Intranasal esketamine as therapeutic option: a case report of an adolescent with treatment resistant depression.

Depression is among the most common mental health disorders worldwide and treatment resistant depression (TRD) represents a major challenge for both patients and clinicians. In recent years ketamine has received attention as an antidepressant agent, demonstrating promising results in TRD in adults. To date, few attempts have been made in treating adolescent TRD with ketamine and none have used intranasal application. This paper discusses a case of a 17-year-old female adolescent suffering from TRD who underwent treatment with intranasal esketamine application (Spravato 28 mg). As symptoms showed clinically insignificant improvement despite modest gains in objective assessments (GAF, CGI, MADRS), treatment was prematurely discontinued. However, the treatment was tolerable and side effects were scarce and mild. Although this case report does not demonstrate clinical effectiveness, ketamine may nonetheless be a promising substance in treating TRD in other adolescents. Questions regarding the safety of ketamine use in the rapidly developing brains of adolescents still remain unanswered. To further explore the potential benefits of this treatment method a short term RCTs for adolescents with TRD is recommended.

Conspiracy beliefs and COVID-19 guideline adherence in adolescent psychiatric outpatients: the predictive role of adverse childhood experiences.

BACKGROUND: Conspiracy beliefs have become widespread throughout the COVID-19 pandemic. Previous studies have shown that endorsing conspiracy beliefs leads to lower protective guideline adherence (i.e., wearing face masks), posing a threat to public health measures. The current study expands this research across the lifespan, i.e., in a sample of adolescents with mental health problems. Here, we investigated the association between conspiracy beliefs and guideline adherence while also exploring the predictors of conspiracy beliefs. METHODS: N = 93 adolescent psychiatric outpatients (57% female, mean age: 15.8) were assessed using anonymous paper-pencil questionnaires. Endorsement of generic and COVID-19 conspiracy beliefs was assessed, in addition to items measuring adherence to protective guidelines and mental health (stress, depressive symptoms, emotional/behavioral problems, and adverse childhood experiences). Multiple regressions and supervised machine learning (conditional random forests) were used for analyses. RESULTS: Fourteen percent of our sample fully endorsed at least one COVID-19 conspiracy theory, while protective guidelines adherence was relatively high (M = 4.92, on a scale from 1 to 7). The endorsement of COVID-19 conspiracy beliefs-but not of generic conspiracy beliefs-was associated with lower guideline adherence (ß = - 0.32, 95% CI - 0.53 to - 0.11, p < .001). Conditional random forests suggested that adverse childhood experiences and peer and conduct problems were relevant predictors of both conspiracy belief categories. CONCLUSION: While a significant proportion of our sample of adolescents in psychiatric treatment endorsed conspiracy beliefs, the majority did not. Furthermore, and to some degree, contrary to public perception, we found that adolescents show relatively good adherence to public health measures-even while experiencing a high degree of mental distress. The predictive value of adverse childhood experiences and peer/conduct problems for conspiracy beliefs might be explained by compensatory mechanisms to ensure the safety, structure, and inclusion that conspiracies provide.

The nature and nurture of resilience-reactions of trizygotic triplet minors to their father's death.

BACKGROUND: Parental bereavement during childhood is associated with an elevated risk for the development of psychiatric problems. This paper seeks to provide insight into the adjustment process of trizygotic triplets dealing with their father's death, thus, trying to give an impression of the individual nature of grief and resilience. METHODS: We examined 11-year-old trizygotic triplets (2 boys and 1 girl) concerning behavioral problems (CBCL/6-18R, YSR/11-18R), posttraumatic stress disorder (UCLA PTSD Index for DSM­5, UPID), depression ("Depressionsinventar für Kinder und Jugendliche," DIKJ), and fear ("Phobiefragebogen für Kinder und Jugendliche," PHOKI) shortly after their father's death and 6 months later. The girl was developmentally delayed and had moderate intellectual disability, while her brothers' development was age-appropriate. RESULTS: The triplets showed very different adjustment to the traumatic event. While the boys showed less psychopathological response to their loss shortly after their father's death and adjusted physiologically during the following 6 months, their sister scored high in almost all dimensions and still presented with notable psychopathological symptoms at the 6­month follow-up. CONCLUSION: Outcomes differ distinctly despite objectively equal risk and protective factors. While it is known that above average intellectual abilities represent a protective factor for posttraumatic stress, these results show that intellectual retardation might be a prominent yet understudied risk factor in dealing with postbereavement psychopathology in children.

