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Girela-Serrano B, Miguélez-Fernández C, Abascal-Peiró S, Peñuelas-Calvo I, Jiménez-Muñoz L, Moreno M, Delgado-Gómez D, Bello HJ, Nicholls D, Baca-García E, Carballo JJ, Porras-Segovia A. Diagnostic trajectories of mental disorders in children and adolescents: a cohort study. Eur Child Adolesc Psychiatry 2024; 33:1481-1494. [PMID: 37422547 DOI: 10.1007/s00787-023-02254-0] [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: 02/07/2023] [Accepted: 06/23/2023] [Indexed: 07/10/2023]
Abstract
Mental disorders in children and adolescents may follow different trajectories, such as remission, change of diagnosis, or addition of two or more comorbid diagnoses, showing a heterotypic pattern. This study aims to describe the main diagnostic trajectories across a broad range of mental disorder diagnostic categories, from childhood to adolescence and from adolescence to young adulthood in a clinical population. A prospective study was conducted among a clinical sample of children and adolescents who were aged 3-17 years at the face-to-face baseline interview. Electronic health records of these participants were reviewed 10 years later. The diagnostic stability over time was examined using the kappa coefficient, and factors associated with stability were explored using simple logistic regression. The study included a sample of 691 participants. The kappa coefficient for diagnostic stability across all diagnoses was 0.574 for the transition from childhood to adulthood, 0.614 from childhood to adolescence, and 0.733 from adolescence to adulthood. Neurodevelopmental diagnoses had the highest stability. Factors associated with higher diagnostic stability included family history of mental disorders, receiving psychopharmacological treatment, and symptom severity at baseline. We found a variable diagnostic stability across different diagnoses and age categories. The different life transitions represent complex periods that should not be overlooked from a clinical standpoint. An appropriate transition from child and adolescent mental health services to adult mental health services may have a positive impact on children and adolescents with mental disorders.
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Affiliation(s)
- Braulio Girela-Serrano
- Westminster Child and Adolescent Mental Health Service, Central and Northwest London NHS Foundation Trust, London, UK
- Division of Psychiatry, Imperial College London, London, UK
| | | | - Sofía Abascal-Peiró
- Department of Psychiatry, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | | | | | - Manon Moreno
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain
| | - David Delgado-Gómez
- Department of Statistics, University Carlos III of Madrid, 28911, Leganés, Spain
| | - Hugo J Bello
- Department of Applied Mathematics, Universidad de Valladolid, Valladolid, Spain
| | - Dasha Nicholls
- Division of Psychiatry, Imperial College London, London, UK
| | - Enrique Baca-García
- Department of Psychiatry, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
- Department of Child and Adolescent Psychiatry, Hospital Universitario 12 de Octubre, Madrid, Spain
- Department of Psychiatry, Hospital Universitario Infanta Elena, Valdemoro, Madrid, Spain
- Department of Psychiatry, Hospital Universitario Central de Villalba, Madrid, Spain
- Department of Psychiatry, Hospital Universitario Rey Juan Carlos, Móstoles, Spain
- Faculty of Health Sciences, Universidad Católica del Maule, Talca, Chile
- CIBERSAM, Madrid, Spain
- Centre Hospitalier Universitaire de Nîmes, Nîmes, France
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Alejandro Porras-Segovia
- Division of Psychiatry, Imperial College London, London, UK.
- Instituto de Investigación Sanitaria Fundación Jiménez Díaz, Madrid, Spain.
- Department of Psychiatry, Hospital Universitario Rey Juan Carlos, Móstoles, Spain.
