Adolescent Psychiatry - Volume 8, Issue 3, 2018

Background: Childhood maltreatment is theorized to undermine the development of mentalizing and to disrupt the consolidation of healthy narcissism and the integration of personality at the level of affect and interpersonal regulation. Consistent with this, mentalizing can be expected to mediate the relationship between childhood maltreatment and vulnerable and grandiose narcissism as well as borderline personality traits, but this has not been examined in adolescents. Objective: The aim of this study was to examine associations between childhood maltreatment and adolescent personality disorder traits and test the mediating role of mentalizing in a sample of 263 adolescents and young adults aged 12 to 21. Methods: Participants recruited from schools and a tertiary institution completed the Childhood Experiences of Care and Abuse Questionnaire (CECA-Q), the Borderline Personality Features Scale for Children (BPFS-C), the Pathological Narcissism Inventory (PNI) and the Reflective Function Questionnaire for Youth (RFQ-Y). Results: Adolescents with histories of sexual and physical abuse reported significantly more borderline personality features, as well as vulnerable and grandiose narcissism. They also reported signficantly more mentalizing difficulties including confusion regarding mental states and excessive certainty regarding mental states of others. Confusion regarding mental states partially mediated the relation between emotional abuse and borderline personality traits, as well as vulnerable and grandiose narcissism. Excessive certainty regarding the mental states of others mediated the relationship between childhood experiences of role reversal and grandiose narcissism. Conclusion: The findings are consistent with a mentalization model of adolescent personality difficulties and show that the relation between childhood maltreatment and personality disorder traits in adolescents may be in part understood in terms of the impact of such experiences on different dimensions of mentalizing.

Background/Objectives: Differentiating bipolar disorder (BD) from a borderline personality disorder (BPD) can be diagnostically challenging as symptoms such as, depression, aggression and interpersonal relationships are common to both conditions. Identifying related and unrelated items between BD and BPD may improve diagnostic accuracy since both diagnoses have varying treatments which can be implemented before a behavioral emergency occurs. This study sought to determine which features of BPD, as assessed by the Borderline Personality Features Scale-Child (BPFS-C), are related to BD in youth diagnosed with BD. Methods: Thirty participants (M: 16, F: 14), with BD, aged 7-17 years (mean ± standard deviation, 12.95 ± 3.08 years) met DSM-V criteria for BD I (n=20) and BD II (n=3). The Course and Outcome of Bipolar Youth criteria was used to establish the BD–Not Otherwise Specified diagnosis (n=7). The 24-item self-report BPFS-C was administered to the youth. Two-tailed Pearson correlations were performed to assess associations between scores on the BPFS-C with scores on various psychopathology-related predictor variables while adjusting for age, race and primary BD diagnosis. Results: Higher BPFS-child scores positively correlated with child scores of more severe depression, self-injurious behaviors, and increased impulsive aggression. Conclusion: BPFS-child scores may assist clinicians in identifying youth with BD who may be on the trajectory to developing BPD and thus, implementing targeted psychotherapeutic interventions.

Background: Problematic internet use (PIU) is continuous failure to control the use of the internet by individuals themselves along with the impairment of their lives in important dimensions such as health, family and business. PIU causes psychological, social and physical health problems especially among young people. Objective: This study aimed to investigate the relationship between PIU, sleep quality and academic achievement in Turkish university students. Methods: The study sample consisted of 912 university students. Data were collected using the Personal Information Form, Pittsburgh Sleep Quality Index, and Problematic Internet Use Scale. Results: The percentage of the sample who used the internet every day was 70.7%. The mean length of the internet use in 54.4% of the students varied from 61-120 minutes. Poor sleep quality was reported by 78.9% of the students. Problematic internet use was more common among the students who used the internet every day, who spent at least 121 minutes on the internet at each use, who preferred to use the internet at night, whose academic achievement score was <2,5 point and whose mothers had lower levels of education. Conclusion: Health professionals need to be aware the effects of today's developing technologies on young people’s health and they should inform young people about the consequences of heavy use of the internet.

