Neuroimaging in child and adolescent psychiatry

Although less well studied in child and adolescent psychiatry than in adult psychiatry, brain imaging has significantly altered psychiatric research and practice. This review focuses on the modalities that are used to image the brain. These include structural imaging techniques of computer tomography (CT) and magnetic resonance imaging (MRI), as well as functional imaging techniques of computed electroencephalography (CEEG), positron emission tomography (PET), and single photon emission computed tomography (SPECT). The technologies are reviewed, strengths and weaknesses of modalities discussed, and research progress reported.     

Malpractice in child and adolescent psychiatry

Over the past 40 years, malpractice suits in child and adolescent psychiatry have gone from almost nonexistent to a source of major concern. Suits that involve child and adolescent patients remain fairly uncommon, and no damages are paid in six out of seven cases. The two cardinal principles for the clinician in avoiding and defending malpractice suits are to practice in accordance with his or her best clinical judgment and to document care, particularly in areas in which an unexpected adverse result may lead to a lawsuit. The most common areas that give rise to suit are failure to protect a child inpatient from assault or sexual interaction with another inpatient, adolescent suicide, medication errors, and issues related to child abuse. Evolving areas of malpractice law derive from incipient patient's rights legislation, development of the "direct victim" test in cases brought by third-party parents against therapists who have diagnosed children as sexually abused, implementation of new federal rules regarding privacy of records, and provision of medical information or treatment over the Internet.     

Training general psychiatry residents in child and adolescent psychiatry

The authors describe the nature of current social and economic forces impacting on the education and future practice of general psychiatry residents in child and adolescent psychiatry. They review theoretical and practical reasons for training in child and adolescent psychiatry, analyze the form and content of what is currently taught based on a national survey of general training programs, and suggest guidelines for the training and postgraduate practice of general psychiatrists in evaluating and treating children and adolescents. The authors conclude that while social and economic changes necessitate general psychiatrists' clinical involvement with children and adolescents, insufficient general training may necessitate postgraduate education and supervision. They pose ethical and professional dilemmas for the field in meeting the national shortage of child and adolescent psychiatrists and propose strategies to enhance recruitment into child and adolescent residency training.     

State-university collaboration in child and adolescent psychiatry

The lack of trained professionals is frequently cited as one reason why emotionally disturbed children and adolescents are greatly underserved in the United States. Because most mental health services to children are delivered in public-sector facilities, state-university collaborations in child and adolescent psychiatry offer one solution to the problem of children's unmet mental health needs. The author examines the special considerations of developing such a collaboration and the incentives for doing so, including remaining involved in the mainstream of mental health, economic constraints on academic programs, and revisions in certification examinations in child and adolescent psychiatry and in accreditation requirements. She describes the state-university collaboration in child and adolescent psychiatry in Maryland, which has helped the state recruit 58 percent of its new graduates into public-sector positions.     

Ethics in child and adolescent forensic psychiatry

Ethical concerns are ever present in the practice of all branches of psychiatry. They are likely to be more acute and commonplace in the practice of child and adolescent psychiatry because of the complication introduced by the immaturity of the patient. Children, depending on their age and developmental stage, may be incapable of giving meaningful consent, and situations in which breaking confidentiality must be considered arise more often. The field of forensic psychiatry is fundamentally different from clinical psychiatry because of the universal involvement of third parties and because interactions with evaluees do not occur within the context of a doctor patient relationship. Arguably, these conditions compel the forensic psychiatrist to function as a double agent. According to Appelbaum, an influential psychiatric ethicist, forensic practice calls for a different set of ethical guidelines that, while humane, do not either imply or derive from the existence of a doctor patient relationship. Others argue that a mix of forensic and clinical ethics is more appropriate. New developments in psychiatry, including the use of the Internet for E-mail and telepsychiatry, require continuing vigilance by the profession so that ethical standards can evolve to cover new circumstances at the frontiers of psychiatric practice.     

Typical neuroleptics in child and adolescent psychiatry

European Child & Adolescent Psychiatry -     

Longitudinal research in child and adolescent psychiatry

An indispensable approach to the study of variations in individual development and of causal mechanisms and processes underlying the course of psychopathology is the longitudinal method. In this introductory review, the strengths and weaknesses of longitudinal research are discussed, and factors hampering progress in this field are outlined. The many advantages of this approach warrant continuing efforts to develop strategies that minimize its drawbacks.     

Atypical neuroleptics in child and adolescent psychiatry

Atypical neuroleptics have enriched our treatment programmes, especially in childhood and adolescent schizophrenia. This article reviews the use of atypical neuroleptics in children and adolescents with schizophrenic disorder. It considers the receptor binding profile and pharmacological properties, indications, side effects, clinical applications and trials of atypical neuroleptics in comparison to the classical neuroleptic haloperidol in adolescent schizophrenia. Special emphasis is placed on the most common atypical neuroleptics clozapine, olanzapine and risperidone since most studies are carried out with these compounds, especially with clozapine. More clinically controlled trials have to be conducted since only one was performed so far. The place of the atypical neuroleptics is discussed and further studies are necessary in order to differentiate the indications tested so far and to find out if the spectrum of indications can be broadened.

     

Atypical neuroleptics in child and adolescent psychiatry

Atypical neuroleptics have enriched our treatment programmes, especially in childhood and adolescent schizophrenia. This article reviews the use of atypical neuroleptics in children and adolescents with schizophrenic disorder. It considers the receptor binding profile and pharmacological properties, indications, side effects, clinical applications and trials of atypical neuroleptics in comparison to the classical neuroleptic haloperidol in adolescent schizophrenia. Special emphasis is placed on the most common atypical neuroleptics clozapine, olanzapine and risperidone since most studies are carried out with these compounds, especially with clozapine. More clinically controlled trials have to be conducted since only one was performed so far. The place of the atypical neuroleptics is discussed and further studies are necessary in order to differentiate the indications tested so far and to find out if the spectrum of indications can be broadened.     

Psychoanalysis and child and adolescent psychiatry.

This report describes psychoanalytic advances in theory and practice as well as changes in knowledge about determinants of behavior from infancy through adolescence. These changes influence how dynamic psychotherapy is conducted. Mother-infant research, affect development, object relations separation-individuation theory, and newer concepts of regulation of self-esteem are explored as they affect treatment strategies. The authors also review countertransference transference and psychoanalytic reconstruing of adolescence as a stage and their influence on how therapy is conducted. Finally, the authors propose using a dynamic formulation as a means of determining where or when the therapist intervenes.