Inpatient Adolescent Psychiatry Research Articles

Internalized stigma and traumatizing effects of psychiatric hospitalization in adolescents: Is there any difference between being hospitalized in adult or adolescent inpatient psychiatric services?

Psychiatric hospitalization serves as a critical treatment modality. However, hospitalization may pose risks of traumatization or stigma. This study primarily examined the internalized stigma and traumatizing effects of psychiatric hospitalization on adolescents. Additionally, the treatment of adolescents within adult inpatient psychiatric services may yield differing stigmatization and posttraumatic stress disorder (PTSD) symptomatology. Hence, the secondary objective was to discern the variance in stigmatization and PTSD symptoms between adolescents treated in adult inpatient psychiatric services (AIPS) and those in child and adolescent inpatient psychiatric services (CAIPS). The cohort consisted of patients from Akdeniz University's Adult Psychiatry Inpatient Service (n = 29) and Uludağ University's Child and Adolescent Psychiatry Inpatient Service (n = 28), matched for age and gender. Assessments using the Child Posttraumatic Stress Disorder-Reaction Index and the Internalized Stigma Scale for Children and Adolescents (ISSCA) were conducted 6 months after discharge. 36.8% and 10.5% of adolescents exhibited "mild" and "very severe" PTSD symptoms, respectively. Adolescents treated in CAIPS had higher Child Posttraumatic Stress Disorder-Reaction Index scores than those in AIPS. However, there was no significant difference between the AIPS and CAIPS groups regarding ISSCA-self and ISSCA-perceived scores. The current findings underscore that psychiatric hospitalization can lead to traumatic experiences in adolescents, especially those treated in CAIPS. Providing informed care and emotional support during hospitalization could bolster resilience and facilitate recovery among these individuals. While adolescents are sometimes placed in AIPS, it is crucial that professionals are adequately trained and supported in managing this vulnerable population. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Long-Acting Injectable Antipsychotic Initiation in Child and Adolescent Patients with Psychiatric Disorders.

Objectives: There are currently no long-acting injectable antipsychotics (LAIAs) that are approved by the Food and Drug Administration for use in child and adolescent patients, however these agents are used off-label for the treatment of various psychiatric disorders. This study aims to describe the initiation and maintenance dosing strategies of LAIAs in child and adolescent psychiatry inpatients. Methods: This was a single-site retrospective chart review of patients less than 18 years of age initiated on an LAIA during an acute psychiatric hospitalization between October 1, 2015, and October 31, 2022. Patient demographics and hospital encounter information were collected and analyzed using descriptive statistics. Results: Of the 6402 unique pediatric patients discharged from the acute psychiatric hospital within the specified timeframe, 45 (0.7%) were newly initiated on an LAIA. The average age was 15.6 years (range 10-17), with a greater proportion of male (n = 26, 57.8%) and Black or African American (n = 27, 60%) patients. The LAIA agents prescribed included paliperidone palmitate (n = 21, 46.7%), aripiprazole monohydrate (n = 15, 33.3%), aripiprazole lauroxil (n = 7, 15.6%), haloperidol decanoate (n = 1, 2.2%), and risperidone microspheres (n = 1, 2.2%). Primary diagnosis via International Classification of Diseases-10 code at discharge included schizophrenia spectrum and other psychotic disorders (n = 19, 42.2%); bipolar disorder (n = 14, 31.1%); disruptive, impulse control, and conduct disorders (n = 6, 13.3%); autistic disorder (n = 5, 11.1%); and attention-deficit/hyperactivity disorder (n = 1, 2.2%). Seventeen patients (37.8%) received a loading dose regimen and/or a maintenance dose regimen that differed from adult package-insert dosing. The mean length of stay was 23.7 days, and 14 patients (31.1%) were readmitted to the psychiatric hospital within 6 months of discharge. The mean number of days to readmission was 71.9 days. Conclusions: This retrospective study is the first to focus on LAIA initiation and maintenance dosing strategies of multiple agents in both a child and adolescent patient population. Further research is required to evaluate the impact of LAIAs on clinical outcomes in this patient population.

