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Objectives:In this study, it was aimed to evaluate both the diagnosis and psychosocial stressors of infants and young children who were assessed in the infant mental health unit according to Diagnostic Classification of Mental Health and Developmental Disorders (DC: 0-5) and the effects of those on parent-infant interaction.Materials and Methods:Children aged 0-5 years who were referred to Infant Mental Health Unit of our department, between June 1st, 2019 and June 1st, 2020, were included. Clinical data including psychiatric evaluations and diagnoses, developmental tests, sociodemographic forms investigating psychosocial difficulties existed in DC: 0-5, parent-infant relationship-global assessment scale (PIR-GAS) scores according to Crowell observation procedure, and psychiatric disorders and diagnoses through clinical interview based on DC: 0-5 were retrospectively analyzed.Results:Among 137 patients evaluated, 111 (81,0%) had psychiatric diagnoses. Fifty three (38.6%) patients were diagnosed with two comorbid psychiatric disorders and 6 patients (4.4%) were diagnosed with 3 comorbid disorders. Global developmental delay (47.4%) was the most common diagnosis among the patients. The most common psychosocial difficulties were hospitalization of the infant or young child (32.8%), non-physical quarrel or conflict between parents or caregivers (28.6%), and medical disease of the infant or young child (27.7%). While there was no significant relationship between PIR-GAS scores and the total number of psychosocial difficulties, the number of psychosocial difficulties related to education or child care was found to be negatively correlated with PIR-GAS scores after categorizing the difficulties reported (p=0.03).Conclusion:It is thought that the findings of the study may be useful for healthcare professionals and parents to develop interventions that will provide adequate support required for psychosocial stressors.

Contains fulltext : 249066.pdf (Publisher’s version ) (Open Access) BACKGROUND: Frontotemporal dementia (FTD) has a profound impact on the spouse and other family caregivers involved. While caregivers have a need for support, it is difficult for healthcare providers to respond to their specific needs. This qualitative study explores the lived experiences and needs of caregivers of persons with FTD to facilitate the development of support. METHODS: Three focus group discussions were organized to explore the lived experiences of Dutch FTD caregivers. The included caregivers (n = 24) were aged 16 years or older and were involved in the care of a relative with FTD. Two researchers independently performed an inductive content analysis using open and axial coding. RESULTS: The main category emerging from the data was a lack of recognition, acknowledgment, and understanding experienced by caregivers. This was linked to caregivers' experiences with (1) complex emotional and behavioral symptoms in the person with FTD, (2) the trivializing responses of family and friends, (3) a perceived lack of knowledge and support from healthcare professionals, and (4) the bureaucratic procedures that accompany caregiving. As a result, caregivers felt lonely and solely responsible for the caregiving role. CONCLUSION: Caregivers of persons with FTD experience a lack of understanding in caring for their relative with FTD, which contributes to feelings of loneliness. A specialized support approach is needed to address the specific needs of caregivers of persons with FTD. Support should address strategies that caregivers can use to inform and involve family and friends in the caregiving situation to prevent loneliness in FTD caregivers.

Assessment of mental illness typically relies on a disorder classification system that is considered to be at odds with the vast disorder comorbidity and symptom heterogeneity that exists within and across patients. Patients with the same disorder diagnosis exhibit diverse symptom profiles and comorbidities creating numerous clinical and research challenges. Here we provide a quantitative analysis of the symptom heterogeneity and disorder comorbidity across a sample of 107,349 adult individuals (aged 18–85 years) from 8 English-speaking countries. Data were acquired using the Mental Health Quotient, an anonymous, online, self-report tool that comprehensively evaluates symptom profiles across 10 common mental health disorders. Dissimilarity of symptom profiles within and between disorders was then computed. We found a continuum of symptom prevalence rather than a clear separation of normal and disordered. While 58.7% of those with 5 or more clinically significant symptoms did not map to the diagnostic criteria of any of the 10 DSM-5 disorders studied, those with symptom profiles that mapped to at least one disorder had, on average, 20 clinically significant symptoms. Within this group, the heterogeneity of symptom profiles was almost as high within a disorder label as between 2 disorder labels and not separable from randomly selected groups of individuals with at least one of any of the 10 disorders. Overall, these results quantify the scale of misalignment between clinical symptom profiles and DSM-5 disorder labels and demonstrate that DSM-5 disorder criteria do not separate individuals from random when the complete mental health symptom profile of an individual is considered. Greater emphasis on empirical, disorder agnostic approaches to symptom profiling would help overcome existing challenges with heterogeneity and comorbidity, aiding clinical and research outcomes.

