Bullying behaviour and substance abuse among underage psychiatric inpatient adolescents

Background and objectiveOnly a few studies have examined the putative association between substance use and bullying others, and to our knowledge none of the previous studies have investigated substance abuse among victims or those who are both bullies and victims. The aim of our study was to investigate substance use among all of these three bullying subgroups and to examine the putative association between substance use and bullying behaviour.MethodsThe study sample consisted of 508 Finnish adolescents (age 12–17) admitted to psychiatric inpatient care between April 2001 and March 2006. We used the Schedule for Affective Disorder and Schizophrenia for School-Age Children Present and Lifetime (K-SADS-PL) to obtain DSM-IV psychiatric diagnoses, information about bullying behaviour and substance abuse of the adolescents. The level of nicotine dependence (ND) was assessed by using the modified Fagerström Tolerance Questionnaire (mFTQ).ResultsOur study showed that both among boys and girls, regular daily smoking and alcohol use among boys were statistically significantly associated with bullying behaviour. Further, among girls, but not among boys, there was also an association between bullying behaviour and more severe substance use, such as ND, use of cannabis and hard drugs.ConclusionSince an association between bullying and severe substance use was found in this study, our novel finding needs replication in adolescent general population samples.     

Psychological functioning and psychiatric morbidity in an elderly urban population in Greece

Summary As part of a systematic epidemiological survey of mental disorders in two Athenian boroughs, a probability sample of 251 elderly community residents was examined by a psychiatrist. For the assessment of their mental health, symptom screening scales were used (Langner and CES-D). Cognitive functioning was also evaluated. An overall psychological functioning profile was composed from previously derived mental health levels. Clinical diagnostic examination was based on a semi-structured schedule (PEF) supplemented by DSM-III criteria.A higher proportion of females than males were characterised as psychologically impaired, reporting nonspecific symtoms of distress. Older respondents of lower socioeconomic status experiencing stressful life events, such as living alone or having been exposed to migration in the past, exhibited a significant degree of psychopathology. Of the sample, 20.3% was diagnosed as suffering from a specific psychiatric illness. The prevalence of organic mental disorders was 5.6% and affective disorders of any type constituted nearly half of the diagnosed psychiatric cases. The implications of this survey are of great importance for the design and the development of preventive strategies and community-based interventions.     

Caregiver burden and correlates among caregivers of children and adolescents with psychiatric morbidity: a descriptive cross sectional study

Objective: To determine levels and correlates of caregiver burden among caregivers of children and adolescents with psychiatric morbidity.

Method: Over a period of four months, a total of 252 caregivers of children and adolescents with psychiatric morbidity were recruited. Data on socio-demographic factors, psychiatric morbidity among caregivers, and level of caregiver burden was collected using a researcher-designed socio-demographic questionnaire, Mini International Neuropsychiatric Interview, and Zarit burden interview, respectively. Data was analysed using statistical package for social sciences (SPSS) version 21.

Results: Females (n = 211, 83.7%) and mothers (n = 182, 72.2%) accounted for the majority of the study participants. The majority of caregivers reported moderate to severe caregiver burden; (n = 100, 39.7%). Being single or separated (B = ?6.91, p = 0.001, β = ?0.18) and presence of psychiatric morbidity (B = 7.44, p = 0.009, β = 0.22) in the caregiver significantly contributed to the high levels of caregiver burden.

Conclusion: Caregivers of children and adolescents with psychiatric morbidity suffer high levels of caregiver burden. A multidisciplinary approach to management of children with psychiatric morbidity to address challenges faced by the caregivers may alleviate the burden; thereby improving clinical outcomes of children and adolescents with psychiatric morbidity.     

Autistic-like behaviour profile and psychiatric morbidity in Fragile X Syndrome

In subjects with Fragile X Syndrome (FXS), the mutation of Fragile X Mental Retardation Type 1 ( FMR-1) gene at Xq27.3 predisposes to Mental Retardation (MR), autistic-like behaviour and to a variety of psychiatric syndromes. However, the longitudinal course of autistic-like behaviour profile and psychiatric morbidity is untested. In this study, we followed up people with FXS for 10 years to establish the stability of their autistic- like behaviour profile and psychiatric morbidity. The autisticlike behaviour profile was assessed using Brief Disability Assessment Schedule (B-DAS) and relevant items from Handicaps, Behaviour and Skills (HBS) Schedule. The psychiatric morbidity was assessed using data from the case notes, Mini Psychiatric Assessment Schedule for Adults with Developmental Disability (Mini PAS-ADD) and clinical interview. Our findings suggest that the autistic-like behaviour pattern is a stable phenotypic feature of FXS, but for increase in resistance to change over time. There is a tenfold increase in the prevalence of psychiatric morbidity in FXS compared to the general population, which does not increase significantly over time.     

