Öz
Giriş
Bu çalışma, Türkiye’de acil psikiyatrik değerlendirme sonrasında psikiyatri yatışına yönlendirilen çocuk ve ergenlerin psikiyatrik profillerini ve yatışla ilişkili özelliklerini incelemeyi amaçlamaktadır.
Yöntemler
Ekim 2022 ile Eylül 2024 tarihleri arasında çocuk acil serviste değerlendirilen ve psikiyatri yatışına yönlendirilen 57 ergenin (36 kız, 21 erkek) dosyaları geriye dönük olarak incelenmiştir. Sosyo-demografik veriler, psikiyatrik tanılar, özkıyım girişimi öyküsü, psikotrop ilaç kullanımı ve yatış sonuçları değerlendirilmiştir.
Bulgular
Yaş, aile yapısı ve okul devam durumu açısından cinsiyetler arasında anlamlı fark bulunmamıştır. Ancak özkıyım girişimi kızlarda (%80,6) erkeklere (%42,9) göre anlamlı düzeyde daha yaygındı (p=0,004). Kızlarda en sık yöntem zehirlenme (%75,9) iken, erkeklerde ası veya yüksekten atlama gibi yöntemler gözlenmiştir. Kızlarda en yaygın tanı depresif bozukluk (%69,4), erkeklerde ise bipolar bozukluk (%23,8) ve psikotik bozukluk (%14,3) idi. Komorbidite kızlarda (%44,4) erkeklere (%19,0) göre daha yüksekti (p=0,053). Başvuru sırasında kızların %91,7’si, erkeklerin %95,2’si psikotrop ilaç kullanmaktaydı. Olguların %50,9’u yatırılarak tedavi altına alınırken, tedavi reddi erkeklerde (%42,9) kızlara (%25) göre daha sık görüldü.
Sonuç
Çalışmamız, psikiyatri başvuru özellikleri ve yatışla ilgili sonuçlarda cinsiyete dayalı belirgin farkları ortaya koymaktadır. Bu bulgular, çocuk acil servislerinde özellikle özkıyımla ilişkili durumlar başta olmak üzere, akut psikiyatrik bozukluklara yönelik erken müdahale stratejilerinin güçlendirilmesi ve psikiyatri yatış hizmetlerine erişimin artırılması gerekliliğini ortaya koymaktadır.
Anahtar Kelimeler: Çocuk ve ergen ruh sağlığı ve hastalıkları, acil başvuru, özkıyım girişimleri
Kaynakça
Adak İ. An overview of emergency services in child and adolescent psychiatry. In: Sabuncuoğlu O, (editor). Emergencies in child and adolescent psychiatry. 1st ed. Ankara: Türkiye Klinikleri; 2021:1-6.
Cutler GJ, Rodean J, Zima BT, Doupnik SK, Zagel AL, et al. Trends in pediatric emergency department visits for mental health conditions and disposition by presence of a psychiatric unit. Acad Pediatr. 2019;19:948-55.
Ezquerra B, Peñuelas-Calvo I, Marti-Estevez I, Taracena-Cuerda M, Baca-García E, et al. Emergency psychiatric care for children and adolescents: factors associated with multiple visits and hospital admissions. Eur Child Adolesc Psychiatry. 2025;34:1883-93.
Janssens A, Hayen S, Walraven V, Leys M, Deboutte D. Emergency psychiatric care for children and adolescents: a literature review. Pediatr Emerg Care. 2013;29:1041-50.
Baren JM, Mace SE, Hendry PL, Dietrich AM, Goldman RD, et al. Children’s mental health emergencies--part 2: emergency department evaluation and treatment of children with mental health disorders. Pediatr Emerg Care. 2008;24:485-98.
Edelsohn GA, Braitman LE, Rabinovich H, Sheves P, Melendez A. Predictors of urgency in a pediatric psychiatric emergency service. J Am Acad Child Adolesc Psychiatry. 2003;42:1197-202.
Bilginer Ç, Karadeniz S, Aydoğdu S, Bulut Şahin D. Child mental health services in emergency department of a university hospital. Turk J Child Adolesc Ment Health. 2021;28:12-9.
Mapelli E, Black T, Doan Q. Trends in pediatric emergency department utilization for mental health-related visits. J Pediatr. 2015;167:905-10.
