Search Results (341)

Background/Objectives: Emergency department (ED) visits for pediatric home accidents may provide an opportunity to identify children who warrant evaluation for attention-deficit/hyperactivity disorder (ADHD). This study primarily evaluated the feasibility of a two-step ED-based ADHD screening and Child and Adolescent Psychiatry referral pathway. A secondary exploratory objective was to compare the frequency of confirmed ADHD between children presenting with home accidents and non-injured ED controls. Methods: This prospective, two-center case-control study was conducted in two emergency departments in Denizli, Turkey, between October 2022 and June 2023. Children aged 5–11 years were enrolled as home-accident cases or non-injured controls. Parents or guardians completed the Turkish-validated Turgay DSM-IV Disruptive Behavior Disorders Rating Scale (DDDRS). Screen-positive children and those with prior documented ADHD were referred for DSM-5-based diagnostic confirmation or record verification by Child and Adolescent Psychiatry specialists blinded to group allocation. Feasibility outcomes included completion of ED screening, referral threshold positivity, and attendance at specialist assessment. Results: The study included 139 home-accident cases and 139 controls. Among 267 children eligible for ED screening, all completed the DDDRS. Forty-nine children (18.4%) met the referral threshold, and 40 of 49 (81.6%) attended the Child and Adolescent Psychiatry assessment. Overall, ADHD was confirmed in 21 cases (15.1%) and 9 controls (6.5%) (unadjusted odds ratio [OR], 2.57; 95% confidence interval [CI], 1.13–5.83; p = 0.020). In an exploratory multivariable logistic regression model adjusted for sex, age, and school grade, confirmed ADHD remained associated with home-accident case status (adjusted OR, 2.45; 95% CI, 1.06–5.65; p = 0.035). However, a sensitivity analysis restricted to children without prior treated ADHD showed a non-significant difference in newly diagnosed ADHD (12/130 vs. 7/137; OR, 1.89; 95% CI, 0.72–4.96; p = 0.190). Conclusions: A two-step ED screening and specialist referral pathway for ADHD after pediatric home-accident presentation was operationally feasible in this two-center sample. The higher overall frequency of confirmed ADHD among home-accident cases should be interpreted as a secondary exploratory finding because it was partly influenced by imbalance in pre-existing ADHD and was not confirmed in the newly diagnosed-only analysis. Larger studies with center-level data, broader confounder measurement, and longitudinal follow-up are needed. Full article

Objectives. To identify associations between CYP3A4*22 and CYP3A5*3 genotypes, CYP2D6 phenotype, and the effectiveness and safety of antipsychotics in neurotypically developed boys with conduct disorders. Methods: The study included neurotypically developed boys aged 7–12 years who were hospitalized for conduct disorders. All patients were prescribed an antipsychotic. Patient follow-up lasted 14 days. Treatment effectiveness was assessed using a clinical aggression assessment (checklist) and the CGI-S, CGI-I, and CGAS scales. Safety was assessed using the UKU SERS and SAS scales. Patients were examined upon enrollment in the study, on day 5, and on day 14. All patients were genotyped for the CYP3A4*22 (rs35599367, C>T), CYP3A5*3 (rs776746, 6986T>C) CYP2D6*3 (rs35742686), CYP2D6*4 (G1846A, rs3892097), CYP2D6*6 (rs5030655), CYP2D6*10 (C100T, rs1065852), CYP2D6*41 (rs28371725) loci. CYP2D6 metabolism type was determined based on genotyping results, and patients were divided into two subgroups: those with normal metabolism (NM) and those with intermediate or poor metabolism (IM + PM). Results: Patients taking carbamazepine (n = 11) were excluded from the analysis of associations between treatment outcomes and the CYP3A4*22 and CYP3A5*3 polymorphisms. The analysis of associations between treatment outcomes and CYP2D6 metabolism type was conducted in two stages: the overall sample and a subsample of patients who were prescribed risperidone (n = 80). No significant associations were found between carrier status of the CYP3A4*22 and CYP3A5*3 polymorphisms and treatment effectiveness parameters. Analysis of the overall sample did not reveal any significant associations between CYP2D6 metabolism subtypes and the effectiveness parameters of drug therapy. Analysis of patients receiving risperidone revealed one statistically significant association: patients with CYP2D6 IM + PM reported headaches more frequently (16.1% vs. 2%; p = 0.03). Carrier status of the CYP3A4*22 polymorphism was significantly associated with asthenia and lethargy on day 5 (50% vs. 9.4%; p = 0.008). Conclusions: Our study identified only a few significant associations between the CYP3A4*22 polymorphism, CYP2D6 slow metabolism, and patients’ reports of early adverse reactions in a 14-day observation period. Further research is needed to identify pharmacogenetic predictors of the efficacy and safety of antipsychotics in neurotypical children with conduct disorders. Full article

