Practitioner Review Research Articles

Practitioner Review: Recognition of Pseudoseizures in Children and Adolescents

Pseudoseizures or their possibility remain a troublesome clinical issue with serious implications as, particularly in older children and adolescents, they can take various forms so that their differential diagnosis is wide. Many of the traditional criteria do not, in fact, discriminate well between pseudoseizures and other episodic disorders, especially those involving dramatic behavioural manifestations. These include certain forms of epilepsy (notably mesial frontal seizures) and some other organic and psychiatric conditions. A number of more reliable diagnostic criteria remain. These include selective clinical criteria and certain findings from carefully conducted EEG monitoring with informed analysis of the results.

Practitioner Review: Communicating with Hospitalised Children: Review and Application of Research Pertaining to Children's Understanding of Health and Illness

There is growing recognition amongst child health care practitioners of children's rights to be informed about their condition and treatment, and to be actively involved in decisions pertaining to their care. In order to facilitate such understanding, there is a need to explore the ways in which such concepts can best be communicated, in particular to younger children whose conceptual ability may be regarded as limited. Consideration of the literature on how children's conceptualisation of health and illness develops reveals diverse perspectives, with seminal work heavily influenced by the work of Piaget (1929), and a belief that the understanding of younger children may be minimal. However, more contemporary theorists refute such beliefs, suggesting that children may have far more potential to understand complex illness concepts than they have previously been given credit for. The work of Carey (1985) and Vygotsky (1962) offers alternative developmental theories congruent with this perspective, which might more appropriately underpin current practice. A variety of clinical situations are then explored in the light of this debate, including preparation of children for hospitalisation, their competence to consent, their views of pain and death, and approaches to child health promotion. Guidelines are offered to practitioners throughout, with the aim of enhancing children's understanding of their conditions, and their active participation in care, which in turn has the potential to optimise care delivery.

Practitioner Review: Communicating with Hospitalised Children: Review and Application of Research Pertaining to Children's Understanding of Health and Illness

There is growing recognition amongst child health care practitioners of children's rights to be informed about their condition and treatment, and to be actively involved in decisions pertaining to their care. In order to facilitate such understanding, there is a need to explore the ways in which such concepts can best be communicated, in particular to younger children whose conceptual ability may be regarded as limited. Consideration of the literature on how children's conceptualisation of health and illness develops reveals diverse perspectives, with seminal work heavily influenced by the work of Piaget (1929), and a belief that the understanding of younger children may be minimal. However, more contemporary theorists refute such beliefs, suggesting that children may have far more potential to understand complex illness concepts than they have previously been given credit for. The work of Carey (1985) and Vygotsky (1962) offers alternative developmental theories congruent with this perspective, which might more appropriately underpin current practice. A variety of clinical situations are then explored in the light of this debate, including preparation of children for hospitalisation, their competence to consent, their views of pain and death, and approaches to child health promotion. Guidelines are offered to practitioners throughout, with the aim of enhancing children's understanding of their conditions, and their active participation in care, which in turn has the potential to optimise care delivery.

Anaesthetic Physiology and Pharmacology

Anaesthetic Physiology and Pharmacology

Practitioner Review: The Assessment and Management of Risk in Adolescents

Much of the relevant literature has focused on the assessment of dangerousness in adults. Up-to-date thinking and research has now taken on the alternative concept of risk and looks not at all-or-nothing long-term predictions, but at short-term frequent decisions about risk, which then assist in the management of the individual and their situation. For this reason it is essential that those presenting evidence for other professionals or for Court should not attempt, or be persuaded, to make long-term predictions. Current research is now showing that some factors, which can be ascertained clinically, are significantly associated with the risk of future violence.

Practitioner Review: The Assessment and Management of Risk in Adolescents

Much of the relevant literature has focused on the assessment of dangerousness in adults. Up-to-date thinking and research has now taken on the alternative concept of risk and looks not at all-or-nothing long-term predictions, but at short-term frequent decisions about risk, which then assist in the management of the individual and their situation. For this reason it is essential that those presenting evidence for other professionals or for Court should not attempt, or be persuaded, to make long-term predictions. Current research is now showing that some factors, which can be ascertained clinically, are significantly associated with the risk of future violence.

