Outpatient Child Psychiatry Research Articles

Identifying and Determining the Symptom Severity Associated With Polyvictimization Among Psychiatrically Impaired Children in the Outpatient Setting

Polyvictimization involves experiencing multiple forms of maltreatment or other interpersonal victimization, and places children at risk for severe psychosocial impairment. Children with psychiatric problems are at risk for polyvictimization, and polyvictimized child psychiatric inpatients have been found to have particularly severe psychiatric symptoms. Cluster analysis was used to identify a polyvictimized subgroup (N = 22, 8%) among 295 outpatient admissions in 2007-2009 to a child psychiatry outpatient clinic, based on chart review of documented maltreatment, parental impairment (history of arrest, psychiatric illness, and substance use), and multiple out-of-home placements. Polyvictimization was associated with severe parent-reported externalizing problems and clinician-rated psychosocial impairment, independent of demographics and psychiatric diagnoses. Posttraumatic stress disorder (PTSD) was the only psychiatric diagnosis associated with polyvictimization. Polyvictimization merits further clinical and research assessment with child psychiatry outpatients. Evidence-based PTSD assessment and treatment for polyvictimized children with adaptations to address their severe impairment and externalizing problems also warrants empirical evaluation.

History of Interpersonal Violence, Abuse, and Nonvictimization Trauma and Severity of Psychiatric Symptoms Among Children in Outpatient Psychiatric Treatment

In a clinical sample of child psychiatry outpatients, chart review data were collected for 114 consecutive admissions over a 1-year period at a Child and Adolescent Outpatient Psychiatry Clinic. Data included history of documented maltreatment, potentially traumatic domestic or community violence, neglect or emotional abuse, and noninterpersonal stressors as well as demographics, psychiatric diagnoses, and parent-rated child emotional and disruptive behavior problems. On a bivariate and multivariate basis, any past exposure to interpersonal violence-but not to noninterpersonal traumas-was related to more severe disruptive behavior problems, independent of the effects of demographics and psychiatric diagnoses. Noninterpersonal trauma and psychiatric diagnoses were associated with emotional problems; exposure to interpersonal violence appeared to partially account for this relationship despite not being independently associated with emotional problem severity. History of exposure to interpersonal violence warrants clinical and research attention as a severity marker and potential treatment focus in psychiatric outpatient services for children, particularly those with disruptive behavior problems.

Psychiatric Morbidity Profiles of Child and Adolescent Psychiatry Out-Patients in a Tertiary-Care Hospital

Background: Psychiatric morbidity is ubiquitous, affecting children, adolescents and adults. Age factorsplay a great role in pattern of morbidity profile. Psychiatric morbidity profile of children and adolescentsmay indicate different needs and priorities. Objective: This study aims to sort out referral pattern, attitudeabout psychiatric referral and morbidity profile among child and adolescent psychiatric out-patients in atertiary-care general hospital. Methodology: A total of 100 consecutive child and adolescent patientsin psychiatry OPD coming into contact with investigator psychiatrist were enrolled during the studyperiod. Diagnoses were made according to the ICD-10. Results: Fifty three of the subjects were female,majority of the cases (79) were of age between 13-18 years. Main ethnicity-caste groups seeking carewere Mongol, Brahmin, Chhetri and indigenous Terai tribes. People from semi-urban and urban settingspredominated in this study. Great majority (more than 80%) had reached this service in the 4th or in morethan the 4th step of their help seeking. Most of the subjects were comfortable and happy about psychiatricreferral. More than half had presented mainly with physical and somatic complaints. Major psychiatricdiagnoses encountered were mood (affective), anxiety, seizure, dissociative conversion disorders andmental retardation. Four percent of subjects had suicidal behaviours and 17% migraine headache.Conclusion: Common psychiatric diagnoses among these child and adolescent out-patients are mood,anxiety, seizure, dissociative conversion disorders and mental retardation.Key words: Attitude to psychiatric consultation; child and adolescent; out-patient; psychiatric morbidityDOI: 10.3126/jnps.v30i2.2604J. Nepal Paediatr. Soc. May-August, 2010 Vol 30(2) 79-84

Measuring outcomes in outpatient child psychiatry: The contribution of electronic technologies and parent report

The objective of this study was to evaluate the impact of electronic technologies on the completion of a standardized rating form in an outpatient child psychiatry clinic, and the feasibility of adding a parent-report measure to the form. An electronic Outcomes Rating Form (e-ORF) was used in conjunction with a web-based patient tracking system and digital pens which allowed form data to be directly entered into a database. Clinician forms were collected for 87% of the 248 children seen for intake, a significant increase over the rate of 72% obtained in the same clinic with paper forms. Rating forms were also obtained from 85% of parents. Clinician- and parent-completed measures were moderately correlated with each other. This study showed that 1) the use of electronic technologies is associated with improved clinician completion rates; 2) it is possible to obtain rating forms from most parents; 3) clinician and parent measures provide related but distinct information; and 4) improvements in functioning found with clinician-report measures are corroborated by independent parent reports.