Applying Adverse Childhood Experience (ACE) Screening in Adolescent Inpatient Mental Health

ABSTRACT This quality improvement project aimed to implement screening for adverse childhood experiences (ACEs) and other related life stressors in inpatient adolescent psychiatry and to assess their relationship with mental health clinical and quality indicators. The project was conducted in a 25-bed adolescent inpatient unit in Los Angeles County from 2022 to 2023. The Pediatric ACEs and Related Life Events Screener (PEARLS) was used for systematic ACE screening. ACE screening results, demographic and clinical data, youth perceptions of trauma-informed care, new PTSD diagnoses, and length of hospitalization were collected throughout the project period. Linear and logistic regression models were used to examine the relationship between ACE scores, stressful life events, and outcome measures. The sample included 103 adolescents admitted for a psychiatric emergency. Most patients were girls (75.7%), and 94% had at least one ACE. The average length of stay was 6.4 days, and 30% of youth received a new diagnosis of PTSD during hospitalization. Higher ACE scores were associated with increased odds of a new PTSD diagnosis. Sexual abuse and death of a parent/caregiver were the only individual items associated with new PTSD diagnosis. This quality improvement project implementing ACE screening in inpatient adolescent psychiatry demonstrated a high prevalence of ACEs among the target population and the need for trauma-informed care. Our findings contribute to the growing efforts to address ACEs and improve the quality of trauma-informed care in child-serving systems.

Predictors and Correlates of Positive Urine Drug Screening in a Retrospective Cohort Analysis of Child and Adolescent Psychiatry Inpatients Throughout the COVID-19 Pandemic.

Youth substance use is associated with significant psychological, neurological, and medical complications. Risk factors for substance use among children and adolescents in the general population include peer and/or parental substance use, certain psychiatric illnesses (eg, Attention-Deficit/Hyperactivity Disorder, depression), and history of maltreatment. Co-occurring substance use and psychiatric illness have been associated with increased suicidality, but few prior studies have characterized substance use among child/adolescent inpatients. As such, it remains unclear how substance use contributing to acute psychiatric presentations has changed since the start of the COVID-19 pandemic. This is a retrospective cohort study of 816 unique child/adolescent psychiatry inpatients with urine drug screening (UDS) results from a diverse urban setting. Charts of patients hospitalized between June 1, 2018 and November 30, 2021 were reviewed for sociodemographic characteristics, indication for admission, psychiatric history, hospital course, treatment plan, and discharge diagnosis. Differences in sociodemographic and clinical characteristics, such as age, race, and diagnoses, between patients with and without positive UDS were explored throughout various periods of the COVID-19 pandemic. Descriptive and comparative statistics were performed, as well as a logistic regression model to identify the predictors of positive UDS. Of the study sample, 18% had a positive UDS. Older age, diagnosis of impulsive or behavioral disorder, and a history of violence were found to be predictors of positive UDS. Asian/South Asian or Hispanic/LatinX race and history of a developmental or intellectual disability were found to be negative predictors. The frequency of positive UDS in this population did not change based on COVID-19. Multiple factors may predispose children and adolescents to substance use. Though no impact of COVID-19 was found in this sample, longer-term studies are needed. This study identifies independent predictors of active substance use in the child and adolescent psychiatric inpatient population.

1.30 Psychiatric Diagnoses and Clinical Characteristics of Asian American Youth Admitted to a New York City Child and Adolescent Psychiatry Inpatient Unit

1.30 Psychiatric Diagnoses and Clinical Characteristics of Asian American Youth Admitted to a New York City Child and Adolescent Psychiatry Inpatient Unit

Concordance between admission and discharge diagnosis of a child and adolescent psychiatry inpatient unit.

Psychiatry is arguably the most medical practice that is affected by culture. The pediatric literature is sparse with respect to the differences between child psychiatric units in different cultures and different countries. In this study, we aim to investigate the discordance between admission diagnosis and discharge diagnosis for child psychiatric disorders. A retrospective analysis was conducted on 206 patients admitted to a university hospital inpatient child and adolescent psychiatry unit in Ontario, Canada. The data extracted from electronic charts were age, gender, DSM-IV-based diagnosis at admission, living arrangement before admission, length of stay (minimum one day), post-discharge diagnosis, and post-discharge outcomes. There was 75% agreement with the discharge diagnosis. We found strong negative and positive associations between conduct disorder at discharge and the prescription of antipsychotics (+), antidepressants (-), and stimulants (-), and there was a strong association between a conduct disorder (CD) diagnosis and medication-free status. The powerful effect size of stimulant medication was specific to the association between a primary diagnosis of ADHD (vs. not-ADHD) and stimulant medication (c2=127.5, df=1, phi=0.79, P<0.0001). We have found a significant agreement between admission and discharge diagnosis. It is suggested that the inpatient stay helped to refine the formulation and to improve the child's well-being.