Background: Pediatric inflammatory multisystem syndrome (PIMS), also referred to as multisystem inflammatory syndrome in children (MIS-C), is a rare but serious post-infectious complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection characterized by systemic hyperinflammation and multiorgan involvement. New-onset neurological and psychiatric symptoms have emerged as critical clinical features, occurring in approximately 12–27% of pediatric patients aged 2–15 years (median age, 10 years) and often indicating a more severe disease course. This narrative review aims to provide a comprehensive overview of the current literature regarding the neurological and psychiatric manifestations of PIMS/MIS-C, focusing on epidemiology, pathophysiology, clinical presentation, neuroimaging findings, biomarkers, treatment strategies, and outcomes. Methods: A narrative literature review was conducted to synthesize current evidence on the neurological and psychiatric spectrum of PIMS/MIS-C. Evaluated parameters included clinical presentations ranging from common symptoms (such as headache, encephalopathy, altered mental status, and seizures) to rare complications (such as ischemic stroke, acute disseminated encephalomyelitis, Guillain–Barré syndrome, and cerebral edema), alongside associated psychiatric disturbances, diagnostic findings, and therapeutic approaches. Results: Neurological and psychiatric manifestations significantly impact the clinical trajectory of PIMS/MIS-C. Acute symptoms include headache, encephalopathy, seizures, and psychiatric disturbances like behavioral changes, hallucinations, delirium, anxiety, and sleep disorders. Neuroimaging in many cases reveals reversible lesions of the splenium of the corpus callosum, while electroencephalography typically demonstrates diffuse slowing consistent with encephalopathy. Early recognition and prompt administration of immunomodulatory therapy—primarily intravenous immunoglobulin and corticosteroids—correlate with favorable neurological recovery in the majority of patients. However, current evidence remains largely observational and heterogeneous, precluding definitive causal conclusions regarding this treatment–outcome relationship. Affected children more frequently require intensive care unit admission and remain at risk for persistent cognitive, behavioral, and psychiatric sequelae. Conclusions: Neurological and psychiatric complications in PIMS/MIS-C are clinically significant indicators of disease severity that require vigilant monitoring and early immunomodulatory intervention. Continued multidisciplinary follow-up and prospective studies are essential to elucidate the long-term neurodevelopmental and psychiatric consequences and to optimize therapeutic strategies for these patients. Full article

Psychological resilience is a key protective factor for mental health. Reducing inequalities in access to childhood experiential activities may foster resilience across socioeconomic backgrounds. However, Japan limits policies ensuring equitable access to such activities before entering elementary school. This cross-sectional study examined the association between exposure to experiential activities before entering elementary school and psychological resilience in Japanese individuals aged 15–39 years (n = 8000). Experiential activities were classified into nature-related, social, and cultural domains and by number and combination (none, any single, any two, and all three types). Psychological resilience was assessed using the 14-item Resilience Scale (Japanese version). Multivariable linear regression models were adjusted for demographic and socioeconomic covariates with Benjamini–Hochberg (BH) correction. Exposure to one or two activity domains was significantly associated with higher psychological resilience, except for the nature-related plus social activities combination. Exposure to all three domains showed the strongest association (β = 8.06, 95% confidence interval [6.73, 9.38], BH-adjusted p < 0.001). Therefore, early childhood experiential activities may promote psychological resilience, with persistent long-term effects. Implementing social policies to reduce the disparity in access may be a key strategy for promoting psychological resilience among Japanese individuals aged 15–39 years. Full article

