Child Psychiatric Practice Research Articles

Precision Psychiatry Implementation in Child and Adolescent Psychiatric Clinical Practice: Opportunities and Challenges

Precision psychiatry is becoming a realistic ambition for clinical practice. Modern data gathering and data analysis tools create great opportunities for prediction of outcomes, decreased trial and error in selecting treatments, and improved understanding of complex mechanisms leading to more effective treatments. Some current challenges to implementation of these approaches are highlighted in this article. These include the limitations related to characteristics of the statistical methods used for precision medicine, standardization and clinical implementation of the various behavioral research paradigms in use, and the process of defining new outcome measures. Some clinical experiences and possible ways forward are also discussed, including patient and clinician interest in objective measures to complement current clinical assessments, sensitivity to existing workflows, a focus on defining new clinical categories rather than attempting to predict DSM diagnosis, and the use of alternative measures as meaningful outcome measures themselves. [ Psychiatr Ann . 2024;54(4):e108-e112.]

Coping Mechanisms of Psychiatric Nurses in Child Mental Health Environments in North West Province, South Africa: A Qualitative Call for Urgency.

There is currently a growing understanding of child mental health. However, with little attention and investment from decision-makers, the prevalence of child mental health challenges shows no signs of diminishing. Psychiatric nursing is a process in which the major knowledge and skills dealing with the interpersonal and intrapersonal dynamics of human beings are practised. These nurses have to cope with this demand in a scant clinical child psychiatric environment. An exploratory, descriptive, and contextual research design was used to postulate the coping mechanism of these nurses in a clinical child psychiatric environment. This study comprised psychiatric nurses, and data were collected through focused group interviews. The findings emphasised the importance of clinical support to enhance quality nursing care and adjustment related to the demands on psychiatric nurses to participate fully in the service. Conclusion: Child and mental health services ought to enable nurses to better deal with the service demands and quality of psychiatric health care. An increased understanding of child mental health challenges is needed so that nurses' roles and functions in child psychiatric practice can be defined. Effective management and support ought to enable psychiatric nurses and health care teams to make decisions that support international development targets.

Telemedicine consultation «patient-doctor» in child psychiatry: methodology and practice

Telepsychiatric assistance in the “doctor-patient” format is at the stage of formation and requires the solution of legal, organizational and methodological issues. The aim of the study was to substantiate the methodology of telemedicine consultations of patients (legal representatives) in child psychiatry. Material and methods. The analysis of the results of 1129 telemedicine consultations (TMK) in the «patient-doctor» format for 559 patients aged 2 to 18 years was carried out. Results. Remote consultations have been tested for the entire spectrum of mental disorders in childhood and adolescence. During the primary patient-doctor TMK, a number of serious regulatory and technical limitations were identified. Repeated TMK «patient — doctor» in child psychiatric practice are defined as the most optimal and safe. There was a significant increase in the number of repeated TMKs and the expansion of the specialties of consultants during the period of restrictive measures in connection with the COVID-19 pandemic. The assessment of the effectiveness of TMK was carried out by means of a sociological survey (questionnaire) of doctors and patients (legal representatives). Conclusion. A methodology has been developed for organizing and conducting telemedicine consultations for patients under the age of 18 (legal representatives) in the field of psychiatry. A survey of beneficiaries recorded their high readiness and satisfaction with remote counseling. A survey of medical workers revealed a positive trend in attitudes towards carrying out TMK. The negative dynamics of the opinions of specialists in connection with the increase in the level of workload indicates the need for further organizational, methodological and educational work on the use of telemedicine technologies.

