Search Results (65)

Background: Cerebral palsy (CP) is a lifelong neurodevelopmental disorder characterised by motor impairment and commonly associated with comorbidities such as cognitive, communicative, and behavioural difficulties. While the physical and functional aspects of CP have been extensively studied, the mental health needs of this population remain largely underexplored, particularly concerning suicidal ideation and self-injurious behaviours. The purpose of this review is to synthesise the existing literature on suicidality in individuals with CP, explore theoretical and clinical risk factors, and identify key gaps in the current evidence base. Methods: A narrative literature review was conducted focusing on studies addressing suicidal ideation, self-harm, or related psychiatric outcomes in individuals with CP. Additional literature on risks and protective factors was included to support theoretical inferences and clinical interpretations. Results: Only a limited number of studies addressed suicidality directly in CP populations. However, several reports document elevated rates of depression, anxiety, and emotional distress, particularly among adults and individuals with higher levels of functioning. Communication barriers, chronic pain, social exclusion, and lack of accessible mental health services emerged as critical risk factors. Protective elements included strong family support, inclusive environments, and access to augmentative communication. Conclusions: Suicidality in individuals with CP is a neglected yet potentially serious concern. Evidence suggests underdiagnosis due to factors such as communication barriers and diagnostic overshadowing. Future research should prioritise disability-informed methodologies and validated tools for suicidal ideation, while clinicians should incorporate routine, adapted mental health screening in CP care to ensure early detection and person-centred management. Full article

This study focuses on the current service/care difficulties and challenges that social institutions in Hungary are facing during their daily operations; how they can react to them utilizing their internal resources, mechanisms, and capacities; and what concrete, tangible needs and demands are emerging in terms of methodological professional support, potential forms, interventions, and direction for professional development. A total of 24 general and 55 specific service and operational problems were identified and assessed in eight different service areas (family and child welfare services, family and child welfare centers, respite care for children, care for the homeless, addiction intervention, care for people with disabilities, care for psychiatric patients, specialized care for the elderly, and basic services for the elderly). The empirical base of the study uses a database of 201 online questionnaires completed by a professional target group working for social service providers in two counties (Győr-Moson-Sopron and Veszprém), representing 166 social service providers. The questionnaires were completed between November and December of 2022. The findings will be used to develop a professional support and development problem map. Social institutions face complex and serious service/care difficulties and challenges in their daily operations. Three distinctive basic problems clearly stand out in both severity and significance from the complex set of factors assessed. The biggest problem in the social care system is clearly the complex challenge of low wages, followed by the administrative burdens in the ranking of operational difficulties, and the third key factor was the psycho-mental workload of staff. Full article

Background/Objectives: The Rapid Access and Stabilization Program (RASP), launched in Nova Scotia in April 2023, aims to improve timely psychiatric care, reduce reliance on emergency services, and provide early intervention. This study describes the sociodemographic and clinical characteristics of the RASP participants and examines their association with acute service use. Methods: This cross-sectional descriptive study used self-reported surveys and administrative data from 738 RASP participants. Descriptive statistics summarized key sociodemographic and clinical variables. Associations between these characteristics and acute service use (emergency department visits, inpatient admissions, and mobile crisis calls) were examined using chi-square and Fisher’s Exact tests. Bonferroni correction was applied for multiple comparisons. Results: The sample was predominantly female (65.2%) and aged 20–40 years (38.4%). Despite high rates of severe anxiety (53.9%) and depression (36.0%), acute service use was low: emergency department visits (7.2%), mobile crisis calls (1.0%), and inpatient admissions (0.8%). Preliminary analyses showed that education level and housing status were associated with ED visits and inpatient admissions. However, these associations did not remain statistically significant after Bonferroni correction. Conclusions: Although mental health symptom severity was high, acute mental health service use remained low after RASP enrollment, indicating the program’s potential in reducing reliance on crisis services. No participant characteristics were significantly associated with acute service use after adjustment, underscoring the complexity of predicting utilization and the need for robust multivariable models. Continued investment in rapid access programs may be essential to improving timely mental health care and supporting early intervention strategies. Full article

