Children's Global Assessment Scale Scores Research Articles

Problematic Substance Use in Adolescent Psychiatric Inpatients: Rates, Clinical Correlates and Effects on Therapeutic Outcomes

Aims: : We aimed to document the clinical rates and correlates of problematic substance use among adolescent inpatients. Background: Adolescents referred to psychiatric inpatient care are likely to present family and social risk factors making them at high risk of substance use disorder. Objective: The objective of this study is to document the rates, clinical correlates, and effects of associated problematic substance use on therapeutic outcomes in adolescents referred to psychiatric inpatient care. Method: The DEP-ADO questionnaire was used to systematically screen out problematic substance use in two 12-18 adolescent inpatient units between January 2017 to December 2018. Inpatients who were screened positively based on the DEP-ADO questionnaire and/or information gathered from repeated interviews with the youths and their families were reported to the liaison addiction unit for diagnosis. The chart-review procedure was used to document clinical correlates (i.e., suicidal behavior, DSM-5 psychiatric diagnoses, the Clinical Global Impression-Severity score) and therapeutic outcomes (i.e., the Clinical Global Impression- Improvement score, change in Children-Global Assessment Scale score during patients’ stay and length of stay). Result: Over two years, 150 adolescents completed the DEP-ADO questionnaire (Mean Age =14.7 ± 1.7; 42% girls). Thirty percent of adolescent inpatients reported some type of problematic substance use, with a higher likelihood of daily tobacco use (OR=2.4), regular cannabis use (OR=2.3), and occasional opioid/heroin use (OR=9.8) compared to the general population. Adolescent inpatients who misused illegal substances prior to admission were 2.5 times more likely to report suicidal behaviors. A strong association was reported between binge drinking behavior and a discharge diagnosis of bipolar disorder (OR=11.0). Therapeutic outcomes were not statistically different with regards to alcohol or illicit substance use status. Conclusion: Inpatient adolescents were at high risk of associated problematic substance use. Patients with co-existing problematic substance use seem to have more severe and chronic forms of mood disturbances, although the response rate to therapeutics provided during their stay was not found to be lower compared to their counterparts without problematic substance use.

43.7 Sex-Based Differences in Clinical Profiles and Cannabis Abstinence in Adolescents Receiving Combination Treatment for ADHD and Comorbid Cannabis Use Disorder

Recent studies indicate sex-based differences in clinical presentation and treatment response for both ADHD and cannabis use disorders (CUDs). Given the high rate of comorbidity of ADHD and CUD, the present study sought to investigate whether sex differences are present in adolescents (ages 13-18 years) with co-occurring ADHD and CUD. This post hoc analysis examined sex-based differences in baseline clinical profiles, cannabis abstinence, and ADHD and substance use disorder (SUD) treatment outcomes in 271 adolescents (19% female, mean age = 16.5 years) meeting DSM-IV criteria for ADHD and comorbid CUD. The sample represents a subset of participants from a 16-week multisite randomized controlled trial of osmotic-release methylphenidate (OROS-MPH) + CBT vs placebo + CBT for the treatment of ADHD and nontobacco SUD (CTN-0028). Compared to males, females with ADHD and CUD had lower self-reported ADHD symptoms and higher global functioning measured via Children's Global Assessment Scale (CGAS) scores at baseline. Both males and females showed significant reductions in days of cannabis use and ADHD symptoms following treatment. There was no evidence of differential improvement in ADHD and nontobacco/noncannabis substance use outcomes with treatment, with persistent sex differences in ADHD symptoms and CGAS scores. Female participants showed greater reductions in cannabis use compared to males, but these differences did not reach statistical significance (eg, reduction in days of cannabis use: –12.0 vs –9.4 days; p = 0.07; end-of-treatment cannabis abstinence: 35% vs 25%; p = 0.13). Sex-based differences in the severity of ADHD symptoms and global functioning are present in adolescents with ADHD and comorbid CUD and largely persist during OROS-MPH + CBT treatment. Identifying overlapping and distinct mechanisms of behavioral change in males and females with co-occurring ADHD and CUD may guide sex-specific and sex-shared intervention development.

