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This narrative review examines recent literature of artificial intelligence (AI) in child and adolescent psychiatry. With increasing mental health disorders in young people along with persistent workforce shortages, AI has emerged as a potential tool to improve efficiency and support clinical decision making. However, using AI raises important ethical concerns which are summarized in our review. Most AI applications in child and adolescent psychiatry remain early in development and are not ready for routine clinical use. AI scribes are likely impractical in many child psychiatry settings because of multiparty visits, consent concerns, and sensitive clinical discussions. Many multimodal diagnostic tools using machine learning still require further testing and can be impractical when relying on costly diagnostics like neuroimaging. Similarly, AI-assisted therapeutics requiring physical hardware like robotics and virtual or augmented reality devices can also be prohibitively expensive. One of the few exceptions includes AI-enabled video and eye-tracking approaches for autism diagnosis. Chatbots and robot companions may provide modest improvements for depression, but evidence remains limited in the pediatric population with risk of serious harm. Concerns of AI include misinformation, algorithmic biases, privacy risks, crisis mismanagement, and excessive emotional attachments to chatbots. AI may eventually support child and adolescent psychiatry, but current evidence supports cautious, supervised use rather than broad clinical adoption. Clinicians should help families understand AI's limits, encourage digital literacy, and ensure that AI remains an adjunct to human care rather than a substitute.
Young people are currently facing multiple global crises. This study provides an overview of recent data from a population-based German study to examine youth mental health in this multi-crisis context and explores coping strategies and social media use. Data were drawn from eight survey waves (T1/2020-T8/2025) of the nationwide COPSY study, including n = 3,312 families and n = 2,291 adolescent self-reports. The design combined longitudinal and repeated cross-sectional measurement. Validated instruments assessed health-related quality of life (HRQoL), symptoms of mental disorders, crisis-related worries, social media use, coping strategies, and resources. Data were analyzed descriptively and compared with pre-pandemic reference data. Cross-sectional associations at T8 were examined using chi-square tests and logistic regression adjusted for age and gender. In autumn 2025, the proportions of children and adolescents reporting low HRQoL (22%), mental health problems (23%), anxiety symptoms (25%), or loneliness (18%) remained slightly above pre-pandemic levels. Worries remained widespread, particularly regarding wars (70%), terrorism (62%) and economic problems (57%). Crisis-related future anxiety was cross-sectionally associated with low HRQoL and mental health problems (ORs = 1.8-3.4) in 2025. Social media use was high, with many youths reporting exposure to distressing content. Active coping strategies were used most frequently, while strong personal, familial, and social resources showed potentially protective associations with mental health outcomes (ORs = 0.1-0.2). Despite signs of recovery, elevated crisis-related worries and strong associations between future anxiety and mental health indicate ongoing vulnerability among youth. Strengthening psychosocial resources and promoting safe digital environments deserve greater attention in public health and prevention efforts.
Autism spectrum disorder (ASD) may be a predisposing factor in the development of catatonia, which has been demonstrated to be effectively treated using electroconvulsive therapy (ECT). CACNA1 channelopathy mutations have been associated with autism spectrum disorder, intellectual disability, and epilepsy. The single published case report of ECT use in CACNA1 subunit mutations demonstrated a negative outcome, and no current case reports on CACNA1B, CACNA1C, CACNA1D, or CACNA1E mutations have been published. We present a case of an adolescent with a known CACNA1D mutation and symptoms of excited catatonia who experienced a reduction in the frequency and severity of self-injurious and violent behavior following treatment with ECT. Our case demonstrates the use of ECT for catatonia in an individual with a CACNA1 mutation without complication and with a positive therapeutic response.
