Remote crisis intervention and suicide risk management in COVID-19 frontline healthcare workers.

Introduction: Despite the propagation of virtual mental health services for vulnerable groups during COVID-19 pandemic, the implementation and evaluation of remote evidence-based practices (EBP) to manage them in low- and middle-income countries remains scarce. In the current study, we describe and evaluate the implementation process and clinical impact of brief, remote, manualized EBP for crisis intervention and suicide risk management among healthcare workers attending patients with COVID-19 (COVID-19-HCWs) in Mexico. Methods: The implementation process comprised community engagement of volunteer mental health specialists, creation of new clinical teams with different disciplines and skills, intervention systematization through manuals and education through 4-h remote training as main strategies. Mexican COVID-19-HCWs who had used a free 24-h helpline rated their pre- and post-intervention emotional distress. Therapists recorded patients' pre-intervention diagnosis, severity, and suicide risk, the techniques used in each case, and their post-treatment perception of COVID-19-HCWs' improvement at the end of the intervention. Results: All techniques included in the intervention manual were employed at least in one case (n = 51). At the beginning of the intervention, 65.9% of the COVID-19-HCWs were considered moderately ill or worse according to Clinical Global Impression-Severity (CGI-S) scores, whereas at the end, 79.4% of them were perceived as much or very much improved according to CGI-Improvement scores (CGI-I), and their emotional distress had been significantly reduced (p < 0.001). Discussion: This prospective study provides evidence that implementation of remote EBP is feasible and useful to reduce emotional distress and suicide risk among COVID-19-HCWs from a middle-income country. However, this study was limited by lack of a control group, improvement ratings provided by therapists and non-anonymous satisfaction ratings.

ICD-11 Guidelines for Mental and Behavioral Disorders of Children and Adolescents: Reliability and Clinical Utility.

OBJECTIVE: ICD-11 clinical guidelines for mental and behavioral disorders must be tested in clinical settings to guarantee their usefulness worldwide. The purpose of this study was to evaluate interrater reliability and clinical utility of the ICD-11 guidelines for children and adolescents in assessing and diagnosing mood, anxiety, and fear-related disorders; attention-deficit hyperactivity disorder (ADHD); and disruptive behavioral disorder (DBD). METHODS: Children and adolescents ages 6-17 from two specialized settings in Mexico City were interviewed. Each was interviewed by a pair of psychiatrists (interviewer and observer), who independently codified established diagnoses and evaluated the clinical utility of the guidelines with each participant. Kappa values were calculated to determine the level of general diagnostic correlation between the two clinicians. RESULTS: A total of 25 psychiatrists evaluated 52 children and adolescents. Kappa values between clinicians ranged from 0.46 to 0.53 for mood, anxiety, and fear-related disorders and for ADHD; the kappa value was 0.81 for DBD guidelines. Over 80% of psychiatrists reported that the guidelines, qualifiers, and descriptions of developmental presentations were quite useful. CONCLUSIONS: ICD-11 guidelines for mental and behavioral disorders of children and adolescents demonstrated mostly moderate interrater reliability and strong interrater reliability in the case of DBD. A large proportion of clinicians regarded the guidelines as quite useful clinical tools.

The role of circadian rhythms in individuals with attention deficit hyperactivity disorder and obesity: A narrative review / El papel de los ritmos circadianos en personas con trastorno por déficit de atención con hiperactividad y obesidad: Una revisión narrativa

