Comparison of characteristics of children and adolescents with and without a history of abuse assessed in an urgent psychiatric clinic.

PURPOSE: The objective was 1) to describe the clinical characteristics of children referred for an urgent psychiatric consult with and without, a history of abuse; 2) to study differences in demographic and clinical variables between the groups; and 3) to examine the relationship between different types of abuse and disposition after assessment. METHODS: This is a 2-year retrospective cohort study of all patients aged 12 to 17 years referred to a hospital urgent psychiatric clinic. Patients were divided into two groups, those with a history of abuse and those without. Study variables included demographics, reason for referral, history of emotional, physical, sexual abuse, substance use, bullying victimization, DSM-5 diagnoses, and disposition. The study population was described using means, frequencies, and percentages, while relationships between types of abuse and clinical and demographic variables were assessed using Mann-Whitney U statistics, Spearman correlations, and logistic regression. RESULTS: The prevalence of any type of abuse was 30.4% (227 of 746 referrals). The abused group were older, more likely to be female, to have a history of substance use, bullying victimization, diagnosis of an externalizing disorder, and more likely to be admitted. Among the abused group, males were significantly more likely to report physical/emotional abuse, and female sexual abuse. There was no difference between different kinds of abuse and final diagnoses. CONCLUSIONS: Almost one-third of children and adolescents referred for urgent psychiatric consultation reported a history of abuse. Awareness of the association between abuse and emergency visits may assist physicians in triaging for urgent psychiatric assessment.

Child and Adolescent Emergency and Urgent Mental Health Delivery Through Telepsychiatry: 12-Month Prospective Study.

BACKGROUND: The significant gap between children and adolescents presenting for emergency mental healthcare and the shortage of child and adolescent psychiatrists constitutes a major barrier to timely access for psychiatric assessment for rural and remote areas. Unlike remote areas, urban emergency departments have in-house psychiatric consultation. Telepsychiatry may be a solution to ensure the same service for remote areas. However, there is a paucity of studies on the use of telepsychiatry for child and adolescent emergency consults. Thus, the aim of our study was to (1) assess patient satisfaction with telepsychiatry and (2) compare clinical characteristics and outcome of telepsychiatry with face-to-face emergency child and adolescent assessments. METHODS: This is a prospective study of telepsychiatry emergency assessments of children and adolescents referred by emergency physicians. The comparison group was age- and gender-matched patients seen for face-to-face urgent assessments. Data were gathered on demographic and clinical variables. Telepsychiatry satisfaction was assessed using a questionnaire. Descriptive statistics and chi-square tests were used to assess group differences for each variable. Logistic regression was used to assess impact of the variables on outcome after the consult. A p value <0.05 was used to determine statistical significance. RESULTS: Sixty (n = 60) assessments were conducted through telepsychiatry in 12 months. Among the telepsychiatry group, Aboriginal patients were over-represented (50% vs. 6.7%, p < 0.001), a higher proportion received a diagnosis of adjustment disorder (22% vs. 8.3%, p = 0.004) or no diagnosis (27% vs. 6.7%, p = 0.004) compared with controls. There was no statistically significant difference between groups on other clinical variables. Patients reported a high degree of satisfaction with telepsychiatry. CONCLUSIONS: Telepsychiatry is acceptable to patients and families for safe emergency assessment and follow-up, reducing unnecessary travel to urban centers. Longer time outcomes are needed to establish validity of telepsychiatry for emergency assessments.

Bullying Victimization (Being Bullied) Among Adolescents Referred for Urgent Psychiatric Consultation: Prevalence and Association With Suicidality.

