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Research paper thumbnail of See Profile

Violent behavior of patients admitted in emergency following drug suicidal attempt: a specific st... more Violent behavior of patients admitted in emergency following drug suicidal attempt: a specific staff educational crisis intervention

Research paper thumbnail of COVID-19-related school disruptions and well-being of children and adolescents in Geneva

BackgroundVarious studies showed the negative impact of COVID-19-related lockdowns and school clo... more BackgroundVarious studies showed the negative impact of COVID-19-related lockdowns and school closures on the well-being of children and adolescents. However, the prevalence and consequences of occasional short-term school disruptions due to COVID-19-related quarantine or isolation remain unknown. This study evaluated their impact on the well-being and stress level of children and adolescents.MethodsIn June/July 2021, we conducted a survey selecting a representative sample of children and adolescents of a Swiss canton population. Parents of school-aged children reported information about them missing school because of COVID-19, from August 2020 to June 2021, as well as about their health-related quality of life (HRQoL) measured with the KINDL® scale and their stress level.ResultsAmong the 538 participants, 216/538 (40.1%) pupils missed school at least once for COVID-19-related causes, with a total of 272 absences. We observed no relationship between the frequency of COVID-19-related...

Research paper thumbnail of 10 Years of Analytical Group Training “in blocks” in Geneva (Switzerland)

European Journal of Psychiatry

After 10 years of experience in Geneva more than 300 health professionals have been through this ... more After 10 years of experience in Geneva more than 300 health professionals have been through this group training. It appears that trainees gained: knowledge about group dynamic, supervision for their practice, and personalexperience in small and large group settings. But even more importantly they gained the opportunity to experience within a multidisciplinary "teaching community" some unique experiences related to "therapeutic communities". This is of particular importance in a changing world, where managed care increases the pressure on the multidisciplinary team, within and between institutions, and where, in parallel, the time available to settle the inevitable conflicts decrease. Given the increase a number of institutions in charge of helping the population we would like in future to propose a program that would attract not only mental health professionals but also professionals from social institutions.

Research paper thumbnail of Gender differences among depressed suicidal children

Research paper thumbnail of Suicidality and Its Relationship to Treatment Outcome in Depressed Adolescents

Suicide and Life-Threatening Behavior, 2004

This study investigates the impact of suicidality on treatment outcome in 107 depressed adolescen... more This study investigates the impact of suicidality on treatment outcome in 107 depressed adolescents who participated in a clinical trial, and received either cognitive-behavioral (CBT), systemic-behavioral-family (SBFT), or non-directivesupportive therapy (NST). Suicidal depressed adolescents had a higher dropout rate and were more likely to be depressed at the end of treatment, in large part due to the particularly poor response of suicidal patients to NST. The relationship between suicidality and treatment response was mediated by severity of depression and hopelessness at intake. Hopelessness should be specifically targeted early in treatment. Suicidal depressed adolescents should not receive NST but a specific treatment like CBT.

Research paper thumbnail of Datapoints: Recent Trends in Suicide Among U.S. Adolescent Males, 1992-2001

Psychiatric Services, 2005

I n the United States black youths have historically had lower suicide rates than white youths, b... more I n the United States black youths have historically had lower suicide rates than white youths, but the gap has been narrowing because of an increase in the suicide rate among young black males (1). Using the mortality database from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (2), we determined trends in suicide deaths between 1992 and 2001 for white males and black males aged 15 to 19 years. Trends in suicide were estimated by using negative binomial rate regression analyses.

Research paper thumbnail of Month of Birth, a Risk Factor for Violent Behaviour in Suicidal Patients Admitted in Emergency?

Psychiatric Quarterly, 2009

Although there are numerous publications on the existing link between month of birth and suicide,... more Although there are numerous publications on the existing link between month of birth and suicide, only two studies focus on suicide attempts and auto-aggressive behavior. Research data suggest that month of birth is related to a variation of 5-HIAA in the cerebrospinal fluid, which correlates with violent behavior (VB). Therefore, the aim of this study is to search, for the first time, for a possible link between month of birth and the occurrence of VB in emergency, for patients admitted for a suicide attempt with medication. This is a 10 months prospective study among all the patients of the canton of Geneva, Switzerland, admitted in emergency for a suicide attempt with medication. During a 10 months study period we included 493 patients, of which 77 (15.62%) presented VB. Higher incidence of VB was found in subjects where born at the end of winter and the beginning of spring, with a maximum for April and a minimum for December. In spite of a relatively small number of subjects, it seems promising to study the occurrence of VB as a function of month of birth in patients admitted in emergency for a suicide attempt.

Research paper thumbnail of Parental functioning improves the developmental quotient of pediatric liver transplant recipients

Pediatric Transplantation, 2013

Psychomotor development in pediatric liver transplant (LT) recipients depends on several factors.... more Psychomotor development in pediatric liver transplant (LT) recipients depends on several factors. Our aim was to evaluate the importance of parental involvement and family dynamics on psychomotor development by assessing (i) children and parents individually, (ii) the parent-child relationship, and (iii) the correlation between parental functioning and patient outcome, all before and after LT. Age-appropriate scales were used before and after LT. Twenty-one patients, 19 mothers, and 16 fathers were evaluated. Developmental quotient (DQ): No subjects scored in the "very good" range. The proportion of children with deficits increased from LT to two yr: 17.6% vs. 28.6%. Subjects 0-2 yr were more likely to have normal DQ at transplant (66.7% vs. 50% for older children). Abnormal DQ was more prevalent two yr post-LT in children older at LT (p = 0.02). The mother-child relationship was normal in 59% of families pre-LT and in 67% at two yr. The relationship was more favorable when the child received a transplant as an infant (p = 0.014 at 12 months post-LT). Normal DQ was associated with higher maternal global functioning score pre-LT (p = 0.03). Paternal performance scores were higher than maternal scores. Children transplanted after two yr of age suffer greater long-term deficits than those transplanted as infants.

Research paper thumbnail of Factor Structure of Borderline Personality Disorder Criteria

Journal of Personality Disorders, 1993

Objective: To examine the factor structure of the Diagnostic and Statistical Manual of Mental Dis... more Objective: To examine the factor structure of the Diagnostic and Statistical Manual of Mental Disorders (DSM), Fourth Edition, criteria for borderline personality disorder (BPD) in a sample of adolescents with a borderline symptomatology. Method: The latent structure of borderline criteria, assessed with the Structured Interview for DSM-IV Personality, was explored with a principal factor analysis in a sample of 107 adolescents with a borderline symptomatology drawn from a European research project on BPDs. Results: The principal component analysis revealed 2 homogeneous factors accounting for 66.8% of the variance. The first factor included internally oriented criteria, such as avoidance of abandonment, identity disturbance, chronic feeling of emptiness, and stress-related paranoid ideation. The second factor included externally oriented criteria, such as unstable relationships, impulsivity, suicidal or self-mutilating behaviours, and inappropriate anger. Affective instability was the only criterion loading on both factors. Conclusions: The results of our study suggests that an internal or external dichotomy may be an appropriate way to conceptualize the structure of borderline criteria in adolescents with a borderline symptomatology, with affective instability being a core feature of BPD at this age. W W W Objectif : Examiner la structure factorielle des critères du Manuel diagnostique et statistique des troubles mentaux (DSM), 4e édition, pour le trouble de la personnalité limite (TPL) dans un échantillon d'adolescents ayant une symptomatologie de personnalité limite. Méthode : La structure latente des critères de la personnalité limite, évaluée par l'entrevue structurée pour le DSM-IV (personnalité), a été explorée par une analyse factorielle principale dans un échantillon de 107 adolescents ayant une symptomatologie de personnalité limite, liés à un projet de recherche européen sur le TPL. Résultats : L'analyse factorielle principale a révélé 2 facteurs homogènes responsables de 66,8 % de la variance. Le premier facteur incluait des critères orientés vers l'intérieur, comme l'évitement ou l'abandon, la perturbation de l'identité, le sentiment de vide chronique, et l'idéation paranoïde liée au stress. Le deuxième facteur comprenait des critères orientés vers l'extérieur, comme les relations instables, l'impulsivité, les comportements suicidaires ou d'automutilation, et la colère exagérée. L'instabilité affective était le seul critère qui logeait sur les deux facteurs. Conclusions : Les résultats de notre étude suggèrent qu'une dichotomie intérieure ou extérieure puisse être une façon appropriée de conceptualiser la structure des critères de la personnalité limite chez les adolescents avec une symptomatologie de la personnalité limite, l'instabilité affective étant une caractéristique fondamentale du TPL à cet âge.

