a model screening program for youth ok para seguir.pdf ok

8/13/2019 A Model Screening Program for Youth Ok Para Seguir.pdf Ok

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A m od e l sc reen ing p rog ram fo r you thColumbia University's TeenScreen program brings kids' mental health issues to lightBY SARAH SILBERT HINAWI E D M

think th t thesurvey that I just tookwasveryhelpfuL.anditgavemeachanceto let someone know how Ifeel.

IthinkaboutHulestiifflikethatiustabouteveryday, hut I have no one totell.

This interview made m e feel that some-one cared about m y eelings, that someonemight have felt the same way I did.

It helped m e relieve some problems in-side that I haven't told [anyone] else.

I think that everyone should take theTeenScreen.. .if they need to get sometliingoff their chest and feelgood....

hese are some respotises from partic-ipants in the Columbia UniversityTeenScreen Program, a vokincary

mental health and suicide-risk screeningprogram beingconductedat more than 450site5 around the nation. Specifically, thesestudents took the DISC Predictive Scales(DPS), a self-administered, computerizedinterview that screens for eight DSM-IVdisorders and suicidality. The DPS is oneof several screening instruments currently-offered hy TeenS creen, a prog ram that pro -vides screening instrum ents and a structuredclinical and case management protocol tohelp identify youth who are struggling,notify theirparents, and sup port families inconnecting to local mental health servicesfor further evaluation.

Although no d ebate occurs about the sig-nificance of you th suicide and men tal illnessas problems in todays society, dehate has

surrounded what m ethods are most successful at preven ting and abating these problem sPopular approaches include educational programs, ho t lines, and m ost recently, screeningPresident Bush s New F reedom Com missionon Mental Health recommended that earlymentai health screening, assessment, andtreatment be common practices. In factthis report identified TeenScreen as a modeprogram for early intervention,*

Studies condu cted on the TeenScreen Program have provided the following support: Screening finds high-school students who are

suffering silently from life-threatening mentalhealth conditions. In a study of almost2 000high-school students who p articipated in aTeenScreen assessment, 74 of studen tswho were contemplating suicide and 50 ofstudents who had made a prior suicide at-tempt were not previously known to be havingproblems by school personnel. In addition,69 of students found to be suffering fromdepression were also unknown.'

Screening is an accurate predictor of mentalhealth problems that may develop into m oreserious conditions. In one sttJdy, screen-ing identified 6 4 of those who went on toexperience recurrent depression or becomesuicidal in young adulthood.Th e TeenScreen Program s basic structure

includes five elements: Pare ntal conse nt. Parental consent is

required for every screening program. Par ticipa nt ass ent. Youth are presented with

their confidentiality rights and are given thechance to sign on or opt out of the screeningprocess.

ontinuedonpage'To read what the President's NewFreedom ommonMental Health said about[heTeenScreen Progrits inal report,visitwww. mentaUjealthcommissigovlreportslFinalReportlFullReport-05.htm.


