Priority mental health disorders of children and adolescents in primary-care pediatric settings in India 3: psychotherapy and other non-pharmacological interventions

The pediatrician is a primary column of support for children and adolescents with a myriad of mental health problems in low-mental health care resource countries like India. While majority of mental health consultations happen in primary-care, and only 10% are referred successfully for specialised help, there is a clear role for pediatrician psychotherapists in primary care. The primary-care pediatricians should be aware of the indications for psychotherapy, the various approaches that could be used in primary-care settings, the structure and the process of the psychotherapeutic technique involved, the suggested specific techniques for the Priority Mental Health Disorders and the evidence available to support their use as well as the developmental modifications that are required based on the cognitive development of the child or adolescent.     

Priority mental health disorders of children and adolescents in primary-care pediatric settings in India 2: diagnosis, pharmacological treatment and referral

The advent of pediatric psychopharmacology has enormously improved psychiatric care of children and adolescents. Nonetheless, our practice of diagnosis, treatment and referral in primary-care pediatric settings is not optimum as current evidence based knowledge is not regularly applied in the actual clinical circumstances. To help primary-care pediatricians minimise this in research-clinical practice, pharmacological treatment and referral in their clinical practice, they need to follow a two-tier diagnostic and multi axial treatment approach. The two-tier diagnostic approach of using a screening measure followed by confirmation of the screen positive cases with reference standard clinical criterion, improves the sensitivity and specificity. The multiaxial treatment has the advantage of offering a holistic approach to the intervention and improve prognosis from the interacting axes. The primary-care physician should be aware of the medications of choice for the Priority Mental Health Disorders and their drug interactions. Finally, referral of cases with atypical presentations, multiple comorbidities and poor response to the first-line of treatment needs referral to the next tier in the system.     

Priority mental health disorders of children and adolescents in primary-care pediatric setting in India 1: developing a child and adolescent mental health policy, program, and service model

India has a huge child and adolescent population. Psychiatric disorders are widely prevalent and the mental health needs of these children are well recognized. Nonetheless, there are no country-centric and child specific mental health policies, plans or programs. There is also a significant lack of human resources for child and adolescent mental health in India. This combination of factors makes the primary care a critical setting for the early identification, treatment, consultation and referral of children and adolescents with mental health and developmental needs. Even though the importance of primary care as a system for addressing the mental health care has been recognized for decades, its potential requires further development in India as the Child and Adolescent Mental Health Services (CAMHS) emerge and evolve. A country and child specific mental health policy, plan and program needs to be formulated as well an integrated, multi-tier CAMHS with a focus on the primary-care physicians as care providers for this population has to be developed.     

Psychopharmacology of pediatric bipolar disorders in children and adolescents

Pediatric bipolar disorder (PBD) is a chronic and disabling illness often leading to serious disruption in the lives of children and adolescents with this condition. Until recently, methodologically stringent data to guide pharmacologic interventions in the youth were scarce. However, clinical trials conducted recently have expanded the existing evidence base, and new data are emerging rapidly. Recent studies have examined the use of lithium, anticonvulsants, and atypical antipsychotics for acute and long-term treatment of PBD. Despite these new advances, further placebo-controlled trials investigating the efficacy and safety of pharmacologic treatment strategies for young people with bipolar disorder are still needed.     

Parent and teacher mental health ratings of children using primary-care services: interrater agreement and implications for mental health screening.

OBJECTIVE: To examine interrater agreement when screening for child mental health problems during primary-care visits. METHODS: Children aged 5 to 10 (n = 227) and one of their parents were systematically recruited from the waiting rooms of 15 primary-care sites located in Baltimore, Md; Washington, DC; and rural New York from 2002 to 2005. The parent and teacher of the child completed the Strengths and Difficulties Questionnaire to measure the child's emotions, behaviors, and functional impairment. RESULTS: Parents and teachers identified a similar proportion of children as having high symptoms (25% vs 23%) and high impairment (27% vs 32%) but rarely agreed in their assessments of specific children. Parent ratings alone missed 52% of children rated by teachers as having both high symptoms and high impairment (kappa = 0.15). Only 6% of these discrepant visits were for mental health problems, making it unlikely that teacher reports would have been solicited. CONCLUSIONS: Parent reports failed to detect half of school-aged children considered to be seriously disturbed by their teachers. Efforts to improve detection of mental health problems by using screening tools in primary care may require algorithms that help providers judge when to solicit teacher reports and how to interpret conflicting information from parents and teachers.     

