COVID-19 lockdown in Spain: Psychological impact is greatest on younger and vulnerable children.

In 2020, quarantine home confinement measures were implemented in Spain to control a pandemic for the first time. The objective of this study is to assess both the psychological and social impact of that 'lockdown' on different age groups of children and adolescents and also the different strategies adopted by families in that situation. We collected data via an online questionnaire answered by 850 participants, parents of young people aged between 4 and 18, between 24th April and 8th May 2020. Our results show that living in a home smaller than 80 m2 is associated with an increased risk of presenting clinical symptoms of emotional or behavioural distress, with an odds ratio of 2.54 (95% CI: 1.07-6.02), p = 0.034; while increased age is a predictor of better psychological functioning during lockdown: coefficient of 0.25 (95% CI: 0.07-0.41), p = 0.004. Moreover, age is also a marker of higher scores on the scale of psychological symptoms, with a coefficient of 0.02 (95% CI: 0.01-0.04), p = .005. To conclude, younger children present poorer behavioural and emotional functioning and more symptoms of emotional distress than adolescents during lockdown. Living in a small home is a risk factor for presenting clinical symptoms. These findings should be taken into consideration when planning for future home confinement episodes and when considering preventative strategies in the realm of mental health care.

Alternatives to inpatient treatment in adolescents with anorexia nervosa: Effectiveness and characteristics of a new intensive model of day patient treatment.

INTRODUCTION: Inpatient Treatment (IT) is the treatment of choice for moderate or severely ill adolescents with Anorexia Nervosa (AN). Nevertheless, it is expensive, and the risk for relapse or readmissions is high. A less costly alternative to IT is Day Patient Treatment (DP), which may also help to avoid relapses and readmissions because facilitates transition from hospital to community treatment. AIM: To assess the effectiveness of the 11-hour DP program for Eating Disorders (DP-ED-11h), a new intensive DP treatment for adolescents with AN, with respect to weight recovery, avoidance of hospital admission and decrease of Length of Stay (LoS). METHOD: A longitudinal, naturalistic study was carried out analysing clinical and sociodemographic variables from 77 patients with AN who were consecutively discharged from DP-ED-11h, during years 2015-2016. RESULTS: There were 77 discharges. The average age was 14.4 years old (SD: 1.62). The LoS at DP-ED-11h was 28.9 days (SD: 18.5). The mean body mass index increased significantly at discharge (17.2 vs. 17.9, p<0.001) and at 12 months follow- up (17.9 vs. 19.3, p<0.001). Twenty nine (70.8%) of the patients treated at DP-ED-11h, who came from a less intensive setting, avoided an admission. Fourteen (18.2%) required readmission at DP-ED-11h within two years. The LoS at IT was significantly reduced (from 33 to 24 days, p<0.043). CONCLUSION: DP-ED-11h has shown to be an effective resource as an alternative to IT for adolescents with moderate to severe AN. This new model has cost-effectiveness implications as it is a safe resource and is less costly than IT.

Alternativas a la hospitalización total en adolescentes con anorexia nerviosa: Eficacia y características de un nuevo modelo intensivo de tratamiento en hospital de día / Alternatives to inpatient treatment in adolescents with anorexia nervosa: Effectiveness and characteristics of a new intensive model of day patient treatment

