http://www.capmh.com The most accessed research articles published by Child and Adolescent Psychiatry and Mental Health 2012-01-26T00:00:00Z Background: Since siblings of pediatric cancer patients are at risk for emotional, behavioral, and social problems, there is considerable interest in development of early psychological interventions. This paper aimed at evaluating the effectiveness of a two-session psychological intervention for siblings of newly diagnosed pediatric cancer patients. Methods: Thirty siblings age 6-17 years were randomly assigned to an intervention group or an active control group with standard psycho-oncological care. The manualized intervention provided to siblings in the first 2 months after the cancer diagnosis of the ill child included medical information, promotion of coping skills, and a psychoeducational booklet for parents. At 4 to 6 weeks, 4 months, and 7 months after the diagnosis, siblings and their parents completed measures (from standardized instruments) of social support, quality of life, medical knowledge, posttraumatic stress symptoms, and anxiety. Results: At follow-up siblings in the intervention group showed better psychological well-being, had better medical knowledge, and reported receiving social support from more people. However, the intervention had no effects on posttraumatic stress symptoms and anxiety. Conclusions: The results of this pilot trial suggest that a two-session sibling intervention can improve siblings' adjustment, particularly psychological well-being, in the early stage after a cancer diagnosis. http://www.capmh.com/content/6/1/3 Alice Prchal Anna Graf Eva Bergstraesser Markus Landolt Child and Adolescent Psychiatry and Mental Health 2012, null:3 2012-01-11T00:00:00Z doi:10.1186/1753-2000-6-3 Improving the well-being of siblings of pediatric cancer patients A two-session intervention for siblings of children with cancer helps to improve their psychological well-being, medical knowledge and reported social support, in the early stage after a diagnosis. /content/figures/1753-2000-6-3-toc.gif Child and Adolescent Psychiatry and Mental Health 1753-2000 ${item.volume} 3 2012-01-11T00:00:00Z PDF Background: The purpose of this study was to gain knowledge about the circumstances related to suicide among children and adolescents 15 years and younger. Methods: We conducted a psychological autopsy, collecting information from parents, hospital records and police reports on persons below the age of 16 who had committed suicide in Norway during a 12-year period (1993-2004) (n=41). Those who committed suicide were compared with children and adolescents who were killed in accidents in the same time period (n=43) and with a community sample. Results: Among the suicides 25% met the criteria for a psychiatric diagnosis and 30% had depressive symptoms at the time of death. Furthermore, 60% of the parents of suicide victims reported the child had some kind of stressful conflict prior to death, whereas only 12% of the parents of the accident victims reported such conflicts. Conclusion: One in four of the suicide victims fulfilled the criteria for a psychiatric diagnosis.The level of sub-threshold depression and of stressful conflict experienced by youths who comitted suicide did not appear to differ substantially from that of their peers, and therefore did not raise sufficient concern for referral to professional help. http://www.capmh.com/content/6/1/1 Anne Freuchen Ellen Kjelsberg Astri Lundervold Berit Groholt Child and Adolescent Psychiatry and Mental Health 2012, null:1 2012-01-04T00:00:00Z doi:10.1186/1753-2000-6-1 /content/figures/1753-2000-6-1-toc.gif Child and Adolescent Psychiatry and Mental Health 1753-2000 ${item.volume} 1 2012-01-04T00:00:00Z PDF Background: The safety of paediatric medications is paramount and contraindications provide clear pragmatic advice. Further advice may be accessed through Summaries of Product Characteristics (SPCs) and relevant national guidelines. The SPC can be considered the ultimate independent guideline and is regularly updated. In 2008, the authors undertook a systematic review of the SPC contraindications of medications licensed in the United Kingdom (UK) for the treatment of Attention Deficit Hyperactivity Disorder (ADHD). At that time, there were fewer contraindications reported in the SPC for atomoxetine than methylphenidate and the specific contraindications varied considerably amongst methylphenidate formulations. In 2009, the European Medicines Agency (EMA) mandated harmonisation of methylphenidate SPCs. Between September and November 2011, there were three changes to the atomoxetine SPC that resulted in revised prescribing information. In addition, Clinical Guidance has also been produced by the National Institute for Health and Clinical Excellence (NICE) (2008), the Scottish Intercollegiate Guidelines Network (SIGN) (2009) and the British National Formulary for Children (BNFC). Methods: An updated systematic review of the Contraindications sections of the SPCs of all medications currently licensed for treatment of ADHD in the UK was undertaken and independent statements regarding contraindications and relevant warnings and precautions were then compared with UK national guidance with the aim of assessing any disparity and potential areas of