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PurposeThe presence of distinct child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) impacts continuity of mental health treatment for young people. However, we do not know the extent of discontinuity of care in Europe nor the effects of discontinuity on the mental health of young people. Current research is limited, as the majority of existing studies are retrospective, based on small samples or used non-standardised information from medical records. The MILESTONE prospective cohort study aims to examine associations between service use, mental health and other outcomes over 24 months, using information from self, parent and clinician reports.ParticipantsSeven hundred sixty-three young people from 39 CAMHS in 8 European countries, their parents and CAMHS clinicians who completed interviews and online questionnaires and were followed up for 2 years after reaching the upper age limit of the CAMHS they receive treatment at.Findings to dateThis cohort profile describes the baseline characteristics of the MILESTONE cohort. The mental health of young people reaching the upper age limit of their CAMHS varied greatly in type and severity: 32.8% of young people reported clinical levels of self-reported problems and 18.6% were rated to be ‘markedly ill’, ‘severely ill’ or ‘among the most extremely ill’ by their clinician. Fifty-seven per cent of young people reported psychotropic medication use in the previous half year.Future plansAnalysis of longitudinal data from the MILESTONE cohort will be used to assess relationships between the demographic and clinical characteristics of young people reaching the upper age limit of their CAMHS and the type of care the young person uses over the next 2 years, such as whether the young person transitions to AMHS. At 2 years follow-up, the mental health outcomes of young people following different care pathways will be compared.Trial registration numberNCT03013595., publishedVersion

Osvrt na tragičan događaj u Beogradu u svibnju, 2023.

Background: Transitioning from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) raises novel ethical aspects for healthcare professionals, as well as for young people, their parents and carers. Method: Focus groups were conducted in Croatia, Ireland and the United Kingdom with youth mental health groups and youth representatives with no mental health (MH) remit. One hundred and eleven participants, aged from 16 to 60 years, contributed to discussions. Results: Perpetuation of stigma, autonomy and decision-making were central themes as both enablers and deterrents of successful transition. The tension between professional (and at times parental) paternalism and young persons' growing autonomy was well captured in the themes; (a) desired practice, (b) who should decide, (c) the process of decision-making and (d) potential harm(s). Conclusions: This study provides insight into the ethical values, particularly autonomy and collaboratively working, which people expect to underpin the transition between CAMHS and AMHS. Key Practitioner Message: Engaging young people early in making decisions about their future care can enhance trust between practitioner and the young person. In addition to diagnosis, a number of factors (such as moving home; waiting lists and stigma) may need to be taken into account when considering the direction of future health care. When possible, alternatives to AMHS should be considered if considered by the young person to be a less-stigmatising treatment option.

Background and Objectives: Locus of control (LOC) is a modifiable mediator of symptoms of posttraumatic stress disorder (PTSD) among traumatized individuals and a potential target of intervention. Compared with studies involving adults, the potential mediation effect of LOC on PTSD symptoms among trauma-exposed children and adolescents is relatively under-explored. This study, therefore, assessed the mediation effects of LOC on the association between lifetime cumulative trauma and PTSD symptoms among a large cohort of adolescents from different cultural background. Design: Cross-sectional study. Methods: LOC was determined using the Multi- Dimension Locus of Control Scale ; Posttraumatic stress symptoms using the UCLA PTSD Reaction Index ; and other significant negative life events using the Life Events Checklist. Results: Among 3826 adolescents who completed the study, external LOC explained 24% of variance (R 2 =.24 ; F2, 3823 = 619.01 ; p

Current research trend is the identification of psychosocial variables that moderate and/or mediate the association between stressors and psychopathological symptoms. Research has shown Locus of Control (LoC) is a key cognitive component of this psychological process in adolescents from individualist cultures. It is unclear whether this finding can be generalized to collectivist adolescents given that LoC is argued to be a culturally relative construct. The study examined the moderating and mediating effects of LoC on the relationship between negative events and psychopathological symptoms (anxiety and depressive symptoms) in adolescents from collectivist countries (n = 2800). Consistent with prior research, negative life events and external LoC were associated with more psychopathological symptoms. Unlike past studies with samples from individualist countries, the study did not produce clear evidence that LoC moderated or mediated this relationship. Results are discussed in terms of cultural differences in the (un)desirability of external control.