Serotonin syndrome (SS) is a potentially life-threatening condition increasingly driven by complex drug-drug interactions (DDIs) as serotonergic agents expand beyond psychiatry into pain management and infectious disease treatment. Current clinical decision support tools often exhibit inconsistencies in detecting these risks, leading to potential under-recognition of severe interactions. This study aimed to detect and validate clinically significant DDIs associated with SS by integrating multisource real-world data. We sought to identify high-priority drug combinations, evaluate the concordance of major DDI checking tools, and highlight critical information gaps to improve patient safety strategies. A multisource, retrospective study combining a systematic literature review, a disproportionality analysis of spontaneous adverse event reports, and a comparative cross-sectional evaluation of online DDI databases. This study employed a multisource approach to detect and evaluate SS-related DDIs. We integrated findings from a systematic literature review (up to June 2025), a disproportionality analysis using the FDA Adverse Event Reporting System (FAERS) with four frequency statistical models, and a comparative assessment of five major DDI checkers (Micromedex, Lexi-Interact, Epocrates, Medscape, and Drugs.com). The systematic review identified high-risk interactions involving not only antidepressants but also non-psychotropic drugs such as linezolid, fentanyl, and methylene blue. FAERS data revealed strong signals for combinations such as linezolid-sertraline and fentanyl-venlafaxine, indicating a rising trend in SS reporting over the past two decades. Evaluation of DDI checkers demonstrated significant discrepancies in sensitivity and severity grading. Notably, 10.16% were not indexed in any of the five databases, including several clinically documented DDIs (e.g., aripiprazole-paracetamol and trazodone-pantoprazole), highlighting critical information gaps. SS remains a significant clinical risk driven by increasingly complex polypharmacy. Relying on a single DDI checker may lead to an underestimation of risk due to inconsistent indexing and severity ratings. Hospital pharmacists should integrate multisource data and maintain high clinical vigilance, particularly for "hidden" serotonergic agents such as certain opioids and antibiotics, to ensure medication safety. Understanding the risks of serotonin syndrome: why checking drug interactions across multiple sources is vital for patient safety Serotonin syndrome is a rare but potentially life-threatening condition caused by an excessive buildup of serotonin—a chemical that helps transmit signals in the brain. This usually happens when a patient takes two or more medications that affect serotonin levels at the same time, leading to a dangerous drug-drug interaction. While these risks are well-known in psychiatry, many other common medications, such as certain painkillers and antibiotics, can also trigger this condition. This study was conducted to identify which drug combinations pose the highest risk and to see how well current digital tools (DDI checkers) warn doctors about them. We combined three types of evidence: a review of all existing medical research, an analysis of over 20 years of global safety reports from the FDA, and a comparison of five major drug-interaction databases used by healthcare professionals. Our findings show that reports of serotonin syndrome have been increasing. We identified several high-risk combinations, including interactions between antidepressants and “hidden” sources like the antibiotic linezolid or the painkiller fentanyl. Crucially, we discovered that no single digital tool is perfect; about 10% of the dangerous interactions we found in real-world reports were not listed in any of the five major databases. Furthermore, the databases often disagreed on how severe an interaction was. For patients and families, this research highlights that medication safety is complex. For healthcare providers, the results suggest that relying on just one computer system to check for drug risks may not be enough. We recommend that hospital pharmacists use multiple information sources and stay extra alert when patients are prescribed new types of antibiotics or painkillers alongside their regular medications. This proactive approach is essential to catching “hidden” risks and keeping patients safe.
Objective: To summarize current evidence on the use of buprenorphine for chronic pain management in individuals with sickle cell disease (SCD) and identify gaps for future research. Data Sources: PubMed, Embase, and Cochrane CENTRAL were systematically searched from database inception through August 2025 using keywords related to buprenorphine, SCD, chronic pain, and analgesia. Searches were limited to human studies published in English. Study Selection: Seven studies were included involving pediatric or adult patients with SCD treated with buprenorphine for chronic pain. Eligible studies reported at least 1 patient-centered outcome, including pain severity, opioid utilization, health care use, or quality of life. Included study designs were case reports, case series, observational studies, and qualitative studies. Abstract-only publications and studies not specific to SCD were excluded. Data Extraction: Two reviewers independently extracted data using the Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews guidelines, with discrepancies resolved by consensus. Data Synthesis: A descriptive synthesis was performed. Most studies evaluated buprenorphine initiation using microinduction strategies. Buprenorphine was generally well tolerated and associated with reduced full opioid agonist use, fewer emergency department visits and hospitalizations, and improvements in functional outcomes and patient-reported autonomy. Study heterogeneity and small sample sizes limited comparative analysis. Conclusions: Available evidence suggests that buprenorphine may be a safe and effective option for chronic pain management in SCD. Larger prospective studies with standardized induction protocols and validated outcome measures are needed to guide clinical practice. Prim Care Companion CNS Disord 2026;28(3):25r04126. Author affiliations are listed at the end of this article.
