Urgencias psiquiátricas infanto-juveniles: 7 años de seguimiento
PDF

Palabras clave

Servicios de emergencia
Psiquiatría
Epidemiologia

Cómo citar

Fernández-Quintana, Águeda, Novo-Ponte, A., Quiroga-Fernández, C., Méndez-Iglesias, R., & Pereiro-Gómez, C. (2018). Urgencias psiquiátricas infanto-juveniles: 7 años de seguimiento. Revista De Psiquiatría Infanto-Juvenil, 35(1), 17-30. https://doi.org/10.31766/revpsij.v35n1a2

Resumen

Introducción: A pesar de la mayor demanda de urgencias psiquiátricas infanto-juveniles, las características de este colectivo no han sido definidas con precisión.


Objetivos: Analizar variables clínicas y sociodemográficas de los menores de 17 años evaluados en Urgencias Psiquiátricas de un hospital general. Estudiar la adherencia terapéutica y la estabilidad diagnóstica tras la atención urgente.


Método: Estudio retrospectivo en una muestra de 218 atenciones psiquiátricas infanto-juveniles durante 7 años (2010-2017).


Resultados: Edad media 13,60 años (DE: 2,36). Sexo: 54% mujeres, 46% varones. El número de atenciones psiquiátricas infanto-juveniles aumentó desde 11,6% en 2010 hasta 23,3% en 2016. Motivo de consulta más frecuente: alteraciones conductuales en varones y autolesiones en mujeres. Antecedentes de intento autolítico mujeres: 46,4%, varones: 14%. La mayoría de los pacientes presentaban antecedentes psiquiátricos personales y familiares. Antecedentes somáticos (17,1%), la enfermedad más prevalente fue la epilepsia (9,7%). El 11,5% consumían tóxicos (droga más frecuente: THC), el abuso de alcohol era más prevalente entre las mujeres. Tasa de hospitalización (14,7%), los pacientes más jóvenes precisaban ingreso con mayor frecuencia. En Urgencias se prescribieron psicofármacos en el 62,3% de los casos (grupo más recetado: antipsicóticos 38,9%). Derivación para seguimiento ambulatorio (72,5%), asistencia a la primera consulta (81%), retirada de prescripciones farmacológicas (58%). Estabilidad diagnostica: 77,8%.

Conclusiones: Existen importantes diferencias de género en las urgencias psiquiátricas infanto-juveniles. Se trata de un colectivo vulnerable, la mayoría de los pacientes tienen antecedentes psiquiátricos personales y familiares, con perfil socio-demográfico desfavorable. Es necesario mejorar la adherencia terapéutica tras la atención urgente.

https://doi.org/10.31766/revpsij.v35n1a2
PDF

Referencias

Taastrøm A, Klahn J, Staal N, Thomsen PH, Johansen A. Children and adolescents in the Psychiatric Emergency Department: a 10-year survey in Copenhagen County. Nord J Psychiatry. 2014 Aug;68(6):385-90. doi: 10.3109/08039488.2013.846410.

Argemí S, Cobo J, Pujol G, Bartoli D, Aldecoa V, García M. Caracteristicas y evolucion de las urgencias psiquiatricas infantojuveniles en un servicio general de urgencias pediatricas hospitalarias. Acta Pediatr Esp. 2010; 68(11): 547-553.

Kua PH, Wu L, Ong EL, Lim ZY, Yiew JL, Thia XH, Sung SC. Understanding decisions leading to nonurgent visits to the paediatric emergency department:caregivers’ perspectives. Singapore Med J. 2016 Jun;57(6):314-9. doi: 10.11622/smedj.2016023.

Parker, KC., Roberts, N., Williams, C. Urgent adolescent psychiatric consultations: from the accident and emergency department to inpatient adolescent psychiatry. J Adolesc 2003, 26, 283-93.

