Search Results (222)

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

Objective: Successful local anesthesia reduces patient pain and anxiety, facilitates the procedure, and enhances overall comfort; however, in children, it may also increase the risk of parafunctional activities in anesthetized areas. This retrospective study aimed to evaluate the factors influencing the risk of self-inflicted injuries. Methods: A study was conducted from January to December 2023 using the records of 4285 pediatric patients aged 4–12 years who underwent dental treatment under local anesthesia. Among 1161 cases at Poznan University (Poland), 73 (6.3%) of self-inflicted injuries were reported. At Rome University (Italy), 823 cases were reviewed, with 522 involving local anesthesia and 23 cases (4.4%) of trauma. Results: The overall prevalence of trauma following local anesthesia was 5.9%, indicating significant clinical concern. The lips were the most commonly affected (69.9%), followed by the cheeks (15.1%) and tongue (15.1%). The study confirmed a positive correlation between younger age and higher trauma incidence, with no significant differences in sex or ethnicity. Longer anesthesia duration and higher anesthetic doses were associated with increased lesion severity. The type of anesthetic also played a role, with articaine showing a higher risk compared to lidocaine. Furthermore, the type of injection influenced trauma incidence, due to the distribution of numbness and exploratory behaviors. Conclusions: Local anesthesia remains an indispensable tool in pain management in pediatric dentistry. However, the risk of self-inflicted injuries is not limited to the youngest patient. Proper education on post-anesthetic care is essential for minimizing complications and ensuring safe and effective dental treatment. Full article

A growing knowledge base highlights the importance of accounting for a variety of social and structural determinants of health (SDOH) when understanding mental and behavioral health among adolescents and young adults. The objective of the current study is to examine patterns of self-reported SDOH deficits and characterize participant health indicators and social identity across classes. Data is from a cross-sectional national study of young people who were recruited through study advertisements on social media and surveyed online. Data were collected between June 2022 and October 2023. Eligibility included (1) ages 13–22 years, (2) living in the United States, and (3) proficient in English. Health indicators included suicide attempts, suicidal ideation, drug overdose, perceived likelihood of living to age 35, non-suicidal self-injury, recent alcohol use, and depression. Five classes of SDOH deficits were identified: (1) Economic Instability, (2) Low Overall SDOH Deficits, (3) High Social SDOH Deficits (adversity and discrimination), (4) High Economic SDOH Deficits, and (5) High Overall SDOH Deficits. Differences across class by health indicators and marginalized identity were found, with high proportions of gender minority and sexual minority youth in both the High Overall SDOH Deficit group and the High Social SDOH Deficit classes. Black youth were more likely to be part of the High Economic SDOH Deficits class. The findings encourage a public health approach that recognizes that improving the health of today’s young people must be connected to policies that reduce poverty, improve neighborhoods, and increase access to basic goods, services, and healthcare. Full article

Background: Suicide and self-injury are serious public health concerns, especially in young populations, owing to multiple social, cultural, and gender determinants. Qualitative evidence exploring narratives regarding the factors behind suicide among young women is rare in Pakistan. Objective: The present study aims to explore the complex dimensions of suicide or self-injury among young women of Southern Punjab. Methods: Semi-structured interviews were conducted in a marginalized district in South Punjab, with participants consenting to in-person meetings at their homes or phone interviews. We collected detailed accounts of fifteen deceased girls or self-harm survivors, with insights provided by close relatives of the victims. Results: Our findings identified several conducive factors to suicidality, including receiving insults in front of others, low self-esteem, household pressures, work burdens, unfulfilled romantic desires, feelings of worthlessness, cheating in love, marriage without choice, and engagement in risky behaviors. These causes could be categorized into personal (such as an inferiority complex), social (a lack of family support and frequent conflicts), and cultural factors (forced marriages). Conclusions: Our study advocates for empowering women through education and restricting access to suicide means, such as pesticides or Paraphenylenediamine (PPD). Moreover, the government should take strict measures to discourage the forced marriage of young females in rural contexts. This study highlights the importance of integrating suicide prevention initiatives with research efforts within Pakistan’s healthcare system. Full article

