Prevalence of psychotic symptoms in childhood and adolescence: a systematic review and meta-analysis of population-based studies

BACKGROUND

Psychotic symptoms occur more frequently in the general population than psychotic disorder and index risk for psychopathology. Multiple studies have reported on the prevalence of these symptoms using self-report questionnaires or clinical interviews but there is a lack of consensus about the prevalence of psychotic symptoms among children and adolescents.

METHOD

We conducted a systematic review of all published literature on psychotic symptom prevalence in two age groups, children aged 9-12 years and adolescents aged 13-18 years, searching through electronic databases PubMed, Ovid Medline, PsycINFO and EMBASE up to June 2011, and extracted prevalence rates.

RESULTS

We identified 19 population studies that reported on psychotic symptom prevalence among children and adolescents. The median prevalence of psychotic symptoms was 17% among children aged 9-12 years and 7.5% among adolescents aged 13-18 years.

CONCLUSIONS

Psychotic symptoms are relatively common in young people, especially in childhood. Prevalence is higher in younger (9-12 years) compared to older (13-18 years) children.

Who gets admitted? Study of referrals and admissions to an adolescent psychiatry inpatient facility over a 6-month period

BACKGROUND

Child and adolescent psychiatry services have historically been neglected in Ireland, in terms of resource provision and research.

AIM

To describe referral and admission patterns to an adolescent inpatient unit in Ireland.

METHODS

We studied reasons for referral and admission decisions relating to all adolescents referred to St. Joseph's Adolescent Inpatient Unit (AIPU), Dublin in the first 6 months following its establishment in 2009.

RESULTS

Forty-one adolescents were referred during the study period; 46 % were admitted. There was no difference between those admitted and not admitted in terms of gender (two-thirds were female), age (mean age 16.2 years), most common reason for referral (depression, in almost one-in-two) and suicidality (present in one-in-two). Amongst those referred, 46 % were resident in the primary catchment area. While a majority of admissions occurred within 5 days of referral (53 %), a significant minority were not admitted until over 20 days after referral (16 %).

CONCLUSIONS

The demographic and clinical characteristics of adolescents referred and admitted to St. Joseph's AIPU are consistent with national and international patterns. At national level, the opening of additional beds for adolescents (such as St. Joseph's AIPU) has had positive effects on admission patterns; our findings indicate a need to further educate referrers about referral criteria, to optimise benefits derived from these new resources. Future studies could examine the potential roles of intensive support services in the community to further maximise use of scarce resources for this patient group.

Cannabis use and childhood trauma interact additively to increase the risk of psychotic symptoms in adolescence

BACKGROUND

Adolescent cannabis use has been shown in many studies to increase the risk of later psychosis. Childhood trauma is associated with both substance misuse and risk for psychosis. In this study our aim was to investigate whether there is a significant interaction between cannabis use and childhood trauma in increasing the risk for experiencing psychotic symptoms during adolescence.

METHOD

Psychiatric interviews using the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS) semi-structured instrument were carried out with 211 adolescents aged between 12 and 15 years and their parents as part of a population-based study. The interview enquired about early traumatic events, cannabis use and psychiatric symptoms in adolescence.

RESULTS

In separate analyses both cannabis use and childhood trauma were significantly associated with risk of experiencing psychotic symptoms. However, the presence of both childhood trauma and early cannabis use significantly increased the risk for psychotic symptoms beyond the risk posed by either risk factor alone, indicating that there was a greater than additive interaction between childhood trauma and cannabis use.

CONCLUSION

Our finding of a greater than additive interaction between childhood trauma and cannabis use may have implications for the identification of individuals at high risk of experiencing psychotic symptoms. For example, measures to actively discourage or intensively treat cannabis use in children and adolescents who have experienced abuse may help to prevent the development of psychosis in this vulnerable group. Our findings require replication in larger samples to confirm this interaction effect.

Biodiversity and climate change in relation to the Natura 2000 network

Abstract. This project will provide the European Commission (EC) with an overview of the likely impacts of climate change on biodiversity in the European Union (EU), particularly within the Natura 2000 (N2K) network of protected areas, and indications of how the design and implementation of current policy might need to be adapted to ensure that the EU delivers its commitment to halt biodiversity loss by 2010 and beyond. The study will identify those species and associated habitats that are likely to be most vulnerable to climate change and the steps required to protect the integrity of the network from negative effects. The study will also assess the impacts of large-scale renewable energy schemes (wind parks, hydroelectric schemes and tidal barrages) on biodiversity and produce guidelines on the sorts of measures that might be used to maintain and protect N2K sites.

Waiting lists. Bone of contention

The number of orthopaedic consultants has increased by 78 per cent since 1984, but average waiting time has hardly changed. Orthopaedics is one of the greatest problem areas for waiting lists although workloads have fallen by about a fifth in the past five years. An extra 85,000 orthopaedic patients will have to be admitted over the next five years if the government is to eliminate waits of more than six months. Consultants oppose the expansion of the staff grades. Specialist centres may have to be established to deal with the backlog.

Consultant work patterns. Blade runners

An analysis of the work of 182 consultant orthopaedic surgeons in two English regions found they averaged seven hours a week operating. A fifth were working below the minimum operating hours recommended by the British Orthopaedic Association. Orthopaedic teams are now seeing fewer outpatients and inpatients than 10 years ago, despite a 50 per cent increase in the number of consultants. The current situation raises serious concerns about appropriate use of specialists' time and operating theatres. Trusts should not appoint any more consultant orthopaedic surgeons until those they have operate for a minimum of eight hours a week.

The anatomy of large inpatient waiting lists

A survey of 31,224 patients on 33 of the largest inpatient surgical waiting lists in Wales and the West Midlands was undertaken in 1986. 19% of the patients were older than 64 years and over 90% lived within their district of treatment or in an adjacent district. Patients awaiting operations for hernia, varicose veins, arthroscopy, cataract, tonsils and adenoids, or sterilisation made up 45% of the lists. 45% of patients had already waited over a year for treatment, and it was evident that many of the lists had not been properly reviewed.