Trends in the Inpatient Mental Health Treatment of Children and Adolescents in US Community Hospitals Between 1990 and 2000

Case, Brady G.; Olfson, Mark; Marcus, Steven C.; Siegel, Carole

doi:10.1001/archpsyc.64.1.89

Cited by 126 publications

(119 citation statements)

References 40 publications

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“…In most cases, patients can remain hospitalized for the length of time necessary in order to reach improvement. In a recent study exploring the transformation of the length of inpatient mental health treatment for young people in the US, the median length of stay for bipolar children and adolescents fell from 19.9 days in 1990 to 5.6 days in 2000 in community hospitals [12]. This difference probably reflects great differences in free access to care especially between the US and France and should be considered when the US and French studies are compared.…”

Section: Discussion J Limitations and Strengthsmentioning

confidence: 99%

“…The sample was composed of 45 females and 35 males with a mean age of 15.7 (±1.9) years (range [12][13][14][15][16][17][18][19]. The socio-demographic and clinical characteristics of the sample are summarized in Table 1.…”

Section: J Statistical Analysismentioning

confidence: 99%

“…To summarize, mixed polarity, low socioeconomic status (SES), young age at onset, previous affective episode, psychosis and female sex were associated at least in one study with a poorer outcome [5,18,27,29,52]. Furthermore, in the US, inpatient treatment tends to be shorter and shorter (median lenght of stay for BD in 2000 is 5.6 days) due to economic pressures [12], which leads to a bias in short-term prognosis studies. As underlined by Strober et al [53], observational data are sparse in the literature on BD in youths despite their great importance for assessment of prognosis and prospective long-term studies.…”

Section: Introductionmentioning

confidence: 99%

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Phenomenology, socio-demographic factors and outcome upon discharge of manic and mixed episodes in hospitalized adolescents

Brunelle

Consoli

Tanguy

et al. 2009

Eur Child Adolesc Psychiatry

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Med J 29, 2006). Little is known on the phenomenology and potential short-term prognosis factors of bipolar episodes in this age population. In particular, very few studies examine this issue on inpatients in the European context of free access to care. Objective To describe the phenomenology of acute manic and mixed episodes in hospitalized adolescents and to analyse potential predictive factors associated with clinical improvement at discharge and length of hospitalization. Methods A total of 80 subjects, aged 12-20 years, consecutively hospitalized for a manic or mixed episode. Sociodemographic and clinical data were extracted by reviewing patients' charts. We used a multivariate analysis to evaluate shortterm outcome predictors. Results The sample was characterized by severe impairment, high rates of psychotic features (N = 50, 62.5%), a long duration of stay (mean 80.4 days), and an overall good improvement (86% very much or much improved). Thirtythree (41.3 %) patients had a history of depressive episodes, 13 (16.3%) had manic or brief psychotic episodes but only 3 (3.7%) had a history of attention deficit/ hyperactivity disorders. More manic episodes than mixed episodes were identified in subjects with mental retardation (MR) and in subjects from migrant and/or low socio-economic families. Overall severity and female gender predicted better improvement in GAF scores. Poor insight and the existence of psychotic features predicted longer duration of stay. Conclusion These results suggest that severe manic and mixed episodes in adolescents with BD-I need prolonged inpatient care to improve and that socio-cultural factors and MR should be examined more closely in youth with BD.j Key words bipolar disorder type I -acute episodeadolescent -prognosissocio-cultural factors BRIEF REPORT

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Section: Discussion J Limitations and Strengthsmentioning

confidence: 99%

Section: J Statistical Analysismentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Phenomenology, socio-demographic factors and outcome upon discharge of manic and mixed episodes in hospitalized adolescents

Brunelle

Consoli

Tanguy

et al. 2009

Eur Child Adolesc Psychiatry

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“…Yet many of these same children could also be appropriately diagnosed with attention deficit hyperactivity disorder (ADHD), comorbid with Oppositional Defiant Disorder (ODD), anxiety, depression, and/or intermittent explo sive disorder. This lack of clarity and agreement among researchers and clinicians on the diagnostic criteria may have contributed to the fortyfold rise in reported prevalence of PBD over the last two decades [8] .…”

Section: Bipolar Disorder (Bd) Is a Chronic Mental Illness Affecmentioning

confidence: 99%

Risk for emerging bipolar disorder, variants, and symptoms in children with attention deficit hyperactivity disorder, now grown up

