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.

Embracing different languages and local differences:Coconstructive patient simulation strengthens host countries’clinical training in psychiatry

BACKGROUND Global education in psychiatry is heavily influenced by knowledge from Western,high-income countries,which obscures local voices and expertise.AIM To adapt a human simulation model to psychiatric education in a context that is specific to local languages and cultures.METHODS We conducted an observational study consisting of six human simulation sessions with standardized patients from two host countries,speaking their native languages,and following an adaptation of the co-constructive patient simulation(CCPS)model.As local faculty became increasingly familiar with the CCPS approach,they took on the role of facilitators—in their country’s native language.RESULTS Fifty-three learners participated:19 child and adolescent psychiatry trainees and 3 faculty members in Türkiye(as a group that met online during 3 consecutive months);and 24 trainees and 7 faculty in Israel(divided into 3 groups,in parallel in-person sessions during a single training day).Each of the six cases reflected local realities and clinical challenges,and was associated with specific learning goals identified by each case-writing trainee.CONCLUSION Human simulation has not been fully incorporated into psychiatric education:The creation of immersive clinical experiences and the strengthening of reflective practice are two areas ripe for development.Our adaptations of CCPS can also strengthen local and regional networks and psychiatric communities of practice.Finally,the model can help question and press against hegemonies in psychiatric training that overshadow local expertise.

Review of the genetic basis of emotion dysregulation in children and adolescents

Previous evidence suggests that emotion dysregulation may have different biological correlates between adults and children/adolescents. Although the role of genetic factors has been extensively studied in adult-onset emotion dysregulation, the genetic basis for pediatriconset emotion dysregulation remains elusive. The current review article presents a summary of previous studies that have suggested a few genetic variants associated with pediatric emotion dysregulation. Among these candidate loci, many prior studies have been focused on serotonin transporter promoter gene polymorphism 5-HTTLPR. Certain alleles of the 5-HTTLPR gene polymorphism have been found to be associated with traits associated with emotion dysregulation, such as aggression, affect reactivity, and insecure attachment. Additionally, genetic variants involving dopamine and neurophysiological biomarkers like the COMT Val158Met(rs460) and dopamine receptor D2/ ankyrin repeat and kinase domain containing one polymorphisms may play a role in emotion dysregulation. Inconsistent findings have been noted, possibly due to the heterogeneity in study designs and characteristics of different populations. Further research on the role of genetic predetermination of emotion dysregulation in children and adolescents is warranted.

Event segmentation in ADHD:neglect of social information and deviant theta activity point to a mechanism underlying ADHD

Background Attention-deficit/hyperactivity disorder(ADHD)is one of the most frequently diagnosed psychiatric conditions in children and adolescents.Although the symptoms appear to be well described,no coherent conceptual mechanistic framework integrates their occurrence and variance and the associated problems that people with ADHD face.Aims The current study proposes that altered event segmentation processes provide a novel mechanistic framework for understanding deficits in ADHD.Methods Adolescents with ADHD and neurotypically developing(NT)peers watched a short movie and were then asked to indicate the boundaries between meaningful segments of the movie.Concomitantly recorded electroencephalography(EEG)data were analysed for differences in frequency band activity and effective connectivity between brain areas.Results Compared with their NT peers,the ADHD group showed less dependence of their segmentation behaviour on social information,indicating that they did not consider social information to the same extent as their unaffected peers.This divergence was accompanied by differences in EEG theta band activity and a different effective connectivity network architecture at the source level.Specifically,NT adolescents primarily showed error signalling in and between the left and right fusiform gyri related to social information processing,which was not the case in the ADHD group.For the ADHD group,the inferior frontal cortex associated with attentional sampling served as a hub instead,indicating problems in the deployment of attentional control.Conclusions This study shows that adolescents with ADHD perceive events differently from their NT peers,in association with a different brain network architecture that reflects less adaptation to the situation and problems in attentional sampling of environmental information.The results call for a novel conceptual view of ADHD,based on event segmentation theory.

