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Impacto de la pandemia por COVID-19 en la salud mental de estudiantes universitarios en Chile
Abstract and Figures
La pandemia por COVID-19 ha tenido un impacto negativo en el bienestar psicológico de la población. El objetivo de este estudio fue evaluar el impacto de la pandemia por COVID-19 en la salud mental de estudiantes universitarios(as) en Chile, explorando el rol de los acontecimientos adversos en el núcleo familiar y las experiencias negativas relacionadas. Contestaron una encuesta en línea 2.411 estudiantes de primer año de una universidad en Chile. Tres de cada cuatro estudiantes reportaron que su estado de ánimo era peor o mucho peor en comparación con el contexto pre-pandémico. Las estudiantes mujeres presentaron significativamente mayores niveles de sintomatología depresiva y ansiosa y reportaron de forma significativa una mayor percepción de empeoramiento del estado de ánimo. Los hallazgos de este estudio refuerzan la necesidad de implementar intervenciones y estrategias orientadas a favorecer una mejor salud mental de los(as) estudiantes universitarios(as) en Chile.
Palabras Claves: COVID-19, salud mental, estudiantes universitarios, sintomatología depresiva, sintomatología ansiosa.
The COVID-19 pandemic has had a negative impact on the psychological well-being of the population. The objective of this study was to evaluate the impact of the COVID-19 pandemic on the mental health of university students in Chile, exploring the role of adverse events in the family and related negative experiences. An online survey was answered by 2,411 first-year students from a university in Chile. Three out of four students reported that their mood was worse or much worse compared to the pre-pandemic context. Female students presented significantly higher levels of depressive and anxious symptoms and reported significantly greater perception of worsening mood. The findings of this study reinforce the need to implement interventions and strategies aimed at promoting better mental health for university students in Chile.
Keywords: COVID-19, mental health, university students, depressive symptoms, anxious symptoms.
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... Based on the above, the present study is justified for the following reasons: (1) Most of the studies that have attempted to investigate people's mental health during the pandemic period have been primarily conducted using a quantitative methodology. This creates the need to complement and deepen the research through other methodological approaches, such as qualitative studies, in order to emphasize adolescents' experiences and lived realities during the confinement period [28]; moreover, (2) the available evidence has focused on the adult population, to the detriment of other age groups, such as children and adolescents [3,29,30]; (3) there is limited knowledge about how adolescents deal with the transformations and tensions associated with daily life during the pandemic [17,31]; and (4) another relevant theoretical background is that, on one hand, some studies suggest that young people reported positive experiences during the pandemic, which contributed to various areas of their lives [12][13][14]. On the other hand, other studies point to the existence of harmful experiences for mental health, which, combined with the circumstances of confinement, favored the emergence of symptoms in this area [25,32]. ...
The COVID-19 pandemic and the confinement measures adopted by most countries have impacted global mental health, with particular interest in the effects on adolescents due to the tension between lockdown measures and the challenges of their developmental stage. Therefore, this study examined the distress and positive experiences reported by adolescents in northern Chile during the pandemic. A comprehensive study was conducted among adolescents in northern Chile. Discussion groups were utilized to investigate their experiences during the pandemic. The discussions were transcribed, and their content was analyzed by thematic analysis to create emerging categories and subcategories. Eleven discussion groups were conducted with a total of 51 adolescents. The findings were organized into two categories: distress and positive experiences during the pandemic. The distress experiences category included experiences related to confinement, educational tensions, risk of contagion, being an adolescent, and anxious-depressive emotions and symptoms. Meanwhile, the positive experiences category highlighted experiences related to interpersonal relationships through social networks, hobbies, activism, and pets. This research provides guiding results for policymakers and mental health authorities to incorporate this information when creating initiatives for working with the adolescent population. It considers the impact on them, but also incorporates the reported positive experiences as coping mechanisms for other difficulties.
... Para algunas familias esto trajo un incremento en las relaciones familiares de manera positiva, pero en otros casos esto tuvo efectos negativos. En este sentido, la UNICEF (2020) refiere que se presentó un aumento en el maltrato hacia las mujeres y niños, y en parte de la población como consecuencia de la alteración en los estilos de vida se fueron presentando cambios en los ciclos de sueño (Mac-Ginty et al., 2021). ...
