A scoping review of social media in child, adolescents and young adults: research findings in depression, anxiety and other clinical challenges.

BACKGROUND: Social media and other technologies are reshaping communication and health. AIMS: This review addresses the relationship between social media use, behavioural health conditions and psychological well-being for youth aged <25 years. METHOD: A scoping review of 11 literature databases from 2000 to 2020 explored research studies in youth in five areas: clinical depression and anxiety, quantitative use, social media mode, engagement and qualitative dimensions and health and well-being. RESULTS: Out of 2820 potential literature references, 140 met the inclusion criteria. The foci were clinical depression and anxiety disorders (n = 78), clinical challenges (e.g. suicidal ideation, cyberbullying) (n = 34) and psychological well-being (n = 28). Most studies focused on Facebook, Twitter, Instagram and YouTube. Few studies are longitudinal in design (n = 26), had comparison groups (n = 27), were randomised controlled trials (n = 3) or used structured assessments (n = 4). Few focused on different youth and sociodemographic populations, particularly for low-income, equity-seeking and deserving populations. Studies examined association (n = 120; 85.7%), mediating (n = 16; 11.4%) and causal (n = 4; 2.9%) relationships. Prospective, longitudinal studies of depression and anxiety appear to indicate that shorter use (≤3 h/day) and purposeful engagement is associated with better mood and psychological well-being. Depression may predict social media use and reduce perception of support. Findings provide families, teachers and providers ways to engage youth. CONCLUSIONS: Research opportunities include clinical outcomes from functional perspective on a health continuum, diverse youth and sociodemographic populations, methodology, intervention and privacy issues. More longitudinal studies, comparison designs and effectiveness approaches are also needed. Health systems face clinical, training and professional development challenges.

Does attention-deficit/hyperactivity disorder increase the risk of minor blunt head trauma in children?

PROBLEM: It is unclear if attention-deficit hyperactivity disorder (ADHD) increases the risk of head trauma in children. METHODS: We conducted a multicenter prospective observational study of children with minor blunt head trauma. Guardians were queried, and medical records were reviewed as to whether the patient had previously been diagnosed with ADHD. Enrolled patients were categorized based on their mechanism of injury, with a comparison of those with motor vehicle collision (MVC) versus non-MVC mechanisms. FINDINGS: A total of 3410 (84%) enrolled children had ADHD status available, and 274 (8.0%; 95% confidence interval, CI: 7.1, 9.0%) had been diagnosed with ADHD. The mean age was 9.2 ± 3.5 years and 64% were males. Rates of ADHD for specific mechanisms of injury were: assaults: 23/131 (17.6%; 95% CI 11.5, 25.2%), automobile versus pedestrian 23/173 (13.3%; 95% CI: 8.6, 19.3%), bicycle crashes 26/148 (17.6%; 95% CI: 11.8, 24.7%), falls 107/1651 (6.5%; 95% 5.3, 7.8%), object struck head 31/421 (7.4%; 5.1, 10.3%), motorized vehicle crashes (e.g., motorcycle, motor scooter) 11/148 (7.4%; 3.8, 12.9%), and MVCs 46/704 (6.5%; 95% CI: 4.8, 8.6%). CONCLUSION: Children with ADHD appear to be at increased risk of head trauma from certain mechanisms of injury including assaults, auto versus pedestrian, and bicycle crashes but are not at an increased risk for falls.

Associations of Irritability With Functional Connectivity of Amygdala and Nucleus Accumbens in Adolescents and Young Adults With ADHD.

OBJECTIVE: Irritability is a common characteristic in ADHD. We examined whether dysfunction in neural connections supporting threat and reward processing was related to irritability in adolescents and young adults with ADHD. METHOD: We used resting-state fMRI to assess connectivity of amygdala and nucleus accumbens seeds in those with ADHD (n = 34) and an age- and gender-matched typically-developing comparison group (n = 34). RESULTS: In those with ADHD, irritability was associated with atypical functional connectivity of both seed regions. Amygdala seeds showed greater connectivity with right inferior frontal gyrus and caudate/putamen, and less connectivity with precuneus. Nucleus accumbens seeds showed altered connectivity with middle temporal gyrus and precuneus. CONCLUSION: The irritability-ADHD presentation is associated with atypical functional connectivity of reward and threat processing regions with cognitive control and emotion processing regions. These patterns provide novel evidence for irritability-associated neural underpinnings in adolescents and young adults with ADHD. The findings suggest cognitive and behavioral treatments that address response to reward, including omission of an expected reward and irritability, may be beneficial for ADHD.

