Naturalistic experience with the use of divalproex sodium on an in-patient unit for adolescent psychiatric patients.

This paper focuses on the importance of data collected not only from controlled clinical trials, but also from naturalistic treatment experience. In particular we examine the use of divalproex sodium either as monotherapy or as part of combined therapy on an in-patient ward for adolescents aged 13-18 years. All admissions in which divalproex sodium use was attempted (n=36) were analysed over a 1-year period. The most common use was in patients with a mixed-presentation bipolar disorder (n=16), followed by patients with major depression (n=7), mania (n=4) or psychoses not otherwise specified (n=4). Divalproex sodium use was evaluated in the control of mania, psychosis, agitation, mood swings, aggression and/or anxiety. Overall, the use of divalproex sodium was associated with a marked improvement along all psychopathological variables in the vast majority of patients. Few side-effects or medical complications were noted. We believe that divalproex sodium is a potentially useful drug in adolescent patients with varying forms of psychopathology.

Child survivors of suicide: psychosocial characteristics.

OBJECTIVE: To describe psychosocial characteristics of children and young adolescents who experienced the recent suicidal death of a parent or sibling. METHOD: Sixteen families with children aged 5 years to 14 years and who experienced the suicidal death of a relative on average within the year of research assessment were recruited from the community and evaluated with standard research instruments for levels of children's psychiatric symptoms and social adjustment. RESULTS: Child survivors of suicide had a higher rate of internalizing symptoms and poorer school adjustments than a standard community sample. Twenty-five percent of the families had children who reported clinically significant symptoms of depression. Approximately 40% of the families included children who reported at least moderate symptoms of posttraumatic stress. Approximately 31% of families had at least one child who reported suicidal ideation, but no child reported a suicide attempt. Significant associations were identified between psychosocial features of the children and parental psychiatric symptoms and stressful life events. CONCLUSION: Child survivors of suicide are at risk for psychiatric symptoms and social maladjustment which require early identification and preventive intervention to minimize risk for more extensive psychosocial morbidity.

Nursing shortage requires lasting solution, not a quick fix.

The current nursing shortage is different from previous ones because downsizing of acute care hospitals, decentralization through service or product line organizational structures, and development of alternative delivery modes have changed both organizations' and health professionals' roles and functions. In today's changing, tightly controlled health care environment, a nursing shortage would be far more serious than previously. Nursing resource planning must take into account the future health care delivery system and concomitant needs for specific numbers and types of nurses. Long-range planning for the nursing shortage must incorporate short-term activities to solve immediate staffing problems within the broader context of strategic change. In the future, attenuated growth of acute care facilities and continued development of care delivery in noninstitutional settings will affect nursing care and change both its clinical and management elements. Planning to meet future requirements for patient care services is focused on four target areas: Ensuring that the nursing staff is qualified for current practice and new services. Developing the nurse's role as patient case manager in the managed health care system. Establishing rewarding careers for nurses in clinical roles, management roles, and other specialized functions. Collaborating with nursing schools in clinical practice, research, and joint ventures. Planning to promote nurses' satisfaction in a variety of organizational settings includes the following: Developing ways to use nursing staff more effectively. Evaluating organizational factors that promote high-quality care. Developing efficient and effective health care teams. Establishing forums for promoting change.