Practitioner Review: Electroconvulsive Therapy in Adolescents

There is increasing interest regarding electroconvulsive therapy (ECT) in young persons but limited information about its optimal use. This paper reviews the indications, effectiveness, and side effects of the treatment in the teenage population and their implications for everyday clinical practice. There is particular reference to factors influencing the clinician to recommend or advise against convulsive therapy, steps in the assessment of patients, and consent issues. Practical aspects of ECT administration are also examined, including treatment locale, anaesthesia, electrode position, stimulus characteristics, EEG monitoring, and use of psychotropics during and after the ECT course.

Practitioner Review: Electroconvulsive Therapy in Adolescents

Practitioner Review: Electroconvulsive Therapy in Adolescents

Practitioner Review: The Assessment and Treatment of Deaf Children with Psychiatric Disorders

Practitioner Review: The Assessment and Treatment of Deaf Children with Psychiatric Disorders

Practitioner Review: The Assessment and Treatment of Deaf Children with Psychiatric Disorders

The assessment and treatment of deaf children with psychiatric disorder is intimately related to the individual child's communication, which in turn is affected by a number of factors, medical, social, and cultural. The deafness can be aetiologically related to the psychiatric disorder or can be incidental. Treatment strategies should be adapted to meet the individual child and family's needs. Deaf professionals have a vital role in mental health services for this population. The use of an interpreter can clarify communication and cultural issues for deaf and hearing children, families, and professionals.

Practitioner Review: Treatment of Schizophrenia in Childhood and Adolescence

This paper reviews the management of schizophrenia occurring during childhood and adolescence. It considers the clinical features of the disorder particular to its early onset before providing a practical framework for assessment and treatment based upon a critical review of the available literature. A multi-modal approach to treatment encompassing the individual and their family is adopted with the roles of pharmacological, psychological, and environmental interventions all considered. The place of the newer "atypical" antipsychotic agents and the likelihood that they will soon become the first-line drugs of choice is particularly discussed.

Practitioner Review: Treatment of Schizophrenia in Childhood and Adolescence

This paper reviews the management of schizophrenia occurring during childhood and adolescence. It considers the clinical features of the disorder particular to its early onset before providing a practical framework for assessment and treatment based upon a critical review of the available literature. A multi‐modal approach to treatment encompassing the individual and their family is adopted with the roles of pharmacological, psychological, and environmental interventions all considered. The place of the newer “atypical” antipsychotic agents and the likelihood that they will soon become the first‐line drugs of choice is particularly discussed.

Practitioner Review: Routes from Research to Clinical Practice in Child Psychiatry: Retrospect and Prospect

Practitioner Review: Routes from Research to Clinical Practice in Child Psychiatry: Retrospect and Prospect

Practitioner Review: Routes from Research to Clinical Practice in Child Psychiatry: Retrospect and Prospect

The last 40 years has seen a virtual revolution in both medical research and medical practice. Child psychiatry has been part of that revolution. The situation in the 1950s is briefly noted and seven examples are used to illustrate how causal research in the past has led to changes in clinical practice. The areas used as examples comprise: autism, hyperactivity/attention deficit syndromes, conduct disorders, depressive conditions, genetic research, organic brain dysfunction, and psychosocial risk processes. Prospects for the future with respect to the impact of research on clinical practice are discussed in relation to molecular genetics, environmental risks, cognitive and affective processing of experiences, links across the lifespan, and functional brain imaging. Attention is drawn to implications for training as well as for practice.

Practitioner Review: Long‐term Consequences of Childhood Cancer

Survival rates in childhood cancer now approach approximately 65%, depending on the specific cancer. Success has been achieved through the use of increasingly aggressive treatments (chemotherapy, radiotherapy, bone-marrow transplantation). These are now recognised to be associated with a range of physical late effects, including problems associated with growth and endocrine function, sensory function, fertility, liver, cardiac, and kidney damage. Recognition of these physical late effects raises the issue of related problems in psychological, educational, and behavioural functioning. There is considerable evidence to suggest that children who are younger on diagnosis are more at risk in terms of cognitive and behavioural late effects compared with those who are diagnosed later. Cancer remains a rare disease in children and consequently only those professionals attached to centres specialising in the care of children with cancer are likely to receive a significant number of referrals. It is important to establish a psychological support service as an integral part of long-term care in order to (a) establish more accurately the incidence of social and psychological late effects and (b) offer advice to the individual about the possible long-term effects of cancer treatment on future health, social, and employment prospects.

