Implementation of an Expressive Writing Intervention for Adolescents during Inpatient Psychiatric Hospitalization

BACKGROUND: Given the high rates of mental health concerns and communication difficulties for adolescents a treatment intervention to allow for effective expression may be therapeutic. One of the leading writing practices is Pennebaker’s Expressive Writing (EW) intervention. EW involves individuals writing about their feelings and thoughts regarding negative life experiences. Benefits of EW include a reduction of psychological symptoms and doctor visits, and better adjustment. OBJECTIVE: To examine the role of using EW and creative writing as a group intervention for youth admitted to an inpatient psychiatric hospital (IPH) METHODS: The current study evaluated participant engagement in a 3-day EW activity facilitated by nurses and graduate students on the IPH unit under the supervision of the IPH unit nurse manager and course instructor. Participants included 23 youth between 12- and 18-years-old RESULTS: Of the 23 participants 49.69% discussed vivid descriptions of illness, 24.5% discussed negative emotions, 20.25% included casual explanation, 5.52% discussed polarized view, and 16.56% discussed their desires, wishes, and goals. The response rate of clinician’s review of the EW content included 58% of clinician’s coding was on the patient’s current state, 24% was on causal explanations, and 18% was on treatment options. CONCLUSION: The current EW intervention facilitated by nursing staff and graduate students in an IPH was found to be engaged in by participants and provide an additional therapeutic resource to participants. EW may foster patient communication with staff about their functioning, mental health concerns, and treatment needs.

Marijuana’s Changing Legal Landscape and Its Implications for Adolescent Psychiatrists: A Report from California

Background Objectives: Thirty-three states and the District of Columbia (DC) have enacted some form of legalized cannabis or cannabinoid for medical conditions (MMJ), 11 of them and DC for recreational use. It has become critical for psychiatrists and other mental health professionals working with adolescents to be aware of diversion of marijuana (MJ) to youth and subsequent potential adverse effects in environments with widely different regulations. The experience of two office-based psychiatrists in California (the first state to legalize MMJ) through case presentations and an informal practice review illustrate the role that diverted MMJ plays in the clinical presentation of youth for psychiatric care, highlighting clinical implications and guidelines for treators as states legalize MJ for adult recreational use. Methods: Two child and adolescent psychiatrists practicing in California over the last twenty years report on their experiences working with adolescent patients and their families during the period of legalized MMJ. After a comprehensive literature review, they report their clinical observations and make recommendations for treators of adolescents. Discussion: There is general confusion among adolescents and their parents about MJ and MMJ. There is a lack of clear regulatory guidelines and a need for better clinical training for prescribing physicians. Diversion of MMJ to teens during periods of legalization of medical marijuana is common in states where it has been not legislated or regulated sufficiently to provide effective safeguards. This lax approach is demonstrated by our case reports and clinical review. Similar experiences have been reported elsewhere. Increased problems with diversion are expected as legalization efforts continue. Professionals and their organizations need to become more active in advocating policies to protect youth from potential harm related to cannabis use and abuse and carefully evaluate its use among their teen patients.

Beier Sentence Completion Test Profiles of Adolescents and Emerging Adults With Internalizing and Externalizing Disorders

