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Objective: To assess changes in profile of psychiatric emergencies in children and adolescents (aged <19 year) during the coronavirus disease 2019 (COVID-19) pandemic compared to pre-pandemic period. Methods: The psychiatric emergency records were analyzed for the period of April, 2019 – September, 2021 to assess the pattern and profile of mental health emergencies in children and adolescents in the period before and after the onset of the pandemic lockdown (i.e., 23 March, 2020). Results: 379 consecutive child and adolescent psychiatric emergencies were identified, of which 219 were seen after the onset of pandemic. Commonest reason for referral in the pandemic group was attempted self-harm (44.3%). The ICD-10 neurotic, stress-related and somatoform disorders constituted the commonest diagnostic category, similar to pre-pandemic period. A significantly higher proportion (44% vs 28%) of children was prescribed benzodiazepines in the pandemic period, compared to the pre-pandemic period. Conclusion: The average monthly psychiatric emergencies in children and adolescents showed no increase during the pandemic period. Self-harm was the commonest cause of psychiatric referral in emergency services mental health crisis in the younger population.
ABSTRACT
O presente estudo busca identificar as contribuições da parceria e as consequências da separação entre a psicanálise e a pedopsiquiatria. Os conceitos de narcisismo e de autoerotismo foram peças-chave para o surgimento e legitimação da pedopsiquiatria como especialidade médica distinta da psiquiatria do adulto. Em um contexto no qual o discurso psiquiátrico vigente defende um referencial essencialmente empirista em detrimento do diálogo com abordagens psicodinâmicas, verifica-se que a rejeição da psicanálise promove a desnaturação da pedopsiquiatria, já que transtornos mentais infantis são reduzidos a disfunções puramente neurológicas.
The present study seeks to identify the contributions of the partnership between psychoanalysis and Child and Adolescent Psychiatry as well as the consequences of their separation. The concepts of narcissism and autoeroticism were fundamental for the emergence and legitimation of child and adolescent psychiatry as a medical specialty distinct from adult Psychiatry. In a context in which the current psychiatric discourse defends an essentially empiricist base to the detriment of the dialogue with psychodynamic approaches, it is verified that the rejection of psychoanalysis promotes the denaturation of Child and Adolescent Psychiatry, since the child mental illness are reduced to purely neurological dysfunctions.
La présente étude a cherché à identifier les contributions du partenariat entre psychanalyse et pédopsychiatrie ainsi que les conséquences de leur séparation. Les concepts de narcisisme et de autoerotisme ont joué un rôle fondamental pour l'émergence et la legitimation de la pédopsychiatrie en tant que specialité médicale distincte de la psychiatrie de l'adulte. Dans un contexte dans lequel le discours psychiatrique actuel défend un referenciel essentielment empiriste au detriment du dialogue avec les approches psychodynamiques, nous avons vérifié que le rejet de la psychanalyse promeut la dénaturation de la pédopsychiatrie, puisque les maladies mentales infantiles sont réduites à des dysfonctionements purement neurologiques.
