Service innovations: second opinions in child and adolescent psychiatry

AIMS AND METHODSTo devise a protocol, reflecting best practice, for obtaining second opinions in child and adolescent psychiatry through discussion with consultants in child and adolescent psychiatry within the Yorkshire region at their quarterly meetings.ResultsThe major pressure for second opinions falls upon the Academic Unit of Child and Adolescent Mental Health and on the in-patient units. Other consultants who are considered to have specialist expertise in certain areas may also receive referrals for second opinions. Both consultants requesting and offering second opinions considered a protocol for obtaining them would be helpful to their practice.Clinical ImplicationsAn agreed protocol between consultants in child and adolescent psychiatry within a region ensures that young people with complex problems have access to second opinions on their diagnosis and management by consultants who can be recommended to referrers by other consultants. The network of consultants ensures such opinions are not requested excessively and that ‘rogue’ opinions without therapeutic follow-up are avoided.

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Clozapine prescribing in adolescent psychiatry: survey of prescribing practice in in-patient units

Psychiatric Bulletin ◽

10.1192/pb.29.10.377 ◽

2005 ◽

Vol 29 (10) ◽

pp. 377-380 ◽

Cited By ~ 12

Author(s):

Giovanni Cirulli

Keyword(s):

Young People ◽

Adolescent Psychiatry ◽

Best Practice ◽

Child And Adolescent Psychiatry ◽

Effective Drug ◽

Clinical Implications ◽

Treatment Resistant ◽

Practice Recommendations ◽

Prescribing Practice ◽

The Uk

Aims and MethodClozapine is an effective drug in treatment-resistant schizophrenia, but it seems to be prescribed for few patients under the age of 18 years. This study reports a survey of consultant psychiatrists working in adolescent units in the UK, looking at their use of clozapine and experience with it.ResultsOut of 83 clinicians, 59 responded (71%). More than 40% of respondents do not use clozapine, and those who do may not always be following best practice recommendations. Reasons for not using clozapine, beliefs about its effectiveness and problems encountered in its use are described.Clinical ImplicationsClozapine may not always be made available to young people with treatment-resistant schizophrenia. There is a need for more education, guidance and debate on clozapine use in child and adolescent psychiatry.

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Cost-effectiveness of intensive home treatment enhanced by inpatient treatment elements in child and adolescent psychiatry in Germany: A randomised trial

European Psychiatry ◽

10.1016/j.eurpsy.2015.01.009 ◽

2015 ◽

Vol 30 (5) ◽

pp. 583-589 ◽

Cited By ~ 21

Author(s):

I. Boege ◽

N. Corpus ◽

R. Schepker ◽

R. Kilian ◽

J.M. Fegert

Keyword(s):

Mental Health ◽

Health Care ◽

Cost Effectiveness ◽

Health Care Costs ◽

Adolescent Psychiatry ◽

Inpatient Treatment ◽

Child And Adolescent ◽

Child And Adolescent Psychiatry ◽

Care Costs

AbstractBackgroundAdmission rate to child and adolescent mental health inpatient units in Germany is high (54 467 admissions in 2013), resources for providing necessary beds are scarce. Alternative pathways to care are needed. Objective of this study was to assess the cost-effectiveness of inpatient treatment versus Hot-BITs-treatment (Hometreatment brings inpatient-treatment outside), a new supported discharge service offering an early discharge followed by 12 weeks of intensive support.MethodsOf 164 consecutively recruited children and adolescents, living within families and being in need of inpatient mental health care, 100 patients consented to participate and were randomised via a computer-list into intervention (n = 54) and control groups (n = 46). Follow-up data were available for 76 patients. Primary outcome was cost-effectiveness. Effectiveness was gathered by therapist-ratings on the Children's Global Assessment Scale (CGAS) at baseline (T1), treatment completion (T2) and an 8-month-follow-up (T3). Cost of service use (health care costs and non–health care costs) was calculated on an intention-to-treat basis at T2 and T3.ResultsSignificant treatment effects were observed for both groups between T1/T2 and T1/T3 (P < 0.001). The Hot-BITs treatment, however, was associated with significantly lower costs at T2 (difference: −6900.47€, P = 0.013) and T3 (difference: −8584.10€, P = 0.007). Bootstrap cost-effectiveness ratio indicated that Hot-BITs was less costly and tended to be more effective at T2 and T3.ConclusionsHot-BITs may be a feasible cost-effective alternative to long inpatient stays in child and adolescent psychiatry. Further rigorous evaluations of the model are required. (Registration number: ISRCTN02672532, part 1, Current Controlled Trials Ltd, URL: http://www.controlled-trials.com).

