Child Psychiatric Clinic Research Articles

Association between Dopamine D4 Receptor Gene Polymorphism and Scores on a Continuous Performance Test in Korean Children with Attention Deficit Hyperactivity Disorder

ObjectiveThe aim of this study was to evaluate the association between a variable number of tandem repeats polymorphism at the dopamine D4 receptor gene (DRD4) and the performance of children with attention deficit hyperactivity disorder (ADHD) in a continuous performance test (CPT).MethodsThis study included 72 ADHD children (mean age=9.39±2.05 years) who were recruited from one child psychiatric clinic. The omission errors, commission errors, reaction time and reaction standardization in the CPT were computed. The number of 48-base pairs tandem repeats in the exon III of DRD4 was analyzed in a blind manner.ResultsThe homozygosity of the 4-repeat allele at DRD4 was significantly associated with fewer commission errors (t=2.364, df=28.685, p=0.025) and standard deviation of reaction time (t=2.351, df=24.648, p=0.027) even after adjusting for age. The results of analyses of CPT measured values among three groups showed that the group with higher frequency of the 4-repeat allele showed a lower mean score of commission errors (F=4.268, df=2, p=0.018).ConclusionThese results suggest a protective role of 4-repeat allele of the DRD4 polymorphisms on commission errors in the CPT in children with ADHD.

Child and Adolescent Psychiatric Clinics of North America: Neuropsychiatric Genetic Syndromes

Journal of Child and Adolescent PsychopharmacologyVol. 18, No. 6 BOOK REVIEWChild and Adolescent Psychiatric Clinics of North America: Neuropsychiatric Genetic SyndromesGabrielle L. ShapiroGabrielle L. ShapiroSearch for more papers by this authorPublished Online:24 Dec 2008https://doi.org/10.1089/cap.2008.1864AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail "Child and Adolescent Psychiatric Clinics of North America: Neuropsychiatric Genetic Syndromes." , 18(6), p. 647FiguresReferencesRelatedDetails Volume 18Issue 6Dec 2008 Information© 2008 Mary Ann Liebert, Inc.To cite this article:Gabrielle L. Shapiro.Child and Adolescent Psychiatric Clinics of North America: Neuropsychiatric Genetic Syndromes.Journal of Child and Adolescent Psychopharmacology.Dec 2008.647-647.http://doi.org/10.1089/cap.2008.1864Published in Volume: 18 Issue 6: December 24, 2008PDF download

Re‐establishing contact: A qualitative exploration of how therapists work with alliance ruptures in adolescent psychotherapy

AbstractWhat challenges do therapists face when they experience ruptures in the working alliance in psychotherapy with adolescent clients; and what are their most typical strategies when they try to re‐establish contact? These issues were explored through qualitative interviews with nine psychotherapists from outpatient child and adolescent psychiatric clinics in Bergen, Norway. A descriptive and hermeneutically informed phenomenological approach was used to analyse the interview transcripts. Most therapists/participants described that they would explore the reason for the rupture from the adolescent's point of view, and all participants often understood ruptures in light of the adolescents’ need for autonomy. However, the participants differed strongly in how much they would focus on the relationship per se, on intrapsychic factors, or on the adolescent's life outside therapy. For the therapists who regarded the relationship as something to be explored, client ambivalence to treatment was seen as something that could be confirmed and validated. If not, ambivalence seemed more likely to be handled as a choice situation. Therapists who explored ambivalence also tried to develop ways to talk about fluctuations in the adolescent's motivation and distress, and often interpreted ‘not wanting therapy’ as a way of communicating difficulties with the relationship.

