Pediatric Treatment-Resistant Obsessive Compulsive Disorder: Treatment Options and Challenges.

Pediatric obsessive-compulsive disorder (OCD) is a chronic, potentially debilitating psychiatric condition. Although effective treatments exist, at least 10% of youth do not achieve remission despite receiving first-line treatments. This article reviews the extant, albeit limited, evidence supporting treatment approaches for youth with treatment-resistant OCD. A literature search for articles addressing pediatric treatment-resistant OCD was conducted through April 11, 2024. These results were augmented by searching for treatment-resistant OCD in adults; treatment strategies discovered for the adult population were then searched in the context of children and adolescents. In general, intensive treatment programs and antipsychotic augmentation of an antidepressant had the most substantial and consistent evidence base for treatment-resistant youth with OCD, although studies were limited and of relatively poor methodological quality (i.e., open trials, naturalistic studies). Several pharmacological approaches (clomipramine, antipsychotics [e.g., aripiprazole, risperidone], riluzole, ketamine, D-cycloserine, memantine, topiramate, N-acetylcysteine, ondansetron), largely based on supporting data among adults, have received varying levels of investigation and support. There is nascent support for how to treat pediatric treatment-resistant OCD. Future treatment studies need to consider how to manage the significant minority of youth who fail to benefit from first-line treatment approaches.

Bidirectionality of smoking and depression in adolescents: a systematic review.

INTRODUCTION: Recently, evidence has been accumulating that both smoking and mental health disorders are continuously increasing among adolescents. This systematic review elucidates the research into evidence of the direction of the association and risk factors influencing the relationship between smoking and depression. We also highlight recent studies on the effects of electronic cigarettes and developments on the association between depression and smoking. METHODS: A literature search was conducted on databases including PubMed, Ovid Medline, EMBASE, and PsycINFO and in relevant neurology and psychiatry journals. Terms used for electronic searches included smoking, tobacco, cigarettes; depression; adolescent, youth; direction. Relevant information was then utilized to synthesize findings on the association between smoking and depression among adolescent population. RESULTS: The initial database searches yielded 2,738 related articles. After screening and cross-referencing, duplicate articles, articles published in languages other than English, and studies on animals, social and lifestyle factors, mood disorders, and substance use were excluded. Of these, a total of 122 publications only focusing on smoking and depression in the adolescent population were selected for synthesis in this qualitative systemic review. These include 110 original research articles, eight meta-analyses and reviews, and four reports and websites. CONCLUSION: The relationship between smoking and depression in the literature does not reflect the cause-effect relationship. The lack of evidence on the direction of the association may reflect futile study designs, confounding factors and/or use of indirect measures of depression and quantification of smoking. Future prospective randomized studies should target elucidation of the causal association.

Bidirectionality of smoking and depression in adolescents: a systematic review

Abstract Introduction Recently, evidence has been accumulating that both smoking and mental health disorders are continuously increasing among adolescents. This systematic review elucidates the research into evidence of the direction of the association and risk factors influencing the relationship between smoking and depression. We also highlight recent studies on the effects of electronic cigarettes and developments on the association between depression and smoking. Methods A literature search was conducted on databases including PubMed, Ovid Medline, EMBASE, and PsycINFO and in relevant neurology and psychiatry journals. Terms used for electronic searches included smoking, tobacco, cigarettes; depression; adolescent, youth; direction. Relevant information was then utilized to synthesize findings on the association between smoking and depression among adolescent population. Results The initial database searches yielded 2,738 related articles. After screening and cross-referencing, duplicate articles, articles published in languages other than English, and studies on animals, social and lifestyle factors, mood disorders, and substance use were excluded. Of these, a total of 122 publications only focusing on smoking and depression in the adolescent population were selected for synthesis in this qualitative systemic review. These include 110 original research articles, eight meta-analyses and reviews, and four reports and websites. Conclusion The relationship between smoking and depression in the literature does not reflect the cause-effect relationship. The lack of evidence on the direction of the association may reflect futile study designs, confounding factors and/or use of indirect measures of depression and quantification of smoking. Future prospective randomized studies should target elucidation of the causal association.

Developmental Understanding of Death and Grief Among Children During COVID-19 Pandemic: Application of Bronfenbrenner's Bioecological Model.

COVID-19 Pandemic has influenced death-related attitudes and understanding during the childhood development leading to a life-long impact. Factors like pandemic-related movement restrictions, school closures, and parents' stay-at-home have exposed children to the phenomenon of grief and death. In that case, children anticipate adverse outcomes and fear while they struggle with unanswered questions. Children may not have coping skills needed to manage their grief in constructive ways to identify, normalize, and express their responses to the loss in their lives. Naming and validating these responses as distinctive aspects of grief process and providing safe space to express their feelings are essential components of a child's coping with loss and grief. This is crucial to consider, as different children react to and are influenced by their environments differently. This article aims to explore the developmental understanding of the process of death and grief by applying the conceptual framework of Bronfenbrenner's theory. Understanding mutual interaction between a child and various ecological systems determines how children perceive death and process grief can facilitate effective communication that has significant implications.

An insight into frequency and predictors leading psychiatric patients to visit faith healers: A hospital-based cross-sectional survey, Karachi, Pakistan.

BACKGROUND: Psychiatric illnesses have recently escalated in numbers, with patients resorting to various forms of healthcare providers, including faith healers. This delays early psychiatric treatment, resulting in further mental health deterioration of the patient. Various factors impact the mode of treatment preferred by psychiatric patients. AIMS: To determine the frequency of psychiatric patients visiting faith healers, presenting at the outpatient department of Liaquat National Hospital, Karachi, Pakistan, and to explore the predictors that direct them toward visiting faith healers. METHODS: This cross-sectional survey was conducted using a semi-structured pre-tested questionnaire, employing a total of 219 male and female psychiatric patients. Patients were recruited through non-random consecutive sampling technique. SPSS 18 was used for statistical analysis. RESULTS: About 32% of the patients had visited a faith healer in their lifetime. Frequency of current visitors declined; the most frequent reason being stated was no relief from their treatment. Students, patients of upper middle class and those coming for initial visit to a psychiatrist were more likely to visit a faith healer. Patients who knew of someone previously visiting a faith healer were less likely to have visited a faith healer. CONCLUSION: This study highlights the importance of a multisectoral approach to dealing with psychiatric patients to help in bridging the treatment gap in mental health.

Remission of Psychosis in Treatment-resistant Schizophrenia Following a Seizure: A Case Report.

The authors report a case of treatment-resistant schizophrenia in a 22-year-old woman, who, despite multiple trials of antipsychotics, did not respond to treatment. Clozapine treatment was initiated, but the patient's symptoms did not remit until after she had a clozapine-induced seizure. The authors discuss the importance in considering that electroconvulsive therapy may be effective in reducing positive and negative symptoms in patients suffering from treatment-resistant schizophrenia.