Search

The detection of individuals at clinical ultra-high risk for psychosis (CHR-P) may be a key limiting step for early interventions, and there is some uncertainty regarding the true clinical reliability of the CHR-P states. The aim of this study was to explore how practitioners who were in the direct treatment of children with psychiatric disorders [child psychiatry specialists/trainees (n = 227, n = 131), adult psychiatrists (n = 27), and child neurologists (n = 2)] perceive the DSM-5-Attenuated Psychosis Syndrome (DSM-5-APS), and their clinical routine practice in the treatment of it. Three vignettes describing fictional cases presented with symptoms of either DSM-5-Schizophrenia, DSM-5-APS, and no psychotic symptoms were created. We asked these practitioners to apply a DSM-5 diagnosis and to choose appropriate treatment(s) for these vignettes. Of the responders, 43% correctly diagnosed the APS vignette, whereas 37.4% mentioned that it had a full-blown psychotic episode. Regarding the therapeutic approach for the APS vignette, 72.1% of all practitioners chose a psychopharmacological intervention and 32% individual psychotherapy. This study showed that the diagnostic inter-rater reliability of the DSM-5-APS among child/adolescent mental health practitioners was consistent with the results from the DSM-5 field trials (Kappa = 0.46). Moreover, almost three in four practitioners endorsed psychopharmacological intervention as a treatment option for the DSM-5-APS case. The lack of evidence of psychopharmacological interventions in CHR-P situations emphasizes that the least harmful interventions should be recommended. Thus, our findings indicated a need for raising awareness regarding the CHR-P paradigm and its treatment as well as the development of solid guidelines that can be implemented in clinical practice.

Background Depression is frequently comorbid with posttraumatic stress disorder (PTSD) and substantially influences its severity, course and outcomes. Published studies linking war-related paediatric PTSD and Major depressive disorder (MDD) were mainly based on cross-sectional studies. Objective To prospectively examine the role of PTSD and other risk/protective factors in the development of depression among adolescents with war-related trauma. Methods A longitudinal study of 160 adolescents aged 15–17 years with war-related trauma and displacement due to war in Eastern Ukraine was performed. Of the 160 adolescents, N = 86 met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-4) criteria for PTSD. All adolescents underwent comprehensive psychiatric assessments that included Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime version (K-SADS-PL) administered to both parents and children. Traumatic exposure was assessed using the modified Traumatic Events Screening Inventory for children (TESI-C). PTSD and MDD were assessed with the Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA) and Children's Depression Rating Scale-Revised (CDRS-R), and diagnosed using DSM-4 criteria. Follow-up and repeated measurements occurred at 6 and 12 months. During the study, adolescents requiring clinical care were referred for best available care in the community. Results Among 92.6% of study completers, 26/79 youth with PTSD developed MDD (32.9%), compared to 6/70 without PTSD (8.5%): relative risk (RR) = 3.83 (95% CI 1.67–8.78), p = 0.0014; Number needed to harm (NNTH) = 4.108 (8.53–2.7). Using logistic regression, variables of school attendance, ‘secondary’ traumatic exposure, and treatment with Trauma-focused Cognitive Behavioral Therapy (TF-CBT) were significantly correlated with the incidence of new-onset depression among adolescents with PTSD. Conclusions War-related trauma with subsequent PTSD appears to be a significant risk factor for the later development of depression in adolescents. The role of PTSD as a moderator of depression merits further investigation in larger scale longitudinal studies in diverse populations.

This article is a summary of perspectives on training curricula from child and adolescent psychiatry trainees globally. We aimed to identify the relative strengths, weaknesses and gaps in learning needs from a trainee's perspective. The 20 early-career child psychiatrists who contributed are from 16 countries and represent all the five continents. We could identify some global challenges as well as local/regional challenges that need to be addressed to develop competent child psychiatrists.

Introduction The most frequent targets for pharmacologic intervention in PDD patients include associated comorbid conditions: hyperactivity, inattention, compulsive-like behaviors, anxiety, depression, aggression, self-injurious behavior, repetitive or stereotypic behaviors, and sleep disturbances [1-2]. Objective To compare efficacy and tolerability of risperidone and atomoxetine in the treatment of severe and challenging behaviors in children with PDD. Methods Was conducted 8-week double-blind, placebo-controlled study with parallel group of comparison and flexible doses of Risperidon (1.0-3.0 mg; MD = 1,8) and Atomoxetine (25.0 – 40.0 mg; MD = 32,8). Were randomized 80 children from 12 to 18 years old (MD = 10,8) with the assessment ≥ 6 points on the diagnostic criteria for DSM IV-TR for autism, ≥12 balls Irritability by ABC-C. All children were assessed by an additional ADI-R, ADOS. Drug efficacy was assessed weekly using the ABC-C, CGI-I / CGI-S, Adverse event recording. Result Risperidone and Atomoxetine are more effective than placebo in Irritability, Agitation, Crying subscales (F = 2,30, DF = 1,47, P = 0,12), Hyperactivity, Noncompliance (F = 103,24, DF = 1,68, ? ≤ 0,0001), Lethargy, Social Withdrawal (F = 2,30, DF = 1,47, P = 0,12), Stereotypic Behavior (F = 27,94, DF = 1,24, ? ≤ 0,0001). In Risperidone therapy was observed Inappropriate Speech retardation, and more frequently extra pyramidal side effects. Conclusion Risperidon (1.0-3.0 mg / day) and Atomoxetine (25.0 – 40.0 mg / day) are more effective than placebo and well-tolerated and can be recommended for treatment of severe and challenging behaviors in children with PDD.