Mandatory buprenorphine training, while useful for learning, is being waived in the United States. The traditional training is largely adult-patient–centered. Our objective is to present a workshop that not only equips the participant with skills for using buprenorphine in any type of clinic, but also approaches many real-life considerations that our presenters have encountered in their experiences in treating adolescents with opioid use disorder and complex comorbid psychiatric disorders.

Characterized by developmental delay with severe speech delay, dental anomalies, cleft palate, skeletal abnormalities, and behavioral difficulties, SATB2-associated syndrome (SAS) is caused by pathogenic variants in SATB2. The SAS phenotype range of severity has been documented previously in large series. Using data from the SAS registry, we present the SAS severity score, a comprehensive scoring rubric that encompasses 15 different individual neurodevelopmental and systemic features. Higher (more severe) systemic and total (sum of neurodevelopmental and systemic scores) scores were seen for null variants located after amino acid 350 (the start of the CUT1 domain), the recurrent missense Arg389Cys variant (n=10), intragenic deletions, and larger chromosomal deletions. The Arg389Cys variant had the highest cognitive, verbal, and sialorrhea severity scores, while large chromosomal deletions had the highest expressive, ambulation, palate, feeding and growth, neurodevelopmental, and total scores. Missense variants not located in the CUT1 or CUT2 domain scored lower in several subcategories. We conclude that the SAS severity score allows quantitative phenotype morbidity description that can be used in routine clinical counseling. Further refinement and validation of the SAS severity score are expected over time. All data from this project can be interactively explored in a new portal.

BACKGROUND AND OBJECTIVESComorbid anxiety is common among buprenorphine patients and may lead to poorer outcomes. This study aimed to examine the prevalence and impact of anxiety severity, measured by the State-Trait Anxiety Inventory (STAI) form Y-1 & Y2 scale, on treatment outcomes (retention and phase advancement) among outpatient buprenorphine-treated patients.METHODSA retrospective chart review of 94 patients admitted to an outpatient buprenorphine treatment program was conducted. Patients were dichotomized into high and low severity groups based upon an STAI State Anxiety (S-Anxiety) and STAI Trait Anxiety (T-Anxiety) score ≥60 and <60, respectively. Associations of anxiety severity on successful phase advancement and retention during the first 90 days of treatment were assessed.RESULTSTwenty-one of 94 (22%) participants reported high S-Anxiety and had a significantly greater likelihood of phase advancement (OR = 12.80, 95% CI = [1.19, 136.71]) than those with low S-Anxiety. No significant associations were found between either S-Anxiety or T-Anxiety and treatment retention. Current alcohol use and UDS negative test results for THC or amphetamines were each associated with phase advancement. THC negative UDS test results were associated with 90-day treatment retention.DISCUSSION AND CONCLUSIONSContrary to prior reports, buprenorphine patients with higher state anxiety severity demonstrated similar retention and more rapid phase advancement than those with lower state anxiety severity.SCIENTIFIC SIGNIFICANCETo our knowledge, this is the first study to quantify current anxiety severity using the STAI scale and evaluate its impact on treatment outcomes among buprenorphine-treated patients.

Objective: This study assessed the initial acceptability of SafeUse, a game-based opioid misuse prevention intervention for delivery via smartphone among adolescents. Evidence-based educational and refusal skills training materials were adapted, and game design elements were applied to clinically and scientifically informed scenarios in which opioids are typically introduced to adolescents using standard product development methods to create the SafeUse prototype. Materials and Methods: In a mixed-methods study, 14 adolescents were assessed on their knowledge and perceptions of opioids before and following 5-7 days of access to SafeUse. Participants provided feedback in focus groups on the acceptability, relevance, and understandability of SafeUse and made suggestions for its improvement. Feedback was coded and summarized as to playability, acceptability, appropriateness, content development, and knowledge transfer. Pre- and post-access quantitative data were analyzed using Wilcoxon matched pairs signed-rank tests. Results: Overall, participants liked SafeUse, its characters, graphics, and approach, finding it more appealing than lectures/reading materials and appropriate for school settings. They moderately to extremely "liked the game," "would like to play more game modules," "liked playing through the decisions," thought the game was realistic/relevant and fun, and they learned new information about opioids. Participants reported increased confidence to refuse opioids and decreased likelihood of accepting opioids from someone they know. Knowledge about opioids increased (P < 0.006), and adolescent perception that prescription drugs are safer than illegal drugs decreased (P < 0.003) after playing SafeUse. Conclusion: Findings suggest that SafeUse is acceptable and likely educational to adolescents and worthy of further development and research.

