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

Background: Callous-unemotional (CU) traits (e.g., lack of empathy and guilt, deficient affect) have been associated with severe and persistent patterns of conduct problems and antisocial behaviour as well as with poorer treatment outcomes. They are now a specifier to the diagnosis of conduct disorder.

Objective: To examine the associations between CU traits and a wide set of psychopathological symptoms (e.g., anxiety, conduct disorder) in a sample of adolescent females.

Method: 200 adolescent females (M = 15.55 years, SD = 1.64) recruited from French high schools located in Montreal, Quebec, Canada (n = 150) and from units/resources managed by the Montreal Youth Center (n = 50) self-reported on their levels of CU traits and psychopathological symptoms.

Results: Participants recruited from high schools, compared to their counterparts from the youth center, had lower scores on most of the scales and subscales of CU traits and psychopathology. The total score of CU traits as well as the callousness-uncaring dimension were correlated with externalizing symptoms for the participants from the schools and from the youth center. However, the total score of CU traits as well as the unemotional dimension were correlated with internalizing symptoms especially among participants from the schools.

Conclusions: Our analyses revealed differences in the patterns of associations depending on the subscales of CU traits and across sample types (i.e., school subsample versus youth center subsample), which should be considered in the assessment of psychopathology in these populations.

Objective: Mental health problems in children, adolescents, and adults with developmental disabilities (DD) are an underserviced clinical area. Although the Royal College of Physicians and Surgeons of Canada requires that experiences with patients with DD must be included during psychiatry residency training, the type and extent of this experience is not specified. The purpose of this study was to examine the current educational opportunities regarding DD in Canadian psychiatry residency programs.

Methods: A survey asking about training in DD was sent to psychiatry residency directors at all 17 medical schools in Canada. The survey consisted of three sections focused on didactic teaching and clinical rotations (required and elective) in DD for residents.

Results: Program directors of all psychiatry residency programs noted that their program included didactic teaching specific to DD, although the time dedicated to this differed greatly, ranging from 2 to 20 hours. Although 13 programs offered electives in DD, only five programs required residents to complete a clinical rotation specific to DD. Two programs did not have required or elective rotations in DD.

Conclusion: These results suggest that training specific to DD is probably inadequate for most residents. This is likely to result in limitations in knowledge and skills required to assess and treat people with DD, decreased comfort working with them, and ultimately reduced quality and availability of psychiatric care for this underserved population. More specific and comprehensive training requirements and opportunities are needed to ensure that residents receive appropriate training in this area.

Objectives: In Canada, little research has focused on emergency department (ED) use by youth involved with child welfare services, a vulnerable population. Our aims were therefore (1) to examine the characteristics of ED users among child welfare-involved youth, 2) to identify predictors of ED use and 3) to identify youth trajectories to EDs.

Methods: Data were collected from child welfare charts from two agencies in Montreal, Canada. Logistic regression was conducted to determine the predictors of ED use. Latent class analysis was used to identify trajectories to the ED.

Results: The sample included 226 youth aged 11-18 years. 33% of youth visited the ED at least once for mental health problems during child welfare involvement. ED users were more likely to be youth with a history of 1) sexual abuse, 2) parental mental illness, and 3) placements outside of the home, compared to youth with no ED visits. Mental health treatment was initiated in the 30 days following an ED presentation in 24% of cases. Three trajectories were found: 1) ED contact initiated by child welfare workers for suicidal ideation/attempts, 2) ED contact initiated by police for substance use and externalized behaviours and 3) ED contact initiated by parents for suicidal ideation/attempts.

Discussion: Despite all youth being followed by child welfare and many already receiving mental health services, youth had high, often recurrent ED use. This highlights the need for stronger coordination between child welfare, youth mental health services and EDs.