Neural basis of working memory in ADHD: Load versus complexity.

Working memory (WM) deficits are key in attention deficit hyperactivity disorder (ADHD). Nevertheless, WM is not universally impaired in ADHD. Additionally, the neural basis for WM deficits in ADHD has not been conclusively established, with regions including the prefrontal cortex, cerebellum, and caudate being implicated. These contradictions may be related to conceptualizations of WM capacity, such as load (amount of information) versus operational-complexity (maintenance-recall or manipulation). For instance, relative to neurotypical (NT) individuals, complex WM operations could be impaired in ADHD, while simpler operations are spared. Alternatively, all operations may be impaired at higher loads. Here, we compared the impact of these two components of WM capacity: load and operational-complexity, between ADHD and NT, behaviorally and neurally. We hypothesized that the impact of WM load would be greater in ADHD, and the neural activation would be altered. Participants (age-range 12-23 years; 50 ADHD (18 females); 82 NT (41 females)) recalled three or four objects (load) in forward or backward order (operational-complexity) during functional magnetic resonance imaging scanning. The effects of diagnosis and task were compared on performance and neural engagement. Behaviorally, we found significant interactions between diagnosis and load, and between diagnosis, load, and complexity. Neurally, we found an interaction between diagnosis and load in the right striatum, and between diagnosis and complexity in the right cerebellum and left occipital gyrus. The ADHD group displayed hypo-activation compared to NT group during higher load and greater complexity. This informs mechanisms of functional problems related to WM in adolescents and young adults with ADHD (e.g., academic performance) and remedial interventions (e.g., WM-training).

Integrating Telepsychiatric Services into the Conventional Systems for Psychiatric Support to Health Care Workers and Their Children During COVID-19 Pandemics: Results from A National Experience.

Background:A system presented here was established to provide psychiatric help for health care workers (HCWs) that combined telehealth applications with local psychosocial support teams, allowing services from video calls to emergency interventions.Introduction:The aim of this study was to determine the effectiveness of a system that combined telehealth applications with local psychosocial support teams.Materials and Methods:A mobile application-based approach supported by the conventional local units was used. A three-step approach including contacting live operators followed by video calls from psychiatrists or child and adolescent psychiatrists and if necessary local unit support was used to provide support.Results:In addition to system records covering sociodemographic variables and initial complaints, a telephone survey, questioning the effectiveness and satisfaction of the system, was used as the main outcome. The number of individuals who asked for a psychiatrist appointment from operators after downloading the application was 1,076 (n = 879 [81.6%] support for self) (n = 197 [18.4%] support for child). Four hundred forty-nine (n = 449) HCWs (41.7%) replied video calls and received psychiatric help from psychiatrists on the time of appointment (n = 351 [78.1%] support for self) (n = 98 [21.8%] support for child). The overall satisfaction level of HCWs for the service they received was 8.1/10 (8.1/10 for support for self, 8.4/10 for support for the child. 86.6% (n = 389).Discussion:The findings of this study suggest that although telepsychiatry may be useful in public health emergencies such as COVID-19 pandemics should not be consisted of only telephone lines or video calls.Conclusions:Systems combining telehealth applications and local intervention teams may be more effective and establishing such organizations is possible in short intervals.

Rapid Conversion of an Outpatient Psychiatric Clinic to a 100% Virtual Telepsychiatry Clinic in Response to COVID-19.

In anticipation of a surge of COVID-19 cases in Northern California, the outpatient psychiatric clinic at UC Davis Health, in which 98% of visits initially occurred in person, was converted to a telepsychiatry clinic, with all visits changed to virtual appointments within 3 business days. The clinic had 73 virtual appointments on its first day after full conversion. This column describes the process, challenges, and lessons learned from this rapid conversion. Patients were generally grateful, providers learned rapidly how to work from home, and the clinic remained financially viable with no immediate losses.

Information Technologies: An Augmentation to Post-Traumatic Stress Disorder Treatment Among Trauma Survivors.