Feasibility, Acceptability, and Sustainability of Telepsychiatry for Children and Adolescents

Feasibility, Acceptability, and Sustainability of Telepsychiatry for Children and Adolescents

Sleep Complaints and Psychiatric Symptoms in Children Evaluated at a Pediatric Mental Health Clinic

To examine the association of sleep problems with psychiatric symptoms in children evaluated at a university-based outpatient child psychiatry clinic. Parents of 174 children attending psychiatric services completed a 47-item Childhood Sleep Questionnaire and the Behavioral Assessment System for Children. Psychiatric diagnosis was obtained through retrospective chart review. Sleep characteristics were compared among 4 diagnostic subcategories: attention-deficit/hyperactivity disorder (ADHD) alone (n=29), ADHD with comorbid mood and anxiety disorders (ADHD+; n=50), mood and anxiety disorders alone (n=67), and other psychiatric disorders (n= 28). Data from sleep habits survey of 174 community children without reported psychiatric history served as controls. Children with psychiatric disorders had a significantly higher prevalence of sleep complaints compared with nonpsychiatric controls. Children with ADHD had frequent nocturnal awakenings, bad dreams, and bedtime struggles. In addition, the presence of leg jerks during sleep was particularly frequent in patients with ADHD compared with any other psychiatric disorder. More frequent nighttime awakenings were present in children with mood and anxiety disorders. Sleep duration and sleep latency strongly correlated with aggression, hyperactivity, and depression. Restless sleep scores highly correlated with all psychiatric symptoms. Sleep problems are highly prevalent among children with psychiatric disorders. Children with ADHD and comorbid anxiety or mood disorders are more likely to report sleep disturbances. Restless sleep, long sleep latency, short sleep duration, and frequent nocturnal awakenings correlate with the severity of psychiatric symptoms.

Diagnostic profiles in outpatient child psychiatry.

Outpatient child psychiatrists appear to be treating a broadening array of complex, highly comorbid, and difficult-to-treat youths. In this study, designed to evaluate the current demographic and diagnostic profile of outpatient child psychiatric patients 1,292 outpatient records from 8 treatment settings were reviewed. Patient age, race, gender, and diagnoses were recorded and analyzed. Externalizing disorders (ADHD and/or behavior disorders) were diagnosed most frequently, followed by internalizing (depressive and anxiety) disorders. Comorbidity was evident in nearly half of all patients, regardless of age. Substance abuse was infrequently reported as a comorbid condition. Externalizing and internalizing pathology frequently co-occurred. Findings reinforce the need for clinician vigilance and thorough assessment of outpatient children and adolescents.

Indikationsentscheidungen zur stationären Aufnahme in kinder- und jugendpsychiatrische Kliniken

To date there has been little empirical investigation of the indications for hospitalising children in child and adolescent psychiatry wards. Therefore we analysed the decision-making models used to establish the criteria for admission to child and adolescent psychiatric clinics. It is assumed that the clinical experience and social orientation of the specialists involved, as well as the standpoint of their respective institutions of health care, play a significant role. The decision-making models of 71 specialists working in the field of in- and outpatient child and adolescent psychiatry were recorded using an adapted structuring process. The hypotheses were examined by comparing the models used by the different professional groups working in inpatient units and by child and adolescent psychiatrists working in private practice to the decision-making models used by assistant medical directors and head physicians. The factors "clinical experience" and "profession group orientation" were found to be of only marginal importance. Only the inpatient nursing staff considered social factors in arriving at an indication. The influence of such "setting" variables is also evident in the fact that the outpatient staff used more narrowly defined criteria and rated their outpatient service as being more sustainable than did the physicians in the inpatient departments. The criteria used by all professions included being a danger to oneself and others, severity of symptoms, the assessment of outpatient resources and efficiency, prospects of success, and the need for intensive treatment. The results of this study provide a basis for further research and indicate the need for additional discussion of the indication criteria currently in use.

