CAPMH Corner (Updated Jun 2026)

Child and Adolescent Psychiatry and Mental Health (CAPMH) is the official IACAPAP Journal. The "CAPMH Corner" of the June 2026 issue of IACAPAP Bulletin summarizes the following three studies recently published in CAPMH – The effectiveness and mechanisms of a filmmaking intervention for adolescent aggression: a mixed methods study (Zhang et al., 2026), Efficacy of parent-infant psychotherapy with mothers with postpartum mental disorder: results from a randomized controlled trial (Kuchinke et al., 2026), and Unusual experiences and early-onset psychosis associated to hallucinogen use in adolescents: a systematic review and meta-analysis (Armanino-Irigaray et al., 2026).

Zhang et al. (2026), discuss the growing concern of adolescent aggression worldwide, highlighting that existing interventions tend to treat aggression as a single undifferentiated construct and fail to engage young people growing up in the digital era. Grounded in the two-factor model of aggression, which distinguishes between reactive aggression (an impulsive, defensive response to perceived threat or provocation) and proactive aggression (a deliberate, goal-oriented behaviour aimed at gaining dominance or resources), as well as the Social Information Processing (SIP) model, art therapy, and narrative therapy, the authors develop a filmmaking intervention and set out to evaluate its efficacy and explore the mechanisms through which it reduces aggression.

The team employs an explanatory sequential mixed-methods design comprising two sub-studies. Sub-study 1 is a randomised controlled trial (RCT) conducted from December 2022 to April 2023 in a special school in South China that enrols youth with aggressive or violent behaviour, truancy, and other problematic conduct. Of 103 students invited, 82 consent to participate and are randomly assigned to a treatment group (n = 40) or a waiting-list control group (n = 42). The filmmaking intervention consists of ten 90-minute sessions delivered twice weekly over approximately two months, through which groups of ten collaboratively produce a micro-film on the theme of aggression. The intervention is structured across five phases: development, pre-production, production, post-production, and exhibition. Group facilitators, who are professionals with three to six years of experience in youth psychology and education, guide the overall process while maintaining a neutral stance on creative decisions. Assessments of aggression (Reactive-Proactive Aggression Questionnaire, RPQ), emotion regulation (Social Competence Scale, SC-E), and empathy (Antisocial Process Screening Device, APSD-Cu) are administered at baseline, post-test, and a three-month follow-up. Due to COVID-19-related withdrawals and early graduations, 62 students (mean age 14.42 years; 33.91% female) complete all three waves of data collection. Sub-study 2, conducted from May to August 2023, involves grounded theory analysis of four micro-films and semi-structured interviews with 12 students and four facilitators.

In Sub-study 1, two-way repeated-measures ANOVA reveals significant time x group interactions in overall aggression (F = 3.28, p = .047, ηp² = 0.05) and reactive aggression (F = 4.69, p = .013, ηp² = 0.07). Post hoc comparisons show that treatment group participants demonstrate significant reductions in overall aggression (MD = -5.18, p < .001) and reactive aggression (MD = -3.82, p < .001) from pre- to post-test, and score significantly lower than the control group at post-test. Emotion regulation improves significantly in the treatment group (MD = 3.97, p < .001), with a moderate to large effect size (ηp² = 0.11). No statistically significant changes are observed in proactive aggression or empathy, although both show positive trends. Aggression scores rise slightly at the three-month follow-up, suggesting limited maintenance of the intervention effects, and the authors speculate that the relatively short intervention period and changed environmental context after students left the structured school setting contribute to this pattern. In Sub-study 2, grounded theory analysis identifies 10 main categories and generates two core theories: filmmaking reduces aggression by enhancing cognitive competence, emotional intelligence, interpersonal competence, engagement, and psychological capital; and filmmaking functions as a narrative therapy approach rooted in humanism, integrating art therapy methods. Implementation recommendations include adequate personnel and technical support, participant grouping by age and gender, and stable and extended time allocation.

The authors acknowledge the study's strengths, particularly its pioneering mixed-methods design combining an RCT with grounded theory, and its theoretically grounded intervention tailored to digital-native youth. They note limitations including retrospective trial registration, a small single-site sample, use of a waiting-list rather than an active control, reliance on brief subscales for emotion regulation and empathy, lack of measurement of maintenance effects, and the absence of formal fidelity checks. They conclude that the filmmaking intervention is moderately effective in reducing adolescent aggression, with its strongest impact on reactive aggression, and that it carries potential as an innovative approach to fostering multiple dimensions of adolescent development. They recommend future research to extend intervention duration, incorporate booster sessions, differentiate proactive and reactive aggressors in participant sampling, and broaden the range of aggression forms targeted.

