Over the past decade, the use of commercial video games and serious games has developed in child and adolescent psychiatry. These games may become relevant alternatives or adjuncts to traditional ...psychotherapy, providing that their effectiveness is properly established. The purpose of this literature review was to evaluate the effectiveness of serious games and commercial video games in the treatment or prevention of psychiatric disorders in children and adolescents.
Medline's database was used to search articles published between January 2012 and July 2019. The following keywords were used for this search: "Video games" OR "Active video game" OR "serious gaming" OR "Serious game" OR "Exergame" AND "Child mental disorder" OR "Adolescent" OR "Child" AND "Therapy" OR "Prevention". Only comparative studies which targeted interventions on children and adolescents suffering from psychiatric disorders were included.
Twenty-two studies, focusing on a wide range of psychiatric conditions, met our inclusion criteria's: 14 evaluated serious games and 8 commercial games. All studies were randomized controlled trials but only two studies compared the intervention game to psychotherapeutic gold standard; other studies used a no-intervention control group or an alternative game as the control group. Eighteen studies reported significant improvements on the symptoms and test scores targeted.
Serious games and commercially available video games can be an effective trajectory for psychotherapy in child and adolescent psychiatry. However, there is a lack of longitudinal studies which assess the sustained effects of these games, and standards for proper evaluation of their effectiveness are missing.
Study of the impact of socioeconomic status on autism spectrum disorders (ASD) and severe intellectual disabilities (ID) has yielded conflicting results. Recent European studies suggested that, ...unlike reports from the United States, low socioeconomic status is associated with an increased risk of ASD. For intellectual disabilities, the links with socioeconomic status vary according to the severity. We wished to clarify the links between socioeconomic status and the prevalence of ASD (with or without ID) and isolated severe ID.
500 children with ASD and 245 children with severe ID (IQ <50) aged 8 years, born 1995 to 2004, were recruited from a French population-based registry. Inclusions were based on clinical diagnoses reported in medical records according to the International Classification of Diseases, 10th Revision. Socioeconomic status was measured by indicators available at block census level which characterize the population of the child's area of residence. Measures of deprivation, employment, occupation, education, immigration and family structure were used. Prevalences were compared between groups of census units defined by the tertiles of socioeconomic level in the general population.
Prevalence of ASD with associated ID was higher in areas with the highest level of deprivation and the highest percentage of unemployed adults, persons with no diploma, immigrants and single-parent families. No association was found when using occupational class. Regarding ASD without associated ID, a higher prevalence was found in areas with the highest percentage of immigrants. No association was found for other socioeconomic indicators. The prevalence of isolated severe ID was likely to be higher in the most disadvantaged groups defined by all indicators.
The prevalence of ASD with associated ID and of severe isolated ID is more likely to be higher in areas with the highest level of deprivation.
Antidepressants-induced movement disorders are rare and imperfectly known adverse drug reactions. The risk may differ between different antidepressants and antidepressants' classes. The objective of ...this study was to assess the putative association of each antidepressant and antidepressants' classes with movement disorders.
Using VigiBase®, the WHO Pharmacovigilance database, disproportionality of movement disorders' reporting was assessed among adverse drug reactions related to any antidepressant, from January 1967 to February 2017, through a case/non-case design. The association between nine subtypes of movement disorders (akathisia, bruxism, dystonia, myoclonus, parkinsonism, restless legs syndrome, tardive dyskinesia, tics, tremor) and antidepressants was estimated through the calculation first of crude Reporting Odds Ratio (ROR), then adjusted ROR on four potential confounding factors: age, sex, drugs described as able to induce movement disorders, and drugs used to treat movement disorders.