Background Autism prevalence has increased rapidly in recent years, however, nationally representative estimates on the ages of first identification and intervention are out of date. Objectives: (1) To estimate the ages at which children with autism receive their first diagnosis, intervention plan, and developmental services; and (2) To evaluate differences in ages at events by birth cohort and sociodemographic characteristics. Methods Using cross-sectional data from the 2016–2018 National Survey of Children’s Health (NSCH), we examined associations via linear regression among a sample of 2303 children aged 2–17 years old, who had ever been diagnosed with autism and either (1) ever had a plan for special education or early intervention, or (2) ever received special services to meet developmental needs. Exposures included age cohort, child, household and healthcare provider characteristics. Results Most children in the study sample (n = 2303) were over age 6 years, male, of non-Hispanic white race/ethnicity and had mild/moderate autism. Mean ages (years) at first diagnosis was 4.56 (SE = 0.13); first plan was 4.43 (SE = 0.11); and first services was 4.10 (SE = 0.11). After adjustment for exposures and survey year, the middle childhood cohort was 18 months older at first intervention (β = 1.49, 95% CI, 1.18–1.81), and adolescents were 38 months older at first diagnosis (β = 3.16, 95% CI, 2.72–3.60) compared to those in early childhood. Younger ages at events were observed among: Hispanic/Latinx as compared to white children, those with moderate or severe symptoms as compared to mild symptoms, and children who received their diagnosis from a specialist as compared to psychologists or psychiatrists. Conclusions Children with autism receive their first diagnosis, intervention plans and developmental services at younger ages than they had in the past. Future research is needed to identify the mechanisms for these improvements in early identification and intervention to accelerate additional progress.

Perinatal mood and anxiety disorders (PMADs) are common, particularly among parents of infants requiring admission to the neonatal intensive care unit (NICU), yet remain underdiagnosed and undertreated. Undertreated parental mental health disorders can interfere with healthy infant development, compounding abnormal neurodevelopment and psychosocial development that preterm or ill newborns may already face. Interdisciplinary efforts to increase PMAD awareness, screening, and referral uptake may improve family-infant health and developmental outcomes in high-risk infants requiring NICU admission. Therefore, special emphasis on PMAD screening and treatment in NICU parents aligns with the American Academy of Pediatrics mission and should be a focus in neonatal care and included in education, quality improvement, and outcome-based research initiatives.

BackgroundTherapeutic trials are now underway in genetic forms of frontotemporal dementia (FTD) but clinical outcome measures are limited. The two most commonly used measures, the Clinical Dementia Rating (CDR)+National Alzheimer’s Disease Coordinating Center (NACC) Frontotemporal Lobar Degeneration (FTLD) and the FTD Rating Scale (FRS), have yet to be compared in detail in the genetic forms of FTD.MethodsThe CDR+NACC FTLD and FRS were assessed cross-sectionally in 725 consecutively recruited participants from the Genetic FTD Initiative: 457 mutation carriers (77 microtubule-associated protein tau (MAPT), 187 GRN, 193 C9orf72) and 268 family members without mutations (non-carrier control group). 231 mutation carriers (51 MAPT, 92 GRN, 88 C9orf72) and 145 non-carriers had available longitudinal data at a follow-up time point.ResultsCross-sectionally, the mean FRS score was lower in all genetic groups compared with controls: GRN mutation carriers mean 83.4 (SD 27.0), MAPT mutation carriers 78.2 (28.8), C9orf72 mutation carriers 71.0 (34.0), controls 96.2 (7.7), p, publishedVersion

Bipolar bozukluk (BB) çocukluk ve ergenlik döneminde okul, aile ve sosyal işlevselliği önemli ölçüde etkileyerek morbidite ve mortaliteye neden olabilmektedir. Bu yaş aralığında ilk epizodun depresyon şeklinde ortaya çıkabilmesi, klinik görünümün farklılıklar göstermesi, subsendromal karma epizod belirtileri varlığı ve çok hızlı döngülülük gibi nedenlerle BB tanısının konulması daha zor olabilmekte ve daha uzun zaman alabilmektedir. BB'un seyrini kavramak ve erken tanı koyabilmek için BB açısından risk altındaki ve prodrom dönemindeki çocuk ve ergenleri tanımak önemlidir. Çocuk ve ergenlerde BB risk faktörleri ailede BB öyküsü, anksiyete bozukluğu, dikkat eksikliği ve hiperaktivite bozukluğu, madde kullanımı, eşik altı duygudurum belirtileri, uyku alışkanlıklarında değişiklikler, ihmal ve istismar öyküsü olarak sıralanabilir. BB'un erken yaşta başlaması, daha fazla komorbidite, daha fazla epizod, daha az sayıda ötimik gün ve sonuçta daha kötü prognozla birlikte genellikle daha şiddetli klinik seyri öngörmektedir. Bipolar disorder (BD) may lead to morbidity and mortality by significantly affecting school, family and social functioning during childhood and adolescence. It may be more difficult and may take a longer time to diagnose BD in this particular age range due to the facts that the first episode may present with depression, variations in the clinical presentation, unclear boundaries of the episodes, presence of subsyndromal mixed episode symptoms, and the ultra-rapid cycling characteristics. It is important to recognize children and adolescents both at risk for BD and in the prodrome period, in order to apprehend the course of BD and to be able to diagnose it early. Risk factors for BD in children and adolescents can be listed as family history of BD, Anxiety Disorder, Attention Deficit and Hyperactivity Disorder, substance use, subthreshold mood symptoms, changes in sleep habits, history of abuse and neglect. Early age of onset of BD generally predicts a more severe clinical course with more comorbidities, more episodes, fewer euthymic days and eventually a worse prognosis.