Background: The COVID-19 pandemic has had a profound impact on pediatric mental health, contributing to a global surge in psychiatric emergencies among children and adolescents. This study aimed to evaluate trends in pediatric emergency department (PED) visits for three key psychiatric conditions—anxiety disorders (ADs), self-injury behaviors (SIBs), and psychomotor agitation (PMA)—before and after the onset of the COVID-19 pandemic. Methods: We conducted a retrospective observational study at a tertiary pediatric hospital in Italy, analyzing all psychiatric presentations to the PED from 1 January 2018 to 31 December 2024. The data were divided into pre-COVID and post-COVID periods and included patient demographics, recurrence of visits, clinical features, hospital admissions, and pharmacological management. Diagnoses were confirmed by chart review. Results: Of 233,867 total PED visits, 1082 were due to primary psychiatric concerns. A marked increase in visits was observed postCOVID: SIB incidence rose from 3.6 to 15.1 per 10,000 visits (p < 0.0001), PMA from 9.4 to 17.8 (p < 0.0001), and AD from 17.7 to 21.6 (p = 0.018). SIB cases showed increased recurrence (from 3.4% to 27.4%, p = 0.004) and greater pharmacological intervention, whereas PMA was associated with a rise in heteroaggression (from 14.3% to 39.8%, p < 0.0001). Pharmacological treatment remained largely consistent, with benzodiazepines and neuroleptics most frequently used. The emerging use of intranasal ketamine was noted in select cases. Conclusions: This study highlights the increasing burden of pediatric psychiatric emergencies in the wake of the COVID-19 pandemic. The findings underscore the urgent need to implement standardized emergency care protocols, strengthen outpatient mental health services, and develop pediatric-specific pharmacological guidelines to improve outcomes in this vulnerable population. Full article

Background and Clinical Significance: Herein, we describe the clinical case of a 17-year-old patient with psychotic disorder secondary to cerebral venous thrombosis due to primary thrombophilia, which was related to protein S deficiency and a heterozygous MTHFR gene mutation with the p.Ala222Val variant. Case presentation: A 17-year-old female, with no history of previous illnesses, was admitted to the emergency service department due to a psychotic break. Psychiatric evaluation detected disorganized thought, euphoria, ideas that were fleeting and loosely associated, psychomotor excitement, and deviant judgment. On the fifth day, an inflammatory process in the parotid gland was detected, pointing out a probable viral meningoencephalitis, prompting antiviral and antimicrobial treatment. One week after antiviral and steroidal anti-inflammatory treatments, the symptoms’ improvement was minimal, which led to further neurological workup. MRI venography revealed a filling defect in the transverse sinus, consistent with cerebral venous thrombosis. Consequently, anticoagulation treatment with enoxaparin was initiated. The patient’s behavior improved, revealing that the encephalopathic symptoms were secondary to thrombosis of the venous sinus. Hematological studies indicated the cause of the venous sinus thrombosis was a primary thrombophilia caused by a heterozygous MTHFR mutation variant p.Ala222Val and a 35% decrease in plasmatic protein S. Conclusions: This case highlights the possible relationship between psychiatric and thrombotic disorders, suggesting that both the MTHFR mutation and protein S deficiency could lead to psychotic disorders. Early detection of thrombotic risk factors in early-onset psychiatric disorders is essential for the comprehensive management of patients. Full article

