Psychiatric Emergencies in Children and Adolescents: A Comprehensive Profile and Short-term Outcome Evaluation in a Prospective Follow-up Study

Abstract

Background:

Emergency psychiatry services play a critical role in providing essential care for children and adolescents with mental health concerns, yet research in this field, especially in India, is limited. Our study aims to address this gap by investigating the demographic and clinical characteristics and short-term outcomes of children and adolescents accessing emergency psychiatric care at our tertiary care center.

Methods:

This prospective study included children and adolescents aged 3–18 who presented with psychiatric disorders to emergency services. All cases were assessed using the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria, the Clinical Global Impression (CGI) scale, and the Children’s Global Assessment Scale (CGAS). Follow-ups were done at three weeks and three months. The Shapiro–Wilk test assessed normality, followed by parametric or nonparametric tests as appropriate.

Results:

The mean age of the sample was 14.8 (standard deviation [SD]: 2.5) years, with boys comprising 57.1% and girls 42.9%. Most visits to emergency services occurred between 1 PM and 6 PM. The most common diagnoses were bipolar affective disorder (23.2%) and conversion/functional neurological symptom disorder (23.2%). Lorazepam and clonazepam were the most commonly prescribed medications at first visit (baseline). At first follow-up (3 weeks), a significant proportion (41.1%) was admitted as inpatients. Olanzapine was the most common drug prescribed during follow-up visits. The CGI scores decreased, while CGAS scores increased, reflecting improved functioning.

Conclusions:

The significant improvement in CGI and CGAS scores over follow-ups demonstrates the effectiveness of crisis intervention and pharmacotherapy in stabilizing clinical severity and enhancing functioning in the short term.

Keywords

Emergency psychiatry services children and adolescents psychiatric disorders

Key Messages:

Integrated care models combining pharmacological and nonpharmacological strategies are feasible in pediatric psychiatric emergencies.

Tailored intervention strategies for common presentations can improve emergency management and inform clinical guidelines.

The study highlights the need for longitudinal studies and personalized treatment plans that account for cultural, environmental, and individual factors to optimize care.

Emergency psychiatric services for children and adolescents play a pivotal role in addressing acute mental health crises, which can manifest in various forms, such as suicidal behavior, and acute behavioral disturbances, such as aggression and emotion dysregulation. The urgency of these situations necessitates immediate intervention to ensure the safety and well-being of young individuals facing mental health challenges. Psychiatric emergencies are classified into four categories: Class 1 (life-threatening), Class 2 (necessitating urgent intervention), Class 3 (requiring prompt intervention), and Class 4 (perceived emergencies).¹ Mental health-related visits constitute 12% of all emergency department visits,² and psychiatric emergencies seen by nonpsychiatrists outnumber those seen by psychiatrists.³ Studies report that child psychiatric emergencies constitute 5% of total emergency department visits⁴ and 10% to over 16% of all psychiatric emergencies.^5,6 Major psychiatric emergencies include suicidal behavior and acute behavioral disturbances.⁷ Other common emergencies include depressive disorders and substance use, with a rising incidence highlighting the need for enhanced emergency psychiatric services.^8,9 These cases often present challenges in assessment, as they may involve a combination of psychiatric and physical symptoms, including treatment-refractory and somatic symptoms.^10,11 However, research on psychiatric emergencies in children is notably limited.¹²

Existing literature indicates a higher prevalence of child and adolescent psychiatric emergencies among females, encompassing a range of issues such as emotional disorders,¹³ aggression,¹⁴ and suicidality.¹⁵ In India, literature on child and adolescent psychiatric emergencies is limited. Singh et al. reported that children constituted 10% of emergencies in a tertiary care center, with a female predominance (63%). Dissociative disorders (27%), aggression (18.5%), and self-harm (16.9%) were the most common presentations.⁵ Sen et al. found no rise in average monthly emergencies during the coronavirus disease 2019 (COVID-19) pandemic but noted self-harm as the leading cause (44.3%) and an increase in benzodiazepine prescriptions (44% vs. 28% pre-pandemic).⁶

