Somatic symptom and related disorders (SSRDs) are commonly encountered in pediatric hospital settings. There is, however, a lack of standardization of care across institutions for youth with these disorders. These patients are diagnostically and psychosocially complex, posing significant challenges for medical and behavioral health care providers. SSRDs are associated with significant health care use, cost to families and hospitals, and risk for iatrogenic interventions and missed diagnoses. With sponsorship from the American Academy of Child and Adolescent Psychiatry and input from multidisciplinary stakeholders, we describe the first attempt to develop a clinical pathway and standardize the care of patients with SSRDs in pediatric hospital settings by a working group of pediatric consultation-liaison psychiatrists from multiple institutions across North America. The authors of the SSRD clinical pathway outline 5 key steps from admission to discharge and include practical, evidence-informed approaches to the assessment and management of children and adolescents who are medically hospitalized with SSRDs.

Obsessive-compulsive disorder (OCD) can be found in about 4% of the general population and is characterized by various compulsions and obsessions that interfere with the person's quality of life from a mild to severe degree. The following discussion reflects on current concepts in this condition, including its epidemiology and etiologic underpinnings (behavioral, neurological, immunological, gastroenterological, as well as genetic). The interplay of PANS and PANDAS are included in this review. In addition, the core concepts of OCD diagnosis, differential diagnosis, and co-morbidities are considered. It is stressed that the quality of life for persons with pediatric OCD as well as for family members can be quite limited and challenged. Thus, principles of management are presented as a guide to improve the quality of life for these persons as much as possible.

OBJECTIVES: Hospitals accredited by The Joint Commission (TJC) are now required to use a validated screening tool and a standardized method for assessment of suicide risk in all behavioral health patients. Our aims for this study were (1) to implement a TJC-compliant process of suicide risk screening and assessment in the pediatric emergency department (ED) and outpatient behavioral health clinic in a large tertiary care children’s hospital, (2) to describe characteristics of this population related to suicide risk, and (3) to report the impact of this new process on ED length of stay (LOS). METHODS: A workflow using the Columbia Suicide Severity Rating Scale was developed and implemented. Monthly reviews of compliance with screening and assessment were conducted. Descriptive statistics were used to define the study population, and multivariable regression was used to model factors associated with high suicide risk and discharge from the ED. ED LOS of behavioral health patients was compared before and after implementation. RESULTS: Average compliance rates for screening was 83% in the ED and 65% in the outpatient clinics. Compliance with standardized assessments in the ED went from 0% before implementation to 88% after implementation. The analysis revealed that 72% of behavioral health patients in the ED and 18% of patients in behavioral health outpatient clinics had a positive suicide risk. ED LOS did not increase. The majority of patients screening at risk was discharged from the hospital after assessment. CONCLUSIONS: A TJC-compliant process for suicide risk screening and assessment was implemented in the ED and outpatient behavioral health clinic for behavioral health patients without increasing ED LOS.

The creation of personalized avatars that may be morphed to simulate realistic changes in body size is useful when studying self-perception of body size. One drawback is that these methods are resource intensive compared to rating scales that rely upon generalized drawings. Little is known about how body perception ratings compare across different methods, particularly across differing levels of personalized detail in visualizations. This knowledge is essential to inform future decisions about the appropriate tradeoff between personalized realism and resource availability. The current study aimed to determine the impact of varying degrees of personalized realism on self-perception of body size. We explored this topic in young adult women, using a generalized line drawing scale, as well as several types of personalized avatars, including 3D textured images presented in immersive virtual reality (VR). Body perception ratings using generalized line drawings were often higher than responses using individualized visualization methods. While the personalized details seemed to help with identification, there were few differences among the three conditions containing different amounts of individualized realism (e.g., photo-realistic texture). These results suggest that using scales based on personalized texture and limb dimensions are beneficial, although presentation in immersive VR may not be essential. 580 scale was validated with an urban, African-American population, but the authors concluded that their instrument should be perceived well by a diverse range of ethnicities.Going beyond cultural specificity, it has been hypothesized that an individualized figure rating scale (i.e., tailored to the individual's actual body dimensions and surface features) could provide an even more precise evaluation of how a person perceives their body shape [3,10]. In both clinical and research settings, the precision of perceptual body image evaluation becomes relevant in illnesses where the key symptom is a disturbance in body image perception-e.g., eating disorders [11]. The purpose of the current study was not to investigate body image disturbances in a clinical population but, rather, to determine if utilizing realistic, individualized avatars would improve the accuracy with which a person could identify their image. As established by Cash and Deagle [12] and echoed by many other researchers [10,[13][14][15], body image is a multi-component concept that incorporates numerous constructs. Of the two major domains of body image (perceptual and attitudinal) [12,13], the perceptual domain was of primary interest in the current study. Given that the interest is in the subject's ability to estimate their body size based on an image of themselves, research from Longo et al. [15] might argue that these depictive methods lie somewhere in between the perceptual and attitudinal domains of body image. Nonetheless, the primary research question of the current project was to study the participants' self-perception of changes in size of thei...