Psychiatric Hospitalization Of Adolescents Research Articles

Impact of physical exercise on depression and anxiety in adolescent inpatients: A randomized controlled trial

BackgroundPhysical exercise therapy is of proven efficacy in the treatment of adults with depression, but corresponding evidence is lacking in depressed adolescent inpatients. The aim of this study was to document the effect of add-on treatment with structured physical exercise in a clinical population of adolescents hospitalized for depression and anxiety in a psychiatric hospital. MethodsA group of 52 adolescent inpatients was randomly assigned to a physical exercise or control program three to four times per week over a six-week period (20 hours in total). The primary outcome was the Hospital Anxiety Depression Scale (HADS) for evaluation of depression and anxiety symptoms. Secondary outcomes were psychological self-assessments, diagnostic interviews, and physical examinations. ResultsSix participants were lost in each group, leaving 20 inpatients each in the intervention and control groups. A linear mixed model with F-test revealed a significant interaction in favor of physical exercise in reducing the mean depression score (HADS-D) by 3.8 points [95% (CI), range 1.8 to 5.7], compared to a mean reduction score of 0.7 [95% (CI), range -0,7 to 2.0] in the control group. No significant interaction was found for anxiety symptoms (HADS-A). LimitationsThe investigation was limited to the six-week hospital window and the small sample size prevented exploring differences in social characteristics. ConclusionStructured physical exercise add-on therapy integrated into the psychiatric hospitalization of adolescents has led to a reduction in their depressive symptoms, demonstrating its effectiveness in the care of adolescent inpatients with depression.

La réponse institutionnelle à l’anorexie mentale

AimsThrough this article, we question the relevance of institutional responses and their implicit theories in the care of patients with anorexia nervosa. We demonstrate the interest of thinking about a care framework based on psychoanalytic theory in a context where the safeguarding of subjects’ narcissism is often centered on the body. MethodWe draw on our clinical experience in a psychiatric hospital for adolescents and young adults. We start from the question of the body, which is at the center of this pathology. Faced with a body—a body on display, a body that has lost its capacities for containment, and that is a site where psychic survival is at stake—, we question the different forms that the institutional response can take : a protective shield role, a role of containment, a role of differentiation between “inside” and “outside.” These institutional responses are evoked by relying on analytical theory, while trying to think through the object relationship—experienced by these patients as never satisfactory. ResultsWe see the importance of defining a framework of care that is different from the concept of the “contract.” A framework of care that should be discussed with the patient, giving them time to take ownership. We insist on the institutional work and the notion of institutional transfer so that the teams can manage these patients’ destructiveness, without feeling as if they themselves are destroyed. A clinical example emphasizes the importance for patients to find a form of autoeroticism when they are alone with themselves. DiscussionSeparation from the environment is often criticized in the management of anorexia. We observe that separation allows the institution to play the role of auxiliary self in a context where the object relationship is experienced as insufficient and/or intrusive. ConclusionIt is important for an institution to define its implicit theoretical approach, in particular in the management of adolescent pathologies. The psychoanalytic approach allows us to better understand destructiveness and the issues of psychic survival. It is a precious tool in constructing a relationship with the patient and in helping her/him out of her/his internal chaos.

Risk factors for weight gain and metabolic syndrome in adolescents with psychiatric disorders: a historical prospective study.