Background: Congenital heart defects (CHD) are prevalent, affecting 1% of live births globally. Despite improved survival rates, adults with CHD face increased risks of psychological distress and neurocognitive deficits. The P-BAHn study (P-BAHn = "Psyche Bei Angeborenen Herzfehlern", Psyche for congenital heart defects) evaluates the mental health status and psychosocial challenges of German children and adolescents with CHD, focusing on retrospectively assessed COVID-19-related burden and patient-/parent-rated experiences with psychological, psychotherapeutic, or psychiatric treatment (PST). Methods: A cross-sectional, online-based survey was conducted using the National Register for Congenital Heart Defects (NRCHD). The final dataset comprised 1567 respondent-level records from 1310 families, including 992 parent reports and 575 self-reports from children/adolescents aged 6 to <18 years. The survey assessed mental health, emotional well-being, psychosocial status, demographics, medical history, and psychological treatment. Data were analyzed descriptively using chi-square tests and t-tests for exploratory unadjusted group comparisons. In addition, exploratory multivariable logistic regression analyses were performed for selected key outcomes. Results: School-related stress was common in young CHD patients (45.3%) and was associated with older age and female sex (51.5% female vs. 35.6% male) in adjusted analyses. Overall, 17.0% of patients reported having a mental illness, most commonly anxiety (6.8%), eating disorders (5.6%), and depression (4.7%); neither sex nor CHD severity was significantly associated with self-reported mental illness in adjusted analyses. Less good/poor self-rated health was associated with older age and complex CHD in both patient and parent reports. Retrospectively assessed pandemic-related changes were perceived as quite or extremely stressful by 23.9% of patients. High COVID-19-related burden was associated with female sex, whereas CHD severity was not significant after adjustment. Among patients with previous or current PST, patient- and parent-rated treatment benefit varied by patient sex and CHD complexity. Previous/current PST was reported by 25.9% of patients and 23.8% of parents and was associated with older age in both respondent groups and with complex CHD in parent reports. Among patients with previous/current PST, 56.4% reported high perceived support. Conclusions: The P-BAHn study highlights the need for targeted psychosocial support for children and adolescents with CHD, including female patients, those with complex conditions, and patients reporting school- or crisis-related burden. Retrospectively reported pandemic-related burden underscores the importance of integrating crisis-sensitive strategies into psychosocial care frameworks. Longitudinal studies are essential to understand mental health trajectories and to evaluate the sustained patient- and parent-perceived benefit as well as clinical effectiveness of PST use. Enhancing support services and refining intervention models will improve the well-being and quality of life for young CHD patients.
Depression and insomnia are both prevalent in older adults and exhibit a bidirectional relationship. Difficulty initiating sleep (DIS) and difficulty maintaining sleep (DMS) are major symptoms of insomnia. However, whether and how these two insomnia symptoms differ in their associations with depression among older adults is unknown. We aimed to investigate the association between insomnia symptoms (DIS and DMS) and depressive symptoms among older adults. We used data of the 3,377 community-dwelling older adults from five waves (2011-2015) of the National Health and Aging Trends Study, a nationally representative survey of Medicare Beneficiaries in the United States. Depressive symptoms were assessed by the Patient Health Questionnaire-2. Insomnia symptoms included self-reports of DIS and DMS. Generalized estimating equation models were used to examine the concurrent and lagged associations between insomnia symptoms and depressive symptoms. Participants were on average 76.0 ± 7.1 years old, predominantly female (59.2%), and non-Hispanic white (72.1%). Both DIS and DMS were concurrently associated with depressive symptoms. Longitudinally, DIS predicted subsequent depressive symptoms even after full adjustment, whereas DMS did not. Conversely, depressive symptoms were concurrently associated with both DIS and DMS, but only predicted subsequent DIS, not DMS. These findings underscore the bidirectional yet distinct relationships between specific insomnia symptoms and depression in older adults. DIS shows consistent bidirectional associations with depressive symptoms, while DMS is only concurrently associated. Understanding the specific interplay between these conditions may enable the development of more targeted and effective prevention and treatment strategies. Not applicable.
