Three-Year Follow-up Study of Children and Adolescents with Anorexia Nervosa Initially Treated in a Continuum of Care Program

Fourteen children and adolescents with anorexia nervosa were treated in a new continuum of care program, and compared to a group previously treated in our traditional inpatient program. For 12 of the 14 patients, outcome was then assessed yearly at 1, 2, and 3 years following acute treatment. At the 3-year follow-up, 8 of 12 patients were at = 90% of Average Body Weight (ABW). The other 4 patients had improved in weight until the 2-year follow-up, then declined below 90% ABW. Lower initial %ABW at program entry, comorbid depression, and insufficient psychotherapy during follow- up may predispose to relapse.     

Prospective Study of Psychiatric Follow-up Default and Medication Compliance after Discharge at a Psychiatric Hospital in Nigeria

We report a prospective follow-up of 81 patients recently discharged from the hospital. Their hospital attendance pattern, medication compliance, mental state and social functioning were measured. Defaulters were followed up in the community. At 3 months, 49.4% had defaulted, while 51.5% were medication noncompliant. Clinical outcome was best for the Non-Defaulter-Medication Compliant (ND-MC) group, worst for the Defaulter-Medication Non-Compliant (D-MNC) group. Reasons for default include feeling well, financial difficulty, medication side effects and stigma. Medication non-compliant patients were more likely to reside more than 20 km away from hospital. There is an urgent need to provide community psychiatric services to improve patients’ access to services and medication compliance.     

Slowed Information Processing Speed at Four Years Poststroke: Evidence and Predictors from a Population-Based Follow-up Study

Background and PurposeSlowed Information Processing Speed (IPS) is a commonly reported cognitive deficit following stroke, affecting up to 50% to 70 % of stroke survivors. IPS has a major influence on poststroke cognitive dysfunction, affecting quality of life and increasing dependence on others. Few studies have examined predictors of slow IPS after stroke, and there is a paucity of data in terms of long-term prevalence. This study examined baseline predictors associated with long-term slow IPS in a population-based stroke incidence cohort, 4 years after stroke onset.MethodsAdults with stroke (n = 133, m = 71.1 ± 13.5 years) completed the Symbol Digit Modalities Test (SDMT) at 4 years poststroke. Baseline predictors were obtained within 2 weeks of the acute event. Multivariate regression linear and logistic models were used to identify baseline predictors (reported as OR with 95%CI) and prevalence of impaired IPS at 4-years.Results51% of people with stroke had low scores on the SDMT as indicated by a score of −1.0 SD to −2.5 SD (ranging from low to very low respectively). There were significant associations between slow IPS at 4-years after controlling for age and education level and the following baseline factors: older age (>75 years) (OR 3.03, 95% CI .9-9.3,P = .05), previous stroke (OR 2.74, 95% CI 1.0-7.4,P = .05), high cholesterol (OR 2.72, 95% CI 1.3-5.4,p = .01), hypertension (OR 1.82, 95% CI 0.9-3.6,p = .05), and presence of coronary artery disease (OR 3.35, 95% CI 1.6-9.6,P = .01), or arrhythmia (OR 4.40, 95% CI 1.5-12.4,P = .01).ConclusionsEven after 4-years poststroke, slowed IPS is highly prevalent, with comorbid vascular risk factors significantly contributing to persistent impaired IPS. Early identification of adults who are at higher risk of deficits in IPS is vital to targeting the timely delivery of cognitive rehabilitation interventions, improving overall outcomes.     

Multimodal treatment of ADHD in the MTA: an alternative outcome analysis

OBJECTIVE: To conduct a post hoc investigation of the utility of a single composite measure of treatment outcome for the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder (MTA) at 14 months postbaseline. BACKGROUND: Examination of multiple measures one at a time in the main MTA intent-to-treat outcome analyses failed to detect a statistically significant advantage of combined treatment (Comb) over medication management (MedMgt). A measure that increases power and precision using a single outcome score may be a useful alternative to multiple outcome measures. METHOD: Factor analysis of baseline scores yielded two "source factors" (parent and teacher) and one "instrument factor" (parent-child interactions). A composite score was created from the average of standardized parent and teacher measures. RESULTS: The composite was internally consistent (alpha = .83), reliable (test-retest over 3 months = 0.86), and correlated 0.61 with clinician global judgments. In an intent-to-treat analysis, Comb was statistically significantly better than all other treatments, with effect sizes ranging from small (0.28) versus MedMgt, to moderately large (0.70) versus a community comparison group. CONCLUSIONS: A composite of ADHD variables may be an important tool in future treatment trials with ADHD and may avoid some of the statistical limitations of multiple measures.     

Titrating Optimal Dose of Osmotic-Controlled Release Oral Delivery (OROS)-Methylphenidate and Its Efficacy and Safety in Korean Children with ADHD: A Multisite Open Labeled Study

Objective

This study was aimed to determine effectiveness and tolerability of Osmotic-controlled Release Oral delivery (OROS) methylphenidate (MPH) and its optimal dose administered openly over a period of up to 12 weeks in drug naïve Korean children with ADHD.

Methods

Subjects (n=143), ages 6 to 18-years, with a clinical diagnosis of any subtype of ADHD were recruited from 7 medical centers in Korea. An individualized dose of OROS-MPH was determined for each subject depending on the response criteria. The subjects were assessed with several symptom rating scales in week 1, 3, 6, 9 and 12.

