Caner MUTLU, Melike OZDEMİR, Özgür YORBIK, Ali Güven KILIÇOĞLU

Psikiyatrik acil serviste görülen davranım bozukluğu olan ergenler için hastaneye yatma olası öngörücüleri

Amaç, bir ruh sağlığı hastanesi acil servisinde görülen davranım bozukluğu (DB) olan ergenlerin hastaneye yatış öngörücülerini araştırmak idi. Yöntem: Hastalar, 6 aylık dönem içerisinde ilk başvurularına göre, yaş, cinsiyet, okul durumu, aile yapısı, geliş belirtileri ve bunların süresi, eşlik eden psikiyatrik tanılar, daha önce acil servis ya da poliklinik kullanımı, önceden psikiyatrik yatış ve ailesinde ruhsal bozukluk öyküsü açısından geriye dönük değerlendirildi. Bulgular: Ortalama yaş 15.69±1.26 yıl idi. Toplam 144 hastanın, %61.8'i (n=89) kız idi ve 50'si (%34.7) hastaneye yatırıldı. Yatırılmadan tedavi edilen hastalara göre, yatarak tedavi edilen hastalarda anlamlı olarak daha fazla suisid düşüncesi, daha uzun belirti süresi, daha fazla eşlik eden bir ruhsal bozukluk ve ailede psikiyatrik bozukluk öyküsü vardı. Çok değişkenli lojistik regresyon analizinde, intihar düşüncesi, eşlik eden bir psikiyatrik bozukluğa sahip olma ve ailede ruhsal bir bozukluk öyküsüne sahip olma, psikiyatrik yataklı üniteye yatışı öngördü. Sonuç: Acil birimlerindeki klinisyenler, intihar düşüncesi, eşlik eden ruhsal bir bozukluğu ve ailede ruhsal bir bozukluk öyküsü olan DB'li ergenlerde hastaneye yatışı öngörmenin farkında olmalıdır. İntihar girişimi, DB'li ergenlerde yatışı öngörmede, direkt etkiden ziyade, indirekt etkiye sahip görünmektedir

Possible Predictors of Hospitalization for Adolescents with Conduct Disorder Seen in Psychiatric Emergency Service

Objective: The aim was to investigate predictors of hospitalization of adolescents with conduct disorder (CD) seen in emergency service of a mental health hospital. Method: Patients were evaluated retrospectively by age, gender, school status, family structure, presenting symptoms and their duration, comorbid psychiatric diagnoses, prior emergency service or outpatient clinic use, prior psychiatric hospitalization and family history of any mental disorder, according to first presentation during a 6-month period. Results: Mean age was 15.69±1.26 years. Of the total of 144 patients, 61.8% (n=89) were female and 50 (34.7%) were hospitalized. Adolescents admitted to the inpatient unit presented significantly more often with suicidal ideation, had longer symptom duration, and were more likely to have a comorbid psychiatric disorder and a family history of a psychiatric disorder compared to those not admitted. In multivariate logistic regression analysis, suicidal ideation, having a comorbid psychiatric disorder, and having family history of a mental disorder predicted admission to the psychiatric inpatient unit. Conclusion: Clinicians in emergency settings should be aware of the prediction of hospitalization in adolescents with CD who have suicidal ideation, a comorbid psychiatric disorder and family history of a mental disorder. Suicide attempt seems to have an indirect effect, rather than a direct effect, on the prediction of hospitalization in youths with CD

