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

Background: Many youth in the criminal justice system are affected by mental health and/or substance use (MHS) challenges, yet only a minority receive treatment. One way to increase access to MHS care is integrated youth services (IYS), a community-based model of service delivery where youth can access evidence-based treatment for their MHS problems and other wellbeing needs, in one location. However, it is unknown what IYS services justice-involved youth prioritize.

Objective: This study explored what components of IYS justice-involved youth deem to be the most important in meeting their MHS service needs, in comparison with non-justice-involved youth, by conducting a secondary analysis of data gathered from a larger Ontario-wide study.

Method: Using a conjoint analysis, n = 55 justice-involved youth, and n = 188 non-justice-involved youth, completed thirteen choice tasks representing different combinations of IYS.

Results: Both justice-involved and non-justice-involved youth exhibited preferences for a broad range of core health services, including mental health services, substance misuse counseling, medication management, and physical or sexual health services. They also preferred a broad range of additional support services, in addition to fast access to care in a community setting that specializes in mental health services, with the incorporation of e-health services. Justice-involved youth prioritized working with a trained peer support worker to learn life skills and help them with the services they need. The importance of youth playing a leadership role in making decisions within IYS organizations was also a distinguishing preference among justice-involved youth.

Conclusions: Tailoring IYS to meet the service preferences of justice-involved youth may enhance service utilization, potentially leading to better outcomes for justice-involved youth and their communities.

Children and adolescents with complex mental health needs often require a level of care that is unsustainable in tertiary settings. Yet, the psychological impact of this on community physicians, who are tasked with providing quality care to this population, is not well understood. Grounded in Self-Determination Theory (SDT), the present study explores how the challenges of caring for these patients is affecting community physicians' basic psychological needs (autonomy, competence, and relatedness) and intrinsic motivation. Participants from Calgary, Alberta, Canada, were invited to complete an anonymous online survey containing questions about managing complex child and adolescent psychiatric patients. We used SDT's needs-based framework and 22-item Intrinsic Motivation Inventory as a component of our pilot study, to explore and understand their ideas. Community physicians reported moderate-high interest/enjoyment and moderate perceived competence in managing complex child and adolescent patients, but little perceived choice and high tension/pressure in carrying out this task. Physician remarks provided meaningful insights into how these clinical experiences are impacting them, psychologically, and where opportunities may exist for interventions to support them and their patients. Findings from this study suggest that the participating community physicians feel interested and adequately skilled to manage complex child and adolescent psychiatric patients, but that systemic barriers are hindering their basic psychological needs and intrinsic motivation to do so. Potential explanations and implications for these findings are discussed.

Background: Oppositional Defiant Disorder (ODD) is a disruptive behavioral disorder; however, increasing evidence emphasizes irritable mood as a primary symptom of ODD.

Objectives: This study investigated whether heterogeneous groups (classes) of individuals can be differentiated based on ODD sub-dimensions (irritability and defiance) or on overall ODD symptoms longitudinally. We also examine associations between ODD trajectory class and comorbid substance use (heavy episodic drinking, cannabis use), mental health (depression and anxiety) and behavioral symptoms (ADHD, aggression and substance use) in both adolescence and young adulthood (controlling for adolescent levels of each of these concerns).

Method: Data were from a randomly recruited community sample of 662 Canadian youth (T1 ages 12-18) followed biennially for 10 years (T6 ages 22-29).

Results: Growth mixture models revealed trajectories classes of ODD based on severity of symptoms. A three-class solution provided the best fit with Low (n = 119; 18%), Moderate (n = 473; 71.5%), and High (n = 70; 10.6%) ODD classes. Class trajectory differences were similarity based on symptoms severity (rather than type) for symptom sub-dimensions (irritability defiance). Adolescent and young adult substance use, mental health symptoms, and behavioral problems were significantly higher for the High ODD trajectory class compared to both other classes. Youth in the Moderate ODD trajectory class also showed higher comorbid symptoms in adolescence and young adulthood, compared to the Low ODD trajectory class.

Conclusion: Early identification of children and adolescents with high or moderate ODD symptoms and interventions that simultaneously address defiance and irritability are supported by the findings.

Background: Thousands of children sustain mild traumatic brain injuries (mTBI) worldwide each year. Multiple physical and somatic symptoms can occur following pediatric mTBI, including new-onset mood symptoms, headaches, and pain.

Objective: This scoping review examined the existing literature pertaining to mood and anxiety symptoms following pediatric mTBI, in order to summarize the current evidence and identify areas for future research.

Methods: The Pubmed, EMBase, and APA PsycINFO databases were searched to identify articles that examined mood and anxiety symptoms in children and adolescents following mTBI.

Results: A total of 20 published articles were included in the review. The existing research suggests that mood and anxiety symptoms are more common in children and adolescents with mTBI, when compared to orthopedically injured or healthy controls. Several factors may contribute to the development of these symptoms: injury characteristics, older age at injury, female sex, and psychosocial variables including lower socioeconomic status and family history of psychiatric disorders.

Conclusion: The findings of this review highlight the need for additional research on the relationship between pediatric mTBI and subsequent mood and anxiety symptoms. We particularly recommend long-term prospective cohort studies which include appropriate control groups as well as a neuroimaging component to distinguish complicated from uncomplicated mTBI.

Clozapine is an antipsychotic medication that has been proven effective for the management of treatment-resistant schizophrenia (TRS). For some patients, it is the only medication that can improve disease burden and quality of life. Clozapine comes with various potentially serious adverse effects which may dissuade physicians from prescribing it despite its well-documented efficacy. One of these adverse effects is clozapine-induced myocarditis (CIM). Due to these risks, patients who undergo a clozapine rechallenge after CIM require close monitoring. Myocardial damage can be reversible if CIM is promptly identified, and clozapine is discontinued appropriately. The gold-standard for diagnosing myocarditis is an endomyocardial biopsy but there are no clear recommendations for how to use less invasive screening assessments to monitor for CIM during a clozapine rechallenge. This review article aims to increase awareness of CIM and provide guidance on monitoring and management. The accompanying case report presents a proposed strategy, including biomarkers that were used to identify inflammation and cardiac injury which guided the treatment of an adolescent patient who had a successful clozapine rechallenge. Further research is necessary to validate the proposed monitoring protocol and to further advance guidance for clinicians.