Editorial Perspective: Rethinking child and adolescent mental health care after COVID-19.

While COVID-19 pandemic has allegedly passed its first peak in most western countries, health systems are progressively adapting to the 'new normality'. In child and adolescent mental health services (CAMHS), such organizational envisioning is needed to cope with the foreseeable psychological effects of prolonged social isolation induced by nation-wide public health measures such as school closure. CAMHS need to ensure flexible responses to the psychopathological consequences of evolving societal dynamics, as dramatically actualized by the unexpected COVID-19 pandemic. This would imply (a) shifting the focus of intervention from symptom reduction and containment of acute crises in a comparatively small number of severe cases to a broader preventive strategy, guided by a gradient of increasing intensity and specificity of treatment; (b) promoting smooth access pathways into services and encouraging participation of families; (c) adopting a transdiagnostic staging model to capture the developmental fluctuations from subsyndromal to syndromal states and back, with related changes in the intensity of the need of care; and (d) implementing digital tools to encourage help-seeking and compliance by digitally native youth.

Disentangling pediatric bipolar disorder and attention deficit-hyperactivity disorder: A neuropsychological approach.

The clinical and diagnostic debate circulating pediatric bipolar disorder (PBD) has been highlighted as one of the most controversial themes in child psychiatry. With atypical symptomatic expression, constituting its predominant diagnostic discrepancy, PBD is manifested through prolonged manic episodes and affective storms, lacking the symptomatic cycling and episodic nature presented in adult BD. Apart from its unique clinical presentation, the substantial symptomatic overlap with attention deficit hyperactivity disorder (ADHD) indicate an important diagnostic challenge in PBD. Specifically, both disorders share core characteristics such as irritability, hyperactivity, excessive talking and distractibility. Against this background of findings on the overlapping symptomatology between PBD and ADHD, current research guidelines highlight the need of exploring non-symptomatic markers as potential clinical phenotypes. Especially in disorders with distinctive biologic underpinnings, both clinicians and researchers have shown increased interest in establishing neuropsychological profiles. Recent neuropsychological studies indicated the distinct nature of neurocognitive deficits in PBD, describing impairments in various cognitive skills during acute episodes phases, while this severe deterioration of cognitive deficits appears to persist even during euthymic states. Regarding neuropsychological assessment in AHD, recent findings suggested dysfunctions in the domains of working memory, verbal memory and response inhibition. Furthermore, neuroimaging studies are fast becoming a key instrument to establish distinct neuropsychological profiles for PBD and ADHD. A large number of neuroimaging studies have indicated abnormalities in limbic, cortical and subcortical brain systems, while meta-analytic findings of voxel based morphometric studies highlight abnormalities in dorsolateral and lateral orbitofrontal-temporal areas in PBD. In recent neuroimaging findings with focus on neurocognitive performance during an emotional Stroop task, patients diagnosed with ADHD indicated activation on higher cortical centres associated with processing speed and significantly decreased role of sustained attention. Furthermore, these findings suggest emotional regulation and inhibitory control are moderately intercorrelated, adding more complexity to the theme of neurocognitive deficits in ADHD. These observations on the neurobiological mechanisms of cognitive impairments in PBD appear to provide robust evidence on a potential specific neuropsychological profile of PBD, the relationship between mood states and neuropsychological functioning, and the link between emotion generation and regulation in children with PBD.

The prevalence of childhood mental disorders in different habitations: are we underestimating their prevalence in rural areas?

Background: Recently, the number of epidemiological studies of child psychiatry has increased, but most of these studies focus on children living in city centres. Unfortunately, one-third of the global population lives in rural areas, and various habitations exist in cities, including city centres and slums. Moreover, despite having a high risk for psychopathology development, individuals who have symptoms but fall outside the limits specified for diagnoses due to having fewer symptoms than those mentioned in diagnostic systems and individuals who do not fulfil the impairment criteria listed in diagnostic systems are not addressed in these studies.Aim: The purpose of this study was to understand the prevalence of DSM-IV childhood psychiatric disorders and subthreshold psychiatric problems from middle-class city centres, city centres in slums, towns and village areas of Turkey with a nationally representative sample using a state-of-the-art methodology.Methods: In total, 1080 children were randomly selected from second and third grades for the study's sample. A structured diagnostic interview was applied.Results: The overall prevalence of psychiatric disorders was 8.4% (n = 91); 7.2% (n = 78) of the children were subthreshold cases. The general prevalence of psychiatric disorders was higher among children living in villages with respect to all the other human settlement areas included in the study.Conclusions: Although global urbanisation foregrounds the mental health of children living in cities, children in rural areas may have a greater risk of developing a mental disorder. This study confirmed that an equal amount of children fell outside of the diagnosing limits.

A 15-year follow-up of former self-harming inpatients in child & adolescent psychiatry - a qualitative study.