Clinical and psychological approaches to the diagnosis of children with autism spectrum disorders

IntroductionThe importance of clinical diagnosis of autism spectrum disorders (ASD) in childhood is due to the timely detection of ASD and the appropriate early start of patient care, depending on the form of ASD. The experience of multidisciplinary collaboration between medical psychologists and clinicians in child psychiatric practice allows us to more accurately determine the depth and severity of autistic manifestations, determine the dynamics of child development, and provide personalized effective care.ObjectivesDevelop diagnostic, clinical and psychological approaches to the diagnosis of ASD.MethodsClinical-psychopathological, clinical-dynamic, clinical-catamnestic, and psychological methods were used. 254 patients aged 4-17 years (average – 7.3 years) with different forms of ASD were examined.Results From the clinical and pathopsychological positions, profiles of six main forms of ASD are identified. Each of the selected profiles corresponds to a specific type of cognitive dysontogenezis. A distorted view of cognitive dysontogenezis in Asperger’s syndrome (F84. 5) and childhood autism dysontogenetic (F84.0). Distorted or deficient types of cognitive dysontogenezis in children’s psychosis (F84. 02). Deficient type of cognitive dysontogenezis in Kanner syndrome (F84. 01). Defecating type of cognitive dysontogenezis in atypical autism syndromal (F84. 11), deficient and regressive-defecating types of cognitive dysontogenezis in atypical child psychosis (F84.12).ConclusionsA three-dimensional model is obtained that allows the most accurate diagnosis of various forms of ASD and the development of personalized routes for patient care and rehabilitation, taking into account the type of cognitive dysontogenezis and based on the zone of the child’s immediate development.

Diagnostic, Clinical, Psychopathological, Psychological Aspects of the Examination of Children with Autism Spectrum Disorders

Objective: recently, much attention has been paid to the problem of autism spectrum disorders (ASD) in childhood. Despite the abundance of psychometric approaches to the diagnosis of autism in childhood, questions remain about the validity of their use in everyday practice. In recent years, works began to appear in the United States calling into question the practice of mandatory use of the “gold standard” methods for diagnosing ASD. Russia has many years of experience in multidisciplinary cooperation of medical psychologists and clinicians in child psychiatric practice, which makes it possible to more accurately determine the depth and severity of autistic manifestations, as well as to determine the dynamics of a child’s development, which will make it possible to provide targeted effective assistance. Aim: to develop diagnostic, clinical-psychopathological, psychological approaches to the diagnosis of autism spectrum disorders in childhood.Patients and methods: the sample consists of 254 patients aged 4–17 years (average age 7.3 years) with different forms of ASD according to ICD-10 (heading F84). The patients were examined by clinical-psychopathological, clinical-dynamic, clinical-follow-up, psychological methods.Results: the study made it possible to define the profiles of six main forms of ASD from a clinical and psychological standpoint: Asperger’s syndrome (F84.5); childhood autism dysontogenetic (F84.0); childhood psychosis (F84.02); Kanner’s syndrome (F84.01), syndromic atypical autism (F84.11),and atypical childhood psychosis (F84.12).Conclusion: the results obtained are presented in a multidisciplinary aspect, which allows the most accurately diagnose one form or another of autism spectrum disorders and to develop personalized routes of patient management.

State and prospects of legal regulation of telemedicine consultation in the patient-specialist format in children's psychiatric practice

Remote interaction of medical workers with patients and (or) their legal representatives (the patient-doctor model) contains a large number of unresolved organizational and legal issues. Analysis of the peculiarities of the organization and legal regulation of telemedicine counseling in child psychiatric practice and the development of recommendations for improving the legal and regulatory framework for remote interaction in the patient-specialist format. The article analyzes the legal and regulatory requirements governing the use of telemedicine technologies in the process of providing psychiatric care. The material for the analysis was the experience of 1129 telemedicine consultations (TMC) in the patient-doctor model in the period from December 2019 to July 2020. Proposals have been formulated to improve the regulatory framework for TMC in psychiatric practice: consideration of the possibility of remote psychiatric examination within the framework of primary TMC; conducting remote medical commissions; elimination of conflicting regulatory requirements governing primary TMC. Conducting repeated TMC seems to be optimal as an effective tool for improving the quality and availability of medical care.

