ABSTRACT
Over the past 20 years increasing interest has been given to children's rights that grant special protections to children living apart from their biological parents. The Adoption Assistance and Child Welfare Act of 1980 was promulgated to prevent unnecessary removal of children from their original families and to ensure permanency when return to their families could not be secured. The psychiatrist's role in this process has been to ensure that effective interventions occur prior to the child being removed from home and that every effort is made to return the child to his or her family of origin once placement has been made. In the event that the child cannot return home, the psychiatrist can assist the court by providing grounds for termination of parental rights and by otherwise ensuring that the child's best interests are protected.
Subject(s)
Child Advocacy/legislation & jurisprudence , Foster Home Care/legislation & jurisprudence , Legal Guardians , Child , Child Welfare/legislation & jurisprudence , Expert Testimony/legislation & jurisprudence , Humans , United StatesABSTRACT
Lack of appropriate training in both public mental health service and rural mental health service is a major factor in the critical shortage of child psychiatrists in rural settings. The authors describe a residency training program in rural public mental health designed to help alleviate that shortage. The program familiarizes fourth-year residents in child psychiatry with the clinical, political, and social aspects of rural public mental health services through didactic and supervisory sessions as well as an eight-month practicum experience involving provision of inservice training and administrative and case-related consultation to staff of mental health agencies. An assessment of the program indicated that participants felt it was beneficial, but the program was only partly successful in increasing the number of child psychiatrists entering practice in rural areas. The authors urge that residency programs in child psychiatry give priority to training child psychiatrists for work in rural settings.
Subject(s)
Child Psychiatry/education , Community Mental Health Services , Internship and Residency , Public Health/education , Rural Health , Humans , Pennsylvania , WorkforceABSTRACT
Over an 11-month period on a Children's Psychiatric Unit 5% of 60 first admissions for hospitalization were apparently associated with adverse effects of psychotropic medication. Forty (66%) of the first admissions had used, prior to hospitalization, a wide variety of drugs including stimulants, major and minor tranquilizers, anticonvulsants, antidepressants and over-the-counter drugs containing antihistamines and analgesics. It is suggested that inappropriate and injudicious use of psychotropic medications may be associated with unanticipated adverse behavioral effects, which can result in deterioration of a child's functioning to the point of necessitating psychiatric hospitalization. Early identification of these unwanted psychotropic effects has diagnostic, prognostic, economic, and legal implications.
Subject(s)
Mental Disorders/drug therapy , Psychotropic Drugs/adverse effects , Adolescent , Child , Child, Preschool , Female , Hospitalization , Hospitals, Psychiatric , Humans , Male , Mental Disorders/therapyABSTRACT
Peregrinating pediatric patients are those who go from physician to physician either within hospitals or from clinic to clinic within a community. They are often the symptom bearers of dysfunctional multiproblem families requiring an interdisciplinary approach to diagnosis and management. Because of the obscure nature of the child's pediatric problems, such children are often shunned by the medical profession and other social agencies, setting in motion a sequence of events that can prove detrimental to the child, his family, the community, and the state. This article illustrates the need for an anticipatory, coordinated approach in the management of this complex psychosocial condition.
Subject(s)
Munchausen Syndrome/psychology , Parents/psychology , Child , Child Advocacy , Female , Hospitalization , Humans , Male , Maternal Behavior , Patient Care Team , Psychological TestsABSTRACT
Postencephalitic behavioral syndrome secondary to measles is an almost extinct condition in Western culture. The present paper describes the clinical state of a 13-year-old pubertal female who presented nine years after the original acute febrile illness. In addition, an innovative behavioral approach to treatment of intractable seizures and aggressive behavior is described.