Smith, DH., Hadorn, DC. Lining up for children’s mental health services: a tool for prioritizing waiting lists. J Am Acad Child Adolesc Psychiatry 2002, 41, 367-77.

Offord, DR., Boyle, MH., Fleming, JE. Ontario child health study: summary of the selected results. Can J Psychiatry 1989, 34, 483-91.

World Health Organization. The World Health Report 2000. Health systems: improving performance. Ginebra: WHO, 2000.

National Institute of Mental Health, 1999. Brief Notes on the Mental Health of Children and Adolescents. Bethesda, MD: National Instituto of Mental Health, 1999.

U.S. Department of Health and Human Services. HHS Fact Sheet on Mental Health Issues. www.hhs.gov.2001.com.

Meehan, P., Lamb, J., Saltzman, L., O’Carroll, P. Attempted suicide among young adults progress toward a meaningful estimate of prevalence. Am J Psychiatry 1992, 149(1), 41-44.

Zelaya de Migliorisi, L., Piris de Almirón, L., Migliorisi, B. Intentos de suicidio en niños y adolescentes. ¿Máscara de Maltrato Infantil? Pediatr. (Asuncion), 2012, vol.39 no.3.

Danice K. Eaton, Laura Kann, Steve Kinchen, Shari Shanklin, Katherine H. Flint, Joseph Hawkins et al. Youth risk behaviour surveillance, United States, 2011. Surveillance Summaries/Vol. 61/No. 4. Morbidity and Mortality Weekly.

Ting SA, Sullivan AF, Boudreaux ED, Miller I, Camargo CA Jr. Trends in US emergency department visits for attempted suicide and selfinflicted injury, 1993-2008. Gen Hosp Psychiatry. 2012 Sep-Oct;34(5):557-65. doi: 10.1016/j.genhosppsych.2012.03.020.

Sihvola E, Keski-Rahkonen A, Dick DM, Pulkkinen L, Rose RJ, Marttunen M, Kaprio J. Minor depression in adolescence: phenomenology and clinical correlates. J Affect Disord. 2007 Jan;97(1-3):211-8.

Ramsawh, HJ., Chavira, DA., Kanegaye, JT., Ancoli-Israel, S., Madati, PJ., Stein, M. Screening for adolescent anxiety disorders in a pediatric emergency department. Pediatric Emergency Care 2012, 10(28), 1041-7.

Manor I, Gutnik I, Ben-Dor DH, Apter A, Sever J, Tyano S, Zalsman G. Possible association between attention deficit hyperactivity disorder and attempted suicide in adolescents - A pilot study. European Psychiatry. 2010;25(3):146–150.

Sourander A, Klomek AB, Niemela S, Haavisto A, Gyllenberg D, Helenius H, Gould MS. Childhood predictors of completed and severe suicide attempts: Findings from the Finnish 1981 Birth Cohort Study. Archives of General Psychiatry. 2009;66(4):398–406.

Impey M, Heun R. Completed suicide, ideation and attempt in attention deficit hyperactive disorder. Acta Psychiatrica Scandinavica. 2012;125(2):93–102.

Horesh N, Gothelf D, Ofek H, Weizman T, Apter A. Impulsivity as a correlate of suicidal behavior in adolescent psychiatric inpatients. Crisis. 1999;20(1):8–14.

Kerr DCR, Washburn JJ, Feingold A, Kramer AC, Ivey AZ, King CA. Sequelae of aggression in acutely suicidal adolescents. Journal of Abnormal Child Psychology. 2007;35(5):817–830.

Kasen S, Cohen P, Chen H. Developmental course of impulsivity and capability from age 10 to age 25 as related to trajectory of suicide attempt in a community cohort. Suicide and Life-Threatening Behavior. 2011;41(2):180–192.

Ben-Yehuda A, Aviram S, Govezensky J, Nitzan U, Levkovitz Y, Bloch Y. Suicidal behavior in minors – Diagnostic differences between children and adolescents. Journal of Developmental & Behavioral Pediatrics. 2012;33(7):542–547.

