Psychiatric emergencies in children
Department of Psychology, University of at Albany State University of New York, Albany, NY, USA. Pediatric Emergency Care
(Impact Factor: 1.05).
09/2002; 18(4):268-70. DOI: 10.1097/00006565-200208000-00009
To examine the demographic and clinical characteristics of children using the pediatric emergency department (ED) in a medical center in Baltimore, Maryland. The rate of admission and length of stay for children who were evaluated in the ED were also examined.
A large, urban medical center with approximately 15,500 visits per year.
During a 13-month period, more than 600 visits to the ED were made for mental health concerns for children aged 2 to 18 years, with psychiatric visits constituting more than 5% of total visits to the ED. Psychiatric visits averaged more than 5 hours' duration in the ED and involved significant effort by medical staff, with approximately one half of visitors undergoing psychiatric admission. Interviews conducted with the ED staff revealed that addressing psychiatric problems in children is a considerable burden and that there is a general lack of resources within the ED and the surrounding community to respond to the needs of children with psychiatric emergencies.
The challenge in most communities is to build a true system of care that involves proactive and more preventive care in natural settings, such as schools, and coordination and improvement of care for youth with more serious problems.
Available from: Jean-Philippe Raynaud
- "L'accueil en urgence en consultation de psychiatrie de l'enfant et de l'adolescent a connu une augmentation importante ces dernières décennies, autant en France qu'aux États-Unis     . Les adolescents représentent ainsi la moitié, voire les trois quarts des patients accueillis en urgence   . "
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ABSTRACT: Abstract in English and in French
In recent years, the number of emergency consultations by teenagers in child and adolescent mental healthcare centers/psychiatric facilities has increased significantly worldwide. Minors monitored by child welfare services (both social child care services and youth judicial protection services) are overrepresented among these adolescents consulting in emergency.
We wanted to study the differences between adolescents consulting in emergency and adolescent consulting in routine, programmed consultation, particularly items such as: personal and family psychological history, diagnosis, social and/or legal trajectory. We also wanted to explore whether adolescents receiving social and/or legal support are overrepresented in this population and show specificities with regard to, for instance, their personal and family history, their clinical manifestations, their health care access and trajectories…
Patients and methods
An unprecedented national multicenter scheme was set up, consisting of 10 teams of public child and adolescent psychiatric departments, well distributed on the French territory and selected on a voluntary basis. During 4 months, after each consultation, trained physicians collected the data used in this study, by filling out a computerized grid, titled “Life course and treatment of children and adolescents”, which includes 83 items.
Four hundred and thirty-three adolescents were included, and we collected complete data for 330 consultations. The data outline the characteristics of adolescents using the psychiatric emergency services in France, which are in keeping with the international literature. They highlight the fragility of their environment, and how they are much more subject to a chaotic trajectory. We were able to identify the overrepresentation of adolescents followed by child welfare services (both social and judicial), which appear as a relevant indicator of turbulences in the lives of these teenagers. Indeed, they are often a consequence of failing early interactions or later abuse. The youth having the most issues, and especially with the legal system, are those having, in their history or currently, the more psychopathological disorders. In a second phase, focusing more specifically on adolescents who receive social and/or judicial support, we showed that they were mainly experiencing externalizing problems (F90 to F92 in ICD-10), which require continuity and longtime care. Numerous and distressing separations in the past of these teenagers are at play once again in the way they chose to use emergency consultation, instead of programmed ones. This consistency, so much needed, can be achieved through the establishment of working partnerships between the different professionals in charge of these adolescents, as an answer to the internal and external chaos they experience.
The emergency consultations are useful, but they are also indicative of the need to reinforce care upstream for these adolescents. Their therapeutic management requires an organization designed to tackle their chaotic trajectory: continuity and institutional cooperation are the cornerstones of a specific treatment. A prospective study could explore more precisely the nature of the supports which are offered afterward to these adolescents and evaluate their efficiency.
