BackgroundDepression is frequently comorbid with posttraumatic stress disorder (PTSD) and substantially influences its severity, course and outcomes. Published studies linking war-related paediatric PTSD and Major depressive disorder (MDD) were mainly based on cross-sectional studies.ObjectiveTo prospectively examine the role of PTSD and other risk/protective factors in the development of depression among adolescents with war-related trauma.MethodsA longitudinal study of 160 adolescents aged 15–17 years with war-related trauma and displacement due to war in Eastern Ukraine was performed. Of the 160 adolescents, N = 86 met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-4) criteria for PTSD. All adolescents underwent comprehensive psychiatric assessments that included Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime version (K-SADS-PL) administered to both parents and children. Traumatic exposure was assessed using the modified Traumatic Events Screening Inventory for children (TESI-C). PTSD and MDD were assessed with the Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA) and Children's Depression Rating Scale-Revised (CDRS-R), and diagnosed using DSM-4 criteria. Follow-up and repeated measurements occurred at 6 and 12 months. During the study, adolescents requiring clinical care were referred for best available care in the community.ResultsAmong 92.6% of study completers, 26/79 youth with PTSD developed MDD (32.9%), compared to 6/70 without PTSD (8.5%): relative risk (RR) = 3.83 (95% CI 1.67–8.78), p = 0.0014; Number needed to harm (NNTH) = 4.108 (8.53–2.7). Using logistic regression, variables of school attendance, ‘secondary’ traumatic exposure, and treatment with Trauma-focused Cognitive Behavioral Therapy (TF-CBT) were significantly correlated with the incidence of new-onset depression among adolescents with PTSD.ConclusionsWar-related trauma with subsequent PTSD appears to be a significant risk factor for the later development of depression in adolescents. The role of PTSD as a moderator of depression merits further investigation in larger scale longitudinal studies in diverse populations.
A nationwide survey of 2,004 adult Ukrainian parents who reported on their experiences of the war, how their own mental health has changed since the invasion in February 2022, and how the mental health of their children has changed. These data were collected between July and September 2022.
Introduction: Military action in Ukraine led to increasing in the number of patients with PTSD among children. Open-label studies demonstrated the efficacy of SSRI's for the treatment of PTSD, primarily paroxetine. Feasibility of using of these drugs in children and adolescents is controversial [1-2]. Objective: To evaluate a short and long-term efficacy and tolerability of fluoxetine in the treatment of PTSD in children. Methods: double-blind, placebo-controlled 12-week study with a fixed dose of fluoxetine (20-40 mg). The trial design consisted of 1-week, single-blind, placebo run-in period, followed by a 12-week treatment period and a 2-week taper phase. Were randomized 110 children aged from 12 to 18 years (MD = 14,2), that have been moved from the combat zone in the east of Ukraine and met the DSM-5criterias for PTSD. Drug efficacy was assessed weekly using the CAPS-2; CGI-I / CGI-S. Safety assessed: Adverse event (AE) recording, suicidality assessment. Result: The reduction in CAPS-2 scales was statistically significant among children randomized to fluoxetine treatment compared with placebo in a week 12 endpoint (treatment difference-11.10; 95% Cl-13.4,-7,38; p <0.001). Significant greater proportion of fluoxetine-treated patient (52%) than placebo-treated (43%) were defined as treatment responders based on CGI scale (adjusted odds ratio = 2.28; 95% Cl 1.75, 2.93; p <0.001). The most common adverse effects in fluoxetine group were somnolence, headache and irritability, each occurring in <20% patients. Conclusion: Fluoxetine at a dose of 20-40 mg / day is more effective than placebo, well-tolerated and can be recommended in pediatric practice.
In Risperidone therapy was observed Inappropriate Speech retardation , and more frequently extra pyramidal side effects. Conclusion: Risperidon (1.0-3.0 mg / day) and Atomoxetine (25.0-40.0 mg / day) are more effective than placebo and well-tolerated and can be recommended for treatment of severe and challenging behaviors in children with PDD.
Purpose: In a public health crisis medical professionals face immense psychological tension that leads to onset of negative mental health outcomes. We aimed to estimate the self-reported level of posttraumatic, anxiety, depression, and stress-related symptoms and their association with the level of perceived social support among healthcare professionals during the coronavirus (COVID-19) pandemic in Ukraine. Methods: A cross-sectional web-based survey conducted during the second wave of the pandemic involved 330 participants. Mental health variables were assessed via the Depression Anxiety Stress Scale (DASS-21) and PTSD Checklist for DSM-5 (PCL-5). The level of perceived social support was assessed via the Multidimensional Scale of Perceived Social Support (MSPSS).
Results:The DASS-21 median score was 42.0 (IQR = 28.0-56.0), with 50.5% of respondents reporting moderate-to-severe depressive symptoms; 55.4% had moderate-to-severe anxiety levels; 42.4% had moderate-to-severe stress levels. The PCL-5 median score was 21.0 (IQR = 12.0-32.0), with 20% of the participants meeting the full criteria for PTSD. The MSPSS median score was 5.3 (IQR = 4.3-6.1), with 61.8% of the participants reporting high, 29.4% medium, and 8.8% low levels of social support, respectively. Logistic analysis revealed that being a younger person, female, having had previous exposure to COVID-19, working in inpatient facilities with COVID patients, and experiencing a lower level of social support were significant risk factors for the onset of mental disorders. Almost 75% of participants exhibited low-to-moderate adherence to psychological/psychiatric care. Conclusions: Health professionals working with COVID patients need to be screened for mental disorders. A campaign aimed at achieving the de-stigmatization of mental care is required.
Марценковський І.А., Марценковська І.І. Український НДІ соціальної і судової психіатрії та наркології, м. Київ, Україна Розлади аутистичного спектра: фактори ризику, особливості діагностики й терапії Резюме. У статті обговорюються сучасні уявлення про взаємодію генного поліморфізму й факторів середовища при маніфестації розладів аутистичного спектра (РАС). Наведено скринінговий інструментарій для оцінки розвитку дитини й попередньої діагностики РАС, порядок остаточної діагностики лікарями-спеціалістами. Висвітлені особливості перебігу РАС при коморбідних психічних розладах і загальних медичних станах. У статті подана модель лікування розладів загального розвитку, розроблена в Українському науково-дослідному інституті соціальної і судової психіатрії та наркології, висвітлені особливості застосування психосоціальних інтервенцій, терапії лікарськими засобами коморбідних психічних і неврологічних розладів.
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