The persistent impact of the COVID-19 pandemic on pediatric emergency department visits for suicidal thoughts and behaviors.

INTRODUCTION: We examined data from a large, high acuity, pediatric psychiatric emergency department (ED) to assess both the immediate and longer-term impact of the pandemic on ED visits for suicidal thoughts and behaviors (STBs) among youth. METHODS: Youth ages 5-17 years presenting at a pediatric psychiatric ED in New York, NY from March 2019-November 2021 were included in this study. Visits were categorized as pre-pandemic, pandemic year 1, or pandemic year 2. We examined changes in demographic and clinical characteristics among patients presenting across the three time periods, as well as multivariable associations between these characteristics and STBs. RESULTS: Over 32 months, 2728 patients presented at 4161 visits. The prevalence of a discharge diagnosis of STBs increased from 21.2% pre-pandemic to 26.3% (p < 0.001) during pandemic year 1, and further increased to 30.1% (p = 0.049) during pandemic year 2. Youth were 21% more likely to receive a discharge diagnosis of STBs in pandemic year 1 (RR 1.21, 95% CI 1.07, 1.36) and 35% more likely in pandemic year 2 (RR 1.35, 95% CI 1.19, 1.52) compared to pre-pandemic baseline. CONCLUSIONS: In a large, high-acuity ED, STBs continued to increase 20 months after the initial COVID-19 lockdown. These findings highlight the persistent detrimental impact of the pandemic on youth mental health.

COVID-19 and Youth Who Have Experienced Commercial Sexual Exploitation: A Role for Child Mental Health Professionals During and in the Aftermath of a Pandemic.

The COVID-19 pandemic has exacerbated some of the most pressing social problems and structural inequities, with a disproportionate impact on some of the most vulnerable youth. The goal of this article is to raise awareness among child mental health professionals of the ways in which the pandemic has likely exacerbated the commercial sexual exploitation of children in the United States. A second goal is to promote child mental health professionals' ability to identify and care for these resilient yet underresourced youth.

Preempting the Development of Antisocial Behavior and Psychopathic Traits.

Antisocial behavior and psychopathic traits are subject to complex patterns of inheritance, gene--environment interactive effects, and powerful environmental influences. Yet genetic factors are important in the etiology of antisocial behavior and psychopathic traits, and identifying youth with an elevated genetic risk may lead to improved interventions and preventive efforts. Additionally, research revealing the importance of gene--environment interactions in the development of antisocial behavior and psychopathic traits should be harnessed to promote more rehabilitative, developmentally appropriate policies to benefit youth in the juvenile justice and social welfare systems.

Conduct Disorder: Biology and Developmental Trajectories.

For centuries, attempting a successful rehabilitation of youth with antisocial behaviors has challenged juvenile justice systems and society. More recently, advances in science and neuroimaging have permitted a deeper understanding of the biological underpinnings of antisocial behavior and psychopathic tendencies. This paper reviews biological findings in youth with conduct disorder, highlighting comparisons to biological findings in adults with antisocial personality disorder and psychopathy. Overall, youth with conduct disorder exhibit several biological findings that are similar to adults with antisocial personality disorder and psychopathy, consistent with theories that conduct disorder is a neurodevelopmental disorder that progresses to these adult conditions. There is evidence that treatment interventions might mitigate this progression and induce biological changes. Further, biological findings might guide interventions to rehabilitate youth and change the developmental trajectory of antisocial behaviors.

Intellectual Disabilities in Juvenile Justice: The Case for Screening.

Recent efforts to reform and improve the juvenile justice system have overlooked one critically important issue-the widespread failure to routinely screen for intellectual and developmental disabilities (I/DD) in young offenders. Pursuant to the Americans with Disabilities Act and Individuals with Disabilities Education Act, offenders with I/DD must receive appropriate accommodations. Yet across the country, adolescents and adults with I/DD must engage with the juvenile justice system without appropriate supports and often with their disabilities unknown to corrections staff, lawyers, judges, and other personnel.

Nature, Nurture, and Attachment: Implications in Light of Expanding Definitions of Parenthood.

Recent expansion of the legal definition of parenthood in New York State raises the question of whether the presence of a genetic relationship between a parent and child trumps environmental and interpersonal factors in the formation of a strong, secure attachment bond. The purpose of this paper is to emphasize that attachment between a child and secure attachment figure is inherently biological, and that such biological attachment supersedes the existence of a genetic parent-child relationship. First, the paper provides an overview of attachment and its biological basis. It then discusses the impact on attachment of environmental and interpersonal influences, which current research suggests have the power to alter brain biology. There is no clear evidence that a genetic relationship confers a significant advantage in terms of attachment. This paper proposes that the term "biological parent" be redefined to include anyone with whom a child shares a strong attachment bond.

