Perceived impact of the COVID-19 pandemic on child and adolescent psychiatric services after 1 year (February/March 2021): ESCAP CovCAP survey.

In April 2020, the European Society for Child and Adolescent Psychiatry (ESCAP) Research Academy and the ESCAP Board launched the first questionnaire of the CovCAP longitudinal survey to estimate the impact of COVID-19 on child and adolescent psychiatry (CAP) services in Europe. In this brief report, we present the main findings from the second questionnaire of the survey, one year after the COVID-19 pandemic began to hit Europe (i.e., February/March 2021). While service delivery to patients and their families was affected in a major way (reported by 68%) at the beginning of the pandemic, the majority of respondents (59%) in this second survey only reported a minor impact on care delivery. The use of telemedicine remained widespread (91%) but the proportion of CAP services partially closed or transformed to accommodate COVID-19 patients (59% in 2020) dropped to 20%. On the other hand, the perceived impact on the mental health and psychopathology of children and adolescents dramatically increased from "medium" (> 50%) in 2020 to "strong" or "extreme" (80%) in 2021. Four nosographic entities were particularly impacted: suicidal crises, anxiety disorders, eating disorders and major depressive episodes. Accordingly, this was associated with a substantial increase in the number of referrals or requests for assessments (91% reported an increase in 2021 while 61% reported a decrease in 2020). Finally, heads of the CAP departments expressed strong concerns regarding the management of the long-term consequences of this crisis, especially regarding the provision of care in light of the perceived increase in referrals

Erfahrungen mit einer OSCE-Station Anamnese via Zoom: Machbarkeit, Akzeptanz und Herausforderungen aus Sicht von Studierenden, Simulationspatient*innen und Prüfenden während der COVID-19-Pandemie

Aim: Assessments of practical clinical competencies pose a challenge during the COVID-19 pandemic. Reports about OSCE stations administered online show that, despite technical feasibility and acceptance, there is a lingering desire for in-person assessments. Barriers and challenges must therefore also be identified in regard to the future integration of digital competencies into the curriculum. Based on a study investigating the feasibility and acceptance of an online OSCE anamnesis station and the descriptions given by students, simulated patients and examiners of the challenges and limitations, we make recommendations for necessary future adaptations to anamnesis training and testing in the context of telemedicine.Method: We surveyed students after completion of an OSCE anamnesis station, adapted to the telemedical setting, that was administered as an alternative assessment to 149 students via Zoom®. Using semi-structured interviews, we analyzed the resulting challenges and limitations as seen by all of the participants.Results: We confirm the existence of good technical and organizational feasibility, positive learning experiences through feedback, the acquisition of clinical competencies, and a high acceptance of this format as an alternative assessment during the pandemic. Using the semi-structured interviews, it was also possible to analyze additional categories that identify necessary adaptations of this type of format.Conclusion: Adaptation of the content-based training for all of the participants and a targeted revision of the checklists, e.g., regarding communication techniques in a telemedicine setting, is required due to the effects of the online format on communication and interactions between students and simulated patients.Zielsetzung: Leistungsüberprüfungen klinisch-praktischer Kompetenzen sind im Rahmen der COVID-19-Pandemie eine Herausforderung. Berichte über online durchgeführte OSCE-Stationen zeigen, trotz technischer Machbarkeit und Akzeptanz, den bleibenden Wunsch nach Präsenzprüfungen. Barrieren und Herausforderungen müssen daher auch im Hinblick auf die zukünftige Integration digitaler Kompetenzen in das Curriculum identifiziert werden. Mit Hilfe einer Untersuchung zur Machbarkeit und Akzeptanz bei der Durchführung einer Anamnese-OSCE-Station im Online-Format und Darstellung von Herausforderungen und Limitationen von Seiten der Studierende, der Simulationspatient*innen und der Prüfenden benennen wir Empfehlungen für zukünftig notwendige Anpassungen für Anamnese-Schulungen und Prüfungen unter telemedizinischen Aspekten.Methodik: Im Anschluss an eine als Prüfungsersatz mit 149 Studierenden via Zoom® durchgeführten und auf ein telemedizinisches Setting angepasste Anamnese-OSCE-Station, führten wir eine Fragebogenerhebung bei Studierenden durch. Mit Hilfe von semistrukturierten Interviews analysierten wir die sich daraus ergebenen Herausforderungen und Limitationen von Seiten aller Beteiligten. Ergebnisse: Wir konnten eine gute technische und organisatorische Machbarkeit, positive Lernerfahrungen durch Feedback und den Erwerb von klinischen Kompetenzen, sowie eine hohe Akzeptanz des Formates als Prüfungsersatz im Rahmen der Pandemie bestätigen. Mit Hilfe der semistrukturierten Interviews konnten zusätzlich Kategorien analysiert werden, die notwendige Anpassungen eines solchen Formates identifizieren. Schlussfolgerung: Eine durch das Online-Format veränderte Kommunikation und Interaktion zwischen Studierenden und Simulationspatient*innen bedarf einer Adaptation der inhaltlichen Schulung aller Beteiligten und einer gezielten Anpassung der Checklisten, z.B. bezüglich Kommunikations-Techniken für ein telemedizinisches Szenari

Supplementary Material for: Rapid emergence of appetite and hunger resulting in weight gain and improvement of eating disorder symptomatology during and after short-term off-label metreleptin treatment of a patient with anorexia nervosa

Off-label treatment of a 15-year-old female patient with anorexia nervosa with human recombinant leptin (metreleptin) for nine days was associated with self-reported increments of appetite and hunger resulting in rapid weight gain, substantial improvement of eating disorder cognitions and of depression. The results further substantiate the effects of metreleptin on both AN and depression. We contrast these results with the widespread view that leptin is an anorexigenic hormone. Randomized controlled trials are warranted to confirm the described effects

The role of hypoleptinemia in the psychological and behavioral adaptation to starvation: Implications for anorexia nervosa.

This narrative review aims to pinpoint mental and behavioral effects of starvation, which may be triggered by hypoleptinemia and as such may be amenable to treatment with leptin receptor agonists. The reduced leptin secretion results from the continuous loss of fat mass, thus initiating a graded triggering of diverse starvation related adaptive functions. In light of leptin receptors located in several peripheral tissues and many brain regions adaptations may extend beyond those of the hypothalamus-pituitary-end organ-axes. We focus on gastrointestinal tract and reward system as relevant examples of peripheral and central effects of leptin. Despite its association with extreme obesity, congenital leptin deficiency with its many parallels to a state of starvation allows the elucidation of mental symptoms amenable to treatment with exogenous leptin in both ob/ob mice and humans with this autosomal recessive disorder. For starvation induced behavioral changes with an intact leptin signaling we particularly focus on rodent models for which proof of concept has been provided for the causative role of hypoleptinemia. For humans, we highlight the major cognitive, emotional and behavioral findings of the Minnesota Starvation Experiment to contrast them with results obtained upon a lesser degree of caloric restriction. Evidence for hypoleptinemia induced mental changes also stems from findings obtained in lipodystrophies. In light of the recently reported beneficial cognitive, emotional and behavioral effects of metreleptin-administration in anorexia nervosa we discuss potential implications for the treatment of this eating disorder. We postulate that leptin has profound psychopharmacological effects in the state of starvation