Elkins IJ, Malone S, Keyes M, Iacono WG, McGue M. The impact of attention-deficit hyperactivity disorder on preadolescent adjustment may be greater girls than for boys. Journal of Clinical Child & Adolescent Psychology. 2011;40(4):532–545.

Mannuzza S, Klein RG. Long-term prognosis in attention-deficit/hyperactivity disorder. Child and Adolescent Psychiatric Clinics of North America. 2000;9(8):711–726.

Zahn-Waxler C, Park JH, Usher B, Belouad F, Cole P, Gruber R. Young children’s representations of conflict and distress: A longitudinal study of boys and girls with disruptive behavior problems. Development and Psychopathology. 2008;20:99–119.

Farone SV, Wilens TE, Petty C. Substance use among ADHD adults: Implications of late onset and sub threshold diagnoses. The American Journal on Addictions. 2007;16(1):24–34.

Torok M, Darke S, Kaye S. Predisposed violent drug users versus drug users who commit violence: Does the order of onset translate to differences in the severity of violent offending? Drug and Alcohol Review. 2012;31(4):558–565.

Pardini DA, Fite PJ. Symptoms of conduct disorder, oppositional defiant disorder, attention deficit/hyperactivity disorder, and callousunemotional traits as unique predictors of psychosocial maladjustment in boys: Advancing an evidence base for DSM-V. Journal of the American Academy of Child & Adolescent Psychiatry. 2010;49(11):1134–1144.

Baren, JM., Mace, SE., Hendry, PL., Dietrich, AM., Goldman, RD, Goldman, RM., Warden, CR. Children’s mental health emergencies--part 2: emergency department evaluation and treatment of children with mental health disorders 2008, 7(24), 485-498.

Chun, TH., Katz, ER., Duffy, SJ., Gerson, RS Challenges of managing pediatric mental health crises in the emergency department. Child and Adolescent Psychiatric Clinics of North America, 2015, 1(24), 21-40.

Dolan, Margaret A; Fein, Joel A. Pediatric and adolescent mental health emergencies in the emergency medical services system. Pediatrics, 2011, 5(127), e1356-e1366.

Hoyle JD Jr, White LJ. Pediatric mental health emergencies: summary of amultidisciplinary panel. Prehosp Emerg Care. 2003 Jan-Mar;7(1):60-5.

Hoyle, JD., White, LJ. Treatment of pediatric and adolescent mental health emergencies in the United States: current practices, models, barriers, and potential solutions. Prehospital Emergency Care 2003, 1(7), 66-73.

Rogers, SC., Griffin, LC., Masso, PD., Stevens, M., Mangini, L., Smith, SR. CARES: improving the care and disposition of psychiatric patients in the pediatric emergency department. Pediatric Emergency Care 2015, 3(31), 173-177.

Hamm MP, Osmond M, Curran J, Scott S, Ali S, Hartling L, Gokiert R, Cappelli M, Hnatko G, Newton AS. A systematic review of crisis interventions used in the emergency department: recommendations for pediatric care and research. Pediatr Emerg Care. 2010 Dec;26(12):952-62. doi: 10.1097/PEC.0b013e3181fe9211.

Mahajan P, Thomas R, Rosenberg DR, et al. Evaluation of a child guidance model for visits for mental disorders to an inner-city pediatric emergency department. Pediatr Emerg Care. 2007;23(4):212Y217.

Foltin GL. Critical issues in urban emergency medical services for children. Pediatrics. 1995 Jul;96(1 Pt 2):174-9.

Heneghan A, Garner AS, Storfer-Isser A, et al. Pediatricians’ role in providing mental health care for children and adolescents: do pediatricians and child and adolescent psychiatrists agree? Journal of developmental and behavioral pediatrics: JDBP. 2008;29(4):262–9

American Academy of Pediatrics Committee on Pediatric Emergency Medicine; American College of Emergency Physicians Pediatric Committee; Emergency Nurses Association Pediatric Committee. Joint policy statement--guidelines for care of children in the emergency department. Ann Emerg Med. 2009 Oct;54(4):543-52. doi: 10.1016/j.annemergmed.2009.08.010. PubMed PMID: 19769888.

