficacy.
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Affiliation(s)
- Zhijian Wilfred Liang
- Department of Developmental Psychiatry, Institute of Mental Health, Singapore.,CareHub, Alexandra Hospital, Singapore
| | - Say How Ong
- Department of Developmental Psychiatry, Institute of Mental Health, Singapore
| | - Yu Huan Xie
- Department of Developmental Psychiatry, Institute of Mental Health, Singapore.,Rogers Behavioral Health, Walnut Creek, CA, USA
| | - Choon Guan Lim
- Department of Developmental Psychiatry, Institute of Mental Health, Singapore
| | - Daniel Fung
- Department of Developmental Psychiatry, Institute of Mental Health, Singapore
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Lorentzen V, Fagermo K, Handegård BH, Skre I, Neumer SP. A randomized controlled trial of a six-session cognitive behavioral treatment of emotional disorders in adolescents 14-17 years old in child and adolescent mental health services (CAMHS). BMC Psychol 2020; 8:25. [PMID: 32171328 PMCID: PMC7073009 DOI: 10.1186/s40359-020-0393-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 03/03/2020] [Indexed: 12/22/2022] Open
Abstract
Background This study aims to investigate effectiveness of a 6-week, transdiagnostic cognitive behavioral therapy (CBT) for anxiety and depression in adolescents, the Structured Material for Therapy (SMART), in naturalistic settings of child and adolescent mental health outpatient services (CAMHS). Methods A randomized controlled trial with waiting list control (WLC) was performed at three community CAMHS in Norway. Referred adolescents (N = 163, age = 15.72, 90.3% girls) scoring 6 or more on the emotional disorders subscale of the Strengths and Difficulties Questionnaire (SDQ) were randomly assigned to SMART or to WLC. Results In the treatment group (CBT), 32.9% improved in the main outcome measure (SDQ), compared to 11.6% in the WLC. Clinically significant and reliable change was experienced by 17.7% in the CBT condition, compared to 5.8% in the WLC. No patients deteriorated. Statistically significant treatment effects were achieved for internalization symptoms, anxiety symptoms and general functioning. Conclusions These promising findings indicate that SMART may be considered as a first step in a stepped care model for anxiety and/or depression treatment in CAMHS. The recovery rates imply that further investigations into the effectiveness of brief treatments should be made. Furthermore, there is a need for more comprehensive second-stage treatments for some of these patients. Trial registration ClinicalTrials.gov Identifier: NCT02150265. First registered May 292,014.
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Affiliation(s)
- Veronica Lorentzen
- Department of Psychology, Faculty of Health Sciences, UIT The Arctic University of Norway, 9037, Tromsø, Norway. .,Department of Child and Adolescent Psychiatry, Divisions of Child and Adolescent Health, University Hospital of North Norway, P.O. Box 19, 9038, Tromsø, Norway.
| | - Kenneth Fagermo
- Department of Child and Adolescent Psychiatry, Divisions of Child and Adolescent Health, University Hospital of North Norway, P.O. Box 19, 9038, Tromsø, Norway
| | - Bjørn Helge Handegård
- Regional Centre for Child and Youth Mental Health and Child Welfare, UIT The Arctic University of Norway, 9037, Tromsø, Norway
| | - Ingunn Skre
- Department of Psychology, Faculty of Health Sciences, UIT The Arctic University of Norway, 9037, Tromsø, Norway.,Department of General Psychiatry, University Hospital of North Norway, P.O. Box 6124, 9291, Tromsø, Norway
| | - Simon-Peter Neumer
- Regional Centre for Child and Youth Mental Health and Child Welfare, UIT The Arctic University of Norway, 9037, Tromsø, Norway.,Regional Centre for Child and Adolescent Mental Health - Eastern and Southern Norway, 0484, Oslo, Norway
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Treatment Gains Are Sustainable in Pediatric Obsessive-Compulsive Disorder: Three-Year Follow-Up From the NordLOTS. J Am Acad Child Adolesc Psychiatry 2020; 59:244-253. [PMID: 30768383 DOI: 10.1016/j.jaac.2019.01.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 01/15/2019] [Accepted: 02/07/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE This study evaluated the long-term outcomes of a stepped care treatment for pediatric obsessive-compulsive disorder (OCD) and investigated whether response to first-step cognitive-behavioral therapy (CBT) is an important indicator of 3-year outcomes. METHOD This study is a part of the Nordic Long-term OCD Treatment Study (NordLOTS), in which 269 children and adolescents were treated with CBT. Nonresponders to CBT were randomized to extended treatment with continued CBT or pharmacotherapy with sertraline. Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) scores no higher than 15 and no higher than 10 were defined as treatment response and remission, respectively. Participants were assessed 2 and 3 years after first-step CBT. Linear mixed-effects models were used to analyze the outcomes. RESULTS Intent-to-treat analyses showed a significant decrease in CY-BOCS total score from baseline (24.6) to 3-year follow-up (5.0; p = .001), with a mean decrease of 5.9 from after treatment to 3-year follow-up. Three years after treatment, 90% (n = 242) of participants were rated as responders and 73% were in clinical remission. The duration of treatment did not influence the symptom level at 3-year follow-up (p = .998) and no significant difference was found (p = .169) between the extended treatment conditions. CONCLUSION The results suggest that evidence-based treatment for pediatric OCD has long-term positive effects, whether a first step of manual-based CBT or extended treatment with CBT or sertraline. The improvements were maintained, and the symptoms decreased further during follow-up and were, after 3 years, similarly independent of treatment duration and form of extended treatment. CLINICAL TRIAL REGISTRATION INFORMATION Nordic Long-term Obsessive-Compulsive Disorder (OCD) Treatment Study; www.controlled-trials.com; ISRCTN66385119.
