Examination of Consultations Requested from the Child and Adolescent Psychiatry Clinic and Factors Predicting Subsequent Outpatient Clinic Attendance

Year 2023, Volume: 9 Issue: 2, 130 - 136, 22.06.2023

Ömer Kardaş , Fatma Bahar Acar , Fulya Demirci

https://doi.org/10.30934/kusbed.1273121

Abstract

Objective: The aim of this study is to evaluate consultations received by the child and adolescent psychiatry consultation-liaison unit and identify factors predicting attendance at the outpatient clinic following consultation.
Methods: A retrospective review was conducted on all consultations requested from the consultation-liaison psychiatry (CLP) unit at our clinic between August 2021 and March 2022. The files of cases who subsequently attended the recommended outpatient clinic were also examined. Data including age, gender, birth and developmental history, family characteristics, school history, clinical features, and number of consultations were recorded and analyzed.
Results: The median age of the sample was 15.1 years (25%: 13.3 – 75%: 16.7). Among the cases, 128 (61.5%) were female and 80 (38.5%) were male. Of the consultations requested, 149 (71.6%) were from emergency services, while 52 (25%) were from inpatient services, with pediatric hematology being the most frequent service. The primary reasons for consultation were suicide attempts (22.1%) and agitation (19.2%). Approximately 26% of cases remained undiagnosed. Major depressive disorder was the most frequently diagnosed condition, accounting for 25.5% of cases. Among the cases recommended for outpatient follow-up at the time of consultation (86% of the total), 53% attended their scheduled appointments. In the predictive model for outpatient attendance, agitation (β=2.11, p<0.05) and suicide attempts (β=0.564, p<0.001) significantly predicted attendance.
Conclusion: This study contributes to the existing literature by examining factors influencing the follow-up process. Our findings support the notion that agitation and suicide attempts are associated with increased morbidity. Early detection of high-risk behaviors such as suicide attempts and agitation is believed to reduce psychiatric morbidity and mortality rates, while also improving treatment compliance.

Keywords

Consultation-liaison, child and adolescent psychiatry, psychosomatic medicine, suicide, agitation