Abstract Background A relationship between attention deficit hyperactivity disorder (ADHD) and obesity has been consistently documented. Obesity and metabolic syndrome have been associated with misalignment between daily activities and circadian rhythm. ADHD patients have a high prevalence of delayed sleep phase syndrome, which is a circadian rhythm disorder. Understanding this relationship is important for the evaluation of obese population at risk. Objective The aim of this narrative review was to summarize the information updated until 2019 about the role of circadian rhythms in obese ADHD individuals. Method A search was performed in MEDLINE, EMBASE, and Google Scholar database. The terms ADHD, obesity, circadian rhythm, sleep disorders, adolescent, adult, Adolesc, circadian, attention deficit hyperactivity disorder, and child were combined with logical functions. Results A total of 132 articles were reviewed. Evidence showed that ADHD subjects have an increased risk to present obesity and circadian rhythms disorders. Some possible pathways for this relationship have been hypothesized including obesity as a risk factor, an underpinned common biological dysfunction, and behavioral and cognitive features of individuals with ADHD. As most of the articles are methodologically cross-sectional, it is not possible to establish causative associations. Discussion and conclusion This review points out the importance of early recognizing and treating circadian rhythms disorders and obesity in ADHD patients. Future studies must be carried out with a longitudinal design to establish the effect of each comorbidity in the treatment of individuals with ADHD.

Resumen Antecedentes La relación entre el trastorno por déficit de atención con hiperactividad (TDAH) y la obesidad se ha documentado consistentemente. Por otro lado, el síndrome metabólico y la obesidad se han asociado con un desfase del ritmo circadiano. En poblaciones clínicas con TDAH se han encontrado una alta prevalencia del trastorno de fase de sueño retrasada, el cual es un trastorno del ritmo circadiano. Entender la relación entre estos padecimientos es importante para evaluar la población en riesgo de obesidad. Objetivo Resumir la información actualizada hasta 2019 sobre el rol del ritmo circadiano en individuos obesos con TDAH. Método Se realizó una búsqueda de artículos en las bases de datos MEDLINE, EMBASE y Google Scholar. Los términos TDAH, obesidad, ritmos circadianos, trastornos del sueño, adolescentes, adultos y niños se combinaron con operadores lógicos. Resultados Se revisaron un total de 132 artículos. La evidencia demostró que los sujetos con TDAH tienen un alto riesgo de sufrir obesidad y ritmos circadianos alterados. Existen algunas hipótesis para establecer esta relación, incluyendo la obesidad como factor de riesgo para TDAH, la disfunción biológica común entre estos trastornos y las características conductuales y cognitivas de los individuos con TDAH. Sin embargo, como la mayoría de los artículos son transversales, no es posible establecer una asociación causal. Discusión y conclusión Esta revisión señala la importancia del reconocimiento temprano y tratamiento de los trastornos del ritmo circadiano y obesidad en pacientes con TDAH. Estudios futuros deben realizarse de manera longitudinal para establecer el efecto de estas comorbilidades en el tratamiento de los individuos con TDAH.

Mental Health Problems among COVID-19 Frontline Healthcare Workers and the Other Country-Level Epidemics: The Case of Mexico.

COVID-19 frontline healthcare workers (FHCW) are struggling to cope with challenges that threaten their wellbeing. We examine the frequency and predictors of the most frequent mental health problems (MHP) among FHCW during the first COVID-19 peak in Mexico, one of the most severely affected countries in terms of FHCW's COVID-19 mortality. A cross-sectional survey was conducted between May 8 and August 18, 2020. A total of 47.5% of the sample (n = 2218) were FHCW. The most frequent MHP were insomnia, depression, posttraumatic stress symptoms, and health anxiety/somatization (whole sample: 45.7, 37.4, 33.9, and 21.3%; FHCW: 52.4, 43.4, 40.3 and 26.1, respectively). As compared to during the initial COVID-19 phase, depression and health anxiety/somatization symptoms as well as experiences of grieving due to COVID-19, personal COVID-19 status, and having relatives and close friends with COVID-19 were more frequent during the COVID-19 peak. Obesity, domestic violence, personal COVID-19 status, and grieving because of COVID-19 were included in regression models for main FHCW's MHP during the COVID-19 peak. In conclusion, measures to decrease other country-level epidemics contributing to the likelihood of COVID-19 complications (obesity) and MHP (domestic violence) as well as FHCW´s probability of COVID-19 infection could safeguard not only their physical but also mental health.

Validity and reliability of the kiddie schedule for affective disorders and schizophrenia present and lifetime version DSM-5 (K-SADS-PL-5) Spanish version.

