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To report new prescriptions of psychotropic medications among adolescents presenting with new onset psychotic symptoms during a 5-year period.
The Northern Ireland Early Onset Psychosis Study is a naturalistic longitudinal observational study of patients with an early onset first psychotic episode. All patients aged <18 years presenting to specialist mental health services across Northern Ireland with new onset psychotic symptoms between 2001 and 2006 were recruited (n=113). Clinical case notes were analysed retrospectively for details of subsequent treatment with psychotropic medications.
A total of 100 patients (88.5%) were prescribed some form of psychotropic medication. Over three-quarters of patients received an antipsychotic as their first medication. Risperidone (45.8%), olanzapine (24.0%) and chlorpromazine (12.5%) were the most commonly prescribed first-line antipsychotic medications. Of a total of 160 antipsychotic prescriptions, 81 (50.6%) were off-label. Prescriptions were most likely to have been deemed off-label owing to medications not being licensed in under-18s (71.6% of off-label prescriptions) but other reasons were medications being used outside licensed age ranges (23.5%) and outside licensed indications (4.9%).
This is the first study examining psychotropic prescribing patterns in a complete sample of all children and adolescents presenting with early onset psychotic episodes in a single geographical area. The observation of risperidone as the most commonly prescribed antipsychotic was in keeping with previous studies in child and adolescent populations. Rates of off-label prescribing were lower than previously observed although our study was the first to investigate off-label prescribing solely in children and adolescents presenting with psychotic symptoms.
To assess the general health and activity levels of 4- and 5-year-old children after intervention for congenital cardiac disease.
Health behaviour outcomes were assessed in 91 children who had surgery or catheter intervention for congenital cardiac disease. The children were classified into four groups according to severity. The main parameters of classification were the presence of residual symptoms, frequency of visits to general practitioner or the Accident and Emergency Department, and ability to participate in physical activity according to a calculated “activity score”.
Children had very few residual symptoms after “corrective surgery”. Those with complex congenital cardiac disease post-Fontan-type repair still had symptoms on average 18.2 days per month. Surprisingly, the complex group had fewer days “sick” from non-cardiac causes and had fewer visits to general practitioner or Accident and Emergency Departments. Regression analysis indicates that three variables had significant relevance to the general practitioner or Accident and Emergency visits: complex congenital cardiac disease, fewer visits; Townsend score – more deprivation – more visits; and maternal worry – higher maternal worry score – more visits. Regression analysis indicates that lower activity score is significantly related to complex cardiac disease and higher maternal worry score.
The majority of this group of 4- and 5-year-old children had few residual symptoms and had good exercise tolerance. Maternal worry is a significant factor in influencing both activity levels and frequency of unscheduled health service demands – general practitioner or Accident and Emergency visits.
Substance misuse is a common comorbid problem in people presenting with
first-episode psychosis and is associated with a poor short-term
The aim of this study is to examine differences in baseline
characteristics and 1-year outcome between individuals with first-episode
psychosis who have never misused substances, those who stop misusing
substances after initial presentation and those who persistently misuse
substances over the 1-year assessment period.
Patients were recruited to the Northern Ireland First Episode Psychosis
Study (n = 272). Clinical assessments were performed at baseline and at 1
year (n = 194) and data were collected from the case notes.
Individuals with persistent substance misuse had more severe depression,
more positive symptoms, poorer functional outcome and greater rates of
relapse at 1 year than those who stopped and those who had never misused
substances. There were no differences in outcome between people who had
never misused substances and those who stopped misusing after
These results support assertive intervention targeted at comorbid
substance misuse in individuals with first-episode psychosis.
Researching psychotic disorders in unison rather than as separate
diagnostic groups is widely advocated, but the viability of such an
approach requires careful consideration from a neurocognitive
To describe cognition in people with bipolar disorder and schizophrenia
and to examine how known causes of variability in individual's
performance contribute to any observed diagnostic differences.
Neurocognitive functioning in people with bipolar disorder
(n = 32), schizophrenia (n = 46) and
healthy controls (n = 67) was compared using analysis of
covariance on data from the Northern Ireland First Episode Psychosis
The bipolar disorder and schizophrenia groups were most impaired on tests
of memory, executive functioning and language. The bipolar group
performed significantly better on tests of response inhibition, verbal
fluency and callosal functioning. Between-group differences could be
explained by the greater proclivity of individuals with schizophrenia to
experience global cognitive impairment and negative symptoms.
Particular impairments are common to people with psychosis and may prove
useful as endophenotypic markers. Considering the degree of individuals'
global cognitive impairment is critical when attempting to understand
patterns of selective impairment both within and between these diagnostic
Are some regions of the United Kingdom ‘cheaper’ than others, in the sense that a given basket of commodities can be bought in them for a smaller outlay of money? Moreover, are such differences, if indeed they do exist, persistent over time? This chapter attempts to provide answers to these questions. If both were answered in the affirmative, then a policy of paying nationally determined unemployment benefits might have, depending upon their region of residence, significantly different consequences for the real incomes of the unemployed and so affect their participation in the labour market. Despite the importance of these questions there is no regional component to the Retail Prices Index (RPI), which is the main, and most prominent, measure of price movements in the United Kingdom.
In attempting to shed some light on this area of darkness, this study used regional price data provided by the Reward Group. These data were used in conjunction with weights derived from the Family Expenditure Survey (FES) to construct regional retail price indices. Both the data and the construction of the weights are described in section 5.2. Differences in regional housing costs might be expected to play an important part in determining cost-of-living differences between regions, and so section 5.3 is devoted to a discussion of the many problems associated with their measurement.