Department of Child and Adolescent Psychiatry, St. Olavs Hospital, Trondheim, Norway.
Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU Norwegian University of Science and Technology, Trondheim, Norway.
Eur Child Adolesc Psychiatry. 2022 Jan;31(1):85-98. doi: 10.1007/s00787-020-01673-7. Epub 2020 Nov 13.
Insufficient care is associated with most psychiatric disorders and psychosocial problems, and is part of the etiology of reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED). To minimize the risk of misdiagnosis, and aid treatment and care, clinicians need to know to which degree RAD and DSED co-occur with other psychopathology and psychosocial problems, a topic little researched in adolescence. In a national study of all adolescents (N = 381; 67% consent; 12-20 years old; 58% girls) in Norwegian residential youth care, the Child and Adolescent Psychiatric Assessment interview yielded information about psychiatric diagnoses and psychosocial problems categorized as present/absent, and the Child Behavior Check List questionnaire was applied for dimensional measures of psychopathology. Most adolescents with a RAD or DSED diagnosis had several cooccurring psychiatric disorders and psychosocial problems. Prevalence rates of both emotional and behavioral disorders were high in adolescent RAD and DSED, as were rates of suicidality, self-harm, victimization from bullying, contact with police, risky sexual behavior and alcohol or drug misuse. Although categorical measures of co-occurring disorders and psychosocial problems revealed few and weak associations with RAD and DSED, dimensional measures uncovered associations between both emotional and behavioral problems and RAD/DSED symptom loads, as well as DSED diagnosis. Given the high degree of comorbidity, adolescents with RAD or DSED-or symptoms thereof-should be assessed for co-occurring psychopathology and related psychosocial problems. Treatment plans should be adjusted accordingly.
大多数精神科疾病和心理社会问题都与关怀不足有关，也是反应性依恋障碍（RAD）和去抑制型社会参与障碍（DSED）发病机制的一部分。为了最大限度地降低误诊风险，帮助治疗和护理，临床医生需要了解 RAD 和 DSED 与其他精神病理学和心理社会问题的共病程度，这是青少年时期研究较少的一个课题。在一项对挪威所有居住在青年照护机构中的青少年（N=381；67%同意；12-20 岁；58%为女孩）的全国性研究中，使用儿童和青少年精神病评估访谈获得了关于精神科诊断和心理社会问题的信息，这些问题分为存在/不存在，并应用儿童行为检查表问卷对精神病理学进行维度测量。大多数具有 RAD 或 DSED 诊断的青少年都有几种共病的精神科疾病和心理社会问题。青少年 RAD 和 DSED 中情绪和行为障碍的患病率都很高，自杀意念、自残、被欺凌受害、与警察接触、风险性行为以及酒精或药物滥用的发生率也很高。尽管共病障碍和心理社会问题的分类测量显示与 RAD 和 DSED 的关联很少且较弱，但维度测量揭示了情绪和行为问题与 RAD/DSED 症状负荷以及 DSED 诊断之间的关联。鉴于共病程度很高，具有 RAD 或 DSED 或其症状的青少年应评估共病的精神病理学和相关心理社会问题，并相应地调整治疗计划。
