Parental attitudes and opinions on the use of psychotropic medication in mental disorders of childhood

<p>Abstract</p> <p>Background</p> <p>The limited number of systematic, controlled studies that assess the safety and efficacy of psychotropic medications for children reinforce the hesitation and reluctance of parents to administer such medications. The aim of this study was to investigate the attitudes of parents of children with psychiatric disorders, towards psychotropic medication.</p> <p>Methods</p> <p>A 20-item questionnaire was distributed to 140 parents during their first contact with an outpatient child psychiatric service. The questionnaire comprised of questions regarding the opinions, knowledge and attitudes of parents towards children's psychotropic medication. Sociodemographic data concerning parents and children were also recorded. Frequency tables were created and the chi-square test and Fisher's exact tests were used for the comparison of the participants' responses according to sex, educational level, age and gender of the child and use of medication.</p> <p>Results</p> <p>Respondents were mostly mothers aged 25–45 years. Children for whom they asked for help with were mostly boys, aged between 6 and 12 years old. A total of 83% of the subjects stated that they knew psychotropic drugs are classified into categories, each having a distinct mechanism of action and effectiveness. A total of 40% believe that there is a proper use of psychotropic medication, while 20% believe that psychiatrists unnecessarily use high doses of psychotropic medication. A total of 80% fear psychotropic agents more than other types of medication. Most parents are afraid to administer psychotropic medication to their child when compared to any other medication, and believe that psychotherapy is the most effective method of dealing with every kind of mental disorders, including childhood schizophrenia (65%). The belief that children who take psychotropic medication from early childhood are more likely to develop drug addiction later is correlated with the parental level of education.</p> <p>Conclusion</p> <p>Parents' opinions and beliefs are not in line with scientific facts. This suggests a need to further inform the parents on the safety and efficacy of psychotropic medication in order to improve treatment compliance.</p

Relational aggression in adolescents with conduct disorder:sex differences and behavioral correlates

As most research on conduct disorder (CD) has been conducted on male participants, it has been suggested that female-specific symptoms may be underestimated based on current DSM-5 criteria. In particular, relational aggression, i.e. the hurtful, often indirect, manipulation of relationships with the intention of damaging the other’s social position, has been proposed as a characteristic of CD that is more common in females. In addition, sex-specific studies on correlates of relational aggressive behavior are lacking. Relational aggression may be strongly related to the correlates of proactive aggression, namely low affective empathy, and high levels of callous-unemotional (CU) traits and relational victimization. Thus, the present study investigated sex differences in relational aggression, and associations between relational aggression and correlates of proactive aggression in 662 adolescents with CD (403 females) and 849 typically-developing controls (568 females) aged 9–18 years (M = 14.74, SD = 2.34) from the European multi-site FemNAT-CD study. Females with CD showed significantly higher levels of relational aggression compared to males with CD, whereas no sex differences were seen in controls. Relational aggression was only partly related to correlates of proactive aggression in CD: Independent of sex, CU traits showed a positive association with relational aggression. In females only, cognitive, but not affective empathy, was negatively associated with relational aggression. Relational victimization was more strongly associated with relational aggression in males compared to females. Despite interesting sex specific correlates of relational aggression, effects are small and the potential clinical implications should be investigated in future studies

Positive and Negative Parenting in Conduct Disorder with High versus Low Levels of Callous-Unemotional Traits

Less is known about the relationship between conduct disorder (CD), callous-unemotional (CU) traits, and positive and negative parenting in youth compared to early childhood. We combined traditional univariate analyses with a novel machine learning classifier (Angle-based Generalized Matrix Learning Vector Quantization) to classify youth (N = 756; 9-18 years) into typically developing (TD) or CD groups with or without elevated CU traits (CD/HCU, CD/LCU, respectively) using youth- A nd parent-reports of parenting behavior. At the group level, both CD/HCU and CD/LCU were associated with high negative and low positive parenting relative to TD. However, only positive parenting differed between the CD/HCU and CD/LCU groups. In classification analyses, performance was best when distinguishing CD/HCU from TD groups and poorest when distinguishing CD/HCU from CD/LCU groups. Positive and negative parenting were both relevant when distinguishing CD/HCU from TD, negative parenting was most relevant when distinguishing between CD/LCU and TD, and positive parenting was most relevant when distinguishing CD/HCU from CD/LCU groups. These findings suggest that while positive parenting distinguishes between CD/HCU and CD/LCU, negative parenting is associated with both CD subtypes. These results highlight the importance of considering multiple parenting behaviors in CD with varying levels of CU traits in late childhood/adolescence

Community Violence Exposure and Conduct Problems in Children and Adolescents with Conduct Disorder and Healthy Controls

