Child Psychiatric Inpatients Research Articles

“A turn in the road, but still a rough journey” - Parent and child perspectives of outcomes after pre-adolescent inpatient psychiatric admission

BackgroundResearch regarding the outcomes of child and adolescent psychiatric inpatients appears insufficient and neglected. Where data are available, the majority of studies focus on adolescents. This study aimed (a) to describe child and parental perspectives of short-, medium- and long-term outcomes of children who have had a pre-adolescent inpatient psychiatric admission, and (b) to analyse these dyadic experiential data to identify outcome variables of importance to families and service users that could be used in future outcomes-based research.MethodsThe study employed a qualitative methodology, using semi-structured in-depth interviews of ten parent-child dyads to (a) collect the perspectives of children who have had an inpatient psychiatric admission at a pre-adolescent unit and their parents, and (b) to analyse the experiences of inpatient admission and perceived outcomes after discharge using thematic analysis.ResultsOverall, inpatient psychiatric admission was viewed as a positive and empowering experience by parents and children. Clear short-term benefits were reported as a result of new diagnoses, medications and new skills gained through the admission process. More than half of parent-child dyads reported long-term benefits, but many families commented on ongoing challenges. Thematic analysis identified diagnostic certainty, acquisition of cognitive and behavioural skills, appropriate educational environment, peer relationships, sustained follow-up and medication management, and parent-child relationships, as important contributors to outcomes. Importantly, the presence or lack of these elements influenced outcomes.ConclusionsThe study explored parent-child dyadic perspectives about their experiences of inpatient mental health admissions for pre-adolescents and perceived outcomes after admission. The majority of families found inpatient admission positive and helpful, and thematic analysis identified a number of functional variables that may predict outcome. However, positive outcomes were associated with ongoing difficulties over time, as indicated by the theme “a turn in the road, but still a rough journey”.

A cross-sectional epidemiological study of non-suicidal self-injury prevalence in Chinese psychiatric patients

Non-suicidal self-injury (NSSI) is a common behaviour among psychiatric patients that is easily overlooked and often brings serious consequences. The current literature is limited to certain groups and uses different diagnostic criteria. Here our aim was to investigate the prevalence of NSSI in psychiatric patients in China. Diagnostic and Statistical Manual of Mental Disorders, fifth edition diagnostic criteria were used to conduct a 2-week cross-sectional survey of all psychiatric patients presenting to 15 hospitals in 14 cities across 8 provinces in China during this period. A total of 3,298 psychiatric patients were included. The highest prevalence of NSSI behaviour was found in adolescents aged 10–19 years (14.3%). The prevalence of NSSI behaviour in females in outpatients (16.9%) and inpatients of child and adolescent psychiatric departments (19.6%), outpatients (5.9%) and inpatients adult psychiatric departments (7.7%) was significantly higher than in males. The prevalence of NSSI behaviour in patients with personality disorders was significantly higher than in any other diagnostic group (46.7%, χ2 = 195.239, P < 0.000). The prevalence of NSSI in psychiatric patients is high, especially in adolescents. Therefore, it is necessary to inform patients and medical workers to effectively treat and manage NSSI. In the broader literature and across country contexts, higher levels of non-suicidal self-injury in adolescents and young adults have been reported. These data are a rare, robust and valuable contribution in documenting differences in non-suicidal self-injury in a large, nationally representative sample in China where the participants were diagnosed with Diagnostic and Statistical Manual of Mental Disorders, fifth edition criteria.

Cognitive flexibility in inpatient children and adolescents with a history of suicide attempts

An increase in suicide rates during adolescence has made it the second leading cause of death for this age group. While potential deficits in cognitive flexibility have been thought to contribute to suicidality, this factor has been evaluated in only a few studies among this age group. The current study sought to evaluate cognitive flexibility in 100 psychiatric inpatient children and adolescents (age X=14.39, SD=2.53), with (n=26) and without (n=74) a history of suicide attempts, using the Wisconsin Card Sorting Test (WCST). Results showed no differences between the groups in WCST scores. However, in a small sub-sample with mood disorders only, those with a history of a suicide attempt performed better than those without such history. These findings are contrary to our hypothesis that those who attempted suicide have worse cognitive flexibility, though consistent with earlier data in adults. Further research is needed to shed light on these findings.

