Months Of Outpatient Treatment Research Articles

Coccidioidal Endophthalmitis Secondary to Coccidoides Posadasii: A Rare Infection in Humans.

To describe the first case of Coccidioides posadasii endophthalmitis. A 41-year-old man referred for acute retinal necrosis (ARN) failing 3 months of outpatient treatment was referred for further management. Three consecutive pars plana vitrectomies were required to identify C. posadasii as the source of the endophthalmitis. Two amphotericin intravitreal injections were delivered in addition to three foscarnet injections, two clindamycin, and one ceftazidime. Therapeutic intervention was complicated by patient compliance. Despite repeated surgical and medical intervention, vision was lost. The patient later developed fungal meningitis. Given parallels between C. posadasii and C. immitis endogenous endophthalmitis, a combined medical and surgical approach can combat C. posadasii in cases of good patient compliance with therapy.

Exploring mental health dynamics during eating disorder treatment: A psychometric network study with panel data

Objective To explore mental health associations during eating disorder (ED) treatment. Based on the dual-continua model of mental health, general and ED-specific psychopathology, as well as emotional, psychological, and social well-being were considered as mental health domains. Method Network analyses with panel data were applied to explore within- (temporal and contemporaneous networks) and between-person effects in a sample of 1250 female ED patients during 12 months of outpatient treatment. The associations between the domains and their centrality were examined. Autoregressive and cross-lagged effects were also estimated. Results ED psychopathology was the most central domain in the temporal network. ED psychopathology changes predicted further ED psychopathology changes and small changes in the other domains. Weak bi-directional associations were found between changes in the well-being domains and general psychopathology. In contrast to the temporal network, ED psychopathology was the least central and psychological well-being the most central domain in the contemporaneous and between-subjects networks. This suggests a central role of psychological well-being for experiencing mental health within time points. Conclusions ED psychopathology may change relatively independent from other mental health domains. Well-being domains may be considered as more stable aspects of mental health.

Long-Term Outcomes of Depression Treatment With Hypnotherapy or Cognitive Behavioral Therapy.

In a recent randomized controlled trial of mild to moderate depression, hypnotherapy (HT) was noninferior to cognitive behavioral therapy (CBT) after 6 months of outpatient treatment. In the present article, we extended the results in a secondary analysis and investigated how HT compares with CBT 1) during the course of the self-rated depressive symptoms throughout the 12-month follow-ups, 2) with regard to the rates of full remission, and 3) for the time to remission after treatment. Of the 152 randomized patients with current depression, 136 were available for the follow-up analyses. The course of self-rated depressive symptoms during follow-ups was analyzed with linear mixed-effects models. Time to a full remission, defined as eight consecutive weeks without depression, was compared between groups in a survival analysis. The self-reported depressive symptoms could be maintained on a low symptom level during the 12-month follow-up for both HT and CBT. Overall, both treatments achieved comparably high long-term remission rates of 73% after a median of 30 weeks. Outpatient psychotherapy with HT achieved good long-term results mostly comparable to CBT.

A pilot study comparing in-person and remote outpatient substance use treatment services on quality-of-life outcomes

BackgroundThe widespread shift from in-person to Telehealth services during the Covid-19 pandemic irreversibly shifted the landscape of outpatient substance use treatment. This shift was necessitated by health, rather than data-driven, reasons. As we reflect on whether to continue providing Telehealth services moving forward, we require empirical support on the effectiveness of Telehealth services (compared to in-person services) in terms of patient outcomes, such as Quality of Life (QOL), to support this decision. ObjectiveTo present data from a pilot project comparing changes in QOL across patients receiving outpatient in-person versus Telehealth substance use treatment in five clinics across New York State. MethodTo retrospectively compare total self-reported QOL scores from admission to 3-months later utilizing the Quality-of-Life Enjoyment and Satisfaction scale during in-person (pre-pandemic, n = 298) and Telehealth (pandemic, n = 316) services with a mixed repeated measures ANOVA. ResultsSelf-reported QOL scores significantly improved across the first three months, regardless of treatment modality ConclusionTelehealth and in-person treatment appear comparable on QOL outcomes over the first 3 months of outpatient treatment. Both modalities are associated with improved QOL scores. Scientific significanceThese preliminary findings provide evidence that Telehealth services are associated with positive patient outcomes and appear comparable to QOL outcomes among patients receiving in-person services. Future directions include further assessment of additional clinical outcomes and investigation into causal mechanisms.