Background: Understanding adolescents' and emerging adults' psychiatric complaints and their relations with psychiatric disorders can be challenging. Beier Sentence Completion Test (BSCT), as a projective test, can be promising in this respect. However, relations between BSCT profiles and adolescent psychopathology are not well known. Aim: This study aimed to examine and compare BSCT profiles of adolescents and emerging adults with internalizing and externalizing disorders. As well as that, the relation of BSCT profiles with depression and anxiety scores was investigated. Objective: To achieve this aim, we retrospectively collected the hospital records of 300 adolescents and emerging adults (aged. 14-21) admitted to an Adolescent Psychiatry Outpatient Unit. Method: The psychiatric diagnosis of the patients was classified as Internalizing (n =100) and Externalizing (n = 100) disorder groups; the control group (n = 100) consisted of adolescents and young adults without any psychiatric diagnosis. BSCT, the Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) were administered on the first admission to all cases before psychiatric evaluation and treatment. BSCT total subfactor (positive, negative, neutral, and non-response) statement scores were compared between groups, and their correlations with BDI and BAI were investigated. Besides, multivariate logistic regression analyses were conducted for estimating any diagnostic group differences, as well as bivariate logistic regression analyses for estimating BDI and BAI cutoff scores with models that included BSCT total subfactor statement scores. Results: It was revealed that lower positive and non-response statements were crucial for distinguishing externalizing and internalizing disorders and that positive and negative statements were correlated with depression and anxiety scores.In the multivariate regression model, these correlations were predictive only for the relationship between internalizing disorders group and low positive statement scores, not higher negative statement scores that can be associated with lack of positive emotional processing in this group. Also, nonresponse statement scores were found to be predictive for externalizing disorder groups. Similarly, BDI cut-off scores were predicted with low positive statement scores. Conclusion: BSCT profiles can be promising for understanding adolescents and emerging adults with internalizing and externalizing disorders. Lack of positive attributions to the self and other domains of life can be important for differentiating adolescent psychopathology.

Current Guidelines for Gender Affirming Care for Transgender Individuals

Background and goals: The guidelines for transgender care are evolving and incorporate a multidisciplinary team approach. These roadmaps entail an understanding of gender development, mental health, and sociocultural factors in individual and family lives, as well as the specific medical needs in the process of transitioning and ongoing treatment. New research is continuing to update the best evidence-based practice. Multiple professional health organizations have published guidelines. The World Professional Association of Transgender Health has pioneered the Standard of Care, currently version seven. Other leading organizations have their own publications with an emphasis on specific relevant medical needs. In this paper, The World Professional Association of Transgender Health Standard of Care and the recommendation of multiple psychiatric and pediatric organizations are reviewed to provide an overview. Discussion: Most current guidelines have similar recommendations in providing care for transgender individuals. The more recent data has shown the benefits of medical transitioning in youth and updated recommendations in this age group. Healthcare professionals are encouraged to stay up to date with these current guidelines. Further research is recommended.

Cumulative Effects of Prenatal and Concurrent Maternal Distress on Psychiatric Disorders in Adolescent Offspring

Background: Mental disorders affect 20% of children and adolescents globally and are among the most chronic and costly problems affecting youth. Offspring exposure to maternal disorders (depression, anxiety, and/or stress) prenatally as well as in adolescence increases the risk of psychopathology in adolescence. Objective: Exposure to maternal distress in pregnancy, as well as in adolescence, has independently been linked to psychopathology in youth. However, our understanding of the cumulative effects of exposure to maternal distress over time remains incomplete. Methods: 1964 participants enrolled in the 2014 Ontario Child Health Study (OCHS) aged 12-17 years completed the Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI-KID). Maternal prenatal distress was defined as mother-reported depression and/or anxiety during pregnancy requiring treatment. Maternal concurrent distress was self-reported when offspring were 12-17 years of age using the Kessler Psychological Distress Scale (K6). We examined associations between increasing levels of exposure to maternal distress (no exposure, prenatal exposure only, concurrent exposure only, both prenatal and concurrent exposure) and the risk of psychiatric disorder in 12-17-year-olds. Results: The odds of major depressive disorder (OR=1.29, 95% CI: 1.01- 1.67) and ADHD (OR=1.30, 95% CI: 1.02-1.65) increased with increasing exposure to maternal distress. Associations between increasing levels of maternal distress and several psychiatric disorders were amplified in males. Conclusions: The accumulation of exposure to maternal distress over time predicts offspring psychopathology in adolescence and emphasizes the significance of the early detection of maternal distress and ongoing monitoring and intervention to reduce the burden of mental disorders in offspring.