BACKGROUND: There are various language adaptations of the Schedule for Affective Disorders and Schizophrenia for School Age Children Present and Lifetime Version (K-SADS-PL). In order to comply with the changes in DSM classification, the Spanish edition of the interview was in need of update and evaluation. METHODS: K-SADS-PL was adapted to correspond to DSM-5 categories. All clinicians received training, and a 90% agreement was reached. Patients and their parents or guardians were interviewed and videotaped, and the videos were exchanged between raters. Factor analysis was performed and inter-rater reliability was calculated only in the case of diagnoses in which there were more than five patients. RESULTS: A total of 74 subjects were included. The Factor Analysis yielded six factors (Depressive, Stress Hyperarousal, Disruptive Behavioral, Irritable Explosive, Obsessive Repetitive and Encopresis), representing 72% of the variance. Kappa values for inter-rater agreement were larger than 0.7 for over half of the disorders. CONCLUSIONS: The factor structure of diagnoses, made with the instrument was found to correspond to the DSM-5 disorder organization. The instrument showed good construct validity and inter-rater reliability, which makes it a useful tool for clinical research studies in children and adolescents.

Construct validity and parent-child agreement of the six new or modified disorders included in the Spanish version of the Kiddie Schedule for Affective Disorders and Schizophrenia present and Lifetime Version DSM-5 (K-SADS-PL-5).

Changes to the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5) incorporate the inclusion or modification of six disorders: Autism Spectrum Disorder, Social Anxiety Disorder, Intermittent Explosive Disorder, Disruptive Mood Dysregulation Disorder, Avoidant/Restrictive Food Intake Disorder and Binge Eating Disorder. The objectives of this study were to assess the construct validity and parent-child agreement of these six disorders in the Spanish language Schedule for Affective Disorders and Schizophrenia for School Age Children Present and Lifetime Version (K-SADS-PL-5) in a clinical population of children and adolescents from Latin America. The Spanish version of the K-SADS-PL was modified to integrate changes made to the DSM-5. Clinicians received training in the K-SADS-PL-5 and 90% agreement between raters was obtained. A total of 80 patients were recruited in four different countries in Latin America. All items from each of the six disorders were included in a factor analysis. Parent-child agreement was calculated for every item of the six disorders, including the effect of sex and age. The factor analysis revealed 6 factors separately grouping the items defining each of the new or modified disorders, with Eigenvalues greater than 2. Very good parent-child agreements (r>0.8) were found for the large majority of the items (93%), even when considering the sex or age of the patient. This independent grouping of disorders suggests that the manner in which the disorders were included into the K-SADS-PL-5 reflects robustly the DSM-5 constructs and displayed a significant inter-informant reliability. These findings support the use of K-SADS-PL-5 as a clinical and research tool to evaluate these new or modified diagnoses.

Funcionamiento neuropsicológico de adolescentes con trastorno bipolar / Neuropsychological functioning of adolescents with bipolar disorder

