The environment influences the way we act, react and adapt to our surroundings whether it is consciously or unconsciously. Though it is widely accepted that multiple interacting systems influence human behaviour and development across the life span, the reality of teasing these factors apart is difficult and challenging. In this brief commentary on Czernine and colleagues\' important and timely paper, \'Can a modernised psychiatric unit space reduce the use of coercive measures in child and adolescent psychiatry?\', I evaluate and build on the evidence presented by making constructive suggestions on ways of improving the status quo healthcare and treatment conditions for children and adolescents today. The underlying assumption is that by furthering this complex yet important area of research in the field of psychiatry and adjacent disciplines, we can improve existing healthcare systems and processes that are aligned with meeting child and adolescent needs.

It is the current consensus amongst the psychiatric community that children undergoing evaluation for developmental delays and/or autism spectrum disorder (ASD) should be offered genetic testing early in the diagnostic process. Identifying genetic abnormalities can provide insight into patient prognosis and may reveal other medical complications that could arise throughout a patient\'s life. Despite these recognized benefits, genetic testing is often delayed or not offered and therefore deprives families of valuable knowledge about their child\'s future health outcomes. We present a case of a six-year-old patient who presented to our child and adolescent psychiatry office for behavioral concerns. She had received an ASD diagnosis years prior to presentation, but for unknown reasons, genetic testing had never been pursued. Genetic testing was obtained in our office, and the results revealed three different mutations that were linked to ASD and various other medical complications including epilepsy. With this knowledge, the patient\'s family gained important insight into their child\'s prognosis. This case highlights the necessity for adopting a point-of-care testing (POCT) model when evaluating children with developmental delays and/or ASD. Through this model, genetic testing would be offered to families during the initial visit for these patients. This would help streamline this process and allow for more widespread detection of genetic disorders linked to ASD and coexisting medical sequelae. Having this knowledge would empower families with a better understanding of their child\'s condition and would allow families to work together with providers to determine the best possible treatment plan.

To reduce coercion in acute inpatient child and adolescent psychiatric units, a better understanding of individuals at risk for seclusion and/or restraint (S/R) is needed. We report data on the proportion of patients secluded/restrained and factors associated with higher risk of S/R. Identifying preventative mechanisms through risk stratification upon inpatient admission can aid the training of mental health professionals, and support shaping specific workflows for at-risk populations for example by joint crisis plans or post-coercion review sessions.
METHODS: A case-control study included all admissions (n = 782) to a department of child and adolescent psychiatry within 36 months between 2019 and 2022. Data on age, sex, out of home care, primary and comorbid ICD-10 diagnoses, length of stay, prior/multiple admissions were compared between admissions with and without S/R using chi square tests for categorical and t-tests for continuous variables. Uni- and multivariate binary logistic regression models were computed.
RESULTS: The overall proportion of S/R was 12.8% (n = 100). Females (p = 0.001), patients in out of home care (p < 0.001), with prior admission (p < 0.001), Post-traumatic stress disorder (PTSD; p < 0.001) and Borderline personality disorder (BPD; p < 0.001) were at a significantly higher risk of S/R. Length of stay in days (OR 1.01), out of home care (OR 3.85), PTSD (OR 6.20), BPD (OR 15.17), Attention deficit hyperactivity disorder (ADHD)/conduct disorder (OR 4.29), and manic episode/bipolar disorder (OR 36.41) were significantly associated with S/R in multivariate regression.
CONCLUSIONS: Child and adolescent psychiatric staff should consider risk factors when using coercive measures. Patients with PTSD and/or BPD are the most vulnerable subgroups. Training of professionals and clinical practice need to be adapted in order to prevent the use of S/R and its potential hazards.

