Psychosocial functioning in adolescent psychiatric patients: a prospective study on changes in psychosocial functioning among severely and moderately impaired adolescent out-patients

Adolescent adjustment disorder: Precipitant stressors and distress symptoms of 89 outpatients

Objective

Research on adolescent adjustment disorder (AD) is scarce. We characterized adolescent outpatients with AD in psychosocial background and treatment received compared with patients with other non-psychotic disorders (OND). Furthermore, we explored precipitant stressors, distress symptoms and behavioral problems among males and females with AD.

Method

Data were collected prospectively on 290 consecutive psychiatric outpatients, aged 12–22 yrs, at a secondary care clinic in Finland. DSM-III-R diagnoses were assigned, based on all available information, at the end of treatment.

Results

AD was the second most common diagnosis among non-psychotic patients (31% of 290). Compared to OND-patients, those with AD were predominantly female and had less severe psychosocial impairment. In multivariate comparisons school-related stressors, problems with law and restlessness characterized males, and parental illness and internalizing symptoms females with AD. Intensity and duration of treatment of AD-patients varied widely.

Conclusions

Adjustment disorder comprised a common clinical entity among adolescent outpatients. Psychiatric assessment and treatment should be individually targeted by taking into account gender-specific stressors and distress symptoms among young people with AD.

Personality characteristics associated with persistent ADHD in late adolescence

This study focused on the personality characteristics associated with Attention-deficit/Hyperactivity disorder (ADHD) in a longitudinal sample of youth, with a particular focus on differences between those with and without persisting ADHD symptoms. Participants with ADHD (n = 90) were initially evaluated when they were 7-11 years old, and re-assessed at 16-22 years of age. Matched control subjects (n = 80) were recruited at the time of the follow-up evaluation. At follow-up, the Kiddie-SADS-PL, a semi-structured psychiatric interview, and the NEO-PI, a self-report personality inventory, were administered. Data were analyzed using multivariate analyses of variance (MANOVA). Results indicate that childhood ADHD is associated with lower scores on the NEO Conscientiousness subscale in adolescents/young adults--irrespective of the degree of ADHD persistence. In contrast, ratings of Neuroticism and Agreeableness appear to be more closely linked to adolescent status; those with persisting symptoms only exhibited increased Neuroticism and decreased Agreeableness. These results suggest that ADHD, and the degree to which symptoms persist into adolescence, may be closely linked to personality structure.

Global assessment of psychosocial functioning in child and adolescent psychiatry. A review of three unidimensional scales (CGAS, GAF, GAPD)

Global assessment of functioning represents an important aspect of assessment in clinical practice and research. It can help identify persons in need of psychiatric treatment, have predictive value and measure change over time, including treatment effects. This review examines publications concerning development, psychometric properties and usefulness of three scales for children: Axis-VI in ICD-10 Global Assessment of Psychosocial Disability (GAPD), Children's Global Assessment Scale (CGAS) and Axis-V in DSM-IV Global Assessment of Functioning Scale (GAF). It is based on literature searches in PubMed and PsycInfo (1977-2003), and screening of Scandinavian and English textbooks on child psychiatry. The three scales differ in theoretical guidelines, descriptions of codes/anchor points and psychometric aspects. CGAS has been evaluated in 69 papers and 33 have been published on GAF used for children. The one paper comparing GAPD and CGAS found both scales sufficiently reliable for clinical practice. Reliability of CGAS and GAF has been found to vary from fair to substantial, depending on raters, training and diagnostic groups. International consensus for the use of one scale for global assessment of functioning for children 4-18 years would improve reliability in clinical practice and ease comparisons of studies across countries. A training programme would assist in this.

Factors associated with early dropout from adolescent psychiatric outpatient treatment

OBJECTIVE

To examine background factors, psychopathology, and psychosocial impairment among adolescents complying with or dropping out early from outpatient psychiatric treatment.

METHOD

Family background, psychiatric history, and other data were collected prospectively on 143 male and 154 female outpatients aged 12 to 22 years. DSM-II-R psychiatric diagnoses were assessed at the end of treatment.

RESULTS

Fifty-three adolescents (17.8%) attended 1 or 2 treatment appointments, and 33 of them (11.1% of 297) then dropped out; 50.5% of the total attended 3 to 13, and 31.6% attended 14 or more appointments. Low parental socioeconomic status was more common among the early dropouts than the other patient groups (88%, 69%, 63%, respectively). The early dropouts had had more problems with the law than the adolescents attending 14 or more appointments (18%, 6%), but less suicidal behavior (24%, 56%, respectively). Among the early dropouts, mood disorders were less common (21%, 49%), especially major depression (0%, 20%), and substance abuse was more common (9%, 0%) than among patients attending 14 or more appointments.

CONCLUSIONS

Low parental socioeconomic status, not having mood disorder, not having psychotropic medication, and having substance abuse were associated with early dropout of adolescents from outpatient psychiatric treatment.