Personalising care options in youth mental health: using multidimensional assessment, clinical stage, pathophysiological mechanisms, and individual illness trajectories to guide treatment selection

Cathrin Rohleder; Jacob J Crouse; Joanne S Carpenter; Frank Iorfino; Shane P Cross; Tracey A Davenport; Daniel F Hermens; Adam J Guastella; F Markus Leweke; Dagar Koethe; Sharon L Naismith; Elizabeth M Scott; Ian B Hickie

doi:10.5694/mja2.50383

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Personalising care options in youth mental health: using multidimensional assessment, clinical stage, pathophysiological mechanisms, and individual illness trajectories to guide treatment selection

Journal article

Peer reviewed

Personalising care options in youth mental health: using multidimensional assessment, clinical stage, pathophysiological mechanisms, and individual illness trajectories to guide treatment selection

Cathrin Rohleder, Jacob J Crouse, Joanne S Carpenter, Frank Iorfino, Shane P Cross, Tracey A Davenport, Daniel F Hermens, Adam J Guastella, F Markus Leweke, Dagar Koethe, …

Medical Journal of Australia, Vol.211(Supplement 9), pp.S32-S41

2019

DOI: https://doi.org/10.5694/mja2.50383

Appears in Thompson Institute Research Collection

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Abstract

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Thompson Institute Special Collection

UniSC Diversity Area - Disability and Inclusion

UniSC Diversity Area - Life Stages

New models of mental health care for young people require that interventions be matched to illness type, clinical stage, underlying pathophysiological mechanisms and individual illness trajectories. Narrow syndrome-focused classifications often direct clinical attention away from other key factors such as functional impairment, self-harm and suicidality, alcohol or other substance misuse, and poor physical health. By contrast, we outline a treatment selection guide for early intervention for adolescent-onset mood and psychotic syndromes (ie, active treatments and indicated and more specific secondary prevention strategies). This guide is based on experiences with the Brain and Mind Centre's highly personalised and measurement-based care model to manage youth mental health. The model incorporates three complementary core concepts: A multidimensional assessment and outcomes framework including: social and occupational function; self-harm, suicidal thoughts and behaviours; alcohol or other substance misuse; physical health; and illness trajectory. Clinical stage. Three common illness subtypes (psychosis, anxious depression, bipolar spectrum) based on three underlying pathophysiological mechanisms (neurodevelopmental, hyperarousal, circadian). These core concepts are not mutually exclusive and together may facilitate improved outcomes through a clinical stage-appropriate and transdiagnostic framework that helps guide decisions regarding the provision of appropriate and effective care options. Given its emphasis on adolescent-onset mood and psychotic syndromes, the Brain and Mind Centre's model of care also respects a fundamental developmental perspective -categorising childhood problems (eg, anxiety and neurodevelopmental difficulties) as risk factors and respecting the fact that young people are in a period of major biological and social transition. Based on these factors, a range of social, psychological and pharmacological interventions are recommended, with an emphasis on balancing the personal benefit-to-cost ratio.

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Title: Personalising care options in youth mental health: using multidimensional assessment, clinical stage, pathophysiological mechanisms, and individual illness trajectories to guide treatment selection
Authors: Cathrin Rohleder (Corresponding Author) - The University of Sydney
Jacob J Crouse (Author) - The University of Sydney
Joanne S Carpenter (Author) - The University of Sydney
Frank Iorfino (Author) - The University of Sydney
Shane P Cross (Author) - The University of Sydney
Tracey A Davenport (Author) - The University of Sydney
Daniel F Hermens (Author) - University of the Sunshine Coast - Thompson Institute
Adam J Guastella (Author) - The University of Sydney
F Markus Leweke (Author) - The University of Sydney
Dagar Koethe (Author) - The University of Sydney
Sharon L Naismith (Author) - The University of Sydney
Elizabeth M Scott (Author) - The University of Sydney
Ian B Hickie (Author) - The University of Sydney
Publication details: Medical Journal of Australia, Vol.211(Supplement 9), pp.S32-S41
Publisher: Wiley-Blackwell Publishing Asia
Date published: 2019
DOI: 10.5694/mja2.50383
ISSN: 0025-729X
Organisation Unit: University of the Sunshine Coast, Queensland; Thompson Institute
Language: English
Record Identifier: 99450835902621
Output Type: Journal article

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Collaboration types: Domestic collaboration; International collaboration
Web Of Science research areas: Psychiatry

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