Investing in mental health during the first 1,000 days of life: Now and future.

COVID-19 has disrupted the mental health services in 93% of the countries worldwide. Approximately 130 countries are affected catastrophically by COVID-19, which limits access to mental health services. Most vulnerable are children, pregnant women, and adults with limited access to mental healthcare.

Perceived stress may mediate the relationship between antenatal depressive symptoms and preterm birth: A pilot observational cohort study.

Background: Screening for changes in pregnancy-related anxiety and depressive symptoms during pregnancy may further our understanding of the relationship between these two variables and preterm birth.

Objectives: To determine whether changes in pregnancy-related anxiety and depressive symptoms during pregnancy influence the risk of preterm birth among Pakistani women; explore whether perceived stress moderates or mediates this relationship, and examine the relationship between the various components of pregnancy-related anxiety and preterm birth.

Methods: A prospective cohort study design was used to recruit a diverse sample of 300 low-risk pregnant women from four centers of Aga Khan Hospital for Women and Children in Karachi, Pakistan.

Debate: COVID-19 and school mental health in Pakistan.

The coronavirus disease 2019 (COVID-19) pandemic and the social distancing procedures have caused disruptions to daily activities. The first preventive procedures by the closing of schools will undoubtedly have short- and long-term consequences for the mental health of school students. The movement restrictions, school closures and stay at home during the COVID-19 pandemic will likely lead to a rise in the rates of domestic violence, loneliness, depression, fear, panic and anxiety, and substance use among school students.

Comorbid Anxiety and Depression among Pregnant Pakistani Women: Higher Rates, Different Vulnerability Characteristics, and the Role of Perceived Stress.

Anxiety and depression commonly co-occur during pregnancy and may increase risk of poor birth outcomes including preterm birth and low birth weight. Our understanding of rates, patterns, and predictors of comorbid anxiety and depression is hindered given the dearth of literature, particularly in low- and middle-income (LMI) countries. The aim of this study is (1) to explore the prevalence and patterns of comorbid antenatal anxiety and depressive symptoms in the mild-to-severe and moderate-to-severe categories among women in a LMI country like Pakistan and (2) to understand the risk factors for comorbid anxiety and depressive symptoms.

Initiating Narrative Medicine at a Medical College in Pakistan: Achievements, Challenges, and Opportunities.

Writing has always been a part of medicine, but it was largely used as a means to disseminate objective data. With changing times, qualitative writing in the form of narrative medicine (NM) is fast coming to the forefront. Data in the field from high-income countries have shown an enhancement in empathy and professionalism alike, for both patients and health care practitioners.

(childhood growth & development) study protocol: factors that impact linear growth in children 9 to 15 years of age in Matiari, Pakistan.

Introduction: Adolescence is a time of significant physical and emotional change, and there is emerging concern that adolescents living in low- and middle-income countries (LMIC) may face substantial challenges in relation to linear growth and mental health. Data on the global burden of stunting after 5 years of age are limited, but estimates suggest up to 50 per cent of all adolescents in some LMIC are stunted. Additionally, many LMIC lack robust mental health care delivery systems.

Global Child and Adolescent Mental Health: A Culturally Informed Focus.

There is no question that there is a significant burden of mental illness in children and families across the globe. Despite heightened awareness of the significance of global mental health and its determinants on public health, there is an increased need for innovative interventions, research, resources, and efforts devoted to this area. It has been clearly established that culture, in all of its complex dimensions and dynamics, is at the heart of this labor.

Child and Adolescent Psychiatry Training: A Global Perspective.

Training programs aim to produce child and adolescent psychiatry professionals who are competent at both clinical work as well as health promotion through teaching and research. Child psychiatry training programs not only offer training in teaching the clinical skills of the discipline of child and adolescent psychiatry but also strive to help with the development of professionalism, ethical behaviors, and leadership skills in their trainees. Ultimately, it is the children of the world who stand to gain by having a skilled work force that adheres to the highest global standards when it comes to the provision of mental health services.

Responding to moderate breaches in professionalism: an intervention for medical students.