Hamm MP, Osmond M, Curran J, Scott S, Ali S, et al. A systematic review of crisis interventions used in the emergency department: recommendations for pediatric care and research. Pediatr Emerg Care. 2010;26:952-62.
Tural Hesapçıoğlu S, Hacıosmanoğlu CD, Okuyucu M, Ceylan MF. Primary diagnosis of the inpatients in child and adolescent psychiatry clinic and their comorbid psychiatric diagnosis. Turkish Medical Journal. 2024;9:1-7.
Lalayants M, Kim M, Prince JD. Psychiatric hospitalization among adolescents. J Behav Health Serv Res. 2018;45:292-9.
Kayan Ocakoğlu B, Alkaş Karaca GE, Erata MC, Ocakoğlu FT, Yerlikaya Oral E, et al. Assessment of children and adolescents’ admissions to pediatric psychiatric emergency department. Psychiatry. 2025;88:41-54.
Bardach NS, Coker TR, Zima BT, Murphy JM, Knapp P, et al. Common and costly hospitalizations for pediatric mental health disorders. Pediatrics. 2014;133:602-9.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. 5th ed. Washington, DC:American Psychiatric Association; 2013.
Shaffer D, Gould MS, Brasic J, Ambrosini P, Fisher P, et al. A children’s global assessment scale (CGAS). Arch Gen Psychiatry. 1983;40:1228-31.
Gökler B, Ünal F, Pehlivantürk B, Çengel Kültür E, Akdemir D, et al. Reliability and validity of schedule for affective disorders and schizophrenia for school age children-present and lifetime version-Turkish version. Turk J Child Adolesc Ment Health. 2004;11:109-16.
Siu AMH. Self-harm and suicide among children and adolescents in Hong Kong: a review of prevalence, risk factors, and prevention strategies. J Adolesc Health. 2019;64(6 Suppl):S59-S64.
Dougherty DM, Mathias CW, Marsh-Richard DM, Prevette KN, Dawes MA, et al. Impulsivity and clinical symptoms among adolescents with non-suicidal self-injury with or without attempted suicide. Psychiatry Res. 2009;169:22-7.
Özbaran B, Köse S, Yılmaz E, Aydın AN, Aydın C. Evaluation of the contribution of inpatient services and experienceson improvement in child and adolescent psychiatry practice. Alpha Psychiatry. 2016;17:120-6.
Cash SJ, Bridge JA. Epidemiology of youth suicide and suicidal behavior. Curr Opin Pediatr. 2009;21:613-9.
Çoban ÖG, Gül ME, Önder A. Evaluation of children and adolescents admitted to emergency service with suicide attempt. J Pediatr Emerg Intensive Care Med. 2022;9:153-7.
Brent DA. Master clinician review: saving holden caulfield: suicide prevention in children and adolescents. J Am Acad Child Adolesc Psychiatry. 2019;58:25-35.
Patel V, Flisher AJ, Hetrick S, McGorry P. Mental health of young people: a global public-health challenge. Lancet. 2007;369:1302-13.
Altuwaijri Y. Trends and prevalence of psychotropic medication use in children and adolescents in the period between 2013 and 2023: a systematic review. Cureus. 2024;16:e55452.
Scharko AM, Sieracki R, Mireski SJ. Long-acting injectable antipsychotic medication use in youth: a systematic review of the literature along with medwatch safety data and prescriber attitudes. J Child Adolesc Psychopharmacol. 2025;35:69-79.
Karadağ M, Türk N, Gökçen C, Topal Z. Sociodemographic and diagnostic characteristics of inpatients in a university hospital child and adolescent psychiatry clinic. Turk J Child Adolesc Ment Health. 2021;28:7-11.
Latalova K, Kamaradova D, Prasko J. Perspectives on perceived stigma and self-stigma in adult male patients with depression. Neuropsychiatr Dis Treat. 2014;10:1399-405.
Dikeç G, Kardelen C, Pilz González L, Mohammadzadeh M, Bilaç Ö, et al. Perceptions and experiences of adolescents with mental disorders and their parents about psychotropic medications in Turkey: a qualitative study. Int J Environ Res Public Health. 2022;19:9589.
Logan DE, King CA. Parental facilitation of adolescent mental health service utilization: a conceptual and empirical review. Clin Psychol Sci Pract. 2001;8:319-33.