Longitudinal research examining children\'s mental health (MH) over the course of the COVID-19 pandemic is scarce. We examined trajectories of depression and anxiety over two pandemic years among children with and without MH disorders. Parents and children 2-18 years completed surveys at seven timepoints (April 2020 to June 2022). Parents completed validated measures of depression and anxiety for children 8-18 years, and validated measures of emotional/behavioural symptoms for children 2-7 years old; children ≥10 years completed validated measures of depression and anxiety. Latent growth curve analysis determined depression and anxiety trajectories, accounting for demographics, child and parent MH. Data were available on 1315 unique children (1259 parent-reports; 550 child-reports). Trajectories were stable across the study period, however individual variation in trajectories was statistically significant. Of included covariates, only initial symptom level predicted symptom trajectories. Among participants with pre-COVID data, a significant increase in depression symptoms relative to pre-pandemic levels was observed; children and adolescents experienced elevated and sustained levels of depression and anxiety during the two-year period. Findings have direct policy implications in the prioritization and of maintenance of educational, recreational, and social activities with added MH supports in the face of future events.

OBJECTIVE: The objective of this study was to identify longitudinal predictors of depressive symptoms in autistic children and youth.
METHODS: Participants were youth with a diagnosis of autism who were part of the Province of Ontario Neurodevelopmental Disorders Network longitudinal substudy. Depressive symptoms were assessed using the child behaviour checklist (CBCL) affective problems subscale. Univariate and multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the associations between clinical and demographic characteristics at baseline (T1) and clinically elevated depressive symptoms (CEDS) approximately 4 years later (T2).
RESULTS: The mean age of participants (n = 75) at T1 was 9.8 years (SD = 2.7) and at T2 was 14.1 years (SD = 2.8). A total of 37% and 35% of participants had CEDS at T1 and T2, respectively. Additionally, 24% of participants had CEDS at both T1 and T2. T1 characteristics associated with T2 CEDS were: loneliness (OR = 3.0, 95% CI, 1.1 to 8.8), self-harm (OR = 4.0, 95% CI, 1.1 to 16.9), suicidal ideation (OR = 3.9, 95% CI, 1.0 to 16.5), more social and adaptive skills (OR = 0.3, 95% CI, 0.1 to 0.9), elevated restricted and repetitive behaviours (OR = 3.8, 95% CI, 1.3 to 11.6), psychotropic medication use (OR = 3.0, 95% CI, 1.1 to 8.4), attention-deficient/hyperactivity disorder (OR = 2.8, 95% CI, 1.1 to 7.8), and T1 CEDS (OR = 8.8, 95% CI, 3.1 to 27.0) (uncorrected for multiple comparisons). Associations persisted after adjusting for age and intelligence quotient (IQ) differences. Age, sex, IQ, teasing/bullying on the CBCL, family psychiatric history and family income were not associated with T2 CEDS.
CONCLUSIONS: Our results highlight both high prevalence and high potential for the persistence of depressive symptoms in autism and emphasize the importance of early support to address loneliness and social participation.
Study assessing risk factors for depression in autistic youthPlain Language SummaryObjectiveThe goal of this study was to find risk factors for depression in autistic youth.MethodsThe study included autistic youth who were part of the Province of Ontario Neurodevelopmental Disorders Network. Symptoms of depression were identified using mental health surveys and screening tools completed by parents. We studied 75 youth over two time points, to understand what factors might predict greater depression risk.ResultsThe average age of our study population at the first visit was 10 years old, and 14 years old at the second visit. Our study found that 37% of participants had elevated symptoms of depression at the first visit, and 35% at the second visit. Factors associated with future depressive symptoms included: loneliness, self-harm, suicidal ideation, high levels of restrictive/repetitive behaviours, depressive symptoms at the first visit, and ADHD. Factors that protected against depressive symptoms included high levels of social skills.ConclusionOur results show high levels of depressive symptoms among autistic youth, and the potential for this to persist over time in this population. Our findings emphasize the importance of early supports to address loneliness and social participation.