The Department of Child and Adolescent Psychiatry at the National Institute of Mental Health and Neuro Sciences (NIMHANS)., the country’s first independent department of its kind, offers a 64-bed inpatient facility for children and adolescents from India’s culturally diverse population. Emergency services are available around the clock and are managed by a dedicated child and adolescent psychiatry team consisting of junior residents, postdoctoral senior residents, consultants, and psychiatric nurses. There is limited research globally in such a setting, with most studies focusing on either pediatric emergencies or psychiatric emergencies and even fewer addressing this context specifically within India. We aimed to address the significant gap in the Indian literature on child and adolescent psychiatric emergencies by providing prospective and naturalistic data on short-term outcomes following emergency psychiatric interventions. Unlike previous Indian studies, which are predominantly retrospective, our approach offers a more accurate and comprehensive understanding of these outcomes in a real-world clinical setting. The rationale for this study lies in the need for evidence-based insights to improve emergency mental health services for young individuals, particularly in India’s diverse cultural context. The findings have important implications for enhancing clinical practices and informing future research to optimize psychiatric emergency care for children and adolescents in India.

Methods

Study Design

We conducted a prospective naturalistic follow-up study from April 1, 2019, to June 30, 2020. At timepoint 1 (T1), a baseline of all the children (aged 3 to 18) seeking emergency services was recorded. A follow-up evaluation was done three weeks and three months from the baseline visit in the outpatient department (OPD) of child and adolescent psychiatry, in the inpatient ward (if the child/adolescent was admitted), or via telephone or email.

Sampling

A baseline of all children and adolescents suffering from psychiatric disorders as per Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and attending emergency services at the National Institute of Mental Health and Neuro Sciences (NIMHANS) was recorded. Systematic random sampling was used to recruit a follow-up sample. Since this study was conducted in an emergency, a pre-emptive list of participants could not be created. Instead, a list of days during the first week of the study, along with the presentation time, was compiled. The starting point for the sampling was then determined through a randomization process (random draw). Recruitment was conducted every fourth day following a fixed interval to minimize bias related to subjective influence, presentation timing, and cases’ potential severity. Only subjects with a reliable informant or caregiver (parent/guardian) who could provide details and written informed consent for participation in the study were recruited. Written informed assent was obtained from adolescents where applicable.

Instruments

This study’s semi-structured proforma was designed to collect the sociodemographic and basic clinical details (T1). In emergency settings, detailed socioeconomic assessments are not feasible. Therefore, the classification at the time of registration, based on the poverty line threshold (rural areas: ₹32 per day; urban areas: ₹47 per day),¹⁶ was used to categorize individuals as either below or above the poverty line. The DSM-5 was used for a detailed evaluation and diagnosis at baseline (T1). In addition, the Children’s Global Assessment Scale (CGAS)¹⁷ was used to assess their level of functioning as appropriate—at baseline (T1) and also at follow-ups (T2, T3). The Clinical Global Impression (CGI) scale is a widely used tool for overall clinical assessment.¹⁸ In this study, the severity version (CGI-S) was used at baseline (T1) to assess initial symptom severity, while the improvement version (CGI-I) was used at follow-up points (T2, T3) to evaluate changes over time.

Statistical Analysis

Shapiro–Wilk’s test was used to assess the normality of the study sample. Friedman’s test was used to analyze CGI and CGAS scores from baseline to the second follow-up. Statistical analysis was carried out using SPSS version 25. Missing data were handled by excluding participants who did not complete the follow-up assessments at three weeks and three months (T2, T3). We did not perform any imputation for missing data to avoid potential bias. However, we used a systematic approach to minimize participant dropout by maintaining contact with caregivers.

Ethical Considerations

Ethical clearance was obtained from the Institute Ethics Committee, and informed consent was obtained from parents and assent from adolescents (where appropriate). Subjects were allowed to withdraw from the study at any point without affecting their routine clinical care. To ensure confidentiality and anonymity, no identifying information was collected. The primary treating team continued treatment as usual as per the standard protocol. Any disclosure about abuse or risk behaviors was taken to the attention of the treating team for appropriate clinical action. We have followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for reporting to ensure methodological rigor and transparency in our study.