Kuchinke et al. (2026), contextualize their work within the well-documented challenge of postpartum maternal mental health problems, mentioning that postpartum anxiety or depression are associated with difficulties in bonding, disrupted parental sensitivity, and increased risk of insecure infant attachment. They note that, while parent-infant psychotherapy (PIP) has an established theoretical basis in attachment theory, psychodynamic principles, and developmental science, the evidence base from randomised controlled trials remains limited and heterogeneous, particularly regarding maternal sensitivity as an outcome. The authors report on the evaluation of focus-based brief parent-infant psychotherapy (PIP-f), a manualized psychodynamic approach delivered over 12 sessions in six weeks, against care-as-usual (CAU) in a multicentre randomised controlled trial conducted as part of the SKKIPPI project (Fricke et al., 2024).

The team recruits German-speaking mothers with at least one ICD-10 psychiatric diagnosis in the postpartum phase and their infants under 12 months of age across five study centres in Berlin, Leipzig, Potsdam, Hamburg, and Flensburg between January 2019 and December 2021. Of 164 families assessed for eligibility, 120 mother-child dyads are randomised using computer-assisted 1:1 block randomisation stratified by setting and study centre: 57 to PIP-f and 63 to CAU. Mothers with more severe psychopathology are assigned to an inpatient setting, while others are treated in non-inpatient contexts. Assessments are conducted at baseline (T0), after six weeks of intervention (T1), and at 12-month follow-up (T2). The primary outcome is maternal sensitivity measured using the direct score of the Emotional Availability Scales (EAS). Secondary outcomes include emotional availability of mother and child, parental reflective functioning (PRFQ), parenting stress (PSI), maternal psychopathological symptoms (assessed via BSCL, EPDS, ASQ, IES, and MINI), child regulatory disorder symptoms (CFS), child behaviour (CBCL), child development (DT), and child attachment security at T2 using the Strange Situation Procedure or Attachment Q-Sort. Video and interview data are coded by independent evaluators blinded to group allocation. Over the course of the study, 50% of dyads discontinue participation, substantially reducing the sample available for follow-up analyses.

PIP-f is not found superior to CAU on the primary outcome of maternal sensitivity at post-intervention (b = 0.129, 95% CI [-0.161, 0.418], p = 0.378). Both groups display high maternal sensitivity at baseline, suggesting a ceiling effect that may have limited the opportunity to observe change. No significant group differences emerge for any secondary outcomes at T1, including maternal psychopathological symptoms and infant regulatory disorder symptoms, with all scores improving over time in both groups. Exploratory longitudinal analyses reveal a significant group x setting interaction for emotional availability in the child domain (EA-child: χ²(4) = 11.2, p = 0.024), indicating that PIP-f produces greater improvements in mother-child interaction relative to CAU specifically within the inpatient setting. A trend toward improved certainty about the child's mental states (PRFQ-CM) is similarly observed for the inpatient PIP-f subgroup. Child attachment security at 12 months does not differ significantly between groups (OR = 2.0, 95% CI [0.64, 6.33], p = 0.226), a finding the authors situate within a broader pattern from the literature whereby brief PIP interventions rarely demonstrate effects on attachment outcomes.

The authors attribute the absence of primary outcome differences partly to a ceiling effect arising from high baseline sensitivity, and suggest that mothers with low-to-moderate psychosocial burden, who are likely overrepresented in the sample, may derive less benefit from PIP than higher-risk groups. They highlight the inpatient findings as clinically meaningful, pointing to PIP-f adding therapeutic value for more vulnerable dyads in structured settings. They acknowledge limitations – including a 50% dropout rate limiting generalizability, the impact of two SARS-CoV-2 lockdowns on recruitment and inpatient access, a final sample smaller than originally planned, reliance on self-report instruments for several outcomes, and the use of two age-appropriate but not fully comparable attachment measures at follow-up. The authors conclude that 12 sessions of PIP-f are not superior to standard care for sensitive mother-child interaction overall, but carry long-term benefits for mothers with more severe symptoms, particularly in the inpatient setting. They suggest future research specifically targeting high-risk populations, testing more intensive or longer interventions, and using extended follow-up periods to assess the sustainability of therapeutic gains.

Armanino-Irigaray et al. (2026), draw attention to the increasing worldwide use of hallucinogens among adolescents and their re-emergence in scientific and public discourse, driven in part by renewed clinical interest in their therapeutic potential for conditions such as depression, anxiety, and post-traumatic stress disorder. They note that adolescence is a particularly vulnerable developmental period, marked by ongoing synaptic pruning and cortical maturation, during which network-level perturbations induced by hallucinogens may be more likely to elicit psychotomimetic responses. While the relationship between cannabis and psychosis is robustly established, the authors highlight that evidence on hallucinogens and early-onset psychosis (EOP) in young people remains sparse and poorly understood. They set out to synthesize available evidence on the prevalence and clinical impact of hallucinogen use in adolescents with EOP, and on the association between hallucinogen exposure and psychotic or psychotic-like symptoms in community samples.