Factors Associated with Readmissions to a Child Psychiatric Inpatient Unit

ABSTRACT Readmission of youth to psychiatric inpatient care has several negative consequences, including increased risk of suicide and need for more frequent hospitalizations, disruption of education, and high cost of care for families as well as hospitals. Previously identified factors predicting readmission to psychiatric inpatient care for youth have included a wide variety of clinical diagnoses, indicating inconsistency in the association between diagnoses and risk of readmission. Instead, the current study focuses on behavioral definitions derived from chief complaints for psychiatric inpatient readmissions. The present study explores the relationship between chief complaint and readmission for patients ages 5–12 who were readmitted within 30 days post-discharge and over 30 days post-discharge from an inpatient psychiatric unit. Results demonstrated that when compared to patients without aggression as their identified chief complaint, patients whose chief complaint was identified as aggression-only and aggression-plus-other-factors were more likely to be readmitted within 30 days post-discharge and to have significantly more 30-day readmissions. Additionally, compared to patients without SI as their identified chief complaint, patients with SI-only as their identified chief complaint were found to be less likely to be readmitted within 30 days and have significantly fewer 30-day readmissions. These results suggest that physical aggression is a unique factor that may increase the risk of readmission for patients 5–12 years old. The results may be particularly useful in identifying crucial treatment components when establishing standards of care for inpatient psychiatric units, though further investigation is needed.

Psychological Abnormalities in Children from the Perspective of Parents with a Mental Disorder

There is increased risk for children with a mentally ill parent to get a mental illness. In Germany, it is assumed that the risk for psychological abnormalities in children with a mentally ill parent is increased by a factor of 2,4. The aim of this study was to give an overview of psychological abnormalities in children with mentally ill parents. Patients were asked about their children and possible psychological abnormalities in their children during their stay in a psychiatric ward. Data of n=118 children (51,7%) of psychiatric inpatients could be used for analyses. One-fourth of the children showed psychological abnormalities. According to their parent, one fourth was also in psychotherapeutic/psychiatric treatment. There were no differences in the abnormalities associated with sociodemographic factors of the parent. Our results show that children of a mentally ill parent also suffer from psychological abnormalities. More explicit analyses of the care situation of these children as well as data from direct interviews with them are needed.

Folic acid, vitamin B12, and psychotic symptoms among young psychiatric inpatients

Introduction: Folic acid and/or vitamin B12 deficiency are known to be associated with neuropsychiatric disorders. However, the association between serum levels of these molecules and psychotic symptoms is not established. The aim of this study was to investigate the association between folic acid and vitamin B12 serum levels and the presence of psychotic symptoms among child and young adult psychiatric inpatients. Material and Methods: This was a retrospective cohort study of 165 patients under 25 years of age admitted due to psychiatric disorders between 2005 and 2018 and with folic acid and vitamin B12 serum levels assessed during hospitalization. Two groups of patients were defined according to presence or absence of psychotic symptoms. Rehospitalization was also assessed. Results: Folic acid serum levels were significantly lower (p=0.01) in children and young adults hospitalized for psychiatric disorders with psychotic symptoms compared to patients of the same age with acute psychiatric illness without psychotic symptoms. A similar non-significant trend was found for vitamin B12. Rehospitalization rates were also higher in the first group. Conclusion: Results from this study suggest that low folic acid serum levels are associated with psychotic symptoms regardless of the baseline diagnosis.

Long-Term Outcome of Adolescent Anorexia Nervosa: Family Treatment Apartments Compared With Child Psychiatric Inpatient Treatment.

