Increasing prevalence of eating disorders in female adolescents compared with children and young adults:an analysis of real-time administrative data

TToo tthhee eeddiittoorr::Eating disorder(ED),as defined by the Diagnostic and Statistical Manual of Mental Disorders(DSM-5),is a persistent disturbance of eating or eating-related behaviour that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning.^(1)The DSM-5 outlines criteria for EDs,including anorexia nervosa,bulimia nervosa,binge-eating disorder,pica,rumination disorder and avoidant/restrictive food intake disorder.EDs are relatively common in young people,affecting 5.5%-17.9%of young women and 0.6%-2.4%of young men by the time they reach early adulthood.

Central choroidal thickness in children and adolescents with anxiety disorders:enhanced depth imaging optical coherence tomography findings

AIM:To measure the central choroidal thickness(ChT)in children and adolescents with anxiety disorders.METHODS:Totally 41 anxiety patients(8-16 y)and 35 healthy controls(age-matched)were evaluated.Complete ophthalmic examination was performed.Inclusion criteria were best corrected visual acuity≥20/20,normal intraocular pressure(IOP;10-21 mm Hg),and no systemic or ocular diseases according to history.The diagnosis of psychiatric disorders was determined using Schedule for Affective Disorders and Schizophrenia for School Aged Children Present-Lifetime Version(K-SADS-PL).Enhanced depth imaging optical coherence tomography(EDI-OCT)was used to measure the central ChT.RESULTS:The mean age was 12.18±3.24 y in the patient group and 12.86±3.15 y in the control group.Age and gender distribution of the two groups was similar.Central ChT mean value was 353.26±31.9μm in anxiety patients while 318.75±60.9μm in the control group.Mean central ChT was statistically significantly higher in the children and adolescents with anxiety disorders than healthy controls(P=0.002).CONCLUSION:The children and adolescents with anxiety disorders have significantly thicker central ChT than controls.In the larger sample,longitudinal studies will contribute to the use of choroidal differences as a clinical marker for monitoring anxiety disorders.

How does a real-world child psychiatric clinic diagnose and treat attention deficit hyperactivity disorder?

AIM: To investigate child and adolescent psychiatrists'(CAPs) attention deficit hyperactivity disorder(ADHD) and oppositional defiant disorder(ODD) diagnoses and treatments in real-world clinical practice. METHODS: The medical records of 69 ADHD children(mean age = 9.5 years), newly referred to the ADHD clinic, were reviewed for their scores of parent- and teacher-reported Vanderbilt ADHD Diagnostic Rating Scales(VADRSs), CAPs' diagnoses of ADHD and ODD, and CAPs' treatment recommendations. Among 63 ADHD subjects who completed both parent and teacher VADRSs, we examined the agreement of the parent and teacher VADRSs. We also examined the concurrent validity of CAPs' ODD diagnoses against the results from the VADRSs. In addition, we compared CAPs' treatment recommendations against established ADHD and ODD guidelines.RESULTS: Among 63 ADHD subjects, the majority of the subjects(92%) met full ADHD diagnostic criteria at least in one setting(parent or teacher) on the VADRSs. Nearly half of the patients met full ADHD diagnostic criteria in two settings(parent and teacher). Relatively low agreement between the parent and teacher VADRSs were found(95%CI:-0.33 to 0.14). For 29 children who scored positive for ODD on the rating scales, CAPs confirmed the ODD diagnosis in only 12 of these casepositives, which is considered as a fair agreement between CAPs and VADRSs(95%CI: 0.10-0.53). For 27 children with no ODD diagnosis made by either CAP or VADRS, more than half of them were recommended for medication only. In contrast, where CAPs made the diagnosis of ODD, or where the parent or teacher VADRS was positive for ODD, almost all of the patients received recommendations for medication and behavior therapy.CONCLUSION: CAPs' ADHD diagnoses have strong concurrent validity against valid rating scales, but ADHD's most common comorbid condition- ODD- may be underrecognized.

Prevalence and Predictors of Depression among Adolescents in Ido Ekiti, South West Nigeria

Background: Depression among adolescents has been recognized as a public health problem all over the world. In Nigeria, as in most developing countries, there is a need for more research on the epidemiology of adolescent depression as this will guide prevention, diagnosis and treatment. Objectives: The study sought to determine the one month prevalence and predictors of depression among a sample of in-school adolescents in a rural region in South West Nigeria. Materials and Methods: This was a cross sectional descriptive survey among 540 secondary school students randomly selected from the six secondary schools in the study area using a Socio demographic Questionnaire and the Patient Health Questionnaire modified for Adolescents. Subsequently, a proportion of them were interviewed with the Kiddies Schedule for Affective Disorders and Schizophrenia. Results: Data were analyzed using the SPSS version 17. Respondents were aged 10 - 19 years (mean age was 14.07 ± 1.84). The one month prevalence of depression among the study population was 16.3% (using weighting method). Logistic regression analysis showed that death of a mother (OR = 11.786, 95% CI, 1.990 - 23.184), being from a polygamous family (OR = 5.781, 95% CI, 3.253 - 24.371), low socioeconomic class (OR = 6.222, 95% CI, 4.705 - 23.379), having a single parent (OR = 2.236, 95% CI, 0.869 - 11.786), having witnessed frequent violence (OR = 12.411, 95% CI, 0.516 - 29.851) and positive history of sexual abuse (OR = 0.203, 95% CI, 0.003 - 0.529) were significantly and independently associated with depression in this sample of adolescents. Conclusion: The one month prevalence of adolescent depression within the study population is slightly higher than what has been reported in other parts of the world. Therefore, there is a need for government to design and implement policies which can help to prevent, detect early, and treat depression among youths especially in rural areas.

