Pub Date : 2020-01-10DOI: 10.2174/221067660902200110090955
N. Moukaddam, Edore Onigu-Otite, V. Tucci
{"title":"Critical Issues in Adolescent Mental Health in the Emergency Department: Looking Beyond Triage and Risk Assessment","authors":"N. Moukaddam, Edore Onigu-Otite, V. Tucci","doi":"10.2174/221067660902200110090955","DOIUrl":"https://doi.org/10.2174/221067660902200110090955","url":null,"abstract":"<jats:sec>\u0000<jats:title />\u0000<jats:p />\u0000</jats:sec>","PeriodicalId":43326,"journal":{"name":"Adolescent Psychiatry","volume":"9 1","pages":"67-68"},"PeriodicalIF":0.4,"publicationDate":"2020-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47250828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-01-10DOI: 10.2174/2210676609666190221152018
Meredith Gansner, E. Belfort, Caroline Leahy, D. Mirda, Nicholas J Carson
Prevalent adolescent digital media use has brought clinical attention to its potential associated risks. While excessive digital media use has been connected to adolescent difficulties with mood and impulsivity, no study has examined digital media’s role in precipitating adolescent psychiatric admissions. Our study aims were to identify and characterize digital media-related admissions in a sample of psychiatrically hospitalized adolescents, and to recognize unique patterns of digital media use within this sample. We hypothesized that adolescents with digital mediarelated admissions would endorse higher amounts of digital media use and problematic online behaviors. We administered a cross-sectional survey of psychiatrically hospitalized adolescents between 2012 and 2016. Admissions were considered related to digital media use either by adolescent report or documentation in the medical record. Unadjusted comparisons were used to examine relationships between digital media-related psychiatric admissions, online behaviors and suicide-related risk factors. 68 of 218 participants (31.2%) had digital media-related admissions. The most frequent cause of digital media-related admission was cyberbullying (31.9%). Teens with digital- media related admissions were significantly more likely to sext, use social media, and be cyberbullied; these adolescents were also at increased risk of suicide planning and hopelessness. Efforts should be made by mental health clinicians to identify and address online relational conflict, as well as to screen for cyberbullying and sexting. Clinicians should consider that adolescents with digital media-related presentations may be at elevated risk of self-harm, with higher rates of suicide planning and hopelessness compared to hospitalized peers with admissions unrelated to digital media.
{"title":"An Assessment of Digital Media-related Admissions in Psychiatrically Hospitalized Adolescents","authors":"Meredith Gansner, E. Belfort, Caroline Leahy, D. Mirda, Nicholas J Carson","doi":"10.2174/2210676609666190221152018","DOIUrl":"https://doi.org/10.2174/2210676609666190221152018","url":null,"abstract":"\u0000\u0000Prevalent adolescent digital media use has brought clinical attention\u0000to its potential associated risks. While excessive digital media use has been connected to adolescent\u0000difficulties with mood and impulsivity, no study has examined digital media’s role in\u0000precipitating adolescent psychiatric admissions.\u0000\u0000\u0000\u0000Our study aims were to identify and characterize digital media-related admissions\u0000in a sample of psychiatrically hospitalized adolescents, and to recognize unique patterns of\u0000digital media use within this sample. We hypothesized that adolescents with digital mediarelated\u0000admissions would endorse higher amounts of digital media use and problematic online\u0000behaviors.\u0000\u0000\u0000\u0000We administered a cross-sectional survey of psychiatrically hospitalized adolescents\u0000between 2012 and 2016. Admissions were considered related to digital media use either\u0000by adolescent report or documentation in the medical record. Unadjusted comparisons\u0000were used to examine relationships between digital media-related psychiatric admissions, online\u0000behaviors and suicide-related risk factors.\u0000\u0000\u0000\u000068 of 218 participants (31.2%) had digital media-related admissions. The most frequent\u0000cause of digital media-related admission was cyberbullying (31.9%). Teens with digital-\u0000media related admissions were significantly more likely to sext, use social media, and be\u0000cyberbullied; these adolescents were also at increased risk of suicide planning and hopelessness.\u0000\u0000\u0000\u0000Efforts should be made by mental health clinicians to identify and address online\u0000relational conflict, as well as to screen for cyberbullying and sexting. Clinicians should\u0000consider that adolescents with digital media-related presentations may be at elevated risk of\u0000self-harm, with higher rates of suicide planning and hopelessness compared to hospitalized\u0000peers with admissions unrelated to digital media.\u0000","PeriodicalId":43326,"journal":{"name":"Adolescent Psychiatry","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2020-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2174/2210676609666190221152018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48705476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-09-02DOI: 10.2174/2211352517666190902144221
