Child Psychiatry Fellows Research Articles

Connect Corner: Adventures in Fortnite

As COVID-19 spread rapidly this spring, families throughout the country faced school closures. Suddenly, children have quite a bit of free time. Many children told me they were filling that time with video games, and I even saw this unfolding in my own home, where my husband suggested it was time to invest in more video games to entertain our children. Much to his dismay, I disagreed. I do not enjoy video games and have always felt hesitant to let our children play them. It was easy for me to enumerate the reasons why I was hesitant, but he challenged me to identify potential positives. I realized I knew very little about video games and it was time to remedy that knowledge gap. I decided that the online game Fortnite deserved some attention. To help me along the way I recruited 3 child psychiatrists (2 from Generation X and one baby boomer) and an incoming child and adolescent psychiatry fellow (representing Millennials) to play. Below is the journey that followed.

From the Front Line: Trainees’ Perspective on Providing Care During COVID-19 Pandemic

From the Front Line: Trainees’ Perspective on Providing Care During COVID-19 Pandemic

Serenity in the Midst of a Pandemic: Resident Toolkit for Responding to COVID-19

Back to table of contents Previous article Next article Residents’ ForumFull AccessSerenity in the Midst of a Pandemic: Resident Toolkit for Responding to COVID-19Rana Elmaghraby, M.D.Rana ElmaghrabySearch for more papers by this author, M.D.Published Online:10 Apr 2020https://doi.org/10.1176/appi.pn.2020.4b29AbstractAre you looking forward to reading another piece about COVID-19? Did you expect to be doing your residency training in the midst of a public health crisis? I am guessing that the majority of us would say no to both questions. While residency training is stressful in itself, the pandemic has added a whole new level of stress that we could not have anticipated.These are unprecedented times. You may be on a roller-coaster of emotions, including a sense of instability, confusion, and panic, but these feelings are normal. While we want to help our patients in this pandemic, we may begin to fear that our feelings may impede our ability to learn and care for our patients. We need to recognize how our own distress can impact our feelings of competency and well-being.You are not alone in trying to deal with your reactions. I would like to share with you a toolkit of some of the tips I am using and consider helpful at this time. The goal is to find serenity in the midst of the storm.Acceptance: Start accepting the current situation for what it is. The sooner you accept it, the more ready you will be to problem solve.Resilience: Find a resilient role model who has coped well in tough times and reach out to that person. See what he or she has done to handle tough situations.Communication: Reach out to residents or staff and share your feelings and experiences in regard to the crisis.Connectedness: Stay connected to your friends and family. Find a support network. This is the best time to allow yourself frequent access to social media to stay connected and feel a sense of camaraderie. Social distancing does not mean isolation.Well-being: Utilize methods to manage or reduce your stress, including mindfulness, healthy diet, exercise, and rest.Reaching out to talk about my experiences and staying connected is comforting me and gives me a sense of collegiality and optimism. In fact, a recent poll conducted by APA found that nearly half of the respondents (48%) have anxiety around getting infected with COVID-19, and even more (62%) worry about their loved ones becoming infected. More than half of respondents (59%) feel that COVID-19 has a serious impact on their day-to-day living. While this poll is not specific to psychiatry residents, it highlights the anxiety and disruption caused by the COVID-19 pandemic.As psychiatry residents, we ought to be role models in learning how to self-regulate our emotions and reaching out to our colleagues in nonpsychiatric residency programs to offer them support and a sense of connectedness. My goal in writing this article is to share my experience with other residents who are going through this unprecedented event and to let them know they are not alone. We can and will do this together. In the end, the center of a tornado is quiet, peaceful, and calm. ■Rana Elmaghraby, M.D., is APA’s resident-fellow member trustee and a child and adolescent psychiatry fellow at the Mayo Clinic. ISSUES NewArchived

High Rates of Internalizing and Externalizing Problems among Syrian Refugees Compared to Turkish Children

