Adolescent Psychiatric Unit Research Articles

Year one review: Staff perception on the implementation of the chair restraint on an adolescent psychiatric inpatient unit.

The purpose of this project was to assess perceptions, thoughts, and feelings of psychiatric mental health nursing staff when utilizing the chair restraint on an adolescent unit. Furthermore, to explore decision making related to choosing the chair restraint verses choosing to use the six-point board as a safety management intervention. This was a phenomenological qualitative study, utilizing semistructured interviews to explore the experiences of nursing staff, consisting of behavioral health specialists, and direct-care staff nurses who work on an adolescent psychiatric unit utilizing both chair restraint and the six-point board. Ten nursing staff were interviewed. Using thematic analysis, staff perceptions, thoughts, and feelings when using mechanical restraints for safety management were explored. Demographics were collected however, there was no variability in the responses and saturation was reached. Five themes emerged from the interviews. The Five themes that emerged were: Restraint chair was less traumatic and preferred, feelings of defeat when de-escalation was not successful, pushing away emotions as protection, units were short staffed, and patient behaviors were seen as a potential barrier to eliminating the six-point board. The results of this study will be used to guide to further develop behavioral health education, orientation for new staff, and to understand ways to support staff through their experiences in managing a patient's unsafe behaviors.

The use of physical restraints and PRN medications in adolescent psychiatric inpatient units.

Although physical restraint practices and psychotropic/sedative pro re neta (PRN, as needed) medications have been commonly used for managing inpatient aggression, little is known about the characteristics of adolescents who receive them in psychiatric adolescent inpatient units. We aimed to determine the relationship between the use of physical restraints and psychotropic/sedative PRN medications, and to characterize individual attributes, substance use, clinical factors, and time of the first restraint episodes of the use of physical restraints and psychotropic/sedative PRN medications. A retrospective case-control study approach was used with the data from electronic health records at a pediatric psychiatric hospital in the United States. Descriptive statistics, χ2 , multivariate logistic regression, and Cox proportional hazard model were used. Participants of younger age and participants with a longer length of stay were significantly associated with the use of physical restraints and psychotropic/sedative PRN medications, although the substance-related risks were not significantly associated with the use of restraints. Physical restraints were more likely to have occurred soon after the admission and tapered off as the length of stay increased. This study provides important information in understanding the risk factors of the use of restraints and psychotropic/sedative PRN medications in psychiatric adolescent inpatient units.

Lived experiences of adolescents admitted for first-episode psychosis in South Africa.

First-episode psychosis is common in adolescents and can be distressful to the person experiencing it for the first time. However, there is limited research globally and specifically in Africa about the lived experiences of adolescents admitted into a psychiatric facility for first-episode psychosis. To understand the adolescents' experiences of psychosis and receiving treatment in a psychiatric facility. Adolescent Inpatient Psychiatric Unit, Tygerberg Hospital, Cape Town, South Africa. This was a qualitative study that used purposive sampling to recruit 15 adolescents with first-episode psychosis and admitted to the Adolescent Inpatient Psychiatric Unit, Tygerberg Hospital in Cape Town, South Africa. Individual interviews were audio recorded, transcribed and analysed using thematic analysis consisting of both inductive and deductive coding. The participants described negative experiences of their first episode psychosis, provided varying explanations for their first episode psychosis and had the insight that cannabis precipitated their episodes. They described both positive and negative interactions with both the other patients and staff. They did not wish to return to the hospital again following their discharge. Participants stated that they wanted to change their lives, return to school and try to prevent a second episode of psychosis. This study provides insights into the lived experiences of adolescents presenting with first-episode psychosis and calls for future research to delve deeper into factors that support or enable recovery among adolescents with psychosis. The findings of this study call for improving the quality of care in the management of first-episode psychosis in adolescents.