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Negative and disorganized symptoms mediate the relationship between verbal learning and global functioning in adolescents with early-onset psychosis. Eur Child Adolesc Psychiatry 2020; 29:1693-1703. [PMID: 32036438 PMCID: PMC7641937 DOI: 10.1007/s00787-020-01479-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 01/23/2020] [Indexed: 12/25/2022]
Abstract
Neurocognitive deficits are associated with impaired global functioning and psychotic symptoms. However, whether symptoms can mediate the relationship between neurocognition and global functioning in adolescent psychosis is unclear. Here, we investigated if symptoms assessed with the Positive And Negative Syndrome Scale (PANSS), mediated the relationship between neurocognitive performance and global functioning in adolescents with non-affective early-onset psychotic disorders (EOP). Sixty-one adolescent EOP patients (age 12-18 years) from 2 Norwegian clinical cohorts were included. Linear regression models were applied to investigate associations between neurocognitive domains from the MATRICS Consensus Cognitive Battery (MCCB) and global functioning. PANSS symptoms were analyzed using the Wallwork/Fortgang five-factor model. Using the INDIRECT macro for SPSS, mediation effects were tested using bootstrapping with 95% bias corrected confidence intervals. Verbal learning was positively associated with global functioning (P < 0.001) and negatively associated with the disorganized symptom factor (P = 0.002), controlling for age, sex and cohort. Testing of indirect effects, controlling for age, sex and cohort, showed that the Negative (point estimate = 1.56, 95% CI 0.22, 3.47) and Disorganized (point estimate = 1.24, 95% CI 0.05, 3.69) symptom factors significantly mediated the relationship between verbal learning and global functioning. We found that verbal learning, negative and disorganized symptoms influenced global functioning in adolescents with EOP, while reality-distorted positive symptoms did not. These results suggest that assessing these domains in EOP is helpful for planning treatment and rehabilitation programs focusing on functional outcome.
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Characteristics of Adolescent Psychiatric Inpatients in Relation to Their History of Preceding Child Psychiatric Inpatient Care. J Nerv Ment Dis 2019; 207:569-574. [PMID: 31260415 DOI: 10.1097/nmd.0000000000001007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Among psychiatric inpatients aged 13 to 17, various familial and clinical characteristics were compared between those with and without a previous history of specialized child psychiatric care (CPSY versus non-CPSY). CPSY adolescents were younger (boys: odds ratio [OR], 0.7; girls: OR, 0.4) at admission to adolescent psychiatric inpatient care, and they more likely had mothers with psychiatric problems (boys: OR, 4.0; girls: OR, 4.8) and child welfare placement background (boys: OR, 2.8; girls: OR, 6.7) compared with non-CPSY adolescents. CPSY girls were also characterized as having unemployed mothers (OR, 3.1) and engaging in nonsuicidal self-injury (OR, 3.1), whereas CPSY boys were diagnosed with anxiety (OR, 2.7) or conduct disorder (OR, 2.8). Based on our study, family-focused care and intervention services are required to prevent continuity of psychiatric disorders from childhood into adolescence.
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Schneider M, Armando M, Schultze-Lutter F, Pontillo M, Vicari S, Debbané M, Eliez S. Prevalence, course and psychosis-predictive value of negative symptoms in 22q11.2 deletion syndrome. Schizophr Res 2019; 206:386-393. [PMID: 30414720 DOI: 10.1016/j.schres.2018.10.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/05/2018] [Accepted: 10/20/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND The 22q11.2 deletion syndrome (22q11DS) is one of the highest known risk factors for schizophrenia and recent findings have highlighted the clinical relevance of ultra-high risk (UHR) criteria in this population. However, studies in other at-risk populations have shown that the presence of negative symptoms (NS) is also of clinical relevance in predicting transition to psychosis. The present study examined in detail the presence and course of NS in 22q11DS, as well as their value in predicting transition to psychosis. METHODS A total of 111 participants aged between 8 and 33 years were assessed with the Structured Interview for Psychosis-Risk Syndromes (SIPS). A follow-up assessment was available for 89 individuals. RESULTS Core NS of at least moderate severity were present in 50.5% of the sample and were more severe in individuals meeting UHR criteria. They predominantly remained stable over time and their emergence between baseline and follow-up assessment was associated with significant functional decline. Some NS were significant predictors of conversion to psychosis and the emergence/persistence of psychosis risk. CONCLUSIONS Altogether, these findings highlight that NS are core manifestations of psychosis in individuals with 22q11DS that strongly impact global functioning. The presence of NS should be a primary target of early therapeutic intervention in this population.
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Affiliation(s)
- Maude Schneider
- Developmental Imaging and Psychopathology lab, Department of Psychiatry, School of Medicine, University of Geneva, Geneva, Switzerland; Center for Contextual Psychiatry, Department of Neuroscience, KU Leuven, Leuven, Belgium.
| | - Marco Armando
- Developmental Imaging and Psychopathology lab, Department of Psychiatry, School of Medicine, University of Geneva, Geneva, Switzerland; Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome, Italy.
| | - Frauke Schultze-Lutter
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Maria Pontillo
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome, Italy
| | - Stefano Vicari
- Child and Adolescence Neuropsychiatry Unit, Department of Neuroscience, Children Hospital Bambino Gesù, Rome, Italy
| | - Martin Debbané
- Developmental Imaging and Psychopathology lab, Department of Psychiatry, School of Medicine, University of Geneva, Geneva, Switzerland; Developmental Clinical Psychology Unit, Faculty of Psychology, University of Geneva, Switzerland; Research Department of Clinical, Educational and Health Psychology, University College London, UK
| | - Stephan Eliez
- Developmental Imaging and Psychopathology lab, Department of Psychiatry, School of Medicine, University of Geneva, Geneva, Switzerland; Department of Genetic Medicine and Development, School of Medicine, University of Geneva, Geneva, Switzerland
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Silverman M, Frankovich J, Nguyen E, Leibold C, Yoon J, Mark Freeman G, Karpel H, Thienemann M. Psychotic symptoms in youth with Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) may reflect syndrome severity and heterogeneity. J Psychiatr Res 2019; 110:93-102. [PMID: 30605785 DOI: 10.1016/j.jpsychires.2018.11.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 11/04/2018] [Accepted: 11/13/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE In the clinical syndrome Pediatric Acute-onset Neuropsychiatric Syndrome (PANS), obsessive compulsive disorder (OCD) and/or food refusal symptoms have an abrupt-onset (over 48 h) coupled with at least two other specified neuropsychiatric symptoms. We aimed to characterize in detail for the first time, psychotic symptoms experienced by children with PANS as well as the impact of psychotic symptoms on disease severity and course of illness. We inform about the diagnosis of the clinical description: PANS and hope to improve evaluation, treatment, diagnostic validity and future investigation. METHODS Retrospective review of 143 consecutive PANS clinic patient charts meeting inclusion criteria. The Caregiver Burden Inventory, Global Impairment Score, and Children's Global Assessment Scale were used to assess impairment. RESULTS Visual and auditory hallucinations were each experienced by 36%, of which most (83%) were transient and complex (non-threatening voices or figures). 6.3% and 5.5% of patients experienced delusions and thought disorganization respectively. Those with psychotic symptoms showed statistically significant differences in disease impairment and caregiver burden. There were no differences in time to treatment access or length of illness. CONCLUSIONS Over 1/3 of children with PANS experienced transient hallucinations. They were more impaired than those without psychotic symptoms, but showed no differences in disease progression. This difference may point toward heterogeneity in PANS. When evaluating children with acute psychotic symptoms, clinicians should screen for abrupt-onset of a symptom cluster including OCD and/or food refusal, with neuropsychiatric symptoms (enuresis, handwriting changes, tics, hyperactivity, sleep disorder) before initiating treatment.