confusion for prescribers. Results: As of November 2011, there were seven medications available in the UK for the treatment of ADHD. There are 15 contraindications for most formulations of methylphenidate, 14 for dexamfetamine and 5 for atomoxetine. Significant differences exist between the SPCs and national guidance part due to the ongoing reactive process of amending the former as new information becomes known. In addition, recommendations are made outside UK SPC licensed indications and a significant contraindication for methylphenidate (suicidal behaviours) is missing from both the NICE and SIGN guidelines. Particular disparity exists relating to monitoring for suicidal and psychiatric side effects. The BNFC has not yet been updated in line with the European Union (EU) Directive on methylphenidate; it does not include any contraindications for atomoxetine but describes contraindications for methylphenidate that are no longer in the SPC. Conclusions: Clinicians seeking prescribing advice from critical independent sources of data, such as SPCs and national guidelines, may be confused by the disparity that exists. There are major differences between guidelines and SPCs and neither should be referred to in isolation. The SPC represents the most relevant source of safety data to aid prescribing of medications for ADHD as they present the most current safety data in line with increased exposure. National guidelines may need more regular updates. http://www.capmh.com/content/6/1/2 Nicola Savill Chris Bushe Child and Adolescent Psychiatry and Mental Health 2012, null:2 2012-01-10T00:00:00Z doi:10.1186/1753-2000-6-2 /content/figures/1753-2000-6-2-toc.gif Child and Adolescent Psychiatry and Mental Health 1753-2000 ${item.volume} 2 2012-01-10T00:00:00Z PDF Background: The aim of this paper was to review and summarize research on prevalence of health risk behaviours, their outcomes as well as risk and protective factors among adolescents in the English-speaking Caribbean. Methods: Searching of online databases and the World Wide Web as well as hand searching of the West Indian Medical Journal were conducted. Papers on research done on adolescents aged 10 – 19 years old and published during the period 1980 – 2005 were included. Results: Ninety-five relevant papers were located. Five papers were published in the 1980s, 47 in the 1990s, and from 2000–2005, 43 papers. Health risk behaviours and outcomes were divided into seven themes. Prevalence data obtained for these, included lifetime prevalence of substance use: cigarettes-24% and marijuana-17%; high risk sexual behaviour: initiation of sexual activity ≤ 10 years old-19% and those having more than six partners-19%; teenage pregnancy: teens account for 15–20% of all pregnancies and one-fifth of these teens were in their second pregnancy; Sexually-Transmitted Infections (STIs): population prevalence of gonorrhoea and/or chlamydia in 18–21 year-olds was 26%; mental health: severe depression in the adolescent age group was 9%, and attempted suicide-12%; violence and juvenile delinquency: carrying a weapon to school in the last 30 days-10% and almost always wanting to kill or injure someone-5%; eating disorders and obesity: overweight-11%, and obesity-7%. Many of the risk behaviours in adolescents were shown to be related to the adolescent's family of origin, home environment and parent-child relationships. Also, the protective effects of family and school connectedness as well as increased religiosity noted in studies from the United States were also applicable in the Caribbean. Conclusion: There is a substantial body of literature on Caribbean adolescents documenting prevalence and correlates of health risk behaviours. Future research should emphasize the designing and testing of interventions to alleviate this burden. http://www.capmh.com/content/3/1/10 Rohan Maharaj Paula Nunes Shamin Renwick Child and Adolescent Psychiatry and Mental Health 2009, null:10 2009-03-17T00:00:00Z doi:10.1186/1753-2000-3-10 /content/figures/1753-2000-3-10-toc.gif Child and Adolescent Psychiatry and Mental Health 1753-2000 ${item.volume} 10 2009-03-17T00:00:00Z XML Background: Lead is toxic to cognitive and behavioral functioning in children even at levels well below those producing physical symptoms. Continuing efforts in the U.S. since about the 1970s to reduce lead exposure in children have dramatically reduced the incidence of elevated blood lead levels (with elevated levels defined by the current U.S. Centers for Disease Control threshold of 10 micrograms/deciliter). The current study examines how much lead toxicity continues to impair the academic achievement of children of New York State, using 2010 test data. Methods: This study relies on three sets of data published for the 57 New York counties outside New York City: school achievement data from the New York State Department of Education, data on incidence of elevated blood lead levels from the New York State Department of Health, and data on income from the U.S. Census Bureau. We studied third grade and eighth grade test scores in English Language Arts and mathematics. Using the county as the unit of analysis, we computed bivariate correlations and regression coefficients, with percent of children achieving at the lowest reported level as the dependent variable