Outcomes of child psychiatric treatment

Authors

  • A. Lundh,

    Corresponding author
    • Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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  • M. Forsman,

    1. Centre for Psychiatric Research and Education, Department of Child and Adolescent Psychiatry, Stockholm, Sweden
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  • E. Serlachius,

    1. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
    2. Centre for Psychiatric Research and Education, Department of Child and Adolescent Psychiatry, Stockholm, Sweden
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  • P. Lichtenstein,

    1. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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  • M. Landén

    1. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
    2. Sahlgrenska Academy, Gothenburg University, Institute of Neuroscience and Physiology, Gothenburg, Sweden
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Anna Lundh, MD, PhD, Department of Clinical Neuroscience, Karolinska Institutet, CAMHS, PO Box 17914, SE118 95 Stockholm, Sweden.

E-mail: anna.lundh@sll.se

Abstract

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.

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