The disruptive behavior disorders in the psychiatric emergency service

Many children and adolescents presenting to the Psychiatric Emergency Service (PES) are diagnosed with the Disruptive Behavior Disorders (DBD), Conduct Disorder (CD), and Oppositional Defiant Disorder (ODD). Sometimes it may be difficult to reliably diagnose these disorders in the PES setting. Given these limitations, a large database of 6 years of PES visits showed 314 patients with DBD compared with 1625 without DBD. More DBD patient visits required the intervention of police and/or the mobile crisis team. These patients are more likely to have additional diagnoses of depression and attention deficit hyperactivity disorder, be in current treatment, or involved with court or the correctional system. They are less frequently referred by other emergency services such as medical ERs. DBD patients do not require emergency medication or psychiatric hospitalization any more frequently than other youngsters presenting to the PES. In the PES setting there is little differentiation between the CD and the ODD population. A more detailed study of the presenting symptomatology of the DBD vs non-DBD patients revealed that DBD patients showed over twice as many disruptive behavior symptoms. Fights and defiance were present significantly more frequently than in controls, with a trend toward increased frequency of bullying and stealing. The clinical and public mental health implications of these findings are discussed.