This review article presents existing research describing how information technologies can be used to improve mental health services for trauma survivors, either by enhancing existing treatment approaches or as a stand-alone means of delivering trauma-relevant interventions. The potential ways in which technology aids in overcoming barriers to care are first addressed in terms of providing mental health treatment. The use of technologies enables shifting the locus of care from the traditional provider's office to mobile, online, and virtual environments which are less threatening for patients with post-traumatic stress disorder (PTSD), helping to overcome the core nature of the illness which includes avoidance and increased personal isolation. We then outline how different technological tools can be used for key therapeutic tasks and conclude by discussing key emergent issues that are shaping current and future use of electronic technologies as part of the continuum of care for trauma-related disorders such as PTSD.

Outpatient Psychiatric Documentation Use by Primary Care Physicians Following De-Sensitization in the Electronic Medical Record.

OBJECTIVE: The authors assessed the ways in which primary care physicians (PCPs) utilize outpatient psychiatric documentation that has recently become accessible to non-psychiatric providers in the UC Davis Healthcare System electronic medical record (EMR). METHODS: The authors distributed a nine-question paper survey to 71 PCPs on the UC Davis Medical Center Campus in Sacramento, California. Questions addressed awareness of changes in accessibility of psychiatric documentation, which parts of the psychiatric note were most useful, and ways in which reviewing psychiatric notes changed providers' practice and perception of patients with mental illness. RESULTS: Survey return rate was 100 % due to in-person distribution and collection of survey. More than half (58 %) of respondents were unaware that they had access to psychiatric notes. Within the psychiatric note, providers focused most on plan, diagnosis, and assessment components. Those who were aware reported improved understanding (97 %) and comfort with discussing mental illness (79 %), increased consideration of side effects of psychiatric medications (79 %), and improved efficiency in encounters with psychiatric patients (97 %). Responses about likelihood to contact psychiatrists directly varied considerably. About 45 % of respondents were more likely to consider psychosomatic etiology for patients who were also seen by outpatient psychiatry. CONCLUSIONS: Overall, PCPs reported that accessibility of outpatient psychiatric notes significantly enhanced their experience of caring for patients with mental illness. Future goals include increasing awareness and education about availability of psychiatric notes as well as optimizing communication between psychiatrists and PCPs. The authors recommend future studies focused on changes in perceptions among providers as a result of continued use of psychiatric documentation.

Treatment of psychosis in children and adolescents: a review.

Recognition and treatment of psychosis in children remain challenging. This may be partly because of the subtle nature of prodromal features and partly because psychosis-like experiences are rather common in that a rich fantasy life is normative for developing children. Recent research suggests that only about 5% of patients with schizophrenia have an onset before age 15 years. To help with early recognition, an understanding of frequently used concepts and terms such as ultra high risk, attenuated symptoms, and clinical high risk for schizophrenia were reviewed as part of this article. During prodrome of schizophrenia, marked difficulties with emotions, cognition, motor skills, and socialization are seen. A careful workup of children in whom a psychotic process is suspected is warranted and may help with diagnostic clarification and likely treatment strategies. In treating a patient at ultra high risk, second-generation antipsychotics may reduce the severity of prodromal symptoms; however, high dropout rates and limited treatment adherence are significant concerns. Other helpful strategies may include treatment with selective serotonin reuptake inhibitors and omega-3 fatty acids and therapies such as cognitive-behavioral therapy. The most important aspect of the early treatment, however, may be working with a specialized multidisciplinary early psychosis treatment team that will address and support the individual and his or her family with academic needs, socialization, and other needs or components in a comprehensive manner.

The child and adolescent telepsychiatry consultation: can it be a more effective clinical process for certain patients than conventional practice?

The literature on the efficacy of telepsychiatry for assessing and treating children and adolescents with mental health problems is still developing, but there is evidence that telepsychiatry is diagnostically valid, and that there is high patient and provider satisfaction. Outcome studies are awaited, with the assumption that telepsychiatry has to demonstrate at least as good outcomes and reliability as face-to-face psychiatric care. In this article we suggest, by reviewing the process of telepsychiatry with children, and illustrating relevant issues with five case studies of patients we have seen, that there is a valid case for arguing that in certain children and adolescents, telepsychiatry, as a consultation process, might actually be a superior method of psychiatric assessment to face-to-face consultation. Four factors stand out supporting this view. These are the novelty of the consultation, the capacity to provide direction, the extra distance involved (both psychological and physical), and the authenticity of the interaction. More research in child and adolescent telepsychiatry is indicated.