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Affiliation(s)
- Melissa Silverman
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States; Stanford Pediatric Acute-onset Neuropsychiatric Sydrome Clinic and Research Program at Lucile Packard Children's Hospital, Stanford University, Stanford, CA, United States.
| | - Jennifer Frankovich
- Pediatric Division of Allergy, Immunology, and Rheumatology, Stanford University, Stanford, CA, United States; Stanford Pediatric Acute-onset Neuropsychiatric Sydrome Clinic and Research Program at Lucile Packard Children's Hospital, Stanford University, Stanford, CA, United States
| | - Emily Nguyen
- Stanford Pediatric Acute-onset Neuropsychiatric Sydrome Clinic and Research Program at Lucile Packard Children's Hospital, Stanford University, Stanford, CA, United States
| | - Collin Leibold
- Pediatric Division of Allergy, Immunology, and Rheumatology, Stanford University, Stanford, CA, United States; Stanford Pediatric Acute-onset Neuropsychiatric Sydrome Clinic and Research Program at Lucile Packard Children's Hospital, Stanford University, Stanford, CA, United States
| | - Jong Yoon
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States; VA Palo Alto Health Care System, 3801 Miranda Ave., Building 4, 2nd Floor, Palo Alto, CA, 94304, United States
| | - G Mark Freeman
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Hannah Karpel
- Pediatric Division of Allergy, Immunology, and Rheumatology, Stanford University, Stanford, CA, United States; Stanford Pediatric Acute-onset Neuropsychiatric Sydrome Clinic and Research Program at Lucile Packard Children's Hospital, Stanford University, Stanford, CA, United States
| | - Margo Thienemann
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States; Stanford Pediatric Acute-onset Neuropsychiatric Sydrome Clinic and Research Program at Lucile Packard Children's Hospital, Stanford University, Stanford, CA, United States
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Müller AD, Gjøde ICT, Eigil MS, Busck H, Bonne M, Nordentoft M, Thorup AAE. VIA Family-a family-based early intervention versus treatment as usual for familial high-risk children: a study protocol for a randomized clinical trial. Trials 2019; 20:112. [PMID: 30736834 PMCID: PMC6368720 DOI: 10.1186/s13063-019-3191-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 01/10/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Children born to parents with a severe mental illness, like schizophrenia, bipolar disorder, or major recurrent depression, have an increased risk of developing a mental illness themselves during life. These children are also more likely to have developmental delays, cognitive disabilities, or social problems, and they may have a higher risk than the background population of experiencing adverse life events. This is due to both genetic and environmental factors, but despite the well-documented increased risk for children with a familial high risk, no family-based early intervention has been developed for them. This study aims to investigate the effect of an early intervention that focuses on reducing risk and increasing resilience for children in families where at least one parent has a severe mental illness. METHODS/DESIGN The study is a randomized clinical trial with 100 children aged 6-12 with familial high risk. It is performed in the context of the Danish health-care system. Families will be recruited from registers or be referred from the primary sector or hospitals. The children and their parents will be assessed at baseline and thereafter randomized and allocated to either treatment as usual or VIA Family. The intervention group will be assigned to a multidisciplinary team of specialists from adult mental health services, child and adolescent mental health services, and social services. This team will provide the basic treatment elements: case management, psychoeducation for the whole family, parental training, a safety plan, and potentially an early intervention if the child has mental problems. The study period is 18 months for both groups, and all participants will be assessed at baseline and after 18 months. The primary outcome measure will be daily functioning of the child, and the secondary measures are the psychopathology of the child, days of absence from school, family functioning, child's home environment, and parental stress. DISCUSSION This study is to our knowledge the first to explore the effects of a multidisciplinary team intervention that provides an intensive and flexible support to match the families' needs for children with a familial high risk for severe mental illness. The study will provide important knowledge about the potential for increasing resilience and reducing risk for children by supporting the whole family. However, a longer follow-up period may be needed. TRIAL REGISTRATION ClinicalTrials.gov, NCT03497663 . Registered on 13 April 2018.
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Affiliation(s)
- Anne D. Müller
- Research Unit, Child and Adolescent Mental Health Center, Lersø Parkallé 107, 1 th, 2100 Copenhagen, Capital Region of Denmark Denmark
| | - Ida C. T. Gjøde
- Research Unit, Child and Adolescent Mental Health Center, Lersø Parkallé 107, 1 th, 2100 Copenhagen, Capital Region of Denmark Denmark
| | - Mette S. Eigil
- Research Unit, Child and Adolescent Mental Health Center, Lersø Parkallé 107, 1 th, 2100 Copenhagen, Capital Region of Denmark Denmark
| | - Helle Busck
- Mental Health Center, Copenhagen, Capital Region of Denmark Denmark
| | - Merete Bonne
- Municipality of Frederiksberg, Family Department, Copenhagen, Denmark
| | - Merete Nordentoft
- Mental Health Center, Copenhagen, Capital Region of Denmark Denmark
- University of Copenhagen, Institute for Clinical Medicine, Faculty of Health Science, Copenhagen, Capital Region of Denmark Denmark
| | - Anne A. E. Thorup
- Research Unit, Child and Adolescent Mental Health Center, Lersø Parkallé 107, 1 th, 2100 Copenhagen, Capital Region of Denmark Denmark
- University of Copenhagen, Institute for Clinical Medicine, Faculty of Health Science, Copenhagen, Capital Region of Denmark Denmark
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Los Reyes AD, Makol BA, Racz SJ, Youngstrom EA, Lerner MD, Keeley LM. The Work and Social Adjustment Scale for Youth: A Measure for Assessing Youth Psychosocial Impairment Regardless of Mental Health Status. JOURNAL OF CHILD AND FAMILY STUDIES 2019; 28:1-16. [PMID: 33311964 PMCID: PMC7731438 DOI: 10.1007/s10826-018-1238-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
A key component of delivering mental health services involves evaluating psychosocial impairments linked to mental health concerns. Youth may experience these impairments in various ways (e.g., dysfunctional family and/or peer relationships, poor school performance). Importantly, youth may display symptoms of mental illness without co-occurring psychosocial impairments, and the reverse may be true. However, all available instruments for assessing youth psychosocial impairments presume the presence of mental health concerns among those assessed. Consequently, key gaps exist in knowledge about the developmental psychopathology of psychosocial impairments; and thus how to understand impairments in the context of youth mental health. To address these issues we developed a modified version of a 5-item measure of adult psychosocial impairments (i.e., Work and Social Adjustment Scale for Youth [WSASY]) and tested its psychometric properties. A mixed clinical/community sample of adolescents and parents completed parallel versions of the WSASY, along with a multi-domain, multi-method battery of measures of adolescent internalizing and externalizing concerns, parent psychosocial functioning, adolescent-parent conflict, adolescent peer functioning, and observed social skills. On both versions of the WSASY, increased scores related to increased adolescent mental health concerns, adolescent-parent conflict, parent psychosocial dysfunction, and peer-related impairments. WSASY scores also distinguished adolescents who displayed co-occurring mental health concerns from those who did not, and related to observed social skills deficits within social interactions with unfamiliar peers. The WSASY opens doors to new areas of inquiry regarding the developmental psychopathology of impairment, including questions regarding the onset of impairments and their links to mental health.
