Five-year predictive validity of DSM-IV conduct disorder research diagnosis in 4(1/2)-5-year-old children.

OBJECTIVE: This longitudinal study of a non-referred, population-based sample tested the 5-year predictive validity of the DSM-IV conduct disorder (CD) research diagnosis in children 4(1/2)-5 years of age. METHOD: In the E-Risk Study, a representative birth cohort of 2,232 children, mothers were interviewed and teachers completed mailed questionnaires to assess children's past 6-month CD symptoms. A follow-up assessment was conducted when children were 10 years old. RESULTS: CD-diagnosed 5-year-olds were significantly more likely than controls to have behavioural and educational difficulties at age 10. Increased risk for age-10 educational difficulties persisted after controlling for age-5 IQ and ADHD diagnosis. Although the majority of CD-diagnosed 5-year-olds had no CD symptoms at age 10, findings suggest that these "remitted" children continued to experience behavioural and educational problems 5 years later despite their apparent remission from CD. CONCLUSIONS: DSM-IV CD symptoms validly identify preschool-aged children who continue to have behavioural and educational problems in middle-childhood.

Mental Health Care Disparities Now and in the Future.

In 2014, the USA spent $3 trillion dollars in health care the most per capita in the world. However, the USA lacks universal health coverage, and lags behind other highly developed and wealthy countries in life expectancy (even some "non wealthy" countries have better outcomes). The USA also has deficits in other health outcome measures. Health care costs in the USA continue to rise annually and many patients receive only mediocre care. In addition, clear disparities exist across different communities, socioeconomic groups, and race and ethnicity groups. As a result, individuals with mental illness are at an increased risk of being homeless, committing suicide, and having problems maintaining a job. This paper will address mental health disparities and review the efforts some states are taking to improve the lifesaving services offered to citizens with mental illness, in order for them to recover and reach their full potentials.

Patient preferences regarding prophylactic cranial irradiation: A discrete choice experiment.

INTRODUCTION: In patients with non-small cell lung cancer (NSCLC) treated with chemoradiotherapy (CRT), prophylactic cranial irradiation (PCI) is not standard practice. This study determined patient preferences for PCI with respect to survival benefit, reduction in brain metastases (BM) and acceptable toxicity. METHODS: A Discrete Choice Experiment was completed pre- and post-treatment. Patients made 15 hypothetical choices between two alternative PCI treatments described by four attributes: amount of life gained, chance of BM, ability to care for oneself, and loss of memory. Participants also chose between PCI and no PCI. RESULTS: 54 and 46 surveys were completed pre- and post-treatment. The most important attributes pre-treatment were: a survival benefit >6months, of 3-6months, avoiding severe problems with memory and self-care, avoiding quite a bit of difficulty with memory and maximally reducing BM recurrence. Post-treatment, BM reduction became more important. 90% of patients would accept PCI for a survival benefit >6months, with a maximal reduction in BM even if severe memory/self-care problems occurred. With a 10% reduction in BM and mild problems with memory and self-care 70% of patients pre- (90% post-treatment) would accept PCI for a survival benefit of 1-3months, and 52% pre- (78% post-treatment) for no survival benefit. CONCLUSION: Improvement in survival is the most important attribute of PCI with patients willing to accept significant toxicity for maximum survival and less toxicity for less survival benefit. BM reduction became more important after treatment. The majority of patients would accept PCI for no survival benefit and a reduction in BM.