Psychiatric disorders and behavioral problems in children and adolescents with Tourette syndrome

Objective: Many previous studies have surveyed associations between Tourette syndrome (TS) and co-morbid psychiatric disorders, but they usually did not include oppositional defiant disorder (ODD), conduct disorder (CD), separation anxiety disorder (SAD), and post-traumatic stress disorder (PTSD). Method: The subjects were children and adolescents with TS who visited a child and adolescent psychiatric clinic, and who were interviewed using DSM-IV diagnostic criteria. Characteristics of their tics were examined by the Yale-Global Tic Severity Scale (Y-GTSS). Behavioral problems were surveyed by the Child Behavior Checklist (CBCL) filled in by the parents. Results: About 87.9% of the subjects were boys. The mean age of the subjects was 11.8 years. The most common psychiatric disorders were attention deficit hyperactivity disorder (ADHD), ODD, nail biting, and obsessive compulsive disorder (OCD). Only one subject was affected by TS without co-morbidities. Among TS patients with co-morbidities, those with disruptive behavioral disorders (DBD) have significantly higher mean scores than patients without DBD on the Externalizing scale, Social problems, Attention problems, Delinquent and Aggression scales. Co-morbidity of anxiety disorders was not related to the CBCL scores. Conclusion: Many of our results were similar to those reported in studies conducted in other parts of the world. TS is more common in boys and nearly all of them had at least one co-morbid disorder. The most common co-morbidity was ADHD. Behavioral problems in TS are related to the co-morbidity with the DBD, and possibly not to the anxiety disorders.

Clinical neuropsychiatric correlates and EEG findings among children with developmental disorders in Lagos, Nigeria

Developmental disorders with or without associated neuropsychiatric complications continue to be one of the major health problems in Africa. The grossly inadequate management/ rehabilitative facilities further worsen this. A prospective study aimed at finding the types of developmental disorders and associated neuropsychiatric complications among children aged </=15 years that presented with developmental disorder in the study centers over 36 month study duration. The study was carried out in the paediatric and child psychiatric clinics as well as the Electroencephalographic (EEG) unit of two major health facilities in Lagos, Nigeria: Lagos University Teaching Hospital (LUTH) and Psychiatric Hospital, Yaba, Lagos. For each subject, socio-demographic data was obtained and appropriate clinical evaluation was carried out to obtain the necessary data and clinical diagnoses. Furthermore, each of the subjects had waking EEG recording using 20-channel computerized Medelec(R)EEG machine. The EEG interpretation was blinded to the clinical history of the subjects. Overall, one hundred and eleven (111) subjects were evaluated over the 36 month study period. The cohort was made up of 63 (56.8%) males and 48 (43.2%) females. The mean age was 4.8 (+/-3.9) years, with most subjects falling in the age group of 0-5 years(69.4%). Mixed specific developmental disorders were most common (55%) followed by that of specific developmental disorders of speech and language (34.2%). Forty-one (36.9%) subjects suffered from one or more types of complications, with seizure, 22(19.8%) being the most common. The waking EEG recording was normal in 22 (19.8%) subjects; while abnormal epileptiform activities were found in 85 (76.6%) of recordings. No statistically significant relationship existed between EEG abnormalities and the factors of age and clinical diagnoses (i.e developmental abnormalities). The small number of subjects in this study is a major hindrance to drawing a general conclusion. However, it has been shown that a number of the cohort in addition to their developmental disorders suffered from such complications as seizures, hyperactivity etc. Furthermore, a significant proportion had EEG abnormalities of the epileptiform types possibly reinforcing the previously known fact of prevalent subtle brain damage among African children. The need for preventive health care is therefore emphasized.

Infant Mental Health Assessment: The use of DC 0‐3 in an outpatient child psychiatric clinic in Scandinavia

The study focuses on Infant Mental Health data from an outpatient psychiatric clinic using the "Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood" (DC 0-3) and parental questionnaires, CBCL and ITSC. In total, 138 infants (aged 0-3) went through the diagnostic procedure. Sixty-eight per cent were diagnosed within Axis I, with regulatory disorder, disorder of affect and traumatic stress disorder being the most frequent diagnoses. In addition, 48% were classified as having a relationship disorder according to Axis II, with an additional 40% being considered to be at risk of developing a relationship disorder. The mothers' and fathers' ratings of their children's externalized and sensitivity problems were in agreement with the clinicians, but the ratings of internalized problems as well as relationship problems presented a more complex pattern.