El objetivo de esta investigación fue determinar los niveles de salud mental positiva en profesionales de la salud en contexto de COVID-19. Se utilizó un enfoque cuantitativo, de tipo descriptivo y un diseño transversal tomando una muestra de 45 profesionales de la salud aplicando el cuestionario de salud mental positiva (SMP) de Lluch (1999). Como principales resultados se obtuvo que la población de estudio presentó un nivel medio de salud mental positiva a nivel general, y con respecto a los factores evaluados en el cuestionario, se obtiene que el factor satisfacción personal se sitúa en un nivel alto, actitud Prosocial en un nivel medio; autocontrol se ubicó en un nivel bajo; autonomía en un nivel medio, resolución de problemas y autoactualización en nivel bajo y habilidades de relación interpersonal en un nivel medio de salud mental positiva.
... Research on the impacts of COVID-19 on children has focused on the realm of mental health (Andrades et al., 2023;Mac-Ginty et al., 2021;Zhen et al., 2022). While this is a key aspect of the crisis, wider impacts on children's everyday lives have been under-studied (with exceptions such as Andres et al., 2023;Cameron et al., 2023;Chamberlain et al., 2021;Garthwaite et al., 2022;Potter et al., 2024aPotter et al., , 2024bRojas-Navarro et al., 2021, and little attention has been paid to how the spaces and mobilities that sustain family life and shape their caringscapes were disarticulated, re-articulated, and re-signified in the process of staying at home. ...
Standing at the intersection between geographies of care and children’s geographies, we present three ethnographic stories (emerging from three ethnographic studies) through which we argue that, as a result of pandemic confinement in Chile, children’s places within their landscapes of care shifted in a twofold sense: First, given the de-mobilisation and spatial concentration of spaces of care at home, children’s place became closer to adults,’ suspending the usual spatial segregation that separates them. And second, in tandem with this new proximity that we refer to as in-person family relationships, new possibilities for the involvement of children in family care practices emerged. This rearrangement of children’s places within landscapes of care brings to the fore two interrelated aspects of family care from children’s perspective. First, the kind and amount of in-person family time spent in a shared space in “normal” times was not enough from the perspective of children’s needs and interests. And second, even though children are usually seen as subjects of care, they are people who care for others and who are able to take on more caring responsibilities than the ones that they usually are expected to.
... The mental health of university students is a problem of growing attention in the international and national community due to the high prevalence of disorders and their serious consequences (Auerbach et al., 2018;Mac-Ginty et al., 2021), including suicide, the second cause of death in this age range (World Health Organization, 2014;Turecki et al., 2019). In Chile, reviews of prevalence studies in university students have estimated a range from 22.9 to 40.7% for psychological distress . ...
Background
Mental disorders in university students are a growing attention problem in the international community due to their high prevalence and serious consequences. One possible reason is university students’ difficulties in coping with stress. Repetitive negative thinking (RNT) is a transdiagnostic process that, when combined with stress, can lead to the development of various disorders. We aim to determine the effect of stress and RNT on predicting various mental health syndromes in university students across 7 days.
Method
Prospective observational study using Momentary Ecological Assessment (EMA) with the OURMIND Mobile App. On day one, 238 university students responded to the SCL-90R questionnaire for symptoms of depression, anxiety, hostility, obsession, psychoticism, paranoia, somatization, and interpersonal sensitivity; RNT styles questionnaires, RRS for rumination and negative reflection, PSWQ for worry; SISCO-II for term academic stress, and sociodemographic. EMA consisted of five assessments a day for 6 days; each time, the students answered items about academic and non-academic stress (EMA-stress), reactive RNT duration and intrusiveness (EMA-RNT process), and reactive RNT rumination, reflection, and worry (EMA-RNT content). On day eight, symptoms were re-assessed. Seven hierarchical stepwise linear regression models were used to test the predictive power of the study variables in the development of SCL-90R symptoms.