Prevalence and Factors Affecting the Use of Antipsychotics and Antipsychotic Polypharmacy in a Child and Adolescent Psychiatry Inpatient Service

Objective: We aimed to examine the antipsychotics used by patients hospitalized in the child and youth inpatient service providing tertiary care to investigate whether there is a difference between admission and discharge, polypharmacy, which antipsychotics are used, and which psychotropics are used concomitant with antipsychotics. Methods: Research data were collected retrospectively from all children and adolescents hospitalized in a child and adolescent psychiatry inpatient service in a university hospital in a 4-year period (2015-2019). The sociodemographic and clinical characteristics of the patients, the antipsychotics they used at admission and discharge, the other psychotropics concomitantly used with antipsychotics, and the side effects associated with antipsychotics during hospitalization were collected from the files of the 363 patients. Results: Patients on antipsychotics increased 12.1% from hospitalization to discharge. Antipsychotic polypharmacy increased from 16.2% at admission to 30.7% at discharge. Logistic regression analysis was performed to investigate the factors affecting antipsychotic and antipsychotic polypharmacy. Self-harm, aggression/violence, and extended hospitalization were factors associated with increased antipsychotic use. Psychotic symptoms, psychotic disorder, and extended hospitalization were factors associated with an increase in antipsychotic polypharmacy. Conclusions: Understanding the factors that may cause antipsychotic use and polypharmacy in inpatient services in children and adolescents may prevent unnecessary drug use and long-term side effects that may occur due to these drugs.

From the Editor-in-Chief's Desk

Journal of Child and Adolescent PsychopharmacologyVol. 33, No. 2 EditorialFree AccessFrom the Editor-in-Chief's DeskHarold S. KoplewiczHarold S. KoplewiczHarold S. Koplewicz, MD, Editor-in-ChiefChild Mind Institute, New York, New York, USA.Search for more papers by this authorPublished Online:20 Mar 2023https://doi.org/10.1089/cap.2023.29235.editorialAboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail To Our Readers:One of my proudest contributions as Editor-in-Chief of this journal has been working with a dedicated team to increase the global representation of research on child and adolescent psychopathology and medication treatment. This issue of the journal bears out this commitment. While Childress et al report on the important open-label safety trial of a new formulation of methylphenidate (MPH) for the treatment of attention-deficit/hyperactivity disorder (ADHD), we also have a paper from a Taiwanese group (Yu et al) on their systematic review and meta-analysis of guanfacine for ADHD treatment. Elsewhere, Büber et al provide valuable insight into prescribing trends for atypical antipsychotics in Turkish inpatient settings.Childress et al describe their trial of serdexmethylphenidate/dexmethylphenidate (SDX/d-MPH; brand name Azstarys), a mixture of d-MPH (which provides an immediate therapeutic effect) and its prodrug SDX (which is gradually converted to active d-MPH later in the day). SDX/d-MPH is approved for the treatment of patients aged 6 years or older with ADHD. The year-long open-label trial is the second phase 3 trial. The authors report that SDX/d-MPH is effective and safe. “SDX/d-MPH treatment produced a noticeable improvement in ADHD-RS-5 and CGI-S scores within 1 month of starting treatment,” they write, “and continued effectiveness was seen during the 1-year treatment period.” Although 60% of subjects reported an adverse event in the treatment phase, these percentages are “equivalent or fewer than those reported with other [MPH] treatments.”The paper from Yu et al on guanfacine, a non-stimulant second-line treatment for ADHD, is a helpful counterpart. In general, the authors report that guanfacine is effective and safe. Looking at the results of 12 randomized controlled trials comparing guanfacine to placebo, the authors were able to identify a population of 2273 participants with available safety data. In this group, 1437 (63.2%) received guanfacine, and 836 (36.8%) received a placebo. “Overall,” the authors write, “1170 (81.4%) participants in the guanfacine group experienced at least one treatment-emergent adverse event (TEAE) compared with 556 (66.5%) in the placebo group.” Low between-study heterogeneity indicates that there are certain persistent side effects of guanfacine, including dry mouth, somnolence, and sedation.Lastly, the paper from Büber et al echoes what we have learned from investigations of antipsychotic prescribing and polypharmacy in US and European settings. Their retrospective chart review included all patients treated at the Pamukkale University Hospital child and adolescent psychiatry inpatient service between 2015 and 2019. “Antipsychotic polypharmacy increased from 16.2% at admission to 30.7% at discharge,” the authors write. “Self-harm, aggression/violence, and extended hospitalization were factors associated with increased antipsychotic use. Psychotic symptoms, psychotic disorder, and extended hospitalization were factors associated with an increase in antipsychotic polypharmacy.”I hope you find the articles in this issue helpful and informative.FiguresReferencesRelatedDetails Volume 33Issue 2Mar 2023 InformationCopyright 2023, Mary Ann Liebert, Inc., publishersTo cite this article:Harold S. Koplewicz.From the Editor-in-Chief's Desk.Journal of Child and Adolescent Psychopharmacology.Mar 2023.39-39.http://doi.org/10.1089/cap.2023.29235.editorialPublished in Volume: 33 Issue 2: March 20, 2023PDF download