Research paper thumbnail of Epileptiform Seizure After Sertraline Treatment in an Adolescent Experiencing Obsessive-Compulsive Disorder and Presenting a Rare Pharmacogenetic Status

Journal of Clinical Psychopharmacology, 2006

2. Liu-Seifert H, Adams DH, Kinon BJ. Discontinuation of treatment of schizophrenic patients is d... more 2. Liu-Seifert H, Adams DH, Kinon BJ. Discontinuation of treatment of schizophrenic patients is driven by poor symptom response: a pooled post-hoc analysis of four atypical antipsychotic drugs. BMC Med. 2005;3:21. 3. Zhao F, Ascher-Svanum H, Mitchell CP, et al. Increased time to all-cause antipsychotic trial discontinuation is associated with better schizophrenia treatment outcomes.

Research paper thumbnail of Clinical Differences Between Suicidal and Nonsuicidal Depressed Children and Adolescents

The Journal of Clinical Psychiatry, 2005

To examine the clinical symptoms and comorbid psychiatric disorders of depressed children and ado... more To examine the clinical symptoms and comorbid psychiatric disorders of depressed children and adolescents with and without clinically significant suicidal ideation. Method: Children and adolescents aged 7 to 17 years with current DSM-III-R major depressive disorder (MDD) (N = 135) were recruited between January 1987 and April 2002. Current MDD symptoms and lifetime comorbid psychiatric disorders were assessed using either a combination of the Schedule for Affective Disorders and Schizophrenia for School Age Children-Epidemiologic and-Present Episode versions or the-Present Lifetime version. Thirty-two percent (N = 43) of the depressed subjects were classified as suicidal (at least suicidal ideation with a plan). Results: Depressed suicidal youth presented with a more severe episode (p = .001) and a poorer functional status (p = .019), were more hopeless (p = .001), and presented more frequently with insomnia (p = .011). There was an interaction between suicide × sex × pubertal status for severity of MDD (p = .013), the presence of hopelessness (p < .001), poor functional status (p = .023), and comorbidity with a lifetime history of any disruptive behavior (p = .019). Among prepubertal depressed males, suicidal boys had significantly increased severity of MDD (p = .025) and poorer functional status (p = .044) than nonsuicidal boys. Among postpubertal depressed females, suicidal girls were more frequently hopeless (p = .008) and presented an increased severity of MDD (p = .022) and more frequent lifetime history of any disruptive behavior (p = .03) when compared with nonsuicidal girls. Conclusion: There appears to be a sex difference for some clinical features, particularly hopelessness, among depressed suicidal children and adolescents. Whether hopelessness is a sexspecific characteristic of depressed suicidal children and adolescents requires further study.

Research paper thumbnail of Lifetime History of Sexual Abuse, Clinical Presentation, and Outcome in a Clinical Trial for Adolescent Depression

The Journal of Clinical Psychiatry, 2004

To investigate the impact of sexual abuse on clinical presentation and treatment outcome in depre... more To investigate the impact of sexual abuse on clinical presentation and treatment outcome in depressed adolescents. 107 adolescent outpatients, 13 to 18 years old, with DSM-III-R major depression were randomly assigned to cognitive-behavioral therapy (CBT), systemic behavioral family therapy (SBFT), or nondirective supportive therapy (NST) from Oct. 1, 1991 through May 31, 1995. Subjects were classified on the basis of the presence or absence of lifetime history of sexual abuse. Since only 1 subject assigned to SBFT had a history of sexual abuse, we restricted our analyses to those 72 subjects assigned to either CBT or NST. The impact of lifetime history of sexual abuse on service use, depression, and treatment outcome was examined. Depressed adolescents with a past history of sexual abuse were more likely, at 2-year follow-up, to have had a psychiatric hospitalization and have a depressive relapse, even controlling for maternal depression, source of referral, race, and treatment assignment. CBT was more efficacious than NST in absence of sexual abuse but was not better than NST in those with a history of sexual abuse. Sexual abuse is a negative predictor of long-term outcome in adolescent depression. CBT for depression may not be as efficacious for those depressed adolescents with a history of sexual abuse. These findings suggest that a history of sexual abuse should be assessed not only in clinical practice, but also in research studies of depressive outcome. Further work is indicated to understand the relationship between sexual abuse and poor outcome in order to help restore these high-risk youths to an optimal developmental trajectory.

Research paper thumbnail of Clinical Response and Risk for Reported Suicidal Ideation and Suicide Attempts in Pediatric Antidepressant Treatment

JAMA, 2007

The authors concluded that antidepressants are effective for paediatric major depressive disorder... more The authors concluded that antidepressants are effective for paediatric major depressive disorder, obsessive-compulsive disorder (OCD) and non-OCD anxiety disorders and that benefits appear greater than the risk of suicidal ideation and suicide attempt, but benefit-to-risk ratios vary with patient and study characteristics. The conclusion is supported by the results presented, but incomplete reporting of review methods hinders confirmation of the reliability of the conclusions. Authors' objectives To evaluate antidepressant treatment for paediatric major depressive disorder (MDD), obsessive-compulsive disorder (OCD) and non-OCD anxiety disorders regarding the efficacy and risks of suicidal ideation and suicide attempt.

Research paper thumbnail of Violent behavior of patients admitted in emergency following drug suicidal attempt: a specific staff educational crisis intervention

General Hospital Psychiatry, 2007

Objective: In spite of much effort to create guidelines on the management of violent behavior (VB... more Objective: In spite of much effort to create guidelines on the management of violent behavior (VB) in emergency departments, little is known about the impact of such guidelines on a real-life emergency environment. The aim of this study is to investigate the impact of a staff educational crisis intervention (SECI) on the reduction of VB in patients admitted to emergency departments following drug suicidal attempt. Method: The impact of a SECI on VB of patient consulting the ER following a drug suicide attempt was assessed by comparing the occurrence of VB before (5 months) and after (5 months) the introduction of a SECI. Results: A significant reduction in VB (from 17.32% to 7.14%) was found with the comparison of two 5-month periods: before (254 patients) and after (224 patients) the introduction of a SECI program (v 2 = 11.238; P = .0008). Conclusion: These preliminary data suggest the need for further prospective randomized studies aiming to prevent VB in emergency departments by developing specific SECI programs.

Research paper thumbnail of Review: psychological therapies can improve psychological symptoms in children who have been sexually abused

Evidence-Based Mental Health, 2004

Q What are the effects of psychological therapies in children who have been sexually abused? METH... more Q What are the effects of psychological therapies in children who have been sexually abused? METHODS Design: Systematic review with narrative synthesis. Data sources: MEDLINE, PsychLIT, CINAHL, and Cochrane Controlled Trials Register searched, plus hand searches of five journals (1997-2002), bibliographies, and reviews. Authors and other experts were contacted. Unpublished sources were explored, including three PhD theses.