Establishing a bond that works: a qualitative study of how psychotherapists make contact with adolescent patients

Objective: To explore psychotherapists' experience of the challenges that occur when they try to establish contact and a therapeutic bond with adolescents in therapy. Design: Qualitative interviews with psychotherapists. A descriptive and hermeneutically informed phenomenological approach was used to analyse the transcripts. Participants: Nine psychotherapists who volunteered to take part in the study were recruited from two outpatient child and adolescent psychiatric clinics in the Bergen area of western Norway. Results: The most common challenges reported by the therapists were: (1) Getting to know the problem in a way that makes it into something that can be worked on together, (2) Finding a role as a therapist, (3) Motivating the adolescent to be personally engaged, (4) Establishing a common frame for joint meaning making, and (5) Handling ambivalence. Conclusion: Psychotherapists working with adolescent patients share some common dilemmas, but differ strongly in their solutions to these dilemmas. The results underline the value of exploring psychotherapists' subjective experience of dilemmas in therapy.

The Obsessive-Compulsive Symptom (OCS) scale of the Child Behavior Checklist: A comparison between Swedish children with Obsessive-Compulsive Disorder from a specialized unit, regular outpatients and a school sample

To evaluate the discriminative power of various items as reported by parents in the OCS-scale extracted from the Child Behavior Checklist (CBCL) problem scale and to compare findings with outcomes of previous validation studies.Children referred to a specialized child psychiatric Obsessive-Compulsive Disorder (OCD) clinic (OCD group) (n=185) receiving a formal OCD diagnosis according to DSM IV criteria based on interviews with the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) were compared to a sample recruited from regular child and adolescent psychiatric outpatient clinics (CPO group) (n=177). Both samples were compared to a normative school sample (SS group) and all three groups were matched for age and gender.Thirty seven CBCL items, mostly representing core internalizing symptoms and parts of the thought problem scale as well as physical and sleep problems, were first identified. Ten of these items (including all discriminative items in previous validation studies) could distinguish children with OCD from CPO patients. In a subsequent analysis, the results of a logistic regression showed that four CBCL items, “Obsessions,” “Fearful and Anxious,” “Compulsions,” and “Worries” remained significant predictors. These four OCS items and previously used CBCL OCS-scales were further examined by means of ROC-analysis showing that the “Obsessions” and “Compulsions” CBCL items were the strongest predictors.These two CBCL items performed well as screens for OCS symptoms in children and adolescents and the addition of similar CBCL items did not further increase sensitivity or specificity. It is suggested that parental responses on these two items could preferably be used as screen for OCD in children and adolescents in regular child psychiatric clinics.

Juvenile Justice: Child and Adolescent Psychiatric Clinics of North America, Volume 15, Issue 2