Following PRISMA guidelines and prior PROSPERO registration, the team conducts a systematic search across PubMed, Web of Science, Cochrane Library, and PsycINFO from inception until July 17, 2025. Two researchers independently screen all titles, abstracts, and full texts, with discrepancies resolved through discussion or consultation with a senior researcher. Studies are included if they enrol individuals with a mean age under 18 years and either evaluate hallucinogen exposure in EOP samples or examine the association between hallucinogen use and psychotic or psychotic-like symptoms in community or general population samples. The term hallucinogens is used as an umbrella encompassing classical serotonergic psychedelics, dissociative agents such as ketamine and phencyclidine, and MDMA, the latter included on the basis of shared and converging neurobiological effects relevant to psychosis vulnerability. Risk of bias is assessed using the Newcastle-Ottawa Scale (NOS), with interrater agreement at Cohen's κ = 0.83. A random-effects meta-analysis using logit-transformed proportions estimates pooled prevalence of hallucinogen use in EOP samples. Due to substantial heterogeneity in study design and outcome reporting, all other outcomes are synthesized narratively. Of 3,806 records identified, 12 studies meet the inclusion criteria: six contribute quantitative data to the meta-analysis and six to the narrative synthesis. The average proportion of female participants across studies is 39.9% and the mean age is 16.1 years. NOS scores range from 4 to 9, with a mean of 6.4.

The pooled prevalence of any hallucinogen use among adolescents with EOP, derived from six clinical studies (total N = 713), is 14.3% (95% CI: 3.9%-40.9%), with substantial between-study heterogeneity (I² = 88.5%), likely reflecting differences in local patterns of polysubstance use and sample characteristics. LSD use ranges from 1.8 to 12.5% and MDMA use from 3.5 to 42.9% across individual studies. Hallucinogen use in EOP is consistently associated with polysubstance use and indicators of clinical complexity, including higher rates of suicidality, conduct disorder, reduced educational attainment, longer duration of untreated psychosis, and greater use of depot antipsychotics and clozapine. A significant association between LSD use and lifetime suicide attempts is identified (OR = 5.7, 95% CI: 1.8-17.8, p = 0.002). In community samples, psychedelic use shows weak and inconsistent associations with psychotic and manic symptoms in unadjusted analyses, and these associations largely attenuate after adjustment for other drug use and genetic vulnerability. A notable exception is a moderation by polygenic risk: adolescents with higher genetic liability for schizophrenia or bipolar I disorder show greater manic symptoms following psychedelic exposure. A Canadian population-based study further reports that among adolescents aged 14-18 years with hallucinogen-related emergency department visits, the hazard ratio for subsequent schizophrenia spectrum disorder is significant for males (HR = 3.26, 95% CI: 2.09-5.08) but not for females.

The authors acknowledge limitations including substantial methodological heterogeneity across studies, an exclusively observational evidence base with residual confounding that cannot be excluded, widespread polysubstance use making it difficult to isolate hallucinogen-specific effects, frequent reliance on self-report rather than clinical assessment, variation in outcome definitions, and the inclusion of mixed-age samples in several studies limiting strict age-specific inferences. They conclude that hallucinogen use is relatively common among adolescents with EOP and is associated with more complex clinical trajectories, particularly higher rates of suicidality. They recommend that clinicians routinely assess hallucinogen use in EOP, especially when evaluating suicide risk or atypical mood presentations, and call for longitudinal, large-scale research that differentiates specific substances and integrates genetic, environmental, and clinical moderators to clarify causal mechanisms and inform prevention strategies.

REFERENCES:  

• Armanino-Irigaray, M., Catalán, A., Aymerich, C.et al.Unusual experiences and early-onset psychosis associated to hallucinogen use in adolescents: a systematic review and meta-analysis.Child Adolesc Psychiatry Ment Health20, 56 (2026). https://doi.org/10.1186/s13034-026-01060-1.
• Fricke, J., Bolster, M., Icke, K. et al, et al. Assessment of psychosocial stress and mental health disorders in parents and their children in early childhood: Cross-Sectional results from the SKKIPPI cohort study. Children (Basel), 11(8), 2024. https://doi.org/10.3390/children11080920.
• Kuchinke, L., Mattheß, J., Eckert, M.et al.Efficacy of parent-infant psychotherapy with mothers with postpartum mental disorder: results from a randomized controlled trial.Child Adolesc Psychiatry Ment Health20, 13 (2026). https://doi.org/10.1186/s13034-025-01013-0.
• Zhang, Y., Fung, A.L.C., Liang, Y.et al.The effectiveness and mechanisms of a filmmaking intervention for adolescent aggression: a mixed methods study.Child Adolesc Psychiatry Ment Health20, 41 (2026). https://doi.org/10.1186/s13034-026-01035-2.
   

IACAPAP Bulletin, Issue 82