Low self-esteem and high psychological distress are common among depressed adolescents presenting to the Pediatric Emergency Department

Background: Increasing psychiatric disorders and alcohol intoxication challenge the pediatric emergency departments (PEDs) to which adolescents are referred owing to acute alcohol intoxication. Objective: This study examined the degree to which adolescents presenting to PED with alcohol intoxication or deliberate self-harm report symptoms of depression and how they differed from non-depressed patients in terms of alcohol use, perceived social support, psychological distress, self-esteem, and suicidal thoughts. Methods: In a sample of 138 adolescents, 12- to 16-years old (62 % females), we assessed the patients' psychiatric status using self-report scales and analyzed blood samples for alcohol. Before discharge, a consulting psychiatrist interviewed each patient to evaluate possible suicidality and organized aftercare when necessary. The mediating data-driven hypothesis was examined. Adolescents scoring >= 10 on the Beck Depression Inventory (BDI) were deemed as screening positive for depression. Results: In 55% of participants, intoxication was by alcohol consumption. Deliberate self-harm was found in 17% of the participants. Of the 138 adolescents, 39 % scored positive on the BDI for depressive symptoms, occurring more commonly in girls. Logistic regression showed that the most significant variables associated with depressive symptoms were female gender, high psychological distress, and low self-esteem. Symptoms of depression served as a mediator between gender and self-esteem and the blood alcohol level. Conclusions: Our findings underscore the importance of identifying mood disorders, suicidality, and self-esteem among adolescents with acute alcohol intoxication at the PED. Intensive psychiatric evaluation in an emergency department is necessary in order to detect those adolescents requiring additional treatment and support.Peer reviewe

Cognitive function during early abstinence from opioid dependence: a comparison to age, gender, and verbal intelligence matched controls

BACKGROUND: Individuals with opioid dependence have cognitive deficits during abuse period in attention, working memory, episodic memory, and executive function. After protracted abstinence consistent cognitive deficit has been found only in executive function. However, few studies have explored cognitive function during first weeks of abstinence. The purpose of this study was to study cognitive function of individuals with opioid dependence during early abstinence. It was hypothesized that cognitive deficits are pronounced immediately after peak withdrawal symptoms have passed and then partially recover. METHODS: Fifteen patients with opioid dependence and fifteen controls matched for, age, gender, and verbal intelligence were tested with a cognitive test battery When patients performed worse than controls correlations between cognitive performance and days of withdrawal, duration of opioid abuse, duration of any substance abuse, or opioid withdrawal symptom inventory score (Short Opiate Withdrawal Scale) were analyzed. RESULTS: Early abstinent opioid dependent patients performed statistically significantly worse than controls in tests measuring complex working memory, executive function, and fluid intelligence. Their complex working memory and fluid intelligence performances correlated statistically significantly with days of withdrawal. CONCLUSION: The results indicate a rather general neurocognitive deficit in higher order cognition. It is suggested that cognitive deficit during early abstinence from opioid dependence is related to withdrawal induced neural dysregulation in the prefrontal cortex and is partly transient