Results

77 of 116 subjects (66.4%) achieved the criteria for response and the average of optimal daily dose for response was to 30.05±12.52 mg per day (0.90±0.31 mg/kg/d) at the end of the study. Optimal dose was not significantly different between ADHD subtypes, whereas, significant higher dose was needed in older aged groups than younger groups. The average of optimal daily dose for response for the subjects aged above 12 years old was 46.38±15.52 per day (0.81±0.28 mg/kg/d) compared to younger groups (p<0.01). No serious adverse effects were reported and the dose did not have a significant effect on adverse effects.

Conclusion

Optimal mean dose of OROS-MPH was significantly different by age groups. Higher dose was needed in older aged groups than younger groups. Effectiveness and tolerability of OROS-MPH in symptoms of ADHD is sustained for up to 12 weeks.     

Follow-up of Children Diagnosed with Pervasive Developmental Disorders: Stability and Change During the Preschool Years

Forty-one children with pervasive developmental disorders (PDDs) receiving eclectic services were assessed twice during their preschool years. Measures were compared over time for the whole group and for diagnostic subgroups: Childhood autism (CA group) and Other PDDs group. The mean intelligence quotient/developmental quotient (IQ/DQ) of the whole group was stable (P = 0.209) and scores on the Childhood Autism Rating Scale (CARS) decreased (P = 0.001). At time 2, the CA group was more impaired than the other PDDs group: autistic symptoms were more severe (P = 0.01), adaptive behavior scores were lower (P = 0.014), and a trend for lower IQ/DQs (P = 0.06). Children in this study seemed to fare better than reported in previous follow-up studies on children with autism.     

Validation of the Modified Checklist for Autism in Toddlers,Revised with Follow-up in a Population Sample of 30-Month-Old Children in Iceland: A Prospective Approach

Journal of Autism and Developmental Disorders - The Modified Checklist for Autism in Toddlers, Revised with Follow-up was validated on a population sample in Reykjavik, Iceland. The participants...     

Outcome of Psychogeriatric Intervention in an Old-Age Home: A 3 Years Follow-up Study

Psychogeriatrics and especially psychiatric services in nursing and old-age homes are sorely lacking in research. Four years ago we developed and implemented a model for service delivery for old-age homes within our hospitals' catchment area. In the first year of operation 48 of 373 residents (13%) were evaluated and treated by a psychogeriatrician. The aim of the present study was to evaluate outcome of these patients three years later. All patients and medical records were re-assessed. During the three-year period 16/48 subjects (33.3%) passed away; of these half were previously diagnosed as suffering from a major depressive episode. None of the subjects who died had attempted suicide. Following a preliminary diagnosis of affective spectrum disorder, 4/48 patients (8.3%) were re-diagnosed at follow up as suffering from dementia. Full or partial remission of the original symptomatology was achieved in 18/32 surviving subjects (50.7%); mostly depressed or anxious patients. We conclude that although mortality rate among elderly psychiatric patients is high persistent interventions lead to successful remission in the majority of patients.     

Safety and Tolerability of Atomoxetine Over 3 to 4 Years in Children and Adolescents With ADHD

ObjectiveTo assess the long-term safety and tolerability of atomoxetine hydrochloride in children and adolescents with attention-deficit/hyperactivity disorder treated for ≥3 years.MethodData from 13 double-blind, placebo-controlled trials and 3 open-label extension studies were pooled. Outcome measures were patient-reported treatment-emergent adverse events (AEs); discontinuations due to AEs, serious AEs, and changes in body weight, height, vital signs, electrocardiogram, and hepatic function tests.ResultsIn total, 714 patients were treated with atomoxetine for ≥3 years (mean follow-up 4.8 years [SD 1.1 years]), including a subset of 508 treated for ≥4 years (mean follow-up 5.3 years [SD 0.8 years]). Most subjects were younger than 12 years at entry (73.8%), male (78.4%), and white (88.9%). The mean final daily dose of atomoxetine was 1.35 mg/kg (SD 0.37 mg/kg). No new or unexpected AEs were observed compared with acute-phase treatment. Less than 6% of patients exhibited aggressive/hostile behaviors, and less than 1.6% reported suicidal ideation/behavior. No clinically significant effects were seen on growth rate, vital signs, or electrocardiographic parameters, and ≤2% of patients showed potentially clinically significant hepatic changes.ConclusionAtomoxetine was safe and well tolerated for children and adolescents with ≥3 and/or ≥4 years of treatment.     

Outcome From Mild Head Injury in Young Children: A Prospective Study

There is a lack of agreement regarding the long-term consequences of mild head injury (HI) at any age, with such effects rarely studied in early childhood. Given the rapid development occurring within the brain during this period, any disruption may have the potential to cause transient or permanent damage to brain structure and function. The present study sought to investigate the behavioral implications of such potential disruptions using a prospective, longitudinal design. Children aged 3-7 years at the time of injury, and suffering from mild HI, were evaluated acutely and at 6 and 30 months post-injury. Pre-injury data were collected with respect to communication, social skills, daily living skills and behavioral function. Results were compared to those from a non-injured control sample matched for age, gender, socioeconomic status, and pre-injury function. Findings showed few group differences. Children with mild HI performed similarly to controls on measures of intellectual ability, receptive language, and both everyday and spatial memory capacity. Group differences were identified for verbal fluency and story recall, with HI children failing to recover over time.