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Child and adolescent self-poisoning: service-related characteristics

Psychiatric Bulletin ◽

10.1192/pb.21.5.267 ◽

1997 ◽

Vol 21 (5) ◽

pp. 267-269 ◽

Cited By ~ 2

Author(s):

Ashraf Nasr ◽

Panos Vostanis ◽

Linda Winkley

Keyword(s):

Mental Health ◽

High Risk ◽

Young People ◽

Child Mental Health ◽

Child And Adolescent ◽

Child And Adolescent Psychiatry ◽

Paediatric Ward ◽

Good Communication ◽

Child Mental Health Services

This study presents the pattern of assessment and 6-month out-patient attendance of 54 children and adolescents who took an overdose over a 12-month period, and were assessed by a district child and adolescent psychiatry service. Attempts were precipitated by arguments (67%) or school-related stressors (19%). In 70.4% of cases, analgesic tablets were used. A psychiatric disorder was present in 51% of the cases. At 6 months, 13% of the patients were still attending for follow-up, while three children (5.5%) had taken a second overdose. Admission to a paediatric ward can facilitate the initiation of treatment. Child mental health services should aim at providing prompt assessment, good communication with other agencies, and follow-up arrangements, particularly with high-risk young people and their families

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Consultant child and adolescent psychiatrists' knowledge of and attitude to the use of legislation concerning young people with psychiatric disorder

Psychiatric Bulletin ◽

10.1192/pb.27.10.367 ◽

2003 ◽

Vol 27 (10) ◽

pp. 367-370 ◽

Cited By ~ 1

Author(s):

Alex Mears ◽

Richard White ◽

Paul Lelliott

Keyword(s):

Mental Health ◽

Young People ◽

Psychiatric Disorder ◽

Child And Adolescent ◽

Legal Framework ◽

Legal Issues ◽

Clinical Implications ◽

Questionnaire Form ◽

Main Message ◽

Better Than

Aims and MethodThis study aimed to examine in-patient child and adolescent consultant psychiatrists' knowledge of and attitude to the Mental Health Act 1983 (MHA), the Children Act 1989 and issues around consent. A questionnaire form was sent to all in-patient consultants in England and Wales.ResultsThe consultants who responded (n=51, 67%) reported a desire for more training in legal issues. Knowledge of the MHA was better than for the Children Act 1989; those who used the MHA at least once every 6 months scored more correct answers to questions about the MHA than did those who used it less frequently or never.Clinical ImplicationsAlthough the study indicates specific gaps in knowledge, the main message is that training should consider the legal framework as a whole, with an emphasis on practical issues about its application in the in-patient setting.

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The Use of Mobile and Wearable Artificial Intelligence in Child and Adolescent Psychiatry – A Scoping Review (Preprint)

10.2196/preprints.33560 ◽

2021 ◽

Author(s):

Victoria Welch ◽

Tom Joshua Wy ◽

Anna Ligezka ◽

Leslie C. Hassett ◽

Paul E. Croarkin ◽

...

Keyword(s):

Mental Health ◽

Artificial Intelligence ◽

Scoping Review ◽

Adolescent Psychiatry ◽

Child And Adolescent ◽

Mental Health Disorders ◽

Wearable Devices ◽

Autism Spectrum ◽

Child And Adolescent Psychiatry ◽

Health Disorders

BACKGROUND Mental health disorders across the life span are a leading cause of medical disabilities. This burden is particularly significant in children and adolescents due to challenges in diagnoses and lack of precision medicine approaches. The advent and widespread adoption of wearable devices (e.g., smartwatches) that generate large volumes of passively collected data that are conducive for artificial intelligence applications to remotely diagnose and manage child and adolescent mental health disorders is promising. OBJECTIVE This study conducted a scoping review to study, characterize and identify areas of innovations with wearable devices that can augment current in-person physician assessments to individualize diagnosis and management of mental health disorders in child and adolescent psychiatry. METHODS This scoping review used PRISMA’s information as a guide. A comprehensive search of several databases from 2011 to June 25, 2021, limited to English language and excluding animal studies, was conducted. The databases included Ovid MEDLINE (R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, Web of Science, and Scopus. RESULTS The initial search yielded 344 articles. 19 articles were left on the final source list for this scoping review. Articles were divided into three main groups: Studies with the main focus on Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorders (ADHD) and Internalizing disorders such as anxiety disorders. Majority of the studies used either ECG strap or wrist worn biosensor. CONCLUSIONS Our scoping review found large heterogeneity of methods and findings in artificial intelligence studies in child psychiatry. Overall, the largest gaps identified in this scoping review are the lack of randomized control trials, most available studies are pilot feasibility trials.

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