[Cannabis use in adolescents : Narrative Review and Position paper of the "Addiction Disorders in Adolescents" task force of the Austrian Society for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy (ÖGKJP)]. / Cannabisgebrauch bei Jugendlichen : Übersicht und Positionspapier der Arbeitsgruppe "Suchtstörungen im Jugendalter" der Österreichischen Gesellschaft für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie (ÖGKJP).

BACKGROUND: Cannabis is the illegal drug most frequently used by Minors in Austria. Due to the gradual decriminalization and legalization that has taken place in many European countries in recent years, the ÖGKJP would like to take a balanced and scientifically based stand on the complex issue of cannabis use and abuse among young people. METHODS: The authors searched the medline for current studies using searches tailored to each specific subtopic. Furthermore, recognized compendiums were quoted. RESULTS: While occasional recreational use of cannabis in adults with completed brain maturation and no risk profile for mental disorders is likely to be relatively harmless, early initiation of use with regular use and the increasingly available, highly potent cannabis varieties can lead to explicit and sometimes irreversible neurocognitive brain dysfunction. CONCLUSION: Legalisation of cannabis consumption for minors needs to be objected to due to the risks of the expected damage in the area of brain development. At the same time, however, it is important to establish sensible legal regulations in order to be able to adequately counteract the fact that over 30% of all European young people occasionally consume cannabis. We are also clearly recommending to not criminalize cannabis users and provide necessary support to vulnerable and addicted cannabis users.

Sodium oxybate for the maintenance of abstinence in alcohol-dependent patients: An international, multicenter, randomized, double-blind, placebo-controlled trial.

BACKGROUND: Sodium oxybate (SMO) has been shown to be effective in the maintenance of abstinence (MoA) in alcohol-dependent patients in a series of small randomized controlled trials (RCTs). These results needed to be confirmed by a large trial investigating the treatment effect and its sustainability after medication discontinuation. AIMS: To confirm the SMO effect on (sustained) MoA in detoxified alcohol-dependent patients. METHODS: Large double-blind, randomized, placebo-controlled trial in detoxified adult alcohol-dependent outpatients (80% men) from 11 sites in four European countries. Patients were randomized to 6 months SMO (3.3-3.9 g/day) or placebo followed by a 6-month medication-free period. Primary outcome was the cumulative abstinence duration (CAD) during the 6-month treatment period defined as the number of days with no alcohol use. Secondary outcomes included CAD during the 12-month study period. RESULTS: Of the 314 alcohol-dependent patients randomized, 154 received SMO and 160 received placebo. Based on the pre-specified fixed-effect two-way analysis of variance including the treatment-by-site interaction, SMO showed efficacy in CAD during the 6-month treatment period: mean difference +43.1 days, 95% confidence interval (17.6-68.5; p = 0.001). Since significant heterogeneity of effect across sites and unequal sample sizes among sites (n = 3-66) were identified, a site-level random meta-analysis was performed with results supporting the pre-specified analysis: mean difference +32.4 days, p = 0.014. The SMO effect was sustained during the medication-free follow-up period. SMO was well-tolerated. CONCLUSIONS: Results of this large RCT in alcohol-dependent patients demonstrated a significant and clinically relevant sustained effect of SMO on CAD. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04648423.

Short-Term Outcome of Inpatient Treatment for Adolescents with Anorexia Nervosa Using DSM-5 Remission Criteria.