Methylphenidate in Children With Attention-Deficit Hyperactivity Disorder (ADHD): Experience from a Sri Lankan Tertiary Children's Hospital

The response to methylphenidate was assessed in children diagnosed as having attention-deficit hyperactivity disorder (ADHD) in 2000 at the Lady Ridgeway Tertiary Hospital for Children in Sri Lanka. They were managed in outpatient child psychiatry clinics. ADHD was diagnosed according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). The severity of the symptoms was determined with a validated Sinhala assessment form based on DSM-IV criteria. The data on problems experienced by the diagnosed children and their families were obtained using an interviewer-administered questionnaire. The severity of the symptoms and problems experienced by the children and their families were reassessed at 6 weeks and 6 months of methylphenidate therapy. Thirty-seven new subjects were diagnosed as having ADHD in 2000, and 36 of them were treated with methylphenidate. The severity of the symptoms and the number of subjects receiving frequent complaints from school were significantly lower 6 weeks after methylphenidate treatment. At 6 months of treatment, the severity of the symptoms was not significantly reduced when compared with the severity assessed 6 weeks after treatment. Methylphenidate did help with school-related problems in the short term, but the long-term effects of methylphenidate were not convincing in this group of subjects and showed poor long-term compliance, probably owing to inadequate improvement seen in symptoms.

Methylphenidate in Children With Attention-Deficit Hyperactivity Disorder (ADHD): Experience from a Sri Lankan Tertiary Children's Hospital

The response to methylphenidate was assessed in children diagnosed as having attention-deficit hyperactivity disorder (ADHD) in 2000 at the Lady Ridgeway Tertiary Hospital for Children in Sri Lanka. They were managed in outpatient child psychiatry clinics. ADHD was diagnosed according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). The severity of the symptoms was determined with a validated Sinhala assessment form based on DSM-IV criteria. The data on problems experienced by the diagnosed children and their families were obtained using an interviewer-administered questionnaire. The severity of the symptoms and problems experienced by the children and their families were reassessed at 6 weeks and 6 months of methylphenidate therapy. Thirty-seven new subjects were diagnosed as having ADHD in 2000, and 36 of them were treated with methylphenidate. The severity of the symptoms and the number of subjects receiving frequent complaints from school were significantly lower 6 weeks after methylphenidate treatment. At 6 months of treatment, the severity of the symptoms was not significantly reduced when compared with the severity assessed 6 weeks after treatment. Methylphenidate did help with school-related problems in the short term, but the long-term effects of methylphenidate were not convincing in this group of subjects and showed poor long-term compliance, probably owing to inadequate improvement seen in symptoms. ( J Child Neurol 2005;20:496—499).

Current Prescribing Patterns in Outpatient Child and Adolescent Psychiatric Practice in Central New York

The aim of this study was to evaluate current prescribing patterns of outpatient child psychiatrists in central New York. Data were drawn from all active files of 1- to 18-year-olds (n = 1292) at eight outpatient treatment locations in central New York on one day in 2002. Age, race, gender, diagnoses, current medications, and doses were recorded. Data was tabulated and analyzed to discern prescribing frequencies and patterns. 74% (956 of 1292) of all patients received psychotropic medication, and 50% of these patients (478 of 956) received two or more medications. The most commonly prescribed medications were stimulants, antidepressants, antipsychotics, alpha-agonists, and "mood stabilizer" anticonvulsants. The most frequent diagnoses were attention-deficit/hyperactivity disorder, other disruptive behavior disorders, anxiety disorders, and depressive disorders. Of those youths who received an antipsychotic medication, 77% did not have a diagnosis of a psychotic disorder. Psychotropic prescribing frequency in outpatient child psychiatry continues to increase, with a substantial majority of youth in psychiatric treatment receiving medication. Stimulants, antidepressants, and antipsychotics have led the way, as in prior studies. Co-prescribing represents a substantial, and growing, proportion of prescribing practice. Antipsychotics are frequently prescribed for nonpsychotic conditions.

