Welcome to the 22nd WCP Congress Program Scheduling

Objectives

The study aimed to explore the associations, (and possible mediation) between the psychosocial impact of the COVID 19 pandemic in India, depressive symptomatology, anxiety/stress levels, and disordered eating behaviours among adults aged between 18 and 35 years.

Methods

This was a community-based, cross-sectional study, conducted via an online questionnaire, in August 2021. Coronavirus Impact Scale (CIS), Depression, Anxiety, Stress Scale (DASS-21), SCOFF questionnaire, and Three-Factor Eating Questionnaire-Revised 18-item version (TFEQ-18) were used. To explore the relationships among psychosocial COVID-19 pandemic impact, psychological distress variables, and disordered eating behaviours, mediation effects were tested using PROCESS v4.0.

Results

Out of 101 valid responses, 51% of subjects reported mild changes in daily routine and 49% reported stress and discord in their families due to the pandemic. Almost 10% of the respondents reported features suggestive of moderate depression and anxiety, while almost 20% of the participants suffered from a likely eating disorder, requiring further clinical evaluation. A positive association was observed between the scores of coronavirus impact scale and that of depression (r=0.366, p<0.001), anxiety (r=0.402, p<0.001), stress (r=0.416, p<0.001) and uncontrolled eating (r=0.198, r=0.047). Also, on mediation analysis, the pandemic was found to have a significant indirect effect on disordered eating patterns (b=0.104, CI=0.09, 2.17).

Conclusions

The COVID-19 pandemic has caused significant psychological distress and has, indirectly mediated disordered eating patterns among the younger population who are already at higher risk for developing mental disorders. Thus, mandatory screening for mental disorders becomes imperative for clinicians in order to formulate targeted community interventions in the long term.

Objectives

The Micronutrients for ADHD in Youth (MADDY) study investigated efficacy and safety of a multinutrient supplement (vitamins, essential minerals and antioxidants) to treat symptoms of ADHD and emotional dysregulation in children age 6 to 12 with ADHD.

Methods

A multi-site double blinded randomized control trial of a 36-ingredient multinutrient product vs placebo (3:2 ratio) for 8 weeks. Outcome measures included: 1) the clinician rated Clinical Global Impression (CGI); 2) parent reported Child and Adolescent Symptom Inventor-5 (CASI-5) 3) safety data using the Pediatrics Adverse Events Scale (PAERS).

Results

Of 135 enrolled in the trial, 126 children had an assessment after starting treatment, comprising the intention-to-treat (ITT) population. On the CGI-I, 54% of those assigned micronutrients vs. 18% of the placebo group were responders (CGI-I<3) (Cramer’s V=0.37, p<0.001). The parent-rated CASI-5 composite scores did not differ between groups (p=0.70); both improved from baseline (p<0.01). PAERS analysis revealed micronutrient group to have a greater overall improvement in the combined score than the placebo group with a between-group difference in change of –0.36 (95% CI: -0.67, -0.04; p=0.03) with ITT data and –0.48 (95% CI: -0.81, -0.15; p=0.005) with per-protocol data.

Conclusions

Clinicians’ rated outcomes showed higher proportion of responders in the micronutrient group compared to placebo while parental reported outcomes found improvement of overall symptoms from baseline to end of RCT but no difference between groups. The multi-nutrient supplement did not result in more adverse events with respect to psychiatric symptoms than placebo, suggesting it is a safe intervention.

Objectives

Children born in the last months of the year are more likely to be diagnosed with ADHD. This relative age effect has been demonstrated in numerous countries and it is believed that it can be explained by the relative immaturity demonstrated by these children when compared to classmates. To the best of the author’s knowledge, this effect has never been reported in Portugal.

Methods

We gathered data regarding the presence of an ADHD diagnosis and month of birth relative to 1876 children and adolescents followed in our child and adolescent psychiatry outpatient clinic in northern Portugal between December 2011 and December 2021.

Results

Children and adolescents born in the second semester of the year had a higher probability of having an ADHD diagnosis, risk ratio = 1,237 (95% CI 1,037-1,477). Those born between August and October were even more likely to have an ADHD diagnosis, risk ratio = 1,315 (95% CI 1,101-1,572). This may be because children born after the September school entry cut-off may delay their entry for one year. We speculate that children born in November and December are specially likely to delay their entry and become the oldest in their classroom instead, making those born in the August-October period the youngest in the classroom. This would explain their increased probability of being diagnosed with ADHD.