The term “la belle indifference” is a French term, which translates to “beautiful ignorance.” La belle indifference is defined as a paradoxical absence of psychological distress despite having a serious medical illness or symptoms related to a health condition. This condition is most commonly associated with conversion disorder (CD). According to the Diagnostic and Statistical Manual of Mental Disorders V (DSM V), conversion disorder is also referred to as functional neurologic symptom disorder (FNSD). FNSD/CD is characterized by the presence of at least one neurological deficit that does not have any medical or neurological etiology and is incompatible with any known medical or neurological disorders. Psychological distress or conflict may be manifested as a physical symptom in patients with CD. La belle indifference is not formally included in DSM V as a diagnosis. However, it is used in conjunction with CD.According to the DSM V, the mere presence of la belle indifference does not confirm the diagnosis of CD. However, la belle indifference is most commonly seen in patients with CD, so this article will focus primarily on its association with CD. For a full review of CD, please refer to the conversion disorder article by StatPearls. In the DSM V, CD is classified under somatic symptom and related disorders (SSD). Other diagnosis included under SSD includes somatic symptom disorder, psychological factors affecting other medical conditions, illness anxiety disorder, and factitious disorder. The most common presentation of FNSD/CD includes weakness or paralysis of one side of the body or bilaterally, abnormal movements (including tremor, myoclonus, dystonic movements, etc.), seizures (psychogenic neuroleptic seizures), swallowing problems (globus), speech problems (dysphonia or aphonia), sensory loss (vision or olfactory issues) and syncopal episodes.

Multiple barriers exist to prescribe buprenorphine effectively and widely for adolescents and young adults with opioid use disorder (OUD), including limited clinical time, insufficient office support, low reimbursement, and concern about medication diversion, resulting in many waivered physicians never prescribing buprenorphine or only prescribing it to a small number of patients. Physicians working with adolescents with OUD who may want to prescribe buprenorphine may feel uncomfortable or ill-equipped to handle the complexities and challenges that come with managing patients with a substance use disorder. This presentation is geared toward physicians who have already completed their waiver training and want to take the next steps to begin prescribing buprenorphine to their patients. This presentation will use simulated case-study examples, small group discussion, and an audience poll to identify challenges and problem-solve ways to mitigate barriers when working with individuals with OUD. Diana Deister, MD, will provide an overview of a typical treatment plan for a youth with an OUD who is prescribed buprenorphine that looks to demystify the complexities of managing patients with OUD. Peter Jackson, MD, will review the pros and cons of different buprenorphine induction strategies to successfully start patients on buprenorphine. Paul Glaser, MD, PhD, will review common challenges in longer term clinical management of youth with OUD, including frequency of contact and patients with concurrent use of illicit substances. Nihit Kumar, MD, will present considerations when patients request to stop buprenorphine treatment, including strategies for successfully tapering off buprenorphine. Finally, Matthew LaCasse, DO, and Brady Heward, MD, will act as discussants to strengthen the understanding of critical concepts when it comes to prescribing buprenorphine, and identify barriers to prescribing in youth with OUD. Medications for OUD including buprenorphine are evidence-based and lifesaving and should be combined with ongoing psychosocial treatments. With the availability of effective treatments to mitigate the effects of the worsening opioid epidemic, physicians should feel empowered and be willing to use buprenorphine as a standard of care when treating adolescents with OUD.

Buprenorphine is rapidly becoming the preferred medication of choice for treatment of opioid use disorder (OUD) due to its better safety profile and ease of access via office-based practice. However, misconceptions exist among patients currently on buprenorphine and among physicians about ending treatment prematurely. Earlier evidence that buprenorphine should be readily discontinued has been refuted by new studies that indicate keeping patients on buprenorphine for as long as they benefit, especially due to high relapse rates that are frequently in the range of 50% to 90%. This presentation will provide an overview of the current guidelines, address misconceptions, and discuss strategies to successfully taper patients off of buprenorphine. The role of ongoing 12-step and other psychosocial supports and the advantages of concurrent naloxone prescription will also be addressed. This presentation will use case vignettes to highlight potential issues and identify challenges involved in successfully tapering patients off of buprenorphine, and engage participants in working through these barriers in small group settings. An audience poll will be used to solidify key concepts. The presenter's own clinical experience working with adolescents and young adults with OUD will also be used to address gaps in knowledge and skills. The goal of this presentation is to help participants work through the dilemma of ending treatment with buprenorphine for OUD in youth. Participants will be able to discuss how to engage patients in a scientifically informed way if they want to end treatment prematurely, and if appropriate, when and how to taper off buprenorphine. This session will result in a better understanding of the challenges faced as well as the factors and considerations in ending OUD treatment successfully. Despite barriers, child and adolescent psychiatrists are in a unique position to engage youth with OUD safely and effectively in treatment with buprenorphine. One aspect of successfully managing these patients is to make a determination about when and how to end treatment so as to set the patient up for success in their future journey of recovery.

There is a critical need to provide evidence-based psychotherapy training to child and adolescent psychiatrists and trainees. Motivational interviewing (MI) is a humanistic, client-centered, and evidence-based psychotherapy that can be adopted for use in almost any clinical setting. This Workshop will provide an intermediate/advanced training experience in MI that both advances attendees’ practical psychotherapy skills and guides them on the path to self-evaluation, as well as to take this experience back to their home institutions to train others, thus magnifying the impact of this Workshop on clinical practice.