Results

During the study period, 11,007 psychiatric emergencies were recorded, of which 235 involved children and adolescents, representing 2.1% of all psychiatric emergencies. Baseline data for this sample were collected. Subsequently, every fourth child/adolescent was invited to participate in the study. Three families did not consent, resulting in a final sample size of 56 subjects recruited for follow-up. Figure 1 represents the recruitment process from baseline to subsequent follow-ups.

Figure 1.

Flowchart of Recruitment Process Through T1, T2, and T3.

Sociodemographic Profile

The mean age of the sample was 14.8 (standard deviation [SD]: 2.5) years. Boys accounted for 60.4 (n = 142) percent of the study sample. The majority were of Hindu religion (82.6%; n = 194) and were from above the poverty line (80%; n = 188). Most children (60.8%; n = 143) presented to emergency services without a formal referral. Usually, a parent served as the primary informant (91.9%; n = 216). Twenty-one children (8.9%) were brought to emergency services from state-run agencies involved in child protection and juvenile justice, including Child Care Institutions, the Child Welfare Committee, and the Juvenile Justice Board. A large majority (83.8%, n = 197) of children and adolescents came between 01 PM and 12 AM, but the most frequent time was between 01 and 06 PM (50.2%, n = 118).

Clinical Profile (at Baseline)

The most common diagnosis of the sample was bipolar affective disorder (BPAD) (21.7%; n = 51), followed by conversion/functional neurological symptom disorder (FNSD; 21.3%; n = 50), major depressive disorder (9.4%; n = 22), and psychotic disorder (8.5%; n = 20). In our sample, 6.8% (n = 16) of children and adolescents had received a diagnosis of attention-deficit/hyperactivity disorder (ADHD). Common comorbidities included specific learning disorders (2.6%; n = 6) and disorders of speech and language development (1.3%; n = 3). A diagnosis was deferred in 14 of 235 subjects (6%) pending further evaluation during follow-up visits. Intellectual developmental disorder (IDD) was not diagnosed at baseline to prevent misdiagnosis in the emergency setting but was confirmed during follow-up. Benzodiazepines were the most frequently administered medications, followed by antipsychotics. Lorazepam was prescribed to 91.5% of cases (n = 215), with a mean dose of 2.16 mg (SD: 0.54), and clonazepam was used in 55.3% (n = 130) at a mean dose of 0.5 mg (SD: 0.11). Among antipsychotics, the most commonly used were risperidone (mean dose 1.67 mg, SD: 0.76), haloperidol (mean dose 5 mg, SD: 0.00), and olanzapine (mean dose 4 mg, SD: 1.26). These medications were selected based on the acute clinical presentations, targeting agitation, aggression, and severe emotional dysregulation. All patients (n = 235) at baseline received individualized psychotherapeutic inputs tailored to their specific clinical condition and family context. These interventions included psychoeducation, crisis intervention, and supportive counseling. Table 1 provides an overview of the clinical management strategies implemented during follow-up visits.

Table 1.

Overview of Clinical Management Strategies at Follow-up Visits (T2 and T3).