Xavier Y. Diao, Milana Mor
Anti-NMDA receptor (NMDAR) encephalitis is an autoimmune syndrome characterized by a well-described constellation of neuropsychiatric symptoms. Its exact pathophysiology is poorly understood, but it is thought to be mediated by autoantibodies against NMDA (N-methyl-D-aspartate)-type glutamate receptors in the central nervous system. There is ongoing literature to suggest that patients with autism spectrum disorder (ASD) have evidence of neuroinflammation—or by definition, encephalitis. To investigate the link between autism spectrum disorder and autoimmune encephalitides. We present a case of anti-NMDA receptor encephalitis in a patient with autism spectrum disorder. “OP” is a 16-year-old male with a history of attention-deficit/ hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) who presented with a 3-day history of acute-onset altered mental status, electroencephalogram (EEG)-corroborated seizures, and slurred speech. Laboratory studies were significant for serum- and cerebrospinal fluid (CSF)-positive NMDA antibodies. The child psychiatry consult-liaison service was consulted for significant agitation and behavioral dyscontrol. We recommended 1:1 observation for safety, as well as antipsychotic agents titrated to clinical effect. The patient had a protracted hospital course, but was eventually discharged to an acute rehabilitation facility for continued stabilization and therapy. It remains to be seen if the relation between encephalitis and ASD is uni- or bidirectional, that is: whether children with ASD have a genetic diathesis to developing encephalitides (such as those mediated by the NMDAR), or conversely, if deranged or inflamed neuroreceptor processes are implicated in the development of ASD.
{"title":"Anti-NMDA Receptor Encephalitis in a Patient with a History of Autism Spectrum Disorder","authors":"Xavier Y. Diao, Milana Mor","doi":"10.2174/2211352517666190902144221","DOIUrl":"https://doi.org/10.2174/2211352517666190902144221","url":null,"abstract":"\u0000\u0000Anti-NMDA receptor (NMDAR) encephalitis is an autoimmune\u0000syndrome characterized by a well-described constellation of neuropsychiatric symptoms. Its\u0000exact pathophysiology is poorly understood, but it is thought to be mediated by autoantibodies\u0000against NMDA (N-methyl-D-aspartate)-type glutamate receptors in the central nervous\u0000system. There is ongoing literature to suggest that patients with autism spectrum disorder\u0000(ASD) have evidence of neuroinflammation—or by definition, encephalitis.\u0000\u0000\u0000\u0000To investigate the link between autism spectrum disorder and autoimmune encephalitides.\u0000\u0000\u0000\u0000We present a case of anti-NMDA receptor encephalitis in a patient with autism\u0000spectrum disorder. “OP” is a 16-year-old male with a history of attention-deficit/ hyperactivity\u0000disorder (ADHD) and autism spectrum disorder (ASD) who presented with a 3-day history\u0000of acute-onset altered mental status, electroencephalogram (EEG)-corroborated seizures,\u0000and slurred speech. Laboratory studies were significant for serum- and cerebrospinal fluid\u0000(CSF)-positive NMDA antibodies. The child psychiatry consult-liaison service was consulted\u0000for significant agitation and behavioral dyscontrol. We recommended 1:1 observation\u0000for safety, as well as antipsychotic agents titrated to clinical effect. The patient had a protracted\u0000hospital course, but was eventually discharged to an acute rehabilitation facility for\u0000continued stabilization and therapy.\u0000\u0000\u0000\u0000It remains to be seen if the relation between encephalitis and ASD is uni- or bidirectional,\u0000that is: whether children with ASD have a genetic diathesis to developing encephalitides\u0000(such as those mediated by the NMDAR), or conversely, if deranged or inflamed\u0000neuroreceptor processes are implicated in the development of ASD.\u0000","PeriodicalId":43326,"journal":{"name":"Adolescent Psychiatry","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42634334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-06-18DOI: 10.2174/2210676609666190618162558
Sindhu Idicula, Amy Vyas, N. Garber
DOI: 10.2174/2210676609666190618162558 Abstract: Background and Goals: Non-suicidal self-injury (NSSI) is a common presenting issue mental health providers experience in all levels of care from outpatient clinics to inpatient units. It is common among adolescents seen in emergency settings, either as a presenting problem or as a covert condition that may not be detected unless specifically assessed for. The presence of NSSI increases the risk of suicide. This article aims to help the clinician develop a better understanding of NSSI – what it may entail, the prevalence, and the motivations for why young people engage in it.
