ABSTRACT
Children (N = 110) hospitalized on a child psychiatric unit improved significantly in psychological functioning at discharge and 1- and 6-months follow-up relative to their functioning at admission. Children who were more impaired at admission made more progress during admission but were more impaired at follow-up than children who had milder symptoms at admission. Children without a behavior disorder had a better outcome than children with a behavior disorder. None of the other variables, alone or in combination, was significantly related to admission progress or follow-up outcome, including specific diagnoses, gender, race, age, IQ, family functioning, negative life events, parent education and employment, biological family history, length of hospitalization, parent involvement during admission and follow-up services.
Subject(s)
Affective Symptoms/therapy , Child Behavior Disorders/therapy , Hospitalization , Mental Disorders/therapy , Affective Symptoms/diagnosis , Affective Symptoms/psychology , Child , Child Behavior Disorders/diagnosis , Child Behavior Disorders/psychology , Family Relations , Female , Follow-Up Studies , Humans , Male , Mental Disorders/diagnosis , Mental Disorders/psychology , Outcome and Process Assessment, Health Care , Personality Assessment , Social EnvironmentABSTRACT
Admission, discharge, and follow-up evaluations of 110 children admitted to a child psychiatric unit (mean 14 days) showed that the children's psychological functioning improved significantly during hospitalization. Gains were not fully maintained at follow-up (1 and 6 months), but the children were still significantly less impaired after discharge than at admission. A nonsignificant difference existed between follow-up scores, indicating no loss of progress or decline in functioning from 1- to 6-month follow-up. The results are consistent with an ABA (A = no inpatient intervention, B = inpatient intervention, A = no inpatient intervention) treatment effect. They are not explained by removal from and return to an unsatisfactory home environment. Psychological functioning after admission was significantly better than after 1 to 6 months of post-discharge psychiatric services. This study offers a clinically feasible approach to evidence-based practice by documenting patient improvement during and after inpatient treatment using a simple, empirically supported assessment instrument.
Subject(s)
Child Psychiatry/methods , Child, Hospitalized/psychology , Evidence-Based Medicine/methods , Hospitalization , Mental Disorders/therapy , Psychiatric Status Rating Scales , Treatment Outcome , Child , Child Psychiatry/standards , Child, Hospitalized/statistics & numerical data , Child, Preschool , Feasibility Studies , Female , Follow-Up Studies , Humans , Male , Psychiatric Department, HospitalABSTRACT
OBJECTIVE: To determine a well-tolerated oral load of divalproex sodium that quickly and reliably achieves therapeutic drug levels in child psychiatry inpatients. METHODS: A retrospective chart review revealed that during a 6-month period, divalproex sodium therapy was initiated in 16 male inpatients (ages 5-14 years). The patients were divided into two groups based on the initial dosing regimen. The first group received approximately 15 mg/kg/day based on actual weight, and the second group received approximately 15 mg/kg/day based on an adjusted ideal body weight (IBW). Weight was adjusted in these patients according to the following formula: IBW + 40% (Observed Weight - IBW). A trough blood level was obtained on day 5 of therapy. RESULTS: Initial drug levels ranged from 46-146 ug/mL (mean = 90.6), of which 13 of 16 (81.3%) were considered within therapeutic range (50-120 ug/mL). Eight of 16 patients (50%) had reported side effects, including sedation and gastrointestinal upset. The majority of these side effects occurred in patients with drug levels > or = 90 ug/mL and were noted to improve with 1-2 days of therapy +/- dosage adjustment. Overweight patients (> or = 15% above IBW) who received the unadjusted 15 mg/kg oral load had significantly higher drug levels than their normal weight counterparts and overweight children who received weight-adjusted dosing (p < 0.003). CONCLUSION: A 15 mg/kg/day oral load of divalproex sodium resulted in therapeutic drug levels on day 5 of treatment and is well tolerated in normal weight children. Overweight children are significantly more likely to experience supratherapeutic drug levels on this regimen, which may affect tolerability. Overweight children appear to benefit from weight-adjusted oral loading.
