The transition from child and adolescent to adult mental health services with a focus on diagnosis progression.

Aims and methodThis article examines mental health disorders as individuals transition from adolescence to adulthood. Data were collected from clinical records of patients who had transitioned from child and adolescent mental health services to adult mental health services in a region in South Wales. Demographics and clinical diagnoses under both services were recorded. Patterns between adolescent and adult disorders as well as comorbidities were investigated using Pearson's χ2-test and Fisher's exact test. RESULTS: Of the 98 patients that transitioned from one service to the other, 74 had changes to their diagnoses. There were 164 total changes to diagnoses, with patients no longer meeting diagnostic criteria for 64 disorders and 100 new disorders being diagnosed. Comorbidity increased in adulthood.Clinical implicationsDiagnoses can evolve, particularly during adolescence and early adulthood. Therefore regular reassessment is paramount for successful treatment.Declaration of interestNone.

Improving transitions for young people who move from child and adolescent mental health services to mental health services for adults: lessons from research and young people's and practitioners' experiences.

PURPOSE OF REVIEW: The importance of ensuring robust arrangements for young people's transitions from specialist child and adolescent mental health services to specialist mental health services for adults is well documented in the international literature. Nonetheless, according to young people, there remains great variation in the quality of services in respect of their transitions. Furthermore, the problems that we report are by no means confined to single continents. This review examines recent literature and explores the themes that emerge from it with a view to finding solutions. RECENT FINDINGS: Our findings from the literature suggest a clear strategic direction to improve the quality of the care of young people who need to move from specialist child and adolescent mental health services to specialist mental health services for adults. Our examination of the literature identifies a number of themes that have been recognized by practitioners and we have used them to define a model of care and aspects of good practice. We think they should be included within all evidence-based policies, protocols and care pathways for young people. There is little literature available that documents the personal experiences of young people in transition and their families, but consistent themes emerge from what is available. SUMMARY: There are a number of topics that require active consideration when preparing young people for transition between services. Despite the limited volume of research, and particularly that which has directly involved young people and families, we know from anecdote, experience and local audit and research that improvements in service design and practice are required. These matters inform the solutions that we suggest. We see as pivotal involving young people directly in planning their own care and setting quality standards for healthcare and other services.

Cognitive behavioural therapy for children and adolescents.

PURPOSE OF REVIEW: The aim is to summarize recent evidence from the National Institute for Health and Clinical Excellence clinical guidelines and high-quality systematic reviews for the use of cognitive behavioural therapy to treat children and adolescents with mental health problems. RECENT FINDINGS: Data from meta-analyses of randomized controlled trials suggest that the best evidence for the potential of cognitive behavioural therapy is in the treatment of children and adolescents with generalized anxiety disorder, depression, obsessive compulsive disorder and posttraumatic stress disorder. More limited evidence suggests that attention deficit hyperactivity disorder and behavioural problems may also respond to cognitive behavioural therapy. We found no or insufficient evidence to determine whether cognitive behavioural therapy is useful for the treatment of antisocial behaviour, psychotic and related disorders, eating disorders, substance misuse and self-harm behaviour. SUMMARY: Clinical guidelines and recent systematic reviews establish that cognitive behavioural therapy has a potentially important role in improving the mental health of children and adolescents.

Care pathways for young people who misuse substances: using the evidence to design services.

PURPOSE OF REVIEW: To review a selection of the literature on the nature and contents of care pathways. We examine recent work on current trends in intervening to meet the needs of young people who misuse substances. RECENT FINDINGS: The recent and growing literature encourages us to adopt care pathways as structured models for service delivery. The increased prevalence and the severity and complexity of the problems experienced by young people who misuse substances evidence the requirement for specialist services for them. SUMMARY: The literature argues for using care pathways to manage better services for intervening with young people who use or misuse substances and recommends their contents. We conclude that care pathways should be based on strategic models of care; however, there remain areas of uncertainty, including those about the balance of services that should be delivered, adoption of prevention programmes, and development of audit tools to monitor the impacts and effectiveness of care pathways. This review provides our recommended list of contents for models of care on which we recommend that associated care pathways should be based.

'Mind control' experiences on the internet: implications for the psychiatric diagnosis of delusions.

BACKGROUND: The DSM criteria for a delusion indicate that it should not include any beliefs held by a person's 'culture or subculture'. The internet has many examples of people reporting 'mind control experiences' (MCEs) on self-published web pages, many of which suggest a community based around such beliefs and experiences. It was hypothesized that some of these reports are likely to reflect delusional beliefs and the hyperlinks between web reports were likely to show evidence of social structure, demonstrating the 'culture or subculture' exemption to be increasingly redundant in light of new technology. SAMPLING AND METHODS: Texts from web sites reporting MCEs (n = 10), experience of cancer (n = 10), depression (n = 10) and being stalked (n = 10) were identified, and were blind-rated by three independent psychiatrists for the presence of delusions. Hyperlinks from web sites reporting MCEs were used to create a network structure; this was compared with a size-matched, randomly generated network and known social networks from the literature using social network analysis. CONCLUSIONS: The sampled web-published accounts of MCEs are highly likely to be influenced by delusional beliefs. Social network analysis suggests there is significant evidence of an online community based around these beliefs. The fact that individuals can form a community based on the content of a potentially delusional belief presents a paradox for the DSM diagnostic criteria for a delusion, and suggests the need to revise and revisit the original operational definition in the light of these new technological developments.