and the percent of preschoolers in the county with elevated blood lead levels as the independent variable. Then we repeated those analyses using partial correlations to control for possible confounding effects of family income, and using multiple regressions with income included. Results: The bivariate correlations between incidence of elevated lead and number of children in the lowest achievement group ranged between 0.38 and 0.47. The partial correlations ranged from 0.29 to 0.40. The regression coefficients, both bivariate and partial (both estimating the increase in percent of children in the lowest achievement group for every percent increase in the children with elevated blood lead levels), ranged from 0.52 to 1.31. All regression coefficients, when rounded to the nearest integer, were approximately 1. Thus, when the percent of children showing elevated lead increases by one percent, the percent of children in the lowest achievement group, according to the regression equations generated, also increases by about one percent. All associations were significant at the 0.05 level. Conclusion: Despite public health advances, and despite the imprecision of measures, an association between the incidence of elevated blood lead and achievement in New York counties is still apparent, not attributable to confounding by income. Efforts to reduce lead exposure should persist with vigor. http://www.capmh.com/content/6/1/4 Jillian Strayhorn Joseph Strayhorn Child and Adolescent Psychiatry and Mental Health 2012, null:4 2012-01-23T00:00:00Z doi:10.1186/1753-2000-6-4 /content/figures/1753-2000-6-4-toc.gif Child and Adolescent Psychiatry and Mental Health 1753-2000 ${item.volume} 4 2012-01-23T00:00:00Z PDF Attachment theory predicts and subsequent empirical research has amply demonstrated that individual variations in patterns of early attachment behaviour are primarily influenced by differences in sensitive responsiveness of caregivers. However, meta-analyses have shown that parenting behaviour accounts for about one third of the variance in attachment security or disorganisation. The exclusively environmental explanation has been challenged by results demonstrating some, albeit inconclusive, evidence of the effect of infant temperament. In this paper, after reviewing briefly the well-demonstrated familial and wider environmental influences, the evidence is reviewed for genetic and gene-environment interaction effects on developing early attachment relationships. Studies investigating the interaction of genes of monoamine neurotransmission with parenting environment in the course of early relationship development suggest that children's differential susceptibility to the rearing environment depends partly on genetic differences. In addition to the overview of environmental and genetic contributions to infant attachment, and especially to disorganised attachment relevant to mental health issues, the few existing studies of gene-attachment interaction effects on development of childhood behavioural problems are also reviewed. A short account of the most important methodological problems to be overcome in molecular genetic studies of psychological and psychiatric phenotypes is also given. Finally, animal research focusing on brain-structural aspects related to early care and the new, conceptually important direction of studying environmental programming of early development through epigenetic modification of gene functioning is examined in brief. http://www.capmh.com/content/3/1/25 Judit Gervai Child and Adolescent Psychiatry and Mental Health 2009, null:25 2009-09-04T00:00:00Z doi:10.1186/1753-2000-3-25 /content/figures/1753-2000-3-25-toc.gif Child and Adolescent Psychiatry and Mental Health 1753-2000 ${item.volume} 25 2009-09-04T00:00:00Z XML ObjectiveTo present the design, methods, and rationale of the Child/Adolescent Anxiety Multimodal Study (CAMS), a recently completed federally-funded, multi-site, randomized placebo-controlled trial that examined the relative efficacy of cognitive-behavior therapy (CBT), sertraline (SRT), and their combination (COMB) against pill placebo (PBO) for the treatment of separation anxiety disorder (SAD), generalized anxiety disorder (GAD) and social phobia (SoP) in children and adolescents. Methods: Following a brief review of the acute outcomes of the CAMS trial, as well as the psychosocial and pharmacologic treatment literature for pediatric anxiety disorders, the design and methods of the CAMS trial are described. Results: CAMS was a six-year, six-site, randomized controlled trial. Four hundred eighty-eight (N = 488) children and adolescents (ages 7-17 years) with DSM-IV-TR diagnoses of SAD, GAD, or SoP were randomly assigned to one of four treatment conditions: CBT, SRT, COMB, or PBO. Assessments of anxiety symptoms, safety, and functional outcomes, as well as putative mediators and moderators of treatment response were completed in a multi-measure, multi-informant fashion. Manual-based therapies, trained clinicians and independent evaluators were used to ensure treatment and assessment fidelity. A multi-layered administrative structure with representation from all sites facilitated cross-site coordination of the entire trial, study protocols and quality assurance. Conclusions: CAMS offers a model for clinical trials