Exposure to community violence through witnessing or being directly victimized has been associated with conduct problems in a range of studies. However, the relationship between community violence exposure (CVE) and conduct problems has never been studied separately in healthy individuals and individuals with conduct disorder (CD). Therefore, it is not clear whether the association between CVE and conduct problems is due to confounding factors, because those with high conduct problems also tend to live in more violent neighborhoods, i.e., an ecological fallacy. Hence, the aim of the present study was: (1) to investigate whether the association between recent CVE and current conduct problems holds true for healthy controls as well as adolescents with a diagnosis of CD; (2) to examine whether the association is stable in both groups when including effects of aggression subtypes (proactive/reactive aggression), age, gender, site and socioeconomic status (SES); and (3) to test whether proactive or reactive aggression mediate the link between CVE and conduct problems. Data from 1178 children and adolescents (62% female; 44% CD) aged between 9 years and 18 years from seven European countries were analyzed. Conduct problems were assessed using the Kiddie-Schedule of Affective Disorders and Schizophrenia diagnostic interview. Information about CVE and aggression subtypes was obtained using self-report questionnaires (Social and Health Assessment and Reactive-Proactive aggression Questionnaire (RPQ), respectively). The association between witnessing community violence and conduct problems was significant in both groups (adolescents with CD and healthy controls). The association was also stable after examining the mediating effects of aggression subtypes while including moderating effects of age, gender and SES and controlling for effects of site in both groups. There were no clear differences between the groups in the strength of the association between witnessing violence and conduct problems. However, we found evidence for a ceiling effect, i.e., individuals with very high levels of conduct problems could not show a further increase if exposed to CVE and vice versa. Results indicate that there was no evidence for an ecological fallacy being the primary cause of the association, i.e., CVE must be considered a valid risk factor in the etiology of CD

Resting autonomic nervous system activity is unrelated to antisocial behaviour dimensions in adolescents: Cross-sectional findings from a European multi-centre study

Purpose: Autonomic nervous system (ANS) functioning has long been studied in relation to antisocial behaviour, but relevant measures (heart rate, heart rate variability, pre-ejection period, respiration rate) have rarely been considered together. This study investigated the relationship between these measures and antisocial behaviour. Methods: Using a sample of 1010 youths with (47.8%) and without conduct disorder (52.2%) aged between 9 and 18. years (659 females, 351 males, mean age = 14.2. years, SD = 2.4), principal component analysis (PCA) was applied to various measures of psychopathology and antisocial behavior. Structural equation modelling was performed in order to test whether the ANS measures predicted PCA-dimensions. Cluster analysis was used in order to classify patterns of ANS activity. Analyses were performed separately for males/females and controlled for body-mass-index, age, caffeine use, cigarette smoking, sports, socioeconomic status, medication, cardiac problems. Results: The PCA yielded three components: antisocial behaviour/comorbid psychopathology, narcissistic traits, and callous-unemotional traits. ANS measures were only weakly correlated with these components. Cluster analysis yielded high and low arousal clusters in both sexes. When controlling for covariates, all associations disappeared. Conclusion: Our findings suggest that resting ANS measures are only weakly related to antisocial behaviour and indicate that smoking should be considered as an important covariate in future psychophysiological studies

Interpersonal trauma: psychodynamic psychotherapy and neurobiology

In psychodynamic theory, trauma is associated with a life event, which is defined by its intensity, by the inability of the person to respond adequately and by its pathologic long-lasting effects on the psychic organization. In this paper, we describe how neurobiological changes link to psychodynamic theory. Initially, Freud believed that all types of neurosis were the result of former traumatic experiences, mainly in the form of sexual trauma. According to the first Freudian theory (1890–1897), hysteric patients suffer mainly from relevant memories. In his later theory of ‘differed action’, i.e., the retroactive attribution of sexual or traumatic meaning to earlier events, Freud links the consequences of sexual trauma in childhood with the onset of pathology in adulthood (Boschan, ). The transmission of trauma from parents to children may take place from one generation to the other. The trauma that is being experienced by the child has an interpersonal character and is being reinforced by the parents’ own traumatic experience. The subject’s interpersonal exposure through the relationship with the direct victims has been recognized as a risk factor for the development of a post-traumatic stress disorder. Trauma may be transmitted from the mother to the foetus during the intrauterine life (Opendak & Sullivan, ). Empirical studies also demonstrate that in the first year of life infants that had witnessed violence against their mothers presented symptoms of a post-traumatic disorder. Traumatic symptomatology in infants includes eating difficulties, sleep disorders, high arousal level and excessive crying, affect disorders and relational problems with adults and peers. Infants that are directly dependant to the caregiver are more vulnerable and at a greater risk to suffer interpersonal trauma and its neurobiological consequences (Opendak & Sullivan, ). In older children symptoms were more related to the severity of violence they had been exposed to than to the mother’s actual emotional state, which shows that the relationship between mother’s and child’s trauma is different in each age stage. The type of attachment and the quality of the mother-child interactional relationship contribute also to the transmission of the trauma. According to Fonagy (), the mother who is experiencing trauma is no longer a source of security and becomes a source of danger. Thus, the mentalization ability may be destroyed by an attachment figure, which caused to the child enough stress related to its own thoughts and emotions to an extent, that the child avoids thoughts about the other’s subjective experience. At a neurobiological level, many studies have shown that the effects of environmental stress on the brain are being mediated through molecular and cellular mechanisms. More specifically, trauma causes changes at a chemical and anatomical level resulting in transforming the subject’s response to future stress. The imprinting mechanisms of traumatic experiences are directly related to the activation of the neurobiological circuits associated with emotion, in which amygdala play a central role. The traumatic experiences are strongly encoded in memory and difficult to be erased. Early stress may result in impaired cognitive function related to disrupted functioning of certain areas of the hippocampus in the short or long term. Infants or young children that have suffered a traumatic experience may are unable to recollect events in a conscious way. However, they may maintain latent memory of the reactions to the experience and the intensity of the emotion. The neurobiological data support the ‘deferred action’ of the psychodynamic theory according which when the impact of early interpersonal trauma is so pervasive, the effects can transcend into later stages, even after the trauma has stopped. The two approaches, psychodynamic and neurobiological, are not opposite, but complementary. Psychodynamic psychotherapists and neurobiologists, based on extended theoretical bases, combine data and enrich the understanding of psychiatric disorders in childhood. The study of interpersonal trauma offers a good example of how different approaches, biological and psychodynamic, may come closer and possibly be unified into a single model, which could result in more effective therapeutic approaches

