Effectiveness of Ketamine for the Treatment of Post-Traumatic Stress Disorder - A Systematic Review and Meta-Analysis.

Objective: Post-traumatic stress disorder (PTSD) is an enduring condition characterized by a chronic course and impairments across several areas. Despite its significance, treatment options remain limited, and remission rates are often low. Ketamine has demonstrated antidepressant properties and appears to be a promising agent in the management of PTSD. Method: A systematic review was conducted in PubMed/MEDLINE, Cochrane Library, Clinicaltrials.gov, Lilacs, Scopus, and Embase, covering studies published between 2012 and December 2022 to assess the effectiveness of ketamine in the treatment of PTSD. Ten studies, consisting of five RCTs, two crossover trials, and three non-randomized trials, were included in the meta-analysis. Results: Ketamine demonstrated significant improvements in PCL-5 scores, both 24 hours after the initial infusion and at the endpoint of the treatment course, which varied between 1 to 4 weeks in each study. Notably, the significance of these differences was assessed using the Two Sample T-test with pooled variance and the Two Sample Welch's T-test, revealing a statistically significant effect for ketamine solely at the endpoint of the treatment course (standardized effect size= 0.25; test power 0.9916; 95% CI = 0.57 to 17.02, p=0.0363). It is important to note that high heterogeneity was observed across all analyses. Conclusions: Our findings suggest that ketamine holds promise as an effective treatment option for PTSD. However, further trials are imperative to establish robust data for this intervention.

Impacts of COVID-19 on children and adolescents: A systematic review analyzing its psychiatric effects.

OBJECTIVE: To summarize the most relevant data from a systematic review on the impact of COVID-19 on children and adolescents, particularly analyzing its psychiatric effects. METHODS: This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and included experimental studies (randomized-individually or pooled-and non-randomized controlled trials), observational studies with a group for internal comparison (cohort studies-prospective and retrospective-and case-control) and qualitative studies in the period from 2021 to 2022. RESULTS: The search identified 325 articles; we removed 125 duplicates. We selected 200 manuscripts, chosen by title and selected abstracts. We excluded 50 records after screening titles and abstracts, as they did not meet the inclusion criteria. We retrieved 150 records selected for a full reading. We excluded 90 text articles and we selected 25 records for the (n) final. Limitations: Due to the short period of data collection, from 2021 to 2022, there is a possibility of lack of relevant studies related to the mental health care of children and adolescents. In addition, there is the possibility of publication bias, such as only significant findings being published. CONCLUSION: The impact of COVID-19 on the mental health of children and adolescents is of great concern to child and youth psychiatry. Situations such as fear, anxiety, panic, depression, sleep and appetite disorders, as well as impairment in social interactions caused by psychic stress, are punctual markers of pain and psychic suffering, which have increasing impacts on the mental health panorama of children and adolescents globally, particularly in vulnerable and socially at-risk populations.

Stolen innocence: Dishonor and taint in times of war.

As soon as they are taken prisoner, children and adolescents in times of war are inserted into a spiral of cruelty that progresses to rape or other countless forms of physical and psychological torture using sex as a weapon. Were these children and adolescents war sex slaves? Oral sex and other sexual barbarities are part of spaces of abuse and humiliation. The damage to the personality structure of these children and adolescents is severe. The psychological consequences are numerous. Over the years, a vicious circle has been observed around this brutality.

Afghan children and adolescents: The burden of poor mental health in contexts of widespread poverty, social inequality and persistent violence.

In Afghanistan, the burden of poor mental health arises in contexts of widespread poverty, social inequality, and persistent violence. Generations of Afghans were born during the conflict, and some never knew peace. Children make up more than half (57%) of the population in need of emergency humanitarian assistance in Afghanistan. Recent assessments indicate that more than a third of children have been exposed to psychological distress due to the loss of family and community members and the constant risk of death and injury. Children and teens are struggling with anxieties and fears, desperately in need of mental health support. The lack of social support manifested itself in various forms of suffering in both children and adolescents. The quality of the environment where children and adolescents grow up shapes their well-being and development.

Abuse and neglect among Ethiopian children and adolescents.

Given the dramatic situation observed in Ethiopia, the biggest humanitarian crisis in decades, children and adolescents have been the most affected. The country experiences climate change and disarrays in the political structure of the state, which increases the risk of insecurity, displacement, and protection. The outlook tends to remain in 2022 due to the expansion of the conflict and the decrease in the access of partners' humanitarian aid groups to the affected regions. The country has high rates of malnutrition, low vaccination coverage, need for educational assistance, water, and sanitation emergency, lack of services to protect against violence, and high rates of children unaccompanied by their families. During the conflict, children, often to save their lives - because they have extended families or unhealthy inter-family relationships - end up looking for work on the streets and falling into a situation of vulnerability. In this context, they become constant victims of sexual abuse and physical violence, leaving deep marks. Still, the country's folk traditions fall back on the girls, significantly in a negative way, when genital mutilation and child marriage are in considerable proportion among girls in the country. However, the humanitarian actions did not concern themselves with referring to the particular needs of adolescent girls, including the involvement of caregivers to reduce the risk of violence. In this sense, it is important to point out that the increase in discrimination, stigmatization, and xenophobia contribute negatively to local tensions and to the improvement of vulnerability and social risk of children and adolescents. Therefore, there is a need for interventions to multisectoral nutrition, due to the prevalence of thinness and stunting that are above the threshold level of public health importance, and the need for urgent humanitarian assistance care to the more than 15 million children affected by this unprecedented crisis.

Echoes of Global Silence: Is there protection and safety for Venezuelan children and adolescents?

As the crisis in Venezuela deepens, an increasing number of children urgently needs shelter, protection, and access to basic services, including food, medicine, clean water, and sanitation. Children and young people in transit are particularly at risk of criminal activity or being separated from their families. The consequences of the humanitarian crisis for children could be devastating for the country's future. The child labor problem was fueled by a mass migration of more than five million Venezuelans that turned many children into livelihoods for their families. The pandemic has aggravated risk factors for child labor. The work ranges from working in dumps to agricultural fields, adding that children in rural areas are more likely to depend on public assistance and are at greater risk of being recruited by gangs. Some Venezuelan women and girls are traveling for hours or days to cross the Colombian border and earn money as sex workers. The complex and multifaceted reality of international migration reveals enormous challenges that directly affect the lives of children and adolescents, especially the most vulnerable, and demand urgent responses from the constituted powers and civil society in the face of countless human rights violations those people experience.