IL SERVIZIO SEMIRESIDENZIALE DI PSICOPATOLOGIA DELL'ADOLESCENZA: UN PONTE DI TRANSIZIONE VERSO UNA NUOVA PROGETTUALITA' DI VITA.

none6noneL. DEL COL; C. SALVIATO; G. CERANTO; P.C. TESTA; R. SORGATO; GATTA M.L., DEL COL; Salviato, Cinzia; G., Ceranto; P. C., Testa; R., Sorgato; Gatta, Michel

FINDINGS TO CONSIDER WHEN PLANNING A RESIDENTIAL OR SEMI-RESIDENTIAL TREATMENT FOR ADOLESCENTS WITH PSICHIATRIC DISORDERS

Aim. The particularity of the adolescent with medium- severe psychopathology and the extreme lack of placements different from hospitals (e.g. residential and semi-residential) often hamper the early intervention of the therapeutic treatment. From our experience from the daily Semi-residential Service for Adolescents at the Childhood and Adolescence Neuropsychiatry Unit of the Public Health Services (Azienda ULSS 16) in Padua, Italy, a retrospective analysis was carried out to identify which factors could be the best indicators for a residential or a semi-residential placement. Sample and methodology. The sample consists of 102 adolescents referred to the daily Semi-residential Service for Adolescents (77 males and 25 females, aged between 12 and 18 years). It was later on divided into two groups: one group stayed in the Semi-residential Service and the second group went into a residential child care institution. All the patients were assessed using the Youth Self report (YSR 11-18) and the Global Assessment Functioning Scale (GAF) when admitted to the Service, and 6 months further on. For each patient the following data were collected: personal and familiar details, schooling, diagnosis, therapeutic objectives, collaboration of the adolescent and his/her family to the treatment and type of intervention. All the data were analysed and compared to find out which could indicate the best early placement for the patient (Semi-residential or residential). Results and conclusions. From this study, it emerges that the residential child care institution is more indicated for the adolescents with: age below 14 years old, monoparental family, externalizing problems (delinquent and aggressive behaviour, conduct or personality disorders), a poor therapeutical compliance (in particular during the first 6 months in the Semi-residential Service) and a lack of parental collaboratio

Adolescents with psychiatric disorder: parents'caregiving experience.

Aim of the research The aim is to study the experience of “caregiving” by parents of psychiatric adolescents in relation to patients’ psychosocial functioning and psychopathology. Sample The sample is formed by adolescents referred to the daily service during the second half of 2007. They are 20 adolescents, 17 male (85%) and 3 female (15%) aged 12 to 19 years, divided in three age groups: 12-14 (20%), 15-17 (65%) and 18-19 (15%). 25 % attends primary school, 40% secondary school, while 35% of patients interrupted educational career. The characteristics of the sample are illustrated in figures 1-4. Methodology Adolescents’ psychosocial functioning and psychopathology were evaluated respectively throughout GAF (Global Assessment of Functioning) and CBCL (Child Behavior Check List). The “caregiving” experience by parents of the psychiatric adolescents was studied using an innovative questionnaire called ECI (Experience of Caregiving Inventory). The study suggests that caregiving experience by parents of psychiatric adolescents is influenced more by the global functioning of the patient (social relationships, autonomy, self esteem,…) rather then by the specific psychopathology (neurotic or psychotic types symptoms)

The Influence Of Parents\u2019 Caregiving Experience On Psychiatric Adolescents\u2019 Outcome

Introduction. The quality of parents\u2019 caregiving experience of adolescents with mental diseases can deeply influence the clinical evolution of patients and the quality of life of the whole family. Aim. The aim of this study was to assess the predictable value of parental caregiving experience referred to the clinical evolution of psychiatric adolescents and their quality of life (QoL). Sample and methodology. The sample consists of 24 adolescents (10 female and 14 male aged between 12 and 18 years) in charge to the daily Semi-residential Service for Adolescents within the Neuropsychiatric Unit for Children and Adolescents of Padua (Italy). Patients were assessed throughout 4 tests with a six-monthly test \u2013 retest methodology: the Health Survey Questionnaire (SF-36) to analyze the adolescent\u2019s QoL, the Toronto Alexithymia Scale (TAS-20) to estimate the presence of alexithymia, the Self-Report Symptom Inventory revise (SCL 90 R) and the Youth Self Report (YSR 11 \u2013 18) of T. Achenbach to point out the presence of psychiatric symptoms, competences and psycho- behavioural profile. Moreover, it was filled in by operators the Global Assessment Functioning Scale (GAF) to evaluate patients global social functioning. Parents of patients were assessed with the Experience of Caregiving Inventory (ECI). For each patient the following data were collected: personal and familiar details, schooling, diagnosis, type of intervention, therapeutic compliance, working alliance. data was analyzed to find out the possible significant relation between the parental caregiving experience and other variables referred to adolescents\u2019 clinical and psychosocial outcome. Data about patients and parents were collected and transferred into a computerized database for computation, which is performed using SPSS version 14. Results and conclusions. From this study it emerges that the positive caregiving parental experience (positive total ECI scale) rather than the negative one, is linked to an improvement in symptomatology (SCL 90): the higher is the positive experience grade, the better will be the clinical improvement achievable with the treatment. It is discussed the important clinical implications of these in regards to the intervention towards parents

Analytical psychodrama with adolescents suffering from psycho-behavioral disorder: short term effects on psychiatric symptoms.