Background: Cannabis use in adolescence is associated with multiple psychosocial problems. Barriers to care limit access to evidence based interventions. Electronic devices can facilitate access to interventions designed to reduce cannabis use. Objective: We conducted a systematic review of randomized trials employing electronically delivered interventions to assess for feasibility and effectiveness of this modality in reducing cannabis use among adolescents and young adults. Methods: Major databases were searched for randomized trials using electronically delivered interventions (web-based + tablets, computers or CD-ROM) for cannabis use in adolescents and young adults published before July 2016. The outcome measure was decrease in cannabis use frequency. We conducted a quality assessment of these studies and qualitatively synthesized study findings. Results: Thirteen articles representing eleven studies were included in this systematic review. Seven studies were effective in reducing cannabis use with small to medium effect sizes (0.07 to 0.66). Studies with significant reduction in cannabis use were likely to be a universal or selective intervention (100% [U], 80% [S)] vs 25% for indicated programs), target early adolescence (100% vs 33% for middle or late adolescence), employ family interaction theory (100% vs [33 -67%] for other theories) and have greater than 6 sessions (100% vs 33% for shorter sessions). Conclusion: Our findings indicate that electronically-delivered interventions aimed at reducing cannabis use are feasible in youth, and can be effective. Certain factors, such as age at delivery, underlying theory, and number of sessions appear to play a role in the effectiveness of this mode of delivery. Further studies are needed to confirm these findings.

Background: Chronic absenteeism from school is a pervasive problem with complex causes and long-reaching consequences. School refusal has been associated with increased likelihood to engage in criminal behavior, sexual risk behaviors, abuse of illicit substances, and dropout of school entirely. Objective: Based on a review of the available literature, the aim of this paper is to describe the current state of research on school refusal, including the role of adolescent substance use, and to discuss treatments for school refusal, including a comprehensive model developed through a collaboration with the New York City Department of Education. Methods: The authors conducted a literature survey using Pub-Med, Google Scholar, JSTOR & Science Direct databases. Key search terms used included: "absenteeism", "attendance", "school refusal", "school avoidance", "truancy", & "substance use". Results: Students who are chronically absent display high rates of psychiatric comorbidities, with anxiety disorders and disruptive behavior disorders being particularly prevalent. Furthermore, substance use and absenteeism have been found to have a relationship of mutual influence with cannabis use showing a strong positive relationship with absenteeism, which in turn entails the need for appropriate screening and referrals for treatment. Current data suggest that behavioral interventions, including social skills training, cognitive behavioral, and dialectical behavioral therapies are the primary treatment modalities, with the addition of pharmacological management when needed. Preliminary data from the Comprehensive Adolescent Rehabilitation and Education Services program in New York City may indicate the pairing of educational and clinical services may improve attendance rates and decrease rates of substance use.

Background: Transitional Age Youth (TAY), the period between 15-25 years old, is now recognized as a unique developmental stage and a highly vulnerable time period for the onset of Serious Mental Illness (SMI). Objective: The study aimed to inform readers about TAY with SMI to improve recognition of their developmental needs and improve patient care. Methods: The authors describe their work with TAY experiencing SMI on inpatient psychiatric units by citing case examples that illustrate individual treatment issues, the level of family involvement in care, and social/systems based practice. Results: TAY patients with SMI are more likely to adhere to ongoing psychiatric care when their developmental needs are addressed while in an acute inpatient setting. Conclusion: Focusing on mental health needs of TAY while applying a developmental perspective can improve patient care and compliance to treatment.

Background: Obsessive-compulsive Disorder (OCD) is a relatively common psychiatric disorder among children and adolescents. Apart from the commonly reported obsessions, childhood OCD can present with unusual or unfamiliar obsessions, making the diagnosis difficult. Suicidal ideas and attempts are high in OCD patients. Very rarely OCD patients also present with suicidal obsessions which need to be differentiated from a genuine suicidal desire for proper management. Methods: We report an uncommon suicidal obsessional fear triggered by “Blue Whale Game” related news in the media in a 14-year-old boy who had been previously well functioning. This patient experienced significant distress and dysfunction due to these repetitive thoughts. After an intervention with medication, his symptoms diminished and he returned to pre-morbid functioning. Discussion: Environmental stressors are considered to play an important role in the development of OCD. Environment interacts with genetic predisposition, which moderates the vulnerability to a stressful experience, in precipitating OCD. This case is unusual in that suicidal obsessions were triggered by an external event, highlighting the interaction between external events and the onset of the obsessive-compulsive disorder.