- Email: [email protected]
3.32 DISRUPTIVE MOOD DYSREGULATION DISORDER IN JUVENILE JUSTICE
NEW RESEARCH POSTERS 3.31 – 3.33
hospitalization (P ¼ 0.009, P ¼ 0.049, and P ¼ 0.047, respectively). During the last five nights of the admission, sleep duration improved and was not associated with parent-reported sleep problems (P ¼ 0.71). Conclusions: Parent report of sleep problems before admission, particularly middle insomnia, was associated significantly with greater parental stress and patient sleep problems initially observed in the hospital. However, this association was not significant for the end of hospitalization, suggesting that aspects of the hospital intervention (pharmacological, behavioral, or environmental) may be associated with improved sleep. Further research is needed to examine the relationship between sleep disturbance and parental stress. The hospital may provide a unique setting to study the relative contributions of sleep routine, parental stress, and medication effects to sleep disturbance in children with ASD.
ASD SLP TREAT Supported the Simons Foundation Autism Research Initiative (#296318), and the Nancy Lurie Marks Family Foundation http://dx.doi.org/10.1016/j.jaac.2016.09.162
3.31 EFFECTIVENESS OF A NEW PARTIAL HOSPITALIZATION MODEL IN ADOLESCENTS WITH AN EATING DISORDER AS AN ALTERNATIVE TO TOTAL HOSPITALIZATION Eduardo Serrano, PhD, Eating Disorders Unit. Child and Adolescents Psychiatry and Psychology Departmen, Hospital Sant Joan de Deu, C/Torrent Lloveras numer 8, 2nd floor, Barcelona 08339, Spain; Marta Carullla, MD; Bernardo Sanchez, MD; Raquel Cecilia, MD; Marta Curet, PsyD; ~as, MSc; Josep Matali, PhD; Ania Perez, MSc; Laura Can Montserrat Dolz, MD Objectives: Total hospitalization (TH) is the chosen treatment method for adolescents with a moderate to severe ED. Nevertheless, it is expensive, and the risk of relapse or rehospitalization is high. A less costly alternative to TH is partial hospitalization (PH), which may enable relapse and rehospitalization to be avoided as it facilitates the hospital to home transition. To measure the effectiveness of the new ambulatory-intensive resource, the PH day program for ED of 11 hours (PHD-ED-11h) is an alternative to TH (avoiding ingress) and a device to continue treatment after hospital discharge of TH to reduce the hospital length of stay. Methods: Hospital discharges in 2015 were analyzed (coinciding with the launch of the PHD-ED-11h devise with 10 available places for patients), checking for variables on age, sex, diagnosis, derivation, provenance, and average length of stay. Results: In 2015, there were 74 releases; 71 (95.94 percent) of these patients were female, with an average age of 14.63 years (DE: 1.81). With regard to diagnosis, 50 (67.56 percent) suffered from AN, 18 (14.32 percent) had an unspecific ED, and six (8.12 percent) had bulimia nervosa. Of all these patients, 34 (45.9 percent) came from TH, and the remaining 40 (54.05 percent) came from less intense ED programs, including those in PH or as an outpatient. The average length of stay of the patients was 26 days (DE: 19.5), which meant that 70 percent of patients who went into PHD-ED-11h avoided a TH. Furthermore, its effectiveness can be seen by observing the annual results of TH where it was reduced to 21 days in 2015 (the year when the program started) from 30 days in 2014. Conclusions: The PHD-ED-11h has been shown to be an effective resource as an alternative to TH for adolescents with moderate-severe ED. Through this program, seven of 10 patients have avoided TH, and from those already hospitalized, the program has precipitated a 9-day reduction to the average length of stay. Patients can be released from TH through an intensive program that continues treatment, assuring not only psychotherapeutic control but meals, eating alterations, and possible compensation measures as well.
DTT EA EBP http://dx.doi.org/10.1016/j.jaac.2016.09.163
S152
www.jaacap.org
3.32 DISRUPTIVE MOOD DYSREGULATION DISORDER IN JUVENILE JUSTICE Megan M. Mroczkowski, MD, Child Psychiatry, Columbia University Medical Center and NewYork-Presbyterian Hospital, 3959 Broadway, CHONY 6N, New York, NY 10032; Larkin McReynolds, PhD; Prudence W. Fisher, PhD; Gail A. Wasserman Objectives: Disruptive mood dysregulation disorder (DMDD) is a new diagnosis for children and adolescents in the DSM-5 categorized under depressive disorders. Our primary goal is to compare children with DMDD to clarify their differences. Our secondary goals are to investigate differential contributors to DMDD versus mood and DMDD versus disruptive behavior disorders among youth in the juvenile justice system. Methods: Diagnostic and demographic data on 9,819 youth were available in the course of a series of collaborations between Columbia University’s Center for the Promotion of Mental Health in Juvenile Justice and juvenile authorities. Youth had participated in mental health self-assessments on the Voice Diagnostic Interview Schedule for Children (V-DISC), and we retrofitted the existing V-DISC data from the ODD module to derive approximated DMDD diagnosis. Results: Youth (3.3 percent) met retrofit criteria for DMDD. Compared with youth with disruptive behavioral disorders, those meeting retrofit criteria for DMDD were more likely to be female, report posttraumatic stress disorder, and have a history of a suicide attempts. Compared with those reporting mood disorders, youth meeting retrofit criteria for DMDD were more likely to report a substance use disorder. Conclusions: These results help clarify the epidemiology of DMDD in the juvenile justice population. Those with DMDD clearly are more similar to those with depressive disorders than they are to those meeting criteria for disruptive behavioral disorders. Although externalizing behaviors leading to juvenile justice involvement may overshadow internalizing symptoms of DMDD, identifying and treating these conditions are feasible in this population.