Maintaining acomprehensive provision of inpatient child and adolescent mental health services in the years to come-aGerman perspective

Aconsiderable number of child and adolescent psychiatry inpatient units in Germany suffer from asignificant shortage of doctors, which endangers the current system of nation-wide availability of high-quality child and adolescent inpatient services. Drawing on recent data, this article pictures the status quo of child and adolescent psychiatry inpatient services in Germany. The authors then discuss the pros and cons of different suggestions of how to cope with the doctor shortage crisis in child and adolescent psychiatry. The following options for action are suggested: reduction of service provision across the board, shift from personnel-intensive inpatient towards home-based treatment, trans-sectoral cooperation by means of tele-psychiatry, delegation of clinical responsibilities to psychologists, limiting ward physicians' tasks to mere medical care of patients, improvement of working conditions in inpatient units, recruitment of doctors from abroad, and increased recruiting efforts at medical school level. From the authors' viewpoint, the latter option offers the best chance of lasting success; however, this requires along-term, nationwide approach and considerable efforts of all departments involved.

Clinical and sociodemographic characteristics of patients hospitalized in a child and adolescent psychiatry inpatient unit

Objective: In this study, it was aimed to examine the clinical and sociodemographic characteristics of patients hospitalized in Ankara City Hospital Child and Adolescent Psychiatry Inpatient Unit during the pandemic period. Material and Methods: Medical records of children and adolescents who were hospitalized in Ankara City Hospital Child and Adolescent Psychiatry Inpatient Unit between March 2021 and March 2022 were retrospectively analyzed. Patients were evaluated in terms of sociodemographic characteristics, clinical diagnosis and treatment, duration of hospitalization, and Clinical Global Impression Scale (CGI) scores at admission and discharge. Results: In our study, the mean age of 132 cases (86 girls, 46 boys) was found 15.1±1.8 years. The main diagnoses of the subjects were 30.3% (n=40) major depressive disorder, 25% (n=33) psychotic disorder, 14.4% (n=19) eating disorders, and the remaining 30.3% (n=40) were other disorders. Comorbidity was found in 63.6% (n=84) of the cases. The presence of eating disorders, comorbidity and antidepressant use were found significantly higher in females. There was a significant differences in major depressive disorder (MDD), bipolar disorder (BD), psychotic disorder, eating disorder, conduct disorder, and post-traumatic stress disorder (PTSD) between admission and discharge CGI-Severity (CGI-S) scores. In addition, there was a significant difference between admission and discharge CGI side effects scores only for BD. Conclusion: In our study, major depressive disorder, psychotic disorder, and eating disorder were the most common diagnoses of cases hospitalized in inpatient unit. There was a comorbidity accompanying two out of every three cases. There are few child and adolescent psychiatry services in our country, and studies on this subject are scarce. It is thought that our study will contribute to the literature on child and adolescent psychiatry inpatient units.

