[Medical child protection during the coronavirus lockdown]. / Medizinischer Kinderschutz während des Corona-Lockdowns: Vergleichende Befunde der Kinderschutzfälle aus Kliniken und Ambulanzen in Deutschland.

BACKGROUND: There are indications that during the lockdown and the measures of social distancing due to the coronavirus disease 2019 (COVID-19) pandemic, physical and sexual child abuse and neglect may have increased. Additionally, decreased social control may have led to a lower detection rate of child protection cases. OBJECTIVE: This study aimed to better understand the impact of the lockdown in Germany on the frequency and severity of child abuse and neglect. To do so the quantity and quality of cases of suspected child abuse and neglect in German pediatric departments and outpatient departments for medical child protection were examined. METHODS: In May 2020 a total of 343 institutions of medical child protection were invited to fill in a questionnaire with items describing their institution and items depicting cases of child protection in March and April 2019 and 2020 regarding age, form and severity of abuse as well as items to describe particular remarks and ideas for child protection during the pandemic. RESULTS: Out of the 343 pediatric departments and outpatient departments of medical child protection invited, the participation rate was 46%. In this study 81 institutions reported the total cases of suspected child abuse or neglect for both March and April 2019 and 2020. The number of cases dropped from 454 to 387 (-15%) in outpatient child abuse clinics and from 307 to 246 (-20%) in pediatric inpatient departments. Regarding the age of affected children and the form of abuse no significant differences were found. CONCLUSION: The study found a decrease in reported cases of suspected child abuse and neglect during the lockdown in March and April 2020 compared to 2019. While the results do not show an increase of total child abuse and neglect, as suspected by many professionals, the decrease in reported cases may be explained by a steep increase in unreported cases due to reduced social control.

Epidemiology of violence against children in migration: A systematic literature review.

BACKGROUND: Children in migration experience various forms of violence before, on, and after their migration journey. Epidemiological research on the prevalence of violence in this highly vulnerable group is lacking, however. METHOD: A PRISMA-guided systematic literature review with a three-tiered search strategy was conducted by searching academic literature databases and gray literature on websites of international organizations and by contacting experts. All empirical studies published within the last 15 years were eligible. Predefined search terms related to violence, children, epidemiology, and migration were used. FINDINGS: Of 1014 records, 17 studies met the inclusion criteria. Sample sizes ranged from 100 to 8,047, with a total of 16,915 children (Mdn = 311). Lifetime prevalence of violence varied considerably: Child physical maltreatment ranged from 9 %-65 % and child sexual abuse from 5 %-20 %. For internally displaced children, violence often occurred at the hands of those who were responsible for their care. Unfortunately, data on the context and country in which the violence occurred-in the country of origin, on route, or in the country of arrival-were lacking. CONCLUSION: The discrepancy between the importance of the topic and the dearth of data is striking. Filling the gaps requires not only more rigorous methodology but also more research in general on the epidemiology of violence against children in migration. We outline methodological challenges and draft an agenda for improved data on the topic. There is an urgent need for evidence that supports the development and adaptation of effective, tailored, and child-sensitive prevention and intervention programs for children in migration.

Magnetic Ureteral Stents Are Feasible in Kidney Transplant Recipients: A Single-Center Experience.

BACKGROUND: Insertion of ureteral catheters is a common procedure in kidney transplantation. The stent is usually removed by cystoscope. Magnetic ureteral stents may be an alternative to conventional stents. OBJECTIVE: To assess the functional efficacy and feasibility of magnetic double J (DJ) stents in kidney transplant recipients. METHODS: We used 6 Fr (diameter), 22 cm (length) magnetic DJs. We examined 7 cases of exclusively AB0-identical living donations. Stent were removed 10-12 days after transplantation. Ureteral Stent Symptoms Questionnaire (USSQ) and visual analog scale (VAS) were used to determine quality of life and pain of the recipients. The total removal time was recorded and cost reduction was calculated. RESULTS: Removal of the magnetic DJ was successful in all cases. The mean±SD duration of the removal was 3.4±1.6 min. The mean±SD overall pain score on the VAS during the procedure was 2.6±1.1. Using this technique was associated with a cost reduction of € 130. CONCLUSION: Using magnetic ureteral stents is a feasible option for living donation AB0-identical kidney transplant recipients.

Quality of life in maltreated children and adult survivors of child maltreatment: a systematic review.

