Changing Trends of Diagnoses in a Child and Adolescent Psychiatry Outpatient Clinic Before and During COVID-19: An Analysis of Registered Data.

BACKGROUND: Investigating the outpatient clinic admissions of children and adolescents significantly affected by the pandemic is crucial in developing policy and intervention methods in the future. The aim of this study is to analyze the admissions of child and adolescent psychiatry outpatient clinics, during the first year since the imposed rearrangements of the COVID-19 pandemic, compared to the one year before. SUBJECTS AND METHODS: This study was conducted between March 2019 and March 2021 and the total number of 5833 patients referred to the hospital was 3168 in the pre-pandemic period (Pre-P) and 2665 in the pandemic (In-P) period. After excluding 78 not fulfilling inclusion criteria, these screened cases were randomized for 700 patients for Pre-P and 700 for In-P within each group. RESULTS: Externalization Disorders and Neurodevelopmental Disorders were the most represented diagnoses categories between the two time periods and showed a statistically significant decrease in admission during the pandemic (p=0.002, p=0.024, respectively). Internalization disorders and the undiagnosed group showed a statistically significant increase during the pandemic (p=0.024, p<0.001, respectively). Significant differences were also shown in the treatment plan (need for pharmacological and psychotherapy) has increased. CONCLUSIONS: This study stands out by providing data on the trend of diagnosis in a child and adolescent psychiatry outpatient clinic before and during the pandemic period. To dominate these trends would be important to provide a basis for policymakers to plan appropriate management methods and levels of support for children and adolescents with different mental disorders.

COVID-19 and Immunization: Reflections and Rationale on Why Child and Adolescent Psychiatry Should Help.

The COVID-19 pandemic has resulted in widespread reflection in medical communities about the role of professional stakeholders in public health interventions. Health professionals, including mental health clinicians, should question how, when, and why they should intervene to address the obstacles and objections to these interventions.

Pilot Study of the MAP Curriculum for Psychotherapy Competencies in Child and Adolescent Psychiatry.

OBJECTIVE: This pilot study aimed to evaluate the relevance, feasibility, acceptability, and instructional efficacy of the Managing and Adapting Practice (MAP) curriculum for enhancing the teaching of psychotherapy to child and adolescent psychiatry (CAP) fellows. MAP is a system of resources and decision models that supports practitioners in selecting and implementing psychotherapeutic interventions for children and adolescents. The MAP curriculum includes modules to guide education about psychotherapeutic procedures (e.g., behavioral activation) common in evidence-based treatments for an array of childhood problems and to support development of competencies in assessment, treatment planning, and reflective practice. METHODS: Curriculum coding was used to examine the relevance of MAP's core components to the skills articulated in the Accreditation Council for Graduate Medical Education (ACGME) CAP milestones. Feasibility, acceptability, and learning outcomes were examined after delivery of the MAP curriculum to 12 CAP fellows at two sites, with instructional features tailored according to faculty preferences and training program structure. RESULTS: Coding suggested that the MAP curriculum was relevant to 95% of the 21 ACGME CAP training subcompetencies. Feasibility was indicated by the successful delivery of 100% of the planned MAP curriculum across the two sites. Acceptability was supported by positive feedback from the CAP fellows, and psychotherapy knowledge increased significantly. Finally, case review scores (mean±SD=2.21±0.15) showed positive posttraining application of MAP to two patients and exceeded scores achieved by other samples of mental health professionals. CONCLUSIONS: This pilot study demonstrated the potential for the MAP curriculum to support CAP education. MAP's versatility as a curriculum supports broader adoption, with continuing rigorous empirical evaluation.

Appearance of extrapyramidal symptoms in adolescent psychiatry patients during COVID-19 infection.

