New findings from longitudinal and treatment studies in youth.

This section of Focus on Child and Adolescent Mental Health presents 3 longitudinal follow-up studies of suicide attempts in youth with first-episode psychosis, sleep problems among adolescents following a disastrous earthquake, and course of mood symptoms (irritability vs elation) in youth with bipolar disorder, as well as a double-blind, placebo-controlled trial that evaluated the efficacy and safety of quetiapine monotherapy in children and adolescents with mania associated with bipolar I disorder. Sanchez-Gistau and colleagues examined the prevalence of suicide attempt, risk factors associated with high risk of suicide, and early predictors of future suicide attempt in a cohort of youth with a first episode of psychosis over a 24-month period. The study included 110 youths aged 9 to 17 years in a first episode of psychosis. First-episode psychosis was defined as the presence of positive psychotic symptoms of less than 6 months’ duration. Diagnostic assessments, clinical assessments, and suicidal behavior were evaluated at baseline, at 12 months, and at 24 months. Eighty-two youths were included in the 2-year follow-up. At baseline, 7.3% of youths had attempted suicide. By year 2, 12.4% of youths with first-episode psychosis had attempted suicide. Significant predictors of suicide attempts were a prior history of suicide attempt, severe depressive symptoms, and receiving antidepressant treatment. Of these, the best predictor of suicide attempt during the 2-year follow-up was high risk of suicide at baseline. The investigators suggest that antidepressants as a predictor were related to high rates of severe depression, which predict suicide attempt. On the basis of these findings, they recommend that a careful assessment of suicidal behavior be conducted at the time of the acute episode because that is the most significant predictor of subsequent suicide attempt. Geng and colleagues sought to determine whether adolescents develop sleep disturbances following a natural disaster. The 2008 Wenchuan earthquake in China had a magnitude of 8.0 Ms and 7.9 Mw and resulted in over 69,000 deaths. The study included 1,573 7th and 10th graders from Dujiangyan City, located 21 km from the epicenter of this earthquake, who were followed over a 2-year period. Assessments were conducted 12 months, 18 months, 24 months, and 30 months following the earthquake. Rating scales were administered to assess sleep, depression, anxiety, social support, and negative life events at each of these assessment periods. The prevalence of sleep problems was stable over the course of the follow-up period, ranging from 28.8% to 30.2%. At 12-month follow-up, 48.9% of adolescents had shortened sleep duration (less than 7 hours), 27.7% had difficulty initiating sleep, 8.8% had difficulty maintaining sleep, 22.6% reported poor sleep quality, and 40.0% had daytime dysfunction. With the exception of difficulty initiating sleep, all of these sleep disturbances persisted over time. Risk factors for sleep problems included older age, witnessing the events, anxiety, depression, low levels of social support, and high levels of negative life events. The authors conclude that the rate of sleep disturbance is higher among those adolescents who experience a natural disaster compared to the general population of Chinese adolescents and that the sleep disturbance persists over time. They recommend early detection and intervention for sleep-related problems in adolescents who are exposed to natural disasters. Children and adolescents with bipolar disorder may exhibit elation, irritability, or elation and irritability during a manic episode. Using subjects from the Course and Outcomes of Bipolar Youth study, Hunt and colleagues, in this online-only offering, examined whether the symptoms of irritability and elation were stable over time and whether the course of illness was different among youth with elated and/or irritable mood during a manic episode. This 4-year follow-up study included 309 children and youths aged 7 to 17 years with bipolar disorder I, II, or not otherwise specified. For these subjects, mood symptoms at baseline assessment were irritable-only (n = 30), Visit