International audience; INTRODUCTION: Disruption of care during transition from child and adolescent mental health services (CAMHS) to adult mental health services may adversely affect the health and well-being of service users. The MILESTONE (Managing the Link and Strengthening Transition from Child to Adult Mental Healthcare) study evaluates the longitudinal course and outcomes of adolescents approaching the transition boundary (TB) of their CAMHS and determines the effectiveness of the model of managed transition in improving outcomes, compared with usual care. METHODS AND ANALYSIS: This is a cohort study with a nested cluster randomised controlled trial. Recruited CAMHS have been randomised to provide either (1) managed transition using the Transition Readiness and Appropriateness Measure score summary as a decision aid, or (2) usual care for young people reaching the TB. Participants are young people within 1 year of reaching the TB of their CAMHS in eight European countries; one parent/carer and a CAMHS clinician for each recruited young person; and adult mental health clinician or other community-based care provider, if young person transitions. The primary outcome is Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA) measuring health and social functioning at 15 months postintervention. The secondary outcomes include mental health, quality of life, transition experience and healthcare usage assessed at 9, 15 and 24 months postintervention. With a mean cluster size of 21, a total of 840 participants randomised in a 1:2 intervention to control are required, providing 89% power to detect a difference in HoNOSCA score of 0.30 SD. The addition of 210 recruits for the cohort study ensures sufficient power for studying predictors, resulting in 1050 participants and an approximate 1:3 randomisation. ETHICS AND DISSEMINATION: The study protocol was approved by the UK National Research Ethics Service (15/WM/0052) and equivalent ethics boards in participating countries. Results will be reported at conferences, in peer-reviewed publications and to all relevant stakeholder groups. TRIAL REGISTRATION NUMBER: ISRCTN83240263; NCT03013595 (pre-results).

Humor ima povoljne učinke na zdravlje jer štiti od negativnih utjecaja stresa i ublažava tjelesnu i emocionalnu bol. Djeluje relaksirajuće, umanjuje strah, tugu i anksioznost te poboljšava imunološki sustav, respiratorni i kardiovaskularni sustav. Omogućuje realniju procjenu situacije i distanciranje od stresa. U bolničkom okruženju korisna je metoda za smanjenje stresa i boli te za postizanje bolje suradnje pacijenata tijekom invazivnih pretraga. Djelovanje klaunova- doktora predstavlja jedinstven način primjene humora u bolničkom okruženju. Rezultati istraživanja potvrđuju da intervencije klaunova-doktora ublažavaju neke negativne učinke hospitalizacije na bolesnike, naročito djecu, jer donose zabavu i smijeh, mijenjaju raspoloženje i percepciju bolesti i liječenja te psihološki osnažuju osobu. Potvrđen je i pozitivan učinak klaunova- doktora na roditelje i članove obitelji bolesne djece, te bolničko osoblje. U radu su prikazane novije spoznaje o učinku humora na tjelesno i mentalno zdravlje te djelovanje klaunova-doktora u svijetu i Hrvatskoj.

Pediatric mental health emergencies constitute a large and growing segment of child and adolescent mental health care. Children and adolescents who present with acute mental health complaints require a concise yet systematic assessment to determine if the young person is suffering from an acute psychiatric disorder versus a mental health problem which presents with a crisis. Acute medical complications emanating from the mental health problem and acute medical conditions causing mental health emergencies need to be ruled out before the urgent mental health assessment can proceed. The emergency department (ED) needs to provide triage, diagnosis, stabilization, initial management, and treatment and referral for a broad spectrum of mental health emergencies, working within a mental health infrastructure in crisis. Assessment and treatment of acute psychiatric emergencies in children and adolescents in the ED require a multidisciplinary team approach consisting ideally of a child psychiatrist, crisis worker or social worker, nursing staff, and an ED physician. The primary goal of an urgent psychiatric assessment in the ED is to determine the safety risk of the patient and if a higher level of care is needed, such as referral to a psychiatric inpatient unit, crisis unit/step-up unit, or urgent mental health outpatient clinic.

