National Institute for Health Research Policy Research Programme grant (115/0001).

This article provides a quantitative and conceptual review of emotion regulation difficulties in trauma-exposed young people, and informs future directions in the field. Despite long-standing interest in the influence of emotion regulation difficulties on different internalizing and externalizing psychiatric disorders in childhood, several questions remain unresolved with respect to children and adolescents with PTSD (post-traumatic stress disorder). Meta-analytic data from adult victims suggest that emotion regulation problems are associated with PTSD, but this has never been studied in children and young people. We therefore provide a conceptual review of features related to the phenomenology, assessment, severity and treatment of emotion regulation difficulties in trauma-exposed children and young people. We combine this with a meta-analysis of published literature. We searched studies in Medline, PsychINFO, and Embase databases based on pre-selected criteria. Eight hundred and eighty-six papers were identified and 41 were included. We found that children and adolescents with a diagnosis of PTSD reported more emotion regulation difficulties than those who did not develop PTSD, and that the overall association between the two symptom dimensions was moderately strong. We identify a number of research priorities: the development of instruments to assess emotion regulation difficulties in children, the design of studies that describe its prevalence in young epidemiological traumatized samples, its predictive role in the onset, severity and persistence of post-traumatic symptoms, and its relevance as a moderator, outcome or treatment target for young survivors.

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Smith (2020) Complex post-traumatic stress symptoms in female adolescents: the role of emotion dysregulation in impairment and trauma exposure after an acute sexual assault,

A systematic review of short and medium-term mental health outcomes in young people following sexual assault Introduction Sexual assault is common worldwide, peaking in mid-to-late adolescence. Global estimates for women having ever experienced non-partner sexual violence were 7.2% in 2010, with the highest rates of up to 21% of women in areas of Sub-Saharan Africa [1]. Intimate partner sexual violence against women is also common worldwide, with prevalence varying by countryfrom 5%, to up to 69% of women having ever experienced this form of sexual violence [2]. Adolescents are the group at the highest risk of sexual assault in the UK [3] with 17.8% of females aged 18-24 disclosing previous sexual abuse [4]. Figures globally appear similar, with 17.4% of females and 4.2% of males from age 1 month to 17 years experiencing sexual assault at some time in the USA [5], and 14.61% of females and 9.99% of males aged 15-17 reporting lifetime sexual victimization in South Africa [6]. Associations between sexual abuse and adverse psychiatric outcomes have long been reported in the literature, with the strongest evidence for links with depression, post-traumatic stress disorder (PTSD), eating disorders, and suicide attempts [7-11]. However, the cross-sectional design of most studies limits the inferences that can be drawn from the results. This also makes it difficult to distinguish between the acute consequences of an index assault, lifetime psychiatric outcomes, and the progress of symptoms over time. We conducted a comprehensive systematic review to evaluate the evidence around short and medium-term (i.e. within three years of assault) mental health outcomes in young people sexually assaulted between the ages of 10 and 24 years. Methods The protocol for this review was developed by clinicians and academics working in the fields of child and adolescent psychiatry, adolescent medicine, and sexual assault. The reporting of results was based on the guidelines provided by the Meta-analyses and Systematic Reviews of Observational Studies group (MOOSE guidelines) [12]. Study question What are the short and medium-term effects on mental health of sexual assault between the ages of 10 and 24 years? Databases and search strategies Five databases (Medline (Ovid), Embase (Ovid), CINAHL (Ebscohost), OpenGrey, and PsycINFO were searched on the 30 th of October 2013 by two reviewers. This search was updated in 2016 and again in November 2018, using Medline and Embase databases only.

Many individuals with borderline personality disorder (BPD) receive medical treatment in clinical practice, although to date, there are no drugs specifically available for BPD. The recent Cochrane guideline suggests a benefit from using second-generation antipsychotics such as olanzapine or aripiprazole; nevertheless, side effects limit their use. Asenapine is a novel FDA-approved atypical antipsychotic for schizophrenia and bipolar disorder. However, it has not yet been tested for BPD. The goal of this observational open-label study was to assess the safety, tolerability and efficacy of asenapine in a series of cases of patients with BPD. Twelve individuals with BPD were recruited and treated with asenapine during an 8-week period. Eight individuals completed the study; a significant improvement was observed in the CGI-BPD (P<0.001) and BSL-23 (P<0.048) scales for BPD symptomatology. Besides, there was a significant improvement in the general psychopathology domains (BPRS, P<0.004), whereas no significant differences were observed in depressive symptoms. No serious adverse effects were reported and a significant weight reduction was observed (P=0.002). Asenapine appears to be a safe and effective agent in the treatment of patients with BPD, especially when other alternatives are not tolerated. These preliminary findings should be replicated in a controlled clinical trial.

Prader–Willi syndrome (PWS) is a rare genetic disorder characterized by a wide range of clinical manifestations, including obesity, hyperphagia, and behavioral problems. Bifidobacterium animalis subsp. lactis strain BPL1 has been shown to improve central adiposity in adults with simple obesity. To evaluate BPL1′s effects in children with PWS, we performed a randomized crossover trial among 39 patients (mean age 10.4 years). Participants were randomized to placebo–BPL1 (n = 19) or BPL1–placebo (n = 20) sequences and underwent a 12-week period with placebo/BPL1 treatments, a 12-week washout period, and a 12-week period with the crossover treatment. Thirty-five subjects completed the study. The main outcome was changes in adiposity, measured by dual-energy X-ray absorptiometry. Secondary outcomes included lipid and glucose metabolism, hyperphagia, and mental health symptoms. Generalized linear modeling was applied to assess differences between treatments. While BPL1 did not modify total fat mass compared to placebo, BPL1 decreased abdominal adiposity in a subgroup of patients older than 4.5 years (n = 28). BPL1 improved fasting insulin concentration and insulin sensitivity. Furthermore, we observed modest improvements in some mental health symptoms. A follow-up trial with a longer treatment period is warranted to determine whether BPL1 supplementation can provide a long-term therapeutic approach for children with PWS (ClinicalTrials.gov NCT03548480).

The new Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-V) includes pathological gambling disorder (PGD) in the subgroup of "Addiction and Related Disorders" due to the similarities between PGD and substance-based addictions in neurobiological, psychological, and social risk factors. Family factors as parental rearing attitudes play a crucial role in the development of substance use disorders and PGD. The aim of the present study was to assess the parental bonding during childhood perceived for adults with PGD compared with healthy controls. Twenty males with PGD and 20 control subjects answered the parental bonding instrument, which measures subjects' recollections of parenting on dimensions of care and protection. Subjects with PGD showed significantly lower maternal and paternal care (p = 0.016 and p = 0.031, respectively) than controls, and higher paternal protection (p = 0.003). The most common parental pattern for PGD subjects was the affectionless control (50% for the father and 60% for the mother). Preliminary results suggest that, as previously reported for substance use disorders, an affectionless control parenting style is associated with PGD.