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with Furosemide in Elderly Patients wlHi Dementia-Related Psychosis in placebo-contioiled trials elflerty paiienis wiiti dementia-related psycriosis, a higher incidence ol moiaiity was oCsen/edin patients ireated with (urosemide pins oral risperidone / .a^: mean age 89 years, range 75-97} whencompared lo patients treated wrttior airisp erido re alone (3 T i ; mean age 84 years, range 70-96) of turosemidealone (4.r=: mean age 80 years, range 67-90}, The irtcraase in mortaiity in paeenis treated ujith fiKosemidepius orai nsperidone was o bserved in two ol the tour citntcai trials.No paldopfiysiotogicai meclianism has teen idenliiied to expiain Ihis linding. and no consistent paltem br causeof death obsen/ed. Nevertheless, caution shojkJ te exercised and Ihe risks and benelits o( ihis combinationshould be ccnsidersd pnor lo the decision lo use There was nc increased incidence a mcrtalny among patientslaking other diuretics as conccmiiant medication with rispendone. Irrespective of treatment, dehydration was anoveraii nsi< factor fcr mortality and should theretore be caretully avoided in elderly patients wrth dementia-relatedpsychosis RISPERDAL*' CONS TA' is not approved lor the treatment of patients with dementia-relatedpsychosis. iSee also Boxed WARNmC WARNINGS: Increased Mortal i ty in Elderly Pat ients wi thDementia-Helated Psychosis)ADVERSE REACTIONSAssociated with Disconlinualion of Treatment in the t2-week, placebo-controlled trial, the incidence olschizophrenic patients who discontinued treatment due to an adverse event was lower with RiSPERDAL'CONSTA' ( t1 % ;221202 patients} than miih placebo (1 3 : 13/98 patients).Incidence in Controlled Trials Commonly OtiservedAdverse Events in Conlrolled Cllnicat TrialsIn the 12 week placebo-controUsd tnaL spontaneously reported, trealment-emergeni adverse evenls with anincidence ol 5% or greater in ai least ooe cf ifie RlSPERD AL' CONS TA" groups (25 mg or 50 mg | and at leasttwice that of pl a c ^ were: somnolence, akalhisia, partunsonism. dyspepsia, constipation, dry mouth, laligue,weight increase. Adverse Events Occurring at an Incidence ol 2 or More in Patients Trealed withniSPERDAL* CONSTA"" were at least as Irequent among patients treated wtlh 25 mg or 50 mg RiSPERDAL"CONSTA" as patients trealed wiUi piaceOo in the 1 2-week, piacebo-conlrolied trialDose Dependency of Adverse EventsEilc apy ami da; Symptoms The overall incidence of EPS-related adverse events (akathisia. dystonia,parkinsonism, and iremor} in patienis trealed with 25 mg filSPERDAL- CONSTA" was comparable to that ofpatients ireated wilh placetm: the incidence cf EPS-reiated adverse evenfs was higher in pafients treated with50 mgRISPERDAL'CONSTA*^.Vital Sign Changes: RISPERD AL* is associafed with orthostatic hypotension and taotiycardia (seePRECAUTIONS}. In the placet)o-controlled trial,orthostatic hypotension was observed 2% ol patients treatedwith 25 mg or 50 mg RISPERDAL- CONSTA^ (see PRECAUTIONS).WeigM Changes:In the 12-week, piacebc-conlrclled tnal,9o of patients Ireated wilh FUSPERDAL" CONSTA*,compared witri 5 of palienis Ireated with placebo, experienced a weighi gain ol i7 of body weight atendpointLaboratory Changes:The percentage ot patients treated with RISPERDAL" CONSTA* who expenencedpotentially mportanl changes in routine serum chemistry, hematology, or urinalysis parameters was similar to orless than that ol placebo patients Additionally, no patients discontinued treatment due to diange s in serumchemislry. hematotogy, or unnaiysis pafarreters,EC GChanpes.-The electrocardiograms ol 202 schizophrenic palients treated with 25 mg or 50 mg RISPERDAL *COMSTA' and 98 stfiizophrenic patients treated with placebo in a 1 2-week, double-blind, placebo-cootrolled trialwere evalualed. Compared with placebo, there were no statistically signrticani differences in OTc intervals (usingFridericia's and linear correction lactors} during trealment wiBi niSPE RDAL" CONSTA".Pain assessment and local miection sile reactions: The mean intensity of iniection pain reported by palientsjsin g a visual analog scale decreased in all treatment groups Irom the first to the lasl inieclion Alter the sisthinfection (Week 10}. invesligalor ratings indicaled Ihal1 % of patients treated wrlh 25 mg or 50 mg RISPERDAL*CONSTA" experienced redness, swelling, or indjralion at Ihe injection siteOther Events Observed During the Premarkel ing Evaluat ion of RISPERDAL* CONSTA* Djring i tspremartteling assessment. RISPERDAL' CONSTA'' was administered to 1499 patients in mulliple-dose sludiesThe conditions and duration of exposure lo RISPERDAL'"' CONSTA ' vaned greatly, and included (in overlappingcalegones) cpen-label and double-blind sludies, uncontrolled and controlled studies, inpatient and outpatientstudies, lied-dose and ntration siudres. and short-term and long-ierm exposure studies. The lollowing reactionswere reported: (Note frequent adverse events are ihose occurring in at leasl 1/100 patients Inlrequent adverseevents are Ihose occumng in 1/100 to 1/1000 patients, rare evenls are those occurring in fewer Ihan 1/1000patients. II is important to emphasize Ihal, although the events reported occurred during treatment withRISPERDAL' CONSTA', they were not necessarily caused by it.