Objectives: The aims of this study are to determine the prevalence of psychopathologies and the sociodemographic characteristics influencing them among Syrian refugees who have applied to the child and adolescent psychiatry clinic, and to compare them to the cases found within the Turkish population. Methods: This is a cross-sectional study with a sample comprising partly of Syrian refugees who applied to the child and adolescent psychiatry clinic and agreed to participate in the study. Additionally, child and adolescent psychiatric cases of Turkish origin were included. The sample size of the study consisted of 146 patients. The parents of all the participants filled out a personal data form and a parent Strength and Difficulties Questionnaire (SDQ) form for ages 4–18 years in Turkish or Arabic according to their native language. The psychiatric evaluation was performed through psychiatric interviews based on the Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5) conducted by a child and adolescent psychiatry fellow for 60–90 minutes each. Results: The study revealed that emotional and conduct problems were significantly more prevalent among Syrian refugees when compared to the native population (p

THIS WORKSHOP WILL BE IMPROVISED: HOW IMPROVISATIONAL THEATER SKILLS CAN SET YOUR EDUCATIONAL AND CLINICAL POTENTIAL FREE

This is a Workshop for educators, clinicians, residents, child psychiatry fellows, and students to improve their communication and teaching skills through a series of interactive sessions based around the principles of improvisational theater. Within the context of the session, the participants will improve their abilities to: think on their feet; learn to adapt to common mistakes and errors in communication; and improve their abilities to connect in the moment with students, colleagues, and patients.

41.4 DEVELOPING A NOVEL RACE-BASED CURRICULUM FOR CHILD AND ADOLESCENT PSYCHIATRY FELLOWS

Developing appropriate didactic curricula centered around race is critical for training child and adolescent psychiatry fellows to understand and address mental health disparities; however, there are few examples of such formal didactic curricula in the mental health literature.

Psychiatrist Patrice Harris, M.D., M.A., Inaugurated 174th AMA President

Psychiatrist Patrice Harris, M.D., M.A., Inaugurated 174th AMA President

Collaboration, Innovation, and Time: A Shared Journey Through Child Psychiatric Consultation in the School Setting.

About 20% of students in U.S. communities have diagnoses of emotional and behavioral disturbances. Even when mental health services are in place, students and teachers often struggle in the classroom. In this column, the authors describe a partnership with a public school system to provide collaborative, innovative support that also offered a novel training opportunity for child and adolescent psychiatry fellows. Over three years of collaborative work, the child psychiatry team (attending child psychiatrist and two child psychiatry fellows) offered direct clinical care and consultation in a school-based clinic. In later years, the team provided ongoing professional development and consultation to teachers, and the model was implemented districtwide. The authors describe challenges of engaging and working in the school setting, which call on key strengths of an effective partnership: communication, respect, and trust. The multiyear partnership offered a mutually beneficial experience for both educators and psychiatry trainees.

Use of Telepsychiatry in Pediatric Emergency Room to Decrease Length of Stay for Psychiatric Patients, Improve Resident On-Call Burden, and Reduce Factors Related to Physician Burnout

Background: Our study aims to demonstrate through implementation of telepsychiatry for child psychiatry patients evaluated in the pediatric emergency room (PedsER); we can reduce length of stay (LOS) and reduce factors contributing to physician burnout through reduction of on-call travel burden. Introduction: Telepsychiatry has increased access to health care using real-time interactive videoconferencing, allowing clinicians and patients in separate locations to have a meaningful clinical encounter. Use has increased over the past several years given cost reduction and need for psychiatric specialty services in under-resourced systems. Materials and Methods: We evaluated data regarding child psychiatry fellow use of telepsychiatry through a prospective real-time questionnaire filled out by the on-call clinician from July 1, 2017 to December 23, 2017 (study period). LOS was measured from the patient's registration time through time of discharge. Results: Telepsychiatry significantly reduced the total monthly LOS for nonhospitalized patients in the PedsER during the study period compared to all prior months (285-193 h; p = 0.032) and compared to a similar prior seasonal time frame (329-193 h; p = 0.017). Telepsychiatry use reduced travel for face-to-face evaluations by 75% and saved 2.22 h per call day. Discussion: Unique in this study is enhancing on-site psychiatric consultation in the emergency room, rather than solving a systems issue of referring out for psychiatric consultation. Moreover, this study uniquely demonstrated a noted improvement in on-call physician travel burden by reducing travel time with telepsychiatry. Physician burnout is notably high during residency training. Factors such as telepsychiatry can improve work efficiency and lend time to activities outside of work, mitigating the onset of this challenging issue. Conclusions: Telepsychiatry was shown to be effective in reducing dwell time and improving on-call burden. This study also showed promise in our system for improving access to other forms of specialized care consultation in PedsER settings.

