Practice Of Child Psychiatry Research Articles

Study of child and adolescent forensic psychiatry : procedure and clinical profile Abstract

IntroductionForensic psychiatry is a specific field of practice in child psychiatry where skills are applied for legal purposes and the expert is faced with certain difficulties.ObjectivesOur objective was to determine the characteristics of the forensic procedure and the clinical profile of the consultants.MethodsCross-sectional and retrospective descriptive study concerning patients consulting the child psychiatry department of Mongi Slim Hospital between January 2018 and December 2019 in the context of a forensic expertise, excluding administrative expertise. Telephone interviews were carried out for the medicolegal follow-up.ResultsThe average age was 9 [+/- 3.1] years and the sex ratio was 0.97. The majority of the requests for expertise came from the specialised unit for violence against women and children (40%). The expert’s task was to carry out a child psychiatric examination in 44% of cases and to establish credibility in 6.8% of cases. Apart from 3 cases of perpetrators, the requests concerned victims of physical (40.1%), sexual (38.6%) and psychological (21.3%) aggression. The assault had taken place within the family in 52% of cases and the alleged aggressor was the father in 36%. The average time between the incident and the request for an expert opinion was significantly longer in cases of sexual assault (p =0.01). The physical assaults concerned more boys (p = 0.05) while those of a sexual nature concerned female children (p=0.005). Victims of sexual aggression showed more sexualised behaviour (p<0.05). No significant differences were found in psychiatric diagnoses according to the type of assault, but an examination without abnormalities was prevalent in cases of psychological assault (p=0.009). Claims were significantly more difficult to interpret in preschool children (p=0.05). Child victims of sexual abuse had more subsequent requests for further investigations (p=0.05) and a judgment, pronounced in 34% of cases, was most often related to psychological abuse (p=0.05).ConclusionsThe practice of forensics requires a specific competence that requires extensive training. Better coordination between the professionals involved is needed as well as the creation of specialised forensic units.Disclosure of InterestNone Declared

Outcomes of transitioning from in-person to virtual appointments in a child psychiatry practice

The COVID-19 pandemic caused a transformation in healthcare delivery at a pace never before experienced, including by the child psychiatry practice at Mayo Clinic Health System in Mankato, Minnesota. The aim of this study was to describe the outcomes of that practice’s transition from in-person to virtual care. This retrospective study comprised two groups of patients who received care in the child psychiatry practice at our institution: before COVID-19, 1 March 2019 to 28 February 2020; and after COVID-19, 1 March 2020 to 28 February 2021. We extracted data related to patient visits from the electronic health record and satisfaction data from a Medical Practice Survey given to patients after visits. Virtual visits increased by 306 per cent within a month of transitioning to virtual care and remain the main visit type for established patients. Findings from patient surveys showed substantial overall improvements in patient experiences with virtual visits, and no-show appointments decreased substantially (from up to 23 per cent to 1 per cent). This study provided data for an overview of how the COVID-19 pandemic affected a child psychiatry practice and of the positive outcomes of transitioning from 100 per cent in-person visits before the pandemic to more than 80 per cent virtual visits. The quick transition to virtual care delivery in the child psychiatry practice was a positive change for patients, families and the care team. We believe that other healthcare systems can learn from our experience.

Diagnosis on the way out - personality on the way in? Priorities in treatment in child and adolescent psychiatry.

The scientific basis for practice in child psychiatry has developed apace. And has thrown up several quandries for an accepted paradigm for good practice anchored to the diagnostic schema developed in adult psychiatry. This paper hopes to stimulate discussion about where alternative paradigms might lead us on a path to precision medicine as applied to child psychiatry.

The Role of the Parent in Psychotherapy with Children

One of the outstanding differences of psychotherapy with children as distinguished from the treatment of adults is the fact that one’s activity is not restricted to just one patient, the sick child, but that one has to deal with the parents and other significant people of the child’s environment as well. Without undue exaggeration one might say that in many cases it is the parents who constitute the real problem in child psychiatry. They often seek help for their own difficulties in rearing their children, for their anxiety and guilt, and for their own annoyance and disappointment about the child’s symptoms and shortcomings. I intend to discuss in this paper some problems in the handling of parents which I have encountered in the private practice of child psychiatry. I shall focus on those aspects which I personally have found difficult and many of which have remained unsolved problems in my daily work. I wish to apologize for presenting a paper which raises new questions instead of answering them. But I do hope to stimulate further thought by raising these questions and to clarify at least some of the issues involved.