Background: Given the immense burden of the widespread use of opioids around the world, exploring treatments that improve drug use outcomes, and craving and withdrawal measures in individuals with opioid use disorder is crucial. This pilot study examined the feasibility and preliminary efficacy of the L-type calcium-channel blocker isradipine (ISR) to improve drug use outcomes, and craving and withdrawal measures during buprenorphine (BUP)/ISR stabilization and subsequent taper in opioid-dependent individuals. Methods: Participants were stabilized on BUP sublingual tablets within the first 2 days of week 1, were then randomized and inducted on either ISR or placebo, gradually increasing the dose over the next 2 weeks, followed by a 10-day BUP taper during weeks 5-6, and ISR/placebo taper during weeks 7 to 8. Assessments included thrice-weekly measures of craving and withdrawal, as well as vital signs and urine drug screens. Medication compliance was assessed by monitoring number of missed clinic visit days. Results: Baseline characteristics of participants (n = 25; 60% male, 96% Caucasian, 48% employed, mean age 32.8 years) did not differ significantly between treatment groups (isradipine, n = 11; placebo, n = 14). During the stabilization phase (n = 19), ISR participants had significantly lower rates of illicit opioid-positive urines (treatment × visit: t = -2.16, P = 0.03), as well as reduction in craving intensity ( t = –2.50, P = 0.01), frequency ( t = –3.43, P < 0.01) and duration ( t = –2.51, P = 0.01). ISR was well tolerated with mild adverse effects. Conclusions: This study was likely underpowered due to being a pilot trial. Although preliminary results suggest ISR may improve BUP-assisted treatment outcomes, concerns about high number of exclusions (n = 11 during taper phase) based on cardiovascular measures as well as ISR-induced changes in vital signs with the immediate release formulation may limit the feasibility of this approach. Trial Registration: Clinicaltrials.gov identifier NCT01895270. Registered 10 July 2013, https://clinicaltrials.gov/ct2/show/NCT01895270?id=NCT01895270&draw=2&rank=1

SATB2-associated syndrome is an autosomal dominant, multisystemic disorder with associated sleep and behavioral abnormalities. Evidence is limited on appropriate management strategies in this population. We describe the medical management of a four-year-old child with poor sleep and significant behavioral problems. After failing initial treatment with melatonin, we initiated treatment clonidine along with high doses of trazodone for sleep. Daytime treatment with quetiapine was added to successfully manage behavioral issues. We present the challenges associated with treatment strategies in children with this syndrome.

There is a critical need to provide evidenced-based psychotherapy training to child and adolescent psychiatrists and trainees. Motivational interviewing (MI) is a humanistic, client-centered, and evidence-based psychotherapy designed for behavior change that can be adopted for use in almost any clinical setting. This Workshop will provide hands-on training in MI theory and fundamental skills.

As the usage of vehicles is increasing day by day, the hazards due to vehicles has also increased [1]. The main cause for accidents is high-speed, drink and drive, over stress work life, using a cellphone while driving, red light Jumping, overtaking in wrong manner, avoiding safety gears, etc. [2] According to the National Crime Records Bureau (NCRB) 2016 report around 148,707 road accident deaths are happening every year [3]. People are losing their life due to the fact that the medical rescue teams are not arriving on time at the place of the accident because there is no proper alert system which can notify the rescue team about the accident as soon as it happens. This paper describes the model for the accident detection notification system which will notify the emergency services about the accident as soon as it takes place. Once the vehicle meets with an accident, the sensor present inside the vehicle will detect it immediately and sends a message(SMS) to the emergency services with the accident coordinates. If the people inside the vehicle are safe a reset button is provided which can be tapped to terminate the message from being sent to the emergency services.

There is a critical need to provide evidenced-based psychotherapy training to child and adolescent psychiatrists. Motivational interviewing (MI) is a humanistic, client-centered, and evidence-based psychotherapy that can be adopted for use in almost any clinical setting. This Workshop will provide an intermediate/advanced training experience in MI that both advances attendees' practical psychotherapy skills and guides them on the path to self-evaluation and to becoming trainers themselves, thus magnifying the impacts of this Workshop on clinical practice.

Despite the availability of effective treatment strategies for opioid use disorders (OUD), physicians in training are not prepared to deal with patients with substance use disorders. With the emerging opioid epidemic, there is a serious need to focus on prevention and effective management of OUD to prevent overdose deaths in adolescents and young adults. This project aims to develop a standardized, effective curriculum to improve the awareness, knowledge, and skills among third-year medical students of managing OUD in adolescents. CorrectionJournal of the American Academy of Child & Adolescent PsychiatryVol. 59Issue 2PreviewIn New Research Poster 2.6, “IMPACT: Improving Awareness and Knowledge in Medical Students Regarding Opioid Use Disorders in Adolescents,” published in the October 2019 Scientific Proceedings supplement issue of the Journal of the American Academy of Child and Adolescent Psychiatry, (2019;58:S172), Patricia Wright, PhD, MPH, RN, was omitted from the author list. The author list should have appeared as follows: Srinivasa Gokarakonda, MD, MPH, Nihit Kumar, MD, Michael Mancino, MD, Patricia Wright, PhD, MPH, RN, Alison Oliveto, PhD. Full-Text PDF