European Child & Adolescent Psychiatry最新文献

Attention-deficit/hyperactivity (ADHD) guidelines recommend that the need for continued stimulant medication treatment of children and adolescents needs to be reviewed at least annually. We aimed to assess the outcomes in clinical practice of placebo-controlled discontinuation trials after long-term methylphenidate treatment. We asked clinicians to implement N = 1 randomized, double-blind, placebo-controlled, cross-over discontinuation trials after at least one year of methylphenidate treatment of children and adolescents (n = 26, 6-15 years of age). We analyzed the effectiveness of ongoing methylphenidate treatment compared to placebo on symptoms of ADHD, oppositional defiant disorder, and conduct disorder according to both parents and teachers, and the global improvement or deterioration according to the clinicians. We also assessed the proportion of individuals who continued using methylphenidate after the discontinuation trial. Teacher-rated hyperactivity and impulsivity symptoms were significantly lower during methylphenidate treatment compared to placebo (β = 3.80, SD = 1.69, t = 2.25, p =.04). No other significant differences were found between methylphenidate and placebo. Almost two-thirds (n = 16, 61.5%) of individuals continued using methylphenidate after the discontinuation trials, of which seven did not deteriorate during placebo according to their clinician. Our findings support the need for regular evaluations of methylphenidate treatment effectiveness and emphasize the importance of including the school setting when evaluating treatments. Better guidance for clinicians when to continue or cease methylphenidate treatment is urgently needed.

Many adolescent girls desire to have a thinner body, including those of normal weight. However, it is not fully known if this reflects solely a preference for a particular body type/size, or also is influenced by holding a distorted perception of one's body size. The current series of studies aimed to examine the (in)accuracy of body size perception among adolescent girls, as well as the extent to which distorted perceptions of body size extended to perceptions of other girls' bodies. In Study 1, 48 pairs of girls who desired to be thinner were asked to estimate the circumferences of three parts (arm, waist and thigh) of their own body and that of a study partner. Participants generally overestimated the circumferences of both their own and their partner's bodies, with this overestimation stable over a four-month follow-up. In contrast, in Study 2, no body size overestimation was observed for self or partners among 44 pairs of girls who were satisfied with their body size. Study 3 further revealed significant correlations between body size overestimation and disordered eating symptomology among 43 pairs of girls who desired to be thinner. As a whole, findings demonstrated that body size overestimation was limited to adolescent girls who were dissatisfied with their body size, and that body size overestimation was associated with disordered eating symptomology. Thus, perceptual distortions in body size may play a role in both body size dissatisfaction and disordered eating among adolescents.

A threatened preterm labour (TPL) represents an adverse prenatal event with potential long-term consequences on the offspring's neurodevelopment, regardless of prematurity condition. This study aimed to assess TPL's impact on children's psychomotor and socioemotional development at 2 years of age. A cohort of mother-infants was recruited at the time of TPL diagnoses and followed up until 30 months of children's corrected age. Participants were classified into three groups regarding gestational age at delivery: Full-term TPL (n = 35), Late Preterm TPL (n = 67), and Very Preterm TPL (n = 41). A Control group (n = 62) of mothers without TPL and their infants born at term completed the sample. Children's assessment was performed using the Ages & Stages Questionnaires for psychomotor development, the Early Childhood Behavior Questionnaire-Very Short Form for temperament, and the Behaviour Rating Inventory of Executive Function-Preschool Version for executive functions. Then, MANCOVAs were conducted to detect differences between groups. TPL children, regardless of delivery time, showed worse emotional regulation (ps < .03) and more inhibition problems (ps < .02) than control ones. In addition, Very preterm TPL children exhibited lower psychomotor development (ps ≤ .040), more difficulties in working memory (ps ≤ .002), and planification/organization (ps ≤ .003) domains. TPL per se may represent a risk factor for children's neurodevelopmental disturbances, specifically in emotional regulation and inhibitory control competencies, even in the absence of prematurity.

Non-suicidal self-injury (NSSI) behavior is a common issue in youth with depression while lacks a prognostic prediction model. This study aims to develop a nomogram for NSSI in youth with depression. A total of 701 patients were included in the analysis based a youth depression cohort. They were further divided into a training set and a validation set. The Lasso regression and binary logistic regression were used to select variables for the nomogram. The nomogram's discrimination, calibration, accuracy, clinical applicability, and generalization involved the use of metrics such as the area under the receiver operating characteristic curve (ROC), Hosmer-Lemeshow (HL) test, Brier score, calibration curve, decision curve analysis (DCA), and internal validation. The Delong test was employed to compare the ROC performance between the two models. These patients had an average age of 19.3+/-3.3 years, and 101 (20.6%) individuals reported NSSI. Five risk factors for NSSI were identified: age, age at first medication, previous instances of NSSI, academic stress score in the Adolescent Self-rating Life Events Check List (ASLEC), and somatic anxiety of the 14 item Hamilton Anxiety Rating Scale (HAMA-14). The training set and validation set of binary logistic regression-based model showed good discrimination (area under the curve (AUC) 0.781, 95% CI: 0.735 ~ 0.827; and 0.757, 95% CI: 0.682 ~ 0.831, respectively), calibration (P = 0.421 and 0.175, respectively), and accuracy (Brier score 0.119 to 0.155 and 0.109 to 0.168, respectively). A prognostic nomogram was developed and validated to assist clinicians in predicting NSSI of youth with depression.