An add-on Ayurvedic approach in the management of lissencephaly- A case report

Abstract Lissencephaly is a rare genetic brain developmental disease characterized by brain malformations, eye anomalies, and congenital muscular dystrophy. The present case is of a 2-year-old child previously diagnosed with lissencephaly, which was well managed with Ayurvedic treatment protocol, in addition to conventional antiepileptic medicines. The patient presented with delayed milestones and recurrent episodes of seizures. Sarvangavata, Kapha Avrita Vyana Vata, and Vyadhija Phakka were the probable Ayurvedic diagnoses considered. Agnideepana (stimulation of digestive/metabolic factors), Srotoshodhana (bio-cleansing of structural and functional channels), Balya (promoting strength), and Vata Shamaka (pacification of Vata Dosha) were the treatment principles adopted in this case. Indukanta Ghrita, Rajanyadi Churna, Gopichandanadi Vati, and Sahacharadi Kashaya were administered internally. Procedures such as Abhyanga (oil massage), Dhanyamla Dhara (therapeutic streaming of sour rice gruel over the body), Pratimarsha Nasya (medication through nasal route), and Jihvalepa (tongue anointment) were performed externally. The child achieved some important milestones within 37 days of inpatient (IP) and 2 months of outpatient treatment; no single episode of seizure was reported during the period. This case report advocates the institution of Ayurvedic treatment protocol in improving the quality of life of lissencephaly patient as an add-on therapy.

Clinical insight level predicts successful quit or control attempts during the first three months of outpatient addiction treatment

IntroductionLow clinical insight in psychiatry is defined as poor recognition of one’s mental illness, including disability to self-evaluate symptom severity. It has been reported as common in addiction and is associated with lower treatment compliance. Longitudinal studies suggest that low clinical insight could be linked to more relapse. However, association with successful quit attempts remains unknown. ObjectiveOur objective was to examine the prospective link between baseline clinical insight level and self-reports of successful attempts to quit / control use during the first 3 months of outpatient addiction treatment. MethodsParticipants were recruited from the ADDICTAQUI cohort at outpatient treatment intake for substance or behavioral addictions. They completed a baseline evaluation using the Addiction Severity Index (ASI), the Mini International Neuropsychiatric Interview (MINI), and the modified Hanil Alcohol Insight Scale (m-HAIS) with a follow-up ASI 3 months later. Data were analyzed using multiple logistic regression and non-parametric tests. ResultsLower clinical insight level at baseline was associated with less successful quit / control attempts during the first 3 months of outpatient treatment compared to a higher clinical insight level, controlling for sociodemographic factors, baseline addiction severity, and comorbidities (n = 54; exp(B) = 0.76; p (FDRcor) = 0.033). ConclusionPoor clinical insight may be a barrier to treatment success, and future studies should examine underlying mechanisms.

Short and long-term outcomes of video observed treatment in tuberculosis patients, the Republic of Moldova.

The Republic of Moldova is among the 18 high priority countries for tuberculosis (TB) in Europe. This study compared adherence and short and long-term TB treatment outcomes for TB patients who experienced asynchronous Video Observed Treatment (aVOT) during three months of outpatient treatment versus Directly Observed Treatment (DOT) in operational conditions in 2016-2017 in Chisinau. We used secondary data from the 2016-2017 Randomized Clinical Trial (RCT) that piloted the aVOT Strategy in Chisinau and data from the national TB register. Relative risk was selected as a measure of association in analysis of treatment strategies (aVOT and DOT under operational conditions) and short and long-term treatment outcomes. From 647 TB patients included in the study, 169 followed the treatment strategy in the RCT (83 in aVOT and 86 in DOT) and 478 were on DOT in operational conditions. Those in aVOT were more likely to have favourable short-term outcome than patients with DOT in operational conditions (RR 0.07; p < 0.001). TB recurrence as an indicator for the long-term outcome, was observed in group with DOT in operational conditions (40 cases, p = 0.006). This study demonstrated that the aVOT treatment strategy was associated with better adherence and both short and long-term TB treatment favourable outcomes. aVOT as a new patient-centred approach supporting TB patients on improving treatment adherence and outcomes might be recommended as an alternative to DOT strategy in the Republic of Moldova.

