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Editorial: The Cass Review – implications and reassurance for practitioners 社论:卡斯评论》--对从业人员的影响和保证。
IF 6.8 3区 医学 Q1 PEDIATRICS Pub Date : 2024-08-18 DOI: 10.1111/camh.12723
Hilary Cass

This editorial perspective summarises the key findings of the independent review of gender identity services for children and young people commissioned by the National Health Service (NHS) in England (the Cass Review). Although the evidence underpinning endocrine interventions in this group of young people remains weak, there is much that mental health practitioners can do to improve their well-being and support their families. The controversies surrounding this group of young people have disempowered local professionals, who have lost confidence in their ability to provide care for them. The reality is that CAMHS professionals already have all the necessary transferrable skills and with a small amount of top up training, they can make a profound difference to the lives of this vulnerable group, which has been marginalised in our healthcare system.

这篇社论总结了英国国民健康服务(NHS)委托进行的儿童和青少年性别认同服务独立审查(卡斯审查)的主要发现。尽管对这部分青少年进行内分泌干预的证据仍然薄弱,但心理健康工作者可以做很多事情来改善他们的福祉并为他们的家庭提供支持。围绕这部分青少年的争议使当地的专业人员丧失了能力,他们对自己为这部分青少年提供护理的能力失去了信心。现实情况是,儿童心理健康服务(CAMHS)的专业人员已经掌握了所有必要的可转移技能,只需接受少量的补充培训,他们就能为这一弱势群体的生活带来深远的影响,而这一群体在我们的医疗保健系统中一直被边缘化。
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引用次数: 0
Letter to the Editor: Addressing the escalating trend of nonmedical use of benzodiazepines and Z-hypnotics among adolescents - a call for gender-sensitive interventions and policy reforms. 致编辑的信:应对青少年非医疗使用苯并二氮杂卓和 Z-催眠药的升级趋势--呼吁采取对性别问题有敏感认识的干预措施和政策改革。
IF 6.8 3区 医学 Q1 PEDIATRICS Pub Date : 2024-08-16 DOI: 10.1111/camh.12731
Lien-Chung Wei, Hsien-Jane Chiu
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引用次数: 0
Commentary: Can a modernised psychiatric unit space reduce the use of coercive measures in child and adolescent psychiatry? A commentary on Czernine et al. (2024). 评论:现代化的精神科空间能否减少儿童和青少年精神病学中强制措施的使用?对 Czernine 等人(2024 年)的评论。
IF 6.8 3区 医学 Q1 PEDIATRICS Pub Date : 2024-08-16 DOI: 10.1111/camh.12732
Keri Ka-Yee Wong

The environment influences the way we act, react and adapt to our surroundings whether it is consciously or unconsciously. Though it is widely accepted that multiple interacting systems influence human behaviour and development across the life span, the reality of teasing these factors apart is difficult and challenging. In this brief commentary on Czernine and colleagues' important and timely paper, 'Can a modernised psychiatric unit space reduce the use of coercive measures in child and adolescent psychiatry?', I evaluate and build on the evidence presented by making constructive suggestions on ways of improving the status quo healthcare and treatment conditions for children and adolescents today. The underlying assumption is that by furthering this complex yet important area of research in the field of psychiatry and adjacent disciplines, we can improve existing healthcare systems and processes that are aligned with meeting child and adolescent needs.

无论是有意识还是无意识,环境都会影响我们的行为、反应和适应环境的方式。尽管人们普遍认为,多种相互作用的系统会影响人的行为和一生的发展,但要将这些因素区分开来却很困难,也很有挑战性。在这篇简短的评论中,我对切尔尼及其同事发表的重要而及时的论文《现代化的精神科空间能否减少儿童青少年精神病学中强制措施的使用?我的基本假设是,通过在精神病学领域及邻近学科进一步开展这一复杂而重要的研究,我们可以改善现有的医疗保健系统和流程,以满足儿童和青少年的需求。
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引用次数: 0
Narrative Matters: When does the history of ADHD not begin? 评论:多动症的历史何时开始?
IF 6.8 3区 医学 Q1 PEDIATRICS Pub Date : 2024-08-15 DOI: 10.1111/camh.12727
Matthew Smith

This commentary discusses the history of ADHD and how it can inform contemporary debates about the disorder. It critiques retrospective histories of ADHD, which propose earlier origins for the disorder than match the historical evidence. It concludes by indicating when ADHD did emerge as a distinctive disorder and why it did so.