Results
When comparing models, adding baseline symptoms increased the models’ predictive power in all symptom groups. In most cases, including EMA-stress generated greater predictive power, except for paranoia and interpersonal sensitivity. Adding the EMA-RNT process increased the prediction of paranoia and obsessive symptoms; for hostility symptoms, RNT styles increased predictive power. For the final regression models, considering the initial symptoms, the EMA-RNT process predicted the progression of symptoms in six out of eight groups, while EMA-non-academic stress predicted the remaining two. Additionally, living with other relatives or friends was a predictor of depressive symptoms.
Discussion
The stress of university life impacts the development of psychiatric symptoms in university students. These results provide evidence of RNT as a transdiagnostic process in several syndromic groups. Universal preventive programs should consider the impact of academic and non-academic stress on university students’ mental health. Targeting RNT would also benefit selective preventive interventions.
The objective of this article was to identify and understand extra-academic aspects that hinder the academic performance of Chilean university students benefiting from free tuition. A total of 42 students, enrolled in 11 Chilean universities representative of the national spectrum, were interviewed. From critical discourse analysis, family and individual aspects hindering academic performance were identified. Amid our findings, students’ attitudes to resignify some of the obstacles to their performance stand out. The obstacles identified express the high social and economic segmentation faced by these non-paying students in the university context.
Keywords: Extra-academic Aspects; Academic Performance; Free Education; Higher Education
Mejorar la educación, el bienestar, el estado de ánimo y por ende el estado de salud mental de los estudiantes universitarios son puntos clave que distintas organizaciones mundiales enfatizan para el desarrollo pleno de la sociedad. El objetivo de la investigación fue establecer una asociación entre el bienestar subjetivo y el estado de ánimo de los jóvenes universitarios del Programa Académico de Psicología de una Universidad Pública del Estado de Nayarit, a través de un estudio cuantitativo de diseño no experimental de tipo transversal-correlacional, en el que se evaluaron las dimensiones de bienestar subjetivo, como la satisfacción con la vida y el afecto positivo, junto con factores de estado de ánimo positivos (vigor y amistad) y negativos (cólera, fatiga, tensión y estado deprimido). La muestra incluyó 140 estudiantes (120 mujeres y 20 hombres), con un promedio de edad de 19.68 años (DE = 2.44). Los instrumentos utilizados fueron la Escala de Bienestar Subjetivo de Calleja y Masón (2020) y la Versión Breve en Español del Cuestionario POMS (Profile of Moods States o Perfil de Estados de Ánimo) de Andrade et al. (2013). Los resultados mostraron una correlación positiva entre el bienestar subjetivo y los estados de ánimo positivos (vigor y amistad) y una correlación negativa con los estados de ánimo de negativos (cólera, fatiga, tensión y estado deprimido). Estos resultados dejan entrever que los estudiantes con un mejor bienestar subjetivo presentan menos emociones negativas, lo cual es crucial para su salud mental, su rendimiento académico y su desarrollo integral.
El presente estudio investiga las experiencias de pertenencia de 112 estudiantes de reciente ingreso a ingeniería durante el período de educación virtual de emergencia en 2021. Se empleó un enfoque cualitativo que recopiló las reflexiones escritas de los estudiantes sobre las razones de su sentido de pertenencia o falta de este durante el período educativo en línea. Además, se evaluó su nivel de pertenencia experimentado durante este período. Los datos fueron analizados mediante análisis de contenido temático. Los resultados revelaron seis categorías principales que abordan la importancia de las actividades vinculadas a la disciplina y profesión, el contacto presencial, los espacios físicos, la emocionalidad experimentada y eventos negativos específicos con docentes. Se concluye que hay varios aspectos que caracterizan la experiencia de pertenencia o falta de ella en estudiantes recién ingresados durante la educación virtual de emergencia, destacando la importancia del vínculo con la actividad disciplinar y la experiencia universitaria.