Suicide ideation, depression and HIV among pregnant women in rural South Africa

Background: Despite public perception to the contrary, pregnancy does not offer a protective effect for suicide ideation. In low and middle income countries (LMIC) multiple concurrent risk factors including unplanned pregnancies, testing for HIV, intimate partner violence and depression may increase suicide risk among pregnant women. We examine suicide ideation among women attending routine antenatal care in rural South Africa. Method: A consecutive series of 109 women in the second half of pregnancy were enrolled in a cross-sectional study at a large primary health care facility in a rural area of KwaZulu-Natal with high HIV prevalence. Using a mixed-methods approach, women were assessed using the Major Depression Section of the Structured Clinical Interview for Depression (SCID) for DSM-IV diagnosis;qualitative interview data were collected on women’s experiences of suicide ideation and plans. Women were assessed two weeks after routine HIV testing as part of Prevention of Mother-to-Child Transmission (PMTCT) screening. Results: Both HIV-positive (49/109) and HIV-negative (60/109) women were assessed. Depression was high (51/109, 46.7%) and equally common amongst HIV-positive and negative women. Suicide ideation was high (30/109, 27.5%) with thoughts of self harm closely linked to suicide plans. Age, previous history of depression and current depression were significantly associated with suicide ideation. Close to equal numbers of HIV-positive and negative women were suicidal. Suicide methods were frequently violent and most women cited family and partnership conflict related to an unplanned pregnancy or their newly HIV-positive status as triggers to their suicide ideation. Conclusions: Rates of suicide ideation among pregnant women testing for HIV are high. Testing HIV-positive causes considerable distress, and among HIV-negative women unplanned and unwanted pregnancies are important risk factors for suicide ideation. Pregnancy brings women into increased contact with the health services with important opportunities for prevention and intervention.

儿童抑郁症的抗抑郁剂治疗(英文)

The Forum about treating depressed children presented in the previous issue of the journal[1,2] highlighted several important issues about this controversial topic.Depressionin children is a devastating disorder that effects psychosocial development and has long-term negative outcomes for both the patients and their families.[3-5] It has a relatively high prevalence of 1 to 2% in children and 3 to 8% in adolescents[3], but there are few randomized controlled trials on the efficacy of pharmacotherapy and other treatments for the disorder.[3-9].

Very early family-based intervention for anxiety:two case studies with toddlers

Anxiety disorders represent the most common categor of psychiatric disorder in children and adolescents and contribute to distress,impairment and dysfunction.try Anxiety disorders or their temperamental precursors are often evident in early childhood,and anxiety can impair functioning,even during preschool age and in toddlerh A growing number of investigators have shown that anxiety in preschoolers can be treated efficaciously using cognitive-behavioural therapy(CBT)administere either by training the parents to apply CBT strategies with their children or through direct intervention with parents and children.To date,most investigators have drawn the line at offering direct CBT to children under the age of 4.However,since toddlers can also present with impairing symptoms,and since behaviour strategi can be applied in older preschoolers with poor languag ability successfully,it ought to be possible to apply CBT anxiety to younger children as well.We therefore prese two cases of very young children with impairing anxiet(ages 26 and 35 months)and illustrate the combinatio parent-only and parent-child CBT sessions that compri their treatment.The treatment was well tolerated by parents and children and showed promise for reducing anxiety symptoms and improving coping skills.

Synapsin Polymorphisms Could Be Correlated with Stroop Simple Reaction Time Scores

Objective: The aim of this study was to research the relationship between Attention Deficit Hyperactivity Disorder (ADHD) and the synapsin III -196G>A and -631C>G polymorphisms and study their impact on neurocognition and behavior in Turkish children and adolescents. Methods: A total of 201 ADHD-diagnosed children and 100 control subjects aged between 8 and 15 years were recruited, and genetic material was obtained from saliva. In the diagnostic assessments, the KSADS- PL semi-structured interview was applied. Children with any comorbid psychiatric diagnosis (with the exclusion of oppositional defiant disorder (ODD)), medical conditions, prior psychotropic drug use history or IQ score below 80 were excluded. For the behavioral and ADHD symptom assessments, the Turgay DSM-IV Disruptive Behaviors Rating Scale, Teacher Report Form (TRF) and Child Behavior Checklist (CBCL) were completed by the parents and teachers. Neurocognitive profiles were evaluated with the CNS-Vital Signs computerized neurocognitive test battery. Results: No significant difference in ADHD prevalence was observed between subjects with the synapsin III gene -196G>A polymorphism and -631C>G polymorphisms. These polymorphisms were also not associated with subtypes of ADHD. We found a relationship between both polymorphisms and Stroop simple reaction time. Conclusion: Synapsin’s effect could be limited during childhood, but synapsin polymorphisms could be associated with Stroop simple reaction time.

农药与孤独症产前和幼年时接触农药与孤独症的风险中度增加有关

孤独症谱系障碍是一种神经发育障碍,以兴趣局限、刻板重复的行为、社交和交流障碍为主要特征。虽然以前这种情况很罕见,但最近的流行病学评估表明,目前在发达国家有1.7%^1~2.6%^2的儿童患有孤独症。