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Affiliation(s)
- Andres De Los Reyes
- Comprehensive Assessment and Intervention Program, Department of Psychology, University of Maryland, College Park, MD 20742
| | - Bridget A Makol
- Comprehensive Assessment and Intervention Program, Department of Psychology, University of Maryland, College Park, MD 20742
| | - Sarah J Racz
- Comprehensive Assessment and Intervention Program, Department of Psychology, University of Maryland, College Park, MD 20742
| | - Eric A Youngstrom
- Department of Psychology and Neuroscience, University of North Carolina, Chapel Hill, NC 27599
| | - Matthew D Lerner
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794
| | - Lauren M Keeley
- Comprehensive Assessment and Intervention Program, Department of Psychology, University of Maryland, College Park, MD 20742
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Ballespí S, Vives J, Debbané M, Sharp C, Barrantes-Vidal N. Beyond diagnosis: Mentalization and mental health from a transdiagnostic point of view in adolescents from non-clinical population. Psychiatry Res 2018; 270:755-763. [PMID: 30551321 DOI: 10.1016/j.psychres.2018.10.048] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 10/17/2018] [Accepted: 10/19/2018] [Indexed: 12/17/2022]
Abstract
An increasing volume of evidence suggests that mentalization (MZ) can be an important factor in the transition from mental health to mental illness and vice versa. However, most studies are focused on the role of MZ in specific disorders. This study aims to evaluate the relationship between MZ and mental health as a trans-diagnostic process. A sample of 172 adolescents aged 12 to 18 years old (M = 14.6, SD = 1.7; 56.4% of girls) was assessed on measures of MZ, psychopathology and psychological functioning from a multimethod and multi-informant perspective. Contrary to predictions, MZ was not associated with general psychopathology and comorbidity, even when explored from a broad, trans-diagnostic perspective. However, we observed a robust association linking MZ to functioning and well-being across many dimensions, involving social, role and several psychological indicators of adjustment and mental health. These results suggest that MZ may contribute to mental health beyond symptoms, not so much associated with psychopathology, but rather resilience and well-being.
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Affiliation(s)
- Sergi Ballespí
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain.
| | - Jaume Vives
- Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Martin Debbané
- Developmental Clinical Psychology Research Unit, Faculty of Psychology and Educational Sciences, University of Geneva, Switzerland; Developmental NeuroImaging and Psychopathology Laboratory, Department of Psychiatry, University of Geneva School of Medicine, Switzerland; Research Department of Clinical, Educational and Health Psychology, University College London, United Kingdom
| | - Carla Sharp
- Department of Psychology, University of Houston, Texas, USA
| | - Neus Barrantes-Vidal
- Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Department of Mental Health. Fundació Sanitària Sant Pere Claver, Barcelona, Catalonia, Spain; Centre for Biomedical Research Network on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
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Szewczuk-Bogusławska M, Kaczmarek-Fojtar M, Moustafa AA, Mahlberg J, Frydecka D, Oleszkowicz A, Bąk O, Misiak B. Assessment of the frequency criterion for the diagnosis of non-suicidal self-injury disorder in female adolescents with conduct disorder. Psychiatry Res 2018; 267:333-339. [PMID: 29957550 DOI: 10.1016/j.psychres.2018.05.054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 04/21/2018] [Accepted: 05/22/2018] [Indexed: 11/17/2022]
Abstract
Recent studies suggest a higher threshold number of self-injuries during the past year than the one proposed in the DSM-5 criteria for non-suicidal self-injury disorder (NSSID). Therefore, we aimed to test a validity of the frequency criterion in girls with conduct disorder (CD) based on psychopathology and the level of functioning. Mixture modelling analysis revealed that the frequency of at least 8 self-harm behaviours in the previous year differentiated adolescents with CD. Thus, we divided adolescents into three subgroups: group 1: at least 8 self-harm acts; group 2: 1-7 self-harm behaviours and group 3: those who did not injure themselves during the last 12 months. Individuals from group 1 were significantly younger and had earlier age of self-harm onset. There were significant differences between groups 1 and 3 in terms of anxiety and depressive symptoms, self-esteem, aggression and the global functioning level. The group 1 scored significantly higher on depressive symptoms compared to the group 2. The group 2 scored significantly higher than the group 3 on the level of hostility. Our results provide further evidence supporting the need for modification of the NSSID frequency criterion.