Introducción: A partir de los cambios que el confinamiento pandémico trajo consigo, la salud mental en el sector educación pasó a ser relevante, toda vez que, estas alteraciones de las prácticas académicas de este periodo están evidenciando secuelas en la salud mental de los estudiantes. Objetivo: Construir y validar un instrumento que mida la salud mental desde una perspectiva socioeconómica, la cual concibe la salud mental como un emergente social. Metodología: Se realizó un estudio cuantitativo, no experimental y transversal. La muestra fue de 313 estudiantes universitarios. Desde una perspectiva teórica socioeconómica, el instrumento se configuró en siete dimensiones, distribuidas en 24 ítems, los cuales fueron medidos a través de una escala de tipo Likert. Resultados: 309 sujetos completaron el instrumento correctamente. El cuestionario creado mostró adecuados índices psicométricos. Las siete dimensiones que se han definido teóricamente son: Salud Mental (SM); Carga Académica (CA); Rendimiento Académico (RA); Apoyo familiar (AF); Relación entre Pares (RP); Disposición docente hacia la salud mental del/la estudiante (DD); y Oferta Programática Institución (OP). Estas dimensiones pueden explicar el 68,7% de la varianza del constructo. Conclusión: La escala de percepción de salud mental para estudiantes universitarios posee validez y fiabilidad, por lo tanto, permite su aplicación como un instrumento adecuado y pertinente.
University students are a risk group for several mental health problems due to their psychological, social, and academic demands. The aim of this study was to determine the prevalence of symptoms associated with depression, anxiety, and stress among university students from northern Chile and their association with specific socio-demographic characteristics. The study was carried out with 696 participants selected through stratified probabilistic sampling. The depression, anxiety, and stress symptoms were assessed with the DASS-21 scale. The scale's reliability was evaluated with Cronbach's α, and for data analysis, we performed summary measures, frequencies, ANOVA, and Scheffé's test in SPSS 26 ®. Additionally, Cohen's d was calculated for effect size. The results show prevalence of depression was 42.3%, anxiety was 53.5%, and stress was 49.6%. Depression was statistically higher in female than male students with low socioeconomic income and with another sexual orientation from heterosexual. Anxiety was higher in females and in students with low socioeconomic incomes, and, in the case of stress, it was most frequent in women. We found a high prevalence of depression, anxiety, and stress, which highlights the need to develop educational strategies, identify high-risk students, and initiate mental health interventions opportunely.
Background:
Chromosome 22q11.2 microdeletion syndrome, a disorder caused by heterozygous loss of genetic material in chromosome region 22q11.2, has a broad range of clinical symptoms. The most common congenital anomalies involve the palate in 80% of patients, and the heart in 50-60% of them. The cause of the phenotypic variability is unknown. Patients usually harbor one of three common deletions sizes: 3, 2 and 1.5 Mb, between low copy repeats (LCR) designated A-D, A-C and A-B, respectively. This study aimed to analyze the association between these 3 deletion sizes and the presence of congenital cardiac and/or palatal malformations in individuals with this condition. A systematic review and meta-analysis were conducted, merging relevant published studies with data from Chilean patients to increase statistical power.
Results:
Eight articles out of 432 were included; the data from these studies was merged with our own, achieving a total of 1514 and 487 patients to evaluate cardiac and palate malformations, respectively. None of the compared deleted chromosomal segments were statistically associated with cardiac defects (ORAB v/s AC-AD: 0.654 [0.408-1.046]; OR AD v/s AB-AC: 1.291 [0.860-1.939]) or palate anomalies (ORAB v/s AC-AD: 1.731 [0.708-4.234]; OR AD v/s AB-AC: 0.628 [0.286-1.382]).
Conclusions:
The lack of association between deletion size and CHD or PA found in this meta-analysis suggests that deletion size does not explain the incomplete penetrance of these 2 major manifestations, and that the critical region for the development of heart and palatal abnormalities is within LCR A-B, the smallest region of overlap among the three deletion sizes.
Background
Akathisia continues to be a significant challenge in current neurological and psychiatric practice. Prompt and accurate detection is often difficult and there is a lack of consensus concerning the neurobiological basis of akathisia. No definitive treatment has been established for akathisia despite numerous preclinical and clinical studies.
