Consumer satisfaction with an adolescent inpatient psychiatric unit

OBJECTIVE

To explore factors influencing the satisfaction of patients, parents, and referring clinicians who used the services of an adolescent inpatient psychiatric unit, and to explore how levels of satisfaction related to the patient's symptomatic and functional improvement during the admission.

METHOD

All 105 adolescents, their families, and the referring community clinicians who used an inpatient service over a 1-year period were asked to rate the patient's symptoms and functioning on admission, at discharge, and 4 months after the patient's return to the community. We obtained satisfaction ratings at discharge, and consumers were asked to rate helpfulness of the ward experience at 4 months postdischarge. Ward psychiatrists provided Children's Global Assessment Scale (CGAS) ratings and diagnoses over the course of the inpatient stay.

RESULTS

Most of the patients (83%) improved during their admission. Consumer satisfaction ratings correlated with improvement of self-identified problems and with the perceived usefulness of discharge recommendations. Satisfaction did not, however, correlate with the patient's symptomatic and functional progress. Interaction with ward staff was an important source of both positive and negative experiences.

CONCLUSION

Our study indicates that inpatient psychiatric staff should attend closely to the consumer's perception of difficulties and the need for practical discharge recommendations.

Child Behaviour Checklist classification of behaviour disorder

OBJECTIVE

The aim of this study was to determine the applicability of the published clinical cut-off scores of the Child Behaviour Checklist (CBCL) for the classification of behaviour disorders.

METHODOLOGY

Child Behaviour Checklists were obtained for 1342 subjects newly referred to the six major mental health centres in Melbourne. The normative community sample of 1002 7-, 12- and 15-year-olds was drawn from a school-based asthma prevalence study.

RESULTS

The mean total problem T-score for the children referred to mental health centres was 67 and was above the clinical range for all age groups. Using referral to psychiatric services as the gold standard, the sensitivity and specificity of the CBCL using a cut-off of > or = 60, was 77.4 and 83.2%, respectively. This compares favourably with the sensitivity of 68% and specificity of 82% for the American sample. Using a cut-off score of > or = 63, the sensitivity was 70.5% and the specificity was 88.6%. The referred and community samples differed with respect to socio-economic status, family structure and mothers' level of education. Fifty-two per cent of the clinically referred children lived with both parents, compared with 89% of the community sample.

CONCLUSIONS

While there are some limitations to this study in terms of both the clinic and community sample, support is provided for the usefulness and applicability of the recommended CBCL cut-off scores in an Australian population.

Teachers' perceptions of maladaptive behaviour in Lebanese refugee children

Research on the psychological status of children who are refugees from war has led to varying results. Children from war conditions or who have been subject to evacuation have been shown to have relatively low levels of disturbed behaviour, have internalising symptoms of anxiety or depression, display behaviour with aggressive features, and suffer slight psychological disturbance, depending on their caretakers' response to the stressful experience. Based on the contrasting evidence and observations within an inner Melbourne Muslim school, this study aimed to determine whether more behaviour problems existed in Muslim children from Lebanese families. Compared with other war refugee Muslim immigrant children, Lebanese children were not found to be more aggressive, but were more anxious. Lebanese males displayed more inattentive behaviour at school than non-Lebanese males. Sex differences were found in adaptive functioning within Lebanese and non-Lebanese groups. Differences in school performance and adaptive functioning were found between Lebanese and normative samples when males and females were analysed separately. These results are discussed in the context of teacher expectations and perceptions of culturally acceptable behaviour.

Clinical and research implications of the co-occurrence of Asperger's and Tourette syndromes

Recent advances in the understanding of Tourette Syndrome and Asperger's Syndrome are reviewed. Reports of the co-occurrence of these two uncommon neuropsychological disorders pose a number of questions, the answers to which are likely to have implications for other conditions at the interface of psychiatry and neurology.

A 13 year follow-up of child psychiatry training

The graduates from two child psychiatry training programmes over a 13 year period responded to a questionnaire designed to elicit their retrospective evaluations of various aspects of their educational experience. Information is presented about areas of knowledge judged important, specific experiences which were helpful and unhelpful, and current patterns of practice of these graduates. Their attitudes toward supervision and supervisors are discussed, as are implications for recruitment of future trainees and teachers/faculty.

Social problem-solving in depressed, conduct-disordered, and normal adolescents

Although past theory and research implicate social problem-solving deficits in both depression and aggressive disorders, research examining carefully diagnosed groups of adolescent depressed and conduct-disordered groups had not previously been conducted. In the current study three groups of adolescents (major depression, conduct-disordered, and normal) were studied using two social problem-solving measures. Both the Means-Ends Problem-Solving task (MEPS) and the Social Situations Analysis measure (SSA) failed to show social problem-solving problem deficits in the depressed group relative to their normal age peers, but did provide corroborative evidence for social problem-solving deficits in the conduct-disordered sample. Relative to the other two groups, the conduct-disordered adolescents were found to generate fewer means to a social end, to anticipate fewer obstacles in the pursuit of solutions to interpersonal situations, and to generate fewer assertive behavioral solutions to difficult social situations. The results are discussed in relation to other work with depressed and aggressive youth, and directions for future research are given.

Use of an amytal interview in the management of factitious deaf mutism

We describe the case of a young woman presenting with deaf mutism and self-damaging behaviour. We emphasize the active investigation of psychological and physical symptoms, combined with gradual and gentle confrontation in a supportive setting.

Affective disorders in children and adolescents: the dysthymic disorder dilemma

From 60 patients referred for assessment of their depressive symptomatology, 13 were found to suffer from major affective disorder and 14 from dysthymic disorder. The results from self-rating scales (the Children's Depression Inventory and the Children's Depression Scale) were compared with the findings from diagnostic interviews (using DSM-III criteria). The large proportion of dysthymic disorders in this sample is compared to the low reported figure in most other samples and some comments about the possible usefulness of this diagnosis are made.

Phototherapy. Short and long-term complications

Use of phototherapy for hyperbilirubinaemia in 300 consecutively treated infants has shown that minor complications are common. With a knowledge of these complications and measures taken to minimize their effects, phototherapy appears to be safe in the short term. The long-term follow-up study showed that growth, and in particular head circumference, was not affected. There was, however, a higher incidence of squints and abnormal developmental performance in those infants treated with phototherapy. This may not have been due to phototherapy usage per se. However, because of these findings, it is suggested that phototherapy should not be used indiscriminately for hyperbilirubinaemia until the results of further long-term studies are available.