CanJPsychiatry 2015;60(10):415–416
The Canadian Journal of Psychiatry Volume 60, Number 10
October 2015
Guest Editorial
Thematic Issue on Child and Adolescent Psychiatry Derryck H Smith, MD, FRCPC1 1
Clinical Professor Emeritus, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia. Correspondence: Suite 505, 805 West Broadway, Vancouver, BC V5Z 1K1; [email protected].
Key Words: bullying, atypical antipsychotics, attention-deficit hyperactivity disorder in young adults Received and accepted June 2015.
open access
I
t is my pleasure and privilege to introduce to you the work of 4 groups of Canadian researchers spanning the country from Montreal to Ontario, Manitoba, and finally British Columbia. Collectively, these papers1–4 demonstrate that research into child and adolescent psychiatry is thriving across Canada. Although these papers all have distinctly Canadian databases, the results are likely applicable to children and youth around the world. In the first paper, from Gobbi et al,1 the research group studied adolescent distress following a period of 4 to 9 months of separation from their fathers. The sample was drawn from an earlier study looking at nicotine dependence in teens, but this study found that separation from fathers had no impact on alcohol or cigarette use. Perhaps not surprisingly teenagers initially suffered increase in depressive symptoms as well as worry about potential financial implications in their family. Worry about relationships shifted initially from concern about their relationship with their father to later being more concerned about their relationship with their mother. The message for clinicians is that we need to be alive to the fact that parental separation can negatively impact teenagers, and that families undergoing separation may benefit from more support from their caregivers, including family physicians, psychiatrists, and pediatricians. The second paper, from Alavi and her group2 at Queen’s University, studied the effects of bullying on adolescent victims using a database from an urgent assessment clinic. Bullying was defined as repeated aggressive behaviour with an imbalance of power between bullies and their victims. The prevalence of bullying was close to 50%, and verbal bullying was more common than physical bullying, which, in turn, was more common than cyberbullying. However, it was cyberbullying that had the biggest negative effect on victims. Suicidal ideation was 3.6 times higher in patients who had experienced cyberbullying. The results of this study strongly suggest that clinicians should inquire carefully about bullying, and in particular cyberbullying, and that symptom questionnaires, which are routinely used in clinical practice, should include questions about bullying. The other obvious implication for society is that bullying is detrimental and dangerous and that efforts should continue to discourage all forms of bullying. The third paper, from Yallop and her group,3 using a large comprehensive database in Manitoba, focused on young adults aged 18 to 29, and the prevalence of attention-deficit hyperactivity disorder (ADHD). The lifetime prevalence in this group was estimated to be 7.11% and the prevalence of stimulant prescription 3.09%. Not surprisingly, 82% of the subjects with ADHD had been diagnosed prior to age 18. The male-to-female sex ratio was 2.7:1, compared with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, ratios of 2:1 in children and 1.6:1 in adults. The authors discussed the lack
www.TheCJP.ca
The Canadian Journal of Psychiatry, Vol 60, No 10, October 2015 W 415
Guest Editorial
of a socioeconomic gradient and postulated that ADHD in this age group may be negatively impacting young adults who are in educational settings. This is an important paper in that it showed a considerably elevated prevalence, compared with the National Comorbidity Survey Replication from 2006. It should reassure clinicians that psychostimulants are not being overprescribed for this group. The fourth paper, from Ronsley and her group4 at the University of British Columbia, who had previously published on metabolic syndrome in children and teenagers treated with second-generation antipsychotics, reports on the first prospective study on this important topic. Patients aged 4 to 18 being treated either with risperidone or quetiapine were followed during a year. Although there was a significant attrition rate, the results were compelling in that children and teenagers treated with these 2 atypical antipsychotics were exposed to a risk of obesity, waist circumference increase, and dyslipidemia. This paper provides compelling evidence that children and teens being treated with atypical antipsychotics should routinely have monitoring of metabolic parameters, and, for those patients who show metabolic abnormalities, early treatment should be initiated. The authors identified a weakness that there was no control group for this study. I was disappointed to see that we were not given diagnoses for the children and teenagers treated with antipsychotics. Although I am in full agreement with the need for ongoing monitoring, it remains my opinion that clinicians must be careful to minimize the use of these medications and to restrict their use to serious psychiatric morbidities in which there are no alternate
416 W La Revue canadienne de psychiatrie, vol 60, no 10, octobre 2015
effective pharmacological, psychotherapeutic, or social interventions. In summary, all 4 of these papers1–4 raise very important clinical issues and should be impactful on clinical practice. They all advance the scientific basis for providing psychiatric care for young patients. They all call for additional research to further inform clinical practice in the management of children, adolescents, and young adults with psychiatric illness.
Acknowledgement
Dr Smith receives funding from Janssen, Shire, and Purdue for lecturing on attention-deficit hyperactivity disorder.
References
1. Gobbi G, Low NCP, Dugas E, et al. Short-term natural course of depressive symptoms and family-related stress in adolescents after separation from father. Can J Psychiatry. 2015;60(10):417–426. 2. Alavi N, Roberts N, Sutton C, et al. Bullying victimization (being bullied) among adolescents referred for urgent psychiatric consultation: prevalence and association with suicidality. Can J Psychiatry. 2015;60(10):427–431. 3. Yallop L, Brownell M, Chateau D, et al. Lifetime prevalence of attention-deficit hyperactivity disorder in young adults: examining variations in the socioeconomic gradient. Can J Psychiatry. 2015;60(10):432–440. 4. Ronsley R, Nguyen D, Davidson J, et al. Increased risk of obesity and metabolic dysregulation following 12 months of secondgeneration antipsychotic treatment in children: a prospective cohort study. Can J Psychiatry. 2015;60(10):441–450.
www.LaRCP.ca
The Canadian Journal of Psychiatry Volume 60, Number 10
October 2015
Guest Editorial
Thematic Issue on Child and Adolescent Psychiatry Derryck H Smith, MD, FRCPC1 1
Clinical Professor Emeritus, Department of Psychiatry, University of British Columbia, Vancouver, British Columbia. Correspondence: Suite 505, 805 West Broadway, Vancouver, BC V5Z 1K1; [email protected].