INTRODUCCIÓN: La Hospitalización Total (HT) es el tratamiento de elección para adolescentes con Anorexia Nerviosa (AN) moderada-grave. Sin embargo, ésta es costosa y el riesgo de recaída o reingresos es alto. Una alternativa menos costosa es la Hospitalización Parcial (HP), que puede ayudar a evitar recaídas y reingresos porque facilita la transición del hospital al tratamiento comunitario. OBJETIVO: Evaluar la eficacia de un tratamiento intensivo en HP para adolescentes con AN, el programa de HP para Trastornos de la Conducta Alimentaria (TCA) de 11 horas (HP-TCA-11h), respecto a la recuperación ponderal, evitar ingresos y disminuir estancias en HT. MÉTODO: Se realizó un estudio longitudinal y naturalístico que analizó las variables clínicas y socio-demográficas de los pacientes con AN que fueron dados de alta consecutivamente del HP-TCA-11h, durante los años 2015-2016. RESULTADOS: Se realizaron 77 altas. La edad media fue de 14.4 años (DE: 1.62). La estancia media fue de 28.9 días (DE: 18.5). La media del índice de masa corporal aumentó significativamente al alta (17.2 frente a 17.9, p < 0.001) y a los 12 meses de seguimiento (17.9 frente a 19.3, p < 0.001). Veintinueve (70.8%) pacientes tratados en HP-TCA-11h, que vinieron de un recurso menos intensivo, evitaron el ingreso en HT. Catorce (18.2%) requirieron un reingreso en HP-TCA-11h en dos años. La estancia media en HT disminuyó significativamente (de 33 a 24 días, p < 0.043). CONCLUSIÓN: HP-TCA-11h ha demostrado ser un recurso eficaz como alternativa a la HT para adolescentes con AN moderada-grave. Este nuevo modelo tiene implicaciones coste-efectivas ya que es un recurso seguro y menos costoso que la HT

INTRODUCTION: Inpatient Treatment (IT) is the treatment of choice for moderate or severely ill adolescents with An-orexia Nervosa (AN). Nevertheless, it is expensive, and the risk for relapse or readmissions is high. A less costly alterna-tive to IT is Day Patient Treatment (DP), which may also help to avoid relapses and readmissions because facilitates tran-sition from hospital to community treatment. AIM: To assess the effectiveness of the 11-hour DP pro-gram for Eating Disorders (DP-ED-11h), a new intensive DP treatment for adolescents with AN, with respect to weight recovery, avoidance of hospital admission and decrease of Length of Stay (LoS). METHOD: A longitudinal, naturalistic study was carried out analysing clinical and sociodemographic variables from 77 patients with AN who were consecutively discharged from DP-ED-11h, during years 2015-2016. RESULTS: There were 77 discharges. The average age was 14.4 years old (SD: 1.62). The LoS at DP-ED-11h was 28.9 days (SD: 18.5). The mean body mass index increased significantly at discharge (17.2 vs.17.9, p < 0.001) and at 12 months fol-low-up (17.9 vs.19.3, p < 0.001). Twenty nine (70.8%) of the patients treated at DP-ED-11h, who came from a less inten-sive setting, avoided an admission. Fourteen (18.2%) required readmission at DP-ED-11h within two years. The LoS at IT was significantly reduced (from 33 to 24 days, p < 0.043). CONCLUSIONS: DP-ED-11h has shown to be an effective resource as an alternative to IT for adolescents with moder-ate to severe AN. This new model has cost-effectiveness im-plications as it is a safe resource and is less costly than IT

Spanish version validation of the Marihuana Motives Measure in a drug-consuming adolescent sample. / Propiedades psicométricas de la versión española del Marihuana Motives Measure en población adolescente consumidora.

INTRODUCTION: Cannabis is the illicit drug mostly widely consumed by adolescents in Spain. The understanding of consumption motives is an important factor for intervention. In Spain, there are no available instruments for their evaluation, hence, the goal of this paper is to study the psychometric properties of the Marihuana Motives Measure (MMM) in a sample of adolescent consumers. MATERIAL AND METHOD: Firstly, translation and back-translation was performed. A total of 228 adolescent consumers of cannabis were evaluated. Factorial analysis was conducted, and the reliability of the total scores and of each scale of the questionnaire was studied through Cronbach's alpha. Test-retest reliability was analyzed through interclass correlations. Validity evidence of the MMM was examined through correlations between current cannabis use, subjective consumption effects measured with the Addiction Research Center Inventory (ARCI), and personality measured with the Millon Adolescent Clinical Inventory (MACI). RESULTS: High reliability was observed in total score of the MMM (Cronbach α = .86), and high and moderate reliability for each of the five factors obtained in the factorial analysis of the MMM, Social = .82, Enhancement = .72, Coping = .83, Expansion = .74, and Conformity = .64. Significant correlations were also observed between cannabis consumption motives and subjective effects, and between consumption motives and personality. CONCLUSION: The Spanish version of the MMM shows a similar factorial structure as the one obtained by the original author, and its measures are reliable and valid for the study of cannabis consumption motives in adolescent consumer population.

