Saundra L. Stock

Reliability and validity of the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID).

OBJECTIVE To investigate the concurrent validity and reliability of the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID), a short structured diagnostic interview for DSM-IV and ICD-10 psychiatric disorders in children and adolescents. METHOD Participants were 226 children and adolescents (190 outpatients and 36 controls) aged 6 to 17 years. To assess the concurrent validity of the MINI-KID, participants were administered the MINI-KID and the Schedule for Affective Disorders and Schizophrenia for School Aged Children-Present and Lifetime Version (K-SADS-PL) by blinded interviewers in a counterbalanced order on the same day. Participants also completed a self-rated measure of disability. In addition, interrater (n = 57) and test-retest (n = 83) reliability data (retest interval, 1-5 days) were collected, and agreement between the parent version of the MINI-KID and the standard MINI-KID (n = 140) was assessed. Data were collected between March 2004 and January 2008. RESULTS Substantial to excellent MINI-KID to K-SADS-PL concordance was found for syndromal diagnoses of any mood disorder, any anxiety disorder, any substance use disorder, any ADHD or behavioral disorder, and any eating disorder (area under curve [AUC] = 0.81-0.96, kappa = 0.56-0.87). Results were more variable for psychotic disorder (AUC = 0.94, kappa = 0.41). Sensitivity was substantial (0.61-1.00) for 15/20 individual DSM-IV disorders. Specificity was excellent (0.81-1.00) for 18 disorders and substantial (> 0.73) for the remaining 2. The MINI-KID identified a median of 3 disorders per subject compared to 2 on the K-SADS-PL and took two-thirds less time to administer (34 vs 103 minutes). Interrater and test-retest kappas were substantial to almost perfect (0.64-1.00) for all individual MINI-KID disorders except dysthymia. Concordance of the parent version (MINI-KID-P) with the standard MINI-KID was good. CONCLUSIONS The MINI-KID generates reliable and valid psychiatric diagnoses for children and adolescents and does so in a third of the time as the K-SADS-PL.

Practice Parameter for the Assessment and Treatment of Children and Adolescents With Schizophrenia

This Practice Parameter reviews the literature on the assessment and treatment of children and adolescents with schizophrenia. Early-onset schizophrenia is diagnosed using the same criteria as in adults and appears to be continuous with the adult form of the disorder. Clinical standards suggest that effective treatment includes antipsychotic medications combined with psychoeducational, psychotherapeutic, and educational interventions. Since this Practice Parameter was last published in 2001, several controlled trials of atypical antipsychotic agents for early-onset schizophrenia have been conducted. However, studies suggest that many youth with early-onset schizophrenia do not respond adequately to available agents and are vulnerable to adverse events, particularly metabolic side effects. Further research is needed to develop more effective and safer treatments.

GFAP expression and social deficits in transgenic mice overexpressing human sAPPα

Autistic individuals display impaired social interactions and language, and restricted, stereotyped behaviors. Elevated levels of secreted amyloid precursor protein‐alpha (sAPPα), the product of α‐secretase cleavage of APP, are found in the plasma of some individuals with autism. The sAPPα protein is neurotrophic and neuroprotective and recently showed a correlation to glial differentiation in human neural stem cells (NSCs) via the IL‐6 pathway. Considering evidence of gliosis in postmortem autistic brains, we hypothesized that subsets of patients with autism would exhibit elevations in CNS sAPPα and mice generated to mimic this observation would display markers suggestive of gliosis and autism‐like behavior. Elevations in sAPPα levels were observed in brains of autistic patients compared to controls. Transgenic mice engineered to overexpress human sAPPα (TgsAPPα mice) displayed hypoactivity, impaired sociability, increased brain glial fibrillary acidic protein (GFAP) expression, and altered Notch1 and IL‐6 levels. NSCs isolated from TgsAPPα mice, and those derived from wild‐type mice treated with sAPPα, displayed suppressed β‐tubulin III and elevated GFAP expression. These results suggest that elevations in brain sAPPα levels are observed in subsets of individuals with autism and TgsAPPα mice display signs suggestive of gliosis and behavioral impairment.

Syndrome of inappropriate antidiuretic hormone associated with escitalopram therapy.

Escitalopram is the selective serotonin reuptake inhibitor (SSRI) most recently approved for use in the United States. It is structurally related to citalopram, but is felt to have a more tolerable side-effect profile than its parent compound. Side effects are not generally serious and include headache, diarrhea, and nausea. While hyponatremia and the syndrome of inappropriate antidiuretic hormone (SIADH) have been associated with treatment with other SSRIs, there has only been one case of escitalopram-induced SIADH reported in the literature to date. We now report another case of a patient who developed SIADH after being treated with escitalopram for 4 weeks. The patients hyponatremia improved following the discontinuation of escitalopram. Clinicians should be aware of this uncommon but significant side effect of SSRIs and monitor high-risk patients for the development of SIADH.

