Case report: Treatment-resistant depression, multiple trauma exposure and suicidality in an adolescent female with previously undiagnosed Autism Spectrum Disorder.

High rates of co-occurring depression are commonly reported in youth with Autism Spectrum Disorder (ASD), especially in individuals without intellectual disability (ID). Depression in ASD undermines adaptive behavior and is associated with a higher risk of suicidality. Females with ASD may be particularly vulnerable due to their greater use of camouflaging strategies. Indeed, in comparison to males, ASD is underdiagnosed in females, despite higher rates of internalizing symptoms and suicidality. Trauma exposure may also play a role in the development of depressive symptoms in this population. Moreover, evidence for effective treatments of depression in autistic youth are lacking, with ASD individuals frequently experiencing low efficacy and side effects. We present the case of an adolescent female with previously undiagnosed ASD without ID, admitted for active suicidal plans and a treatment-resistant depression (TRD), occurred after a COVID-19 lockdown in the context of cumulative exposure to stressful life events. Comprehensive clinical assessments performed at intake confirmed severe depression with suicidality. Intensive psychotherapy and different changes in medications were carried out (SSRI, SNRI, SNRI + NaSSA, SNRI + aripiprazole), all of which were ineffective, with persistent suicidal thoughts, often requiring intensive individual monitoring. The patient was finally successfully treated with lithium augmentation of fluoxetine, with no side effects. During hospitalization she was also evaluated by an ASD specialized center, where a diagnosis of ASD was made according to the Autism Diagnostic Observation Schedule (ADOS) and the Autism Diagnostic Interview-Revised (ADI-R) scores, as well as to clinical judgment of a senior psychiatrist. The present case report shows that clinicians should not overlook undiagnosed autism as a possible cause of TRD, especially in females without ID, where higher rates of under diagnosis may be in part related to their greater use of camouflage. It also suggests that ASD underdiagnosis and resulting unmet needs may be involved in vulnerability to stressful experiences, depression, and suicidality. Furthermore, it shows the complexity of providing care to TRD in youth with autism, suggesting that an augmentation therapy with lithium, a commonly recommended therapeutic strategy for refractory depression in typically developing samples, may also be effective in this population.

[AdoASSIP, a novel therapeutic tool for the prevention of youth suicide]. / AdoASSIP: un nouvel outil thérapeutique dans la prévention du suicide des jeunes.

Suicide is the leading cause of death among Swiss adolescents. Often, a suicide attempt is the outcome of a "suicidal process" at the end of which death is perceived as the only means of escaping from intolerable psychic pain. A suicide attempt entails a high risk of repetition. AdoASSIP, a brief adjunctive therapy adapted for adolescents, which is being implemented in Switzerland, specifically aims at reducing that risk. Starting from the story of the suicide attempt told by the adolescent, patient and therapist jointly try to better understand the "logic" of the suicidal process. Short-term and long-term needs, as well as warning-signs of a crisis are identified, and a safety plan is developed. AdoASSIP is now available in the cantons of Geneva and Vaud.

Le suicide est la première cause de mortalité chez les adolescents suisses. Une tentative de suicide est souvent l'issue d'un «processus suicidaire¼ au terme duquel la mort est perçue comme seul moyen d'échapper à une douleur psychique intolérable. Une tentative de suicide comporte un risque important de réitération. AdoASSIP, une thérapie brève adjonctive adaptée pour les adolescents, qui est en cours d'implantation en Suisse, vise spécifiquement à diminuer ce risque. À partir du récit de la tentative de suicide racontée par l'adolescent, patient et thérapeute essayent conjointement de mieux comprendre la «logique¼ du processus suicidaire. Les besoins clés à court et long termes, ainsi que les signaux d'alerte d'une crise, sont identifiés et un plan de sécurité est élaboré. AdoASSIP est désormais disponible dans les cantons de Genève et Vaud.

The Impact of COVID on Adolescent Mental Health, Self-Harm and Suicide: How Can Primary Care Provider Respond? A Position Paper of the European Academy of Pediatrics.

Adolescents aged 10 to 19 live a period of their life marked by opportunities and vulnerabilities during which the issue of mental health is of prime importance. Since several decades, and especially since the start of the COVID pandemic, mental health problems and disorders among adolescents have increased around the world. Depression, self-harm and suicidal behavior are common during this period of life, and pediatricians can play a pivotal role in identifying affected or vulnerable youngsters. This article describes risk factors for self-harm and suicidal behavior and reviews how primary care pediatricians and health professionals can respond to such situations. This scoping review is based on existing evidences as well as the authors clinical experience. It suggests concrete actions that can be taken to secure the life of at risk teenagers, and discusses how to organize the transfer to mental health professionals when needed.