Objective: Intolerance of uncertainty (IU) is a transdiagnostic cognitive construct associated with anxiety, emotional dysregulation, and psychopathology across multiple clinical conditions. This study aimed to adapt the Intolerance of Uncertainty Index A (IUI-A) into Turkish and evaluate its psychometric properties in a high-risk clinical adolescent sample. Methods: One hundred forty adolescents aged 12–17 years (Mage = 15.71, SD = 1.39; 84.3% female) were recruited from a Child and Adolescent Psychiatry Outpatient Clinic. The sample comprised adolescents presenting with suicidal ideation without a prior attempt (SI; n = 42, 30%) or a history of at least one suicide attempt (SA; n = 98, 70%). The majority met criteria for at least one psychiatric diagnosis, with depressive disorder (77.1%) and anxiety-spectrum conditions most prevalent. Analyses included exploratory and confirmatory factor analysis, internal consistency estimation, and assessments of convergent, discriminant, and known-groups validity. Results: EFA supported a two-factor model (Inhibitory IU and Prospective IU) explaining 61.04% of the variance. CFA indicated partially acceptable fit (χ²/df = 2.48, RMSEA = 0.102, CFI = 0.900, TLI = 0.882, SRMR = 0.054), with RMSEA and TLI falling outside conventional thresholds. Internal consistency was strong (α = 0.933, ω = 0.935). IUI-A scores correlated strongly with the IUS-12, and the SA group scored significantly higher on both IU subscales, with group differences persisting after adjustment for key covariates. Conclusion: The Turkish IUI-A provides preliminary, though methodologically provisional, evidence of validity and reliability for assessing IU in high-risk adolescent populations, with several limitations requiring further investigation. Full article

The article investigates how electroconvulsive therapy (ECT) is represented in the following four literary works of the 21st century: October’s Child, Store Kongensgade 23, The Parakeet, and I Am What I Remember. The article argues that electroconvulsive therapy is treated as a mnemonic metaphor that highlights not just its significance for individual experiences of memory loss following treatment and how such treatment elicits traumas that span generations, but also how ECT can be said to have a gendered bias. The article attempts to show how the practice of ECT is emblematic of a certain patriarchal tendency within psychiatry that obfuscates women’s chance of being heard. It makes the argument that ECT as a metaphor paradoxically works as a narrative catalyst that forces a practice of remembrance, and that this practice is in many ways a feminist project. As such, it offers a critical insight into psychiatric practices and shows the importance of giving voice to those who suffer from after-effects of psychiatric treatment. Finally, the article argues that ECT is a feminized metaphor that continues a figurative line of thought in Western social imagination, which entangles women, technology, and mental illness. Full article

Background/Objectives: Physical literacy (PL) is increasingly being recognized as an important factor associated with physical activity participation and health outcomes. However, evidence remains limited regarding the association between PL and quality of life (QOL) in adults, particularly the statistical indirect association through moderate-to-vigorous physical activity (MVPA). Therefore, this cross-sectional study aimed to examine the associations among PL, MVPA, and QOL in Japanese adults and to assess the statistical indirect association between PL and QOL through MVPA. Methods: Japanese adults aged 18–64 years were recruited from a commercial online survey panel using age- and sex-quota sampling in 2023. After excluding incomplete or inconsistent responses and participants with missing or incomplete MVPA data, 861 participants were ultimately included. PL, QOL, and MVPA were assessed using the Physical Literacy for Life tool, World Health Organization QOL-26, and International Physical Activity Questionnaire, respectively. Associations among PL, MVPA, and QOL were examined using Pearson’s correlations, multiple linear regression, and mediation analysis with PROCESS macro (Model 4). Results: PL was positively correlated with MVPA (r = 0.257, p < 0.01) and QOL (r = 0.416, p < 0.01); MVPA was positively correlated with QOL (r = 0.248, p < 0.01). PL remained significantly associated with QOL after including MVPA and covariates (β = 0.374, p < 0.01). The statistical indirect association between PL and QOL through MVPA was significant (b = 0.0011, BootSE = 0.0003, 95% bootstrap confidence intervals: 0.0005–0.0018), indicating a modest indirect association through MVPA. Conclusions: PL was positively associated with QOL among Japanese adults, and MVPA partially explained this association in a statistical mediation model. Full article

