Evaluation of the physical health of adolescent in-patients in generic and secure services: retrospective case-note review

Abstract

Aims and methodTo assess physical health needs of adolescent in-patients by routine monitoring. A retrospective analysis of case notes was conducted on a 6-month intake to generic and secure adolescent mental health units in Greater Manchester, UK.ResultsFifty individuals were admitted (52% female, average age 15.84 years). Diagnoses varied and 66% were prescribed medications before admission. All had a physical health assessment, which identified various physical health risk factors. Average body mass index was 25.99 (range 15.8–44), and increased during in-patient treatment for 84% of individuals who had their body mass recorded more than once. A total of 28% of individuals smoked. Lipids and prolactin levels were elevated across the sample.Clinical implicationsThis evaluation strengthens the argument to optimise physical healthcare for adolescent in-patients and develop physical health interventions, particularly given that we observed elevated lipids and prolactin. Physical health and well-being may not be prioritised when assessing and managing young peoples' mental health, despite their increased vulnerability for comorbid conditions.

The clinical and behavioral cardiometabolic risk of children and young people on mental health inpatient units: A systematic review and meta-analysis

“… Psychosis Group = 81.5 days (sd 98.9) Non-Psychosis Group = 42.2 days (sd 60.5) Psychosis Group mainly schizophrenia (87.7%, n = 71); Non-Psychosis Group = conduct/ADHD (47.7%, n = 136), adjustment disorders (24.6%, n = 70), neurodevelopmental but hospitalized due to non-psychotic behavioral deterioration (15.1%, n = 43) Antispychotics for Psychosis Group 33.3% (n = 27), Non-Psychosis Group 33.7% (n = 93) Cross-sectional (Retrospective cohort) BMI, Weight, Tobacco Use 24.9% young people smoked and individuals with non-psychotic disorders had slightly higher average BMI scores than psychotic disorders (although both were within the healthy weight range). Carney et al, (2019) [ 19 ] UK Adolescent inpatients aged 13–18 in generic or secure mental health inpatient unit in the UK, presenting with a range of complex mental health needs which cannot be met safely within the community. 50 15.84 (sd 1.46) 52% female (n = 26), 48% male (n = 24) Mixed gender generic adolescent inpatient service providing evidence based treatments for young people with complex mental health needs.…”

“…Eleven studies reported BMI values (n = 1731), ranging from 18.2–32.5 [ 19 , 28 , 29 , 33 , 34 , 39 , 40 , 44 , 48 , 56 ]. The weighted average was 23.96 (95% CI 22.79–25.13), and fell within the healthy weight range (18.5–24.9).…”

“…Four studies reported bodyweight (n = 197), ranging from 32.8–68.58 kg [ 19 , 28 , 40 , 48 ]. The weighted average was 46.6 kg (95% CI 35.52–57.67 kg).…”

“…Indeed, previous research has found physical health problems are common on adolescent inpatient units, but often go undetected and untreated [ 18 ]. Our recent service evaluation also found evidence of poor physical health upon admission to CAMHS inpatient units, including high levels of obesity which increased suddenly over time, metabolic dysfunction and behavioral risk [ 19 ]. However, to date there has been no synthesis of the literature on physical health or cardiometabolic risk of adolescent inpatients receiving mental health care.…”

Physical health interventions on adolescent mental health inpatient units: A systematic review and call to action

“…They often present with risk factors for poor physical health which precede the onset of illness. For example, many have high BMI values on admission, which rapidly increase with duration of stay (Carney, Imran, Law, Folstad, & Parker, 2019). They also display pre-cursors to developing metabolic disorders and preventable physical health conditions, such as dysregulated blood metabolites and hyperprolactinemia (Carney et al, 2016;Carney et al, 2019;Cordes et al, 2017;Eapen et al, 2012;Vancampfort et al, 2017).…”