Ibogaine has garnered interest for its potential therapeutic properties in substance use and psychiatric disorders. Unlike classic psychedelics such as psilocybin or LSD, ibogaine remains underexplored in clinical research. This review aimed to synthesize the clinical literature on ibogaine use in humans over the past 3 decades, focusing on outcomes and safety. We conducted a narrative review of studies on ibogaine's clinical use published from 1990 to February 2025, including randomized controlled trials (RCTs), open-label, retrospective, and observational studies. Databases were searched for reports on efficacy and safety across various indications. Twenty-four studies and 38 case reports/series were included. Most of the positive efficacy data come from uncontrolled, open-label, or retrospective studies, many conducted in nonclinical settings, with a high risk of bias. No double-blind RCT to date has demonstrated that ibogaine or noribogaine can effectively treat opioid use disorder (OUD). Only 1 small RCT reported significant effects for cocaine use disorder. Although observational data suggest that ibogaine may alleviate symptoms of OUD, PTSD, or polysubstance dependence, these findings remain exploratory. Moreover, serious ibogaine-related adverse events have been reported, especially cardiotoxicity due to QT prolongation, which represents a considerable risk given the currently unproven efficacy. While ibogaine remains a compound of interest for neuropsychiatric research, current evidence is insufficient to support its clinical use. Further studies are needed to better demonstrate ibogaine's efficacy, optimize its safety profile, and determine how it could be integrated into psychiatric care, especially in relation to the emerging therapeutic use of classic psychedelics.
Severe atherosclerotic internal carotid artery stenosis may progress to complete internal carotid artery occlusion (ICAO). Therefore, ICAO represents an advanced form of carotid artery disease. We sought to investigate the association between ICAO with atherosclerotic disease in other arterial beds and vascular risk factors and to identify the patient implications of the diagnosis of ICAO. Using the term "Internal carotid artery occlusion", a search of PubMed/MEDLINE, Scopus and Embase between 1980 and 2025 revealed 10,588 results. After exclusion of case reports, letters to the Editor and Editorials, 5,771 reports were identified. Following meticulous screening of the identified reports, 28 studies specifically addressing ICAO patient cohorts were included in the final analysis. A quantitative and qualitative synthesis analysis was performed. A questionnaire was subsequently developed and sent out to 63 participants from the United States (n=21) and several European countries (n=42), aiming to achieve consensus regarding the optimal management of patients with ICAO. Three participants did not respond. The Consensus Coordinator abstained from voting to avoid introducing bias, resulting in a final voting panel of 60 participants. Across included studies, the proportion of patients with ICAO presenting with neurologic symptoms varied widely, ranging from 38-100%, while approximately 24-27% of patients were asymptomatic at the time of diagnosis. Consensus (≥75%) was achieved in 11 of the 17 (64.7%) pre-specified statements. Most participants agreed that atherosclerotic ICAO represents a systemic manifestation of advanced atherosclerosis rather than isolated cerebrovascular pathology (56/60; 93.3%). Duplex ultrasound should be used as the first-line diagnostic tool for suspected ICAO, with CTA or MRA confirmation if necessary (59/60; 98.3%). Optimal medical therapy (including antiplatelet, antihypertensives, statins, and glycemic control) remains the cornerstone of ICAO management (59/60; 98.3%). Lifestyle and metabolic risk factor optimization, smoking cessation, optimizing body weight, a healthy diet and exercise, should be strongly advised in all ICAO patients (60/60; 100%). Most participants concurred that ICAO revascularization should be centralized in specialized vascular-neuro centers equipped for intra-operative neuromonitoring and advanced hemodynamic control (57/60; 95.0%). Finally, most participants agreed that current evidence for ICAO intervention is insufficient and that a global registry should be created to record outcomes and guide future trials (56/60; 93.3%). This international, multi-specialty consensus highlights ICAO as a marker of advanced, systemic atherosclerosis. Management should emphasize comprehensive evaluation for multisystem vascular disease and aggressive modification of cardiovascular risk factors. Best medical therapy remains the cornerstone of the management of patients with ICAO, with conservative or invasive interventions considered selectively based on symptom status, anatomic considerations, procedural risk, and institutional expertise, to reduce the overall cardiovascular disease burden.
