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OBJECTIVES: We explore adolescents' and their parents' experiences of internet-based emotion regulation therapy for non-suicidal self-injury (NSSI). DESIGN: A qualitative study nested within a controlled feasibility trial. METHODS: Online, semi-structured focus group interviews were conducted with outpatient adolescents with NSSI aged 13-17 years (n = 9) and their parents (n = 8) who had received therapist-guided Internet-delivered Emotion Regulation Individual Therapy for Adolescents (IERITA). Transcripts were analysed using reflexive thematic analysis. RESULTS: Three main themes were generated: (1) Fatigue - barriers to and during treatment, comprised of two sub-themes 'Arriving to services exhausted, needing motivation, and leaving feeling abandoned' and 'the burden of IERITA and the consequences of fatigue', (2) inter- and intrapersonal insights as facilitators of change and (3) Online, written contact with the therapist is beneficial and contributes with less pressure, comprised of three sub-themes 'the therapist behind the screen is essential', 'less pressure sitting alone: the physical absence of a therapist' and 'engaging on your own terms, in your own tempo'. Themes were consistent among adolescents and parents. CONCLUSION: Fatigue due to therapeutic engagement and previous help-seeking processes created barriers for engagement. Emotion regulation therapy was experienced as beneficial leading to inter- and intra-personal insights, facilitating change of maladaptive patterns. Therapists were regarded as indispensable, and the internet-based format did not hinder therapeutic alliance. The written format allowed for reflection and alleviated the pressure of relating to the therapist. Further research should explore experiences of other online treatment formats (e.g. synchronous or video-based) with regard to benefits, fatigue and therapist interaction.
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Background & Objectives: Terror catastrophizing, defined as an ongoing fear of future terrorist attacks, is associated with a higher incidence of anxiety disorders, among other psychological impacts. However, previous studies examining terror catastrophizing's relationship to other mental health disorders are limited. The current study sought to determine if patients diagnosed with anxiety and depression would experience increased terror catastrophizing. Additionally, this study aimed to investigate whether parental terror catastrophizing increases children's internalizing symptoms.Design & Methods: Individuals were randomly drawn from the Danish Civil Registration System and invited to complete a series of questionnaires to measure terror catastrophizing tendency, lifetime parental trauma, and children's internalizing symptoms. In total, n = 4,175 invitees completed the survey of which 933 reported on a child between 6 and 18 years. Responses were analyzed using a generalized linear regression model.Results: Participants diagnosed with anxiety alone or comorbid with depression were more likely to experience symptoms of terror catastrophizing than undiagnosed participants (ß = 0.10, p < .001; ß = 0.07, p = .012). Furthermore, the parental tendency to catastrophize terror was associated with higher internalizing symptoms in children (ß = 0.09, p = .006), even after taking parental diagnoses, as well as lifetime and childhood trauma into account.Conclusion: The results can inform clinical practices to account for a patient's potential to exhibit increased terror catastrophizing tendencies or be more affected by traumatic events. Additionally, they can offer insights for designing novel preventative interventions for the whole family, due to the relation between parental tendencies for terror catastrophizing and the internalizing symptoms observed in children.
Diagnoses of comorbid anxiety and depression tend to have increased terror catastrophizing (TC); however, a sole anxiety diagnosis is associated with more TC, while sole depression is not.Informative for clinical practice to understand how patients with TC tendencies are more likely to be impacted by traumatic events.Parental TC symptoms are linked to internalizing symptoms in children; thus, this could inform the design of novel preventative interventions.
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Ansiedade , Catastrofização , Depressão , Terrorismo , Humanos , Masculino , Feminino , Depressão/psicologia , Dinamarca , Catastrofização/psicologia , Terrorismo/psicologia , Adolescente , Criança , Inquéritos e Questionários , Adulto , Ansiedade/psicologia , Pais/psicologia , Pessoa de Meia-Idade , Medo/psicologiaRESUMO
Evidence suggests a role for low-grade inflammation and oxidative stress in the pathophysiology of bipolar disorder. We conducted a systematic review and meta-analysis of peripheral markers of inflammation and oxidative stress in children and adolescents under 20 years of age with bipolar disorder. We searched PubMed, Embase and psycINFO and performed random effects meta-analysis calculating standardized mean differences (SMD) of marker levels between patients with bipolar disorder and healthy control individuals. Ten studies comprising a total of 418 patients with bipolar disorder and 3017 healthy control individuals were included. The levels of C-Reactive Protein were higher in patients with bipolar disorder compared with healthy individuals (SMD 0.53; 95â¯%CI: 0.33-0.74; I2 = 0â¯%). For other biomarkers there were no statistically significant differences between groups. Findings were limited by a low number of studies and participants and methodological issues in the included studies. More and larger studies using rigorous methodology are needed to establish the role of inflammation and oxidative stress in children and adolescents with bipolar disorder.
