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A nationwide survey of 2,004 adult Ukrainian parents who reported on their experiences of the war, how their own mental health has changed since the invasion in February 2022, and how the mental health of their children has changed. These data were collected between July and September 2022.

Background: It is expected that the ongoing war in Ukraine will have a considerable negative impact on the mental health of the country’s population. This study aims to provide a preliminary estimate of the degree of change in the mental health problems of Ukrainian children following Russia’s invasion of Ukraine in February 2022, and identify the sociodemographic and war-related risk factors associated with these changes.Methods: A nationwide, opportunistic sample of 1,238 parents reported on a single randomly chosen child within their household as part of The Mental Health of Parents and Children in Ukraine Study. Data were collected between July 15th and September 5th 2022. Participants completed modified versions of the Pediatric Symptom Checklist (PSC-17) which was adapted to capture change in the frequency of symptoms since the Russian attack.Results: Parents reported increases across all 17 indicators of internalizing, externalizing and attention problems of the PSC-17. Increases were most pronounced within the internalizing domain, with 35% of parents reporting that their child worried more since the beginning of the war. Various individual, parental and war-related factors were associated with increases across the three domains. Exposure to war trauma, pre-existing mental health problems, and child age were amongst the strongest predictors of change. Conclusion: The Russian war on Ukraine has likely led to an increase in common mental health problems for children in the general population. Further research is required to determine the extent and outcomes of this increase, and to develop strategies to help those most in need.

The Russian invasion of Ukraine on February 24, 2022, has caused social, political, and financial instability worldwide. In Ukraine, the war has brought the greatest levels of violence, devastation, and disruption seen in Europe since World War II. Of course, the impact of war on the mental health of Ukrainian young people is likely substantial. Yet, more specific information about the prevalence and distribution of mental health disorders in young people is essential to document their needs, to select the best interventions, and to deliver these through international humanitarian efforts. The study by Osokina and Silwal et al.

Background: High rates of posttraumatic stress disorder (PTSD) have been documented in war-affected populations. The prevalence of CPTSD has never been assessed in an active war zone. Here, we provide initial data on war-related experiences, and estimated prevalence rates of ICD-11 PTSD and Complex PTSD (CPTSD) in the general adult population of Ukraine during the Russian war. We also examined how war-related stressors, PTSD, and CPTSD were associated with age, sex, and living location in Ukraine. Method: Self-report data were gathered from a nationwide sample of 2,004 adult parents of children under 18 from the general population of Ukraine approximately six months after Russia’s invasion. Results: All participants were exposed to at least one war-related stressor, and the mean number of exposures was 9.07 (range = 1-26). Additionally, 25.9% (95% CI = 23.9%, 27.8%) met diagnostic requirements for probable PTSD and 14.6% (95% CI = 12.9%, 16.0%) met requirements for probable CPTSD. There was evidence of a strong dose-response relationship between war-related stressors and meeting criteria for probable PTSD and CPTSD. Participants who had the highest exposure to war-related stressors were significantly more likely to meet the requirements for probable PTSD (OR = 4.20; 95% CI = 2.96 -5.95) or CPTSD (OR = 8.12; 95% CI = 5.11 - 12.91) compared to the least exposed.Conclusions: Humanitarian responses to the mental health needs of the Ukrainian population will need to take account of posttraumatic stress reactions. Education in diagnosing and treating PTSD/CPTSD, especially in the situation of a significant lack of human resources and continuing displacement of the population, is necessary.

Background: There is currently limited information on how Russia’s war on Ukraine has affected the mental health of people living in Ukraine. Understanding the mental health effects of the war, and identifying who has been worst affected, is critical to informing mental health responses. A nationwide sample of parents in Ukraine were surveyed to (1) determine how symptoms of anxiety, depression, loneliness, and hazardous alcohol use have changed since February 24th, 2022, and (2) identify risk-factors associated with changes in mental health. Methods: A nationwide, opportunistic sample (N = 2,004) of adult parents in Ukraine were surveyed as part of The Mental Health of Parents and Children in Ukraine Study. Participants completed modified self-report measures of generalized anxiety, major depression, loneliness, and hazardous alcohol use to capture change in the frequency of these symptoms since February 24th 2022.Results: Overall increases in symptoms of anxiety, depression, loneliness, and hazardous alcohol use were observed, with most people reporting increased symptoms of anxiety (72%), depression (62%), and fewer reporting increased loneliness (47%) and hazardous drinking (8%). Demographic and war-related variables were associated with increases in mental health problems, however, exposure to a higher number of war-related stressors and caring for a child with an emotional or behavioural problem were most robustly associated with increased symptoms of all mental health problems. Conclusion: Russia’s war on Ukraine has probably led to increases in mental health problems for most adults in Ukraine. These findings suggest where limited mental health resources may be most effectively deployed.

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.

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.