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Identification of trauma exposure and PTSD in adolescent psychiatric inpatients: An exploratory study

Authors

  • Jennifer F. Havens,

    Corresponding author
    1. Department of Child & Adolescent Psychiatry, Bellevue Hospital Center, New York, New York, USA
    2. Department of Child & Adolescent Psychiatry, New York University School of Medicine, New York, New York, USA
    • Department of Child & Adolescent Psychiatry, New York University School of Medicine, Bellevue Hospital Center, 462 First Avenue, Room 21S25, New York, NY 10016.
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  • Omar G. Gudiño,

    1. Department of Child & Adolescent Psychiatry, Bellevue Hospital Center, New York, New York, USA
    2. Department of Child & Adolescent Psychiatry, New York University School of Medicine, New York, New York, USA
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  • Emily A. Biggs,

    1. Department of Child & Adolescent Psychiatry, Bellevue Hospital Center, New York, New York, USA
    2. Department of Child & Adolescent Psychiatry, New York University School of Medicine, New York, New York, USA
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  • Ursula N. Diamond,

    1. Department of Child & Adolescent Psychiatry, Bellevue Hospital Center, New York, New York, USA
    2. Department of Child & Adolescent Psychiatry, New York University School of Medicine, New York, New York, USA
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  • J. Rebecca Weis,

    1. Department of Child & Adolescent Psychiatry, Bellevue Hospital Center, New York, New York, USA
    2. Department of Child & Adolescent Psychiatry, New York University School of Medicine, New York, New York, USA
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  • Marylene Cloitre

    1. Department of Child & Adolescent Psychiatry, New York University School of Medicine, New York, New York, USA
    2. National Center for PTSD, Palo Alto, California, USA
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Abstract

Trauma exposure and posttraumatic stress disorder (PTSD), though prevalent among adolescent psychiatric inpatients, are underidentified in standard clinical practice. In a retrospective chart review of 140 adolescents admitted to a psychiatric inpatient unit, we examined associations between probable PTSD identified through the Child PTSD Symptom Scale and adolescents' service use and clinical characteristics. Results suggest a large discrepancy between rates of probable PTSD identified through standardized assessment and during the emergency room psychiatric evaluation (28.6% vs. 2.2%). Adolescents with probable PTSD had greater clinical severity and service utilization, an increased likelihood of being diagnosed with bipolar disorder (27.5% vs. 9.2%) and being prescribed antipsychotic medications (47.5% vs. 27.6%), and were prescribed more psychotropic medications. Upon discharge, those with probable PTSD were more than those without to be assigned a diagnosis of PTSD (45% vs. 7.1%), a comorbid diagnosis of major depressive disorder (30% vs. 14.3%), to be prescribed an antidepressant medication (52.5% vs. 33.7%), and to be prescribed more medications. The underidentification of trauma exposure and PTSD has important implications for the care of adolescents given that accurate diagnosis is a prerequisite for providing effective care. Improved methods for identifying trauma-related problems in standard clinical practice are needed.

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