Psychometric properties and normative data of the Latvian and Russian language versions of the strengths and difficulties questionnaire (SDQ) in the Latvian general adolescent population.

OBJECTIVES: Mental health screening instruments are essential in population health research and clinical practice. The strengths and difficulties questionnaire (SDQ) self-report version has been widely used across the globe to screen for mental health problems in adolescent populations. This study aimed to explore the psychometric properties of the Latvian and Russian language versions of the SDQ in a representative sample of a general population of Latvian adolescents and establish the population-based normative scores. MATERIALS AND METHODS: This analysis was based on data from the international Health Behaviour in School-aged Children study year 2017/2018 Latvian database. The sample comprised 2683 Latvian and 1321 Russian-speaking 11-, 13-, and 15-year-old adolescents. RESULTS: Significant language-based variance was observed in the mean scores of the externalising subscales of the SDQ, with Latvian-speaking adolescents reporting higher levels of conduct problems and hyperactivity. The reliability was satisfactory (ordinal alpha >0.7) only for the prosocial behaviour, emotional, internalising problems, and total difficulties subscales, while conduct, hyperactivity, peer, and externalising problems scales demonstrated lower internal consistency (ordinal alpha 0.5-0.7). Confirmatory factor analysis (CFA) did not support the hypothesised narrow-band five-factor or broad-band three-factor structure of the SDQ. The normative banding scores were calculated for both language variants. CONCLUSIONS: This study suggests that the self-report SDQ must be used cautiously in Latvian adolescents because some SDQ subscales lack reliability. When used in population research, the internalising subscales seem more reliable than the externalising ones. More research is needed regarding the reliability of the SDQ in clinical adolescent populations.

Clinical Utility of the Parent-Report Version of the Strengths and Difficulties Questionnaire (SDQ) in Latvian Child and Adolescent Psychiatry Practice.

Background and Objectives: Screening instruments can be crucial in child and adolescent mental healthcare practice by allowing professionals to triage the patient flow in a limited resource setting and help in clinical decision making. Our study aimed to examine whether the Strengths and Difficulties Questionnaire (SDQ), with the application of the original UK-based scoring algorithm, can reliably detect children and adolescents with different mental disorders in a clinical population sample. Materials and Methods: a total of 363 outpatients aged 2 to 17 years from two outpatient child psychiatry centres in Latvia were screened with the parent-report version of the SDQ and assigned clinical psychiatric diagnoses. The ability of the SDQ to predict the clinical diagnosis in major diagnostic groups (emotional, conduct, hyperactivity, and developmental disorders) was assessed. Results: The subscales of the parent-report SDQ showed a significant correlation with the corresponding clinical diagnoses. The sensitivity of the SDQ ranged 65-78%, and the specificity was 57-78%. The discriminative ability of the SDQ, as measured by the diagnostic odds ratio, did not quite reach the level of clinical utility in specialised psychiatric settings. Conclusions: We suggest the SDQ be used in primary healthcare settings, where it can be an essential tool to help family physicians recognise children needing further specialised psychiatric evaluation. There is a need to assess the psychometric properties and validate the SDQ in a larger populational sample in Latvia, determine the population-specific cut-off scores, and reassess the performance of the scale in primary healthcare practice.

Attitudes towards migration from the eastern coast of the Baltic Sea: similar history but different psychiatric trainees?

This article aimed to describe and compare migration tendencies between junior doctors training in psychiatry in the Baltic countries. A cross-sectional survey was circulated in Estonia, Latvia and Lithuania in 2013-2014 as part of the Brain Drain study. The 61-item, anonymous questionnaire covered participants' demographic data, experiences of short-term mobility, long-term migration and trainees' attitudes towards migration. In this sample (n = 95) of psychiatric trainees in the Baltic countries, the majority were female (79.1%), training in adult psychiatry (77.9%). A vast majority (87.0%) of psychiatric trainees in the Baltic countries have 'ever' considered leaving the country; almost half (in Estonia) or more than a half (in Lithuania and Latvia) were considering leaving 'now'; yet a minority took 'practical steps' towards migration. For all trainees in the Baltic states, personal reasons were the most important to stay in their country. Whilst regarding reasons to leave, financial was top in Lithuania, while trainees from Estonia and Latvia indicated personal reasons as key to emigrate. Several psychiatric trainees in the Baltic countries had considered migration, with many calling for improvements in their salaries. These findings call for further investigation and action to support the workforce in the Baltics.

Correction to: The child and adolescent psychiatry: study of training in Europe (CAP­STATE).

The original article has been corrected.