这篇评论讨论了多动症的历史,以及它如何为当代有关该疾病的辩论提供信息。它批判了多动症的回顾性历史,这些历史提出了比历史证据更早的多动症起源。最后,它指出了多动症作为一种独特的疾病出现的时间和原因。
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引用次数: 0
Commentary: Who gets the credit for “discovering” ADHD and what is the question, really? 叙述事项:谁是 "发现 "多动症的功臣?问题到底是什么?
IF 6.8 3区 医学 Q1 PEDIATRICS Pub Date : 2024-08-13 DOI: 10.1111/camh.12730
Gabrielle A. Carlson

Recognition of hyperactivity, impulsivity, distractibility, and emotional lability as a clinical syndrome is at the heart of identifying whether there is a discoverer of the condition of attention deficit hyperactivity disorder (ADHD). Just as clinics of children diagnosed with ADHD do not capture a homogeneous group of boys and girls, however, history does not either. What different observers/clinicians have chosen to highlight reflects what is important to them and to the times in which they lived. The child/children described by Heinrich Hoffman (of Fidgety Phil fame) and George Still (who highlighted impulsive aggression as a moral defect), for instance, did not come with a list of criteria (with which even now we cannot always agree) to prove unequivocally that they had ADHD. Who cares! It is sufficient that they recognized the importance of certain co-occurring behaviors and shared their observations with us such that we can conclude our clinic's children were recognized by good past observers. ADHD-like children, like the poor, have probably always been with us.

将多动、冲动、注意力分散和情绪不稳视为一种临床综合征,是确定注意力缺陷多动障碍(ADHD)是否存在发现者的核心所在。然而,被诊断为多动症儿童的诊所并不能捕捉到同质的男孩和女孩群体,病史也是如此。不同的观察者/临床医生所选择强调的内容,反映了对他们和他们所生活的时代来说哪些是重要的。例如,海因里希-霍夫曼(Heinrich Hoffman,"浮躁菲尔 "的成名人物)和乔治-斯蒂尔(George Still,强调冲动攻击是一种道德缺陷)所描述的儿童,并没有列出一系列标准(即使现在我们也不能总是同意这些标准)来明确证明他们患有多动症。谁在乎呢?他们认识到了某些并发行为的重要性,并与我们分享了他们的观察结果,因此我们可以得出结论,我们诊所的孩子是被过去优秀的观察者识别出来的,这就足够了。类似多动症的儿童就像穷人一样,可能一直与我们同在。
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引用次数: 0
Staff Perspectives: Why are adolescent inpatients secluded and what causes changes in rates of seclusion on a unit? 工作人员的观点:为什么要对青少年住院病人实施隔离,是什么导致了病房隔离率的变化?
IF 6.8 3区 医学 Q1 PEDIATRICS Pub Date : 2024-08-08 DOI: 10.1111/camh.12729
Miriam K. Yurtbasi, Michael Gordon, Christine Pavlou, Glenn Melvin

Background

The use of seclusion in Adolescent Inpatient Psychiatric Units is being heavily scrutinised due to its forceful nature and potential to cause harm. This study aimed to understand staff perspectives on reasons for seclusion in an Adolescent Inpatient Psychiatric Unit.

Method

A mixed methods approach that included the Attitudes to Seclusion Survey followed by a semi-structured interview on the reasons for seclusion was used. We recruited 31 participants who worked on the unit of which 27 were involved in seclusion.

Results

The findings showed that the majority of staff view seclusion as undesirable and believe it should only be used out of necessity. However, there was disagreement among staff about the reasons why adolescents were secluded and whether those reasons were justified. Staff identified factors that contributed to increases in seclusion but also provided several ways in which seclusion could be reduced.

Conclusions

These findings highlight a need for precision on what constitutes justifiable use of seclusion to reduce the potential for misuse. It also shows opportunities exist for further reduction in seclusion through teamwork and communication.