This study evaluated the short-term outcome of a multimodal inpatient treatment concept for adolescents with anorexia nervosa (AN). In this prospective observational study, a cohort of 126 female adolescents with AN (age range: 11-17, mean age: 14.83) was longitudinally followed from admission to discharge (average duration of stay: 77 days). We used gold-standard clinical interviews and self-report data, as well as DSM-5 remission criteria, to evaluate the treatment outcome. From admission to discharge, body-mass-index (BMI) significantly improved by 2.6 kg/m2. Data from clinical interviews and self-reports yielded similar improvements in restraint eating and eating concerns (large effects). Lower effects were observed for variables assessing weight/shape concerns and drive for thinness. At discharge, 23.2% of patients showed full remission of AN, 31.3% partial remission, and 45.5% no remission according to DSM-5 criteria. Differences in remission groups were found regarding AN severity, age at admission, and use of antidepressant medication. Living with both parents, longer duration of inpatient treatment and the use of antipsychotic medication were significantly associated with higher BMI change. The findings provide evidence for the short-term effectiveness of our inpatient treatment concept. We recommend using DSM-5 based remission criteria to evaluate the treatment outcome to improve the comparability of studies.

[Youth and Alcohol : A survey with a view to the situation in Austria]. / Jugend und Alkohol : Eine Bestandsaufnahme mit Blick auf die Situation in Österreich.

The present paper deals with the role of alcohol in our society and its importance for young people. Specifics of the interaction of alcohol and the adolescent brain are illustrated and the epidemiological development of alcohol consumption in Austrian minors is being described. Significant risks for problematic consumption patterns and possible ways of prevention are also discussed.

Research in minors with a recent history of trauma-A bold venture?

Little research has been performed so far on the mental health state of grieving and recently traumatized children. "The Buoy" ("Die Boje"), a low threshold ambulatory provides non-bureaucratic help and short time psychotherapy to children and adolescents in need of professional support at no charge and treats about 1400 minors per year. Whilst performing a study on these patients with special regard to their social network, we found the process of recruitment to be extraordinarily challenging. Only about 25% of the eligible patients could be recruited successfully within during the period of one year. In this paper we try to examine the barriers we had to overcome in gaining access to the sensitive field of grieving and traumatized children and adolescents who rely on low threshold psychotherapeutic and neuropsychiatric support and analyze the factors leading to the high number of dropouts. In addition, the consequences for our results will be discussed.

Psychopathology and Quality of Life in Traumatized or Victimized Underage Individuals as Factors for Forensic Multilevel Assessment-A Pilot Investigation.

Background: Psychological sequels to criminal violence can be long lasting and severe. They are in many countries not sufficiently considered in court cases as an important circumstance that could be used to assess the severity of the crime, also guiding redress, compensation, and rehabilitation of the victim, and-in children-child custody considerations. So far, the focus of forensic assessment has often been limited to diagnostic categories, especially "posttraumatic stress disorder" (PTSD), a diagnosis that presently is subjected to rapidly changing definitions both in and between diagnostic systems. Other indicators such as quality of life (QoL) might be of equal importance as compared to clinical or research diagnostic categories to understand and evaluate the impact of a crime and the amount of help needed and, in the legal context, redress to be asked. Symptoms might differ depending on the crime encountered. Objective and Methods: QoL and general symptom patterns including a PTSD diagnosis were assessed in a group of 10- to 17-year-old minors with (n = 33) and without (n = 49) PTSD diagnosis who all had experienced sexual abuse, physical abuse, death of a parent, or their parents' divorce, using standardized diagnostic instruments. Results: PTSD patients reported a significantly lower QoL than non-PTSD controls. Reported symptom patterns with potential impact on life, such as intrusive thoughts, differed between the victims of different crime types, with the highest rates of both intrusive symptoms and combined symptom profile in victims of sexual abuse. Data indicate that the changes between older and present criteria and between DSM and recently published ICD 11 might help identify different groups and symptom profiles. Conclusion: Specific trauma-related symptom profiles integrating the type of crime encountered and its individual impact on QoL may help improve future forensic assessment and guide compensation and rehabilitation plans. Carefully designed studies are now needed to further explore the use and forensic usability of complex indicators and the impact of violence in different forensic settings.

No evidence of subgroups found in amphetamine consumers in Iran.

