The use of restraint and seclusion is highly regulated in psychiatric inpatient settings. However, the majority of studies of restraint and seclusion are based on public hospitals serving adult patients, with some limited data available on adolescents and children. This paper presents prospectively collected data on restraint and seclusion over a 2-year period at a private psychiatric hospital whose patients include large numbers of both adolescents and pre-adolescent children. 2 years of restraint and seclusion data were analyzed on a total of 2,411 unique patients. Types of seclusion included in-room seclusion on the treatment unit and off-unit seclusion in a separate seclusion annex. Restraints consisted solely of short term (<15 min) and longer term (>14 min) manual restraints. The use of IM medication was also recorded. The precipitants of these events were examined. These included physical and verbal threats, stabbing or throwing objects, attempts to elope, attempts to hurt one's self or another, or property destruction. Out of 2,411 child and adolescent in-patients admitted during the period under review, only 703 (29%) experienced restraint or seclusion. Among these, the modal number of events per patient was one (n = 156), but the maximum number of occurrences was 163. Child patients had a much higher frequency of events (n = 396, 53%) than adolescents (n = 307, 19%). There were notable differences in the types of seclusion events, with children typically experiencing in-room seclusion on the unit. When age was examined as a continuous variable, younger patients had a higher prevalence of restraint and seclusion, significantly more restraint and seclusion, and these restraint and seclusion events were significantly shorter than those seen in older patients. Multiple other potential determinants of these events were examined, including diagnosis, symptom severity at admission, age, and gender, but none of these predicted these events. Restraint and seclusion events were more common for children and less so for adolescents, with robust age effects for the likelihood of any seclusions, the number of seclusions and restraints, and the duration of seclusions and restraints. Patients who experienced restraint or seclusion typically required it only once during their hospitalization. Only age was found to be a predictor of the restraint and seclusion variables. Given these findings, it appears that management of agitated behavior in children and adolescents may be a qualitatively different phenomenon. Future research should be directed at understanding the determinants of high frequency agitated behavior and developing alternatives to seclusion or restraint.

Treatment early in the course of psychosis can improve prognostic outcomes, facilitate adaptive functioning, and reduce familial and societal burden. However, little is known about the pathway of first episode psychosis (FEP) from the perspective of highly adherent adolescents and young adults. This study sought to understand the pathways in youth self-determination and self-management of treatment by investigating youth and parents' changing perceptions of illness in the early course of psychosis. Twenty-eight (n = 28) interviews were conducted using a semistructured interview guide on 12 adolescents following their FEP hospitalization and 16 parents. Standardized self-report forms and hospital inpatient records were used to collect and confirm demographic and clinical data. On average, three years had passed from initial hospitalization (age 16.2 years, SD = 1.2) to time of interview (age 19.3 years, SD = 2.3), thus allowing for a range of experiences across the early period of illness. Highly adherent adolescents experienced identifiable temporal phases of early psychosis, comprised of emergent and specific themes. Parents described a parallel pathway toward supporting their child's self-determination and self-management of treatments, with some distinct experiential differences. Five dominant themes that emerged across time were symptom recognition, awareness of change, negative appraisals, positive appraisals, and treatment self-management. Examining how these themes evolve over the early course of psychosis can help guide interventions that are compatible with the parent and adolescent's perceptions of illness at that point in time, and can therefore work in concert with the family's existing efforts to understand and manage their emerging condition and progress toward recovery.

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