Background: Borderline Personality Disorder (BPD) is a growing health concern, characterized by emotional dysregulation, impulsivity, and unstable interpersonal relationships. One of the core features of BPD is self-harm, which has significant implications for clinical management, risk assessment, and treatment planning. Accurate assessment tools are essential in evaluating symptom severity and identifying individuals at high risk of self-injurious behaviors, thereby guiding clinical interventions effectively. This study aimed to assess the psychometric properties, factor structure, and diagnostic utility of the Greek version of the Borderline Personality Disorder Severity Index-IV (BPDSI-IV), providing preliminary evidence for its reliability and validity. Methods: A total of 128 individuals with BPD and 32 healthy controls were assessed using the BPDSI-IV together with the Brief Symptom Inventory-53 (BSI-53), the BPD Checklist, the Rosenberg Self-Esteem Scale, the WHOQOL-BREF, and the Defense Style Questionnaire-40 (DSQ-40). BPD diagnoses were confirmed using the Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD). Internal consistency, confirmatory factor analysis (CFA) of previously suggested models, exploratory and confirmatory bifactor modeling, and validity assessments were conducted. Results: The BPDSI-IV showed strong internal consistency (α = 0.92, ωt = 0.96), with most subscales demonstrating adequate reliability. Exploratory bifactor analysis using the Schmid–Leiman transformation supported a model with a dominant severity factor (ωh = 0.69), reinforcing the dimensional nature of BPD. CFA supported this bifactorial approach. BPDSI-IV scores significantly discriminated BPD patients from controls (p < 0.001). Strong correlations with measures of psychopathology and self-esteem, and correlations with quality of life further supported its validity. Conclusions: The Greek BPDSI-IV demonstrated strong reliability and validity indicators. Structured assessment tools, such as the BPDSI-IV, can enhance early intervention and research on the course of borderline personality disorder symptoms. Full article

Background: Previous studies have demonstrated that involuntary smoking (e.g., secondhand smoke [SHS] and thirdhand smoke [THS]) is not only associated with an increased risk of several physical health problems, such as cardiovascular disease and cancer, but also impacts mental health, including depression and anxiety. However, the relationships between SHS and THS exposure and non-suicidal self-injury (NSSI), suicidal ideation (SI), and suicide attempts (SAs) remain unclear. Methods: Participants were recruited at a Chinese vocational college via voluntary online surveys conducted on campus. Self-reported SHS exposure was determined by the frequency of contact with smokers or detecting tobacco odors in living environments, while THS was assessed through regular contact with smoker-contaminated surfaces (e.g., clothing, furniture, textiles). Logistic regression analysis was performed to evaluate the associations of SHS and THS exposure with the prevalence of NSSI, SI, and SAs in never-smoking participants. Results: The study included 5716 participants (mean age = 19.3 years; females, 85.4%). The prevalence of SHS and THS exposure was 87.6% and 77.4%, with 8.8% reporting ≥15 min of SHS exposure on at least one day per week. After controlling for potential covariates, exposure to SHS (≥15 min on at least one day per week) was significantly associated with the odds of SAs (OR [95%CI] = 1.85 [1.17–2.91]). Additionally, daily THS exposure was significantly associated with increased past-year NSSI prevalence (2.35 [1.29–4.28]) compared to those without THS exposure, with similar associations observed for SI (2.11 [1.28–3.48]) and SAs (2.40 [1.23–4.69]). Conclusions: Exposure to SHS and THS was significantly associated with increased likelihood of NSSI, SI, and SAs among young adults at a Chinese vocational college. Further studies are needed to validate these associations across more diverse populations. Full article

(1) Background: Housing instability is a public health issue in both developed and developing countries. This exploratory pilot study examines executive functioning (EF) and the history of acquired brain injury (ABI) in youth and young adults experiencing homelessness (YYEH). (2) Methods: Twenty-three YYEH (ages 18–25; 48% male) were recruited from a drop-in center in Central Ohio. The Ohio State University TBI Identification Method (OSU TBI-ID+ABI) was used to screen for exposure to ABI. Outcomes were measured using the Behavior Rating Inventory of Executive Function for Adults (BRIEF-A) and the NIH Toolbox Cognitive Battery. (3) Results: Eighty-seven percent of participants reported a lifetime history of ABI, including traumatic brain injury or hypoxic-anoxic brain injury. Overall, participants did not present with elevated EF scores on outcome measures. Those with multiple lifetime ABIs (n = 16) had significantly higher scores than those with a single ABI (n = 4), representing poorer EF, on shift, self-monitor, task monitor, and the Global Executive Composite of the BRIEF-A. There was no evidence of significant differences between participants on outcome measures based on injury mechanism. (4) Conclusions: In this pilot sample, those with multiple reported ABIs demonstrated decreased EF performance, and these differences were noted in specific areas of EF. To ensure YYEH have access to services, resource support and intervention providers should consider the cognitive profiles of the youth they serve. Full article

