Critical analysis of treatment practice of children with conduct disorders at the Belarusian mental health centre
U. Pikirenia, Y. LapchukIntroduction
Conduct disorders with emotional symptoms (ICD-10 F92.8) are prevalent causes of child and adolescent psychiatric admissions. International guidelines prioritise psychosocial interventions and caution against routine pharmacotherapy. We assessed real-world practices in a national referral centre against national and international recommendations.
Objectives
To evaluate inpatient treatments and discharge recommendations for children with F92.8 and quantify concordance with national (Belarus) and international guidance.
Methods
Retrospective audit of discharge summaries (2019–2023) received from Belarusian National Mental Health Centre of 30 pediatric patients (aged 9–15, 63% female) diagnosed with F92.8 was conducted. Extracted variables: age, sex, length of stay, comorbidity, receipt of psychotherapy, and prescribed medications. Descriptive statistics were calculated. The audit complied with local regulations for analysis of anonymised clinical records.
Results
Thirty patients (63% female), median age 14 years (IQR 9–15), median stay 26 days (IQR 22–35); 63% had recorded comorbidities.
Psychotherapy during admission was documented in 40%; outpatient psychotherapy was recommended in 66.7%.
All patients received medication; the median number of concurrent drugs was 3 (IQR 2–3.75).
Antipsychotics were prescribed in 73.3% of cases, including agents not approved for paediatric use or outside local protocol (e.g., quetiapine 27.3%, olanzapine 4.5%); protocol-listed agents (periciazine 45.5%, chlorprothixene 13.6%) predominated, clozapine was not used.
Antidepressants were prescribed in 33.3%; 70% of these prescriptions (notably fluvoxamine and paroxetine) fell outside national recommendations/labels for this age group.
Antiepileptic drugs were given to 53.3% (oxcarbazepine and valproate), frequently without a relevant comorbidity.
Nootropics and vitamins were prescribed in 53.3% (phenibut 56.3% of nootropic recipients), despite limited evidence of benefit and potential safety concerns. Overall, practice showed high polypharmacy and a shortfall in documented psychosocial care relative to guidance.
Conclusions
Treatment strategies at the Centre exhibited significant deviations from national and international guidelines, notably an excessive reliance on polypharmacy and inadequate psychotherapy implementation.
Service realignment is warranted: routine provision and documentation of family-centred psychosocial interventions should be prioritised; pharmacotherapy, when indicated, should follow age-appropriate labels and guidelines, favour monotherapy, and target comorbidity.
These data may inform quality-improvement initiatives and guideline implementation efforts.
Disclosure of Interest
None Declared