Newton, AS., Ali, S., Johnson, DW., Haines, C., Rosychuk, RJ., Keaschuk, RA., Jacobs, P., Klassen, TP. A 4-year review of pediatric mental health emergencies in Alberta. CJEM Canadian Journal of Emergency Medical Care, 2009, 5(11),447 – 5

Leyva Correa M., et al. Caracterización de algunos factores socio-psicológicos en adolescentes con intento suicida en el municipio Morón, Mediciego 2012; 18 (Supl. 2).

Di Lorenzo R, Cimino N, Di Pietro E, Pollutri G, Neviani V, Ferri P. A 5-year retrospective study of demographic, anamnestic, and clinical factors related to psychiatric hospitalizations of adolescent patients. Neuropsychiatr Dis Treat. 2016. 18;12:191-201.

Stewart SE, Manion IG, Davidson SI, et al. Suicidal children and adolescents with first emergency room presentations: predictors of six-month outcome. J Am Acad Child Adolesc Psychiatry. 2001;40(5):580Y587

Toledo, M. Variables Clínicas y Demográficas de las urgencias psiquiátricas infantiles en el Hospital Hermilio Valdizan. Revista de Psiquiatria y Salud Mental Hermilio Valdizan, Vol V Nº 1 Enero-Junio 2004, pp 83-91.

Starling J, Bridgland K, Rose D. Psychiatric emergencies in children and adolescents: an Emergency Department audit. Australas Psychiatry. 2006 Dec;14(4):403-7.

Kennedy A, Cloutier P, Glennie JE, Gray C. Establishing best practice in pediatric emergency mental health: a prospective study examining clinical characteristics. Pediatric Emergency Care. 2009. 25(6), 380-6. doi: 10.1097/PEC.0b013e3181a79223.

Akkaya-Kalayci, T., Popow, C., Waldhör, T., Winkler, D., Özlü-Erkilic, Z., 2017. Psychiatric emergencies of minors with and without migration background. Neuropsychiatr 31, 1-7.

Crespo Marcos D, Solana García MJ, Marañón Pardillo R, Gutiérrez Regidor C, Crespo Medina M, Míguez Navarro C, Vázquez López P. Psychiatric patients in the pediatric emergency department of a tertiary care center: review of a 6-month period. An Pediatr (Barc). 2006 Jun;64(6):536-41.

Sullivan, A M y Rivera, J. Profile of a comprehensive psychiatric emergency program in a New York City municipal hospital. Psychiatric Quarterly 2000, 2(71), 123-38

Healy, E., Swaroopa, S., Subotsky, F., Fombonne, E. Emergency presentations to an inner-city adolescent psychiatric service. Journal of adolescence 2002, 4(25), 397-404

Liu, S., Ali, S., Rosychuk, R.J., Newton, A.S., 2014. Characteristics of children and youth who visit the emergency department for a behavioural disorder. J Can Acad Child Adolesc Psychiatry 23, 111-7.

Jiménez-Escobar I, Weingerz-Mehl S, Castillo-Macedo E, Jiménez-Gutiérrez C, Gutiérrez-Castrellón P. Characterization of adolescents and reason for the visit when attending the pediatric emergency department of the General Hospital Dr. Manuel Gea González. Gac Med Mex. 2016;152(1):30-5.

Gauthier, JM., Witte, TK., & Correia, CJ. Suicide Ideation, Alcohol Consumption, Motives, and Related Problems: Exploring the Association in College Students. Suicide & Life-threatening behaviors, 2016.