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1. Olsson M. DSM diagnosis of conduct disorder (CD)--a review. Nord J Psychiatry 2009; 63:102-112. [CrossRef]
2. Olsson M, Hansson K, Cederblad M. A long-term follow-up of conduct disorder adolescents into adulthood. Nord J Psychiatry 2006; 60:469-479. [CrossRef]
3. Breslow RE, Klinger BI, Erickson BJ. The disruptive behavior disorders in the psychiatric emergency service. Gen Hosp Psychiatry 1999; 21:214-219. [CrossRef]
4. Lee J, Korczak D. Emergency physician referrals to the pediatric crisis clinic: reasons for referral, diagnosis and disposition. J Can Acad Child Adolesc Psychiatry 2010; 19:297-302.
5. Mahajan P, Alpern ER, Grupp-Phelan J, Chamberlain J, Dong L, Holubkov R, Jacobs E, Stanley R, Tunik M, Sonnett M, Miller S, Foltin GL; Pediatric Emergency Care Applied Research Network (PECARN). Epidemiology of psychiatric-related visits to emergency departments in a multicenter collaborative research pediatric network. Pediatr Emerg Care 2009; 25:715-720. [CrossRef]
6. Matsu CR, Goebert D, Chung-Do JJ, Carlton B, SugimotoMatsuda J, Nishimura S. Disparities in psychiatric emergency department visits among youth in Hawai’i, 2000-2010. J Pediatr 2013; 162:618-623. [CrossRef]
7. Huffman LC, Wang NE, Saynina O, Wren FJ, Wise PH, Horwitz SM. Predictors of hospitalization after an emergency department visit for California youths with psychiatric disorders. Psychiatr Serv 2012; 63:896-905. [CrossRef]
8. 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; 22:85-89. [CrossRef]
9. Dolan MA, Fein JA; Committee on Pediatric Emergency Medicine. Pediatric and adolescent mental health emergencies in the emergency medical services system. Pediatrics 2011; 127:e1356-e1366. [CrossRef]
10. Gyllenberg D, Sourander A, Niemelä S, Helenius H, Sillanmäki L, Piha J, Kumpulainen K, Tamminen T, Moilanen I, Almqvist F. Childhood predictors of later psychiatric hospital treatment: findings from the Finnish 1981 birth cohort study. Eur Child Adolesc Psychiatry 2010; 19:823-833. [CrossRef]
11. Lambert EW, Wahler RG, Andrade AR, Bickman L. Looking for the disorder in conduct disorder. J Abnorm Psychol 2001; 110:110-123. [CrossRef]
12. Masi G, Milone A, Manfredi A, Pari C, Paziente A, Millepiedi S. Conduct disorder in referred children and adolescents: clinical and therapeutic issues. Compr Psychiatry 2008; 49:146-153. [CrossRef]
13. Wagner A, Jennen-Steinmetz C, Göpel C, Schmidt MH. How effective are interventions in children and adolescents with antisocial behavior? A utilization study. Z Kinder Jugendpsychiatr Psychother 2004; 32:5-16. (German) [CrossRef]
14. Zagar RJ, Grove WM, Busch KG. Delinquency best treatments: how to divert youths from violence while saving lives and detention costs. Behav Sci Law 2013; 31:381-396. [CrossRef]
15. Scott S. Conduct disorder. In Rey JM (editor). IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions, 2012, 1-29. (http://iacapap.org/ wp-content/uploads/D.3-CONDUCT-DISORDER-072012.pdf Access date: 11.04.2015)
16. American Psychiatric Association. Diagnostic and statistical manual of mental disorders, DSM-IV, 4th ed. Washington, DC: American Psychiatric Association, 1994.
17. Asarnow JR, Baraff LJ, Berk M, Grob C, Devich-Navarro M, Suddath R, Piacentini J, Tang L. Pediatric emergency department suicidal patients: two-site evaluation of suicide ideators, single attempters, and repeat attempters. J Am Acad Child Adolesc Psychiatry 2008; 47:958-966. [CrossRef]
18. Berk MS, Asarnow JR. Assessment of suicidal youth in the emergency department. Suicide Life Threat Behav 2015; 45:345- 359. [CrossRef]
19. Dervic K, Brent DA, Oquendo MA. Completed suicide in childhood. Psychiatr Clin North Am 2008; 31:271-291. [CrossRef]
20. Posner K, Brown GK, Stanley B, Brent DA, Yershova KV, Oquendo MA, Currier GW, Melvin GA, Greenhill L, Shen S, Mann JJ. The Columbia-Suicide Severity Rating Scale: initial validity and internal consistency findings from three multisite studies with adolescents and adults. Am J Psychiatry 2011; 168:1266-1277. [CrossRef]
21. Ozcelik B, Karamustafalioglu O. Adolescence and evaluation of risk factors for suicide in adolescents. Dusunen Adam The Journal of Psychiatry and Neurological Sciences 2002; 15:68-76. (Turkish)
22. Koplin B, Agathen J. Suicidality in children and adolescents: a review. Curr Opin Pediatr 2002; 14:713-717. [CrossRef]
23. Gould MS, Greenberg T, Velting DM, Shaffer D. Youth suicide risk and and preventive interventions: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry 2003; 42:386-405. [CrossRef]