Functional outcomes and patient satisfaction following inpatient treatment for childhood-onset schizophrenia spectrum disorders vs non-psychotic disorders in children in the United Kingdom.

The aim of this study was to compare clinical characteristics and treatment outcomes between children with Childhood-onset schizophrenia spectrum disorders (COSS) and children with other severe non-psychotic psychiatric conditions (non-COSS), all admitted to a national mental health inpatient children's unit. We conducted a retrospective study of all children discharged from a national children's inpatient unit in the United Kingdom, between 2009 and 2018. We compared functional and treatment outcomes and satisfaction with treatment in COSS with non-COSS in the whole sample and separately for male and female patients. A total of 211 children (55% boys) were included in the sample. The mean age on admission was 129.7 months (10.8 years; age range, 6-12).Twenty cases were diagnosed with COSS (9.5%). In the whole sample, COSS patients had significantly lower Children's Global Assessment Scale (CGAS) scores on admission compared to non-COSS (P = .006). There was a trend towards children with COSS as a group having a longer admission (M = 194.6 days, SD = 125.4) compared to non-COSS (M = 135.8 days, SD = 86.2), (P = .053). Females with COSS seemed to have more significant differences compared to females with non-COSS, in particular, longer admissions (P = .016) and worse CGAS scores at discharge (P = .04), whilst in males, these differences seemed to be attenuated. Children with COSS have lower functioning at the point of inpatient admission and possibly longer admissions, but similar satisfaction with treatment at discharge from hospital compared with non-COSS. Females with COSS may have worse functional outcomes compared to non-COSS at discharge.

Specialized Therapeutic Assessment-Based Recovery-Focused Treatment for Young People With Self-Harm: Pilot Study.

Background: Suicide is the second leading cause of death in young people worldwide. Self-harm is the strongest predictor of death by suicide. There is increasing evidence that psychological therapies are efficacious in treating self-harm in adolescents. However, studies so far have predominantly focused on highly selective groups of adolescents and have investigated interventions that require intensive training and considerable expense. Methods: We conducted a pilot study of a novel psychological therapy package, Specialized Therapeutic Assessment-Based Recovery-Focused Treatment (START) that consists of Therapeutic Assessment followed by treatment in one of three modules, depending on adolescents’ needs and preferences: Solution Focused Brief Therapy, Cognitive Behavior Therapy (CBT), or Mentalization Based Treatment. Adolescents (12–17) with at least one self-harm episode in the previous 6 months referred for community treatment, who had no intellectual disability, psychosis or autism were eligible for START. The primary outcome measure was the number of self-harm (regardless of suicidal intent) episodes 6 months before and 6 months after commencing START. Secondary outcomes included measures of psychopathology, functional impairment and family satisfaction. Results: Twenty-one consecutively referred adolescents were recruited and 15 received a therapeutic module of START: three received Solution Focused Brief Therapy, nine CBT, and three Mentalization Based Treatment. There was a statistically significant reduction in the number of self-harm episodes from a mean of 7.93 (SD = 12.26) to 1.00 (SD = 1.47), p < 0.02 following START. There was also a significant reduction in self-harm episodes, Revised Children’s Anxiety and Depression Scale scores and a statistically significant improvement in Children Global Assessment Scale scores for the CBT group alone. There were no significant differences in any other outcomes. Most families were somewhat or very much satisfied with the intervention. Conclusion: The results show that START was associated with a reduction in self-harm and depression and anxiety symptoms, which could indicate that START should be rigorously studied in a randomized control trial (RCT). However, the model had difficulties in its implementation, with CBT being only module that was offered to enough young people to allow before and after analysis. CBT appears to be the most promising module in treating adolescents with self-harm referred to community mental health services.