Key Words: bullying, atypical antipsychotics, attention-deficit hyperactivity disorder in young adults Received and accepted June 2015.
open access
I
t is my pleasure and privilege to introduce to you the work of 4 groups of Canadian researchers spanning the country from Montreal to Ontario, Manitoba, and finally British Columbia. Collectively, these papers1–4 demonstrate that research into child and adolescent psychiatry is thriving across Canada. Although these papers all have distinctly Canadian databases, the results are likely applicable to children and youth around the world. In the first paper, from Gobbi et al,1 the research group studied adolescent distress following a period of 4 to 9 months of separation from their fathers. The sample was drawn from an earlier study looking at nicotine dependence in teens, but this study found that separation from fathers had no impact on alcohol or cigarette use. Perhaps not surprisingly teenagers initially suffered increase in depressive symptoms as well as worry about potential financial implications in their family. Worry about relationships shifted initially from concern about their relationship with their father to later being more concerned about their relationship with their mother. The message for clinicians is that we need to be alive to the fact that parental separation can negatively impact teenagers, and that families undergoing separation may benefit from more support from their caregivers, including family physicians, psychiatrists, and pediatricians. The second paper, from Alavi and her group2 at Queen’s University, studied the effects of bullying on adolescent victims using a database from an urgent assessment clinic. Bullying was defined as repeated aggressive behaviour with an imbalance of power between bullies and their victims. The prevalence of bullying was close to 50%, and verbal bullying was more common than physical bullying, which, in turn, was more common than cyberbullying. However, it was cyberbullying that had the biggest negative effect on victims. Suicidal ideation was 3.6 times higher in patients who had experienced cyberbullying. The results of this study strongly suggest that clinicians should inquire carefully about bullying, and in particular cyberbullying, and that symptom questionnaires, which are routinely used in clinical practice, should include questions about bullying. The other obvious implication for society is that bullying is detrimental and dangerous and that efforts should continue to discourage all forms of bullying. The third paper, from Yallop and her group,3 using a large comprehensive database in Manitoba, focused on young adults aged 18 to 29, and the prevalence of attention-deficit hyperactivity disorder (ADHD). The lifetime prevalence in this group was estimated to be 7.11% and the prevalence of stimulant prescription 3.09%. Not surprisingly, 82% of the subjects with ADHD had been diagnosed prior to age 18. The male-to-female sex ratio was 2.7:1, compared with the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, ratios of 2:1 in children and 1.6:1 in adults. The authors discussed the lack
www.TheCJP.ca
The Canadian Journal of Psychiatry, Vol 60, No 10, October 2015 W 415
Guest Editorial
of a socioeconomic gradient and postulated that ADHD in this age group may be negatively impacting young adults who are in educational settings. This is an important paper in that it showed a considerably elevated prevalence, compared with the National Comorbidity Survey Replication from 2006. It should reassure clinicians that psychostimulants are not being overprescribed for this group. The fourth paper, from Ronsley and her group4 at the University of British Columbia, who had previously published on metabolic syndrome in children and teenagers treated with second-generation antipsychotics, reports on the first prospective study on this important topic. Patients aged 4 to 18 being treated either with risperidone or quetiapine were followed during a year. Although there was a significant attrition rate, the results were compelling in that children and teenagers treated with these 2 atypical antipsychotics were exposed to a risk of obesity, waist circumference increase, and dyslipidemia. This paper provides compelling evidence that children and teens being treated with atypical antipsychotics should routinely have monitoring of metabolic parameters, and, for those patients who show metabolic abnormalities, early treatment should be initiated. The authors identified a weakness that there was no control group for this study. I was disappointed to see that we were not given diagnoses for the children and teenagers treated with antipsychotics. Although I am in full agreement with the need for ongoing monitoring, it remains my opinion that clinicians must be careful to minimize the use of these medications and to restrict their use to serious psychiatric morbidities in which there are no alternate
416 W La Revue canadienne de psychiatrie, vol 60, no 10, octobre 2015
effective pharmacological, psychotherapeutic, or social interventions. In summary, all 4 of these papers1–4 raise very important clinical issues and should be impactful on clinical practice. They all advance the scientific basis for providing psychiatric care for young patients. They all call for additional research to further inform clinical practice in the management of children, adolescents, and young adults with psychiatric illness.
Acknowledgement
Dr Smith receives funding from Janssen, Shire, and Purdue for lecturing on attention-deficit hyperactivity disorder.
References
1. Gobbi G, Low NCP, Dugas E, et al. Short-term natural course of depressive symptoms and family-related stress in adolescents after separation from father. Can J Psychiatry. 2015;60(10):417–426. 2. Alavi N, Roberts N, Sutton C, et al. Bullying victimization (being bullied) among adolescents referred for urgent psychiatric consultation: prevalence and association with suicidality. Can J Psychiatry. 2015;60(10):427–431. 3. Yallop L, Brownell M, Chateau D, et al. Lifetime prevalence of attention-deficit hyperactivity disorder in young adults: examining variations in the socioeconomic gradient. Can J Psychiatry. 2015;60(10):432–440. 4. Ronsley R, Nguyen D, Davidson J, et al. Increased risk of obesity and metabolic dysregulation following 12 months of secondgeneration antipsychotic treatment in children: a prospective cohort study. Can J Psychiatry. 2015;60(10):441–450.
www.LaRCP.ca