Research paper thumbnail of Screening for bipolar disorder in adolescents with the Mood Disorder Questionnaire - Adolescent version (MDQ-A) and the Child Bipolar Questionnaire (CBQ)

Early Intervention in Psychiatry, 2012

Aim: Screening instruments for bipolar disorders (BDs) in children and adolescents have been deve... more Aim: Screening instruments for bipolar disorders (BDs) in children and adolescents have been developed recently. The present study examined performances of the French versions of the Mood Disorder Questionnaire-Adolescent version (MDQ-A) and Child Bipolar Questionnaire (CBQ) in a sample of in-and outpatients. Methods: Seventy-six adolescents (age 13-18) and parents first completed the MDQ-A (adolescent and parent versions) and CBQ screening instruments. About 3 weeks later, they had a diagnostic interview with the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime (K-SADS-PL), and the adolescent MDQ-A self-report was completed a second time. Results: Eight of 76 patients (10.5%) met K-SADS-PL diagnostic criteria for BD. Test-retest reliability of the adolescent MDQ-A self-report was moderate (kappa = 0.66), whereas agreement between adolescent and parent reports was poor (kappa = 0.07). Sensitivity and specificity of the MDQ-A with respect to K-SADS-PL were 75.0% and 57.4% for the adolescent version, and 87.5% and 63.2% for the parent version. Corresponding figures were 50.0% and 73.5% for the CBQ. All three screening instruments had low positive predictive values (17.1% for the MDQ-A adolescent version; 21.9% for the MDQ-A parent version; 18.2% for the CBQ), whereas negative predictive values were higher than 90%. Conclusions: The present study points to modest performances of the MDQ-A and CBQ to detect BDs in adolescents, with diagnostic criteria for BD being unmet for a majority of patients who screened positive.

Research paper thumbnail of Reducing hospital readmission in depression and schizophrenia: current evidence

Current Opinion in Psychiatry, 2004

Purpose of review It is estimated that the readmission rate for discharged psychiatric patients i... more Purpose of review It is estimated that the readmission rate for discharged psychiatric patients is approximately 40-50% within 1 year of hospital discharge. This review focuses on recent developments in our understanding of predictors of readmission in depression and schizophrenia, and on quality improvement methods and models aimed at reducing readmission rates for these patients. Recent findings Multiple factors contribute to the risk of hospital readmission; however, demographic and clinical characteristics alone are of limited utility in identifying patients most likely to be readmitted. Recent research has emphasized the role of enhancing treatment and medication adherence, which is of critical importance given the strong association between nonadherence and rehospitalization. Methodological work is currently underway to improve the measurement of medication adherence and continuity of care, which have been difficult to assess in the past. Despite significant progress during the past few years, the development and evaluation of structured disease management programs for depression and bipolar disorder continues to represent an important challenge for future research. Summary Empirical work is needed to evaluate the effectiveness of different approaches to reducing patient readmission following hospital discharge.

Research paper thumbnail of Child Psychopharmacology, Effect Sizes, and the Big Bang

American Journal of Psychiatry, 2005

Research paper thumbnail of Emergent Suicidality in a Clinical Psychotherapy Trial for Adolescent Depression

American Journal of Psychiatry, 2005

The authors&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;a... more The authors&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; goal was to examine the incidence and predictors of emergent suicidality that occurred during a clinical trial of psychotherapy for adolescent depression. The rates and predictors of emergent suicidality in 88 medication-free depressed adolescent outpatients who reported no current suicidality during an intake interview were assessed over 12 to 16 weeks of psychotherapy treatment. The incidence of emergent suicidality was 12.5% (11 of 88 subjects). Self-reported suicidal thoughts at intake were a significant predictor of emergent suicidality, even when suicidality was denied at intake interview. Emergent suicidality is a common occurrence in psychosocial treatment of adolescent depression, with rates similar to those reported recently in antidepressant trials. To evaluate accurately the role of treatment in emergent suicidality, it is important to assess self-reported suicidality at intake and to balance treatment groups on this key predictor of emergent suicidality.

Research paper thumbnail of Placebo Response in Randomized Controlled Trials of Antidepressants for Pediatric Major Depressive Disorder

American Journal of Psychiatry, 2009

The authors examined characteristics and predictors of response to placebo in all available repor... more The authors examined characteristics and predictors of response to placebo in all available reports of shortterm randomized controlled trials of antidepressants for pediatric major depressive disorder. Method: Response, defined as a score ≤2 on the improvement item of the Clinical Global Impression scale, and potential predictors were extracted from 12 published and unpublished randomized controlled trials of second-generation antidepressants in participants 6-18 years of age with major depression. Results: The single best predictor of the proportion of patients taking placebo who responded to treatment was the number of study sites. Baseline severity of illness also emerged as a significant inverse predictor of placebo response, although the strength of this relationship was diminished when number of sites was controlled for. After one large fluoxetine trial was excluded, younger participants showed a higher placebo response rate than older adolescents. Higher placebo response rates in more recent studies were explained by an increasing trend toward large multisite trials and by publication delays and failures to publish some negative trials. Conclusions: The recent shift toward large multisite trials of antidepressant medications for pediatric major depression may be contributing to an increasing incidence of response to placebo. Pharmacotherapy studies of pediatric depression that carefully recruit patients with at least moderately severe depression may be more informative and efficient than many trials conducted to date. Such studies should have sufficient power to determine whether age moderates medication and placebo response.

Research paper thumbnail of See Profile

Violent behavior of patients admitted in emergency following drug suicidal attempt: a specific st... more Violent behavior of patients admitted in emergency following drug suicidal attempt: a specific staff educational crisis intervention

Research paper thumbnail of COVID-19-related school disruptions and well-being of children and adolescents in Geneva

BackgroundVarious studies showed the negative impact of COVID-19-related lockdowns and school clo... more BackgroundVarious studies showed the negative impact of COVID-19-related lockdowns and school closures on the well-being of children and adolescents. However, the prevalence and consequences of occasional short-term school disruptions due to COVID-19-related quarantine or isolation remain unknown. This study evaluated their impact on the well-being and stress level of children and adolescents.MethodsIn June/July 2021, we conducted a survey selecting a representative sample of children and adolescents of a Swiss canton population. Parents of school-aged children reported information about them missing school because of COVID-19, from August 2020 to June 2021, as well as about their health-related quality of life (HRQoL) measured with the KINDL® scale and their stress level.ResultsAmong the 538 participants, 216/538 (40.1%) pupils missed school at least once for COVID-19-related causes, with a total of 272 absences. We observed no relationship between the frequency of COVID-19-related...

Research paper thumbnail of 10 Years of Analytical Group Training “in blocks” in Geneva (Switzerland)

European Journal of Psychiatry

After 10 years of experience in Geneva more than 300 health professionals have been through this ... more After 10 years of experience in Geneva more than 300 health professionals have been through this group training. It appears that trainees gained: knowledge about group dynamic, supervision for their practice, and personalexperience in small and large group settings. But even more importantly they gained the opportunity to experience within a multidisciplinary "teaching community" some unique experiences related to "therapeutic communities". This is of particular importance in a changing world, where managed care increases the pressure on the multidisciplinary team, within and between institutions, and where, in parallel, the time available to settle the inevitable conflicts decrease. Given the increase a number of institutions in charge of helping the population we would like in future to propose a program that would attract not only mental health professionals but also professionals from social institutions.