The aim of this study was to assess the therapeutic efficacy of analytical psychodrama groups for psychiatric adolescents. Six patients with various psychiatric diseases (mean age 16.67 years, SD\ub11.21) were assessed before, during and after psychotherapy (12 sessions, one a week) by administering the Symptom Check List- 90 (SCL 90 R) to identify any changes in their symptoms. Their clinical pictures are described, with observations on their treatment. The findings were compared with those of a clinical control group. The results demonstrated the efficacy of the treatment in terms of symptom reduction, with statistically significant differences by comparison with the control group

12 months follow up of psychiatric adolescents treated with a interprofessional intervention.

Aim : The aim is to study the first one year outcome of psychiatric adolescents treated with a multiprofessional intervention, in terms of psychopathology and global psychosocial functioning. The context is a Service for Adolescents, a daily center, which receives adolescents between 12 and 19 with psychopathological disorders of middle - severe seriousness. Multiprofessional team is formed by a child neuropsychiatrist, a psychologist and three educationals. Patients undergo a multimodal treatment, characterized by integrated educational and clinical actions. Sample : Among 100 adolescents who were referred to the Centre, 65 individuals had been clinically followed for 12 months. The sample is formed by 48 males (71,6%) and 19 females (28,4%) aged 12 to 19 years. 20 adolescents (31 %) attend primary school, 22 adolescents (34 %) secondary school, while 22 patients (35 %) interrupted educational career. Methodology: To verify the efficacy of treatments, it has run a retrospective study which has analysed those treated patients for whom one year follow up was available. The psychiatric disorders of the subjects were diagnosed according to ICD 10 (WHO 1994). The Global Assessment Functioning Scale (GAF) and Youth Self Report (YSR 11-18) were used to evaluate therapeutic efficacy of interventions 12 months after the beginning. Data about patients were collected in an anamnesis schedule, then transferred into a computerised database for computation, which is performed using SSPS version 10 and SAS\uae package, rel. 9.1.3. Results: One year follow up shows that the multiprofessional treatment has been efficacy. Actually, with regards to YSR scores, it is to be noticed a general improvement of symptoms and problems reported by adolescents 12 months. Moreover according to the operators\u2019 valuation throughout the GAF, one year later too, it is to be noticed a general improvement in the initial conditions, pointed out by the ascendant trends in the ratings

Enhanced infection prophylaxis reduces mortality in severely immunosuppressed HIV-infected adults and older children initiating antiretroviral therapy in Kenya, Malawi, Uganda and Zimbabwe: the REALITY trial

Meeting abstract FRAB0101LB from 21st International AIDS Conference 18–22 July 2016, Durban, South Africa. Introduction: Mortality from infections is high in the first 6 months of antiretroviral therapy (ART) among HIV‐infected adults and children with advanced disease in sub‐Saharan Africa. Whether an enhanced package of infection prophylaxis at ART initiation would reduce mortality is unknown. Methods: The REALITY 2×2×2 factorial open‐label trial (ISRCTN43622374) randomized ART‐naïve HIV‐infected adults and children >5 years with CD4 <100 cells/mm3. This randomization compared initiating ART with enhanced prophylaxis (continuous cotrimoxazole plus 12 weeks isoniazid/pyridoxine (anti‐tuberculosis) and fluconazole (anti‐cryptococcal/candida), 5 days azithromycin (anti‐bacterial/protozoal) and single‐dose albendazole (anti‐helminth)), versus standard‐of‐care cotrimoxazole. Isoniazid/pyridoxine/cotrimoxazole was formulated as a scored fixed‐dose combination. Two other randomizations investigated 12‐week adjunctive raltegravir or supplementary food. The primary endpoint was 24‐week mortality. Results: 1805 eligible adults (n = 1733; 96.0%) and children/adolescents (n = 72; 4.0%) (median 36 years; 53.2% male) were randomized to enhanced (n = 906) or standard prophylaxis (n = 899) and followed for 48 weeks (3.8% loss‐to‐follow‐up). Median baseline CD4 was 36 cells/mm3 (IQR: 16–62) but 47.3% were WHO Stage 1/2. 80 (8.9%) enhanced versus 108(12.2%) standard prophylaxis died before 24 weeks (adjusted hazard ratio (aHR) = 0.73 (95% CI: 0.54–0.97) p = 0.03; Figure 1) and 98(11.0%) versus 127(14.4%) respectively died before 48 weeks (aHR = 0.75 (0.58–0.98) p = 0.04), with no evidence of interaction with the two other randomizations (p > 0.8). Enhanced prophylaxis significantly reduced incidence of tuberculosis (p = 0.02), cryptococcal disease (p = 0.01), oral/oesophageal candidiasis (p = 0.02), deaths of unknown cause (p = 0.02) and (marginally) hospitalisations (p = 0.06) but not presumed severe bacterial infections (p = 0.38). Serious and grade 4 adverse events were marginally less common with enhanced prophylaxis (p = 0.06). CD4 increases and VL suppression were similar between groups (p > 0.2). Conclusions: Enhanced infection prophylaxis at ART initiation reduces early mortality by 25% among HIV‐infected adults and children with advanced disease. The pill burden did not adversely affect VL suppression. Policy makers should consider adopting and implementing this low‐cost broad infection prevention package which could save 3.3 lives for every 100 individuals treated