Aripiprazole in the Treatment of Bipolar Disorder in Children and Adolescents

Journal of Child and Adolescent PsychopharmacologyVol. 14, No. 4 Letters to the EditorAripiprazole in the Treatment of Bipolar Disorder in Children and AdolescentsJames P. DurkinIIJames P. DurkinIISearch for more papers by this authorPublished Online:20 Jan 2005https://doi.org/10.1089/cap.2004.14.505AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail "Aripiprazole in the Treatment of Bipolar Disorder in Children and Adolescents." , 14(4), pp. 505–506FiguresReferencesRelatedDetailsCited byAripiprazole use in Children and Adolescents: A Public Hospital Child Psychiatry Outpatient Department's Experience8 November 2016 | Klinik Psikofarmakoloji Bülteni-Bulletin of Clinical Psychopharmacology, Vol. 24, No. 1Open-label study comparing the efficacy and tolerability of aripiprazole and haloperidol in the treatment of pediatric tic disorders28 December 2010 | European Child & Adolescent Psychiatry, Vol. 20, No. 3Prescription de l’aripiprazole chez l’enfant et l’adolescentTherapies, Vol. 66, No. 2Psychopharmacology of pediatric bipolar disorder9 January 2014 | Expert Review of Neurotherapeutics, Vol. 10, No. 7Aripiprazole Monotherapy in Children and Young Adolescents with Pervasive Developmental DisordersCNS Drugs, Vol. 23, No. 6Clinical Implications of Antipsychotic-Induced Hyperprolactinemia in Patients With Schizophrenia Spectrum or Bipolar Spectrum DisordersJournal of Clinical Psychopharmacology, Vol. 27, No. 6Psychopharmacology of pediatric bipolar disorder: a review9 November 2006 | Psychopharmacology, Vol. 191, No. 1Clinical Effects and Adverse Reactions of Off-Label Use of Aripiprazole in Children and Adolescents with Developmental Disabilities Maria R. Valicenti-McDermott and Howard Demb29 October 2006 | Journal of Child and Adolescent Psychopharmacology, Vol. 16, No. 5 Volume 14Issue 4Dec 2004 InformationCopyright 2004, Mary Ann Liebert, Inc.To cite this article:James P. DurkinII.Aripiprazole in the Treatment of Bipolar Disorder in Children and Adolescents.Journal of Child and Adolescent Psychopharmacology.Dec 2004.505-506.http://doi.org/10.1089/cap.2004.14.505Published in Volume: 14 Issue 4: January 20, 2005PDF download

Identified Problems and Service Utilization Patterns Among Kinship Families Accessing Mental Health Services

This study examined the mental health problems and service utilization patterns of kinship families who accessed services in an urban outpatient child psychiatry clinic. A random sample of children who completed the intake process during a calendar year yielded 47 children, or 19% of the sample, whose primary caregiver was a relative, other than a biological parent; approximately half of those families were involved with the child welfare system. Data from an administrative database and from medical records describe the diagnoses, identified problems, and services used by the kinship families. Academic or school-related problems emerged as an identified problem in approximately half of the kinship cases, but school intervention was not a primary target for clinicians. The kinship sample was also compared with a random stratified sample of children who were living with primary caregivers other than kin. Kinship families were more likely to be African-American, but few differences were found between kin and non-kin cases on diagnoses and frequency, duration, or type of services received. The findings suggest that collaboration with schools might increase the engagement and retention of kinship families in mental health services.

Étude des comportements violents chez l’enfant : évaluation d’une série de 10 cas cliniques à trois et six ans

The author presents a series of ten clinical cases of three years-old children who were referred to an outpatient child psychiatry clinic for symptoms essentially composed of violence and aggressiveness. A first study published in 1998 analysed the psychodynamic factors most frequently encountered. The results of this first study are regrouped with an assessment made three years later, though a survey mailed to the parents. The results show a durable reduction of violent behaviour in most cases. However more than half of these children developed oppositional defiant disorder. These disorders, of better prognostic evolution, raise the hypothesis of the child’s attempt to structure his personality. The increase of prevalence of these symptoms in young children is debatable and the author concludes in the necessity of early preventive intervention and of other studies including broader series of case report.

Family Evaluation Clinic: Training Psychiatrists to Think Systemically.

A family evaluation training program, Family Evaluation Clinic (FEC), was conducted in an outpatient child psychiatry clinic serving a low-income, African-American, urban population. To determine the success of the program in meeting its training goals, the authors reviewed patient attendance rates and collected survey data from trainees who participated in evaluations conducted between 1994 and 2000. Patient attendance rates were high, and trainees indicated that the program was helpful and valuable to them in their current practice. The authors discuss advantages and disadvantages of FEC as a training method and share recommendations for future family evaluation training in a general residency program.