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Introducción: Se implementan actualmente nuevos modelos de hospitalización psiquiátrica infantojuvenil, para hacer frente a la creciente demanda de recursos de atención psiquiátrica intensiva requeridos por esta población. Objetivo: Identificar las características clínicas y demográficas de los niños y adolescentes con diagnóstico psiquiátrico hospitalizados en Salas de Pediatría de un Hospital General Pediátrico. Metodología: Estudio descriptivo, retrospectivo de corte transversal, en base a historias clínicas de 180 casos hospitalizados en el periodo enero-agosto del año 2015.Variables: Edad, sexo, procedencia, motivo de ingreso, diagnóstico psiquiátrico, tipo de patología psiquiátrica, medicación, servicio desde el cual se indicó la evaluación psiquiátrica, días de hospitalización, seguimiento y derivación. Resultados: En el periodo de estudio se identificaron 180 pacientes hospitalizados con uno o más diagnósticos psiquiátricos, de los cuales 67.2% eran del sexo femenino. La mediana de la edad fue de 13 años. De un total de 387 diagnósticos constatados, los seis diagnósticos psiquiátricos más frecuentes fueron: los diferentes tipos de maltrato infantil (42,89%), los trastornos depresivos (21,71%), los intentos suicidas (8,27%), el trastorno adaptativo (4,39%) y el trastorno por estrés post traumático (4,13%). El 56% presentó comorbilidad de dos o más diagnósticos psiquiátricos. La internación fue indicada principalmente desde las Salas de Urgencias (67,3%). El 54,4% (98/180) estuvo hospitalizado de 1 a 3 días. En el 47,2% de los casos se indicó psicofarmacoterapia. Conclusión: Se registró mayor frecuencia de diagnóstico psiquiátrico en adolescentes y en el sexo femenino. La sospecha de abuso sexual infantil representó un frecuente motivo de ingreso. Las distintas formas de maltrato Infantil, los trastornos depresivos y los intentos suicidas, al constituir los diagnósticos psiquiátricos más frecuentes, requieren parámetros de evaluación y tratamiento específicos y efectivos para su adecuado manejo multidisciplinario. Las Salas de Urgencias Pediátricas cumplen un importante rol como puerta de entrada de estos pacientes al sistema de salud y al continuum de servicios de atención a la salud mental.
Introduction: New models of child and adolescent psychiatric hospitalizations are currently being implemented to meet the growing demand for intensive psychiatric care resources required by this population. Objective: To identify the clinical and demographic characteristics of children and adolescents with psychiatric diagnosis hospitalized on the Pediatric Service of a General Pediatric Hospital. Materials and Methods: This was a descriptive, retrospective cross-sectional study, based on the clinical histories of 180 hospitalized cases during January-August of 2015. Variables: Age, sex, place of origin, reason for admission, psychiatric diagnosis, type of psychiatric pathology, medication, clinical service from which the psychiatric evaluation was initiated, hospitalization days, follow-up and referral. Results: During the study period, 180 hospitalized patients were identified with one or more psychiatric diagnoses, of which 67.2% were female. The median age was 13 years. Of a total of 387 diagnoses found, the six most frequent psychiatric diagnoses were: different types of child abuse (42.89%), depressive disorders (21.71%), suicide attempts (8.27%), adaptive disorders (4.39%) and post traumatic stress disorder (4.13%). 56% had two or more comorbid psychiatric diagnoses. The hospitalization was initiated mainly from the Emergency Department (67.3%). 54.4% (98/180) were hospitalized for 1 to 3 days. In 47.2% of cases, psychopharmacotherapy was indicated. Conclusion: There was a higher frequency of psychiatric diagnoses in adolescents and in the female sex. Suspicion of child sexual abuse represented a frequent reason for admission. The different forms of child abuse, depressive disorders and suicide attempts, as they constitute the most frequent psychiatric diagnoses, require specific and effective evaluation and treatment parameters for their adequate multidisciplinary management. The Pediatric Emergency Department plays an important role as a gateway for these patients into the health system and the mental health care services continuum.
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Resumen: El programa de Educación Médica Continua (EMC) de SOPNIA consiste en actividades científicas orientadas a la actualización permanente en Neurología y Psiquiatría de niños y adolescentes. Está dirigido a socios SOPNIA, médicos especialistas en Neurología Pediátrica, Psiquiatría de la Infancia y Adolescencia y médicos especialistas certificados de especialidades afines (1).Este programa desde el año 2014 inicia cursos de capacitación de post grado vía e-learning, ya que este sistema permite flexibilidad de tiempo, mayores oportunidades para acceso, favorece el desarrollo de competencias y destrezas específicas como el estudio autorregulado, con una modalidad 100% on-line a través de nuestra plataforma vía página web de SOPNIA. Se analiza experiencia realizada Palabras clave: educación médica continua, Psiquiatría infantil, Neurología pediátrica, curso e-learning, educación en página web.