Although most forcibly displaced individuals remain within their country of origin, internally displaced persons (IDPs) remain under-represented in mental health research. We estimated the prevalence of mental disorders among IDPs and compared prevalence and psychosocial functioning with non-displaced controls. We searched MEDLINE, PsycINFO and Web of Science for peer-reviewed reports published until 20 June 2025 in any language. We included studies on point prevalence of mental disorders in adult IDPs as assessed with validated measurements based on the International Classification of Diseases or Diagnostic and Statistical Manual of Mental Disorders. Studies had to assess mental disorders in at least 100 participants at least 1 month postdisplacement. For studies that included non-displaced control groups, we also assessed other mental-health-related outcomes. All analyses used a random effects model. The protocol was registered with PROSPERO, CRD42024596202. We identified 20774 unique study reports, of which 132 (124 independent datasets and 195 741 participants, with 61.3% female IDPs) met our inclusion criteria. The estimated pooled prevalence of current post-traumatic stress disorder (PTSD) was 39.8% (95% CI 34.9% to 44.8%; I²=98.9%), depression 35.8% (95% CI 27.0% to 45.8%; I²=99.3%), generalised anxiety disorder 29.4% (95% CI 20.3% to 40.5%; I²=99.4%), insomnia 38.6% (95% CI 33.2% to 44.2%; I²=95.5%), panic disorder 6.0% (95% CI 2.7% to 12.9%; I²=95.9%), alcohol use disorder 2.2% (95% CI 0.1% to 6.2%; I²=97.3%) and suicidality 9.2% (95% CI 1.3% to 44.1%; I²=99.2%). The odds of PTSD and depression compared with non-displaced controls were increased by 70%-117% and IDPs reported significantly higher somatic complaints and general distress and lower psychosocial well-being. Displacement cause and socioeconomic conditions in the affected countries insufficiently explained the large heterogeneity in findings. High risk of selection and outcome measurement bias was observed. The results highlight the mental health burden in IDPs, which calls for scalable and sustainable interventions. The findings further indicate that estimates vary substantially across contexts.
Irritability is a prevalent and impairing feature associated with autism, yet remains poorly understood, particularly in adults. Drawing heavily on insights translated from pediatric and transdiagnostic literatures, we propose that irritability in autistic individuals often reflects a psychophysiological stress or threat response, rooted in a vulnerable neurobiology (e.g., sensory sensitivities, intolerance of uncertainty), but may also stem from intrinsic neurobiological dysregulation independent of environmental triggers. The current treatment paradigm for autistic adults, largely extrapolated from pediatric antipsychotic trials, leaves these adults critically underserved due to a lack of evidence-based treatments, clinical trials, or validated tools to measure their internal experience. This viewpoint deconstructs irritability, differentiating its affective nature from aggression, and highlights heterogeneity across the lifespan and support needs. We critique the limitations of current assessment methods and recommend a shift toward a multi-modal strategy integrating self-report (when feasible) with objective, physiologically-informed tools (e.g., wearable biosensors) and nuanced observer reports. We argue that the field is poised for neuroscience-informed treatment innovation-including novel pharmacological agents and adapted psychosocial interventions-but is hampered by a lack of rigorous clinical trials in adults. Finally, we call for mechanistically driven trials to address the large unmet burden of inadequately treated irritability, ultimately improving the quality of life for autistic adults and their families/caregivers. Irritability in autistic adults is a major crisis, but most treatments are decades old and were only tested on children. Drawing on evidence primarily from youth and related conditions, our review explains that irritability is often a physical and emotional stress response to things like sensory overload or trauma, not just a “behavior problem.” We call for urgent research into new, adult‐focused treatments and tools, like wearable sensors, to directly address the root causes of this distress.
While subconjunctival hemorrhages (SCHs) have been suggested by some to be sentinel injuries which should prompt further evaluation for abuse, the risk of abuse in children with isolated SCHs is not currently known. To determine if infants and young children with isolated SCHs have current or subsequent concerns for physical abuse. Children 1 to <48 months old with SCHs diagnosed between 2011 and 2015 within a large, integrated healthcare system were included and followed until their fifth birthdays. Retrospective cohort study. Children with isolated SCHs had no other injuries identified within 7 days before or after the SCHs. Child physical abuse before the child's fifth birthday was identified by diagnosis codes and free-text review of medical notes and radiology reports. We identified 1281 patients with SCHs (mean [SD] age 22.5 [14] months), 603 (47.1%) were female. Only 12 children (0.9%) had physical abuse. Among children with isolated SCHs, 0.4% had physical abuse, compared to 3.0% of those with non-isolated SCHs (p < 0.001). For infants <12 months old, 0.6% with isolated SCHs had physical abuse, compared to 10.0% of those with non-isolated SCHs. Most children with SCHs in our study did not have child physical abuse before their fifth birthday. Children with isolated SCHs had a lower risk of future abuse compared to children with non-isolated SCHs.
