Elena Maria Garralda

Imperial College London | Imperial · Centre for Mental Health

Objective Paediatric intensive care unit (PICU) admission represents a traumatic event for many children. Follow-up studies have found post-traumatic stress disorder (PTSD) rates of 10–30%, with a particular prevalence following admission for sepsis. Dysregulated inflammatory responses are associated with PTSD. Sepsis involves a marked inflammatory...

Objective Paediatric intensive care unit (PICU) admission represents a traumatic event for many children. Follow-up studies have found post-traumatic stress disorder (PTSD) rates of 10-30%, with a particular prevalence following admission for sepsis. Dysregulated inflammatory responses are associated with PTSD. Sepsis involves a marked inflammatory...

Adults and young people with somatoform disorders and somatic symptoms retrospectively report high rates of sexual abuse. We aimed to assess somatic symptoms in young people in the aftermath of a sexual assault and to document links with assault characteristics, with psychopathology and with related functional impairment. This was a prospective coh...

Following approval of the ICD‐11 by the World Health Assembly in May 2019, World Health Organization (WHO) member states will transition from the ICD‐10 to the ICD‐11, with reporting of health statistics based on the new system to begin on January 1, 2022. The WHO Department of Mental Health and Substance Abuse will publish Clinical Descriptions an...

Objectives: To evaluate the feasibility and acceptability of different methods of collecting follow-up data from parents 12 months after their child's emergency admission to a PICU. Design: Mixed-methods explanatory sequential design. Setting: One regional PICU transport service and three PICUs in England. Patients: Children undergoing emerg...

Background Survivors of critical illness in childhood commonly display subsequent psychiatric symptoms including emotional and behavioural difficulties, and manifestations of post-traumatic stress disorder (PTSD). Anomalies in inflammatory profiles are an established finding in these childhood psychiatric conditions. Objective This exploratory stu...

Aim To examine the association between corticosteroid use in paediatric intensive care units (PICU) and subsequent symptoms of post-traumatic stress disorder (PTSD). Methods The subjects were children aged 8–16 years admitted to PICU with sepsis, meningoencephalitis (ME) and other disorders. Illness information was extracted from case notes; 3–6 m...

In this exploratory case–control study, we investigated basal cortisol regulation in 5–16-year-old children, 3–6 months following PICU (paediatric intensive care) admission. This was nested within a study of child psychological and cognitive function; 47 children were assessed alongside 56 healthy controls. Saliva samples were collected three times...

This chapter discusses the epidemiology, aetiology, diagnosis, prognosis, assessment, treatment of anxiety disorders in children and adolescents. Anxiety is an unpleasant feeling of apprehension accompanied by physiological, cognitive and behavioural processes. Honed by millennia of natural selection to protect us from danger, the anxiety response...

The two most widely used classification systems of mental health disorders are the World Health Organization's International Classification of Diseases (ICD) and the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM). Classification in child and adolescent psychiatry is a tool for communication amongst cl...

In the past few decades there has been a steady growth of research and knowledge on the nature and treatment of child and youth mental disorders. This chapter addresses the classification of child and adolescent mental health disorders in the recently published 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM-5, and...

Hallucinations (erroneous percepts in the absence of identifiable stimuli) are a key feature of psychotic states, but they have long been known to present in children with non-psychotic psychiatric disorders. Recent epidemiological studies of child populations found surprisingly high rates (about 10%) of hallucinatory experiences. These hallucinato...

Background: The paediatric population is known to be at high risk for psychiatric problems. Paediatric liaison child/adolescent mental health services (PL-CAMHS) have been developed to help increase recognition and management of psychiatric morbidity in the paediatric setting. This report describes clinical activity by a psychological medicine PL-...

There is a growing research interest in childhood hallucinations as predictors of psychotic states. This work appears to have limited direct relevance for clinical child psychiatric practice, but it highlights the continuing relevance of research into precursors of psychotic states and into the determinants of clinically relevant hallucinations in...

Objective To assess feasibility and pilot a supported psychoeducational tool to improve parent and child mental health following discharge from a paediatric intensive care unit (PICU), in preparation for a large randomised controlled trial (RCT). Design Feasibility assessment and single-centre, parallel group, pilot RCT. A concealed computer genera...

Background. There is limited research in self-perceived stigma among children and adolescents with sickle cell disease (SCD). We applied the concept of “stigma dimensions” to measure the predictors of self-perceived stigma in young people with SCD. Objective. In accordance with “stigma dimensions”, we hypothesized that young people with visible cli...

Non-specialist community or primary health care settings are the first point of contact for families seeking professional attention for health problems. Although their role in attending to children and young people with mental health problems has been comparatively little documented, evidence for its potential is slowly accumulating. This chapter d...