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Biomarcadores , Transtorno Bipolar , Inflamação , Estresse Oxidativo , Humanos , Transtorno Bipolar/sangue , Transtorno Bipolar/metabolismo , Transtorno Bipolar/fisiopatologia , Estresse Oxidativo/fisiologia , Criança , Adolescente , Biomarcadores/sangue , Inflamação/metabolismo , Inflamação/sangue , Proteína C-Reativa/metabolismoRESUMO
The impact of stigmatisation on adults with mental illnesses has been thoroughly demonstrated. However, little is known about experiences of stigmatisation among adolescents with mental illness. Through semi-structured interviews with 34 Danish adolescents (14-19 years) diagnosed with psychosis, this study explores adolescents' experiences of psychosis stigma. On the basis of phenomenological analysis, we find that stigmatisation is widely experienced, and psychosis is generally regarded as more stigmatising than co-morbid mental illnesses. The participants engage in different strategies to manage possible stigma, especially strategies of (non-)disclosure. Disclosure is experienced as both therapeutic and normative, but also bears the risk of stigmatisation, and is therefore associated with numerous considerations. Being understood when disclosing is central to the participants, and lack of understanding from others is a continuous challenge. Nevertheless, participants experience benefits when feeling understood by people they confide in and can to a degree create the grounds for this through centralising aspects of their experiences of psychosis and mental illness. We argue that disclosure is both a stigma management strategy and a normative imperative, and that being understood or not is a challenge transcending stigma definitions.Clinical trial registration: Danish Health and Medicines Authority: 2612-4168. The Ethics Committee of Capital Region: H-3-2009-123. ClinicalTrials.gov: NCT01119014. Danish Data Protection Agency: 2009-41-3991.
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BACKGROUND: Bipolar disorders (BD) figures on top of the World Health Organization classification of disabling disorders. It is unclear if there are socioeconomic, functioning, and cognition differences in young patients newly diagnosed with BD and whether these are different for young and adult patients newly diagnosed with BD. Understanding these differences is important for tailored treatment and support. METHODS: Participant groups included 401 patients newly diagnosed with BD, 145 of their unaffected first-degree relatives (UR) and 209 healthy control individuals (HC). First, we compared socio-economic status, functioning and cognition between young patients newly diagnosed with BD (150), UR (61) and HC (92) (15-25 years) and adult patients newly diagnosed with BD (251), UR (84) and HC (117) (>25 years), respectively. Second, within patients, we compared functioning and cognition between young and adult patients newly diagnosed with BD. RESULTS: In both participant groups, patients newly diagnosed with BD, and to a lesser degree UR, had lower socio-economic status and impaired functioning and cognition compared with HC. Further, young patients newly diagnosed with BD were less functionally impaired, than adults newly diagnosed with BD, whereas cognition did not differ between groups. LIMITATIONS: Applied tools for assessments of functioning and cognition are not validated below age 18. CONCLUSIONS: Overall, lower socio-economic status and impaired functioning and cognition were found both in young and adult patients newly diagnosed with BD and their UR compared with young and adult HC, respectively. Young patients were less functionally impaired than adults, but cognition was similarly impaired.