Comparison of effectiveness and cost-effectiveness of an intensive community supported discharge service versus treatment as usual for adolescents with psychiatric emergencies: a randomised controlled trial

SummaryBackgroundIntensive community treatment to reduce dependency on adolescent psychiatric inpatient care is recommended in guidelines but has not been assessed in a randomised controlled trial in the UK. We designed a supported discharge service (SDS) provided by an intensive community treatment team and compared outcomes with usual care.MethodsEligible patients for this randomised controlled trial were younger than 18 years and had been admitted for psychiatric inpatient care in the South London and Maudsley NHS Foundation Trust. Patients were assigned 1:1 to either the SDS or to usual care by use of a computer-generated pseudorandom code with random permuted blocks of varying sizes. The primary outcome was number of inpatient bed-days, change in Strengths and Difficulties Questionnaire (SDQ) scores, and change in Children's Global Assessment Scale (CGAS) scores at 6 months, assessed by intention to treat. Cost-effectiveness was explored with acceptability curves based on CGAS scores and quality-adjusted life-years (QALYs) calculated from the three-level EuroQol measure of health-related quality of life (EQ-5D-3L), taking a health and social care perspective. This study is registered with the ISRCTN Registry, number ISRCTN82129964.FindingsHospital use at 6 months was significantly lower in the SDS group than in the usual care group (unadjusted median 34 IQR 17–63 vs 50 days, 19–125, p=0·04). The ratio of mean total inpatient days for usual care to SDS was 1·67 (95% CI 1·02–2·81, p=0·04), which decreased to 1·65 (0·99–2·77, p=0·057) when adjusted for differences in hospital use before randomisation. Scores for SDQ and CGAS did not differ between groups. The cost-effectiveness acceptability curve based on QALYs showed that the probability of SDS being cost-effective compared with usual care was around 60% with a willingness-to-pay threshold of £20 000–30 000 per QALY, and that based on CGAS showed at least 58% probability of SDS being cost-effective compared with usual care irrespective of willingness to pay. We recorded no adverse events attributable to SDS or usual care.InterpretationSDS provided by an intensive community treatment team reduced bed usage at 6 months' follow-up but had no effect on functional status and symptoms of mental health disorders compared with usual care. The possibility of preventing admissions, particularly through features such as reduced self-harm and improved reintegration into school, with intensive community treatment should be investigated in future studies.FundingSouth London and Maudsley NHS Trust.

Adolescent patients with eating disorders and their parents: a study of self-image and outcome at an intensive outpatient program.

The main aim of this clinical study was to explore how adolescent patients with eating disorders and their parents report their perceived self-image, using Structural Analysis of Social Behavior (SASB), before and after treatment at an intensive outpatient program. Another aim was to relate the self-image of the young patients to the outcome measures body mass index (BMI) and Children's Global Assessment Scale (C-GAS) score. A total of 93 individuals (32 adolescents, 34 mothers, and 27 fathers) completed the SASB self-report questionnaire before and after family-based treatment combined with an individual approach at a child and youth psychiatry day care unit. The patients were also assessed using the C-GAS, and their BMI was calculated. The self-image (SASB) of the adolescent patients was negative before treatment and changed to positive after treatment, especially regarding the clusters self-love (higher) and self-blame (lower). A positive correlation between change in self-love and in C-GAS score was found, which rose significantly. Increased self-love was an important factor, explaining a variance of 26%. BMI also increased significantly, but without any correlation to change in SASB. The patients' fathers exhibited low on the cluster self-protection. Mothers' profiles were in line with a non-clinical group. Results indicate that the self-imageof adolescent patients change from negative to positive alongside with a mainly positive outcome of the ED after treatment. Low self-protection according to SASB among fathers suggests the need for greater focus on their involvement.

Co-occurrence of communication disorder and psychiatric disorders in maltreated children and adolescents: relationship with global functioning.

