Characteristics and Triage of Children Presenting in Mental Health Crisis to Emergency Departments at Detroit Regional Hospitals

Williams, Kristen; Levine, Amanda R.; Ledgerwood, David M.; Amirsadri, Alireza; Lundahl, Leslie H.

doi:10.1097/pec.0000000000001057

Cited by 19 publications

(22 citation statements)

References 11 publications

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“…A psychiatric emergency is defined as an acute disturbance of a patient's mood, thought or behavior, by which the individual may cause harm to either himself or others ( 1 ). Initial support for those patients, in many cases, is psychiatric emergency care ( 2 , 3 ), where circumstances for urgent presentations by young people range from small events to life-threatening situations ( 4 , 5 ). Multiple reasons are presented for emergency appearances, the main symptoms are self-injurious thoughts and self-injurious behaviors ( 6 ).…”

Section: Introductionmentioning

confidence: 99%

Emotional Reactivity and Family-Related Factors Associated With Self-Injurious Behavior in Adolescents Presenting to a Child and Adolescent Psychiatric Emergency Service

et al. 2021

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Background: Adolescents presenting in a child and adolescent psychiatric emergency service show various psychiatric disturbances, most commonly suicidal ideation, suicide attempts, and non-suicidal self-injury (NSSI). It was postulated that especially disturbed emotion regulation contributes to self-injurious behavior of young people. This study aims to investigate the relevance of emotional reactivity (ER), as part of emotion regulation, during an acute crisis, how it relates to self-injurious behavior reinforcement and how a family as well as peers' history of self-injurious behavior are associated with self-injurious behavior of presenting adolescents. Additionally, crisis-triggering background factors were evaluated from the perspective of patients and their caregivers.Methods: A consecutive sample of 86 adolescents aged 11–18 years presenting to the emergency outpatient department due to self-injurious thoughts and behavior received a pretreatment psychiatric evaluation. Among other psychometric measures and structured clinical interviews, ER was measured via the Emotion Reactivity Scale (ERS). Family-related aspects were collected both through evaluation of history and through questionnaires filled in by custodians or parents.Results: Data analysis revealed that suicidal ideation was significantly related to family history with self-injurious behavior in comparison with a family background without such a history. A significant positive correlation was apparent between the ERS sensitivity score and occurrence of NSSI within the past year. A relationship between the ERS and distinct types of reinforcement as a motivation factor for NSSI was found. Post-hoc tests revealed a significant difference between boys and girls when no positive peers' history is present with boys having lower ERS scores than girls, but no difference when both groups had friends engaging in self-injurious behavior. There was only moderate agreement between parents and their children in naming reasons for the current crisis involving NSSI.Conclusion: Emotional regulation, especially ER, has an influence on patients' acute psychiatric symptomatology and when experiencing an acute crisis should be brought into focus early at psychiatric assessment. A history of self-injurious behavior taken from patient's family members and close circle of friends and agreement on reasons for the crisis should be routinely included in the exploration of a patient presenting with self-injurious behavior.

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Section: Introductionmentioning

confidence: 99%

Emotional Reactivity and Family-Related Factors Associated With Self-Injurious Behavior in Adolescents Presenting to a Child and Adolescent Psychiatric Emergency Service

et al. 2021

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“…This increasing number of emerging cases constitutes a constantly growing challenge for the clinic, in terms of personnel, structure and organization. Either, it suggests that additional psychiatric disorders will have to be examined diagnostically in the future, especially since the emergency presentation is partly the gateway to child and adolescent psychiatric treatment (8,9). Or it suggests that the burden of multiple diagnoses on patients is likely to be increased and, accordingly, multiple aspects need to be considered in the emergency consultation.…”

Section: Discussionmentioning

confidence: 99%

“…Emergency child and adolescent psychiatric care is often the entry point to mental health care (8,9). The number of emergency-related child and adolescent psychiatric visits has been growing in recent years (10)(11)(12).…”

Section: Introductionmentioning

confidence: 99%

Suicidality Presented to a Child and Adolescent Psychiatry Emergency Service: Increasing Rate and Changing Characteristics

et al. 2021

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Background: Children and adolescents who present to child and adolescent psychiatric emergency departments show a variety of reasons for their presentations. Suicidality, in particular suicidal thoughts and suicide attempts, as well as non-suicidal self-injury (NSSI) play a large and important role. In this context, inpatient admissions frequently serve as crisis intervention.Methods: In this study, face-to-face emergency presentations to the emergency department at our Clinic of Child and Adolescent Psychiatry (CAP) were analyzed over the years 2014-2018, the 4th quarter (October-December) of each year. Data from 902 emergency presentations were evaluated, primarily with regard to suicidal thoughts, suicide attempts, and NSSI as reasons for presentation.Results: Data demonstrated that the number of emergency presentations increased in general and especially for suicidal thoughts and NSSI as reasons for presentation. In addition, suicidal thoughts, suicide attempts, and NSSI as reasons for emergency presentation were more likely to result in crisis-related inpatient admissions. Furthermore, reporting suicide attempts at emergency presentation was associated with longer inpatient stays. Finally, cases with multiple diagnoses increased independent of the general increase in emergency presentations.Conclusion: The increase of utilization of clinics with CAP outpatient emergency patients and following admissions to the inpatient units for crisis intervention poses a major challenge for the future. It is important to prepare for the assessment and treatment of suicidality, which is of extraordinary importance in the care of emergency patients.

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“…Hallucinations are false sensory perceptions while delusions represent false, fixed beliefs which cannot be corrected by rational argument 1. Presentation of a child in the A&E with altered behaviour including psychotic features is not unusual 2. New-onset psychotic symptoms in children pose a significant diagnostic challenge due to several reasons.…”

Section: Introductionmentioning

confidence: 99%

Fifteen-minute consultation: an approach to a child presenting to the emergency department with acute psychotic symptoms

Israni

Kumar

Hussain

2017

Arch Dis Child Educ Pract Ed

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Presentation of a child in the A&E with altered behaviour including psychotic features is not unusual. New-onset psychotic symptoms in children pose a significant diagnostic challenge due to several reasons. First, primary psychotic conditions are uncommon in pre-pubertal children. Second, differentiating between delirium and psychosis can be difficult in children, more so in infants, toddlers and young children. Third, intervening and managing a secondary cause of psychosis can significantly optimise outcome. Prompt recognition of a possible underlying cause for a child's psychotic behaviour is essential, and at the same time challenging, in the emergency department. This article attempts to present a systematic approach to a child with acute onset of psychotic symptoms in an emergency setting.

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Characteristics and Triage of Children Presenting in Mental Health Crisis to Emergency Departments at Detroit Regional Hospitals

Abstract: Results provide descriptive information regarding child psychiatric emergency presentations in the city of Detroit. The identified factors that help determine triage to inpatient hospitalization suggest areas for possible resource allocation and potential ED-based intervention.

Cited by 19 publications

References 11 publications

Emotional Reactivity and Family-Related Factors Associated With Self-Injurious Behavior in Adolescents Presenting to a Child and Adolescent Psychiatric Emergency Service

Emotional Reactivity and Family-Related Factors Associated With Self-Injurious Behavior in Adolescents Presenting to a Child and Adolescent Psychiatric Emergency Service

Suicidality Presented to a Child and Adolescent Psychiatry Emergency Service: Increasing Rate and Changing Characteristics

Fifteen-minute consultation: an approach to a child presenting to the emergency department with acute psychotic symptoms

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