Prevalence and correlates of mental disorders in Israeli adolescents: results from a national mental health survey

Background: The development of epidemiological instruments has enabled the assessment of mental disorders in youth in countries that plan policy according to evidence‐based principles. The Israel Survey of Mental Health among Adolescents (ISMEHA) was conducted in 2004–2005 in a representative sample of 957 adolescents aged 14–17 and their mothers. Methods: The aims of this study were to estimate prevalence rates of internalizing and externalizing mental disorders and their socio‐demographic and health correlates. Disorders were ascertained with the Development and Well‐Being Assessment inventory and verified by child psychiatrists. Results: The prevalence rates were 11.7%, 8.1% and 4.8% for any disorder, internalizing disorders and externalizing disorders, respectively. Distinct risk factors were associated with the different types of disorders: internalizing disorders were associated with female gender, chronic medical conditions and being cared for by a welfare agency. Risk factors for externalizing disorders were male gender, having divorced or single parents, being an only child or having only one sibling. Learning disability was associated with both types of disorders. Conclusions: The risk and protective factors related to internalizing and externalizing disorders are interpreted within the framework of family composition in this multicultural society.     

Inflammatory bowel disease in children and adolescents: mental health and family functioning

BACKGROUND: Inflammatory bowel disease in children and adolescents often leads to an extremely complex somatic and psychiatric situation. The psychological effect of inflammatory bowel disease warrants further investigation, especially concerning salutogenetic factors that may lead to good mental health despite bad somatic conditions. METHODS: These studies used a multimethod design comprising both semiquantitative measures, such as rating scales and questionnaires, and qualitative in-depth interviews with both the child and his or her parents. Clinical comparison groups of matched children with diabetes and chronic tension headaches and matched children without chronic physical disease were examined. RESULTS: Inflammatory bowel disease often leads to psychiatric sequelae. Emotional disorders, especially depression and anxiety symptoms, were found to be common. Self-esteem was lowered. A subgroup of children with good mental health despite bad somatic conditions was found. They exhibited certain characteristics, including good knowledge of the disease, an internal locus of control, a good family climate, and an open social network. CONCLUSIONS: This study shows that the well-being of a chronically ill child depends not only on the course of the physical disease but also on the psychological and social complications that often seem to accompany a disease of this kind. The importance of taking good care of the psychosocial aspects of inflammatory bowel disease within the comprehensive treatment program is discussed.     

Prevalence of pervasive developmental disorders in children and adolescents with mental retardation

BACKGROUND: Insight into the prevalence of pervasive developmental disorder (PDD) in children and adolescents with mental retardation (MR) is known to be of clinical importance. However, estimating this prevalence is complicated. The literature reports prevalence rates ranging from 3% through 50%. This variation seems to be related to the concepts of PDD under study, the instruments used, and the studied populations. The present study aimed to estimate a reliable prevalence rate of PDD. METHODS: A total population-based screening with the PDD-MRS and the ABC (n=825) was followed by further assessment of children and adolescents at high risk for PDD according to these instruments, and for controls, with the ADI-R, ADOS-G and a DSM-IV-TR classification (n=188). RESULTS: The instruments lead to different prevalence rates that range from 7.8% to 19.8%. The differences in the estimated prevalence rates are related to the concept of PDD and the instruments they represent. The DSM-IV-TR prevalence (16.7%) seems to be the most reliable and well-founded estimate, since this prevalence rate is based on information from multiple informants and multiple time periods. CONCLUSIONS: The reported prevalence rates provide policy makers with an up-to-date and more substantiated guideline for the allocation of resources for children and adolescents with MR and PDD. The height of the prevalence should alert professionals that PDD is widespread in the population with MR.     

Practitioner Review: Unguided and guided self-help interventions for common mental health disorders in children and adolescents: a systematic review and meta-analysis

Mental health problems are common in children and adolescents, yet evidence-based treatments are hard to access. Self-help interventions can increase such access. The aim of this paper was to conduct a systematic review and meta-analysis of the use of guided and unguided self-help for children and young people with symptoms of common mental health disorders. In contrast to previous reviews of self-help in children, all types of self-help and multiple mental health disorders were investigated in order to increase power to investigate potential moderators of efficacy. Importantly, studies with control arms as well as those comparing against traditional face-to-face treatments were included. Fifty studies (n = 3396 participants in self-help/guided self-help conditions) met the inclusion criteria. Results demonstrated a moderate positive effect size for guided and unguided self-help interventions when compared against a control group (n = 44; g = 0.49; 95% CI: 0.37 to 0.61, p < .01) and a small but significant negative effect size when compared to other therapies (n = 15; g = −0.17; 95% CI: –0.27 to –0.07, p < .01). Few potential moderators had a significant effect on outcome. Most comparisons resulted in significant heterogeneity and therefore results are interpreted with caution.     