Bullying, depression, and suicidality in adolescents

OBJECTIVE: To assess the association between bullying behavior and depression, suicidal ideation, and suicide attempts among adolescents. METHOD: A self-report survey was completed by 9th- through 12th-grade students (n = 2342) in six New York State high schools from 2002 through 2004. Regression analyses were conducted to examine the association between being victimized and bullying others with depression, ideation, and attempts. RESULTS: Approximately 9% of the sample reported being victimized frequently, and 13% reported bullying others frequently. Frequent exposure to victimization or bullying others was related to high risks of depression, ideation, and suicide attempts compared with adolescents not involved in bullying behavior. Infrequent involvement in bullying behavior also was related to increased risk of depression and suicidality, particularly among girls. The findings indicate that both victims and bullies are at high risk and that the most troubled adolescents are those who are both victims and bullies. Psychopathology was associated with bullying behavior both in and away from school. CONCLUSIONS: Victimization and bullying are potential risk factors for adolescent depression and suicidality. In evaluations of students involved in bullying behavior, it is important to assess depression and suicidality.     

Comorbid psychiatric disorders, sex, and methamphetamine use in adolescents: a case-control study

The purpose of this case-control study was to elucidate the relative proportions of amphetamine use disorder (AUD) and amphetamine-induced disorder (AID) in a group of adolescents with the use of methamphetamine (MAMP) and to examine the risks for psychiatric comorbidity and sex for MAMP use. Psychiatric comorbidity in the preceding year was determined for 200 adolescent MAMP users and 400 drug-free control subjects by diagnostic interview using the Kiddie epidemiologic version of the Schedule for Affective Disorders and Schizophrenia. The proportions of AUD and AID were calculated, and the association between psychiatric comorbidity, sex, and MAMP use was assessed. The results revealed that among the MAMP users, 65 subjects (32.5%) had AUD, whereas 19 (9.5%) had AID. Early use of MAMP use was seen in AUD, whereas high-frequency MAMP use was associated with the occurrence of AID. Alcohol, nicotine, and betel nut use disorders were more prevalent in MAMP users for both sexes. By applying conditional logistic regression analysis, it was demonstrated that MAMP use was associated with conduct disorder in males, whereas in females, it was associated with conduct disorder and adjustment disorder. The results indicated that age of first use and subsequent frequency of MAMP use appeared to be associated with the development of amphetamine-related disorders. Sex differences in the association between psychiatric comorbidity and MAMP use were demonstrated. These factors have to be taken into consideration when intervening for adolescent MAMP use.     

Carnitine levels in valproic acid-treated psychiatric patients: a cross-sectional study

BACKGROUND: Carnitine facilitates the transport of long-chain fatty acids across the mitochondria for beta oxidation, and the removal of potentially toxic acylcoenzyme-A metabolites from the inner aspect of mitochondrion as acylcarnitines. Previous studies suggest a significant decrease in carnitine concentrations and changes in the ratio of acylcarnitine to free carnitine in seizure-disoriented patients treated with valproic acid (VPA), which may lead to clinical manifestations of carnitine deficiency. This study sought to explore whether the same decrease in plasma free carnitine and increase in acylcarnitines are seen when VPA is used in the treatment of patients with psychiatric disease. METHOD: Thirty psychiatric patients treated with VPA for at least six months were selected for the study and granted informed consent for participation. Exclusion criteria included liver disorder or pancreatitis, metabolic defects known to affect plasma carnitine levels, or noncompliance with VPA regimen. Plasma free carnitine, total carnitine, VPA, and amylase levels were determined, and liver function tests (LFTs) were performed. Pearson correlations were conducted between VPA levels, levels and ratios of carnitines, as well as LFTs and amylase levels. RESULTS: Plasma free and total carnitine levels were lower than the reported normal range for the laboratory performing the assay, and the ratio of acylcarnitine to free carnitine was increased. There was a significant positive correlation of VPA levels and acylcarnitine-free carnitine ratio, a trend toward significance between VPA levels and acylcarnitine levels, and a marginal negative correlation between VPA levels and free carnitine levels. VPA levels correlated also with several LFTs and acylcarnitine levels. Octanoyl carnitine and acylcarnitine levels, as well as acylcarnitine-free carnitine and octanoyl-free carnitine ratios, correlated significantly with amylase levels. CONCLUSION: Although the study was limited by a cross-sectional design without direct control comparison, the findings suggest that patients with various psychiatric conditions treated with polypharmacy that includes VPA may have lower plasma carnitine levels than would be expected in healthy controls.     