Prevalence and correlates of restrictive interventions in an Irish child and adolescent psychiatric unit: a 4-year retrospective study

BackgroundThere has been a global effort to reduce the use of restrictive interventions (RIs) in healthcare settings. In order to reduce unnecessary RIs, it is essential to understand their use in mental health settings. To date, there have been few studies examining the use of RIs in child and adolescent mental health settings, with no such studies in Ireland.AimsThe purpose of this study is to examine the prevalence and frequency of physical restraints and seclusion and to identify any associated demographic and clinical characteristics.MethodsThis is a 4-year retrospective study of the use of seclusion and physical restraint in an Irish child and adolescent psychiatric inpatient unit from 2018 to 2021. Computer-based data collection sheets and patient records were retrospectively reviewed. Eating disorder and non-eating disorder samples were analysed.ResultsOf 499 hospital admissions from 2018 to 2021, 6% (n = 29) had at least one episode of seclusion and 18% (n = 88) had at least one episode of physical restraint. Age, gender and ethnicity were not significantly associated with rates of RI. Unemployment, prior hospitalization, involuntary legal status and longer length of stay were significantly associated with higher rates of RIs in the non-eating disorder group. Involuntary legal status was associated with higher rates of physical restraint in the eating disorder group. Patients with a diagnosis of eating disorder and psychosis had the highest prevalence of physical restraints and seclusions respectively.ConclusionsIdentifying youth who are at greater risk of requiring RIs may allow early and targeted intervention and prevention.

Interpersonal violence and recurrent headache among adolescents with a history of psychiatric problems

BackgroundInterpersonal violence (IPV) is found to be associated with mental health problems and pain disorders such as headache among children and adolescents. It is well-known that adolescents in need of mental health services have experienced IPV more often than adolescents in the general population. However, there has not been much focus on pain conditions in child and adolescent psychiatric populations.MethodsData from the current study are based on a 3-year follow-up of the CAP-survey, which is a study of adolescents in the child and adolescent psychiatric unit population of St. Olavs Hospital (Trondheim University Hospital). The baseline study was conducted between 2009 and 2011, with 717 participants between 13 and 18 years. All participants were enrolled, or newly referred to the child and adolescent psychiatric clinic. At follow-up, 570 participants completed questionnaire, and 550 completed a diagnostic interview. The participants were aged 16–21 years (mean age 18.6 years).ResultsA third of the adolescents reported frequent headaches (weekly or daily). Adolescents with more severe mental problems were more likely to experience frequent headaches. Adolescents exposed to unpleasant sexual acts or bullying, reported more frequent headaches than non-exposed participants. Participants exposed to three or more types of IPV seemed to be at particularly high risk of experiencing frequent headache.ConclusionsBoth experiences of interpersonal violence and headache are common in this clinical psychiatric population. Clinicians should assess for headache disorders in addition to psychiatric and trauma assessment and provide need-based treatment to enhance chance of recovery among adolescents in mental health services.

Family oriented intervention for families of adolescents with attention deficit hyperactivity disorder: A feasibility study.

Based on eight research criteria, this study examines the feasibility of a 5-week Family Strength-Oriented Therapeutic Conversation (FAM-SOTC) for caregivers of adolescents diagnosed with attention deficit hyperactivity disorder(ADHD); this intervention aims to improve outcomes of both caregivers and adolescents. The FAM-SOTC intervention was implemented at an adolescent psychiatric outpatient unit with 10 caregivers of 10 adolescents diagnosed with ADHD. The feasibility criteria were addressed through survey responses, diary reports, and a one-group pre- and posttest quasi-experimental design. The assessment of eight feasibility criteria showed promising results for the further evaluation of the intervention. This feasibility study has produced promising results, which represent a step toward a more extensive study, designed to evaluate a protocol that may offer educational and supportive programs for families of adolescents with ADHD, enhancing their self-management behavior. Further studies are warranted to test the FAM-SOTC intervention using a larger sample.

