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ABSTRACT: Little has been written on the value of composing narrative letters to adolescent psychiatric inpatients as rated by those who receive them.
Survey of youth, family members, and professionals given copies of a narrative discharge letter written as an alternative to a copy of an initial discharge letter written to the referrer.
Narrative letters conceptualized and validated youth experience, progress, and future directions in a language easily understood by the youth and family members, enabling reflection and empowerment.
Narrative letter writing is a valuable therapeutic tool to facilitate reflective, empowering partnerships among professionals, youth, and family members.
Journal of Child and Adolescent Psychiatric Nursing 11/2009; 22(4):182-8.
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ABSTRACT: The objective of this study was to evaluate the efficacy and tolerability of quetiapine in the treatment of first onset psychosis in older adolescents using risperidone as a comparator. Twenty-two patients with first onset psychosis were randomized to receive quetiapine (up to 800 mg/day) or risperidone (up to 6 mg/day) for 6 weeks. Raters blind to treatment assignment performed outcome symptom ratings. No statistical differences emerged in terms of efficacy or tolerability between the two drugs. However, there were some clinically notable differences that seem to favour the efficacy of risperidone over quetiapine. Patients taking quetiapine, although improved, showed less clinical improvement on scores for total positive and negative symptoms, clinical global severity and depression at 6 weeks than patients taking risperidone. Although both treatments were associated with weight gain and sedation, more patients on quetiapine experienced over 10% weight gain. However, fewer patients who were taking quetiapine required anticholinergic medication or experienced extrapyramidal side effects than patients taking risperidone. Risperidone was significantly more likely to be associated with elevation in serum prolactin levels in this population. In conclusion, the results in this small trial show that adolescent patients may benefit more from treatment with risperidone than quetiapine. However, those susceptible to side effects, particularly hyperprolactinaemia, may be more suitable for treatment with quetiapine.
International clinical psychopharmacology 10/2009; 25(1):1-6. · 3.35 Impact Factor
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ABSTRACT: The aim of this paper was to determine if patients undergoing treatment at an older adolescent inpatient unit receive psychoeducation according to the unit philosophy of providing timely and pertinent information regarding illness/diagnosis, medication, diet, outpatient follow-up, and alcohol/ drug use.
Data were gathered prospectively as part of a quality assurance initiative at the Christchurch Youth Inpatient Unit. Patients were interviewed by a registered nurse using a structured audit tool.
Participants reported receiving adequate information on medication and illness, and most received information on outpatient follow-up and alcohol and drug use. However, the majority reported a lack of information/ advice about diet. Patients' reported awareness of relapse prevention and the relationship of alcohol and other drugs use to medication and treatment was lower than expected.
The audit highlighted areas of discrepancy between information staff believed they had delivered and information youth perceived as received. Psychiatric staff working with young people need be aware of the timing, language and mode of delivery of psychoeducation to enable their patients to 'take in' the information provided.
Australasian Psychiatry 04/2009; 18(1):53-6. · 0.86 Impact Factor
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ABSTRACT: To determine the level of compliance with official guidelines for prescribing mood stabilizers among adolescents in Christchurch, New Zealand.
A retrospective audit of clinical files of patients aged 13-19 years attending inpatient and outpatient services in the Child, Adolescent and Family Service in the Canterbury District catchment area was carried out against set criteria derived from the Ministry of Health Guidelines regarding the use of mood stabilizers (lithium and sodium valproate). A guideline compliance index was also created to measure overall compliance.
Over a period of 3 years beginning from January 2000, we identified 68 episodes of initiation among 58 adolescents. Of those, 91.2% were for indications set in the guidelines. More than half appeared to have been given no information about the medication, and only 61.8% had documented consent. Two-thirds had a full laboratory work-up before initiation. More than one-third had no evidence of communication with general practitioners about being initiated on a mood stabilizer. Overall, only 13.2% were 100% compliant and only 50% were 80% compliant.
In general, mood stabilizers were prescribed as indicated, but adherence to the guidelines beyond that appears to fall short of standards set by the guidelines.
Australasian Psychiatry 10/2006; 14(3):304-9. · 0.86 Impact Factor