Project Number

yok

References

• Samsel C, Ribeiro M, Ibeziako P, DeMaso DR. Integrated Behavioral Health Care in Pediatric Subspecialty Clinics. Child Adolesc Psychiatr Clin N Am. 2017;26(4). doi:10.1016/j.chc.2017.06.004
• Pinsky E, Rauch PK, Abrams AN. Pediatric consultation and psychiatric aspects of somatic disease. Rutter’s Child and Adolescent Psychiatry. Published online 2015:586-598.
• Hendrie HC, Lindgren D, Hay DP, et al. Comorbidity Profile and Healthcare Utilization in Elderly Patients with Serious Mental Illnesses. The American Journal of Geriatric Psychiatry. 2013;21(12):1267-1276. doi:10.1016/j.jagp.2013.01.056
• Bardach NS, Coker TR, Zima BT, et al. Common and costly hospitalizations for pediatric mental health disorders. Pediatrics. 2014;133(4). doi:10.1542/peds.2013-3165
• Ibeziako P, Bujoreanu S. Approach to psychosomatic illness in adolescents. Curr Opin Pediatr. 2011;23(4). doi:10.1097/MOP.0b013e3283483f1c
• Holmes J, Montana C, Powell G. Liaison Mental Health Services for Older People: A Literature review, service mapping and in-depth evaluation of service models. Research Service .Published online 2010.
• Snell C, DeMaso DR. Adaptation and coping in chronic childhood physical illness. Textbook of pediatric psychosomatic medicine. Published online 2010.
• American Psychiatric Association D, Association AP. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. Vol 5. American psychiatric association Washington, DC; 2013.
• Ersoy Şimşek EG, Eyüboğlu M, Eyüboğlu D. Bir Üniversite Hastanesinde Çocuk ve Ergen Psikiyatrisi Konsültasyonlarının Değerlendirilmesi. Osmangazi Journal of Medicine. 2018;00. doi:10.20515/otd.480686
• Aktepe E, Kocaman O, Işık A, Eroğlu FÖ. Bir Üniversite Hastanesinde İstenen Çocuk ve Ergen Psikiyatrisi Konsültasyon Hizmetlerinin Değerlendirilmesi. TAF Preventive Medicine Bulletin. 2013;12(5).
• Çolpan M, Eray S, Vural P. Evaluation of Consultations Requested from the Departments of Child and Adolescent Psychiatry of Uludag University Hospital within the Previous Year. Güncel Pediatri. 2013;11(3):102-106. doi:10.4274/Jcp.11.63825
• Pittsenbarger ZE, Mannix R. Trends in pediatric visits to the emergency department for psychiatric illnesses. Academic Emergency Medicine. 2014;21(1). doi:10.1111/acem.12282
• Woodgate M, Garralda ME. Paediatric liaison work by child and adolescent mental health services. Child Adolesc Ment Health. 2006;11(1). doi:10.1111/j.1475-3588.2005.00373.x
• Alpaslan AH, Koçak U, Çobanoğlu C, Görücü Y. Bir üniversite hastanesinde hastalardan istenen çocuk ve ergen psikiyatrisi konsültasyonlarının değerlendirilmesi. Yeni Symposium. 2015;53(3). doi:10.5455/NYS.20151214020808
• Tekkalaki B, Patil V, Chate S, Patil N, Patil S, Sushruth V. Pediatric referrals to psychiatry in a Tertiary Care General Hospital: A descriptive study. Journal of Mental Health and Human Behaviour. 2017;22(1):40. doi:10.4103/jmhhb.jmhhb_41_16
• Göker Z, Güney E, Gülser D, Üneri Ö. Bir eğitim ve araştırma hastanesinde yatarak tedavi gören çocuk ve ergenler için istenen psikiyatri konsültasyonlarının değerlendirilmesi. Türkiye Çocuk Hastalıkları Dergisi. 2014;8(1):17-24.
• Kılıç BG, Uslu R, Aysev A. A preliminary evaluation of consultation-liaison psychiatry services for children at a university hospital: Lessons learned to enhance efficacy. Yeni Symposium. 2007;45(4).
• Dil LM, Vuijk PJ. Emergency presentations to an inner-city psychiatric service for children and adolescents. Child Care in Practice. 2012;18(3). doi:10.1080/13575279.2012.683774
• Benenson JF. Sex differences. The Cambridge encyclopedia of child development. Published online 2005:366-373.
• Ambrose AJH, Prager LM. Suicide Evaluation in the Pediatric Emergency Setting. Child Adolesc Psychiatr Clin N Am. 2018;27(3):387-397. doi:10.1016/j.chc.2018.03.003
• Flaherty LT. Perspectives on Female Adolescent Development and Psychopathology. Adolesc Psychiatry. 2011;1(2). doi:10.2174/2210677411101020146
• Bilginer Ç, Karadeniz S, Aydoğdu S, Bulut Şahin D. Child Mental Health Services in Emergency Department of a University Hospital. Turkish Journal of Child and Adolescent Mental Health. 2021;28(1):12-19. doi:10.4274/tjcamh.galenos.2020.91300
• So P, Wierdsma AI, Vermeiren RRJM, Mulder CL. Psychiatric Emergencies in Minors: The Impact of Sex and Age. Pediatr Emerg Care. 2022;38(6):258-263.
• Randall MM, Parlette K, Reibling E, et al. Young children with psychiatric complaints in the pediatric emergency department. American Journal of Emergency Medicine. 2021;46. doi:10.1016/j.ajem.2020.10.006
• Mutlu C, Kilicoglu AG, Gunes H, et al. Characteristics of Pediatric Psychiatric Emergency Population in a Mental Health Hospital. Eurasian Journal of Emergency Medicine. 2015;14(3). doi:10.5152/eajem.2015.71354
• Bujoreanu S, White MT, Gerber B, Ibeziako P. Effect of timing of psychiatry consultation on length of pediatric hospitalization and hospital charges. Hosp Pediatr. 2015;5(5). doi:10.1542/hpeds.2014-0079
• Topal Z, Karadağ M, Çalişgan B, Subaşi Turğut F, Gökçen C, Bahşi İ. Characteristics of Child and Adolescent Psychiatry Consultations at a University Hospital and Accuracy Rates of Recognition of Childhood Psychiatric Diseases by Nonpsychiatry Specialists. Middle Black Sea Journal of Health Science. Published online 2021. doi:10.19127/mbsjohs.881342
• Bowling AA, Bearman SK, Wang W, Guzman LA, Daleiden E. Pediatric Consultation-Liaison: Patient Characteristics and Considerations for Training in Evidence-Based Practices. J Clin Psychol Med Settings. 2021;28(3):529-542. doi:10.1007/s10880-020-09738-0
• Özkan ÖG, Sapmaz ŞY, Kandemir H. Pediatri Kliniğinde Yatarak Tedavi Gören Hastalarda, Çocuk Psikiyatrisi Konsültasyonlarının Değerlendirilmesi. Klinik Psikiyatri Dergisi. 2017;20(4).
• Emiroğlu N, Aras Ş, Yalın Ş. Yatan hastalar için istenen çocuk ve ergen psikiyatrisi konsültasyonlarının değerlendirilmesi Evaluation of the child and adolescent psychiatric inpatient consultations. Anadolu Psikiyatri Derg. 2009;10.
• Gokcen C, Celik YI. The Evaluation Of Child And Adolescent Psychiatry Consultations from other Inpatient Clinics in a Training Hospital. Sakarya Medical Journal. 2011;1(4):140-144. doi:10.5505/sakaryamj.2011.25744
• Arslantaş H, Gültekin BK, Söylemez A, Dereboy F. Bir üniversite hastanesi psikiyatri polikliniğine ilk kez başvuran hastaların damgalamayla ilgili inanç, tutum ve davranışları. Published online 2010.
• Çam O, Bilge A. Ruhsal hastalığa yönelik damgalama ile mücadele. TAF Preventive Medicine Bulletin. 2010;9(1).
• Pescosolido BA, Perry BL, Martin JK, McLeod JD, Jensen PS. Stigmatizing attitudes and beliefs about treatment and psychiatric medications for children with mental illness. Psychiatric Services. 2007;58(5):613-618.
• Elif A, Berkem M. İntihar girişiminde bulunan ergenlerde psikiyatrik tanıların, demografik ve klinik özelliklerin değerlendirilmesi. Fırat Tıp Dergisi. 2012;17(4):228-232.
• Tishler CL, Reiss NS, Rhodes AR. Suicidal behavior in children younger than twelve: a diagnostic challenge for emergency department personnel. Academic Emergency Medicine. 2007;14(9):810-818.
• Santiago LI, Tunik MG, Foltin GL, Mojica MA. Children requiring psychiatric consultation in the pediatric emergency department: epidemiology, resource utilization, and complications. Pediatr Emerg Care. 2006;22(2):85-89.
• Cuypers PJ V, Danckaerts M, Sabbe M, Demyttenaere K, Bruffaerts R. The paediatric psychiatric emergency population in a university teaching hospital in Belgium (2003–2008). Eur J Emerg Med. 2014;21(5):384-386.