Variable	First Follow-up (T2) n = 56	Second Follow-up (T3) n = 49
Mode of Follow-up
Direct	69.6% (n = 39)	63.3% (n = 31)
Telephone	19.6% (n = 11)	36.7% (n = 18)
Treatment Setting
Outpatient	58.9% (n = 33)	93.9% (n = 46)
Inpatient	41.1% (n = 23)	6.1% (n = 3)
Cognitive Profile
Average	83.9% (n = 47)	96.0% (n = 45)
Borderline intelligence	1.8% (n = 1)	0
Mild intellectual developmental Disorder	10.7% (n = 6)	2.0% (n = 1)
Moderate intellectual developmental disorder	3.6% (n = 2)	2.0% (n = 1)
Investigations (Done at Follow-up)
Routine (hemogram, liver function tests, renal function tests, thyroid function tests)	82.1% (n = 46)	46.9% (n = 23)
Autoimmune profile	8.9 (n = 5)	0% (n = 0)
CT scan/MRI	26.8 (n = 15)	2.0% (n = 1)
Electroencephalogram (EEG)	16.1% (n = 9)	2.0% (n = 1)
Psychometry advised	39.3% (n = 22)	22.4% (n = 11)
Medication
Antipsychotics	32.1% (n = 18)	22.4% (n = 11)
SSRI	19.6% (n = 11)	14.3% (n = 7)
Mood stabilizers	10.7% (n = 6)	12.2% (n = 6)
Combination	14.3% (n = 8)	16.3% (n = 8)
First follow-up (T2): olanzapine (n = 16, mean dose 10 mg, SD-5.01) > risperidone (n = 14, mean dose 3 mg) > clonazepam (n = 12, mean dose 0.45 mg) Second follow-up (T3): olanzapine (n = 11, mean dose 10.22 mg) > risperidone (n = 10, mean dose 2.8 mg)
Psychotherapy
Cognitive behavior therapy	7.1% (n = 4)	14.3% (n = 7)
Supportive therapy	87.5% (n = 49)	85.7% (n = 42)
Parent management training	33.9% (n = 19)	30.6% (n = 15)
Family therapy	12.5% (n = 7)	14.3% (n = 7)
Parent-mediated interventions	17.9% (n = 10)	16.3% (n = 8)
Referral
Neurology	17.9% (n = 10)	6.1% (n = 3)
Pediatrics	7.1% (n = 4)	4.1% (n=2)
Speech pathology and audiology	3.6% (n = 2)	0
Outcome measures
Mean CGI-improvement score	2.14	2.10
Mean CGAS score	69	73.5

CGAS: Children’s Global Assessment Severity, CGI: Clinical Global Impression, CT: Computed tomography, MRI: Magnetic resonance imaging, SD: Standard deviation, SSRI: Selective serotonin reuptake inhibitors.

Short-term Outcome

At the first follow-up, it was noted that over 40% (n = 22) of the children and adolescents presenting to psychiatric emergency services required inpatient admission, underscoring the severity of their conditions. Additionally, suicidality was observed in 14.3% of the follow-up cases (n = 8). The mean CGI score decreased from 4.69 (SD: 0.769) at baseline to 2.55 (SD: 0.738) at the first follow-up and further to 2.22 (SD: 0.941) at the second follow-up, indicating improvement in clinical severity of the illness. The mean CGAS scores increased from (38.14) 39.8 (SD: 9.463) at baseline to 69.18 (SD: 10.770) at the first follow-up and further to 73.57 (SD: 16.170) at the second follow-up. Shapiro–Wilk test indicated that CGI and CGAS scores did not follow a normal distribution (Table 2). Friedman test analysis was done. It showed a significant change in CGI scores (P = .000) and CGAS scores (P = .000) from baseline to the last visit, indicating substantial improvement. Figure 2 illustrates the changes in CGI and CGAS scores over time, using line diagrams to represent the trajectory of clinical improvement across follow-up visits.

Table 2.

Shapiro–Wilk Test Results Indicating Non-normal Distribution of CGI and CGAS Scores.

Test of Normality
	Statistic	df	Sig.
CGI score	0.882	8	0.197
CGAS score	0.748	8	0.008
F1 CGI	0.732	8	0.005
F1 CGAS	0.835	8	0.067
F2 CGI	0.724	8	0.004
F2 CGAS	0.882	8	0.197

CGAS: Children’s Global Assessment Severity, CGI: Clinical Global Impression, F1: Follow-up 1, F2: Follow-up 2.

Figure 2.

CGAS – Children’s Global Assessment Severity, CGI – Clinical Global Impression.

Analysis of clinical improvement of BPAD v/s conversion disorder/ FNSD:

The Shapiro–Wilk test for normality indicated that the sample did not follow a normal distribution. Therefore, the effect of individual disorders on CGI/CGAS was analyzed by comparing the mean change from baseline. In children and adolescents with BPAD, median CGI scores decreased from 5 to 2.5, and CGAS scores increased from 30 to 65. In conversion disorder/FNSD, CGI scores dropped from 4 to 1, and CGAS scores rose from 50 to 90. Symptom severity reduction was slightly higher in conversion disorder/FNSD 56% versus 52% for BPAD. However, functional improvement was more remarkable in BPAD, with a 117% increase in CGAS scores compared to 64% for conversion disorder/FNSD. These results suggest differential symptom and functional recovery patterns across the two disorders. The Friedman test demonstrated statistical significance for all findings (P < .001), as presented in Table 3.