Children with autism spectrum disorder (ASD) exhibit gut mucosal immune alterations, but the co-regulatory architecture linking stool immune proteins and cytokines within the same cohort remains unstudied. In 115 children (74 ASD, 41 controls; age 5–18 years), seven stool immune proteins (IgA subclasses, α₁-antitrypsin and calprotectin subunits) were quantified by UHPLC-MS/MS and ten by Luminex—chemokines eotaxin/CCL11 and IL-8/CXCL8 plus eight cytokines—each normalised to total protein. Age-adjusted partial Spearman correlations were computed for all 70 protein–cytokine pairs per stratum, using Benjamini–Hochberg correction, bootstrap confidence intervals and Fisher r-to-z tests. No pair survived FDR correction in any stratum. IgA1 and IL-1β/TP correlated positively across all strata (full cohort ρ = 0.409, 95% CI 0.131–0.634, n = 62; controls 0.583; ASD 0.210), with no significant between-group difference (Fisher z = 1.70, p = 0.090). Multiple imputation attenuated this to ρ = 0.265 (95% CI 0.055–0.452). An inverse trend between IL-1β/TP and CARS score (ρ = −0.336, n = 41) did not survive correction (p-FDR = 0.576). This power-limited, hypothesis-generating study identifies an exploratory IgA1–IL-1β mucosal axis present across groups, with no confirmed between-group difference. Adequately powered multi-centre studies are required. Full article

Network orientation reflects beliefs about whether seeking help from others is desirable, safe, and useful. Cross-national studies have often focused on differences in the mean levels of negative network orientation; however, similar help-seeking scores may conceal distinct underlying psychosocial structures. Methods: A cross-sectional study was conducted among 676 university students from Mexico (n = 422) and Russia (n = 254). Participants completed the Network Orientation Scale (NOS), Rosenberg Self-Esteem Scale, Generalized Trust Scale, and Interpersonal Sympathy Scale. Mean comparisons, Pearson correlations with Fisher’s r-to-z tests, and multivariable linear interaction models were performed. Results: Mean NOS levels were similar across countries, but the psychosocial correlates differed substantially. Russian students reported higher generalized trust and higher self-esteem, whereas interpersonal sympathy was comparable between the countries. Greater interpersonal sympathy was associated with higher network avoidance in both populations, while generalized trust was associated with lower network avoidance, with a stronger effect in Russia. Self-esteem was not significantly associated with network orientation in Mexico but was significantly associated with lower network orientation in Russia. Continuous multivariable interaction models demonstrated a significant self-esteem × country interaction. Men showed higher network orientation than women in both countries. Conclusions: Although Mexican and Russian university students showed similar average levels of negative network orientation, the psychosocial structure underlying help-seeking differed across contexts. These findings suggest that help-seeking tendencies should not be interpreted solely through mean comparisons, but also through the psychosocial configurations shaping support-seeking within each cultural setting. Full article

Children whose primary caregivers experience mental illness and adverse psychosocial complexity are at increased risk of experiencing mental, physical, and relational challenges. Perinatal mental health services have commonly focused on treating the parental mental health problem; however, emerging evidence shows that parental mental health interventions alone are not sufficient to address the complex needs of both caregivers and their children. To address this gap in services, a new, highly specialised program—the Nurturing Connections Program—was implemented across three Australian local health districts within the State of New South Wales. The program is targeted to caregivers of young children referred to mental health services and aims to improve caregiver mental health and psychosocial adversity, child developmental outcomes, and the child–caregiver relationship. This study evaluated caregivers’ experiences with, and views of, the program. Twelve caregivers participated in semi-structured, in-depth interviews. A reflexive thematic analysis approach guided data interpretation. Four themes and three subthemes emerged from the data: (1) motivation for attending the program; (2) program components received; (3) post-program outcomes (subthemes: Caregiver-related outcomes, Child-related outcomes, and interpersonal outcomes); and (4) areas for program improvement. This study’s findings highlight program benefits, program facilitators and areas for improvement. Full article