}Psychiatnc Disorders requentaniiety, psychosis, depression,agitation, naivouaiess, paranoid reaction,delusion.apalfiy. Inlrequent: anorexia, impaired conceniration, impolenre, eniotuxial lability, manic readion, decreased libido.increased appetite, amnesia, confusion,euphona, depersonalizalk)n, paronina, delinum, psyOiotic depression.Central and Periphery Nervous System Disorders Frequent- tiypertonia, dystonia. Infrequent- dyskinesia.vertigo, ieg cramps, lardive dyskinesia', involuntary muscle contractions, paraesthesia, abnormal gait,bradykinesia. convulsions, hypokinesia. alaxia, fecal incontinence, ocuk)gync cnsis, letany, apraxia. dementia,migraine.Ram.neuroleptic malignant syndrome.Body as aV^ole/GeneralDisordws Frequent: back pain,chest pain,asthenia. Inlrequent.malaise, choking.Gasttoinlestinal DisordersFrequent:nausea, vomiting, abdominal pain Inlieqtient:gastntis, gastroesophagealreflux, flatulence, hemontioids, melena. dysphagia, recial h emc rtiage, stomatitis, colitis, gastnc ulcer, gingivitis,irritable bowel syndrome, ulcerative stomatilis mspiratory System Disorders FmQueni:dyspneaInlrequentpneumonia, stridor, hemcjptysis Hare: pulmonary edema. Skin and /^ipendage Disorders Frequent rasti.Inlrequent eczema, pruritus, erythematous rash,d enraiilis, alopecia, seborrbea, pholosensitivity reaction,increased sweating. Metabolic and Nutritional Disorders Intiequent- hyperuricemia. hyperglycemia,hyperlipemia, hypokalemia, glycosuria, hypercholesterolemia, obesity, dehydration, diabetes mellilus,hyponatremia. Museulo-Skeletal System Disorders Frequentarthralgia. skeletal pain inlrequeni-torticollis,arttirosis, muscle weakness, tendinitis, arthritis, arthropathy. Heart Rate and Rhythm Disorders Frequent:tachycardia Inlrequent: bradycardia, AV block, palpitation, bundle t)ranch block, flare. T-wave inversionCardiovascular DisordersFrequent-hypotension Inlrequent:poslural hypolension.Urinary System DisordersFrequent unnary inconlinence tnlrequenthematuria. mictunticn frequency, renal pain, unnary retention VisionDisorders infrequent: coniunctivitis. eye pain, abnonnal accommodalion Reproductive Disorders, FemaleFKQuenl.amenorrtiea. Intrequent: nonpuerperal lactation, vaginilis, dysmenorrhea. breast pain, leukorrheaResistance mechanism Disorders Infrequent:abscess. Liver and Biliary System Disorders Frequeniincreased hepatic enzymes Intiequeni. hepatomegaly, increased SGPT. flare: bilirubinemia, increased GGT,fiepalitis, hepatocellular damage, laundice, fatty liver, increased SGOT. Reproductive Disorders, MaleInfrequent ejaculation failure Application Site DisordersFrequent- infection silepain.Inlrequent. miection sitereaction Hesring an d Ve sfibo/arOisorderslnfrequ enl: earache, dealness.heanng decreased Red Blood CellDisordersFrequent anemia White Celt and Resistance Disorders Inlrequent:lymphadencpalhy, leucopenia,cervical lymphadenopalhy Hare granulocytcpema, leukocytosis, lymphcpema.Endocrine DisordersInlrequent:hyperprolactmemia, gynecomastia, hypothyroidism. Platelet, Bleeding and Clotting Disorders Inlrequentpurpura. epistaxis. Rare,pulmonary embolism, hematoma thrombocylopenia. Myo-. Er\do-, and Pericsrdialand Velve Disorders Infrequent:myocardial ischemia, angina pectoris, myocardial inlarction VasculariExtracardiac) DisordersInltequent-phletiilis Rare:intermitleni claudicalion. flushing, thrombophlebitis,Postintroduction Reports Adverse events reported since market introductbn which were temporally (bul notnecessarily causally) relaled to oral RISPERDAL' therapy include the following: anaphylaclic reaction,angioedema, apnea, airial fibnllation, cerebrovascular disorder, including cerebrovascular accident,hyperglycemia, diahetes melMus aggravated, including diabetic ketoacidosis, intestinal obstnjction, laundice,mania, pancreatitis, Parkinson's disease aggravated, pulmonary embolism. There have been rare reports ofsudden dealha/id/orcardiopulmonary arrest in patients receiving oral RISPERDAL" A causal relationship withoral RISPERDAL* has not been eslablished. It is importani to note lhat sudden and unexpected death may occurin psychotic patients vilieffier they remain untreated or wtielher they are trealed with oUier anbpsychotic dnjgs .DRUG ABUSE AND DEPENDENCE

