Interventions to reduce wait times for adolescents seeking mental health services: a scoping review protocol.

INTRODUCTION: The demand for adolescent mental health services has increased significantly in recent years, leading to excessive wait times for adolescents seeking mental health services and poor mental health outcomes. Timely access to mental health services is critical to reducing the risk of symptom chronicity and progression to mental disorder. A better understanding of whether and how interventions to reduce wait times impact mental health outcomes is needed to guide mental health policymakers and service planners in their approach to reducing wait times. METHODS AND ANALYSIS: The scoping review will use Arksey and O'Malley's six-stage framework for scoping reviews and Rayyan to support screening, data extraction and evidence synthesis. The review will be conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. We will search the Cochrane Library, EBSCOhost, MEDLINE (Ovid), PsycArticles (Ovid), PsycINFO (Ovid), EMBASE (Ovid), Web of Science, ProQuest and Scopus databases for peer-reviewed texts published in English between 1 January 2000 and 28 February 2023. We will also search Google Scholar for additional grey literature. To be eligible for inclusion, studies must focus on adolescent populations aged 13-18 years and report on interventions to reduce wait times for any mental health service except crisis and emergency services. Title, abstract and full-text screening will be done by two reviewers. We will extract data describing the interventions and their effects on wait times and adolescent mental health outcomes, and we will identify strengths and limitations in the evidence base to inform recommendations for future research. A youth advisory group with lived experience of mental health difficulties will be consulted throughout the review process. ETHICS AND DISSEMINATION: Ethics approval is not required. Findings will be disseminated via peer-reviewed publications and presented at conferences. STUDY REGISTRATION: The protocol was registered with the Open Science Framework on 20 February 2023 (https://osf.io/qt4zy).

Sertraline-Induced Tics: A Case Report and Narrative Review.

This brief report describes the case of a 16-year-old girl who was commenced on sertraline for anxiety and depression, and subsequently developed severe and debilitating motor tics. Cessation of sertraline was associated with the resolution of tics; after this, paroxetine was trialled and well tolerated with good response of targeted symptoms and without re-emergence of tics. A narrative literature review yielded a retrospective observational study and eight single case reports on selective serotonin receptor inhibitor-induced motor tics (three in adolescents and five in adults). Tics are not commonly considered as a side-effect of SSRIs. This case report is novel is several aspects: the tics emergence was immediate whereas previous cases were delayed; the tics symptoms were measured and quantified by a validated scale; a dose-response relationship was observed; to our knowledge, our case was the first adolescent female reported; and finally, paroxetine was well-tolerated as a substitute, although it is unclear whether the observed tics-sparing effect is co-incidental, ideocratic or can be replicated.

Gender (r)evolution and contemporary psychiatry.

Perlson et al's editorial 'Envisioning a future for transgender and gender-diverse people beyond the DSM' heralds the arrival of the ICD-11's gender incongruence categories among conditions related to sexual health, brightening the spotlight on the re- (or rather de-)classification of gender-related disorders, which is a step in the right direction.

Epidemiology of personality disorders in individuals with gender dysphoria.

PURPOSE OF REVIEW: Prevalence estimates of personality disorders (PD) in individuals with gender dysphoria (GD) are variable and heterogeneous, as psychiatric comorbidity and long-term follow-up data from gender-diverse samples are still limited. This review aims to assess prevalence rates across age groups and discuss potential reasons for variability in PD prevalence estimates among transgender people. RECENT FINDINGS: International epidemiological data from several countries indicate that the best available estimates of the prevalence of any PD diagnosis in transgender youth are around 20% for adolescents and tend to increase to nearly 50% in trans-adults. The paucity of available data on personality dysfunction in children and adolescents with GD precluded us from definitive conclusions on the trends of emerging PDs in this population. Estimates of PD prevalence in transgender and gender-diverse people seem to be highly affected by methodological characteristics of the studies with no universally agreed reference standards for this population. SUMMARY: The review of epidemiological studies on PD among gender-diverse people highlights the need for using more standardized study methodologies to make findings comparable. Nevertheless, international epidemiological data seem to support the link association between the development of PD and GD.

Lurasidone for Adolescents With Complex Mental Disorders: A Case Series.

OBJECTIVES: Lurasidone is a new second generation (atypical) antipsychotic agent with unique receptor affinity and side-effect profiles, but limited literature is available on its use in adolescent populations. Contrasting with research treatment trials which typically recruit patients by stringent selection criteria, this case series examined the effects and tolerability of using lurasidone in adolescents within real-life clinical settings in treating complex cases who had not responded to other therapy options. METHODS: We conducted a retrospective case-note audit of 6 adolescents aged 14 to 17 years old attending community child and adolescent mental health services (CAMHS) who were prescribed lurasidone. RESULTS: Lurasidone had been prescribed for a range of "hard-to-manage" conditions with complex comorbidities, in adolescents in relation to specific use of lurasidone on the basis of clinical and pharmacological indications after exhausting more conventional treatment options. Case-note review suggested response to lurasidone was clinically positive in 3 cases, equivocal/marginal in 2 cases, and ineffective in 1 case. There were no cases of poor tolerance or adverse effects. Notably, positive responses for depressive and irritable mood symptoms were specifically recorded by prescribing clinicians, indicative of benefits on symptom improvement. No lurasidone attributed weight gain, galactorrhoea, metabolic abnormalities, sexual dysfunction or intolerance were reported. Pro-cognitive effects were not detected; but our findings were constrained by the non-systematic and incomplete information ascertainment, typical in retrospective case-note review. CONCLUSION: This case series provides preliminary data supporting lurasidone's potential use in adolescents of complex clinical needs (but without a clinical diagnosis of bipolar disorder) within real-life clinical settings. Lurasidone appears to show a weight-sparing effect, in addition to improving mood symptoms in some cases. Lurasidone deserves further study for its use in the adolescent population (outside the remit of FDA) given its potential more favorable risk-benefit profile in young people. The favorable tolerability appear to be borne out by the pharmacodynamic predictions in our complex patients who would be excluded in formal clinical trial studies.

The role of dissociation and abuse among adolescents who self-harm.

OBJECTIVES: Retrospective recall of dissociative symptoms has been found to mediate the association between childhood abuse and deliberate self-harm (DSH) in later life. To disentangle the effect of recall bias, we tested whether dissociation symptoms ascertained during an acute DSH presentation mediates this link. METHOD: All participants with DSH were recruited during emergency presentation. Seventy-one individuals aged 11-17 years with overdose (OD) and/or self-injury (SI) participated in semi-structured interviews and psychiatric assessment to measure abuse and dissociation. An age- and gender-matched comparison group of 42 non-psychiatric patients admitted to the same service were also assessed. RESULTS: The DSH groups reported significantly higher levels of abuse and dissociation compared to comparison group. Dissociation significantly mediated the association between abuse and DSH. Of the four dissociation subtypes, 'depersonalisation' was the primary mediator. Adolescents with chronic patterns of DSH and the 'OD + SI' self-harm type reported more severe dissociation. CONCLUSION: Exposure to abuse significantly increased the risk of DSH in adolescence. This association was mediated by dissociation. Our findings suggest a possible dose-response relationship between dissociation with DSH chronicity and the 'OD + SI' self-harm type, implicating the importance of evaluating dissociation and depersonalisation symptoms as well as abuse exposure in DSH management.