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News Release – Children and adolescents admitted to psychiatric hospitals

ISP Conference on Mental Health Services features findings of a study suggesting the risks of shortening the length of stay for children and adolescents admitted to psychiatric hospitals.   WASHINGTON, Oct. 6, 2016 /ChildAdvocate/ — The ISP Conference on Mental Health Services provides a opportunity to learn, share, and network with researchers and leaders from around the world.  The Conference takes place at The Washington Hilton from October 6-9, 2016.   Today the conference features a study from Penn State University of College of Medicine that looks at whether shorter lengths of stay in psychiatric inpatient programs are associated with higher risks of readmissions for children and adolescents.  Other factors are also analyzed.  While psychiatric admissions for children and adolescent once were more than 30 days, changes in care and insurance restrictions have dropped that to just days.  While admissions of 14 days are now considered appropriate for many patients, approval can limit treatment to 24 hours in some cases.  The authors attempted to determine if this improved or compromised care.  Readmission rates of children having to return to the hospital are one measure as to the success of the program and more readmissions suggest that the care is not sufficient.  This study shows that the trend demonstrates that decreased length of stay is significantly associated with increased readmission rates when looking at 12 month increments.  The study included 3,896 children and adolescents admitted to inpatient psychiatric units at a large, multidisciplinary academic medical center during major changes in inpatient care from 1991-2003.  The average age was 10.7 years.  The findings are consistent with clinical impressions that readmissions increased as a direct result of...

SSRI Syndrome: A Review of Cases

Jimmy O. Ibikunle, M.D., Penn State College of Medicine, Department of Psychiatry, 500 University Drive, Hershey, PA 17033 1. Recognize constellation of signs and symptoms for diagnosis of serotonin syndrome. 2. Demonstrate understanding of pharmacokinetics pertinent in medication management with serotonergic agents. Serotonin syndrome is a toxic, potentially fatal hyperserotonergic state.(1) It has been reported at initiation, in overdose and combination of serotonergic agents. It also occurs in recreational substance abuse Sternbach’s diagnostic criteria(1) include autonomic, neuromuscular and cognitive symptoms and signs. Method: A retrospective chart review of toxicology consults at a university medical center for reported or suspected overdose and drug interactions involving at least one known serotonergic agent(2) was done. Individuals with substance intoxication and animal bites were excluded. Results: Of the 173 cases, over a 5-year period, 5 met criteria(1) for serotonin syndrome, constituting 2.89%. Mean age was 34.4. Four patients were female. One required ICU stay; others were discharged within 24 hours; all survived. Three cases occurred in the course of medication adjustments: switching from fluoxetine to trazodone, augmenting fluoxetine with Lithium and simultaneously increasing doses of fluoxetine and trazodone. Two cases involved intentional overdose: one with venlafaxine and the other with sertraline; the latter followed a recent switch to fluvoxamine. Cognitive symptoms were the most common initial presentation. Conclusion: Occurrence during medication changes supports an iatrogenic etiology. No cases involved a MAOI, notorious for its precipitant effect, and fluoxetine’s pharmacokinetics(2) suggests its predisposition. References: Sternbach H. The serotonin syndrome. American Journal of Psychiatry, 1991;148:705-13. Mills KC. Serotonin syndrome. American Family Physician, 1995;25:1475-82. Additional information from the author at...

Smoking during Pregnancy

Exposure to Tobacco During Pregnancy Affects Behavior in Newborns (The Nemours Foundation) According to a survey by the Centers for Disease Control and Prevention (CDC), more than 12% of women who gave birth during 1999 smoked during pregnancy. Smoking during pregnancy passes nicotine and other dangerous substances to the fetus and increases the risk of stillbirth, birth defects, low birthweight, sudden infant death syndrome (SIDS), and cancer. Maternal smoking has also been shown to affect the developing nervous system of the fetus. Researchers from Brown Medical School in Providence, Rhode Island, examined the effects of maternal smoking on a newborn’s body functions and behavior. Shortly after delivery in the hospital, the mothers of 56 full-term infants answered questions about their use of cigarettes during pregnancy and provided saliva samples to confirm their smoking or nonsmoking status. The mothers who smoked reported the number of cigarettes they smoked in a typical day of each trimester of pregnancy. Within 48 hours after birth, all of the infants underwent examinations of neurological and behavioral function, including tests for reflexes, central nervous system function, and visual function. In general, the infants who were exposed to tobacco were more excitable, had greater muscle tension, and showed other symptoms similar to infants going through drug withdrawal. Babies who had been exposed to tobacco needed to be picked up and touched more, and also showed more signs of physical stress in the central nervous system, gastrointestinal system, and visual system. The more cigarettes per day a mother smoked, the greater the effects on the newborn’s body functions and behavior. What This Mean to You: Smoking during...

