Outcomes of child psychiatric treatment

OBJECTIVE

The aim of this study was to investigate outcomes of child psychiatric outpatient treatment as usual and to identify outcome predictors, with special regard to attention-deficit/hyperactivity disorder (ADHD), mood disorder, obsessive-compulsive disorder and conduct disorder.

METHOD

Routinely collected data from 12 613 outpatients between July 2006 and January 2010 in Stockholm, Sweden were analysed. The outcome measure was change in Children's Global Assessment Scale (CGAS) ratings between first visit and case closure (∆CGAS).

RESULTS

CGAS improved during the course of treatment across all diagnostic groups, ranging from a mean change of 4 (mental retardation) to 16 (suicide attempts). ∆CGAS was two times higher in the mood disorder group compared with the ADHD group. In the mood disorder group, several psychotherapies were associated with better outcome but not medication. In the ADHD group, psychotherapeutic interventions were also associated with better outcome, but those who received treatment with central stimulants received less non-medical interventions.

CONCLUSION

Whereas the functional impairment and the level of improvement in mood disorder corresponded to previous efficacy studies, the ADHD patients were more impaired and improved less after treatment. This should prompt a critical discussion as to whether ADHD patients receive the best available treatment in CAMHS in Stockholm and elsewhere.

Maximal voluntary force of bilateral and unilateral leg extension

The aims were: (1) to investigate whether the 10-20% lower force during bilateral (BL) as compared to unilateral (UL) leg extension could be due to a general inability to activate fully a large number of muscles simultaneously, (2) to analyse the EMG signal of the quadriceps femoris during leg extensions, (3) to study the BL/UL force ratio in extension of the knee, and (4) to study the BL/UL leg extension force ratio in untrained and trained subjects. A 10% lower maximal voluntary isometric force was demonstrated during BL as compared to UL leg extension. This force discrepancy did not change when a total arm load of 250 N was applied simultaneously. Nor did the absolute force levels change, which indicates that the lower BL leg extension force is not due to a general mechanism of reduced activation with an increased number of muscles recruited in maximal voluntary contractions. Integrated EMG activity, mean power frequency and root mean square value of the EMG amplitude did not differ between UL and BL leg extensions. The knee extension force was slightly greater (4%) during BL than UL contractions. These findings are arguments against a reduced activation of the knee extensor muscles being the cause of the lower bilateral leg extension force. No differences in BL/UL force ratio were noted between groups of untrained and trained subjects despite the fact that several of the trained groups do different forms of BL leg extensions regularly. Thus, it does not appear that training readily affects the BL/UL leg extension force ratio.