Substance use among Danish psychiatric patients: a cross-sectional study

Background: Patients with psychiatric disorders have a greater risk of mortality than the general population. Use or abuse of substances, including alcohol, play a crucial part in this context. Moreover, it is well known that drug use can worsen psychopathology and reduce treatment compliance. However, the magnitude of these problems among Danish psychiatric patients has not been studied previously.

Aims: The aim of this study is to investigate substance use among psychiatric patients in the Capital Region of Denmark.

Methods: Outpatients from five psychiatric units were asked to complete a questionnaire regarding their use of alcohol and other drugs of abuse. The questionnaire was based on the Alcohol Use Disorder Identification Test (AUDIT), supplemented by questions regarding use of tobacco and illicit drugs. The results were compared with those uses in the general population.

Results: In total, 412 psychiatric patients participated in the study, and 33% had an AUDIT-score ≥8, indicating problematic alcohol use according to the AUDIT guidelines. The mean weekly alcohol intake was 9.7?±?28.3 standard drinks, and 47% were current smokers with a mean daily use of 19.9?±?13.8 cigarette equivalents. Compared to the general population, the psychiatric patients had higher odds of being current smokers and having used illicit drugs within the past month. Women with psychiatric disorders were twice as likely to binge drink on a monthly basis. No significant difference was found in the patients’ AUDIT scores compared to the general population.

Conclusions: Our findings demonstrate a substantial and problematic use of tobacco and illicit drugs among Danish psychiatric patients, greater than in the general population.     

Education as a social pathway from parental socioeconomic position to depression in late adolescence and early adulthood: a Finnish population-based register study

Purpose

There is inconsistent evidence for social differentials in the risk of depression in youth, and little is known about how education at this age influences the risk. We assess how parental socioeconomic position (SEP) and education predict depression from late adolescence to early adulthood, a time of major educational transitions.

Methods

We followed a nationally representative 20 % sample of Finnish adolescents born in 1986–1990 (n = 60,829) over two educational transitory stages at the age of 17–19 and 20–23 covering the years 2003–2011. We identified incident depression using health care register data. We estimated the risk of depression by parental SEP and personal education using Cox regression, adjusting for family structure, parental depression and the individual’s own psychiatric history.

Results

Lower parental income was associated with up to a twofold risk of depression. This effect was almost fully attributable to other parental characteristics or mediated by the individual’s own education. Educational differences in risk were attenuated following adjustment for prior psychiatric history. Adjusted for all covariates, not being in education increased the risk up to 2.5-fold compared to being enrolled in general upper secondary school at the age of 17–19 and in tertiary education at the age of 20–23. Vocationally oriented women experienced a 20 % higher risk than their academically oriented counterparts in both age groups.

Conclusions

Education constitutes a social pathway from parental SEP to the risk of depression in youth, whereby educational differences previously shown in adults are observed already before the establishment of adulthood SEP.