DMDD EPI JJS http://dx.doi.org/10.1016/j.jaac.2016.09.164
3.33 AFFECTIVE, ANXIETY, SUBSTANCE-RELATED, AND EXTERNALIZING DISORDERS AND THEIR RELATIONSHIP TO CRIMINAL RECIDIVISM IN DETAINED MALE ADOLESCENT OFFENDERS Dorothea Stiefel, MD, Forensic Child and Adolescent Psychiatry, University Hospital of Zurich, Neptunstrasse 60, Zurich 8032, Switzerland; Cornelia Bessler, MD; Belinda Plattner, MD; Marcel Aebi, PhD Objectives: Studies from Austria, the Netherlands, and the United States have discovered high rates of psychiatric disorders in detained adolescent offenders, with 70–90 percent suffering from at least one psychiatric disorder. This rate is three or more times higher than the rate of psychiatric disorders within the general adolescent population. The few existing studies found externalizing disorders to be most strongly related to criminal recidivism. We tested the presence of psychiatric disorders and their connection to criminal reoffenses in a sample group of male adolescent offenders from the Zurich Juvenile Detention Centre (Switzerland). Methods: We assessed psychopathology in a consecutive sample group of 122 detained boys using a structured standardized interview (Mini International Neuropsychiatric Interview for Children and Adolescents, MINI–KID). Thereafter, criminal recidivism was obtained from official data within 365 days after their release from detention. Results: Of the sample group, 90.2 percent met criteria for at least one psychiatric disorder. In particular, 80.3 percent had an externalizing disorder (e.g., CD, ADHD); 64.8 percent had a substance-related disorder, 32.8 percent had an anxiety disorder, and 28.7 percent had an affective disorder. Chi-squared statistics and Cox regression analyses found the presence of externalizing disorders and the presence of drug-related disorders associated with violent reoffenses but not with general reoffenses. In addition, young age was found to be a risk factor for violent reoffenses.
J OURNAL
OF THE
AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016
hospitalization (P ¼ 0.009, P ¼ 0.049, and P ¼ 0.047, respectively). During the last five nights of the admission, sleep duration improved and was not associated with parent-reported sleep problems (P ¼ 0.71). Conclusions: Parent report of sleep problems before admission, particularly middle insomnia, was associated significantly with greater parental stress and patient sleep problems initially observed in the hospital. However, this association was not significant for the end of hospitalization, suggesting that aspects of the hospital intervention (pharmacological, behavioral, or environmental) may be associated with improved sleep. Further research is needed to examine the relationship between sleep disturbance and parental stress. The hospital may provide a unique setting to study the relative contributions of sleep routine, parental stress, and medication effects to sleep disturbance in children with ASD.
ASD SLP TREAT Supported the Simons Foundation Autism Research Initiative (#296318), and the Nancy Lurie Marks Family Foundation http://dx.doi.org/10.1016/j.jaac.2016.09.162
3.31 EFFECTIVENESS OF A NEW PARTIAL HOSPITALIZATION MODEL IN ADOLESCENTS WITH AN EATING DISORDER AS AN ALTERNATIVE TO TOTAL HOSPITALIZATION Eduardo Serrano, PhD, Eating Disorders Unit. Child and Adolescents Psychiatry and Psychology Departmen, Hospital Sant Joan de Deu, C/Torrent Lloveras numer 8, 2nd floor, Barcelona 08339, Spain; Marta Carullla, MD; Bernardo Sanchez, MD; Raquel Cecilia, MD; Marta Curet, PsyD; ~as, MSc; Josep Matali, PhD; Ania Perez, MSc; Laura Can Montserrat Dolz, MD Objectives: Total hospitalization (TH) is the chosen treatment method for adolescents with a moderate to severe ED. Nevertheless, it is expensive, and the risk of relapse or rehospitalization is high. A less costly alternative to TH is partial hospitalization (PH), which may enable relapse and rehospitalization to be avoided as it facilitates the hospital to home transition. To measure the effectiveness of the new ambulatory-intensive resource, the PH day program for ED of 11 hours (PHD-ED-11h) is an alternative to TH (avoiding ingress) and a device to continue treatment after hospital discharge of TH to reduce the hospital length of stay. Methods: Hospital discharges in 2015 were analyzed (coinciding with the launch of the PHD-ED-11h devise with 10 available places for patients), checking for variables on age, sex, diagnosis, derivation, provenance, and average length of stay. Results: In 2015, there were 74 releases; 71 (95.94 percent) of these patients were female, with an average age of 14.63 years (DE: 1.81). With regard to diagnosis, 50 (67.56 percent) suffered from AN, 18 (14.32 percent) had an unspecific ED, and six (8.12 percent) had bulimia nervosa. Of all these patients, 34 (45.9 percent) came from TH, and the remaining 40 (54.05 percent) came from less intense ED programs, including those in PH or as an outpatient. The average length of stay of the patients was 26 days (DE: 19.5), which meant that 70 percent of patients who went into PHD-ED-11h avoided a TH. Furthermore, its effectiveness can be seen by observing the annual results of TH where it was reduced to 21 days in 2015 (the year when the program started) from 30 days in 2014. Conclusions: The PHD-ED-11h has been shown to be an effective resource as an alternative to TH for adolescents with moderate-severe ED. Through this program, seven of 10 patients have avoided TH, and from those already hospitalized, the program has precipitated a 9-day reduction to the average length of stay. Patients can be released from TH through an intensive program that continues treatment, assuring not only psychotherapeutic control but meals, eating alterations, and possible compensation measures as well.
