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The utility of quality of life (QoL) as an outcome measure in youth-specific primary mental health care settings has yet to be determined. We aimed to determine: (i) whether heterogeneity on individual items of a QoL measure could be used to identify distinct groups of help-seeking young people; and (ii) the validity of these groups based on having clinically meaningful differences in demographic and clinical characteristics.
Methods
Young people, at their first presentation to one of five primary mental health services, completed a range of questionnaires, including the Assessment of Quality of Life–6 dimensions adolescent version (AQoL-6D). Latent class analysis (LCA) and multivariate multinomial logistic regression were used to define classes based on AQoL-6D and determine demographic and clinical characteristics associated with class membership.
Results
1107 young people (12–25 years) participated. Four groups were identified: (i) no-to-mild impairment in QoL; (ii) moderate impairment across dimensions but especially mental health and coping; (iii) moderate impairment across dimensions but especially on the pain dimension; and (iv) poor QoL across all dimensions along with a greater likelihood of complex and severe clinical presentations. Differences between groups were observed with respect to demographic and clinical features.
Conclusions
Adding multi-attribute utility instruments such as the AQoL-6D to routine data collection in mental health services might generate insights into the care needs of young people beyond reducing psychological distress and promoting symptom recovery. In young people with impairments across all QoL dimensions, the need for a holistic and personalised approach to treatment and recovery is heightened.
The importance of timely identification and treatment of psychosis are increasingly the focus of early interventions, with research targeting the initial high-risk period in the months following first-episode hospitalization. However, ongoing psychiatric treatment and service utilization after the symptoms have been stabilized over the initial years following first-episode has received less research attention.
Objectives
To model the variables predicting continued service utilization with psychiatrists for adolescents following their first-episode psychosis; examine associated temporal patterns in continued psychiatric service utilization.
Methods
This study utilized a cohort design to assess adolescents (age 14.4 ± 2.5 years) discharged following their index hospitalization for first-episode psychosis. Bivariate analyses were conducted on predictor variables associated with psychiatric service utilization. All significant predictor variables were included in a logistic regression model.
Results
Variables that were significantly associated with psychiatric service utilization included: diagnosis with a schizophrenia spectrum disorder rather than major mood disorder with psychotic features (OR = 24.0; P = 0.02), a first degree relative with depression (OR = 0.12; P = 0.05), and months since last psychiatric inpatient discharge (OR = 0.92; P = 0.02). Further examination of time since last hospitalization found that all adolescents continued service utilization up to 18 months post-discharge.
Conclusions
Key findings highlight the importance of early diagnosis, that a first degree relative with depression may negatively influence the adolescent's ongoing service utilization, and that 18 months post-discharge may a critical time to review current treatment strategies and collaborate with youth and families to ensure that services continue to meet their needs.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Despite recent findings pointing toward cannabis psychosis as one area where gender differences may exist, there has been a widespread lack of attention paid to gender as a determinant of health in both psychiatric services and within the field of addiction.
Objectives
To explore gender differences in treatment presentations for people with cannabis psychosis.
Aims
To use national data sets to investigate gender differences.
Methods
Analysis of British Crime Survey data and a Hospital Episode Statistics data set were used in combination with data from previously published epidemiological studies to compare gender differences.
Results
Male cannabis users outnumber female users by 2:1, a similar gender ratio is found for those admitted to hospital with a diagnosis of schizophrenia or psychosis. However this ratio increases significantly for those admitted to hospital with a diagnosis of cannabis psychosis, with males outnumbering females by 4:1.
Conclusions
This research brings into focus the marked gender differences in cannabis psychosis. Attending to gender is important for research and treatment with the aim of improving understanding and providing gender sensitive services.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
By
M. M. Hedman, University of Idaho Moscow, Idaho, USA,
F. Postberg, University of Heidelberg Heidelberg, GERMANY,
D. P. Hamilton, University of Maryland College Park, Maryland, USA,
S. Renner, University of Lille Lille, FRANCE,
H.-W. Hsu, University of Colorado Boulder, Colorado, USA
All of the giant planets in the outer Solar System possess rings composed primarily of particles less than 100 microns across. Such small particles are conventionally referred to as “dust grains” regardless of their composition, and so these rings are considered “dusty rings” (as opposed to the more famous main rings of Saturn and Uranus, whose particles are more than a millimeter across). Dusty rings are often very tenuous and so can be much more difficult to observe than Saturn's broad, bright, and dense main rings. Nevertheless, dusty rings are extremely interesting because they have very rich dynamics and are extremely sensitive probes of their environment.
The high surface-area-to-volume ratio of dust-sized grains makes them much more responsive to non-gravitational forces like solar radiation pressure, plasma drag, and torques from the planet's electromagnetic field. Furthermore, sub-millimeter particles can be lost from the ring system on relatively short timescales due to erosion via charged-particle and micrometeoroid bombardment or through ejection by the non-gravitational forces listed above. This means that small particles need to be constantly supplied to these rings from larger bodies, and indeed all of the known dusty rings are associated with larger objects that are the likely sources of dusty debris. The most dramatic example of this is Saturn's E ring, which is clearly supplied by material erupting from beneath the surface of the geologically active moon Enceladus. However, this is a special case, and most dusty rings are instead associated with denser rings (which are composed primarily of millimeter-to-metersized particles) or small moons. These objects can serve as dust sources because they are constantly being bombarded by micrometeoroids, and these impacts release fine debris that can escape the weak gravitational fields of these small bodies and go into orbit around the planet. Note that the amount of dust released by this process depends on the size, mass, and regolith properties of the source object, and calculations of the dust production rate based on simple estimates of impact ejecta velocity distributions suggest that source moons that are several kilometers across are the most efficient at producing dusty rings (Burns et al., 1999).
By
I. De Pater, University of California, Berkeley Berkeley, California, USA,
D. P. Hamilton, University of Maryland College Park, Maryland, USA,
M. R. Showalter, SETI Institute Mountain View, California, USA,
H. B. Throop, Planetary Science Institute Tucson, Arizona, USA,
J. A. Burns, Cornell University Ithaca, New York, USA