Parental mental health problems can impact child mental health, as well as treatment of child mental health problems. The aim of this study was to investigate self-reported mental health problems in parents of children referred to outpatient child and adolescent mental health services (CAMHS) and to compare child mental health problems, family variables, treatment received and parent participation in treatment planning between parents above and below the cut-off for elevated mental health problems. The sample included N = 111 parents of N = 98 children. Parental reports covering their own and their children's mental health problems, family functioning, adult relationship satisfaction, and previous treatment for mental health problems were collected at the time of the child's intake appointment. Questions concerning contact with CAMHS were completed one year later. At the time of the intake appointment, 44% of the children had a parent who reported elevated mental health problems. In these families, children reportedly had significantly more mental health problems and problematic family functioning was more common than in families where parent mental health problems were not elevated. Parents with elevated mental health problems received group-based parent support/education to a greater extent during the first year of contact with CAHMS and reported less participation in treatment planning compared to parents without elevated mental health problems. To conclude, findings indicate that co-occurring mental health problems are common in parents when their child is referred to CAMHS, and in these families, it is reported that children have more symptoms, and more families experience problematic functioning. These factors merit consideration in assessment and treatment planning, indicating increased treatment needs in this group of families.

Objective: This study investigated differences in mental health and well-being, risk behaviors, and social life factors among adolescents who experienced different forms of suicidality.

Methods: We examined 18-years-olds in the Danish National Birth Cohort (N = 47,852). Suicidality was defined with mutually exclusive categories ranging from no suicidality, self-reported suicide ideation, plans, and attempt as well as hospital-recorded suicide attempt. The proportion of adolescents with self-reported poor mental health and well-being, risk behaviors, and social life factors were compared across forms of suicidality. Sample weights were applied.

Results: Depressive symptoms were reported by 14% (95% CI 13%;14%) of girls with no suicidality, 44% (95% CI 43%;45%) of girls with suicide ideation, and 68% (95% CI 65%;72%) 66% (95% CI 60%;72%) of girls with self-reported suicide attempt or hospital-recorded suicide attempt respectively. Among boys, depressive symptoms were reported by 5% (95% CI 4%;5%) of those with no suicidality, 27% (95% CI 26%;28%) of those with suicide ideation, and 51% (95% CI 45%;57%) and 40% (95% CI 22%;58%) of those with self-reported suicide attempt or hospital-recorded suicide attempt respectively. Likewise, other aspects of poor mental health and well-being gradually increased relative with more severe forms of suicidality, while no notable differences were identified between adolescents with self-reported and hospital-recorded suicide attempt. Similar tendencies were observed for risk behaviors and social life factors.

Conclusion: These findings suggest that adolescents with suicidality, including the large proportion with suicide ideation only, faces challenges across several parameters of mental health and well-being, risk behavior, and social life factors. This emphasizes the need for community-based interventions to identify and support the large group of adolescents experiencing both more and less severe forms of suicidality. Clinicians should prioritize comprehensive psychiatric intervention to address the complex needs of suicidal adolescents effectively.

Adolescence increases vulnerability to mental ill-health, particularly anxiety disorders like Social Anxiety Disorder (SAD) and Generalized Anxiety Disorder (GAD). Still, the understanding of Psychological Flexibility/Inflexibility (PF/PI) as a transdiagnostic framework relevant to explaining these difficulties and the efficacy of Acceptance and Commitment Therapy (ACT) in addressing adolescent SAD and GAD remains limited. Hence, this study has two aims: examining the role of PI/PF on adolescents' mental health and assessing ACT's efficacy for adolescent SAD and GAD. We will collect data from 400 community adolescents and employ network analysis to explore connections between PI/PF processes, anxiety, and flourishing. We will also investigate pathways linking PI/PF processes with flourishing and anxiety across samples (clinical SAD, clinical GAD, and mentally healthy groups), expecting to find similar patterns. Furthermore, a Randomized Controlled Trial with three groups (control, SAD experimental and GAD experimental), each comprising 29 participants, and four assessment moments (pre- and post-intervention and 3- and 6-months follow-up) will be conducted. Similar improvements are anticipated in both experimental groups, driven by changes in PI/PF processes. Findings from this work will provide valuable evidence to PI/PF as accurate conceptualizations of human suffering and expand the transdiagnostic application of ACT to adolescents with anxiety disorders.

Stimulant medication is effective in alleviating overall symptom severity of attention-deficit/hyperactivity disorder (ADHD), yet interindividual variability in treatment response and tolerability still exists. While network analysis has identified differences in ADHD symptom relations, the impact of stimulant medication remains unexplored. Increased understanding of this association could provide valuable insights for optimizing treatment approaches for individuals with ADHD. In this study, we compared and characterized ADHD symptom networks (including 18 ADHD symptoms) between stimulant-treated (n = 348) and untreated (n = 70) individuals with ADHD and non-ADHD controls (NACs; n = 444). Moreover, we compared symptom networks between subgroups defined by their stimulant treatment trajectory (early-and-intense use, late-and-moderate use). Stimulant-treated individuals with ADHD showed stronger associations between symptoms, compared with untreated individuals with ADHD and NACs. We found no differences in symptom networks between the stimulant treatment trajectory subgroups. Prospective longitudinal studies are needed to disentangle whether the identified differences stem from treatment or pre-existing factors.