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- Volume 14, Issue 2, 2024
Adolescent Psychiatry - Volume 14, Issue 2, 2024
Volume 14, Issue 2, 2024
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PANDAS: Twenty-Five Years Later
More LessBackground: It has been 25 years since the definition of the concept of Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS). The abrupt onset of neuropsychiatric symptoms requires a comprehensive differential diagnosis involving complementary tests and optimal treatment selection. Methods: This paper describes aspects related to the diagnosis and clinical management of PANDAS. A clinical perspective is developed starting from an example that meets the Swedo's criteria. Discussion: A comprehensive approach, including interdisciplinary management and urgent evaluation of potential organic causes, is crucial for effective treatment. Treatment decisions should consider severity, symptoms, and available evidence. Collaboration with neuropediatric or neurological services is needed. ASLO/anti-DNase B and 25-OH-Vitamin D tests are valuable for atypical OCD/Tic presentations, always maintaining a broader organic screening.
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Comparative Associations between Substances Used with Depression and Anxiety in a Sample of High School Students in Turkey
Authors: Ali Unlu, Parna Prajapati, Mariam Rahmani and Andres PumariegaObjective: To explore the associations between the type and the amount of substances used with depression and anxiety symptoms by high school students. Methods: The study data was collected by the Istanbul Department of Education on 31,604 high school students which was a survey of 66 questions administered in the school setting. The primary questions and sub-questions on anxiety and depression scores were added to generate a scaled score. Specific substances used by the participants were used to explore the relationship between substance use and depression and anxiety scores by using multinomial logistic regression models. Two regression models were analyzed, one for each dependent variable, keeping the significance level at 0.05. Odds ratios were calculated to explore the association between depression and anxiety scores and specific substance use among the youth. Results: The participants with low levels of anxiety were at an increased odds of using heavy amounts of sleep pills (OR=1.6) and alcohol (OR=1.3) as compared to those without anxiety. In addition to sleep pills and alcohol, illicit substances such as LSD and inhalant use were also seen in the participants with higher levels of anxiety. The participants with low levels of depression were found to be at an increased odds of using sleep pills (OR=1.8) and alcohol (OR=1.3). In addition to this pattern of substance use, participants with higher levels of depression were also found to be heavy cocaine users, low inhalant users, heavy steroid users, and low alcohol users. A decrease in the use of homemade brews was seen in the participants with low and high levels of depression as compared to those who didn't have any depressive symptoms. Conclusion: A unique pattern of drug and alcohol use was found in the participants experiencing varying levels of anxiety and depression.
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Reduced Stress among COVID-Symptomatic Undergraduates: Act With Awareness, Nonjudgment, and Nonreactivity as Key Facets of Mindfulness
Authors: Zoe Sirotiak, Jenna L. Adamowicz and Emily B.K. ThomasObjective: Associations between mindfulness and improved physical and psychological health have been established, but COVID-19 presents a novel context. This study examined the relationship between individual mindfulness facets and general stress among college students experiencing at least one symptom of acute COVID-19 infection in the context of the pandemic. Methods: Five hundred sixteen university students experiencing at least one CDC-identified COVID-19 symptom completed measures of general stress, mindfulness, and somatic symptoms in 2020-2021 during the COVID-19 pandemic following IRB approval and informed consent. Results: The act with awareness, nonjudgment, and nonreactivity facets of mindfulness were associated with general stress. In total, the model accounted for over half of the variance in general stress (R2 = 0.51, p < 0.001). Conclusion: Mindfulness may be particularly important in explaining general stress among college students reporting a symptom of COVID-19. Mindfulness may benefit college students as the pandemic continues to unfold, and monitoring one's physical health remains a primary mitigation strategy. These results may also inform understanding and responses to future public health emergencies in which monitoring somatic symptoms is encouraged by public health officials to contain the spread.
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Family Functioning and Unmet Mental Health Needs among School-Aged Youth
Background: Unmet mental health needs can lead to worsening outcomes in youth. Given that youth depend on family for access to mental health services, and positive family functioning is associated with improved health outcomes, understanding the association between family-level factors and youth's unmet mental health needs is essential to inform appropriate solutions. Objective: This study aimed to examine the association between family functioning (parental aggravation, parent-child communication, family resilience) and unmet mental health needs among school-aged youth. Methods: A cross-sectional analysis of the combined 2019-2020 National Survey on Children's Health (NSDH) dataset was performed (n=9,204). Bivariate and multivariate logistic regression models were used to examine the association between unmet mental health needs (primary outcome) and family functioning using three explanatory variables, parental aggravation, parent-child communication, and family resilience. We also examined age-related differences in these associations between children aged 6-11 and adolescents aged 12-17. Results: The weighted proportion of youth with reported unmet mental health needs was 18%. Weighted unadjusted analyses showed that low family resilience was associated with 60% higher odds of unmet mental health needs, while parental aggravation and poor parentchild communication were not associated with unmet mental health needs. After adjusting for potential confounders, low family resilience was associated with 50% higher odds of unmet mental health needs among school-aged youth (AOR=1.53, 95% CI: 1.15-2.05). Being Black (AOR=2.29, 95% CI: 1.42-3.70), younger (AOR=0.95, 95% CI: 0.91-0.99), lacking consistent health insurance (AOR=2.68, 95% CI: 1.62-4.44), and having a mother with poor maternal health (AOR=1.84, 95% CI: 1.36-2.47), were also associated with unmet mental health needs. Among children aged 6-11 years, low family resilience, being Black, lacking consistent insurance, and having a mother with poor maternal health were associated with unmet mental health needs (all p's <0.05). Similarly, among adolescents aged 12-17 years, low family resilience, being Black, lacking consistent insurance, and having a mother with poor maternal health were associated with unmet mental health needs (all p<0.05). Having a parent with a college education was associated with lower odds of unmet mental health needs among children (6-11 years), but not adolescents (12-17 years). Conclusion: Our findings have suggested an association between low family resilience and unmet mental health needs among school-aged youth. Since families are an integral part of meeting youth's needs, applying approaches to addressing unmet mental health needs that consider family resilience and parental well-being is imperative. Identifying and addressing factors contributing to unmet health needs barriers may help address existing racial disparities.
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