Persistent neuropsychological deficits have been reported in adult bipolar affective disorder, and impairments in executive functions, attention, verbal learning and memory, are postulated as neurocognitive endophenotypes. However, there is a lack of information about the neuropsychological functioning in Pediatric Bipolar Disorder (PBD). Hence, it is important to study this pediatric disorder because it could help, in first place, to clarify if children and adolescents with this disorder have neurocognitive impairments and secondly to analyze if the neuropsychological impairments in PBD are alike to those reported in adults. Neuropsychological characterization of PBD has been complicated because it has a 60%-90% comorbidity with Attention Deficit Hyperactivity Disorder (ADHD). Several studies have reported ADHD neuropsychological impairment in executive functions, sustained attention and working memory. Meanwhile, few studies in PBD have reported impairments in vigilance, working memory, interference control, speed processing, abstract problem solving and verbal learning. Yet, it is unknown if these deficiencies are distinct to the ones reported in ADHD or if they are a more severe manifestation of the same deficits. The objective of the present study was to assess the neuropsychological functioning of PBD by means of a battery of tests to analyze the capacities of complex problem solving, abstract reasoning and planning. We seeked if PBD presents other neuropsychological impairments beyond executive functions, verbal learning and memory, and attention that have been reported in adults with this disorder. Two groups were assessed, the first one included fourteen adolescent patients with PBD in euthimic phase, the other group consisted of eleven asyntomatic adolescents selected by means of absence of bipolar, affective, psychotic or neurodevelopmental disorders. Each participant was evaluated by certified neuropsychologists during three sessions of one hour each. As study variables we considered the general capacity for complex problem solving measured by subtest of the Intelligence Scales of Wechsler (WAIS or WISC-R) that were administered and qualified according to Lezak's proposals. We also assessed abstract reasoning, cognitive flexibility and planning measured by the Wisconsin Card Sorting Test (WCST) and Tower of London Drexel University (TOL DX). Results were analized with SPSS 11 program using U Mann-Whitney test with statistic significance at p <0.05 and <0.01. The results obtained, showed that adolescents with PBD had impairments in neuropsychological functioning. Some of the deficits are alike the impairments reported in adults with bipolar disorder, specially in tasks that involve executive funcioning like working memory and planning. Besides, we detected impairments in other neuropsychological measures that are associated with complex problem solving capacities that no other studies have reported, suggesting that PBD show neuropsychological impairments that go beyond those reported in adult patients. Capacities for complex problem solving were related to diminished scores for Wechsler's subtests of information, vocabulary, similarities, comprehension, picture completion, block designs and digit symbol. These subtests are associated with language abilities, concept formation, verbal reasoning, visual reasoning and speed of information processing. Although in our study adolecents with PBD scored within the normal range on Intellectual Quotient (IQ) full, verbal and executive scales, analysis showed statistical differences when compared to control group, suggesting a potentially more insidious impact of the early onset of the disorder on overall cognitive functioning. This impact can directly affect through disease evolves, or indirectly disrupting academic functioning. PBD group also differed from control group on variables that measured executive functions like planning and working memory as could be seen in Digit Span Wechsler's subtests and TOL 's total move, total rule violation and total execution time variables. Explanation of deficits could involve problems with speed processing, given the lower scores obtained on Wechsler's digit-symbol substitution subtest; or with executive deficits, such as organization and problem solving ruled out by working memory and language reasoning. Whatever the explanation could be, our data contributes to the possibility of a continuity of domains of neuropsychological impairment in people with early and later onset of bipolar disorder, although direct comparison of such groups is necessary in future studies. As such, these neuropsychological findings also could provide support for the validity of the differential diagnosis in children and adolescents with bipolar disorder. The neuropsychological impairments found in our research are consistent with the behavioral dyscontrol, poor frustration tolerance and impulsive aggression that are characteristic of PBD. It is proposed that the ability to regulate attention has implications for emotional regulation, meanwhile verbal reasoning deficits may reflect difficulties with effortful semantic processing, and impairments in executive functions such as working memory and planning, contribute to self-control and completion of goal-directed behavior. Together, deficits in these domains may impair the ability of PBD to attend to cues in the environment that assist the regulation of emotion and arousal, and to limit the ability for identifying and implementing novel and prosocial options for behavior by processing efficiently cues that are presented and ignore emotionally salient or distracting stimuly. It is important to point out that not all capacities for complex problem solving were impaired in PBD. There were no differences in Wechsler's subtests of object assembly, picture arrangement or arithmetic, neither differences were observed in TOL's variables of total correct, total time violation, total problem-solving or none of WCST variables. These findings can be associated with preserved capacities for set shifting, abstract reasoning, interference control, arithmetic reasoning, sequencing thinking, interpretation of socio-emotional clues and visuo-spatial planning. However, more work is needed to elucidate the meaning of this preserved capacities and how they interact with the impairments already discussed. In this sense, it is possible to speculate that although the impairments already described can influence on academic functioning, the preserved capacities might exert an important role in the regulation of adaptive behavior. As a conclusion, our data indicate neuropsychological deficits in youth with PBD in domains of executive functioning and capacities for general problem solving. These findings add to a growing body of work documenting the presence of neurocognitive underpinnings of bipolar disorder in adolescents. Data suggests that measures of verbal reasoning, visual reasoning, speed processing, working memory and planning might be explored further in future functional neuroimaging studies of PBD.