Amphetamine type substances are the second most commonly consumed illicit drug type and their use is an important contributor to the global burden of disease. This investigation set out to determine whether, similar to alcohol or nicotine addiction, subgroups of consumers can also be found in amphetamine addicts. 204 consumers of methamphetamine only (n = 50) or both methamphetamine and heroin (n = 154) have been investigated in Mashhad, Iran by means of "Lesch Alcoholism Typology". No significant differences in consumption pattern or age of onset have been found between the different types. Many subjects, however, reported symptoms of anxiety (n=78) or depression (n = 129) prior to drug use. These findings highlight the need for high quality epidemiological studies further addressing this issue.

[Transitional and Adolescent Psychiatry in Austria: A Pilot Study on the Attitudes of Experts]. / Transitions- und Adoleszenzpsychiatrie in Österreich: Eine Pilotuntersuchung zur Sicht von Expert(innen).

Transitional and Adolescent Psychiatry in Austria: A Pilot Study on the Attitudes of Experts Abstract. OBJECTIVE: This pilot study establishes baseline data on the current situation of transitional processes in Austrian psychiatry. We sought to gather information on the specific problems and needs occurring during the transition of mentally ill adolescents from child and adolescent to adult psychiatry. METHOD: Professionals (psychiatrists, psychologists, psychotherapists) working in child and adolescent psychiatry and adult psychiatry (N = 86) were assessed by means of an online survey concerning their experience with the transition of young adults. RESULTS: Almost all of the subjects queried (98.8 %) considered the current system inappropriate, and the majority (70.9 %) thought that patients would not tolerate transition from youth to adult psychiatric institutions very well. Only 16.3 % reported having a structured transition protocol at their workplace. Further 83.7 % expressed the need to improve collaboration between adolescent and adult psychiatry. CONCLUSIONS: This sample of Austrian healthcare professionals describes large deficits regarding transitional issues in psychiatry. There is an urgent need to establish structured protocols for transition, especially since experiences occurring during this vulnerable period are crucial to the mental health of young people later in life.

Attention deficit hyperactivity disorder and substance abuse: An investigation in young Austrian males.

BACKGROUND: Many studies have found an association between Substance Use Disorders (SUDs) and Attention Deficit Hyperactivity Disorder (ADHD) in children, adolescents and adults. We intended to determine whether substance abuse and SUDs are associated with former and current ADHD symptomatology in a non-clinical sample of 17 and 18 year old males. METHOD: A representative sample of 3280 young men (6.8% of all males born in Austria in the respective year) was investigated during the examination for military service. We collected data on past (WURS) and current (ADHD symptom checklist) ADHD symptomatology, substance abuse, parental substance use and abuse and motives for substance use. RESULTS: Measured by WURS, 10.1% had scored positive for past ADHD symptoms. 2.7% of all subjects stated that they have been treated for ADHD and 1.5% reported that they had at one point received pharmacological treatment for the condition. Abuse of alcohol, nicotine and illicit substances was significantly (p<.01) more frequent in subjects with ADHD syndrome. Perceived parental alcohol abuse increased the risk for ADHD in the offspring. Motives for substance use differed greatly between groups. LIMITATIONS: The sample consists of men only. Subjects had to be fit enough to be enlisted military service, generating a possible bias towards healthier subjects. The cross-sectional design does not allow conclusions about the temporal relationships between ADHD symptoms and substance abuse. CONCLUSION: Identification of vulnerability factors for comorbid ADHD and SUD in adolescence should be intensified. Preventive strategies ought to be established.

[The diagnostic relevance of CBCL and YSR in diagnosing PTSD in adolescence]. / Zur diagnostischen Relevanz von CBCL und YSR bei Diagnose einer PTBS im Jugendalter.

