Bullying Victimization in Children and Adolescents and Its Impact on Academic Outcomes.

ABSTRACT: Bullying victimization has been identified as a significant factor influencing academic outcomes. We sought to evaluate the educational outcomes and psychiatric comorbidities in children and adolescents who are victims of bullying using the National Survey of Children's Health dataset for the study. The participants were children and adolescents (age: 6-17 years) categorized into two groups: group 1, not bullied (n = 21,015), and group 2, bullied more than once (n = 21,775). Individuals whose health status was fair or poor have experienced more bullying (2.4% vs. 1.4%, p < 0.001). Individuals in the group 2 were more likely to repeat the grades than the group 1 (7.1% vs. 5.9%, p = 0.039). Individuals who were missing ≥11 school days and sometimes or never engaged in school were observed to be more in the group 2 compared with the group 1 (5.9% vs. 3.2% and 20.3% vs. 10.6%, p < 0.001). In conclusion, bullying victimization could be a risk factor and associated with decreased academic outcomes.

Shortage of Mental Health Professionals Doing Research: A Cause for Concern.

ABSTRACT: Research plays a crucial role in advancing health care. Physician scientists, who bring together clinical and scientific perspectives, are integral to this effort. However, the pursuit of research careers among physicians has declined due to several obstacles, including inadequate support, training, time, and financial constraints. Emergency medicine and psychiatric specialties receive less support than other specialties, and COVID-19 has worsened the challenges. The COVID-19 has made things harder for physician scientists, increasing clinical demands and causing research delays. To tackle this, future physician scientists should receive organized training that includes mandatory research activities during their training. Large-scale studies should identify barriers to research and offer mentoring for young physician scientists. Encouraging female researchers and involving research faculty in residency training is crucial. Collaboration between physician and PhD researchers is essential for the future of medical research. It is vital to address these to advance health care and improve mental health outcomes.

Cannabis Pen-Induced Psychosisin a First-Time Adolescent User.

Cannabis is a widely used illicit substance that is historically consumed via smoking, but alternative methods of cannabis consumption have been growing in popularity over the past several decades. One such modality is vaporization, which can appeal specifically to adolescent consumers given these pen devices' ease of concealment, lack of characteristic odor, and marketability. Cannabis products designed for vaping often have higher concentrations of the psychoactive component of cannabis, tetrahydrocannabinol (THC), when compared with traditional cannabis leaf smoking. This can increase the intensity of cannabis-related effects such as analgesia, relaxation, appetite stimulation, and reduced nausea and emesis, but also potentially increases the risk for adverse effects such as dysphoria, and more severely, cannabis-induced psychosis (CIP). Here, we present the case of an adolescent female who was brought after school to our emergency department presenting with symptoms of acute psychosis. Her subsequent workup was effectively normal apart from a urine drug screen positive for THC, which the patient confirmed was due to use of a cannabis pen prior to leaving school that day. This prompted the diagnosis of CIP, which was self-limited and resolved without significant intervention. We use this case to provide the symptomatology and treatment of CIP secondary to cannabis pen use, as well as more broadly discuss the potential implications of cannabis vaping on adolescent neurodevelopment, substance use, and psychiatric comorbidities.

Efficacy of Cognitive Behavioral Therapy for Insomnia for the Treatment of Child and Adolescent Anxiety and Depression: A Systematic Review From Randomized Controlled Trials.

ABSTRACT: Cognitive behavioral therapy for insomnia (CBT-I) has shown promising results in the adult population. However, there is not enough evidence for children and adolescents. Hence, we evaluated the current evidence of CBT-I in the treatment of anxiety and depression in children and adolescents. Published randomized clinical trials published before June 2020 were searched from PubMed, Cochrane Library of database, clinicaltrials.gov, and Google Scholar. Out of seven included studies, six studies assessed the effect of CBT-I on depression, and five assessed the effect on anxiety. In this review, most studies in this review showed a strong effect of CBT-I on symptoms of depression. Although a positive effect of CBT-I on anxiety was noted, only a small number of studies have considered this management. These findings should be considered preliminary, and further large-scale studies are warranted to further explore this finding further.

Homicidal ideation and psychiatric comorbidities in the inpatient adolescents aged 12-17.