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Transtorno Bipolar , Adulto , Humanos , Adolescente , Transtorno Bipolar/diagnóstico , Transtorno Bipolar/epidemiologia , Estudos Transversais , Status Econômico , Estudos de Casos e Controles , CogniçãoRESUMO
BACKGROUND: Psychotic experiences (PEs) are common in help-seeking youths with non-psychotic mental health problems, yet the clinical importance of PEs as potential effect modifiers of psychotherapy interventions has been scarcely examined. We examined if PEs were associated with a differential response to transdiagnostic cognitive behavioural therapy (CBT) aimed at common emotional and behavioural problems. METHODS: We present secondary analyses from the Mind My Mind (MMM) trial that randomized 396, 6-16-year-old youths to either 9-13 sessions of transdiagnostic modular community-based CBT (MMM) or community-based management as usual (MAU). MMM was superior to MAU in reducing parent-reported impact of mental health problems according to the Strengths and Difficulties Questionnaire (SDQ). PEs were assessed by semi-structured screening interviews at baseline. The contrast between subgroups (presence/absence of PEs) was calculated to test if PEs are potential effect modifiers regarding the change in parent-reported SDQ-impact (primary outcome, rated 0[low]-10[high]) and other SDQ-related outcomes. RESULTS: Baseline PEs were present in 74 (19%) of youths. The superior effect of MMM on changes in SDQ-impact from baseline to week 18 was not effect modified by the presence of PEs (PEs[yes] -0.89 [95%CI -1.77;-0.01] vs. PEs[no] -1.10 [95%CI -1.52;-0.68], p-value for interaction .68). For secondary outcomes similar patterns were observed. Limitations Statistical power was limited to show if PEs modified treatment response. Replication and meta-analytic evidence are needed. CONCLUSIONS: The beneficial effects of MMM transdiagnostic CBT did not differ by PE-status, indicating that youths with emotional and behavioural problems could be offered such psychotherapy irrespective of co-occurring PEs.
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Terapia Cognitivo-Comportamental , Transtornos Mentais , Adolescente , Criança , Humanos , Emoções , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Saúde Mental , Psicoterapia , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
OBJECTIVES: The traditional view on psychiatric disorders as categorical and distinct is being challenged by perspectives emphasizing the relevance of dimensional and transdiagnostic assessment. However, most diagnostic instruments are based on a categorical view with a threshold-approach to disease classification. METHODS: We here describe algorithms for dimensionalizing the psychopathological ratings of the widely used diagnostic interview for children and adolescents, the Kiddie-Schedule for Affective Disorders and Schizophrenia - Present and Lifetime Version (K-SADS-PL). We further evaluate the criterion-related construct validity of the dimensionalized attention-deficit/hyperactivity disorder (ADHD) scales using Rasch models in a sample of 590 children (mean age 10.29 (.36), 49% girls). RESULTS: The algorithms generate scores of current symptom load, i.e., the sum of clinician-rated symptoms within each disorder assessed with the interview. We found support for counting symptoms of inattention and hyperactivity/impulsivity, respectively, but not for a single combined ADHD scale. CONCLUSIONS: The algorithms constitute an initial step in creating a framework for clinician-rated dimensional analyses of symptoms derived from the K-SADS-PL, but future studies are needed to further evaluate the construct validity of the remaining scales and the reliability and clinical utility of the method. We believe that our proposed algorithms offer a novel method of dimensional psychopathological assessment, which can be applied in multiple branches of child and adolescent psychiatry.
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Transtorno do Deficit de Atenção com Hiperatividade , Criança , Feminino , Humanos , Adolescente , Masculino , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Reprodutibilidade dos Testes , Psicopatologia , Escalas de Graduação Psiquiátrica , Psiquiatria do AdolescenteRESUMO
Psychopharmacological treatment is an important component of the multimodal intervention approach to treating mental health conditions in children and adolescents. Currently, there are many unmet needs but also opportunities, alongside possible risks to consider, regarding the pharmacological treatment of mental health conditions in children and adolescents. In this Position Paper, we highlight and address these unmet needs and opportunities, including the perspectives of clinicians and researchers from the European College of Neuropsychopharmacology-Child and Adolescent Network, alongside those of experts by lived experience from national and international associations, via a survey involving 644 participants from 13 countries, and of regulators, through representation from the European Medicines Agency. We present and discuss the evidence base for medications currently used for mental disorders in children and adolescents, medications in the pipeline, opportunities in the development of novel medications, crucial priorities for the conduct of future clinical studies, challenges and opportunities in terms of the regulatory and legislative framework, and innovations in the way research is conducted, reported, and promoted.