Author(s): Illan-Gala, Ignacio; Casaletto, Kaitlin B; Borrego-Ecija, Sergi; Arenaza-Urquijo, Eider M; Wolf, Amy; Cobigo, Yann; Goh, Sheng Yang M; Staffaroni, Adam M; Alcolea, Daniel; Fortea, Juan; Blesa, Rafael; Clarimon, Jordi; Iulita, Maria Florencia; Brugulat-Serrat, Anna; Llado, Albert; Grinberg, Lea T; Possin, Katherine; Rankin, Katherine P; Kramer, Joel H; Rabinovici, Gil D; Boxer, Adam; Seeley, William W; Sturm, Virginia E; Gorno-Tempini, Maria Luisa; Miller, Bruce L; Sanchez-Valle, Raquel; Perry, David C; Lleo, Alberto; Rosen, Howard J | Abstract: IntroductionBiological sex is an increasingly recognized factor driving clinical and structural heterogeneity in Alzheimer's disease, but its role in the behavioral variant of frontotemporal dementia (bvFTD) is unknown.MethodsWe included 216 patients with bvFTD and 235 controls with magnetic resonance imaging (MRI) from a large multicenter cohort. We compared the clinical characteristics and cortical thickness between men and women with bvFTD and controls. We followed the residuals approach to study behavioral and cognitive reserve.ResultsAt diagnosis, women with bvFTD showed greater atrophy burden in the frontotemporal regions compared to men despite similar clinical characteristics. For a similar amount of atrophy, women demonstrated better-than-expected scores on executive function and fewer changes in apathy, sleep, and appetite than men.DiscussionOur findings suggest that women might have greater behavioral and executive reserve than men, and neurodegeneration must be more severe in women to produce symptoms similar in severity to those in men.

Background Attention-Deficit/ Hyperactivity Disorder (ADHD) is one of the most common childhood neurobehavioral conditions. Symptoms related to this disorder cause a significant impairment in school tasks and in the activities of children’s daily lives; an early diagnosis and appropriate treatment could almost certainly help improve their outcomes. The current study, part of the Models Of Child Health Appraised (MOCHA) project, aims to explore the age at which children experience the onset or diagnosis of ADHD in European countries. Methods A systematic review was done examining the studies reporting the age of onset/diagnosis (AO/AD) of ADHD in European countries (28 European Member States plus 2 European Economic Area countries), published between January 1, 2010 and December 31, 2019. Of the 2276 identified studies, 44 met all the predefined criteria and were included in the review. Results The lowest mean AO in the children diagnosed with ADHD alone was 2.25 years and the highest was 7.5 years. It was 15.3 years in the children with ADHD and disruptive behaviour disorder. The mean AD ranges between 6.2 and 18.1 years. Conclusions Our findings indicate that there is a wide variability in both the AO and AD of ADHD, and a too large distance between AO and AD. Since studies in the literature suggest that an early identification of ADHD symptoms may facilitate early referral and treatment, it would be important to understand the underlying reasons behind the wide variability found. Trial registration PROSPERO registration: CRD42017070631.

In recent decades, clinicians have developed the construct of ultra-high risk (UHR) for psychosis to characterize the prodromal phase of psychosis or classify people with weakly expressed psychotic symptoms. In this conceptual analysis, we have gathered up-to-date data about the clinical picture of neurocognition and social cognition in people at UHR for psychosis. We also discuss treatment options. A well-chosen therapeutic approach can help to deal with difficulties and delay or even prevent the development of full-blown psychotic disorders in the UHR group. Despite much evidence supporting the benefits of therapy, early interventions are still not as widely used as they should be. Thus, a better understanding of the UHR state is very important for all healthcare workers.

Background: Anorexia nervosa is a psychosomatic disorder and is commonly associated with impaired oral health. Dentists can play a relevant role in the early diagnosis of anorexia nervosa. With the help of intra- and extraoral examinations and anamnesis, the dentist can detect characteristic signs and symptoms of this eating disorder. The purpose of this study was to determine the knowledge regarding the oral and physical manifestations of anorexia nervosa among general dental practitioners and specialist dentists of Poland.Material and Methods: A pretested online questionnaire consisting of a first part asking for the characteristics of the participant and a second part with 22 specific questions on their general knowledge of anorexia nervosa and knowledge of physical and oral manifestations of this eating disorder was used.Results: A total of 369 dentists completed the questionnaire. The Polish dentists in this study reported sufficient knowledge regarding anorexia nervosa. However, younger dentists and general dental practitioners had relatively lower knowledge scores than other groups. The dentists mainly had difficulties with the oral symptoms of anorexia nervosa.Conclusion: Despite Polish dentists having sufficient knowledge about anorexia nervosa in relation to the general symptoms of anorexia, there are deficits with regard to oral manifestations. Therefore, there is a need to increase continuing education in this field, which can improve early diagnosis of this disease by dental practitioners and referral to specialists for treatment.