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Baranger DAA, Lindenmuth M, Nance M, Guyer AE, Keenan K, Hipwell AE, Shaw DS, Forbes EE. The longitudinal stability of fMRI activation during reward processing in adolescents and young adults. Neuroimage 2021; 232:117872. [PMID: 33609668 PMCID: PMC8238413 DOI: 10.1016/j.neuroimage.2021.117872] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 02/12/2021] [Accepted: 02/13/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The use of functional neuroimaging has been an extremely fruitful avenue for investigating the neural basis of human reward function. This approach has included identification of potential neurobiological mechanisms of psychiatric disease and examination of environmental, experiential, and biological factors that may contribute to disease risk via effects on the reward system. However, a central and largely unexamined assumption of much of this research is that neural reward function is an individual difference characteristic that is relatively stable and trait-like over time. METHODS In two independent samples of adolescents and young adults studied longitudinally (Ns = 145 & 139, 100% female and 100% male, ages 15-21 and 20-22, 2-4 scans and 2 scans respectively), we tested within-person stability of reward-task BOLD activation, with a median of 1 and 2 years between scans. We examined multiple commonly used contrasts of active states and baseline in both the anticipation and feedback phases of a card-guessing reward task. We examined the effects of cortical parcellation resolution, contrast, network (reward regions and resting-state networks), region-size, and activation strength and variability on the stability of reward-related activation. RESULTS In both samples, contrasts of an active state relative to a baseline were more stable (ICC: intra-class correlation; e.g., Win>Baseline; mean ICC = 0.13 - 0.33) than contrasts of two active states (e.g., Win>Loss; mean ICC = 0.048 - 0.05). Additionally, activation in reward regions was less stable than in many non-task networks (e.g., dorsal attention), and activation in regions with greater between-subject variability showed higher stability in both samples. CONCLUSIONS These results show that some contrasts from functional neuroimaging activation during a card guessing reward task have partially trait-like properties in adolescent and young adult samples over 1-2 years. Notably, results suggest that contrasts intended to map cognitive function and show robust group-level effects (i.e. Win > Loss) may be less effective in studies of individual differences and disease risk. The robustness of group-level activation should be weighed against other factors when selecting regions of interest in individual difference fMRI studies.
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Affiliation(s)
- David A A Baranger
- University of Pittsburgh School of Medicine, Department of Psychiatry, 121 Meyran Avenue, Pittsburgh, PA 15213, United States.
| | - Morgan Lindenmuth
- University of Pittsburgh School of Medicine, Department of Psychiatry, 121 Meyran Avenue, Pittsburgh, PA 15213, United States
| | - Melissa Nance
- University of Pittsburgh School of Medicine, Department of Psychiatry, 121 Meyran Avenue, Pittsburgh, PA 15213, United States
| | - Amanda E Guyer
- Center for Mind and Brain, University of California Davis, Davis, CA, United States; Department of Human Ecology, University of California Davis, Davis, CA, United States
| | - Kate Keenan
- University of Chicago, Department of Psychiatry and Behavioral Neuroscience, Chicago, IL, United States
| | - Alison E Hipwell
- University of Pittsburgh School of Medicine, Department of Psychiatry, 121 Meyran Avenue, Pittsburgh, PA 15213, United States
| | - Daniel S Shaw
- University of Pittsburgh, Department of Psychology, Pittsburgh, PA, United States
| | - Erika E Forbes
- University of Pittsburgh School of Medicine, Department of Psychiatry, 121 Meyran Avenue, Pittsburgh, PA 15213, United States; University of Pittsburgh, Department of Psychology, Pittsburgh, PA, United States
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Jalenques I, Cyrille D, Derost P, Hartmann A, Lauron S, Jameux C, Tauveron-Jalenques U, Guiguet-Auclair C, Rondepierre F. Cross-cultural adaptation and psychometric evaluation of the French version of the Gilles de la Tourette Syndrome Quality of Life Scale (GTS-QOL). PLoS One 2020; 15:e0243912. [PMID: 33351837 PMCID: PMC7755204 DOI: 10.1371/journal.pone.0243912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 12/01/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The Gilles de la Tourette Syndrome-Quality of Life Scale (GTS-QOL) is a self-rated disease-specific questionnaire to assess health-related quality of life of subjects with GTS. Our aim was to perform the cross-cultural adaptation of the GTS-QOL into French and to assess its psychometric properties. METHODS The GTS-QOL was cross-culturally adapted by conducting forward and backward translations, following international guidelines. The psychometric properties of the GTS-QOL-French were assessed in 109 participants aged 16 years and above with regard to factor structure, internal consistency, reliability and convergent validity with the MOVES (Motor tic, Obsessions and compulsions, Vocal tic Evaluation Survey) and the WHOQOL-BREF (World Health Organization Quality of Life Brief). RESULTS Exploratory factor analysis of the GTS-QOL-French resulted in a 6-factor solution and did not replicate the original structure in four subscales. The results showed good acceptability (missing values per subscale ranging from 0% to 0.9%), good internal consistency (Cronbach's alpha ranging from 0.68 to 0.94) and good test-retest reliability (intraclass correlation coefficients ranging from 0.70 to 0.81). Convergent validity with the MOVES and WHOQOL-BREF scales showed high correlations. DISCUSSION Our study provides evidence of the good psychometric properties of the GTS-QOL-French. The cross-cultural adaptation and validation of this specific instrument will make it possible to assess health-related quality of life in French-speaking subjects with GTS. The GTS-QOL-French could be recommended for use in future research.