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Transtornos Mentais , Psicofarmacologia , Adolescente , Humanos , Transtornos Mentais/tratamento farmacológico , Saúde MentalRESUMO
BACKGROUND: Paediatric delirium (PD) is increasingly recognised as a common disorder in critically ill children with a reported prevalence ranging from 9% to 66%. We validated the PD component of the Sophia Observation withdrawal Symptoms-Paediatric Delirium (SOS-PD) scale in a Danish setting to provide increased awareness and reliable identification of this critical condition, thereby paving the way for improved pathways to targeted delirium care. OBJECTIVE: The objectives of this study were to criterion validate the PD component of the SOS-PD screening tool by comparing blinded psychiatric and nurse assessments and to estimate the prevalence of delirium in critically ill children in a Danish context. METHODS: A prospective observational study was performed on critically ill children aged between 3 m and 18 y, admitted to an intensive care unit, with a hospital stay of 48 h or more. Assessments took place on a fixed weekday over an 18-month period. To test accuracy and criterion validity, bedside nurses' SOS-PD assessments were compared to the reference standard, a diagnostic assessment performed by a child psychiatrist according to the Diagnostic and Statistical Manual-V criteria by use of the Vanderbilt Assessment of Delirium in Infants and Children. RESULTS: We included 141 children in the study, 30 (21%) of whom were diagnosed with delirium by the child psychiatrist. The accuracy of the delirium diagnosis was 93.6% (95% confidence interval [CI]: 88.3-97.1) among the nurses' SOS-PD assessments compared to the reference standard. The SOS-PD demonstrated a high sensitivity of 83.3% (95% CI: 65.3-94.4) and a high specificity of 96.4% (95% CI: 91.0-99.0) with five false-negative and four false-positive cases. CONCLUSION: The PD component of the SOS-PD tool has good accuracy and validity for assessments performed by nurses compared to a child psychiatrist's diagnosis in critically ill children in a Danish setting. We recommend the use of the SOS-PD instrument in clinical practice.
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Delírio , Síndrome de Abstinência a Substâncias , Lactente , Criança , Humanos , Pré-Escolar , Delírio/epidemiologia , Estado Terminal , Sensibilidade e Especificidade , Reprodutibilidade dos Testes , Unidades de Terapia Intensiva , DinamarcaRESUMO
OBJECTIVE: Offspring of parents with schizophrenia spectrum disorders (SSD) have an increased risk of neurodevelopmental disturbances. However, the ability to provide very early interventions to support these children and their families requires profound knowledge regarding characteristic features of both the parents and their offspring. Information on this subject is currently sparse. The aim of the present study is to investigate clinical and sociodemographic variables in offspring in the age range of 0-3 years of mothers diagnosed with SSD. METHODS: The study is descriptive with a cross-sectional design and includes parent-child dyads consisting of mothers diagnosed with SSD (ICD-10: F20-29) and their offspring aged 0-3 years, who were referred for examination and intervention at the infant and toddler psychiatric units, at the Mental Health Services, Capital Region, Copenhagen University Hospitals in two locations (Bispebjerg and Glostrup). Clinical and sociodemographic data were extracted from the Copenhagen "Infant Psychiatric Database" and processed by descriptive analysis. RESULTS: Out of 95 parent-child dyads considered for the study population, 85 were included. 27.8% of the mothers had psychiatric comorbidities, and 18.9% of the fathers had a psychiatric diagnosis at the time of investigation. Of the children, 89.7% were born full term (≥37th week) and most of them had a birth weight of ≥2500 g (81.8%). Of the mothers, 50% had experienced pregnancy complications of varying severity. Birth complications were seen in 62.9% of the dyads. Psychopathology was identified in 50% of the children at age 0-3 years, and 62.2% of the parent-child dyads appeared to have an affected relationship. CONCLUSION: Results show widespread psychopathology in offspring aged 0-3 years of mothers with SSD. Moreover, several psychosocial stressors, clinical parental features, and relational disturbances are identified. These results contribute to a better understanding and identification of early risk markers of long-term psychopathology in this infant patient group, and hence serve as potential targets for early interventions.
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Filho de Pais com Deficiência , Transtornos Mentais , Esquizofrenia , Feminino , Lactente , Gravidez , Humanos , Recém-Nascido , Pré-Escolar , Esquizofrenia/epidemiologia , Estudos Transversais , Mães/psicologia , Transtornos Mentais/epidemiologia , Psicopatologia , Pais/psicologia , Filho de Pais com Deficiência/psicologiaRESUMO
Atypical neurocognitive functioning has been found in adult patients with obsessive-compulsive disorder (OCD). However, little work has been done in children and adolescents with OCD. In this study, we investigated neurocognitive functioning in a large and representative sample of newly diagnosed children and adolescents with OCD compared to non-psychiatric controls. Children and adolescents with OCD (n = 119) and non-psychiatric controls (n = 90) underwent psychopathological assessment, intelligence testing, and a neurocognitive test battery spanning cognitive flexibility, planning and decision-making, working memory, fluency, and processing speed. The MANOVA main effect revealed that children and adolescents with OCD performed significantly worse than the control group (p < .001, [Formula: see text] = 0.256). Atypical patient performance was particularly found for indices of cognitive flexibility, decision-making, working memory, and processing speed. We found no evidence of differences in planning or fluency. Moreover, we found no significant associations between neurocognitive performance and OCD symptom severity or comorbidity status. Our results indicate that children and adolescents with OCD show selective atypical neurocognitive functioning. These difficulties do not appear to drive their OCD symptoms. However, they may contribute to lifespan difficulties and interfere with treatment efficacy, an objective of our research currently.