Research paper thumbnail of Gender differences among depressed suicidal children

Research paper thumbnail of Suicidality and Its Relationship to Treatment Outcome in Depressed Adolescents

Suicide and Life-Threatening Behavior, 2004

This study investigates the impact of suicidality on treatment outcome in 107 depressed adolescen... more This study investigates the impact of suicidality on treatment outcome in 107 depressed adolescents who participated in a clinical trial, and received either cognitive-behavioral (CBT), systemic-behavioral-family (SBFT), or non-directivesupportive therapy (NST). Suicidal depressed adolescents had a higher dropout rate and were more likely to be depressed at the end of treatment, in large part due to the particularly poor response of suicidal patients to NST. The relationship between suicidality and treatment response was mediated by severity of depression and hopelessness at intake. Hopelessness should be specifically targeted early in treatment. Suicidal depressed adolescents should not receive NST but a specific treatment like CBT.

Research paper thumbnail of Datapoints: Recent Trends in Suicide Among U.S. Adolescent Males, 1992-2001

Psychiatric Services, 2005

I n the United States black youths have historically had lower suicide rates than white youths, b... more I n the United States black youths have historically had lower suicide rates than white youths, but the gap has been narrowing because of an increase in the suicide rate among young black males (1). Using the mortality database from the Centers for Disease Control and Prevention's Wide-Ranging Online Data for Epidemiologic Research (2), we determined trends in suicide deaths between 1992 and 2001 for white males and black males aged 15 to 19 years. Trends in suicide were estimated by using negative binomial rate regression analyses.

Research paper thumbnail of Month of Birth, a Risk Factor for Violent Behaviour in Suicidal Patients Admitted in Emergency?

Psychiatric Quarterly, 2009

Although there are numerous publications on the existing link between month of birth and suicide,... more Although there are numerous publications on the existing link between month of birth and suicide, only two studies focus on suicide attempts and auto-aggressive behavior. Research data suggest that month of birth is related to a variation of 5-HIAA in the cerebrospinal fluid, which correlates with violent behavior (VB). Therefore, the aim of this study is to search, for the first time, for a possible link between month of birth and the occurrence of VB in emergency, for patients admitted for a suicide attempt with medication. This is a 10 months prospective study among all the patients of the canton of Geneva, Switzerland, admitted in emergency for a suicide attempt with medication. During a 10 months study period we included 493 patients, of which 77 (15.62%) presented VB. Higher incidence of VB was found in subjects where born at the end of winter and the beginning of spring, with a maximum for April and a minimum for December. In spite of a relatively small number of subjects, it seems promising to study the occurrence of VB as a function of month of birth in patients admitted in emergency for a suicide attempt.

Research paper thumbnail of Parental functioning improves the developmental quotient of pediatric liver transplant recipients

Pediatric Transplantation, 2013

Psychomotor development in pediatric liver transplant (LT) recipients depends on several factors.... more Psychomotor development in pediatric liver transplant (LT) recipients depends on several factors. Our aim was to evaluate the importance of parental involvement and family dynamics on psychomotor development by assessing (i) children and parents individually, (ii) the parent-child relationship, and (iii) the correlation between parental functioning and patient outcome, all before and after LT. Age-appropriate scales were used before and after LT. Twenty-one patients, 19 mothers, and 16 fathers were evaluated. Developmental quotient (DQ): No subjects scored in the &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;very good&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; range. The proportion of children with deficits increased from LT to two yr: 17.6% vs. 28.6%. Subjects 0-2 yr were more likely to have normal DQ at transplant (66.7% vs. 50% for older children). Abnormal DQ was more prevalent two yr post-LT in children older at LT (p = 0.02). The mother-child relationship was normal in 59% of families pre-LT and in 67% at two yr. The relationship was more favorable when the child received a transplant as an infant (p = 0.014 at 12 months post-LT). Normal DQ was associated with higher maternal global functioning score pre-LT (p = 0.03). Paternal performance scores were higher than maternal scores. Children transplanted after two yr of age suffer greater long-term deficits than those transplanted as infants.

Research paper thumbnail of Factor Structure of Borderline Personality Disorder Criteria

Journal of Personality Disorders, 1993

Objective: To examine the factor structure of the Diagnostic and Statistical Manual of Mental Dis... more Objective: To examine the factor structure of the Diagnostic and Statistical Manual of Mental Disorders (DSM), Fourth Edition, criteria for borderline personality disorder (BPD) in a sample of adolescents with a borderline symptomatology. Method: The latent structure of borderline criteria, assessed with the Structured Interview for DSM-IV Personality, was explored with a principal factor analysis in a sample of 107 adolescents with a borderline symptomatology drawn from a European research project on BPDs. Results: The principal component analysis revealed 2 homogeneous factors accounting for 66.8% of the variance. The first factor included internally oriented criteria, such as avoidance of abandonment, identity disturbance, chronic feeling of emptiness, and stress-related paranoid ideation. The second factor included externally oriented criteria, such as unstable relationships, impulsivity, suicidal or self-mutilating behaviours, and inappropriate anger. Affective instability was the only criterion loading on both factors. Conclusions: The results of our study suggests that an internal or external dichotomy may be an appropriate way to conceptualize the structure of borderline criteria in adolescents with a borderline symptomatology, with affective instability being a core feature of BPD at this age. W W W Objectif : Examiner la structure factorielle des critères du Manuel diagnostique et statistique des troubles mentaux (DSM), 4e édition, pour le trouble de la personnalité limite (TPL) dans un échantillon d'adolescents ayant une symptomatologie de personnalité limite. Méthode : La structure latente des critères de la personnalité limite, évaluée par l'entrevue structurée pour le DSM-IV (personnalité), a été explorée par une analyse factorielle principale dans un échantillon de 107 adolescents ayant une symptomatologie de personnalité limite, liés à un projet de recherche européen sur le TPL. Résultats : L'analyse factorielle principale a révélé 2 facteurs homogènes responsables de 66,8 % de la variance. Le premier facteur incluait des critères orientés vers l'intérieur, comme l'évitement ou l'abandon, la perturbation de l'identité, le sentiment de vide chronique, et l'idéation paranoïde liée au stress. Le deuxième facteur comprenait des critères orientés vers l'extérieur, comme les relations instables, l'impulsivité, les comportements suicidaires ou d'automutilation, et la colère exagérée. L'instabilité affective était le seul critère qui logeait sur les deux facteurs. Conclusions : Les résultats de notre étude suggèrent qu'une dichotomie intérieure ou extérieure puisse être une façon appropriée de conceptualiser la structure des critères de la personnalité limite chez les adolescents avec une symptomatologie de la personnalité limite, l'instabilité affective étant une caractéristique fondamentale du TPL à cet âge.

Research paper thumbnail of Epileptiform Seizure After Sertraline Treatment in an Adolescent Experiencing Obsessive-Compulsive Disorder and Presenting a Rare Pharmacogenetic Status

Journal of Clinical Psychopharmacology, 2006

2. Liu-Seifert H, Adams DH, Kinon BJ. Discontinuation of treatment of schizophrenic patients is d... more 2. Liu-Seifert H, Adams DH, Kinon BJ. Discontinuation of treatment of schizophrenic patients is driven by poor symptom response: a pooled post-hoc analysis of four atypical antipsychotic drugs. BMC Med. 2005;3:21. 3. Zhao F, Ascher-Svanum H, Mitchell CP, et al. Increased time to all-cause antipsychotic trial discontinuation is associated with better schizophrenia treatment outcomes.