The continued medical education program (EMC) of SOPNIA consists of scientific activities aimed at updating physicians on pediatric neurology and psychiatry. It is aimed at SOPNIA members, specialists in pediatric neurology, child and adolescent psychiatry and certified physicians of related medial specialties.Since 2014, this program began graduate training via e-learning, for this system allows time flexibility, greater access opportunity, favors the development of specific skills and competencies such as self-regulated study, with a 100% online mode through our platform via SOPNIA website. We analyze our experience.Key words: continued medical education, child and adolescent psychiatry, pediatric neurology, e-learning, online education, website education
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OBJECTIVE: The purpose of this study was to examine the validity and reliability of the Korean Comprehensive Scale for the Assessment of Challenging Behavior in Developmental Disorders (K-CSCB). METHODS: In total, the parents of 189 patients with autism spectrum disorder (ASD) and 168 controls completed the K-CSCB, the Behavior Problems Inventory (BPI) and Child Behavior Checklist (CBCL). The reliability and validity of the K-CSCB was investigated. RESULTS: The K-CSCB was found to be a reliable instrument (Cronbach's α=0.97). There was a significant difference between the ASD and control groups in all subscale scores. Scores on the K-CSCB subscales were significantly correlated with those on the BPI and CBCL. The diagnostic validity was 97.7%, and the cut-off score with the highest sensitivity and specificity was 12.5 points. CONCLUSION: The K-CSCB is the first tool in Korean to assess problematic behavior in individuals with ASD, and this study shows that it is a valid and reliable instrument. We expect the K-CSCB to be widely used in clinical and research settings.
Subject(s)
Child , Humans , Autism Spectrum Disorder , Autistic Disorder , Checklist , Child Behavior , Neurodevelopmental Disorders , Parents , Psychometrics , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
Japan has been facing a serious shortfall of child and adolescent psychiatric workforce relative to increasing service needs. Likely because of a combination of limited workforce supply and limited trust or perception of effectiveness, mental health services are under-utilized by the educational and child welfare systems. Child and adolescent psychiatry (CAP) has not been a formally established specialty in Japan. The lack of basic structure in the specialty most likely contributes to a lack of training facilities, limited exposure to and interest in the specialty, and hence an inadequate workforce. To date, there exists no standardized training program for CAP in Japan and each training hospital determines its own teaching curriculum and training content. Clinical experience in CAP varies greatly among hospitals. To solve current problems in child and adolescent psychiatry in Japan, we advocate for the development and establishment of a more standardized child and adolescent psychiatry training system that is akin to what exists in the US and that teaches and evaluates according to specific competencies. Through standardizing care and education and ultimately improving workforce, the quality of mental health services can be raised. The tragic and costly consequences of unidentified and untreated mental illness in youth can be avoided by taking timely evidence based actions in partnership with others.
Subject(s)
Adolescent , Adolescent , Child , Humans , Adolescent Psychiatry , Child Welfare , Curriculum , Education , Japan , Mental Health ServicesABSTRACT
Japan has been facing a serious shortfall of child and adolescent psychiatric workforce relative to increasing service needs. Likely because of a combination of limited workforce supply and limited trust or perception of effectiveness, mental health services are under-utilized by the educational and child welfare systems. Child and adolescent psychiatry (CAP) has not been a formally established specialty in Japan. The lack of basic structure in the specialty most likely contributes to a lack of training facilities, limited exposure to and interest in the specialty, and hence an inadequate workforce. To date, there exists no standardized training program for CAP in Japan and each training hospital determines its own teaching curriculum and training content. Clinical experience in CAP varies greatly among hospitals. To solve current problems in child and adolescent psychiatry in Japan, we advocate for the development and establishment of a more standardized child and adolescent psychiatry training system that is akin to what exists in the US and that teaches and evaluates according to specific competencies. Through standardizing care and education and ultimately improving workforce, the quality of mental health services can be raised. The tragic and costly consequences of unidentified and untreated mental illness in youth can be avoided by taking timely evidence based actions in partnership with others.