BACKGROUND: Children and adolescents living with mental health problems often experience stress and poor mood states, which may influence their quality of life and well-being. Arts interventions may improve mood and well-being and reduce physiological stress in this vulnerable population.
METHODS: A cohort of patients in child and adolescent psychiatry (N = 42; age range: 12-18 years) participated in one of four arts activities including choir singing (n = 11), textile design (n = 9), drama (n = 16), and clownery (n = 6). They were led by professional artists and delivered through five consecutive 90-min daily afternoon sessions over the course of 1 week. Questionnaires of mood and saliva samples before and after each session served to assess short-term psychobiological changes. In addition, patients reported their quality of life and well-being at the beginning and at the end of the 1‑week program.
RESULTS: Results showed that alertness was significantly enhanced after textile design (∆post-pre = 4.08, 95% CI [0.77, 7.39]) and after singing (∆post-pre = 2.20, 95% CI [-0.55, 4.94]). Moreover, mood tended to be positively affected by textile design (∆post-pre = 2.89, 95% CI [-0.39, 6.18]). Quality of life increased significantly after singing (∆post-pre = 5.49, 95% CI [1.05, 9.92]). Arts participation except singing was associated with significant reductions in salivary cortisol (sCort) (textile design ∆post-pre = -0.81 ng/mL, 95% CI [-1.48, -0.14]; drama ∆post-pre = -0.76 ng/mL, 95% CI [-1.28, -0.24]; clownery ∆post-pre = -0.74 ng/mL, 95% CI [-1.47, -0.01]). No significant changes were observed for well-being over the whole program and salivary immunoglobulin A (sIgA) after any of the arts activities.
CONCLUSIONS: These results suggest that arts participation can improve mood state and reduce stress in young people with mental disorders, but there is a need for further studies.
UNASSIGNED: HINTERGRUND: Kinder und Jugendliche mit psychischen Problemen leiden häufig unter Stress und negativer Stimmung, was ihre Lebensqualität und ihr Wohlbefinden beeinträchtigen kann. Künstlerische Interventionen können die Stimmung und das Wohlbefinden verbessern und den physiologischen Stress in dieser gefährdeten Bevölkerungsgruppe reduzieren.
METHODS: Eine Kohorte von Patienten der Kinder- und Jugendpsychiatrie (N = 42; Altersspanne: 12–18 Jahre) nahm an einer von 4 künstlerischen Aktivitäten teil, darunter Chorgesang (n = 11), Textildesign (n = 9), Schauspiel (n = 16) und Clownerie (n = 6). Diese wurden von professionellen Künstler*innen geleitet und über einen Zeitraum von einer Woche in fünf 90-minütigen, täglichen Nachmittagssitzungen durchgeführt. Fragebögen von Stimmungs- und Speichelproben vor und nach jeder Sitzung dienten dazu, kurzfristige psychobiologische Veränderungen zu erfassen. Darüber hinaus berichteten die Patienten zu Beginn und am Ende des einwöchigen Programms über ihre Lebensqualität und ihr Wohlbefinden.
UNASSIGNED: Die Ergebnisse zeigten, dass die Wachsamkeit nach Textildesign (∆post-prä = 4,08, 95%-KI [0,77, 7,39] und Singen (∆post-prä = 2,20, 95%-KI [−0,55, 4,94] signifikant erhöht war. Darüber hinaus wurde die Stimmung tendenziell durch Textildesign positiv beeinflusst (∆post-prä = 2,89, 95%-KI [−0,39, 6,18]). Die Lebensqualität stieg nach dem Singen signifikant an (∆post-prä = 5,49, 95%-KI [1,05, 9,92]). Die Teilnahme an den künstlerischen Aktivitäten mit Ausnahme des Singens war mit einer signifikanten Reduktion des Kortisolspiegels verbunden (Textildesign ∆post-prä = −0,81 ng/ml, 95%-KI [−1,48, −0,14]; Schauspiel ∆post-prä = −0,76 ng/ml, 95%-KI [−1,28, −0,24]; Clownerie ∆post-prä = −0,74 ng/ml, 95%-KI [−1,47, −0,01]). Es wurden keine signifikanten Veränderungen des Wohlbefindens während des gesamten Programms und des Immunglobulins A nach einer der künstlerischen Aktivitäten beobachtet.
UNASSIGNED: Diese Ergebnisse weisen deutlich daraufhin, dass die Teilnahme der psychisch kranken Kinder und Jugendlichen an künstlerischen Aktivitäten deren Stimmung verbessern und den Stress senken kann. Gleichzeitig zeigt sich auch die Notwendigkeit weiterer Studien.