Drug-related hospital admissions: a review of Australian studies published 1988-1996.

To examine the extent of drug-related hospital admissions in Australia by reviewing Australian studies published between 1988 and 1996. The terms "drug-related", "admissions", "readmissions", "hospitalisation", "hospitalization" and "iatrogenic" were used to search MEDLINE and Australian Public Affairs Information Service databases. The Australian Journal of Hospital Pharmacy and conference proceedings of the Society of Hospital Pharmacists and the Australasian Pharmaceutical Science Association were searched manually. Studies were included if they were Australian, had the primary aim of identifying drug-related admissions, and had at least one clinical pharmacist or medical practitioner review the admissions. Total number of admissions assessed; proportion considered drug-related; drug groups implicated; and proportion considered avoidable. 14 studies were identified; 2.4%-3.6% of all hospital admissions were reported to be drug-related. 6%-7% of emergency admissions, 12% of all admissions to medical wards and 15%-22% of all emergency admissions among the elderly were drug related. Between 32% and 69% of drug-related admissions were reported as definitely or possibly preventable. Drug groups most commonly implicated were cytotoxics, cardiovascular agents, antihypertensives, anticoagulants and non-steroidal anti-inflammatory drugs. Drug-related hospital admissions are a significant and expensive public health problem in Australia, and approximately half were considered possibly or probably preventable.

Practitioner Review: Psychological and Educational Treatments for Autism

The review discusses various interventions that have been used in the treatment of children with autism. It concludes that no single mode of treatment is ever likely to be effective for all children and all families. Instead, intervention will need to be adapted to individual needs and the value of approaches that involve a functional analysis of problems is explored. It is suggested that many so called "challenging" behaviours result from the child's fundamental difficulties in communication and social understanding, or from the ritualistic and obsessional tendencies that are also characteristic of autism. Possible ways in which parents and teachers might deal with problems in these areas are discussed. The importance of early diagnosis, and with it early, practical advice for families is stressed.

Practitioner review: physical investigations in mental retardation.

Mental retardation occurs in more than 1% of the child population. A cause can be found in almost 80% of individuals with severe mental retardation, but in fewer than 40% of those with mild mental retardation. A work-up is indicated in all cases of mental retardation. A medical doctor with specific training in the field is needed to make "decision-tree diagnosis" and to suggest the most appropriate physical investigations in each case. This paper provides practical guidelines for diagnosis and work-up both in severe and mild mental retardation.

Practitioner review: the pharmacotherapy of adolescent depression.

This paper is a review of the pharmacotherapy of adolescent depression. It begins with a brief discussion regarding the nature of adolescent depression and then critically evaluates the available evidence regarding the efficacy and tolerability of psychotropic intervention as it has, to date, been reported. As the available evidence suggests that tricyclic antidepressants have failed to show efficacy, yet demonstrate significant problems with tolerability and safety, the remainder of the article describes how clinicians should prescribe antidepressants using the serotonin reuptake inhibitors. Areas covered include assessment, treatment initiation, dosing, outcome evaluation, adverse events, and combinations. The review concludes with a discussion of long-term therapy with antidepressant medications.

Client Perceptions of the Rehabilitation Counseling Relationship: Humanistic Approaches and Related Outcomes

For persons with disabilities, help-seeking behavior requires courage, trust, and confidence in others. It is critical for rehabilitation counselors to be cognizant of how they may be perceived by the client. This article focuses on the relationship attitudes, and behaviors which enable the formation of an effective therapeutic relationship. A review is made of the humanistic approaches and conditions relevant to the therapeutic relationship and rehabilitation client outcome. This article is to serve as a primer for rehabilitation counseling students and a review for veteran practitioners.