The essential feature of the somatoform and related disorders is the presence of impairing physical symptoms that cause concern but are not explained by a medical or psychiatric disorder. Such symptoms are usually associated with emotional conflict or psychosocial stress. This chapter describes how these disorders present in children, and it follow...

The National Institute for Health and Care Excellence (NICE) guideline summary recommended that Child and Adolescent Mental Health Services should work with primary healthcare professionals to develop systems for detecting, assessing, supporting, and referring depressed children and young people, with provision for those who are less seriously affe...

To study 12-month persistence of neuropsychological deficits in PICU survivors. Prospective follow-up study. Two PICUs. Children 5-16 years old with neuropsychological deficits 3-6 months following PICU care for meningoencephalitis, sepsis, and other critical illnesses (excluding other primary neurological disorders). None. Neuropsychological funct...

To assess mental and physical wellbeing in school-aged children following admission to pediatric intensive care and to examine risk factors for worse outcome. A prospective cohort study. Two PICUs. A consecutive sample of 88 patients 5-16 years old (median age, 10.00 yr; interquartile range, 6.00-13.00 yr) admitted to PICU from 2007 to 2010 with se...

Auditory hallucinations are uncommon paediatric presentations, but they can be alarming and lead to emergency consultations. This review outlines the phenomenology of auditory hallucinations, their assessment and clinical significance. Auditory hallucinations are seen in the course of acute medical disorders, often together with decreased levels of...

The World Health Organization (WHO)'s priorities for the development of the classification of mental and behavioural disorders in the ICD-11 include increasing its clinical utility in global mental health settings (1) and improving the identification and diagnosis of mental disorders among children and adolescents (2). An issue that has been hotly...

Background and aims Admission to paediatric intensive care (PIC) has been linked to subsequent post-traumatic stress symptoms (PTSS) in parents. This study aimed to obtain initial estimates regarding the effect of a brief intervention on parent PTSS and explore the mediating effect of baseline parental stress. Methods Parents of children aged 4–16...

Psychopathology in parents and children is increased after Paediatric Intensive Care Unit (PICU) admission; few studies have evaluated interventions to reduce this. Objective. Evaluation of the feasibility of setting up a joint paediatric and psychiatric follow-up clinic for families after PICU discharge. Design. Feasibility study offering joint fo...

Thompson et al [1][1] considered the use of the Paddington Complexity Scale[2][2] to quantify the case complexity of their child and adolescent mental health service (CAMHS) attenders, but discarded it largely because their study was based on CAMHS records which did not record systematically

PurposeDepression in young people attending primary care is common and is associated with impairment and recurrence into adulthood. However, it remains under-recognized. This study evaluated the feasibility of training primary care practitioners (PCPs) in screening and therapeutic identification of adolescent depression, and assessed its effects on...

Child and Family When looking at therapy and recent empirical evidence, genetic aspects in treatment (DNA), have given moral, motivation and/or hope especially to children who are familial in and who have progressive disorders. On a forensic psychology basis this can lead to thoughts of superiority and/or STIGMA. In example mockery of freedom of in...

Child and Family When looking at therapy and recent empirical evidence, genetic aspects in treatment (DNA), have given moral, motivation and/or hope especially to children who are familial in and who have progressive disorders. On a forensic psychology basis this can lead to thoughts of superiority and/or STIGMA. In example mockery of freedom of in...

Background: Little is known about conversion disorder in childhood. Aims: To document clinical incidence, features, management and 12-month outcome of non-transient conversion disorder in under 16-year-olds in the U.K. and Ireland. Method: Surveillance through the British Paediatric Surveillance Unit and Child and Adolescent Psychiatry Surveil...

Objective: To assess short-term neuropsychological function and academic performance in school children following admission to intensive care and to explore the role of critical neurologic and systemic infection. Design: A prospective observational case-control study. Setting: Two PICUs. Subjects: A consecutive sample of 88 children aged 5-1...

Objective: To assess the frequency and associations of abdominal pain in a sample of British secondary school young people and to examine predictors of impairment and health care use. Methods: Cross-sectional study of young people aged 11-16 years that completed questionnaires documenting abdominal pain, related impairment and health care consul...

Background The nature of adolescent sub-syndromal depression has not been investigated in primary care. Aims To document frequency, characteristics and 6 month outcome of sub-syndromal depression amongst adolescent primary care attenders. Method Primary care attenders (13–18 years) completed depression screening questionnaires (Mood and Feelings Qu...