Subject(s)
Adolescent , Adolescent , Child , Humans , Adolescent Psychiatry , Child Welfare , Curriculum , Education , Japan , Mental Health ServicesABSTRACT
When in need of medical treatment, Korean citizens have a choice of practitioners of western medicine (WM) or Traditional Korean Medicine (TKM). However, the two branches frequently conflict with one another, particularly with regard to mental disorders. This study was designed to compare the utilization of WM and TKM, focusing on child/adolescent patients with mental disorders. We analyzed F-code (Mental and behavioral disorders) claims from the Korean Health Insurance Review and Assessment Service, including data from 0-18-year-old patients from 2010 to 2012. Slightly more men than women utilized WM, while TKM use was almost evenly balanced. WM claims increased with advancing age, whereas utilization of TKM was common for the 0-6 age group. In WM and TKM, the total number of claims relying on the National Health Insurance Service (NHIS) was 331,154 (92.78%) and 73,282 (97.85%), respectively, and the number of claims relying on medical aid was 25,753 (7.22%) and 1,610 (2.15%), respectively. The most frequent F-coded claim in WM was F90 (Hyperkinetic disorders), with 64,088 claims (17.96%), and that in TKM was F45 (Somatoform disorders), with 28,852 claims (38.52%). The prevalence of a single disorder without comorbidities was 168,764 (47.29%) in WM and 52,615 (70.25%) in TKM. From these data, we conclude that WM takes prevalence over TKM in cases of attention deficit/hyperactivity disorder (ADHD), as well as in psychological problems such as depression and anxiety. On the other hand, patients utilizing TKM more commonly present with physical health problems including somatoform problems, sleep, and eating disorders.
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Attention Deficit Disorder with Hyperactivity/epidemiology , Cognitive Behavioral Therapy , Databases, Factual , Demography , Incidence , Insurance Claim Reporting , Medicine, Korean Traditional , Mental Disorders/epidemiology , Republic of Korea , Social ClassABSTRACT
Se realizó un estudio observacional, descriptivo y transversal en el Hospital Infantil Norte Docente "Dr. Juan de la Cruz Martínez Maceira" de la provincia de Santiago de Cuba en el 2010, a fin de describir los factores relacionados con la conducta suicida en 26 de 31 adolescentes de 11 a 17 años, atendidos en dicha institución durante ese período. Se halló que el grupo más afectado fue el de 14-15 años, con primacía del sexo femenino. Entre los factores de riesgo predominantes figuraron, por citar los principales en la casuística: los maltratos físicos y psicológicos como las humillaciones efectuadas por los propios padres; la falta de redes de apoyo familiar en la mayoría de ellos; la ausencia de solución de sus problemas; la ingestión de medicamentos para suicidarse, fundamentalmente psicofármacos, así como la depresión y el consumo de alcohol como antecedentes patológicos familiares.
An observational, descriptive and cross sectional study was carried out in "Dr. Juan de la Cruz Martínez Maceira" Teaching Northern Pediatric Hospital from Santiago de Cuba province in 2010, in order to describe the factors related to the suicidal behavior in 26 of 31 adolescents from 11 to 17 years, assisted in this institution during that period. It was found that the most affected group was that of 14-15 years, with prevalence of the female sex. Among the predominant risk factors there were, as the main ones in the case material: the physical and psychological abuses as the humiliations carried out by parents; the lack of family support groups in most of them; the absence of solution to their problems; the drugs ingestion to commit suicide, fundamentally psychodrugs, as well as depression and the alcohol consumption as family pathological history.
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Se destaca el rol de la epidemiología evolutiva científica para la comprensión de las causas de trastornos psiquiátricos, factores de riesgo, estrategias preventivas y monitoreo de eficacia de los tratamientos. Se resumen estudios de edad de comienzo de los trastornos psiquiátricos, factores de riesgo y protectores, causas de trastornos y solución de controversias acerca de cambios seculares en la prevalencia. Se destacan aspectos que deben tomarse en cuenta en investigaciones futuras.
The role of developmental scientific epidemiology in understanding causes and risk for psychiatric disorders, proposing preventive strategies and monitoring treatment efficacy is stressed. Studies of age of onset of disorders, risk and protective factors, causal research, solving controversies about secular changes in prevalence are summarized. Aspects that need to be highlighted in future developments are outlined.