Objectives: Adolescents with a homicidal tendency is a growing concern in the United States. Studies in the past have showcased the relationship between homicidal ideation (HI) and psychiatric illnesses, but very limited information is available on the adolescent and inpatient population. We aim to evaluate the prevalence of demographic characteristics and psychiatric disorders in adolescents with and without HI. Materials and methods: Adolescent (age 12-17) population admitted to the hospital with the diagnosis of homicidal ideation was identified from the 2016-2018 National Inpatient Sample Dataset (NISD). Patients without HI were defined as the control group. The prevalence of psychiatric comorbidities between the groups was compared by applying the Rao-Scott adjusted chi-square test. We used multivariable logistic regression to generate odds ratio (OR) of homicidal ideation as an outcome; we adjusted age, sex, race, socioeconomic status, substance use disorders, alcohol use disorders, and psychiatric comorbidities. Results: A total of 18,935 patients (mean age: 14.5) with HI diagnosis were identified in this study. Majority of the patients were male subjects in the HI group compared to the control group (58.7 vs. 41.2%, p < 0.001). Racially, HI was more prevalent in white race (56.0 vs. 52.6%, p < 0.001) and black race (22.3 vs. 17.8%, p < 0.001), compared to Hispanic race (14.9 vs. 21.3%, p < 0.001). Major depression (Odds ratio [OR]: 2.66, p < 0.001), bipolar disorder (OR: 3.52, p < 0.001), anxiety disorder (OR: 1.85, p < 0.001), ADHD, and other conduct disorders (OR: 4.01, p < 0.001), schizophrenia (OR: 4.35, p < 0.001) are strong predictors of HI. Suicidality was prevalent in 66.9% of patients with HI. Conclusion: We found a higher prevalence of psychiatric illnesses such as depression, anxiety, and bipolar disorder in adolescents with homicidal ideation in the inpatient setting. White and black races were more prevalent in patients with homicidal ideation. Further large-scale longitudinal research studies are warranted to establish the correlation between psychiatric disorders and homicidal ideation among adolescents.

The role of metformin in treatment of weight gain associated with atypical antipsychotic treatment in children and adolescents: A systematic review and meta-analysis of randomized controlled trials.

Introduction: Second-generation antipsychotics are associated with significant weight gain. The aim of this systematic review and meta-analysis was to determine the efficacy and safety of metformin for the treatment of weight gain in children and young adults treated with second-generation antipsychotics. Methods: We followed PRISMA guidelines to evaluated studies published before March 2020 in Medline, Google Scholar, PubMed, Cochrane library database, annual scientific sessions of the American Psychiatric Association, American Academy of Child and Adolescent, Psychiatry, and American Society of Clinical Psychopharmacology. Studies included compared metformin with the placebo for management of weight gain in children and adolescents taking atypical antipsychotics. Non-randomized studies, animal experiment studies, editorials, and review studies were excluded. Multiple parameters, including change in anthropometric-biochemical parameters, drug discontinuation rate, and side effects among the groups were assessed. The random-effects method was used for meta-analysis. Results: Four studies with were included in the final analysis (213 patients; metformin: 106; control: 107). After pooled analysis, 12-16 weeks of metformin therapy was associated with a significant reduction in weight [(mean difference (MD): -4.53 lbs, confidence interval (CI): -6.19 to -2.87, p-value < 0.001)], and BMI z score [MD, -0.09, CI: -0.16, -0.03, p-value: 0.004] compared to control. Metformin was also associated with a significant reduction in insulin resistance [MD: -1.38, CI: -2.26 to -0.51, p-value: 0.002]. There were higher odds of nausea-vomiting [OR: 4.07, CI: 1.32-12.54, p-value: 0.02] and diarrhea [OR: 2.93, CI: 1.50-5.71, p-value: 0.002] in the metformin group. However, there was no difference in drug discontinuation rate [OR: 1.45, CI: 0.41-5.06, p-value: 0.56]. Conclusion: Metformin may prove beneficial in the treatment of weight gain in children treated with second-generation antipsychotics. The pooled treatment effect showed a significant reduction in BMI Z-score and weight in just 12-16 weeks. The limitations include small sample size, variation in metformin dose, and duration of treatment. This meta-analysis should be interpreted as promising, and further larger studies are warranted before drawing a conclusion.

Burden of Psychiatric Disorders in Moyamoya Disease: A National Inpatient Perspective From 2007-2014.