Table 3.

Friedman Test Results Showing Statistical Significance: Conversion Disorder Versus Functional Neurological Symptom Disorder (FNSD).

	Arm	Baseline (T1)	Follow-up 1 (T2)	Follow-up 2 (T3)	Average Percentage Change (%)	Chi-square	df	P Value
CGI	BPAD	5 (6–5)	3 (3–2)	2.5 (3–2)	52.36	20.762	2	<.001
CGI	Conversion disorder /FNSD	4 (4–4)	2 (2–2)	1 (3–1)	56.51	18.474	2	<.001
CGAS	BPAD	30 (40–30)	70 (70–60)	65 (87–60)	117.70	18.660	2	<.001
CGAS	Conversion /FNSD	50 (50–50)	80 (80–70)	90 (95–60)	64.54	17.610	2	<.001

BPAD: Bipolar affective disorder, CGAS: Children’s Global Assessment Severity, CGI: Clinical Global Impression.

Discussion

The clinical prevalence of child and adolescent psychiatric emergencies at our center was 2.1% of all psychiatric emergencies, which is notably lower than the 16.7% reported by Sen et al. at another tertiary care center.⁶ Our pediatric psychiatry emergency services are integrated within a broader network, including daily outpatient child and adolescent psychiatric clinics. This network likely diverts many cases to outpatient settings, reducing the need for emergency-level interventions and potentially preventing crises from escalating to emergency care. Our study found that the mean age of children presenting to pediatric psychiatry emergency services was 14 years, which aligns with studies showing that children aged 12–15 years are the most common age group.^4,19–21 While literature reports a male preponderance of 40%–55%,^4,13,14,21 over 60% of our cases involved boys, possibly reflecting referral bias. Most participants were Hindu (82.6%; n = 194), reflecting local demographics, and 80% (n = 188) were above the poverty line, though socioeconomic status was assessed using simplified criteria due to time constraints. In most cases (91.9%; n = 116), parents were the primary informants, indicating caregivers usually accompanied children.

Mattsson et al. reported that over a quarter of emergency consultations occurred between 8 PM and 8 AM.¹⁵ In contrast, most visits in our study occurred between 1 PM and 6 PM, likely due to registrations for outpatient services closing by 1 PM, redirecting patients to emergency care. Suicidality (20%–45%) and disorganized behaviors are common in psychiatric emergencies,^{13–16,21–26} but BPAD and conversion/FNSD were the most frequent in our study. This partially aligns with Singh et al.,⁵ who reported 27% of dissociative disorders, reflecting sociocultural factors in the Indian context.²⁷ The department’s close collaboration with neurology services results in frequent referrals for dissociative disorder presentations, such as seizure-like episodes, unconsciousness, or paralysis, after ruling out neurological conditions. Children and adolescents with suicidal ideation or aborted attempts are typically brought to the regular child and adolescent psychiatry OPD. Those with suicide attempts are referred to our OPD for further psychiatric care and follow-up after stabilization and resolution of the acute medical crisis in general hospital settings. Additionally, cases involving aggression or suicidality may have been categorized under bipolar disorder, as our focus was on diagnostic categories rather than specific symptoms.

The primary management of pediatric psychiatric emergencies involves de-escalation techniques aimed at reducing aggression and agitation^26,28–30 alongside pharmacological treatment that plays a crucial role in stabilizing the patient.^28,30 These approaches highlight the importance of a comprehensive strategy combining nonpharmacological interventions with appropriate medication to address acute psychiatric crises effectively. Pharmacological management commonly includes antipsychotics/neuroleptics, anxiolytics,^28,31 and benzodiazepines.²⁸ In our study, benzodiazepines were the most frequently administered medications in emergency services, followed by antipsychotics. Psychoeducation, crisis intervention, and supportive counseling were tailored to meet patients’ needs and clinical conditions. This pattern reflects the need to manage acute agitation and anxiety effectively, consistent with established practices in psychiatric emergency care.