Sex, Sexuality and Gender-Related Issues in Child Psychiatric Practice: A Review

In child and adolescent psychiatric practice, it is important for a clinician to be aware of contexts in which children are brought with concerns related to sexual behaviors. Johnson described a continuum of natural and healthy behaviors to sexually aggressive behaviors. Sexual development begins in fetal life and continues through infancy, childhood, and adolescence along characteristic pathways. Typically, developing children exhibit a wide range of sexual behaviors. Children and adolescents may display increased or deviant sexual behavior as a result of certain stressors, traumatic experiences, or psychiatric illnesses. This has been emerging as an important clinical issue over the past few years. It is important to distinguish between normal behaviors and disordered behaviors before planning any intervention. This article summarizes the sexuality- and gender-related issues that are encountered in child and adolescent psychiatric practice.

Clinicians\u2019 attitudes toward standardized assessment and diagnosis within child and adolescent psychiatry

BackgroundThere is a strong call for clinically useful standardized assessment tools in everyday child and adolescent psychiatric practice. The attitudes of clinicians have been raised as a key-facilitating factor when implementing new methods. An explorative study was conducted aimed to investigate the clinicians’ attitudes regarding standardized assessments and usefulness of diagnoses in treatment planning.Methods411 mental health service personnel working with outpatient and inpatient assessment and treatment within the specialist child and adolescent mental health services, Stockholm County Council were asked to participate in the study, of which 345 (84%) agreed answer a questionnaire. The questionnaire included questions regarding Attitudes toward Standardized Assessment and Utility of Diagnosis. Descriptive analyses were performed and four subscales were compared with information from a similar study in US using the same instruments. The demographic and professional characteristics (age, working years, gender, education, profession, management position, involvement in assessment, level of service) in terms of prediction of attitudes were studied by univariate and multivariate linear regressions.ResultsOverall, the clinicians had quite positive attitudes and were more positive compared to a similar study conducted in the US earlier. There were differences in attitudes due to several characteristics but the only characteristic predicting all subscales was type of profession (counselor, nurse, psychiatrist, psychologist, other), with counselors being less positive than other groups.ConclusionThe overall positive attitudes toward standard assessment are of importance in the development of evidence-based practice and our study implies that clinicians in general value and are willing to use standardized assessment. Nevertheless, there are specific issues such as adequate training and available translated assessment instrument that need to be addressed. When implementing new methods in practice, there are general as well as specific resistances that need to be overcome. Studies in different cultural settings are of importance to further extend the knowledge of what is general and what is specific barriers.

Developmental Considerations in Substance Use Disorders: From Pregnancy to Puberty and Beyond

The implementation of developmentally informed clinical interventions for individuals and families struggling with substance use disorders (SUDs) is essential in child and adolescent psychiatric practice.

Visual hallucination induced by duloxetine use: a male case diagnosed with generalized anxiety disorder

Duloxetine is a serotonin-noradrenaline reuptake inhibitor. It has been increasingly used in child and adolescent psychiatric practice in recent years. In this paper, we presented a 16-year-old mal...

Prescribing Trends of Atypical Antipsychotic Drugs in an Outpatient Unit of a Child and Adolescent Clinic in Turkey.

Use of antipsychotic agents in the management of various psychopathologies in Child and Adolescent Psychiatric practice is gradually increasing. This study aimed to evaluate the sociodemographic and clinical features of children and adolescents who applied to an outpatient clinic of child and adolescent psychiatry department in Turkey and were prescribed atypical antipsychotics. Patients with prescription codes of ATC N05A (except N05AN lithium) were accepted to denote those with atypical antipsychotic treatment. Sociodemographic and clinical variables, pharmacological mechanisms and groups and use of multiple agents for 212 patients with atypical antipsychotic treatment were collected and recorded. Patients (6.6%) evaluated within a year were prescribed antipsychotic agents (APs). The majority of the sample consisted of adolescents and especially females. The most common diagnoses managed with atypical antipsychotic were attention-deficit/hyperactivity disorder, MDD, and mental retardation/intellectual disability in decreasing frequency. Males with attention-deficit/hyperactivity disorder, CD, and autism spectrum disorders and females with MDD and PTSD were more frequently prescribed APs. Most common indications were irritability, impulsivity, and self-harming behaviors. Most common agents were risperidone, aripiprazole, and quetiapine in decreasing order of frequency. Most common adverse effects were reported as sedation, increased appetite, and hyperprolactinemia. Our results support the prevalence of off-label use of AP agents in managing various childhood psychopathologies also in Turkey. Further studies from multiple centers and using reliable and valid measurements are needed to determine the extent and predictors of AP use in outpatient samples from different child and adolescent centers.