Method
We reviewed antipsychotic-induced akathisia including its clinical presentation, proposed underlying pathophysiology, current and under investigation therapeutic strategies.
Conclusion
Despite the initial promise that second generation antipsychotics would be devoid of akathisia effects, this has not been confirmed. Currently, there are limited therapeutic options for the clinical practice and the evidence supporting the most widely used treatments (beta blockers, anticholinergic drugs) is still absent or inconsistent.
A higher-than-expected frequency of schizophrenia in patients with 22q11.2 deletion syndrome suggests that chromosome 22q11.2 harbors the responsive genes related to the pathophysiology of schizophrenia. The TBX1 gene, which maps to the region on chromosome 22q11.2, plays a vital role in neuronal functions. Haploinsufficiency of the TBX1 gene is associated with schizophrenia endophenotype. This study aimed to investigate whether the TBX1 gene is associated with schizophrenia. We searched for mutations in the TBX1 gene in 652 patients with schizophrenia and 567 control subjects using a re-sequencing method and conducted a reporter gene assay. We identified six SNPs and 25 rare mutations with no association with schizophrenia from Taiwan. Notably, we identified two rare schizophrenia-specific mutations (c.-123G>C and c.-11delC) located at 5′ UTR of the TBX1 gene. The reporter gene assay showed that c.-123C significantly decreased promoter activity, while c.-11delC increased promoter activity compared with the wild-type. Our findings suggest that the TBX1 gene is unlikely a major susceptible gene for schizophrenia in an ethnic Chinese population for Taiwan, but a few rare mutations in the TBX1 gene may contribute to the pathogenesis of schizophrenia in some patients.
Background
Individuals with 22q11.2 Deletion Syndrome (22q11.2 DS) are a specific high-risk group for developing schizophrenia (SZ), schizoaffective disorder (SAD) and autism spectrum disorders (ASD). Several genes in the deleted region have been implicated in the development of SZ, e.g., PRODH and DGCR8. However, the mechanistic connection between these genes and the neuropsychiatric phenotype remains unclear. To elucidate the molecular consequences of 22q11.2 deletion in early neural development, we carried out RNA-seq analysis to investigate gene expression in early differentiating human neurons derived from induced pluripotent stem cells (iPSCs) of 22q11.2 DS SZ and SAD patients. Methods
Eight cases (ten iPSC-neuron samples in total including duplicate clones) and seven controls (nine in total including duplicate clones) were subjected to RNA sequencing. Using a systems level analysis, differentially expressed genes/gene-modules and pathway of interests were identified. Lastly, we related our findings from in vitro neuronal cultures to brain development by mapping differentially expressed genes to BrainSpan transcriptomes. ResultsWe observed ~2-fold reduction in expression of almost all genes in the 22q11.2 region in SZ (37 genes reached p-value < 0.05, 36 of which reached a false discovery rate < 0.05). Outside of the deleted region, 745 genes showed significant differences in expression between SZ and control neurons (p < 0.05). Function enrichment and network analysis of the differentially expressed genes uncovered converging evidence on abnormal expression in key functional pathways, such as apoptosis, cell cycle and survival, and MAPK signaling in the SZ and SAD samples. By leveraging transcriptome profiles of normal human brain tissues across human development into adulthood, we showed that the differentially expressed genes converge on a sub-network mediated by CDC45 and the cell cycle, which would be disrupted by the 22q11.2 deletion during embryonic brain development, and another sub-network modulated by PRODH, which could contribute to disruption of brain function during adolescence. Conclusions
This study has provided evidence for disruption of potential molecular events in SZ patient with 22q11.2 deletion and related our findings from in vitro neuronal cultures to functional perturbations that can occur during brain development in SZ.
Over the past 15 years, the number of pediatric patients presenting to the emergency room in psychiatric crisis has nearly doubled. Suicidality and aggression are among the most common presenting problems, making it important for providers to have up-to-date knowledge about the assessment and management of these frequently encountered clinical issues. Psychometrically sound suicide risk assessment tools are available for use in the emergency room setting, which can be administered efficiently with minimal provider training. Rates of off-label medication use in the pediatric population continue to increase and are often used in the management of acute agitation in the pediatric population. The current literature will be reviewed and summarized for application in emergent treatment settings. Overall, evidence to inform best practice is limited, leading to opportunities for innovation in health care delivery, the development of new research aims, and discussion of challenging clinical dilemmas.