{"title":"The Emergency Assessment and Management of Non-Suicidal Self-Injury in Adolescents","authors":"Sindhu Idicula, Amy Vyas, N. Garber","doi":"10.2174/2210676609666190618162558","DOIUrl":"https://doi.org/10.2174/2210676609666190618162558","url":null,"abstract":"DOI: 10.2174/2210676609666190618162558 Abstract: Background and Goals: Non-suicidal self-injury (NSSI) is a common presenting issue mental health providers experience in all levels of care from outpatient clinics to inpatient units. It is common among adolescents seen in emergency settings, either as a presenting problem or as a covert condition that may not be detected unless specifically assessed for. The presence of NSSI increases the risk of suicide. This article aims to help the clinician develop a better understanding of NSSI – what it may entail, the prevalence, and the motivations for why young people engage in it.","PeriodicalId":43326,"journal":{"name":"Adolescent Psychiatry","volume":"09 1","pages":"1-1"},"PeriodicalIF":0.4,"publicationDate":"2019-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2174/2210676609666190618162558","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48315986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-05-31DOI: 10.2174/2210676608666180913130616
A. Cheetham, A. Jorm, C. Wilson, B. Berridge, F. Blee, D. Lubman
Adolescents experiencing mental health problems often approach their peers rather than seeking professional help. A better understanding of adolescents’ stigmatising attitudes towards mental illness will help inform interventions that aim to improve the quality of advice that young people provide to their peers. In particular, there is a need for research examining adolescents’ attitudes towards alcohol misuse, given it’s increase in prevalence during this period as well as the adverse outcomes that are associated with untreated early drinking problems. High-school students (n=2447) were recruited as part of an intervention focussed on overcoming barriers to accessing help for mental health and substance use problems. Participants were presented with two vignettes that described a peer experiencing depression and alcohol misuse, respectively, and completed the General Help-Seeking Questionnaire as well as a 10-item scale measuring stigmatising attitudes. Past helping behavior was also assessed. Compared to depression, a peer experiencing alcohol misuse was more likely to be considered “weak” rather than sick, and was perceived as more dangerous and unpredictable. The “weak-not-sick” and “dangerousness” dimensions of stigma predicted weaker intentions to encourage help-seeking from informal sources, while ‘dangerousness’ predicted stronger intentions to encourage formal help-seeking. Both dimensions were associated with fewer instances of past helping behavior. Young people stigmatise alcohol misuse more severely than depression. Overall, stigma was associated with weaker intentions to encourage peers to seek help. While perceptions of ‘dangerousness’ were associated with stronger intentions to seek help from formal sources, this association may not translate into actual helping behavior.