Objective: Moyamoya disease is a cerebrovascular illness that causes progressive stenosis of the intracranial internal carotid arteries and their proximal branches, increasing the risk of stroke. Moyamoya disease is associated with a small number of neuropsychiatric symptoms. The objective of this study was to investigate psychiatric comorbidities and trends in patients with Moyamoya disease in the United States.Methods: US National Inpatient Sample data from 2007 to 2014 were used for analyses in this cross-sectional study. The frequency of psychiatric and nonpsychiatric disorders among adult patients with known Moyamoya disease was assessed. Baseline demographics included in the analysis and diagnostic codes used to identify psychiatric disorders were determined. Categorical and continuous data were assessed using Pearson χ2 test and Mann-Whitney U test, respectively. All analyses were conducted using SPSS version 22.0.Results: The prevalence of psychiatric comorbidities was 38.7% (7,861/20,289). The most common psychiatric disorders were mood disorders (17.8%) and anxiety disorders (8%). Psychosis and drug abuse were present in 4.4% and 4.1% of patients, respectively. Approximately 1 in 4 patients (22.2%) with Moyamoya disease had previously been screened for mental health or substance abuse. The rate of suicide or self-inflicted injury was 0.8%.Conclusions: The impact of Moyamoya disease on mental health services is expected to grow, as the condition's prevalence is increasing at a rate of approximately 1.5- to 2-fold. A multidisciplinary approach between neurology, psychiatry, and primary care can improve screening and management of comorbid psychiatric disorders.

Amorphization of Drugs for Transdermal Delivery-a Recent Update.

Amorphous solid dispersion is a popular formulation approach for orally administered poorly water-soluble drugs, especially for BCS class II. But oral delivery could not be an automatic choice for some drugs with high first-pass metabolism susceptibility. In such cases, transdermal delivery is considered an alternative if the drug is potent and the dose is less than 10 mg. Amorphization of drugs causes supersaturation and enhances the thermodynamic activity of the drugs. Hence, drug transport through the skin could be improved. The stabilization of amorphous system is a persistent challenge that restricts its application. A polymeric system, where amorphous drug is dispersed in a polymeric carrier, helps its stability. However, high excipient load often becomes problematic for the polymeric amorphous system. Coamorphous formulation is another approach, where one drug is mixed with another drug or low molecular weight compound, which stabilizes each other, restricts crystallization, and maintains a single-phase homogenous amorphous system. Prevention of recrystallization along with enhanced skin permeation has been observed by the transdermal coamorphous system. But scalable manufacturing methods, extensive stability study and in-depth in vivo evaluation are lacking. This review has critically studied the mechanistic aspects of amorphization and transdermal permeation by analyzing recent researches in this field to propose a future direction.

Does Insomnia Increase the Risk of Suicide in Hospitalized Patients with Major Depressive Disorder? A Nationwide Inpatient Analysis from 2006 to 2015.

Introduction. Insomnia is an important symptom associated with major depressive disorder (MDD). In addition, it is one of the risk factors for suicide. Studies have shown the relationship be-tween insomnia and suicidal behavior in patients with MDD. However, this association has not been evaluated in a large sample of hospitalized patients. Objectives. To evaluate the suicidal be-havior in MDD patients with insomnia compared to those without insomnia. Methods. From the National Inpatient Sample (NIS 2006−2015) database using the ICD-9 code, patients' data were obtained with the primary diagnosis of MDD and comorbid diagnosis of insomnia disorders (MDD+I). These patients were compared with MDD patients without insomnia disorders (MDD−I) by performing a 1:2 match for the primary diagnosis code. Suicidal ideation/attempt da-ta were compared between the groups by multivariate logistic regression analysis. Results. After the diagnostic code matching, 139061 patients were included in the MDD+I group and 276496 patients in the MDD−I group. MDD+I patients were older (47 years vs. 45 years, p < 0.001) com-pared to the MDD−I group. The rate of suicidal ideation/attempt was 56.0% in the MDD+I group and 42.0% in the MDD−I group (p < 0.001). After adjusting for age, sex, race, borderline personal-ity disorders, anxiety disorders, and substance use disorders, 'insomnia' was associated with 1.71 times higher odds of suicidal behavior among MDD patients admitted to the hospital. (Odds ratio: 1.71, 95% confidence interval 1.60−1.82, p < 0.001). Conclusions. Insomnia among MDD patients is significantly associated with the risk of suicide. MDD patients with insomnia need to be closely monitored for suicidal behavior.

Initial Presentation of OCD and Psychosis in an Adolescent during the COVID-19 Pandemic.