Research paper thumbnail of Clinical Differences Between Suicidal and Nonsuicidal Depressed Children and Adolescents

The Journal of Clinical Psychiatry, 2005

To examine the clinical symptoms and comorbid psychiatric disorders of depressed children and ado... more To examine the clinical symptoms and comorbid psychiatric disorders of depressed children and adolescents with and without clinically significant suicidal ideation. Method: Children and adolescents aged 7 to 17 years with current DSM-III-R major depressive disorder (MDD) (N = 135) were recruited between January 1987 and April 2002. Current MDD symptoms and lifetime comorbid psychiatric disorders were assessed using either a combination of the Schedule for Affective Disorders and Schizophrenia for School Age Children-Epidemiologic and-Present Episode versions or the-Present Lifetime version. Thirty-two percent (N = 43) of the depressed subjects were classified as suicidal (at least suicidal ideation with a plan). Results: Depressed suicidal youth presented with a more severe episode (p = .001) and a poorer functional status (p = .019), were more hopeless (p = .001), and presented more frequently with insomnia (p = .011). There was an interaction between suicide × sex × pubertal status for severity of MDD (p = .013), the presence of hopelessness (p < .001), poor functional status (p = .023), and comorbidity with a lifetime history of any disruptive behavior (p = .019). Among prepubertal depressed males, suicidal boys had significantly increased severity of MDD (p = .025) and poorer functional status (p = .044) than nonsuicidal boys. Among postpubertal depressed females, suicidal girls were more frequently hopeless (p = .008) and presented an increased severity of MDD (p = .022) and more frequent lifetime history of any disruptive behavior (p = .03) when compared with nonsuicidal girls. Conclusion: There appears to be a sex difference for some clinical features, particularly hopelessness, among depressed suicidal children and adolescents. Whether hopelessness is a sexspecific characteristic of depressed suicidal children and adolescents requires further study.

Research paper thumbnail of Lifetime History of Sexual Abuse, Clinical Presentation, and Outcome in a Clinical Trial for Adolescent Depression

The Journal of Clinical Psychiatry, 2004

To investigate the impact of sexual abuse on clinical presentation and treatment outcome in depre... more To investigate the impact of sexual abuse on clinical presentation and treatment outcome in depressed adolescents. 107 adolescent outpatients, 13 to 18 years old, with DSM-III-R major depression were randomly assigned to cognitive-behavioral therapy (CBT), systemic behavioral family therapy (SBFT), or nondirective supportive therapy (NST) from Oct. 1, 1991 through May 31, 1995. Subjects were classified on the basis of the presence or absence of lifetime history of sexual abuse. Since only 1 subject assigned to SBFT had a history of sexual abuse, we restricted our analyses to those 72 subjects assigned to either CBT or NST. The impact of lifetime history of sexual abuse on service use, depression, and treatment outcome was examined. Depressed adolescents with a past history of sexual abuse were more likely, at 2-year follow-up, to have had a psychiatric hospitalization and have a depressive relapse, even controlling for maternal depression, source of referral, race, and treatment assignment. CBT was more efficacious than NST in absence of sexual abuse but was not better than NST in those with a history of sexual abuse. Sexual abuse is a negative predictor of long-term outcome in adolescent depression. CBT for depression may not be as efficacious for those depressed adolescents with a history of sexual abuse. These findings suggest that a history of sexual abuse should be assessed not only in clinical practice, but also in research studies of depressive outcome. Further work is indicated to understand the relationship between sexual abuse and poor outcome in order to help restore these high-risk youths to an optimal developmental trajectory.

Research paper thumbnail of Clinical Response and Risk for Reported Suicidal Ideation and Suicide Attempts in Pediatric Antidepressant Treatment

JAMA, 2007

The authors concluded that antidepressants are effective for paediatric major depressive disorder... more The authors concluded that antidepressants are effective for paediatric major depressive disorder, obsessive-compulsive disorder (OCD) and non-OCD anxiety disorders and that benefits appear greater than the risk of suicidal ideation and suicide attempt, but benefit-to-risk ratios vary with patient and study characteristics. The conclusion is supported by the results presented, but incomplete reporting of review methods hinders confirmation of the reliability of the conclusions. Authors' objectives To evaluate antidepressant treatment for paediatric major depressive disorder (MDD), obsessive-compulsive disorder (OCD) and non-OCD anxiety disorders regarding the efficacy and risks of suicidal ideation and suicide attempt.

Research paper thumbnail of Violent behavior of patients admitted in emergency following drug suicidal attempt: a specific staff educational crisis intervention

General Hospital Psychiatry, 2007

Objective: In spite of much effort to create guidelines on the management of violent behavior (VB... more Objective: In spite of much effort to create guidelines on the management of violent behavior (VB) in emergency departments, little is known about the impact of such guidelines on a real-life emergency environment. The aim of this study is to investigate the impact of a staff educational crisis intervention (SECI) on the reduction of VB in patients admitted to emergency departments following drug suicidal attempt. Method: The impact of a SECI on VB of patient consulting the ER following a drug suicide attempt was assessed by comparing the occurrence of VB before (5 months) and after (5 months) the introduction of a SECI. Results: A significant reduction in VB (from 17.32% to 7.14%) was found with the comparison of two 5-month periods: before (254 patients) and after (224 patients) the introduction of a SECI program (v 2 = 11.238; P = .0008). Conclusion: These preliminary data suggest the need for further prospective randomized studies aiming to prevent VB in emergency departments by developing specific SECI programs.

Research paper thumbnail of Review: psychological therapies can improve psychological symptoms in children who have been sexually abused

Evidence-Based Mental Health, 2004

Q What are the effects of psychological therapies in children who have been sexually abused? METH... more Q What are the effects of psychological therapies in children who have been sexually abused? METHODS Design: Systematic review with narrative synthesis. Data sources: MEDLINE, PsychLIT, CINAHL, and Cochrane Controlled Trials Register searched, plus hand searches of five journals (1997-2002), bibliographies, and reviews. Authors and other experts were contacted. Unpublished sources were explored, including three PhD theses.

Research paper thumbnail of Screening for bipolar disorder in adolescents with the Mood Disorder Questionnaire - Adolescent version (MDQ-A) and the Child Bipolar Questionnaire (CBQ)

Early Intervention in Psychiatry, 2012

Aim: Screening instruments for bipolar disorders (BDs) in children and adolescents have been deve... more Aim: Screening instruments for bipolar disorders (BDs) in children and adolescents have been developed recently. The present study examined performances of the French versions of the Mood Disorder Questionnaire-Adolescent version (MDQ-A) and Child Bipolar Questionnaire (CBQ) in a sample of in-and outpatients. Methods: Seventy-six adolescents (age 13-18) and parents first completed the MDQ-A (adolescent and parent versions) and CBQ screening instruments. About 3 weeks later, they had a diagnostic interview with the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime (K-SADS-PL), and the adolescent MDQ-A self-report was completed a second time. Results: Eight of 76 patients (10.5%) met K-SADS-PL diagnostic criteria for BD. Test-retest reliability of the adolescent MDQ-A self-report was moderate (kappa = 0.66), whereas agreement between adolescent and parent reports was poor (kappa = 0.07). Sensitivity and specificity of the MDQ-A with respect to K-SADS-PL were 75.0% and 57.4% for the adolescent version, and 87.5% and 63.2% for the parent version. Corresponding figures were 50.0% and 73.5% for the CBQ. All three screening instruments had low positive predictive values (17.1% for the MDQ-A adolescent version; 21.9% for the MDQ-A parent version; 18.2% for the CBQ), whereas negative predictive values were higher than 90%. Conclusions: The present study points to modest performances of the MDQ-A and CBQ to detect BDs in adolescents, with diagnostic criteria for BD being unmet for a majority of patients who screened positive.