Motivational deficits are a core clinical feature across mood and psychotic disorders, although distinct mechanisms may contribute to similar symptom presentations. We aimed to understand diagnostic groups differences in daily reports of consummatory and anticipatory pleasure, physical and mental effort exertion, and goal-directed behaviors. Additionally, we explored how subjective value computation during decision-making in lab settings mapped onto real-world motivated behaviors. Participants from five diagnostic groups-healthy control (n = 81), schizophrenia-spectrum disorder (n = 56), current major depression (n = 58), remitted major depression (n = 48), and bipolar I disorder (n = 53)-completed ecological momentary assessment measures for two weeks. Additionally, we used a person-centered modeling approach to examine subjective value representation during two laboratory-based effort-cost decision-making paradigms. We examined the association between decision-making, subjective pleasure and effort ratings, and motivated behaviors. We observed lower consummatory and anticipatory pleasure ratings in current major depression, which was mediated by self-reported motivational impairments. Individuals with psychosis or bipolar disorder were less likely to engage in goal-directed behaviors, and all patient groups reported increased subjective effort sensitivity in daily living. Moreover, systematic subjective value representation during effort-cost decision-making was associated with, yet did not fully account for, differences in goal-directed behaviors across disorders. These findings point toward both common features and heterogeneities in motivated behaviors, hedonic experiences, and effort sensitivity across diagnostic boundaries. Meanwhile, individual differences in effort-cost decision-making only partially contributed to real-world motivational deficits, suggesting a need for future research to parse out transdiagnostic affective and cognitive mechanisms underlying motivational deficits.
A lack of positive and the presence of negative parenting are frequently mentioned as risk factors for the development and maintenance of childhood and adolescent depression. However, meta-analytic research is mostly based on parenting as perceived by the child or parent, with the potential risk of a reporter bias. Also, specific patterns of observed child behavior among children with childhood depression are often overlooked and there currently is no meta-analysis on this topic. The current meta-analyses integrate the cross-sectional and longitudinal relation between observed parenting and childhood depression, and the cross-sectional relation between observed child behavior and childhood depression. This preregistered study (k = 90) includes 350 effect sizes on five observed parenting behaviors and 131 effect sizes on six observed child behaviors in parent-child interactions that were found via PsychINFO, Web of Science, and Proquest Dissertations and Theses (until the end of September 2024). Multilevel meta-analyses show that parental warmth/support and harsh control/criticism co-occur with and precede childhood depression, with small effect sizes, while childhood depression generally did not precede negative parenting. This aligns with previous research based on subjective reports, indicating that low parental warmth and higher criticism may form risk factors for childhood depression. Observed parental autonomy granting, guidance/structure, and parental depressed affect did not relate to childhood depression. Further, children with depression showed more negative affect, reduced autonomy and engagement, illustrating the interactional challenges these families face. Family interventions could validate and address the challenges posed to children as well as parents in families with a child with depression.
Depression is one of the most prevalent mental health problems in adolescence. Due to the covert nature of depressive symptoms, parents play an important role in recognizing distress and seeking intervention for their child. However, research often reports discrepancies between parent and adolescent reports of depressive symptoms, and integrating and interpreting these discrepancies remains a challenge. The present study used a trifactor model to isolate sources of variance stemming from shared and unique perspectives in a sample of 583 parent-adolescent dyads (59% male; Mage= 14.22, SD = 1.81). Consensus between parents and adolescents was characterized by feelings of sadness, whereas unique views of adolescent depressive symptoms highlighted somatic symptoms (e.g., overtiredness), with adolescents generally reporting more symptoms. Adolescents' attachment security and family affective responsiveness were associated with lower depressive symptoms reported by adolescents, whereas parents' reports of problem-solving skills were associated with lower depressive symptoms reported by parents. These findings emphasize the importance of considering the degree of parent-adolescent agreement regarding adolescent mental health and educating parents to raise awareness of their adolescents' mental health, which could facilitate early detection and intervention. Furthermore, prevention and intervention efforts should target promoting family functioning through open and affective communication.