A systemic‐oriented child and adolescent psychiatric unit in Piraeus, Greece: Sailing in troubled waters

AbstractA systemic approach to child and adolescent psychiatry involves not only the immediate family but also the wider environment in which the subject lives. Despite growing evidence confirming the effectiveness of systemic family therapy in child and adolescent psychiatry, this approach is not well represented in inpatient services in Greece. We present systemic principles as practiced at a child and adolescent psychiatric inpatient clinic embedded in a general hospital. We consider the competencies and strengths achieved by the team within a systemic epistemology, the difficulties of functioning in a biomedical‐oriented environment, and the challenges faced during the 10‐year socioeconomic crisis and the COVID‐19 pandemic.

Staff perspectives on the effects of seclusion in adolescent psychiatric inpatient care.

Nurses are at the forefront of seclusion in adolescent psychiatric units. Understanding nurses and other staff perspectives on the effects of seclusion is critical in the ongoing effort to minimize and eliminate seclusion. The aim of this study was to gain a better understanding of staff attitudes, experiences, and beliefs about the effects of seclusion on both themselves and patients. Thirty-one staff members (including 20 nurses) completed the Attitudes to Seclusion Survey and 24 participated in semi-structured interviews to explore their beliefs and experiences of seclusion use in adolescent psychiatric inpatient care. Analysis of the questionnaire showed overwhelming agreement in the negative impacts of seclusion on patients, while there was uncertainty around the positive impacts of seclusion. Using a combination of the intuitive approach and thematic analysis, five themes were identified from interviews with staff, three unique to nurses: (i) staff were reluctant to use seclusion but felt it was necessary, (ii) nurses felt under-resourcing led to increased chances of seclusion, (iii) staff believed seclusion negatively impacted the patients, (iv) nurses felt their relationships with patients were negatively impacted, and (v) seclusion also had a negative effect on nurses. Clinical recommendations included a systematic and structured approach to debriefing to repair ruptures in the therapeutic relationship; staffing to be based on the acuity of the unit rather than occupancy; alternatives to seclusion that meet the needs of service providers and consumers. Future research should compare staff and patient perspectives, include multiple sites, and greater participation of non-nursing staff.

Infant and preschool childhood Screen time and psychopathology or parental concerns in a Portuguese Sample

Objectives: This study intends to characterize the habits of screen time exposure in a sample of infants, toddlers, and preschoolers and to assess if there’s a relationship between the proportion of early childhood excessive exposure to screen time and the presence of psychopathology and parental concerns.
 Methods: A cross-sectional cohort study of patients in a Child and Adolescent Psychiatric outpatient unit and children followed exclusively in Primary Health Care in the same geographic area was carried out. The information was collected from a self-report filled questionnaire by the caregiver, between October 1, 2018 and June 30, 2019. The exposure time was defined according to the American Academy of Pediatrics recommendations regarding the average daily exposure time.
 Results: The need for a Child and Adolescent Psychiatry follow-up consultation and behavior concerns during early childhood are significantly associated with screen time, with a greater proportion within the group with an average daily exposure time higher than recommended (p=0,006 and p=0,032 respectively).
 Conclusion: The study found an association between screen time exposure, parent behavior concerns and the need for follow-up in Child and Adolescence Psychiatry outpatient. Further studies are needed in order to better understand this subject.

WHEN YOUNG CHILDREN WITH AGGRESSION NEED INPATIENT LEVEL OF CARE: AN INNOVATIVE FAMILY-BASED CARE PATHWAY ON A CHILD INPATIENT PSYCHIATRIC UNIT

Even though young children may be less susceptible to the COVID-19 virus, they are one of the most vulnerable groups in terms of the psychological consequences of this pandemic. As outpatient care is overwhelmed with accommodating their needs, desperate parents have been showing up in local emergency rooms asking for help. Some of the children are admitted to acute inpatient child and adolescent psychiatric units that may be ill-equipped in caring for them. Typically, only specialized clinicians treat young children in outpatient psychiatric clinics.

