Stephen Stathis

Head circumference in ELBW babies is associated with learning difficulties and cognition but not ADHD in the school‐aged child

This study examines whether a small head circumference (HC) and low head‐circumference growth velocity (HGV) during the first year of life predict consequences at school age in learning, cognition, and concentration. A total of 124 extremely‐low‐birthweight (ELBW) infants (birthweight 500 to 999 g) born between 1977 and 1986 were eligible for follow‐up at the corrected ages of 4, 8, and 12 months and 2, 4, and 6 years. Infants were categorized as having a small HC (<3% or 3 to 10%) on the basis of the 1990 British growth data which allowed standardized z ‐scores to be calculated for HC, independent of gestation and corrected age. HGV measurements were calculated using differences in the HC z ‐scores. In 1995, parents of 87 children agreed to participate in a study of learning and attention at school age. Attention‐deficit–hyperactivity disorder (ADHD) was assessed using the Du Paul Rating Scale. Academic performances were based on a teacher questionnaire dealing with aspects of reading, writing, mathematics, and spelling. A child was considered to have a learning difficulty if academic problems were present in at least one of these four areas. Intellectual ability was assessed using the McCarthy Scale at 6 years. HC <3% and 3 to 10% at 8 months’corrected age was strongly associated with school‐aged learning problems (P=0.004), with a moderate specificity (70%), positive predictive value (PPV) (67%), and sensitivity (67%). HGV ?10% from birth to 4 months was also associated with learning problems at school age (P=0.01) with a higher specificity (98%) and PPV (88%) but lower sensitivity (20%). A logistic regression analysis was performed with the risk for

A preliminary case series on the use of quetiapine for posttraumatic stress disorder in juveniles within a youth detention center

Abstract: Juveniles within the youth justice system have high rates of psychiatric morbidity, including posttraumatic stress disorder (PTSD). This case series describes 6 young people aged 15 to 17 years within a youth detention center who met the criteria for PTSD and reported an improvement in symptoms after 6 weeks of treatment with low-dose quetiapine. The primary outcome measure used was the Traumatic Symptom Checklist in Children. The dose of quetiapine ranged from 50 to 200 mg/d; T scores for PTSD symptoms decreased from 75 (SD, ±5.2; range, 68-82) to 54 (SD, ±7.4; range, 43-62) (P < 0.01). Significant improvements in symptoms of dissociation (P < 0.01), anxiety (P < 0.01), depression (P < 0.01), and anger (P < 0.05) were also noted over the 6-week evaluation period. Low-dose quetiapine was tolerated well, with no persisting side effects or adverse events. Nighttime sedation was reported, although this was viewed as beneficial. All young people opted to continue with treatment after the assessment period. This preliminary case series suggests that juveniles in detention who have PTSD may benefit from treatment with quetiapine. Caution is needed in interpreting these findings. Both larger open-label and blinded trials are warranted to define the use of quetiapine in the treatment of PTSD in the adolescent forensic population.

Use of the Massachusetts Youth Screening Instrument to assess mental health problems in young people within an Australian youth detention centre.

Aim:  To screen for mental health problems in an Australian adolescent forensic population, evaluate the Massachusetts Youth Screening Instrument Version 2 (MAYSI‐2) in providing a preliminary assessment of those needs, and to explore the level of mental health problems in vulnerable populations within detention.

Behavioural and cognitive associations of short stature at 5 years.

Objectives: To determine the extent to which childhood short stature is associated with cognitive, behavioural and chronic health problems, and whether these problems could be attributed to recognized adverse biological, psychosocial or psychological factors.

Developing an integrated substance use and mental health service in the specialised setting of a youth detention centre

This article describes the frequency of co-morbid substance use and mental health problems of young people within the youth justice system and demonstrates that mental health and drug and alcohol services can be integrated and work effectively. The establishment of an integrated Mental Health Alcohol Tobacco and Other Drugs Service (MHATODS) to juveniles in detention represents a shift away from the traditional paradigm of separate services frequently found throughout Australia. The development of referral procedures and adolescent-focused treatment programmes that are tailored to the specific needs of this disadvantaged population are discussed. A wide-ranging literature review illustrates the consequences of the high prevalence of co-morbid substance use and mental health problems in juveniles within the youth justice system. A retrospective and descriptive account is given of the expansion of the MHATODS, including the recruitment of an Indigenous health worker, the incorporation of an automatic referral process for young people with substance use problems and the development of a brief four-session drug and alcohol counselling programme and a group relapse prevention programme. The proportion of Indigenous clients referred to MHATODS is now equitable to referrals of non-Indigenous youth. The introduction of an automatic voluntary referral process resulted in an increase in referrals for drug and alcohol assessment and counselling from 17% to 64% of total referrals. Of those young people commencing the drug and alcohol programme, 32% completed all sessions. While young people reportedly enjoyed the group programme, feedback from participants indicated that they felt vulnerable in a group setting. MHATODS recognises the limitations of the prevailing paradigm of separate service delivery for mental health and drug and alcohol treatment, and has developed an integrated treatment service for juveniles in detention. The service has expanded its referral base for substance use problems by employing an Indigenous health worker, and initiating an automatic referral process for young people admitted into detention who have a history of significant substance use. Early evidence indicates increased utilisation of drug and alcohol services by young people in detention.

E-CYMHS: an expansion of a child and youth telepsychiatry model in Queensland.

Objectives: The purpose of this study was to describe the evolution of the E-Child and Youth Mental Health Service (E-CYMHS), which supports regional and rural mental health services by providing access to consultant child and adolescent psychiatrists to isolated staff in regional areas, where access to specialist psychiatric services is limited. Conclusions: E-CYMHS provides a level of parity in mental health care between metropolitan, regional and remote services through the provision of regular videoconferencing services with child and adolescent psychiatrists and senior allied health clinicians. The three key features which underpin the success of the service are: 1. A central co-ordinator of services; 2. Provision of support outside regular videoconference times; and 3. Routine outreach visits that foster community capacity-building. E-CYMHS has been well received by the regional mental health services it supports, and the total provision of services has more than doubled over the last three years. It is anticipated that as telepsychiatry is increasingly viewed as a credible alternative to traditional means of patient care, this trend is likely to continue.

A cost-minimization analysis of a telepaediatric mental health service for patients in rural and remote Queensland

The e-Child and Youth Mental Health Service (eCYMHS) is delivered by videoconferencing to nine rural and regional sites in Queensland. Between July 2004 and December 2006, a total of 317 videoconference clinics were offered, with 606 patient consultations. A cost-minimization analysis was undertaken to compare the actual costs of videoconference consultations with the potential costs of face-to-face consultations with the same specialists in Brisbane (i.e. patient travel) and the potential costs of face-to-face consultations in the regions (i.e. visiting psychiatrist). The actual cost of providing telepaediatrics during the 30–month period was

Telemedicine for rural and remote child and youth mental health services

230,753 (

A mental health and substance abuse service for a youth detention centre

1 = US

A comparative assessment of suicide risk for young people in youth detention

0.86 or €0.63). The potential cost of patient travel was