Repeated admissions of children and adolescents after inpatient psychiatric treatment point to underrecognized issues in the post-discharge period. The family environment is a promising target for sustained recovery. However, recent systematic reviews on predictors of psychiatric readmission in children and adolescents were unable to synthesize most family-level factors due to conceptual and methodological differences. To address this, we conducted a scoping review following PRISMA-ScR guidelines to (a) synthesize literature on family-related structural and process variables associated with youth psychiatric readmission and (b) identify conceptual and methodological gaps. We included primary and secondary studies in English or German language examining family-related constructs in relation to inpatient readmission. Eighty-three reports retrieved via a multi-tiered search strategy (including PubMed, PsycInfo, Scopus, Web of Science, ProQuest Dissertations & Theses Global, and Google Scholar) were included (79 empirical studies, three study protocols, and one meta-analytic review). Empirical studies have increased in recent years, were primarily conducted in the United States, and largely relied on retrospective or record-based data. Evidence was concentrated on structural characteristics. Among the examined constructs, results linked readmission to indicators of structurally burdened or disrupted caregiving environments (e.g., institutional or foster care), family psychiatric problems (e.g., history of or current psychopathology), and treatment involvement. In contrast, research on specific family processes remains sparse despite their established significance in adult populations. Findings support the relevance of various family factors for youth psychiatric readmission but highlight gaps regarding complex associations, short-term risks, and prospective studies of family processes.
This study compared psychiatrist and primary care practitioner (PCP) perspectives on pharmacogenomics and barriers to its use in guiding antidepressant prescribing. Psychiatrists and PCPs across the USA were invited to complete an anonymous 31-item online survey that collected demographic information, knowledge and experience with pharmacogenomics, and attitudes and perspectives on the clinical use of pharmacogenomics. Psychiatrists (n = 36) reported greater familiarity and experience with antidepressant pharmacogenomics than PCPs (n = 11); however, both lacked familiarity with implementing pharmacogenomic testing and related clinical resources. Identified barriers to testing among psychiatrists focused predominantly on concerns over clinical utility and applicability to patients. The reported barriers among PCPs were lack of test information and lack of knowledge on how to order and how to utilize pharmacogenomic results. However, all respondents supported multigene panel-based pharmacogenomic testing and including all potentially impacted medications in test reports. Despite a low overall response rate and disproportionate survey participation between provider types, this study identified knowledge and experience as current barriers for psychiatrists and PCPs to implement pharmacogenomic-guided antidepressant prescribing. Importantly, both clinician groups indicated interest in pharmacogenomics education, professional support for implementation, and panel-based pharmacogenomic testing with comprehensive medication management reporting.
Chemotherapy-related cognitive impairment (CRCI) represents an increasingly recognized problem in the growing cancer survivor population within the US and worldwide. CRCI is characterized by deficits in memory, sustained attention, and executive function, which significantly worsens the cancer survivors' quality of life. An increasing number of studies have been conducted using novel intervention approaches aimed at mitigating CRCI. In this systematic review, we sought to summarize the current evidence of cognitive improvement in cancer survivors receiving non-pharmacological interventions with neurostimulatory effects following chemotherapy. We screened five databases (Embase, MEDLINE, PubMED, Scopus, and PsycINFO) for original articles reporting the administration of any type of brain stimulation or complementary/alternative therapies targeting the central and/or peripheral nervous system to improve cognitive outcomes in cancer survivors reporting CRCI. We systematically extracted information from each eligible study using participant, intervention, comparison, outcome(s), and study design (PICOS) framework according to Cochrane recommendations. We used the critical appraisal tool by Joanna Briggs Institute to assess the risk of bias. After screening 2,708 manuscripts, we performed a full-text review of 77 papers and identified 17 studies that met our inclusion criteria: nine randomized controlled trials, four case reports, one case series, two quasi-experimental study, and one cohort study. We identified seven studies which focused on CRCI and 10 others where cognitive function was properly reported for inclusion. Subjective and objective cognitive outcome measures reflecting overall performance, attention, working memory, processing speed, and quality of life with separate cognitive function reporting were assessed in patient(s) treated with transcranial direct current stimulation, transcranial magnetic stimulation, multisensory stimulation, Flexyx neurotherapy system, acupuncture, and electroacupuncture. Mild improvements in some of the cognitive outcome measures were observed in all studies. The weaknesses of these studies can be attributed to insufficient statistical power and testing, lack of a control group, randomization, blinding, and incorrect statistical methods. We found only a handful of trials reporting cognitive outcomes in CRCI interventions, with small sample sizes and biased study designs limiting the validity of the statistically significant findings. Our systematic review provides rationale for assessing the impact of non-pharmacological neurostimulatory techniques on CRCI in large-scale randomized controlled trials.