Eating disorders – case series of a child and adolescent psychiatry inpatient unit

Eating disorders – case series of a child and adolescent psychiatry inpatient unit

Patterns of adolescent non-suicidal self-injury in a Romanian child and adolescent psychiatry inpatient unit

Patterns of adolescent non-suicidal self-injury in a Romanian child and adolescent psychiatry inpatient unit

Adverse childhood experiences as risk factors for recurrent admissions in young psychiatric inpatients.

Patients who require psychiatric inpatient treatment early in life are a particularly at-risk population. Factors such as adverse childhood experiences (ACEs) are, however, not well studied in those requiring psychiatric inpatient treatment during both childhood or adolescence and adulthood. Thus, the aim of the current study was to investigate, in young adult inpatients, the risk factors for prior admissions in Child and Adolescent Psychiatry, with a focus on ACEs. An explorative population-based systematic chart investigation of psychiatric inpatients aged 18-25 was conducted at the University Hospital Tulln, Austria. Data analysis was done with descriptive methods and Pearson's chi- squared-, Fisher's exact-, Mann-Whitney-U-tests and predictive logistic regression models. The sample comprised 390 inpatients (51.8% female), with an average age of 20 years at first psychiatric hospital admission. Those with a former child and adolescent psychiatry inpatient treatment (10.3%) were predominantly female (77.5%). Their number of documented ACEs was increased compared to those without former child and adolescent psychiatry admissions (2 vs 1.1), with up to twice as many experiences of family dysfunction, neglect or abuse. Sexual abuse (OR: 3.0), having been an adopted or fostered child (OR: 4.5), and female sex (OR: 3.0) were identified as main risk factors. Furthermore, former child and adolescent psychiatry inpatients suffered from higher rates of psychosomatic or personality disorders, comorbidities and functional impairment, and were readmitted twice as often in young adulthood. Young adult inpatients with reoccurring psychiatric inpatient treatments have increased rates of severe ACEs. Thus, special attention should be given to identifying ACEs, evaluating needs for psychosocial support and therapy, and meeting these needs after discharge.

Acting out and psychoanalytically informed treatment in inpatient adolescent psychiatry.

Acting out and psychoanalytically informed treatment in inpatient adolescent psychiatry.

The relationship between smoking, alcohol, and substance abuse and psychiatric diseases among adolescents treated in a child and adolescent psychiatry inpatient unit

This study aimed to investigate the prevalence of smoking, alcohol, and substance abuse disorders among adolescents hospitalized in a university hospital child and adolescent psychiatry inpatient unit with different diagnoses, and to determine the rates of these disorders according to the mental illness diagnosis groups. The study was conducted with 346 adolescents aged 12-18 who had been hospitalized with any psychiatric diagnosis between September 2016 and January 2020 in the child and adolescent psychiatry inpatient unit. The study considered the psychiatric diagnoses, based on the results of the DSM-5-based psychiatric interview; sociodemographic and clinical characteristics; the psychopathology history of first-degree relatives; comorbidities; length of hospital stay; income levels, and smoking, alcohol, and substance abuse. Twenty-four percent (n=83) of the participants had been smoking for 18 months or longer, 6.9% (n=24) were using alcohol, and 1% (n=28) were substance abusers. When the diagnosis distributions were examined, smoking was found to be higher in those with depressive disorders and trauma and related disorders, while smoking, alcohol, and substance use were found to be higher in the disruptive behavior disorder group. Smoking was found to be significantly lower in the obsessive-compulsive disorder group. Smoking, alcohol, and substance use among inpatient children and adolescents may worsen their existing psychopathology, so health professionals working in this field should consider this situation.

Debate: Developmental and integrative approaches in child and adolescent psychiatry inpatient facilities: the case of a tertiary university hospital in Paris.