Mental Health Interventions in Juvenile Detention Institutions: A Systematic Review of What Works

Background: Incarcerated adolescents within the juvenile justice system are more likely to be diagnosed with poor mental health compared with their non-incarcerated peers. Conducting clinical trials on mental health interventions among an incarcerated adolescent population is challenging due to the nature of detention facilities. Objectives: This systematic review examines available literature on Randomized Clinical Trials (RCT) done to assess mental health interventions among incarcerated adolescents globally and to determine the type of intervention that would best work in this setting. In this study, a systematic review was conducted to search, identify, and recommend effective interventions best suited to preserve and improve the mental wellbeing of incarcerated adolescents within the detention institution setting. Method: The search was performed in Medline via Ovid, Cochrane Library, Scopus, and Web of Science databases to retrieve related publications released between 1970 and March 2021. The principal inclusion criteria were RCT articles issued in English that reported any mental health interventions performed in juvenile detention centers involving delinquent adolescents aged 10 to 19 years old. Results: The search discovered 10 related articles that fulfilled the required inclusion criteria. In total, there were seven different types of mental health interventions used in all the studies. The three major themes identified among the selected studies are the interventions for coping strategies, risky behavior, and attention disorder among incarcerated adolescents. The efficacy of the interventions was dependent on the level of intelligence, duration of incarceration, risk of treatment diffusion, and depression symptoms among incarcerated adolescents. Conclusions: Cognitive behavioral therapy (CBT) intervention that is simple, brief, unique, and targets depressive symptoms, has the potential to be most efficacious in improving mental health among incarcerated adolescents.

The Current Status of Sociopolitical and Legal Issues Facing Sexual and Gender Minority Youth

Background: Adolescents today have unprecedented and uninterrupted access to news and current events through broadcast and social media. Lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) adolescents may be especially cognizant of media and public discourse pertaining to law and policy changes affecting the legal rights of their communities. The minority stress framework explains how sociopolitical discourse impacts mental health among sexual and gender minority youths. Objectives: This paper identifies and describes contemporary sociopolitical and legal issues that may impact LGBTQ adolescents’ mental health. Methods: Authors describe the minority stress framework as applied to gender and sexual identity and explore key sociopolitical and legal topics relevant to LGBTQ adolescents, including employment; medical care bans; health insurance coverage; conversion therapy; religious exemptions in health care; housing rights; and rights in schools and school districts, including participation in sports. Results: LGBTQ youth experience rejection, prejudice, and discrimination directly through adverse legislative or administrative action and more pervasively through the dominant cultural beliefs and sociopolitical messaging that such developments manifest. Conclusion: Mental health clinicians who are aware of legal issues and sociopolitical debate pertinent to LGBTQ rights are better prepared to address their significant impact on LGBTQ adolescents’ mental health.

School Re-Entry of Adolescent Patients Discharged from Psychiatric Hospital: One Step in Continuous Quality Improvement

Objective: School re-entry following hospitalization for psychiatric care has been reported as difficult for many adolescent patients. Continuous quality improvement initiatives may improve programming to enhance school re-entry experiences. The purpose of this study was to explore the school re-entry perspectives of the youth discharged from a psychiatric inpatient unit after implementing programs that patients previously identified as needed. Methods: A survey was administered to the youth about one month after discharge to gather their perspective of their school re-entry, along with self-rated resilience and stress. Results: Twenty-six youth (23%) participated in the post-discharge survey who reported a mean age of 15.6 years (SD 1.0), 77% identified as female, 13 (50%) provided very positive re-entry comments, eight (31%) reported moderately positive experiences, and five (19%) reported a very poor school re-entry. Mean perceived resilience (4.01, SD 0.6) and stress (3.42, SD 0.8) scores suggest youth thought they had good resilience and moderate stress. Conclusions: Most youth reported a good school re-entry. Considerable concerns remain for the 19% who reported a poor school re-entry who may benefit from specialized outpatient or day programming post-discharge before attempting a return to school. Future directions for research are provided.