Parental satisfaction and outcome: a 4-year study in a child and adolescent mental health service

OBJECTIVE: The aim of this paper is to examine the facets of parental satisfaction and its relationship with clinician-rated outcome in a child and adolescent mental health service. METHOD: Patients (n = 1278) consecutively assessed between 1992 and 1996 were included in the study. When treatment ended, clinicians rated the outcome of the intervention and parents were asked to complete a satisfaction questionnaire. RESULTS: Sixty-nine per cent of cases were rated by clinicians as having a positive outcome. Outpatients were more likely to be given a positive rating than inpatients. Satisfaction questionnaires were returned by 40% of parents; 76% of these were mostly or very satisfied. Satisfaction scores increased with the number of outpatient sessions attended but did not differ between inpatients and outpatients. There was a significant but small agreement (27% better than chance) between clinicians' rating of outcome and parental satisfaction. Level of agreement varied according to service provided and the number of sessions attended. While rates of positive outcome increased over the study period, ratings of satisfaction were stable. CONCLUSIONS: Overall, ratings of satisfaction were comparable with those reported in other studies. Variations in concordance between parents and clinicians show that outcome and satisfaction, although related, are different constructs influenced by different factors depending on the services provided. Focusing on specific aspects of satisfaction, as opposed to global measures, may be more useful for services, although such undertakings must be supported with efforts to improve clinical outcomes.     

Use of St. John's Wort by adolescents with a psychiatric disorder

Herbal remedies are commonly used for psychiatric problems, but there is virtually no data about the use of these substances by young persons or by patients in treatment. Four adolescents who used St. John's Wort while under psychiatric care are described. Three of the patients had been reluctant to reveal this to their psychiatrist, believing the doctor had no interest in alternative medicine or would disapprove. Patient beliefs that prescribed medication has limitations and that natural products are safe contributed to the use of herbal remedies. The cases raise a number of issues, including the need for clinicians to routinely ask patients about alternative medicine use, to learn more about these treatments, and to discuss these approaches objectively with patients.     

Encrusted alkaline cystitis and malacoplakia

Urinary infection due to urea splitting bacteria leads to a rise in urinary pH, favouring the precipitation of calcium salts and struvita crystals. If deposited on the surface of a bladder with chronic inflammation or some other previous lesion, may produce an alkaline encrusted cystitis, now a rare condition. In the case here presented, occurred in a 69-year-old male. Corynebacterium urealyticum grown in the urine, and some foci of malakoplakia were found in the area of encrustation endoscopically excised. This case seems to be the third example of alkaline encrusted cystitis associated with malakoplakia reported in the bibliography. These two conditions share similar clinical signs and may probably have a common aetiopathogenesis.     

Platelet monoamine oxidase in healthy subjects: The “biochemical high-risk paradigm” revisited

Summary Activity of platelet monoamine oxidase (MAO) has repeatedly been reported to be associated with various forms of psychopathology. This investigation was designed to reexamine the biochemical high-risk paradigm developed by Buchsbaum et al. (1976). In 383 healthy students (193 males, 190 females) platelet MAO activity was measured. The 35 students with the lowest and 37 with the highest enzyme activities were then examined with three personality tests (16 PF of Cattell, Freiburger Persönlichkeitsinventar, Eysenck Personality Questionnaire). Furthermore, biographic data with respect to psychosocial problems were explored. There were no consistent differences between subjects with low or high platelet MAO. Therefore, we could not confirm any correlation between psychopathology and platelet MAO in this study.Supported by the Deutsche Forschungsgemeinschaft     

Pharmacokinetics of tiaprofenic acid in children after a single oral dose

Summary. Twelve healthy children in three age groups anaesthetized for minor surgery were given a single oral dose of tiaprofenic acid (3 mg · kg^–1) (TA). Seven blood samples and zero to 8 and 8 to 24 h urines were collected. TA concentrations in plasma and urine were measured by HPLC.No significant difference was found between the age groups in the kinetic parameters of TA and no correlation was found between these parameters and age; t_max=2.12h, C_max=8.78mg · l^–1, AUC_{(08 h)} 33.9mg · h · l^–1, AUC=39.3 mg · h · l^–1, t_1/2=2.35 h, V_z=0.319 l · kg^–1, CL=0.094 l · h^–1 · kg^–1. Renal clearance was 14 ml · h^–1. kg^–1. 33% of the TA dose was recovered in the 24 h urine, 48% of which was conjugated, whereas in adults, TA is only found in urine as conjugates.The apparent plasma clearance was significantly higher (56%) than in 12 healthy adults given 1.5 mg · kg^–1 TA. Volume of distribution and t_1/2 did not significantly differ between children and adults. Since no relationship has been established between plasma TA and either efficacy or toxicity, a different dose regimen cannot be recommended in 3–11 year-old children from that in adults.     

Eggshell modifications in captive American kestrels resulting from aroclor® 1248 in the diet

American kestrels (Falco sparverius) were fed diets containing 3 g/g Aroclor^® 1 1248 or control diets from mid-January until July. Eggs were removed from first clutches 2 to 4 days after laying ceased and shell thickness and shell dimensions were measured. Contents of the third egg of each clutch, the carcasses of all adults that received Aroclor^® 1248 and of three males and three females that received the control diet were analyzed for DDE, Aroclors^® 1248, 1254 and 1260, and dieldrin. Concentrations of PCBs, DDE and dieldrin were significantly higher (P < 0.03) in eggs and carcasses from treated adults than in controls. Shell thickness and shell thickness index of eggs from treated adults were reduced 5.0% (P < 0.0001) and 4.8% (P < 0.0001), respectively, from those of controls.     

Pharmacokinetics of the placental transfer and distribution of clorazepate and its metabolite nordiazepam in the feto-placental unit and in the neonate

Summary Clorazepate 20mg was given i. m. to 49 mothers during the first stage of labour. The elimination of the drug was studied in 27 newborns produced by these mothers. The same dose was given to 13 women who underwent amniocentesis and to 7 women who were breast-feeding. Total nordiazepam, i.e. the sum of clorazepate and its metabolite nordiazepam, was determined by gas-liquid chromatography in maternal blood, umbilical cord blood (both arterial and venous), amniotic fluid and in milk. Clorazepate was found to cross the placental barrier slowly, but nordiazepam was transferred more rapidly. Nordiazepam was found in the milk and in the blood of neonates after breast-feeding had started.     

Family environment in attention deficit hyperactivity, oppositional defiant and conduct disorders

OBJECTIVE: This study aims to ascertain whether there were differences in family environment among patients with attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder and conduct disorder. METHOD: The records of 233 patients, selected for high or low scores on a scale that taps ADHD symptoms, were reviewed by three clinicians who made DSM-IV diagnoses and rated the family environment with the Global Family Environment Scale (GFES). Self-report data obtained from the parent and child versions of the Child Behaviour Checklist were also used. The quality of the family environment was then compared between the various diagnostic groups. RESULTS: A poorer family environment was associated with conduct disorder and oppositional defiant disorder and predicted a worse outcome (e.g. admission to a non-psychiatric institution, drug and alcohol abuse). Quality of the family environment did not vary according to ADHD diagnosis or gender. CONCLUSIONS: There seems to be no association between the quality of the family environment and a diagnosis of ADHD among referred adolescents. However, there is an association with conduct disorder. Interventions that improve family environment in the early years of life may prevent the development of conduct problems.