[What happens with child and adolescent psychiatric patients? Cooperation between pediatrics and psychiatry is required].

1,420 child and adolescent psychiatric patients from a County Council in Northern Sweden were prospectively monitored during observation periods ranging from 5-20 years. These follow-ups focused on the patients phi risk of future suicide, need of psychiatric care in adulthood, and risk of future criminality. In as much as every fourth child and adolescent psychiatric patient (male:female ratio = 1:2) required subsequent psychiatric care, while every third (male:female ratio = 2:1) demonstrated criminal behavior, these results indicate that improvements are needed in co-operative efforts linking child and adolescent psychiatry on the one hand with general psychiatry and social welfare authorities on the other. However, the majority of patients in general psychiatric care in corresponding age-groups were not the same former child and adolescent psychiatric patients. In a previous investigation of pediatric patients in ambulatory care it was found that every seventh patient was not physically ill although presenting with somatic symptoms, but suffered from undiscovered psychiatric problems. Considering the fact that patients in this group might well become patients in general psychiatry, yet never treated in child and adolescent psychiatry, then questions arise concerning ways to improve preventive measures and care. The following results also merit attention: 25 former child psychiatric patients died during follow-up. Mean age at death was 22 years (range 12-33 years). 14 suicided and another two died of "uncertain causes". None of those who suicided had previously been admitted to a child psychiatric unit after attempted suicide. The majority had suffered from serious psychosocial problems related to parental factors such as parental psychiatric illness, alcoholism/drug-abuse and neglect.