Since the start of the pandemic, there has been an increase in the incidence of psychiatric morbidity among those infected with coronavirus disease 2019 (COVID-19) and those indirectly affected by COVID-19. There has been a considerable increase in the number of individuals with such psychiatric conditions as depression, acute stress disorders, anxiety, and posttraumatic stress disorder (PTSD). About one-third of patients with COVID-19 are reported to have developed short and long-term neuropsychiatric conditions such as delirium, agitation, altered consciousness, hypoxic encephalopathy encephalitis, dysexecutive syndrome, cerebrovascular complications (e.g., stroke), hypoxic encephalopathy, convulsions, neuromuscular dysfunction, demyelinating processes, or parkinsonism through several pathophysiological mechanisms. Nevertheless, as the pandemic progressed, data on neuropsychiatric manifestations implied that the pathologic capacity of COVID-19 and its association with the onset and/or exacerbation of psychiatric morbidity indicate that COVID-19 is potentially related to neuropsychiatric involvement. Patients with existing mental disorders under psychotropic treatment exposed to the COVID-19 infection have been represented by an increased risk of worsened psychiatric symptoms and expanded drug side effects. The present study aimed to describe five pediatric patients with various psychiatric illness that experienced COVID-19 infection and had potentially associated neuropsychiatric involvement, such as exacerbation of underlying psychiatric symptoms and extrapyramidal side effects. To the best of our knowledge, the present study is the first to describe adolescents with COVID-19 infection that presented with a series of manifestations in the form of an increase in extrapyramidal symptoms (EPS)  during exacerbation of underlying psychiatric disease.

Repenser les partenariats entre écoles primaires et secteurs de psychiatrie infanto-juvénile en temps de COVID-19.

INTRODUCTION: On a global scale, bringing together schools and public child psychiatry services is favored to promote the development of early interventions that could improve health trajectories, from prevention to treatment, for children exposed to psychological and psychiatric difficulties. In a public health perspective, contextualizing these practices is essential in order to ensure their sustainability and efficiency. This article sheds light on the stakes of these partnerships and their advantages in responding to the health, social, and economic mark that has been left behind by the crisis accompanying the brutal onset of the Covid-19 epidemic. AIMS: Improving the health care management for children with mental health problems or problems of a psychological nature implies taking into account their environment beyond the therapeutic framework. Interventional research, currently underway, is taking place in several sites in France: primary schools, Medical-psychological centers (CMP), and Local Committees on Mental Health (CLSM). The goal is to provide an inventory and an analysis of the partnership and interventional structures that are most efficient, based on the needs and available resources at each site. This research envisages a diversification and a contextualization of the offer of care, with great concern for equity and therapeutic efficacy, starting from school. RESULTS: More than simple results, our aim is to make suggestions as to how to better accompany the end of confinement and the months to come. The development of partnerships in regions that are strongly marked by social and economic inequalities is a priority in terms of public health and the direction of local policies. These partnerships would contribute to a global strategy of evaluating the needs and the personalized accompaniment of children. Formalizing the intervention with the interface being the school sector will support the school staff in overcoming the health crisis that is affecting their institution. The steady rise of CLSMs will enhance local coordination and collaboration to help the most psychologically vulnerable children and aid their parents, given their situation, to support the development of their children. CONCLUSION: Restoring human and material resources to existing structures, notably in the sector of child psychiatry so that it can accomplish its public service mission seems to be a priority today. Establishing school-CMP-CLSM partnerships can contribute to providing local policy direction in the interest of elaborating individual and collective strategies that can ensure needs-adapted care that is accessible to as many children as possible.

The Impact of COVID-19 on Pediatric Telepsychiatry Training in Child and Adolescent Psychiatry Fellowships.