Psychiatric outcomes in outpatients affected by long COVID:A link between mental health and persistence of olfactory complaint

BACKGROUND Anosmia was one of the main symptoms of coronavirus disease 2019(COVID-19).A psychiatric history(i.e.,depression)may be an independent contributor to the risk of COVID-19 diagnosis,and COVID-19 survivors appear to have an increased risk of neuropsychiatric sequelae(bidirectional association).AIM To compare the rate of psychiatric disorder among post-COVID patients without anosmia vs patients with persistent olfactory complaints.METHODS We conducted a prospective case control study from March 2020 to May 2021.Patients recruited at the ENT department of Nice University Hospital had a subjective olfactory complaint(visual analogue scale)for over 6 wk and a molecular or CT-proven severe acute respiratory syndrome coronavirus 2 diagnosis confirmed by serology.Post-COVID patients without persistent olfactory disorders were recruited at the university hospital infectiology department.Psychiatric medical histories were collected by a psychiatrist during the assessments.RESULTS Thirty-four patients with post-COVID-19 olfactory complaints were included in the first group of the study.Fifty percent of the patients were female(n=17).The group’s mean age was 40.5±12.9 years.The control group included 32 participants,of which 34.4%were female(n=11),and had a mean age of 61.2±12.2 years.The rate of psychiatric disorder among post-COVID patients with olfactory complaints was significatively higher(41.7%)than among patients without(18.8%)(χ2=5.9,P=0.015).CONCLUSION The presence of a psychiatric history may constitute a potential risk factor for the development of long COVID due to persistent anosmia.It therefore seems important to establish reinforced health monitoring after a COVID 19 infection in at-risk patients.Further prospective,translational,and collaborative studies are needed to extrapolate these results to the general population.

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.

Phenomenology of obsessive-compulsive disorder in children and adolescents: Sample from a tertiary care center in Istanbul, Turkey

BACKGROUND Obsessive-compulsive disorder(OCD)is a heterogeneous disease in many respects and exhibits this diversity in terms of phenomenology.It also displays several different characteristics in children compared to adults.AIM To describe the socio-demographic and phenomenological features of children with OCD and to investigate the impact of these features on response to pharmacotherapy.METHODS This retrospective study was carried out with 150 children and adolescents who had been diagnosed with OCD between 2014 and 2018.Data was collected by examining the files of the patients with diagnosis of OCD and similar disorders from the hospital database.Yale-Brown Obsessive-Compulsive Scale for Children was used for the assessment of obsession-compulsion subtypes.The Clinical Global Impression(CGI)scale was used to evaluate the severity of the disease(CGI-S)and global improvement(CGI-I).The predictors of treatment response were evaluated using linear regression analysis.The level of significance for all statistic tests was set as P<0.05.RESULTS The sample was divided into prepubertal(44%)and adolescent(56%)age groups.The most prevalent obsessions were contamination and aggression obsessions,and the most frequent compulsions were washing and checking.While contamination was observed more commonly in the prepubertal age group,the religious obsession was seen more frequently in adolescents.Patients with aggression obsession presented a higher frequency of comorbid anxiety(P=0.022)and mood subgroups(P>0.05).A lower CGI-I score was linked to a lower CGI-S score(95%confidence interval 0.21-0.39,P<0.001)and the prepubertal age of admission(95%confidence interval 0.03-0.87,P=0.020).CONCLUSION The phenomenology of OCD shows differences depending on the age group and the comorbid psychiatric disorders.Earlier identification and treatment of OCD may help to prevent the impairment of the mental health of children and adolescents.

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.

Risk for emerging bipolar disorder, variants, and symptoms in children with attention deficit hyperactivity disorder, now grown up