Here/In This Issue and There/Abstract Thinking: The First Year: Incorporating Maternal Mental Health Into Child Psychiatric Practice

Here/In This Issue and There/Abstract Thinking: The First Year: Incorporating Maternal Mental Health Into Child Psychiatric Practice

Prescribing pattern of psychotropic medications in child psychiatric practice in a mental referral hospital in Botswana.

IntroductionThere is a growing preference for psycho-pharmacological therapy over non-pharmacological care. The prescription pattern and the choice of psychotropic medications vary in different settings. Whilst newer agents and rational prescribing are favored in the more specialized settings, the pattern remains unclear in less specialized units, largely due to lack of data. The aims were to conduct a treatment audit in the only mental referral hospital in Botswana, which is a non-specialized child and adolescent care setting and see how it conforms to best practice.MethodsA retrospective audit which involved the extraction of socio-demographic and clinical information from the records of patients who were ≤ 17 years and seen from January 1, 2012-July 31, 2016.ResultsA total of 238 files were used for this report. Mean age (SD) was 12.41 (4.1) years. Of the 120 (50.4%) patients who had pharmacological intervention, only 85(70.8%) had monotherapy. The most commonly prescribed psychotropic agents were antipsychotics (40%). Off-label use of antipsychotics and polypharmacy were 31.2% and 29.2% respectively.ConclusionThe level of conformity to standard practice in terms of psychotropic prescribing in our setting is consistent with the reports from developed countries where more specialized care ostensibly exists. Further studies will be necessary to determine the scope of psychotropic use.

Transformational Impact of Health Information Technology on the Clinical Practice of Child and Adolescent Psychiatry.

Compared with other medical specialties, psychiatrists have been slower adopters of health information technology (IT) practices, such as electronic health records (EHRs). This delay in implementation could compromise patient safety and impede integration into accountable care organizations and multidisciplinary treatment settings. This article focuses on optimizing use of EHRs for clinical practice, leveraging health IT to improve quality of care, and focusing on the potential for future growth in health IT in child and adolescent psychiatric practice. Aligning with other medical fields and focusing on transparency of mental health treatment will help psychiatrists reach parity with other medical specialties.

Visualiser l’esprit de l’enfant : une généalogie de l’image en pédopsychiatrie

Over the last forty years, video has become an almost ubiquitous tool in child psychiatric practice. The increasing presence of moving images poses difficult questions from a philosophical and historical perspective: how do we know what happens in the mind of the child? This paper addresses the question in inquiring into the historical conditions of possibility for the emergence of video as a method for generating child psychiatric knowledge. It proposes a genealogy of moving images that draws on both the history of science and film history. The article sets out with a discussion of the work of the French neurologist Guillaume-Benjamin Duchenne de Boulogne (1806–1875) as a first historical example for an interest in employing chrono-photographic means for the electro-physiological study of emotions in children. I suggest that Duchenne's work points to an ambiguous position of the child in the late nineteenth century, constituting a figure of both identification and alterity. I then show how Charles Darwin's study of infants re-situates the child in an evolutionary perspective, now taking a pivotal position for the anthropological understanding of the human condition. Darwin's work spurred experimentation with babies and infants and led to a cultural preoccupation with theories of recapitulation, as I will illustrate with the research of the British physician Louis Robinson (1857–1928). Part and parcel of this development was an interest in visualizing and recording children in both scientific and popular culture. The chrono-photographic studies of Eadweard Muybridge (1830–1904) and the 1895 film Repas de bébé by the Lumière brothers both testify to this new observational paradigm. I follow the paradigm into the twentieth century with the example of the filmic work of Arnold Gesell (1880–1961) that can be considered a precursor to current practices of video-based microanalysis. Finally, I present the point of view shot and the subjective camera as an alternative, or rather, a supplementary mode of visualization that seeks to understand the child's perspective through sympathetic insight. Films by Kurt Lewin (1890–1947) and recent scientific studies using eye-tracking methods will be set into this tradition. Overall, the paper argues that the crossroads of child studies and moving images at the turn-of-the-century have contributed to the emergence of two visual traditions that, until today, negotiate cultural ideas about the child, and, in this sense, participate in the construction of a fiction about the mind of the child.