DTT EA EBP http://dx.doi.org/10.1016/j.jaac.2016.09.163
S152
www.jaacap.org
3.32 DISRUPTIVE MOOD DYSREGULATION DISORDER IN JUVENILE JUSTICE Megan M. Mroczkowski, MD, Child Psychiatry, Columbia University Medical Center and NewYork-Presbyterian Hospital, 3959 Broadway, CHONY 6N, New York, NY 10032; Larkin McReynolds, PhD; Prudence W. Fisher, PhD; Gail A. Wasserman Objectives: Disruptive mood dysregulation disorder (DMDD) is a new diagnosis for children and adolescents in the DSM-5 categorized under depressive disorders. Our primary goal is to compare children with DMDD to clarify their differences. Our secondary goals are to investigate differential contributors to DMDD versus mood and DMDD versus disruptive behavior disorders among youth in the juvenile justice system. Methods: Diagnostic and demographic data on 9,819 youth were available in the course of a series of collaborations between Columbia University’s Center for the Promotion of Mental Health in Juvenile Justice and juvenile authorities. Youth had participated in mental health self-assessments on the Voice Diagnostic Interview Schedule for Children (V-DISC), and we retrofitted the existing V-DISC data from the ODD module to derive approximated DMDD diagnosis. Results: Youth (3.3 percent) met retrofit criteria for DMDD. Compared with youth with disruptive behavioral disorders, those meeting retrofit criteria for DMDD were more likely to be female, report posttraumatic stress disorder, and have a history of a suicide attempts. Compared with those reporting mood disorders, youth meeting retrofit criteria for DMDD were more likely to report a substance use disorder. Conclusions: These results help clarify the epidemiology of DMDD in the juvenile justice population. Those with DMDD clearly are more similar to those with depressive disorders than they are to those meeting criteria for disruptive behavioral disorders. Although externalizing behaviors leading to juvenile justice involvement may overshadow internalizing symptoms of DMDD, identifying and treating these conditions are feasible in this population.
DMDD EPI JJS http://dx.doi.org/10.1016/j.jaac.2016.09.164
3.33 AFFECTIVE, ANXIETY, SUBSTANCE-RELATED, AND EXTERNALIZING DISORDERS AND THEIR RELATIONSHIP TO CRIMINAL RECIDIVISM IN DETAINED MALE ADOLESCENT OFFENDERS Dorothea Stiefel, MD, Forensic Child and Adolescent Psychiatry, University Hospital of Zurich, Neptunstrasse 60, Zurich 8032, Switzerland; Cornelia Bessler, MD; Belinda Plattner, MD; Marcel Aebi, PhD Objectives: Studies from Austria, the Netherlands, and the United States have discovered high rates of psychiatric disorders in detained adolescent offenders, with 70–90 percent suffering from at least one psychiatric disorder. This rate is three or more times higher than the rate of psychiatric disorders within the general adolescent population. The few existing studies found externalizing disorders to be most strongly related to criminal recidivism. We tested the presence of psychiatric disorders and their connection to criminal reoffenses in a sample group of male adolescent offenders from the Zurich Juvenile Detention Centre (Switzerland). Methods: We assessed psychopathology in a consecutive sample group of 122 detained boys using a structured standardized interview (Mini International Neuropsychiatric Interview for Children and Adolescents, MINI–KID). Thereafter, criminal recidivism was obtained from official data within 365 days after their release from detention. Results: Of the sample group, 90.2 percent met criteria for at least one psychiatric disorder. In particular, 80.3 percent had an externalizing disorder (e.g., CD, ADHD); 64.8 percent had a substance-related disorder, 32.8 percent had an anxiety disorder, and 28.7 percent had an affective disorder. Chi-squared statistics and Cox regression analyses found the presence of externalizing disorders and the presence of drug-related disorders associated with violent reoffenses but not with general reoffenses. In addition, young age was found to be a risk factor for violent reoffenses.
J OURNAL
OF THE
AMERICAN ACADEMY OF CHILD & ADOLESCENT P SYCHIATRY VOLUME 55 NUMBER 10S OCTOBER 2016