Risk factors for adolescents developing substance use disorders; what should our prevention programs be targeting?

This review identifies the main risk factors and high risk groups of adolescents with substance use disorders (SUD). Furthermore it presents the epidemiological data on SUDs in Malta and discusses possible ways of tackling prevention, whilst offering suggestions based seminal studies from published literature to service developers. Adolescence is a developmental period a high risk, more than half individuals with SUDs identify that the problem began before the age of 20. 18% of adolescents in Europe have reported a lifetime use of illicit drugs, the prevalence rates in Malta are similar. Risk factors for SUDs include; heritable factors; familial patterns and psychiatric disorders. Environmental factors include; family functioning, parenting practices, child maltreatment, peer influences, substance availability and consumption opportunities. One predictive phenotype for SUDs is psychological dysregulation characterised by cognitive, behavioural and emotional difficulties with daily challenges in childhood. The regular use of substances is associated with depression, anxiety, PTSD, behaviour problems. Highest risk groups as those having two parents with a SUD, living with single parents, sexual orientation differences, early use of substances, psychological dysregulation and an attitude of ambivalence towards the use of substances. Over 70% of adolescents receiving treatment for SUD had a history of trauma. Parental practices such as knowledge, communication and awareness are an important protective factor which may help reduce the influential negative influence from peers on substance use. Focusing on abstinence alone in treatment is insufficient as adolescents present with; lower problem recognition, higher rates of binge use and co-morbid psychiatric problems compared to adults. Preventative measures targeted to high risk adolescents were correcting misperceptions is a primary focus may have important benefits. This may reduce the general ambivalence with regards to drug use, thereby reducing the influence from friends. Secondly, correcting misconceptions may lead to adolescents changing the assumption that one’s friends are all positively predisposed to substance use. It’s estimated that for every dollar invested in addiction treatment, $4-7 are saved in drug related crime, theft and criminal justice costs.peer-reviewe

User satisfaction of Children and Young People’s Service, Malta

Background Few published studies have evaluated the service users’ satisfaction of a Children and Young People Service (CYPS). An association between child and carers’ satisfaction and their attendance to CYPS exists. The aims of this study were to evaluate the service users’ views of the national CYPS, Malta and disseminate findings to policy makers to inform service development. Method Young People (YP) attending CYPS from 1st to 30th November 2014 were invited to fill in an anonymized Charleston psychiatric outpatient satisfaction scale in Maltese or English. The quantitative data was collected from 13 questions using a Likert scale and analysed using statistical correlations. The qualitative data was collected from three open ended questions and analysed using a thematic analysis. Results The sample population was 211 (97.7% response rate), average age 9.97 years (SD 3.34, CI ± 0.45). Overall quality of care was significantly (p<0.001) correlated with; 'respect shown for YP’s treatment opinions’ (r=0.539), 'matching treatment plan to YP’s individual needs' (r=0.320), and 'helpfulness of the services received' (r=0.618). Thematic analysis findings included; waiting lists and the interval between reviews were perceived as too long, difficultly establishing a therapeutic relationship, and lack of age appropriate environment which hindered attendance. Conclusions This is the first service user satisfaction evaluation for CYPS, Malta. Increasing staff to reduce waiting times and having reviews by the same clinician would ensure continuity of care and improve the therapeutic relationship. Better communication between services is required through school visits and paediatricians. Extending opening times, facilitating the referral process and improving accessibility may decrease barriers to service. Artwork and a well-lit environment could help engagement. Despite the above, YP still felt that overall CYPS provided an individualised treatment plan where staff work collaboratively to scaffold YP and meet their needs.peer-reviewe

Attention deficit hyperactivity disorder across the lifespan

This article is a research summary of published and non-published work pertaining to Attention Deficit Hyperactivity Disorders (ADHD). ADHD is one of the most common child mental health disorders and is under-recognised in children (5.29%) and adults (2.5%). ADHD is highly heritable with a multifactorial pattern of inheritance. Siblings and parents of a child with ADHD are 4 to 5 times more likely to have ADHD. Methylphenidate is the first line pharmacological treatment with a combined response (this includes trials of other licensed amphetamines) rate of 95%. All clinicians working in mental health should be aware of this disorder, comfortable diagnosing and treating people with ADHD. Young people with untreated ADHD are 5 times more likely to develop antisocial behaviour, substance abuse and other co morbid psychiatric disorders.peer-reviewe

Teleneurology clinics for polyneuropathy: a pilot study.