Anorexia Nervosa (AN) is a psychiatric illness with serious medical and physiological implications. Anorexia Nervosa is characterised by significant disruptions in weight, growth and physical health resulting from disordered behaviours such as food restriction, purging and inappropriate exercise. The illness is associated with substantial physical, psychological, social and economic burdens affecting all areas of functioning. Typically emerging in adolescence, AN can have a chronic course and high risk of mortality, with evidence suggesting that approximately 10% of individuals diagnosed with AN will die from medical complications or completed suicide. Whilst inpatient treatment reduces mortality risks through nutritional and weight restoration, outpatient treatment is the preferred level of intervention. In the case of adolescents, family-based treatment (FBT) is the recommended and most researched outpatient model for medically stable adolescents. However, access to FBT is limited, and there are several barriers that exist to receiving care from trained clinicians. This review provides a literature update on studies reporting the real-world access challenges for FBT, with particular attention paid to non-research settings. The review also highlights how digitally delivered treatment, specifically telehealth, has been used to increase access to FBT and examines the preliminary outcomes of telehealth-delivered FBT, which appear comparable to traditional in-person care. Despite these promising findings, provider, intervention and systemic factors have challenged the delivery of traditional in-person and telehealth FBT in real-world settings. Critical areas for future research include the need to understand the impact of potential confounders and what adaptions may be required to increase model feasibility in community settings, where access to specialist services is often limited and access challenges are most felt. Full article

Background/Objectives: Child abuse is a pervasive global issue with significant implications for the physical, emotional, and psychological well-being of victims. This review highlights the clinical, molecular, and therapeutic dimensions of child abuse, emphasizing its long-term impact and the need for interdisciplinary approaches. Early exposure to abuse activates the hypothalamic-pituitary-adrenal (HPA) axis, leading to chronic cortisol release and subsequent neuroplastic changes in brain regions such as the hippocampus, amygdala, and prefrontal cortex. These molecular alterations, including epigenetic modifications and inflammatory responses, contribute to the heightened risk of psychiatric disorders and chronic illnesses in survivors. Clinically, child abuse presents with diverse manifestations ranging from physical injuries to psychological and developmental disorders, making timely diagnosis challenging. Methods: A multidisciplinary approach involving thorough clinical evaluation, detailed histories, and collaboration with child protection services is essential for accurate diagnosis and effective intervention. Results: Recent advances in molecular biology have identified biomarkers, such as stress-related hormones and epigenetic changes, which provide novel insights into the physiological impact of abuse and potential targets for therapeutic intervention. Current treatment strategies prioritize the child’s safety, psychological well-being, and prevention of further abuse. Trauma-focused cognitive behavioral therapy and family-centered interventions are pivotal in promoting recovery and resilience. Conclusions: Emerging research focuses on integrating molecular findings with clinical practice, utilizing digital health tools, and leveraging big data to develop predictive models and personalized treatments. Interdisciplinary collaboration remains crucial to translating research into policy and practice, ultimately aiming to mitigate the impact of child abuse and improve outcomes for survivors. Full article

The increasing prevalence of emergency room (ER) visits for mental health concerns presents a significant challenge for healthcare systems. This study aimed to analyze the socio-demographic and clinical characteristics associated with frequent users of psychiatric consultations in the ER of Maggiore della Carità University Hospital in Novara, Italy. A retrospective observational study was conducted over a six-year period (2017–2022), including all psychiatric consultations recorded in a hospital database. Frequent users were defined as individuals undergoing at least three psychiatric consultations in the ER within a year. Univariable and multivariable logistic models were employed to identify significant socio-demographic and clinical predictors of frequent use. Of the 1565 individuals who received psychiatric consultations in the ER, 92 (5.88%) were identified as frequent users. Factors associated with higher ER utilization included being unmarried (aOR 1.35, 95% CI 1.02–1.79), younger age (aOR 1.32, 95% CI 1.02–1.72), homelessness, diagnosis of schizophrenia, substance use disorder (aOR 1.49, 95% CI 1.06–2.09), and ongoing psychopharmacological treatment (aOR 1.56, 95% CI 1.12–2.18). These findings highlight the need for targeted interventions to improve care continuity and community-based support for individuals at risk of frequent ER visits for psychiatric reasons. Full article