Purpose: Children gain increased health and well-being by participating in physical activity (PA) and exercise. Globally, only 19% of children meet the World Health Organisation recommendations on PA and the rates are even lower among children with disabilities. Children with disabilities are often dependent on assistive exercise products (AEP) to be able to perform PA and exercise. The aim was to identify facilitating and hindering factors for PA of children with cerebral palsy, and additionally to identify conditions for implementation of an AEP for PA in this group. Materials and methods: Interviews were conducted with healthcare professionals, decision-makers and researchers (N = 11 about experiences of implementing an AEP to support PA for children with cerebral palsy who are non-ambulant), until saturation was sustained. Interviews were transcribed verbatim and analysed through directed content analysis. Results: Factors that influenced PA in this population were related to the child and the child's immediate environment, characteristics of the AEP itself and the assistive technology system. Findings indicate that severe disabilities contribute to increased complexity affecting implementation. Implementation in this assistive technology system was made more difficult due to boundaries between a development coalition focusing on hope and innovation and a professional bureaucracy coalition, focusing on professional accountability. Conclusion: Communication across boundaries between stakeholders cannot rely only on transfer of information (dissemination) but depend on skilful management and transformation of boundaries concerning more fundamental differences involving interests. This study adds to the current state of knowledge where we have shown that the children’s dependency on their social and physical environment not only affects the child and their caregivers but has profound implications for the development and implementation of assistive technology systems and assistive exercise products. In this paper, we have shown that a focus on boundaries and the role of the implementation object and related resources that act as facilitators or inhibitors for boundary work can allow for a more dynamic and action-oriented understanding of implementation processes in complex healthcare organisations. Within the research setting, the assistive exercise product was part of a scientific community and regulated and used according to a study protocol. Implementation would mean that it transforms into an assistive exercise product that is regulated in ways that conform to laws, policies, guidelines and professional standards relevant to the service. This transformation involves boundary work between different communities of stakeholders that relate to the same physical object: the assistive exercise product. It follows from this that there is no “Archimedean point” in intervention research or implementation studies. Researchers and change agents do not have a privileged, neutral perspective. They also make up a community with its own epistemic culture, and this has to be dealt with, made explicit and taken into account in order to navigate boundaries. In this study, it was possible to identify the contours of two coalitions. We suggest that different coalitions with different orientations dynamically interact to decide the trajectory from idea/research object to a functioning assistive exercise product. Consequently, successful implementation relies on setting up structures and processes that address the interests and assumptions that inform different coalitions. This is a way to understand why early involvement of stakeholders, participatory approaches and participatory design have been shown to be successful. We therefore suggest that not only objects or innovations in themselves, but also research products like reports, presentations and participatory research that structures boundary work can be explored as boundary objects.
Expectancies for alcohol analgesia (EAA; beliefs that alcohol use can reduce pain) are linked to heavier drinking in chronic non-cancer pain; however, no studies have examined EAA in those with cancer-related pain. These secondary analyses examined cross-sectional associations among EAA, alcohol use, and pain among breast cancer survivors with persistent pain due to aromatase inhibitors (AIs; arthralgia). Data were from 213 female breast cancer survivors with AI-associated arthralgia (M age = 58.9, 77.5% White) who completed baseline assessment in a behavioral pain intervention trial. Alcohol consumption and alcohol use severity were assessed via the Alcohol Use Disorders Identification Test (AUDIT). Linear/logistic regressions were conducted covarying for depression, anxiety, age, race, and pain severity. EAA scores were related to greater likelihood of current drinking (AOR = 6.02, p = 0.003). Among participants who reported current alcohol use (n = 153), EAA scores were associated with greater alcohol consumption and alcohol use severity (ps < 0.001). Probing of a significant pain severity x EAA interaction (p = 0.015) indicated that EAA scores were more strongly associated with alcohol use severity among participants with less (vs. more) severe pain. In breast cancer survivors with AI-associated arthralgia, EAA are related to greater likelihood of drinking and heavier/more problematic alcohol use, which may reduce efficacy of AIs while increasing risk for side effects. EAA scores were more strongly associated with drinking in women with less severe pain.