Science topic

Adolescent Psychiatry - Science topic

The medical science that deals with the origin, diagnosis, prevention, and treatment of mental disorders in individuals 13-18 years.
Questions related to Adolescent Psychiatry
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I have not found many studies about this treatment. It has been approved by FDA based on very preliminary evidence. How much time does FDA take in general to approve a treatment in mental health field?
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I agree that we do not know how eTNS works on ADHD children, but in terms of clinical application, I recommend to use it because there are parents worrying about side effects of medication as well as being unable to manage ADHD symptoms.
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I believe while doing research about depression we are doing a huge mistake. We often use screening tools for depression, such a self-reported scale (e.g. EURO-D), and those who are at risk are often called "depressed".
Being at high risk for depression does not mean being depressed.
I often read about incredibly high prevalence of depression in many studies, but then in the methods I see a screening tool was used to measure depressive symptoms.
Depression is not diagnosed in such a way.
Diagnosis of depression can be done only in a clinical setting.
While using scale for screening, we need to talk about "individuals at high risk for depression" or individuals with "high level of depressive symptoms".
It is like if we would refer to those with low tolerance to glucose as diabetic after asking them the value of glucose last time they made a blood test. Actually, this would be even more accurate.
What is your idea?
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I agree with Michael Uebel that PHQ-9 is a useful screening tool, as well as other validated questionnaires (Zung's SDS, CES-D, HADS, Whooley, etc.). However, they are just screening tools, not diagnostic tools. A positive screening indicates that there is a likelihood of having a depressive disorder.
E.g., it is accepted that the operational features (sensitivity, specificity...) of the PHQ9 are sufficiently good to recommend its use as a screening tool, but its predictive positive value (at best: in a population with high prevalence of depression) could be around of 50 % (i. e., 50% of positive results in PHQ 9 do not have depression).
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child psychiatry
neuroscience
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Many Thanks, It is great website
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I'm doing a critical analysis test your knowledge report.
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Google Scholar, PubMed Central, Pubmed, HINARI
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I wonder if different approaches are taken to using naso-gastric feeding in anorexia nervosa patients in different countries / clinics. I would like to hear about policies and practices in different places. Only because of somatic indications, which? Also because of psychological indications, which?
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I am only a sr administrative assistant.
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I could really use some adolescent-specific information on selective mutism. I am interested in therapy approaches, manuals, anecdotes, insights, whatever you've got. 
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Dear carl, 
The selective mutism may start earlier and continue into teenage. Here are some ideas. You can always discuss with the authors to the papers here on RG: 
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Psychiatric Social Worker means social worker practicing in psychiatric field or mental health field.
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No, but I would like to know it too. I am a Portuguese social worker and a PhD in Mental Health.
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 A 20 year old male had suffered from mild head trauma. He had no neurological deficits and no investigations were carried out. Hours later he started stuttering when speaking and claims it is as a result of his head trauma. Stuttering has been present for 3 days. How can a doctor tell if it is true stuttering or the person is faking it.
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A speech language pathologist with a Board Specialization in Fluency Disorders (or similar specialization) should easily ascertain this.  There are plenty of behaviors that can separate a malingerer and a true stutterer.   With this said, it is possible to have a fluency difficulty as a result of a TBI.  A formal speech language evaluation is warranted here in any case.
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Can anyone suggest a scale for measuring cognitive development in adolescence?
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You can use also the Weschler Non Varbal (WNV), quick and easy to use !
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I developed a 25-item measure to assess callous-unemotional traits in adolescents.  While the intended construct is not comprehensive as the YPI, it is somewhat similar to the YPI in that some items are phrased to have a higher valence of interest or appeal to adolescents, e.g., "It really doesn't bother me if someone gets shot or dies, unless it's my family or friend"; "I don't mean to sound cold, but I've got to think about myself first, that's just the way life is". This measure is written in American English.  I am interested in finding researchers who could pilot this scale.  If translated to another language, two or three items use colloquial expression and would require a very good translation.
Please contact me 
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Yes, of course.  Thank you for your interest.
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In the last few years many prescribers do not prescribe IR-MPH in their practice, although clinical guidelines do not support this practice, especially in the titration phase. A pharmaceutical industry is very strong towards newer forms and atomoxetine, which is lower in term of efficacy (effect sizes obtained from meta-analyses). How IR-MPH should be used that patients with ADHD are treated more appropriate? Easy question but hard to answer.
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At the end of the day, despite what treatment guidelines say about what is first line treatment for ADHD, it comes down to cost and value. Industry-sponsored articles from thought leaders in association with industry will not be able to answer this without bias. For patients without the resources to buy more expensive, patented, long-acting medications, then this is an easy answer- MPH-IR is a cost-effective solution. For 3rd-party payers that pay for more expensive, patented, long-acting medications, they should do their own cost-analysis and not be swayed by the biased literature regarding ADHD treatment guidelines.