BACKGROUND: Suicidal behavior by children and adolescents has been and remains one of the most intractable of our social ills. Despite the general downward trend in suicide rates, children and adolescents remain one of the most at-risk groups. Suicidal behavior in all its manifestations is a biopsychosocial problem in which the superiority of one approach or the other cannot be unambiguously justified. It flows from this that strategies that aim to prevent suicide should weave together not just the medical and psychological aspects of the issue, but the social, legal, pedagogical, and other dimensions as well.
OBJECTIVE: To develop an integrated approach that could provide primary, secondary, and tertiary prevention of suicidal behavior in children, provide the routing of patients, and coordinate actions both between the outpatient link and inpatient specialized care and between different departments, primarily between the Moscow Department of Healthcare and the Department of Education.
METHODS: We analyzed the dynamics of the number of admissions to the Scientific and Practical Center for Mental Health of Children and Adolescents named after G.E. Sukhareva of Moscow Health Department (Sukhareva Center) with suicidal manifestations in 2019-2022. Organization of the Crisis Care Clinic (Crisis Clinic), which specializes in helping children and adolescents aged 11 to 17 who find themselves in a situation of psychological crisis, have suicidal tendencies, display self-injurious behavior, experience grief, violence, or have suffered abuse.
RESULTS: A comprehensive multi-disciplinary approach is identified as the most efficient way to treat and prevent suicidal behavior in children and adolescents. Psychopharmacotherapy is used to influence severe depressive symptomatology, reduce anxiety, moderate sedation, correct behavioral disorders, etc. In addition to medication, comprehensive psychotherapeutic assistance is recommended. The leading therapeutic approaches are cognitive-behavioral, including DBT, and family therapy, with the efforts of therapists concentrated on alleviating post-traumatic stress, depression, and behavioral problems, as well as resolving intrafamily conflicts.
CONCLUSIONS: The need to remedy severe crisis conditions and their associated psychopathological repercussions (including suicidal and self-harming behavior) calls for coordinated efforts on the part of specialists from different fields of knowledge related to childhood and adolescence. Our analysis of the experience of working with children and adolescents in the Crisis Clinic at the Sukhareva Center shows that there is high demand for such highly specialized institutions and that the basic principles laid down at its creation, urgency, stage, and continuity of care, poly-professionalism with a focus on non-drug treatment methods, orientation towards the patient\'s family are relevant.
UNASSIGNED: Суицидальное поведение детей и подростков было и остается одной из наиболее значимых социальных проблем. Не смотря на общую тенденцию к снижению уровня суицидов, подростковый и юношеский возраст остается одной из основных групп риска. Суицидальное поведение во всех его проявлениях представляет собой биопсихосоциальную проблему, в которой невозможно выделить преобладание того или иного подхода. Соответственно, стратегии превенции суицида должны включать не только медицинские и психологические, но и социальные, юридические, педагогические и другие аспекты.
UNASSIGNED: Разработка комплексного подхода, позволяющего обеспечить первичную, вторичную и третичную профилактику суицидального поведения у детей, обеспечить маршрутизацию пациентов, согласовав действия как между амбулаторным звеном и стационарной специализированной помощью, так и между различными ведомствами, в первую очередь, между Департаментом здравоохранения и Департаментом образования г. Москвы.
UNASSIGNED: Анализ динамики числа госпитализаций в Центр им. Г.Е. Сухаревой с суицидальными проявлениями в 2019–2022 гг. Организация клиники кризисной помощи, специализирующейся на оказании помощи детям и подросткам 11–17 лет, находящимся в ситуации психологического кризиса, имеющим суицидальные тенденции, самоповреждающее поведение, переживающим горе, насилие, жестокое обращение.
UNASSIGNED: Наиболее эффективным для лечения и профилактики суицидального поведения у детей и подростков признан комплексный полипрофессиональный подход. Психофармакотерапия используется для воздействия на тяжелую депрессивную симптоматику, для снижения тревоги, умеренной седации, коррекции нарушений поведения и т.п. Помимо медикаментозной, рекомендовано широкое применение психотерапевтической помощи. Ведущими психотерапевтическим подходами является когнитивно-поведенческая, в том числе DBT, и семейная психотерапия, при этом усилия психотерапевтов направлены на купирование посттравматического стресса, депрессии и поведенческих проблем, а также разрешение внутрисемейных конфликтов.
UNASSIGNED: Таким образом, необходимость коррекции острых кризисных состояний и ассоциированных с ними психопатологических феноменов (в том числе суицидального и самоповреждающего поведения), требует скоординированных усилий специалистов из различных областей знания, связанных с детским и подростковым возрастом. Анализ опыта работы с детьми и подростками в условиях Клиники кризисной помощи при ГБУЗ «НПЦ ПЗДП им. Г.Е. Сухаревой ДЗМ» показывает высокую востребованность такого рода узкоспециализированных структур, а основные принципы, заложенные при ее создании — безотлагательность, этапность и преемственность помощи, полипрофессиональность с фокусом на нелекарственных методах лечения, ориентацию на семью пациента — актуальными.