Much has been written about how we understand, teach and evaluate professionalism in medical training. Less often described are explicit responses to mild or moderate professionalism concerns in medical students. To address this need, Baylor College of Medicine created a mechanism to assess professionalism competency for medical students and policies to address breaches in professional behavior.

Practice parameter for cultural competence in child and adolescent psychiatric practice.

The United States faces a rapidly changing demographic and cultural landscape, with its population becoming increasingly multiracial and multicultural. In consequence, cultural and racial factors relating to mental illness and emotional disturbances deserve closer attention and consideration. This Practice Parameter outlines clinical applications of the principle of cultural competence that will enable child and adolescent mental health clinicians to better serve diverse children, adolescents, and their families.

Psychiatric residents' attitudes toward and experiences with the clinical-skills verification process: a pilot study on U.S. and international medical graduates.

Objective: The authors report on a pilot study of the experiences and perceptions of foreign international medical graduate (F-IMG), United States international medical graduate (US-IMG), and United States medical graduate (USMG) psychiatric residents with the newly mandated Clinical Skills Verification (CSV) process. The goal was to identify and suggest remedies to any problems with the implementation of CSV in order to facilitate its success as an evaluation tool with all the three groups of residents.

Method: The authors designed a 51-item survey questionnaire to gather demographic data and information about three principal content areas: 1) views on the effectiveness of the program; 2) the assessment experience; and 3) evaluation and feedback.

Use of aripiprazole in adolescents with a history of lupus-associated psychosis and refractory psychiatric manifestations.

Neurologic and psychiatric manifestations are prevalent in children and adults with lupus (labeled by convention neuropsychiatric systemic lupus erythematosus or NPSLE). However, there is a paucity of data on the evaluation and management of NPSLE in youth, with only a few publications describing the use of atypical antipsychotics in children and adolescents with lupus. In children, aripiprazole, a D2/5-HT1A partial agonist, appears to cause less prominent metabolic derangements than other second-generation antipsychotics.

Training child and adolescent psychiatrists to be culturally competent.

The changing face of the United States urges the field of child and adolescent psychiatry toward more culturally sensitive care. This article gives a comprehensive review of the history of cultural education, empirical findings that speak to its need, and the challenges that may be faced in the conception and implementation of a cultural competency curriculum. The American Academy of Child and Adolescent Psychiatry's model curriculum is presented to help child and adolescent residency programs design one that is specific to their resources and needs.

Toolbox for evaluating residents as teachers.

Objective: The authors review existing assessment tools related to evaluating residents' teaching skills and teaching effectiveness.

Methods: PubMed and PsycInfo databases were searched using combinations of keywords including "residents," "residents as teachers," "teaching skills," and "assessments" or "rating scales."

Results: Eleven evaluation tools that utilized self-reports, learner evaluations, or observed structured teaching evaluations were found.

Depression in pregnancy and the postpartum period: balancing adverse effects of untreated illness with treatment risks.

The author reviews the risks and benefits of untreated maternal depression during pregnancy and the postnatal period and its effects on the well-being of the mother and infant. She then discusses the significant role psychiatrists can play in detecting and managing maternal depression as a primary measure for preventing future child psychopathology. A literature search was conducted on PubMed to identify both preclinical and clinical studies concerning deleterious effects of maternal depression on offspring.

Lower effectiveness of divalproex versus valproic acid in a prospective, quasi-experimental clinical trial involving 9,260 psychiatric admissions.

Objective: The authors examined clinical differences between divalproex sodium and generic immediate-release valproic acid.

Method: This 6-year prospective, quasi-experimental clinical trial compared the effectiveness and tolerability of divalproex and valproic acid. The dependent variables were length of hospital stay, rehospitalization rate, and adverse drug reactions in 9,260 psychiatric admissions.

Effect of passive myocardium on the compliance of porcine coronary arteries.

The objective of this study was to determine the effect of passive myocardium on the coronary arteries under distension and compression. To simulate distension and compression, we placed a diastolic-arrested heart in a Lucite box, where both the intravascular pressure and external (box) pressure were varied independently and expressed as a pressure difference (DeltaP = intravascular pressure - box pressure). The DeltaP-cross-sectional area relationship of the first several generations of porcine coronary arteries and the DeltaP-volume relationship of the coronary arterial tree (vessels >0.