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Bodily Distress Disorder and Dissociative Disorders are disorders frequently encountered across paediatric specialties. These disorders place high psychosocial, educational and financial strains on children and their families as well as a substantial burden on the health care system with a potential risk for iatrogenic harm to the child due to unnecessary diagnostic evaluations and fruitless treatment attempts leading to increased costs. Predisposing factors include neurodevelopmental disorders and often co-morbidities such as anxiety and depression exist. The current best evidence-based treatment is psychological interventions that involve active participation from both the child and the parents. As early diagnostics and relevant intervention may improve prognosis and potentially decrease the risk of continued persistent and disabling somatic and co-occurring psychiatric symptoms later in life, it is important to address these disorders in young people. Due to the particular characteristics of somatic complaints combined with a high risk of psychiatric co-morbidities and specialised psychological interventions as best evidence-based practice, the diagnostics and treatment should optimally take place in close collaboration between the paediatric/medical setting and child and adolescent psychiatry.
An emerging picture has seen increasing numbers of young people with mental health crisis attend paediatric emergency departments in Ireland. Following paediatric review, many are referred to in-house paediatric liaison psychiatry (PLP) services. This pilot study describes referral patterns and practice over a 1-month period across three Dublin centres.
Methods:
Case notes of all referrals to PLP were reviewed to extract relevant clinical and administrative data. For those admitted, costs associated with length of stay were estimated. Clinical profile, management and intra-hospital pathway differences were explored.
Results:
Fifty-nine young people under 16 years presented to one of the three EDs with an acute MH presentation. The sample consisted of 39 females (66%) with a mean age of 13.7 years. The majority (n = 34, 58%) presented out of hours. A substantial portion of youths presenting (n = 37, 63%) were admitted, and had a mean duration of stay of 4.51 days. There were differences between hospitals in terms of frequency of presentation with self-harm, admission rates and length of stay.
Discussion:
Different PLP service configuration, staffing and funding streams may explain some of the differences observed across centres, although the findings should be interpreted with caution given the limited sample size. Standardisation of service provision and management is needed for PLP services. Additional community CAMHS resourcing is needed to support the development of alternative pathways for youth in need of urgent MH review.
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