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In 2006, staff in child and adolescent mental health services (CAMHS) in Lincolnshire, UK, felt that cases were becoming increasingly complex. The Pearce Case Complexity Scale (PCCS) and a staff opinions questionnaire were used to measure subjective and objective changes in case complexity in a relatively stable CAMHS service over a 10-year period from 1996 to 2006, with data examined between 2008 and 2010.
Clinicians reported an increase in case complexity over time. However, the PCCS did not show a significant change in the decade studied.
Staff anxiety could be a determinant of judgements they make about case complexity in CAMHS.
To investigate the effectiveness of switching children with attention-deficit hyperactivity disorder (ADHD) from immediate- to sustained-release psychostimulants (Concerta XL, a novel methylphenidate hydro-chloride) and to examine factors associated with treatment success or failure. This was a retrospective study of all such children known to four clinicians in Lincolnshire, over a 2-year period. The initial response to treatment and the response to slow-release psychostimulant as judged by the clinicians were recorded. Data were analysed using the Statistical Package for the Social Sciences version 12.
Of the children who were switched (n=97) and on whom clinical judgement was available (n=92), a statistically significant number (32%) responded poorly (P<0.001). In 26 out of the 97 patients, the switching was considered as a treatment failure and they were switched back to the original immediate-release stimulants. There was no significant-difference with possible confounding variables between children who responded well and those who responded poorly after switching to sustained-release drug.
In a real-life clinical situation there is a significant failure rate when a child with ADHD is switched from an immediate- to sustained-release psychostimulant. Further studies are needed.
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