Victimization and Vulnerability: A Study of Incarceration, Interpersonal Trauma, and Patient-Physician Trust.

Despite the critical importance of patient-physician trust, it may be compromised among vulnerable patients, such as (1) incarcerated patients and (2) those patients who have been victims of trauma. The purpose of this study was to examine patient-physician trust among forensic and civilian psychiatric inpatient populations and to explore whether it varied based on a patient's history of incarceration and/or victimization. A trust survey (WFPTS) and a trauma instrument (LEC-5) were administered to 93 patients hospitalized on forensic and civilian psychiatric hospital units in a large, urban public hospital. Results showed no difference in patient-physician trust between incarcerated and civilian patients. Similarly, there was no effect of a history of physical assault or sexual assault on ratings of patient-physician trust. However, the hospitalized civilian and forensic patients who reported being the victim of weapons assault had significantly lower patient-physician trust scores than their counterparts.

Patient-satisfaction surveys on a scale of 0 to 10: improving health care, or leading it astray?

Patient-satisfaction surveys can call attention to the importance of treating patients with dignity and respect, but good ratings depend more on manipulable patient perceptions than on good medicine. In fact, the pressure to get good ratings can lead to bad medicine.

Primary cutaneous vs. parotid mucoepidermoid carcinoma of the scalp: A case report.

Primary cutaneous mucoepidermoid carcinoma remains a rare occurrence. This is the first report of a case of primary cutaneous mucoepidermoid carcinoma originating on the scalp and subsequently metastasizing to the parotid gland. The patient was a 53-year-old female who presented with a purple mass on her scalp since 5 months prior to examination. Histopathology revealed nests and islands of atypical epithelioid cells with pleomorphism, medium to prominent nucleoli, and scattered mucin deposition highlighting with a mucicarmine stain. The atypical cells demonstrated intravascular involvement. These findings were compatible with metastatic adenocarcinoma. Later, fine needle aspiration of the patient's parotid lesion revealed malignant cells from a poorly differentiated carcinoma that appeared similar to the patient's previously excised scalp lesion. In addition to summarizing this patient's presentation, clinical course, and management, we discuss the diagnostic challenges posed by this atypical presentation. Primary cutaneous mucoepidermoid carcinoma should be considered in the differential diagnosis of patients presenting with a scalp mass. Moreover, patients with primary cutaneous mucoepidermoid carcinoma originating on the scalp should be evaluated for possible metastases.

The temporoparietal adipofascial flap for the correction of recurrent idiopathic enophthalmos.

Enophthalmos, the posterior displacement of a normal-size ocular globe relative to the orbital cavity, is usually repaired using autogenous grafts or alloplastic materials. We present the case of a 40-year-old man with bilateral idiopathic enophthalmos whose symptoms recurred 8 years after initial successful surgical repair. We describe the successful and safe use of a bilateral temporoparietal adipofascial flap in the treatment of recurrent idiopathic enophthalmos.

Intraoperative anatomical variations during greater occipital nerve decompression.

OBJECT: A study was conducted to elucidate anatomical variations of the GON and surrounding occipital tissues. METHODS: Anatomical and surgical variations were prospectively recorded for 272 patients who underwent greater occipital nerve (GON) decompression by a single surgeon between 2003 and 2012. Data collection was performed intraoperatively and specifically for the purposes of this study. Documented anatomical variations of the GON and surrounding occipital region included the extension of trapezius musculature to the midline, abnormal lymph nodes, and GON branching. Necessary variations in the surgical procedure were also noted, including resection of a lateral portion of semispinalis capitis muscle and occipital arterectomy. RESULTS: The GON pierced the semispinalis muscle in all patients bilaterally. The extension of trapezius musculature to the midline was discovered in 67.3 percent of patients and lymph node enlargement was discovered in 1.5 percent of patients. Branching of the GON was noted in 7.4 percent of patients and muscles or vessels between GON branches were noted in 3.7 percent of patients. Occipital arterectomy was required in 64.0 percent of patients and resection of a lateral segment of semispinalis muscle was required in 10.7 percent of patients. CONCLUSIONS: The new anatomical variations described in this study improve understanding of the intraoperative anatomy of the occipital region and prevent difficulty in finding the GON due to dissection in the wrong plane, ensuring that MH patients receive maximal benefit from surgical treatment.