Admitted for an Eating Disorder: Challenges Clinical Psychologists Face in Working with Patients and Their Families on a Consultation-Liaison Service in a Tertiary Pediatric Hospital.

Eating disorders are one of the most common causes of pediatric hospitalizations due to primary mental health diagnoses. The purpose of this article is to discuss the challenges clinical psychologists face in working with patients with eating disorders and their families during medical admissions. Using the Psychiatry Consultation Service at a tertiary pediatric academic medical center in the Northeast as a framework, authors present the responsibilities of clinical psychologists on this service and their role within the larger, interdisciplinary team. Topics addressed also include systemic challenges, medical and psychiatric comorbidities, and differential psychiatric diagnoses. Case examples are provided to highlight various challenges as well as potential solutions and approaches. Clinical implications, limitations, and directions for future research are also discussed.

Psychiatric Boarding in the Pediatric Inpatient Medical Setting: A Retrospective Analysis.

BACKGROUND AND OBJECTIVES: Psychiatric concerns are a common presenting problem for pediatric providers across many settings, particularly on inpatient medical services. The volume of youth requiring intensive psychiatric treatment outnumbers the availability of psychiatric placements, and as a result many youth must board on pediatric medical units while awaiting placement. As the phenomenon of boarding in the inpatient pediatric setting increases, it is important to understand trends in boarding volume and characteristics of pediatric psychiatric boarders (PBs) and understand the supports they receive while boarding. METHODS: A retrospective chart review of patients admitted as PBs to a medical inpatient unit at a large northeastern US pediatric hospital during 2013. RESULTS: Four hundred thirty-seven PBs were admitted to the medical service from January to December 2013, representing a more than 50% increase from PB admissions in 2011 and 2012. Most PBs were admitted for suicidal attempt and/or ideation. Average length of boarding was 3.11 ± 3.34 days. PBs received a wide range of mental health supports throughout their admissions. PBs demonstrated modest but statistically significant clinical improvements over the course of their stay, with only a small proportion demonstrating clinical deterioration. CONCLUSIONS: Psychiatric boarding presents many challenges for families, providers, and the health care system, and PBs have complex psychiatric histories and needs. However, boarding may offer a valuable opportunity for psychiatric intervention and stabilization among psychiatrically vulnerable youth.

Somatoform disorders and trauma in medically-admitted children, adolescents, and young adults: prevalence rates and psychosocial characteristics.

OBJECTIVE: The purpose of this study is to describe past traumatic experiences in medically-admitted pediatric and young adult patients diagnosed with somatoform disorders and to explore the demographic, diagnostic, and psychosocial differences between those with and without trauma histories. METHODS: Retrospective medical record reviews were performed for patients (aged 3-29 years) seen by the Psychiatry Consultation Service (2010-2011) at a pediatric medical hospital and diagnosed with a somatoform disorder. Clinical data collected included demographics, medical history, current physical symptoms, psychiatric diagnoses and history, trauma history, coping styles, family psychiatric and medical history, peer and family factors, psychiatric disposition after discharge, and service utilization. RESULTS: The mean age of the 180 identified patients was 15.1 years. Most patients were girls (75.0%) and White (71.7%). Somatoform diagnoses were primarily pain (51.4%) and conversion disorders (28.9%). Rates of trauma were similar to national norms (29.7%). Trauma history did not correlate with age, sex, race, income, length of hospitalization, or type of somatoform disorders. However, patients with trauma histories had significantly higher rates of psychiatric comorbidities (76.0% vs. 50.8%), past psychiatric treatment (81.1% vs. 59.1%), parent mental illness (69.8% vs. 38.6%), and family conflict (52.8% vs. 37.0%) and were more likely to require inpatient psychiatric hospitalization on discharge (18.9% vs. 6.3%). CONCLUSION: Prevalence of trauma in a sample of medically-admitted pediatric and young adult patients with somatoform diagnoses was similar to national norms. However, patients with a history of trauma had unique psychiatric and psychosocial profiles compared to those without a history of trauma.

Depression, illness severity, and healthcare utilization in cystic fibrosis.

Cystic fibrosis (CF) is an illness associated with high healthcare utilization and healthcare costs, even when compared to other chronic illnesses. In a variety of medical populations, depression has been found to be associated with lower adherence and poorer medical outcomes. The current study is a retrospective chart review of a matched set of 40 patients with CF, half with and half without a depressive disorder diagnosis. Participants were matched on the basis of their age, gender and lung function, and compared in terms of their illness severity (lung function and weight), medical adherence, and healthcare utilization during the year prior to and following diagnosis of depression and a comparable time period for the non-depressed group. Results show an association between depression and BMI, with only the depressed group showing significant decreases in the year following their depressive disorder diagnosis (from a mean BMI z-score of -0.48 to -1.04). Depression was also strongly associated with greater healthcare utilization and healthcare costs relative to those of comparably medically ill controls, in that depressed youth were hospitalized at over three times the rate of non-depressed youth, and their healthcare costs were more than four times higher (mean number of admissions per year for the depressed group of 4.00 vs. 1.20 for the non-depressed group; mean annual costs of $280,000 for the depressed vs. $60,116 for the non-depressed). These findings highlight the importance of addressing the mental health needs of chronically ill patients as a path to better health outcomes and decreasing need for medical services.

Psychiatric concerns in pediatric epilepsy.

Pediatric epilepsy is a common, chronic, and challenging physical illness for children and their families. This article provides a medical overview and discusses the cognitive functioning and psychosocial adjustment as well as the psychiatric management for children and adolescents with pediatric epilepsy. The management of these children involves establishing a collaborative health care approach, evaluating academic functioning, considering psychotherapy, and managing psychopharmacologic treatment. A thorough understanding of the biopsychosocial concerns in pediatric epilepsy can enable medical providers and mental health clinicians to promote resiliency and adaptation in children and their families facing troubling seizure disorders.

Psychiatric concerns in pediatric epilepsy.

Pediatric epilepsy is a common, chronic, and challenging physical illness for children and their families. This article provides a medical overview and discusses the cognitive functioning and psychosocial adjustment as well as the psychiatric management for children and adolescents with pediatric epilepsy. The management of these children involves establishing a collaborative health care approach, evaluating academic functioning, considering psychotherapy, and managing psychopharmacologic treatment. A thorough understanding of the biopsychosocial concerns in pediatric epilepsy can enable medical providers and mental health clinicians to promote resiliency and adaptation in children and their families facing troubling seizure disorders.

Developmental and neuropsychological perspectives on the Wisconsin Card Sorting Test in children.

The purpose of this study was to advance our understanding of the Wisconsin Card Sorting Test (WCST) as a measure of a set-shifting component of neuropsychological executive function among children by investigating the level of difficulty posed by the order of administering number (vs. shape and color) as a sorting criterion in the test. A total of 196 participants at three different ages groups (6, 11-12, and 18-19 yrs.) were administered the standard or a modified version of the WCST. Results revealed several age-related trends: (a) increases in the number of categories completed, (b) increases in test efficiency, and (c) differences in task difficulty as a function of the order in which the number sorting criterion was administered in the test. Implications of these findings are discussed in terms of the construct validity of the WCST for young children.