Adolescents with mental disorders are at increased risk for being overweight or obese, and subsequently developing metabolic syndrome. However, data regarding risk factors for weight gain during psychiatric hospitalization of adolescents are limited and inconsistent. The aim of this study was to investigate the sociodemographic, clinical, and pharmacological risk factors for weight gain during psychiatric treatment, in order to improve prevention of subsequent metabolic syndrome. We conducted a historical prospective study of 146 adolescent patients (mean age 15.2±1.9 years, 52.7% males), consecutively admitted for day treatment in an adolescent day unit (length of stay 141±76 days). Anthropometric measurements and laboratory analyses of fasting glucose and lipid levels were conducted as part of the routine medical care at admission and discharge. Psychiatric diagnoses, medication histories, and sociodemographic data were obtained from the electronic medical records system. A significant increase in age- and gender adjusted body mass index (BMI) (i.e., z score) was observed (0.5±1.2 vs. 0.7±1.1 at admission and discharge, respectively, p<0.001). Male subjects were more prone to weight gain than females (odds ratio [OR]=3.5, 95% CI=1.2-10.3) and BMI z score at admission was inversely associated with weight gain (R (2)=0.2, p<0.0001). Surprisingly, age at admission, psychiatric diagnoses, length of stay, and number of medications were not associated with weight gain. Despite weight gain, fasting blood glucose and lipid profile did not change significantly during the study period. Hospitalization of adolescents in a psychiatric day unit may be associated with a significant weight gain, especially in male subjects and those with normal weight at admission. Efforts should be aimed to reduce weight gain among youth with psychiatric disorders during treatment, to avoid a subsequent metabolic syndrome.

State mental health policy: shifting resources to the community: closing the Illinois State Psychiatric Hospital for Adolescents in Chicago.

ince deinstitutionalization, thereapportionment of mental healthservices from large state-operated fa-cilities into community-based pro-grams has evolved unsteadily. In thepast decade, the census of state hos-pitals has shrunk to the point thatclosing these facilities has become aviable option (1). A number of clo-sures have occurred in recent years,and the majority have involved hospi-tals that served adults with severeand persistent mental illness (2,3).No closures of state-operated facili-ties for children have been discussedin the mental health services litera-ture. This paper details a three-yearprocess of ending the involvement ofthe Illinois state government in thedirect provision of inpatient care tochildren and adolescents in theChicago area.Several challenges have been iden-tified as barriers to the successful clo-sure of state facilities (4–6). Clinicalconsiderations include whether suffi-cient community treatment alterna-tives exist to address the needs ofpersons who were formerly treated atthe state hospital (4). Decisionsabout employment and human re-source allocation must address po-tentially broad implications for laborwhen a facility is closed (5). Finally,the transition of the physical plantfrom a hospital to its next use must beconsidered (6). Each of these con-cerns must be addressed in a coordi-nated fashion.

Being a Gay or Lesbian Professional in a Psychiatric Hospital for Adolescents

Differing styles and ranges of self-disclosure are highlighted through interviews with lesbian and gay clinical staff at an in-patient setting in the Midwest. Each staff, three men and one woman aged 44 to 62, is presented through a psychosocial history concerning religious, marital, and coming out issues. Participants are interviewed about their style and degree of disclosure of homosexuality to staff, clients, and family. The author concludes that degree of “coming out” correlates with positive adjustment to sexual orientation for the interviewees more than with fears about job loss or personal reprisal.

A Comparison of Correctional and Mental Health Referrals in the Juvenile Court

This article presents the results of the first study to compare only court-referred adolescents in the mental health and criminal justice systems. The study reviewed the files of all 93 adolescents whom the Connecticut juvenile courts referred from July 1, 1993, to June 30, 1994, to Connecticut's only state-run psychiatric hospital for adolescents, and the files of all 241 adolescents whom the same courts referred that same year to the state's only juvenile correctional facility. The study analyzed the relationship between seven independent variables—gender, age, race, severity and other aspects of the alleged criminal offense, the court making the referral, family constellation, and the population size of the subject's home town—and referral for a mental health evaluation. Four of the independent variables—race, whether the subject was charged with a sex offense, age, and severity of the alleged offense—were significantly related to referral.

The Use of Poetry and Ritual with Troubled Adolescents

Poetry is a way to access a dimension of being that is usually concealed. Ritual is a perennial method to make fruitful contact with that same deeper, more encompassing, dimension that inspires our humanity. Poetry and ritual are thus tools that adolescents who have lost their way and find themselves in residential treatment programs can be encouraged to learn to use to articulate and begin to alleviate their anxiety and despair in the face of alienating discourses that appear to have the power to define their selves. This article capitalizes on the popularity of the hit movie Dead Poets Society to reinforce insights into the need for a balanced education of young people that would include learning how to connect with the sacred in and around them. It also picks up where the film "Dead Poets Society" fell short and shows how participants in a ritual such as a poetry circle can and must be trained to follow specific steps that insure that no harm will come to them as a result of the activation of deep-seated energies during the meetings. A brief account of how the model was applied in the context of a psychiatric hospital for adolescents is offered.

