Citation

Carlson GA, Chua J, Pan K, Hasan T, Bied A, Martin A, Klein DN. J. Am. Acad. Child Adolesc. Psychiatry 2019; ePub(ePub): ePub.

Affiliation

State University of New York at Stony Brook, NY.

Copyright

(Copyright © 2019, American Academy of Child Adolescent Psychiatry, Publisher Lippincott Williams and Wilkins)

DOI

10.1016/j.jaac.2019.07.940

PMID

31381991

Abstract

OBJECTIVE: There are few data to guide management of agitated and aggressive psychiatrically hospitalized children. Available studies do not account for setting, age, sex, diagnosis, admission reason, or clinical intervention. Seclusion, restraint and physical holds (S/R/H) are usually the only outcome measure. In this study we examine changes in PRN (pro re nata, or 'as needed') psychotropic medication use to manage severe aggression on a children's psychiatric inpatient unit, comparing rates before and after a behavior modification program (BMP) was discontinued.

METHOD: We compare 661 children (ages 5-12) in 5 cohorts over 10 years, 510 (77%) of whom were admitted for aggressive behavior. PRN use per 1,000 patient-days was the primary outcome measure, but S/R/H was also examined. We use as predictors: BMP status, full- or half-time child psychiatry physician (CAP) oversight, diagnosis, age, length of stay and neuroleptic use.

RESULTS: Children admitted for aggression had high rates of externalizing disorders (79%), low rates of mood (27%), and anxiety disorders (21%), and significantly higher rates of PRN and S/R/H use (p<0.001). Rate of PRN use was significantly lower (p<0.001) when the BMP was present (mean[SD], 163[319] per 1,000 patient-days) than absent (483[569]; p<0.001). Higher PRN use was predicted by: BMP absence, neuroleptic treatment, and young patient age (p<0.001), and by half-time CAP oversight (p=0.002).

CONCLUSION: In this sample of young children with primarily externalizing disorders, data support the effectiveness of a BMP in lowering rates of PRN and S/R/H use.

Copyright © 2019. Published by Elsevier Inc.

Language: en

Keywords

PRN; aggression; behavior modification; child; seclusion