{"title":"Stigmatising Attitudes Towards Depression and Alcohol Misuse in Young People: Relationships with Help-Seeking Intentions and Behavior","authors":"A. Cheetham, A. Jorm, C. Wilson, B. Berridge, F. Blee, D. Lubman","doi":"10.2174/2210676608666180913130616","DOIUrl":"https://doi.org/10.2174/2210676608666180913130616","url":null,"abstract":"\u0000\u0000Adolescents experiencing mental health problems\u0000often approach their peers rather than seeking professional help. A better understanding of\u0000adolescents’ stigmatising attitudes towards mental illness will help inform interventions that\u0000aim to improve the quality of advice that young people provide to their peers. In particular,\u0000there is a need for research examining adolescents’ attitudes towards alcohol misuse, given\u0000it’s increase in prevalence during this period as well as the adverse outcomes that are\u0000associated with untreated early drinking problems.\u0000\u0000\u0000\u0000High-school students (n=2447) were recruited as part of an intervention focussed\u0000on overcoming barriers to accessing help for mental health and substance use problems.\u0000Participants were presented with two vignettes that described a peer experiencing depression\u0000and alcohol misuse, respectively, and completed the General Help-Seeking Questionnaire as\u0000well as a 10-item scale measuring stigmatising attitudes. Past helping behavior was also\u0000assessed.\u0000\u0000\u0000\u0000Compared to depression, a peer experiencing alcohol misuse was more likely to be\u0000considered “weak” rather than sick, and was perceived as more dangerous and unpredictable.\u0000The “weak-not-sick” and “dangerousness” dimensions of stigma predicted weaker intentions\u0000to encourage help-seeking from informal sources, while ‘dangerousness’ predicted stronger\u0000intentions to encourage formal help-seeking. Both dimensions were associated with fewer\u0000instances of past helping behavior.\u0000\u0000\u0000\u0000Young people stigmatise alcohol misuse more severely than depression.\u0000Overall, stigma was associated with weaker intentions to encourage peers to seek help. While\u0000perceptions of ‘dangerousness’ were associated with stronger intentions to seek help from\u0000formal sources, this association may not translate into actual helping behavior.\u0000","PeriodicalId":43326,"journal":{"name":"Adolescent Psychiatry","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-05-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2174/2210676608666180913130616","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43685587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-03-31DOI: 10.2174/2210676608666181031105706
Himanshu Sharma, B. Sharma, N. Patel
Body Dysmorphic Disorder (BDD) is characterized by an abnormal preoccupation with alleged misshapen body parts. There is often poor insight and effort is made to hide the imagined defects, and consultation may be sought seeking unnecessary cosmetic surgery or procedures. It is underdiagnosed and established treatment protocols are lacking. The disease has a chronic and undulating course and is seriously compromises quality of life. Despite the fact that the prime age of onset of BDD is during adolescence relatively little has been written about it during this phase of life. This review aims to comprehensively cover the present understanding of BDD, including clinical features, epidemiology, psychopathology, nomenclature, comorbidity and management. A literature search was undertaken using suitable key words on Google Scholar, MEDLINE & PsychoINFO up to June 2018 limited to articles in English. he prevalence of BDD is variable in the general and psychiatric population with equal gender distribution. Both sexes are equally affected. It is associated with poor functioning and a chronic course. There is considerable comorbidity and diagnostic overlap between BDD and obsessive-compulsive disorder, major depressive disorder, social anxiety disorder, anorexia nervosa, schizophrenia spectrum disorders and personality disorders. Psychiatric consultation is often late. Selective Serotonin Reuptake Inhibitors (SSRIs) and Cognitive Behavior Therapy (CBT) are currently the first line modalities for treatment. Internet based CBT, Acceptance and commitment therapy, and repetitive Transcranial Magnetic Stimulation (rTMS) are emerging treatment options. BDD is a complex disorder with still lot of uncertainty about its diagnostic placement, treatment approaches, especially for refractory patients, and prognosis. Further study is needed to clarify its prevalence, especially in adolescents; to fully understand its neurobiological aspects, to determine its exact relation to obsessive compulsive related disorders, and to develop better treatment approaches.