PURPOSE: To review data on health-related quality of life (HRQoL) in individuals with childhood trauma, including psychological maltreatment, physical maltreatment, sexual abuse, and neglect. METHODS: The literature search was conducted with pre-defined keywords using the following electronic bibliographic databases: EMBASE, PubMed, MEDLINE, CINAHL, PsyINFO, PSYNDEX, and Cochrane Database of Systematic Reviews. Further databases were searched for relevant dissertations. Study selection and data extraction were completed by two independent reviewers. RESULTS: The literature search yielded 1568 entries. Nineteen articles met all inclusion criteria and were retained for further analysis. Findings quite consistently showed significant negative associations between child maltreatment and both self- and proxy-rated HRQoL. Effect sizes range from small to large. Number of types of maltreatment and HRQoL were found to be negatively related. CONCLUSION: Data on HRQoL for maltreated children are still rare. Studies often investigate adult survivors of child maltreatment. Considering HRQoL in children and adolescents who suffered maltreatment would allow the planning of effective interventions and the evaluation of treatments to improve HRQoL of these children.

Increased number of activated T cells in lymphocyte subsets of maltreated children: data from a pilot study.

OBJECTIVE: Maltreatment in childhood has been related to enduring changes in the immune system of adults, such as increased cell-mediated immune response. PURPOSE: Due to the lack of data in children, this study examined lymphocyte subset numbers and distribution during youth. METHODS: In 27 cases of 42 healthy but maltreated children, fully participating at follow-up 1-3years after the intervention of child protection team, and 19 cases of previously matched controls, analysis of blood samples by fluorescent activated cell sorter was consented. RESULTS: With regard to age references, total lymphocyte counts were aberrant in maltreated children but not in controls. When compared to controls, the percentages and absolute numbers of activated (HLA-DR+) CD4+helper and CD8+cytotoxic T cells were significantly higher in maltreated children. CONCLUSIONS: According to the typical distribution of HLA-DR+cells we assumed an increased stimulated cell-mediated immune function in maltreated children.

Service delivery in child psychiatry: provider shortage isn't the only problem.

Although the shortage of pediatric mental health practitioners in the United States is often cited as the major stumbling block to good care, several deficiencies and problems related to service delivery may be just as great a threat to the delivery of child and adolescent psychological and psychiatric clinical care. Problems and suggestions for change related to research, training, insurance, hospitalization, practitioner collaboration and role definition are discussed.

Targeting the dopamine system in the treatment of attention-deficit/hyperactivity disorder.

Attention-deficit/hyperactivity disorder (ADHD) is a highly heritable condition that affects a significant number of children and adults worldwide. During the past 30 years, the diagnosis and treatment of ADHD has relied on clinical assessment and empirical experience with stimulant medications. More recently, advances in family genetic studies, molecular genetic studies, preclinical research, radiographic imaging techniques and neuropsychological evaluation have significantly enhanced our understanding of the neurobiology of ADHD. This review highlights the current central role of dopamine in the pathophysiology and treatment of ADHD and implications for future advances in diagnosis and treatment.

Psychopharmacologic treatment of aggressive preschoolers: a chart review.

Very young children with severe aggression are a growing focus of care in child psychiatry. Notwithstanding diagnostic uncertainties in this age group, medication, not usually considered a first-line intervention, is becoming a treatment option for a growing number of clinicians in spite of a dearth of research in this area. This chart review assessed the patient characteristics, diagnoses and treatment responses of aggressive preschoolers who were treated in a university child psychiatry outpatient clinic from 2001-2004. The most common diagnoses were Attention Deficit Hyperactivity Disorder (ADHD), Disruptive Behavior Disorder and Posttraumatic Stress Disorder (PTSD). Medication was prescribed for a majority of the children with prominent aggression; atypical antipsychotics were prescribed with the greatest frequency, followed by stimulants and then alpha agonists--treatment response ratings indicated moderate to marked improved in a majority of the preschoolers who received one or a combination of these medications. Findings support the need for controlled trials of medication in preschoolers with severe aggression.

Diagnostic profiles in outpatient child psychiatry.

Outpatient child psychiatrists appear to be treating a broadening array of complex, highly comorbid, and difficult-to-treat youths. In this study, designed to evaluate the current demographic and diagnostic profile of outpatient child psychiatric patients 1,292 outpatient records from 8 treatment settings were reviewed. Patient age, race, gender, and diagnoses were recorded and analyzed. Externalizing disorders (ADHD and/or behavior disorders) were diagnosed most frequently, followed by internalizing (depressive and anxiety) disorders. Comorbidity was evident in nearly half of all patients, regardless of age. Substance abuse was infrequently reported as a comorbid condition. Externalizing and internalizing pathology frequently co-occurred. Findings reinforce the need for clinician vigilance and thorough assessment of outpatient children and adolescents.