背景:由于其强制性质和可能造成的伤害,在青少年精神病住院部使用隔离正在受到严格审查。本研究旨在了解员工对青少年精神病住院部实施隔离的原因的看法:我们采用了一种混合方法,包括隔离态度调查和关于隔离原因的半结构式访谈。我们招募了 31 名在该病房工作的参与者,其中 27 人参与了隔离:调查结果显示,大多数员工认为隔离是不可取的,并认为只有在必要时才应使用隔离。然而,对于隔离青少年的原因以及这些原因是否合理,工作人员之间存在分歧。工作人员指出了导致隔离现象增加的因素,但也提供了几种可以减少隔离现象的方法:这些调查结果表明,有必要明确什么是合理使用隔离,以减少滥用隔离的可能性。研究还表明,通过团队合作和沟通,有机会进一步减少隔离。
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引用次数: 0
Letter to the Editor: Detecting and treating young people at risk for psychosis is essential, but early intervention for those with a psychotic disorder should be a priority for CAMHS 致编辑的信检测和治疗有精神病风险的青少年是至关重要的,但对患有精神病的青少年进行早期干预应该是儿童青少年心理健康服务(CAMHS)的首要任务。
IF 6.8 3区 医学 Q1 PEDIATRICS Pub Date : 2024-08-08 DOI: 10.1111/camh.12728
Luis Alameda, Philippe Conus
<p>We read the article by Salazar de Pablo and Arango (<span>2023</span>) with great interest. The authors discuss some advantages and limitations from the Clinical high Risk for Psychosis (CHR-P) paradigm; mentioning a few additional perspectives that could be addressed in CAMHS services beyond the current CHR-P model. Among various propositions, they suggest training professionals working in primary care to assess psychosis-like experiences and to propose transdiagnostic cost-effective interventions such as psychoeducation and treatment for those where psychopathology emerges in the form of anxiety and depression. What they propose is very similar to the Head Space model developed in Australia, and which broadens the narrow focus of CHR-P and Early Intervention (EI) for psychosis. Head Space, created in 2006 in Australia, offers support to young people aged 12–25 facing a large range of psychological issues in a low stigma environment. More than 150 centres have now been implemented in Australia, embedded in the community and primary care such as the one proposed by Salazar de Pablo and Arango. Headspace has successfully been granted substantial funding over the last 2 decades and has provided 4.4 million interventions to more than 700,000 young Australians since its creation (McGorry et al., <span>2007</span>; Rickwood et al., <span>2023</span>). It is however worth noting that at this stage, considerable concerns have been raised in terms of evidence-base results on the efficacy of this approach, as well as other problems such as the deficient coordination with the standard governmental healthcare services where patients should be referred in case of established disorder or suicidality, leading to duplication in care (Hilferty, Cassells, Muir, & Katz, <span>2016</span>; Kisely & Looi, <span>2022</span>). These concerns have reduced the broad exportation of the model to other countries (Looi, Allison, Bastiampillai, & Kisely, <span>2021</span>), although similar strategies are currently being developed in some places (https://www.birmingham.ac.uk/research/heroes/youth-mental-health.aspx) which is encouraging. Hopefully, new data from Head Space can further help to expand this model as Salazar de Pablo and Arango propose.</p><p>There is another point we would like to raise. While Salazar de Pablo and Arango focus their paper on the CHR-P paradigm and suggest it should be implemented in CAMHS, we think the necessity for adequate treatment of patients with First Episode Psychosis (FEP) should not be forgotten. Indeed, if implementation of the identification of at risk mental state is an important step towards preventive treatment, patients with FEP definitely need adequate treatment. FEP programmes have now been implemented around the World for more than 30 years and their positive impact on outcome is strongly established. Despite a very strong accumulation of evidence, many countries in Europe and around the World, still do not have
我们饶有兴趣地阅读了 Salazar de Pablo 和 Arango(2023 年)的文章。作者讨论了精神病临床高风险(CHR-P)模式的一些优势和局限性;提到了在当前的 CHR-P 模式之外,可以在 CAMHS 服务中解决的一些其他观点。在各种提议中,他们建议对从事初级保健的专业人员进行培训,以评估类似精神病的经历,并提出具有成本效益的跨诊断干预措施,如针对以焦虑和抑郁形式出现精神病理学的患者进行心理教育和治疗。他们提出的建议与澳大利亚开发的 "头部空间"(Head Space)模式非常相似,该模式拓宽了 "精神疾病早期干预"(CHR-P)和 "早期干预"(EI)对精神病的狭隘关注。2006 年在澳大利亚创立的 "头部空间"(Head Space)为 12-25 岁、面临各种心理问题的青少年提供支持,让他们在一个低耻辱感的环境中成长。目前,澳大利亚已经建立了 150 多个中心,这些中心都设在社区和基层医疗机构,如 Salazar de Pablo 和 Arango 提议建立的中心。在过去的 20 年里,"头部空间 "成功获得了大量资金,自成立以来已为 70 多万澳大利亚青少年提供了 440 万次干预(McGorry 等人,2007 年;Rickwood 等人,2023 年)。然而,值得注意的是,在现阶段,人们对这一方法的有效性的证据基础结果以及其他问题提出了相当大的担忧,例如与标准的政府医疗保健服务之间的协调不足,在患者已经出现失调或自杀倾向的情况下,应将其转介到标准的政府医疗保健服务中,从而导致重复护理(Hilferty、Cassells、Muir、& Katz,2016;Kisely & Looi,2022)。这些担忧减少了该模式向其他国家的广泛输出(Looi, Allison, Bastiampillai, & Kisely, 2021),尽管目前一些地方正在制定类似的战略(https://www.birmingham.ac.uk/research/heroes/youth-mental-health.aspx),这令人鼓舞。希望来自 "头部空间 "的新数据能够进一步帮助扩展这一模式,正如 Salazar de Pablo 和 Arango 所建议的那样。虽然 Salazar de Pablo 和 Arango 将他们的论文重点放在 CHR-P 范式上,并建议在 CAMHS 中实施该范式,但我们认为不应忘记对首发精神病(FEP)患者进行适当治疗的必要性。事实上,如果识别高危精神状态的实施是预防性治疗的重要一步,那么首次发病精神病患者肯定需要适当的治疗。现已在世界各地实施了 30 多年的 "首次精神病治疗计划",其对治疗效果的积极影响已得到有力证实。尽管已经积累了大量的证据,但欧洲和世界上许多国家仍然没有适当的儿童早期干预计划。这一点在儿童心理、情感和健康服务中表现得更为明显,至少在过去,人们对诊断出精神病还有些不情愿。因此,我们建议,当青少年出现精神病的临床表现时,应向他们提供对年轻成人患者有更好疗效的 "早期干预 "策略。
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引用次数: 0
Debate: How the business model of social media fuels the need for greater moderation 辩论:社交媒体的商业模式如何助长了加强节制的必要性。
IF 6.8 3区 医学 Q1 PEDIATRICS Pub Date : 2024-07-10 DOI: 10.1111/camh.12724
Richard Graham