Improving child and adolescent psychiatry education for medical students: An inter-organizational collaborative action plan

ObjectiveA new Child and Adolescent Psychiatry in Medical Education (CAPME) Task Force, sponsored by the Association for Directors of Medical Student Education in Psychiatry (ADMSEP), has created an inter-organizational partnership between child and adolescent psychiatry (CAP) educators and medical student educators in psychiatry. This paper outlines the task force design and strategic plan to address the longstanding dearth of CAP training for medical students.MethodThe CAPME ADMSEP Task Force, formed in 2010, identified common challenges to teaching CAP among ADMSEP’s CAPME Task Force members, utilizing focus-group discussions and a needs-assessment survey. The Task Force was organized into five major sections, with inter-organizational action plans to address identified areas of need, such as portable modules and development of benchmark CAP competencies.ResultsThe authors predict that all new physicians, regardless of specialty, will be better trained in CAP. Increased exposure may also improve recruitment into this underserved area.

A survey of United States general psychiatry residency programs : Program characteristics and relationship to the 1994 national residency matching program results

We developed a questionnaire regarding issues in psychiatric residency training and distributed it to the chief residents at all United States general psychiatry residency training programs. We hoped to examine psychiatry residency program characteristics and see if any particular characteristics had a significant relationship to improved success in the 1994 National Residency Matching Program (NRMP) results. We found that those programs with six or more PGY-1 positions available in the NRMP, those programs with an associated child and adolescent psychiatry residency training program, and those programs offering a research elective had a higher PGY-1 match through the NRMP than programs without these features.

A Survey of Psychiatry Residency Programs: Association Between Program Characteristics and Success in the 2003 NRMP

While the number of medical students entering psychiatry has increased since the 1990’s, little has been written about the program characteristics that draw students to specific psychiatry residency programs. We developed a survey regarding residency program characteristics and distributed it to the chief residents of each psychiatry residency program in the USA. Survey results were tabulated, and the presence of specific characteristics were correlated to the 2003 National Resident Matching Program (NRMP) results. We found that the presence of a substance abuse, geriatric psychiatry or a child and adolescent psychiatry fellowship were all associated with increased NRMP success. Programs with regular resident meetings had significantly higher success in the NRMP than those programs without meetings. Programs that had six or more PGY-I positions available in the NRMP revealed a trend towards higher NRMP success than smaller programs. Finally, in some cases, higher intern salaries were associated with higher NRMP success.

Statement Regarding the National Resident Matching Program Child and Adolescent Psychiatry Match: A Call to Uphold the Gentlepersons’ Agreement

Previous authors [1] have described the decision and process of choosing a psychiatry residency as a “seminal event” (p. 436). The Child and Adolescent Psychiatry (CAP) Caucus of the American Association of Directors of Psychiatric Residency Training (AADPRT) has highlighted that the process for CAP fellowship is no less important and can seem, at times, daunting. Thus, the CAP Caucus of AADPRT, which represents CAP program directors nationally, has had a series of discussions at the AADPRT annual meeting in order to selfgovern the process as it relates to recruitment of applicants from general residency into CAP training programs. The process has resulted in a gentleperson’s agreement that, though not legally binding, highlights the mutually agreed upon “rules of the game”. (Gentleperson’s Agreement is a more inclusive version of the term Gentlemen’s Agreement, which originated from President Theodore Roosevelt’s efforts to calm tensions between Japan and the USA in the early 1900s.) As of the date of this publication, there are 125 accredited CAP training programs in the U.S. In 2013, the specialty joined the Association of American Medical Colleges’ Electronic Residency Application Service (ERAS) process. In doing so, CAP programs agreed to follow the spirit of the “All In” process, whereby programs that participated in the National Resident Matching Program (NRMP) and ERAS were to take all their positions (at least those posted after July 1), exclusively through the Match. The NRMP oversees the Match for CAP fellowships. The NRMP match participation agreement [2] governs the process; however, a few issues have developed and are still considered to be sources of difficulty in child and adolescent training programs. A gentlepersons’ agreement was agreed upon by a near-unanimous voice vote at the AADPRT annual meeting in Tucson, Arizona, March 2014. The terms of this gentlepersons’ agreement include the following:

Potential Autoepitope within the Extracellular Region of Contactin-Associated Protein-like 2 in Mice.

Aims Implicated in autoimmune encephalitis, neuromyotonia and genetic forms of autism, here we report that contactin-associated protein-like 2 (CNTNAP2) contains a potential autoepitope within the extracellular region. Methodology CNTNAP2 sequence-similar regions (CSSRs) from human pathogens were identified. Sera from autistic and control children were obtained and analyzed for the presence of antibodies able to bind CSSRs. One such candidate CSSR was evaluated for evidence of autoimmune responses to CNTNAP2 in a mouse model of acute infection. Results Autistic and control children sera contained antibodies able to discrete regions of CNTNAP2. In a murine model of acute infection, a CSSR derived from the N-terminal extracellular region of CNTNAP2 resulted in anti-CNTNAP2 antibody production, proinflammatory cytokine elevation, cerebellar and cortical white matter T-cell infiltration as well as motor dysfunction. Conclusion Taken together, these data suggest that CNTNAP2 contains a potential autoepitope within the extracellular region.