Child and Adolescent Psychiatry Fellowship Program Participation in the National Resident Matching Program Match: Trends and Implications for Recruitment.

OBJECTIVE: Recruitment is one of the most important missions for the Child and Adolescent Psychiatry (CAP) Caucus of the American Association of Directors of Psychiatric Residency Training, the American Academy of Child and Adolescent Psychiatry, and the American Association of Directors of Child and Adolescent Psychiatry. A review of the National Resident Matching Program (NRMP) Match data is needed to inform current and future practices. METHODS: The NRMP, Accreditation Council for Graduate Medical Education, and Association of American Medical College databases were queried from 1996 to 2021. RESULTS: The NRMP data show that the number of programs participating in the Match has increased from 87 in 1996 to 106 in 2021 and that the percentage of programs that fill their positions in the Match is increasing and has increased from 41% in 1996 to 67% in 2021. However, each year, a percentage of programs do not fill their positions offered in the Match. The numbers indicate a surplus of positions for the number of applicants that appears to be increasing, and there are currently 49 more positions than applicants. CONCLUSIONS: Trends in the CAP Match are encouraging, and importantly, more programs and applicants are using the Match. One concerning trend is the surplus of positions while there is a great need for child psychiatrists. More research is needed on the incentives for programs and applicants to participate in the Match and how to increase interest in child and adolescent psychiatry.

The Use of Simulation in Teaching.

Simulation-based medical education (SBME) provides experiential learning for medical trainees without any risk of harm to patients. Simulation is now included in most medical school and residency curricula. In psychiatric education, simulation programs are rapidly expanding and innovating. Major applications of SBME in psychiatry include achieving close observation of trainees with patients, preparing trainees for unstable patient scenarios, and exposing trainees to a broader range of psychopathology. This review article covers the history of SBME, simulation modalities, current use of SBME in psychiatry, a case study from one institution, and recommendations for incorporating simulation in psychiatry education.

Sexual Health in Child and Adolescent Psychiatry: Multi-Site Implementation Through Synchronized Videoconferencing of an Educational Resource Using Standardized Patients.

Objective: Matters of sexuality and sexual health are common in the practice of child and adolescent psychiatry (CAP), yet clinicians can feel ill-equipped to address them with confidence. To address this gap in training and practice, we developed, implemented, and evaluated an educational module enhanced by videotaped depictions of expert clinicians interacting with professional actors performing as standardized patients (SPs). Methods: We developed an educational resource highlighting common issues of sexual health relevant to CAP practice, including sexual development, psychotropic-related side effects, and sexuality in children with autism. We wrote original scripts, based on which two clinicians interacted with three SPs. Digital recordings were edited to yield 5 clips with a cumulative running time of 20 min. The clips were interspersed during a 90-min session comprising didactic and interactive components. Due to the COVID-19 pandemic, we used synchronous videoconferencing, which allowed content dissemination to several training programs across the country. Results: We recruited 125 learners from 16 CAP training programs through the American Academy of CAP's Alliance for Learning and Innovation (AALI). Routine inquiry into adolescent patients' sexual function was uncommon, reported by only 28% of participants, with "awkward" and "uncomfortable" the most common terms mentioned in reference to the clinical task. The didactic intervention led to measurable improvements after 2 weeks in skills and knowledge (p = 0.004) and in attitudes (p < 0.001). The three items with the greatest improvement were: (a) availability of developmentally tailored resources; (b) comfort in addressing sexual development with underage patients; and (c) with parents or guardians of neuroatypical or developmentally disabled patients (p < 0.001 for each). Conclusions: A sexual health curriculum enriched by video-based examples can lead to measurable improvement in outcomes pertinent to the clinical practice of CAP. These educational materials are available for distribution, use and adaptation by local instructors. Our study also provides proof-of-principle for the use of multisite educational initiatives in CAP through synchronized videoconferencing.

Child and adolescent psychiatry training in the USA: current pathways.