AIM: To determine the prevalence of bipolar disorder(BD) and sub-threshold symptoms in children with attention deficit hyperactivity disorder(ADHD) through 14 years' follow-up, when participants were between 21-24 years old.METHODS: First, we examined rates of BD type Ⅰ?and Ⅱ diagnoses in youth participating in the NIMH-funded Multimodal Treatment Study of ADHD(MTA). We used the diagnostic interview schedule for children(DISC), administered to both parents(DISC-P) and youth(DISCY). We compared the MTA study subjects with ADHD(n = 579) to a local normative comparison group(LNCG, n = 289) at 4 different assessment points: 6, 8, 12, and 14 years of follow-ups. To evaluate the bipolar variants, we compared total symptom counts(TSC) of DSM manic and hypomanic symptoms that were generated by DISC in ADHD and LNCG subjects. Then we sub-divided the TSC into pathognomonic manic(PM) and non-specific manic(NSM) symptoms. We compared the PM and NSM in ADHD and LNCG at each assessment point and over time. We also evaluated the irritability as category A2 manic symptom in both groups and over time. Finally, we studied the irritability symptom in correlation with PM and NSM in ADHD and LNCG subjects.RESULTS: DISC-generated BD diagnosis did not differ significantly in rates between ADHD(1.89%) and LNCG 1.38%). Interestingly, no participant met BD diagnosis more than once in the 4 assessment points in 14 years. However, on the symptom level, ADHD subjects reported significantly higher mean TSC scores: ADHD 3.0; LNCG 1.7; P < 0.001. ADHD status was associated with higher mean NSM: ADHD 2.0 vs LNCG 1.1; P < 0.0001. Also, ADHD subjects had higher PM symptoms than LNCG, with PM means over all time points of 1.3 ADHD; 0.9 LNCG; P = 0.0001. Examining both NSM and PM, ADHD status associated with greater NSM than PM. However, Over 14 years, the NSM symptoms declined and changed to PM over time(df 3, 2523; F = 20.1; P < 0.0001). Finally, Irritability(BD DSM criterion-A2) rates were significantly higher in ADHD than LNCG(χ2 = 122.2, P < 0.0001), but irritability was associated more strongly with NSM than PM(df 3, 2538; F = 43.2; P < 0.0001).CONCLUSION: Individuals with ADHD do not appear to be at significantly greater risk for developing BD, but do show higher rates of BD symptoms, especially NSM. The greater linkage of irritability to NSM than to PM suggests caution when making BD diagnoses based on irritability alone as one of 2(A-level) symptoms for BD diagnosis, particularly in view of its frequent presentation with other psychopathologies.

A cohort study of adolescents with depression in China:tracking multidimensional outcomes and early biomarkers for intervention

Background Depression in adolescents is recognised as a global public health concern,but little is known about the trajectory of its clinical symptoms and pathogenesis.Understanding the nature of adolescents with depression and identifying earlybiomarkers can facilitatepersonalised intervention andreducediseaseburden.Aims To track multidimensional outcomes of adolescents with depression and develop objective biomarkers for diagnosis,as well as response to treatment,prognosis and guidance for early identification and intervention.Methods This is a multidimensional cohort study on the Symptomatic trajectory and Biomarkers of Early Adolescent Depression(sBEAD).We planned to recruit more than 1000 adolescents with depression and 300 healthy controls within 5 years.Multidimensional clinical presentations and objective indicators are collected at baseline,weeks 4,8,12 and 24,and years 1,2,3,4 and 5.Conclusions To the best of our knowledge,this is the first longitudinal cohort study that examines multidimensional clinical manifestations and multilevel objective markers in Chinese adolescents with depression.This study aims at providing early individualised interventions for young,depressed patients to reduce the burden of disease.

Adolescent anxiety disorders and the developing brain: comparing neuroimaging findings in adolescents and adults

Adolescence is the peak period for the incidence of anxiety disorders.Recent findings have revealed the immaturity of neural networks underlying emotional regulation in this population.Brain vulnerability to anxiety in adolescence is related to the unsynchronised development of anxiety-relevant brain functional systems.However,our current knowledge on brain deficits in adolescent anxiety is mainly borrowed from studies on adults.Understanding adolescent-specific brain deficits is essential for developing biomarkers and brain-based therapies targeting adolescent anxiety.This article reviews and compares recent neuroimaging literature on anxiety-related brain structural and functional deficits between adolescent and adult populations,and proposes a model highlighting the differences between adolescence and adulthood in anxiety-related brain networks.This model emphasises that in adolescence the emotional control system tends to be hypoactivated,the fear conditioning system is immature,and the reward and stress response systems are hypersensitive.Furthermore,the striatum’s functional links to the amygdala and the prefrontal cortex are strengthened,while the link between the prefrontal cortex and the amygdala is weakened in adolescence.This model helps to explain why adolescents are vulnerable to anxiety disorders and provides insights into potential brain-based approaches to intervene in adolescent anxiety disorders.