44.4 Developing a Novel Race-Based Curriculum for Child and Adolescent Psychiatry Fellows

44.4 Developing a Novel Race-Based Curriculum for Child and Adolescent Psychiatry Fellows

1.54 Training Child Psychiatry Fellows in Pediatric Integrated Behavioral Health: An Examination of Key Rotation Components and Perceived Value by Trainees

1.54 Training Child Psychiatry Fellows in Pediatric Integrated Behavioral Health: An Examination of Key Rotation Components and Perceived Value by Trainees

Bullying in Child and Adolescent Psychiatric Training: The Need for Identification and Prevention

Case: A 26-year-old first-year psychiatry resident presents for rounds on her first day of a child consult-liaison rotation. She is anxious to begin the rotation because she will be working with an attending psychiatrist who is known as being difficult to please. The resident presents the case of a child in the emergency room to the attending, a second-year child and adolescent psychiatry fellow, and several medical students. The resident who is presenting the case begins to notice that the attending makes eye contact only with the fellow and then asks him to present the assessment and plan for the patient she just has presented. Using “herself as an instrument” to pick up on subtle interpersonal dynamics, the resident senses that the attending is annoyed with her and that she is not doing a good job on her first day.

Psychiatrists Go Beyond Call of Duty to Respond to Harvey’s Victims

Psychiatrists Go Beyond Call of Duty to Respond to Harvey’s Victims

2.46 Implementation of a Direct-Observation Diagnostic Assessment Clinic in a Child and Adolescent Psychiatry Fellowship Program

The literature outlines several models for teaching medical students and family medicine and general psychiatry residents to conduct a psychiatric interview. To our knowledge, there are no published reports describing the implementation of a direct-observation clinic for child and adolescent psychiatry fellows. We propose that a direct-observation model is a feasible and valuable educational experience. Our objective was to design and implement a direct-observation psychiatric assessment clinic for first-year child and adolescent psychiatry fellows.

2.48 Consultation/Liaison and Emergency Department Cross-Campus Initiative: How Do Child Psychiatry Fellows Optimize Learning on Two Different Campuses?

2.48 Consultation/Liaison and Emergency Department Cross-Campus Initiative: How Do Child Psychiatry Fellows Optimize Learning on Two Different Campuses?

2.16 Electronic Medical Record Identification of At-Risk Patients in a Child Psychiatry Fellow Outpatient Clinic

2.16 Electronic Medical Record Identification of At-Risk Patients in a Child Psychiatry Fellow Outpatient Clinic

Experiences with the Child and Adolescent Psychiatry Milestones: Results of Two Nationwide Surveys.

Child and Adolescent Psychiatry began using milestones in 2015 as a way to document observable progress through training. The study is the first assessment of Child and Adolescent Psychiatry (CAP) faculty and fellows' experience with the milestones. This study presents findings from two surveys conducted one year apart. The first electronic survey polled CAP fellows and faculty nationwide using five opinion questions; demographic data and comments were also gathered. The second, four-question survey polled CAP faculty at the American Association of Directors of Psychiatry Residency Training annual meeting. Seventy-nine fellows and 101 faculty members responded to the first survey. Averaged over the five questions, 53% of faculty and 49% of fellows responded positively, with 29 and 33% respectively giving neutral responses. Participants were a diverse group in terms of geographic distribution, program size, and experience level. Comments were predominantly negative or mixed. Fifty CAP faculty and fellows responded to the second survey. Of the three opinion questions, positive responses ranged from 62 to 90%. Forty percent of respondents reported having had no faculty development on the milestones. Implementing the milestones has been a mixed experience for faculty and fellows. Direct comparison between these two surveys is not possible given their different content and format. Future directions include standardization of faculty development sessions, and improved structures to create and share best practices for assessment of trainees.

