Breaking the Cycle: Predicting Agitation Crises in Child and Adolescent Inpatient Psychiatry

Area of Science:

• Child and Adolescent Psychiatry
• Psychiatric Inpatient Care
• Clinical Psychology

Background:

• Agitation in child and adolescent psychiatric inpatients presents significant safety risks to patients and staff.
• Emergency medication, particularly intramuscular (IM) injections, is sometimes necessary to manage acute agitation.
• Understanding the predictors of IM medication use is crucial for developing targeted interventions.

Purpose of the Study:

• To identify biopsychosocial factors associated with the use of intramuscular (IM) agitation emergency medication in child and adolescent psychiatric inpatients.
• To determine predictors that increase or decrease the likelihood of receiving IM medication during hospitalization.

Main Methods:

• Retrospective review of 1,101 child and adolescent psychiatric inpatients hospitalized between June 2018 and November 2021.
• Linear regression analysis was employed to identify predictors of IM medication administration.

Main Results:

• Out of 1,101 patients, 196 received IM medication.
• Female sex was associated with a lower likelihood of IM medication use.
• Factors increasing the likelihood of IM medication use included prior child protective services involvement, history of violence, previous psychiatric hospitalizations, and polypharmacy (use of multiple home psychiatric medications).

Conclusions:

• Biopsychosocial factors significantly influence the need for emergency IM agitation medication in pediatric psychiatric inpatients.
• Identifying patients at higher risk can inform proactive management strategies to reduce agitation and reliance on pharmacological interventions.
• Further research should focus on refining predictive models and exploring non-pharmacological approaches for agitation management.