Best Practices in Managing Child and Adolescent Behavioral Health Emergencies

Points & Pearls Excerpt

• Relying solely on the past medical history and/or previous psychiatric diagnosis can be very misleading, and has been demonstrated to lead to anchoring or momentum bias.
• Ask about previous medical or psychiatric diagnoses and medication history and compliance. Associated mood disorders and prior suicide attempts are the main risk factors for suicide in the adolescent population.
• Firearms or weapons remain the second most frequent cause of mortality among completed suicides in children and adolescents; thus, screening for access to weapons and need for focused interventions for at-risk patients is essential.

Most Important References

• Gould MS, Fisher P, Parides M, et al. Psychosocial risk factors of child and adolescent completed suicide. Arch Gen Psychiatry. 1996;53(12):1155-1162. (Prospective; 267 patients) DOI: http://dx.doi.org/10.1001/archpsyc.1996.01830120095016
• Mahajan P, Alpern ER, Grupp-Phelan J, et al. Epidemiology of psychiatric-related visits to emergency departments in a multicenter collaborative research pediatric network. Pediatr Emerg Care. 2009;25(11):715-720. (Retrospective; 84,793 visits) DOI: http://dx.doi.org/10.1097/PEC.0b013e3181bec82f
• Lee CS, Williamson LR, Martin SE, et al. Adverse events in very young children prescribed psychotropic medications: preliminary findings from an acute clinical sample. J Child Adolesc Psychopharmacol. 2015;25(6):509-513. (Prospective; 158 patients) DOI: http://dx.doi.org/10.1089/cap.2015.0034
• Horowitz LM, Bridge JA, Teach SJ, et al. Ask Suicide-Screening Questions (ASQ): a brief instrument for the pediatric emergency department. Arch Pediatr Adolesc Med. 2012;166(12):1170-1176. (Prospective cross-sectional; 524 patients) DOI: http://dx.doi.org/10.1001/archpediatrics.2012.1276
• Murrough JW, Iosifescu DV, Chang LC, et al. Antidepressant efficacy of ketamine in treatment-resistant major depression: a two-site randomized controlled trial. Am J Psychiatry. 2013;170(10):1134-1142. (Randomized controlled trial; 73 patients) DOI: http://dx.doi.org/10.1176/appi.ajp.2013.13030392
• Asarnow JR, Baraff LJ, Berk M, et al. An emergency department intervention for linking pediatric suicidal patients to follow-up mental health treatment. Psychiatr Serv. 2011;62(11):1303-1309. (Randomized controlled trial; 181 patients) DOI: http://dx.doi.org/10.1176/ps.62.11.pss6211_1303