OBJECTIVE: To examine the prevalence of bullying victimization among adolescents referred for urgent psychiatric consultation, to study the association between bullying victimization and suicidality, and to examine the relation between different types of bullying and suicidality. METHOD: A retrospective chart review was conducted for all adolescents referred to a hospital-based urgent consultation clinic. Our study sample consisted of adolescents with a history of bullying victimization. The Research Ethics Board of Queen's University provided approval. Data analysis was conducted using SPSS (IBM SPSS Inc, Armonk, NY). Chi-square tests were used for sex, suicidal ideation, history of physical and sexual abuse, and time and type of bullying, and an independent sample t test was used for age. RESULTS: The prevalence of bullying victimization was 48.5% (182 of 375). There was a significant association between being bullied and suicidal ideation (P = 0.01), and between sex and suicidal ideation (P ≤ 0.001). Victims of cyberbullying reported more suicidal ideation than those who experienced physical or verbal bullying (P = 0.04). CONCLUSIONS: Bullying victimization, especially cyberbullying, is associated with increased risk of suicidal ideation among adolescents referred for psychiatric risk assessment. The detailed history of the type and duration of bullying experienced by the victims should be considered when conducting a psychiatric risk assessment.

Concordance between admission and discharge diagnosis of a child and adolescent psychiatry inpatient unit.

BACKGROUND: Psychiatry is arguably the most medical practice that is affected by culture. The pediatric literature is sparse with respect to the differences between child psychiatric units in different cultures and different countries. In this study, we aim to investigate the discordance between admission diagnosis and discharge diagnosis for child psychiatric disorders. METHODS: A retrospective analysis was conducted on 206 patients admitted to a university hospital inpatient child and adolescent psychiatry unit in Ontario, Canada. The data extracted from electronic charts were age, gender, DSM-IV-based diagnosis at admission, living arrangement before admission, length of stay (minimum one day), post-discharge diagnosis, and post-discharge outcomes. RESULTS: There was 75% agreement with the discharge diagnosis. We found strong negative and positive associations between conduct disorder at discharge and the prescription of antipsychotics (+), antidepressants (-), and stimulants (-), and there was a strong association between a conduct disorder (CD) diagnosis and medication-free status. The powerful effect size of stimulant medication was specific to the association between a primary diagnosis of ADHD (vs. not-ADHD) and stimulant medication (c2=127.5, df=1, phi=0.79, P<0.0001). CONCLUSIONS: We have found a significant agreement between admission and discharge diagnosis. It is suggested that the inpatient stay helped to refine the formulation and to improve the child's well-being.

Attention Deficit Hyperactivity Disorder Presentations to The Child and Adolescent Mental Health Urgent Consult Clinic.

OBJECTIVE: The objective of the present study is to compare and contrast demographic and clinical characteristics of patients diagnosed with and without ADHD referred to the Child and Adolescent Mental Health Urgent Consult Clinic (CAMHUCC) in order to identify any differences between the patient groups and potentially improve care of these patients in the community. METHODS: This is retrospective cohort study of all children and adolescents, who were referred to the CAMHUCC between 2012 and 2014. Using data routinely collected at the clinic, individuals with ADHD were compared to individuals without ADHD. Data analysis was conducted using frequencies, percentages, means and standard deviations to describe participant demographic and clinical information, and comparisons between individuals with and without ADHD was made using Mann-Whitney U statistics. RESULTS: Of the 803 urgent assessments at the clinic, 367 (45.7%) were diagnosed with ADHD. Individuals with ADHD were statistically significantly more likely to be younger, male, referred for aggression, and not living with both parents. Individuals with ADHD were also more likely to be referred for follow-up than those without ADHD, and were more likely to have had at least one previous admission to the CAMHUCC. CONCLUSIONS: Individuals with ADHD account for a significant proportion of child and adolescent presentations to CAMHUCC. Provision of urgent psychiatric care to young people with ADHD represents a significant utilization of resources on health care in terms of initial assessment, higher rates of follow up care, need for risk assessment and referral to CMHA.