Conclusions

This is the first time the relative age effect for ADHD diagnosis is reported in Portugal. These results suggest that the month of birth should be considered when diagnosing ADHD.

Objectives

About 30% of children and 60-80% of adults with Attention Deficit Hyperactivity Disorder (ADHD) have related Sleep Disorders. Its prevalence, clinical impact and the specific implications for therapy for both disorders makes this a relevant topic.

Methods

A brief non-systematized review on the subject, using the most current literature available on PubMed and Google Scholar.

Results

A wide variety of sleep disturbances are found in ADHD – daytime hypersomnia, changes in sleep architecture, restless legs syndrome, periodic limb movement disorder, obstructive sleep apnea syndrome, circadian rhythm disturbances and early insomnia.

The impact of stimulant therapy on sleep quality cannot be underestimated, especially its approach.

It is difficult to establish whether sleep disorders are intrinsic to ADHD or if they occur as comorbidities. Sleep disorders can even have similar symptoms to ADHD and lead to misdiagnosis. A conceptual model for the relationship between ADHD and sleep disorders will be discussed, not forgetting common etiological and genetic background.

Conclusions

The relationship between ADHD and sleep disorders is complex and bi-directional, with confounding factors such as ADHD pharmacotherapy and other psychiatric comorbidities. Although there is little doubt about the impact of ADHD on sleep and the importance of its treatment, the exact association between sleep disorders and ADHD remains unclear.

Objectives

Humans are ubiquitously exposed to air pollutants, including polycyclic aromatic hydrocarbons (PAH). In developmental models, risk markers of internalizing problems include behavioral inhibition and altered cognitive control, which are influenced by prenatal exposure to PAH in animal models. We examine the mediating effects of shyness as a measure of behavioral inhibition, and the moderating effects of anterior cingulate cortex (ACC) activity during cognitive control on associations between prenatal PAH exposure and child internalizing problems.

Methods

Fifty-three participants from a prospective longitudinal birth-cohort (N=126) were old enough to participate. Personal air monitoring in the third trimester of pregnancy measured prenatal PAH. Emotionality Activity Sociability Temperament Survey measured shyness at age 5. Child Behavior Check List measured internalizing problems at age 7-9. General linear models included a regressor for correct trials parametrically modulated by trial-wise reaction time (RT) during the Simon Spatial Incompatibility Task at age 7-9 (n=30). Linear regression tested ACC [xyz=−6,12,48]-RT modulation of PAH-related effects on internalizing problems and mediating effects of shyness (covariates: motion, sex, age, income, tobacco exposure).

Results

Shyness positively predicted internalizing problems and mediated PAH-related internalizing problems (β=.15, 95% CI_mediation: .02 to .32). ACC activity moderated PAH-related internalizing problems; PAH predicted internalizing problems when children showed greater ACC-RT activation, indicating higher monitoring during cognitive control (β = .30, p_interaction=.04).

Conclusions

Prenatal PAH exposure increased shyness, increasing risk for internalizing problems; PAH-related internalizing problems were present only in children who showed higher monitoring during cognitive control. Reducing exposure to air pollution may thus improve child mental health outcomes globally.

Objectives

To review the literature regarding the artistic movement of abstract expressionism in order to understand, and then characterize, the prevalence of psychopathological symptoms/mental ilness among the main artists.

Methods

We conducted a MEDLINE search using mental illness, abstract expressionism, Rothko, Pollock and Gorky as keywords, selecting studies written in English.

Results

The notion that creativity is somehow related to psychopathology has become an axiom in Western culture. Abstract expressionism arose in New York after the Second World War. It was the first artistic American movement to achieve international influence and it is based on portraying elements that do not represent any real objective shapes, through lines, colors, tones and textures. It is a form of art infused with strong emotional and expressive content, often characterized by gestural brushstrokes and dripped and splattered paints onto a large canvas. Some authors suggested that artistic creation in abstract expressionists was based on psychic automatism, which involves involuntary actions. Behind the spectacular success of abstract expressionism lies individual cost and dysfunction: more than half of New York expressionists sought psychiatric treatment, required hospitalization or committed suicide. Here we talk about Jackson Pollock, Mark Rothko and Arshile Gorky.

Conclusions

We are inundated with historical anecdotes fueling the stereotype of the suffering artist and the mad genius, however empirical evidence is limited. The prevalence of the assumption impacts the way that we view creativity in others and in ourselves - “The Irascible Eighteen” are an example of that.