In the current clinical psychiatric practice in most of the world, treatment decisions are based on a person’s capacity to make these decisions. When a person lacks the capacity to understand and appreciate treatment decisions, in many jurisdictions a third-party substitute decision maker (SDM) is appointed on his or her behalf in order to promote safety and optimal clinical outcome. In Ontario, Canada, for example, family members (typically) or public guardians are appointed as SDMs, and they form an integral part of the medical–legal system in psychiatric care. Clinicians working with both patients and their SDMs in these circumstances encounter unique challenges and deliver care in specialized ways, though little research has focused on their experiences and reflections. Based on focus group data, this qualitative study uses a descriptive and interpretative phenomenological approach through thematic analysis to examine these aspects from clinicians working in both inpatient and outpatient settings of an urban teaching hospital’s psychiatric services in Toronto, Canada. Seven key themes emerged: Clinicians (1) appreciate hardships and challenges in lives of SDMs and patients—including the challenging emotions and experiences on both sides, and the risks and relational changes from being an SDM; (2) have an understanding of the patient’s situation and respect for patient autonomy and wishes—they are promoter of autonomy and mindful of patients’ prior wishes amidst patients’ fluctuating capacity, facilitating communication, keeping patients informed and promoting transitioning from SDM to self-determination; (3) have a special working relationship with family SDMs—including supporting SDMs, avoiding harm from delayed or denied treatment, and educating and collaborating with SDMs while maintaining professional boundaries; (4) at times find it difficult working with SDMs—stemming from working with over-involved or uninterested family SDMs, coping with perceived poor SDM decisions, and they sometimes ponder if SDMs are necessary; (5) delineate differences between family and Public Guardian and Trustee (PGT) SDMs—they see PGT as closely aligned with medical decision makers, while family SDMs are more intimately involved and more likely to disagree with a physician’s recommendation; (6) recognize the importance of the SDM role in various contexts—through seeing social values in having SDMs, and acknowledging that having SDMS help them to feel better about their actions as they work to protect the patients; and (7) express ideas on how to improve the current system—at public, societal, and family SDM levels. We conclude that clinicians have unique mediating roles, with privilege and responsibility in understanding the different roles and challenges patients and SDMs face, and have opportunities to improve patient and SDM experiences, clinical outcomes, carry out education, and advocate for ethically just decisions. These clinical roles also come with frustration, discomfort, moral distress and at times vicarious trauma. Clinicians’ unique understanding of this complex and nuanced intersection of patient care provides insight into the core issues of autonomy, duty to care and protect, advocacy, and emotional dynamics involved in this sector as a larger philosophical and social movement to abolish SDMs, as advocated by the Convention on the Rights of Persons with Disability (CRPD), is taking place. We briefly discuss the role of supported decision making as an alternative as. Full article

Background/Objectives: Advanced psychiatric nurses’ clinical skills and expertise are increasingly challenging registered nurses in mental health. Understanding registered nurses’ perceptions of the role of advanced psychiatric nurses is vital for improving mental healthcare delivery and fostering collaboration for effective patient outcomes. This integrative review aims to explore how registered nurses perceive the role of advanced psychiatric nurses in mental healthcare. Methods: An integrative review methodology was used to synthesize the existing literature following PRISMA guidelines. Both qualitative and quantitative studies provided a comprehensive understanding of the registered nurses’ perceptions regarding the role of advanced psychiatric nurses in mental health nursing. Results: Several key themes emerged from studies included in this review, including recognition of expertise, role ambiguity and boundaries, and the need for structured education and training. Conclusions: This review highlights the need to clarify roles and how communication is essential for improving collaboration, team cohesion, and patient outcomes while promoting interprofessional education to optimize mental healthcare, in addition to bridging the knowledge gap or the discrepancy between registered nurses and advanced psychiatric nurses. What registered nurses know and what they need to know to perform tasks will improve the quality of mental healthcare and optimize services for individuals with mental health needs. Full article

