Predictors and Moderators of Clinical Outcomes in Adolescents with Severe Mental Disorders After an Assertive Community Treatment.

Previous studies have shown that stressful life events (SLEs), gender, social functioning and pretreatment severity are some of the predictors and/or moderators of treatment outcome in psychiatric care. The current study explored the effect of these predictors and moderators on the treatment outcome related to assertive community treatment (ACT) proposed to young people with severe mental disorders. 98 patients were assessed for externalizing and emotional difficulties, at admission and then at discharge of an ACT. Analyses revealed significant improvements in terms of symptomatology. In particular, regression analyses showed that pretreatment severity is a significant predictor of the outcome on emotional symptoms and is moderated by SLE on the outcome on externalizing symptoms. Furthermore, higher social functioning proved to predict better outcome on externalizing symptoms. Our results further evidence that these factors can explain inter-individual differences in outcome related to ACT. The theoretical and clinical implications of these results are discussed.

[What role may general practitioners play in the treatment of adolescents suffering from psychotropic substance use and misuse?]. / Ouelle place pour le médecin de premier recours dans la prise en charge d'adolescents consommateurs de substances psychotropes?

Substance use and misuse are well-known public health issues. Indeed, more than half of the adolescents involved with substances has seen a general practitioner at least once in a recent period. Early identification of substance use and misuse among teenagers is a major issue, in which general practitioners could play a larger role. The DEPART program, based in the canton of Vaud, offers specific support to help general practitioners identify substance use and misuse early on and, when necessary, provide specific care in the form of motivational interviewing.

Six-month outcomes among socially marginalized alcohol and drug users attending a drop-in center allowing alcohol consumption.

BACKGROUND: Despite their experience of substance-related harm, few socially marginalized alcohol and other drug (AOD) users access substance use treatment. Thus, identifying alternative approaches for this population is important. This program evaluation documented substance use and health-related quality of life (QoL) following exposure to such an alternative approach: a harm-reduction drop-in center allowing alcohol consumption onsite. METHODS: Participants (N=85) were socially marginalized AOD users (e.g., alcohol, heroin) attending a harm-reduction drop-in center in the French-speaking part of Switzerland. Time and drop-in center attendance were predictors of substance-use outcomes and mental and physical health-related QoL, which were measured at baseline, 1- and 6-month follow-ups. RESULTS: Findings indicated that, for each month of the evaluation, participants' alcohol use and related problems decreased by 5% and 7%, respectively. Drop-in center attendance predicted additional decreases in drug-related problem severity and improvements in mental health-related QoL. CONCLUSION: Participants' alcohol use and related problems decreased over time. Additionally, participants evinced improved mental health-related QoL and decreased drug-related problem severity with greater drop-in center attendance. Harm-reduction drop-in centers allowing alcohol consumption onsite are promising interventions for socially marginalized AOD users.

Clinical Utility of the 2 New Scales of the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA): A Naturalistic, Prospective Study in a Psychiatric Unit for Adolescents.

OBJECTIVES: The goal of this study was to assess the clinical usefulness of the emotional symptoms (Emo) and externalizing problems (Ext) scales compared with the Total score on the Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA). METHODS: The HoNOSCA was rated at admission and discharge for 260 adolescent inpatients. The primary outcomes assessed were (a) the sensitivity of the 3 HoNOSCA scores to clinical improvement; and (b) the between diagnoses discriminative value of these scores. RESULTS: Analyses of variances [2 (time: admission vs. discharge) × 5 (diagnostic groups)] revealed a main effect of time for the 3 scores, a main effect of the diagnostic group for the Total and Ext scores, and an interaction effect between time and diagnosis for the Emo score. A moderate correlation was observed between the change in Ext and Emo scores between admission and discharge. DISCUSSION: These 2 new scales of the HoNOSCA demonstrated good clinical utility and the ability to assess different aspects of clinical improvements. A significant discriminative value of both scores was observed. SIGNIFICANT OUTCOMES: The clinical utility of the 2 new scales on the HoNOSCA was established. These 2 new scales provided a sensitive measure of clinical outcome for assessing improvement between admission and discharge on a psychiatric inpatient unit for adolescents, regardless of diagnostic group, and captured additional information about clinical improvements. Adolescents with psychosis and conduct disorders presented with higher externalizing symptoms than those with other disorders, as rated on the HoNOSCA, at admission and discharge. The Emo score differentiated between clinical improvement in patients with psychosis versus eating disorders. LIMITATIONS: The sample in this study represented a homogeneous population of adolescent inpatients, so that further research is needed before these findings can be generalized to outpatients. In addition, the small number of patients in some diagnostic groups did not allow for their inclusion in some of the statistical analyses.