At the first follow-up, over 40% of participants required inpatient care, consistent with Christodulu et al.’s findings that 45% of pediatric psychiatric emergencies necessitate hospitalization.⁴ Admission decisions are influenced by factors such as bipolar spectrum diagnoses,³² symptom severity, prior hospitalizations, family disruptions, or law enforcement referrals. Higher suicide risk, female gender, and family psychiatric history also significantly increase admission likelihood.^33,34 The mean CGI score significantly decreased, while CGAS scores increased from baseline to the second follow-up (P < .001 for both), reflecting improved clinical severity and functioning. These improvements likely stem from effective crisis intervention and pharmacological strategies known to reduce acute symptoms and improve overall functioning.^26,30 Notably, 86% of children received psychotherapy at the second follow-up, with 26.8% (n = 15) undergoing parent-management training and 12.5% (n = 7) family therapy. Evidence supports that combining medication with psychotherapy enhances outcomes in pediatric psychiatric care.^35,36

Strengths and Limitations

Our study, with 235 children and adolescents seeking emergency psychiatric care, is the first prospective study in India. Using a follow-up design at three weeks and three months, it offers real-world insights into patient outcomes. Unlike previous studies, we focused on clinical diagnoses and management strategies, employing systematic random sampling, standard diagnostic criteria, and valid tools such as CGI and CGAS for assessments. Notably, there was 0% attrition between T1 and T2, indicating strong initial retention. However, a 12.5% dropout rate (n = 7) occurred between T2 and T3, which, along with the modest sample size, may limit the generalizability of the findings. Including participants with multiple comorbidities is a strength of the study, though their specific impact on clinical outcomes was not analyzed, representing a limitation. Limitations include a shorter follow-up duration of three months, absence of severity assessment using disorder-specific scales, lack of a control group, and potential bias due to unblinded assessments and systematic random sampling.

Future research should address these limitations to enhance generalizability. Longer-term longitudinal studies can evaluate the sustained impact of interventions and identify predictors of relapse or sustained recovery. Additionally, research should focus on personalized treatment plans that consider cultural and environmental factors to optimize outcomes for children in diverse settings.

Conclusions

Our study highlights the critical role of integrated pharmacological and nonpharmacological strategies in managing pediatric psychiatric emergencies, as evidenced by the frequent use of benzodiazepines and antipsychotics alongside psychosocial interventions. The significant improvement in CGI and CGAS scores across follow-ups underscores the effectiveness of crisis intervention and pharmacotherapy in stabilizing symptoms and enhancing functioning. The more remarkable functional recovery observed in BPAD emphasizes the need for diagnosis-specific, tailored interventions to address variability in recovery patterns. These findings underscore the importance of implementing integrated care models in clinical practice to improve outcomes for children and adolescents in acute psychiatric crises. Future research, with larger sample sizes and controlled study designs, is essential to validate these findings and enhance their generalizability.

Supplemental Material

Supplemental material for this article available online.

Footnotes

Acknowledgements

We are grateful to all the children and their families who consented to participate in this study.

Consent for Publication

The assent and consent obtained from participants and their parents/carers, respectively, included consent for publication of their data within written reports.

Data Availability Statement

The data supporting the findings of this study are easily available from the corresponding author, upon reasonable request.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest to the research, authorship, and/or publication of this article.

Declaration Regarding the Use of Generative AI

None used.

Ethics Committee Approval

Approval to conduct the study was obtained from the Institutional Ethics Committee of the National Institute of Mental Health and Neurosciences (NIMHANS). NO. NIMH/DO/IEC GEH. Sc. DI0/2019. The children and their parents were provided with written and verbal explanations of the purpose and procedures of the study. Written informed assent and consent were taken from all the participants and their parents, respectively. Anonymity and confidentiality were maintained.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article. It was carried out as a nonfunded research project.

Prior Presentations

Nil.

Simultaneous Submission to Another Journal or Resource

We confirm that this manuscript has not been published elsewhere and is not under consideration by another journal.