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Affiliation(s)
| | | | - Ahmed A Moustafa
- School of Social Sciences and Psychology, Marcs Institute of Brain and Behaviour, Western Sydney University, Penrith, NSW, Australia
| | - Justin Mahlberg
- School of Social Sciences and Psychology, Marcs Institute of Brain and Behaviour, Western Sydney University, Penrith, NSW, Australia
| | - Dorota Frydecka
- Department of Psychiatry, Wroclaw Medical University, Wrocław, Poland
| | | | - Olga Bąk
- Institute of Psychology, University of Wroclaw, Wrocław, Poland
| | - Błażej Misiak
- Department of Genetics, Wroclaw Medical University, Wrocław, Poland
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Healy C, Campbell D, Coughlan H, Clarke M, Kelleher I, Cannon M. Childhood psychotic experiences are associated with poorer global functioning throughout adolescence and into early adulthood. Acta Psychiatr Scand 2018; 138:26-34. [PMID: 29855047 DOI: 10.1111/acps.12907] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/10/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Psychotic experiences (PEs) are common in childhood and have been associated with concurrent mental disorder and poorer global functioning. Little is known about the effects of childhood PEs on future functioning. We investigated the effects of childhood PEs on global functioning from childhood into early adulthood. METHOD Fifty-six participants from a community sample completed all three waves of the Adolescent Brain Development study (T1x¯ Age: 11.69, T2x¯ Age: 15.80 T3x¯Age: 18.80). At each phase, participants completed a clinical interview assessing for PEs, mental disorder and global function. Repeated measures models, adjusted for mental disorder and gender, were used to compare current (C-GAF) and most severe past (MSP-GAF) functioning in participants who had reported PEs in childhood and controls. RESULTS Participants with a history of PEs had significantly poorer C-GAF (P < 0.001) and MSP-GAF scores (P < 0.001). Poorer functioning was evident in childhood (C-GAF: P = 0.001; MSP-GAF: P < 0.001), adolescence (C-GAF: P < 0.001; MSP-GAF: P = 0.004) and early adulthood (C-GAF: P = 0.001; MSP-GAF: P = 0.076). DISCUSSION Children who report PEs have persistently poorer functioning through to early adulthood. The longitudinal association between childhood PEs and global functioning highlights the underlying global vulnerability in children reporting PEs, beyond what can be explained by mental disorder.
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Affiliation(s)
- C Healy
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - D Campbell
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - H Coughlan
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - M Clarke
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland.,Department of Psychology, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - I Kelleher
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - M Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland.,Department of Psychiatry, Beaumont Hospital, Dublin 9, Ireland.,Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin 2, Ireland
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Schei J, Nøvik TS, Thomsen PH, Lydersen S, Indredavik MS, Jozefiak T. What Predicts a Good Adolescent to Adult Transition in ADHD? The Role of Self-Reported Resilience. J Atten Disord 2018; 22:547-560. [PMID: 26399710 DOI: 10.1177/1087054715604362] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE ADHD is a disorder associated with impairment and comorbid psychiatric problems in young adulthood; therefore, factors that may imply a more favorable outcome among adolescents with ADHD are of interest. METHOD This study used a longitudinal design to assess whether adolescent personal resilience characteristics during adolescence protected against psychosocial impairment, depression, and anxiety 3 years later. Self-reported protective factors were used as baseline measures in the assessment of 190 clinically referred adolescents with ADHD. A semi-structured diagnostic interview was performed at the follow-up. RESULTS In a group of youth with ADHD, personal resilience characteristics were associated with better psychosocial functioning in young adulthood, and less depression and anxiety. CONCLUSION Although further research is needed, these results indicate that personal resilience characteristics may be protective factors in the transitional period from adolescence to early adulthood.
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Affiliation(s)
- Jorun Schei
- 1 St. Olavs University Hospital, Trondheim, Norway.,2 Norwegian University of Science and Technology, Trondheim, Norway
| | - Torunn Stene Nøvik
- 1 St. Olavs University Hospital, Trondheim, Norway.,2 Norwegian University of Science and Technology, Trondheim, Norway
| | - Per Hove Thomsen
- 1 St. Olavs University Hospital, Trondheim, Norway.,2 Norwegian University of Science and Technology, Trondheim, Norway.,3 Aarhus University Hospital, Denmark
| | - Stian Lydersen
- 2 Norwegian University of Science and Technology, Trondheim, Norway
| | - Marit S Indredavik
- 1 St. Olavs University Hospital, Trondheim, Norway.,2 Norwegian University of Science and Technology, Trondheim, Norway
| | - Thomas Jozefiak
- 1 St. Olavs University Hospital, Trondheim, Norway.,2 Norwegian University of Science and Technology, Trondheim, Norway
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Ballesteros-Urpí A, Pardo-Hernández H, Ferrero-Gregori A, Torralbas-Ortega J, Puntí-Vidal J, Tàpies Olivet P, Izaguirre Eguren J, Vergés Balasch P, Lara Lloveras A, Bertomeu S, Peramiquel M, Herreros V, Vidal À, Font E, Romero S, Garcia M, Lázaro L, Morer À. Validation of the Spanish and Catalan versions of the Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA). Psychiatry Res 2018; 261:554-559. [PMID: 29407722 DOI: 10.1016/j.psychres.2017.12.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 10/10/2017] [Accepted: 12/20/2017] [Indexed: 11/15/2022]
Abstract
Outcome measurement in outpatient and day-care mental health facilities for children and adolescents in Spain remains limited, in part due to a lack of validated scales. To address this issue, we translated HoNOSCA (glossary, score sheet, self-rated questionnaire, and parent/legal guardian questionnaire) into Spanish and Catalan using a reverse translation approach. We ascertained the validity and psychometric quality of the HoNOSCA in Spanish by assessing correlation with the Children's Global Assessment Scale (C-GAS). We recruited 64 participants 7-17 years of age in five day-care Psychiatry hospitals in Catalonia (Spain). Two evaluators administered both instruments twice, two weeks apart. Patients and parents/legal guardians completed the corresponding HoNOSCA versions. We calculated Cronbach's alpha for assessing internal consistency, intra-class correlation coefficients (ICC) for inter-rater and test-retest reliability, and Pearson's correlation coefficients for validity. We found that all HoNOSCA versions in Spanish presented satisfactory internal consistency, inter-rater and test-retest reliability. Concurrent validity for HoNOSCA-Glossary was also acceptable, with Pearson's coefficients of -0.543 and -0.519 for evaluators in the first administration, and of -0.675 and -0.685 in the second administration. HoNOSCA was also successfully translated into Catalan; acceptability was determined using cognitive interviews.
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Affiliation(s)
- Anna Ballesteros-Urpí
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic de Barcelona, Carrer Villarroel 170, 08036 Barcelona, Spain.