This case study explores the use of multiple pre-treatment assessments (functional analysis, reinforcer assessment, alternative self-restraint assessment, modified augmented competing stimulus assessment) to inform a comprehensive treatment package for an adolescent male exhibiting Subtype-3 automatically maintained self-injurious behavior (SIB). These assessments guided the development of a treatment package involving continuous access to competing stimuli and alternative self-restraint responses, differential reinforcement of alternative behaviors, and blocking hand-to-head hits across three contexts. The study also details many points of collaboration between the experimenters and the family and other specialists. Results showed decreases in SIB that were accompanied by a reduction in mechanical restraints and access to alternative activities. Full article

Background/Objectives: The co-morbidity between neurodevelopmental tics and functional tic-like behaviors (FTBs) in patients with Tourette syndrome (TS) is relatively under-investigated. The demographic and clinical characteristics of a large sample of patients with TS who presented with co-morbid FTBs (functional overlay) were assessed to raise awareness of this complex clinical presentation and to shed light on the differential diagnosis between the two conditions. Methods: We analyzed the clinical data of 63 patients (44 females, mean age 24 years, range 13–40) with pre-existing TS who (sub)acutely developed co-morbid FTBs (TS + FTBs) after the onset of the COVID-19 pandemic and compared them with 63 age- and gender-matched controls with TS (neurodevelopmental tics only). The diagnosis of co-morbid FTBs was validated by the European Society for the Study of Tourette Syndrome (ESSTS) criteria. Results: Complex vocal tics (p < 0.001), including coprolalia (p = 0.002), and self-injurious behaviors (p < 0.001), often as part of tic attacks (p < 0.001), were confirmed to be more commonly reported by the group of patients with TS + FTBs, who were also more likely to present with anxiety (p < 0.001) and other functional neurological symptoms (p < 0.001) compared to patients with TS. Conclusions: Patients with TS and co-morbid FTBs can pose significant diagnostic and treatment challenges. By systematically applying ESSTS criteria, we confirmed specific red flags for the diagnosis of functional overlay in patients with TS. The correct identification of this composite clinical phenotype plays a key role in preventing the misdiagnosis of treatment-resistant TS and implementing tailored treatment interventions. Full article

The present study used a person-centered approach to examine the latent patterns of cumulative family risk and emotion regulation difficulties in adolescents and their relationships with non-suicidal self-injury. A sample of 1046 primary and secondary school students was analyzed using latent class analysis and latent profile analysis to identify subgroups of cumulative family risk and emotion regulation difficulties, respectively. The results were as follows: (1) Two latent classes of cumulative family risk were identified: a high-risk group (30.78%) and a low-risk group (69.22%). Adolescents in the high-risk group had significantly higher self-injury scores. (2) Three latent profiles of emotion regulation difficulties were identified: a low-difficulty group (56.02%), a medium-difficulty group (32.60%), and a high-difficulty group (11.38%). Adolescents in the high-difficulty group had the highest self-injury scores. (3) The logistic regression showed that adolescents in the high-risk group were more likely to belong to the high-difficulty group, followed by the medium- and low-difficulty groups. In summary, adolescents with high levels of cumulative family risk are also more likely to exhibit high levels of emotion regulation difficulties and self-injurious behavior. Full article

This study employed Linguistic Inquiry and Word Count (LIWC-22) software, a language analysis tool, to examine Spanish-language pro-NSSI Tumblr posts. Pro-NSSI, or “pro non suicidal self-injury”, refers to online content that normalizes or supports self-harming behaviors. Given the strong associations between NSSI and conditions such as post-traumatic stress disorder (PTSD), anxiety, and depression, understanding how these behaviors are discussed online can help improve interventions. A year’s worth of public posts were collected, focusing on captions and hashtags that included NSSI-related terms. Using Linguistic Inquiry and Word Count (LIWC) software, we analyzed linguistic and psychological markers. Log-likelihood ratio tests revealed significantly higher frequencies of words related to negative emotions, sadness, health, and death compared to standard blog norms. Mixed-language posts showed notable code-switching, suggesting a possible emotional distancing mechanism when discussing self-harm. The findings indicate that Spanish-speaking adolescents engaging in pro-NSSI communities exhibit unique linguistic and psychological characteristics, with important implications for clinical assessment and intervention. Mental health counselors and educators can use these insights to develop culturally and linguistically responsive strategies for prevention and support. Full article