{"title":"Body Dysmorphic Disorder in Adolescents","authors":"Himanshu Sharma, B. Sharma, N. Patel","doi":"10.2174/2210676608666181031105706","DOIUrl":"https://doi.org/10.2174/2210676608666181031105706","url":null,"abstract":"\u0000\u0000Body Dysmorphic Disorder (BDD) is characterized\u0000by an abnormal preoccupation with alleged misshapen body parts. There is often poor insight\u0000and effort is made to hide the imagined defects, and consultation may be sought seeking\u0000unnecessary cosmetic surgery or procedures. It is underdiagnosed and established treatment\u0000protocols are lacking. The disease has a chronic and undulating course and is seriously\u0000compromises quality of life. Despite the fact that the prime age of onset of BDD is during\u0000adolescence relatively little has been written about it during this phase of life. This review\u0000aims to comprehensively cover the present understanding of BDD, including clinical\u0000features, epidemiology, psychopathology, nomenclature, comorbidity and management.\u0000\u0000\u0000\u0000A literature search was undertaken using suitable key words on Google Scholar,\u0000MEDLINE & PsychoINFO up to June 2018 limited to articles in English.\u0000\u0000\u0000\u0000he prevalence of BDD is variable in the general and psychiatric population with\u0000equal gender distribution. Both sexes are equally affected. It is associated with poor\u0000functioning and a chronic course. There is considerable comorbidity and diagnostic overlap\u0000between BDD and obsessive-compulsive disorder, major depressive disorder, social anxiety\u0000disorder, anorexia nervosa, schizophrenia spectrum disorders and personality disorders.\u0000Psychiatric consultation is often late. Selective Serotonin Reuptake Inhibitors (SSRIs) and\u0000Cognitive Behavior Therapy (CBT) are currently the first line modalities for treatment.\u0000Internet based CBT, Acceptance and commitment therapy, and repetitive Transcranial\u0000Magnetic Stimulation (rTMS) are emerging treatment options.\u0000\u0000\u0000\u0000 BDD is a complex disorder with still lot of uncertainty about its diagnostic\u0000placement, treatment approaches, especially for refractory patients, and prognosis. Further\u0000study is needed to clarify its prevalence, especially in adolescents; to fully understand its\u0000neurobiological aspects, to determine its exact relation to obsessive compulsive related\u0000disorders, and to develop better treatment approaches. \u0000","PeriodicalId":43326,"journal":{"name":"Adolescent Psychiatry","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2174/2210676608666181031105706","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43544124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-03-31DOI: 10.2174/2210676609666181204125951
Nicolas Garel, P. Garel
Despite increased attention and recognition of autism spectrum disorders, many patients suffering from these disorders remain undiagnosed or are diagnosed late due to their subtle clinical presentation. The challenge for clinicians working in the field of mental health is not in screening and diagnosing young children showing typical signs of autism spectrum disorders, but rather in identifying patients at the high-functioning end of the spectrum whose intellectual abilities mask their social deficits. Because therapeutic interventions differ radically once the diagnosis of ASD has been made, it is important to understand the trajectory of those adolescents and identify clues that could help raise the diagnosis of ASD earlier. Records of eight adolescents with a late diagnosis of ASD were retrospectively reviewed to identify relevant clinical features that were overlooked in childhood and early adolescence. The patients were previously misdiagnosed with multiple mental health disorders. These cases showed striking similarities in terms of developmental history, reasons for misdiagnosis, and the clinical picture at the time of ASD recognition. The cases were characterized by complex and fluctuating symptomatology, including depression, anxiety, behavioural problems, self-injurious behaviour and suicidal thoughts. Their Autism Spectrum Disorder (ASD) went previously undiagnosed due to the individual’s intelligence and learning abilities, which masked their social deficits and developmental irregularities. Signs of ASD were continuously present since childhood in all the eight cases. Once the developmental histories and the psychiatric evaluation of these adolescents were done by psychiatrists with appropriate knowledge of autism, the diagnosis of ASD was made. The ASD hypothesis should be raised in the presence of confusing symptoms that do not respond to usual treatment and are accompanied by an irregular developmental background. It is indeed a difficult diagnosis to make; however, the focused clinician can note subtle signs of ASD despite the intellectual learning of social codes. Family history, developmental irregularities, rigidity, difficulty in spontaneously understanding emotions, discomfort in groups and the need to be alone are significant indicators to recognize. Once the diagnosis has been considered, it must be confirmed or rejected by an experienced multidisciplinary team. The challenge for clinicians working in the field of mental health is not in screening and diagnosing young children showing typical signs of ASD, but rather in identifying patients who are at high-functioning end of the spectrum whose intellectual abilities mask their social deficits.