Introduction: The family is rarely involved in treatment when the patient with anorexia nervosa (AN) is hospitalized. Family treatment apartment (FTA) represents an intervention that includes the family in the intensive treatment of AN. This study compares the short- and long-term outcomes of adolescents treated in FTA with those who received inpatient hospital care. In FTA, the parents are responsible for providing meal support, whereas in hospital care, the staff is responsible.Methods: Sixty-eight previous patients admitted during the period 1990–2009 participated in a follow-up, 43 from the FTA where the whole family is admitted for treatment and 25 from regular psychiatric inpatient care. The follow-up consisted of a personal meeting with structured interviews, measurement of height and weight, and self-rating questionnaires.Result: Readmissions due to weight loss within 6 months from discharge were less common in the FTA group. At follow-up, 14.2 years after admission, there was no difference in eating disorder pathology between the groups. There were significantly lower scores on general psychiatric pathology and significantly higher scores on quality of life in the FTA group.Discussion: The treatment in FTA aims to give the family the ability to handle AN when it is most challenging. FTA may thus provide a helpful context for treatment with a basic sense of security along with skills that could contribute to better general mental health at follow-up.

Rates of Dual Diagnosis in Child and Adolescent Psychiatric Inpatients: A Scoping Review.

Child and adolescent psychiatric (CAP) inpatient admissions have increased since 2009 and the clinical profile of these patients has become more complex. Unrecognized dual diagnosis, that is, comorbid substance use or substance use disorder (SUD) may contribute to this problem, but the prevalence of dual diagnosis in this population is inadequately understood. The goal of this scoping review was to summarize the range and content of research on this topic. MEDLINE, EMBASE, and PsychINFO databases were systematically searched for studies published from 2008 to 2019 containing information on rates of comorbid substance use or SUD in CAP inpatients. A total of 23,326 abstracts were located. After removing duplicates, screening abstracts and full-text papers, and extracting data with full-text reviews, fourteen studies meeting our criteria remained. Rates of substance use or SUD ranged from 0.9% to 54.8%, differing on the basis of: (1) type of outcome; (2) type of data source; and (3) whether samples had a specific diagnostic focus or not. Rates of any type of SUD were reported in approximately 25% of samples from administrative databases, in 17.7% to 38.5% of chart reviews, and in 55% of studies with data from clinical research examinations. The highest rates of substance-specific substance use or SUD were for alcohol, cannabis, and nicotine. We located 14 studies, but methodologic heterogeneity precluded quantitative calculation of a single estimate for the prevalence of dual diagnosis. However, most of the rates suggest that this is an important problem in CAP inpatients, meriting further research. We suggest ways to improve future studies.

Elevated Rates of Restraint and Seclusion in Child and Adolescent Psychiatric Inpatients in China and Their Associated Factors.

To investigate the rate of restraint and seclusion (R&S) use in child and adolescent psychiatric inpatients in China and to examine factors associated with use of these interventions. As part of an official national survey, 41 provincial tertiary psychiatric hospitals in China were selected. Data from 196 youth inpatients discharged from these hospitals from March 19 to 31, 2019 were retrieved and analyzed. (1) The overall rate of R&S was 29.1% (N = 57) and the rate of restraint was 28.6% (N = 56), and seclusion was 11.7% (N = 23) respectively. (2) Compared to patients who did not require R&S, those who required R&S were more likely to have been hospitalized on an involuntary basis, more likely to present with either manic symptoms or aggressive behavior as primary reason for admission, had more frequent aggressive behaviors during hospitalization, and had a significantly longer length of stay. (3) A logistic regression showed that aggressive behaviors during hospitalization was significantly associated with the use of R&S (OR = 21.277, p < 0.001), along with three other factors: manic symptoms as a reason for admission, involuntary admission and a lower GAF score at admission (all p < 0.01). The rate of R&S is dramatically higher in child and adolescent psychiatric hospitalizations in China compared to other regions. Targeted training of staff, development of precise operational guidelines for appropriate use of R&S, and strict oversight are urgently needed to minimize the inappropriate use of R&S in child and adolescent patients.