Deep vein thrombosis is a condition in which a thrombus forms in one of the deep veins of the body, most often in the legs. It may manifest with pain, swelling, redness, or increased temperature of the limb, potentially leading to fatal complications such as pulmonary embolism. This is a case of a 15-year-old psychiatric patient diagnosed with deep vein thrombosis of the left lower limb of uncertain etiology. The patient presented few risk factors associated with venous thromboembolism disorder such as immobilization, antipsychotic treatment, and obesity. Even though psychiatry deals primarily with the mind of a patient, somatic complications occur very often and should not be underestimated. One of those complications is deep vein thrombosis, which is worth remembering, especially when applying procedures during which patients are immobilized for a long period.

Prior to COVID-19, there were already increasing rates of youth with mental health concerns, including an increase in youth presenting to medical emergency departments (EDs) with mental health chief complaints and limited access to treatment. This trend worsened during the pandemic, and rates of youth presenting to medical EDs with suicidal ideation and self-harm increased 50% from 2019 to 2022. This resulted in a \"boarding\" crisis, in part, due to a lack of inpatient psychiatric hospitalization beds, and many youth were left without access to adequate treatment. Additional study of innovations in health care delivery will be paramount in meeting this need.

Recent advances in psychiatric genetics have enabled the use of polygenic risk scores (PRS) to estimate genetic risk for psychiatric disorders. However, the potential use of PRS in child and adolescent psychiatry has raised concerns. This study provides an in-depth examination of attitudes among child and adolescent psychiatrists (CAP) regarding the use of PRS in psychiatry. We conducted semi-structured interviews with U.S.-based CAP (n = 29) who possess expertise in genetics. The majority of CAP indicated that PRS have limited clinical utility in their current form and are not ready for clinical implementation. Most clinicians stated that nothing would motivate them to generate PRS at present; however, some exceptions were noted (e.g., parent/family request). Clinicians spoke to challenges related to ordering, interpreting, and explaining PRS to patients and families. CAP raised concerns regarding the potential for this information to be misinterpreted or misused by patients, families, clinicians, and outside entities such as insurance companies. Finally, some CAP noted that PRS may lead to increased stigmatization of psychiatric disorders, and at the extreme, could be used to support eugenics. As PRS testing increases, it will be critical to examine CAP and other stakeholders\' views to ensure responsible implementation of this technology.