Repetitive behaviors are actions that are performed consistently and repeatedly, often without an obvious functional purpose. These types of behaviors are common and diverse in individuals with Autism Spectrum Disorder (ASD) and can influence daily life, making social integration difficult for individuals who experience them and thus becoming a source of distress. Research show that, in most individuals with ASD, sensory processing tends to be affected. It has been suggested that, in children with ASD, sensory processing disorders can cause them to experience their environment in an exaggerated or diminished way, and this affects their behavior. Repetitive behaviors may emerge as a way to regulate the level of stimulation and achieve a state of sensory balance. Objectives: The aim of this investigation is to study differences and relationships between the sensory profile and repetitive behavior in autism. Methods: A total of 48 students, aged 4 to 26 years (M = 14.39; SD = 7.24), participated. The Bodfish Repetitive Behavior Scale and Sensory Profile 2 by Dunn were used as instruments of measure. Results: Results show that the student groups differ only in some variables, with Level 3 students being the most affected. In this sense, Level 3 students present with higher self-injury, greater tactile and movement processing difficulties, and higher registration (passive response and a high threshold of perception). Hyper-reactivity shows a weak prediction power over insistence of sameness, while hypo-reactivity showed none. Conclusions: Correlations between repetitive behavior and sensory processing were weak and of low magnitude, which contradicts the previous literature. Full article

Behavior-analytic treatments successfully reduce individuals’ destructive behavior (e.g., self-injurious behavior, aggression, property destruction, disruption); however, there is limited research evaluating these treatments’ effects on individuals’ physiological stress responses, even though stress can have significant negative impacts on quality of life. Research from other fields has demonstrated that salivary cortisol concentration is a valid biomarker for stress, so researchers could potentially use this biomarker to assess the stress of individuals with limited communication repertoires who also engage in destructive behavior. The purpose of this research was to assess changes in salivary cortisol concentrations as a biomarker for stress with two participants to evaluate whether conditions that evoke destructive behavior induce stress relative to conditions that do not evoke destructive behavior. For one participant, salivary cortisol concentrations tended to increase following exposures to stimuli that evoked destructive behavior compared to conditions that did not evoke destructive behavior. The other participant had elevated salivary cortisol concentrations across all conditions. Salivary cortisol may be a useful biomarker for evaluating physiological stress as an outcome measure during research on the assessment and treatment of destructive behavior. Full article

Considering that neurological injuries cannot typically self-recover, there is a need to develop new methods to study neuronal outgrowth in a controllable manner in vitro. In this study, a precise flow-controlled microfluidic system featuring custom-designed chambers that integrate laser-microstructured polyethylene terephthalate (PET) substrates comprising microgrooves (MGs) was developed to investigate the combined effect of shear stress and topography on Neuro-2a (N2a) cells’ behavior. The MGs were positioned parallel to the flow direction and the response of N2a cells was evaluated in terms of growth and differentiation. Our results demonstrate that flow-induced shear stress could inhibit the differentiation of N2a cells. This microfluidic system could potentially be used as a new model system to study the impact of shear stress on cell differentiation. Full article

Background/Objectives: Autism spectrum disorder (ASD) is a complex neurodevelopmental disorder characterized by difficulties in social interaction, communication, and repetitive behaviors. Recent evidence indicates a significant relationship between ASD and imbalances in microbiota, particularly in the oral and gastrointestinal areas. This review examines the impact of oral microbiota, self-injurious behaviors (SIB), sensory sensitivity, and dietary choices on the comorbidities associated with ASD. Methods: An extensive literature review was conducted using PubMed and Scopus. The focus was on human studies with full-text availability, utilizing search terms related to ASD, oral health, oral microbiota, and neurodevelopmental disorders. The research was evaluated for methodological quality and its relevance to the connections between microbiota, oral health, and ASD. Results: Individuals with ASD face unique oral health challenges, including injuries from self-injurious behaviors and increased sensory sensitivity, which complicate oral hygiene and care. Selective eating can lead to nutritional deficiencies and worsen oral health issues. Dysbiosis in oral and gut microbiota, marked by altered levels of acetate, propionate, and butyrate, interferes with gut-brain and oral-brain connections, contributing to behavioral and neurological symptoms. Treatment options such as probiotics, fecal microbiota transfer, and sensory integration therapies can potentially alleviate symptoms and improve quality of life. Conclusions: The relationship between ASD, oral health, and microbiota suggests a bidirectional influence through neuroinflammatory mechanisms and metabolic disturbances. Proactive strategies focusing on microbiota and dental health may help reduce comorbidities and enhance the overall management of ASD, underscoring the need for further research into microbiota–host interactions and their therapeutic potential. Full article