Clinical characteristics and biological treatment of adult patient with juvenile idiopathic arthritis

OBJECTIVE To explore the clinical characteristics and biological treatment of juvenile Idiopathic arthritis (JIA) after adulthood. METHODS Selected 358 patients with previous medical history diagnosed by JIA who were hospitalized in the Department of Rheumatology and Immunology, West China Hospital of Sichuan University from January 1, 2009 to January 1, 2019. Perform retrospective analysis of basic information, clinical symptoms, diagnostic indicators, treatment plans, outpatient follow-up (inpatients require outpatient follow-up treatment) and diagnosis and treatment process of 90 eligible cases included, and observe different ages and different courses of disease. The clinical characteristics of young and middle-aged idiopathic arthritis in adults and the outpatient situation of using biological agents for 6 months. RESULTS According to age, they were divided into ≤26 years old group (42 cases) and >26 years old group (48 cases). Under examination [rheumatoid factor (RF), anti-nuclear antibody (ANA), anti-neutrophil antibody (ANCA), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), interleukin-1β (IL-1β), interleukin 6 (IL-6), hemoglobin (HGB), white blood cell count (WBC), human leukocyte antigen-B27 (HLA-B27), complement 3 (C3), etc.], concurrent in terms of symptoms, treatment and prognosis, the ≤26-year-old group was generally lighter than the >26-year-old group; that was, the older the age, the heavier the onset of inflammation and other symptoms, the more complications, the worse the treatment effect, and the worse the prognosis, and there were statistical differences academic significance (P 19 years group (44 cases). In terms of examination (RF, ANA, ANCA, ESR, CRP, IL-1β, IL-6, HGB, HLA-B27, C3, etc.), complications, treatment and prognosis, the course of disease ≤19 years group was compared with the disease course> 19 years group Overall mild; that was, the longer the course of the disease, the more severe the onset of symptoms such as inflammation, the more complications, the worse the treatment effect, and the worse the prognosis, P < 0.05, the difference was statistically significant. After 6 months of outpatient treatment with biological agents, it was found that biological agents could improve some of the patients' clinical symptoms and delay the further development of the disease. Compared with the non-biological agent treatment group (48 cases), the biological agent group (42 cases) benefited, and the difference was statistically significant (P < 0.05). CONCLUSION Through retrospective analysis, this article believes that although adult JIA is diagnosed as connective tissue disease, it has special clinical characteristics with the course of the disease and age. Therefore, it should be recommended to give special attention to JIA patients after adulthood, require regular medical treatment in the adult rheumatology department, according to the corresponding connective tissue disease or JIA diagnosis, and standard treatment; at the same time, pay attention to the history of JIA. In the comparison of biological and non-biological treatment, it is proved that biological treatment can effectively improve some of the clinical symptoms of JIA patients after adulthood. Therefore, it is recommended that biological treatment be used as soon as possible if economic conditions permit to delay the development of the disease.

P.436 Cognitive function in alcohol dependent patients after six months of out-patient treatment

This paper proposes an ultra-miniaturised, flexible 5.8 GHz antenna to give better performance for an ingestible wireless capsule endoscopy system. The use of an artificial magnetic conductor (AMC) unit cell in this design helps in enhancing the gain, improving the efficiency and reducing the size at resonance. This novel AMC-based layer is modelled as a radiator, and is excited by a complementary strip feed. The proposed design is printed on a flexible polyimide material of size 4.6 × 7.6 × 0.15 mm, with dielectric constant 3.5 and loss tangent 0.008. The antenna has an omni-directional radiation pattern with gain 1.64 dBi. The size is reduced drastically by bending the structure to fit inside a standard-sized ingestible capsule of 26 × 11 mm. The performance metrics of the antenna after placing inside the wireless ingestible capsule are presented with the help of an analysis of the reflection coefficient curves, radiation pattern, specific absorption rate (SAR) and field distributions. In addition, different positions and orientations of the antenna and different bending conditions are used, and these cases are solved using our AMC-based unit cell radiator. We carry out simulations using High Frequency Structure Simulator (HFSS) and measurements are made by immersing the fabricated antenna in minced meat. The results of this novel structure are compared with those of other ingestible antennas proposed in the literature. The proposed design has a SAR value of 0.82505 W/kg at around 5.8 GHz over 1 g of tissue, thereby redirecting the radiation away from the human body. This conformal AMC structure achieved better miniaturisation while maintaining the antenna resonance and SAR within permissible limits.

Changes of quality of life and cognitive function in individuals with Internet gaming disorder: A 6-month follow-up.

