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Medical News & Research

Children and families need special information to address medical and psychiatric issues.

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,...

Millions of children are not receiving health benefits

WASHINGTON | Wed Sep 8, 2010 Joanne Allen, editing by Anthony Boadle, report for Reuters that “An estimated five million uninsured children in the United States were eligible for Medicaid or the Children’s Health Insurance Program (CHIP) but were not enrolled in either plan, according to a new report.  The study published on Friday in the journal “Health Affairs” recommended policy reforms and broader efforts to get uninsured children into government medical programs, including the use of income tax data for automatic enrollment.”  These findings were reported on http://www.reuters.com. Every state is effected by the budget issues.  Children’s health insurance is just one of the under funded areas that affect children and families.  A combination of State and Federal funds are involved with this process. Benjamin D. Sommers reports that “Keeping children who are eligible for Medicaid and the Children’s Health Insurance Program (CHIP) enrolled in these programs remains an important policy challenge.“  See Health...

Prescriptions for Stimulants, Antidepressants on the Rise for Preschoolers

February 22, 2000 JAMA/MedscapeWire The amount of prescriptions being written for preschoolers for stimulants and antidepressants is on the rise, suggesting increased unapproved use of these medications, according to an article in the February 23 issue of The Journal of the American Medical Association. Julie Magno Zito, PhD, from the University of Maryland, Baltimore, and colleagues studied the prescription records of children aged 2 to 4 years enrolled in 2 Medicaid programs (Midwestern state Medicaid program and Mid-Atlantic state Medicaid program) and 1 health maintenance organization (HMO, in the Northwest United States) to determine the prevalence of psychotropic medication use in preschoolers. Psychotropic medications are drugs such as stimulants, antidepressants, sedatives, and antipsychotic drugs that have an effect on the mind. The researchers analyzed data from 1991, 1993, and 1995 from more than 200,000 patients. “Several prominent trends characterized the use of psychotropic medications in preschoolers during the early to mid 1990s,” the authors explain. “Overall, there were large increases for all study medications (except neuroleptics) and considerable variation according to gender, age, geographic region, and health care system. These findings are remarkable in light of the limited knowledge base that underlies psychotropic medication use in very young children.” In 1995, the prevalence rates per 1,000 2- through 4-year-old children in the Midwestern state Medicaid program were 12.3 for stimulants, 3.2 for antidepressants, and 2.3 for clonidine; in the mid-Atlantic state Medicaid program prevalence rates were 8.9 for stimulants, 1.6 for antidepressants, and 1.4 for clonidine; and in the HMO program prevalence rates were 5.1 for stimulants, 0.7 for antidepressants, and 1.9 for clonidine. Increases in prevalences were noted...

Parents Worry about Hospitalized Kids

FRIDAY, Aug. 7 (HealthDay News)— Many parents worry that their child may be the victim of medical errors while in the hospital, a new study has found.“In a survey of 278 parents of children hospitalized in 2005 at Seattle Children’s Hospital, nearly two-thirds reported feeling the need to watch over their child’s care to ensure there were no medical errors.“ The findings were published in a recent issue of the Journal of Hospital...

Health on the Internet

Before doctor’s visit, many surf Internet for info Last Updated: 2003-02-13 12:55:50 -0400 (Reuters Health) By Hannah Cleaver BERLIN (Reuters Health) – One in four Internet users search online for medical information before or after a visit to the doctor, according to a new survey conducted in Germany. This growing tendency is seen as a two-edged sword by doctors, who feel that an involved patient is a better patient, but worry about the quality of information people are getting, an expert said. The poll showed that 7% of Internet users go online to search for medical information before a visit to the doctor, while 8% check things out on the web after an appointment and 10% look on the Internet before and afterwards. A further 53% of the more than 1,700 Internet users questioned by polling company TNS Emnid said they could imagine themselves using the Internet as a source of information in conjunction with a visit to the doctor. Roland Ilzhoefer, spokesman for the KVB, the association covering most general practitioners and non-hospital specialists, told Reuters Health there were two sides to such use of independent information sources. “On the one side it is good when a patient is interested in their injury or illness, interested enough to get information for themselves from whatever source, be that newspapers, magazines or books and of course the Internet.” Those patients are more likely to follow-through with prescribed treatments, he said. “But of course, on the other hand, the question remains of how dependable the information that the patient has found, actually is. And even if it is useful information, it...

Deadly Drug Side Effects

Drug side effects can be deadly in children under 2 Last Updated: 2002-11-05 11:06:07 -0400 (Reuters Health) By Natalie Engler NEW YORK (Reuters Health) – Medications used to treat either a mother or child played a role in nearly 6,000 serious side effects, including 769 deaths, in children under 2 years of age in the US between 1997 and 2000, according to an analysis of cases reported to the Food and Drug Administration. Medications given to pregnant or breast-feeding women may have caused a large proportion of adverse events, and just four drugs were the principal suspect in more than one third of all the reported deaths. “The results of this study underscore the need for additional testing in the youngest pediatric patients and for greater vigilance in the use of higher risk drugs and in medication for pregnant and lactating women,” the researchers report in the November issue of the journal Pediatrics. However, they note that the reports do not prove that the medication was the actual cause of the side effect or death. Overall, the investigators identified 1,902 drugs, chemicals, biological products, vaccines, over-the-counter medications, vitamins, minerals, dietary supplements and other substances in the reports, but just 17 drugs were indicated in more than half of the serious side effects or deaths in children given medication directly. The vast majority of deaths (84%) happened before the infant’s first birthday. In the study, Thomas J. Moore of George Washington University in Washington DC and his colleagues analyzed over 7,000 reports of adverse drug reactions in children under age 2 received by the US Food and Drug Administration from...

Kids on Behavioral Meds

The Child Advocate is devoted to children and the parents and professionals that work with them and advocate for them. Children on medication for behavioral problems is a major concern for parents. The information presented at this site is for general use only and is not intended to provide personal advice or substitute for the advice of a qualified professional. If you have questions about the information presented here, please consult the resources listed or other professional in your area. US kids on behavioral meds tripled in a decade NEW YORK, Apr 25 (Reuters Health) – The number of children in the United States prescribed medications to treat depression, attention-deficit/hyperactivity disorder (ADHD) or other behavioral conditions nearly tripled between 1986 and 1996, according to the results of a study. The overall annual rate for the prescription of these types of medications–called psychotropic medications because they aim to treat emotional/behavioral conditions–was 14 children per 1,000 in 1987 and increased to 39 children per 1,000 in 1996, the investigators found. In the study, Dr. Mark Olfson of Columbia University in New York City and colleagues reviewed surveys of medication use for more than 50,000 people including about 17,000 children under the age of 18 years in 1986 and 1996. The findings are published in the May issue of the Journal of the American Academy of Child and Adolescent Psychiatry. Olfson and his team found that the number of children taking stimulants such as Ritalin and Adderall, used to treat ADHD, quadrupled from 6 children per 1,000 in 1986 to 24 per 1,000 in 1996. Those taking antidepressants such as Prozac or...
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