Chromosome 22q11.2 microdeletions impart a high but incomplete risk for schizophrenia. Possible mechanisms include genome-wide effects of DGCR8 haploinsufficiency. In a proof-of-principle study to assess the power of this model, we used high quality whole-genome sequencing of nine individuals with 22q11.2 deletions and extreme phenotypes (schizophrenia, or no psychotic disorder at age >50 years). The schizophrenia group had a greater burden of rare damaging variants impacting protein-coding neurofunctional genes, including genes involved in neuron projection (nominal p=0.02, joint burden of three variant types). Variants in the intact 22q11.2 region were not major contributors. Restricting to genes affected by a DGCR8 mechanism tended to amplify between-group differences. Damaging variants in highly conserved long intergenic non-coding RNA genes were also enriched in the schizophrenia group (nominal p=0.04). The findings support the 22q11.2 deletion model as a threshold-lowering first hit for schizophrenia risk. If applied to a larger and thus better-powered cohort, this appears to be a promising approach to identify genome-wide rare variants in coding and non-coding sequence that perturb gene networks relevant to idiopathic schizophrenia. Similarly designed studies exploiting genetic models may prove useful to help delineate the genetic architecture of other complex phenotypes.
22q11.2 deletion syndrome is characterised by a well defined microdeletion that is associated with a high risk of neuropsychiatric disorders, including intellectual disability, schizophrenia, attention-deficit hyperactivity disorder, autism spectrum disorder, anxiety disorders, seizures and epilepsy, and early-onset Parkinson's disease. Preclinical and clinical data reveal substantial variability of the neuropsychiatric phenotype despite the shared underlying deletion in this genetic model. Factors that might explain this variability include genetic background effects, additional rare pathogenic variants, and potential regulatory functions of some genes in the 22q11.2 deletion region. These factors might also be relevant to the pathophysiology of these neuropsychiatric disorders in the general population. We review studies that might provide insight into pathophysiological mechanisms underlying the expression of neuropsychiatric disorders in 22q11.2 deletion syndrome, and potential implications for these common disorders in the general (non-deleted) population. The recurrent hemizygous 22q11.2 deletion, associated with 22q11.2 deletion syndrome, has attracted attention as a genetic model for common neuropsychiatric disorders because of its association with substantially increased risk of such disorders.1 Studying such a model has many advantages. First, 22q11.2 deletion has been genetically well characterised.2 Second, most genes present in the region typically deleted at the 22q11.2 locus are expressed in the brain.3-5 Third, genetic diagnosis might be made early in life, long before recognisable neuropsychiatric disorders have emerged. Thus, this genetic condition offers a unique opportunity for early intervention, and monitoring individuals with 22q11.2 deletion syndrome throughout life could provide important information on factors contributing to disease risk and protection. Despite the commonly deleted region being shared by about 90% of individuals with 22q11.2 deletion syndrome, neuropsychiatric outcomes are highly variable between individuals and across the lifespan. A clear link remains to be established between genotype and phenotype.3,5 In this Review, we summarise preclinical and clinical studies investigating biological mechanisms in 22q11.2 deletion syndrome, with a focus on those that might provide insight into mechanisms underlying neuropsychiatric disorders in 22q11.2 deletion syndrome and in the general population.
Background:
Akathisia is a common and distressing neuropsychiatric syndrome associated with antipsychotic medication, characterised by subjective and objective psychomotor restlessness. The goal of this guideline is to provide clinicians with recommendations on the assessment and treatment of akathisia.
Methods:
We performed a systematic review of therapeutic studies assessing the treatment of antipsychotic-induced extrapyramidal symptoms. Forty studies on akathisia and 4 systematic reviews evaluating the adverse effects of antipsychotics were used in the formulation of recommendations. Studies were rated for methodological quality using the American Academy of Neurology Risk of Bias Classification system. The overall level of evidence classifications and grades of recommendation were made using the Scottish Intercollegiate Guidelines Network framework.