Psychostimulants in Preschool Children With Attention-Deficit/Hyperactivity Disorder: Clinical Evidence From a Developmental Disorders Institution

To examine psychostimulant response in preschool children with attention-deficit/hyperactivity disorder (ADHD) in an outpatient child psychiatry clinic (housed within a developmental disorders institution) over 3, 12, and 24 months of treatment. A systematic retrospective chart review was conducted for 27 preschool children with ADHD who were started on psychostimulants between the ages of 3 and 5 years, inclusive. Two child and adolescent psychiatrists reviewed each chart independently, using the Clinical Global Impressions (CGI) scale to rate the severity of illness and global improvement and the Side Effects Rating Form to rate side effects. Over 24 months, psychostimulants were stopped in three children (11%) because of side effects and concomitant psychotropic medications were added in seven children (26%). The CGI severity-of-illness ratings showed a significant effect of time over 3, 12, and 24 months of psychostimulant treatment (all p values < .0001). Rate of response was 74% at 3 months and 70% at 12 and 24 months. Side effects were mostly mild and occurred in 63% of the children at 3 months, 41% at 12 months, and 29% at 24 months. The findings suggest that preschool children with developmental disorders respond to psychostimulants but need close monitoring because of frequent side effects. Inasmuch as the study participants were recruited from a child psychiatry clinic housed within a developmental disorders institution and had a high rate of developmental disorders, the findings may not generalize to other preschool children with ADHD.

Trauma exposure among children with oppositional defiant disorder and attention deficit-hyperactivity disorder.

Consecutive admissions to an outpatient child psychiatry clinic diagnosed with oppositional defiant disorder (ODD), attention deficit-hyperactivity disorder (ADHD), or adjustment disorder were assessed for trauma exposure by a structured clinical interview and parent report. Controlling for age, gender, severity of internalizing behavior problems, social competence, family psychopathology, and parent-child relationship quality (assessed by parent report), an ODD diagnosis, with or without comorbid ADHD, was associated with increased likelihood of prior victimization (but not nonvictimization) trauma. ADHD alone was not associated with an increased likelihood of a history of trauma exposure. Traumatic victimization contributed uniquely to the prediction of ODD but not ADHD diagnoses. Children in psychiatric treatment who are diagnosed with ODD, but not those diagnosed solely with ADHD, may particularly require evaluation and care for posttraumatic sequelae.

Traumatic Brain Injury in a Child Psychiatry Inpatient Population: A Controlled Study

To extend our findings from child psychiatry outpatients to child psychiatry inpatients regarding the similarity of children with a history of traumatic brain injury (TBI), particularly mild TBI, to matched children without such a history. This is a chart review of patients consecutively admitted to a child psychiatry inpatient unit over a 5-year period. Children with TBI were matched by age, sex, race, and social class to children with no history of TBI. Axis I and II diagnoses and diagnostic clusters and use of special education services and IQ scores were compared. Fifty-six (8.1%) of 694 consecutive patients admitted had a definite TBI. Not one of more than 50 variables compared between TBI and control subjects was significantly different. In a child psychiatry inpatient unit, patients with a history of TBI were virtually indistinguishable from matched children without TBI. Caution should be exercised before attributing the child's problems, especially long-term problems, to the TBI unless the injury was severe or the child is exhibiting related phobic or posttraumatic stress symptomatology.

Traumatic Brain Injury in a Child Psychiatry Outpatient Clinic: A Controlled Study

To demonstrate the similarity of children with a history of traumatic brain injury (TBI), particularly mild TBI, to matched children without such a history, within a child psychiatry outpatient clinic. This is a chart review of patients presenting to a child psychiatry outpatient clinic over a 3-year period. Children with TBI were matched by age, sex, race, and social class to children with no history of TBI. Axis I and II diagnoses, use of special education services, and IQ scores were compared. Seventy-four (5.6%) of 1,333 consecutive clinic cases had a definite TBI. Of these, 64 were mild. Only 3 of 59 comparisons that were made between TBI and control subjects were significant. A developmental communication disorder cluster was significantly more frequent in the TBI group. Autism and a pervasive developmental disorder cluster were significantly more frequent in the control group. In a child psychiatry clinic, patients with a history of TBI are virtually indistinguishable from matched children without TBI. Caution should be exercised before attributing the child's problems, especially long-term problems, to the TBI unless the injury was severe or the child is exhibiting related phobic or posttraumatic stress symptomatology.

The growth and development of an infant mental health program: An integrated perspective

This article details the development of the Infant Mental Health Clinical and Training Program at the University of Colorado School of Medicine from 1976 to the present. The article discusses the clinical sites where the program takes place, which include the Neonatal Intensive Care Unit, outpatient child psychiatry clinic, and day treatment programs. Trainees from several mental health disciplines participate in the program, including predoctoral psychology externs, interns from the Clinical Psychology Internship, residents from the Child Psychiatry Training Program, and postdoctoral research fellows in developmental psychopathology. Recently, the Infant Mental Health Program has also been able to offer its own training positions. The philosophical models of clinical service and training are outlined. The article concludes by looking at future directions and challenges for the Infant Mental Health Program. © 1997 Michigan Association for Infant Mental Health