     

Gender differences in psychiatric morbidity and violent behaviour among a household population in Great Britain

Background Men are more violent than women. It is unclear whether psychiatric morbidity contributes to this gender difference in the general population. This study examined gender differences in psychiatric diagnosis and violent behaviour to test whether risk from psychiatric morbidity accounted for gender differences in violent behaviour; whether violent males were more vulnerable to risk from psychiatric morbidity; and, whether violent women surmounted a higher threshold of risk from psychiatric morbidity. Methods Cross-sectional random sample of 8,397 household residents in Great Britain was assessed using structured questionnaires to measure violent behaviour and psychiatric morbidity. Weighted multilevel regression models were used to test hypotheses, adjusting for demographic factors, psychiatric comorbidity and area effects of violence. Results Men were more likely to report violence than women and were exposed to greater risks from substance dependence, Antisocial Personality Disorder (ASPD) and hazardous drinking. Women were exposed to greater risks from affective/anxiety disorders. Psychiatric morbidity explained 22% of the gender difference in violence. Violent men were less vulnerable to risk from any Personality Disorder (PD), in particular ASPD, than violent women. Violent women reported a higher etiological threshold for affective/anxiety disorders and any PD; violent men higher threshold for alcohol dependence and hazardous drinking. Conclusions Psychiatric morbidity has moderate impact on higher levels of violence among men. Antisocial Personality Disorder poses a greater risk for violence among women than men. Affective/anxiety disorders and any PD are more severe conditions among violent women; alcohol dependence and hazardous drinking are more severe among violent men, confirming the “Threshold of Risk” hypothesis.     

Gender and minor psychiatric morbidity: results of a case-control study in a developing country

OBJECTIVE: Women suffer from minor psychiatric disorders (MPM) more frequently than men. Most of the studies were conducted in England and in the United States and some reported the higher occurrence of MPM among women to be modified by marital status and others by sociodemographic variables. The present study intends to address this question in a developing country. METHOD: A population based case-control study was conducted in three important urban centers in Brazil. Two hundred seventy-six individuals diagnosed as new cases of MPM and 261 controls were selected to investigate the role of a set of sociodemographic variables in the association between gender and MPM using logistic regression models. RESULTS: Univariate analysis showed that women were more likely than men to suffer from MPM (OR = 3.34; 2.27-4.91). After controlling for other sociodemographic variables, female gender was still positively associated with MPM, but not in a homogeneous way. A multiplicative interaction of gender with age group was found (LRT = 6.01; 2 df; p = 0.05) suggesting an increment in the magnitude of the association among those older than thirty years. Odds-ratios were 2.33 (1.19-4.55), 6.85 (2.86-16.41), and 7.47 (2.90-19.22) for age groups of fourteen to twenty-nine; thirty to forty-four; forty-five or more, respectively. There was no evidence of interaction of gender with marital status or other sociodemographic variables. CONCLUSIONS: The findings are consistent with the modification of the association between gender and MPM being mediated by social factors.     

Epileptic morbidity: psychiatric sequelae in the family--a case study

Psychiatric complications associated with the epileptic patient have often been referred to in the literature; however, psychiatric sequelae occurring in the family of an epileptic patient have received far less attention. In this case study, the author presents such an example and suggests that neuropsychiatrists treating the epileptic patient be aware that significant psychiatric sequelae may exist in the family.     

Medical and psychiatric comorbidity in psychiatric beds in general hospitals: A cross-sectional study in Tokyo

Aims:  Although somatic diseases in psychiatric patients are increasing with the increase of the aged population, psychiatric wards in general hospitals in Japan have progressively been decreasing. The purpose of this cross-sectional study was to clarify whether psychiatric beds in general hospitals play sufficient roles in medical comorbidities of psychiatric patients or not.
Methods:  This was a cross-sectional study performed all over Tokyo during the 2-month period from April to May 2007. The total number of patients who require admission due to both somatic and psychiatric diseases was investigated with their demographic and clinical characteristics.
Results:  The total number of patients admitted to psychiatric beds in general hospitals for the above-mentioned reason was 326, while the number of patients who could not be admitted to them despite the same reason was 88. The rate of surgical diseases in the latter group was higher than that in the former group. In the latter group, diseases requiring orthopedic surgery (22%) and abdominal surgery (22%) were the most frequent, followed by gastrointestinal and hepatic diseases (8%), and gynecological diseases (7%). Patients who had attempted suicide were included more in the latter group than in the former group. Even in the former group, general hospitals could not respond to 34% of requests for emergency admission.
Conclusion:  Psychiatric beds in general hospitals do not necessarily function for medical comorbidities in psychiatric patients, especially in severe and emergency cases. Not only the quantity but also the quality of psychiatric wards in general hospitals should be reconsidered.     