Controlled Substance C lass RISPERDAL' CONSTA* (nsperidone} is not a controlled substance.For more information on symptoms and trealment of overdosage, see full prescribing information,7519504 - US Patent 4,804,663 Revised April 2005 Janssen 20030t-CS-352BS

J AN SSEN PHARMACEUTICAPROOUCTS, L.PiluSviile.NJ 03560

ADOLESCENTS

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Instrument administration Once assent has been obtained, theparticipant completes a screening instrument. These instruments arenot diagnostic but do identity which youths are at risk and need morescreening.

Clinical interview Ttie ciinicai interview is an essential part ot thescreening process. During this interview, a mentai health protes-sional assesses the screening instrument's results and based on thisassessment, determines the need for further evaluation. Approximatelyone-third ot those who take the screening instrument go on for a clinicalinterview,

Case manag emen t/parental notification Tomake the link to furthermental health services for identified teens (usually 17% of the originalpopulation screened w ill need this kind of referral), some case manage-ment is necessary. This inciudes contacting parents, providing inform a-tion and resources, and helping families that accept the referral throughat least the first appointment.

T he ieenS creen Program 's streng th is in several key anduniqueattr ibutes :

Screening instrument breadth and effectiveness All ot thescreening instrumen ts used by tbeTeenScreeii Program have beendeveloped and researched by the Division of Child and AdolescentPsychiatry at Colu mb ia University. Mos t ' leenSer een sites use oneof two main screening instruments, the Columbia Health Screen(CHS) and the DPS. Both instruments are the subject of researchpublished in tbe journal ofthe American Academy of Child andAdolescentPsychiatry which has shown them to be effective andvalid screening tools.' '

T h e C H Sis apaper-and-peneil screen looking for the risk factorsfor suicide, and it includes questions about depression, suicidalideation and attempts, anxiety, alcohol and drug use, and generalhealth problems. It usually takes about ten minutes to complete,and it can be used for you th ages 11 to 18. Th e C H S is availablein English and Spanish.

Th e D PS ts a com puterized mental health screen that includesquestions abou t depression, suicidal ideation a nd attem pts, anxiety,alcohol and drug use, and general health problems. It is designedfor youth ages 9 to 18, and it also takes about ten minutes tocom plete. Participants take tbe screen on a com puter and hear thequestions read aloud through headphones. The DPS is availablein English and Spanish.

Program flexibility and acco mm oda tion No two TeenScreensites run the same way. Because of screening programs' diverse


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DOES MORE THANONEDIAGNOSISMEAN MORE THAN ONE TREATMENTPROVIDER?A t R o g e r s M e m o r i a l H o s p i ta l w e s p e c ia l iz e i n d u a l a n d m u l t i p l ed i a g n o s e s . O u r c o n t i n u u m o f re s i d e n t ia l m e n t a l h e a l th c a r e ism a n a g e d b y fu l l - t i m e o n - s t a f f m e d i c a l e x p e r ts .