Subject(s)
Child Behavior Disorders/therapy , Encephalitis/complications , Measles/complications , Patient Care Team , Adolescent , Aggression/drug effects , Anticonvulsants/therapeutic use , Brain Damage, Chronic/therapy , Child Behavior Disorders/diagnosis , Epilepsy, Temporal Lobe/therapy , Female , Haloperidol/therapeutic use , Humans , Intellectual Disability/therapy , Intelligence , Milieu Therapy , Social AdjustmentABSTRACT
The present study evaluated behavioral treatment of symptoms of depression in a 10 yr-old boy. Diagnosis of the child's depression was made on the basis of DSM-III criteria. Information was obtained from separate interviews with the child and mother and from multiple assessment instruments. Ratings from several sources (mother, psychiatrist, psychologist and staff) confirmed the diagnosis. Four behaviors that characterized the child's depression were selected for intervention and included inappropriate body position, lact of eye contact, poor speech and bland affect. Treatment, evaluated in a multiple-baseline design across symptoms, consisted of the combination of instructions, modeling, role-playing and feedback. Results indicated that behaviors characteristic of childhood depression could be reliably identified and effectively treated by behavioral techniques. Treatment effects were maintained at 12-week follow-up assessment.
Subject(s)
Behavior Therapy/methods , Depressive Disorder/therapy , Child , Depressive Disorder/psychology , Humans , Intellectual Disability/psychology , Male , Psychological Tests , Residential Treatment , Role Playing , Social Adjustment , Verbal BehaviorABSTRACT
Observations of a pediatric ward's response to the repeated hospitalization of an asthmatic child revealed a close parallel to the transactional patterns described in families of children with psychosomatic illnesses. Characteristics of such families include enmeshment, overprotectiveness, rigidity and resistance to change, lack of conflict resolution, and use of the child's sick role to relieve tension and discomfort within the family. In this article we have attempted to demonstrate the similarity of responses between these families and groups of hospital ward personnel. Resolution of the ward personnel's internal conflict was followed by changes in the coping abilities of the staff, with a successful outcome for a second child with a similar clinical condition.
Subject(s)
Attitude of Health Personnel , Medical Staff, Hospital/psychology , Pediatrics , Psychophysiologic Disorders/psychology , Asthma/psychology , Asthma/therapy , Child , Conflict, Psychological , Family , Female , Humans , Male , Sick Role , Transactional AnalysisABSTRACT
A variant of the Capgras syndrome is described in a 43-year-old woman who had vitiligo and multinodular goitre. The unusual feature of the case was that the patient not only misidentified members of her own family but also claimed that she herself had been replaced by a double.
Subject(s)
Delusions/psychology , Psychotic Disorders/psychology , Adult , Female , Goiter, Nodular/complications , Humans , Syndrome , Vitiligo/complicationsABSTRACT
Recent advances in alcohol withdrawal states are described. New concepts of classification, the development of the syndrome and its management are outlined. In the light of recent research, more optimistic results for this much maligned but common condition may be achieved.
Subject(s)
Alcoholism/therapy , Substance Withdrawal Syndrome/therapy , Adrenergic beta-Antagonists/therapeutic use , Adult , Alcoholism/drug therapy , Anti-Anxiety Agents/therapeutic use , Chlordiazepoxide/therapeutic use , Diazepam/therapeutic use , Humans , Substance Withdrawal Syndrome/drug therapy , Substance-Related Disorders/drug therapySubject(s)
Psychoses, Alcoholic/diagnosis , Adult , Female , Humans , Male , Middle Aged , Psychoses, Alcoholic/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
The results of treatment 1 year after initial contact for detoxification in a group of Black (Blacks, Cape Coloureds and Asiatics) and White male alcoholics who were referred to specialized alcoholic treatment units are described. It is concluded that unsuitable patients are sent to these units, and that more effective management should take place at the first point of contact.
Subject(s)
Alcoholism/therapy , Emergency Services, Psychiatric , Mental Health Services , Adult , Black or African American , Black People , Follow-Up Studies , Hospital Units , Humans , Male , Middle Aged , Referral and Consultation , South Africa , White PeopleABSTRACT
A study of White and Black (Black, Cape Coloured and Asiatic) male alcoholics who attended the psychiatric emergency service unit at Groote Schuur Hospital, Cape Town, is presented. The psychosocial and clinical characteristics are described and compared. In addition, the associated physical and psychiatric morbidity is tabulated.