Ces dernières années, les consultations urgentes des adolescents en psychiatrie de l’enfant et de l’adolescent ont connu une augmentation importante au niveau international. Les mineurs suivis par les services de protection de l’enfance sont surreprésentés dans cette population.
Étudier les différences entre adolescents consultant en urgence et adolescents utilisant les consultations classiques, programmées : antécédents personnels et familiaux, diagnostic, parcours social et/ou judiciaire. Explorer si les adolescents suivis par les services de protection de l’enfance présentent des spécificités quant à leurs antécédents, leurs manifestations cliniques, leurs trajectoires, leurs modalités d’accès aux soins…
Patients et méthode
Un dispositif multicentrique inédit a été constitué : 10 équipes de service public de pédopsychiatrie, réparties sur le territoire national. Les données ont été recueillies par des médecins spécialisés, après chaque consultation, à l’aide d’un outil informatisé de 83 items : la grille « Parcours de vie et de soins des enfants et adolescents ».
Quatre cent trente-trois adolescents ont été inclus et les données complètes recueillies pour 330 consultations. Conformes avec la littérature internationale, elles dessinent les caractéristiques des adolescents consultant en urgence en France : environnement fragile, parcours chaotiques, surreprésentation des suivis par les services de protection de l’enfance, absence de psychopathologie spécifique, même si certains troubles sont davantage représentés.
Si les dispositifs de consultations en urgence restent nécessaires, ils révèlent la nécessité d’un travail d’amont et d’aval. Les soins doivent être pensés et organisés en privilégiant l’accès aux soins, la continuité et les partenariats.
Neuropsychiatrie de l Enfance et de l Adolescence 02/2015; 63(2):124-132.
Available from: David Da Fonseca
- "First, these results suggest that the ED is being used as part of a continuum of care for patients already in treatment, particularly those displaying disruptive behavior (schizophrenia and disorders occurring in childhood and adolescence). For Christodulu et al. , repeat users are less compliant with outpatient followup. Second, substance use disorders are well known as factors associated with recidivism in the ED [29, 30]. "
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ABSTRACT: The aim of this study was to describe the characteristics of children and adolescents admitted to the psychiatric emergency department (ED) of a French public teaching hospital over a six-year study period (2001-2006). Data for all episodes of care in the psychiatric ED from January 1, 2001, to December 31, 2006, delivered to adolescents aged less than 18 years were retrospectively analyzed. During the six-year study period, 335 episodes of care in the psychiatric ED were experienced by 264 different adolescents. They accounted for 2.0% of the 16,754 care episodes of the ED; 164 patients (62.1) were female and the average age was 16.5 (SD = 1.6). The neurotic, stress-related, and somatoform disorders were the most frequent (25.4%) and concerned mainly anxiety disorders (15.2%). The frequency of the absence of psychiatric diagnosis (22.7%) was high. A total of 48 children and adolescents (18.2%) benefited from more than one episode of care. Several factors were associated to a higher number of visits to the ED: substance use, schizophrenia, disorders of adult personality and behaviour, disorders occurring in childhood and adolescence, and dual diagnosis. In conclusion, mental health disorders in children and adolescents are a serious problem associated with several potentially modifiable factors.
01/2013; 2013(4, article e40):651530. DOI:10.1155/2013/651530
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ABSTRACT: This article provides background on national movements toward expanded school mental health (ESMH) programs and school-based health centers (SBHCs), and presents advantages and challenges of joining these two systems of child and adolescent health care. Delivering ESMH through SBHCs promotes an interdisciplinary approach, health–mental health care integration, and benefits including enhancing referral bases, improving screening of problems, and enhanced confidentiality and privacy. But this integrated approach also presents challenges including managing referrals and significant needs, handling crises, building a focus on prevention and mental health promotion, handling administrative demands, and coping with limited resources. These challenges, ideas for overcoming them, and future directions for this promising service delivery approach are discussed. © 2003 Wiley Periodicals, Inc. Psychol Schs 40: 297–308, 2003.
Psychology in the Schools 05/2003; 40(3):297 - 308. DOI:10.1002/pits.10089 · 0.72 Impact Factor
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