Introducción: El cannabis es la sustancia ilegal que más consumen los adolescentes españoles. Entender los motivos de consumo es un factor importante para la intervención. Actualmente no existe en España un instrumento para su evaluación. El objetivo del presente trabajo es estudiar las propiedades psicométricas de la versión española del cuestionario Marihuana Motives Measure (MMM) en una población de adolescentes consumidores. Material y Métodos: Se llevó a cabo una traducción y retrotraducción del MMM. Un total de 228 adolescentes consumidores de cánnabis fueron evaluados. Se realizó un análisis factorial y se estudió la fiabilidad de la puntuación total y de cada una de las escalas del cuestionario a partir del Alfa de Cronbach. El estudio de la evidencia de validez del MMM se realizó mediante el examen de las correlaciones entre el uso actual de cánnabis, los efectos subjetivos del consumo través del cuestionario ARCI (Addiction Research Center Inventory) y la personalidad, mediante el cuestionario MACI (Millon Adolescent Clinical Inventory). Resultados: Se observó una alta fiabilidad de la puntuación total del MMM (Alfa de Cronbach= 0,86) y entre alta y moderada para cada uno de los cinco factores obtenidos al realizar el análisis factorial del MMM, Social = 0,82; Enhancement = 0,72; Coping = 0,83; Expansion = 0,74; Conformity = 0,64. Además, se observaron correlaciones significativas tanto entre motivos de consumo de cannabis y efectos subjetivos, así como entre motivos de consumo y personalidad. Conclusiones: La versión española del MMM muestra una estructura factorial similar a la obtenida por el autor original y sus medidas resultan fiables y válidas para el estudio de los motivos de consumo de cánnabis en población adolescente consumidora.

Propiedades psicométricas de la versión española del Marihuana Motives Measure en población adolescente consumidora / Spanish version validation of the Marihuana Motives Measure in a drug-consuming adolescent sample

Introducción: El cannabis es la sustancia ilegal que más consumen los adolescentes españoles. Entender los motivos de consumo es un factor importante para la intervención. Actualmente no existe en España un instrumento para su evaluación. El objetivo del presente trabajo es estudiar las propiedades psicométricas de la versión española del cuestionario Marihuana Motives Measure (MMM) en una población de adolescentes consumidores. Material y Métodos: Se llevó a cabo una traducción y retrotraducción del MMM. Un total de 228 adolescentes consumidores de cánnabis fueron evaluados. Se realizó un análisis factorial y se estudió la fiabilidad de la puntuación total y de cada una de las escalas del cuestionario a partir del Alfa de Cronbach. El estudio de la evidencia de validez del MMM se realizó mediante el examen de las correlaciones entre el uso actual de cánnabis, los efectos subjetivos del consumo través del cuestionario ARCI (Addiction Research Center Inventory) y la personalidad, mediante el cuestionario MACI (Millon Adolescent Clinical Inventory). Resultados: Se observó una alta fiabilidad de la puntuación total del MMM (Alfa de Cronbach= 0,86) y entre alta y moderada para cada uno de los cinco factores obtenidos al realizar el análisis factorial del MMM, Social = 0,82; Enhancement = 0,72; Coping = 0,83; Expansion = 0,74; Conformity = 0,64. Además, se observaron correlaciones significativas tanto entre motivos de consumo de cannabis y efectos subjetivos, así como entre motivos de consumo y personalidad. Conclusiones: La versión española del MMM muestra una estructura factorial similar a la obtenida por el autor original y sus medidas resultan fiables y válidas para el estudio de los motivos de consumo de cánnabis en población adolescente consumidora