Prevalence and comorbidity of borderline personality traits in the Quebec general population aged 12-14years.

The early identification of borderline personality traits (BPT) in adolescents helps to prevent their progression. Data are available for the clinical population, but little has been published on the general population, especially regarding age and sex distribution in adolescence. Even less is known about the comorbidity of BPT with other mental disorders. We estimated the prevalence of BPT, by sex, age, and comorbidity, in a sample of adolescents aged 12-14years (n = 799) from the Quebec Mental Health Survey. A complex sampling design was used to ensure representativeness. BPT was assessed with the abbreviated-diagnostic interview for borderlines-revised, with the adolescent as an informant. Reliability coefficients were above 0.80. Several levels of severity were explored using an independent criterion, defined by impairment according to the Columbia impairment scale. The overall prevalence of BPT was 6.3%. Prevalence estimates for the most impaired were 3.2% for the entire sample and 1.3% for 12-year-olds. Prevalence increased significantly with age for most impairment levels but did not differ significantly between the sexes. In adolescents, BPT displayed moderate-to-strong comorbidity with anxiety (AD) and insomnia disorders, and very strong comorbidity with depressive (DD), attention deficit hyperactivity (ADHD), and oppositional defiant/conduct disorders (ODD/CD). We, therefore, make two clinical recommendations for child psychiatry practice: (1) with respect to the lower rate of male adolescents attending BPT Health Programs, increase BPT screening in male adolescents; (2) evaluate BPT when children with ADHD or ODD/CD develop AD or DD during adolescence.

Highlighting successes and challenges of the mental health system in Tunisia: an overview of services, facilities, and human resources

Background Tunisia is a lower-middle-income country located in North Africa with strengths and challenges to its mental health system. Aims We present an overview of available services, facilities, and human resources to offer mental health care in Tunisia. Methods We conducted a cross-sectional study, where data for the year 2017 was collected between May 2018 and May 2019 by consulting stakeholders involved in the health field in Tunisia. We compare this information with data published in the WHO-AIMS report (2008), which presents mental health data in Tunisia for the year 2004. Results Successes of the mental health system in Tunisia include an increase in the ratios of psychiatrists and psychologists, with these ratios being higher than those of other lower-middle-income countries; a flourishing child-psychiatry practice; and an increase in people being treated for mental health conditions. Challenges include psychiatrists being over-represented in large cities along the coastline and in the private sector, and most people receiving treatment in specialized mental health facilities. Conclusions The further operationalization of the National Strategy for Mental Health Promotion is envisioned, through the training of non-specialists in mental health care and incentives offered to psychiatrists to work in the country’s interior and the public sector.

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

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

6.2 Therapy Apps: What They Can and Can’t Do

By the end of this session, the attendee will understand the following: 1) the spectrum of behavioral intervention technologies available in child and adolescent mental health; 2) the rationale and evidence for these interventions; and 3) how these might be implemented into the practice of child psychiatry, including strengths and limitations.

AACAP Integrated Care Initiative Aims to Change Culture of Care for Youth

AACAP Integrated Care Initiative Aims to Change Culture of Care for Youth

Beyond Reactive Attachment Disorder: How Might Attachment Research Inform Child Psychiatry Practice?

This article provides an updated review of attachment research with a focus on how comprehensive clinical assessment and intervention informs the care of young children. Child psychiatrists can serve as an important part of care coordination teams working with young children who have histories of early maltreatment and/or disruption in caregiving whether or not the children they are seeing meet criteria for an attachment disorder. Child psychiatrists should be familiar with both comprehensive assessment and the recent attachment-based interventions and appreciate how pharmacotherapy can be a useful adjunctive intervention when intensive therapy alone is ineffective.