Internet gaming disorder (IGD) contributes to poor quality of life (QOL) and cognitive dysfunction and is increasingly recognized as a social problem in various countries. However, no evidence exists to determine whether QOL and cognitive dysfunction stabilize after appropriate management. The present study addressed improvement in QOL and cognitive functioning associated with changes in addiction symptoms following outpatient management for IGD. A total of 84 young males (IGD group: N = 44, mean age: 19.159 ± 5.216 years; healthy control group: N = 40, mean age: 21.375 ± 6.307 years) participated in this study. We administered self-report questionnaires at baseline to assess clinical and psychological characteristics, and conducted traditional and computerized neuropsychological tests. Nineteen patients with IGD completed follow-up tests in the same manner after 6 months of outpatient treatment, which included pharmacotherapy with selective serotonin reuptake inhibitors. A baseline comparison of patients with IGD against the healthy control group showed that the IGD patients had more symptoms of depression and anxiety, higher degrees of impulsiveness and anger/aggression, higher levels of distress, poorer QOL, and impaired response inhibition. After 6 months of treatment, patients with IGD showed significant improvements in the severity of IGD, as well as in QOL, response inhibition, and executive functioning. Additionally, a stepwise multiple regression analysis revealed a favorable prognosis for IGD patients with low working memory functioning and high executive functioning at baseline. These results provide evidence regarding longitudinal changes in QOL and cognitive function following psychiatric intervention for IGD. Furthermore, it appears that response inhibition may be an objective state marker underlying the pathophysiology of IGD.

Sociodemographic variables and efficacy study in psychotic patients after 12 months of outpatient treatment with paliperidone palmitate (PP)

IntroductionPsychotic disorders are serious mental illnesses that compromise the quality of life of patients. It is important to know the characteristics of the affected population, seek to improve the adhesion and functionality.ObjectivesTo describe the sociodemographic characteristics of patients treated with Palmitato Paliperidona (PP). Analyze the efficacy variables, adherence to treatment.MethodsCross-sectional study of 15 patients in outpatient follow-up after 12 months of treatment with PP. Sociodemographic characteristics are collected, mean dose of PP, through a mirror study. Scales to measure the functionality, clinical status and attitude towards medication apply: Scale of personal and social functioning (PSP), Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression Scale (CGI-SI) and attitudes toward Inventory Medication (DAI).ResultsThe sample consists of 15 patients (54% male). 81% are single; 77% live alone and 94% not working. The mean dose of PP is 147 mg/month. DAI shows a good attitude to the treatment (80%). The PSP shows that 22% of patients have serious difficulties in its development. The CGI-SI shows that 67% are moderately sick and the BPRS that 33% of patients have a serious disorder.ConclusionsThe demographic profile of patients after 12 months of treatment with PP coincides with male, unmarried, unemployed, living alone. Most have good adherence. The variables measured by the CGI-SI, BPRS and PSP, displayed moderately ill patients with severe difficulties or marked on their autonomy.Disclosure of interestThe authors have not supplied their declaration of competing interest.

자궁내막증으로 인한 골반통과 기타 동반 증상에 대해 증상 스트레스 도구와 삶의 질 측정도구로 평가한 調經種玉湯 加味方 치험례

Objectives : This study is to report the clinical effect of oriental medicine on a patient suffering from endometriosis with chronic pelvic pain and other accompanied various symptoms. Methods : The 32 years old patient had suffered from endometriosis symptoms including pelvic pain, menstrual cramping, disuresia, and other pains over 8 years. The patient received herbal medication, acupuncture, abdominal moxibustion during 5 months of outpatient treatment. The clinical effects were evaluated through TSD (Total Symptom Distress) and EHP-5 (Short-From Endometriosis Health Profile Questionnaire). Results : The various clinical symptoms were improved during the treatment. The TSD and EHP-5 score also noticeably reduced. Conclusions : This case study showed that oriental medicine, acupuncture and moxibustion treatment appeared to effectively reduce various symptom of endometriosis.

Acceptance-based Behavior Therapy for Depression With Psychosis: Results From a Pilot Feasibility Randomized Controlled Trial.

Acceptance-based depression and psychosis therapy (ADAPT), a mindfulness/acceptance-based behavioral activation treatment, showed clinically significant effects in the treatment of depression with psychosis in a previous open trial. The goal of the current study was to further test the feasibility of ADAPT to determine the utility of testing it in a future clinical trial, following a stage model of treatment development. Feasibility was determined by randomizing a small number of patients (N=13) with comorbid depression and psychosis to medication treatment as usual plus enhanced assessment and monitoring versus ADAPT for 4 months of outpatient treatment. Both conditions were deemed acceptable by patients. Differences in between-subjects effect sizes favored ADAPT posttreatment and were in the medium to large range for depression, psychosocial functioning, and experiential avoidance (ie, the target mechanism). Thus ADAPT shows promise for improving outcomes compared with medications alone and requires testing in a fully powered randomized trial.