Classification,prevalence and integrated care for neurodevelopmental and child mental health disorders:A brief overview for paediatricians

‘Neurodevelopmental disorders’comprise a group of congenital or acquired longterm conditions that are attributed to disturbance of the brain and or neuromuscular system and create functional limitations,including autism spectrum disorder,attention deficit/hyperactivity disorder,tic disorder/Tourette’s syndrome,developmental language disorders and intellectual disability.Cerebral palsy and epilepsy are often associated with these conditions within the broader framework of paediatric neurodisability.Co-occurrence with each other and with other mental health disorders including anxiety and mood disorders and behavioural disturbance is often the norm.Together these are referred to as neurodevelopmental,emotional,behavioural,and intellectual disorders(NDEBIDs)in this paper.Varying prevalence rates for NDEBID have been reported in developed countries,up to 15%,based on varying methodologies and definitions.NDEBIDs are commonly managed by either child health paediatricians or child/adolescent mental health(CAMH)professionals,working within multidisciplinary teams alongside social care,education,allied healthcare practitioners and voluntary sector.Fragmented services are common problems for children and young people with multi-morbidity,and often complicated by subthreshold diagnoses.Despite repeated reviews,limited consensus among clinicians about classification of the various NDEBIDs may hamper service improvement based upon research.The recently developed“Mental,Behavioural and Neurodevelopmental disorder”chapter of the International Classification of Diseases-11 offers a way forward.In this narrative review we search the extant literature and discussed a brief overview of the aetiology and prevalence of NDEBID,enumerate common problems associated with current classification systems and provide recommendations for a more integrated approach to the nosology and clinical care of these related conditions.

Sleep problems, strengths and difficulties in elementary school children

Aim: To assess behavioral and sleep disturbances in childhood, it is necessary to implement standardized brief questionnaires for children and their parents. Especially complaints of insomnia often are underdiagnosed in pediatric medicine. Methods: We developed a sleep questionnaire (K?SI-KJ) and used it together with German versions of the SDQ (parent and child reports) for epidemiologic studies in Cologne. The sleep questionnaire obtains 33 items for parents and 28 items for children. Ratings were dichotomized for this analysis in “sometimes/ often present” versus “not present”. The German versions of SDQ contain 5 subscales each with 5 items. Data from a sample of 1490 children of fourth grade in elementary schools inCologne(age ranged from 8 to 11 years) are shown. Results: Children indicate signs of sleep disturbances in higher frequency than their parents do. Concerning gender and ethnical group, there no significant differences can be shown. Children with signs of insomnia, dyssomnia, daytime sleepiness or restless sleep?showed significantly higher scores for all relevant SDQ subscales in parental and children's reports. Children with signs of parasomnia showed higher scores concerning emotional problems and the SDQ total score. Children with enuresis showed higher scores for all SDQ subscales and the total score.

Emotional Context Distorts Both Time and Space in Children

According to a generalized magnitude system, the representation of time, space and number relies on a common cognitive mechanism. However, in the context of negative emotional stimuli, temporal durations undergo a subjective overestimation, while numerosity judgments are underestimated. This finding clearly challenged the existence of a generalized magnitude system. In this study, we aimed to investigate whether angry faces biases both temporal and spatial estimates compared to neutral faces in children aged 5 - 6-year-old and 9 - 10-year-old. Children were to judge as short or long either the temporal interval or the distance separating two visual stimuli in a bisection task. Overall, the study suggests that negative emotion with high arousal (angry faces) leads to a distortion of both duration and distance. Such distortion is reported early in development, even before the maturation of time perception.

Online Social Skills Group Training for Adolescents and Young Adults with 22q11.2 Deletion Syndrome (22q11.2DS)

Somatic, cognitive and psychiatric obstacles contribute to social impairment in 22q11.2DS and prevent adequate responses during interactions. We adapted the autism-specific SOSTA-FRA program for use during online group sessions with geographically-isolated 22q11DS adolescents or adults. The 12 weekly sessions targeted communication, emotional awareness, and reciprocity. Twenty-two participants were evaluated on behaviour, social responsiveness, and cognition pre- and post-intervention. Parents completed a questionnaire to ascertain whether the intervention met their needs. Parents were satisfied with the format and curriculum contents and reported improved emotional awareness, well-being, and reciprocity post-intervention. Pre-post results suggest large effects on social awareness and small to medium effects on social motivation. Results indicate that online social skills training is feasible and effective for individuals with 22q11.2DS.