Co-Existence of Motor Coordination Impairments in Semi-Hospitalized Children and Adolescents with Psychiatric Disorders

Background: Recent evidence suggests that children and adolescents presenting poor motor skills are at greater risk of developing internalizing symptoms, emotional/behavioural and externalizing problems. Motor coordination difficulties, as in Developmental Coordination Disorder, co-occurrence with Attention Deficit/Hyperactivity and Autism Spectrum Disorders are well documented. Few studies investigated the co-occurrence of motor difficulties and mood, anxiety, psychotic and emerging personality disorders in children and adolescents. Objectives: To investigate whether children presenting psychiatric symptomatology manifest motor coordination difficulties. Methods: 48 children and adolescents in semi-hospitalisation in a psychiatric-day facility were selected during a period of two years and screened according to DSM-5 criteria and a motor coordination assessment battery. Results: Our findings demonstrated motor difficulties (percentile ≤ 16 in Movement Assessment Battery for Children-2) to be significantly more prevalent among children and adolescents with Bipolar (15.62%), Psychotic (9.37%), Attention Deficit/Hyperactivity (21.87%) and Autistic disorders (18.75%). Motor coordination difficulties were equally prevalent among children presenting Anxiety (12.50%), Conduct (3.12%), Eating (3.12%) and Depressive disorders (9.37%) although no significant difference were detected between groups. Youth presenting traits of Emerging Personality Disorders did not reveal motor difficulties. Conclusion: The co-occurrence of motor deficits and internalizing symptoms, such as in Bipolar and Psychotic disorders is somehow unexpected but offer evidence to support some previous findings in the literature. The presence of motor coordination deficits among patients with Attention deficit/ Hyperactivity and Autistic disorders is congruent to previous literature. Future research should further explore the association of motor deficits with Bipolar and Psychotic disorders in larger samples, and highlights the need for motor assessment in the practice of child psychiatry.

Нейропсихологический метод в дифференциальной клинико-психологической диагностике когнитивных нарушений у детей и подростков с психической патологией

The article describes the neuropsychological techniques which are applied in the clinical practice in child psychiatry. It describes a system of qualitative and quantitative neuropsychological diagnostics. The role of neuropsychological analysis of the cognitive deficits associated with schizophrenia spectrum disorders in children and adolescents is reflected. Hierarchical cluster analysis according to neuropsychological diagnosis helps in the establishing the psychiatric diagnosis.

The Use of Health Information Technology Within Collaborative and Integrated Models of Child Psychiatry Practice.

There is a consistent need for more child and adolescent psychiatrists. Despite increased recruitment of child and adolescent psychiatry trainees, traditional models of care will likely not be able to meet the need of youth with mental illness. Integrated care models focusing on population-based, team-based, measurement-based, and evidenced-based care have been effective in addressing accessibility and quality of care. These integrated models have specific needs regarding health information technology (HIT). HIT has been used in a variety of different ways in several integrated care models. HIT can aid in implementation of these models but is not without its challenges.

Profiles of Youths With PTSD and Addiction

ABSTRACTObjective: Understanding the relationship between PTSD and addiction in adolescents may dramatically improve evidence-based practice in child psychiatry. We hypothesized that in a sample of substance addicted youth, PTSD would correlate with (1) female gender and racial minority status, (2) preference for anxiolytic substances, (3) higher burden of self injury and suicide attempts, and (4) earlier age of first use. Methods: One-hundred and ninety-five adolescents (52% female, ages 14–18) were court-referred to residential treatment and assessed at intake. Multi-informant data regarding Axis I diagnostic status and other clinical variables were collected via rater-administered, semi-structured interviews; medical chart review; and youth, parent, and clinician reports. Differences between subjects were evaluated using Fisher's exact test for binary variables or Kruskal-Wallis Chi-Square Test. Results: Substance dependent youth with comorbid PTSD were significantly more likely to be female and Latino. PTSD was correlated with preference for alcohol, narcotics, tranquilizers and inhalants. In addition, PTSD was correlated with higher burden of self-injury and suicidal behavior. Youth with PTSD were also more likely to have begun using before age 13 and reported that PTSD symptoms preceded first use. Conclusions: Girls and Latinos may be particularly vulnerable in developing comorbid substance dependence and PTSD. Drug preferences among youth with PTSD may reflect tendencies to target symptoms such as hypervigilance and anxiety. The recognition and early intervention among youth with trauma could prevent early first use and eventual substance dependency.

Childhood: a suitable case for treatment?