Purpose: Self-harm is common among adolescents, and is even more frequent among psychiatric populations. The aim of this study was to increase knowledge and understanding of different aspects of life for adults who, when adolescents, had engaged in severe self-harm during inpatient stays.Material and methods: Individual semi-structured interviews were held with seven former inpatients with a history of severe self-harm during inpatient stay in their adolescence. The interviews were analysed using a qualitative method, and the results were described in the form of categories and sub-categories.Results: Five categories, with 16 sub-categories, were found to be related to the former patients' experiences of their lives. At the time of the interviews, the subjects were in their early thirties and had no ongoing self-harm. In childhood they had experienced a dysfunctional relationship with one or both of their parents, and self-harm was one of several destructive behaviours. Friendships outside the unit were difficult during adolescence. Soon after admission to the psychiatric inpatient unit, relationships with other patients became important and contributed to them wanting to stay at the unit. Meaningful relationships and being part of a social context with healthy expectations were seen as important factors for stopping self-harm at a later stage. The subjects' experiences of their life today ranged from not enjoying it to accepting their current situation.Conclusion: These findings are based on a small sample, but they indicate the importance of relationships and the social context in contributing to and then ending self-harm.

Better than Better: The New Focus on Well-Being in Child Psychiatry.

Training and practice within child psychiatry has focused predominantly on mental illness rather than mental health. A growing body of evidence, however, is demonstrating the importance for clinicians also to be able to focus directly on enhancing positive traits and emotions and increasing well-being and health promotion in their patients. This complementary aspect of mental health care has been called well-being and positive psychiatry, among other terms. Being able to apply these principles to standard practice requires new knowledge, skills, and attitudes that are not part of traditional psychiatric training.

Make a Joyful Noise: Integrating Music into Child Psychiatry Evaluation and Treatment.

Music is a significant part of daily life for most youth, affording clinical opportunities to cultivate positive emotions, engagement, relationships, meaning, and accomplishment. Clinical inquiry into what types of music elicit different emotions, how music fits into daily life routines, how music connects one to others, and how music anchors life events can improve the clinician-patient alliance and patient well-being practices. Music may be useful in home and school settings to help youth manage diverse moods. Practicing an instrument effectively accelerates accomplishment and pleasure, which applies to other life activities.

[History and current challenges of paediatric psychiatry in maternity units]. / Historique et défis actuels de la pédopsychiatrie en maternité.

The legal framework of mother-baby care has evolved over the last thirty years driven by innovative programmes put in place by hospital health professionals. Liaison in perinatal care lies at the crossroads of different temporalities and treatment objectives, and requires constant dialogue between the liaison caregivers and those in maternity. The aim is to form a holding environment facilitating the establishment of an adapted response to the complexity of the clinical situations encountered.

[50 years specialty for child and adolescent psychiatry in Germany. History, current situation, and future perspectives]. / 50 Jahre Facharzt für Kinder- und Jugendpsychiatrie in DeutschlandGeschichte, Gegenwart und Zukunftsperspektiven 1.

50 years specialty for child and adolescent psychiatry in Germany. History, current situation, and future perspectives Abstract. Abstracts: Method: Review of the historical background and implementation of an independent medical specialty "child and adolescent psychiatry" (CAP) in Germany. Results: The implementation of an independent specialty for CAP in 1968 was crucial for the progressive further development of the discipline. The Enquête Commission "Psychiatry" of the Federal Government, followed by the Model Program "Psychiatry", the Staff Regulations for Psychiatry, the Agreement on the Social Psychiatry and the Psychotherapy Act have had significant impact on the care for psychiatrically ill children and adolescents and their families. This led to an institutional anchoring of new structures, covering three of the four leading principles of the Model Program, namely integration into medicine, community-based and appropriate care. Equality of psychiatric patients with other patient groups has, nevertheless, not yet been achieved and is still to be claimed. Current and future challenges are: (1) The realistic evaluation of new research methods and epochal trends and elimination of opposites, (2) the establishment of future-oriented research initiatives, (3) the intensive promotion of clinical and scientific staff members, and (4) a renewed attention for the subjective perspective of the illness. Conclusions: The implementation of an independent specialty "child and adolescent psychiatry" was an important stimulus for the further development of the discipline. Essential demands for the future will be: the integration of CAP into the curriculum for medical students and the promotion of young researchers within the scope of regional and supra-regional projects.

Building Child and Adolescent Psychiatry Expertise in Ghana Through Training and Knowledge Dissemination: a Review of the Initial Collaboration Stages, Opportunities, and Challenges.