Child psychiatry in China: Present situation and future prospects.

Child psychiatry in China: Present situation and future prospects.

Differential Symptom Outcomes in Adolescence as a Function of Specific Kinds of Child Abuse

Childhood abuse has been found to increase risk for the development of several psychiatric syndromes, particularly in conjunction with subsequent traumatic experiences. It is possible that different forms of abuse have different clinical presentations close to the time of abuse. In this study we examined the prevalence and consequences of three different forms of abuse in child and adolescent psychiatric inpatients.

Suicides and Suicide attempts among Child and Adolescent Psychiatric Inpatients in Iran

Suicides and Suicide attempts among Child and Adolescent Psychiatric Inpatients in Iran

Characteristics of Adolescent Psychiatric Inpatients in Relation to Their History of Preceding Child Psychiatric Inpatient Care.

Among psychiatric inpatients aged 13 to 17, various familial and clinical characteristics were compared between those with and without a previous history of specialized child psychiatric care (CPSY versus non-CPSY). CPSY adolescents were younger (boys: odds ratio [OR], 0.7; girls: OR, 0.4) at admission to adolescent psychiatric inpatient care, and they more likely had mothers with psychiatric problems (boys: OR, 4.0; girls: OR, 4.8) and child welfare placement background (boys: OR, 2.8; girls: OR, 6.7) compared with non-CPSY adolescents. CPSY girls were also characterized as having unemployed mothers (OR, 3.1) and engaging in nonsuicidal self-injury (OR, 3.1), whereas CPSY boys were diagnosed with anxiety (OR, 2.7) or conduct disorder (OR, 2.8). Based on our study, family-focused care and intervention services are required to prevent continuity of psychiatric disorders from childhood into adolescence.

Suicidality among child and adolescent psychiatric inpatients: time trend study comparing 2000 and 2011

Child and adolescent inpatient treatment has faced major changes since the year 2000, including shorter inpatient stays and a greater use of psychotropic drugs. This study explored changes and correlates of suicidal threats and suicide acts among inpatients, by comparing Finnish cross-sectional surveys from 2000 to 2011. A questionnaire that explored the background, diagnosis and treatment characteristics of inpatients was sent to all child and psychiatric wards in Finland. The data collection was carried out on specified days in 2000 and 2011. We received comprehensive data on 504 patients from 64/69 (93%) wards in 2000 and on 412 patients from 75/79 (95%) wards in 2011. The Spectrum of Suicidal Behaviour Scale was used to explore suicidality. The prevalence of suicidality did not change in this nationwide study: suicidal threat rates were 38% in 2000 and 37% in 2011, and suicide attempts in both years were 11%. The prevalence of suicidal acts was higher among girls and teenagers, while low general functioning, defined as Children’s Global Assessment Scale scores of under 30, was associated with both suicidal threats and acts. Violent acts were associated with both suicidal threats and acts in 2000, but not in 2011. Despite changes in treatment practices and shorter inpatient stays, the prevalence of suicidality in child and adolescent inpatient treatment remained unchanged in Finland in 2000 and 2011.

Treatment effectiveness of a mindfulness-based inpatient group psychotherapy in adolescent substance use disorder - study protocol for a randomized controlled trial