BACKGROUND: The present study sought to examine the symptomatology of children and adolescents with a history of trauma experience of using the German versions of Child Behavior Checklist (CBCL) and Youth Self Report (YSR). We pursue the question to what extent symptoms differ among adolescents with and without posttraumatic stress disorder (PTSD). A further objective is comparing self-assessment of the children and adolescents with the rating of their parents or caregivers. METHODS: Overall N = 41 patients, aged 11-18 years, and one caregiver of each patient were surveyed. All patients were referred to the forensic ambulance of the University Clinic of Child and Adolescent Psychiatry in consequence of acute burden or violent trauma. RESULTS: Concerning the two global Scales ("Internalizing" and "Externalizing" symptoms), adolescents with PTSD reported significantly more problems than adolescents without PTSD diagnosis. Further, results on Externalizing Scale showed a systematic higher problem estimation of children and adolescents when compared to their parents. CONCLUSIONS: The present findings reveal a divergence between child and parent ratings on clinically relevant behavioral problems. Symptoms experienced by the children and youth are often not being recognized by parents. Therefore, it is essential to include the perceptions of the parents at the beginning of diagnostic assessment and counteract possible parental misunderstanding.

The influence of reported ADHD and substance abuse on suicidal ideation in a non-clinical sample of young men.

This study intended to determine whether former and current ADHD symptomatology is associated with suicidal ideation in a non-clinical sample of 18 year old males. We performed a cross sectional descriptive study of 3280 men during the examination for military service. The investigation included a screening for substance abuse, past (WURS) and current (ADHD symptom checklist) ADHD symptomatology and an interview about suicidal ideations. We found a correlation of suicidal ideations with a history of ADHD symptomatology. ADHD symptoms were strongly consistent over time. These results indicate that a history of (diagnosed or undiagnosed) ADHD could be a predictor for suicidal ideations. Surveying a history of ADHD in primary care might help identify subjects at risk for suicidal tendencies.

Emotional expressiveness and avoidance in narratives of unaccompanied refugee minors.

OBJECTIVE: The aim of this study was to examine a cohort of unaccompanied refugee minors (URMs) by means of psycholinguistic methods in order to obtain a more subtle picture of their degree of traumatization. METHODS: Twenty-eight participants were included in the Stress-Inducing Speech Task (SIST) consisting of a free association (FA) and a stress (STR) condition. Narratives were examined by means of (1) quantitative parameters (word count); (2) psycholinguistic variables (temporal junctures, TJs), narrative structure, referential activity (RA)-a measure of emotional expressivity; and (3) content analysis ratings. RESULTS: Word count was significantly lower than in age-matched norms. In the FA condition, TJs were lower, but in the STR condition, rates were comparable. RA was significantly higher in both conditions. Content analysis ratings showed that the experiences described by these youths were potentially traumatic in nature. CONCLUSIONS: This pattern of narrative shows a mixture of fulfilling the task demand, while containing an emotionally charged narrative. Narrative structure was absent in the FA condition, but preserved in the STR condition, as URMs struggled with the description of non-normative events. This indicates that these youths have not yet emotionally dealt with and fully integrated their trauma experiences.

"The Buoy": Utilization of a low-threshold ambulatory setting for traumatized children and adolescents in Austria.

BACKGROUND: This investigation intended to assess the use of an outpatient clinic providing low-threshold, short-term trauma therapy for children and adolescents across the first 6 years of its existence. METHODS: A retrospective analysis of the records of all patients undergoing treatment in this institution between 2001 and 2007 (n = 2510) has been performed. We evaluated demographic data, reason for contacting the unit, the referring person or institution, the person or institution in charge of the care and custody of the child, the number of contacts with the clinic, presence of physical or psychiatric illness of a parent, and medications prescribed. RESULTS: Ages of patients ranged from 1 to 17. Gender distribution was even. Having experienced the death of a relative, experienced violence, or having witnessed traumatic death were the main reasons for presentation. The utilization rates of immigrants rose throughout the observation period. Children from foster care were seen less frequently than expected. Medication was hardly prescribed. CONCLUSIONS: Ample utilization of this institution clearly demonstrates the need for short-term acute outpatient trauma therapy for children and adolescents. Efforts to provide easily accessible institutions for youth who experience traumatic events should be stepped up.

Experiences of Domestic and School Violence Among Child and Adolescent Psychiatric Outpatients.