Introduction: Cannabis is the illicit drug mostly widely consumed by adolescents in Spain. The understanding of consumption motives is an important factor for intervention. In Spain, there are no available instruments for their evaluation, hence, the goal of this paper is to study the psychometric properties of the Marihuana Motives Measure (MMM) in a sample of adolescent consumers. Material and Method: Firstly, translation and back-translation was performed. A total of 228 adolescent consumers of cannabis were evaluated. Factorial analysis was conducted, and the reliability of the total scores and of each scale of the questionnaire was studied through Cronbach’s alpha. Test-retest reliability was analyzed through interclass correlations. Validity evidence of the MMM was examined through correlations between current cannabis use, subjective consumption effects measured with the Addiction Research Center Inventory (ARCI), and personality measured with the Millon Adolescent Clinical Inventory (MACI). Results: High reliability was observed in total score of the MMM (Cronbach alfa = .86), and high and moderate reliability for each of the five factors obtained in the factorial analysis of the MMM, Social = .82, Enhancement = .72, Coping = .83, Expansion = .74, and Conformity = .64. Significant correlations were also observed between cannabis consumption motives and subjective effects, and between consumption motives and personality. Conclusion: The Spanish version of the MMM shows a similar factorial structure as the one obtained by the original author, and its measures are reliable and valid for the study of cannabis consumption motives in adolescent consumer population

Ideación suicida y conductas autolesivas en adolescentes con Trastornos de la Conducta Alimentaria / Suicidal ideation and self-injurious behavior in adolescents with eating disorders

Introducción. Es conocida la presencia de ideas suicidas y comportamientos autolesivos en pacientes con Trastornos de la Conducta Alimentaria (TCA), sin embargo, esta asociación no está claramente definida empíricamente. El objetivo del estudio es determinar la prevalencia de ideación suicida y conductas autolesivas en adolescentes con TCA. Un segundo objetivo es estudiar la asociación entre conducta autolesiva e ideación suicida, gravedad de la sintomatología alimentaria, depresiva, ansiosa, motivación para el cambio y perfeccionismo. Metodología. Se evaluaron a 109 pacientes (edad media: 14,74 años (DE:1,53); 87,2% mujeres) con el Inventario de TCA (EDI-2), el Inventario de Depresión de Beck (BDI-II), el Inventario de Ansiedad Estado/Rasgo (STAI), la Escala de Perfeccionismo en Niños y Adolescentes (CAPS) y el Cuestionario de Etapas de Cambio en la Anorexia Nerviosa (ANSOCQ). Resultados. Cuarenta y siete pacientes (43,1%) presentaron ideación suicida y 34 (31,2%) conductas autolesivas. La presencia de ideación suicida no discriminó entre pacientes TCA con y sin comportamiento autolesivo. Los pacientes con comportamiento autolesivo presentaron una puntuación significativamente mayor en todas las escalas del EDI-2, a excepción de Miedo a Madurar, en la puntuación total del BDI-II, STAI y en la CAPS. Se encontró una asociación entre la conducta autolesiva y la motivación para el cambio. Conclusiones. Un porcentaje importante de adolescentes con TCA presentan ideación suicida y comportamientos autolesivos, siendo el perfil psicopatológico de estos pacientes más grave. La presencia de ideación suicida en adolescentes con TCA no tiene necesariamente implicaciones con la conducta autolesiva, este comportamiento podría explicarse como consecuencia de la necesidad de regular emociones negativas intensas (AU)

