Introduction: COVID-19 represents a serious threat to mental health worldwide. The aim of this study is to identify changes in adolescent psychiatry treatment demand in a tertiary hospital in Madrid during the first month (March 11 to April 11) after the pandemic declaration by the World Health Organization (WHO). We hypothesized that fear of contagion within COVID-19 may deter people from asking for psychiatric care.Method: The current study is retrospective, observational, and transversal. We reviewed the clinical records of 89 adolescents who went to the Emergency Room (ER) or were hospitalized at the Acute Inpatient Unit (AIU) at the Puerta de Hierro University Hospital-Majadahonda (PHUH-M) between March 11 and April 11. Socio-demographic, clinical, and demand variables were included in the study. Chi-square or Fisher exact tests were performed to compare categorical variables. We used the U Mann-Whitney test to compare quantitative variables. The level of statistical significance was set at p< 0.05. Analyses were conducted using SPSS v11.0.Results: The number of adolescents demanding psychiatric care at the ER dropped from 64 adolescents in 2019 to 25 in 2020. Similarly, psychiatric demand collapsed from 31 to 18 patients when comparing 2019 and 2020. Furthermore, the average hospital stay in 2020 trended toward a decrease when compared to 2019 (8.94 ± 4.87 vs. 14.32 ±10.23, p = 0.08). Self-injurious thoughts and behaviors were the most predominant reasons for consultation at both ER and AIU.Conclusion: The demand for adolescent psychiatric care decreased in the first month after the declaration of the pandemic. Our findings may be explained by (1) the fear of contagion, (2) the strict confinement measures, and (3) the initial shock as an adaptive reaction described in other disasters. Further studies are needed.

Background: The clinical presentation of children and adolescents referred to mental health services is frequently complicated by comorbid and severe affective and behavioral dysregulation. This dysregulation phenotype seems to be an indicator of overall psychopathology, symptom severity and functional impairment. Currently, this phenotype is assessed by the Child Behavior Checklist. However, the widely used Strengths and Difficulties Questionnaire (SDQ) has been recently validated to screen the Dysregulation Profile (SDQ-DP) in clinical settings. The objective of this study was to determine the prevalence and demographic, psychosocial and clinical correlates of the SDQ-DP phenotype in a Spanish clinical sample. Sampling and Methods: In a clinical sample of 623 consecutively referred children and adolescents (4-17 years old), we compared clinical and sociodemographic correlates between subjects who met the SDQ-DP criteria (DP) and those who did not (NO_DP). Sociodemographic data, parent-rated SDQ, Children's Global Assessment Scale, Clinical Global Impression, family Apgar scale and clinical diagnoses were collected by experienced child and adolescent psychiatrists. Results: Overall in our sample, 175 subjects (28.1%) met the SDQ-DP criteria (DP group). Compared with the NO_DP group, the DP subjects had significantly higher scores on internalizing and externalizing psychopathology, problems with peers and overall problems as well as significantly lower scores on prosocial behavior. Clinical diagnoses assigned revealed that DP subjects showed significantly greater psychiatric comorbidity. DP subjects also showed significantly worse family functioning and increased symptom severity and significantly lower scores on psychosocial functioning. Conclusions: A high prevalence of children and adolescents with the dysregulated profile, assessed by the SDQ-DP, was found in our clinical setting. The SDQ-DP may serve as an index of overall psychological severity and functional impairment. In addition, it may indicate family dysfunction. Further research is needed to validate the clinical value of SDQ-DP by examining longitudinal stability, heritability, adult outcome, risk factors and diagnostic correlates.

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Non-suicidal self-injury (NSSI) in adolescents is a major public health concern. The first goal of our study was to describe the characteristics and functions of NSSI and NSSI thoughts in an adolescent outpatient sample. The second goal was to examine which clinical factors discriminate between these two groups of patients. A group of 267 subjects was recruited from the Adolescent Outpatient Psychiatric Services, Jiménez Díaz Foundation (Madrid, Spain) from November 2011 to October 2012. All participants were administered the Spanish version of the Self-Injurious Thoughts and Behaviors Interview (SITBI). A total of 21.7% of patients reported having engaged in NSSI at least once in their lifetime. The most strongly endorsed function for NSSI was automatic negative reinforcement. In comparison with patients in the NSSI Thoughts group and the control group, patients in the NSSI group scored higher in Internalization of Anger and in all the scales comprising the Children's Depression Inventory. Our findings on the prevalence and functions of NSSI are consistent with the literature. NSSI was mainly performed for emotion regulation purposes; specifically, NSSI seems to be used to cope with anger and depression. In addition, internalization of anger might play a significant role in the maintenance of this behavior.