ABSTRACT
In the daily work of multidisciplinary teams on child and adolescent psychiatric wards team-meetings play a central role to coordinate various treatment activities. In medical literature studies on the topic are lacking, and only few articles were found. The authors explore by a descriptive-hermeneutic analysis the numerous functions of meetings for the treatment team. To them belong catharsis, containment, reflection, regulation and integration. Psychodynamic, group dynamical and institutional factors will be described regarding their influence on the therapy management. Issues of power in institutions will be comprised in the discussion. The dialectical tension between professionalism and emotionality in the work with patients especially from the borderline-spectrum as well as between unity and diversity within the treatment team in regard to the different roles of each and everyone team member will be presented. Hints at how to manage these tensions will be given to preserve the therapeutical milieu on the ward.
Subject(s)
Child Behavior Disorders/therapy , Interprofessional Relations , Mental Disorders/therapy , Patient Care Planning , Patient Care Team , Psychiatric Department, Hospital , Adolescent , Child , Child Behavior Disorders/psychology , Defense Mechanisms , Female , Humans , Male , Object Attachment , Outcome and Process Assessment, Health Care , Professional-Patient Relations , Psychoanalytic TherapyABSTRACT
Despite of the inculpatory effects of coercive measures on both patients and clinicans, only few publications regarding the influencing factors on the use of seclusion and restraint could be found. This study intended to investigate clinic- and patient-related factors which contribute to increasing und intensified incidents of seclusion and restraint. All incidents of coercive measures in a Swiss clinic during the years 2002 and 2003 were evaluated restrospectively. Data included detailed information about each coercive incident as well as patients and personnel involved. Statistics were conducted with SPSS. Adolescent age, female gender, previous experiences of violence and diagnoses of the ICD-10-category F9 and F6 were linked with high frequencies and intensive coercive interventions on the side of patient-related factors. Regarding clinic-related factors a fairly different handling could be found comparing different wards. Besides psychopathological aspects of the patients and structural characteristics of the clinic different understandings of disease-management, the nature of the therapeutic relations and environmental factors contribute to frequency, intensity and kind of coercive measures. A detailed evaluation of the use of coercive interventions can help to prevent unnecessary and incriminatory violence.
Subject(s)
Affective Symptoms/therapy , Child Behavior Disorders/therapy , Hospitals, Psychiatric , Patient Isolation/psychology , Restraint, Physical/psychology , Adolescent , Affective Symptoms/diagnosis , Affective Symptoms/psychology , Child , Child Behavior Disorders/diagnosis , Child Behavior Disorders/psychology , Coercion , Disease Management , Female , Hospitals, Psychiatric/statistics & numerical data , Humans , Male , Patient Isolation/statistics & numerical data , Power, Psychological , Professional-Patient Relations , Restraint, Physical/statistics & numerical data , Retrospective Studies , Risk Factors , Social Environment , Switzerland , Utilization Review/statistics & numerical data , Violence/prevention & control , Violence/psychologyABSTRACT
A case report describes an adolescent girl with a treatment-resistant bipolar disorder, who developed pericarditis and polyserositis while being treated with clozapine. The sparse literature about this rare, severe side effect of clozapine is discussed. Clinical recommendations with regard to monitoring are given. If myocarditis/polyserositis occurs, clozapine has to be discontinued immediately.
Subject(s)
Antipsychotic Agents/adverse effects , Bipolar Disorder/complications , Clozapine/adverse effects , Pericarditis/chemically induced , Serositis/chemically induced , Adolescent , Agranulocytosis/chemically induced , Agranulocytosis/complications , Antipsychotic Agents/therapeutic use , Bipolar Disorder/drug therapy , Clozapine/therapeutic use , Female , Humans , Pericarditis/complications , Psychiatric Status Rating Scales , Serositis/complicationsABSTRACT
In the last two decades considerable changes influenced the scope of inpatient treatment in child and adolescent psychiatry. Proceeding from a literature review dilemmas between available research data and clinical practice will be pointed out. Proposals will be made to take into account the complex developmental processes, the individuality and the social context by psychic impaired children and adolescents requiring hospitalisation. This could improve the transfer of research findings into the clinical practice. It will be argued against a confusion of economical interests with research findings.
Subject(s)
Critical Pathways , Empiricism , Hospitalization/statistics & numerical data , Length of Stay/statistics & numerical data , Mental Disorders/therapy , Adolescent , Child , Female , Follow-Up Studies , Germany , Humans , Male , Mental Disorders/epidemiology , Mental Disorders/psychology , Outcome and Process Assessment, Health CareABSTRACT
It will be largely supposed that early intervention in schizophrenia improves the outcome of the illness. The paper summarizes the up today significant knowledge about the early recognition and treatment of schizophrenic psychosis in the adolescence. It will be pointed at the diagnostic difficulties and peculiarities in this age group. A comprehensive repeated assessment is necessary if prodromal symptoms of schizophrenia respectively psychotic states have to be taken in account. It will be pleaded for a early low dosis therapy with atypical neuroleptics to prevent the "psychotic catastrophe", that means the full outbreak of the disease. The pharmacotherapy should be a part of an intensive multimodal treatment program. The longstanding continuity of the relations to one and the same treatment setting and therapist responsible for it seems to influence the outcome positively.
Subject(s)
Antipsychotic Agents/administration & dosage , Schizophrenia/drug therapy , Schizophrenic Psychology , Schizotypal Personality Disorder/drug therapy , Adolescent , Antipsychotic Agents/adverse effects , Combined Modality Therapy , Dose-Response Relationship, Drug , Female , Humans , Long-Term Care , Male , Prognosis , Schizophrenia/diagnosis , Schizotypal Personality Disorder/diagnosis , Schizotypal Personality Disorder/psychologyABSTRACT
The health system is engaged in conduct disorders by children and adolescents as they represent a psychiatric diagnosis. They come likewise under the responsibility of community services and in part even justice while they exhibit a broad spectrum of social and conduct problems. Where the activities of the institutions mentioned overlap, arise questions of competence and responsibility. According to available empirical data and clinical experiences issues of indication for inpatient treatment in child and adolescence psychiatry units, however, the difficulties how to deal with these patients will be described. Conclusions with regard to possibilities, limits and contraindications for inpatient treatment of children and adolescents with conduct disorders will be drawn.