The current business model of social media companies is to keep users engaged and on screen, so that data can be obtained from them, and targeted advertisements sold. To maintain user engagement, recommender systems (algorithms) promote content, which can be extreme, and includes mental health content. Extreme mental health content, such as self-harm images, can be pushed to any user and then more and more extreme content can be pushed to them. The normalisation, amplification or glamorisation of harmful content can have negative impacts upon the user, who may struggle to express what is happening online to anyone. In contrast with the views of Zhang et al. (Child and Adolescent Mental Health, 2024, 29, 104), without greater, timely moderation of harmful content, the promotion of self-harm, suicide and eating disorders will continue on social media, with potentially devastating consequences.

目前,社交媒体公司的商业模式是让用户持续参与并出现在屏幕上,这样就能从他们那里获得数据,并销售有针对性的广告。为了保持用户的参与度,推荐系统(算法)会推广一些内容,这些内容可能是极端的,包括心理健康内容。极端的心理健康内容,如自残图片,可以推送给任何用户,然后越来越多的极端内容也可以推送给他们。有害内容的正常化、放大或美化可能会对用户产生负面影响,他们可能难以向任何人表达网上发生的事情。与 Zhang 等人(《儿童与青少年心理健康》,2024 年,29,104)的观点相反,如果不及时对有害内容进行更大程度的节制,社交媒体上对自残、自杀和饮食失调的宣传将继续下去,并可能带来毁灭性的后果。
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引用次数: 0
Trends in the nonmedical misuse of benzodiazepines and Z-hypnotics among school-aged adolescents (2016–2021): gender differences and related factors 学龄青少年非医疗滥用苯二氮卓和 Z-催眠药的趋势(2016-2021 年):性别差异及相关因素。
IF 6.8 3区 医学 Q1 PEDIATRICS Pub Date : 2024-05-22 DOI: 10.1111/camh.12716
Pilar Carrasco-Garrido, Valentín Hernández-Barrera, Isabel Jiménez-Trujillo, Lidiane Lima Florencio, Carmen Gallardo Pino, Spencer Yeamans, Domingo Palacios-Ceña

Background

The misuse of psychotropic medication has increased during the past decade, especially among adolescents. The aim of our study was to describe the prevalence and patterns of the nonmedical use of benzodiazepines (BDZ) and Z-hypnotics among school-aged adolescents through the lens of sex. In addition, we sought to analyze the temporal evolution of the nonmedical use of these drugs during the period 2016–2021.

Methods

The temporal evolution of the nonmedical use of these drugs was analyzed based on survey data collected in 2016, 2018 and 2021, which includes the first years of the COVID-19 pandemic. To assess the possible effect of the COVID-19 pandemic, the year at survey was conducted was introduced as a categorical variable. We used data from the Spanish State Survey on Drug Use in Secondary Education, which covers drug use among students aged 14–18 years. Using multivariate logistic regression models, we estimated the independent effect of different variables (sociodemographic data, use of other psychoactive substances, risk perception and availability) on the nonmedical use of BDZ and Z-hypnotics.