This manuscript reviews contemporary training in the field of child and adolescent psychiatry in the USA. There are multiple well-defined pathways to becoming a child and adolescent psychiatrist in the USA. The Accreditation Council of Graduate Medical Education oversees child and adolescent psychiatry training programs and ensures that training programs are meeting the appropriate common and program-specific requirements. The American Board of Psychiatry and Neurology ensures that the individual child and adolescent psychiatrist is competent. There is a substantial shortage of child and adolescent psychiatrists in the US, and efforts are being made to increase the number of and accessibility of trained child and adolescent psychiatrists. Child and adolescent psychiatry training in the United Sates is constantly evolving and future directions include increased engagement of medical students and general psychiatry residents, new abbreviated pathways for training, and international collaboration between programs.

Does physician continuity within a clinical trial increase retention and compliance among adolescent smokers?

BACKGROUND: Retention and compliance are hurdles in many clinical trials designed for adolescents. Factors that may improve these issues in a challenging population may lead to increased data and power in much needed adolescent substance abuse research. METHODS: Within a large-scale smoking cessation study for adolescents, physician continuity (PC) was examined to determine its effect on retention, compliance, and cessation. RESULTS: In an analysis of 98 participants, participants with physician continuity throughout the study were more likely to attend more treatment visits and be medication compliant. It was also found that PC had no effect on participant smoking cessation. CONCLUSIONS: It appears that PC may be one way to increase retention and compliance within an adolescent clinical trial, without interfering with the specific aim of the research study (in this case, smoking cessation).

Adolescent Medication Misuse: Results from the MUSC Inventory of Medication Experiences (MIME).

OBJECTIVES: To survey a diverse high school population on current prescription and over-the-counter medication misuse behaviors and attitudes. METHODS: We administered the MUSC Inventory of Medication Experiences (MIME), a newly developed self-report instrument, in demographically diverse high schools in Charleston, SC, to assess the feasibility of its administration and determine characteristics associated with medication misuse among high school students. RESULTS: A total of 3182 students completed the MIME (93% completion rate). Nearly one-third (31%) reported misuse of a medication more than once a month. Analysis was conducted to evaluate associations between misuse and age (<15=33%, 15=32%, 16=33%, 17=30%, 18=26%, >18=34%; p=.35), grade (9=29%, 10=32%, 11=33%, 12=30%; p=.22), race (White 34%, African-American 26%, others 30%; p<.001), gender (M=32%, F=28%; p=.01), parent/guardian level of education (college=30%; p=.12), if a participant was prescribed medication (yes=46%, no=21%; p<.001), if a family member was prescribed medication (yes=40%, no=26%; p<.001), and if a family member had ever offered their prescribed medication to the student (yes=91%, no=29%; p<.001). CONCLUSION: Medication misuse may be more pervasive than originally thought, with a notably high level among those most familiar with medications.

Varenicline versus bupropion XL for smoking cessation in older adolescents: a randomized, double-blind pilot trial.

INTRODUCTION: Despite tremendous potential public health impact, little work has focused on development of evidence-based smoking cessation treatments for adolescents, including pharmacotherapies. No prior studies have explored the feasibility and safety of varenicline and bupropion XL, 2 potentially promising pharmacotherapies, as smoking cessation treatments in adolescents. METHODS: Treatment-seeking older adolescent smokers (ages 15-20) were randomized (double-blind) to varenicline (n = 15) or bupropion XL (n = 14), with 1-week titration and active treatment for 7 weeks. Structured safety, tolerability, and efficacy assessments (cotinine-confirmed 7-day point prevalence abstinence) were conducted weekly. RESULTS: There were no serious adverse events. Two participants discontinued bupropion XL due to adverse effects, and none discontinued varenicline. Over the course of treatment, participants receiving varenicline reduced from 14.1 ± 6.3 (mean ± SD) to 0.9 ± 2.1 cigarettes/day (CPD, 4 achieved abstinence), while those receiving bupropion XL reduced from 15.8 ± 4.4 to 3.1 ± 4.0 CPD (2 achieved abstinence). CONCLUSIONS: These preliminary results support the feasibility and safety of conducting adequately powered, placebo-controlled efficacy studies of varenicline and bupropion XL for adolescent smoking cessation.