Objective:To study the co-occurrence of psychiatric disorders (PD) and communication disorders (CD) and their relationship with global functioning in maltreated children and adolescents.Methods:The sample comprised 143 maltreated children and adolescents (55.8% male). All underwent clinical communication and psychiatric evaluations, as well as global functioning assessment using the Children’s Global Assessment Scale (C-GAS).Results:Four groups emerged from evaluation: Group 1 (n=7, 4.9%) did not exhibit any disorders; Group 2 (n=26, 18.2%) exhibited PD; Group 3 (n=34, 23.8%) exhibited CD; and Group 4 (n=76, 53.1%) exhibited both PD and CD on evaluation. Significant differences in global functioning scores were found between G1 and G2, G1 and G4, G2 and G4, and G3 and G4, with the highest C-GAS scores found in G1 and the lowest in G4.Conclusion:Rates of PD and CD are high in this maltreated population. The presence of PD has a major impact on C-GAS score, and the simultaneous presence of CD increases the already impaired function of PD. Demonstration of the additive effects of PD and CD on youth functioning suggests that professionals should be alert to the presence of both disorders to better act preventively and therapeutically in a high-risk population.

Young Australians with moderate to severe mental health problems: client data and outcomes at Children and Young People's Mental Health

Almost a quarter of young Australians experience a mental health issue that may become chronic if left untreated. Children and Young People's Mental Health (CYPMH) is a specialist tertiary service for young people with moderate to severe mental health problems on the Central Coast in Australia. This paper presents an overview of client data and service use collected over a 1 year period specific to the Youth Mental Health (YMH) component of the service. Client data, including demographic characteristics, service usage, presenting issues and standardized outcome measures, were analysed using SPSS. Clinicians routinely collect MH-OAT (Mental Health Outcomes and Assessment Tools) measures at different points in a client's episode of care, and each of these measures was analysed separately. Wilcoxon Z and a series of McNemar's tests were used to report on the difference between admission and discharge scores. During a designated 1 year period, 830 referrals to YMH were received. The most prevalent presenting issue was suicidal ideation followed by deliberate self-harm and depression. A comparison of admission and discharge outcome scores shows significant improvement by discharge on a range of measures. Specifically, analysis identified significant differences between admission and discharge HoNOSCA (Health of the Nation Outcomes Scales for Children and Adolescents) and CGAS (Children's Global Assessment Scale) scores for young people aged 12-17 and HONOS (Health of the Nation Outcomes Scale) scores for young people aged 18-24. The clinical outcomes for young people are positive with improvements seen on a range of measures.

The Effect of Sertraline on the Quality of Life for Children and Adolescents with Anxiety Disorder.

In this study, we aimed to determine the changes in quality of life of children/adolescents with anxiety disorders during six months of sertraline treatment, to investigate parent-child/adolescent concordance in perception of quality of life and to examine the effect of treatment on children/adolescents. In this study, 30 patients with anxiety disorders according to criteria specified in Diagnostic and Statistical Manual of Mental Disorders, 4th. Edition (DSM-IV) were assigned to sertraline treatment. The patients were evaluated using the Pediatric Quality of Life Inventory (PedsQL), State-Trait Anxiety Inventory for Children, Clinical Global Impression Scale (CGI) and the Children's Global Assessment Scale (CGAS) at 0th, 2nd and 6th months. PedsQL total scores increased significantly with the treatment in children and adolescents (p<.001), however, no differences were observed in parent proxy report (p=.326). The mean CGAS score was 59.85±7.73 at the beginning of treatment and 73.70±7.01 at the end of treatment (p<.001). The average CGI score decreased from 4.68±.96 to 2.27±.84. It was observed that perception of quality of life in children and adolescents with anxiety disorders increased with the treatment.

