Background The new coronavirus pandemic (COVID-19) has been accompanied by severe psychological pressure on the entire population. However, little is known about how this pandemic could affect the more vulnerable population with severe mental illness. Aims To explore adolescent psychiatric inpatients’ perceptions, emotional reactions and needs during the first wave of the COVID-19 pandemic. Methods Individual in-depth interviews were conducted with nine psychiatric inpatients aged 12–17 years. Through open-ended questions, interviewers initiated five themes: (a) knowledge about coronavirus pandemic, (b) changes in everyday routine due to the pandemic, (c) adolescents’ feelings about the pandemic, (d) adolescents’ positive thoughts and behaviors, and (e) how the social environment can help adolescents deal with the pandemic-related situation. A thematic analysis was conducted using line-by-line open coding. Results Regarding their knowledge of the impact of the current pandemic, almost all adolescents focused on information about the nature of coronavirus and on existing crisis management practices. Almost all patients identified predominantly negative changes due to the quarantine state, including restrictions on both social life and personal freedom as well as excessive contact with family members during home isolation. As far as their emotions were concerned, adolescents did acknowledge anxiety about self-harm and harming their loved ones as well as mood swings within the family nucleus; anxiety was also manifested about the unknown and the management of the pandemic in other countries. Avoidance of thought rumination about the coronavirus and its consequences, positive thinking and looking towards the future were reported as constructive strategies for coping with challenging emotions. Additionally, a sense of belongingness seems to have been playing a pivotal role in the adolescents coping strategies. Trust in the authorities and the community was another quite noteworthy point that emerged during the interviews. Lastly, our findings indicated adolescents’ benefit from receiving balanced health messaging coupled with balanced thinking within their social and family environment. Conclusions Enhanced comprehension of possible mediating psychological pathways is needed to help clinicians, researchers, and decision-makers to avert the deterioration of mental disorders and overall functioning, as well as additional stress-related disorders.

Background: The new coronavirus pandemic (COVID-19) has been accompanied by great psychological pressure on the entire population. However, little is known about how this pandemic could affect the more vulnerable population with severe mental illness.Aims: To explore adolescent psychiatric inpatients' perceptions, emotional reactions and needs during the first wave of the COVID-19 pandemic.Methods: Individual in-depth interviews were conducted with nine psychiatric inpatients aged 12-17 years. Five themes were initiated by interviewers through open-ended questions: (1) knowledge about the coronavirus pandemic, (2) changes in everyday routine, (3) feelings about the pandemic, (4) helpful thoughts and behaviors, and (5) practices of helping adolescents with their difficulties concerning the pandemic. A thematic analysis was conducted using line-by-line open coding.Results: Regarding their knowledge about the impact of the current pandemic, almost all adolescents focused on information about the nature of coronavirus and existing crisis management practices. Nearly all patients identified mainly negative changes due to the quarantine state, such as restrictions on social life and personal freedom, and excessive contact with family members during home isolation. With regard to their feelings, they acknowledged anxiety about harm to self and beloved ones, mood changes within the family nucleus, the unknown, and the management of the pandemic in other countries. Avoiding thought rumination about the coronavirus and its consequences, focusing on the positive, and looking into and towards the future were reported as helpful strategies for coping with difficult feelings. Additionally, a sense of belongingness insofar as they are not alone and share a common experience, seems central to the adolescents' arsenal of coping strategies. Confidence in the authorities and the community was another particularly interesting point that emerged during the interviews. Last, our findings indicated adolescents' benefit from receiving balanced health messaging, in addition to balanced thinking within their social and family environment.Conclusions: Better comprehension of possible mediating psychological pathways is needed in order to help clinicians, researchers and decision-makers develop psychosocial support interventions, to prevent the deterioration of mental disorders and overall functioning, as well as additional stress-related disorders.

Posttraumatic stress disorder (PTSD) is common in young people in need of inpatient and outpatient mental health services but PTSD is underdiagnosed in clinical settings (Havens et al., 2012). Despite the high prevalence and clinical significance of early recognition of trauma exposure and PTSD in mental health settings, currently there are few empirical data that shed light on the treatment implications in acute care: 40–50% of children and adolescents up to the age of 18 have been exposed to traumatic events and 6% suffer from PTSD. In psychiatric inpatients, the percentages are 46–96% and 21–29% respectively (Gudiño et al., 2014). Young people are also at risk of presenting with psychiatric symptoms, including anxiety, depression, delinquent behaviour, separation anxiety and self-harming behaviours (Havens et al., 2012). The under-identification of PTSD symptoms in clinical settings may hinder effective treatments.In order to examine the rates of trauma exposure and PTSD in inpatient psychiatric settings, we conducted a study of 56 children and adolescents who were admitted to the inpatient unit of the Department of Child Psychiatry, Athens University Medical School at the Aghia Sophia Children’s General Hospital, Athens, Greece, over a three-year period, Results revealed that 75% of the hospitalized children and adolescents had been exposed to violent events, either in their family or in the community. Of them, 26% (19% of the total inpatient population) had developed PTSD while the majority had presented symptoms of PTSD.In addition, of those children and adolescents with PTSD symptoms, 60% required longer hospitalizations and need acute care treatment. Youth diagnosed with PTSD presented with high levels of clinical severity and complexity. High rates of comorbidity were also observed among those with PTSD; the main comorbid disorders found were mood disorders (75% of all cases), but also somatization, conduct, generalized anxiety and, in some, eating and psychotic disorders. In 73% of PTSD cases and in 48.4% of those exposed to traumatic events, suicidal attempts were reported (67 and 53% had reported suicidal ideation) while the percentage of the inpatients with attempted suicides as a result of other psychiatric disorders was 19%. Youth with exposure to trauma and PTSD presented at admission with major impairment in functioning in several areas as measured by the Children’s Global Assessment Scale (C-GAS) (mean score = 32.8, with 91–100 showing superior functioning in all areas). Nevertheless, there is limited research on functioning (i.e. academic performance, peer relationships) in youth with PTSD which is much needed considering that it affects executive cognitive functions and mood. It is worth reporting that in our study, the systematic use of Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime version (K-SADS-PL) in the inpatient unit mainly led to the identification of trauma and consequent PTSD. The discrepancy between rates of PTSD at the intake and later throu...

This case study presents case conceptualization, therapeutic intervention, and the subjective and objective therapeutic progress of a 14-year-old adolescent hospitalized with posttraumatic stress disorder (PTSD) following emotional, physical, and sexual abuse by his father. The adaptive information processing (AIP) model that informs eye movement desensitization and reprocessing (EMDR) therapy and the theory of structural dissociation of the personality (TSDP) were used to conceptualize and guide the treatment. Stabilization and orientation to the present were essential to integrate his traumatic memories into a life narrative, and this became a major goal and an outcome of treatment. A single-case AB design was applied in assessing the impact of intervention. The UCLA PTSD Symptom Scale, Strengths and Difficulties Questionnaire—HEL (SDQ-HEL), State-Trait Anxiety Inventory (STAI), and Dissociative Experiences Scale II were administered at 5 different time points to assess changes in the youth’s subjective emotional state and indicated substantial improvement. In addition, objective behavior change (using O’Neill’s Behavior Checklist) was recorded on a daily basis for 7 months and showed a large decrease in the frequency of targeted maladaptive behaviors. The article describes the treatment process which helped the youth to regain a sense of time; establish a coherent sense of self; and maintain adaptive perceptions, emotions, attitudes, and behaviors.

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