24. Siklar Z, Savar S, Sarioglu S, Tiras U, Dallar Y. The evaluation of the adolescent suicide cases that applied to our hospital. Turkiye Klinikleri J Pediatr 2004; 13:129-132. (Turkish)
25. Dilli D, Dallar Y, Cakir I. Psychological characteristics of adolescent suicide attempters presenting to a pediatric emergency service. Turkish Journal of Medical Sciences 2010; 40:377-390.
26. Jans T, Taneli Y, Warnke A. Suicide and self-harming behaviour (Chapter E.4). In Rey JM (editor). IACAPAP e-Textbook of Child and Adolescent Mental Health. Geneva: International Association for Child and Adolescent Psychiatry and Allied Professions, 2012, 1-35. (http://http://iacapap.org/wp-content/ uploads/E.4-SUICIDE-072012.pdf Access date: 13.04.2015)
27. Unlu G, Aksoy Z, Ersan EE. Evaluation of child and adolescents with attempted suicide. Pamukkale Medical Journal 2014; 7:176- 183. (Turkish) [CrossRef]
28. Colucci E, Martin G. Ethnocultural aspects of suicide in young people: a systematic literature review part 2: risk factors, precipitating agents, and attitudes towards suicide. Suicide Life Threat Behav 2007; 37:222-237. [CrossRef]
29. Coskun M, Zoroglu S, Ghaziuddin N. Suicide rates among Turkish and American youth: a cross-cultural comparison. Arch Suicide Res 2012; 16:59-72. [CrossRef]
30. Eskin M, Palova E, Krokavcova M. Suicidal behavior and attitudes in Slovak and Turkish high school students: a cross-cultural investigation. Arch Suicide Res 2014; 18:58-73. [CrossRef]
31. Waseem M, Diaz-Guerrero RJ, Cosme R, Ain Y, Leber M, Gerber LM. Do all children with suicidal ideation receive a significant psychiatric intervention? Pediatr Int 2015; 57:381-384. [CrossRef]
32. Friedman S, Margolis R, David OJ, Kesselman M. Predicting psychiatric admission from an emergency room. Psychiatric, psychosocial, and methodological factors. J Nerv Ment Dis 1983; 171:155-158. [CrossRef]
33. Goldberg JF, Ernst CL, Bird S. Predicting hospitalization versus discharge of suicidal patients presenting to a psychiatric emergency service. Psychiatr Serv 2007; 58:561-565. [CrossRef]
34. Ziegenbein M, Anreis C, Brüggen B, Ohlmeier M, Kropp S. Possible criteria for inpatient psychiatric admissions: which patients are transferred from emergency services to inpatient psychiatric treatment? BMC Health Serv Res 2006; 6:150. [CrossRef]
35. Nock MK, Kessler RC. Prevalence of and risk factors for suicide attempts versus suicide gestures: analysis of the National Comorbidity Survey. J Abnorm Psychol 2006; 115:616-623. [CrossRef]
36. Loeber R, Burke JD, Lahey BB, Winters A, Zera M. Oppositional defiant and conduct disorder: a review of the past 10 years, part I. J Am Acad Child Adolesc Psychiatry 2000; 39:1468-1484. [CrossRef]
37. Dalsgaard S, Mortensen PB, Frydenberg M, Thomsen PH. Conduct problems, gender and adult psychiatric outcome of children with attention-deficit hyperactivity disorder. Br J Psychiatry 2002; 181:416-421. [CrossRef]
38. Halamandaris PV, Anderson TR. Children and adolescents in the psychiatry emergency setting. Psychiatr Clin North Am 1999; 22:865-874. [CrossRef]
39. Larkin GL, Claassen CA, Emond JA, Pelletier AJ, Camargo CA. Trends in U.S. emergency department visits for mental health conditions, 1992 to 2001. Psychiatr Serv 2005; 56:671-677. [CrossRef]
40. Hillard JR, Slomowitz M, Deddens J. Determinants of emergency psychiatric admission for adolescents and adults. Am J Psychiatry 1988; 145:1416-1419. [CrossRef]
41. Atay IM, Yaman GB, Demirdas A, Akpinar A. Outcomes of suicide attempters in the emergency unit of a university hospital. Anatolian Journal of Psychiatry 2014; 15:124-131. [CrossRef]
42. Coskun M, Bozkurt H, Ayaydin H, Karakoc S, Suleyman F, Ucok A, Zoroglu S. Clinical and sociodemographic features of adolescents hospitalized in the psychiatric inpatient unit of a university hospital. Turkish Journal of Child and Adolescent Mental Health 2012; 19:17-24. (Turkish)
43. Gutterman EM, Markowitz JS, LoConte JS, Beier J. Determinants for hospitalization from an emergency mental health service. J Am Acad Child Adolesc Psychiatry 1993; 32:114-122. [CrossRef]
44. Bridge JA, Goldstein TR, Brent DA. Adolescent suicide and suicidal behavior. J Child Psychol Psychiatry 2006; 47:372-394. [CrossRef]
45. Toros F, Bilgin NG, Sasmaz T, Bugdayci R, Camdeviren H. Suicide attempts and risk factors among children and adolescents. Yonsei Med J 2004;45:367-374. [CrossRef]
46. Turhan E, Inandi T, Aslan M, Zeren C. Epidemiology of attempted suicide in Hatay, Turkey. Neurosciences (Riyadh) 2011; 16:347-352.
47. White CL, Bateman A, Fisher WH, Geller JL. Factors associated with admission to public and private hospitals from a psychiatric emergency screening site. Psychiatr Serv 1995; 46:467-472. [CrossRef]