Early career psychiatrists advocate reorientation not redeployment for COVID-19 care.

In this letter, as early career psychiatrists we highlight the urgent need to address the mental health fallout of the COVID 19 pandemic. We advocate the reorientation of mental healthcare services cadre to provide proactive mental health care services. For this purpose, the focus with regard to the COVID 19 pandemic needs to shift from acute care for the infected persons to the medium and long term care for those who are affected by COVID 19. The latter category includes survivors with protracted symptoms and family members. We also recognize the need for mental health surveillance and support for those losing loved ones, and experiencing financial and emotional adversities. This will also aid provision of better mental health care services by trainee and early career professional who through redeployment have had challenges in achieving learning and training competencies. Redeployment has affected Low and Middle income countries worse and reorientation will benefit these settings the most

The adult outcome of childhood quasi-autism arising following extreme institutional deprivation

Background: Rutter and colleagues' seminal observation that extended early life exposure to extreme institutional deprivation can result in what he termed quasi-autism (QA), informed both our understanding of the effects of adversity on development and the nature of autism. Here we provide the first detailed analysis of the adult outcomes of the group of institutionally deprived-then-adopted children identified as displaying QA.Methods: twenty-six adult adoptees identified with QA in childhood (Childhood QA+) were compared to 75 adoptees who experienced extended institutional deprivation (>6 months) but no QA (Childhood QA−), and 116 adoptees exposed to Low/No institutional deprivation. The outcomes were child-to-adult developmental trajectories of neuro-developmental symptoms (autism, attention-deficit/hyperactivity disorder (ADHD), disinhibited social engagement (DSE) and cognitive impairment), adult functioning, life satisfaction and mental health.Results: childhood QA+ was associated with elevated and persistent trajectories of broad-based autism-related difficulties, ADHD and DSE symptoms and low IQ, as well as adult mental health difficulties and functional impairment, including high rates of low educational attainment and unemployment. Life satisfaction and self-esteem were unaffected. Autism-related communication problems, in particular, predicted negative adult outcomes. Childhood QA+ was still associated with poor outcomes even when ADHD, DSE and IQ were controlled.Conclusions: early and time-limited institutional deprivation has a critical impact on adult functioning, in part via its association with an early established and persistent variant of autism, especially related to communication difficulties. Apparent similarities and differences to non-deprivation related autism are discussed

Evaluating the tendencies of community practitioners who actively practice in child and adolescent psychiatry to diagnose and treat DSM-5 attenuated psychotic syndrome

The detection of individuals at clinical ultra-high risk for psychosis (CHR-P) may be a key limiting step for early interventions, and there is some uncertainty regarding the true clinical reliability of the CHR-P states. The aim of this study was to explore how practitioners who were in the direct treatment of children with psychiatric disorders [child psychiatry specialists/trainees (n = 227, n = 131), adult psychiatrists (n = 27), and child neurologists (n = 2)] perceive the DSM-5-Attenuated Psychosis Syndrome (DSM-5-APS), and their clinical routine practice in the treatment of it. Three vignettes describing fictional cases presented with symptoms of either DSM-5-Schizophrenia, DSM-5-APS, and no psychotic symptoms were created. We asked these practitioners to apply a DSM-5 diagnosis and to choose appropriate treatment(s) for these vignettes. Of the responders, 43% correctly diagnosed the APS vignette, whereas 37.4% mentioned that it had a full-blown psychotic episode. Regarding the therapeutic approach for the APS vignette, 72.1% of all practitioners chose a psychopharmacological intervention and 32% individual psychotherapy. This study showed that the diagnostic inter-rater reliability of the DSM-5-APS among child/adolescent mental health practitioners was consistent with the results from the DSM-5 field trials (Kappa = 0.46). Moreover, almost three in four practitioners endorsed psychopharmacological intervention as a treatment option for the DSM-5-APS case. The lack of evidence of psychopharmacological interventions in CHR-P situations emphasizes that the least harmful interventions should be recommended. Thus, our findings indicated a need for raising awareness regarding the CHR-P paradigm and its treatment as well as the development of solid guidelines that can be implemented in clinical practice.info:eu-repo/semantics/publishe

One-carbon metabolism and stress in chilfren and adolescents with psychosis risk syndrome: preliminary data

Resumen del trabajo presentado en el Congress of the Schizophrenia International Research Socieaty (SIRS), celebrado del 4 al 8 de abril de 2020A dysregulation in one-carbon metabolism, involving folate, vitamin B12 and homocysteine (Hcys) could be implicated in the physiopathology of schizophrenia (for a review, Frankenburg, 2007). Higher Hcys levels have been associated with the disease compared to healthy controls in adults as well as in children and adolescents (Levere et al, 2014). Up to our knowledge, there are no studies in children and adolescents at risk for schizophrenia and other psychosis (Psychosis Risk Syndrome, PRS) testing the one-carbon metabolism parameters. Only a few groups have published results focused only in this population (for a review, Tor et al, 2018). This study aims to compare blood parameters associated with one-carbon metabolism, the clinical and demographic characteristics and stressful life events of a sample of children and adolescents with PRS and healthy controls (HC).Peer reviewe