Medical comorbidity of sleep disorders in children and adolescents

Purpose of review Sleep disorders in children and adolescents often present with various medical comorbidities. The aim of this review is to present the recent literature findings on this issue. Recent findings The major medical comorbid conditions that accompany insomnia or short sleep duration in children and adolescents are obesity and metabolic syndrome, growth hormone deficiency, allergic conditions, various disorders accompanied by chronic pain, neoplasms and blood malignancies, and genetic and congenital disorders. Hypersomnia is mainly related to malignancies. Children and adolescents with obstructive sleep apnoea syndrome or sleep-disordered breathing may suffer from obesity and metabolic syndrome, polycystic ovaries, hypothyroidism, asthma, epilepsy, various ear nose throat disorders, congenital malformations or genetic conditions. Parasomnias may be comorbid with some medical conditions, but the main challenge in their evaluation is the differential diagnosis from nocturnal epileptic seizures. Summary The co-occurrence of sleep disorders and medical conditions in childhood and adolescence is quite frequent and has an impact on general health and quality of life

Sleep and its relationship to health-related quality of life in children and adolescents with inactive juvenile idiopathic arthritis

Aim of the work: To describe and compare sleep disturbance in children and adolescents with inactive juvenile idiopathic arthritis (JIA) and to study their relation to health-related quality of life (HRQoL). Patients and methods: Fifty JIA patients and 50 controls along with their parents were studied. Sleep disturbance was assessed by the Children's Sleep Habits Questionnaire (CSHQ) and HRQoL was assessed according to the revised KINDLR questionnaire. Results: The 50 JIA children were 14 boys (28%) and 36 girls (72%); 58% children and 42% adolescent. The mean age of participants was comparable between boys (11.6 ± 2.9 years) and girls (11.4 ± 3.3 years) either in JIA (p = .76) or control (p = .56). Patients enrolled had enthesitis-related arthritis in 6(12%), RF-positive polyarthritis in 8(16%), oligoarthritis in 32(64%), systemic arthritis in 2(4%) and psoriatic arthritis in 2(4%). Patients had higher CSHQ score (45.5 ± 8.2) and a lower KINDLR (72.4 ± 16.8) compared to the control (40.4 ± 3.4 and 78.3 ± 5.4; p < .0001 and p = .02 respectively). There were no differences between children and adolescents however, Sleep Onset Delay was significantly highest in systemic-onset children (p = .028) and KINDLR emotional subscale was significantly increased in those with oligoarthritis (81.6 ± 16.6) (p = .02). All subscales significantly correlated with their corresponding total score (p < .01). Age at onset” with Emotional subscale were predictive of poor sleep and with number of hospitalizations for poor quality of life. Conclusions: Children and adolescents with inactive JIA, while taking medications, experience more disturbed sleep than matched control. This disturbance in their sleep entails in significant lower levels of HRQoL. Keywords: Juvenile idiopathic arthritis, Sleep disturbance, CSHQ, Health-related quality of life, KINDLRquestionnaire, Inactive diseas

Case report: Matricide by a 17-year old boy with Asperger&apos;s syndrome

This case study presents a 17-year-old boy with Asperger&apos;s syndrome (AS) who was charged with matricide. The adolescent had neither prior history of aggression and violent behavior nor an established history of co-morbid disorder. The case illustrates challenging clinical issues of forensic relevance within the framework of psychiatric evaluation of young people with AS committing violent crimes. It exemplifies how the failure to recognize AS related vulnerabilities and special needs when compounded by cumulative stress can lead to a grave outcome. (C) 2016 Elsevier Ltd. All rights reserved