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Affiliation(s)
- Isabelle Jalenques
- Centre de Compétence Gilles de la Tourette, Service de Psychiatrie de l’Adulte A et Psychologie Médicale, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Diane Cyrille
- Centre de Compétence Gilles de la Tourette, Service de Psychiatrie de l’Adulte A et Psychologie Médicale, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Philippe Derost
- Service de Neurologie, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Andreas Hartmann
- Assistance Publique-Hôpitaux de Paris (AP-HP), Pitié-Salpêtrière Hospital, National Reference Center for Tourette Syndrome, Paris, France
| | - Sophie Lauron
- Centre de Compétence Gilles de la Tourette, Service de Psychiatrie de l’Adulte A et Psychologie Médicale, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Clara Jameux
- Centre de Compétence Gilles de la Tourette, Service de Psychiatrie de l’Adulte A et Psychologie Médicale, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Urbain Tauveron-Jalenques
- Centre de Compétence Gilles de la Tourette, Service de Psychiatrie de l’Adulte A et Psychologie Médicale, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Candy Guiguet-Auclair
- Université Clermont Auvergne, CHU Clermont-Ferrand, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Fabien Rondepierre
- Centre de Compétence Gilles de la Tourette, Service de Psychiatrie de l’Adulte A et Psychologie Médicale, CHU Clermont-Ferrand, Université Clermont Auvergne, Clermont-Ferrand, France
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Amidi Naeini A, Ranjbar H, Mohammadsadeghi H, Alavi K, Ahmadkhaniha H, Rasoulian M. Assessment of psychiatrists' approaches regarding disclosure of psychiatric disorders to their patients: a qualitative study. Med J Islam Repub Iran 2020; 34:82. [PMID: 33306057 PMCID: PMC7711037 DOI: 10.34171/mjiri.34.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Indexed: 11/10/2022] Open
Abstract
Background: Diagnosis disclosure is the result of a shift in medical approaches from traditional paternalism to participatory and patient-centered decision making. Disclosure of psychiatric diagnosis remained uncommon and controversial. Giving information about psychiatric illnesses is very complicated, and it is affected by several factors. While clinical guidelines provide a clear pathway for treating patients, in practice, the treatment of patients is influenced by cultural and social factors. The aim of the current study was a qualitative assessment of psychiatrists’ approaches regarding the disclosure of psychiatric disorders to their patients.
Methods: The current study was conducted with a qualitative approach. The participants were purposefully selected psychiatrists from three medical universities in Tehran, Iran. The data gathered using the semi-structured interview method. Sixteen interviews with 14 psychiatrists were conducted. Data were analyzed using thematic analysis.
Results: Psychiatrists decide to disclose the diagnosis based on several factors. We summarized these factors in a central theme, passive situational decision making based on paternalism and displacement of responsibility. It has two subthemes, including "passive and situational decision making" and "paternalism and displacement of responsibility." Each theme presented by detailed quotations.
Conclusion: The results of this study showed that psychiatrists did not actively disclose the diagnosis name to patients. Diagnosis disclosure was influenced by several factors, such as the certainty about the diagnosis and the severity of the disease. This passive approach does not respect the patient's rights. The paternalistic nature of this approach mandates psychiatrists to consider themselves as the responsible perosn for their patients’ welfare.