INTRODUCTION:Polyneuropathy (PN) is a common condition with significant morbidity. We developed tele-polyneuropathy (tele-PN) clinics to improve access to neurology and increase guideline-concordant PN care. This article describes the mixed-methods evaluation of pilot tele-PN clinics at three community sites within the Greater Los Angeles VA Healthcare System. METHODS:For the first 25 patients (48 scheduled visits), we recorded the duration of the tele-PN visit and exam; the performance on three guideline-concordant care indicators (PN screening labs, opiate reduction, physical therapy for falls); and patient-satisfaction scores. We elicited comments about the tele-PN clinic from patients and the clinical team. We combined descriptive statistics with qualitative themes to determine the feasibility and acceptability of the tele-PN clinics. RESULTS:The average tele-PN encounter and exam times were 28.5 and 9.1&nbsp;min, respectively. PN screening lab completion increased from 80 to 100%. Opiate freedom improved from 68 to 88%. Physical therapy for patients with recent falls increased from 58 to 100%. The tele-PN clinic was preferred for follow-up over in-person clinics in 86% of cases. Convenience was paramount to the clinic's success, saving an average of 231&nbsp;min per patient in round-trip travel. The medical team's caring and collaborative spirit received high praise. While the clinic's efficiency was equal or superior to in-person care, the limited treatment options for PN and the small clinical exam space are areas for improvement. CONCLUSION:In this pilot, we were able to efficiently see and examine patients remotely, promote guideline-concordant PN care, and provide a high-satisfaction encounter

Cardiovascular Imaging in the Management of Atrial Fibrillation

Atrial fibrillation (AF) is he most commonly encountered arrhythmia in clinical practice, with an overall prevalence of 0.4% in the general population. Recent advances in technology and in the understanding of the pathophysiology of AF have led to more definitive and potentially curative therapeutic approaches. Echocardiography has a well-established role in the assessment of cardiac structure and function and risk stratification, and has become an essential part of the guidelines for management of AF. The development of intracardiac echocardiography has led to real-time guidance of percutaneous interventions, including radiofrequency ablation and left atrial appendage closure procedures for patients with AF. Other imaging modalities, including computed tomography and magnetic resonance angiography, have allowed for more accurate measurement and better understanding of the cardiac anatomy. We review the impact of various imaging modalities in the evaluation and management of AF

Mediators of outcome in adolescent psychotherapy and their implications for theories and mechanisms of change: a systematic review

Psychotherapeutic treatment of adolescents requires age-specific approaches and thus plausibly also involves different change mechanisms than adult psychotherapy. To guide further research and improve therapeutic outcomes for adolescents, we reviewed all RCTs investigating mechanisms of change in the psychological treatment of adolescents to identify the most promising age-, disorder- or treatment-specific mediators. Following the preferred reporting items for systematic reviews (PRISMA), 106 studies were included that reported 252 statistical mediation tests assessed with 181 different measures. Most often studied and significant mediators were cognitive, followed by family-related, and behavioral variables. Several mediators were identified to be promising for future investigations: changes in negative thoughts, dysfunctional beliefs and metacognitive skills; family functioning and parenting skills; as well as successful engagement in therapy activities and increased impulse control. Symptom change during therapy was least often a mediator for other therapeutic changes. Relational and emotional mediators were largely understudied, whereas peer-influence appeared a promising mediator for intervention outcomes. Adolescence-specific mediators were most commonly investigated. Majority of studied mediators were not disorder-specific. There was a tendency to mainly test change mechanisms of specific theoretical models without considering other possible change theories. Further, virtually no studies fulfilled all criteria for rigorously investigating mediation and only nine were classified with an overall good study quality. While bearing in mind the current limitations in study designs, methodological rigor and reporting, there appears to be substantial evidence for transdiagnostic age-specific change models in the psychological treatment of adolescents. For future research, need for consensus on a core set of transdiagnostic and transtheoretical mediators and measures is highlighted. These should address likely core mechanisms of change, as well as take into account age-relevant developmental challenges and biological markers.38 página

Predictors and moderators of outcome of psychotherapeutic interventions for mental disorders in adolescents and young adults : protocol for systematic reviews

Background: Adolescence and young adulthood is a risk period for the emergence of mental disorders. There is strong evidence that psychotherapeutic interventions are effective for most mental disorders. However, very little is known about which of the different psychotherapeutic treatment modalities are effective for whom. This large systematic review aims to address this critical gap within the literature on non-specific predictors and moderators of the outcomes of psychotherapeutic interventions among adolescents and young adults with mental disorders. Methods: The protocol is being reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) Statement. PubMed and PsycINFO databases will be searched for randomized controlled and quasi-experimental/naturalistic clinical trials. Risk of bias of all included studies will be assessed by the Mixed Methods Appraisal Tool. The quality of predictor and moderator variables will be also assessed. A narrative synthesis will be conducted for all included studies. Discussion: This systematic review will strengthen the evidence base on effective mental health interventions for young people, being the first to explore predictors and moderators of outcome of psychotherapeutic interventions for a wide range of mental disorders in young people.Peer reviewe