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The article focuses on the management of youth with concurrent disorders, co-occurrence of substance use disorder and another mental disorder through an evidence-based lens. Topics include the development of a treatment program and quality improvement approach, the challenges of implementing measurement-based care (MBC), and the consideration of treatment decisions in cases of psychotic symptoms co-occurring with ongoing substance use.

The article describes the cases of teenagers undergoing dialectical behavior treatment (DBT) program and the role of medical marijuana in them. One clinician mentions that cannabis will not be prescribed to a 19-year-old patient in light of his high-risk behaviours with history of overdoses on medications. Another clinician explains the factors he will consider in examining the effect of a DBT program on the patient. Also noted is the lack of effect of age on managing the case of a 15-year-old.

Objective: Our group aims to improve treatment response for adolescents with depression through the use of an Integrated Care Pathway (ICP) we developed using: (1) recommendations from a high quality Clinical Practice Guideline (CPG); and, (2) a measurement-based care framework. Method: Pre-specified criteria will identify eligible adolescents in two outpatient hospital study sites. Study group allocation, to the ICP versus treatment as usual (TAU), is based on site of presentation. The primary clinical outcome is reduction of depression symptoms, assessed using the Childhood Depression Rating Scale – Revised (CDRS-R). Measures will be taken at baseline and every four weeks until 20 weeks of treatment has been offered. Results: Our overall hypothesis is that the ICP will be associated with greater improvement in depressive symptoms compared to TAU. Feasibility targets for this pilot trial include the following: recruitment of 30 participants per site over a 21-month period, 95% baseline assessment completion rates, 90% clinician adherence to the ICP in the intervention arm and 80% completion of the scheduled CDRS-R measures over the 20-week interval. Focus-group feedback from youth and parents will also produce qualitative information. Conclusions: If feasibility targets are met, and preliminary results regarding clinical outcomes are promising, then a multi-center cluster RCT would be pursued. [ABSTRACT FROM AUTHOR]

Objectives: Recent published evidence suggests that adjunctive trazodone treatment may limit serotonin reuptake inhibitor (SRI) response in depressed adolescents in the context of a controlled trial. This study examined the effects of adjunctive trazodone on depression outcome in adolescents in a naturalistic treatment environment. Methods: We conducted a cohort study through chart review of a clinical sample. Patients in our sample were 15 to 18 years of age treated with either a selective serotonin reuptake inhibitor or serotonin and norepinephrine reuptake inhibitor. The treatment took place in the setting of a partial hospitalization program at a tertiary care centre from 2009-2014. The main outcome measure was the change in Beck Depression Inventory II (BDI-II) score from admission to discharge. We compared this outcome in patients who were exposed to adjunctive trazodone treatment compared to adolescents who did not receive trazodone in the final four weeks of the program. Results: Exposure to trazodone was significantly associated with non-response to treatment in our sample (n = 35; β1 = -7.76; 95% CI -0.52 to - 15.0; p<0.05; R² = 0.13). In exploring potential confounders, higher baseline BDI-II scores appeared to predict greater change in BDI-II scores from pre- to post-treatment. Conclusion: In keeping with previous research, we found that trazodone exposure was associated with treatment non-response in adolescents taking SRIs. The findings should be interpreted cautiously since they are limited by small sample size. Future randomized controlled trials of trazodone in samples of adolescents taking SRIs for depression are warranted. [ABSTRACT FROM AUTHOR]

Objective: Establishing a diagnosis of Borderline Personality Disorder (BPD) in adolescents is often met with controversy, in part, due to potential stigmatizing effects. We wished to explore the adolescent patient experience of being diagnosed with BPD. Method: The Impact of Diagnosis Scale (IODS) is a self-report measure we developed with questions targeting patients' subjective experience of receiving a diagnosis of BPD. The IODS was administered to 23 adolescents approximately one month after a diagnosis of BPD had been disclosed to them. Results: Twenty-one participants had analyzable data. The internal consistency of the measure demonstrated Cronbach's alpha of 0.66. We found wide variability in responses. Patients tended to view the diagnosis as an accurate representation of their symptoms. Conclusion: The IODS represents a novel means by which clinicians might better appreciate how disclosing the diagnosis of BPD may impact a patient's understanding of one's difficulties. [ABSTRACT FROM AUTHOR]

Objectives: To examine the association between clozapine treatment and frequency of cannabis use in adolescents with co-occurring psychotic and cannabis use disorder in a retrospective cohort chart review. Method: We conducted a retrospective cohort chart review of patients diagnosed with a psychotic disorder and concurrent cannabis use disorder admitted to a tertiary care youth inpatient unit from 2010-2012. Longitudinal exposure and outcome data was coded monthby- month. Frequency of cannabis use was measured using a 7-point ordinal scale. Severity of psychosis was measured on a 3-point ordinal scale. Mixed effects regression modeling was used to describe the relationship between exposure and outcome variables. Results: Thirteen patients had exposure to clozapine and fourteen had no exposure to clozapine. Cannabis use decreased in patients treated with clozapine, compared to patients treated with other antipsychotics (OR 2.8; 95% CI 0.97-7.9). Compared to no medication, clozapine exposure was associated with significantly less cannabis use (OR 7.1; 95% CI 2.3-22.3). Relative to treatment with other antipsychotics, clozapine exposure was significantly associated with lower severity of psychotic symptoms (OR 3.7; 95% CI 1.2-11.8). Conclusions: Clozapine may lead to decreased cannabis use and psychotic symptoms in adolescents with concurrent psychosis and substance use. Clinical trials are warranted. [ABSTRACT FROM AUTHOR]

Objective: This study presents a comprehensive report of children and adolescents who engaged in self-harm during their admission to a psychiatric inpatient unit. Method: A chart review was conducted on all admissions to an acute care psychiatric inpatient unit in a Canadian children's hospital over a one-year period. Details on patients with self-harm behaviour during the admission were recorded, including: demographics, presentation to hospital, self-harm behaviour and outcome. Baseline variables for patients with and without self-harm behaviour during admission were compared. Results: Self-harm incidents were reported in 60 of 501 (12%) admissions during the one-year period of the study. Fourteen percent of patients (50 of 351) accounted for total number of 136 self-harm incidents. Half of these incidents (49%) occurred outside of the hospital setting, when patients were on passes. Using the Beck Lethality Scale (0-10), mean severity of the self-injury attempts was 0.33, and there were no serious negative outcomes. Conclusion: Self-harm behaviour during inpatient psychiatric admission is a common issue among youth, despite safety strategies in place. While self-harm behaviour is one of the most common reasons for admission to psychiatric inpatient unit, our understanding of nature of these acts during the admission and contributing factors are limited. Further research is required to better understand these factors, and to develop strategies to better support these patients. [ABSTRACT FROM AUTHOR]