OBJECTIVE: This report summarizes findings from a 2020 survey of US child and adolescent psychiatry training programs that explored the impact of the COVID-19 pandemic on pediatric telepsychiatry training. The authors hypothesized that telepsychiatry training significantly increased during the pandemic, in part due to legal and regulatory waivers during the COVID-19 public health emergency. METHODS: In August 2020, an anonymous, 28-question online survey was emailed to all (138) accredited child psychiatry fellowships on the Accreditation Council for Graduate Medical Education website. Forty-nine programs responded (36%). This analysis focuses on three of the 28 questions relevant to the hypotheses: characteristics of the program's training in telepsychiatry; perceived impediments to clinical training; and perceived impediments to didactic training pre-COVID onset vs. post-COVID onset, respectively. Total scores were created to investigate differences in training programs and impediments to including telepsychiatry pre- and post-COVID onset. Paired sample t-tests were used to compare means pre- and post-COVID onset. RESULTS: Results provided support for significant differences between training components related to telepsychiatry pre- and post-COVID onset, with participants reporting more training components post-COVID onset (M = 5.69) than pre-COVID onset (M = 1.80); t(48) = 9.33, p < .001. Participants also reported significantly fewer barriers to providing clinical experiences in pediatric telepsychiatry post-COVID onset (M = 2.65) than pre-COVID onset (M = 4.90); t(48) = - 4.20, p < .001. CONCLUSIONS: During the COVID-19 pandemic, pediatric telepsychiatry training in child psychiatry fellowships increased significantly. Perceived barriers to providing clinical, but not didactic, training decreased significantly.

Evaluation of COVID-19-related psychological distress in parents of children referring to a child and adolescent psychiatry outpatient clinic: a university hospital sample.

AIMS: We aimed to determine parents' levels of anxiety and fear and suspicion in relation to the COVID-19 period and the possible predictive factors for these variables in families admitted to a child and adolescent psychiatry outpatient clinic of a university hospital in Turkey. In this way, it is hoped to contribute to the identification of priority target groups in psychosocial support services. METHOD: The research study group consisted of 600 patients aged 0-18 years and their parents who were referred to a child and adolescent psychiatry outpatient clinic of a university hospital. Parents completed the COVID-19-related psychological distress (CORPD) scale and the data recording form developed specifically for this study. All cases included in the study were examined by a child and adolescent psychiatrist for diagnostic evaluation and their current diagnoses were recorded. RESULTS: Parents of children with any psychiatric diagnosis had higher suspicion scores on the CORPD scale and parents of children with high COVID-19-related anxiety also had higher anxiety and fear scores on the same scale. Logistic regression analysis revealed that negative changes in family relationships increased the risk of higher maternal COVID-19-related suspicion. CONCLUSIONS: The most important factors associated with parental high CORPD levels were negative changes in family relationships and children with high COVID-19-related anxiety. Children's high COVID-19-related anxiety levels were associated with living with a single parent or separation from parents, negative changes in family relationships, previous COVID-19 infection in the family, and changes in daily routines.

Using real patients in e-learning: case-based online training in child and adolescent psychiatry.

Objectives: In undergraduate medical education and in the subject of child and adolescent psychiatry, examining young patients face-to-face is a key element of teaching. With the abrupt shutdown of face-to-face teaching caused by the SARS-CoV-2 pandemic, a case-based online training program integrating audio and video of real patients was developed. Methods: The blended learning platform CaseTrain guides medical students in their final year through real child-psychiatric patient cases, such as anorexia, autism, or attention deficit disorder, through presentation of video and audio of real patients and parents. The teaching format complements lectures on child psychiatric topics, comprising asynchronous elements (self-study using the digital material) as well as synchronous elements (web-conferences with a specialist). Learning objectives for students were set to develop knowledge of the spectra of psychiatric disorders that affect children and to recognize approaches how to assess and manage common psychiatric problems of childhood and adolescence. Results: The feedback from medical students through oral and written evaluation was positive. They appreciated getting to know 'real-world patients' in times of such a pandemic, to learn explorative techniques from role models, and to be in close contact with the supervising specialist. In consequence of critical feedback on the length of some video sequences, these training units will undergo revision. Conclusions: Case-based online training may continue to be a useful option in a post-pandemic future as integral part of medical education, complementing face-to-face lectures and training in (child) psychiatry.

A National Pediatric Telepsychiatry Curriculum for Graduate Medical Education and Continuing Medical Education.