Back to table of contents Previous article Next article Book ReviewFull AccessJuvenile Justice: Child and Adolescent Psychiatric Clinics of North America, Volume 15, Issue 2Thomas Grisso Ph.D.Thomas Grisso Ph.D.Search for more papers by this authorPublished Online:1 Nov 2007https://doi.org/10.1176/ps.2007.58.11.1503aAboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail This is the first issue in the Clinics series devoted to juvenile justice, and it provides an overview of mental health issues relevant to the juvenile justice system. As the book's preface explains, in the United States and many other countries during the 1990s the juvenile justice system became increasingly retributive and less rehabilitative in its objectives. But a few years ago research began to reveal that a large proportion of youths in juvenile justice programs—around two of three—met clinical criteria for one or more mental disorders. This has fueled new interest and attention regarding ways to respond to the mental health needs of youths as they enter, are processed through, and are in the custody of the juvenile justice system.This interest has produced other recent works devoted to the topic, but few with the breadth and diversity of this volume. Its 13 invited articles are clustered in three sections that cover a wide range of topics, including the nature and prevalence of mental disorders among youths in the juvenile justice system, methods and issues in identifying youths' disorders, and reviews of treatment methods within the context of juvenile justice objectives, programs, and resources.Another source of diversity for this volume is its international perspective. Its editors are Robert Vermeiren of Leiden University in the Netherlands, and Vladislav Ruchkin of the Karolinska Institute in Sweden and Yale University. Almost half of the articles are authored by North Americans, and the rest are by authors with primary or joint affiliations in Europe or Russia—with some collaboration with American authors. In addition, the authors represent a balanced blend of psychiatrists and psychologists, all of whom value and apply a decidedly empirical perspective in their reviews and discussions of the issues.Overall the articles are well written and well researched, and most of them offer up-to-date information with excellent depth and a degree of synthesis that avoids a tedious study-by-study review. The articles that review mental disorders avoid clinical generality and instead discuss disorders in the context of delinquent youths specifically. Regarding assessment of youths, the chapters on mental health screening and on violence risk assessment are especially strong, but the volume offers little for students of juvenile forensic assessment, such as evaluations to address specific legal questions related to transfer to criminal court and competence to stand trial. The reviews of treatments focus on what can be applied practically and what works within juvenile justice settings specifically.International reviews focusing on legal or systematic questions run the risk of offering discussions that are relevant for some countries but not for others because of jurisdictional differences. The risk in this case was worth it. Indeed, one is impressed by the many cross-national commonalities faced by clinicians who are concerned with the relationships between mental disorders and delinquency, as well as identification and treatment of mental disorders within a juvenile justice context.Dr. Grisso is affiliated with the Department of Psychiatry, University of Massachusetts Medical School, Worcester. FiguresReferencesCited byDetailsCited byNone Volume 58Issue 11 November, 2007Pages 1503-1504PSYCHIATRIC SERVICES November 2007 Volume 58 Number 11 Metrics PDF download History Published online 1 November 2007 Published in print 1 November 2007

Juvenile Justice: Child and Adolescent Psychiatric Clinics of North America, Volume 15, Issue 2

Juvenile Justice: Child and Adolescent Psychiatric Clinics of North America, Volume 15, Issue 2

Intensive Family Therapy

The main objective was to study intensive family therapy (IFT) within a treatment program carried out at a child and adolescent psychiatric clinic. Our study uses a quasi-experimental design with pre-treatment, post-treatment, and follow-up assessment and comprises 46 consecutive families, using the Family Relations Scale, Symptom Check List-90, and Child Behavior Check List. Baseline values reveal a heavy problem load. Significant differences were, however, shown from pre-treatment to the six-month follow-up and pre-treatment to the two-year follow-up on all three scales. The effect sizes from pre-treatment to the six-month follow-up were low to medium. IFT works for multi-problem families, with continued improvements after completed treatment.

Clinical Precursors of Adolescent Conduct Disorder in Children With Attention-Deficit/Hyperactivity Disorder

To examine precursors of adolescent conduct disorder (CD) in children with attention-deficit/hyperactivity disorder (ADHD), investigating the significance of childhood oppositional defiant disorder (ODD) and ADHD. A total of 151 children with ADHD recruited from child psychiatric and pediatric clinics were assessed through standardized diagnostic interviews at ages 6 to 13 years and in adolescence 5 years later. Using multiple regression analysis, we assessed baseline ODD diagnosis and ODD, CD, and ADHD symptom scores as clinical predictors of adolescent CD diagnosis and symptom scores. Childhood ODD (diagnosis and severity) was significantly associated with adolescent CD (diagnosis and severity), independent of childhood ADHD severity and childhood CD. Children with a diagnosis of ODD were almost three times more likely to develop CD in adolescence (odds ratio = 2.79, 95% CI 1.16-6.70, p = .02). Childhood ADHD severity predicted adolescent CD scores but not diagnosis of CD (although there was a trend toward association). The presence of at least one CD symptom in childhood predicted adolescent CD severity. ODD is a significant precursor of adolescent CD in children with ADHD independent of ADHD severity. Considering the negative prognosis of ADHD with comorbid CD, it is imperative that clinicians pay specific attention to the presence of childhood ODD behaviors.