Research paper thumbnail of Reducing hospital readmission in depression and schizophrenia: current evidence

Current Opinion in Psychiatry, 2004

Purpose of review It is estimated that the readmission rate for discharged psychiatric patients i... more Purpose of review It is estimated that the readmission rate for discharged psychiatric patients is approximately 40-50% within 1 year of hospital discharge. This review focuses on recent developments in our understanding of predictors of readmission in depression and schizophrenia, and on quality improvement methods and models aimed at reducing readmission rates for these patients. Recent findings Multiple factors contribute to the risk of hospital readmission; however, demographic and clinical characteristics alone are of limited utility in identifying patients most likely to be readmitted. Recent research has emphasized the role of enhancing treatment and medication adherence, which is of critical importance given the strong association between nonadherence and rehospitalization. Methodological work is currently underway to improve the measurement of medication adherence and continuity of care, which have been difficult to assess in the past. Despite significant progress during the past few years, the development and evaluation of structured disease management programs for depression and bipolar disorder continues to represent an important challenge for future research. Summary Empirical work is needed to evaluate the effectiveness of different approaches to reducing patient readmission following hospital discharge.

Research paper thumbnail of Child Psychopharmacology, Effect Sizes, and the Big Bang

American Journal of Psychiatry, 2005

Research paper thumbnail of Emergent Suicidality in a Clinical Psychotherapy Trial for Adolescent Depression

American Journal of Psychiatry, 2005

The authors&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;a... more The authors&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; goal was to examine the incidence and predictors of emergent suicidality that occurred during a clinical trial of psychotherapy for adolescent depression. The rates and predictors of emergent suicidality in 88 medication-free depressed adolescent outpatients who reported no current suicidality during an intake interview were assessed over 12 to 16 weeks of psychotherapy treatment. The incidence of emergent suicidality was 12.5% (11 of 88 subjects). Self-reported suicidal thoughts at intake were a significant predictor of emergent suicidality, even when suicidality was denied at intake interview. Emergent suicidality is a common occurrence in psychosocial treatment of adolescent depression, with rates similar to those reported recently in antidepressant trials. To evaluate accurately the role of treatment in emergent suicidality, it is important to assess self-reported suicidality at intake and to balance treatment groups on this key predictor of emergent suicidality.

Research paper thumbnail of Placebo Response in Randomized Controlled Trials of Antidepressants for Pediatric Major Depressive Disorder

American Journal of Psychiatry, 2009

The authors examined characteristics and predictors of response to placebo in all available repor... more The authors examined characteristics and predictors of response to placebo in all available reports of shortterm randomized controlled trials of antidepressants for pediatric major depressive disorder. Method: Response, defined as a score ≤2 on the improvement item of the Clinical Global Impression scale, and potential predictors were extracted from 12 published and unpublished randomized controlled trials of second-generation antidepressants in participants 6-18 years of age with major depression. Results: The single best predictor of the proportion of patients taking placebo who responded to treatment was the number of study sites. Baseline severity of illness also emerged as a significant inverse predictor of placebo response, although the strength of this relationship was diminished when number of sites was controlled for. After one large fluoxetine trial was excluded, younger participants showed a higher placebo response rate than older adolescents. Higher placebo response rates in more recent studies were explained by an increasing trend toward large multisite trials and by publication delays and failures to publish some negative trials. Conclusions: The recent shift toward large multisite trials of antidepressant medications for pediatric major depression may be contributing to an increasing incidence of response to placebo. Pharmacotherapy studies of pediatric depression that carefully recruit patients with at least moderately severe depression may be more informative and efficient than many trials conducted to date. Such studies should have sufficient power to determine whether age moderates medication and placebo response.

Research paper thumbnail of Child psychopharmacology, effect sizes, and the big bang

Research paper thumbnail of Recent trends in suicide among US adolescent males, 1992-2001

Research paper thumbnail of Emergent suicidality in a clinical psychotherapy trial for adolescent depression

Objective: The authors' goal was to examine the incidence and predictors of emergent suicidality ... more Objective: The authors' goal was to examine the incidence and predictors of emergent suicidality that occurred during a clinical trial of psychotherapy for adolescent depression. Method: The rates and predictors of emergent suicidality in 88 medication-free depressed adolescent outpatients who reported no current suicidality during an intake interview were assessed over 12 to 16 weeks of psychotherapy treatment. Results: The incidence of emergent suicidality was 12.5\% (11 of 88 subjects). Self-reported suicidal thoughts at intake were a significant predictor of emergent suicidality, even when suicidality was denied at intake interview. Conclusions: Emergent suicidality is a common occurrence in psychosocial treatment of adolescent depression, with rates similar to those reported recently in antidepressant trials. To evaluate accurately the role of treatment in emergent suicidality, it is important to assess self-reported suicidality at intake and to balance treatment groups on this key predictor of emergent suicidality.

Research paper thumbnail of Epileptiform seizure after sertraline treatment in an adolescent experiencing obsessive-compulsive disorder and presenting a rare pharmacogenetic status

Research paper thumbnail of Violent behavior of patients admitted in emergency following drug suicidal attempt: a specific staff educational crisis intervention

Objective: In spite of much effort to create guidelines on the management of violent behavior (VB... more Objective: In spite of much effort to create guidelines on the management of violent behavior (VB) in emergency departments, little is known about the impact of such guidelines on a real-life emergency environment. The aim of this study is to investigate the impact of a staff educational crisis intervention (SECI) on the reduction of VB in patients admitted to emergency departments following drug suicidal attempt. Method: The impact of a SECI on VB of patient consulting the ER following a drug suicide attempt was assessed by comparing the occurrence of VB before (5 months) and after (5 months) the introduction of a SECI. Results: A significant reduction in VB (from 17.32\% to 7.14\%) was found with the comparison of two 5-month periods: before (254 patients) and after (224 patients) the introduction of a SECI program (chi(2)= 11.238; P = .0008). Conclusion: These preliminary data suggest the need for further prospective randomized studies aiming to prevent VB in emergency departments by developing specific SECI programs. (c) 2007 Elsevier Inc. All rights reserved.

Research paper thumbnail of Characteristics of adolescent depression

Adolescent depression is a chronic, recurrent, and serious illness associated with significant mo... more Adolescent depression is a chronic, recurrent, and serious illness associated with significant morbidity and mortality. Its presentation can be misleading because it can present with irritability instead of sadness. Four components are key to the initiation of treatment: 1) identify the signs that indicating the need of urgent and specialized treatment; 2) determine the presence of suicide ideation and behaviors and establish a no-suicide contract; 3) educate parents and patients about the symptoms, complications, prognosis, and treatment of depression; 4) identify and lessening hopelessness because it is associated with poor adherence to treatment and suicidal behavior. Depression is a treatable condition if treated with all the existing therapeutic tools. The long-term follow up is critical to identify and treat relapses and recurrences.

Research paper thumbnail of Lifetime history of sexual abuse, clinical presentation, and outcome in a clinical trial for adolescent depression

Objective: To investigate the impact of sexual abuse on clinical presentation and treatment outco... more Objective: To investigate the impact of sexual abuse on clinical presentation and treatment outcome in depressed adolescents. Method: 107 adolescent outpatients, 13 to 18 years old, with DSM-III-R major depression were randomly assigned to cognitive-behavioral therapy (CBT), systemic behavioral family therapy (SBFT), or nondirective supportive therapy (NST) from Oct. 1, 1991 through May 31, 1995. Subjects were classified on the basis of the presence or absence of lifetime history of sexual abuse. Since only I subject assigned to SBFT had a history of sexual abuse, we restricted our analyses to those 72 subjects assigned to either CBT or NST. The impact of lifetime history of sexual abuse on service use, depression, and treatment outcome was examined. Results: Depressed adolescents with a past history of sexual abuse were more likely, at 2-year follow-up, to have had a psychiatric hospitalization and have a depressive relapse, even controlling for maternal depression, source of referral, race, and treatment assignment. CBT was more efficacious than NST in absence of sexual abuse but was not better than NST in those with a history of sexual abuse. Conclusion: Sexual abuse is a negative predictor of long-term outcome in adolescent depression. CBT for depression may not be as efficacious for those depressed adolescents with a history of sexual abuse. These findings suggest that a history of sexual abuse should be assessed not only in clinical practice, but also in research studies of depressive outcome. Further work is indicated to understand the relationship between sexual abuse and poor outcome in order to help restore these high-risk youths to an optimal developmental trajectory.