Objectives: Our goal was to develop an open access nationally disseminated online curriculum for use in graduate and continuing medical education on the topic of pediatric telepsychiatry to enhance the uptake of telepsychiatry among child psychiatry training programs and improve access to mental health care for youth and families. Methods: Following Kern's 6-stage model of curriculum development, we identified a core problem, conducted a needs assessment, developed broad goals and measurable objectives in a competency-based model, and developed educational content and methods. The curriculum was reviewed by experts and feedback incorporated. Given the urgent need for such a curriculum due to the COVID-19 pandemic, the curriculum was immediately posted on the American Academy of Child and Adolescent Psychiatry and American Association of Directors of Psychiatric Residency Training websites. Further evaluation will be conducted over the next year. Results: The curriculum covers the six areas of core competence adapted for pediatric telepsychiatry and includes teaching content and resources, evaluation tools, and information about other resources. Conclusion: This online curriculum is available online and provides an important resource and set of standards for pediatric telepsychiatry training. Its online format allows for ongoing revision as the telepsychiatry landscape changes.

Media use before, during and after COVID-19 lockdown according to parents in a clinically referred sample in child and adolescent psychiatry: Results of an online survey in Switzerland.

BACKGROUND: To investigate the consequences of COVID-19 lockdown on screen media use in children and adolescents with mental health problems, an online survey was conducted on leisure media use before, during and after the lockdown of spring 2020. METHOD: Parents of patients (10-18 yrs) referred to child and adolescent psychiatry participated in an anonymous online survey, approximately six weeks after the first easing of lockdown measures. Parents rated the amount, the content and the psychological impact of their children's media use before, during and after the lockdown. RESULTS: N = 477 parents completed the survey. Patients showed a significant increase in media time during the lockdown (including devices such as mobile, tablet/PC, video game console, TV, and activities such as gaming, social media) and a moderate increase in the negative impact of media use on everyday life. After the lockdown, total media time returned to pre-COVID-19 levels in most patients, but remained slightly higher in males. A worsening of the main psychopathological problem during lockdown was related to elevated media time in children (10-13 yrs), but not in adolescents (14-18 yrs). CONCLUSION: According to parents' retrospective ratings, the increase in screen media time was reversible, and seems to reflect an expected coping strategy during lockdown. However, male patients did not completely return to pre-COVID-19 gaming time, and a small number continued to display excessive gaming.

Addressing Well-being, Burnout, and Professional Fulfillment in Child and Adolescent Psychiatry Trainees During the COVID-19 Pandemic Through Implementation of a Virtual Balint-Like Group: a Pilot Study.

OBJECTIVE: Physicians, including psychiatrists and psychiatry trainees, are at higher risk of burnout compared to the average working population. The COVID-19 pandemic heightens this risk. This pilot aims to enhance professional fulfillment and support while decreasing risk and prevalence of burnout in Child and Adolescent Psychiatry (CAP) trainees through virtual delivery of a Balint-like group incorporating brief emotional awareness modules. METHODS: Six CAP trainees participated. Eight 60-min sessions held every 2 weeks were co-facilitated by a psychologist and psychiatrist who developed the curricular content. Five of the eight semi-structured sessions combined a brief emotional awareness enhancing module with a Balint-based approach to case review. The authors assessed trainee well-being, professional fulfillment, and sense of professional support pre- and post-intervention with the Well-being Index (WBI), Stanford Professional Fulfillment Index (PFI), and the authors' own supplemental survey. Descriptive statistics were reported. RESULTS: Trainees found the curriculum feasible and useful. Surveys showed a reduction in burnout from three to zero participants (p = 0.03) and specific improvements in enthusiasm (p = 0.013), empathy with colleagues (p = 0.093), and connectedness with colleagues (p = 0.007) and patients (p = 0.042) at work. There were also improvements in happiness (p = 0.042) and valued contributions at work (p = 0.004). CONCLUSIONS: A novel well-being curriculum focused on combining brief emotional awareness enhancing modules with a Balint-like approach enhances professional fulfillment and a sense of professional support and decreases the risk and prevalence of burnout, even when delivered virtually to a group of CAP fellows. Results support the planned expansion of this low-cost, high-value intervention for trainee well-being.