Out of the 14,270,446 reports included in VigiBase®, 1,027,405 (7.2%) contained at least one antidepressant, among whom 29,253 (2.8%) reported movement disorders. The female/male sex ratio was 2.15 and the mean age 50.9 ± 18.0 years. We found a significant increased ROR for antidepressants in general for all subtypes of movement disorders, with the highest association with bruxism (ROR 10.37, 95% CI 9.62-11.17) and the lowest with tics (ROR 1.49, 95% CI 1.38-1.60). When comparing each of the classes of antidepressants with the others, a significant association was observed for all subtypes of movement disorders except restless legs syndrome with serotonin reuptake inhibitors (SRIs) only. Among antidepressants, mirtazapine, vortioxetine, amoxapine, phenelzine, tryptophan and fluvoxamine were associated with the highest level to movement disorders and citalopram, paroxetine, duloxetine and mirtazapine were the most frequently associated with movement disorders. An association was also found with eight other antidepressants.
A potential harmful association was found between movement disorders and use of the antidepressants mirtazapine, vortioxetine, amoxapine, phenelzine, tryptophan, fluvoxamine, citalopram, paroxetine, duloxetine, bupropion, clomipramine, escitalopram, fluoxetine, mianserin, sertraline, venlafaxine and vilazodone. Clinicians should beware of these adverse effects and monitor early warning signs carefully. However, this observational study must be interpreted as an exploratory analysis, and these results should be refined by future epidemiological studies.
Purpose
This systematic review registered in PROSPERO (CRD42021225296) aimed to describe the use of the French national health insurance information system, which covers the entire French population ...(67 million inhabitants), for research in the field of mental health.
Methods
Three electronic databases and a journal hand‐search identified 15 265 articles from January 1, 2003 (year of creation of the database) to October 31, 2020. Studies of any design were eligible for inclusion provided that they (i) made use of at least one component of the French health insurance database and (ii) focused on a topic in near and far connection with the field of mental health in France. Database used, design and methods, study period, population, key findings, and type of use for medical research were described.
Results
A total of 152 studies were included in the review analysis. There was an increase in the number of published articles over time throughout the studied period. Studies focusing on adults (n = 139) largely outnumbered those focusing on children and adolescents (n = 11). Pharmacoepidemiological studies were by far the most frequent (n = 123), followed by methodological studies (n = 23), epidemiological studies (n = 17), and health economics studies (n = 3). The most studied psychotropic drugs were antidepressants (n = 27), anxiolytics (n = 27), and opioids (n = 25) while fewer studies focused on methylphenidate (n = 6) and on mood stabilizers (n = 5). Few studies specifically focused on psychiatric disorders, mainly depression (n = 4), suicide (n = 4), and psychotic disorders (n = 3).
Conclusion
This systematic review highlighted a relatively poor exploitation of the Système national des données de santé database in the field of psychiatric research with regard to the great possibilities it offers, with a clear lag in certain fields such as epidemiological or health economics studies and in specific populations, in particular children and adolescents.
Anorexia nervosa is a severe and potentially life-threatening disorder. However, although the role of parents in treatment is now clearly recognized and therapeutic groups for parents have been used ...for years, there are but few existent studies concerning their organisation and effectiveness. The objectives of this study were, on the one hand, to evaluate the parents’ and therapists’ subjective experience of these groups through a systematic review of the literature, and on the other hand, to assess the state of current practices in France using an online questionnaire.
The Medline and Web of Science databases were systematically searched. French practices were explored through a questionnaire sent by e-mail to French units treating patients suffering from anorexia nervosa.
Eleven studies were identified, ten of which used only subjective assessment without a control group. They all converged toward the same conclusion: therapeutic groups are perceived, by parents and therapists, as an interesting option in the treatment of anorexia nervosa. The group process allows parents to gain insight into their family dynamics. Therefore, they were able to replicate at home what they have learned during the sessions. The evaluation of French practices showed that one third of the units used a therapeutic group. The frequency and duration of the sessions were relatively homogenous: 75.7% were held once a month or every two months and the average duration was 90minutes. Other characteristics of the groups were more heterogeneous.
While the level of evidence supporting the use of therapeutic groups for parents of patients with anorexia nervosa is low, the perceived effectiveness of these groups is high, both among parents and therapists, and they are commonly used in France. Further research is needed to evaluate their effectiveness.