Over the past two decades, there has been more focus on the concept of dissociation in patients experiencing both acute and/or chronic combat-related trauma. We report a case of a 40-year war veteran with PTSD, with symptoms indicating presence of intermittent dissociative states following re-traumatisation fifteen years after the war trauma. This unusual clinical scenario presented a challenging clinical case which does not meet criteria of the current classification for dissociative disorders.

Dječja i adolescentna psihijatrija ima u Hrvatskoj više decenija svoju vrijednu tradiciju. Od godine 1994. postoji subspecijalizacija iz dječje psihijatrije, kao dio opće psihijatrije. Rezultat rada niza dječjih psihijatara, kao i Europskih trendova je da danas imamo samostalnu specijalizaciju iz dječje psihijatrije od godine 2011. Dječja psihijatrija ima svoje posebnosti u odnosu na odraslu psihijatriju. Smatra se da oko 50% poremećaja dijagnosticiranih u odrasloj dobi zapravo svoj početak imaju u djetinjstvu, što naglašava važnost mentalnog zdravlja djece i adolescenata. Mentalno zdravlje djece stoga dobiva i nacionalnu važnost. Većina dječjih psihijatara danas radi u institucijama, manji broj ih radi u primarnoj zdravstvenoj zaštiti odnosno pri zavodima za javno zdravstvo. Danas postoji u Hrvatskoj oko 50 dječjih psihijatara, potrebno ih je barem dvostruko više da bi se zadovoljile potrebe djece s psihičkim smetnjama. Prevalencija psihičkih smetnji djece i adolescenata u zadnjim godinama raste, što ukazuje na veliku potrebu liječenja. U Hrvatskoj je sustav vrlo centraliziran, u odnosu na regije i manja mjesta. U pojedinim KBC-ovima u Hrvatskoj ne postoje dnevne bolnice (KBC Osijek, KBC Split), kao niti stacionarni odjeli (KBC Split), što je potrebno u skoroj budućnosti otvoriti, i dosta je napora u zadnje vrijeme uloženo da se ovi problemi riješen. Tzv. «master plan» koji je trenutno u saborskoj proceduri je prema našem mišljenju stručno neopravdano zaobišao dječju i adolescentnu psihijatriju, o čemu je obavješteno nadležno Ministarstvo zdravlja, predsjednik Vlade, saborski zastupnici, stručne udruge, pravobraniteljica za djecu, kao i šira javnost. Smatramo da je potrebno da dječja psihijatrija dobije status «deficitarne i razvojne» struke, za što je već dobivena suglasnost nekoliko stručnih društava HLZ-a. Potrebno je osigurati prikladne uvjete za rad pojedinih (sub)specijalista iz dječje i adolescentne psihijatrije, uz po mogućnosti njihovo puno radno vrijeme rada s djecom i adolescentima, ali i osiguranjem multidisciplinarnosti (uključenost psihologa, defektologa, socijalnih radnika, medicinskih sestara i drugih struka). Dječji psihijatri bi u budućnosti trebali biti više orjentirani na prevenciju i edukaciju. U skoroj budućnosti je izgledno da će se otvoriti posebne Klinike za dječju i adolescentnu psihijatriju pri pojedinim KBC-ovima u Hrvatskoj.

Most studies examining adolescent alcohol and substance use or abuse hardly include samples from developing countries. To bridge some gap, the prevalence and associated social correlates of alcohol and substance use and abuse was examined among a cohort of school-going adolescents sampled from seven developing countries. Alcohol and substance abuse was measured using the CRAFFT instrument, independent socio-demographic correlates were determined using regression models. A total of 2, 454 adolescents completed the study among which 40.9% reported using either alcohol or at least one other substance during the previous 12 months. This was mostly alcohol (37.8%), followed by marihuana/hashish (8.6%) and other substances (8.1%). Among the adolescents who reported using at least one substance ; 45% (18.3% of total sample) had CRAFFT scores indicative of problematic or hazardous substance use. Several personal and family factors were independently associated with use/abuse, and the modifiable nature of these factors calls for appropriate intervention strategies.