methods applicable to psychosocial and psychopharmacological comparative treatment trials by using state-of-the-art methods and rigorous cross-site quality controls. CAMS also provided a large-scale examination of the relative and combined efficacy and safety of the best evidenced-based psychosocial (CBT) and pharmacologic (SSRI) treatments to date for the most commonly occurring pediatric anxiety disorders. Primary and secondary results of CAMS will hold important implications for informing practice-relevant decisions regarding the initial treatment of youth with anxiety disorders.Trial registrationClinicalTrials.gov NCT00052078. http://www.capmh.com/content/4/1/1 Scott Compton John Walkup Anne Albano John Piacentini Boris Birmaher Joel Sherrill Golda Ginsburg Moira Rynn James McCracken Bruce Waslick Satish Iyengar Phillip Kendall John March Child and Adolescent Psychiatry and Mental Health 2010, null:1 2010-01-05T00:00:00Z doi:10.1186/1753-2000-4-1 /content/figures/1753-2000-4-1-toc.gif Child and Adolescent Psychiatry and Mental Health 1753-2000 ${item.volume} 1 2010-01-05T00:00:00Z XML This is the first reported case of an adolescent male with anorexia nervosa in Iraq. This disorder is believed to be rare in males across cultures and uncommon for both genders in Arab countries. The patient met the DSM-IV diagnostic criteria for anorexia nervosa. He was hospitalized and received medical and psychiatric treatment at local facilities as discussed below and responded well to treatment. http://www.capmh.com/content/6/1/5 Maha Younis Lava Ali Child and Adolescent Psychiatry and Mental Health 2012, null:5 2012-01-26T00:00:00Z doi:10.1186/1753-2000-6-5 /content/figures/1753-2000-6-5-toc.gif Child and Adolescent Psychiatry and Mental Health 1753-2000 ${item.volume} 5 2012-01-26T00:00:00Z PDF Anti-NMDA-Receptor encephalitis is a severe form of encephalitis that was recently identified in the context of acute neuropsychiatric presentation. Here, we describe the case of a 17-year-old girl referred for an acute mania with psychotic features and a clinical picture deteriorated to a catatonic state. Positive diagnosis of anti-NMDA-receptor encephalitis suggested specific treatment. She improved after plasma exchange and immunosuppressive therapy. Post-cognitive sequelae (memory impairment) disappeared within 2-year follow-up and intensive cognitive rehabilitation. http://www.capmh.com/content/5/1/15 Angele Consoli Karine Ronen Isabelle An-Gourfinkel Martine Barbeau Donata Marra Nathalie Costedoat Delphine Montefiore Philippe Maksud Olivier Bonnot Adrien Didelot Zahir Amoura Marie Vidailhet David Cohen Child and Adolescent Psychiatry and Mental Health 2011, null:15 2011-05-13T00:00:00Z doi:10.1186/1753-2000-5-15 /content/figures/1753-2000-5-15-toc.gif Child and Adolescent Psychiatry and Mental Health 1753-2000 ${item.volume} 15 2011-05-13T00:00:00Z XML Background: To date, there are no empirically validated treatments of good quality for adolescents showing suicidality and non-suicidal self-injurious behavior. Risk factors for suicide are impulsive and non-suicidal self-injurious behavior, depression, conduct disorders and child abuse. Behind this background, we tested the main hypothesis of our study; that Dialectical Behavioral Therapy for Adolescents is an effective treatment for these patients. Methods: Dialectical Behavioral Therapy (DBT) has been developed by Marsha Linehan - especially for the outpatient treatment of chronically non-suicidal patients diagnosed with borderline personality disorder. The modified version of DBT for Adolescents (DBT-A) from Rathus & Miller has been adapted for a 16-24 week outpatient treatment in the German-speaking area by our group. The efficacy of treatment was measured by a pre-/post- comparison and a one-year follow-up with the aid of standardized instruments (SCL-90-R, CBCL, YSR, ILC, CGI). Results: In the pilot study, 12 adolescents were treated. At the beginning of therapy, 83% of patients fulfilled five or more DSM-IV criteria for borderline personality disorder. From the beginning of therapy to one year after its end, the mean value of these diagnostic criteria decreased significantly from 5.8 to 2.75. 75% of patients were kept in therapy. For the behavioral domains according to the SCL-90-R and YSR, we have found effect sizes between 0.54 and 2.14.During treatment, non-suicidal self-injurious behavior reduced significantly. Before the start of therapy, 8 of 12 patients had attempted suicide at least once. There were neither suicidal attempts during treatment with DBT-A nor at the one-year follow-up. Conclusions: The promising results suggest that the interventions were well accepted by the patients and their families, and were associated with improvement in multiple domains including suicidality, non-suicidal self-injurious behavior, emotion dysregulation and depression from the beginning of therapy to the one-year follow-up. http://www.capmh.com/content/5/1/3 Christian Fleischhaker Renate Bohme Barbara Sixt Christiane Bruck Csilla Schneider Eberhard Schulz Child and Adolescent Psychiatry and Mental Health 2011, null:3 2011-01-28T00:00:00Z doi:10.1186/1753-2000-5-3 /content/figures/1753-2000-5-3-toc.gif Child and Adolescent Psychiatry and Mental Health 1753-2000 ${item.volume} 3 2011-01-28T00:00:00Z XML