L’anorexie mentale est un trouble sévère et potentiellement létal. Pourtant, bien que le rôle des parents dans le traitement soit aujourd’hui clairement reconnu et que les groupes thérapeutiques pour parents soient utilisés depuis des années, il n’existe que peu de données concernant leur organisation et leur efficacité. Les objectifs de cette étude étaient, d’une part, d’évaluer l’expérience subjective de ces groupes par les parents et les thérapeutes à travers une revue systématique de la littérature, et, d’autre part, de faire le point sur l’état des pratiques actuelles en France à l’aide d’un questionnaire en ligne.
Les bases de données Medline et Web of Science ont été systématiquement interrogées. Les pratiques françaises ont été explorées à travers un questionnaire envoyé par e-mail aux unités françaises prenant en charge des patients souffrant d’anorexie mentale.
Onze études ont été identifiées, dont dix n’ont utilisé que l’évaluation subjective sans groupe de contrôle. Elles convergeaient toutes vers la même conclusion: les groupes thérapeutiques sont perçus, par les parents et les thérapeutes, comme une option intéressante dans le traitement de l’anorexie mentale. Le processus de groupe permet aux parents de mieux comprendre leur dynamique familiale et de reproduire à la maison ce qu’ils ont appris pendant les séances. L’évaluation des pratiques françaises a montré qu’un tiers des unités utilisait un groupe thérapeutique. La fréquence et la durée des sessions étaient relativement homogènes : 75,7 % avaient lieu une fois par mois ou tous les deux mois et la durée moyenne était de 90minutes. Les autres caractéristiques des groupes étaient plus hétérogènes.
Bien que le niveau de preuve soutenant l’utilisation de groupes thérapeutiques pour les parents de patients souffrant d’anorexie mentale soit faible, l’efficacité perçue de ces groupes est élevée, tant chez les parents que chez les thérapeutes, et ils sont couramment utilisés en France. Des recherches supplémentaires sont nécessaires pour évaluer leur efficacité.
Psychotic disorders are one of the most severe mental disorders in children, adolescents, and adults. Accordingly, schizophrenia spectrum and other psychotic disorders (SSD) represent the third ...leading cause of disability-adjusted life years in young people aged 10–24 years worldwide. Their poor outcome is generally associated with an early age of onset and a longer duration of untreated psychosis and illness.To prevent and reduce the burden caused by psychotic disorders, during the past 2 decades, early detection of risk for psychosis has been intensively investigated, and in particular, predictive power for early signs of risk has been translated into clinical practice. This intensive research on early detection has led to the development of the clinical high-risk state for psychosis (CHR-P) construct to enable the identification of subjects at enhanced imminent risk of development of a first-episode psychotic disorder 9. In particular, the attenuated and transient positive symptoms of the ultra-high-risk criteria and the basic symptom criterion “cognitive disturbances” open promising routes to an indicated prevention and have recently been considered by the European Psychiatric Association (EPA) as diagnostic criteria of a psychosis-risk syndrome.This editorial aims to discuss the particularities associated with the implementation of the CHR-P model in child and adolescent psychiatry, and to propose some priority axes and strategies to sustain this integration.
We would like to thank Rimvall and colleagues for their comments regarding our recent editorial on the deployment of clinical high risk for psychosis (CHR-P) paradigms in child and adolescent ...psychiatry (CAP). We take this opportunity to precisely clarify the purpose of our statement and to enrich this important debate.First, Rimvall and colleagues present CHR-P and patient-centered approaches as antinomic and mutually exclusive. This dichotomy is not supported by the current state of research in CHR-P. Recent models integrate CHR-P with precision as well as patient-centered medicine (e.g. Psychosis Polyrisk Scores (PPS), including genetic and non-genetic information ).