Clinical Review of New Medications for Treating Attention-Deficit/Hyperactivity Disorder

As a busy child and adolescent psychiatry fellow, I appreciate having access to condensed information about new psychopharmacologic treatments available on the market, which helps me remain informed and improves my patients’ care. I appreciated when my faculty mentor brought to my attention Daughton’s 2009 article1 that reviews attention-deficit/hyperactivity disorder (ADHD) pharmacotherapies. However, several years have elapsed since that article was published, and there have been new medications released to market. These medications are not novel compounds but rather new preparations of existing compounds that broaden modes of administration and provide additional pharmacokinetic variations. Thus, a brief update is in order.

Using Social Media to Identify Those With Mental Illness and Substance Use Disorders

Back to table of contents Previous article Next article CommentaryFull AccessUsing Social Media to Identify Those With Mental Illness and Substance Use DisordersShawn E. McNeil, M.D.Shawn E. McNeilSearch for more papers by this author, M.D.Published Online:10 Mar 2017https://doi.org/10.1176/appi.ajp-rj.2016.111205AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail The increasingly invasive nature of modern social media platforms presents a unique opportunity for identifying individuals at risk for mental illness. Social media allows individuals to create material and to choose with whom they wish to share it (1). Like scenes leaping to life from the pages of A Midsummer Night’s Dream, the drama and passion in the lives of today’s youths (and a growing number of adults) seem to jump from the edifices of their digital selves. These ideas, statements, links, and photographs sent out via social media comprise the digital persona of any given person.Social media presents a unique platform for identifying and interacting with persons suffering from mental illness. Computer algorithms can scan online profiles, seeking out the digital signs and symptoms of mental health issues. For example, DrugAbuse.com examined over 3 million posts on the social media site Instagram that were related to various music festivals and examined them for references to drug use. It found that 43% of posts about the Electric Daisy Carnival contained references to ecstasy (methylenedioxymethamphetamine), and 82% of posts about Marley Fest contained references to marijuana (2). The direct correlation between music festival attendance and substance use disorder is a premature conclusion. However, the association may justify the use of targeted advertisements for substance use disorder treatment programs toward this population.Crisis Text Line is a crisis intervention service that connects individuals struggling with problems such as suicidal ideation, addiction, sexual abuse, and eating disorders with counselors, who field their text messages and help them navigate difficult situations. Data from the millions of texts received reveal trends that could be used to predict the likelihood of certain behaviors among persons reaching out for professional help. Thirty percent of texts this service receives are about suicide and depression. Language used in the texts may correlate with certain behaviors such as substance abuse or self-injurious activity (3).Although social media can be used to reach out to those with mental illness, we know that technology can also exacerbate crises. The “Werther effect,” also referred to as “contagion,” is a term describing the genesis of suicidal behavior spawned by media reports (4). This is an interesting phenomenon that should be addressed when clinicians are screening patients for suicide risk. Social media will affect the majority of our patients, such that we should hope to clarify its role as part of our social history taking.As mental health clinicians, we need to be aware of the connection between social media and human behavior. Scientists should be able to harness the predictive potential of these technologies in identifying those most vulnerable. We should seek to understand the significance of a patient’s interaction with social media when taking a thorough history. Future research should focus on the development of advanced algorithms that can efficiently identify the highest-risk individuals. Additionally, research into the effectiveness and appropriateness of various interventions should be done to guide clinicians and public health officials in finding the best way to engage these patients.Dr. McNeil is a first-year child and adolescent psychiatry fellow in the Department of Psychiatry, LSU Health Sciences Center, Shreveport, La.The author thanks Spencer Hansen, M.D., for insightful guidance on this commentary.

ANNA-1 Paraneoplastic Encephalomyelitis Presenting as Rapidly Progressing Dementia in a Man With Undiagnosed Small Cell Lung Cancer

ANNA-1 Paraneoplastic Encephalomyelitis Presenting as Rapidly Progressing Dementia in a Man With Undiagnosed Small Cell Lung Cancer