SSRI withdrawal syndrome in children and adolescents: a narrative literature review.

INTRODUCTION: While there is considerable published evidence regarding the nature and severity of Selective Serotonin Reuptake Inhibitor (SSRI) discontinuation symptoms in the adult population, information relating to the child and adolescent population remains scarce. This narrative review examined the published literature on SSRI withdrawal symptoms in the under-18-year-old age group. MEDLINE and PsycINFO were comprehensively searched from inception to 5 May 2023. AREAS COVERED: This review highlights the importance of recognizing SSRI withdrawal in children and adolescents and summarizes available literature and guidelines for safe discontinuation. EXPERT OPINION: Evidence of the presence of SSRI withdrawal phenomenon in children and adolescents mainly originates from case reports and extrapolated adult data. Existing data on SSRI withdrawal syndrome in children and adolescents is therefore limited, and there is a need for formal research in this specific population to establish with more certainty the nature and extent of SSRI withdrawal syndrome. Nevertheless, there is currently enough evidence available for prescribing clinicians to provide psychoeducation to patients and families about the possibility of withdrawal symptoms when SSRI treatment is considered. The need for gradual and planned discontinuation should also be discussed for safe withdrawal.

Improving the quality of structured clinical documentation in a child and adolescent psychiatry outpatient service: Findings from an audit cycle.

This paper summarizes a novel quality improvement initiative by a Child and Adolescent Psychiatry outpatient service to enhance the quality of clinical documentation through effective use of a standardized template. It involved carrying out an initial audit, implementation of an action plan to rectify the identified shortcomings, and completion of the audit cycle by repeating the process a year later. A significant improvement was noted across all the measurable standards. We have demonstrated that standardization of clinical documentation, reviewing and addressing factors affecting the compliance rates, and providing necessary training to doctors can all enhance the quality of clinical documentation.

COVID-19 pandemic fears and obsessive-compulsive symptoms in adolescents with pre-existing mental disorders: An exploratory cross-sectional study.

BACKGROUND: Previous research has established an association between pandemic fears and the development of obsessive-compulsive symptoms mainly in the general population. AIM: To explore whether COVID-19 pandemic fears are associated with obsessive-compulsive symptoms and vice versa in adolescents with preexisting mental and behavioural disorders. METHODS: A questionnaire-based cross-sectional study among adolescents with pre-existing mental disorders. The extent of worrying related to the COVID-19 pandemic was measured using the COVID-19 inventory whereas obsessive-compulsive symptoms were assessed using the obsessive-compulsive inventory-revised (OCI-R). Pearson correlation coefficient (r) was used to explore the relationship between COVID-19 pandemic fears and the development of obsessive-compulsive symptoms. RESULTS: A total of 57 patients out of 63 participants (90.4%) had a COVID-19 inventory score of 12 or higher suggesting that a vast majority of young people with mental disorders had significant pandemic-related worries. Out of these 57 patients, over half (31) had an OCI-R modified score of 17 or higher indicating significant obsessive-compulsive symptoms. A positive correlation was found between the means of the two scores. This relationship was statistically significant - {r = 0.405, Sig. (two-tailed) = 0.001}. CONCLUSION: Adolescents with mental disorders can exhibit significant pandemic fears and this is likely to be associated with obsessive-compulsive symptoms.

Two Sisters From Qatar With TUSC3 Genetic Mutation: Psychiatric Considerations.

Defects in the tumor suppressor candidate 3 (TUSC3) gene have been identified in individuals with autosomal recessive intellectual disability (ARID). Our report on two sisters from Qatar with a mutation in the TUSC3 gene focuses on the behavioral manifestations and management provided to them. The sisters, daughters of consanguineous parents, exhibited aggressive and impulsive behavior, along with hyperactivity and emotional dysregulation. They also exhibited abnormal sleep and eating patterns. Behavioral therapy and psychotropic medications including aripiprazole 3.75mg, clonidine 0.025mg, and guanfacine 1mg were used for the management of aggressive and agitated behavior. The two girls showed a reduction in aggressive behavior, hyperactivity, impulsivity, and insomnia in response to 2mg daily of guanfacine. Few families around the world were reported to have mutations in the TUSC3 gene resulting in intellectual disability. We describe the first two reported cases of TUSC3 gene mutation in Qatar. We encourage further research to study the effects of TUSC3 gene mutation, its manifestations, and treatment.

Masturbatory Guilt Leading to Severe Depression.

Masturbation is a common sexual behavior in humans. However, it is viewed negatively across cultures and is prohibited by almost all religions. These views lead to certain cultural beliefs that affect the sexual behavior of people and have implications on the mental health of the individual. There is limited literature linking masturbatory guilt with psychopathology. Here, we present a case in which masturbatory guilt contributed to the development of a depressive illness in a young male. The patient presented with typical symptoms of severe major depressive disorder with resulting impairment of academic and social performance. Our approach to treatment included utilizing a combination of psychotherapy, antidepressant and antipsychotic medications and vitamin supplementation with notable clinical improvement. The article highlights the importance of incorporating various cultural beliefs into an individualized treatment plan, particularly in unique cases where behaviors that may be stigmatized - perhaps wrongfully so - are involved.

Polysubstance Use Disorder After Sleeve Gastrectomy.

We describe a case of polysubstance use disorder that occurred after sleeve gastrectomy. Alcohol, cannabis, and stimulant use disorder was diagnosed a few years after the bariatric surgery when the patient developed a substance-induced psychotic disorder. Treatments included psychotropic medications to treat his psychosis and involvement in a drug rehabilitation and relapse prevention program. This case highlights the importance of a preoperative assessment of substance use risk in patients undergoing bariatric surgeries as well as the need for close follow-up postoperatively.