References

Rosenn

. Psychiatric emergencies in children and adolescents. In Bassuk

and Birk

(eds) Emergency psychiatry: Concepts, methods, and practices. Springer US, 1984, pp. 303–350. doi: 10.1007/978-1-4684-4751-4_18.

Lee

, Herrin

, Bobo

, . Predictors of return visits among insured emergency department mental health and substance abuse patients, 2005–2013. West J Emerg Med, 2017; 18(5): 884–893. doi: 10.5811/westjem.2017.6.33850.

Weissberg

. Emergency psychiatry: A critical educational omission. Ann Int Med, 1991; 114(3): 246–247. doi: 10.7326/0003-4819-114-3-246.

Christodulu

, Lichenstein

, Weist

, . Psychiatric emergencies in children. Pediatr Emerg Care, 2002; 18(4): 268–270. doi: 10.1097/00006565-200208000-00009.

Singh

, Kumar

and Deep

Pediatric psychiatric emergencies at a tertiary care center in India. Indian Pediatr, 2020; 57(12): 1124–1126. Epub June 12, 2020. PMID: 32533684.

Sen

, Deep

, Chawla

, . Pattern of psychiatric emergencies in children and adolescents at a tertiary care centre after onset of COVID-19 pandemic. Indian Pediatr, 2023; 60: 127–132. doi: 10.1007/s13312-023-2810-1.

Böcker

. The psychiatric emergency in general practice. Fortschritte Der Medizin, 1978; 96(21): 117–120.

Benyamina

. Psychiatric emergencies in drug addiction. La Revue Du Praticien, 2003; 53(11): 1201–1208.

Sudarsanan

, Chaudhury

, Pawar

, . Psychiatric emergencies. Med J Armed Forces India, 2004; 60: 59–62. doi: 10.1016/S0377-1237(04)80162-X.

10.

Tucci

, Moukaddam

, Alam

, . Emergency department medical clearance of patients with psychiatric or behavioral emergencies, Part 1. Psychiatr Clin North Am, 2017; 40(3): 411–423. doi: 10.1016/j.psc.2017.04.001. PMID: 28800798.

11.

Testa

, Giannuzzi

, Sollazzo

, . Psychiatric emergencies (Part I): Psychiatric disorders causing organic symptoms. Eur Rev Med Pharmacol Sci, 2013; 17(Suppl 1): 55–64.

12.

Wheat

, Dschida

and Talen

. Psychiatric emergencies. Prim Care, 2016; 43(2): 341–354. doi: 10.1016/j.pop.2016.01.009.

13.

Garralda

. Child psychiatric emergencies: A research note. J Child Psychol Psychiatry, 1983; 24(2): 261–267. doi: 10.1111/j.1469-7610.1983.tb00574.x.

14.

Pikard

, Roberts

and Groll

Pediatric referrals for urgent psychiatric consultation: Clinical characteristics, diagnoses and outcome of 4- to 12-year-old Children. J Can Acad Child Adolesc Psychiatry, 2018; 27(4): 245–251.

15.

Mattsson

, Hawkins

and Seese

. Child psychiatric emergencies. Clinical characteristics and follow-up results. Arch Gen Psychiatry, 1967; 17(5): 584–592. doi: 10.1001/archpsyc.1967.01730290072009.

16.

Seemon

. Understanding the poverty line in India. https://rangde.in/blog/understanding-the-poverty-line-in-india (2024, accessed 25 March 2025 )

17.

Shaffer

, Gould

, Brasic

, . A children’s global assessment scale (CGAS). Arch Gen Psychiatry, 1983; 40(11): 1228–1231.

18.

Busner

and Targum

. The clinical global impressions scale: Applying a research tool in clinical practice. Psychiatry, 2007; 4(7): 28–37.

19.

Falsafi

. Pediatric psychiatric emergencies. J Child Adolesc Psychiatr Nurs, 2001; 14(2): 81–88. doi: 10.1111/j.1744-6171.2001.tb00296.x.

20.