Mental health of asylum seekers: a cross-sectional study of psychiatric disorders

ABSTRACT: BACKGROUND: Asylum procedures are known to be protracted, stretching to over ten years in many host countries. International research shows high levels of distress for asylum seekers. Little is known about actual psychiatric morbidity in this population, especially during the first few years postmigration. METHODS: The mental health status of two groups of asylum seekers was assessed: Group 1 (n = 43) had arrived in Switzerland 2.9 (SD 1.1) months prior to assessment, while Group 2 (n = 43) had arrived 15.5 (SD 3.2) months prior to assessment. Psychiatric disorders were diagnosed using the Mini International Neuropsychiatric Interview (MINI). Symptom severity of posttraumatic stress disorder (Posttraumatic Diagnostic Scale), anxiety (Hopkins Symptom Checklist), depression (Hopkins Symptom Checklist), and pain (Verbal Rating Scale) were assessed using self-report questionnaires. Post-migratory factors such as German language proficiency and social contacts were also assessed. Interviews were conducted with the assistance of trained interpreters. RESULTS: Four out of ten participants met diagnostic criteria for at least one DSM-IV disorder. Groups did not differ with respect to psychiatric morbidity or symptom levels. Major depression (31.4%) and PTSD (23.3%) were diagnosed most frequently. The number of experienced traumatic event types was highly correlated with psychiatric morbidity. CONCLUSIONS: Psychiatric morbidity in asylum seekers in the first two years after arrival is high, with no indication of a decrease in mental distress over time. Traumatic experiences seem to play a major role in morbidity during this time. Considering the magnitude of clinically relevant distress, a short psychological screening upon arrival with a focus on traumatic experiences may be warranted.     

Normative values of polysomnographic parameters in Chinese children and adolescents: a cross-sectional study

ObjectiveThe objectives of this study were to characterise age-specific normal polysomnography values in healthy children and to establish reference values for paediatric sleep studies.MethodsHealthy children and adolescents aged 3–14 years were recruited from families of hospital employees. The subjects were divided into young (three to five years old) and old (6–14 years old) groups. Each child was subjected to overnight polysomnography. The polysomnographic parameters of sleep architecture, respiratory events and oxygen saturations of the two groups were compared.ResultsNinety-nine subjects, including 33 3–5 year olds and 66 6–14 years olds, were recruited. The old group yielded a higher per cent of N2 sleep and lower per cent of R sleep than the young group. Sleep efficiency and latency were similar between the two groups. The average of the total apnoea/hypopnoea index (AHI) was different between the two groups (1.02 ± 0.99 vs 0.51 ± 0.57, p = 0.007). The average central apnoea index (CAI) in the young group was higher than that of the old group (0.7 ± 0.82 vs 0.28 ± 0.42, p = 0.001), with 97.5 percentile of 3.8 and 1.4, respectively. The obstructive apnoea index (OAI) and obstructive apnoea hypopnoea index(OAHI) were similar in the two groups (OAI: 0.08 ± 0.12 and 0.07 ± 0.14, and OAHI: 0.18 ± 0.21 and 0.19 ± 0.26, respectively). The mean lowest SaO₂ in the young group was significantly lower than that of the old group because of central apnoea events.ConclusionsThe findings were consistent with previously published data regarding sleep architecture, oxygen saturations, and relative rarity of respiratory events in normal children. The occurrence of central apnoea varied with age. Therefore, it is suggested that different normal cut-off values be used for children in different age groups.     

Healthcare utilization and psychiatric morbidity in violent offenders: findings from a prospective cohort study

Social Psychiatry and Psychiatric Epidemiology - Although persistent offenders with histories of imprisonment and violence have disproportionate high rates of psychiatric disorders, little is known...     

The overlap between psychiatric symptoms and challenging behaviour: a preliminary study

Increasingly, challenging behaviour is explained by way of psychiatric symptomatology. This poses possible pitfalls. First, the possibility exists that both psychiatric symptoms and challenging behaviour are concurrent expressions of common underlying factors. Second, psychiatric symptoms may be rated as present on the basis of challenging behaviour, which may render it more difficult to explain the latter by way of the former. The present study was conducted in order to investigate possible overlaps between psychiatric symptoms and challenging behaviour, when symptoms are rated by caregivers. The results indicate considerable overlaps. Implications for explaining challenging behaviour are discussed, as well as limitations of the study, first and foremost the use of untrained assessors and small sample size.