Citation

Abright AR. J. Am. Acad. Child Adolesc. Psychiatry 2019; ePub(ePub): ePub.

Affiliation

Icahn School of Medicine at Mount Sinai, New York, NY. Electronic address: abrighta@nychhc.org.

Copyright

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

DOI

10.1016/j.jaac.2019.10.009

PMID

31655102

Abstract

Aggressive behaviors not manageable at home, school or in other community settings constitute one of the major reasons for psychiatric hospitalization of children but reduction and prevention of such behaviors in inpatient settings remain elusive goals. Strategies with varying degrees of success have ranged from reliance on therapeutic milieu as a positive treatment agent in and of itself to psychotherapeutic, behavioral and psychopharmacologic approaches targeted to specific disorders. Challenges include the diverse biologic, psychological, familial, environmental and diagnostic factors that may be associated with aggressive episodes, limitations in adapting evidence-based, disorder- specific treatments developed in non-inpatient or specialized settings (for example, for individuals with autism spectrum disorder and other developmental disabilities) to the contingencies of 24-hour care in general inpatient units, and implementation of interventions such as time-outs, manual holds and PRN (pro re nata) and STAT medications for agitation in the context of current Joint Commission standards for seclusion, restraint (physical and chemical) and behavior management

Language: en