Innovations in Practice: Further evidence on the effectiveness of the strengths and difficulties added value score as an outcome measure for child and adolescent services.

BACKGROUND: The Strengths and Difficulties Added Value Score (SDQ AVS) uses a large epidemiological study to predict follow-up parental SDQ scores for the evaluation of routine outcomes. METHOD: We tested the prediction of the SDQ AVS derived from a national population survey separately on scores for the waiting list control and intervention groups in a randomised controlled trial. If the SDQ AVS is to be clinically useful, it needs to function as expected across different populations. RESULTS: In the control arm, the SDQ AVS predicted an effect size of 0.15 (95% CI -0.01-0.30) compared to an expected effect size of 0, as the children in this arm received no treatment. In the experimental arm, the SDQ AVS predicted an effect size of 0.62 (95% CI 0.42-0.83) compared to the study effect size of 0.53. Change scores overestimated the effect size in both arms (control 0.50 95% CI 0.34-0.66, intervention 0.85 95% CI 0.66-1.04). CONCLUSION: Our findings suggest that the SDQ AVS adjusts for spontaneous improvement, regression to the mean and attenuation.

'To know before hand is to freeze and kill' Commentary on Should psychiatrists write fiction?

In this article I argue that fictional accounts of mental illness should be unethically unobliged. I suggest that art is not generated with conscious ethical intent and provide evidence that art proceeding from an ethical agenda is more likely to be poor art. I also consider ways in which a writer-doctor might need to compromise what they articulate to maintain a professional ethical integrity. Declaration of interest None.

Mindfulness-Based Cognitive Therapy for Young People and Their Carers: a Mixed-Method Feasibility Study.

We aimed to evaluate whether mindfulness-based cognitive therapy (MBCT) was feasible and acceptable for young people, their parents and the clinicians working with them; whether a parallel course for parents was a useful addition; and whether attendance at MBCT was associated with improved outcomes. The design was a mixed-method service evaluation of an eight-session MBCT programme for young people who were recovering from depression. The course was a manualised eight-session group intervention. Both young people (n = 18) and parents (n = 21) completed validated measures before and after the course. Semi-structured interviews were completed with some group participants and clinical staff working in the service. Care records were searched for additional contact following the intervention. Qualitative data from young people, parents and clinicians suggested that MBCT was acceptable and feasible and provided strategies to cope. The parent course was reported to provide personal support to parents and helped them cope with their child's depression whilst also impacting the family, promoted shared understanding of depression and strategies to combat it and addressed intergenerational aspects of depression. Eighty-four per cent of participants attended at least 6/8 sessions, and 48% required no further intervention within the following year. Young people had statistically significant improvements across all outcome measures, whilst parents had statistically significant improvements in rumination, self-compassion and decentring.

The effect of elevated mutation rates on the evolution of cooperation and virulence of Pseudomonas aeruginosa.

Within-host competition between parasite genotypes can play an important role in the evolution of parasite virulence. For example, competition can increase virulence by imposing selection for parasites that replicate at a faster absolute rate within the host, but may also decrease virulence by selecting for faster relative growth rates through social exploitation of conspecifics. For many parasites, both outcomes are possible. We investigated how competition affected the evolution of virulence of the opportunistic pathogen Pseudomonas aeruginosa in caterpillar hosts, over the course of an approximately 60 generation selection experiment. We initiated infections with clonal populations of either wild-type bacteria or an isogenic mutant with an approximately 100-fold higher mutation rate, resulting in low and high between-genotype competition, respectively. We observed the evolution of increased virulence, growth rate, and public goods cheating (exploitation of extracellular iron scavenging siderophores produced by ancestral populations) in mutator but not wild-type, populations. We conclude increases in absolute within-host growth rates appear to be more important than social cheating in driving virulence evolution in this experimental context.