Subject(s)
Humans , Child , Adolescent , Adolescent Psychiatry , Child Psychiatry , Developmental Disabilities/epidemiology , Epidemiologic Studies , Mental Disorders/epidemiology , Age Factors , Biological Evolution , Risk FactorsABSTRACT
The aims of this revision is to update information on epidemiology of child and adolescent psychiatric disorders, including studies done in Spanish speaking and Latin American countries. Current points of view and evidence for transcultural validity of nosological constructs in child and adolescent psychiatry are reviewed. Evidence derived from structured interviews and combined categorical and dimensional approaches are shown. Prevalence reports vary from five to 22 percent, depending on the methodology, type of interview, sample and inclusion of impairment criteria. A national study was done in Great Britain, showing 9, 7 percent prevalence. In the USA, there are several regional and some collaborative studies, and a national study of adolescents has started. In Puerto Rico, a prevalence of l9,8 percent was reported, which was adjusted to 6, 9 percent adding impairment criteria. In Taubaté, Brazil, 12,7 percent full diagnoses and 3,5 percent) sub-syndromatic diagnoses were found. In México City, 39,9 percent psychiatric disorders were reported, » of which were mild, II moderate and 1/5 severe. In Chile, a study in Santiago schoolchildren showed 15, 7 percent>, measured by a clinical interview using ICD-10 syndromatic and impairment criteria. Co morbidity studies are commented. Usefulness of epidemiology in studying prevalence, health burden, service needs, use and barriers to care is summarized. The importance of having this type of information for the design of preventive and treatment programmers is analyzed.
El objetivo de esta revisión es actualizar la información sobre epidemiología de trastornos psiquiátricos en niños y adolescentes, incluyendo estudios realizados en países de habla hispana y latinoamericanos. Se revisan los puntos de vista actuales y la evidencia de validez transcultural de los constructos nosológicos en psiquiatría del niño y adolescentes. Se muestra la evidencia surgida de entrevistas estructuradas y de enfoques combinados dimensionales/categoriales. Las cifras de prevalencia varían entre 5 a 22 por ciento, dependiendo de la metodología, tipo de entrevista, muestras e inclusión del criterio de discapacidad. Un estudio a nivel nacional efectuado en la Gran Bretaña, mostró 9,7 por ciento de trastornos psiquiátricos en niños y adolescentes. En EE UUse han efectuado varios estudios regionales, algunos colaborativos, y se ha iniciado el primer estudio nacional en adolescentes. En Puerto Rico se reportó una prevalencia de 19, 8 por ciento, que se ajustó a 6,9 por ciento al añadir el criterio de impedimento. En Taubaté, Brazil, se encontraron 12,7 por ciento de diagnósticos completos y 3,5 por ciento subsindromaticos. En Ciudad de México se informó un 39,9 por ciento) de trastornos psiquiátricos, » de los cuales eran leves, la 1/2 moderados y 1/5 graves. En Chile, un estudio de niños escolares de Santiago mostró 15,7 por ciento de prevalencia, medida con una entrevista clínica y utilizando criterios CIE-10 sindromáticos y de impedimento. Se resume la utilidad de la epidemiología para estudiar la prevalencia, carga de salud, necesidad y uso de servicios. Se comenta la importancia de contar con este tipo de información para diseñar programas de prevención y tratamiento.
Subject(s)
Humans , Male , Adolescent , Female , Child , Adolescent Psychiatry , Child Psychiatry , Mental Disorders/epidemiology , PrevalenceABSTRACT
Intensive short stay psychiatric hospitalization modality within a private general hospital is discussed as a part of a continuum of care for severe cases undergoing a decompensation of their illness. Diagnosis and treatment of 38 children and adolescents is described. Results and follow up are reported. All acute crisis were resolved and some new diagnoses were formulated. Patients received treatment for their acute symptoms, and started treatment for their core disorders. Coordinations for continuation of ambulatory treatment were implemented. Lessons learned from the experience and implications for future treatment programs are discussed.