Research paper thumbnail of 10 years of analytical group training ``in blocks{''} in Geneva (Switzerland)

After 10 years of experience in Geneva more than 300 health professionals have been through this ... more After 10 years of experience in Geneva more than 300 health professionals have been through this group training. It appears that trainees Pined: knowledge about group dynamic, supervision for their practice, and personal experience in small and large group settings. But even more importantly they gained the opportunity to experience within a multidisciplinary ``teaching community{''} some unique experiences related to ``therapeutic communities{''}. This is of particular importance in a changing world, where managed care increases the pressure on the multidisciplinary team, within and between institutions, and where, in parallel, the time available to settle the inevitable conflicts decrease. Given the increase a number of institutions in charge of helping the population we would like in future to propose a program that would attract not only mental health professionals but also professionals from social institutions.

Research paper thumbnail of Suicidality and its relationship to treatment outcome in depressed adolescents

This study investigates the impact of suicidality on treatment outcome in 107 depressed adolescen... more This study investigates the impact of suicidality on treatment outcome in 107 depressed adolescents who participated in a clinical trial, and received either cognitive-behavioral (CBT), systemic-behavioral-family (SBFT), or non-directive-supportive therapy (NST). Suicidal depressed adolescents had a higher dropout rate and were more likely to be depressed at the end of treatment, in large part due to the particularly poor response of suicidal patients to NST The relationship between suicidality and treatment response was mediated by severity of depression and hopelessness at intake. Hopelessness should be specifically targeted early in treatment. Suicidal depressed adolescents should not receive NST but a specific treatment like CBT.

Research paper thumbnail of Gender differences among depressed suicidal children

Research paper thumbnail of The outcome of adolescent depression in a treatment study

Research paper thumbnail of Reducing hospital readmission in depression and schizophrenia: current evidence

Purpose of review It is estimated that the readmission rate for discharged psychiatric patients i... more Purpose of review It is estimated that the readmission rate for discharged psychiatric patients is approximately 40-50\% within 1 year of hospital discharge. This review focuses on recent developments in our understanding of predictors of readmission in depression and schizophrenia, and on quality improvement methods and models aimed at reducing readmission rates for these patients. Recent findings Multiple factors contribute to the risk of hospital readmission; however, demographic and clinical characteristics alone are of limited utility in identifying patients most likely to be readmitted. Recent research has emphasized the role of enhancing treatment and medication adherence, which is of critical importance given the strong association between nonadherence and rehospitalization. Methodological work is currently underway to improve the measurement of medication adherence and continuity of care, which have been difficult to assess in the past. Despite significant progress during the past few years, the development and evaluation of structured disease management programs for depression and bipolar disorder continues to represent an important challenge for future research. Summary Empirical work is needed to evaluate the effectiveness of different approaches to reducing patient readmission following hospital discharge.

Research paper thumbnail of Clinical differences between suicidal and nonsuicidal depressed children and adolescents

Objective: To examine the clinical symptoms and comorbid psychiatric disorders of depressed child... more Objective: To examine the clinical symptoms and comorbid psychiatric disorders of depressed children and adolescents with and without clinically significant suicidal ideation. Method: Children and adolescents aged 7 to 17 years with current DSM-III-R major depressive disorder (MDD) (N = 135) were recruited between January 1987 and April 2002. Current MDD symptoms and lifetime comorbid psychiatric disorders were assessed using either a combination of the Schedule for Affective Disorders and Schizophrenia for School Age Children-Epidemiologic and -Present Episode versions or the -Present Lifetime version. Thirty-two percent (N = 43) of the depressed subjects were classified as suicidal (at least suicidal ideation with a plan). Results: Depressed suicidal youth presented with a more severe episode (p = .001) and a poorer functional status (p = .019), were more hopeless (p = .001), and presented more frequently with insomnia (p = .011). There was an interaction between suicide x sex x pubertal status for severity of MDD (p = .013), the presence of hopelessness (p < .001), poor functional status (p = .023), and comorbidity with a lifetime history of any disruptive behavior (p = .019). Among prepubertal depressed males, suicidal boys had significantly increased severity of MDD (p =.025) and poorer functional status (p = .044) than nonsuicidal boys. Among postpubertal depressed females, suicidal girls were more frequently hopeless (p = .008) and presented an increased severity of MDD (p = .022) and more frequent lifetime history of any disruptive behavior (p = .03) when compared with nonsuicidal girls. Conclusion: There appears to be a sex difference for some clinical features, particularly hopelessness, among depressed suicidal children and adolescents. Whether hopelessness is a sex-specific characteristic of depressed suicidal children and adolescents requires further study.

Research paper thumbnail of Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment - A meta-analysis of randomized controlled trials

Context The US Food and Drug Administration (FDA) has issued warnings that use of antidepressant ... more Context The US Food and Drug Administration (FDA) has issued warnings that use of antidepressant medications poses a small but significantly increased risk of suicidal ideation/ suicide attempt for children and adolescents. Objective To assess the efficacy and risk of reported suicidal ideation/ suicide attempt of antidepressants for treatment of pediatric major depressive disorder (MDD), obsessive-compulsive disorder (OCD), and non-OCD anxiety disorders. Data Sources and Study Selection PubMed ( 1988 to July 2006), relevant US and British regulatory agency reports, published abstracts of important scientific meetings (1998-2006), clinical trial registries, and information from authors. Studies were published and unpublished randomized, placebo-controlled, parallel-group trials of second-generation antidepressants ( selective serotonin reuptake inhibitors, nefazodone, venlafaxine, and mirtazapine) in participants younger than 19 years with MDD, OCD, or non-OCD anxiety disorders. Data Extraction Information was extracted on study characteristics, efficacy outcomes, and spontaneously reported suicidal ideation/ suicide attempt. Data Synthesis Twenty-seven trials of pediatric MDD( n= 15), OCD ( n= 6), and non-OCD anxiety disorders ( n= 6) were selected, and risk differences for response and for suicidal ideation/ suicide attempt estimated by random-effects methods. Pooled risk differences in rates of primary study-defined measures of responder status significantly favored antidepressants for MDD( 11.0\%; {[}95\% confidence interval \{CI\}, 7.1\% to 14.9\%]), OCD( 19.8\% {[} 95\% CI, 13.0\% to 26.6\%), and non-OCD anxiety disorders (37.1\% {[}22.5\% to 51.7\%]), corresponding to a number needed to treat (NNT) of 10 ( 95\% CI, 7 to 15), 6 ( 4 to 8), and 3 ( 2 to 5), respectively. While there was increased risk difference of suicidal ideation/ suicide attempt across all trials and indications for drug vs placebo (0.7\%; 95\% CI, 0.1\% to 1.3\%) ( number needed to harm, 143 {[} 95\% CI, 77 to 1000]), the pooled risk differences within each indication were not statistically significant: 0.9\% ( 95\% CI, - 0.1\% to 1.9\%) for MDD, 0.5\% (- 1.2\% to 2.2\%) for OCD, and 0.7\% (- 0.4\% to 1.8\%) for non-OCD anxiety disorders. There were no completed suicides. Age-stratified analyses showed that for children younger than 12 years with MDD, only fluoxetine showed benefit over placebo. In MDD trials, efficacy was moderated by age, duration of depression, and number of sites in the treatment trial. Conclusions Relative to placebo, antidepressants are efficacious for pediatric MDD, OCD, and non-OCD anxiety disorders, although the effects are strongest in non-OCD anxiety disorders, intermediate in OCD, and more modest in MDD. Benefits of antidepressants appear to be much greater than risks from suicidal ideation/ suicide attempt across indications, although comparison of benefit to risk varies as a function of indication, age, chronicity, and study conditions.