The aim of this study was to examine the relationships between pathological narcissism (narcissistic grandiosity and narcissistic vulnerability), dysfunctional attitudes (perfectionism and dependency on other people), and depressive symptoms in psychiatric outpatients. A sample of 234 adult psychiatric outpatients (57.3% male ; mean age 44.39 years) completed the Pathological Narcissism Inventory, the Dysfunctional Attitudes Scale-Form A, and the Depression, Anxiety, Stress Scales-21. Narcissistic vulnerability exhibited unique positive correlations with depressive symptoms, whereas narcissistic grandiosity showed substantially weaker correlations with depressive symptoms. Perfectionism partially mediated the relationship between narcissistic vulnerability and depressive symptoms. The mediating role of dependency was not confirmed. Among adult psychiatric outpatients, narcissistic vulnerability is more strongly related to depressive symptoms than narcissistic grandiosity, and dysfunctional perfectionism represents one of the underlying mechanisms of this relationship. The implications of these findings are discussed in relation to the Diagnostic and Statistical Manual of Mental Disorders diagnostic criteria and the treatment of pathological narcissism.

SAŽETAK Pozadina i cilj: Samoubilačka promišljanja (SP) su indikator i prediktor psihološkog distresa. Istraživali smo njihovu učestalost kod ranih adolescenata i njihovu povezanost sa sociodemografskim varijablama, ponašanjima, stavovima, roditeljskim sudioništvom u ratu, depresivnim simptomima i crtama ličnosti. Tragali smo i za specifičnim spolnim razlikama ili obrascima. Tvoriva i postupci: Presječna studija s korištenjem samoiskaznog upitnika provedena je na 803 dvanaestogodišnjaka. Samoubilačka promišljanja su procjenjivanja sa tri dihotomna pitanja. Ostali podatci su prikupljani uporabom sociodemografskog upitnika, Eysenckovog upitnka ličnosti za djecu iadolescente (JEPQ) i Skale dječje depresivnosti (CDI). Nenamjerno ozljeđivanje, fizički obračuni te sudjelovanje u vršnjačkom zlostavljanju je procjenjivano korištenjem pitanja iz upitnika SZO Zdravstveno ponašanje u djece školske dobi (WHO-HBSC). Rezutati: Pronađena je učestalost SP do 17, 6%. Nisu uočene spolne razlike. SP u dječaka su povezana sa nižim obrazovanjem majke ; napučenijim obiteljima ; redoslijedom rođenja ; roditeljskim sudioništvom u ratu ; fizičkim obračunima ; češće su žrtve vršnjačkog nasilja i zloupotrebljavaju supstance. Kod djevojčica su pronađeni povezanost sa nižim roditeljskim obrazovanjem ; većim brojem braće ; slabijom percepcijom odnosa sa roditeljima ; roditeljskog međusobnog odnosa ; slabijim osjećajem obiteljske kohezije i kontrole ; negativnim stavom prema školi ; rjeđim odlascima na vjerske obrede ; fizičkim obračunima te sudjelovanjem u vršnjačkom zlostavljanju i kao akter i kao žrtva. Depresivni simptomi su povezani sa SP u oba spola. Zaključak: Iako nema spolne razlike u učestalosti SP ona ipak pokazuju spolno specifični obrazac. Ovo u određenoj mjeri može biti objašnjivo sa roditeljskim sudioništvom u ratu kao i socioekonomskim promjenama koje su uzrokovane tranzicijom. Nalazi istraživanja mogu imati potencijalno važne kliničke i preventivne implikacije.

Report a case of infantile masturbation where “diagnosis” is established but still there were etiological questions and a need for some kind of intervention because of parental distress