Clinical child psychology and psychiatry最新文献

Aims: Dyadic Developmental Psychotherapy (DDP) is a family-based psychotherapeutic intervention designed to help children and young people with the psychological difficulties resulting from developmental trauma. The study aims to understand the experience of DDP from a child's perspective. Method: Six children participated, aged between 8 and 12 years old, adopted or living with extended family under special guardianship orders, and accessing ongoing DDP interventions. Narrative story stem methodologies were utilised to elicit projective responses, alongside creative visual methodologies. Data was analysed using Interpretative Phenomenological Analysis. Results: Two master themes and eight subthemes were identified, describing a dynamic process where the qualities of the therapeutic interactions were salient, generating potential for increased caregiver closeness and connection. A cycle of interactive repair was important to maintain the process of developing trust. Five of the six participants were able to express benefits of the therapy, depicting increased connection and closeness with caregivers. Implications: Findings infer that the attuned presence of therapeutic adults in DDP may influence perceived differences in attachment security, through the active involvement of caregivers. Outcomes are likely to be moderated through therapist effects. Play and activity-based research techniques were helpful in promoting meaningful inclusion for this group of children.

BackgroundUnderstanding inequalities in mental health care is vital for the development of more equitable services. This study investigates inequalities in out-of-area admissions to general adolescent units, a controversial but necessary part of Child and Adolescent Mental Health care in England.MethodsAnonymised data on 279 out-of-area (at-distance or out-of-region) admissions to general adolescent units in England between February 2021-2022 were analysed for an association between demographics (age, sex, ethnicity) or clinical characteristics (diagnosis and risks) and admission characteristics (7+ day wait for a bed, distance from home, admission out-of-region, compulsory admission and length of stay >6 months).ResultsNo association was found between demographic characteristics and admission characteristics. Personality disorder was the only diagnosis associated with admission greater distance from home. Young people with personality disorder or neurodevelopmental disorder were more likely to be admitted compulsorily (OR = 8.89 and OR = 1.93 respectively). Those with suicide risk were more likely to be admitted non-compulsorily (OR = 2.06) but more likely to be admitted out-of-region (OR = 2.25).DiscussionWithin these data, the clinical presentation of the young person influenced their out-of-area admission characteristics. Young people with a diagnosis of personality disorder may be particularly likely to experience more negative aspects of out-of-area admission.

Background: Early-onset depression is an increasing concern, contributing to long-term disability and suicide. Diagnostic assessments are essential for effective treatment. However, research suggests that Child and Adolescent Psychiatry practices remain inadequate. Knowledge of healthcare processes is limited, with no consensus on conceptualising or measuring quality. This study aimed to investigate depression assessments in Swedish outpatient Child and Adolescent Psychiatry, including associations with predictors and diagnostic timeliness. Methods: Medical records (n = 284) from patients aged 8-17 with depression were collected from 10 services. Quality indicators for depressive symptoms, suicidality, comorbidities, and functioning were developed from guidelines. Indicator occurrences were assessed, summarised into components, and analysed using regression and correlations. Results: Indicator occurrences ranged from 8% to 84%, averaging 49%. Documentation varied considerably for risk aspects (57%). Distinct depressive characteristics (63%) occurred nearly twice as often as subtler symptoms (35%). Comorbidities (13%-22%) were rarely documented, whereas functioning and life situation (69%) were well-recorded. Predictors explained up to 28% of variance, with unidentified service-related factors explaining 10%. Better documentation weakly correlated with earlier diagnoses. Conclusions: Findings indicate the need for guideline implementation and further investigation into assessment inequities. Improving quality might promote earlier diagnoses. The indicators may be applicable in similar settings.

PurposeThe present research leveraged a nationally representative dataset to examine between-group differences in adolescent suicide consideration and attempts by weight status and perceived closeness to others.FindingsAdolescents with overweight and obesity were more likely to report past year suicide consideration (1.54x and 1.43x as likely) and attempts (1.74x and 1.59x as likely) compared to adolescents with healthy weight. A significantly smaller proportion of adolescents with obesity endorsed closeness to others at school compared to adolescents with healthy weight. Adolescents who felt close to others were less likely to report either suicidal ideation or attempts, regardless of weight status. Compared to the healthy weight group, significantly higher proportions of adolescents with overweight or obesity endorsed attempting suicide, both among adolescents who felt close to others, X²(2) = 14.76, p = .001, n = 4773, and those who did not, X²(2) = 18.58, p < .001, n = 2859.ConclusionsAdolescents with overweight and obesity were more likely to consider and attempt suicide relative to those with healthy weight, regardless of perceived closeness to others. Perceived closeness was associated with lower likelihood of suicide consideration and attempts among all weight groups. Further investigation may clarify the prospective utility of social closeness for adolescent suicide risk reduction, especially among those with overweight/obesity.

