Novel Insights into Somatic Comorbidities in Children and Adolescents Across Psychiatric Diagnoses: An Explorative Study.

Many children with psychiatric disorders display somatic symptoms, although these are frequently overlooked. As somatic morbidity early in life negatively influences long-term outcomes, it is relevant to assess comorbidity. However, studies of simultaneous psychiatric and somatic assessment in children are lacking. The aim of this study was to assess the prevalence of somatic comorbidities in a clinical sample of children and adolescents with psychiatric disorders in a naturalistic design. Data were assessed from 276 children with various psychiatric disorders (neurodevelopmental disorders, affective disorders, eating disorders and psychosis) aged 6-18 years. These data were collected as part of routine clinical assessment, including physical examination and retrospectively analyzed. For a subsample (n = 97), blood testing on vitamin D3, lipid spectrum, glucose and prolactin was available. Results of this cross-sectional study revealed that food intake problems (43%) and insomnia (66%) were common. On physical examination, 20% of the children were overweight, 12% displayed obesity and 38% had minor physical anomalies. Blood testing (n = 97) highlighted vitamin D3 deficiency (< 50 nmol/L) in 73% of the children. None of the predefined variables (gender, age, medication and socioeconomic factors) contributed significantly to the prevalence of somatic comorbidities. The main somatic comorbidities in this broad child- and adolescent psychiatric population consisted of (1) problems associated with food intake, including obesity and vitamin D3 deficiency and (2) sleeping problems, mainly insomnia. Child and adolescent psychiatrists need to be aware of potential somatic comorbidities and may promote a healthy lifestyle.

[Intensive home treatment of adolescents in crisis: treat the parents along with 'psychiatric' adolescents]. / Intensieve thuisbehandeling van jongeren in crisis: behandel ouders mee bij 'psychiatrische' adolescenten.

OBJECTIVE: To investigate whether a new intensive home treatment (IHT) model for adolescents with psychiatric problems is more effective or more efficient than previous treatment methods involving long-term clinical admission. DESIGN: Descriptive, retrospective study. METHOD: The previous treatment model for adolescents in crisis consisted of clinical admission for 6 months or longer. To implement the new treatment model, 4 admission wards with 34 beds were converted to 1 'high & intensive care' (HIC) ward with 7 beds, in combination with IHT care for the family in the home environment. Admission to the HIC is short-term, and the parents are admitted along with their child. The new model was used from May 2013. The number of patients receiving care, the length of treatment, patient satisfaction, the number of beds and the costs were investigated and compared with data from the years 2011 and 2012. RESULTS: In comparison with the previous treatment model, this IHT treatment model revealed that more adolescents could be treated in the course of 1 year (125 compared with 70 per year) with a shorter duration of treatment (2 weeks clinical admission if required and 4 months ambulatory treatment, compared with 6 to 7 months clinical treatment) and with lower costs (€ 28,000 compared with € 55,000) with the same level of patient satisfaction. CONCLUSION: Although initial treatment results are positive, more extensive investigation is required into treatment effectiveness and cost efficiency of the IHT model for adolescents over a longer period of time.