Adolescent Psychiatry - Volume 13, Issue 2, 2023

Cannabidiol (CBD), a plant-derived cannabinoid compound found in cannabis, has been readily available in the United States since the legalization of hemp products in 2018. With all 50 states legalizing some form of CBD, many products have appeared in the marketplace. The American public generally considers CBD a safe and effective way to manage pain, mental health conditions, and other health issues in children and adults, even though CBD has only been approved for the treatment of specific types of pediatric seizures. This report describes early findings from preclinical CBD studies, select clinical trials, and naturalistic observational studies of CBD users and identifies knowledge gaps in this emerging field, especially those relating to the developmental effects of CBD. The main goal of this report is to identify priorities for future CBD research, particularly those that will benefit the field of child and adolescent psychiatry.

Background: COVID-19 pandemic restrictions resulted in psychosocial stress and increased potential for psychiatric disorders in the adolescent population. Adolescent psychiatric disorders are increasingly managed with psychotropic medications. We aimed to evaluate the first-time prescription rates of psychotropic medications128;”antidepressants, antipsychotics, hypnotics, sedatives, mood stabilizers, and psychostimulants128;”in adolescent patients during the COVID-19 pandemic compared to the years immediately prior.Methods: We utilized electronic health records, claims data, and pharmaceutical data generated from 68 healthcare organizations stored within the TriNetX Research Network to conduct a retrospective matched cohort study. Adolescent patients aged 10-19 years presenting for outpatient evaluation were placed into two cohorts: 1) outpatient evaluation before (2017-2019) and 2) during (2020-2022) the COVID-19 pandemic. Patients with prior history of psychiatric disorders and/or prior use of psychotropic medications were excluded. The main outcome was first-time psychotropic medication prescription within 90 days of outpatient evaluation. We used propensity score matching with logistic regression to build cohorts of equal size based on covariates of interest.Results: A total of 1,612,283 adolescents presenting before the COVID-19 pandemic and 1,008,161 adolescents presenting during the COVID-19 pandemic were identified. After matching on age, race/ethnicity, smoking status, and obesity status, a total of 1,005,408 adolescents were included in each cohort, each with an average age of 14.7 ± 2.84 years and 52% female and 48% male. The standardized differences between propensity scores were less than 0.1, suggesting a minimal difference between the two groups. Prescription rates for antipsychotics and benzodiazepines were increased for adolescents presenting during the pandemic (Risk Ratio (RR): 1.58, 95% confidence intervals (CI) 1.48-1.69). However, this group had decreased prescription rates for antidepressants (RR: 0.6, 95% CI 0.57-0.63), anxiolytics (RR: 0.78, 95% CI 0.75-0.81), psychostimulants (RR: 0.26, 95% CI 0.25-0.27), and mood stabilizers (RR: 0.44, 95% CI 0.39-0.49).Conclusion: Adolescents presenting for outpatient evaluation during the COVID-19 pandemic were prescribed antipsychotics and benzodiazepines at an increased rate relative to the years immediately prior, suggesting an increased need for sedation in this patient population. Given reduced access to care during the COVID-19 pandemic, the decreased prescription rate observed for other psychotropic medication classes does not necessarily reflect a decreased incidence of the associated psychiatric disorders.

Background: Communication disorders are associated with psychopathology and social distress in adolescents, yet moderate or less severe deficits often go undiagnosed. Data from a quality improvement initiative was analyzed from the Communication Perception Estimate Scale (CoPES), a self-report scale for receptive-expressive and pragmatic language deficits in youth receiving mental health services.Objective: To identify the frequency of communication deficits (CDs) among youth in psychiatric care and identify patterns of self-reported symptoms. The scale may be used as a clinical screening tool for Language disorder and Social (Pragmatic) communication disorder.Methods: CoPES is a 31-item scale administered to 318 adolescents 11-18 years old, asking questions about receptive-expressive and pragmatic CDs. In the first 12 items, subjects identified the frequency of communication disorder symptoms using a forced-choice scale; in the following items, frustration with CDs, yes or no for earlier intervention, and current interest in getting help for CDs. Respondents are from five representative clinical services.Results: Patients were divided into self-identified groups: 14.5% significant Receptive-Expressive deficits only (R-ED); 6.6% significant Pragmatic deficits only (PD); 29.9% Both significant Receptive-Expressive and Pragmatic deficits (BCD); and 49.1% with limited or no deficits (NCD). The R-ED group expressed high rates of frustration and requests for help with Receptive-Expressive deficits. The PD group reported elevated rates of frustration in both areas. The BCD group indicated significantly more frustration and requests for help with both language areas compared to the NCD group.Conclusion: This data supports the need for greater awareness and consideration of communication disorders in youth presenting for psychiatric care.

Background: Fear of Missing Out (FoMO) on social media has emerged as a significant concern, particularly among college students, with implications for mental well-being and internet use. While previous studies have explored various aspects of mindfulness about digital behaviors, the specific link between mindfulness and FoMO, as well as the potential mechanisms involved, remains underexplored.Objective: Guided by the Conservation of Resources (COR) theory and the Interaction of Person-Affect-Cognition-Execution (I-PACE) model, this study investigates the relationship between mindfulness and FoMO among Chinese college students. Additionally, it explores the mediating roles of cognitive bias and the need to belong in understanding how mindfulness influences FoMO.Methods: Data was collected from 748 university students from two universities in China. Participants completed questionnaires assessing mindfulness, cognitive bias, the need to belong, and FoMO. Statistical analyses, including mediation models and bootstrapping, were conducted using SPSS 25.0 and the PROCESS macro version 3.3.Results: The SPSS PROCESS macro Model 4 analysis revealed that the relationships between mindfulness and FoMO (β=-.011, p=.738) and between Attention to Positive Information (API) and FoMO (β=.029, p=.383) were nonsignificant. Mindfulness exhibited negative associations with Attention to Negative Information (ANI) (β=- .250, p<.001) and the need to belong (β=-.254, p<.001) and positive associations with API (β=.268, p<.001). Furthermore, ANI positively correlated with FoMO (β=.182, p<.001), and the need to belong had a significant positive impact on FoMO (β=.503, p<.001). The mediation analysis indicated that the effect of mindfulness on FoMO was fully mediated by ANI and the need to belong, with no direct effect through API.Conclusion: Recognizing mindfulness as a valuable psychological resource, this research offers insights for developing targeted interventions aimed at reducing FoMO and promoting healthier social media engagement among this population. These findings contribute to the broader understanding of the interplay between mindfulness, cognitive processes, motivation, and FoMO, offering guidance for future research and practical interventions.