Oxcarbazepine in the treatment of child psychiatric disorders: a retrospective chart review.

Though not considered a first-line treatment, oxcarbazepine has become an option in the expanding effort to ameliorate severely dysregulated mood and behavioral symptoms in youth. Like most pharmaceuticals in child and adolescent psychiatry, oxcarbazepine is not U.S. Food and Drug Administration (FDA)-approved for the treatment of psychiatric disorders. A search of the world literature found a single case report pertaining to this topic. This paper is a chart review of 14 children and adolescents treated with oxcarbazepine who presented with moderate to severe problems with anger and irritability associated with a range of Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) diagnoses. A majority (70%) of patients was treatment-resistant to prior psychopharmacologic efforts, and 70% were receiving combined treatment with other agents in addition to oxcarbazepine. Moderate clinical global improvement was reported in 50% of patients receiving oxcarbazepine; tolerability was good in 86%.

Current prescribing patterns in outpatient child and adolescent psychiatric practice in central New York.

OBJECTIVE: The aim of this study was to evaluate current prescribing patterns of outpatient child psychiatrists in central New York. METHODS: Data were drawn from all active files of 1- to 18-year-olds (n = 1292) at eight outpatient treatment locations in central New York on one day in 2002. Age, race, gender, diagnoses, current medications, and doses were recorded. Data was tabulated and analyzed to discern prescribing frequencies and patterns. RESULTS: 74% (956 of 1292) of all patients received psychotropic medication, and 50% of these patients (478 of 956) received two or more medications. The most commonly prescribed medications were stimulants, antidepressants, antipsychotics, alpha-agonists, and "mood stabilizer" anticonvulsants. The most frequent diagnoses were attention-deficit/hyperactivity disorder, other disruptive behavior disorders, anxiety disorders, and depressive disorders. Of those youths who received an antipsychotic medication, 77% did not have a diagnosis of a psychotic disorder. CONCLUSIONS: Psychotropic prescribing frequency in outpatient child psychiatry continues to increase, with a substantial majority of youth in psychiatric treatment receiving medication. Stimulants, antidepressants, and antipsychotics have led the way, as in prior studies. Co-prescribing represents a substantial, and growing, proportion of prescribing practice. Antipsychotics are frequently prescribed for nonpsychotic conditions.

Intramuscular ziprasidone in youth: a retrospective chart review.

OBJECTIVE: The aim of this study was to assess the tolerability and effectiveness of intramuscular ziprasidone in inpatient children and adolescents. METHOD: A retrospective chart review was conducted of child and adolescent inpatients at a private psychiatric hospital in central New York between January 1, 2003 and August 30, 2003. Subjects who had received intramuscular ziprasidone were identified, and their age, gender, and dosage were recorded. Nursing-shift notes were reviewed to ascertain the need for repeat injection and for adverse reactions. RESULTS: Forty-nine youths received intramuscular ziprasidone; 43 injections were 20 mg and 6 injections were 10 mg. Readministration within 4 hours was required in only 1 subject. No adverse events were recorded. CONCLUSION: Intramuscular ziprasidone was well tolerated and effective for acutely agitated and aggressive inpatient youth.

Aripiprazole in an adult with Asperger disorder.

OBJECTIVE: To report a case of aripiprazole-responsive adult Asperger disorder. CASE SUMMARY: A 34-year-old white man with lifelong, disabling Asperger disorder and a 20-year history of failed psychotherapeutic and pharmacologic interventions was prescribed aripiprazole, with dramatic symptomatic improvement. DISCUSSION: Multiple prior pharmacologic efforts over several years aimed predominantly at altering serotonin and dopamine neurotransmission resulted in treatment failure due to intolerable adverse effects, exacerbation of underlying symptoms, or nonresponse. Aripiprazole, with a complex profile of neurotransmitter affinities, has produced significant core symptom changes. Improved sociability; increased self-awareness; reduced rigidity, anxiety, and irritability; and reduced preoccupation with circumscribed esoteric interests are among the effects noted. CONCLUSIONS: Previously intractable Asperger disorder symptoms in a 34-year-old man were ameliorated with aripiprazole.