Background/Objective: To address the growing demand for mental health services, Nova Scotia Health introduced the Rapid Access Stabilization Program (RASP) through its Mental Health and Addictions Program (MHAP) in April 2023. RASP is designed to help reduce long wait times, frequent emergency department visits, and admissions to provide early intervention for individuals experiencing mental health problems. The RASP focuses on rapid access and early mental health intervention, aiming to prevent the worsening of patients’ symptoms, improve access to psychiatric care, and reduce service pressures on programs like the Community Mental Health Program (CMHP), which provide more extended, ongoing mental health support. This study compared participants’ sociodemographic and clinical profiles in the RASP and the CMHP. Methods: Data were collected from 1392 participants accessing mental health support either through the RASP or CMHP. A comparative analysis of sociodemographic factors (e.g., age, education, and income) and clinical characteristics (e.g., depression, anxiety, resilience, and substance use) was conducted. Chi-square tests and independent sample t-tests were used to evaluate the mean differences between the groups. Results: Significant sociodemographic and clinical differences emerged between the RASP and CMHP participants. The RASP group was older (M = 40.10 vs. 34.52 years) and more socioeconomically stable, with higher rates of employment (55.3% vs. 47.9%) and homeownership (36.5% vs. 17.7%). In contrast, the CMHP group had higher unemployment (25.7% vs. 16.5%) and lower income levels, with 47.5% earning <CAD 29,590 compared to 30.3% in the RASP group. Clinical profiles differed markedly: depression was more prevalent in the RASP (48.2% vs. 19.3%), whereas the CMHP had higher rates of psychosis (10.6% vs. 2.5%) and substance use disorder (7.8% vs. 1.9%). The RASP participants exhibited higher anxiety (GAD-7: M = 14.17 vs. 11.81) and depression symptoms (PHQ-9: M = 16.62 vs. 14.20) but lower resilience (BRS: M = 2.47 vs. 2.77). The CMHP participants had more adverse childhood experiences (ACE: M = 3.92 vs. 3.16) and lower suicidal intent (81.4% vs. 99.4% had no intention to act). Conclusions: The findings highlighted the unique profiles between the RASP and CMHP participants, suggesting the need for program-specific interventions. While the CMHP participants may benefit from integrated social support and trauma-informed care, the RASP participants may require cognitive behavioral therapy and resilience-building interventions. Tailoring mental health services to meet these unique needs could enhance program effectiveness and patient outcomes across both groups. Full article

Marginalized populations face significant barriers to mental health care, such as stigma, poverty, and limited access to adapted services, with conventional psychiatric approaches often falling short. This study aimed to explore how psychiatric care can be adapted to better meet the needs of vulnerable populations. Data were collected from psychiatry residents, psychiatrists, and community organization staff during a course on vulnerable populations, using semi-structured discussions and analyzed through grounded theory with iterative coding. Seven main themes emerged: (1) barriers and needs of vulnerable populations, highlighting challenges like homelessness and stigma; (2) psychiatric interventions and flexible approaches, emphasizing tailored care; (3) collaboration with community organizations, focusing on partnerships to improve care access; (4) ethical approach and respect for rights, ensuring dignity in treatment; (5) specific populations and associated challenges, addressing the needs of groups like LGBTQ+ youth and migrants; (6) intervention and support models, such as proximity-based care and post-hospitalization follow-up; (7) innovation and evolution of practices, focusing on research and institutional adaptations. This study emphasizes the need for personalized, intersectoral care, recommending improved collaboration, flexible models, and greater clinical exposure, with future research exploring how psychiatric education can better prepare clinicians to work with marginalized groups. Full article

