Physical health interventions on adolescent mental health inpatient units: A systematic review and call to action.

AIM: Physical health inequalities experienced by people with mental health conditions are labelled an international scandal; due to the 15 to 30-year gap in life expectancy, driven mostly by physical health conditions. Lifestyle interventions are recommended to prevent the onset of poor physical health in people with mental illness. Yet, there is less high-quality evidence for adolescents, particularly those in inpatient settings. We aimed to assess existing literature reporting physical health or lifestyle interventions conducted on adolescent mental health inpatient units. METHOD: An electronic search of MEDLINE, PsycINFO, Embase, the Cochrane Central Register of Controlled Trials and AMED was conducted on 13th June 2019. Eligible studies included peer-reviewed English language research articles of physical health interventions delivered within child and adolescent mental health inpatient services. A narrative synthesis was conducted on the data. RESULTS: Only three studies were identified implementing health interventions for adolescent inpatients. The interventions consisted of two physical health interventions aiming to increase activity levels within routine care (one gym-based, one sports led) and a yoga intervention. Outcome measurements varied and benefits were observed in relation to overall health (HONOSCA), physical health (waist, hip and chest circumference) and behaviour. CONCLUSIONS: Although preliminary results suggest lifestyle interventions may be feasible and beneficial for this group, more work is needed to fully understand the best way to implement these interventions within adolescent clinical settings. Adolescent inpatients are an important target for such interventions, affording the opportunity to prevent the onset of physical comorbidities.

Evaluation of the physical health of adolescent in-patients in generic and secure services: retrospective case-note review.

AIMS AND METHOD: To assess physical health needs of adolescent in-patients by routine monitoring. A retrospective analysis of case notes was conducted on a 6-month intake to generic and secure adolescent mental health units in Greater Manchester, UK. RESULTS: Fifty individuals were admitted (52% female, average age 15.84 years). Diagnoses varied and 66% were prescribed medications before admission. All had a physical health assessment, which identified various physical health risk factors. Average body mass index was 25.99 (range 15.8-44), and increased during in-patient treatment for 84% of individuals who had their body mass recorded more than once. A total of 28% of individuals smoked. Lipids and prolactin levels were elevated across the sample. CLINICAL IMPLICATIONS: This evaluation strengthens the argument to optimise physical healthcare for adolescent in-patients and develop physical health interventions, particularly given that we observed elevated lipids and prolactin. Physical health and well-being may not be prioritised when assessing and managing young peoples' mental health, despite their increased vulnerability for comorbid conditions.

A role for risperidone in the treatment of communication disorder and comorbid mental health problems?

This case report describes the co-occurrence of a psychiatric disorder with a specific communication disorder in a teenage girl who presented to youth mental health services in crisis, posing a significant risk of harm to herself and others. Description of this case would be of interest to practitioners in youth mental health in relation to the assessment and treatment of young people with similar difficulties. We present the case of a 17-year-old girl previously admitted to an inpatient adolescent unit. Her diagnosis was reformulated 4 months into her second admission to include a specific communication disorder with both receptive and expressive difficulties, evident from her pragmatic use of language. She was started on risperidone in month eight; following this, a significant improvement was seen and the patient was discharged a month later. Prior to the start of risperidone, a referral had been made to low secure adolescent services for further assessment and advice on management, due to the patient's challenging presentation and poor engagement with treatment.

Antipsychotic prescribing: old wine in new bottles?

BACKGROUND: Recent research suggests first generation antipsychotic medications may be no less effective or tolerated than second generation antipsychotics. AIMS: To review prescribing practices in UK adolescent mental health settings. METHOD: A review of literature and a postal survey (structured questionnaire) of clinicians in UK adolescent mental health settings (80 general and specialised in-patient units) were conducted. RESULTS: Second generation antipsychotics remain the drug of first choice for most UK clinicians (based on a survey response rate of 40%). CONCLUSIONS: Guidelines for antipsychotic use in adolescents need updating. Clinicians who qualified in the last 10 years may need specific training and experience in use of first generation antipsychotics.