Causes of Adolescent Onset Anorexia Nervosa: Patient Perspectives*

This qualitative study describes the perspectives of former anorexia nervosa (AN) patients with respect to why they believed they developed AN. Previous patients with initial treatment in child and adolescent psychiatric clinics in northern Sweden were interviewed 8 and 16 years after initial assessment. The question, “What do you think today about the reasons why you got AN?” was asked at both interviews. Content analyze was used to categorize the answers. Causes were attributed to self, family, and socio-cultural stressors outside of the family. Most common were high own demands and perfectionism. At the second follow-up there were more answers in the family categories. The results agreed with results from risk-factor research.

Association of 4-Repeat Allele of the Dopamine D4 Receptor Gene Exon III Polymorphism and Response to Methylphenidate Treatment in Korean ADHD Children

In the present study, we investigated the association between the 4-repeat allele at the dopamine receptor D4 (DRD4) gene and the response to treatment with methylphenidate (MPH) in Korean children with attention deficit hyperactivity disorder (ADHD). The study subjects were 83 children with ADHD (8.40+/-1.73 years) who were recruited from two child psychiatric clinics in South Korea. All of the drug-naive ADHD children were treated with MPH for about 8 weeks. An improvement of more than or equal to [corrected] 50% in the ADHD Rating Scale-IV (ARS) scores after 8 weeks of treatment compared with the baseline ARS scores before the treatment was considered as a 'good response', whereas an improvement of less than [corrected] 50% was considered as a 'poor response'. After the genotyping for DRD4 was performed, we investigated the association between the genotype at DRD4 and the response to MPH treatment. We performed a comparison of the response to MPH treatment between the two largest groups, viz. the subjects with and without the 4/4 genotype at DRD4. According to the ARS scores of the subjects as assessed by their parents and by their teachers, we found that while 71.1 and 80.0% (32/45 and 24/30), respectively, of those with a good response to MPH treatment showed the 4/4 genotype at DRD4, only 31.6 and 37.7% (12/38 and 20/53), respectively, of those with a poor response to MPH treatment showed the 4/4 genotype at DRD4 (Pearson chi2-values=12.926 and 13.737, respectively, both df=1, and both p<0.01). Our findings support the existence of an association between the 4-repeat allele at DRD4 and good response to MPH in Korean ADHD children.

Letter

Back to table of contents Previous article Next article LetterFull AccessLetterGregory A. Aarons Ph.D.Gregory A. Aarons Ph.D.Search for more papers by this authorPublished Online:1 Nov 2006https://doi.org/10.1176/ps.2006.57.11.1656AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail In Reply: Mr. Seitzer's letter regarding my article supports the contention that high-quality leadership is an important consideration in the provision of high-quality mental health services. Establishing a link between leadership and the attitudes of mental health service providers toward adopting innovation and change—evidence-based practices in particular—was the main point of the article. The article does not, however, contend that evidence-based practices are the only means of improving outcomes for those involved in mental health services. There is considerable debate regarding applicability, standards for fidelity, and the need for local adaptation of evidence-based practices. The article takes no stand on the value of evidence-based practices per se. The Evidence-Based Practice Attitudes Scale ( 1 ), which was used in the study, was developed because providers' attitudes toward adopting innovation have been largely ignored in the research literature, even while the impetus to disseminate and implement evidence-based practices has gained momentum. Mr. Seitzer's assertion that outcomes matter more than particular practices raises a complex and important issue. Services might be greatly improved if outcomes were routinely empirically assessed in usual care. Rigorous outcome measurement and use of such outcome data to inform clinical practice are relatively rare. Indeed, research suggests that clinicians' attitudes about using such measures vary greatly, with some believing that clinical knowledge and judgment are at least as accurate as empirically reliable and valid assessment, thus obviating the need for such measures ( 2 ). There is evidence that draws such an assumption into question ( 3 ). Assessments will likely be beneficial to the degree that they can be incorporated into the clinical process both to better understand initial diagnoses and problems and to track clinical progress. Although my study did not directly address outcome assessment, it did establish a link between leadership and providers' attitudes toward adopting evidence-based practices as part of a research program on improving the context for delivery of high-quality mental health services and implementation of innovation ( 4 ). An innovation in mental health care may or may not be evidence based. What is emerging from this line of research is that leadership and organizational context are likely to play an important role in implementing innovation and promoting more positive outcomes for mental health and social service agencies and clinics ( 5 ). Reference1. Aarons GA: Mental health provider attitudes toward adoption of evidence-based practice: the Evidence-Based Practice Attitude Scale (EBPAS). Mental Health Services Research 6:61-74, 2004Google Scholar2. Garland AF, Kruse M, Aarons GA: Clinicians and outcome measurement: what's the use? Journal of Behavioral Health Services and Research 30:393-405, 2003Google Scholar3. Dawes RM, Faust D, Meehl PE: Clinical versus actuarial judgment. Science 243:1668-1674, 1989Google Scholar4. Aarons GA: Measuring provider attitudes toward evidence-based practice: consideration of organizational context and individual differences. Child and Adolescent Psychiatric Clinics of North America 14:255-271, 2005Google Scholar5. Glisson C: The organizational context of children's mental health services. Clinical Child and Family Psychology Review 5:233-253, 2002Google Scholar FiguresReferencesCited byDetailsCited byNone Volume 57Issue 11 November, 2006Pages 1656-1656PSYCHIATRIC SERVICES November 2006 Volume 57 Number 11 Metrics PDF download History Published online 1 November 2006 Published in print 1 November 2006

