Faculty Bibliography

Ketamine is known within the medical field for its anesthetic properties, yet its unique psychedelic and antidepressant properties are being increasingly recognized. We document the case of a patient with bipolar I disorder and an extensive history of substance dependence who used large doses of ketamine (1-3 g) on a daily basis over a period of 5 years, and described acute antidepressant effects as well as diminished cravings for alcohol. While his use was untenable and ultimately led to an inpatient admission, it is notable that he did not experience a withdrawal syndrome nor did he have any observable cognitive deficits upon cessation of use. Such a unique drug profile suggests that further exploration of its risks and therapeutic potential in treating mood and addiction disorders is warranted. (Am J Addict 2015;24:7-9).

The study aimed to identify clinical strategies and challenges around transition from Assertive Community Treatment (ACT) to less intensive services. Six focus groups were conducted with ACT team leaders (n = 49). Themes were grouped under four intervention-focused domains: (1) client/clinical, (2) family and natural supports, (3) ACT staff and team, and (4) public mental health system. Barriers to transition included beliefs that clients and families would not want to terminate services (due to loss of relationships, fear of failure, preference for ACT model), clinical concerns that transition would not be successful (due to limited client skills, relapse without ACT support), systems challenges (clinic waiting lists, transportation barriers, eligibility restrictions, stigma against ACT clients), and staff ambivalence (loss of relationship with client, impact on caseload). Strategies to support transition included building skills for transition, engaging supports, celebrating success, enhanced coordination with new providers, and integrating and structuring transition in ACT routines.

Children with mental health problems are increasingly being evaluated and treated in pediatric clinical settings. This article focuses on the epidemiology, evaluation, and management of the 2 most common pediatric mental health emergencies, suicidal and homicidal/aggressive patients, as well as the equally challenging population of children with autism or other developmental disabilities.

Background: Increased attention has been paid to identifying and responding to the mental health and social emotional needs of young children in low income countries. There is lack of brief screening scales and assessment tools to characterize child mental health burden or to evaluate impact of early intervention in Sub-Saharan African (SSA) countries. This study sought to determine reliability and validity of three different parent/caregiver brief screening tools in a SSA country - Uganda. The Pediatric Symptom Checklist (14 item Pictorial Scale) (Gardner et al., 2007), assesses child behavioral problems using a pictorial format that takes into account the low literacy rates in SSA countries. The Social Competence Scale (12 items) (Gouley, et al., 2007) utilizes a strength-based evaluation approach to assess children's emotional regulation and prosocial/communication competence. The Strength and Difficult Questionnaire (SDQ; 25 items) (Goodman, et al., 1997, 2009), is available in 80 languages, focuses on psychiatric symptoms and assesses hyperactivity, emotional symptoms, peer problems and conduct problems. Methods: Parents of 303 Ugandan 4-9 year-old children from the community were recruited and interviewed, and 103 of these who were also part of an ongoing school-based mental health intervention trial were interviewed a 2nd time (about 5 months after 1st assessment). Data from both time points were utilized to establish reliability and validity. Data from the control sample (n=42) were used for evaluating test-retest reliability. The mean age of participating parents was 35.92 years (SD = 9.80 years). About one third of parents (32%) were single, and 48% had primary or less education. Study children were an average 6.51 years old (SD = 1.08 years) and all were enrolled in Nursery to Primary 3 in Kampala, Uganda. For the purpose of validation measurement, we also included Patient Health Questionnaire (assessing parental depression; Kroenke et al., 2001; alpha=.83) and Parenting Stress Scale (PSI, Abidin, 1995; 5 items, alpha= .63). Findings: Consistent with developers' conceptual frameworks, two factors emerged from the Pictorial Scale (Internalizing and Externalizing problems) and Social Competence Scales (Emotion regulation and Prosocial/Communication skills). However, for the SDQ scale, only one-factor emerged, with estimated 21-27% of children having abnormal level of problem behaviors. All three brief screening tools applied in this study had adequate reliability and validity. Reliability (assessed by Chronbach's alpha) ranged from .61-.68 for Pictorial scale, .61-.63 for SDQ, and .71-.87 for Social Competence Scale. All social emotional and mental health scales included were related in expected ways. The strength-based Social Competence scale is also sensitive to intervention evaluation. Interpretation: Our findings suggest that selection of instruments needs to include parent literacy levels and cultural contexts. A strength-based measure may be more relevant than pathology-based measures in SSA context

The entorhinal cortex (EC) is one of the first brain areas to display neuropathology in Alzheimer's disease. A mouse model which simulates amyloid-beta (Abeta) neuropathology, the Tg2576 mouse, was used to address these early changes. Here, we show EC abnormalities occur in 2- to 4-month-old Tg2576 mice, an age before Abeta deposition and where previous studies suggest that there are few behavioral impairments. First we show, using a sandwich enzyme-linked immunosorbent assay, that soluble human Abeta40 and Abeta42 are detectable in the EC of 2-month-old Tg2576 mice before Abeta deposition. We then demonstrate that 2- to 4-month-old Tg2576 mice are impaired at object placement, an EC-dependent cognitive task. Next, we show that defects in neuronal nuclear antigen expression and myelin uptake occur in the superficial layers of the EC in 2- to 4-month-old Tg2576 mice. In slices from Tg2576 mice that contained the EC, there were repetitive field potentials evoked by a single stimulus to the underlying white matter, and a greater response to reduced extracellular magnesium ([Mg2+]o), suggesting increased excitability. However, deep layer neurons in Tg2576 mice had longer latencies to antidromic activation than wild type mice. The results show changes in the EC at early ages and suggest that altered excitability occurs before extensive plaque pathology.

This article provides an overview of the two books presented in the issue Journal of the American Academy of Child & Adolescent Psychiatry. The first book, Being a Teen: Everything Teen Girls and Boys Should Know About Relationships, Sex, Love, Health, Identity, and More By Jane Fonda is the culmination of the author's experience with teens and what the author believes teens need to know. The second book, Healing After Parent Loss in Childhood and Adolescence: Therapeutic Interventions and Theoretical Considerations edited by Phyllis Cohen, K. Mark Sossin, and Richard Ruth is a new volume dedicated to clinical work with children and adolescents who have lost a parent to death. Sickles reviews a book of advice for teens, and Weis reviews a new text describing therapeutic interventions for children after the loss of a parent.