Los estudios neuropsicológicos del trastorno bipolar en adultos han señalado alteraciones en las funciones ejecutivas, mnésicas y atencionales como endofenotipos neurocognitivos del trastorno. Sin embargo, se conoce poco sobre la caracterización neuropsicológica del Trastorno Bipolar Pediátrico (TBPP), misma que ha sido complicada dado que existe una comorbilidad del 60%-90% con el Trastorno por Déficit de Atención con Hiperactividad (TDAH). Así, desde la perspectiva neuropsicológica, el TBPP ha sido poco estudiado. Existen algunas investigaciones que no reportan alteraciones neurocognitivas, y otras reportan deficiencias en tareas de vigilancia, memoria de trabajo, control de interferencia, velocidad de procesamiento, solución de problemas abstractos y aprendizaje verbal. Sin embargo, aún se desconoce si estas deficiencias son distintas a las observadas en el TDAH, o si son formas más severas de las mismas alteraciones del TDAH. Por lo tanto, el objetivo del presente estudio fue evaluar el funcionamiento neuropsicológico del TBPP por medio de una batería de pruebas integrada para analizar las capacidades en la solución de problemas complejos, razonamiento abstracto y habilidades de planeación. Esto con la finalidad de valorar si el TBPP cursa con otras alteraciones neuropsicológicas, más allá de la esfera de la atención, memoria y del funcionamiento ejecutivo, como se han descrito hasta el momento en adultos con trastorno bipolar. Así, se comparó el funcionamiento neurocognitivo en un grupo de 14 pacientes adolescentes con diagnóstico de TBPP en fase de eutímia y un grupo control de 11 adolescentes asintomáticos. Además, se consideraron como variables del estudio la capacidad general para solucionar problemas, medida por medio de las subpruebas de las Escalas de Inteligencia de Wechsler, así como las habilidades de razonamiento abstracto, flexibilidad cognoscitiva y planeación, medidos con el Test de Clasificación de Tarjetas de Wisconsin y la Torre de Londres Drexel University. Los resultados señalaron que los adolescentes con TBPP presentan alteraciones en el funcionamiento neuropsicológico. Algunas de las deficiencias encontradas son parecidas a las alteraciones reportadas en adultos, especialmente ante tareas que involucran funciones ejecutivas como la memoria de trabajo y la planeación. Además de esto, se detectaron alteraciones en otras mediciones neuropsicológicas que implican la capacidad para solucionar problemas complejos y que no han sido reportadas en estudios previos. Al evaluar la capacidad general para solucionar problemas, se encontraron alteraciones en las habilidades de lenguaje, formación de conceptos, razonamiento verbal, razonamiento visual práctico/ conceptual, análisis-síntesis visual y velocidad de procesamiento. También se observaron deficiencias en las funciones ejecutivas que involucran la planeación y la memoria de trabajo. De tal manera, que nuestros datos ofrecen la posibilidad de plantear una continuidad en la alteración de las funciones ejecutivas en el trastorno bipolar tanto de inicio temprano como en el tardío. Estos hallazgos también pueden considerarse un apoyo para la validez del diagnóstico diferencial del trastorno bipolar en adolescentes. Como conclusión, podemos señalar que nuestros resultados son consistentes con la bibliografía en general al indicar que existen deficiencias neuropsicológicas en adolescentes con TBPP, al tiempo que se mencionan otras alteraciones no descritas con anterioridad. Estas deficiencias involucran el funcionamiento ejecutivo y otros dominios cognitivos que influyen sobre la capacidad general para solucionar problemas. Además, se sugiere que las mediciones que involucran el razonamiento verbal, razonamiento visual, velocidad de procesamiento, memoria de trabajo y planeación podrían examinarse con mayor detenimiento en futuros estudios de neuroimagen funcional en el TBPP.