Catatonia in a 10-year-old boy with early childhood neglect and disruptive behaviours in psychiatric residential treatment.

Catatonia is a rare medical condition that can be fatal in paediatric patients if left untreated. It is often misdiagnosed or underdiagnosed. There are no published cases of catatonia in traumatised children living in long-term psychiatric care. However, there is some evidence that childhood maltreatment in its variant forms may be a risk for the development of catatonia in children and adolescents. In this case, a 10-year-old boy with intrauterine exposure to alcohol and multiple drugs and early childhood deprivation, developed neuroleptic-induced catatonia in an intensive psychiatric residential treatment centre approximately 24 hours after receiving a first-time intramuscular injection of haloperidol 5 mg for acute agitation. He had no known predisposing factors for catatonia such as psychosis, autism, neurological or general medical problems. This 10-year-old child's early childhood trauma should be considered as a predisposing factor for catatonia.

Virginia Tech as a Sentinel Event: The Role of Psychiatry in Managing Emotionally Troubled Students on College and University Campuses.

This article reviews the role of psychiatry in colleges and universities, and argues that psychiatrists are significantly underutilized as consultants and educators in managing emotionally troubled students. Focusing on the 2007 Virginia Tech mass shooting case as a sentinel event, the article outlines mental health issues facing post-secondary institutions and legal issues related to psychiatric services, including the following: the increased need for psychiatric services on campus; communication challenges among campus groups involved in managing high-risk students; efforts to balance patient confidentiality with public safety; confusion over privacy laws; and the changing role of the campus psychiatrist. An important conclusion is that psychiatrists working in campus settings have distinctive, vital skill sets that enable them to go far beyond their traditional roles of psychiatric evaluation and treatment and to serve in critical leadership, educational, and consultative capacities to benefit both emotionally troubled students and the wider campus community.

The evolution of public psychiatry fellowships.

OBJECTIVE: The growth of Public Psychiatry Fellowships (PPFs) has reached a new developmental stage, providing a wide array of academic partnerships and educational opportunities in psychiatric leadership and administration. The authors examine the evolution of these programs and illustrate three distinct models. METHODS: Data from yearly surveys and discussions with PPF directors were used to identify key similarities and areas of divergence as the programs have evolved. RESULTS: The first period of program expansion took place 8-10 years ago when new programs were modeled on the Columbia PPF, and key elements of that program and the American Association of Community Psychiatrists (AACP) guidelines were incorporated broadly. Examples of multiple source (Columbia), single source (Yale and UCSF), and grant-funded programs (Alabama and UCSD) are presented. CONCLUSIONS: A review of the current status of PPFs reveals a diversity of structures and strategies for success, which can be attributed to the range of their funding sources. The advantages and potential disadvantages of those models are outlined with respect to the educational experience and opportunities for growth and sustainability.

Public psychiatry fellowships: a developing network of public-academic collaborations.

In response to the expanding public behavioral health care system, a network of 15 public-community psychiatry fellowships has developed over the past six years. The fellowship directors meet yearly to sustain and develop fellowships to recruit and retain psychiatrists in the public sector. This column describes five types of public-academic collaborations on which the fellowships are based. The collaborations focus on structural and fiscal arrangements; recruitment and retention; program evaluation, program research, and policy; primary care integration; and career development. These collaborations serve to train psychiatrists who will play a key role in the rapidly evolving health care system.

Screening for risk factors associated with violence in pediatric patients presenting to a psychiatric emergency department.

OBJECTIVE: This exploratory study was a chart review that examined whether risk factors for violence were adequately reported in 425 pediatric patients assessed by psychiatry residents in a psychiatric emergency room. RESULTS: Overall, psychiatric residents rarely documented asking about important risk factors such as gun access, gang affiliation, history of police contact, and domestic violence; however, high rates of positive endorsement were found when queries concerning risk factors were documented in the chart. Despite being the most common method of homicide/suicide in youth, gun access was assessed by residents in only 3% of patients. Domestic violence was endorsed as positive 100% of the time when it was documented. Pediatric patients presenting with violence were more likely to be screened for past violence than those with suicide and other complaints. Males were more likely to have a history of prior violence. CONCLUSIONS: Most psychiatric residents failed to document thorough risk assessments for violence in pediatric patients in an emergency setting. This has important medical-legal and treatment planning implications.