Performance-Based Assessment in Child and Adolescent Psychiatry Residency Training.

OBJECTIVE: This study aimed to examine the application of the Objective Structured Clinical Examination (OSCE) to the assessment of competency among child and adolescent psychiatry (CAP) residents and to analyze the feedback from the residents and the examiners. METHODS: The OSCE was administered to 53 CAP residents based on three seniority levels over a 14-year period. The results of 147 OSCEs applied to residents and the feedback received were evaluated. OSCE scores were calculated based on the scores given by the examiners and standardized patients (SPs). RESULTS: Examiners' communication skills scores were significantly higher than examiners' task performance scores but were not significantly different than the SPs' scores. Intraclass correlation coefficients indicated that examiners and SPs were very consistent in their assessments among themselves. The scores given by the examiners and the SPs were not different between genders except for female residents' communication skills scores given by SPs in the OSCE-senior. With regard to the feedback on the OSCE, it was determined that examiners gave significantly higher scores than residents on every item except for "neutrality of the examiners." CONCLUSIONS: A standard OSCE including different station types was structured to assess the progressive clinical skills of residents over the years. Using the OSCE contributed to CAP residency training far beyond assessment, creating a useful educational experience for both the trainers and the residents. Despite the challenge experienced related to SPs, the OSCE was found to be useful in improving training programs.

Cerebellar volume in early-onset schizophrenia and its association with severity of symptoms.

OBJECTIVES: This study aimed to investigate whether early-onset schizophrenia (EOS) cases differ from controls regarding volumes of the total cerebellum and the right and left cerebellar hemispheres, and volumetric asymmetry. Correlations of cerebellar volumes and asymmetry indices with severity of symptoms and general functioning in cases of EOS were also assessed. METHODS: Adolescents with EOS (n = 23) were compared with controls (n = 23). Sociodemographic and clinical data, and magnetic resonance imaging scans that were acquired for routine clinical purposes were collected retrospectively. Cerebellar volumes were evaluated using the stereological method. Asymmetry indices were subsequently calculated. Scores of the Positive and Negative Syndrome Scale and the Children's Global Assessment Scale were used to assess the severity of symptoms and general functionality. RESULTS: There were no significant differences in any of the cerebellar volumes and asymmetry indices between the two groups. Neither cerebellar volumes nor asymmetry indices were correlated with the severity of symptoms and general functionality in EOS. CONCLUSIONS: Our findings suggest that the early-onset form of schizophrenia does not show apparent volumetric changes of the cerebellum. Additionally, the neural circuits involved in formation of symptomatology may not reflect any correlation with cerebellar volumes at mid-adolescence.

Do serum BDNF levels vary in self-harm behavior among adolescents and are they correlated with traumatic experiences?

The aim of this study was to compare serum brain-derived neurotrophic factor (BDNF) levels between adolescents that harm themselves, those that receive psychiatric treatment but do not harm themselves, healthy adolescents, and childhood traumas and to investigate the relationship between traumatic experiences and serum BDNF levels. The cases were divided into two groups of 40 adolescents exhibiting self-harm behavior (self-harm/diagnosed group) and 30 adolescents receiving psychiatric treatment but not exhibiting self-harm behaviors (non self-harm/diagnosed group). The control group (healthy control group) consisted of 35 healthy adolescents with no psychiatric disorders or self-harm behaviors. The adolescents were asked to fill in the Inventory of Statements About Self Injury (ISAS) and Childhood Trauma Questionnaire (CTQ). For BDNF measurement, blood samples were taken from the cases and controls. The serum BDNF level of self-harming adolescents who used the self-cutting method was significantly lower than that of other groups, and serum BDNF levels decreased with the increase in the emotional neglect and abuse severity of self-harming adolescents during childhood. In our study, serum BDNF levels decreased with the increase in emotional abuse in self-harming adolescents. This finding may indicate that neuroplasticity can be affected by a negative emotional environment during the early period.

Factors affecting improvement of children and adolescents who were treated in the child and adolescent psychiatry inpatient unit.

Objective This study aimed to assess the correlates and predictors of improvement in general functioning of children and adolescents who are treated in the child and adolescent psychiatry (CAMHS) inpatient unit. Methods Hospital records of 308 children and adolescents who were treated for at least 1 month in the CAMHS inpatient unit from 2005-2016 were included. Associations with individual, familial, and clinical variables and the difference in Children's Global Assessment Scale (ΔCGAS) scores at admission and discharge were evaluated. Results Positive predictors of ΔCGAS were older age and lower CGAS scores at admission, whereas high familial risk scores at admission and diagnosis of early-onset schizophrenia negatively predicted ΔCGAS (B = 0.698, p = 0002; B = -0.620, p < 0.001; B = -0.842, p = 0.002; B =-9.184, p = 0.000, respectively). Familial risk scores were significantly and negatively correlated with ΔCGAS (p = 0.004, Spearman's rho = -0.2). Conclusions This study indicates that improvement in general functioning during inpatient treatment in CAMHS is better at an older age and with lower general functioning at admission. However, high familial risks and diagnosis of early-onset schizophrenia weakens this improvement.

Do mothers with high sodium levels in their breast milk have high depression and anxiety scores?

Objective This study aimed to assess the possible association of high breast milk sodium levels with postpartum depression and anxiety. Methods A total of 150 mothers and their healthy, exclusively breastfed newborns aged 8 to 15 days were recruited. Mothers were asked to complete scales for evaluation of postnatal depression and anxiety following an interview for consent and sociodemographic data collection. Breast milk samples were obtained to measure sodium and potassium (K) levels. Results Forty-nine mothers had higher than expected breast milk Na concentrations and a high Na/K ratio. These mothers scored significantly higher on the scales of postnatal depression and state anxiety ( P = 0.018 and P = 0.048, respectively). Conclusions This study shows that compared to normal breast milk Na levels and Na/K ratio, high breast milk Na and high Na/K ratio, with possible serious consequences in infants, are associated with maternal depressive and anxious symptoms in the postpartum period.

Forensic child and adolescent psychiatry: from field experiences to education standards.

OBJECTIVE: Forensic evaluation of children is one of the most problematic areas of child and adolescent psychiatry. In this study we aimed to examine Turkish Child and adolescent psychiatrists' attitudes and problems in forensic psychiatry. METHOD: Thirty nine (80%) of all practitioners who are on their compulsory medical service programme countrywide were reached and requested to complete a questionnaire. RESULTS: 76.9% of the specialists found their education to be inadequate in dealing with practical issues. The most common reason of this inadequacy was endorsed as not receiving structured forensic evaluation training. The inadequate number or skills of health professionals from other disciplines and excessive workload were the leading factors mentioned as negatively affecting the quality of assessments. Most favoured solutions to solve current problems were reported as reorganising the residency training and curriculum of child and adolescent psychiatrists and establishing education programmes for other disciplines. CONCLUSION: The standardisation of forensic psychiatry education in child and adolescent psychiatry training and the establishment of global standards for forensic evaluation teams and processes should be considered as the first steps in enhancing the global quality of child and adolescent forensic psychiatric evaluations.