BackgroundCurrent treatments for adolescents with substance use disorder (SUD) have had only limited success. In recent years, research has underlined the role of self-regulatory processes and impulsivity in the development and maintenance of SUD in adolescents. Mindfulness has gained much attention due to its capacity to influence self-regulatory processes, particularly in adult populations. Initial studies have shown the potential of mindfulness-based approaches in younger SUD patients. The aim of the present clinical trial is to evaluate the added treatment effect of a mindfulness-based group psychotherapy (“Mind it!”) for adolescents with SUD in comparison to the current standard treatment. Moreover, we seek to explore the feasibility of the intervention and possible mediators of treatment effects.Methods/designThere will be N = 340 participants aged between 13 and 19 years who are receiving child or adolescent psychiatric or psychotherapeutic inpatient or day treatment targeting their SUD and who have reported substance use 30 days before detoxification and do not show acute psychotic or suicidal symptoms at baseline. The study is a prospective randomized controlled multi-center trial in which patients are assessed: (1) after completing a prior detoxification phase (t0), (2) at 4 weeks (t1), (3) at 8 weeks (t2), and (4) at 6 months after t2 (t3). Participants in the intervention group will receive mindfulness-based group psychotherapy in addition to their existing treatment regime. The primary outcome is substance use in the past 30 days at follow-up based on the Timeline Followback self-report. Secondary outcomes include craving, severity of dependence, and abstinence motivation. Mindfulness, impulsivity, and emotion regulation will be analyzed as possible mediators of treatment effects.DiscussionThis trial is expected to provide evidence of the added effect of a novel, safe, and feasible treatment option for adolescents with SUD.Trial registrationGerman Register of Clinical Studies, DRKS00014041. Registered on 17 April 2018.

Psychopathology and impairment of quality of life in offspring of psychiatric inpatients in southern Brazil: a preliminary study

ObjectiveTo evaluate the quality of life and risk of psychopathology in the infant and adolescent offspring of psychiatric inpatients from a general hospital unit.MethodsOffspring (4–17 years old) of psychiatric inpatients were interviewed face-to-face and assessed with the Strengths and Difficulties Questionnaire (SDQ). Interviews with caregivers and the hospitalized parents were also performed. The quality of life of the offspring, psychopathology of their hospitalized parents, and their current caregivers were investigated in order to evaluate any associations between these aspects and psychopathology in the offspring.ResultsThirty-four children of 25 patients were evaluated, 38.2% of which presented high risk for some type of psychopathology including hyperactivity or attention deficit disorder (38.2%), behavioral disorders (20.6%), and emotional disorders (17.6%). While only the minority of these children (17.6%) were already receiving mental health treatment, another 41.2% of them exhibited some degree of symptoms and were only referred for specialized assessment. Additionally, 61.8% of the children were reported to be suffering from some impairment in their quality of life.ConclusionThis preliminary study found a high rate of psychopathology in children of psychiatric inpatients. These results corroborate previous evidence that children and adolescents with parents with severe psychopathology are at high risk for developing mental disorders. Public policies and standard protocols of action directed to this population are urgently needed, especially for offspring of parents that are hospitalized in psychiatric in-patient units of general hospitals.

6.41 Relationship Between Restraint and Seclusion and Treatment Satisfaction in Child and Adolescent Psychiatric Inpatients

Few studies examine the relationship between experiencing restraint and/or seclusion (R/S) and satisfaction with treatment at the time of discharge from acute mental health hospitalization. Most research has been conducted in adult or subacute sample groups. This study reports differences in treatment satisfaction ratings in children (ie, ages 5–12 years) and adolescents (ie, ages 13–17 years) in acute inpatient care who have experienced R/S and in those who have not experienced any R/S.

Theory of Mind Deficits and Reactive Aggression in Child Psychiatric Inpatients: Indirect Effects Through Emotion Dysregulation

Nationwide, there is a pressing need to develop more efficacious treatment regimens for reactively aggressive youth receiving inpatient psychiatric services. Identifying the relevant clinical characteristics of youth with reactive aggression is an important first step in this process. Past research findings and theoretical formulations have suggested that deficits in both social skills and emotional regulation abilities are significantly associated with the development of reactive aggression in children. Utilizing a highly aggressive child inpatient sample (65 males and 36 females) receiving crisis-stabilization services, we tested the hypothesis that emotion dysregulation statistically mediated the relationship between theory of mind deficits and reactive aggression. As hypothesized, results of bootstrapped mediational analyses indicated that theory of mind deficits were associated with higher levels of reactive aggression via the indirect influence of dysregulated affect. These findings suggest that intervention programs for reactively aggressive children should promote both theory of mind skills and emotion regulation abilities. Children that develop more thoughtful styles of perspective taking coupled with an enhanced ability to modulate their emotions may develop a greater ability to employ the rational conflict resolution skills that underlie peaceful social relationships.