OC15 - Leading nursing educational progress in child mental health.

Theme: Nursing education, management and leadership. Given the increasingly complex mental health needs of children and young people and the critical shortage of proficient mental health specialists, a study of US nursing education programs was done. Does the current paediatric nursing workforce preparation best meet the distinct needs of young people with behavioral and mental health challenges is the key question? Experts in the field of child psychiatric nursing practice, education and research came together to find model nursing programs for educational and clinical preparation. This presentation will report an analysis of the content of curricula-preparing psychiatric mental health nurse practitioners, models for adaptation to paediatric nurses' training and recommendations for leadership strategies. Describe existing US nursing education models for child and youth mental health care. Propose strategies for education leadership.

Child Maltreatment Prevention and the Scope of Child and Adolescent Psychiatry.

Child maltreatment is one of the most deleterious known influences on the mental health and development of children. This article briefly reviews a complement of methods that are ready to incorporate into child and adolescent psychiatric practice, by having been validated either with respect to the prevention of child maltreatment or with respect to adverse outcomes associated with maltreatment (and primarily focused on enhancing the caregiving environment); they are feasible for integration into clinical decision making, and most importantly, can be included in the training of the next generation of clinicians.

Troubles développementaux de la coordination (TDC) : perspective clinique et synthèse de l’état des connaissances

BackgroundImpairments in fine motor skills and clumsiness are common in children and adolescents who are referred to child and adolescent psychiatrists. Here, we propose an overview of the current state of knowledge useful to the clinician faced with praxis disorders. MethodDevelopmental dyspraxia now match with developmental coordination disorder (DCD) in DSM-5. We cover the clinical aspects of the disorder, including etiological and pathophysiological views. ResultsFine motor skill examination with occupational therapist and validated testing is the basis of positive diagnosis. Clinical manifestations of DCD are numerous as its etiological and pathophysiological bases. This may be explained by the impact of DCD on early affective development, learning acquisition and social interaction quality in children. The frequency of co-occurring disorders of DCD (such as visual-spatial impairments, attention deficit, depression, school refusal, etc.) argues for the need to apprehend them taking into account the overall functioning of the child and adolescent. This comprehensive approach is crucial in defining the principles of their care management that should include motor skill remediation as well as treatment of all comorbidities. ConclusionDCD is common in child and adolescent psychiatric practice. It is often misdiagnosed because of prominent comorbidities and requires a multidisciplinary approach.

The Complicated Journey of a Family

Questions are presented at “consideration points” that follow a section that gives information about the case. One or more choices may be correct for each question; make your choices on the basis of your clinical knowledge and the history provided. Read all of the options for each question before making any selections. You are given points on a graded scale for the best possible answer(s), and points are deducted for answers that would result in a poor outcome or delay your arriving at the right answer. Answers that have little or no impact receive zero points. At the end of the exercise, you will add up your points to obtain a total score.

AACAP Helps Psychiatrists Address Patients’ Cultural Factors

AACAP Helps Psychiatrists Address Patients’ Cultural Factors