Appearance of extrapyramidal symptoms in adolescent psychiatry patients during COVID-19 infection.

Since the start of the pandemic, there has been an increase in the incidence of psychiatric morbidity among those infected with coronavirus disease 2019 (COVID-19) and those indirectly affected by COVID-19. There has been a considerable increase in the number of individuals with such psychiatric conditions as depression, acute stress disorders, anxiety, and posttraumatic stress disorder (PTSD). About one-third of patients with COVID-19 are reported to have developed short and long-term neuropsychiatric conditions such as delirium, agitation, altered consciousness, hypoxic encephalopathy encephalitis, dysexecutive syndrome, cerebrovascular complications (e.g., stroke), hypoxic encephalopathy, convulsions, neuromuscular dysfunction, demyelinating processes, or parkinsonism through several pathophysiological mechanisms. Nevertheless, as the pandemic progressed, data on neuropsychiatric manifestations implied that the pathologic capacity of COVID-19 and its association with the onset and/or exacerbation of psychiatric morbidity indicate that COVID-19 is potentially related to neuropsychiatric involvement. Patients with existing mental disorders under psychotropic treatment exposed to the COVID-19 infection have been represented by an increased risk of worsened psychiatric symptoms and expanded drug side effects. The present study aimed to describe five pediatric patients with various psychiatric illness that experienced COVID-19 infection and had potentially associated neuropsychiatric involvement, such as exacerbation of underlying psychiatric symptoms and extrapyramidal side effects. To the best of our knowledge, the present study is the first to describe adolescents with COVID-19 infection that presented with a series of manifestations in the form of an increase in extrapyramidal symptoms (EPS)  during exacerbation of underlying psychiatric disease.

Development and validation of Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) for Internet Gaming Disorder (IGD) and factor analytic assessment.

OBJECTIVE: To develop and validate Kiddie Schedule for Affective Disorders and Schizophrenia, Present and Lifetime version (K-SADS-PL) for Internet Gaming Disorder (IGD) in adolescents. METHODS: Questions and threshold criteria of the K-SADS-IGD was generated based on the related section of K-SADS-PL. Then, the sample consist of IGD group and matched control group with no significant difference in psychiatric comorbidities from clinical settings were included to assess the psychometric properties of the K-SADS-IGD. Exploratory and Confirmatory Factor analysis were conducted to evaluate and compare DSM model of IGD and two different Models of IGD proposal in adolescents. RESULTS: Exploratory Factor Analysis of K-SADS-IGD revealed a single factor explaining 61.469% of the total variance. Confirmatory Factor Analysis indicates that although the K-SADS-IGD model fit indices were also acceptable, Model 1, which excluded the 7th criterion of IGD criteria of DSM-5 showed better fit in adolescent population. The Likelihood Ratio Positive and the Likelihood Ratio Negative estimates for the diagnosis of K-SADS-IGD were 31.4 and 0.12, respectively, suggesting that K-SADS-IGD was beneficial for determining the presence and the absence of IGD in adolescents. Also, K-SADS-IGD could detect disordered gamers with significantly low functionality (even after controlling the impact of comorbidities) from non-disordered gamers. CONCLUSION: K-SADS-IGD was found to be a reliable and valid instrument in adolescents. The model excluding 7th criteria of DSM-5 IGD was found to be more consistent than the current DSM-5 IGD model in the adolescent population. Therefore, the diagnostic criteria might be required to adjust according to the age group since the clinical symptomatology of IGD in adolescents may differ from that in adults. The K-SADS-IGD may meet the need for a certain and standardized tool to assess IGD in this population.