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The transgenerational effects of parental diagnoses, trauma and coping mechanisms on children's internalizing symptoms are not well understood. In a population-based study of 933 families combining data from a web-based survey and the Danish registers, we used an online survey of parents to examine how parental diagnoses, trauma and coping mechanisms affect the development of internalizing symptoms in children aged 6 to 18 years. To account for attrition, we used inverse probability weights in our regression models. Children of parents diagnosed with depression or anxiety displayed more internalizing symptoms than children of controls. Similarly, children of parents who experienced multiple trauma had significantly more internalizing symptoms. In contrast, we observed significantly fewer internalizing symptoms among children of parents who felt they could cope well. The protective effect of parental coping persisted even after adjusting for parental diagnoses or trauma. Interventions boosting parental coping mechanisms might help to prevent the development of internalizing symptoms in children even among patients who have been diagnosed with depression or anxiety or experienced a high trauma load.
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BACKGROUND: Physiological signals such as heart rate and electrodermal activity can provide insight into an individual's mental state, which are invaluable information for mental health care. Using recordings of physiological signals from wearable devices in the wild can facilitate objective monitoring of symptom severity and evaluation of treatment progress. OBJECTIVE: We designed a study to evaluate the feasibility of predicting obsessive-compulsive disorder (OCD) events from physiological signals recorded using wrist-worn devices in the wild. Here, we present an analysis plan for the study to document our a priori hypotheses and increase the robustness of the findings of our planned study. METHODS: In total, 18 children and adolescents aged between 8 and 16 years were included in this study. Nine outpatients with an OCD diagnosis were recruited from a child and adolescent mental health center. Nine youths without a psychiatric diagnosis were recruited from the catchment area. Patients completed a clinical interview to assess OCD severity, types of OCD, and number of OCD symptoms in the clinic. Participants wore a biosensor on their wrist for up to 8 weeks in their everyday lives. Patients were asked to press an event tag button on the biosensor when they were stressed by OCD symptoms. Participants without a psychiatric diagnosis were asked to press this button whenever they felt really scared. Before and after the 8-week observation period, participants wore the biosensor under controlled conditions of rest and stress in the clinic. Features are extracted from 4 different physiological signals within sliding windows to predict the distress event logged by participants during data collection. We will test the prediction models within participants across time and multiple participants. Model selection and estimation using 2-layer cross-validation are outlined for both scenarios. RESULTS: Participants were included between December 2021 and December 2022. Participants included 10 female and 8 male participants with an even sex distribution between groups. Patients were aged between 10 and 16 years, and adolescents without a psychiatric diagnosis were between the ages of 8 and 16 years. Most patients had moderate to moderate to severe OCD, except for 1 patient with mild OCD. CONCLUSIONS: The strength of the planned study is the investigation of predictions of OCD events in the wild. Major challenges of the study are the inherent noise of in-the-wild data and the lack of contextual knowledge associated with the recorded signals. This preregistered analysis plan discusses in detail how we plan to address these challenges and may help reduce interpretation bias of the upcoming results. If the obtained results from this study are promising, we will be closer to automated detection of OCD events outside of clinical experiments. This is an important tool for the assessment and treatment of OCD in youth. TRIAL REGISTRATION: ClinicalTrials.gov NCT05064527; https://clinicaltrials.gov/study/NCT05064527. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/48571.