Functional outcomes of maltreated children and adolescents in a community-based rehabilitation program in Brazil: Six-month improvement and baseline predictors

This study sought to implement outcomes monitoring and to review outcome data from a community-based rehabilitation program for maltreated children and adolescents in São Paulo, Brazil. Maltreated children and adolescents (N=452) were enrolled in The Equilibrium Program (TEP), a multidisciplinary community-based rehabilitation program. About half (n=230) of the participants were successfully evaluated using the Children's Global Assessment Scale (C-GAS) at entry, 3, and/or 6 months later. Analysis of outcomes used hierarchical linear modeling of functional change from baseline. With a baseline C-GAS score of 51.7 (SD=14.22), average improvement was 2.8 and 5.5 points at 3 and 6 months, respectively (reflecting small to moderate effect sizes=0.20 and 0.39). Improvement was associated with Problems related to upbringing (p<.02) at entry and absence of Physical abuse (p<.05) and Negative life events in childhood (p<.05) but was not associated with sociodemographics or any specific psychiatric diagnosis. This study showed that outcomes monitoring is feasible in a community-based program in a developing country. Although there was no untreated control group for comparison and specific evidence-based treatments were not used, it is notable that significant improvement, with small to moderate effect size, was observed.

Antipsychotic augmentation of selective serotonin reuptake inhibitors in resistant tic-related obsessive-compulsive disorder in children and adolescents: A naturalistic comparative study

The aim of this study is to assess efficacy of augmentation of SSRIs with risperidone or aripiprazole in youths with tic-related Obsessive-Compulsive Disorder (OCD) non responders to an SSRI monotherapy. 120 consecutive patients (age range 7–18 years) were treated with an SSRI monotherapy for at least 12 weeks, 51 (42.5%) were responders, and the 69 non-responders (mean age 13.7 ± 2.4 years) were included in this study. 35 patients received an augmentation with risperidone (1.7 ± .8 mg/day), and 34 with aripiprazole (8.9 ± 3.1 mg/day) for 12 weeks. Regarding the OCD symptomatology, at the endpoint the Clinical Global Impression-Severity score (CGI-S) improved from 5.6 ± .8 (severely ill), to 3.2 ± .9 (mild to moderately ill) (p < .0001), and the Children-Global Assessment Scale (C-GAS) from 40.3 ± 5.2 to 53.8 ± 9.2 (p < .0001). Thirty-nine patients (56.5%) were responders in OCD symptomatology (CGI-I score 1 or 2, CGI-S score 3 or less and C-GAS score 50 or more during three consecutive months after a 12-week treatment). Compared to non responders, they were less impaired at the baseline in CGI-S (p < .0001) and C-GAS (p < .0001). Subtypes of OCD and comorbidity did not affect the response. No differences were found between risperidone and aripiprazole augmentation. 47 patients (68.1%) significantly improved tics, without differences between risperidone and aripiprazole. None discontinued medications because of side effects, but risperidone was associated with weight gain and sedation, and aripiprazole to mild/moderate agitation. In tic-related pediatric OCD, augmentation of SSRIs with risperidone or aripiprazole was tolerated and effective in about half of the patients non responding to an SSRI.

Anxiety in children with mood disorders: a treatment help or hindrance?

This study examined the role of comorbid anxiety in treatment outcome for children with mood disorders (N = 165; age 8-11) participating in Multi-Family Psychoeducational Psychotherapy (MF-PEP). Assessments occurred at baseline, 6, 12, and 18 months for two randomly assigned groups: immediate treatment and 1-year wait-list. Most children (69%) had comorbid anxiety disorders. Baseline comorbid anxiety, as reported on the Children's Interview for Psychiatric Syndromes (ChIPS), was associated with higher Children's Depression Rating Scale- Revised (CDRS-R) scores but not Young Mania Rating Scale (YMRS) scores. Higher levels of anxiety symptoms were associated with lower Children's Global Assessment Scale (C-GAS) scores. Participation in MF-PEP did not significantly reduce anxiety symptoms (p = 0.62). However, presence of comorbid anxiety did not impede reduction in depressive (CDRS-R, p = 0.74) or manic (YMRS scores, p = 0.94) symptoms following MF-PEP. More baseline anxiety symptoms were associated with greater improvement in C-GAS scores post-treatment (p = 0.02). Implications are discussed.