| | - Héctor Pardo-Hernández
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB Sant Pau), Carrer Sant Antoni Maria Claret, 167, Pavelló 18, Ground Floor, 08041 Barcelona, Spain
| | - Andreu Ferrero-Gregori
- Iberoamerican Cochrane Centre, Sant Pau Biomedical Research Institute (IIB Sant Pau), Carrer Sant Antoni Maria Claret, 167, Pavelló 18, Ground Floor, 08041 Barcelona, Spain
| | - Jordi Torralbas-Ortega
- Mental Health Center. Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Sabadell, Barcelona, Spain
| | - Joaquim Puntí-Vidal
- Mental Health Center. Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Sabadell, Barcelona, Spain
| | - Pere Tàpies Olivet
- Osona Salut Mental, Consorci Hospitalari de Vic, Carrer de Sant Miquel Xic, 2, 08500 Vic, Barcelona
| | - Jon Izaguirre Eguren
- CSMIJ i Hospital de Dia per Adolescents, Hospital Sant Joan de Déu de Mollet, Pablo Picasso, 54 baixos, 08100 Mollet del Vallès, Barcelona, Spain
| | - Pere Vergés Balasch
- CSMIJ i Hospital de Dia per Adolescents, Hospital Sant Joan de Déu de Mollet, Pablo Picasso, 54 baixos, 08100 Mollet del Vallès, Barcelona, Spain
| | - Anaís Lara Lloveras
- Servei de Salut Mental, Hospital Sant Joan de Déu de Manresa, Dr. Joan Soler, s/n, 08243 Manresa, Barcelona, Spain
| | - Santiago Bertomeu
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic de Barcelona, Carrer Villarroel 170, 08036 Barcelona, Spain
| | - Montserrat Peramiquel
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic de Barcelona, Carrer Villarroel 170, 08036 Barcelona, Spain
| | - Victoria Herreros
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic de Barcelona, Carrer Villarroel 170, 08036 Barcelona, Spain
| | - Àngela Vidal
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic de Barcelona, Carrer Villarroel 170, 08036 Barcelona, Spain
| | - Elena Font
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic de Barcelona, Carrer Villarroel 170, 08036 Barcelona, Spain
| | - Soledad Romero
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic de Barcelona, Carrer Villarroel 170, 08036 Barcelona, Spain; Centro de Investigación en Red de Salud Mental (CIBERSAM), Instituto Carlos III, Barcelona, Spain
| | - Marta Garcia
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic de Barcelona, Carrer Villarroel 170, 08036 Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Carrer Villarroel 170, 08036 Barcelona, Spain
| | - Luisa Lázaro
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic de Barcelona, Carrer Villarroel 170, 08036 Barcelona, Spain; Centro de Investigación en Red de Salud Mental (CIBERSAM), Instituto Carlos III, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Carrer Villarroel 170, 08036 Barcelona, Spain
| | - Àstrid Morer
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic de Barcelona, Carrer Villarroel 170, 08036 Barcelona, Spain; Centro de Investigación en Red de Salud Mental (CIBERSAM), Instituto Carlos III, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Carrer Villarroel 170, 08036 Barcelona, Spain
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Kantzer AK, Fernell E, Westerlund J, Hagberg B, Gillberg C, Miniscalco C. Young children who screen positive for autism: Stability, change and "comorbidity" over two years. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 72:297-307. [PMID: 27818061 DOI: 10.1016/j.ridd.2016.10.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 10/10/2016] [Accepted: 10/10/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Autism spectrum disorder (ASD) is a developmental disorder with a wide variety of clinical phenotypes and co-occurrences with other neurodevelopmental conditions. Symptoms may change over time. AIMS The aim of the present study was to prospectively follow 96 children, initially assessed for suspected ASD at an average age of 2.9 years. METHODS AND PROCEDURES All children had been identified with autistic symptoms in a general population child health screening program, and had been referred to the Child Neuropsychiatry Clinic in Gothenburg, Sweden for further assessment by a multi-professional team at Time 1 (T1). This assessment included a broad neurodevelopmental examination, structured interviews, a cognitive test and evaluations of the child́s adaptive and global functioning. Two years later, at Time 2 (T2), the children and their parents were invited for a follow-up assessment by the same team using the same methods. OUTCOMES AND RESULTS Of the 96 children, 76 had met and 20 had not met full criteria for ASD at T1. Of the same 96 children, 79 met full ASD criteria at T2. The vast majority of children with ASD also had other neurodevelopmental symptoms or diagnoses. Hyperactivity was observed in 42% of children with ASD at T2, and Intellectual Developmental Disorder in 30%. Borderline Intellectual Functioning was found in 25%, and severe speech and language disorder in 20%. The children who did not meet criteria for ASD at T2 had symptoms of or met criteria for other neurodevelopmental/neuropsychiatric disorders in combination with marked autistic traits. Changes in developmental profiles between T1 and T2 were common in this group of young children with ASD. The main effect of Cognitive level at T1 explained more than twice as much of the variance in Vineland scores as did the ASD subtype; children with IDD had significantly lower scores than children in the BIF and AIF group. Co-existence with other conditions was the rule. CONCLUSIONS AND IMPLICATIONS Reassessments covering the whole range of these conditions are necessary for an optimized intervention-adapted to the individual child's needs.
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Affiliation(s)
- Anne-Katrin Kantzer
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Sweden; Department of Child and Adolescent Psychiatry, NU Hospital Organization, Uddevalla, Sweden.
| | - Elisabeth Fernell
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Joakim Westerlund
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Sweden; Institute of Psychology, Stockholm University, Stockholm, Sweden
| | - Bibbi Hagberg
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Sweden; Child Neuropsychiatry Clinic, University of Gothenburg, Gothenburg, Sweden
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Carmela Miniscalco
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, University of Gothenburg, Sweden; Division of Speech and Language Pathology, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
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Münzer A, Rosner R, Ganser HG, Naumann A, Plener PL, Witt A, Goldbeck L. Usual Care for Maltreatment-Related Pediatric Posttraumatic Stress Disorder in Germany. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2017; 46:135-141. [PMID: 29035141 DOI: 10.1024/1422-4917/a000548] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Child maltreatment represents a major risk factor for the development of emotional and behavioral problems, especially posttraumatic stress disorder (PTSD). While effective trauma-focused treatments are available, little is known about the usual mental healthcare for abused youths in Germany. The present study compared the utilization of mental healthcare in abused youths who had developed a PTSD (N = 95) with a group presenting other mental disorders (N = 146). Semistructured interviews were used to assess maltreatment histories, current mental health, and healthcare utilization. In addition, potential child factors associated with access to mental healthcare (age and level of functioning) were examined. Results showed that 65 % of both diagnostic groups currently fail to use any mental healthcare service. Of the participants with PTSD, 43 (45 %) had never received any mental healthcare intervention. Investigations on potential barriers are necessary to close the huge gap between clinical services and evidence-based, trauma-focused interventions.
