Trauma Exposure and Suicidality in a Pediatric Emergency Psychiatric Population.

OBJECTIVES: The increasing rates of depression and suicidality in children and adolescents are reflected in the increasing number of mental health-related visits to emergency departments. Despite the high rates of traumatic exposure experienced by high-acuity children and adolescents and a known link to suicidal ideation, the systematic review of trauma history is not a consistent part of emergency department assessments for suicide ideation or attempt. In the present study, we examined the prevalence of suicidality as well as traumatic exposures in children and adolescents presenting to a dedicated pediatric psychiatric emergency department. METHODS: Suicide ideation, suicide attempts, and trauma exposure history were identified through a retrospective chart review of youth (n = 861) who presented to a dedicated child psychiatric emergency department during a 1-year period. Bivariate analyses comparing demographic and trauma history for children with and without suicidality and a multivariable logistic regression were performed. RESULTS: Childhood adversity was common, with 52% of youth reporting at least one type of trauma exposure. Emotional abuse, physical abuse, and sexual abuse/assault were associated with suicidality. Any trauma exposure and the total number of different trauma exposures were associated with reported suicide attempt. After adjusting for sociodemographic characteristics, children who reported a history of emotional abuse had 3.2-fold increased odds of attempted suicide. Children who reported a history of being a victim of bullying had 1.9-fold increased odds of current suicidal ideation. CONCLUSIONS: Traumatic experiences were common in youth presenting with suicidality. Traumatic experiences are frequently underrecognized in treatment settings because they are not part of routine evaluations and are often overlooked when trauma-related symptoms are not the presenting problem. Addressing traumatic experiences underlying depression and suicidal ideation is a necessary step in effective treatment. Emergency departments need to implement routine screening for traumatic exposures in children presenting with suicidal ideation or attempt.

Receptive Music Therapy Is More Effective than Interactive Music Therapy to Relieve Behavioral and Psychological Symptoms of Dementia: A Systematic Review and Meta-Analysis.

BACKGROUND: Music therapy is demonstrated to be effective to relieve the agitation among people with dementia, but the comparative effectiveness of methods of music engagement for people with dementia is uncertain. OBJECTIVE: To evaluate the effects on cognitive functions and behavioral symptoms between interactive and receptive music therapies for people with dementia. METHODS: Prospective studies evaluating interactive and receptive music therapies were identified from the OVID databases, included MEDLINE, EMBASE, PsycINFO, and CINAHL. Supplementary search was conducted in Google Scholar. The primary outcome focused on cognitive function; the secondary outcomes were apathy, anxiety, depressive symptoms, agitation, and other behavioral problems. All outcomes were measured by the standard assessment tools. The heterogeneity of studies was examined, and the effects were pooled by meta-analysis. Quality of studies and risk of bias were assessed. RESULTS: Thirty-eight trials involving 1418 participants with dementia were included. The mean age ranged from 75 to 90 years, and the percentage of male participants ranged from 6% to 83%. No significant difference was found between participants receiving interactive or receptive music therapy and usual care in cognitive function; the mean difference (MD) of Mini-Mental State Examination was 0.18 [95% confidence interval (CI) -1.34 to 1.69], and -0.15 (95% CI -0.55 to 0.25), respectively. Participants with receptive music therapy had significant decrease in agitation (Cohen-Mansfield Agitation Inventory: MD = -7.99, 95% CI -5.11 to -0.87) and behavioral problems (Neuropsychiatric Inventory: MD = -3.02 95% CI -5.90 to -0.15) compared to usual care, while no significant difference was found between interactive music therapy and usual care in behavioral problems and psychiatric symptoms. CONCLUSIONS: This study demonstrated that receptive music therapy could reduce agitation, behavioral problems, and anxiety in older people with dementia, and appears to be more effective than interactive music therapy. It is easy and convenient to implement receptive music therapy; therefore, we recommended the use of receptive music therapy in nursing homes, day care centers, and client homes.

Origami-based tunable truss structures for non-volatile mechanical memory operation.

Origami has recently received significant interest from the scientific community as a method for designing building blocks to construct metamaterials. However, the primary focus has been placed on their kinematic applications by leveraging the compactness and auxeticity of planar origami platforms. Here, we present volumetric origami cells-specifically triangulated cylindrical origami (TCO)-with tunable stability and stiffness, and demonstrate their feasibility as non-volatile mechanical memory storage devices. We show that a pair of TCO cells can develop a double-well potential to store bit information. What makes this origami-based approach more appealing is the realization of two-bit mechanical memory, in which two pairs of TCO cells are interconnected and one pair acts as a control for the other pair. By assembling TCO-based truss structures, we experimentally verify the tunable nature of the TCO units and demonstrate the operation of purely mechanical one- and two-bit memory storage prototypes.Origami is a popular method to design building blocks for mechanical metamaterials. Here, the authors assemble a volumetric origami-based structure, predict its axial and rotational movements during folding, and demonstrate the operation of mechanical one- and two-bit memory storage.

Utilization Patterns at a Specialized Children's Comprehensive Psychiatric Emergency Program.

OBJECTIVE: Most youths experiencing a psychiatric crisis present to emergency departments (EDs) that lack the specialized staff to evaluate them, so youths are often discharged without appropriate mental health assessment or treatment. To better understand the needs of this population, this study described clinical details and disposition associated with visits for psychiatric emergencies to a specialized ED staffed 24/7 by child psychiatrists. METHODS: Through retrospective chart review, 1,180 visits to the ED during its first year of operation were reviewed for clinical characteristics, prior service utilization, and demographic characteristics. Bivariate analyses (chi-square test and Wilcoxon rank sum test) compared differences in disposition (evaluate and release, brief stabilization, and inpatient psychiatric admission) associated with characteristics of the children's first visit (N=885). Measures with bivariate association of p<.10 were further assessed by using multinomial logistic regression analyses. RESULTS: For most visits (59%), children were evaluated and released, 13% were briefly stabilized, and 28% were admitted for psychiatric treatment. Youths with mood or psychotic disorders were more likely to be admitted, as were those with current suicidality or aggression. Many youths who presented with aggression were also identified as having suicidality or self-harm. CONCLUSIONS: Clinical factors, especially suicidality, predicted psychiatric admission. Admission rates for youths with suicidality were significantly higher in this study than previously reported, suggesting the availability of child psychiatrists in this ED allowed greater ascertainment of suicide risk (and thus hospitalization to mitigate that risk) than occurs in EDs without such staffing.