PURPOSE OF REVIEW: Improving child and adolescent mental health (CAMH) is a priority worldwide. The majority of children with psychiatric conditions in low-middle-income countries (LMIC), like Ghana, receive no treatment due largely to limited resources and few CAMH training opportunities. The Komfo Anokye Teaching Hospital (KATH) and University of Michigan (UM) established a partnership to expand CAMH training for general psychiatrists in Ghana. Lessons learned from the early stages of the collaboration can serve as an adaptable roadmap for similar efforts to expand CAMH training in LMIC. RECENT FINDINGS: Previous articles have discussed global academic partnership, training, and capacity building programs; however, early challenges, opportunities, and preparatory stages involved in creating a mutually beneficial collaboration aimed at improving child psychiatry expertise in a LMIC are under explored in the global mental health literature. This article seeks to fill that gap by using examples to highlight unique considerations for institutions in the initial stages of establishing their global partnership. The early stages of a global partnership can impact the success of the collaboration. Collaborations should be bi-directional, sensitive to local culture, and flexible and establish achievable sustainable goals.

The Workforce Shortage of Child and Adolescent Psychiatrists: Is It Time for a Different Approach?

Psychiatric disorders affect a large number of children around the world. Recent data have reported that approximately 10% to 13% of children have a serious emotional disturbance with significant functional impairment, suggesting that at least 1 in 10 children require mental health services.1,2 Approximately half the adults with mental illness received their diagnosis before 15 years of age3 and close to three fourths of mental health disorders start by the mid-20s.4 Mental illnesses are associated with a large disease burden because these conditions lead to increases in morbidity, mortality, and financial costs. For example, in high-income countries such as the United States, 3 of the leading illnesses associated with pediatric disease burden are psychiatric (depression, bipolar disorder, and schizophrenia) and psychiatric illness in children and adolescents is a key risk factor for completed suicide.5 In the United States, suicide is the second leading cause of death in people 15 to 24 years of age,6 with rural areas having particularly high suicide rates.7 What is even more disconcerting is the fact that most youngsters who might benefit from psychiatric or behavioral health treatment do not receive it. For example, only 45% of adolescents with mental illness received psychiatric services in 2013. This number is even smaller for children and adolescents with internalizing disorders and for minorities.8.

Ansiedad, miedos hospitalarios y alteraciones conductuales en la hospitalización infantil / Anxiety, hospital fears and conduct and behavioral alterations during pediatric hospitalization

Introducción. El ingreso hospitalario es una experiencia susceptible de generar alteraciones emocionales o conductuales a cualquier edad. Este estudio pretende analizar la respuesta de ansiedad, miedos y/o alteraciones conductuales en pacientes pediátricos expuestos a un ingreso hospitalario convencional no quirúrgico y las relaciones existentes entre dichas respuestas y determinadas variables moduladoras. Metodología. Diseño de cohortes. La recogida de datos se realizó en tres momentos (M1: al ingreso; M2: al alta; M3: a las dos semanas del alta), sobre una muestra de 30 pacientes de 6 a 15 años y 30 cuidadores. Se realizó una comparación de medias de medidas repetidas (t de Student) de las variables de respuesta y su correlación (Coeficiente correlación de Pearson) con variables moduladoras. Resultados. Los resultados del análisis intrasujeto muestran significación en cuanto a los niveles de ansiedad estado del paciente en M1 versus M3 (t=3.93, p<0.0001, d=0.69) y la magnitud de alteraciones conductuales totales registradas en M1 versus M3 (t=-5.02, p<0.0001, d=0.60). Se objetivó relación significativa positiva entre variables moduladoras del paciente (ansiedad rasgo) y del cuidador (ansiedad rasgo-estado, estrategias de afrontamiento) y las variables de respuesta de ansiedad y alteraciones conductuales del paciente. Conclusiones. La exposición a una hospitalización convencional no quirúrgica puede producir consecuencias negativas a nivel emocional y conductual en el niño, presentes más allá del ingreso hospitalario. Determinadas variables, del paciente y del cuidador, son factores de vulnerabilidad psicológica ante el proceso de hospitalización

Introduction. A hospital admission is an experience capable of generating emotional and behavioral alterations at any age. This study pretends to analyze the response of anxiety, fears and/or behavioral alterations in pediatric patients exposed to a conventional non-surgical hospital admission and the existing relationship between these responses and certain modulating variables. Metodology. Design of cohorts. Data collection was carried out in three stages (M1: at admission; M2: at discharge; M3: 2 weeks after discharge), on a 30 patient sample between the ages of 6 to 15 years and 30 caregivers. A comparison was made on the mean of the repeated measurements (Student t) of the respond variables and their correlation (Pearson's Coefficient Correlation) with modulating variables. Results. The results of the intra-subject analysis showed significance in terms of anxiety levels state in patients in M1 versus M3 (t=3.93, p<.0001, d=0.69) and the magnitude of the total behavioral alterations registered in M1 versus M3 (t=-5.02, p<.0001, d=0.60). It was observed that a significant relationship between modulating variables of patients (anxiety risk) and of the caregiver (anxiety character state, constrategy of confrontation) and the variables of response of the anxiety and behavioral alterations of the patient. Conclusions. Exposure of a conventional non-surgical hospital admission may have negative consequences at an emotional and behavioral level in children, present far beyond the hospital admission. Certain variables, from the patient and the caregiver, are psychological vulnerability factors before a hospitalization process