{"title":"Diagnosis of Autism Spectrum Disorder in Adolescents with Complex Clinical Presentations: A Montreal Case Series","authors":"Nicolas Garel, P. Garel","doi":"10.2174/2210676609666181204125951","DOIUrl":"https://doi.org/10.2174/2210676609666181204125951","url":null,"abstract":"\u0000\u0000Despite increased attention and recognition of autism spectrum\u0000disorders, many patients suffering from these disorders remain undiagnosed or are diagnosed\u0000late due to their subtle clinical presentation. The challenge for clinicians working in the field\u0000of mental health is not in screening and diagnosing young children showing typical signs of\u0000autism spectrum disorders, but rather in identifying patients at the high-functioning end of\u0000the spectrum whose intellectual abilities mask their social deficits.\u0000\u0000\u0000\u0000Because therapeutic interventions differ radically once the diagnosis of ASD has\u0000been made, it is important to understand the trajectory of those adolescents and identify clues\u0000that could help raise the diagnosis of ASD earlier.\u0000\u0000\u0000\u0000Records of eight adolescents with a late diagnosis of ASD were retrospectively\u0000reviewed to identify relevant clinical features that were overlooked in childhood and early\u0000adolescence.\u0000\u0000\u0000\u0000The patients were previously misdiagnosed with multiple mental health disorders.\u0000These cases showed striking similarities in terms of developmental history, reasons for\u0000misdiagnosis, and the clinical picture at the time of ASD recognition. The cases were\u0000characterized by complex and fluctuating symptomatology, including depression, anxiety,\u0000behavioural problems, self-injurious behaviour and suicidal thoughts. Their Autism\u0000Spectrum Disorder (ASD) went previously undiagnosed due to the individual’s intelligence\u0000and learning abilities, which masked their social deficits and developmental irregularities.\u0000Signs of ASD were continuously present since childhood in all the eight cases. Once the\u0000developmental histories and the psychiatric evaluation of these adolescents were done by\u0000psychiatrists with appropriate knowledge of autism, the diagnosis of ASD was made.\u0000\u0000\u0000\u0000The ASD hypothesis should be raised in the presence of confusing symptoms\u0000that do not respond to usual treatment and are accompanied by an irregular developmental\u0000background. It is indeed a difficult diagnosis to make; however, the focused clinician can\u0000note subtle signs of ASD despite the intellectual learning of social codes. Family history,\u0000developmental irregularities, rigidity, difficulty in spontaneously understanding emotions,\u0000discomfort in groups and the need to be alone are significant indicators to recognize. Once\u0000the diagnosis has been considered, it must be confirmed or rejected by an experienced\u0000multidisciplinary team. The challenge for clinicians working in the field of mental health is\u0000not in screening and diagnosing young children showing typical signs of ASD, but rather in\u0000identifying patients who are at high-functioning end of the spectrum whose intellectual\u0000abilities mask their social deficits.\u0000","PeriodicalId":43326,"journal":{"name":"Adolescent Psychiatry","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2174/2210676609666181204125951","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47662961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-03-31DOI: 10.2174/2210676608666181031102235
N. Chadi, Elli Weisbaum, Catherine Malboeuf-Hurtubise, S. Kohut, C. Viner, N. Palaniyar, M. Kaufman, Jake Locke, Dzung X Vo
Mindfulness-Based Interventions (MBIs) can improve mental health and well-being in adolescents with chronic illnesses. However, there are many barriers such as reduced mobility and distance which compromise accessibility to MBIs. The aim of this study was to determine the effectiveness of the Mindful Awareness and Resilience Skills for Adolescents (MARS-A) program in youth with chronic illnesses delivered in person or via eHealth. In this mixed method randomized controlled trial, participants received weekly 90- minute long MARS-A sessions for 8 weeks, either in person or via a secure eHealth audiovisual platform allowing group interactions in real time. Data was collected at baseline, immediately after and two months post-MBI through saliva analyses, electronic participant logs and validated questionnaires assessing mindfulness skills and mental health outcomes. Seven participants per group completed the intervention (total n=14, completion rate 77.8%). Paired t-test analyses revealed a significant reduction in depression/anxiety scores immediately post-intervention (p=0.048, Cohen’s d=0.934) and a significant reduction in pre-post mindfulness cortisol levels at week 8 (p=0.022, Cohen’s d=0.534) in the eHealth group. Frequency and duration of weekly individual home practice (eHealth: 6.5 times; 28.8 minutes; in-person: 6.0 times; 30.6 minutes) were similar in both groups and maintained at follow-up. This is the first study comparing in-person and eHealth delivery of an 8-week MBI for adolescents with chronic illnesses. Although the study was limited by the small size of the sample, our results suggest that eHealth delivery of MBIs may represent a promising avenue for increasing availability in this population.