Introduction. The presence of suicidal thoughts and self-injurious behaviors in patients with eating disorders (ED) is well-known; however, this association is currently not defined empirically. The aim of the study is to determine the prevalence of suicidal ideation and self-harm in adolescents with eating disorders. A second objective is to study the association between self-injurious behavior and suicidal ideation, severity of eating disorder symptoms and symptoms of depression and anxiety, motivation to change and perfectionism. Methodology. We evaluated 109 patients (mean age, 14.74 years (SD: 1.53); 87.2% female) using the Eating Disorder Inventory (EDI-2), the Beck Depression Inventory (BDI-II), the State-Trait Anxiety Inventory (STAI), the Child and Adolescent Perfectionism Scale (CAPS) and the Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ). Results. Forty-seven patients (43.1%) had suicidal ideation and 34 (31.2%), self-injurious behavior. The presence of suicidal ideation did not discriminate between patients with or without self-injurious behavior. Patients who self-harm had significantly higher scores on all scales of the EDI-2, except for ‘maturity fears’, in the total scores of BDI-II, STAI and CAPS. An association between self-injurious behavior and motivation to change was found. Conclusions. A significant percentage of adolescents with eating disorders present suicidal ideation and self-injurious behavior, making the psychopathological profile of these patients more severe. The presence of suicidal ideation in adolescents with eating disorders does not necessarily mply that they have self-injurious behavior; rather, such behavior could be a result of the need to regulate intense negative emotions (AU)

Suicidal ideation and self-injurious behavior in adolescents with eating disorders.

INTRODUCTION: The presence of suicidal thoughts and self-injurious behaviors in patients with eating disorders (ED) is well-known; however, this association is currently not defined empirically. The aim of the study is to determine the prevalence of suicidal ideation and self-harm in adolescents with eating disorders. A second objective is to study the association between self-injurious behavior and suicidal ideation, severity of eating disorder symptoms and symptoms of depression and anxiety, motivation to change and perfectionism. METHODOLOGY: We evaluated 109 patients (mean age, 14.74 years (SD: 1.53); 87.2% female) using the Eating Disorder Inventory (EDI-2), the Beck Depression Inventory (BDI-II), the State-Trait Anxiety Inventory (STAI), the Child and Adolescent Perfectionism Scale (CAPS) and the Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ). RESULTS: Forty-seven patients (43.1%) had suicidal ideation and 34 (31.2%), self-injurious behavior. The presence of suicidal ideation did not discriminate between patients with or without self-injurious behavior. Patients who self-harm had significantly higher scores on all scales of the EDI-2, except for “maturity fears”, in the total scores of BDI-II, STAI and CAPS. An association between selfinjurious behavior and motivation to change was found. CONCLUSIONS: A significant percentage of adolescents with eating disorders present suicidal ideation and selfinjurious behavior, making the psychopathological profile of these patients more severe. The presence of suicidal ideation in adolescents with eating disorders does not necessarily imply that they have self-injurious behavior; rather, such behavior could be a result of the need to regulate intense negative emotions.

[Psychoactive drugs use and related visits of adolescents to the emergency department]. / Implicación de las sustancias psicoactivas en las consultas de adolescentes en urgencias.

BACKGROUND AND OBJECTIVES: To describe psychoactive substances (PS)-related visits of adolescents to the emergency department and to explore possible differential features in patients according to the kind of PS consumed. PATIENTS AND METHODS: Observational and analytic study. PS-related visits of adolescents to the emergency department during 30 months were studied. Patients were divided in two groups: those with alcohol intoxication only (Group_1) and those with other PS (Group_2) and they were compared. RESULTS: 333 consults were included, corresponding to 321 patients. Their mean age was 16,1 years (SD:1,1 years). Two hundred sixty-two(78,7%) were alcohol-related visits, and 110(33%) were related with another PS consumption. Of the 262 alcohol-related visits, 223 were only related with alcohol(Group_1), while the other 110 visits made up Group_2. Group_2 was composed of more males, more adolescents placed in Institutional Care and more adolescents with psychiatric records than Group_1. Likewise, distribution of Group_2 visits was less predictable than distribution of Group_1. CONCLUSIONS: PS consumption is a frequent major complaint in an Emergency Department. There are more poly-intoxications in males with psycho-social problems. In those cases, consumption seems to happen regardless of the time in the day or the day of the week.

