High-risk adolescents admitted to acute inpatient psychiatric care: a retrospective clinical analysis of severe externalizing psychopathology and readmission.

Background: Adolescents requiring acute inpatient psychiatric care for severe behavioral and emotional dysregulation represent one of the most clinically vulnerable populations within child and adolescent mental health services. While international studies have documented high rates of psychiatric morbidity among adolescents presenting with externalizing pathology and crisis-related admissions, region-specific data from Central and Eastern Europe remain limited. This study aimed to characterize the clinical mental health profile of high-risk adolescents admitted to acute inpatient psychiatric care and to examine patterns of hospitalization and readmission within this population. Methods: A retrospective cohort study was conducted at a national child and adolescent psychiatric inpatient unit in Hungary. Medical records of adolescents aged 10-19 years admitted between 2009 and 2019 under acute, medically indicated inpatient conditions, including cases involving police or judicial contact, were analyzed. Psychiatric diagnoses were established using standardized assessment tools, including the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-Kid), Child Behavior Checklist (CBCL), Strengths and Difficulties Questionnaire (SDQ), and Piéron Attention Test. Statistical analyses examined diagnostic prevalence, demographic characteristics, and readmission patterns, including Kaplan-Meier survival analysis of time to readmission. Results: The final cohort consisted of 570 high-risk adolescents, predominantly male (72.1%), with a mean age of 15.3 years (SD ± 2.1). Psychiatric morbidity was substantial, with conduct disorder (76.2%) and substance use disorders (78.4%) representing the most prevalent diagnoses. Attention-deficit/hyperactivity disorder (17.6%), oppositional defiant disorder (14.9%), post-traumatic stress disorder (10.1%), and psychotic disorders (3.2%) were also identified. One-quarter of participants experienced multiple hospital admissions. While gender was not significantly associated with readmission intervals, increasing age emerged as a significant predictor of earlier readmission, indicating heightened clinical instability among older adolescents. Conclusions: High-risk adolescents admitted to acute inpatient psychiatric care exhibit an exceptionally high burden of psychiatric disorders, dominated by severe externalizing and substance-related conditions. The findings suggest that acute hospitalization in this population reflects cumulative developmental and psychosocial vulnerability rather than isolated behavioral crises. These results underscore the need for integrated, trauma-informed, and developmentally sensitive psychiatric care pathways, with particular emphasis on early identification, continuity of care, and relapse prevention in clinically unstable adolescents.