Objectives

Previous research on the general population has shown that loneliness in children has been associated with the subsequent onset of depressive symptoms and internalizing problems. However, there is a paucity of research regarding loneliness in school-aged neurotypical siblings of individuals with Autism Spectrum Disorder (ASD). This study aimed to investigate ASD-siblings feelings of loneliness in comparison to a group of age and sex matched controls.

Methods

233 school-aged children participated in this study and divided into two groups -118 siblings of children with ASD (ASD-group) and 115 siblings of typically developing (TD) children (comparison group). Participants answered a demographic questionnaire and the Children’s Loneliness and Social Dissatisfaction Questionnaire (LSDQ). Logistic regression was performed to compare the two groups in terms of siblings’ feelings of Loneliness and Social dissatisfaction after controlling for demographics.

Results

A marginal difference, X2 (4, N=233) =9.90, p=.042 was found in (TD) sibling’s age, due to significantly lower frequency of children age class above 12 yrs (N=4; 3.5%) in the comparison group. Results showed that ASD-siblings in the present study scored higher in the LSDQ (mean total score in LSDQ was 28.40±11.31) than siblings of TD children (mean total score in LSDQ was 23.24±6.74).

Conclusions

The significant differences found regarding these feelings between the two groups (ASD vs comparison) constitutes a novel finding, shedding further light in ASD-research and paving the way for new research queries. Further, assessing loneliness in school-age ASD-siblings could be informative in identifying children at risk for adjustment or emotional problems later in life.

Objectives

Introduction: This work consists of a systematic review that focuses on the role of community violence, as a contextual factor, in the development of mental disorders in adolescents and young adults. Objective: to evaluate the impact of community violence on internalizing mental health symptoms in adolescents and young adults, to investigate whether be a witness or a victim is associated with different risks, and to identify whether gender, age, and race moderate this association.

Methods

Methods: systematic review of observational studies. The population includes adolescents and young adults (10-24 years), exposure involved individuals who experienced community violence, and outcomes consist of internalizing mental health symptoms. Selection, extraction and quality assessment were performed independently by two researchers.

Results

Results: A total of 2,987 works were identified; after selection and extraction, 42 works remained. Higher exposure to community violence was positively associated with internalizing mental health symptoms. Being a witness is less harmful tor mental health than being a victim. Few studies tested age and race as modifiers, but the one who tested race found that Latins and black adolescents had more internalizing symptoms than white young people at the same level of exposure to community violence. Male gender and family support appear to be protective factors in other studies.

Conclusions

Conclusion: This review confirms the positive relationship between community violence and internalizing mental health symptoms in adolescents and provides relevant information that can direct public efforts to build policies in the prevention of both problems.

Objectives

Neurodevelopmental disorders (NDDs) are a serious and complex health concern starting from childhood and affecting around 15% of children and adolescents worldwide, leading to impaired cognition, communication, adaptive behaviour, and psychomotor skills. However, a systematic understanding of the aetiology of NDDs, their co-occurrence, and co-occurrence with other conditions during childhood and adolescence remains incomplete. This meta-analysis bridges gaps in our knowledge. First, we meta-analysed the literature on the relative contribution of genetic and environmental factors to NDDs. Second, we considered the literature on the overlap between different NDD categories. Lastly, we synthesized the literature on the co-occurrence between NDDs and disruptive, impulse control and conduct disorders (DICCs).

Methods

We performed multilevel, random-effects meta-analyses on 296 independent studies, including over 4 million children and adolescents.

Results

We found all NDDs to be substantially heritable (family-based heritability= 0.66; SNP heritability= 0.19). Grand family-based heritability estimates differed, albeit not significantly, across NDDs, ranging from 0.86 for intellectual disabilities to 0.62 for specific learning disorders. SNP heritability ranged between 0.15 for autism spectrum disorder to 0.30 for communication disorders. Meta-analytic genetic correlations between NDDs, and between NDDs and DICCs were moderate to strong. However, given the paucity of available studies covering the co-occurrence of NDDs and DICCs, these could only be estimated for a few disorders.

Conclusions

While our work provides direct evidence to inform and potentially guide clinical and educational diagnostic procedures and practice, it also highlights the imbalance in the research effort that has characterized developmental genetics research.