An Open-Label Study of Aripiprazole in Children with a Bipolar Disorder

The purpose of this open-label study was to describe the effectiveness of aripiprazole (APZ) in the treatment of children with bipolar disorders suffering from manic symptomatology. Symptomatic outpatients (Young Mania Rating Scale [YMRS] score ≥15) meeting strict, unmodified, Diagnostic and Statistical Manual of Mental Disorders, 4th edition, diagnostic symptom criteria for a bipolar disorder, ages 4-9 years, were eligible. Subjects were treated prospectively with flexible doses of APZ (maximum daily dose of 15 mg/day), for up to 16 weeks or until a priori response criteria were met. Outcome measures included the YMRS, Clinical Global Impressions Scale-Severity, Children's Global Assessment Scale (CGAS), and the Children's Depression Rating Scale-Revised (CDRS-R). A priori response criteria consisted of 3 of 4 consecutive weeks with (1) CDRS-R <29; (2) YMRS <10; and (3) CGAS >50. Ninety-six children (62 males; mean age of 6.9 (SD = 1.7), received APZ for an average length of treatment of 12.5 (SD = 3.9) weeks. Significant improvements in YMRS, CDRS-R, CGAS, and Clinical Global Impressions Scale-Severity scores (p < 0.001) were noted at the end of study participation. Sixty of the subjects (62.5%) met a priori response criteria at study's end. The most common side effects noted were stomachache, increased appetite, and headache. Two subjects were removed from the study due to side effects [epistaxis (n = 1); akathisia (n = 1)]. Subjects experienced an average weight gain of 2.4 (SD = 1.9) kg. APZ may be effective in the acute treatment of symptoms of children with bipolar illnesses.

Evaluating outcomes of the child and adolescent psychiatric unit: A prospective study

BackgroundThe aims of this prospective study are to clarify the outcomes of child psychiatric inpatient treatment and to identify factors associated with patient improvement.MethodsThe attending psychiatrist used the Children's Global Assessment Scale (CGAS) to assess youths at admission to and discharge from a child and adolescent psychiatric unit in Japan(N = 126, mean age = 12.8, SD = 1.9). Hospital records gathered sociodemographic and clinical variables. In addition, youths and their primary caregivers assessed themselves using the Youth Self Report (YSR) and the Child Behavior Checklist (CBCL), respectively. Longitudinal analyses compared each scales' baseline and discharge scores. We also examined factors associated with changes in functioning (CGAS).ResultsLongitudinal comparisons revealed that CGAS, CBCL and YSR scores showed improvement over time (CGAS: t = -14.40, p = 0.00; CBCL: t = 3.80, p = 0.00; YSR: t = 2.40, p = 0.02). Linear regressions determined that the factors associated with improvement in CGAS included age, lower CGAS scores at admission, frequency of group therapy and psychiatric diagnosis.ConclusionsThis evaluation of children and adolescents in an inpatient unit demonstrated clinical improvement over time and identified factors associated with said improvement.

923 Do Low Birth Weight Individuals Outgrow Psychiatric Problems as They Enter Adulthood?

Background and aims: Assess the continuity of psychiatric symptoms and disorders from adolescence to young adult age. Methods: In a population based follow up at age 14 (T1) and age 20 (T2) of 38 persons born with very low birth weight (VLBW: birth weight ≤1500 g), 43 term born small for gestational age (SGA: birth weight < 10th percentile) and 64 term born controls, mental health was assessed using psychiatric interview; Schedule for Affective Disorder and Schizophrenia for School aged children (K-SADS) and Children's Global Assessment Scale (CGAS). Outcome at T1 and T2 was compared. Psychiatric problems were defined as having psychiatric disorders or symptoms ≥75% of diagnostic criteria. Results: The VLBW and the SGA group had more psychiatric problems and lower mean CGAS scores at T2 than controls (p≤0.02). Anxiety disorders and ADHD were the most frequent disorders. In the VLBW group 10 of 13 with psychiatric problems at T1 still had problems at T2; of these 6 of 8 with symptoms at T1 had disorders at T2. In the term SGA group, 9 of 10 with psychiatric problems at T1 still had problems at T2; of these 4 of 6 with symptoms at T1 had disorders at T2. Increasing CGAS at T1 reduced the risk for having a psychiatric disorder at T2 in both low birth weight groups. Conclusion: The low birth weight individuals did not outgrow psychiatric problems as they entered adulthood, and low psychosocial function in adolescence was associated with psychiatric diagnoses in young adulthood.