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A mixture of positive psychology/subject focused therapy and training in communication thru the format of empowerment.
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Sure. You can contact me via this website if you have further questions. Your goals are very clear and it sounds that you are a very compassionate therapist. For indication one, I would suggest to train her in positive reframing. The second goal really blends in with empowerment. To train self efficacy, I believe that journaling is a great approach to enable her to look at her strengths by herself after leaving the institution. 
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I have read extensively of the proposed danger in this particular medication and would like statistics surrounding its adverse effects; also if comparisons to other mood stabilizers' side-effects are available, that would be great too. Thank you!
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The group of agents labelled mood stabilizers has grown bigger, but lithium is the only one that has been in use as such for more than half a century. This means that the long-term clinical experience and the amount of research on widely differing aspects of lithium is difficult to compete with for the "new-comers". We recently found that out of 130 lithium patients, 9 had been treated for more than 30 years, 1 for 44; this 84-year old gentleman had no evident tolerability problem. We do not have such long-term experience/evidence for most of lithium's competitors.
I agree with David Straton that lamotrigine is an important alternative, and recommend a Danish study, directly comparing lithium with lamotrigine (Licht et al. 2010, Bipolar Disorders). Drop out due to adverse events did not differ, but tremor, diarrhoea, thirst and polyuria were (as expected) more common among those on lithium. Headache and dizziness were the most common events in the lamotrigine group. However, lamotrigine was introduced 20 years ago, and very few patients have been taking it for more than a decade. Concerning efficacy, patients with frequent manias and/or psychotic symptoms during episodes usually have poorer effect from lamotrigine.
Valproate and carbamazepine, on the other hand, have been used for many years for epilepsia. Recently, authorities strongly advised against the use of valproate in women of fertile age, due to high frequency of quite severe teratotoxicity. Carbamazepine have less efficacy data, but cause less weight gain than valproate and lithium. On the other hand, pharmacokinetic interactions are problematic with this drug whenever combined with any of a long list of drugs.
Of the antipsychotic drugs, quetiapine and aripiprazol are often well tolerated. However, they are more recent on the market than lamotrigine, and the risk of dyskinesia and other extrapyramidal side-effects is there, albeit low frequency. I have seen persisting dyskinesias (for 1 year) after aripiprazol in one patient that had taken it for only 2 years.
Back to lithium, recent studies have shown a neuroprotective effect in bipolar patients (e.g. Hajek et al. 2012), and some studies support a preventive effect against Alzheimer's dementia (while valproate in some cases have given rise to a reversible dementia).
Based on this, if I should choose a stabilizer for my own use, lithium would be the drug of choice, in spite of polyuria etc.
Mats B. Humble, M.D.
Örebro University
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Does anyone know of validated instruments to measure a respondent's (a) attitudes, (b) perceptions, and/or (c) actual disclosure(s) of a psychiatric disability? I'm interested in when, why, with whom, and in what contexts individuals might choose to disclose - or not (understanding that perhaps these questions are best answered with qualitative data). And, relatedly, I'm thinking of investigating disclosure of mental illness among adolescents and emerging adults in academic settings.
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Hi Laura,
The work of the Iowa Self-Stigma group may be of interest to you. They have a couple of interesting scales on help-seeking behavior, including one specifically geared toward academic settings.
As for perceptions/attitudes, there are a number of scales out there, including the Reported and Intended Behaviour Scale (Evans-Lacko et al [more for social distance]) and Attitudes Toward Mental Illness and Its Treatment Scales (Kobau et al).
Lastly, Corrigan offers a myriad of stigma scales, including ones testing individual's knowledge about mental illness, its etiology, etc. There is also one specifically for adolescents (the AQ-8-C).
-Joe
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We are developing an instrument to assess treatmet outcomes of substance abuse treatment of adolescents. We want to identify scales of famliy functioning to use them as a model for the family dimension in our measure.
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Hi Juan,
For use in larger scale research, we have found that relevant items of the Communities That Care Youth Survey are valid and reliable.  There are a small number of scales (family cohesion, family conflict, family management), with each scale containing 3-4 items).  The full questionnaire is available at;
I attach a couple of publications that have used these scales to predict adolescent substance abuse. 
Hope this is helpful.  Best wishes
Adrian
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I'm looking for an existing brief questionnaire or a screening tool to detect self-harming and suicide risk in a youth population exposed to traumatic experiences to be administered after their attendance to a forensic interview; a brief intervention would be needed as a subsequent strategy to prevent self-harming and suicide risk.
