Clinical child psychology and psychiatry最新文献

More adolescents than ever are being hospitalised in mental health units. As with all forms of clinical intervention, psychiatric inpatient admission poses its own risks of harm resulting from treatment (iatrogenesis), of which there is minimal literature. In this article we explore the factors that contribute to iatrogenic processes in the adolescent inpatient environment. Of note, the socialization of unsafe behaviours in these environments can contribute to poorer treatment outcomes as well as the harmful effects of experiencing, or witnessing, coercive and traumatising clinical practices. Inpatient admissions also have a systemic impact on family and community ecosystems that can detrimentally influence young people while they are in hospital and even after returning to the community. Recommendations for minimizing and preventing iatrogenic harm for adolescents in inpatient environments are outlined, as well as the patient characteristics that might make young people more vulnerable to these deleterious processes.

BackgroundThe pressures on community Children and Young People's Mental Health Service (CYPMHS) clinicians to manage and maintain caseloads can be immense, therefore discharging young people from CYPMHS in a safe and timely way is often discussed as a priority. However, there is limited research into how discharge can be done well, especially for discharge occurring prior to children and young people (CYP) reaching the upper age limit of CYPMHS. Thus, this study aimed to gain a better understanding of the barriers and facilitators discharging CYP from community CYPMHS, by exploring clinicians experiences of discharging CYP from their service.MethodSemi-structured interviews of 30-40 minutes were conducted with 12 clinicians working at different CYPMHS in England and analysed using codebook thematic analysis.ResultsSix themes were identified. These included, "perfectionistic approach towards treatment outcomes", "reducing dependence on CYPMHS through empowerment", "a lack of flexibility in the wider system", "lack of collaborative care", "an increasing pressure on the service" and "keeping the focus on discharge".ConclusionClinicians face multiple barriers when discharging CYP which should be addressed, alongside enhancing the use of reported facilitators to ensure timely, safe and well-managed discharges.

BackgroundObsessive-compulsive disorder (OCD) and autism spectrum disorder (ASD) often co-occur and have overlapping symptom profiles. Detection and diagnosis of ASD in youth with OCD can therefore be challenging but is crucial to inform care planning.AimThe current study aimed to provide a psychometric evaluation of the Social Communication Questionnaire (SCQ), a widely used parent-report measure for assessing ASD traits, in youth with OCD.MethodIn total, 484 young people with an ICD-10 diagnosis of OCD completed a battery of measures as part of a specialist clinical assessment.ResultsExploratory factor analyses (EFA) suggested a multidimensional factor solution for the SCQ, although an adequate factor solution was not identified due to cross-loading and/or weak loading items. The SCQ had good internal consistency (KR20 = 0.85), and good convergent validity with the Strengths and Difficulties Questionnaire (SDQ) Prosocial Behaviour subscale (r = -0.52) and Peer Problems subscale (r = 0.48). The SCQ differentiated those with versus without a clinical diagnosis of ASD with reasonable accuracy (area under the curve = .76).DiscussionThe current findings support the use of the SCQ as a measure of ASD traits in youth with OCD, suggesting that this quick and easy-to-administer measure could aid detection of ASD in this population.

BackgroundChildren and adolescents with autism spectrum disorder (ASD) frequently experience functional somatic symptoms (FSS), although the underlying causes often remain unclear. Various biological and psychological factors, both individual and within families, such as alexithymia or health anxiety, can intensify these symptoms, sometimes resulting in excessive and unnecessary medical interventions.MethodsA narrative review of the literature was conducted, alongside the presentation of a case report involving a 13-year-old boy with ASD. The case illustrates how personal and familial factors can influence the presentation of FSS and the risks of inappropriate treatment.DiscussionThe findings suggest that psychological and familial factors play a significant role in the manifestation of FSS in ASD. These factors can increase the risk of unnecessary medicalization, as they often lead to misinterpretation of symptoms by caregivers and healthcare providers. The case report further underscores how the interaction of personal and familial dynamics can complicate the management of FSS. A comprehensive biopsychosocial approach that addresses both the individual and the family is crucial for managing FSS in ASD. Future research should focus on developing targeted interventions that address these psychological and familial influences to enhance the quality of care and reduce unnecessary and potentially harmful healthcare utilization in ASD.

BackgroundThe number of children and young people (CYP) experiencing mental health crises in the UK is increasing. The NHS Long Term Plan (2019) prioritises crisis care for CYP. There is a lack of research and understanding into staff views and understandings of these services. The Crisis and Home Treatment Service (CAHTS) is a service within Child and Adolescent Mental Health Services (CAMHS) across Bath and Northeast Somerset, Swindon, and Wiltshire (BSW) and is a key component of the crisis mental health care for CYP. The aims of this study were to gain an insight into staff's views and understandings of the CAHTS, and to explore and identify areas for improvement for future practice and policy for the CAHTS.MethodsThe study employed a mixed-methods design, obtaining quantitative and qualitative data, by distributing online surveys (n = 37) and semi-structured interviews (n = 9) to gather staff views and understandings. Participants were recruited by opportunistic sampling. Interviews were recorded and transcribed, and a thematic analysis was undertaken.ResultsParticipants 'agreed' that CAHTS were acting in accordance with their core principles and were 'highly likely' to use the service in the future. The thematic analysis revealed seven themes, the four most dominant themes identified were: good qualities of the CAHT service, working collaboratively, good clinician skills and understaffed for demand.ConclusionsThe data provides insight into staff's views and understandings of the CAHTS. From the themes derived, the study identified various implications for the CAHTS including further training for staff.