[Impact of the Covid-19 pandemic on psychological disorders in adolescents and young adults]. / Impact de la pandémie de Covid-19 sur les troubles psychiques des adolescents et jeunes adultes.

The current pandemic and its economic and social consequences increase the stress of young people and their families. For the most vulnerable young people, this situation of increased or cumulative stress may be a risk factor for the emergence or relapse of psychological disorders. In this article, we propose a brief literature review of the research published on this issue since the emergence of the crisis put in perspective of local observations and possible interventions for practitioners.

La pandémie que nous traversons ainsi que ses conséquences économiques et sociales augmentent le stress des jeunes et de leurs familles. Pour les jeunes les plus vulnérables, cette situation de stress accru ou cumulé peut être un facteur de risque pour l'émergence ou la rechute de troubles psychiques. Nous proposons dans cet article une brève revue de littérature des recherches publiées sur cette question depuis l'émergence de la crise mise dans la perspective d'observations locales et des pistes d'interventions pour les praticiens.

Identifying the determinants of perceived quality in outpatient child and adolescent mental health services from the perspectives of parents and patients.

This cross-sectional survey adopting a multiple-informant perspective explores the factors that influence perceived quality (i.e., therapeutic alliance and satisfaction) in an outpatient setting within child and adolescent mental health services (CAMHS). A total of 1433 participants (parents, n = 770, and patients, n = 663) attending or having attended (drop-out) outpatient units participated in the study. The outcome measures were satisfaction (Client Satisfaction Questionnaire) and the therapeutic alliance (Helping Alliance Questionnaire). The determinants of these quality indicators were socio-demographic variables (e.g., age, gender, and mother's socio-economic status), factors related to the extent of difficulties (number of reasons for the consultation, number of people who referred the child to the CAMHS), the approach to treatment at outset (agreeing to the consultation, feeling reassured at the first appointment), the organizational friendliness (secretary, waiting room, waiting time for the first appointment) and the organization of the therapy (frequency of sessions, time for questions, change of therapist). The approach to treatment at outset, accessibility by phone, satisfaction with the frequency of the sessions and having enough time for questions were the factors that consistently explain the quality indicators from both perspectives (patients and parents). In contrast, the socio-demographic variables as well as the extent of difficulties and factors related to the organizational friendliness and the organization of the therapy (frequency of sessions, change of therapist) were not related to the quality indicators. This study identifies key determinants of the quality indicators from the perspective of patients and parents that should be considered to improve CAMHS care quality. First appointments should be carefully prepared, and clinicians should centre care on the needs and expectations of patients and parents.

[Psychometric properties of the Consumer Satisfaction Questionnaire (CSQ-8) and the Helping Alliance Questionnaire (HAQ)]. / Qualités psychométriques du Consumer satisfaction questionnaire (CSQ-8) et du Helping alliance questionnaire (HAQ).

BACKGROUND: This study was based on data from a quality of care assessment survey conducted in 2011 in outpatient polyclinics of the Vaud Canton in Switzerland, comprising questionnaires completed by 568 children over the age often and 672 parents of children of all ages. The objective of this study was to evaluate the psychometric qualities of the eight-item French versions for children of the Helping Alliance Questionnaire (HAQ) and the Consumer Satisfaction Questionnaire (CSQ-8) to allow formal validation and clinical application of these tools in the context of French-speaking child psychiatry. METHODOLOGY: Responses from children over the age often to the HAQ and CSQ-8 questionnaires were submitted to confirmatory factorial analysis (CFA) for ordinal data to verify their good fit with the original long versions. Construct validity (correspondence between scores on the scales and other external criteria considered to evaluate similar concepts) of the child questionnaires was tested by Spearman's correlation with the parents' responses and their feeling of being reassured or in agreement with respect to the first visit, and with the perception of the help provided by individual and family interviews. RESULTS: CFA showed an acceptable fit with the one-dimensional model of the original scales, both for the HAQ and the CSQ-8. Significant positive correlations of the scales with the parents' responses and with other convergent external criteria confirmed the good construct validity. CONCLUSIONS: These psychometric analyses provide a basis for the validation and clinical application of the abridged French versions of the HAQ and CSQ-8 in quality of care assessment in child psychiatry.