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Hi Gloriana,
I understand the clinical context very well. I coordinate an EU funded project - Suicidality: Treatment Occurring in Paediatrics (STOP), which specifically involved developing web-based 'easy to use' measures using the HealthTrackerTM platform which uses computer adaptive testing. The STOP Suicidality Risk and Resilience Scale; STOP Medication Side-effects Suicidality Scale; and the STOP Suicidality Assessment Scale (a measure of suicidal thoughts, behaviour and non-suicidal self-injury) have been developed in English, translated into Spanish, French, Dutch, German and Italian and can be completed by patients and parents remotely, allowing the clinician to use his limited clinic time more effectively. The scales have undergone initial validation and is currently being used in 6 cohorts of children who are each being followed up for 52 weeks :- 8 to 18 year old cohorts who are on antipsychotics (risperidone, aripiprazole) for any condition; a depression cohort undergoing treatment (fluoxetine, CBT); a cohort being treated for respiratory allergies or asthma (with montelukast or other medications), and a cohort of healthy normal controls. The completed data will be analysed in April 2015 and the 3 instruments will be available for clinical and research use. Apart from the three STOP instruments, the HealthTrackerTM (a web-based health monitoring platform) includes psychopathology / side-effects / QoL measures for children/adolescents/parents/teachers/clinicians (including animated ones for younger children) and helps longitudinal monitoring. It is possible that this system may assist in your clinical practice.
The STOP website can be accessed at http://www.stop-study.com
I hope this helps.
Best wishes
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The therapeutic milieu has been central to residential child and adolescent mental health and other areas of mental health. The milieu facilitates the growth of healing and resilience by providing a nurturing environment in which clients can trust that they will be kept safe whilst they explore/work on both their strengths and needs until they feel confident enough to engage in coping with their issues and the challenges of everyday life experiences. Putting trust in others when feeling vulnerable is tough and can create difficult dynamics for staff, clients carers and impact on other extant systems with whom they interact. Staff need education and support to consistently work with clients and to use every moment to moment as an opportunity to tune into their client and offer the relevant balance of nurture and challenge to promote trust, a sense of autonomy, a sense of competence, a positive identity and the confidence to engage in relationships and cope with everyday challenges within their lived experiences. The aim of compassionate, client centred care , which is supported by wider systems in the creation of an safe, respectful, healing environment appears to resonates with current health care aims , highlighted for example in the UK by the Berwick report, the Francis report. Furthermore, to be successful, the therapeutic milieu has to work as a subsystem and liaise and collaborate with all other systems ( from family to community, education, housing social services) with whom the client/family interacts.
Given the wealth of research on the therapeutic milieu, to what extent do others feel/have experience in the transferability of the principles of therapeutic milieu research and literature to general wards e.g. wards caring for elderly vulnerable patients? Also, to what extent can the whole system approach of an effective milieu, (which responds to the interdependence of individual systems, family systems and wider community systems) be transferred to the current model of health as a complex, whole systems approach in which client and families require the support of a 'virtual' 24 hour life milieu in which the strengths and needs of each client at an individual, family and community level can be negotiated with the client, matched with a package of feasible health and social care ? Residential therapeutic care has been reduced globally in mental health because it is expensive . The creation of a virtual therapeutic milieu is a tough road. In your experience, is it/could it be therapeutically and cost effective?
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Dear all,
For the evidence of beneficial effects of a therapeutic milieu (regardless of the context), considerable evidence has turned up in recent neurobiological reseearch on the stress system (HPA-axis) and the dopamine-serotonine system.
Recent longitudinal research form our group shows a decline in aggressive tendencies, ADHD, callous and unemotional traits, criminal cognitions, and thinking errors to be related to a positive climate (for an oversight see Souverein, van der Helm & Stams, 2013). Our research, togeher with the research of Pam Maras shows these relationships are also found in the classroom and relationships with parents (publications pending).
As mental health nurses, social workers and teacher but also parents have a great influence on the climate, we are currently researching which factors in the percieved work climate influence the other climate domains, as all settings influence each other (Bronfenbrenner).
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Adherence and compliance in child and adolescent psychiatry are part of subjective pharmacology and closely linked to lay theories of psychiatric diseases. Since often clients and their parents to not stick to treatment plans I would appreciate suggestions concerning literature and future resarch projects
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I think that parents' beliefs about psychopharmacological therapies is an important component in adherence to such drug category. I am afraid that most parents have negative views and negative beliefs about psychopharmacological medicines which affects adherence of their children to their medications
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This is especially for suicidality. It is one of major issues when everyone speaks about public health burden of different mental disorders, as most important negative outcome. But in RCT-s this is one of the main exclusion criteria. It means that we have moderately ill people in RCT-s.
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Also, Michele Fornaro who is on Research Gate has just released the publication below:
Instable depressive mixed states "treated" with antidepressants may trigger suicidality: a proposed framework
Michele Fornaro, Matteo Martino, Concetta De Pasquale, Driss Moussaoui
05/2013;