Revista de Psiquiatría Infanto-Juvenil

Does Increasing Emergency Bed Capacity Lead to More Visits? A Pre-Post Study on the Incorporation of a Dedicated Child and Adolescent Psychiatric Area in a Tertiary Hospital's Emergency Department

2025-06-27T19:57:54+00:00

Introduction: In health policy, Roemer's Law argues that "a hospital bed built is a bed filled". This law has not been studied in child and adolescent psychiatric emergency departments. Objectives: To compare the number and characteristics of child and adolescent emergency visits before and after the incorporation of a unit dedicated to providing urgent psychiatric care exclusively to minors in a tertiary hospital. Methods: A retrospective pre-post study was conducted on all emergency psychiatric visits by minors at Hospital Clínic in Barcelona (Spain) during a 10-month period before and after the implementation of the dedicated area. Univariate variables were compared with T-student, chi-square and Mann-Whitney U tests. A linear regression model was performed to predict the expected variation in visits, using data from previous years (2012–2018). Results: 70 additional visits occurred (866 vs 936, 8% increase). The regression model identified an expected increase of 67.1 visits per year (CI 95% 46.1-88.2, p<0.001). The additional visits therefore fell within the expected range of variation. The average visit duration decreased (3.03h vs 2.75h, p=0.02). Conclusions: It cannot be concluded that the new unit had an effect on the number of visits. The increase may be the result of the age distribution of the studied population (different healthcare-seeking behaviours and dynamics in minors) and the limited timeframe of the study (ten months). The latter suggests the need for a longer-term research focus. The finding of shorter visits might indicate an improvement in the quality of care.

Clinical and epidemiological analysis of the use of psychotropic drugs in children hospitalized in a national reference center

2025-06-27T19:57:43+00:00

Introduction: Given the problem of the increase in the prescription of psychotropic drugs, we sought to conduct a prospective study to establish the prevalence and clinical and epidemiological characteristics of the use of psychotropic drugs in paediatric patients. Objectives: To analyse the clinical and epidemiological characteristics of the use of psychotropic drugs in paediatric patients at the Pereira Rossel Hospital between the months of September and October 2023. Materials and methods: A descriptive, cross-sectional study was conducted by reviewing the electronic medical records and performing interviews. All children and adolescents between the ages of 2 and 14 who were admitted to moderate paediatric care wards and were receiving psychotropic drugs at the time of admission were included. Results: Within the classification of psychotropic drugs, 72% used antipsychotics. 47% of patients presented polypharmacy. The most used drug in monotherapy was Risperidone. Regarding polypharmacy, the most frequent combinations were antipsychotics with antidepressants. The most frequent reason for prescribing psychotropic drugs was disruptive disorders, impulse control disorders and behavioural disorders. Conclusion: Our study identified an increase in the use of psychotropic drugs in polytherapy and a need for proper monitoring following prescription. There was also a lack of indications for non-pharmacological treatments. Additional studies should be conducted to further explore these aspects and compare the effectiveness of the different approaches, in order to create a protocol for action for children and adolescents with mental health disorders.

Cómo la medicina del sueño puede contribuir al campo de la psiquiatría

2025-06-27T19:56:53+00:00

Saber qué es y qué no es un trastorno de sueño es clave en el abordaje y el correcto tratamiento de un niño o adolescente con problemas mentales.

La relación entre el sueño y la salud mental en la edad infanto-juvenil ha sido ampliamente descrita, de manera que las alteraciones de sueño en población con afecciones psiquiátricas y del neurodesarrollo ascienden hasta el 90% (1-3). Los trastornos mentales no son problemas a lo largo del día solo, sino que son problemas que afectan las 24 horas, por lo tanto, casi de manera constante vamos a encontrar problemas de sueño.

Differential Diagnosis of Tourette Syndrome in Individuals with Autism Spectrum Disorder: A Case Study

2025-06-27T19:57:30+00:00

Introduction: Autism Spectrum Disorder (ASD) and Tourette Syndrome (TS) are two neurodevelopmental conditions that can present similar symptoms. This case study aims to establish the differential diagnosis between both conditions in a minor identified as "L”. Clinical case description: Through a review of the medical history and the observation of current behaviors using the Yale Global Tics Severity Scale (YGTSS) and the IDEA Inventory by Riviere, it is possible to differentiate that repetitive behaviors in ASD tend to be rhythmic and self-regulatory, whereas tics in TS are non-rhythmic movements preceded by premonitory sensory impulses, usually accompanied by discomfort, which can be difficult to identify in individuals with ASD. Conclusions/Discussion: This case study highlights the importance of a detailed clinical evaluation that analyzes the function of motor movements and vocal expressions, medical history, and the difficulties caused by the overlap between both conditions.

Effectiveness of Lithium Treatment in Kleine-Levin Syndrome: A Case Report

2025-06-27T19:57:18+00:00

Introduction: This case describes a 14-year-old male patient diagnosed with Kleine-Levin Syndrome (KLS), who was attended by the Child and Adolescent Consultation-Liaison Psychiatry Team after presenting two episodes of hypersomnia and behavioral disturbances. Given the severity and recurrence of the episodes, a multidisciplinary approach was implemented, including discussions on differential diagnosis and consensus on therapeutic management. Case description: Due to the lack of response to conventional treatments, treatment with lithium carbonate was initiated, leading to a rapid remission of symptoms and the prevention of new episodes over a 12-month follow-up. The patient subsequently experienced a brief relapse with lower intensity and shorter duration, which was stabilized after adjusting the lithium dose. Discussion and conclusions: This case underscores the importance of a multidisciplinary approach in managing KLS, as well as the therapeutic potential of lithium for severe and refractory cases.

Postural Orthostatic Tachycardia Syndrome and Austism Spectrum Disorder

2025-06-27T19:57:06+00:00

Introduction: Studies on the function of the autonomic nervous system in patients with autism spectrum disorder show a higher prevalence of autonomic nervous system dysfunction with greater sympathetic excitation. Among the different forms of autonomic nervous system dysautonomia, we find postural orthostatic tachycardia syndrome. Case description: We present the case of an adolescent diagnosed with autism spectrum disorder who, during a hospital admission, presented tachycardia, sweating, bluish discoloration of the extremities and marked asthenia. Assessed by the Cardiology Unit during admission, treatment with bisoprolol was initiated and aripiprazole was withdrawn. The symptoms, although intermittent, persisted over time, and the patient was referred to an arrhythmia unit. A tilt table test was performed, and the patient was diagnosed with postural orthostatic tachycardia syndrome. Conclusions and Discusion: Patients with autism spectrum disorder have a higher prevalence of autonomic nervous system dysfunction.