Stabilization of Circadian Rhythm, Its Augmentation by Bright Light Treatment and Its Importance for ADHD and Depression of Adolescents

Objective: ADHD is characterized by the progressive development of, impulsiveness, attentional difficulties and sometimes also excessive hyperactivity. Main biological reason is a quantitative reduction of the neurotransmitter dopamine in the forebrain. A lack of dopamine is also typical for depressive disorders. Methods: Bright light therapy is proven to be effective in treating depression. Purpose of our study is to verify the therapeutic effectiveness of Bright light therapy in subjects affected by ADHD. Results: Results show a significant improvement which lasts for at least 4 weeks, which is superposed by regulation of the circadian rhythm. Initial decrease of especially morning saliva melatonin levels, due to regular sleep under in-patient conditions, is followed by symptom improvement and a raising evening melatonin level, due to activation during the day. This level decreases as soon as activation is ceased. Conclusion: Bright light therapy seems to be effective as add-on therapy for ADHD, but in fact, stabilization of the circadian rhythm is the most important therapeutic intervention, either for ADHD or for depression, as demonstrated in another study.

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.

Cancer: Education and Primary Prevention Starts in Childhood and Adolescence

At least one third of all newly diagnosed cancers could be prevented if lifestyle factors were changed. The University Cancer Center Dresden initiated two programs aiming at cancer awareness and intentions to engage in health-promoting behavior among children and adolescents. Study 1 examined sun protection knowledge of 80 preschool children in a non-randomized design and Study 2 inspected 235 7th grade students’ knowledge of cancer and its behavioral risk-factors as well as intentions on health-promoting behavior using a randomized pre-post design on group-level. Study 1 showed significant improvement of sun protection knowledge in preschool children (p 0.05). Study 2 was effective in increasing knowledge about risk factors for cancer (p 0.001) and in increasing intentions to engage in health-promoting behavior (p 0.001). Communicating health-related behavior in preschools as well as school-based programs targeting multiple cancer-related risk factors are promising tools for primary prevention of cancer.

Deliberate self-harm among pediatric psychiatric inpatients in China:A single-center retrospective study

BACKGROUND For children and adolescents,deliberate self-harm(DSH)is becoming a mental health problem of concern.Despite several studies on the prevalence and factors of DSH in the world,there is little information on DSH among children and adolescents in China.This study explores the prevalence,types,associated risk factors and tendency of DSH in pediatric psychiatric inpatients in China.AIM To understand the situation of DSH among hospitalized children and adolescents and its related factors.METHODS In this study,we retrospectively studied 1414 hospitalized children and adolescents with mental illness at Xiamen Mental Health Center from 2014 to 2019,extracted the demographic and clinical data of all patients,and analyzed clinical risk factors of DSH.RESULTS A total of 239(16.90%)patients engaged in at least one type of DSH in our study.Cutting(n=115,48.12%)was the most common type of DSH.Females(n=171,71.55%)were more likely to engage in DSH than males(n=68,28.45%).DSH was positively associated with depressive disorders[OR=3.845(2.196-6.732);P<0.01],female[OR=2.536(1.815-3.542);P<0.01],parental marital status[OR=5.387(2.254-12.875);P<0.01]and negative family history of psychiatric illness[OR=7.767(2.952-20.433);P<0.01],but not with occupation,substance use and history of physical abuse.CONCLUSION Our findings suggest that for patients with depression,females,an abnormal marriage of parents,and no history of mental illness,attention should be paid to the occurrence of DSH.

Advances in the treatment of autism spectrum disorder:Wharton jelly mesenchymal stem cell transplantation

BACKGROUND Autism spectrum disorder(ASD)is a complex neurodevelopmental disorder with multifaceted origins.In recent studies,neuroinflammation and immune dysregulation have come to the forefront in its pathogenesis.There are studies suggesting that stem cell therapy may be effective in the treatment of ASD.AIM To evolve the landscape of ASD treatment,focusing on the potential benefits and safety of stem cell transplantation.METHODS A detailed case report is presented,displaying the positive outcomes observed in a child who underwent intrathecal and intravenous Wharton’s jelly-derived mesenchymal stem cells(WJ-MSCs)transplantation combined with neurorehabilitation.RESULTS The study demonstrates a significant improvement in the child’s functional outcomes(Childhood Autism Rating Scale,Denver 2 Developmental Screening Test),especially in language and gross motor skills.No serious side effects were encountered during the 2-year follow-up.CONCLUSION The findings support the safety and effectiveness of WJ-MSC transplantation in managing ASD.