Background/Objectives: Evidence-based information is crucial for policymakers and providers of mental health and psychosocial services (MHPSS) for unaccompanied asylum-seeking children (UASC). However, there is a scarcity of national-level studies investigating the MHPSS needs of UASC and how these are addressed in Greece. The research objectives of this study were to explore: (a) the psychosocial and mental health needs of UASC living in Greek long-term accommodation facilities as perceived by MHPSS providers, and (b) the range of services across the country, highlighting gaps and best practices in service delivery. Method: An exploratory, predominantly quantitative design was adopted to map UASC’s psychosocial difficulties, mental health problems, and MHPSS delivery. Purposive sampling was implemented, with 16 of 17 NGOs operating long-term accommodation facilities for UASC and 16 child and adolescent mental health services (CAMHS) participating. The sample included 79 participants (34 facility coordinators, 28 field psychologists, and 16 CAMHS directors). A 5-W mapping tool (Who, Where, What, When, and Which) was used for data collection, through an online survey. Data analysis involved quantitative and qualitative methods (content analysis). Results: Of 798 minors, almost 59% showed signs of behavioral or emotional disturbance, with over half referred for psychiatric assessment and 27.7% needing inpatient care. Aggression, disruptive behaviors, self-harm, and suicidal ideation were the most challenging issues. CAMHS directors reported a high rate of crisis-driven responses, with 42.1% of UASC needing emergency psychiatric evaluation. Psychosocial support was hindered by communication difficulties, lack of a shared care philosophy, understaffing, job insecurity, and limited resources. Conclusions: Our findings highlight the mental health needs of UASC, and the challenges faced by facility coordinators, psychologists, and community mental health specialists. Future research should focus on the institutional and organizational factors influencing service delivery to improve support for UASC. Full article

Introduction: The COVID-19 pandemic precipitated substantial disruptions in healthcare utilization globally. In Japan, reduced healthcare utilization during the pandemic’s early phases had been documented previously. However, few studies have investigated the impact of the pandemic’s later stages (2022–2023) on healthcare utilization rates, particularly in the Japanese context. Methods: We employed a quasi-Poisson regression model, adapted from the FluMOMO framework, to analyze temporal trends in Japanese healthcare utilization throughout the pandemic until November 2023. We estimated inpatient and outpatient volumes and hospital length of stay by bed type (general and psychiatric). Results: In general hospital beds, inpatient volumes remained significantly below pre-pandemic levels for every month until November 2023, with a reduction of 7.8 percent in 2023 compared to pre-pandemic levels. Psychiatric inpatient volumes, which had been declining before the pandemic, continued this downward trend, with the average occupancy rate decreasing by approximately 5.3% to 81.3% in 2023 compared to pre-pandemic levels. Significantly reduced outpatient volumes for both general and psychiatric care, in addition to prolonged lengths of hospital stay for psychiatric beds, were observed sporadically for several months in 2022 and 2023, persisting beyond the cessation of state of emergency and quasi-state of emergency declarations. Conclusion: The COVID-19 pandemic fundamentally altered healthcare utilization patterns in Japan. We observed a sustained reduction in general and psychiatric inpatient volumes relative to pre-pandemic baselines nationwide. The prolonged impact on healthcare utilization patterns, persisting beyond emergency measures, warrants continued monitoring of service delivery. Full article

Adults with a history of living in residential youth care (RYC) face elevated risks across various life domains. In this cohort profile paper, we outline the design of a comprehensive follow-up study—the VINGO study—targeting young adults (22–30 years) with a history of living in RYC (T2). We describe the recruitment strategy and present sample characteristics. Data were collected in the baseline study (T1) from 2011 to 2014. At T1, the 400 adolescent participants showed a high prevalence of mental disorders, maltreatment experiences, substance use, and self-reported suicide attempts. Data collection at T2 10 years later (2021–2023) included self-reported sociodemographic information, physical health, childhood maltreatment, dissociation, quality of life, social support, and self-esteem using standardized and validated instruments. A diagnostic psychiatric assessment and subjective evaluation of service utilization were conducted by telephone interviews. Additionally, a qualitative sub-study involved in-depth interviews of fourteen participants. We reached a 52% response rate at T2. Comparing participants (n = 157, 107 females) to non-participants (n = 243, 123 females) based on T1 data revealed that T2 participants had a higher prevalence of depression, anxiety, and conduct disorder and a lower prevalence of ADHD at T1. Furthermore, T2 participants reported more suicide attempts, experiences of maltreatment, and problematic substance use at T1. Our results show that we reached a burdened population, positioning the VINGO study as a unique opportunity to examine a vulnerable population of emerging adults. Full article