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Affiliation(s)
- Annika Münzer
- 1 Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Ulm, Ulm, Germany
| | - Rita Rosner
- 2 Department of Psychology, Catholic University Eichstätt-Ingolstadt, Germany
| | - Helene Gertrud Ganser
- 1 Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Ulm, Ulm, Germany
| | - Alexander Naumann
- 3 Department of Child and Adolescent Psychiatry/Psychotherapy, Lüneburg Psychiatric Hospital, Lüneburg, Germany
| | - Paul L. Plener
- 1 Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Ulm, Ulm, Germany
| | - Andreas Witt
- 1 Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Ulm, Ulm, Germany
| | - Lutz Goldbeck
- 1 Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Ulm, Ulm, Germany
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Abstract
Although a broad array of neurocognitive dysfunctions are associated with ADHD, it is unknown whether these dysfunctions play a role in the course of ADHD symptoms. The present longitudinal study investigated whether neurocognitive functions assessed at study-entry (mean age = 11.5 years, SD = 2.7) predicted ADHD symptom severity and overall functioning 6 years later (mean age = 17.4 years, 82.6 % = male) in a carefully phenotyped large sample of 226 Caucasian participants from 182 families diagnosed with ADHD-combined type. Outcome measures were dimensional measures of ADHD symptom severity and the Kiddie-Global Assessment Scale (K-GAS) for overall functioning. Predictors were derived from component scores for 8 domains of neurocognitive functioning: working memory, motor inhibition, cognitive inhibition, reaction time variability, timing, information processing speed, motor control, intelligence. Effects of age, gender, and pharmacological treatment were considered. Results showed that better working memory predicted lower ADHD symptom severity (R2 = 3.0 %), and less reaction time variability predicted better overall functioning (higher K-GAS-score, R2 = 5.6 %). Predictors were still significant with baseline behavior included in the models. The role of neurocognitive functioning in the long term outcome of ADHD behavior is discussed.
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Camilleri N, Newbury-Birch D, McArdle P, Stocken DD, Thick T, Le Couteur A. Innovations in Practice: A case control and follow-up study of 'hard to reach' young people who suffered from multiple complex mental disorders. Child Adolesc Ment Health 2017; 22:49-57. [PMID: 32680404 DOI: 10.1111/camh.12202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/02/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Innovations Project (IP) was a new multidisciplinary team based within an inner city, walk-in health centre, North East England (throughout 2011). The aim was to describe the social and mental disorders of the hard to reach young people (HTRYP) from the IP and compare with a matched sample who attended a Community Mental Health Team (CMHT) and follow-up both samples 24 months after discharge. METHODS A retrospective review of clinical case notes of YP who attended the IP and CMHT. A 24-month (postdischarge) follow-up evaluation of the mental state and social function of the YP in both groups using Health of the Nation Outcome Scales for Child and Adolescent Mental Health (HoNOSCA) and Children's Global Assessment Scale (CGAS). RESULTS Thirty-six referrals were accepted over a one-year period by the IP, 31 met criteria for the HTRYP, 15 were offered individually tailored therapy. The HTRYP who were more deprived compared to the CMHT matched sample (n = 115), experienced a higher median number of mental disorders (n = 3 compared to CMHT n = 1), higher severity scores and lower levels of social function (HTRYP HoNOSCA mean: 19.1 (95% CI 15.9-22.2) and CMHT mean: 11.2 (95% CI 2.0-23.0) p = <.001, and HTRYP CGAS mean: 51.0 (95% CI 46.0-56.2) and CMHT mean: 58.9 (95% CI 52.9-64.8), p = .05). The HTRYP made significantly greater improvement compared to CMHTYP; (HoNOSCA p = <.001 and CGAS p = <.002) at discharge. A total of 13 HTRYP and 9 CMHT YP attended the follow-up review at 24 months. There was substantial variability in terms of social function between the YP within each sample. CONCLUSIONS The term 'HTR' describes a state that may be often temporary, as opposed to lifelong. A bespoke service offering a developmental theoretical framework, regular reviews and an individualised care plan, was able to engage and had the potential to reduce morbidity suffered by HTRYP.
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Affiliation(s)
- Nigel Camilleri
- Institute of Health and Society, Newcastle University, Baddilley-Clarke Building, Richardson Street, Newcastle upon Tyne, NE2 4AX, UK.,Tees Esk and Wear Valleys NHS Foundation Trust, Edward Pease Way, Darlington, County Durham DL2 2TS, UK
| | | | - Paul McArdle
- Northumberland Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - Deborah D Stocken
- Institute of Health and Society, Newcastle University, Baddilley-Clarke Building, Richardson Street, Newcastle upon Tyne, NE2 4AX, UK
| | - Tony Thick
- Ponteland Road Health Centre, Newcastle upon Tyne, UK
| | - Ann Le Couteur
- Institute of Health and Society, Newcastle University, Baddilley-Clarke Building, Richardson Street, Newcastle upon Tyne, NE2 4AX, UK.,Northumberland Tyne and Wear NHS Foundation Trust, Newcastle, UK
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West M, Melvin G, McNamara F, Gordon M. An evaluation of the use and efficacy of a sensory room within an adolescent psychiatric inpatient unit. Aust Occup Ther J 2017; 64:253-263. [DOI: 10.1111/1440-1630.12358] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Monique West
- Monash University Centre for Developmental Psychiatry & Psychology; Notting Hill Victoria Australia
| | - Glenn Melvin
- Monash University Centre for Developmental Psychiatry & Psychology; Notting Hill Victoria Australia
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Robustelli BL, Newberry RE, Whisman MA, Mittal VA. Social relationships in young adults at ultra high risk for psychosis. Psychiatry Res 2017; 247:345-351. [PMID: 27987484 PMCID: PMC5217827 DOI: 10.1016/j.psychres.2016.12.008] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 09/17/2016] [Indexed: 11/15/2022]
Abstract
Studies suggest that individuals with schizophrenia have smaller social networks and less satisfying relationships. However, much is still unknown about the typical quantity and quality of social relationships in young adults during the ultra high-risk (UHR) period. Investigating these relationships holds significant importance for improving understanding of etiological processes, mapping the social environment, and highlighting treatment targets in a critical period. A total of 85 participants (44 UHR and 41 healthy controls) completed measures examining the participants' social relationships, social support, and loneliness. Mean differences between the UHR and healthy control participants and associations between social relationships and symptoms and functioning were examined. Results indicated significant differences between groups on several indices. Specifically, the UHR youth reported fewer close friends, less diverse social networks, less perceived social support, poorer relationship quality with family and friends, and more loneliness. Notably, within the UHR group, being lonely and having fewer and worse quality relationships was associated with greater symptom severity and lower overall functioning. This study suggests that youth at high-risk of developing psychosis have fewer and poorer quality social relationships. Interventions that focus on increasing the quantity and quality of young adults' social networks may be beneficial for this population.