Psychosocial outcome and psychiatric comorbidity in older adolescents with Tourette syndrome: controlled study

Children with Tourette syndrome generally experience improvement of tics by age 18 years, but psychosocial and comorbidity outcomes at this age are unclear. To compare psychosocial outcomes and lifetime comorbidity rates in older adolescents with Tourette syndrome and controls. We hypothesised a priori that individuals with Tourette syndrome would have lower Children's Global Assessment Scale (CGAS) scores. A total of 65 individuals with Tourette syndrome, identified in childhood, and 65 matched community controls without tic or obsessive-compulsive disorder (OCD) symptoms were assessed around 18 years of age regarding psychosocial functioning and lifetime psychiatric disorders. Compared with controls, individuals with Tourette syndrome had substantially lower CGAS scores (P = 10(-8)) and higher rates of attention-deficit hyperactivity disorder (ADHD), major depression, learning disorder and conduct disorder (P< or =0.01). In the participants with Tourette syndrome, poorer psychosocial outcomes were associated with greater ADHD, OCD and tic severity. Clinically ascertained children with Tourette syndrome typically have impaired psychosocial functioning and high comorbidity rates in late adolescence.

Depressive Disorders among Adolescents Managed in a Child and Adolescent Mental Health Service

The aims were to describe the prevalence and treatment of depressive disorders among case-managed adolescents attending a regional Child and Adolescent Mental Health Service (CAMHS). An observational study was conducted in a regional CAMHS over a 3-month period. Clinicians recorded treatment of their case-managed adolescents aged 12-18 years at the end of each calendar month. The Health of the Nation Outcome Scale for Children and Adolescents (HoNOSCA) and Children's Global Assessment Scale (CGAS) were collected at the beginning of the study period or at entry into the service, and repeated at discharge from the service or at the conclusion of the study period. Adolescents also completed the Reynold's Adolescent Depression Scale, 2nd edition. Depressive disorders were the most common clinician diagnosis reported (22%). There was no statistically significant difference in treatment for depressed compared to non-depressed adolescents. There was a statistically significant improvement in both the HoNOSCA scores (p <0.001) and CGAS scores (p <0.001) for the whole sample. Treatment appeared to be the same in type for depressed compared to non-depressed adolescents case managed within CAMHS.

Psychosocial Functioning and Health-Related Quality of Life in Children and Adolescents Treated with Open-Label Ziprasidone for Bipolar Mania, Schizophrenia, or Schizoaffective Disorder

The aim of this study was to examine global functioning, health-related quality of life (HRQOL), and clinical outcome in children and adolescents with bipolar I disorder, schizophrenia, or schizoaffective disorder following ziprasidone treatment. Sixty-three subjects (aged 10-17 years) received open-label ziprasidone, titrated from 10 to 40 mg twice a day (b.i.d.) (low-dose group) or from 20 to 80 mg b.i.d. (high-dose group); fixed doses were used until week 3, followed by flexible doses for 6 months. The Children's Global Assessment Scale (CGAS) characterized functional impairment at baseline and following treatment. The Child Health Questionnaire (CHQ) assessed HRQOL at baseline. Baseline CHQ showed greater impairment in psychosocial functioning than in physical health. Baseline mean CGAS scores were substantially below normal (i.e., <70), indicating functional impairment. Improvement in CGAS scores occurred as early as the first week of treatment. The low correlations between both CHQ and CGAS and the efficacy measures at baseline indicate that these scales measure different constructs. Nevertheless, there was good correlation between improvements in the CGAS and changes in Brief Psychiatric Rating Scale-Anchored (BPRS-A) and Young Mania Rating Scale (YMRS) during ziprasidone treatment. CHQ and CGAS scales may be useful together with standard efficacy measures for children and adolescents with these disorders.