ObjectiveSince the onset of the COVID-19 pandemic, rates of anxiety and depression in youth have risen. Telepsychiatry is a potential mode of intervention for such digital natives. This systematic review aims to examine the effectiveness of telepsychiatry for youth with depression and/or anxiety.MethodsFour electronic databases, PubMed, MEDLINE, Embase, PsycINFO, were searched from their inception to May 12, 2024. Included studies were assessed for study quality and risk of bias.ResultsA search returning 29,944 records yielded 26 included studies, comprising 1,558 youths. Of 13 studies comparing depressive symptoms pre- and post-telepsychiatry intervention, symptom severity was significantly lower post-intervention compared to baseline (Hedges' g: 0.83; 95% CI: 0.59, 1.08). Similarly, of six studies comparing pre- and post-telepsychiatry intervention anxiety symptoms, anxiety scores were significantly lower post-intervention (Hedges' g: 1.15; 95% CI: 0.79, 1.50). Patients undergoing telepsychiatry also had superior outcomes when compared to waitlist control groups for depression (Hedges' g: 0.54; 95% CI: 0.23, 0.85) but not anxiety (Hedges' g: 0.50; 95% CI: -0.09, 1.10). Certainty of these estimates ranged from moderate to very low. Qualitative feedback noted subjective improvement in symptoms and high levels of satisfaction.ConclusionTelepsychiatry has potential as a therapeutic intervention for youth anxiety and depression. Further research with more controlled methodology is needed for development of recommendations that can guide growing use of this technology.

BackgroundGlobally, there is an increasing trend of forcibly displaced people, of which over 40% are children. Unaccompanied asylum-seeking children (UASC) are at risk of experiencing psychological distress and developing mental health difficulties. However, in the UK, the approach from statutory mental health services is inconsistent across different geographical areas.AimThis report outlines recommendations for statutory mental health services in the UK in relation to working with UASC.MethodA rapid evaluation method was adopted including interviewing fifteen key informants as well as reviewing existing clinical guidelines. Key informants included clinicians, service managers, social workers and commissioners from Local Authorities, National Health Services, and third sector partners. Recommendations were synthesised using narrative synthesis.Results and conclusionExisting service provision and barriers to the implementation of interventions were summarised and compared against existing guidelines. The report presents recommendations on assessments, screening tools, and psychological interventions for developing a pathway for UASC within statutory services.

ObjectiveAnxiety rates amongst autistic youth range from 11% to 84%. While Cognitive Behavioural Therapy (CBT) is an effective treatment of anxiety in neurotypical youth, there are concerns autistic youth lack the cognitive resources necessary to effectively engage with CBT. It is also unclear whether standard or adapted CBT is more effective. This review aims to compare the effects of standard and adapted CBT in the treatment of anxiety in autistic youth.MethodsArticles were searched across three online databases. 24 articles were selected for final review. All articles were published between 2008 and 2024. Total sample size was 1,140 and participant age ranged from 4-18 years. Various designs, settings, and CBT formats were incorporated.ResultsWhen treating anxiety in autistic youth, standard CBT is effective although CBT adapted to accommodate the autism-related needs of the youth appears more effective, with gains maintained up to 26 months post-treatment. Statistical analysis was not significant.ConclusionsStandard and adapted CBT are effective treatments of anxiety in autistic youth. To optimise outcomes, it may be important to consider the common cognitive styles associated with autism and adapt the therapeutic intervention accordingly. However, there is not yet statistical evidence for this hypothesis.

Previous research has demonstrated the positive associations with parental support with better mental health outcomes in gender-diverse young people. However, less is known about what happens within a family structure if an unsupportive parent or family member leaves the family unit and sees the child only on the condition that they present in a way that conforms to their birth gender. This paper will focus on the first interviews with nine families within the wider sample of 39 families in the LOGIC-Q (Longitudinal Outcomes of Gender Identity in Children - qualitative) study who reported they had experienced rejection by a parent or family member after the young person had disclosed their gender non-conformity. These families' narratives are examined through two themes: How rejection impacts visitation, and Moving past the loss of rejection. The families all spoke about how they had adapted to the loss of their family members. They described how any negative impact would have been worse had they stayed living together, or were in contact with, the rejecting family member. Here, it becomes important then to understand the context of why a gender-diverse young person may choose to no longer see a parent or family member.