C-19The Effect of Sexual Abuse on Psychiatric Inpatient Children's IQ and Executive Functioning

C-19The Effect of Sexual Abuse on Psychiatric Inpatient Children's IQ and Executive Functioning

Trauma and post-traumatic stress disorder among psychiatric inpatient children and adolescents

ABSTRACTPosttraumatic stress disorder (PTSD) is common in young people in need of inpatient and outpatient mental health services but PTSD is underdiagnosed in clinical settings (Havens et al., 2012). Despite the high prevalence and clinical significance of early recognition of trauma exposure and PTSD in mental health settings, currently there are few empirical data that shed light on the treatment implications in acute care: 40–50% of children and adolescents up to the age of 18 have been exposed to traumatic events and 6% suffer from PTSD. In psychiatric inpatients, the percentages are 46–96% and 21–29% respectively (Gudiño et al., 2014). Young people are also at risk of presenting with psychiatric symptoms, including anxiety, depression, delinquent behaviour, separation anxiety and self-harming behaviours (Havens et al., 2012). The under-identification of PTSD symptoms in clinical settings may hinder effective treatments.In order to examine the rates of trauma exposure and PTSD in inpatient psychiatric settings, we conducted a study of 56 children and adolescents who were admitted to the inpatient unit of the Department of Child Psychiatry, Athens University Medical School at the Aghia Sophia Children’s General Hospital, Athens, Greece, over a three-year period, Results revealed that 75% of the hospitalized children and adolescents had been exposed to violent events, either in their family or in the community. Of them, 26% (19% of the total inpatient population) had developed PTSD while the majority had presented symptoms of PTSD.In addition, of those children and adolescents with PTSD symptoms, 60% required longer hospitalizations and need acute care treatment. Youth diagnosed with PTSD presented with high levels of clinical severity and complexity. High rates of comorbidity were also observed among those with PTSD; the main comorbid disorders found were mood disorders (75% of all cases), but also somatization, conduct, generalized anxiety and, in some, eating and psychotic disorders. In 73% of PTSD cases and in 48.4% of those exposed to traumatic events, suicidal attempts were reported (67 and 53% had reported suicidal ideation) while the percentage of the inpatients with attempted suicides as a result of other psychiatric disorders was 19%. Youth with exposure to trauma and PTSD presented at admission with major impairment in functioning in several areas as measured by the Children’s Global Assessment Scale (C-GAS) (mean score = 32.8, with 91–100 showing superior functioning in all areas). Nevertheless, there is limited research on functioning (i.e. academic performance, peer relationships) in youth with PTSD which is much needed considering that it affects executive cognitive functions and mood. It is worth reporting that in our study, the systematic use of Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime version (K-SADS-PL) in the inpatient unit mainly led to the identification of trauma and consequent PTSD. The discrepancy between rates of PTSD at the intake and later through standardized assessment was large as also reported in other studies (e.g. Havens et al., 2012).Despite the high prevalence of PTSD, many studies, including our study, show that PTSD is underdiagnosed in psychiatric acute care settings. An adequate assessment (Verlinden et al., 2015) is critical and ensures the best available level of care and effective treatment. With 70% of youth experiencing exposure to environmental traumatic stressors, the above study stresses the significance of early screening of trauma-related events in psychiatric patients. The identification through systematic questioning with structured or semi-structured interviews of youth’s exposure to trauma should be followed by trauma related therapies inside the inpatient setting and/or on an outpatient basis. We also propose that future research should focus on the clinical and social needs of the trauma exposed youth and their societal background and the prevention of manifestations related to psychiatric disorders.