Journal of the Canadian Academy of Child and Adolescent Psychiatry最新文献

Background: Obesity can negatively impact adolescents' self-esteem, and lipomastia can further complicate the situation.

Objective: The current study endeavors to examine the influence of lipomastia on the levels of social anxiety and self-esteem in individuals with obesity.

Methods: Seventy adolescent male outpatients with obesity completed a form of demographics, the SAS-A (Social Anxiety Scale for Adolescents), and the Rosenberg Self-Esteem Scale (RSES-10 item). Participants were stratified according to the presence of lipomastia, and correlation analyses were conducted to investigate the association between social anxiety and self-esteem in relation to lipomastia.

Results: No significant difference was found between the lipomastia and non-lipomastia groups regarding self-esteem. While the lipomastia group had slightly higher overall social anxiety scores, significant differences were noted only in fear of negative evaluation. There was no relationship between the SAS-A total score and anthropometric measurements in both groups. However, a negative relationship was observed between self-esteem and anthropometric measurements in the lipomastia group, whereas such a relationship was not observed in the control group.

Conclusion: Adolescents with lipomastia showed higher social anxiety, particularly fear of negative evaluation, despite similar demographic and anthropometric characteristics to their peers. Higher BMI correlated with lower self-esteem, highlighting the complex interplay between body image, self-esteem, and social anxiety. These findings underscore the need for targeted interventions to support adolescents with obesity and lipomastia.

Catatonia is a severe psychomotor syndrome that can be life-threatening if not promptly diagnosed and treated. While benzodiazepines and electroconvulsive therapy (ECT) are established treatments for catatonia in adults, there is limited literature on their efficacy and safety in adolescents. Additionally, the use of N-methyl-D-aspartate (NMDA) antagonists, such as memantine, has been explored as a potential treatment option; however, there is a lack of extensive research in the pediatric population. We report the case of a 16-year-old boy who presented with refractory catatonia. The patient initially appeared to respond to lorazepam but experienced adverse effects, necessitating a switch to clonazepam. Despite some improvement, his condition deteriorated, leading to the initiation of ECT, which was associated with significant improvements. However, stagnation in clinical progress prompted the introduction of memantine, an NMDA antagonist. Memantine was well tolerated and appeared to contribute to further symptom resolution. The patient achieved full remission of catatonia in approximately 2 months and sustained well-being 19 weeks post-discharge with a treatment regimen of olanzapine, memantine and clonazepam. This case highlights the potential efficacy of combining benzodiazepines, ECT, and NMDA antagonists in treating refractory catatonia in adolescents. Our findings support considering NMDA antagonists in treatment protocols, particularly when conventional therapies are ineffective or inaccessible. Further research is needed to validate these results and establish comprehensive guidelines for managing pediatric catatonia.

Background: Parents play an essential role in helping an adolescent who has a mental health concern; however, there are no measures of parental mental health literacy for parents of adolescents. Few measures of mental health literacy assess the underlying components of the construct, and measures that assess facets of mental health literacy in parents are limited in psychometric quality.

Objective: To develop and psychometrically evaluate a theoretically informed measure of parental mental health literacy, the Parental Mental Health Literacy (ParM-Lit) scale.

Method: The ParM-Lit was developed through the generation of items across key domains, expert review of items, and parental feedback. Parents of adolescents (N = 698) completed an online survey including the ParM-Lit and measures of parental attitudes toward help-seeking and knowledge of mental health disorders.

Results: Exploratory and confirmatory factor analyses supported a 4- and 5-factor model; however, a 31-item, 4-factor model showed slightly superior fit. Internal consistency of the overall ParM-Lit scale was very good (α = .89), and test-retest reliability was moderate (ICC = .68; 95% CI = .61-.75). The ParM-Lit was strongly associated with parental attitudes towards help-seeking and moderately associated with knowledge of mental health disorders.

Conclusions: The ParM-Lit is the first measure of parental mental health literacy, and our findings support its psychometric properties. This final 31-item measure holds promise for advancing measurement of parental mental health literacy in clinical and research settings.

Objective: We examined the mediating role of positive coping skills in the relationship between community belonging and flourishing mental health among Canadian youth, while investigating variations across ethnoracial backgrounds.

Methods: Utilising data from the Canadian Community Health Survey-Mental Health Component 2012 cycle, we conducted a mediation analysis using a counterfactual framework on a nationally representative sample of 5,338 youth aged 15-29. The primary outcome, flourishing mental health, was measured using Keyes' Mental Health Continuum. The mediating effect of positive coping skills on the relationship between community belonging and mental health was quantified, and subgroup analyses to compare this relationship in two subgroups of youth identifying as White versus those who do not identify.

Results: Positive coping skills accounted for 13.9% of the mediation pathway from community belonging to flourishing mental health. Notably, youth who did not identify as White demonstrated a stronger association between community belonging and flourishing, with a comparatively smaller portion of their pathway mediated by positive coping. The total, direct, and indirect effects indicated a significant positive relationship between community belonging and positive mental health, mediated by positive coping skills.

Conclusion: Positive coping skills significantly mediated the relationship between community belonging and flourishing mental health in Canadian youth. However, the strength and nature of this relationship varied across ethnoracial backgrounds, suggesting a potential need for tailored interventions. These findings have implications for clinicians in adopting strategies that not only foster positive coping skills but also promote community engagement and respect for cultural diversity, thereby supporting the mental health of all youth in Canada.

Autism spectrum disorder (ASD) is a neurodevelopmental condition affecting 1 in 36 children, characterized by deficits in social communication and restricted, repetitive behaviors. Self-injurious behaviors (SIBs), such as head-banging and biting, are prevalent in ASD, affecting up to 50% of individuals. These behaviors pose significant risks, including physical injury and social isolation. While behavioural therapies are the first-line treatment, their effectiveness is often limited, necessitating the use of pharmacological interventions. However, there is a paucity of evidence regarding the effective pharmacological management of SIBs in this population. Gabapentin, an anticonvulsant also used for neuropathic pain, has shown potential in managing SIBs, despite limited evidence in pediatric populations thus far. It acts as a GABA analog, inhibiting voltage-dependent calcium channels. Gabapentin is generally well-tolerated, with mild adverse effects like fatigue and dizziness. In this report, we present a case detailing the use of gabapentin in a 13-year-old non-verbal male with ASD and severe SIBs. Despite extensive subspeciality evaluations and various treatments, his SIBs persisted, significantly negatively impacting his quality of life. Oral gabapentin was introduced and progressively titrated up to 600mg TID, leading to a notable reduction in the frequency and severity of SIBs within days. The patient's episodes became shorter and more manageable, with no adverse effects reported. This case highlights gabapentin's potential as an effective treatment for severe SIBs in pediatric patients with ASD, particularly when chronic pain is suspected as a contributing factor. Further research is warranted to explore its effectiveness in this population and establish guidelines for its use.

In this rejoinder we address 13 concerns elicited by our invited commentary "An update on the scientific evidence for and against the legal banning of disciplinary spanking." In addition to defending assertions made in the initial commentary, we make several new substantive arguments. In response to dissenters' equating of non-experimental evidence against spanking with non-experimental evidence against smoking, we demonstrate that the two are very dissimilar. We question the purpose of spanking bans, providing stronger evidence that they do not seem to prevent child abuse. We review Canada's association with the UN's Convention on the Rights of the Child (CRC) before and after the 2006 classification of all physical punishment as violence. We discuss the disciplining of children with disabilities. We encourage fellow researchers to avoid the scholar-advocacy bias, appropriately discriminating methodological evaluations of empirical evidence from personal convictions.