{"title":"In-person vs. eHealth Mindfulness-based Intervention for Adolescents with Chronic Illnesses: A Pilot Randomized Trial","authors":"N. Chadi, Elli Weisbaum, Catherine Malboeuf-Hurtubise, S. Kohut, C. Viner, N. Palaniyar, M. Kaufman, Jake Locke, Dzung X Vo","doi":"10.2174/2210676608666181031102235","DOIUrl":"https://doi.org/10.2174/2210676608666181031102235","url":null,"abstract":"\u0000\u0000Mindfulness-Based Interventions (MBIs) can improve mental health\u0000and well-being in adolescents with chronic illnesses. However, there are many barriers such\u0000as reduced mobility and distance which compromise accessibility to MBIs.\u0000\u0000\u0000\u0000The aim of this study was to determine the effectiveness of the Mindful\u0000Awareness and Resilience Skills for Adolescents (MARS-A) program in youth with chronic\u0000illnesses delivered in person or via eHealth.\u0000\u0000\u0000\u0000 In this mixed method randomized controlled trial, participants received weekly 90-\u0000minute long MARS-A sessions for 8 weeks, either in person or via a secure eHealth audiovisual\u0000platform allowing group interactions in real time. Data was collected at baseline,\u0000immediately after and two months post-MBI through saliva analyses, electronic participant\u0000logs and validated questionnaires assessing mindfulness skills and mental health outcomes.\u0000\u0000\u0000\u0000Seven participants per group completed the intervention (total n=14, completion\u0000rate 77.8%). Paired t-test analyses revealed a significant reduction in depression/anxiety\u0000scores immediately post-intervention (p=0.048, Cohen’s d=0.934) and a significant reduction\u0000in pre-post mindfulness cortisol levels at week 8 (p=0.022, Cohen’s d=0.534) in the eHealth\u0000group. Frequency and duration of weekly individual home practice (eHealth: 6.5 times; 28.8\u0000minutes; in-person: 6.0 times; 30.6 minutes) were similar in both groups and maintained at\u0000follow-up.\u0000\u0000\u0000\u0000 This is the first study comparing in-person and eHealth delivery of an 8-week\u0000MBI for adolescents with chronic illnesses. Although the study was limited by the small size\u0000of the sample, our results suggest that eHealth delivery of MBIs may represent a promising\u0000avenue for increasing availability in this population.\u0000","PeriodicalId":43326,"journal":{"name":"Adolescent Psychiatry","volume":" ","pages":""},"PeriodicalIF":0.4,"publicationDate":"2019-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.2174/2210676608666181031102235","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47140354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2019-03-31DOI: 10.2174/2210676609666181220125513
Y. Oshodi, E. Campbell, F. Lesi
Autism Spectrum Disorders (ASDs) exist in Africa as they do everywhere in the world. Historically they have been under recognized and under studied. The aim of this paper is to review the existing challenges of ASD care and diagnosis in Africa, with a view to describing workable unique strategies deployable within the continent. We present an overview of the existing medical literature and summarize key findings in relation to the topic of ASD in Africa. First, as a preliminary step, we highlight key findings from previous epidemiological surveys. Second, we undertook a review of relevant available evidence from the various African regions. When the authors were familiar with additional local or regional scientific works, these were also used and referenced. There has been a growing awareness of the extent to which ASDs exist and have an impact on affected individuals and their families. There are many barriers to diagnosis and effective interventions. These include lack of trained personnel, stigma and cultural beliefs regarding etiology, disparities in resources between urban and rural areas, and poverty. Nonetheless, partnerships to support research and the development of culturally appropriate interventions can be developed and strengths exist in the communities that can be harnessed to improve care.
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