Sleep Apnea in Children

Doctors Should Screen Kids for Snoring and Sleep Apnea Mon Apr 1,11:48 AM ET By Melissa Schorr NEW YORK (Reuters Health) – For the first time, the American Academy of Pediatrics (AAP) is recommending that doctors screen all children for snoring to determine if they might be at risk of obstructive sleep apnea, a temporary collapse of the upper airway that occurs during sleep. Symptoms of the condition include snoring, often with pauses, snorts or gasps as breathing temporarily stops and restarts. “Our hope is this will raise awareness of this condition among pediatricians so more children will be diagnosed,” AAP committee chair Dr. Carole L. Marcus, director of the pediatric sleep center at Johns Hopkins University in Baltimore, Maryland, told Reuters Health. During the past 3 years, the committee conducted a review of more than 2,000 medical journal articles to develop the first-of-their-kind guidelines on sleep apnea among children. While about 3% to 12% of youngsters snore, about 2% are thought to have obstructive sleep apnea syndrome. If left untreated, sleep apnea can cause significant health problems such as poor growth, neurological or behavioral problems, and in the most severe cases, heart problems. “People are familiar with this for adults, but don’t realize this is common in children because they look fine when they are awake,” Marcus noted. “People don’t think to bring up the condition of snoring.” However, the guidelines recommend that pediatricians should ask all children and their parents whether or not the child snores. Those who do snore should be further questioned on whether the snoring is continuous, causes the child to choke or gasp,...

Majority of children don’t get appropriate health care

Up to three-quarters of children and adolescents don’t get appropriate care Washington, D.C., April 15, 2004—Despite a number of noted successes, American children largely don’t get the quality of health care they should, with up to three-quarters of children and adolescents not receiving care scientifically proven or recommended, according to a new overview of children’s health care released today by The Commonwealth Fund. The review, Quality of Health Care for Children and Adolescents: A Chartbook, shows a number of clear advances in children’s health care and improved outcomes on a series of measures. But it also notes that one-third of children with asthma don’t get appropriate controller medications and three-fourths of children with severe mental health problems don’t get evaluation or treatment. In addition, it illustrates ongoing racial disparities in care and inadequate attention to widely effective preventive measures. Distilled from a review of 500 studies, the report illustrates through 40 charts and commentary the quality of care children receive in numerous categories, such as preventive care and treatment of chronic conditions. The chartbook was produced by Sheila Leatherman, research professor at the University of North Carolina School of Public Health, and Douglas McCarthy, president of Issues Research, Inc., based in Durango, CO, in consultation with national experts in child and adolescent care quality. “Given the fact that we spend far more on health care than other countries, we should be doing better for our children,” Leatherman said. “The report shows dangerous lapses in patient safety, substantial shortcomings in providing effective and recommended care, persistent racial and ethnic disparities in care, and widespread failure to provide needed preventive services...

Overdose: A Review of 100 Consecutive Cases

1. Evaluate and treat patients with significant overdose. 2. Understand risk factors for significant overdose. Patients who overdose represent a significant challenge(1) for consultation-liaison psychiatrists. Methods: A retrospective chart review of 100 patients over 18 consecutively admitted from July through December, 1998 by the toxicology service following overdose warranting hospitalization was performed. Diagnoses were based on DSM-IV criteria. Results: Seventy-eight percent of the 100 toxicology cases reported suicidal intent. The age range was 18 to 79; the mean was 34.8. Fifty-five percent were female. The primary psychiatric diagnoses are as follows: 64% mood disorder, 16% substance related disorder, 8% adjustment disorder, 7% psychotic disorder, 2% anxiety disorder, 3% other. Sixty-eight percent had a prior Axis I diagnosis other than substance abuse. Forty-one percent were currently receiving psychiatric treatment. Sixty-four percent had co-existing substance abuse. Twenty-nine percent ingested at least one substance of abuse as part of the overdose. Forty-six percent had previously attempted suicide. Seventy-five percent identified a stressful life event. Conclusion: Adult overdose patients share risk factors(1,2) for suicidal behavior including the presence of an Axis I diagnosis, particularly a mood disorder; lack of current psychiatric treatment; history of prior suicide attempt; and significant life stressors. Substance abuse represents a significant independent and comorbid risk factor for overdose.   Klerman GL. Clinical epidemiology of suicide. Journal of Clinical Psychiatry, 1987;48:33-8. Beaumont G, Hertzel W. Patients at risk of suicide and overdose. Psychopharmacology,...
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