OBJECTIF: L'objectif de la présente étude est de comparer et de contraster les caractéristiques démographiques et cliniques des patients diagnostiqués avec et sans trouble de déficit d'attention avec hyperactivité (TDAH) qui sont adressés à la clinique de consultation d'urgence pour santé mentale d'enfants et d'adolescents (CCUSMEA) afin de distinguer toute différence entre les groupes de patients et de potentiellement améliorer les soins de ces patients dans la communauté. MÉTHODES: C'est une étude de cohorte rétrospective de tous les enfants et adolescents qui ont été aiguillés à la CCUSMEA entre 2012 et 2014. À l'aide des données recueillies régulièrement à la clinique, les personnes souffrant de TDAH ont été comparées avec les personnes sans TDAH. L'analyse des données a été menée à l'aide des fréquences, des pourcentages, des moyennes et des écarts types pour décrire les données démographiques et cliniques des participants, et les comparaisons entre les personnes avec et sans TDAH ont été faites à l'aide du test U statistique de Mann-Whitney. RÉSULTATS: Sur les 803 évaluations d'urgence à la clinique, 367 (45,7 %) ont été diagnostiquées avec le TDAH. Les personnes souffrant du TDAH étaient statistiquement plus significativement susceptibles d'être plus jeunes, de sexe masculin, aiguillées pour une agression, et ne vivant pas avec leurs deux parents. Les personnes souffrant du TDAH étaient également plus susceptibles d'être adressées à un suivi que celles sans TDAH, et étaient plus susceptibles d'avoir eu plus d'une admission précédente à la CCUSMEA. CONCLUSIONS: Les personnes souffrant du TDAH représentent une proportion significative des présentations d'enfants et d'adolescents à la CCUSMEA. L'offre de soins psychiatriques d'urgence aux jeunes gens souffrant du TDAH représente une utilisation significative des ressources des soins de santé en ce qui concerne l'évaluation initiale, les taux plus élevés des soins de suivi, le besoin d'une évaluation de risque et l'aiguillage à CMHA.

Emergency Department Referrals for Adolescent Urgent Psychiatric Consultation: Comparison of Clinical Characteristics of Repeat-presentations and Single-presentation.

OBJECTIVE: a) to examine the demographic and clinical characteristics of repeat-presentations to an adolescent urgent psychiatric clinic, and b) to compare them with single-time presentation. METHOD: This 18-month retrospective study compared repeat-presenters to age and gender matched single-time presenters. Demographic variables included age gender and ethnicity. Clinical variables included reason for referral, family history, diagnosis, recommendations and compliance. Data were analyzed using descriptive statistics, McNemar's Chi-square tests for matched pairs, and conditional logistic regression. RESULTS: Of 624 assessments 24% (N=151) were repeat-presentations. Compared with single-presentation, repeat-presentation group had a higher proportion of Aboriginal youth (X2 (1) = 108.28 p < 0.01), a higher proportion in special educational placement (X2 (1) = 6.82, p < 0.01), a higher proportion with a family history of anxiety disorders (X2 (1) = 10.62, p = 0.01) and substance use disorder (X2 (1) = 18.99, p < 0.01). Conditional logistic regression results suggested that repeat-presentation group had higher odds of past hospital admission (OR: 3.50, p < 0.01) higher odds of family history of mood disorders (OR: 4.86, p < 0.01) and of antisocial disorders (OR: 4.97, p = 0.02), and lower odds of recommendation compliance (OR: 0.10, p < 0.01). CONCLUSION: Repeat-presentations for urgent psychiatric consultation constitute a quarter of referrals to the urgent psychiatric clinic. Identifying and addressing factors that contribute to repeat-presentations may, assist in improving treatment compliance by ensuring focused interventions and service delivery for these youth. In turn, this will improve access to the limited urgent services for other youth.