Results

In total, survey data from 95,700 adolescents were included in our analysis. The nonmedical use of BDZ and Z-hypnotics increased among adolescents during the study period. The adjusted odds ratio (AOR) from 2016 to 2018 was 1.11 (95% CI 0.94–1.31) and from 2018 to 2021 the AOR was 1.26 (95% CI 1.08–1.46), using 2016 and 2018, respectively, as reference years. The nonmedical use of BDZ and Z-hypnotics was more likely in adolescent girls than boys (AOR = 2.11). The nonmedical use of prescription opioids (AOR = 3.44), novel psychoactive substances and other illicit psychoactive drugs (AOR = 4.10) were risk factors for the nonmedical use of BDZ and Z-hypnotics in both sexes. Use of cannabis (AOR = 1.38) was a predictor of nonmedical use in female adolescents only.

Conclusions

This study shows that the trend of the nonmedical use of BDZ and Z-hypnotics among school-aged adolescents in Spain increased between 2016 and 2021. Among adolescents aged 14 to 18, the probability of nonmedical use of these psychoactive substances was twice as high for female adolescents as for male adolescents.

背景:在过去十年中,滥用精神药物的现象有所增加,尤其是在青少年中。我们的研究旨在通过性别视角,描述学龄青少年非医疗使用苯二氮卓(BDZ)和Z-催眠药的流行程度和模式。此外,我们还试图分析 2016-2021 年期间这些药物非医疗使用的时间演变情况:我们根据 2016 年、2018 年和 2021 年收集的调查数据分析了这些药物非医疗使用的时间演变,其中包括 COVID-19 大流行的最初几年。为了评估 COVID-19 大流行可能产生的影响,我们将调查年份作为一个分类变量。我们使用的数据来自西班牙中等教育阶段毒品使用情况国家调查(Spanish State Survey on Drug Use in Secondary Education),该调查涵盖了 14-18 岁学生的毒品使用情况。通过多变量逻辑回归模型,我们估算了不同变量(社会人口学数据、使用其他精神活性物质、风险认知和可获得性)对非医疗使用 BDZ 和 Z-催眠药的独立影响:共有 95 700 名青少年的调查数据纳入了我们的分析。在研究期间,青少年非医疗使用 BDZ 和 Z-催眠药的情况有所增加。以2016年和2018年为参照年,2016年至2018年的调整后几率比(AOR)为1.11(95% CI 0.94-1.31),2018年至2021年的调整后几率比(AOR)为1.26(95% CI 1.08-1.46)。青春期女孩非医疗使用 BDZ 和 Z-hypnotics 的可能性高于男孩(AOR = 2.11)。非医疗使用处方类阿片(AOR = 3.44)、新型精神活性物质和其他非法精神活性药物(AOR = 4.10)是男女青少年非医疗使用BDZ和Z-催眠药的风险因素。使用大麻(AOR = 1.38)仅是女性青少年非医疗使用的预测因素:这项研究表明,2016 年至 2021 年期间,西班牙学龄青少年非医疗使用 BDZ 和 Z-催眠药的趋势有所上升。在14至18岁的青少年中,女性青少年非医疗使用这些精神活性物质的概率是男性青少年的两倍。
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引用次数: 0
Debate: More, not less social media content moderation? How to better protect youth mental health online 辩论:对社交媒体内容进行更多而非更少的控制?如何更好地保护青少年的网络心理健康?
IF 6.8 3区 医学 Q1 PEDIATRICS Pub Date : 2024-05-13 DOI: 10.1111/camh.12717
Ian Russell

Background

This article challenges Zhang et al.'s claims that social media content moderation is proving detrimental to youth mental health and asserts that greater emphasis on the systemic risks posed by social media platforms is required.

Method

This commentary draws on my lived experience as a bereaved parent, empiricial evidence and ongoing public policy and regulatory debates.

Conclusions

Greater attention should be paid to the effects of algorithmic recommendation systems, which can result in teenagers becoming rapidly exposed to large amounts of harmful content on social media sites such as Instagram, Pinterest and TikTok.

背景:这篇文章对张(Zhang)等人关于社交媒体内容节制不利于青少年心理健康的说法提出了质疑,并认为需要更加重视社交媒体平台带来的系统性风险:本评论借鉴了我作为失去亲人的父母的亲身经历、经验证据以及正在进行的公共政策和监管辩论:应更多地关注算法推荐系统的影响,它可能导致青少年迅速接触到 Instagram、Pinterest 和 TikTok 等社交媒体网站上的大量有害内容。
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引用次数: 0
期刊
Child and Adolescent Mental Health
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