Background/Objectives: The digital transition in school settings is reshaping children’s learning, writing practices, and mental health trajectories. This narrative review examines whether handwriting still matters in contemporary hybrid educational environments from a multidisciplinary perspective. Methods: Evidence from neuroscience, developmental psychology, educational sciences, pediatrics, and child psychiatry was narratively synthesized, with attention to handwriting, digital exposure, learning, emotional regulation, and vulnerable populations. Results: Handwriting uniquely integrates fine motor control, visuomotor coordination, orthographic processing, attention, and embodied cognition, supporting early literacy, memory consolidation, conceptual learning, and reflective writing. Conversely, excessive or poorly mediated digital exposure may interact with attentional fragmentation, sleep disruption, online stressors, problematic use, and internalizing symptoms, particularly in vulnerable children and adolescents. Digital tools remain essential for personalization, accessibility, and compensatory support, especially for students with neurodevelopmental or learning difficulties. Conclusions: Handwriting and digital technologies should not be framed as competing educational paradigms. A developmentally sensitive hybrid model is needed, preserving handwriting during key stages of literacy and self-regulation while integrating digital tools as purposeful, individualized resources for learning, inclusion, and school mental health promotion. Full article

Background: Competence (within the legal and bioethical framework in Spain, the term ‘competence’ is used as equivalent to healthcare decision-making capacity) in the field of child and adolescent psychiatry is a complex and evolving issue. Legal frameworks vary by country and legal tradition. Most concerns relate to treatment decisions within mental health, but in fact there is a wide range of decisions with a relevant impact on patients’ lives and quality of life over the long term. Forensic science must adapt its current practice to the worldwide challenge presented by this evidence. Objectives: This article will present a current research project about competence (healthcare decision-making capacity) in a sample of adolescent and child population in Spain. The final objective will be to validate the Spanish version of the MacCAT semi-structured interview consenting to psychiatric admission in adolescents in a mixed sample. We also examine some of the influences that must be taken into account in this research. Methodology: This is an instrumental and methodological study utilizing a sequential mixed-methods design (qualitative content validation followed by a quantitative psychometric evaluation). A process of adaptation of the Spanish MacCAT to consent to psychiatric admission in the adolescent population. A pilot study will initially be conducted to evaluate question comprehension and duration. Subsequently, a cross-sectional study will be carried out to assess inter-rater reliability, internal consistency, and validity. Evaluation will include clinical and neuropsychological assessment in five departments at two University Hospitals. Expected results: We will establish new evidence about the evaluation of competence in adolescent psychiatry; to date, no studies have been identified assessing the capacity to consent to psychiatric admission among Spanish-speaking adolescents, nor the factors potentially related to such competence. To our knowledge, the relationship between competence and illness awareness in the adolescent population remains unexplored in the literature, and its analysis constitutes one of the novel contributions of the present study. In addition, we will adapt and validate a well-known evaluation scale to the specific environments of our medical and psychiatric health departments. Conclusions: Objective evaluation of competence for medical interventions and treatments is a challenge in clinical and forensic examination. New evidence is necessary to operationalize classical evaluations in standardized ways, adapted to different countries, legal systems and forensic traditions. Full article

Background: The COVID-19 pandemic and related containment measures profoundly affected child and adolescent mental health, with increasing evidence of a rise in psychiatric symptomatology and healthcare burden. This study aimed to evaluate temporal changes in neuropsychiatric presentations before, during, and after the COVID-19 pandemic in a pediatric clinical population. Methods: In this retrospective single-center study, 505 children and adolescents referred to a pediatric neuropsychiatry service were included and stratified into three periods: pre-pandemic (n = 112), pandemic (n = 231), and post-pandemic (n = 162). Clinical and healthcare-related variables were retrospectively collected, including reasons for referral, psychiatric diagnoses, premorbid conditions, and pharmacological treatments. Comparative analyses were performed to identify temporal variations in psychopathological profiles and clinical management. Results: A significant increase in psychiatric symptomatology emerged in the post-pandemic period compared with the pre-pandemic period. In particular, eating disorders, mood disturbances, self-harm, and somatic symptom presentations showed a marked increase over time, presenting as recurrent and associated phenotypes that peaked or consolidated after the acute emergency. The pandemic period was primarily characterized by a greater need for psychopharmacological intervention, specifically driven by the clinical need to manage acute behavioral crises. Overall, findings indicated a persistent increase in the complexity and severity of neuropsychiatric presentations beyond the acute phase of the pandemic. Conclusions: The COVID-19 pandemic was associated with substantial changes in pediatric neuropsychiatric presentations and treatment needs. The persistence of the increased psychopathological burden in the post-pandemic period highlights long-term mental health trajectories associated with the pandemic era. These emerging patterns of phenotypic complexity demonstrate that child and adolescent psychiatric services must transition from single-diagnosis models toward integrated care networks. Practically, strengthening community-based early intervention and creating rapid-access crisis support are essential to manage severe emotional dysregulation in the community and reduce acute psychiatric hospitalizations. Full article