The child and adolescent psychiatry: study of training in Europe (CAP-STATE).

There is great cultural diversity across Europe. This is reflected in the organisation of child and adolescent mental health (CAMH) services and the training of the respective professionals in different countries in Europe. Patients and their parents will want a high quality, knowledgeable, and skillful service from child and adolescent psychiatrists (CAPs) wherever they see them in Europe. A European comparison of training programs allows all stakeholders in different European countries to assess the diversity and to initiate discussions as to the introduction of improvements within national training programs. Major issues to be addressed in comparing child and adolescent psychiatric training programs across Europe include: (1) formal organisation and content of training programs and the relationship to adult psychiatry and paediatrics; (2) flexibility of training, given different trainee interests and that many trainees will have young families; (3) quality of governance of training systems; (4) access to research; and (5) networking. The Child and Adolescent Psychiatry-Study of Training in Europe (CAP-State) is a survey of training for child and adolescent psychiatrists (CAPs) across European countries. It aims to revisit and extend the survey carried out in 2006 by Karabekiroglu and colleagues. The current article is embedded in a special issue of European Child + Adolescent Psychiatry attempting to for the first time address training in CAP at the European and global levels. Structured information was sought from each of 38 European and neighboring countries (subsequently loosely referred to as Europe) and obtained from 31. The information was provided by a senior trainee or recently qualified specialist and their information was checked and supplemented by information from a senior child and adolescent psychiatry trainer. Results showed that there is a very wide range of provision of training in child and adolescent psychiatry in different countries in Europe. There remains very substantial diversity in training across Europe and in the degree to which it is subject to national oversight and governance. Some possible reasons for this variation are discussed and some recommendations made.

Satisfaction with psychiatric in-patient care as rated by patients at discharge from hospitals in 11 countries.

PURPOSE: There is disregard in the scientific literature for the evaluation of psychiatric in-patient care as rated directly by patients. In this context, we aimed to explore satisfaction of people treated in mental health in-patient facilities. The project was a part of the Young Psychiatrist Program by the Association for the Improvement of Mental Health Programmes. METHODS: This is an international multicentre cross-sectional study conducted in 25 hospitals across 11 countries. The research team at each study site approached a consecutive target sample of 30 discharged patients to measure their satisfaction using the five-item study-specific questionnaire. Individual and institution level correlates of 'low satisfaction' were examined by comparisons of binary and multivariate associations in multilevel regression models. RESULTS: A final study sample consisted of 673 participants. Total satisfaction scores were highly skewed towards the upper end of the scale, with a median total score of 44 (interquartile range 38-48) out of 50. After taking clustering into account, the only independent correlates of low satisfaction were schizophrenia diagnosis and low psychiatrist to patient ratio. CONCLUSION: Further studies on patients' satisfaction should additionally pay attention to treatment expectations formed by the previous experience of treatment, service-related knowledge, stigma and patients' disempowerment, and power imbalance.

Acute psychosis due to non-paraneoplastic anti-NMDA-receptor encephalitis in a teenage girl: Case report.

Anti-N-methyl-d-aspartate receptor (NMDAR) encephalitis is a disease occurring when antibodies produced by the body's own immune system attack NMDA-type glutamate receptors in the brain. Most anti-NMDAR encephalitis cases are associated with paraneoplastic syndrome. We analyze the case of a 15-year-old girl who was hospitalized in a child psychiatry clinic in Riga, Latvia, with de novo acute polymorphic psychotic disorder gradually progressing to a catatonic state. The patient received antipsychotic and electroconvulsive therapy with no beneficial effect. The council of doctors discussed differential diagnoses of schizophrenia-induced catatonia and the autoimmune limbic encephalitis-induced catatonic condition. When the diagnosis of anti-NMDAR autoimmune encephalitis was finally confirmed by repeated immunological assays (specific immunoglobulin [Ig] G and IgM in her blood serum and cerebrospinal fluid), and a paraneoplastic process was ruled out, she was started on immunomodulating therapy (methylprednisolone, Ig, plasmapheresis, rituximab), which changed the course of her disease. On immunomodulating treatment, her physical and mental health have gradually improved to almost complete reconvalescence. Psychiatrists should consider anti-NMDAR encephalitis as a differential diagnosis in first-episode psychosis patients presenting with disorientation, disturbed consciousness, pronounced cognitive deficits, movement disorder, dysautonomia, or rapid deterioration, and test for specific IgG NR1 autoantibodies, even if there are no specific findings on routine neuroimaging, electroencephalography (EEG), or cerebrospinal fluid tests.