Based on the specific experience of a tertiary university hospital in Paris, France, we propose a theoretical framework encompassing developmental, multidimensional, eco-systemic, and multifactorial perspectives for child and adolescent psychiatry. Consequently, a modern CAPD should be multidisciplinary and implemented in a large medical setting with close disciplines, should promote tailored and integrative treatment, should include some organizational aspects (e.g., tutoring), and should also be opened to cultural and school interventions. Finally, for complex cases, it should keep ambitious goals in terms of both clinical and functional recovery.

Pakistan's First Child & Adolescent Psychiatry Inpatient Unit: Characteristics of admitted patients and response to treatment over a 7-year period.

Background & Objective:Child & adolescent mental health needs to be considered as an integral component of overall health, however significant gaps exist in service provision especially inpatient services in Pakistan. The paper presents the characteristics of admitted youths and response to treatment in Pakistan’s first dedicated child & adolescent psychiatry inpatient unit in Lahore over a period of first seven years. The aim of this study was to better understand the various characteristics of children and youth admitted to this inpatient unit and response to treatment over a seven years’ period since the inception of the unit.Methods:Inpatient medical records of children & adolescents admitted to dedicated Child & Adolescent Inpatient Unit at King Edward Medical University, Lahore were reviewed. Data was extracted regarding referral patterns, sociodemographic factors and diagnosis for the first seven years, from 2012 to 2019. Patients’ scores on Strengths and Difficulties Questionnaire and Clinical Global Impressions Scales administered during intake were also reviewed.Results:Six hundred and thirty-four (634) patients, 56% (355) being females were admitted to the unit during seven years with mean age of 12.3 ± 2.3. Mean duration of admission was 15.60 ± 6.3 days. Most predominant ICD-10 Axis-I psychiatric diagnosis were neurotic, stress related and somatoform disorders (262); mood disorders (78); schizophrenia, schizotypal & delusional disorders (77) and behavioral and emotional disorders with onset usually occurring in childhood and adolescence (44). One hundred and fifty-nine (25%) children had comorbid diagnosis of intellectual disability on Axis-III. Strengths and difficulties questionnaire scores were in abnormal range for significant proportion (>50 %) of patients. CGI mean scores showed marked improvement at discharge.Conclusion:Neurotic, stress related and somatoform disorders are the most common diagnosis in youth needing inpatient treatment in Pakistani setup. Study results indicate that there is a clear need for specialized inpatient child and adolescent services such as ours in low- & middle-income countries.

Adolescent psychiatry inpatient services in Sri Lanka: Present status and future directions.

Adolescent psychiatry inpatient services in Sri Lanka: Present status and future directions.

New initiatives: A psychiatric inpatient facility for older adolescents in India.

Context:Almost 1/5th of the adolescent population suffers from mental morbidity. In older adolescents, clinical challenges are accompanied by unique psychosocial and developmental needs. Recent legislations in India – the Mental Health Care Act, 2017 and the Juvenile Justice Act, 2015 – mandate specific arrangements and provisions for evaluation and treatment of children and adolescents. A separate inpatient Adolescent Psychiatry Center (APC) was started at National Institute of Mental Health and Neurosciences, Bangalore, in 2016.Aims:(a) The aim of this study is to present the need for, development, infrastructure and workforce at APC; (b) to describe clinical profile of adolescents admitted to APC and (c) to identify clinical and psychosocial challenges in the management of older adolescents.Setting and Design:The paper covers consecutive inpatient admissions over the first 7 months of APC.Materials and Methods:Data were gathered from a review of hospital records, staff meetings, and case files.Statistical Analysis:Qualitative data, such as clinical management challenges, are summarized under major emergent themes. Quantitative data are summarized as means with standard deviations and frequencies with percentages.Results:Males, from urban, nuclear family background constituted the majority admissions. Family stressors and risk behaviors were prevalent. Unique clinical challenges included – risk behaviors, issues related to autonomy, conflict with family and conflict with the legal system.Conclusions:Older adolescents need to be treated in an environment appropriate to their age and developmental stage. Restructuring of spaces, routines, and creative inputs to interventions strategies must be made for healing environments for youngsters. APC could be a model for the development of other similar centers.

6.37 Yoga Therapy on an Inpatient Adolescent Psychiatry Unit in Relation to Self-Reported Anxiety

6.37 Yoga Therapy on an Inpatient Adolescent Psychiatry Unit in Relation to Self-Reported Anxiety