Psychiatry of Transitional Age − An Important Area That Has Not Yet Received Much Attention

Introduction

The period of emerging adulthood is a psychosociological term established since the late 1990s. The transitional phase between adolescence and adulthood is usually defined as ages 16–24 (25). During this time, a key maturation process occurs, which is certainly not linear or simple.

Moreover, the phase of emerging adulthood is being extended in contemporary societies according to international data, and it is not uncommon for people around the age of 30 to still live with their parents. This period is especially challenging for individuals suffering from mental disorders − a significant portion of which arise de novo during this time. Transitional psychiatry is still at its very beginning, mainly due to the separate development of child and adult psychiatry.

Issues in Transitional Psychiatry

Child and adolescent psychiatry developed between the world wars and over time gained international renown. The current issue is not the insufficient care in child and adolescent psychiatry, but the transition to adult psychiatry. In the Czech Republic, child psychiatric care ends at the age of 19, while an adult psychiatrist can take over a patient starting at age 15. This boundary slightly differs in other countries but is generally very similar. The issue of transitional age cannot be bounded by reaching a specific age.

A considerable number of adolescent patients need to transition to adult psychiatry. The transition in services seems to be best ensured for psychotic disorders, unlike neurodevelopmental disorders, neurotic illnesses, and patients with personality disorders. Unfortunately, some young people get “lost” from psychiatric care during the transitional age, with the most vulnerable group being children in foster care and institutional upbringing.

As mentioned, child and adolescent psychiatric services developed separately from adult psychiatry historically. The cornerstone of child and adolescent psychiatry is viewing the patient as part of a family unit, with parents playing an important role in treatment decisions. In contrast, adult psychiatry views the patient more individually and focuses less on family, given the wide scope of this field, which ranges from young adults to gerontopsychiatry.

There is currently no separate field of transitional psychiatry in the Czech Republic; however, it is still at a nascent stage even abroad. The good news is that such services already exist in some countries, such as Australia, Denmark, the United Kingdom, and Ireland, where these new possibilities are being tested, and findings about their specific forms are being gathered.

Key Areas in Transitional Psychiatry

One of the most important areas is establishing a functional transitional psychiatry system, both in outpatient and hospital settings. In the Czech Republic, our knowledge about this process is still limited, and according to available literature, no studies focused on transitional age issues had been conducted until 2021. Currently, the major problem is the transition between psychiatric fields, which is mostly administrative and more of a “handover” rather than an actual “transition.” This should be planned well in advance, involving the patient and their family, and naturally include cooperation between different specializations. Some experts suggest creating a new specialty rather than trying to fix the dysfunctional bridge between two types of services.

Other key areas, according to experts, include training specialists with the potential creation of a new subspecialty in transitional psychiatry and intensifying neurobiological research. Improvement in education is crucial regarding psychiatric disorders, which peak during this period, including addictions, psychotic disorders, self-harming behaviors, and suicidal tendencies.

Experts also highlight the importance of integrating transitional psychiatry into forensic psychiatry due to the high risk of delinquencies and numerous social issues associated with mental disorders. Another integral part is assisting with the transition into adulthood, including integration into the workforce and social life of adults.

Conclusion

Transitional psychiatry represents an underexplored area of mental science. It has only gained more attention in recent years, primarily abroad. Mastering the transition from adolescence to adulthood is a crucial part of treating many mental disorders, many of which arise precisely during this critical period of mental development.

Ideally, the transition from child and adolescent psychiatric care to adult psychiatric care should be a planned process focused on the needs of young adults, ensuring continuity of care, minimizing the negative impact of mental illness on their quality of life, and allowing them to realize their potential to the fullest extent possible.

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Sources:
1. Driessen M., Fegert J. M., Freyberger H. J. et al. Transitionspsychiatrie − eine aktuelle Herausforderung. [Transition psychiatry − a contemporary challenge.] Psychiatrische Praxis 2019; 46 (3): 125−127, doi: 10.1055/a-0860-4844.
2. Fegert J. M., Hauth I., Banaschewski T., Freyberger H. J. Transition from adolescence to adulthood: the challenges to establish "transition psychiatry". European Society for Child and Adolescent Psychiatry, 2016. Available at: www.escap.eu/events/past-escap-congresses/geneva/duplicate-of-madrid-keynote-and-symposiums/transitions-from-adolescence-to-adulthood-key-issue-paper
2. Zagatová V. Transition of patients from care by child and adolescent psychiatrists to care by adult psychiatrists. Czech and Slovak Psychiatry 2021; 117 (3): 122−130.