Sleep and Residual Sedation After Administration of Zaleplon, Zolpidem, and Placebo During Experimental Middle-of-the-Night Awakening

To assess the efficacy of zaleplon 10 mg and zolpidem 10 mg administered during experimental middle-of-the-night awakenings in patients with sleep-maintenance insomnia using objective polysomnographic measures and to assess daytime residual sedation 4 to 7 hours after dosing using sleep-latency testing. A randomized, double-blind, placebo-controlled, 3-period, crossover design was used to study 37 adults with insomnia who received treatment during an experimental awakening 4 hours after bedtime. Latency to persistent sleep and total sleep time before and after awakening were recorded. The primary residual sedation measure was a sleep latency test conducted hourly from 4 to 7 hours after treatment. Self-report measure of alertness and concentration and digit symbol substitution tests were examined concurrently. Sleep disorders centers. Thirty-seven adults with sleep-maintenance insomnia. Zaleplon 10 mg, zolpidem 10 mg, or placebo. Thirty-one patients had efficacy-evaluable data; 37 patients received at least 1 dose of study medication and were included in the safety analysis. Compared with placebo, latency to persistent sleep after both zaleplon and zolpidem was shorter and total sleep time after administration of the drugs was longer (overall p < .001, Dunnett p < .001 for all posthoc comparisons). Significant differences from placebo were not found with zaleplon in daytime-sedation measures. At 4, 5, and 7 hours after zolpidem, sleep onset on sleep latency testing was shorter than after placebo (overall p < .001 for all, Dunnett tests for posthoc comparisons p < .001, p < .001, p < .05, respectively). Self-report measures of concentration (4, 5, and 6 hours, overall p < .05, Dunnett p < .05 for each time point) and alertness (4 hours, overall p < .05, Dunnett p < .05), and Digit Symbol Substitution Test scores (4 and 5 hours, overall p < .001, Dunnett p < .01 for both time points) after zolpidem were also lower than with placebo. Zaleplon 10 mg and zolpidem 10 mg effectively shorten sleep latency and lengthen sleep duration after dosing, when administered during experimental nocturnal awakening. Residual sedation was not detected as little as 4 hours after zaleplon 10 mg, whereas residual sedation was detected with zolpidem 10 mg up to 7 hours after treatment. These findings suggest that zaleplon may be an appropriate treatment for use when patients awaken during the night and have difficulty reinitiating sleep.