1.66 Rates of Self-Reported Childhood Trauma in Youth Who Are Psychiatrically Hospitalized: Comparisons to a Population-Based Representative Community Sample

Youth who are psychiatrically admitted often underreport traumatic experiences during clinical interviews. To guide trauma-informed care (TIC) on a child and adolescent psychiatric inpatient unit, rates of self-reported trauma were compared to a community sample. We hypothesized that psychiatrically admitted youth will report higher rates of childhood emotional, physical, and sexual abuse than youth from a matched community sample, including those with clinically significant psychiatric symptoms.

Self injuries in adolescence, an unusual clinical presentation of autism

IntroductionAlthough autism is only twice more common in men than women in general population, in clinical samples women are underrepresented. This difference may be due to a poor sensitivity of current diagnostic criteria of autism related to females. We present a 13-year-old woman referred to the adolescent psychiatric unit for anxiety, self injuries and suicidal ideation. After careful assessment of current symptoms and neurodevelopmental milestones, deficits in emotional-comunicational reciprocity, nonverbal comunication and relationships emerged, as well as inflexible adherence to routines and restricted interests. The diagnose of autism spectrum disorder was made and the patient started a specific treatment.ObjectivesTo review the clinical features of autism spectrum disorders in adolescent females and its differential diagnosis.MethodsReview of the literature on autism spectrum disorders in female and its specific features.ResultsThe “Female Autism Phenotype” is a group features that are more common in autistic women, as opposed to the classic symptoms of autism in men. Some of these differential characteristics are: fewer social impairments and higher levels of social motivation; more age and gender appropriate restricted and repetitive interests; more internalizing rather than externalizing symptoms; and a tendency towards camouflagingConclusions- Autism in women is frequently underdiagnosed. - Females express autism in ways that not allways meet the current diagnostic criteria. - The “Female Autism Phenotype” has been proposed as an specific way of expression of autism in females.DisclosureNo significant relationships.

Increased severity of mental health symptoms among adolescent inpatients during COVID-19

ObjectivePrior research suggests that the COVID-19 pandemic has been detrimental to adolescent mental health. However, no research has examined whether the pandemic is associated with increased symptom severity among high-risk youth, such as those hospitalized for a psychiatric crisis. MethodOver a four-year period, upon admission to an adolescent psychiatric inpatient unit, youth completed measures of depression (Center for Epidemiologic Studies Depression Scale), feeling like a burden and lack of belongingness (Interpersonal Needs Questionnaire), trauma-related symptoms (Child Trauma Screen), suicidal thoughts and behaviors (Self-Injurious Thoughts and Behaviors Interview Self-Report Version). We compared the severity of these symptoms for patients admitted during the pandemic to the severity for patients admitted to the same unit in the three years before the pandemic. ResultsAcross most symptoms, youth hospitalized during the pandemic reported increased severity compared to those hospitalized before the pandemic. ConclusionsAdolescents requiring psychiatric hospitalization during the pandemic reported increased symptom severity compared to adolescents hospitalized on the same inpatient unit in the three years prior to the pandemic.

Case Analysis of Sprint Interval Training for Adolescents With Severe Mental Illness

Case Analysis of Sprint Interval Training for Adolescents With Severe Mental Illness

Reducing seclusion use in an Australian child and adolescent psychiatric inpatient unit