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Introduction: Obsessive-compulsive disorders (OCD) are marked by distress, negative emotions, mental processes and behaviors that are reflected in physiological signals such as heart rate, electrodermal activity, and skin temperature. Continuous monitoring of physiological signals associated with OCD symptoms may make measures of OCD more objective and facilitate close monitoring of prodromal symptoms, treatment progress and risk of relapse. Thus, we explored the feasibility of capturing OCD events in the real world using an unobtrusive wrist worn biosensor and machine learning models. Methods: Nine adolescents (ages 10-17 years) with mild to moderate-severe OCD were recruited from child and adolescent mental health services. Participants were asked to wear the biosensor in the lab during conditions of rest and exposure to OCD symptom-triggering stimuli and for up to 8 weeks in their everyday lives and register OCD events. We explored the relationships among physiological data, registered OCD events, age, OCD symptom severity and symptom types. In the machine learning models, we considered detection of OCD events as a binary classification problem. A nested cross-validation strategy with either random 10-folds, leave-one-subject-out, or leave-week(s)-out in both layers was used. We compared the performance of four models: logistic regression, random forest (RF), feedforward neural networks, and mixed-effect random forest (MERF). To explore the ability of the models to detect OCD events in new patients, we assessed the performance of participant-based generalized models. To explore the ability of models to detect OCD events in future, unseen data from the same patients, we compared the performance of temporal generalized models trained on multiple patients with personalized models trained on single patients. Results: Eight of the nine participants collected biosensor signals totaling 2, 405 h and registered 1, 639 OCD events. Better performance was obtained when generalizing across time compared to across patients. Generalized temporal models trained on multiple patients were found to perform better than personalized models trained on single patients. RF and MERF models outperformed the other models in terms of accuracy in all cross-validation strategies, reaching 70% accuracy in random and participant cross-validation. Conclusion: Our pilot results suggest that it is possible to detect OCD episodes in the everyday lives of adolescents using physiological signals captured with a wearable biosensor. Large scale studies are needed to train and test models capable of detecting and predicting episodes. Clinical trial registration: ClinicalTrials.gov: NCT05064527, registered October 1, 2021.
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BACKGROUND: Obsessive compulsive disorder (OCD) in youth is characterized by behaviors, emotions, physiological reactions, and family interaction patterns. An essential component of therapy involves increasing awareness of the links among thoughts, emotions, behaviors, bodily sensations, and family interactions. An automatic assessment tool using physiological signals from a wearable biosensor may enable continuous symptom monitoring inside and outside of the clinic and support cognitive behavioral therapy for OCD. OBJECTIVE: The primary aim of this study is to evaluate the feasibility and acceptability of using a wearable biosensor to monitor OCD symptoms. The secondary aim is to explore the feasibility of developing clinical and research tools that can detect and predict OCD-relevant internal states and interpersonal processes with the use of speech and behavioral signals. METHODS: Eligibility criteria for the study include children and adolescents between 8 and 17 years of age diagnosed with OCD, controls with no psychiatric diagnoses, and one parent of the participating youths. Youths and parents wear biosensors on their wrists that measure pulse, electrodermal activity, skin temperature, and acceleration. Patients and their parents mark OCD episodes, while control youths and their parents mark youth fear episodes. Continuous, in-the-wild data collection will last for 8 weeks. Controlled experiments designed to link physiological, speech, behavioral, and biochemical signals to mental states are performed at baseline and after 8 weeks. Interpersonal interactions in the experiments are filmed and coded for behavior. The films are also processed with computer vision and for speech signals. Participants complete clinical interviews and questionnaires at baseline, and at weeks 4, 7, and 8. Feasibility criteria were set for recruitment, retention, biosensor functionality and acceptability, adherence to wearing the biosensor, and safety related to the biosensor. As a first step in learning the associations between signals and OCD-related parameters, we will use paired t tests and mixed effects models with repeated measures to assess associations between oxytocin, individual biosignal features, and outcomes such as stress-rest and case-control comparisons. RESULTS: The first participant was enrolled on December 3, 2021, and recruitment closed on December 31, 2022. Nine patient dyads and nine control dyads were recruited. Sixteen participating dyads completed follow-up assessments. CONCLUSIONS: The results of this study will provide preliminary evidence for the extent to which a wearable biosensor that collects physiological signals can be used to monitor OCD severity and events in youths. If we find the study to be feasible, further studies will be conducted to integrate biosensor signals output into machine learning algorithms that can provide patients, parents, and therapists with actionable insights into OCD symptoms and treatment progress. Future definitive studies will be tasked with testing the accuracy of machine learning models to detect and predict OCD episodes and classify clinical severity. TRIAL REGISTRATION: ClinicalTrials.gov NCT05064527; https://clinicaltrials.gov/ct2/show/NCT05064527. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/45123.