Aripiprazole Monotherapy in Children and Young Adolescents with Pervasive Developmental Disorders

Pervasive developmental disorders (PDDs) are severe psychiatric disorders characterized by impairment in social interactions, in verbal and non-verbal communication, and by restricted and stereotyped patterns of interest and behaviour, with onset in the first 3 years of life. The appropriate use of pharmacotherapy can improve some aberrant symptoms and behaviours and increase the person's response to non-pharmacological interventions. To describe clinical outcomes, or symptom changes, and adverse effects during naturalistic treatment with aripiprazole monotherapy in children with PDDs and severe behavioural disorders (such as aggression against self and/or others, hostility, hyperactivity, severe impulsiveness). This retrospective naturalistic study included 34 patients (23 males and 11 females, age range 4.5-15 years, mean age 10.2 +/- 3.3 years), admitted during 2006-2007, diagnosed according to DSM-IV criteria and followed up for 4-12 months (mean 7.0 +/- 3.6 months). Outcome measures were three global measures of clinical and functional impairment and improvement from baseline: the Clinical Global Impression-Severity (CGI-S) and CGI-Improvement (CGI-I) scales; the Children's Global Assessment Scale (C-GAS); and the Childhood Autism Rating Scale (CARS), a specific measure of PDD symptoms. The mean baseline CGI-S was 5.7 +/- 0.8 (markedly ill/severely ill). The mean final dosage of aripiprazole was 8.1 +/- 4.9 mg/day. At the endpoint, 11 patients (32.4%) were 'much improved' or 'very much improved' (CGI-I score of 1 or 2), 12 patients (35.3%) were 'minimally improved' (CGI-I score of 3) and 10 (29.4%) were 'unchanged' or 'worsened' (CGI-I score of 4 or 5). C-GAS and CARS scores significantly improved (p < 0.0001, effect sizes 0.59 and 0.62, respectively). Nine patients (26.5%) experienced moderate to severe agitation, which was associated with self-injurious behaviours in five of these patients, and five patients presented with sleep disorders. Twelve patients (35.3%) discontinued medication during the follow-up because of lack of efficacy or adverse effects. In these severely impaired children with PDDs, aripiprazole monotherapy was associated with a significant improvement in maladaptive behaviours in one-third of patients. Agitation and insomnia were the most frequent adverse effects. Further controlled studies in larger samples to explore possible predictors of efficacy are warranted.

Which factors impact on clinician-rated impairment in children with ADHD?

To describe the associations between a range of demographic, family and clinical factors and clinician-rated measures of global impairment in children with ADHD symptoms obtained at the baseline assessment in the ADHD Observational Research in Europe (ADORE) study. Global impairment was measured by clinicians using the Clinical Global Impression-Severity (CGI-S) scale and the Children's Global Assessment Scale (CGAS). Associations with independent variables were investigated using forward-stepwise regression models. For the CGI-S and CGAS analyses, complete data sets were available for 1,265 and 985 children, respectively. The baseline mean CGI-S score in this population was 4.4 (SD 0.9) and the mean CGAS score was 55.0 (SD 10.6). Factors significantly associated with increased impairment on both outcome measures were: increased severity of ADHD symptoms, increased peer relationship problems and presence of oppositional defiant disorder and/or conduct disorder. Also, the presence of anxiety and/or depression and the presence of somatic symptoms were associated with increased impairment on CGI-S,while family health problems and premature birth were associated with increased impairment on CGAS. The severity of clinician-rated impairment in the ADORE sample is increased by the presence of disruptive behaviour problems and emotional problems, somatic symptoms, peer relationship difficulties, family health problems and premature birth.