OBJECTIF: a) Examiner les caractéristiques démographiques et cliniques des visites répétées à une clinique psychiatrique d'urgence pour adolescents et b) les comparer à celles d'une visite unique. MÉTHODE: Cette étude rétrospective sur 18 mois a comparé les visiteurs répétés avec des visiteurs uniques appariés selon l'âge et le sexe. Les variables démographiques comprenaient l'âge, le sexe et l'origine ethnique. Les variables cliniques étaient notamment la raison de l'aiguillage, les antécédents familiaux, le diagnostic, les recommandations et l'observance. Les données ont été analysées à l'aide de statistiques descriptives, de tests du chi carré de McNemar pour paires appariées, et de la régression logistique conditionnelle. RÉSULTATS: Sur les 624 évaluations, 24% (N = 151) étaient des visites répétées. Comparé aux visiteurs uniques, le groupe des visites répétées avait une proportion plus élevée de jeunes autochtones (X2 (1) = 108,28, p < 0,01), une proportion plus élevée de placements en éducation spécialisée (X2 (1) = 6,82, p < 0,01), et une proportion plus élevée de sujets ayant des antécédents familiaux de troubles anxieux (X2 (1) = 10,62, p = 0,01) et de troubles d'utilisation de substances (X2 (1) = 18,99, p < 0,01). Les résultats de la régression logistique conditionnelle suggéraient que le groupe des visites répétées avait des probabilités plus élevées d'hospitalisations passées (RC 3,50, p < 0,01), des probabilités plus élevées d'antécédents familiaux de troubles de l'humeur (RC 4,86, p < 0,01) et de troubles antisociaux (RC 4,97, p = 0,02), et des probabilités plus faibles d'observance des recommandations (RC 0,10, p < 0,01). CONCLUSION: Les visites répétées pour une consultation psychiatrique urgente constituent un quart de l'aiguillage à la clinique psychiatrique d'urgence. Identifier et aborder les facteurs qui contribuent aux visites répétées peut aider à améliorer l'observance du traitement en assurant des interventions ciblées et la prestation de services à ces jeunes. Cela améliorera ensuite l'accès aux services d'urgence limités pour les autres jeunes.

Pediatric Referrals for Urgent Psychiatric Consultation: Clinical Characteristics, Diagnoses and Outcome of 4 to 12 Year Old Children.

OBJECTIVES: 1) To describe clinical characteristics and outcomes of children referred for urgent psychiatric consultation to a Child and Adolescent Mental Health Urgent Consult Clinic (CAMHUCC); and, 2) To study the association between referral source, clinical characteristics, and post assessment outcome. METHOD: This is a 12-month retrospective cohort study of children aged 4 to 12-years referred to a CAMHUCC. The clinic's electronic data base contains demographic and clinical information including reason for referral, diagnosis, and consult outcome. Study data were extracted and analyzed using descriptive statistics and Mann-Whitney U tests. RESULTS: The study sample consisted of 120 children, 41.5% male, average age 9.03 years (SD=2.2). Fifty-percent were referred by Children's Mental Health Agencies (CMHA) and 31.7% by Emergency Departments. The most frequent reason for referral was aggression (64.1%). Most common diagnoses were externalizing disorders (76.7%). Thirty-percent had an identified learning disorder, 80% were referred back to the community and 14.2% were referred to outpatient clinic. There was a significant association between referral from an Emergency Department and female gender (p=0.048) and brief follow-up with CAMHUCC (p=0.006). CONCLUSION: Regardless of source of referral, the most common reason for urgent psychiatric referral was aggression and the majority of individuals did not require inpatient psychiatric care. Collaborative multiagency education in child and adolescent mental health disorders, including the role of learning disabilities in externalizing behaviors, may improve the capacity of CMHA and schools to identify and provide focused interventions that may, in turn, reduce behavioral crisis and visits to Emergency Departments and urgent clinics.