Objectives

Mental Health Long Term Care (MH-LTC) allows patients with severe mental illness to undertake psychosocial rehabilitation, in order to regain their autonomy and reintegration into the community in which they live. In Portugal, MH-LTC is constituted by residential and outpatient structures, according to patients’ needs, their degree of psychosocial disability, and their socio-family support.

This work aims to analyze the referrals made to the Portuguese MH-LTC from its establishment, in 2017, until 2019.

Methods

A national retrospective observational study was carried out based on the analysis of Portuguese secondary data, between April 2017 and December 2019, related to the referrals to the MH-LTC.

Results

During the analyzed study period, there were 669 referrals to the MH-LTC, of which 376 were made for residential structures and 293 for ambulatory structures. There was a greater number of referrals from the North (n=330) and the Lisbon and Tagus Valley (n=203) regions of Portugal. With regard to the type of institution from which the referral was made, general hospitals present the highest number (n=305).

Conclusions

Still in the initial stage of development in Portugal, the MH-LTC could be a fundamental resource. Health professionals’ perception of the MH-LTC and its typologies can contribute to a greater number of referrals and, consequently, boost the MH-LTC growth and thus contribute to better outcomes in patients presenting with severe mental illness.

Objectives

Objectives: We leveraged the unique Swedish population-based registers to explore temporal trajectories of benzodiazepines and benzodiazepine-related z-drugs (BZDR) prescribing in different ages and the role of patient-related and prescriber-related predictors of distinct trajectories among the incident BZDR-recipients.

Methods

Methods: Data on the incident BZDR use in individuals aged 0-17, 18-64, and 65 years and older were retrieved from the Swedish Prescribing Drug Register. Temporal trajectories were built by means of the group based trajectory modelling based on the number of BZDR use days within each of 5 consecutive years. The multinomial logistic regression models were fitted to assess the predictors of distinct trajectory membership.

Results

Results: The proportion of individuals with the ‘discontinued’ trajectory was the largest in the youngest group (63.7%) and reduced to 30.9% in the elderly (see Figure 1A-C attached). Conversely, the ‘maintained’ trajectory membership considerably increased with age from 5.4% to 36.9%. In all ages, compared to the ‘discontinued’ trajectory membership, the strongest predictors of the ‘decreasing’, ‘slow decreasing’, and the ‘maintained’ trajectory memberships included prescriber-related factors, such as multiple initial BZDRs and concomitant prescribing of psychotropic, antiepileptic, and analgesic drugs. The predictive values of patient-related factors varied between ages.

Conclusions

Conclusions: A considerable number of BZDR-recipients maintained long-term use for several years with very slow reduction in the duration of treatment. The prescribing-related factors were most predictive of such pattern of BZDR use. This indicates the importance of raising prescribing caution and providing support to prescribers to make evidence-based decisions on initiating and monitoring BZDR treatment.

Objectives

To present results of comparative study documented high levels of traumatic stress among Canadian homelessness services frontline workers before COVID-19 with significant increase during the pandemic.

Methods

Staff from organizations serving persons experiencing homelessness in Calgary participated in a survey workplace mental health in 2015 and 2020-21. The 2015 data (pre-COVID) provided a baseline allowing for examination of increased stress due to the pandemic. The original survey included measures of direct and secondary traumatic stress, burnout, compassion satisfaction and prior traumatic experiences and the 2020-21 survey, expanded to an additional six Canadian cities, added measures of life-time traumatic experiences, adverse childhood experiences and resilience.

Results

Pre-pandemic (2016) rates of acute stress, indicative of PTSD, were 41% (N=312) and had risen to 47.3% (N=164) in the first city and to 51% nation-wide (N=574). Most respondents (75%) reported low-moderate levels of burnout in 2015 which remained relatively unchanged 2020-21. Similarly, most respondents reported high average levels of compassion satisfaction in both study years. Rates of PTSD symptoms were higher among workers in case manager/client coordinator roles than those shelter staff working “on the floor”.

Conclusions

The COVID pandemic exacerbated psychological injury from traumatic stress in frontline homelessness services staff. However, burnout did not increase, and compassion satisfaction remained high. This suggests that the primary dynamic is intrusive anxiety and emotional exhaustion associated with ubiquitous trauma induced by the COVID-19 pandemic. Case managers working at socially isolated locations had greater levels of PTSS, suggesting that traumatic response is aggravated by isolation from colleagues and other workplace supports.