E a t i n g D i s o r d e t s C e n t e rO b s e s s i v e C o m p u l s iv e D i s o rd e r C e n t e rH e r r i n g t o n R e c o v e r y C e n t e rC h i l d A d o l e s c e n t C e n te r

J C A H O a c c r e d i te dF re e p h o n e a s s e s s m e n t s1 800 767 4411

w w v i / . r o g e r s h o s p i t a l . o r gC I R C L E 1 2 ON R E A D E R S E R V I C E C A R D

The Joint Commissioncongratulates

Pikes Peak lVlentalHealth CenterColorado Springs Colorado

Winnerof the 2005Ernest Amory Codman AwardThe Codman Award recognizesexcellence in the use of perform-ance measures to achieve healthcare quality improvement.www.jcaho.org/codman.htm

J o i n t o m m is s i o non ccreditation otHealthcare OrganizationsSettingth Standardtoraaality inHealBi CareClltCLE13ON READER SERVICE CARD

ADOLESCENTS

naturescreenings have been conducted everywhere from fostecare toclinics, to themost comm on setting, schoolspro tocolare developed to accommodate each screening environm ent .

TeenScreen staff and materials provide guidancefor developinsites on how screening might work in their comm unity or organization, and they help design a screening strategy specific to their nee dand goals. A selection of in strum entsis available (computerized opaper-and-pencil). Staff selection can vary significantly, accordinto individua l stafFqualifications and availability, and screening cabe conducted usingavariety ofme thods and environments .

Affordability TeenScreen provides itsservicesconsulting, training, aiid programmatic materialsand screening instruments yrfofch rgeto qualifying communities (this qualification isbased ocommi tmenttoscreening, as well asscreening plan andpotential)This means that theprogram s only costs arerunning it on thesitlevel, which includes staffing, adm inistrative costs such as filinganmailing supplies,and other optional costs such as computers.Clinical and case management guidelines Th e goal of screening young peopleformental health disorders andsuicidality is tensure that identified y outh get a complete m ental health evaluatioan d anyother help they need. TeenScreen is the only screeninprogram for youth that offers as t ructure for clinical foUow-uand case managem ent. These p rotocols were developedbyclinicafaculty in Colu mb ias Division of Child and Adolescent Psychiatryand they offer cliniciansandcase tnanagers tools and guidelines tconduct their work. These materials both facilitate and safeguarthe clinical interview andcase manag emen t process, making aaccurateandeffective referral m ore likely.

TeenScreenhasgon e from itsinception as a research project inthe early 1990s to anational p ublic-health initiative today. Withstatewide screening initiatives underw ayinFlorida, Iowa, Nevad aNew M exico,andOhio ; new federal legislation suppo rting screenin gas ame thod ofsuicide prevention and providing funding folocal screening efforts; and an ever-expanding number of siteth roughout the country, the program has never been clo.ser tachieving itsgoal of offering avoluntary mental health screeninto allAmerican youth, BH M

Sarah Silbert Hinawi, EdM,wasformerly the Special Projects Coordinatorfothe Columbia Univers ity TeenScreen Program. For mote info rmatio n, please visw ww .teens cr een.otg.

To send comments tothe at ithot and ed itors, please e-mail teenscreen1105behaviotal.net. To otdet repr ints in quantit ies of 100 or mote, call 866) 376454.References

1. Shaffer D Craft L. Methodsot adolescent suicide prevention. JClin Psychiatry l999;60(suppl 2):70-4.2. McCu ireL, Flynn L.The C olumbia TeenScreen Program: Providing mentahealth check-ups toyouth. Emotional andBehavioral Disorders inYout2003;2:83-6. Shaffer D, Scott M, Wilcox H.etal. The Columbia Suicide Screen: Validitand reliabilityofascreen for youth suicide and depression. J Am Acad Chil

Adolcsc Psychiatry 20 04;43:71 -9.4. Lucas CP, Zhang H Fisher I W,etal. TheDISC Predictive Scales (DPSEfficiently screenmg for diagnoses. | Am Acad Child Adolesc Psychiatr


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a model screening program for youth ok para seguir.pdf ok

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