Consultsa urgentes de adolescentes por consumo de alcohol y otras sustancias psicoactivas / Consultations about drugs and alcohol abuse among adolescents in an emergency department

Fundamento. En los últimos años, la edad media de inicio del consumo de alcohol y otras drogas ha disminuido, y las consultas derivadas de su consumo son cada vez más frecuentes en los servicios de urgencias. Objetivo. Documentar el papel del Alcohol y otras Sustancias Psicoactivas (ASP) en las consultas de los adolescentes. Método. Estudio descriptivo observacional de los adolescentes que consultaron en Urgencias durante los años 2007 y 2008 con clínica secundaria al consumo de ASP. Resultados. Se realizaron 263 (1%) consultas con clínica relacionada con ASP (principalmente alteración de la conciencia; 200, 76%). Correspondían a 258 pacientes; cinco (1,9%) consultaron dos veces. La edad media fue de 16,1 (DE 1,1) años; el 50,4% eran chicos. El 76,4% fueron trasladados en ambulancia, con predominio de consultas de viernes a domingo (63,8%) y de 19:00 a 07:00 h (79,1%). En 198 (75,3%) consultas los pacientes presentaban intoxicación etílica, en 149 (75,3%) se determinaron niveles de alcohol en sangre, siendo la concentración media de 191 (DE 53) mg/dl. De las otras drogas, se detectó cannabis en 70 (26,65) consultas, cocaína en 11 (4,2%), anfetaminas en 5 (1,9%), opiáceos en 4 (1,5%) y benzodiacepinas en 3 (1,1%). También hubo dos casos (0,8%) de inhalación de disolventes. Veintiocho (10,6%) casos dieron positivo para dos tóxicos, las combinaciones más frecuentes fueron alcohol-cannabis (14; 50%) y cannabiscocaína (5; 17,8%), y uno (0,4%), por tres (alcohol-cannabis-cocaína). Conclusiones. El consumo abusivo de alcohol es la causa más frecuente de intoxicación en adolescentes. Existe un porcentaje considerable de poli-intoxicaciones. Los fines de semana y las noches son los momentos de más consultas, probablemente por el consumo ligado al tiempo de ocio(AU)

Background. Substance abuse is a public health concern. Lately, the mean age of drug and alcohol consumption initiation has decreased and the number of emergency consultations about their abuse has increased. Objective. To describe the characteristics of adolescents presenting to the emergency department due to drug and alcohol abuse. Method. We conducted an observational and descriptive study of all patients aged 12-18 years presenting to a pediatric emergency department between 1 January 2007 and 31 December 2008 with drugs and/or alcohol abuse symptoms. Results. 263 emergency consultations corresponding to 258 patients were included (there were 5 (1.9%) patients with 2 consultations). Their mean age was 16.1(SD 1.1) years; 50.4% were males. 76.4% of them arrived by ambulance. Patients with substance abuse were overrepresented during the weekend (63.8%) and during the night (79.1%). The decreased level of consciousness was the main symptom in 200 (76%). There were 198 (75.3%) patients with alcohol intoxication, in 149 (75.3%) of them blood ethanol level was determined (mean 191mg/dl; SD 53mg/dl). The other reported drugs were cannabis (70; 26.7%), cocaine (11; 4.2%), amphetamines (5; 1.9%), opiates (4; 1.5%), benzodiazepine (3; 1.1%) and volatile substances (2; 0.8%). In 28 cases (10.6%) two drugs were combined (most frequent combinations: alcohol-cannabis (14; 50%) and cannabis-cocaine (5; 17.8%); and in one (0.4%) three (alcohol-cannabis-cocaine). Conclusions. Abuse of alcohol is the most frequent cause of adolescent intoxication. There is an important proportion of poly-drug abuses. A high number of patients with drug abuse arrive to Emergency Department during weekends and nights, probably in connection with their use of the free time(AU)