Characterization of the cases referred and consulted in a child and adolescent psyschiatry clinic. A retrospective study.

Abstract

Child Mental Health Services have been dealing¸ over the last decades, with a growing number of children in need of evaluation and treatment. Recent studies estimate that 10 to 20% of children and adolescents met criteria for, at least, one psychiatric diagnosis, and that only one fifth gets appropriate treatment. Thus, in order to optimize service planning and management we performed an analysis of the cases referred to and observed at one Child and Adolescent Psychiatry Clinic between 2004 and 2007, as well as descriptive analysis of the youth population observed at the same clinic during 2007. In the 4 year period studied, 1923 children were consulted in a total of 9609 appointments. Sample mean age was 9.89 years with a clear male gender preponderance. During 2007, 480 patients were consulted and it was possible to observe a predominance of nuclear family structure and around 71% of cases living in Sintra. Regarding the source of referral, 29% of the cases were referred by the assistant physician and in 26% by school teachers; the main complaints were behavior problems (30%) and learning disabilities (15%). It was also possible to characterize complaints according to the different referral sources. On a psychodynamic diagnostic level, 56% of all cases met criteria for a Depressive Organization. According to DSM-IV-TR diagnostic criteria for Axis I disorders, we found 30% of Emotional Disorders and 24.8% of Conduct Disorders and Attention Deficit and Hyperactive Disorder. Mean waiting times between referral and the first appointment varied between 55 days (cases referred from the Emergency Department) and 141 days (school referrals). Only a deeper and detailed analysis of this reality will allow the planning and implementation of measures needed to optimize Child and Adolescent Mental Health services and the answer they can give to patients and families.