Research paper thumbnail of Placebo Response in Randomized Controlled Trials of Antidepressants for Pediatric Major Depressive Disorder

Objective: The authors examined characteristics and predictors of response to placebo in all avai... more Objective: The authors examined characteristics and predictors of response to placebo in all available reports of short-term randomized controlled trials of antidepressants for pediatric major depressive disorder. Method: Response, defined as a score <= 2 on the improvement item of the Clinical Global Impression scale, and potential predictors were extracted from 12 published and unpublished randomized controlled trials of second-generation antidepressants in participants 6-18 years of age with major depression. Results: The single best predictor of the proportion of patients taking placebo who responded to treatment was the number of study sites. Baseline severity of illness also emerged as a significant inverse predictor of placebo response, although the strength of this relationship was diminished when number of sites was controlled for. After one large fluoxetine trial was excluded, younger participants showed a higher placebo response rate than older adolescents. Higher placebo response rates in more recent studies were explained by an increasing trend toward large multisite trials and by publication delays and failures to publish some negative trials. Conclusions: The recent shift toward large multisite trials of antidepressant medications for pediatric major depression may be contributing to an increasing incidence of response to placebo. Pharmacotherapy studies of pediatric depression that carefully recruit patients with at least moderately severe depression may be more informative and efficient than many trials conducted to date. Such studies should have sufficient power to determine whether age moderates medication and placebo response.

Research paper thumbnail of Impaired Decision Making in Adolescent Suicide Attempters

Objective: Decision-making deficits have been linked to suicidal behavior in adults. However, it ... more Objective: Decision-making deficits have been linked to suicidal behavior in adults. However, it remains unclear whether impaired decision making plays a role in the etiopathogenesis of youth suicidal behavior. The purpose of this study was to examine decision-making processes in adolescent suicide attempters and never-suicidal comparison subjects. Method: Using the Iowa Gambling Task, the authors examined decision making in 40 adolescent suicide attempters, 13 to 18 years old, and 40 never-suicidal, demographically matched psychiatric comparison subjects. Results: Overall, suicide attempters performed significantly worse on the Iowa Gambling Task than comparison subjects. This difference in overall task performance between the groups persisted in an exact conditional logistic regression analysis that controlled for affective disorder, current psychotropic medication use, impulsivity, and hostility (adjusted odds ratio = 0.96, 95\% confidence interval = 0.90-0.99, p < 0.05). A two-way repeated-measures analysis of variance revealed a significant group-by-block interaction, demonstrating that attempters failed to learn during the task, picking approximately the same proportion of disadvantageous cards in the first and final blocks of the task. In contrast, comparison subjects picked proportionately fewer cards from the disadvantageous decks as the task progressed. Within the attempter group, overall task performance did not correlate with any characteristic of the index attempt or with the personality dimensions of impulsivity, hostility, and emotional lability. Conclusions: Similar to findings in adults, impaired decision making is associated with suicidal behavior in adolescents. Longitudinal studies are needed to elucidate the temporal relationship between decision-making processes and suicidal behavior and to help frame potential targets for early identification and preventive interventions to reduce youth suicide and suicidal behavior. J. Am. Acad. Child Adolesc. Psychiatry, 2012;51(4):394-403.

Research paper thumbnail of Factor Structure of Borderline Personality Disorder Symptomatology in Adolescents

Objective: To examine the factor structure of the Diagnostic and Statistical Manual of Mental Dis... more Objective: To examine the factor structure of the Diagnostic and Statistical Manual of Mental Disorders (DSM), Fourth Edition, criteria for borderline personality disorder (BPD) in a sample of adolescents with a borderline symptomatology. Method: The latent structure of borderline criteria, assessed with the Structured Interview for DSM-IV Personality, was explored with a principal factor analysis in a sample of 107 adolescents with a borderline symptomatology drawn from a European research project on BPDs. Results: The principal component analysis revealed 2 homogeneous factors accounting for 66.8\% of the variance. The first factor included internally oriented criteria, such as avoidance of abandonment, identity disturbance, chronic feeling of emptiness, and stress-related paranoid ideation. The second factor included externally oriented criteria, such as unstable relationships, impulsivity, suicidal or self-mutilating behaviours, and inappropriate anger. Affective instability was the only criterion loading on both factors. Conclusions: The results of our study suggests that an internal or external dichotomy may be an appropriate way to conceptualize the structure of borderline criteria in adolescents with a borderline symptomatology, with affective instability being a core feature of BPD at this age.

Research paper thumbnail of Parental functioning improves the developmental quotient of pediatric liver transplant recipients

Psychomotor development in pediatric liver transplant (LT) recipients depends on several factors.... more Psychomotor development in pediatric liver transplant (LT) recipients depends on several factors. Our aim was to evaluate the importance of parental involvement and family dynamics on psychomotor development by assessing (i) children and parents individually, (ii) the parentchild relationship, and (iii) the correlation between parental functioning and patient outcome, all before and after LT. Age-appropriate scales were used before and after LT. Twenty-one patients, 19 mothers, and 16 fathers were evaluated. Developmental quotient (DQ): No subjects scored in the very good range. The proportion of children with deficits increased from LT to two yr: 17.6\% vs. 28.6\%. Subjects 02yr were more likely to have normal DQ at transplant (66.7\% vs. 50\% for older children). Abnormal DQ was more prevalent two yr post-LT in children older at LT (p=0.02). The motherchild relationship was normal in 59\% of families pre-LT and in 67\% at two yr. The relationship was more favorable when the child received a transplant as an infant (p=0.014 at 12months post-LT). Normal DQ was associated with higher maternal global functioning score pre-LT (p=0.03). Paternal performance scores were higher than maternal scores. Children transplanted after twoyr of age suffer greater long-term deficits than those transplanted as infants.

Research paper thumbnail of Screening for bipolar disorder in adolescents with the Mood Disorder Questionnaire - Adolescent version (MDQ-A) and the Child Bipolar Questionnaire (CBQ)

Aim: Screening instruments for bipolar disorders (BDs) in children and adolescents have been deve... more Aim: Screening instruments for bipolar disorders (BDs) in children and adolescents have been developed recently. The present study examined performances of the French versions of the Mood Disorder Questionnaire - Adolescent version (MDQ-A) and Child Bipolar Questionnaire (CBQ) in a sample of in-and outpatients. Methods: Seventy-six adolescents (age 13-18) and parents first completed the MDQ-A (adolescent and parent versions) and CBQ screening instruments. About 3 weeks later, they had a diagnostic interview with the Kiddie-Schedule for Affective Disorders and Schizophrenia - Present and Lifetime (K-SADS-PL), and the adolescent MDQ-A self-report was completed a second time. Results: Eight of 76 patients (10.5\%) met K-SADS-PL diagnostic criteria for BD. Test-retest reliability of the adolescent MDQ-A self-report was moderate (kappa = 0.66), whereas agreement between adolescent and parent reports was poor (kappa = 0.07). Sensitivity and specificity of the MDQ-A with respect to K-SADS-PL were 75.0\% and 57.4\% for the adolescent version, and 87.5\% and 63.2\% for the parent version. Corresponding figures were 50.0\% and 73.5\% for the CBQ. All three screening instruments had low positive predictive values (17.1\% for the MDQ-A adolescent version; 21.9\% for the MDQ-A parent version; 18.2\% for the CBQ), whereas negative predictive values were higher than 90\%. Conclusions: The present study points to modest performances of the MDQ-A and CBQ to detect BDs in adolescents, with diagnostic criteria for BD being unmet for a majority of patients who screened positive.