We examine the contemporary debate on attention deficit hyperactivity disorder, in which concerns about medicalisation and overuse of drug treatments are paramount. We show medicalisation in attention deficit hyperactivity disorder to be a complex issue that requires systematic research to be properly understood. In particular, we suggest that the debate on this disorder might be more productive and less divisive if longitudinal, evidence-based understanding of the harms and benefits of psychiatric diagnosis and misdiagnosis existed, as well as better access to effective, non-drug treatments. If articulation of the values that should guide clinical practice in child psychiatry is encouraged, this might create greater trust and less division.

A rare condition in child psychiatry practice: childhood disintegrative disorder

Childhood disintegrative disorder is a very rare pervasive developmental disorder characterized by normal development of verbal and nonverbal communication skills, social interaction, play, bladder and bowel control and motor behavior at least in the first two years, followed by regression between 2-10 years of age in two or more of the mentioned developmental areas. Estimated prevalence of the childhood disintegrative disorder is around 1.1-6.4 per 100.000 children and the common age of onset is 3.36 years. The present report describes a boy who developed childhood disintegrative disorder after approximately 3 years of normal development and clinical features are discussed in the light of the clinical literature.

Table of Contents

AbstractHistorical trauma: A panoramic perspectiveSpanish is coming to a child psychiatry practice near youRegular marijuana use harmful for teens' brains: APAImportance of health care providers in smoking prevention and cessationAAP urges caution in prescribing ADHD medicationsParents with mood episodes biased in reporting their children's psychopathologyLithium exposure during pregnancy linked with cardiovascular defectsGame shows and children: No longer a trivial pursuit

To treat or not to treat? and How to treat? Two questions whose answers are far removed from evidence informed practice in child psychiatry

To treat or not to treat? and How to treat? Two questions whose answers are far removed from evidence informed practice in child psychiatry

Use of pharmacotherapy for insomnia in child psychiatry practice: A national survey

ObjectiveTo examine clinical practice patterns regarding non-prescription and prescription medication use for insomnia by child and adolescent psychiatrists. MethodsSurvey mailed to 6018 members of the American Academy of Child and Adolescent Psychiatry. ResultsThe final sample (N=1273) reported that insomnia was a major problem in almost a third of their school-aged and adolescent patients and endorsed using medication to treat the insomnia in at least a quarter of these patients. Overall, 96% of respondents recommended at least one of the listed prescription medications in a typical month, and 88% recommended an over-the-counter medication. Alpha agonists were the most commonly prescribed insomnia medication for ADHD (81%), significantly higher than in MR/DD (67%), mood (40%), or anxiety disorders (31%). Trazodone was the most commonly prescribed insomnia medication for children with mood (78%) and anxiety disorders (72%). Antidepressants as a class were also commonly used for children in these diagnostic groups. Atypical antipsychotics, anticonvulsants, and short-acting hypnotics were also more likely to be used in children with mood disorders. Melatonin was recommended by more than one-third of respondents. Mitigation of the effects of sleep disruption on daytime functioning was endorsed as an important rationale for the use of sleep medication; concerns about side effects and the lack of empirical support regarding efficacy were cited as significant barriers to their use. ConclusionsInsomnia is a significant clinical problem in children treated by child psychiatrists for a variety of behavioral, neurodevelopmental, and psychiatric conditions. Management with a broad array of psychotropic medications is common and indicates a highly variable clinical approach to insomnia in this pediatric population.

Revalidation: Are we Meeting Training Needs? Training and its Influence on the Practice of Child Psychiatry and Psychotherapy

Revalidation and renewal of registration are issues of concern to most psychiatrists. Keeping up-to-date with current knowledge is an essential part of the renewal of license to practice. Training needs of psychiatrists are addressed in postgraduate courses and the gaps in training and updating of knowledge addressed through continuing medical education programs. This study aims to look at whether the training needs of psychiatrists working in the state of Kerala are being met. Two aspects of training and practice, child and adolescent psychiatry and psychotherapy, were assessed using a questionnaire. A significant number of respondents had not received any training in either of these areas in their postgraduate training. This did not affect their practice; most respondents continued to practice psychotherapy and see child patients despite not being trained. These two areas can thus be identified as lacunae in the curriculum as well as a need which should be addressed through Continuation Medical education programs.