Elmaadawi

Jensen

Arnold

et al. 2015

WJP

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World Journal of Psychiatry W J P Retrospective Study ORIGINAL ARTICLEorted significantly higher mean TSC scores: ADHD 3.0; LNCG 1.7; P < 0.001. ADHD status was associated with higher mean NSM: ADHD 2.0 vs LNCG 1.1; P < 0.0001. Also, ADHD subjects had higher PM symptoms than LNCG, with PM means over all time points of 1.3 ADHD; 0.9 LNCG; P = 0.0001. Examining both NSM and PM, ADHD status associated with greater NSM than PM. However, Over 14 years, the NSM symptoms declined and changed to PM over time (df 3, 2523; F = 20.1; P < 0.0001). Finally, Irritability (BD DSM criterion-A2) rates were significantly higher in ADHD than LNCG (χ 2 = 122.2, P < 0.0001), but irritability was associated more strongly with NSM than PM (df 3, 2538; F = 43.2; P < 0.0001). CONCLUSION:Individuals with ADHD do not appear to be at significantly greater risk for developing BD, but do show higher rates of BD symptoms, especially NSM. The greater linkage of irritability to NSM than to PM suggests caution when making BD diagnoses based on irritability alone as one of 2 (A-level) symptoms for BD diagnosis, particularly in view of its frequent presentation with other psychopathologies.Key words: Multimodal treatment study of attention deficit hyperactivity disorder; Irritability; Attention deficit hyperactivity disorder; Diagnostic interview schedule for children; Bipolar disorder Core tip: Despite its formal DSM delineation, alternative pediatric bipolar disorder (BD) definitions have been debated for decades. Some research suggests that attention deficit hyperactivity disorder (ADHD) poses a risk for BD and that pediatric BD presents differently as non-episodic, greater chronicity, and more frequent irritability. In our study, we found the ADHD status is not a risk factor for developing BD over 14 years of followups. When we controlled for overlapping ADHD/BD, nonspecific symptoms showed decreasing rates of BD in ADHD-diagnosed children. Clinicians are encouraged to pay greater attention to specific symptoms of mania in order to establish an accurate BD diagnosis. Furthermore, irritability (DSM criteria A2), was a nonspecific symptom of mania and linked to common psychopathologies in the early development of these children.

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“…Demands on health production is high in emergency units [4]. Treatment is mainly based on pharmacologic interventions [4], with components of common factors [5], crisis intervention [6] and therapeutic milieu [7].…”

Section: Introductionmentioning

confidence: 99%

Issues in Child and Adolescent Inpatient Assessment and Evaluation After Discharge: Protocol for App Development and a Randomized Controlled Trial (Preprint)

Hansson¹,

Johansson²,

Andersson³

et al. 2018

Preprint

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Background: New methods for in-and outpatient data collection and for improvning outpatient compliance after discharge are called for. Interactive and mobile technologies i.e. smartphone applications (apps) have shown promising results, e.g. helping unwell people by offering support and resources. Screening the current condition, including comorbidity, is a vital part of psychiatric care. Comorbid conditions, especially in emergency evaluation, are often missed leading to inaccurate diagnosis and treatment. Also in child and adolescent psychiatric emergency settings, little is known regarding treatment satisfaction. One way of improving diagnostic accuracy and to increase knowledge regarding treatment satisfaction is to use a structured diagnostic process as well as adding a tool to assess consumer satisfaction. Digitalized screening and follow-up has the advantage of making the administration and scoring easier and less time consuming leading to higher response rate. To address the described problems we decided to create a smartphone application: Blå Appen. Objective: The aim of this paper is to describe the development of Blå Appen and to describe the two planned research studies to evaluate the application. Methods: Blå Appen was developed through 7 different steps: (1) Identifying the need for quick and easy information gathering; (2) identifying desired information and choosing adequate screening questionnaires (3) examining the feasibility in acute psychiatric environment -pilot study; (4) getting organizational acceptancefeasibility study; (5) App construction; (6) Workshop with adolescents -what do the patients think; (7) evaluation -research study 1 & 2. Results: (1) We decided to create a smartphone application based on our previous work on interactive voice response. (2) Eleven validated screening questionnaires were chosen with regard to frequent comorbid states in child & adolescent psychiatry. (3) A pilot study was performed (n=16) indicating good acceptability. In the next step (4) we performed a feasibility study concluding that the method we planned adds value for our patients and no existing solutions were found on the market. The IT department gave their final approval for funding in May 2015. (5) The work resulted in a public procurement. (6) We performed a workshop indicating good feasibility. (7) Two studies will be performed, one in inpatients identifying comorbid conditions and the other to assess outpatient compliance and treatment outcome. Conclusions: A technically advanced and easy-to-use web based mobile phone application corresponding to the unit's needs was developed and two studies to evaluate its usefulness were planned.

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Trends in the Inpatient Mental Health Treatment of Children and Adolescents in US Community Hospitals Between 1990 and 2000

Cited by 126 publications

References 40 publications

Phenomenology, socio-demographic factors and outcome upon discharge of manic and mixed episodes in hospitalized adolescents

Phenomenology, socio-demographic factors and outcome upon discharge of manic and mixed episodes in hospitalized adolescents

Risk for emerging bipolar disorder, variants, and symptoms in children with attention deficit hyperactivity disorder, now grown up

Issues in Child and Adolescent Inpatient Assessment and Evaluation After Discharge: Protocol for App Development and a Randomized Controlled Trial (Preprint)

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