Fear-based advertising and the increase in psychiatric hospitalization of adolescents.

Fear-based advertising and the increase in psychiatric hospitalization of adolescents.

Patient, Parent, and Staff Attitudes toward Allowing Adolescent Psychiatric Inpatients to Smoke

A smoking attitude survey was developed and administered to adolescent patients, parents, and staff members at a psychiatric hospital for adolescents 6 months before and 6 months after the institution of a patient smoking ban. Attitudes before the ban were significantly more favorable toward allowing patient smoking than attitudes after the ban; smokers were significantly more in favor of allowing patient smoking than nonsmokers; and patients were significantly more in favor of allowing patient smoking than parents, who were significantly more in favor of allowing patient smoking than staff (overall ps less than 0.0001; post-hoc ps less than 0.05). The findings support the feasibility of implementing smoking bans in adolescent inpatient facilities.

Patient Care Monitoring Review at a Psychiatric Hospital for Adolescents

Patient care monitoring review (PCMR) allows a mental health facility's professional staff to collectively address difficult cases. The Devereux Center, a psychiatric hospital in Kennesaw, Georgia, conducted a study examining its PCMR system's effectiveness in individual cases. The study also looked at PCMR cases in aggregate to identify problematic trends in patient care. Findings showed that the hospital's PCMR system was generally effective: Few patient cases were referred to PCMR more than once for the same or similar reasons, and most recommendations made by the PCMR committee were followed by the hospital's direct care staff. Aggregate analysis of PCMR cases identified several patient groups whose needs could be better met through more individualized and specialized forms of care. As a result of the study, several improvements were made in both the hospital's structure of care and the PCMR system.

Borderline daughters: An optimal configuration for their growth

A significant majority of patients with borderline personality disorder, in a long-term psychiatric hospital for adolescents, had been the daughters of younger middle class mothers (14–20) with fathers absent since birth or before age 5. This family configuration is optimal for the growth of a symbiotic mother-daughter relationship and the identity disorder prevalent in borderline patients. The similar histories of these patients are examined. They can be described in two categories: those who combine precocious sexuality with infantile behavior and a smaller group with a somewhat masculine pseudo-mature identity. The first group usually attempts to retreat to the father, has clinging, dependent relationships with males, sexually acts out and is at a very high risk for pregnancy and a repetition of the mothers' lives.

The Staff Member's Crisis of Control in Psychiatric Residential Treatment:

A difficulty encountered in the smooth operation of a psychiatric hospital or residential treatment center is the conflict between freedom and nonpunitiveness and the need for adequate control. Authors examine staff members' difficult adjustment to an open psychiatric hospital for adolescents which has few external controls. Staff members experience a crisis of control which may result in: (1) misuse of standard procedures to gain control; (2) possessiveness of patients; (3) projection of the need for control so that it is seen in neutral situations; (4) regression in the face of countertransference; (5) control of employees below them in the hierarchy. Institutional contributions to this crisis include: (1) the premature requirement for staff competence which results in the therapist's inappropriate reliance on the patient's behavior to reflect it, and (2) the influence of the psychoanalytic model and psychoanalytic neutrality which can make therapists and other staff members feel helpless and irresponsi...

Psychiatric hospitalization of adolescents and successful mainstream reentry.

Eighty-eight adolescent patients of a state mental hospital were followed up 6 months after discharge. Within that period, 43% had been rehospitalized. The major differences between the recidivist and nonrecidivist groups were that, of those who were successful in staying in the mainstream, more returned to school, more had at least one biological parent in the home, fewer had had a significant family member hospitalized, and they had shorter hospitalizations prior to discharge. Type and severity of psychopathology, and personal and demographic variables did not differentiate between the two groups. A natural history of chronic hospitalization is posited and the potential of education to interrupt the rehospitalization “revolving door” is discussed.