The COVID-19 pandemic is unparalleled in recent history when accounting for the true disease burden and dramatic impact on physical and mental health. Due to its infectious pathology, COVID-19 presents with a variety of symptoms including neuropsychiatric complications. Moreover, factors such as quarantine, social isolation, and fear of illness have negatively impacted the health of non-COVID-19 patients. There has been significant literature reporting new-onset psychiatric illness in all global populations including those without history of psychiatric illness. This report discusses an adolescent male without prior psychiatric history presenting with new onset symptoms of obsessive-compulsive disorder and psychosis in the context of COVID-19. There are considerable reports describing new-onset obsessive-compulsive disorder, albeit conflicting in terms of prevalence and exacerbations in the setting of COVID-19 in both adult and adolescent populations but limited reports of new-onset psychosis in those same populations and setting.

The Promise of Predictive Biomarkers for Antipsychotic Efficacy: A Review of Peripheral microRNAs to Evaluate Schizophrenia Treatment Response.

With the ongoing evolution in genetics, recent evidence highlights the role of circulatory microRNA (miRNA) for schizophrenia. The objective of this article is to explore the role of blood/serum miRNA expression in schizophrenia management and to review the expression of different miRNAs before and after treatment with antipsychotics. miRNAs can help increase the accuracy of diagnosis, identify patients at risk of developing schizophrenia, and possibly predict drug response. The collective evidence from this review showed that several miRNAs are promising candidates for schizophrenia diagnosis, management, and prognosis.

Pimavanserin in the Treatment of Parkinson's Disease Psychosis: Meta-analysis and Meta-regression of Randomized Clinical Trials.

Background: Up to 60 percent of patients with Parkinson's disease (PD) develop Parkinson's disease psychosis (PDP). PDP is associated with a significant economic burden. The management of PDP has been divided into two approaches-one focuses on decreasing the doses of anti-Parkinsonian medications and the other involves prescribing atypical antipsychotics. Of these atypical antipsychotics, pimavanserin is United States (US) Food and Drug Administration (FDA)-approved specifically for the treatment of PDP. Objective: The goal was to evaluate the safety and efficacy of pimavanserin in the treatment of PDP based on data from randomized clinical trials. Methods: All the articles, which assessed pimavanserin's effect on the treatment of PDP, were retrieved from Google Scholar, PubMed, and abstracts from annual scientific sessions. The data on dose, therapy duration, patient numbers, and study duration were collected. These data were analyzed with random effect modeling using the inverse variance method and the Mantel-Haenszel method. Results: Four studies comparing pimavanserin to a placebo provided data on 680 patients (263 placebo, 417 pimavanserin). Treatment with pimavanserin was associated with a significant reduction in scores using the Scale of Assessment of Positive Symptoms, Hallucinations, and Delusion (SAPS-H+D) (mean difference [MD]: -1.55 [-2.71, -0.379], p=0.009). The groups had similar composite scores for Unified Parkinson's Disease Rating Scale II and III (UPDRS II and III) (MD: 0.093 [-1.28, 1.46], p=0.89). Interestingly, pimavanserin was protective against orthostatic hypotension (risk ratio: 0.33 [0.30, 0.37], p<0.001). All other adverse events were similarly distributed across both groups. Conclusion: There was a significant improvement in psychosis symptoms in patients with PD who took pimavanserin. Pimavanserin was also shown to be protective against orthostatic hypotension.

Increased Suicidality and Worse Outcomes in MDD Patients With OSA: A Nationwide Inpatient Analysis of 11 Years From 2006 to 2017.

BACKGROUND: Major depressive disorder (MDD) is the most common psychiatric disorder characterized by changes in mood, cognition, and physical symptoms. MDD has an approximate 18% prevalence of comorbid OSA. Several studies have looked into plausible mechanisms that have shown a strong relationship between OSA and MDD. OBJECTIVES: The primary objective of this study was to compare suicidal ideation/attempt among MDD patients with and without a comorbid diagnosis of OSA. The secondary objective was to compare the length of stay, total hospital charge, recurrent or severity of depression, and clinical comorbidities. METHODS: Data were obtained from the National (Nationwide) Inpatient Sample dataset from 2006 to 2017. For data collection, we queried for all adult patients (age ≥ 18 y), with MDD as a primary indication of admission. Further, we categorized MDD patients with and without a secondary diagnosis of OSA. To reduce the imbalance in baseline characteristics between the groups, we performed one to one age-gender matching between MDD patients with and without OSA. RESULTS: In the matched cohort, 79,308 patients were included in MDD with OSA and 78,792 patients in the MDD without OSA group. MDD patients with OSA were more likely to be racially white (80% vs 75%, P < 0.001), and to have more clinical comorbidities (hypertension, heart failure, obesity, and chronic lung disease). Prevalence of recurrent type of depression (77% vs 69%, P < 0.001) and moderate to severe depression (72% vs 68%, P < 0.001) was more likely in the MDD with OSA group. Further, suicidality (composite of suicidal ideation/attempt) was more in MDD with OSA (49.5%) compared to MDD without OSA (41.8%) (P < 0.001). In the multivariate analysis, MDD with OSA was associated with higher odds of suicidal ideation/act compared to MDD without OSA (adjusted odds ratio: 1.27, P < 0.001). The total length of stay was longer in the MDD with OSA group (7.4 vs 6.9 d, P < 0.001). CONCLUSIONS: In our study, poorer outcomes were observed in patients with MDD and OSA. Hence, clinicians should be vigilant for symptoms of OSA in patients with recurrent MDD or treatment-resistant MDD. We recommend that a thorough suicide risk assessment should be conducted in MDD patients with OSA, and validated questionnaires should be a part of the evaluation.

