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Signorini G, Singh SP, Boricevic-Marsanic V, Dieleman G, Dodig-Ćurković K, Franic T, Gerritsen SE, Griffin J, Maras A, McNicholas F, O'Hara L, Purper-Ouakil D, Paul M, Santosh P, Schulze U, Street C, Tremmery S, Tuomainen H, Verhulst F, Warwick J, de Girolamo G. Architecture and functioning of child and adolescent mental health services: a 28-country survey in Europe. Lancet Psychiatry 2017; 4:715-724. [PMID: 28596067 DOI: 10.1016/s2215-0366(17)30127-x] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 02/06/2017] [Accepted: 02/20/2017] [Indexed: 11/15/2022]
Abstract
The WHO Child and Adolescent Mental Health Atlas, published in 2005, reported that child and adolescent mental health services (CAMHS) in Europe differed substantially in their architecture and functioning. We assessed the characteristics of national CAMHS across the European Union (EU), including legal aspects of adolescent care. Using an online mapping survey aimed at expert(s) in each country, we obtained data for all 28 countries in the EU. The characteristics and activities of CAMHS (ie, availability of services, inpatient beds, and clinicians and organisations, and delivery of specific CAMHS services and treatments) varied considerably between countries, as did funding sources and user access. Neurodevelopmental disorders were the most frequent diagnostic group (up to 81%) for people seen at CAMHS (data available from only 13 [46%] countries). 20 (70%) countries reported having an official national child and adolescent mental health policy, covering young people until their official age of transition to adulthood. The heterogeneity in resource allocation did not seem to match epidemiological burden. Substantial improvements in the planning, monitoring, and delivery of mental health services for children and adolescents are needed.
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Affiliation(s)
- Giulia Signorini
- Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Center, Brescia, Italy.
| | - Swaran P Singh
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | | | - Gwen Dieleman
- Erasmus University Medical Centre, Rotterdam, Netherlands
| | | | - Tomislav Franic
- Department of Psychiatry, Clinical Hospital Center Split, Split, Croatia
| | | | - James Griffin
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Athanasios Maras
- Erasmus University Medical Centre, Rotterdam, Netherlands; Yulius Academy, Rotterdam, Netherlands
| | - Fiona McNicholas
- Department of Child and Adolescent Psychiatry, School of Medicine and Medical Science, University College Dublin, Dublin; Geary Institute, University College Dublin, Dublin; Department of Child Psychiatry, Our Lady's Hospital for Sick Children, Crumlin, Dublin; Lucena Clinic, Rathgar, Dublin
| | - Lesley O'Hara
- Department of Child and Adolescent Psychiatry, School of Medicine and Medical Science, University College Dublin, Dublin
| | - Diane Purper-Ouakil
- Département de Médecine Psychologique Enfants et Adolescents, CHU Montpellier-St Eloi Hôpital, Montpellier, France
| | - Moli Paul
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Paramala Santosh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; Centre for Interventional Paediatric Psychopharmacology and Rare Diseases, National and Specialist Child and Adolescent Mental Health Services, Maudsley Hospital, London, UK; HealthTracker Ltd, Gillingham, UK
| | - Ulrike Schulze
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - Cathy Street
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Sabine Tremmery
- Department of Neurosciences, Child & Adolescent Psychiatry, University of Leuven, Leuven, Belgium
| | - Helena Tuomainen
- Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Frank Verhulst
- Department of Child and Adolescent Psychiatry and Psychology, Rotterdam, Netherlands
| | - Jane Warwick
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Giovanni de Girolamo
- Psychiatric Epidemiology and Evaluation Unit, Saint John of God Clinical Research Center, Brescia, Italy
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102
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Marwaha S, Thompson A. Response to letters by Baethge et al. and Martino et al. Int J Bipolar Disord 2017; 5:21. [PMID: 28447332 PMCID: PMC5449354 DOI: 10.1186/s40345-017-0090-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 03/16/2017] [Indexed: 11/10/2022] Open
Affiliation(s)
- Steven Marwaha
- Unit of Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK. .,Affective Disorders Service (IPU 3-8), Coventry, UK.
| | - Andrew Thompson
- Unit of Mental Health and Wellbeing, Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK.,North Warwickshire Early Intervention in Psychosis Service, Coventry and Warwickshire NHS Partnership Trust, Nuneaton, UK
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104
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Poon JYK, Leung CM. Outcome of first-episode acute and transient psychotic disorder in Hong Kong Chinese: a 20-year retrospective follow-up study. Nord J Psychiatry 2017; 71:139-144. [PMID: 27834101 DOI: 10.1080/08039488.2016.1252426] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND 'Acute and transient psychotic disorder' (ATPD) is a category in ICD-10 marked by psychosis with acute onset and early remission. It remains relatively under-researched, despite controversies over its nosological status in the current classification system. AIMS (1) To assess the changes in diagnosis over time in patients initially diagnosed as ATPD. (2) To identify factors predicting changes in diagnosis, and compare the long-term outcomes of various patterns of diagnostic shift. (3) To make recommendations on the classification and treatment of ATPD based on the findings of the study. METHODS This was a retrospective longitudinal study based on review of medical records of patients first admitted to a regional hospital in Hong Kong for ATPD during the period from 1990-2000. RESULTS Of the 87 subjects initially diagnosed as ATPD, 64.4% had their diagnoses revised over an average of 20 years, mostly to bipolar disorder and schizophrenia. Among those with diagnosis of ATPD unchanged, 54.8% had one single episode, while the remaining 45.2% had recurrence. Subjects with diagnostic shift had significantly younger age of onset, more first-degree relatives with a history of mental illness, and more subsequent psychiatric admissions. CONCLUSIONS ATPD is likely a composite category consisting of clinically distinct outcome groups, for which further research is warranted to identify diagnostic features that distinguish them at initial presentation and revise the current nosological status of ATPD. Long-term follow-up, judicial use of antipsychotics, and education on prognosis are of paramount importance in managing patients diagnosed with ATPD.
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Affiliation(s)
| | - Chi Ming Leung
- a Department of Psychiatry , Shatin Hospital , Hong Kong SAR , PR China
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