Background: Gene-modifying trials offer hope for improvement in chronic paediatric disorders, but they may also lead to disappointment and have an adverse emotional effect on families. This study aimed to examine emotional impact on participants in a paediatric exon-skipping trial. Methods: Nineteen male children with Duchenne muscular dystrophy...

Rates of depressive disorder in adolescents attending primary care are increasing. Most presentations are for physical complaints and concurrent depressive symptoms go unrecognised and untreated. Primary care practitioners describe reluctance to intervene due to lack of confidence and skills. This paper describes the development and implementation...

Mild-to-moderate depression in young people is associated with impaired social functioning and high rates of affective disorder in adult life. Earlier recognition of depression in young people has the potential to reduce the burden of depression in adulthood. However, depression in teenagers is underdiagnosed and undertreated. To assess the usabili...

The link between physical and psychological disorder in children and adolescents is well established. Children with chronic illness are at increased risk of emotional and behavioural disorders. In addition, repeated presentations with physical symptoms may represent underlying psychological distress or psychiatric disorder. Because of the inextrica...

Frequent attendance to primary care services has shown an association with psychosocial factors in adult and child populations. Little is known about the psychosocial correlates of attendance in adolescents. To study the contribution of psychosocial factors to frequent primary care attendance in a community sample of young British people. The metho...

Aims and method To carry out a survey to ascertain the role of academic clinical fellowship posts within the integrated academic training programme for academic training in child and adolescent psychiatry. Questionnaires were sent to UK academic child psychiatric units. Results A total of 18 units returned questionnaires; this identified eight uni...

Aims and method We developed material for a lecture hall teaching programme in child and adolescent psychiatry for medical students. Although lecture hall settings are not traditionally seen as conducive to exploring concepts, debating positions and encouraging higher-order thinking, we aimed to integrate these processes into the programme alongsid...

Depressive disorder is common amongst adolescents attending primary care, but little is known about its time course. To determine the 6-month outcome of depressive disorder in adolescent primary care attendees with regard to the time to recovery from (1) the date of index GP consultation and (2) the date of depressive episode onset, and to identify...

In 2009, a conference at Imperial College London brought together experts on the primary care provision of child and adolescent mental health. The following paper highlights various themes from the conference, and particularly focuses on general practice. Despite international and national guidance, child and adolescent mental health provision in p...

We report clinical safety and biochemical efficacy from a dose-ranging study of intravenously administered AVI-4658 phosphorodiamidate morpholino oligomer (PMO) in patients with Duchenne muscular dystrophy. We undertook an open-label, phase 2, dose-escalation study (0·5, 1·0, 2·0, 4·0, 10·0, and 20·0 mg/kg bodyweight) in ambulant patients with Duch...

Unexplained physical complaints are common in children and form the basis for childhood somatization (the manifestation of distress through somatic symptoms) and somatoform disorders. Emotional symptoms and anxiety disorders are often comorbid with both unexplained physical symptoms and somatoform disorders. Risk factors include stress sensibility...

En France, la psychiatrie de l’enfant et de l’adolescent est aujourd’hui à la croisée des chemins et dans une situation paradoxale : comment ne pas renoncer à la richesse de son histoire et des apports qui ont contribué à ses fondations (approche multidimensionnelle, psychanalyse, thérapies institutionnelles, accès aux soins pour tous, soins de pro...

Duchenne Muscular Dystrophy (DMD) is a progressively debilitating neuromuscular disorder markedly affecting family life. To obtain descriptive accounts from siblings about impact and coping with DMD and consider implications for psychological function. Semi-structured interviews with a purposive sample of healthy siblings of young people with DMD a...

Nocturnal ventilation has improved the physical status and life span of childhood neuromuscular disorders: the purpose of this study was to assess the implications for sleep and well-being in patients and carers. Ten young men (age range 12-25 years) with neuromuscular disorders on assisted ventilation and/or their main carers completed questionnai...

Background The hypothalamus-pituitary-adrenal (HPA) and sympathetic-adrenal-medullary (SAM) axes play an important role in the stress responses of children with critical illness admitted to a paediatric intensive care unit (PICU). While lower levels of plasma cortisol during admission for meningococcal disease have been associated with higher morta...

Unexplained physical complaints are common in children, and form the basis for childhood somatization (the manifestation of distress through somatic symptoms) and somatoform disorders. Emotional symptoms and anxiety disorders are often comorbid with both unexplained physical symptoms and somatoform disorders. Risk factors include stress sensibility...

This study aimed to investigate child and carers' attitudes towards child involvement in paediatric consultations. Semi-structured qualitative interviews explored child and carers' attitudes towards child involvement at different stages of the paediatric consultation process. Twenty families (21 children, 17 mothers and 5 fathers) were interviewed...