Hospitalization Can Correct Behavioral Feeding Disorders in Children by Resetting the Pedagogic Climate

Background: Behavioral feeding disorders are common among children, which sometimes become progressive, and consequently, children may refuse to eat anything. Parents have lots of difficulties to reset such a disturbed eating pattern. The aim of this study was to perform an analysis of clinical intervention in behavioral feeding disorders in young children. Methods: We conducted a retrospective analysis of data of 28 children aged 1 - 9 years with behavioral feeding disorders. A pediatrician and pediatric social worker conducted the training in two groups: outpatient or inpatient setting. Both groups were treated with parental education and guidance. The inpatient group also had a temporarily (2 weeks) resetting of the pedagogic climate in a pediatric ward of a general hospital under guidance of a pediatric social worker. Results: Almost all parents were inconsistent in applying appropriate behavioral contingencies during meals. Eleven patients followed 8 months of outpatient treatment and 25 patients followed 2 weeks of inpatient treatment. The overall success rate of outpatient treatment after 2 weeks was 18%, and that of inpatient treatment after 8 months was 88%. The corrected relapse rates are 18% and 56% respectively after 6 months. Conclusion: Short clinical intervention in a structured pedagogic environment is a successful treatment in behavioral feeding disorders. Herewith, pediatricians have a powerful tool for treating behavioral feeding disorders by temporarily resetting and changing the pedagogic climate.

GENDER AND AGE DIFFERENCES OF BRAIN NATRIURETIC PEPTIDE CONCENTRATION IN PATIENTS WITH MYOCARDIAL INFARCTION

Aim. To measure the changes in brain natriuretic peptide (NT-proBNP) in patients with acute myocardial infarction with ST segment elevation (STEMI) according to the age and gender Material and methods. Totally 223 patients with STEMI included, of those 167 (74,88%) were men and 56 (25,11%) women. Average age of women was 61,80 (57;68) years, of men — 57,15 (51;63) years (p=0,0003). The follow-up period starting during hospitalization included 12 months of outpatient treatment. After 12 months the endpoints were assessed. The NT-proBNP concentration was measured on 10-14th day after infarction using serum by testing system "BIOMEDICA GRUPPE". Results. In women from older group NT-proBNP concentration was higher than in younger patients by 38%, in men — by 57,31%. In men with poor prognosis level of NT-proBNP was significantly higher (96,35 fM/ml) comparing to those with benign prognosis (63,8), p=0,0108. There were no such differences in women. Conclusion. Trustworthy differences of the biomarker studied between men and women do not exist, however in men and in women either of older group (more than 65) there are higher levels of NT-proBNP, than in younger group. Also men with poor prognosis in higher age group do have the highest NT-proBNP level.

Does School Functioning Matter in Patients of Child and Adolescent Mental Health Services?

General population studies have demonstrated that good school functioning protects children and adolescents against mental health problems. However, no such studies of clinical populations have been conducted. Therefore, we explored the association between school functioning and mental health in patients referred to child and adolescent mental health services (CAMHS). We also examined whether good school functioning and general social competence at referral predicted better mental health outcomes after six months of outpatient treatment. Of 345 patients, aged 8-15.5 years, referred as outpatients to CAMHS in a Norwegian county, 192 were eligible for a six-month follow-up study. Parents filled out the Child Behavior Checklist (CBCL) for 120 of these children and teachers completed the Teachers' Report Form (TRF) for 122 children. Teacher-reported adaptive functioning (r = -0.65) and academic skills (r = -0.42), and parent-reported social competence (r = -0.35) and school competence (r = -0.27) were significantly (p < 0.01) negatively associated with total emotional and behavioral problems at baseline. Parent-reported school competence and the total level of emotional and behavioral problems at referral significantly (p < 0.05) predicted the total level of emotional and behavioral problems six months after referral. Both teacher- and parent-reported school functioning were associated with mental health in CAMHS patients. Only parent-reported school competence predicted total levels of emotional and behavioral problems six months after referral. Therapists, teachers, and parents should cooperate closely when planning and conducting child and adolescent psychiatric treatments, and school should be considered an important area for intervention.

