Departments of Psychiatry and Pediatrics, Tufts Medical Center/Tufts University School of Medicine, 800 Washington Street #1007, Boston, MA 02111 USA.
Psychiatr Q. 2013 Jun;84(2):159-68. doi: 10.1007/s11126-012-9235-1.
Research has focused on changes in the psychiatric treatment of youth in outpatient settings, but less is known about trends in inpatient care. This study documents changes in the lengths of stay (LOS), clinical profiles of youth, and medication use within an inpatient setting in Massachusetts between 1991 and 2008. A chart review of 233 medical records of psychiatrically hospitalized youth was conducted at three points in time (1991, 1998, and 2008). Sample includes youth between ages 4 and 18. Clinical data, including LOS, diagnoses and other clinical variables, and number and type of medications prescribed were compared across sample years. Findings indicate a significant decrease in the LOS coupled with a concurrent increase in psychotropic medication use between each successive sample year. The prescription of anti-psychotic medications, in particular, increased significantly. On clinical indices, findings show that there was an increase in the diagnosis of bipolar spectrum disorders and a concurrent decrease in unipolar diagnoses in the 2008 sample. Attention-deficit and developmental disorders showed little change. Trauma-related disorders were significantly less frequently diagnosed in 2008. Children hospitalized in 1998 and 2008 had more prior hospitalizations and presented with greater acuity than those in the 1991 sample. Results highlight important changes that have occurred in child/adolescent inpatient settings over the past two decades. Data suggest that these changes have not resulted in decreased rates of inpatient hospitalization for youth with more severe psychiatric disorders.
研究主要集中在门诊环境中青少年精神科治疗的变化上，但对住院治疗的趋势知之甚少。本研究记录了马萨诸塞州在 1991 年至 2008 年间住院环境中青少年的住院时间（LOS）、临床特征和药物使用的变化。对三个时间点（1991 年、1998 年和 2008 年）的 233 名住院青少年的医疗记录进行了图表审查。样本包括 4 至 18 岁的青少年。比较了不同样本年份的 LOS、诊断和其他临床变量以及开处的药物数量和类型等临床数据。结果表明，住院时间显著缩短，而连续样本年份的精神药物使用量却同时增加。特别是抗精神病药物的处方显著增加。在临床指数方面，研究结果表明，双相谱系障碍的诊断有所增加，而 2008 年样本中单相诊断的比例同时下降。注意力缺陷和发育障碍的变化不大。与创伤相关的障碍在 2008 年的诊断率显著降低。1998 年和 2008 年住院的儿童的住院次数多于 1991 年的样本，病情也更为严重。研究结果突出了过去二十年来儿童/青少年住院环境中发生的重要变化。数据表明，这些变化并没有导致严重精神疾病青少年的住院率降低。
