Pakistan’s First Child & Adolescent Psychiatry Inpatient Unit: Characteristics of admitted patients and response to treatment over a 7-year period

Abstract

Background & Objective: Child & adolescent mental health needs to be considered as an integral component of overall health, however significant gaps exist in service provision especially inpatient services in Pakistan. The paper presents the characteristics of admitted youths and response to treatment in Pakistan’s first dedicated child & adolescent psychiatry inpatient unit in Lahore over a period of first seven years. The aim of this study was to better understand the various characteristics of children and youth admitted to this inpatient unit and response to treatment over a seven years’ period since the inception of the unit.
 Methods: Inpatient medical records of children & adolescents admitted to dedicated Child & Adolescent Inpatient Unit at King Edward Medical University, Lahore were reviewed. Data was extracted regarding referral patterns, sociodemographic factors and diagnosis for the first seven years, from 2012 to 2019. Patients’ scores on Strengths and Difficulties Questionnaire and Clinical Global Impressions Scales administered during intake were also reviewed.
 Results: Six hundred and thirty-four (634) patients, 56% (355) being females were admitted to the unit during seven years with mean age of 12.3±2.3. Mean duration of admission was 15.60±6.3 days. Most predominant ICD-10 Axis-I psychiatric diagnosis were neurotic, stress related and somatoform disorders (262); mood disorders (78); schizophrenia, schizotypal & delusional disorders (77) and behavioral and emotional disorders with onset usually occurring in childhood and adolescence (44). One hundred and fifty-nine (25%) children had comorbid diagnosis of intellectual disability on Axis-III. Strengths and difficulties questionnaire scores were in abnormal range for significant proportion (>50 %) of patients. CGI mean scores showed marked improvement at discharge.
 Conclusion: Neurotic, stress related and somatoform disorders are the most common diagnosis in youth needing inpatient treatment in Pakistani setup. Study results indicate that there is a clear need for specialized inpatient child and adolescent services such as ours in low- & middle-income countries.
 doi: https://doi.org/10.12669/pjms.37.2.2611
 How to cite this:Imran N, Bodla ZH, Asif A, Shoukat R, Azeem MW. Pakistan’s First Child & Adolescent Psychiatry Inpatient Unit: Characteristics of admitted patients and response to treatment over a 7-year period. Pak J Med Sci. 2021;37(2):---------. doi: https://doi.org/10.12669/pjms.37.2.2611
 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

A systematic review of in-patient psychiatric care for people with intellectual disabilities and/or autism: effectiveness, patient safety and experience

“…24,25 The majority of studies were conducted in the UK, Scandinavia and Canada; however, a smaller number of studies took place in other European countries, Asia and Australia. 26,27,28,29,30,31,32,33 Methodologically, most studies lacked appropriate comparison samples or did not collect data prospectively at intervals (data collection periods ranged from 1 month to over 10 years, with a median of 36 months), and instead were cross-sectional and observational, describing a single group of participants (Table 2). For studies that included a comparison group, there was variability in the amount of detail provided, with some specifying sampling strategies or matching criteria 34 and others providing little information.…”

“…33,62 There were relatively fewer papers that focused specifically on discharge pathways for children and adolescents; however, there was tentative evidence to indicate that when admitted to secure services, they were more likely to transfer to another specialist unit, including secure in-patient services, whereas those within non-secure units tended to return home. 93,139 There was evidence that admission to in-patient services was associated with a reduction in clinical symptoms among children and adolescents with intellectual disabilities and/or autism, 28,33,90,94 bearing in mind that this conclusion is based on fewer papers than similar conclusions in the literature for adults included within this systematic view. There was also evidence that admission to a specialist in-patient service was associated with greater improvements and few readmissions, compared with admission to GMH in-patient services.…”

“…90,91 Both GMH and specialist intellectual disability services for children and adolescents with intellectual disabilities and/or autism were described as 'locked', and 24-h care was provided by nurses, psychologists, psychiatrists and allied health professionals. 28,92,93 Studies that included child and adolescent participants provided more information about staffing, service structure and approach than found within the adult literature, allowing for differentiation between GMH and specialist intellectual disabilities and/or autism in-patient services. 94 For example, Smith and Berney 93 described the differences between patient need within two 'open' wards with different levels of dependence based on severity of intellectual disabilities, and one low-secure ward within their specialist intellectual disabilities service; they described how these wards used focused behavioural and activities-based programmes more so than GMH units.…”

“…There were 20 different studies that investigated aspects of effectiveness associated with admission to a psychiatric in-patient service for children and adolescents. 25,28,30,31,33,[61][62][63][64][65][66][67][90][91][92][93][94][95]138,139 Length of stay Mean length of stay was available from 13 papers for children and adolescents (minimum 13.4 days, maximum 263 days). 28,33,[61][62][63]66,67,[90][91][92][93][94][95] Length-of-stay data indicated that a shorter length of stay was associated with admission to specialist higher-dependency intellectual disability in-patient services compared with secure open in-patient services 93 and GMH in-patient services.…”

Guided self-help Urdu version of the living life to the full intervention for secondary school adolescents with low mood and anxiety in Pakistan: A feasibility study

“…A recent community-based survey shows that 17.2% Pakistani adolescents report depression while 21.4% report anxiety ( Khalid et al., 2018 ). There is a strong need for specialized mental health services for children and adolescents in the country ( Imran et al., 2021 ). Community based prevention and intervention programs for depression and anxiety should be given top priory in such countries to avoid the development of the disease and its associated impairment ( Wong et al., 2014 ).…”