Sexual Health of Adolescents Admitted to A Psychiatric Unit

BACKGROUND: Research suggests an association between certain psychiatric conditions and high-risk adolescent sexual activity. In fact, pregnancy is three times more likely in adolescent girls with major mental health disorders in comparison to those without mental illness. Given a proportion of adolescents with mental health disorders will require admission to the hospital for acute psychiatric concerns, this could serve as a useful time point to screen for risky sexual behaviour in high-risk youth.

OBJECTIVES: Our objective was to review the history screening practices at admission and throughout an inpatient stay for adolescents on an inpatient psychiatry unit and to review any resulting referrals or treatment relating to sexual health.

DESIGN/METHODS: A chart review was conducted which included one hundred randomly selected adolescent patients admitted to an inpa-tient psychiatry unit over a 12 month period (January 2013-December 2013). Measures extracted from charts included demographic information, reason for admission, psychiatric diagnoses, documented sexual health related data and any investigations, co-morbidities, treatment and/or follow up booked related to sexual health. Ethics approval was obtained prior to study onset.

RESULTS: The majority of patients were female (79%) and the mean age of study subjects was 15.24 (SD=1.30). The majority of patients admitted received a discharge diagnosis of a major depressive disorder (57%) and the mean length of stay was 11.14 days (SD=7.75). Of the patients admitted, 85% did not appear to have sexual health questions asked on admission and 61% did not have any documented sexual health questions asked throughout their inpatient admission. 17% of patients had sexual activity information documented and very few patients had any STI screening or pregnancy testing (9 patients and 14 patients, respectively).

CONCLUSION: Adolescents with major mental health disorders may be at increased risk for risky sexual behaviours. We found that sexual health practices were only addressed in a minority of patients during their inpatient psychiatric admission. This interaction with the health care system represents an underutilized opportunity to provide counselling and anticipatory guidance to adolescents regarding their sexual health.

Atlanto-Axial Infection after Acupuncture

A 67-year-old man presented with neck cellulitis following acupuncture for cervical spondylosis. Blood cultures were positive for methicillin-sensitive Staphylococcus aureus. Increased neck pain and bacteraemia prompted MRI, which showed atlanto-axial septic arthritis without signs of infection of the tissues between the superficial cellulitic area and the atlanto-axial joint, thus making direct extension of infection unlikely. It is more likely that haematogenous spread of infection resulted in seeding in the atlanto-axial joint, with the proximity of the arthritis and acupuncture site being coincidental. Acupuncture is a treatment option for some indolent pain conditions. As such, acupuncture services are likely to be more frequently utilised. A history of acupuncture is rarely requested by the admitting doctor and seldom offered voluntarily by the patient, especially where the site of infection due to haematogenous spread is distant from the needling location. Awareness of infectious complications following acupuncture can reduce morbidity through early intervention.

Atlanto-axial infection after acupuncture

A 67-year-old man presented with neck cellulitis following acupuncture for cervical spondylosis. Blood cultures were positive for methicillin-sensitive Staphylococcus aureus. Increased neck pain and bacteraemia prompted MRI, which showed atlanto-axial septic arthritis without signs of infection of the tissues between the superficial cellulitic area and the atlanto-axial joint, thus making direct extension of infection unlikely. It is more likely that haematogenous spread of infection resulted in seeding in the atlanto-axial joint, with the proximity of the arthritis and acupuncture site being coincidental. Acupuncture is a treatment option for some indolent pain conditions. As such, acupuncture services are likely to be more frequently utilised. A history of acupuncture is rarely requested by the admitting doctor and seldom offered voluntarily by the patient, especially where the site of infection due to haematogenous spread is distant from the needling location. Awareness of infectious complications following acupuncture can reduce morbidity through early intervention.