Canadian youth experienced profound impacts to mental health (MH) support throughout the COVID-19 pandemic. Given the risk for long-term negative outcomes from unmet MH needs, it is critical to understand access barriers. The purpose of this study was to explore the longitudinal data and personal narratives on MH challenges, needs and access barriers. The Personal Impacts of COVID-19 Survey was administered to parents regarding their youth at baseline (November 2020–July 2021) and follow-up (November 2021–October 2022). Semi-structured interviews of selected youth and parents were conducted. Quantitative data from 507 baseline surveys, 177 follow-up surveys and qualitative data from 35 interviews were included in the study. A modified explanatory sequential/nested mixed methods design was used to analyze the data. Results showed that the use of MH supports among youth increased between timepoints, although 20% had persisting unmet needs for MH supports at follow-up. Youth described waitlist barriers and difficulties finding the “right” therapist, and parents described significant difficulties navigating the MH system that profoundly impacted their families’ ability to access care and mitigate negative MH outcomes. Increased clinician availability, school MH supports, parental education, and tools for navigating the MH system are needed to better support families. Full article

Background: Immune dysregulation and gut dysbiosis are increasingly implicated in autism spectrum disorder (ASD), but compartment-specific intestinal cytokine profiles remain poorly defined. Aim: To characterize stool cytokine profiles and pro-/anti-inflammatory balance in children with ASD across development. Methods: We analyzed stool samples from 283 children (109 controls, 104 mild ASD, 70 severe ASD; age 0.9–21.5 years) recruited at a tertiary centre. Nine cytokines (IFN-γ, IL-1α, IL-1β, IL-4, IL-6, IL-8, IL-10, IL-17, TNF-α) were measured using a Luminex multi-plex assay; IL-15 was excluded due to >70% missing values. Group comparisons used Mann–Whitney U tests, with age stratification at the cohort median (≤9.5 vs. >9.5 years). A composite pro-/anti-inflammatory ratio (IL-1α + IL-1β + IL-6 + IL-8 + IL-17 + TNF-α + IFN-γ divided by IL-4 + IL-10) was calculated. Results: In the overall cohort, stool IL-8 and IL-4 were significantly decreased in ASD versus controls (IL-8: median 0.36 vs. 0.49 ng/L, p = 0.0041; IL-4: 0.28 vs. 0.30 ng/L, p = 0.0316), with a graded reduction from controls to mild and severe ASD. Age-stratified analysis revealed that IL-8 reduction was confined to younger children (≤9.5 years; p = 0.0025) and absent in older children, while IL-1β was significantly reduced in younger ASD children and tended to reverse in older ASD children. The pro-/anti-inflammatory ratio was markedly elevated in severe ASD (median 491 vs. 209 in controls; p = 0.059), particularly in older children. Stool IL-8 and IL-1β correlated inversely with CARS scores within the ASD group. Conclusions: Children with ASD show decreased stool IL-8 and IL-4 and a shift toward a pro-inflammatory cytokine balance, with the strongest alterations during early childhood. These findings are consistent with the hypothesis of a developmental window of intestinal immune dysregulation in ASD, with stool IL-8 as the primary FDR-corrected finding. The present cross-sectional data do not establish causality and independent replication is required before clinical conclusions are drawn. Full article