BackgroundIn inpatient psychiatric units, seclusion (isolation in a locked room) is recommended only as a last resort for serious aggression or agitation. In response to an increase in seclusion during 2015, an 8-bed child and adolescent inpatient unit implemented a suite of multidisciplinary interventions. This study examines changes in seclusion rates following intervention implementation and assesses whether specific patient factors were associated with seclusion rates before and after interventions. MethodMulti-modal interventions, comprised of patient treatment plans, intake and handover meetings, staff supervision and debriefing sessions, were implemented from January 2016. We compared quarterly seclusion rates (episodes per 1000 patient days) across a thirteen-year period, from July 2008 to June 2021. Change in seclusion rates following intervention was evaluated using a segmented regression analysis. We examined whether patient factors were associated with seclusion rates, and whether the duration of seclusion episodes differed before and after interventions. ResultsThere was a 100% reduction in seclusion rates in the 6 months following intervention implementation, from 28.4 episodes per 1000 patient days in July–September 2015, to 4.7 episodes in January–March 2016, reaching 0.0 episodes by April–June 2016. This reduction was maintained until April–June 2021. Most patients with seclusion events before and after intervention implementation had a neurodevelopmental disorder diagnosis and a minority of patients accounted for most seclusion events. There was a 65% reduction in the average duration of seclusion episodes following interventions, however this was not statistically significant. LimitationsDue to a crisis in staff morale, interventions were implemented simultaneously, preventing an understanding of whether a single intervention accounted for change. While not addressed in the current study, assessing perceptions of staff, children and parents following intervention implementation may have elucidated barriers and facilitators to change. ConclusionsMultidisciplinary, patient-centered interventions may be effective for long-term reduction of seclusion rates in inpatient psychiatric units. These findings highlight patient factors associated with seclusion reduction which should be considered when implementing interventions.

Perspectives croisées des adolescents et des soignants sur les médiations thérapeutiques en psychiatrie : une étude qualitative

ObjectiveWe aimed to explore the adolescents’ and caregivers’ lived experiences during therapeutic mediation in an adolescent psychiatric inpatient unit. MethodsThis qualitative study, using semi-structured interviews and photo-elicitation, took place in the CHU of Rouen. Data were collected, until theoretical sufficiency was reached, through semi-structured interviews and a photo-elicitation tool. Inductive Process to analyze the Structure of Lived-Experience was used to process the data. ResultsEighteen participants were included, 10 caregivers and 8 teenagers. The crossed analyses of adolescents’ and caregivers’ interviews showed four lived experiences: to verbalize, to meet, to feel with the body and to grow up. The analysis concluded there was a divergence in the representation of the purpose of therapeutics mediations between adolescents and caregivers.Perspectives We suggest verbalization is not central. We propose to go through the body and to consider the reactivation of the separation individuation process.

21.6 The Effectiveness of Mindfulness Meditation and Nursing Education in Decreasing the Events of Insomnia, Emotional, and Behavioral Disturbances in an Adolescent Inpatient Psychiatric Unit

Mindfulness meditation practices have become increasingly popular in schools and medical settings. Meditation practices for insomnia is a safe, relatively inexpensive, low-risk, and easy-to-implement option for people who have difficulty accessing other types of therapy or medication. These interventions are relatively safer than pharmacological interventions and can have potential long-term benefits. This poster will analyze the reduction in the number of medications used to treat insomnia and affective disturbances in an inpatient adolescent psychiatric unit. Ten-minute mindfulness meditation groups were conducted on the unit as a part of a quality improvement project. This intervention was carried out 5 days a week for a total period of 3 months. Handouts were given to nursing staff on how to manage insomnia and agitation on the unit. Data were collected on the number of as-needed or emergent medications used to treat insomnia or agitation 3 months prior to the intervention and 3 months during the period of the study and then compared. A total of 51 adolescents admitted to the unit during the 3-month period of the study participated in the meditation groups. When compared to the baseline data of 42 adolescents in the 3 months prior to the initiation of the intervention, mean events of oral, as-needed, or emergent medications for agitation or insomnia decreased from 6.3 to 4.1 per adolescent (p > 0.05), and mean events of any medication, oral or intramuscular, prescribed for insomnia or agitation decreased from 6.8 to 4.6 per adolescent (p > 0.05). After comparing the 2 groups, there was a decrease in the number of episodes of agitation and insomnia on the unit; however, the difference did not reach statistical significance. Mindfulness meditation can be an effective strategy to reduce events of insomnia or agitation on the unit, and further studies may help in determining the effectiveness of this modality.