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Affiliation(s)
- Briana L. Robustelli
- Department of Psychology and Neuroscience, University of Colorado, Boulder, 345 UCB, Boulder, CO 80309-0345, United States,Correspondence to: University of Colorado Boulder, Department of Psychology and Neuroscience, 345 UCB, Boulder, CO 80309-0345, Telephone: 518-657-1202, Fax: 303-492-2967.
| | - Raeana E. Newberry
- Department of Psychology and Neuroscience, University of Colorado, Boulder, 345 UCB, Boulder, CO 80309-0345, United States
| | - Mark A. Whisman
- Department of Psychology and Neuroscience, University of Colorado, Boulder, 345 UCB, Boulder, CO 80309-0345, United States
| | - Vijay A. Mittal
- Department of Psychology, Department of Psychiatry, Institute for Policy Research, Northwestern University, Swift Hall 102, 2029 Sheridan Road, Evanston, IL 60208, United States
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Gezelius C, Wahlund B, Carlsson L, Wiberg B. Adolescent patients with eating disorders and their parents: a study of self-image and outcome at an intensive outpatient program. Eat Weight Disord 2016; 21:607-616. [PMID: 27170194 DOI: 10.1007/s40519-016-0286-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 04/11/2016] [Indexed: 11/25/2022] Open
Abstract
PURPOSE The main aim of this clinical study was to explore how adolescent patients with eating disorders and their parents report their perceived self-image, using Structural Analysis of Social Behavior (SASB), before and after treatment at an intensive outpatient program. Another aim was to relate the self-image of the young patients to the outcome measures body mass index (BMI) and Children's Global Assessment Scale (C-GAS) score. METHODS A total of 93 individuals (32 adolescents, 34 mothers, and 27 fathers) completed the SASB self-report questionnaire before and after family-based treatment combined with an individual approach at a child and youth psychiatry day care unit. The patients were also assessed using the C-GAS, and their BMI was calculated. RESULTS The self-image (SASB) of the adolescent patients was negative before treatment and changed to positive after treatment, especially regarding the clusters self-love (higher) and self-blame (lower). A positive correlation between change in self-love and in C-GAS score was found, which rose significantly. Increased self-love was an important factor, explaining a variance of 26 %. BMI also increased significantly, but without any correlation to change in SASB. The patients' fathers exhibited low on the cluster self-protection. Mothers' profiles were in line with a non-clinical group. CONCLUSIONS Results indicate that the self-image of adolescent patients change from negative to positive alongside with a mainly positive outcome of the ED after treatment. Low self-protection according to SASB among fathers suggests the need for greater focus on their involvement.
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Affiliation(s)
- Christina Gezelius
- Department of Child and Youth Psychiatry, Falun Central Hospital, Falun, Sweden. .,Center for Clinical Research Dalarna, Nissers väg 3, 791 82, Falun, Sweden.
| | - Björn Wahlund
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | - Lars Carlsson
- Department of Child and Youth Psychiatry, Falun Central Hospital, Falun, Sweden
| | - Britt Wiberg
- Department of Psychology, Umeå University, Umeå, Sweden
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Pharmacogenetic study focused on fluoxetine pharmacodynamics in children and adolescent patients. Pharmacogenet Genomics 2016; 26:487-496. [DOI: 10.1097/fpc.0000000000000240] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Reversal-learning deficits in childhood-onset bipolar disorder across the transition from childhood to young adulthood. J Affect Disord 2016; 203:46-54. [PMID: 27280962 PMCID: PMC4975956 DOI: 10.1016/j.jad.2016.05.046] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 04/25/2016] [Accepted: 05/22/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Bipolar disorder (BD) is a severe mental illness that can have high costs for youths (<18 years old) and adults. Relative to healthy controls (HC), individuals with BD often show impaired attention, working memory, executive function, and cognitive flexibility (the ability to adapt to changing reward/punishment contingencies). In our study of youths and young adults with BD, we investigated 1) how cognitive flexibility varies developmentally in BD, and 2) whether it is independent of other executive function deficits associated with BD. METHODS We measured errors on a reversal-learning task, as well as spatial working memory and other executive function, among participants with BD (N=75) and HC (N=130), 7-27 years old. Regression analyses focused on the effects of diagnosis on reversal-learning errors, controlling for age, gender, IQ, spatial span, and executive function. Similar analyses examined non-reversal errors to rule out general task impairment. RESULTS Participants with BD, regardless of age, gender, or cognitive ability, showed more errors than HC on the response reversal stages of the cognitive flexibility task. However, participants with BD did not show more errors on non-reversal stages, even when controlling for other variables. LIMITATIONS Study limitations include the cross-sectional, rather than longitudinal, design; inability to measure non-linear age effects; and inclusion of medicated participants and those with psychiatric comorbidity. CONCLUSIONS Individuals with BD show a specific impairment in reversing a previously rewarded response, which persists across the transition from childhood to young adulthood. Tailored interventions targeting this deficit may be effective throughout this developmentally turbulent time.
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Spjut Jansson B, Miniscalco C, Westerlund J, Kantzer AK, Fernell E, Gillberg C. Children who screen positive for autism at 2.5 years and receive early intervention: a prospective naturalistic 2-year outcome study. Neuropsychiatr Dis Treat 2016; 12:2255-63. [PMID: 27621636 PMCID: PMC5012621 DOI: 10.2147/ndt.s108899] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Previous research has stressed the importance of early identification and intervention for children with autism spectrum disorders. METHODS Children who had screened positive for autism at the age of 2.5 years in a general population screening and then received a diagnosis of autism spectrum disorder were enrolled in an intervention program provided by Swedish habilitation services. The following interventions were available: a comprehensive intervention based on Applied Behavior Analysis - Intensive Learning (IL) - in two settings, which included home- and preschool-based (IL Regular) and only home-based (IL Modified) and eclectic interventions. RESULTS There was considerable variability in terms of outcome, but intervention group status was not associated with any of the chosen outcome variables. CONCLUSION The main finding was that the type of intervention was not critical for outcome of adaptive or global functioning. The variability in outcome demonstrates the need for continuous assessments and evaluation of the child's function and behavior throughout the intervention period.
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Affiliation(s)
- Birgitta Spjut Jansson
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg
- Unit of Child and Adolescent Habilitation
- Department of Psychology, University of Gothenburg
| | - Carmela Miniscalco
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg
- Division of Speech and Language Pathology, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg
| | - Joakim Westerlund
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg
- Department of Psychology, University of Stockholm, Stockholm
| | - Anne-Katrin Kantzer
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg
- Department of Child and Adolescent Psychiatry, NU Hospital Organization, Trollhättan, Sweden
| | - Elisabeth Fernell
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg
| | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Sahlgrenska Academy, Institute of Neuroscience and Physiology, University of Gothenburg
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