Results:
As a good practice point, clinicians should systematically assess akathisia with a validated scale before starting antipsychotics and during antipsychotic dosage titration. For the management of akathisia, there was adequate evidence to allow recommendations regarding antipsychotic dose reduction, antipsychotic polypharmacy, switching antipsychotic medication, and the use of adjuvant medications including beta-blockers, anticholinergics, 5HT2A antagonists, benzodiazepines, and vitamin B6.
Conclusion:
The treatment of antipsychotic-induced akathisia should be personalised, with consideration of antipsychotic dose reduction, cessation of antipsychotic polypharmacy, and switching to an antipsychotic with a perceived lower liability for akathisia, before the use of adjuvant medications. The choice of adjuvant medications should favour the more established treatments, with careful consideration of contraindications and side effects. Limitations in the evidence should be acknowledged and prompt cautious prescribing, particularly with respect to the duration of use of adjuvant medications, is warranted.
Purpose of review:
Schizophrenia occurs in ∼25% of individuals with 22q11.2 deletion syndrome (22q11.2DS), the strongest known molecular genetic risk factor for schizophrenia. This review highlights recent literature in 22q11.2DS as it pertains to psychosis and schizophrenia.
Recent findings:
Advances in noninvasive prenatal testing allow for early detection of 22q11.2DS in utero, whereas premature birth has been shown to be a significant risk factor for development of psychotic illness in 22q11.2DS. Impairments in various domains of cognitive and social functioning, as well as neuroanatomical alterations, are comparable with those in other high-risk groups and may serve as early signs of psychosis in 22q11.2DS. Novel research on the pathogenesis of schizophrenia in 22q11.2DS using cellular and mouse models indicates changes in expression of genes within the 22q11.2 deletion region and elsewhere in the genome, implicating molecular pathways involved in schizophrenia and associated neurocognitive deficits. Increased risks of obesity and of Parkinson's disease in 22q11.2DS warrant consideration in antipsychotic management.
Summary:
Progress in characterizing and predicting psychotic illness in 22q11.2DS supports this identifiable subpopulation as a molecular model with important implications for understanding the pathogenesis of schizophrenia in the general population and for development of potential novel therapies.
Mental health complaints are frequent in the pediatric emergency department (PED). The objective of this study was to describe trends over time in PED utilization for mental health care at in a single pediatric tertiary care hospital. It is our hypothesis that the resources used by this patient population are high and that mental health-related visits have increased over the most recent decade.
This was a retrospective study of all pediatric mental health presentations to the PED from January 2009 to July 2013 at a single pediatric hospital. All patients aged 1 to 19 years with an International Classification of Diseases, Ninth Revision code of 291, 292, 295 to 309, and 311 to 314 were included. Data collected included demographic data, medications received, restraint use, suicidality, length of stay (LOS), charges incurred, final disposition, and daily PED operation variables. Trends over time in presentation, charges, and LOS were analyzed using multiple mixed effects regression models after adjusting for potential patient and PED level confounding variables and clustering of multiple visits within patients.
A total of 732 PED visits from 2009 to 2013 were identified representing 646 unique patients. The average age was 13.8 years, and 53% were male. Approximately 25% of the patients expressed suicidal ideation, and 44% of those had attempted suicide before arrival. Behavioral or chemical restraints were used in 33% of patients during their PED visit. There were statistically significant increases in annual visits, LOS, and charges over this period (P < 0.05). Increased charges were significantly associated with longer LOS (P = 0.0062). Charges (P = 0.46) and LOS (P = 0.62) were not significantly different between suicidal and nonsuicidal patients. Approximately 21% of patients were admitted or transferred to another facility.
In this single-center study, we found evidence that the resources required to care for pediatric patients with mental health complaints have increased significantly over time both by increased number of annual visits and an increasing LOS. Further research is necessary to determine if our data are consistent with national trends to further our understanding of the problem and improve resource allocation.