父母冲突与儿童青少年心理健康:自我概念的中介作用

目的探讨儿童青少年自我概念在父母冲突与心理健康之间的中介作用。方法采用方便抽样的方法调查某县689名中小学生的心理问题、自我概念水平和父母冲突情况。研究工具包括一般情况调查表、长处和困难问卷、自我描述问卷和儿童对婚姻冲突感知量表,采用结构方程模型建立中介作用模型,并进行多群组结构方程模型分析,采用Bootstrap法对中介效应的显著性进行检验。结果父母冲突与儿童青少年心理问题呈正相关(P0.05),父母冲突与自我概念呈负相关(P0.01),自我概念与心理问题呈负相关(P0.01)。儿童青少年自我概念在父母冲突和心理问题之间起部分中介作用,中介效应占总效应值的60%。学业阶段在父母冲突、心理问题、自我概念三者关系中起调节作用,性别无调节作用。结论自我概念在父母冲突与心理健康之间发挥重要作用,对于暴露于父母冲突环境下的儿童青少年,应注重提高其自我概念水平。     

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??Children and adolescents with mental disorders present impairment on perception?? emotion??cognition or behavior.Clinical assessment methods for children and adolescents with mental disorders include interview??mental state examination and psychological assessment.This review introduced the process of assessment and diagnosis of children and adolescents in order to assist the clinician to make accurate diagnosis and appropriate treatment plan.     

Gender disparities in mental health service use of Puerto Rican children and adolescents

BACKGROUND: Differences in service utilization indicating that boys use more mental health services than girls were analyzed to see if they could be explained by known correlates of service use. These correlates were arranged into individual (severe emotional disturbance, level of impairment and externalizing disorders), family (parental education, psychopathology and parental concern) and school factors (difficulties with school work). The objectives were to understand and identify the factors accounting for gender differences in mental health service utilization in order to develop alternatives to promote equity in service delivery. METHODS: A representative sample of 1,896 children 4 to 17 years of age and their primary caretakers were interviewed for this study. Reports of service use were obtained using the Service Assessment for Children and Adolescents. Logistic regression was used to assess the relationship between gender and service use, adjusting for known correlates. RESULTS: Our results showed that, except for impairment, other individual, family and school factors did not explain gender differences in service utilization. Males with impairment were 2.87 times more likely to receive services than impaired females (p 相似文献   

Neurological disorders in children and adolescents

Objective  To ascertain the prevalence of active epilepsy, febrile seizures (FS), cerebral palsy (CP) and tic disorders (TD) in aged 19 years or less. Methods  This was a cross-sectional observational study conducted as a two-stage door-to-door survey of a stratified randomly selected population in 2003-04. Trained field workers screened the population followed by case examination by the field neurologist. Results  A total of 16979 (male 8898, female 8081) subjects aged ≤ 19 years were surveyed. The prevalence rates per 100,000 population of active epilepsy, FS, CP and TD with 95% confidence intervals are 700.87 (580.60–838.68), 1113.14 (960.07–1283.59), 282.70 (CI 208.43–374.82) and 35.34 (12.96–76.92) respectively. Active epilepsy prevalence shows a rising trend and that of other disorders a declining trend with age. Of the epileptics who had brain CT scans, 23.4% showed single or multiple lesions suggestive of neurocysticercosis. Regarding treatment, 23.5% of the epileptics never received any antiepileptic drugs. Among those with history of FS, 9.5% developed epilepsy later on. The prevalence of FS among slum dwellers is lower than in the non-slum population. Among CP cases, 39.6% gave history of birth anoxia, 16.7% kernicterus and 31.3% epilepsy. Prevalence of CP is significantly associated with lower education status. Conclusion  The prevalence of CP and TD is lower than reported from western countries. CP prevalence is also comparatively lower than in many community studies from India. Compared to western nations, higher proportion of FS cases develops epilepsy. A third of the CP cases have seizures which is higher than in many Indian studies. Birth anoxia is a common cause of CP and educational underachievement is frequent.     

Conduct disorders in children and adolescents

Conduct disorders in children and adolescents are common problems presenting to professionals involved with child health. This review describes their prevalence and aetiology, as well as relevant evidenced-based interventions crucial to successful management.