Giret

, Sibertin-Blanc

, Sender

, . L’urgence existe-t-elle en psychiatrie de l’enfant et de l’adolescent? Do psychiatric emergencies exist in children and adolescents?. Sem Hop, 1982; 58(42): 2477–2480. French. PMID: 6297038.

21.

Sheridan

, Spiro

, Fu

, . Mental health utilization in a pediatric emergency department. Pediatr Emerg Care, 2015; 31(8): 555–559. doi: 10.1097/PEC.0000000000000343.

22.

Starling

, Bridgland

and Rose

Psychiatric emergencies in children and adolescents: an emergency department audit. Australas Psychiatry, 2006; 14(4): 403–407. doi: 10.1080/j.1440-1665.2006.02313.x.

23.

Scivoletto

, Boarati

and Turkiewicz

Psychiatric emergencies in childhood and adolescence. Braz J Psychiatry, 2010; 32(Suppl 2): S112–S120 doi: 10.1590/S1516-44462010000600008.

24.

Carubia

, Becker

and Levine

. Child psychiatric emergencies: Updates on trends, clinical care, and practice challenges. Curr Psychiatry Rep, 2016; 18: 41. doi: 10.1007/s11920-016-0670-9.

25.

Hiscock

, Neely

, Lei

, . Paediatric mental and physical health presentations to emergency departments, Victoria, 2008–2015. Med J Aust, 2018; 208(8): 343–348. doi: 10.5694/mja17.00434.

26.

Feuer

, Rocker

, Saggu

, . Best practices in managing child and adolescent behavioral health emergencies. Pediatr Emerg Med Pract, 2018; 15(1): 1–28. PMID: 29261480.

27.

Moyon

, Thomas

and Girimaji

. Subjective experiences of dissociative and conversion disorders among adolescents in India. Int J Soc Psychiatry, 2022; 68(7): 1507–1515. doi: 10.1177/00207640211036178.

28.

Extein

. Psychopharmacology in psychiatric emergencies. Int J Psychiatry Med, 1981; 10(3): 189–204. doi: 10.2190/83PE-KC25-5BE7-8LWJ Irl Extein.

29.

Mavrogiorgou

, Brüne

and Juckel

The management of psychiatric emergencies. Dtsch Arztebl Int, 2011; 108(13): 222–230. doi: 10.3238/arztebl.2011.0222.

30.

Gerson

, Malas

and Mroczkowski

. Crisis in the emergency department: The evaluation and management of acute agitation in children and adolescents. Child Adolesc Psychiatr Clin N Am, 2018; 27(3): 367–386. doi: 10.1016/j.chc.2018.02.002.

31.

Wilhelm

, Schacht

and Wagner

Use of antipsychotics and benzodiazepines in patients with psychiatric emergencies: Results of an observational trial. BMC Psychiatry, 2008; 8: 61. doi: 10.1186/1471-244X-8-61.

32.

Mendenhall

, Demeter

, Findling

, . Mental health service use by children with serious emotional and behavioral disturbance: Results from the LAMS study. Psychiatr Serv, 2011; 62(6): 650–658. doi: 10.1176/ps.62.6.pss6206_0650.

33.

, Wierdsma

, Kasius

, . Predictors of voluntary and compulsory admissions after psychiatric emergency consultation in youth. Eur Child Adolesc Psychiatry, 2021; 30(5): 747–756. doi: 10.1007/s00787-020-01558-9.

34.

Stewart

, Semovski

and Lapshina

Adolescent inpatient mental health admissions: an exploration of interpersonal poly victimization, family dysfunction, self-harm, and suicidal behaviors. Child Psychiatry Hum Dev, 2024; 55(4): 963–974. doi: 10.1007/s10578-022-01450-4.

35.

Bennett

, Shafran

, Coughtrey

, . Psychological interventions for mental health disorders in children with chronic physical illness: A systematic review. Arch Dis Child, 2015; 100(4): 308–316. doi: 10.1136/archdischild-2014-307474.

36.

Reeves

and Anthony

Multimodal treatments versus pharmacotherapy alone in children with psychiatric disorders: Implications of access, effectiveness, and contextual treatment. Pediatric Drugs, 2009; 11(3): 165–169. doi: 10.2165/00148581-200911030-00002.

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