Background The COVID-19 pandemic, associated with confinement and social isolation, seems to have impacted the course of many mental disorders in children and adolescents. An increase in hospital ...admission rates for juvenile anorexia nervosa (AN) has been documented in many regions of the world. However, data from Europe are scarce. Methods We asked clinicians in specialized eating disorder units in hospitals of maximum care in France, Germany, Italy, Spain, Sweden, and the Netherlands to report on (i) overall (inpatient and outpatient) and (ii) inpatient admission rates for adolescents with AN during 2019 and 2020. Additionally, a modified version of the COVID Isolation Eating Scale (CIES) was used to assess the child and adolescent psychiatrists' estimations of a possible increase in symptom severity in children and adolescents with AN during the COVID-19 pandemic and to (iii) inquire about the contributing factors perceived by the caring professionals. Results Four out of six representatives of European hospitals described a higher rate of overall admissions during the pandemic. Three hospitals out of six reported an increase in inpatient admissions, and two centres had constant high numbers of admissions of both outpatients and inpatients. The clinicians perceived a higher symptom severity in 2020 than in 2019, especially involving more frequent use of social media, longer duration of exercising, and more restrictive eating. They supposed an increase in social media consumption, a perceived "loss of control", and a lack of in-person assessments and weight controls as the main contributing factors for the deterioration in AN numbers and symptomatology. Conclusions The COVID-19 pandemic seems to have had a deep impact on symptom severity in AN, which is mirrored by a large increase in admission rates across Europe. An increase in exercise, social media consumption, a perceived "loss of control", and a lack of face-to-face health care seem to have contributed to this development. Further investigation is required to identify which factors may lead to the increase in incidence and deterioration of childhood and adolescent AN. Possible preventive means for the future could include educating paediatricians and health care workers about AN, regular weight assessment, and home-based treatments. Keywords: COVID-19 pandemic, Anorexia nervosa, Hospital admissions, Europe
Background Young patients suffering from anorexia nervosa (AN) frequently need further treatment in Adult Mental Health Services (AMHS). The transition period from Child and Adolescent Mental Health ...Services (CAMHS) to AMHS is a critical time, with a high risk of disengagement from healthcare. We explored physicians' perspectives of the transition to triangulate the multiple perspectives of physicians, parents and those with a lived AN experience to more comprehensively characterize the challenges in this process of treatment transition. Methods Using purposive sampling, we recruited 16 physicians confronted with transition in AN (adult psychiatrists, child and adolescent psychiatrists and pediatrician) and conducted semi-structured interviews, which were anonymized, transcribed, and analyzed following the reflexive thematic analysis framework. Results Our analysis produced three main themes. First, a shared agreement on the transition's malfunction, where participants depicted transition as a dissatisfying, violent event. Second, the conception of AN as a disorder with specific needs, challenging the transition process especially regarding physicians' engagement. Finally, the ideal transition conceived as a serene experience of separation, with unanimous agreement on the necessity to start the transition depending on patients' needs rather than their age, in order to turn transitions into moments of care. Conclusion Our results are in line with other qualitative research studying transition in AN and in other chronic diseases, either focusing on the experience of healthcare workers, families, or patients. Our research shows transition in AN as an anxiety-inducing experience for physicians, patients and families alike. Moreover, we highlight a gap in the way physicians perceive and assist the patient's greater autonomy, depending on their specialty. Helping physicians to manage their patient's autonomy, which is a cornerstone of the transition readiness concept, could be a very efficient way to improve transitions in AN. Plain English summary Anorexia Nervosa (AN) is a severe disease, which most of the time starts during adolescence. Transition from Child and Adolescent Mental Health Services to Adult Mental Health Services is at risk of disengagement from healthcare. In order to better understand this process, we interviewed expert physicians about their experiences of transition in AN using a qualitative thematic analysis which highlighted three main themes. First, a shared agreement on the transition's malfunction. Second, the conception of AN as a disorder with specific needs challenging the transition process. Finally, the ideal transition conceived as a serene experience of separation, which needs to be started depending on patients' needs rather than their age. We also show differences in the way physicians perceive and assist the patient's greater autonomy acquired during the transition. Helping physicians to support their patients in acquiring autonomy, which is a cornerstone of the transition readiness concept, could be a very efficient way to improve transitions in AN. Keywords: Adolescent, Young adult, Anorexia nervosa, Transition to adult care, Psychiatrists, Mental health services, Qualitative research
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