Predicting Aggressive and Disruptive Behavior in Referred 6- to 12-Year-Old Boys

The authors investigated the predictive and incremental validity of the Early Assessment Risk List for boys (EARL-20B; Augimeri, Koegl, Webster, & Levene, 2001), a structured clinical checklist designed for the professional judgment of risk for aggressive and disruptive behaviors and risk/needs factor-based management of this risk. Seventy-six boys consecutively referred to child psychiatric outpatient clinics in mid-Sweden were evaluated according to the EARL-20B and with independent (not EARL-20B-based) clinical evaluations. The participants were prospectively followed after 6 and 30 months. EARL- 20B-based assessments were positively and moderately associated with aggressive (reactive and proactive aggression) and disruptive behavior (conduct problems and DSM-IV Conduct Disorder) at both subsequent evaluations. Clinical evaluations made without the instrument were not as consistently associated with outcome. Incremental predictive validity over unstructured clinical evaluations and Conduct Disorder at baseline suggested promising clinical utility. The checklist might be used to support clinical decision making for referred boys at risk for continued antisocial behavior.

Patient Perspectives of Recovery in Adolescent Onset Anorexia Nervosa

The aim of this qualitative study was to describe the patients' perspective of the recovery process from anorexia nervosa. On average 16 years after initial assessment at child and adolescent psychiatric clinics, 68 women were interviewed about what they attributed as important factors in the recovery process of their adolescent onset anorexia nervosa. The answers were coded using content analysis. Those having recovered (n = 58) were able to describe clear turning points in their history and mentioned as most important aspects in their recovery: friends, own decisions, activities, treatment, family of origin, and own family.

Discharge Against Medical Advice From Inpatient Psychiatric Treatment: A Literature Review

A comprehensive review of the literature examined discharge from inpatient psychiatric settings against medical advice (excluding elopements) over the past 50 years. Specifically, definitions, prevalence, predictors, temporal patterns, consequences, and interventions pertaining to such discharge were explored. The authors searched the PubMed and PsycINFO databases and selected articles for review if studies had been conducted in an inpatient setting or included discharge against medical advice as one of the aims or results and if findings were based on formal statistical analyses. Sixty-one articles met the selection criteria. Prevalence of discharge against medical advice ranged from 3 to 51 percent and increased over time. Discharge against medical advice was most commonly predicted by patient factors, such as young age; single marital status; male gender; comorbid diagnosis of personality or substance use disorders; pessimistic attitudes toward treatment; antisocial, aggressive, or disruptive behavior; and history of numerous hospitalizations ending in discharges against medical advice. It was also predicted by provider variables, such as failure to orient patients to hospitalization and failure to establish a supportive provider-patient relationship, and by temporal variables, such as evening and night shifts. Outcomes of patients discharged against medical advice were characterized by poor outcomes in several domains of functioning and more frequent rehospitalizations. Prediction of patients at risk of discharge against medical advice is possible with several defined variables. Awareness of the factors involved in discharge against medical advice should facilitate clinical decision making and the development of successful interventions for high-risk patients.

An open clinical trial of cognitive-behaviour therapy in children and adolescents with obsessive–compulsive disorder administered in regular outpatient clinics

The aim of the present study was to examine the effectiveness of manual-guided cognitive-behaviour therapy (CBT) for childhood obsessive–compulsive disorder (OCD) administered within three regular, i.e., non-academic, Norwegian outpatient child psychiatric clinics. MethodsA total of 28 youngsters, aged 8–17 with primary OCD entered the study. Assessment at intake included Norwegian versions of the K-SADS-PL, Children's Yale–Brown Obsessive Compulsive Scale (CY-BOCS), and a measure of OCD-specific functional impairment (Child OCD Impact Scale (COIS)). Therapy consisted of 12 manual-guided sessions with combined individual and family CBT-based interventions and was conducted by psychologists and physicians under training and supervision. Outcome was assessed after treatment and at 3- and 6-month follow-ups by means of the CY-BOCS, the Clinical Global Impression (CGI) and the CGI-Improvement scales, and the COIS. ResultsTwenty-four youngsters (86%) completed treatment and were available for the follow-up assessments. Significant improvements were found on all outcome measures after treatment, including a mean symptom reduction on the CY-BOCS of 60.6%, increasing to 68.8% at the 6-month follow-up. Estimates of within-group effect sizes showed strong effects of treatment. ConclusionThe results of the present study suggest that manual-guided CBT for childhood OCD can be successfully implemented in non-academic community child psychiatric settings with outcomes in accordance with previous findings from highly specialised university clinics.