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Background: Knowledge on adverse events in psychotherapy for youth with OCD is sparse. No official guidelines exist for defining or monitoring adverse events in psychotherapy. Recent recommendations call for more qualitative and quantitative assessment of adverse events in psychotherapy trials. This mixed methods study aims to expand knowledge on adverse events in psychotherapy for youth with OCD. Methods: This is an analysis plan for a convergent mixed methods study within a randomized clinical trial (the TECTO trial). We include at least 128 youth aged 8-17 years with obsessive-compulsive disorder (OCD). Participants are randomized to either family-based cognitive behavioral therapy (FCBT) or family-based psychoeducation and relaxation training (FPRT). Adverse events are monitored quantitatively with the Negative Effects Questionnaire. Furthermore, we assess psychiatric symptoms, global functioning, quality of life, and family factors to investigate predictors for adverse events. We conduct semi-structured qualitative interviews with all youths and their parents on their experience of adverse events in FCBT or FPRT. For the mixed methods analysis, we will merge 1) a qualitative content analysis with descriptive statistics comparing the types, frequencies, and severity of adverse events; 2) a qualitative content analysis of the perceived causes for adverse events with prediction models for adverse events; and 3) a thematic analysis of the participants' treatment evaluation with a correlational analysis of adverse events and OCD severity. Discussion: The in-depth mixed methods analysis can inform 1) safer and more effective psychotherapy for OCD; 2) instruments and guidelines for monitoring adverse events; and 3) patient information on potential adverse events. The main limitation is risk of missing data. Trial registration: ClinicalTrials.gov identifier: NCT03595098. Registered on July 23, 2018.
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Mind My Mind (MMM) cognitive behavioral therapy (CBT) manualized treatment is effective in the management of common emotional and behavioral mental health problems in youth, yet not all individuals respond satisfactorily to treatment. This study explored potential effect modifiers, i.e., baseline factors associated with a differential treatment effect. We conducted secondary effect modifier analyses with MMM trial data, which involved randomization of 396 youths aged 6-16 years to either MMM CBT treatment (9-13 sessions) or management as usual in local community settings. We examined sociodemographic- (sex, age, family composition, ethnicity, parental education, and income) and clinical variables (mental disorders and duration of mental health problems) as potential effect modifiers of the a) change in parent-rated impact of mental health problems measured by the Strengths and Difficulties Questionnaire (SDQ) or b) response (reduction of ≥1 on SDQ-impact). In intention-to-treat analyses, superior treatment (net) benefits from the MMM intervention were found among youths who met criteria for any mental disorder at baseline (-1.25 [95%CI: -1.67;-0.82]) compared to youths that did not meet diagnostic criteria (-0.22 [95%CI:-1.09;0.65]). Comorbidity vs no comorbidity (-1.84 [95%CI:-2.58;-1.10] vs -0.72 [95%CI:-1.15;-0.29]) and longer duration of untreated mental health problems, i.e., more vs less than 6 months (-1.16 [95%CI:-1.55;-0.78] vs 0.43 [95%CI:-1.01;1.86]) were also associated with superior treatment benefits. The sociodemographic factors were not associated with differential treatment effects in the intention-to-treat analyses. These findings suggest that community-based programs like the MMM are well-suited for youths with substantial mental health problems. Clinical Trials Identifier: NCT03535805.
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Terapia Cognitivo-Comportamental , Transtornos Mentais , Adolescente , Humanos , Cognição , Emoções , Transtornos Mentais/diagnóstico , Transtornos Mentais/terapia , Saúde Mental , Resultado do TratamentoRESUMO
INTRODUCTION: Emotional dysregulation (ED) is a transdiagnostic phenomenon that has received increased attention, because of its potential ability to explain the development and maintenance of various psychiatric disorders. The identification of ED may serve as a potential target for both preventive and treatment interventions, however, the frequency of transdiagnostic ED among children and adolescents has not previously been evaluated. Our aim was to evaluate the frequency and types of ED in accepted and rejected referrals to the Child and Adolescent Mental Health Center (CAMHC), Mental Health Services, Copenhagen, Denmark, regardless of psychiatric status and across diagnoses. We aimed to evaluate how often ED would be a leading cause in seeking professional help, and whether children with ED not directly reflecting symptoms of known psychopathology would have higher rejection rates than children with more distinct symptoms of psychopathology. Finally, we assessed associations between sex and age with various types of ED. METHODS: We examined ED in a retrospective chart review of referrals of children and adolescents aged 3-17 years to the CAMHC between August 1st, 2020, and August 1st, 2021. We ranked problems described in the referral as primary, secondary, and tertiary depending on severity. Further, we examined group differences in the frequency of ED in accepted versus rejected referrals, as well as group differences in types of ED in age and sex distributions, and diagnoses occurring with specific types of ED. RESULTS: ED was present in 62.3% of the 999 referrals and was assessed as the primary issue in twice as many rejected referrals (11.4%) compared to accepted referrals (5.7%). Boys were significantly more often described with externalizing and internalizing behavior (55.5% vs. 31.6%; 35.1% vs. 26.5%) as well as incongruent affect (10.0% vs. 4.7%), whereas girls were more often described with depressed mood (47.5% vs. 38.0%) and self-harm (23.8% vs. 9.4%). The frequency of different types of ED varied with age. CONCLUSION: The present study is the first to evaluate the frequency of ED in children and adolescents referred to mental health services. The study offers insights into the high frequency of ED and the associations between ED and subsequent diagnoses, which may prove to be a method of early identification of risk of psychopathology. Our findings suggest that ED may rightly be considered a transdiagnostic factor, independent of specific psychiatric disorders, and that an ED-centered as opposed to diagnosis-specific approach to assessment, prevention, and treatment could target transversal symptoms of psychopathology in a more holistic manner.
