Characterizing the unmet mental health needs of urban adolescents

Background Untreated mental illness among adolescents is a serious public health concern. This study offers a classification tool for mental illness based on severity and identifies a starting point for needed interventions. Methods We assessed the prevalence and severity of serious emotional disturbances (SED)/serious mental illnesses (SMI) among transition-aged adolescents in an urban primary care practice and identified those with unmet needs. Medical records were abstracted for 16–22 year-old patients with at least one International Classification of Diseases (ICD)-9 diagnosis of serious emotional disturbances (SED)/serious mental illnesses (SMI) seen between May 1, 2014 and July 31, 2015. The primary outcome was whether 16–22 year-old patients with serious emotional disturbances (SED)/serious mental illnesses (SMI) diagnoses were connected to mental health care and associated factors including severity of mental illness, provider referral and psychotropic medication use. Results We identified 546 patients with a mean age of 18.8 years [standard deviation (SD) ± 1.7]. Ninety percent were African American and 86% were publicly insured. Based on the illness severity criteria, 189 (35%) were categorized as “mild”, 293 (54%) as “moderate” and 64 (12%) as “severe”. The majority (n = 460, 84.3%) had a mental health referral, but only 219 (40%) were connected to care. Adolescents aged 18–22 had 48% fewer odds to be connected to care compared to those aged 16–17 (odds ratio, 0.52; 95% confidence interval, 0.34–0.80; p-value = 0.003). Conclusions There is a gap in mental health services among a sample of minority adolescents in an urban environment with mental health needs. The gap is especially prevalent among older adolescents aging out of the pediatric system. Primary care providers (PCPs) are central to ensuring access to treatment, though they may be unable to meet the needs of patients with severe forms of serious emotional disturbances (SED)/serious mental illnesses (SMI). Our study characterizes the mental health needs of minority adolescents by severity and offers direction for identifying those who would most benefit from additional resources and support.

Measuring Functional Impairment in Children and Adolescents: Psychometric Properties of the Columbia Impairment Scale (CIS)

The role of measuring functional impairment holds an important place in research, clinical practice, and service provision for children and adolescents. Responding to the growing need to measure serious emotional disturbances at the local, state, and national level, the Columbia Impairment Scale (CIS) was developed in the early 1990s and has remained one of the several popular scales for assessing functional impairment. However, despite the growing popularity of the instrument in research and practice, only a few studies to date have specifically examined the psychometric properties of the CIS. In this article, we describe the results of the first item response theory analysis of the CIS utilizing nationally representative data from the Medical Expenditure Panel Survey ( N = 69,966). The results of our analysis lend support to the essential unidimensionality of the CIS and demonstrate that the scale is most reliable for those who exhibit high levels of functional impairment. Given the psychometric properties of the scale identified by our analysis, we contend that the CIS is a viable measure in the ongoing efforts to establish a national epidemiologic surveillance system to track the prevalence and impact of serious emotional disturbances in children and adolescents.

The use of oxybutynin for treating facial hyperhidrosis

BACKGROUND: Facial hyperhidrosis is a disease that may lead patients to serious emotional disturbances. Video-assisted thoracic sympathectomy provides excellent resolution of facial hyperhidrosis, but is associated with certain complications. The most frequent and important complication is compensatory hyperhidrosis. Especially in patients who have undergone resection of the second thoracic ganglion, the risk of severe compensatory hyperhidrosis is higher, which may cause dissatisfaction with the procedure. OBJECTIVE: The aim of this study was to evaluate the efficacy of the use of low doses of oxybutynin in treating facial hyperhidrosis as well as the level of patient satisfaction with its use. METHODS: 25 patients with facial hyperhidrosis were treated with oxybutynin. The patients underwent 2 evaluations: before and after treatment. These evaluations were used to assess the patients' clinical improvement and quality of life. RESULTS: We observed that more than 75% of the patients evolved with an improvement in facial hyperhidrosis, and 52% of them presented a great improvement. CONCLUSION: Treatment of facial hyperhidrosis with oxybutynin is a good alternative to sympathectomy, since it presents good results and improves quality of life, in addition to not exposing patients to the risk of experiencing the side effects of sympathectomy