Bupropion SR and contingency management for adolescent smoking cessation.

There is a significant need for evidence-based treatments for adolescent smoking cessation. Prior research, although limited, has suggested potential roles for bupropion sustained-release (SR) and contingency management (CM), but no previous studies have assessed their combined effect. In a double-blind, placebo-controlled design, 134 adolescent smokers were randomized to receive a 6-week course of bupropion SR + CM, bupropion SR + non-CM, placebo + CM, or placebo + non-CM, with final follow-up at 12 weeks. The primary outcome was 7-day cotinine-verified point prevalence abstinence, allowing for a 2-week grace period. Combined bupropion SR + CM treatment yielded significantly superior abstinence rates during active treatment when compared with placebo + non-CM treatment. In addition, combined treatment showed greater efficacy at multiple time points than did either bupropion SR + non-CM or placebo + CM treatment. Combined bupropion SR and CM appears efficacious, at least in the short-term, for adolescent smoking cessation and may be superior to either intervention alone.

Attention-deficit/hyperactivity disorder confounds nicotine withdrawal self-report in adolescent smokers.

Individuals with attention-deficit/hyperactivity disorder (ADHD) are more likely than those without ADHD to initiate smoking and develop nicotine dependence. Recent research indicates that adults with ADHD experience more severe nicotine withdrawal symptoms than those without ADHD. However, little is known about nicotine withdrawal in adolescent smokers with history of ADHD. Among a sample of 134 nicotine-dependent adolescents entering a smoking cessation research study, participants completed the Minnesota Nicotine Withdrawal Scale (MNWS) and lifetime diagnostic assessment for ADHD during the baseline visit. Responses on individual items and MNWS total score were compared between participants with and without history of ADHD. In addition, correlations between MNWS responses and current ADHD symptoms were investigated among participants with history of ADHD. Forty-eight participants (36%) met lifetime ADHD criteria. Adolescent smokers with history of ADHD scored significantly higher on MNWS than those without history of ADHD. Among participants with history of ADHD, responses on the MNWS difficulty concentrating, restlessness/impatience, and anxiety/nervousness items each correlated positively with several current ADHD symptoms. Treatment-seeking adolescent smokers with history of ADHD are more likely to endorse nicotine withdrawal symptoms than those without history of ADHD. However, it does not appear that the symptoms reported in this sample represent a valid "withdrawal syndrome," particularly because these smokers had not yet formally attempted to quit. Rather, the data likely reflect common features between ADHD and nicotine withdrawal. Smoking research, particularly among adolescents in whom ADHD is so common, should carefully consider the complex issue of comorbid ADHD and nicotine dependence.

Malignant catatonia in a patient with bipolar disorder, B12 deficiency, and neuroleptic malignant syndrome: one cause or three?

A Case is presented of a 23-year-old woman with progressive onset of paranoid psychosis and catatonia, who was ultimately found to have both vitamin B12 deficiency and a family history of bipolar disorder. The patient was initially diagnosed with schizophrenia and treated with the antipsychotic medication ziprasidone. Her condition rapidly worsened to a state consistent with either neuroleptic malignant syndrome or malignant catatonia. Work-up then revealed vitamin B12 deficiency and a family history of bipolar disorder. Her symptoms improved rapidly but partially with benzodiazepines and electrocon-vulsive therapy, and completely with addition of valproic acid, vitamin B12 replacement, and re-introduction of antipsychotic medication in the form of olanzapine. The authors discuss the differential diagnosis of catatonia as reflecting a high likelihood of underlying mood disorder; the evaluation and management of malignant catatonia and malignant neuroleptic syndrome; and the role of vitamin B12 deficiency in precipitating psychotic symptoms. The case also illustrates the problems of diagnosing and managing a multifactorial disorder with psychiatric, general medical, and perhaps iatrogenic components.