Cohort profile: demographic and clinical characteristics of the MILESTONE longitudinal cohort of young people approaching the upper age limit of their child mental health care service in Europe.

PURPOSE: The presence of distinct child and adolescent mental health services (CAMHS) and adult mental health services (AMHS) impacts continuity of mental health treatment for young people. However, we do not know the extent of discontinuity of care in Europe nor the effects of discontinuity on the mental health of young people. Current research is limited, as the majority of existing studies are retrospective, based on small samples or used non-standardised information from medical records. The MILESTONE prospective cohort study aims to examine associations between service use, mental health and other outcomes over 24 months, using information from self, parent and clinician reports. PARTICIPANTS: Seven hundred sixty-three young people from 39 CAMHS in 8 European countries, their parents and CAMHS clinicians who completed interviews and online questionnaires and were followed up for 2 years after reaching the upper age limit of the CAMHS they receive treatment at. FINDINGS TO DATE: This cohort profile describes the baseline characteristics of the MILESTONE cohort. The mental health of young people reaching the upper age limit of their CAMHS varied greatly in type and severity: 32.8% of young people reported clinical levels of self-reported problems and 18.6% were rated to be 'markedly ill', 'severely ill' or 'among the most extremely ill' by their clinician. Fifty-seven per cent of young people reported psychotropic medication use in the previous half year. FUTURE PLANS: Analysis of longitudinal data from the MILESTONE cohort will be used to assess relationships between the demographic and clinical characteristics of young people reaching the upper age limit of their CAMHS and the type of care the young person uses over the next 2 years, such as whether the young person transitions to AMHS. At 2 years follow-up, the mental health outcomes of young people following different care pathways will be compared. TRIAL REGISTRATION NUMBER: NCT03013595.

Impulsivity in depressed children and adolescents: a comparison between behavioral and neuropsychological data.

Impulsivity at the neuropsychological and behavioral levels was investigated in a sample of drug-naive depressed children and adolescents. The performance of 21 patients with a current diagnosis of mood disorder was compared with that of 21 normal controls on tests of executive functions related to impulsivity (Matching Familiar Figures Test, Continuous Performance Test, Verbal Fluency, Stroop Test, and Walk-Don't Walk) and on impulsive/restless behavior on the Conners' Parent Rating Scale. Depressed children and adolescents showed a pattern of conservative response style, with slow reaction times and attentional problems, similar to that observed in adults, and a general delay/difficulty in response initiation on the Fluency Test. Depressed participants were rated by their parents as being significantly more impulsive/restless than controls. However, there was no evidence of an impulsive cognitive response style in more impulsive/restless patients. Symptom severity (Hamilton Rating Scale for Depression) and subjective mood state (Children's Depression Inventory) were also taken into account.