Prognostic Factors During Outpatient Treatment for Alcohol Dependence: Cohort Study with 6 months of Treatment Follow-up

To identify prognostic factors to outpatient alcohol treatment on admission as well as during the treatment period. A cohort study of n = 209 alcoholic patients (DSM-IV) during 6 months of outpatient treatment. Eight medical doctors from two hospitals were involved. Co-responsible participation in treatment was a necessary condition. At admission, we documented socio demographic factors, use of other drugs and severity of alcohol consumption. During the 6 months, we observed medication for prevention of alcohol relapse [disulfiram (DIS), acamprosate], number of sessions with the doctor, number of phases of the consultation and medication for depression. Primary outcome variables were time to first heavy relapse and abstinence of heavy alcohol consumption. These were measured with Timeline Followback. Five or more alcohol units of 10 g in one relapse day were considered heavy relapse. The patients were 84% males, with 41 years median age; the median alcohol consumption was 192 g per day with a median duration of 13 years of heavy consumption. The median education was 6 years with 61% of the patients from lower socio-economic levels. The Kaplan-Meier heavy relapse rate at 6 months was 23%. On admission to treatment, female gender, lower socio-economic levels, cocaine use, >20 years of consumption, gamma glutamyl transferase values above normal and five or more alcohol-related problems on the Alcohol-Related Problem Questionnaire predicted worse outcomes. Having a full-time job and shorter abstinence time before treatment (until 7 days) predicted better outcomes. During the 6 months, we found that DIS for <120 days was a prognostic factor of worse outcomes. DIS for at least 120 days, >50% of adherence to consultations and more than two phases on each consultation predicted better outcomes. The combined sensitivity and specificity for DIS for at least 120 days, >50% of adherence to consultations and more than two phases on consultation regarding abstinence from heavy relapse were respectively 100 and 71%. During 6 months of outpatient treatment, longer adherence to DIS and consultations as well as more phases in a consultation involving necessarily a co-responsible predict a good outcome independently of the patient features at admission.

The Black Dress

The Black Dress

Antidepressant Switching Among Adherent Patients Treated for Depression

This study examined the pharmacologic, clinical, and demographic factors associated with switching antidepressants during the first three months of outpatient treatment for episodes of depression. A cohort analysis of outpatients aged 18-75 and treated for a depressive disorder (N=56,521) was performed with PharMetrics administrative data from 2001-2006. Patients commencing antidepressant treatment who continued to receive the initial antidepressant or a second antidepressant for > or = 72 of the first 90 days were selected. Antidepressant switching was defined as prescription of a second antidepressant within 90 days of the first antidepressant prescription and continuation of the second antidepressant for > or = 15 days after termination of the first antidepressant. Overall, 8.6% of patients switched antidepressants during the first 90 days of treatment. The highest rates of switching were among patients initiating trazodone (47.4%), tricyclic antidepressants (26.6%), and mirtazapine (17.2%); the lowest switching rates occurred after starting venlafaxine (6.5%) or sertraline (7.4%). Antidepressant switching was significantly related to recent emergency mental health treatment (adjusted odds ratio [AOR]=1.7, 99% confidence interval [CI]=1.3-2.2); treatment of major depressive disorder versus other depressive disorders (AOR=1.4, CI=1.3-1.5), especially severe major depressive episodes (AOR=1.6, CI=1.4-1.9); and inversely related to moderately high versus low initial antidepressant dose (AOR=.7, CI=.6-.8). Several other patient characteristics were significant but less powerful predictors of antidepressant switching. Among adults with depression starting antidepressant therapy, medication switching commonly occurs during the first three months of treatment. Greater clinical severity and low initial dosing may increase the risk of switching antidepressants.

Residential treatment following outpatient treatment for children with mild to borderline intellectual disabilities: A study of child and family characteristics

In this study, the question was explored whether children with a mild intellectual disability (MID) who were placed in residential treatment following outpatient treatment differ significantly on child and family characteristics from children with MID and not placed in residential treatment following outpatient treatment. The records of the children were examined with respect to various child and family characteristics. Retrospective case analyses were thus undertaken. The results showed those children placed in residential treatment to have experienced significantly more often a traumatic event than the other children. Those children placed in residential treatment had received significantly fewer months of outpatient treatment than those not placed in residential treatment. Finally, there were significantly more children placed in residential treatment having educationally incapable parents or parents with alcohol/drug problems and/or psychiatric problems than in the other group. The findings are discussed in light of a disturbed balance between the support needs and means of the family which can lead to placement of a child in a residential treatment. The possibilities of a multisystemic model for outpatient treatment are discussed.