CHILDREN AND ADOLESCENTS IN THE PSYCHIATRIC EMERGENCY SETTING

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Emergencies in child and adolescent psychiatry occur in a variety of settings, so clinicians must be familiar not only with the most common emergencies but also with approaches to assessment and disposition planning. This article discusses the elements that are unique to emergencies in child and adolescent psychiatry and provides practitioners with a foundation for conducting an evaluation and making recommendations for treatment. Because of space limitations, this is not an exhaustive discussion of this vast topic, but references for further study are provided.

Section snippets

EPIDEMIOLOGY

Epidemiologic data on the frequency or prevalence of emergency evaluations of children and adolescents are not readily available. Where appropriate, available epidemiologic data are provided under specific clinical situations.

GENERAL PRINCIPLES

The idea of an emergency as a situation requiring immediate attention is a useful concept in child psychiatry because children and adolescents rarely present themselves for psychiatric emergency services. Emergencies are defined by several factors. A child's behavior or thoughts are brought to psychiatric attention when an adult figure interprets them as inappropriate or unmanageable in the current environment. Another distinguishing factor of child psychiatric emergencies is the multitude of

Suicide

Threatened suicide or unsuccessful attempts are the most common emergency in child and adolescent psychiatry.9 Community surveys estimate that approximately 9% of adolescents and 1% of preadolescents report suicide attempts. Of further importance is that studies demonstrate a greatly increased rate of suicide attempts in samples of children and adolescents with histories of psychiatric treatment.5 Some studies indicate that 90% of adolescents who commit suicide have a psychiatric diagnosis,

TREATMENT AND DISPOSITION PLANNING

When an overall assessment of these children, their families, and risk involved has been completed, a decision regarding appropriate treatment and disposition can be made. If acute danger to the child or others because of symptoms of an Axis I or II disorder is present, inpatient psychiatric hospitalization is indicated. If the child is in danger because of an unsafe home setting, out-of-home placement through child protective services is probably indicated. Such placement may be in an

SUMMARY

Emergencies in child and adolescent psychiatry are not uncommon, occur in a variety of settings, and require referral to resources offering different levels of care. Clinicians must be familiar with basic tenets of emergency assessment and treatment whether practicing alone in a rural area or as part of an interdisciplinary team in a busy urban hospital. Recommendations for future research include gathering more extensive epidemiologic data and data regarding practice patterns nationwide and

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Address reprint requests to Phill V. Halamandaris, MD, 455 W. 23rd Street, Suite 1A, New York, NY 10011

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Department of Psychiatry, Division of Child and Adolescent Psychiatry, New York University, New York, New York

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