Se analiza una modalidad de tratamiento intensivo de hospitalización psiquiátrica de corta estadía en un hospital general privado, como una parte del tratamiento de casos graves que están sufriendo una descompensación de su enfermedad. Se describe el diagnóstico y tratamiento de 38 niños y adolescentes. Se informan los resultados y el seguimiento. Todas las crisis agudas fueron resueltas y se formularon algunos diagnósticos nuevos. Los pacientes recibieron tratamientos para sus síntomas agudos e iniciaron tratamientos para sus enfermedades de base. Se implementaron coordinaciones para la continuación del tratamiento ambulatorio. Las lecciones aprendidas de la experiencia y sus implicaciones para planes de tratamiento futuros son discutidas.
Subject(s)
Humans , Adolescent , Child , Critical Care/methods , Hospitals, Private , Psychotherapy, Brief , Mental Disorders/diagnosis , Mental Disorders/therapy , Acute Disease , Adolescent Psychiatry , Child Psychiatry , Follow-Up Studies , Hospitalization , Length of Stay , Outcome and Process Assessment, Health Care , Patient Care Team , Psychiatric Department, Hospital , Treatment OutcomeABSTRACT
Although the scientific evidence is not entirely supportive, atypical antipsychotics have been used widely for the treatment of children and adolescents with mental illnesses as alternatives to typical antipsychotics which have more serious unwanted adverse effects than atypical neuroleptics. On the basis of clinical experiences and research data, atypical antipsychotics have been prescribed for adolescents with schizophrenia, manic or mixed episodes of bipolar disorders, tic disorders, aberrant behaviors in pervasive developmental disorders, and impulsive or violent behaviors in disruptive behavior disorders. Due to their efficacy and relatively more tolerable side effects, the use of atypical antipsychotics has become increasingly popular in child and adolescent psychiatry. However, we should pay attention to the limitations associated with short-term clinical experiences and the lack of well-designed controlled studies, especially in terms of adverse effects including those involving metabolic processes.
Subject(s)
Adolescent , Child , Humans , Adolescent Psychiatry , Antipsychotic Agents , Bipolar Disorder , Mental Disorders , Schizophrenia , Tic DisordersABSTRACT
Today, one in ten children and adolescents suffers from mental illness severe enough to result in significant functional impairment. Children and adolescents with mental disorders are at much greater risk for dropping out of school and suffering longterm impairments. There are growing interests to explore the neurobiological etiology of child and adolescent psychiatric disorder. Here we will provide recent advances in neuroscientific approach to the research in child and adolescent psychiatry; 1) Animal Model Study in Child and Adolescent Psychiatric disorder, 2) Latest Updates on Molecular Genetics and Pharmacogenomic Study in Child and Adolescent Psychiatric Field 3) An update on Neuroimaging Study in Child and Adolescent Psychiatric disorder, and 4) The Present and the Future on Clinical Neuropsychopharmacology in Child and Adolescent Psychiatric Field.
Subject(s)
Adolescent , Adolescent , Child , Humans , Adolescent Psychiatry , Mental Disorders , Models, Animal , Molecular Biology , Neuroimaging , NeurosciencesABSTRACT
In studying child and adolescent psychiatry (CAP), animal models are extremely useful to explore the pathogenesis of disorders or to experiment drugs as substitutes for the human body. Particularly in young children, the accuracy of their expression can be low and there are many restrictions in experiments directly upon the patients including difficulties in medication and tests. However, it is not easy to develop animal models because standards for diagnosis are phenomenological and based on behavioral descriptions. The biggest problem in research using animal models in CAP is that it is difficult to make representative models specific to each disorder. The present study reviewed articles about research with animal models in connection to disorders common in CAP such as autism , Tourette syndrome (TS), attention deficit/hyperactivity disorder (ADHD) and mental retardation (MR). Recent researches through animal models are mainly focused on anatomical studies on sites related to disorders and genetic studies. Although there have been many researches for autism, they still seem to be away from establishing representative models. For TS, it is not easy to make specific animal models because of the complexity of the syndrome, but animal models have been greatly helpful to find pathogenesis and develop remedies for TS. In ADHD, Spontaneously Hypertensive Rats (SHR) model is recognized as a fine model. With regard to MR, a majority of studies are gene researches related to known abnormal chromosomes. Throughout this review, authors recognized that only few articles have been published using animal models for CAP in Korea. We hope that research using animal models will be more activated in Korea.