What Do We Do When Things Fall Apart? Rapid Creation of a Pilot Psychiatric Intensive Care Unit in Response to Increased Acuity on a Psychiatric Inpatient Unit for Children and Adolescents

ABSTRACT The past two decades have seen a sharp increase in suicide and psychiatric hospitalizations for children and adolescents. While many youth are served well in the inpatient psychiatry setting, a subset of this population does not stabilize during an average length of stay and with the typical therapeutic interventions provided by an inpatient unit. This study examines the creation of a psychiatric Intensive Care Unit (ICU) for patients who exhibited the most severe and acute mental illness, self-injury, and aggressive behaviors on a child and adolescent psychiatric inpatient unit. The ICU was created in response to increasing numbers of restraints, assaults, and patient and staff injuries in the months preceding creation of the program and potential contagion effect of safety issues amongst patients. Post-implementation, nominal reductions in safety metrics were found in both the ICU and general milieus for patient and staff injuries and assaults. Nominal decreases in restraints and self-injury were also found in the ICU. Significant decreases in property destruction were found in both milieus and restraints significantly decreased in the general milieu. In addition, patients who participated in the ICU milieu were less likely to be re-admitted to an inpatient psychiatric unit following hospitalization. Overall, the ICU was well-received by staff and patients’ caregivers.

A-35 Relationship between Suicidality and Discrepancies in Verbal and Nonverbal Intelligence in Adolescents

Abstract Objective Many have examined the relationship between intellectual functioning (IQ) and suicidality in children and adolescents. However, no study to date has investigated how discrepancies between verbal and nonverbal IQ may influence suicide risk in adolescents. This study used a sample of patients hospitalized on an adolescent psychiatric unit to compare number of lifetime suicide attempts (SA) among those with a ≥ 22-point difference between verbal and nonverbal abilities. Method Data were retroactively collected from a convenience sample. Patients were grouped based on discrepancies between Perceptual Reasoning Index (PRI) and Verbal Comprehension Index (VCI) scores (VCI > PRI & VCI). Results The number of lifetime ACEs or size of IQ discrepancy did not significantly differ between groups; however, those in the VCI < PRI (μ = 1.13 ± 0.98) group had a significant higher number of SAs than those in the VCI > PRI group (μ = 0.50 ± 0.86) (t(32) = 2.01, p = 0.05). Hedges’ g revealed large effect for IQ discrepancy type and number of SAs. Linear regression modeling revealed a positive association between number of ACEs and number of SAs (ß = 0.10, t(33) = 2.71, p = 0.01). Size of IQ discrepancy was not significantly contributory to total SAs. Conclusion VCI being considerably lower than PRI may increase risk of SA in adolescents. This risk may be further exacerbated by lifetime number of ACEs.

COVID-19 Related Daily Stressors, Coping, and Suicidal Ideation in Psychiatrically Hospitalized Youth.

BackgroundGiven reports of the adverse effects of COVID-19 on adolescent mental health, it is critical to understand how it impacts psychiatrically hospitalized youth who may be particularly vulnerable to its effects.ObjectiveThis study aimed to advance our understanding of high-risk adolescents’ experiences of COVID-19, including COVID-19-related stress, changes in daily functioning, and coping as they relate to suicidal ideation (SI).MethodParticipants were 107 youth (ages 11–18; M = 15.06, SD = 1.79) admitted to an adolescent psychiatric inpatient unit during the time when the initial COVID-19 safety measures (i.e., school closure, stay-at-home- order) and reopening initiatives (Phase I, II, and III) were implemented in Rhode Island between March 13th and July 19th 2020. Adolescents completed measures of COVID-19-related stress, coping, functioning, and SI at the time of admission.ResultsNearly half of the sample (43%) reported a negative impact of COVID-19 on daily functioning. Youth who endorsed COVID-19-related decline in functioning evidenced higher levels of SI compared to youth with no change or improvement in functioning due to COVID-19. Overall levels of stress were not associated with SI. Greater coping repertoire, but not the use of specific coping strategies was associated with higher levels of SI.ConclusionsFindings demonstrate the importance of examining COVID-19-related changes in functioning and broadening repertoire of coping strategies among adolescents at high risk for SI.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10566-021-09641-1.