The experience of cumulative childhood adversities, such as exposure to domestic violence or abuse by caregivers, has been described as risk factor for poor mental health outcomes in adolescence and adulthood. We performed an investigation of experience of violence in all patients aged 6 to 20 years who had consulted the Department of Child and Adolescent Psychiatry, Medical University of Vienna, as outpatients during the period of one year. We were using the Childhood Trauma Interview (CTI) in order to obtain information on the kind of violence. Seventy-five percent of all patients had reported experiences of violence. These youth were significantly more often involved in acts of school violence, thus a significant correlation between experience of domestic violence and violence at school could be revealed. The results of our study emphasize the need for interventions preventing violence both in domestic and in school environments.

[Quality management in weight restitution in Anorexia nervosa--pathophysiology, evidence-based practice and prevention of the refeeding syndrome]. / Zur Qualitätssicherung der Gewichtsrestitution bei Magersucht--Pathophysiologie, evidenzbasierte Praxis und Vermeidung des Refeeding-Syndroms.

During refeeding syndrome-a well-known and dreaded complication of weight-restauration in anorexia nervosa-a shift of electrolytes and fluid can occur in malnourished patients and might therefore lead to-potentially fatal-cardiovascular, respiratory and neurological symptoms. Causes of this are metabolic and hormonal changes during re-establishment of a carbohydrate-rich diet. This syndrome is most commonly associated with hypophosphatemia, which can however be accompanied by other chemical laboratory abnormalities. Standardized guidelines for the prevention and management of the refeeding syndrome have not yet been established. In case and cohort studies different low- and high-calorie diet protocols led to comparable results with similar complication rates. A focus should be placed on prevention of serious complications by careful monitoring. The pathophysiology, the main constituents in the development of the refeeding syndrome, recommendations for risk assessment and treatment, and current evidence are discussed.

Beating the odds: an approach to the topic of resilience in children and adolescents.

The concept of good mental functioning despite negative influences first arose more than a hundred years ago and has received increasing interest during the last decades. For a long time, lack of unified definition of concept and terms rendered research difficult to compare. Nowadays, consent is reached on a definition of resilience as "an individual's ability to properly adapt to stress and adversity" and a large number of studies have been performed trying to identify factors that render children resilient. Among these, interpersonal factors like gender, intelligence, aspects of character and temperament as well as genes; factors within the family like a stable and positive relation to an adult; and factors of the broader environment like being integrated into the community have been those most articulately pointed out by research. Although, to date, research on resilience has been extensive, there is still a lack of robust, comparative, empirical studies allowing policy formulation for fostering resilience in children at risk.

Sodium oxybate in the treatment of alcohol withdrawal syndrome: a randomized double-blind comparative study versus oxazepam. The GATE 1 trial.

BACKGROUND: Benzodiazepines (BDZs) are the gold standard in the treatment of alcohol withdrawal syndrome (AWS). Sodium oxybate (SMO) has been tested as a treatment for AWS with encouraging results. The aim of this phase IV, multicenter, randomized, double-blind, double-dummy study was to evaluate the efficacy of SMO in comparison with oxazepam in the treatment of uncomplicated AWS. METHODS: Alcohol-dependent outpatients (n = 126) affected by uncomplicated AWS according to the Clinical Institute Withdrawal Assessment for Alcohol-revised (CIWA-Ar) scale were enrolled in the study and randomized in two groups: 61 patients received SMO and 65 patients received oxazepam for 10 days. The primary endpoint was the reduction of symptoms of AWS measured by the change in the total CIWA-Ar score from baseline (day 1) to the end of the study (day 10). This study is registered with ClinicalTrials.gov, number: NCT02090504 RESULTS: A significant decrease of the mean total CIWA-Ar score from baseline to the end of the study was found in both the SMO (p < 0.0001) and the oxazepam group (p < 0.0001), with no significant differences between the two treatments (p = 0.21). Treatment with SMO and oxazepam resulted in a marked decrease in the severity of the mean CIWA subscales, i.e. sweating, tremor, and anxiety, with no significant differences between the two treatments. Both drugs were well tolerated and no severe side effects were reported. CONCLUSION: SMO is as effective as oxazepam, one of the gold standard BDZs, in the treatment of uncomplicated AWS. Due to its tolerability and absence of significant side effects, SMO may be considered a valid alternative choice in the treatment of AWS.