OBJECTIFS: 1) Décrire les caractéristiques cliniques et les résultats d'enfants référés à une consultation psychiatrique d'urgence dans une clinique de consultation d'urgence pour la santé mentale d'enfants et d'adolescents (CCUSMEA). 2) Étudier l'association entre la source de la référence, les caractéristiques cliniques, et le résultat après l'évaluation. MÉTHODE: Il s'agit d'une étude de cohorte rétrospective de 12 mois auprès d'enfants de 4 à 12 ans référés à une CCUSMEA. La base de données électroniques de la clinique contient des données démographiques et des renseignements cliniques dont le motif de la référence, le diagnostic et le résultat de la consultation. Les données de l'étude ont été extraites et analysées à l'aide de statistiques descriptives et des tests U de Mann-Whitney. RÉSULTATS: L'échantillon de l'étude consistait en 120 enfants, dont 41,5 % étaient des garçons, de 9,03 ans d'âge moyen (ET = 2,2). Cinquante pour cent ont été référés par des organismes de santé mentale pour enfants (OSME) et 31,7 % par des services d'urgence. Le motif le plus fréquent des références était l'agression (64,1 %). Les diagnostics les plus communs étaient les troubles externalisés (76,7 %). Trente pour cent avaient un trouble d'apprentissage dépisté, 80 % étaient renvoyés dans la communauté et 14,2 % étaient référés à une clinique ambulatoire. Il y avait une association significative entre une référence provenant d'un service d'urgence et le sexe féminin (p = 0,048) et un bref suivi à la CCUSMEA (p = 0,006). CONCLUSION: Peu importe la source de la référence, le motif le plus commun d'une référence à une urgence psychiatrique était l'agression et la majorité des personnes ne nécessitait pas d'hospitalisation pour soins psychiatriques. L'éducation en collaboration de multi-organismes en matière de troubles de santé mentale pédiatriques, y compris le rôle des difficultés d'apprentissage dans les comportements externalisés, peut améliorer la capacité des OSME et des écoles de reconnaître et de fournir des interventions ciblées qui peuvent à leur tour réduire les crises de comportement et les visites aux services et aux cliniques d'urgence.

Comparison of parental socio-demographic factors in children and adolescents presenting with internalizing and externalizing disorders.

OBJECTIVE: This study aimed to: (a) examine parental socio-demographic factors in children and adolescents referred to an outpatient service for internalizing and externalizing disorders, and (b) compare the demographic variables and diagnoses for the two diagnostic groups. METHODS: Parents of all children who were referred to the child and adolescent outpatient service were asked to participate. Following their informed consent, they completed a socio-demographic questionnaire for themselves and a Child Behaviour Checklist (CBCL) for their child. The CBCL scores and the diagnoses assigned by the psychiatrists were then recorded for each child. Diagnoses were classified as internalizing or externalizing based on the primary DSM-IV diagnosis assigned by the psychiatrists. Data for the two groups were compared for study variables using Pearson correlation, t-tests, one-way ANOVA and logistic regression. RESULTS: Children who had externalizing disorders tended to live with unemployed single parents who had lower education levels and lived in rented or assisted housing. Children with internalizing problems tended to live in owned homes with employed parents. There was no significant association between age or gender for either group. CONCLUSION: Previous literature has reported an association between low SES and more mental health problems; however, the relationship between different indicators of SES and diagnosis is not clear. Despite small numbers, our study revealed significant differences between the parental socio-demographic factors for externalizing compared with internalizing disorders.

Two-year prospective study of characteristics and outcome of adolescents referred to an adolescent urgent psychiatric clinic.

OBJECTIVE: (a) To describe the clinical characteristics and outcome of adolescents referred for urgent psychiatric consultation, and (b) compare suicidal with non-suicidal referrals. METHODS: This was a 2-year prospective study. Data was gathered on demographic, historical and clinical variables. Comparison of suicidal and non-suicidal patients was conducted using χ2. A hospital database was used for referral and wait times. RESULTS: Of 805 assessments, 55% were referred by emergency physicians and 28% by primary care physicians. Sixty-four percent of referrals were referred for suicidal behavior and depression and 19.6% for aggression. Eighty percent had a positive family psychiatric history and 59% were bullied. The most frequent psychiatrist assigned diagnosis was attention deficit disorder/attention deficit hyperactivity disorder (ADD/ADHD). Almost a quarter did not require psychiatric follow-up. Referrals to an outpatient clinic and admission were reduced significantly. Greater suicidality was associated with being female, presence of bullying-victimization and substance abuse [χ2(1)=9.33, p=0.002]. CONCLUSION: Suicidal behavior is the most common reason for urgent psychiatric consults. ADHD was the most frequent psychiatrist assigned diagnosis. Urgent psychiatric services can reduce admissions, referrals and wait times for hospital based clinics for low lethality, low intent suicidal behaviors and facilitate triage to community services.