Diagnostic Trends of Minors in Psychiatric Emergency Care: An Observational Study

• Andrea Jiménez-Mayoral ^[2] ; Dídac Florensa ^[1] ; Vicent Llorca-Bofí ^[3] ; María Irigoyen-Otiñano ^[4]
  1. [1] Universitat de Lleida

     Universitat de Lleida

     Lérida, España

     
  2. [2] Psychiatry Service, Santa Maria University Hospital, 25198 Lleida, Spain; Group of Biological Functionings of Mental Disorders, Institute for Biomedical Research in Lleida (IRB), 25198 Lleida, Spain
  3. [3] Barcelona Clinic Schizophrenia Unit (BCSU), Institute of Biomedical Research August Pi i Sunyer (IDIBAPS), Biomedical Research Networking Center for Mental Health, Carlos III Health Institute (CIBERSAM), 08036 Barcelona, Spain; Department of Medicine, University of Barcelona, 08036 Barcelona, Spain
  4. [4] Psychiatry Service, Santa Maria University Hospital, 25198 Lleida, Spain; Group of Biological Functionings of Mental Disorders, Institute for Biomedical Research in Lleida (IRB), 25198 Lleida, Spain; CIBERSAM Group 10, Center for Biomedical Research in Mental Health Network (CIBERSAM), 28029 Madrid, Spain

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• Localización: Actas españolas de psiquiatría, ISSN 1139-9287, Vol. 54, Nº. 1, 2026, págs. 163-171
• Idioma: inglés
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• Resumen

  • Background: Diagnostic stability in child and adolescent psychiatry is a key indicator of validity and essential for clinical decision-making. Few longitudinal studies have examined diagnostic trajectories after a first emergency psychiatric contact.

    Methods: We conducted a retrospective observational cohort study at Santa Maria University Hospital (Lleida, Spain). A total of 583 patients aged 4–18 years presenting for their first psychiatric emergency visit between 2017 and 2023 were included, with 24-month follow-up. Sociodemographic and clinical data were extracted from Electronic Health Records. Diagnostic transitions were summarized using transition matrices. An exploratory association analysis (Apriori algorithm) identified frequent T1→T2 patterns, reported with confidence and lift. Diagnostic stability was defined as the proportion of patients retaining the same diagnosis at follow-up.

    Results: Median age at baseline 14.9 years (interquartile range [13–16]); 54.55% were female. Schizophrenia/psychosis showed the highest stability (71%), followed by intellectual disability with gender identity disorder (67%). Mood disorders showed moderate stability (~44%), while others such as eating disorders (26%) or conduct disorders (17%) had lower stability. The strongest associations were “no prior diagnosis → eating disorder” (confidence = 1.00; lift = 12.76) and “autism spectrum disorder + attention-deficit/hyperactivity disorder (ADHD) → conduct disorders” (confidence = 0.66; lift = 2.55).

    Conclusions: Diagnostic stability is heterogeneous, with high persistence in schizophrenia/psychosis and low in eating disorders and ADHD. Association analysis identified specific trajectories that may help anticipate clinical evolution. Findings highlight the importance of longitudinal evaluation in early psychiatric care.