The transition from child and adolescent to adult mental health services with a focus on diagnosis progression

Abstract

Aims and methodThis article examines mental health disorders as individuals transition from adolescence to adulthood. Data were collected from clinical records of patients who had transitioned from child and adolescent mental health services to adult mental health services in a region in South Wales. Demographics and clinical diagnoses under both services were recorded. Patterns between adolescent and adult disorders as well as comorbidities were investigated using Pearson's χ2-test and Fisher's exact test.ResultsOf the 98 patients that transitioned from one service to the other, 74 had changes to their diagnoses. There were 164 total changes to diagnoses, with patients no longer meeting diagnostic criteria for 64 disorders and 100 new disorders being diagnosed. Comorbidity increased in adulthood.Clinical implicationsDiagnoses can evolve, particularly during adolescence and early adulthood. Therefore regular reassessment is paramount for successful treatment.Declaration of interestNone.

Adverse childhood experiences as risk factors for recurrent admissions in young psychiatric inpatients

“…As expected, young inpatients with a former CAP admission were burdened with higher cross-category comorbidity, with an average of nearly three diagnostic categories across all psychiatric inpatient treatments. Increased rates of comorbidity in patients with former CAP treatment have been previously reported in studies examining the transition from CAP to adult psychiatric care ( 34 , 58 ). Furthermore, diagnostic change during this service transition – which has been observed to occur in three quarters of CAP inpatients in a recent study in Wales ( 58 ) – could have contributed to the increased rates of cross-categorical comorbidity in the current study, which assessed admissions spanning childhood, adolescence and young adulthood.…”

Unterstützungsmöglichkeiten von jungen Erwachsenen mit einer psychischen Erkrankung und Herausforderungen während der Transition

“…B. ein vorzeitiger Therapieabbruch oder die Ablehnung indizierter Behandlungsangebote resultieren 14 , 15 . Zudem ist zu beobachten, dass sich aus fachlicher Sicht – auch entwicklungspsychopathologisch bedingt – die diagnostische Einschätzung von Symptomen junger Erwachsener verändern kann, wenn sie in die psychiatrisch-psychotherapeutischen Dienste für Erwachsene wechseln 15 , 16 .…”

Diagnosis on the way out – personality on the way in? Priorities in treatment in child and adolescent psychiatry

“…ICD-10 wisely urged us to avoid diagnosing personality disorders, and never before the age of 16, and so it appears we also neglected the role played by personality development and our adaptations to the trials of surviving. It should not surprise us that when transitioning to adult psychiatry, a large number of diagnoses made in child psychiatry are converted into personality disorders by adult psychiatrists (Collins & Muñoz-Solomando, 2018). I now urge a debate on whether clinicians should pay greater attention to personality development and its consequences in child psychiatry.…”