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Affiliation(s)
| | - Hadi Ranjbar
- Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Science, Tehran, Iran
| | - Homa Mohammadsadeghi
- Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Science, Tehran, Iran
| | - Kaveh Alavi
- Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Science, Tehran, Iran
| | - Hamidreza Ahmadkhaniha
- Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Science, Tehran, Iran
| | - Maryam Rasoulian
- Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Science, Tehran, Iran
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Lived Experiences of Diagnostic Shifts in Child and Adolescent Mental Health Contexts: a Qualitative Interview Study with Young People and Parents. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 48:979-993. [PMID: 32447487 DOI: 10.1007/s10802-020-00657-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Psychiatric diagnoses are important resources in helping young people and families make sense of emotional or behavioural difficulties. However, the poor reliability of diagnoses in childhood means many young service-users experience their diagnosis being removed, revised or supplemented over time. No previous research has investigated how young service-users experience, understand or respond to alteration of their original diagnosis. The current study adopted a qualitative approach to explore the lived experience of diagnostic shifts in youth mental health contexts. Narrative interviews were conducted with families living in Ireland, who had direct experience of diagnostic shifts. Participants included 21 parents (19 female) and 14 young people (8 female, mean age = 14). Thematic analysis explored the range of interpretations and implications of diagnostic shifts in families' lives, identifying three themes that underpinned participants' narratives. Diverse Trajectories & Experiences outlined the variety of contexts for diagnostic shifts, ways they were communicated to parents and young people, and their clinical consequences. A Process of Readjustment captured processes of emotional and conceptual adaptation that followed a diagnostic shift. Finally, Social Repositioning explored how diagnostic shifts could prompt changes to interpersonal relations, social identity and stigma experiences. The study shows that diagnostic shifts carry significant emotional, social and practical repercussions. While diagnostic shifts may threaten the therapeutic relationship and service-user understanding, they also offer opportunities to enhance young people's self-concept, social relationships and therapeutic engagement. Clinician awareness of the socio-emotional implications of diagnostic shifts is vital to inform sensitive communication and support strategies.
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O’Connor C, Downs J, Shetty H, McNicholas F. Diagnostic trajectories in child and adolescent mental health services: exploring the prevalence and patterns of diagnostic adjustments in an electronic mental health case register. Eur Child Adolesc Psychiatry 2020; 29:1111-1123. [PMID: 31679098 PMCID: PMC7369254 DOI: 10.1007/s00787-019-01428-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 10/22/2019] [Indexed: 12/03/2022]
Abstract
Community-based epidemiological studies show transitions between psychiatric disorders are common during child development. However, little research has explored the prevalence or patterns of the diagnostic adjustments that occur in child and adolescent mental health services (CAMHS). Understanding diagnostic trajectories is necessary to inform theory development in developmental psychopathology and clinical judgements regarding risk and prognosis. In this study, data from CAMHS clinical records were extracted from a British mental health case register (N = 12,543). Analysis calculated the proportion of children whose clinical records showed a longitudinal diagnostic adjustment (i.e. addition of a subsequent diagnosis of a different diagnostic class, at > 30 days' distance from their first diagnosis). Regression analyses investigated typical diagnostic sequences and their relationships with socio-demographic variables, service use and standardised measures of mental health. Analysis found that 19.3% of CAMHS attendees had undergone a longitudinal diagnostic adjustment. Ethnicity, diagnostic class and symptom profiles significantly influenced the likelihood of a diagnostic adjustment. Affective and anxiety/stress-related disorders longitudinally predicted each other, as did hyperkinetic and conduct disorders, and hyperkinetic and pervasive developmental disorders. Results suggest that approximately one in five young service users have their original psychiatric diagnosis revised or supplemented during their time in CAMHS. By revealing the most common diagnostic sequences, this study enables policy makers to anticipate future service needs and clinicians to make informed projections about their patients' likely trajectories. Further research is required to understand how young people experience diagnostic adjustments and their psychological and pragmatic implications.
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Affiliation(s)
- Cliodhna O’Connor
- grid.7886.10000 0001 0768 2743School of Psychology, University College Dublin, Dublin, Ireland ,grid.7886.10000 0001 0768 2743School of Medicine and Medical Science, University College Dublin, Dublin, Ireland
| | - Johnny Downs
- grid.37640.360000 0000 9439 0839NIHR Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK ,grid.13097.3c0000 0001 2322 6764Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Hitesh Shetty
- grid.37640.360000 0000 9439 0839NIHR Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Fiona McNicholas
- grid.7886.10000 0001 0768 2743School of Medicine and Medical Science, University College Dublin, Dublin, Ireland ,St John of God Hospitaller Services, Dublin, Ireland ,grid.417322.10000 0004 0516 3853Our Lady’s Hospital for Sick Children, Crumlin, Ireland
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