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Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care.
The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions.
We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures.
We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.
The main pharmacotherapy of Attention Deficit Hyperactivity Disorder (ADHD) is stimulants, especially methylphenidate (MPH). MPH efficacy is assessed by subjective measures. The Test of Variables of Attention (TOVA) is a known objective assessment measure. In order to assess the accuracy of patients' reports, we used Clinical Global Impression – Compared (CGI-C-C) before and after MPH challenge comparing to the objective TOVA alterations.
165 children and adolescents, who were referred to the ADHD unit and were diagnosed as ADHD were included. TOVA was done before and after MPH challenge (0.3 mg/Kg). All patients filled CGI-C-C blind to the TOVA results.
165 patients participated in the study, M:F ratio 67%:33% respectively. Average age was 11.09+3.43 yrs. ADHD mixed type: ADHD inattentive type, 50.6%:48.1% respectively. A significant inverse correlation was found between CGI-C-C and the Commission (C) score of TOVA (r=-0.32, p< 0.01), but not for any of the other scores. Age had a significant role in the accuracy of estimation. A significant negative correlation between the age and the tendency to assess improvement was found (r = -.210, p<0.01). There were no differences by gender or diagnosis. A dependence was found between consistent normal results of ADHD score change and self assessment of improvement (F = 4.22, p<0.05).
A partial correlation was found between subjective and objective measures with regard to response to MPH, mostly for the behavioral aspects. The older the patient the more likely he/she is to estimate improvement, but the role of a placebo effect cannot be ruled out.
The proposed course targets a major international public health issue: the cause of death of about 100, 000 children and adolescents world-wide each year, suicide. It is the second leading cause of death in that age group in many European countries. There are over three million suicide attempts made by adolescents annually. Although genetic and family risk factors are highly associated with both suicide and with suicide attempts, the specific genetic alleles that transmit this vulnerability between generations have yet to be identified.
Some risk factors for teen suicide attempts and completion have been identified and will be discussed, including an Axis I psychiatric disorder (e.g. mood disorder), family discord, aggressive-impulsive traits and physical and sexual abuse. One key factor consistently associated with suicide and suicidal behavior and will get a special attention in the course is a family history of suicidal behavior. This is as strong a risk factor as major depression, and stronger than environmental factors such as abuse. Suicidal behavior runs in families, independently of axis I or II diagnosis. Gene-environment interaction models in children and families will be presented and discussed. We will propose a stress-diathesis model of suicidal behavior and a practical tool for risk assessment for the clinician.
Both adolescent suicide and attention deficit hyperactivity disorder (ADHD) are troubling phenomena with high comorbidity, including impulsivity, depression and personality disorders (PD). Studies on the association between these two phenomena are relatively rare. This pilot study's aim was to estimate the rate of ADHD in adolescents attempting suicide.
Subjects constituted consecutive admissions to the psychiatric emergency room (ER) who were admitted as a result of attempting suicide. Assessment included the use of the Kiddie-SADS, Strengths and Difficulties Questionnaire (SDQ) and the Conners’ Rating Scale (CRS). Those diagnosed as suffering from ADHD were assessed by a standardized Continuous Performance Test (Test of Variables of Attention [TOVA]) that included methylphenidate (MPH) challenge. Twenty-three (23) adolescents completed the study. M:F ratio was 5:18, respectively.
Of the 23 participants who completed the study, 65% were diagnosed with ADHD, 43.5% with depression and 39% with cluster B PD. ADD/ADHD ratio was 66%:34%. Only five of the patients were formerly diagnosed as ADHD, only three had been medicated and 14 out of 15 adolescents responded well to MPH challenge.
These preliminary results suggest a significant association between ADHD and suicidal behavior in adolescents. Further study is needed to establish this association and assess the causality.
The aim of the course is to give adult psychiatrists some basic knowledge in infant psychiatry that has become in the recent years, very relevant to the understanding the link between brain development, early childhood experiences, pathophysiology of personality disorders in adulthood, and psychotherapeutic transferential processes.
The course will be built as follows:
The first part will cover very recent data on the impact of early experiences in general, and attachment experiences in particular, on brain development and development of a theory of mind and empathy. Concepts of resilience, vulnerability, bio-psycho-social risk and protective factors will also be explored in length. Through these basic concepts, we will show how infant psychiatry is linked to prevention of adult psychopathology, and how the early attachment experiences reflect themselves in the psychotherapeutic process.
The second part will be clinical and will illustrate the basic concepts learned in the first part. A clinical case will be presented to show the development of borderline personality disorder from early childhood to adulthood, its transgenerational transmission to the offspring through disturbed attachment relationship, and some of the processes that took place during the dyadic mother-infant psychotherapy. We will show how parenthood can become a new motivation for change.
The course applies who any adult psychiatrist who is interested in the field of developmental psychopathology, and no previous experience with young children is needed. Clinical experience with personality disordered patients will be an advantage.
Adolescent suicide is a worldwide troubling phenomenon that has high comorbidity, including impulsivity, depression, and personality disorders. Attention Deficit Hyperactivity Disorder (ADHD) includes attention, impulsivity and hyperactivity. Comorbidity includes depression and substance abuse, and has a higher rate in adolescents and adults. Studies considering the association between these phenomena are surprisingly rare. This pilot study estimated the percentage of ADHD in a population of adolescents who attempted suicide. Population included all adolescents (12-18 yrs.) who were brought to local ER after attempting suicide. Assessment included an interview according to the DSM-IV criteria, the Strengths and Difficulties Questionnaire parents (SDQ-P) the Conners' Rating Scale parents (CRS-P), and Kiddie-SADS. Test Of Variables of Attention (TOVA) with methylphenidate (MPH) challenge was done after the clinical evaluation to those diagnosed as ADHD.
45 suicidal adolescents were registered in the ER and were assessed. 23 adolescents completed the assessment. Male: female ratio was 5:18 accordingly. The prominent diagnoses included ADHD (65%), depression (43%), cluster B personality disorders (35%), and Conduct Disorder (13%). ADD/ADHD ratio was 43/22 (66%:34%). Some suffered from more than 2 diagnoses and 1 had no diagnosis at all. 47.6% were diagnosed as hyperactive by SDQ-P, and 70% as ADHD by CRS-P. 14/15 (93%) were evaluated as ADHD by TOVA and most responded well to MPH. Five patients were diagnosed before the study as ADHD, but only three were medicated. These results, though primary, suggest a significant relationship between the two disorders and indicate a need to further study this correlation
Studies performed with schizophrenic adults who were resistant to classical neuroleptics showed improvement in 30% of the patients when treated with clozapine. Very early onset schizophrenic patients benefit only partially from conventional antipsychotics and are at increased risk of developing extrapyramidal symptoms; clozapine may offer an alternative treatment for these patients.
Eleven neuroleptic-resistant children (< 13 years) with schizophrenia were treated with clozapine. Improvement was monitored during the first 16 weeks using the Brief Psychiatric Rating Scale, Positive and Negative Syndrome Scale and Clinical Global Impression. The mean clozapine dosage was 227.3 (s.d. 34.4) mg/day at the end of the 16 weeks.
There was an overall statistically significant reduction in all parameters, especially positive symptoms, implying a favourable outcome. Most of the improvement occurred during the first 6 to 8 weeks. The major side-effects were somnolence and drooling (no agranulocytosis).
Clozapine may be a promising drug for the treatment of resistant childhood-onset schizophrenia.
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