Young people (YP) have long been underserved in mental health research. Co-production is part of a significant shift in youth mental health research from tokenistic involvement practices towards more genuine, meaningful collaboration with the group that the research affects: young people. This commentary reflects on learnings from a co-production process in the context of Can We Connect (CWC), a qualitative study on where YP seek mental health information online and their attitudes towards what is available. Young researchers were involved in planning, co-conducting the interviews, contributed to the data analysis and dissemination. Based on our shared experiences as a research team, we aim to provide insights into and recommendations for co-production within qualitative youth mental health research. We (n = 12, including 4 young researchers, aged 16-18) reflected on our experiences of either being, or collaborating with, a young researcher in CWC. For us, having young researchers in a research team brings (1) value to YP and (2) value to research. (3) Capitalising on differences is important, (4) having structured support for young researchers and (5) balancing levels of involvement. Open, transparent and honest communication is key to building trust, enabling young researchers to be meaningfully involved members of research teams.

BackgroundChild and Adolescent Mental Health Services (CAMHS) currently seeks to implement service models that are better suited for young service users with complex mental health needs. This study explored what adolescents view as the key components of a well-functioning contact with CAMHS.MethodsThis study was conducted as part of the ongoing implementation of Flexible Assertive Community Treatment (FACT) in the CAMHS in Stockholm, Sweden. Interviews were conducted with 14 adolescents (64% females) aged 14 to 18 (M = 15.78, SD = 1.32) with intensive or longstanding contact with CAMHS. The interviews were analyzed using reflexive thematic analysis.ResultsFive key themes were generated: (1) "being involved in my care" - receiving relevant information and being part of important care decisions; (2) "accessing care when I need it" - ensuring services are easily accessible and present in the community; (3) "building a good relationship" - developing strong connections with mental health professionals; (4) "sharing the burden" - improving support and organization to reduce stress related to the healthcare system; and (5) "personalizing my care" - tailoring care to individual preferences and circumstances.ConclusionsThe findings emphasize the importance of engaging young service users in developing a mental health service that meets complex needs.

Little is known about how parent-child dynamics change when parents engage in parenting intervention programmes. To explore this, the Contextualising and Learning in Mental Health Support (CALMS) app was developed to capture daily parent-reports of these key family dynamics. This small-scale pilot study aimed to test (a) the feasibility of recruiting parents attending parenting programmes to a study of parent-child dynamics throughout a 10-12-week intervention and (b) adherence to reporting parent and child behaviours in CALMS during this period. Nine parents were recruited to complete CALMS from two parenting groups and three participated in feedback interviews. Recruitment was shown to be feasible, and adherence acceptable. Most parents reported that CALMS was easy to use, not burdensome and increased their awareness of their own and their child's behaviours. Feasible and acceptable to parents attending parenting intervention, CALMS may have therapeutic benefits that should be explored in future research.

Child and adolescent obsessive-compulsive disorder (OCD) can be complicated by secondary enuresis. In fact, enuresis appears to be more common in these patients than in the general population. In this brief review, we explore various factors that may explain the intriguing link between OCD and enuresis. This review emphasizes the potential bidirectional link between OCD and enuresis, highlighting the possible role of various causes of enuresis within the specific context of OCD, such as pharmacological side effects or a potential autoimmune etiology. Based on these considerations, we propose an algorithm for managing enuresis in children and adolescents with OCD, developed through collaboration between pediatric urologists and child psychiatrists. The goal of this algorithm was to support clinicians in addressing this specific and often overlooked clinical situation.

Psychiatric hospitalization of a child or adolescent is a highly stressful time for parents, who play a central role in their child's mental illness and recovery. Little is known of evidence-based interventions to support parents during their child's admission. This scoping review aims to examine the evidence for existing parent-focused interventions in the acute inpatient child and adolescent psychiatry setting. A literature search was conducted across six databases. Three authors were involved in screening and data extraction procedures. Results were categorized by (1) intervention format, (2) intervention content and treatment targets, (3) feasibility outcomes, and (4) parent outcomes. Nine studies encompassing 9 interventions were included in the final review. Interventions included parent groups (n = 3), 1:1 peer support (n = 2), individualized family-based assessments and interventions (n = 2), an adolescent milieu curriculum (n = 1), and a website intervention (n = 1). Outcomes were heterogeneous which limited comparison between interventions. All interventions were well-received by parents. We conclude that results of this review do not support any one intervention, though all led to parent satisfaction. Some feasibility challenges were encountered, which should be considered in future implementation. More rigorous studies are needed to provide stronger evidence for any one type of parent-focused intervention in the acute inpatient child and adolescent setting.

This study aims to investigate the specific effects of Flash Technique (FT) on adolescents with test anxiety. This follow-up study consists of 38 adolescents, 14-17 years of age (M = 15.39, SD = 1.13). Pre-post assessments were conducted using the Test Anxiety Inventory (TAI), Scale of Attitudes Negatively Affecting the Performance I/Test (POET), and Beck Anxiety Inventory (BAI) at baseline, at the end of the 4^th and 12^th weeks of therapy. The FT was applied for 12 weeks, with one weekly session as an intervention. As a result of the therapy process, the baseline means of total BAI scores decreased from 25.26 to 2.18; the baseline means of TAI decreased from 149.79 to 39.13, and the baseline mean of POET decreased from 298.47 to 73.84 at the end of the 12th week of therapy. Also, the baseline means of SUD scores decreased from 9.42 to zero at the end of the 12th week of treatment. All the adolescents showed complete improvement after the 12th week of the FT. The study findings showed that the test anxiety symptoms significantly decreased with the treatment of the FT. FT can be an effective intervention for test anxiety in adolescents.