Mnemonic Discrimination Deficits in First-Episode Psychosis and a Ketamine Model Suggest Dentate Gyrus Pathology Linked to NMDA Receptor Hypofunction.

BACKGROUND: Converging evidence from neuroimaging and postmortem studies suggests that hippocampal subfields are differentially affected in schizophrenia. Recent studies report dentate gyrus dysfunction in chronic schizophrenia, but the underlying mechanisms remain to be elucidated. Here, we sought to examine if this deficit is already present in first-episode psychosis and if NMDA receptor hypofunction, a putative central pathophysiological mechanism in schizophrenia, experimentally induced by ketamine, would result in a similar abnormality. METHODS: We applied a mnemonic discrimination task selectively taxing pattern separation in two experiments: 1) a group of 23 patients with first-episode psychosis and 23 matched healthy volunteers and 2) a group of 19 healthy volunteers before and during a ketamine challenge (0.27 mg/kg over 10 min, then 0.25 mg/kg/hour for 50 min, 0.01 mL/s). We calculated response bias-corrected pattern separation and recognition scores. We also examined the relationships between task performance and symptom severity as well as ketamine levels. RESULTS: We reported a deficit in pattern separation performance in patients with first-episode psychosis compared with healthy volunteers (p = .04) and in volunteers during the ketamine challenge compared with baseline (p = .003). Pattern recognition was lower in patients with first-episode psychosis than in control subjects (p < .01). Exploratory analyses revealed no correlation between task performance and Repeatable Battery for the Assessment of Neuropsychological Status total scores or positive symptoms in patients with first-episode psychosis or with ketamine serum levels. CONCLUSIONS: We observed a mnemonic discrimination deficit in both datasets. Our findings suggest a tentative mechanistic link between dentate gyrus dysfunction in first-episode psychosis and NMDA receptor hypofunction.

Association Between Major Depressive Disorder and Sleep Disturbances Through Inflammation in Adolescents.

BACKGROUND: Although approximately 13% of adolescents suffer from Major Depressive Disorder (MDD), and many adolescents have reported sleep disturbances, the relationship between sleep disturbances and MDD in adolescents is poorly understood. Thus, our objective was to study how adolescent MDD was related to sleep disturbances in a cross-sectional study, and the potential role of inflammation linking adolescent MDD to sleep disturbances. METHODS: Ninety-two female and male, African American and White, adolescents aged 15 to 18 years completed the study. Adolescents were diagnosed with MDD according to the Diagnostic and Statistical Manual of Mental Disorders-5 as confirmed by the MINI International Diagnostic Interview. The severity of depression was assessed using the Quick Inventory of Depressive Symptomatology. Sleep disturbance was measured using the Pediatric Sleep Questionnaires (PSQ). Blood sample was collected from each participant for measuring the inflammatory factors. RESULTS: Compared with the controls (n=39), adolescents with MDD (n=53) had greater PSQ scores (0.32 ± 0.02 vs. 0.10 ± 0.02). In adolescents with MDD, PSQ scores were correlated with the severity of depressive symptoms (r=0.31, p<0.05). In addition, tumor necrosis factor-α levels were greatly elevated in the MDD group (2.4 ± 0.1 vs. 1.8 ± 0.1 pg/ml) compared with the controls. Severity of depressive symptoms was best predicted by PSQ scores, medications, and childhood experiences. CONCLUSIONS: Sleep disturbance measured by the PSQ is associated with severe depressive symptoms in adolescents, and one potential pathway may be through elevated tumor necrosis factor-α. Further research is warranted to probe a cause and effect relationship among sleep disturbances, MDD, and chronic inflammation.