Thapar and colleagues’ review of managing and preventing depression in adolescents highlights primary care’s role in detection and initial management and alludes to pragmatic psychosocial approaches.1 However, attempts to increase the involvement of primary care are impeded by concerns about medicalising depression, which means that psychological p...

Duchenne muscular dystrophy (DMD) is a progressive, impairing, life-limiting disorder of childhood. Little is known about how siblings adapt to this. The aim of this study is to document psychosocial adjustment in siblings of patients with DMD. Healthy siblings (11-18 years old) of young people with DMD attending a specialist paediatric centre and...

Mutations that disrupt the open reading frame and prevent full translation of DMD, the gene that encodes dystrophin, underlie the fatal X-linked disease Duchenne muscular dystrophy. Oligonucleotides targeted to splicing elements (splice switching oligonucleotides) in DMD pre-mRNA can lead to exon skipping, restoration of the open reading frame, and...

To ascertain whether increases in psychological symptoms in children and parents after meningococcal disease are sustained over time, and to examine the psychosocial and illness associations of 12-mo psychological outcome. A prospective, cohort study using repeated measures. Three pediatric intensive care units and 19 general pediatric wards across...

Outcome auditing of specialist child and adolescent mental health services (CAMHS) is now well under way internationally. There is, however, debate about objectives and tools. A case is made for the achievable goal of enhancing service accountability through user satisfaction information and clinician-rated contextualised measures of improvements i...

Adolescence is a time of increased health risk behaviours and depressive symptoms and disorders. Most young people with depressive disorders, however, are not under the care of specialist child and adolescent mental health services, and there is increasing interest in identifying alternative appropriate settings which are acceptable for young peopl...

Chronic fatigue syndrome (CFS) in young people may be regarded as a modern disease. The syndrome became an established part of clinical paediatric practice in western countries over the turn of the 20th century. Interest has grown speedily however, and now a number of countries have developed guidelines for assessment and treatment. Chronic fatigue...

To conduct meta-analyses of neuropsychological performance in young people with type 1 diabetes. Meta-analysis of 24 studies. Studies published between 1980 and 2005 were identified. The inclusion criteria were: young people who were < or =19 years of age with type 1 diabetes, a case-control design and standardized neuropsychological tests of seven...

To present normative and psychometric data on somatic symptoms using the Children's Somatization Inventory (CSI) in a nonclinical sample of British young people, and to assess associations with stress and functional impairment. A total of 1,173 students (11- to 16-years old) completed the CSI and self-report psychopathology measures. The median CSI...

Although depression is common amongst adolescents attending general practice, little is known about factors which influence consultation. This study aims to identify factors that contribute to GP attendance in adolescents with high levels of mood symptoms. Case-control study of 13 to 17-year-olds attending (cases, N = 156) and not attending (contro...

Background: The Primary Mental Health Worker (PMHW) interface role was introduced in England 13 years ago. This study evaluated the development of the role. Method: 415 English PMHWs (64% of workforce) completed a survey about the services they provide, management organisation, training and development, and job satisfaction. Results: PMHWs perceive...

Background: The role of primary mental health worker (PMHW) in CAMHS was established in 1995 although comparatively little research has explored the attributes required to successfully undertake this role. Method: Qualitative interviews with PMHWs and staff working in primary care were conducted and thematic analysis was performed. Results: In addi...

This article summarizes various aspects of anxiety disorder in children and adolescents using the latest research findings. Anxiety is an emotion, an unpleasant feeling of tension or apprehension accompanied by physiological changes and worries or fears. It can become maladaptive if excessive or developmentally inappropriate; if it also causes sign...

Medically unexplained somatic symptoms are common in children and adolescents. They can be an expression of somatization (psychological difficulty or distress manifested through somatic symptoms that are attributed to physical illness) and/or of a somatoform disorder. The most common somatoform disorders in children are persistent somatoform pain d...

Little is known about neuropsychological status following acute severe paediatric illness. This pilot study explored the effects on memory function of severe acute paediatric illness and associations between memory functioning and psychiatric sequelae. Case control study of children after paediatric intensive care unit (PICU) discharge and healthy...

This article describes assessment scales (mainly questionnaires) that can be used to screen for behavioural and emotional adjustment in children and families. This article focuses on instruments that are readily accessible, easy to use, do not require specific training, and may be useful for practitioners as an adjunct to clinical assessment. Infor...

The aim of this article is to examine clinical outcomes in a child psychiatry inpatient unit using dedicated measures. Clinicians completed contextual (Paddington Complexity Scale - PCS) and clinical change (Health of the Nation Outcome Scales for Children and Adolescents - HoNOSCA) questionnaires on admission and discharge for consecutive admissio...