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Transtornos Mentais , Serviços de Saúde Mental , Masculino , Feminino , Humanos , Adolescente , Criança , Estudos Retrospectivos , Transtornos Mentais/diagnóstico , PsicopatologiaRESUMO
BACKGROUND: A growing body of evidence suggests that pediatric bipolar disorder (PBD) frequently co-occurs with comorbid psychiatric disorders that may impact functioning. OBJECTIVE: To review existing literature on the prevalence of psychiatric comorbidity and general functioning in patients with a primary diagnosis of PBD. METHODS: We performed a systematic literature search on the PubMed, Embase and PsycInfo databases on November 16th, 2022. We included original papers on patients ≤18 years with primary PBD and any comorbid psychiatric disorder, diagnosed according to a validated diagnostic tool. Risk of bias of the individual studies was assessed using the STROBE checklist. We calculated weighted means to assess the comorbidity prevalence. The review complied with PRISMA statement guidelines. RESULTS: Twenty studies with a total study population of 2722 patients with PBD were included (mean age = 12.2 years). We found an overall high prevalence of comorbidity in patients with PBD. The most common comorbidities were attention-deficit-hyperactivity disorder (ADHD) (60%) and oppositional defiant disorder (ODD) (47%). Anxiety disorders, obsessive-compulsive disorder, conduct disorder, tic disorders and substance-related disorders affected between 13.2% and 29% of patients, while one in 10 had comorbid mental retardation or autism spectrum disorder (ASD). The prevalence of comorbid disorders was lower in studies that assessed the current prevalence in patients in full or partial remission. General functioning was overall not specifically decreased in patients with comorbidity. CONCLUSIONS: Comorbidity across a broad range of disorders was high in children diagnosed with PBD, especially regarding ADHD, ASD, behavioral and anxiety disorders including OCD. Future original studies should assess current prevalence of comorbidities in patients with PBD who are in remission to obtain more reliable estimates of psychiatric comorbidity in this patient group. The review highlights the clinical and scientific importance of comorbidity in PBD.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Transtorno do Espectro Autista , Transtorno Bipolar , Transtorno Obsessivo-Compulsivo , Humanos , Criança , Transtorno Bipolar/epidemiologia , Transtorno Bipolar/diagnóstico , Transtorno do Espectro Autista/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Transtorno Obsessivo-Compulsivo/epidemiologia , ComorbidadeRESUMO
We aimed to identify promising novel medications for child and adolescent mental health problems. We systematically searched https://clinicaltrials.gov/ and https://www.clinicaltrialsregister.eu/ (from 01/01/2010-08/23/2022) for phase 2 or 3 randomized controlled trials (RCTs) of medications without regulatory approval in the US, Europe or Asia, including also RCTs of dietary interventions/probiotics. Additionally, we searched phase 4 RCTs of agents targeting unlicensed indications for children/adolescents with mental health disorders. We retrieved 234 ongoing or completed RCTs, including 26 (11%) with positive findings on ≥ 1 primary outcome, 43 (18%) with negative/unavailable results on every primary outcome, and 165 (70%) without publicly available statistical results. The only two compounds with evidence of significant effects that were replicated in ≥ 1 additional RCT without any negative RCTs were dasotraline for attention-deficit/hyperactivity disorder, and carbetocin for hyperphagia in Prader-Willi syndrome. Among other strategies, targeting specific symptom dimensions in samples stratified based on clinical characteristics or established biomarkers may increase chances of success in future development programmes.