Bellos, S., Skapinakis, P., Rai, D., Zitko, P., Araya, R., Lewis, G., Lionis, C., & Mavreas, V. Longitudinal association between different levels of alcohol consumption and a new onset of depression and generalized anxiety disorder: Results from an international study in primary care. Psychiatry Research. 2016, 243, 30-34

Matalí Costa JL, Serrano Troncoso E, Pardo Gallego M, Trenchs Sainz de la Maza V, Curcoy Barcenilla A, Luaces Cubells C, San Molina L. Profile of adolescents seen in emergency departments with acute alcohol poisoning. An Pediatr (Barc). 2012 Jan;76(1):30-7. doi: 10.1016/j.anpedi.2011.07.003.

Verrotti A, Carrozzino D, Milioni M, Minna M, Fulcheri M. Epilepsy and its main psychiatric comorbidities in adults and children. J Neurol Sci. 2014, 15;343(1-2):23-9.

Truman CD, Reutter L. Care-giving and careseeking behaviours of parents who take their children to an emergency department for nonurgent care. Can J Public Health. 2002 Jan-Feb;93(1):41-6.

Janssens A, Hayen S, Walraven V, Leys M, Deboutte D. Emergency psychiatric care for children and adolescents: a literature review. Pediatr Emerg Care. 2013 Sep;29(9):1041-50. doi: 10.1097/PEC.0b013e3182a393e7

Sullivan, A M y Rivera, J. Profile of a comprehensive psychiatric emergency program in a New York City municipal hospital. Psychiatric Quarterly 2000, 2(71), 123-38

Healy, E., Swaroopa, S., Subotsky, F., Fombonne, E. Emergency presentations to an inner-city adolescent psychiatric service. Journal of adolescence 2002, 4(25), 397-404

Liu, S., Ali, S., Rosychuk, R.J., Newton, A.S., 2014. Characteristics of children and youth who visit the emergency department for a behavioural disorder. J Can Acad Child Adolesc Psychiatry 23, 111-7.

Jiménez-Escobar I, Weingerz-Mehl S, Castillo-Macedo E, Jiménez-Gutiérrez C, Gutiérrez-Castrellón P. Characterization of adolescents and reason for the visit when attending the pediatric emergency department of the General Hospital Dr. Manuel Gea González. Gac Med Mex. 2016;152(1):30-5.

Gauthier, JM., Witte, TK., & Correia, CJ. Suicide Ideation, Alcohol Consumption, Motives, and Related Problems: Exploring the Association in College Students. Suicide & Life-threatening behaviors, 2016.

Bellos, S., Skapinakis, P., Rai, D., Zitko, P., Araya, R., Lewis, G., Lionis, C., & Mavreas, V. Longitudinal association between different levels of alcohol consumption and a new onset of depression and generalized anxiety disorder: Results from an international study in primary care. Psychiatry Research. 2016, 243, 30-34.

Matalí Costa JL, Serrano Troncoso E, Pardo Gallego M, Trenchs Sainz de la Maza V, Curcoy Barcenilla A, Luaces Cubells C, San Molina L. Profile of adolescents seen in emergency departments with acute alcohol poisoning. An Pediatr (Barc). 2012 Jan;76(1):30-7. doi: 10.1016/j.anpedi.2011.07.003.

Verrotti A, Carrozzino D, Milioni M, Minna M, Fulcheri M. Epilepsy and its main psychiatric comorbidities in adults and children. J Neurol Sci. 2014, 15;343(1-2):23-9.

Truman CD, Reutter L. Care-giving and careseeking behaviours of parents who take their children to an emergency department for nonurgent care. Can J Public Health. 2002 Jan-Feb;93(1):41-6.

Janssens A, Hayen S, Walraven V, Leys M, Deboutte D. Emergency psychiatric care for children and adolescents: a literature review. Pediatr Emerg Care. 2013 Sep;29(9):1041-50. doi: 10.1097/PEC.0b013e3182a393e7

Descargas

Los datos de descarga todavía no están disponibles.