Gender Disparities in the Child Psychiatry Ranks.

Child and adolescent psychiatry is among the top 5 medical specialties in the United States with greatest representation of women among active residents (62.5%) and of female physicians among currently practicing physicians (52.7%).1,2 (Note that our use of "gender" (women or men) and "sex" (female or male) parallels use in the referenced publications. We recognize that gender and sex are not interchangeable.) Previous studies have found women faculty physicians to be disadvantaged in attaining higher salaries, National Institutes of Health (NIH) funding, promotion, and tenure-even in majority-women specialties.3,4 Pediatrics, another specialty in which women predominate, has found a disproportionate number of women faculty in junior academic ranks.3 Furthermore, women remain a stark minority in senior-ranking leadership positions.5 To our knowledge, no previous publications have examined the proportion of women physicians at different faculty ranks in US academic child and adolescent psychiatry. In the summer of 2018, we began a search for a named/endowed professor position in child and adolescent psychiatry. Recognizing gender and racial disparities in recruitment, we conducted a comprehensive search for all child and adolescent psychiatry faculty members within the United States. We decided to use the collected data to investigate gender disparities among academic child and adolescent psychiatry physicians. We hypothesized that gender disparities would increase with child and adolescent psychiatry physicians' academic ranks, with greatest disparities among full professors. As separate points of inquiry, we explored gender distribution among division directors and named/endowed faculty.

The Creation of a Psychiatry-Palliative Care Liaison Team: Using Psychiatrists to Extend Palliative Care Delivery and Access During the COVID-19 Crisis.

CONTEXT: During the course of March and April 2020, New York City experienced a surge of a 170,000 coronavirus disease 2019 (COVID-19) cases, overwhelming hospital systems and leading to an unprecedented need for palliative care services. OBJECTIVES: To present a model for rapid palliative care workforce expansion under crisis conditions, using supervised advanced psychiatry trainees to provide primary palliative services in the acute care and emergency setting. METHODS: In response to the New York City COVID-19 surge, advanced psychiatry trainees at New York-Presbyterian Columbia University Irving Medical Center were rapidly trained and redeployed to a newly formed psychiatry-palliative care liaison team. Under the supervision of consultation-liaison psychiatrists (who also served as team coordinators), these trainees provided circumscribed palliative care services to patients and/or their families, including goals-of-care discussions and psychosocial support. Palliative care attendings remained available to all team members for more advanced and specialized supervision. RESULTS: The psychiatry-palliative care liaison team effectively provided palliative care services during the early phase and peak of New York City's COVID-19 crisis, managing up to 16 new cases per day and provided longitudinal follow-up, thereby enabling palliative care specialists to focus on providing services requiring specialist-level palliative care expertise. CONCLUSION: By training and supervising psychiatrists and advanced psychiatry trainees in specific palliative care roles, palliative care teams could more effectively meet markedly increased service needs of varying complexity during the COVID-19 crisis. As new geographic regions experience possible COVID-19 surges in the coming months, this may serve as a model for rapidly increasing palliative care workforce.

Assessment and Treatment of Anxiety Among Children and Adolescents.

Among children and adolescents, anxiety disorders are common psychiatric disorders that confer risk of comorbid psychiatric disorders and social and academic impairment. This review focuses on the assessment and treatment of anxiety disorders among children and adolescents, with attention to separation anxiety disorder, social phobia disorder (social anxiety disorder), panic disorder, and generalized anxiety disorder. Comprehensive assessment of child and adolescent anxiety disorders benefits from a multimethod approach to evaluation and diagnosis, including semistructured interviews; child and informant questionnaires; collateral information from parents, teachers, pediatricians, and school psychologists; and behavioral observations. Because anxiety symptoms can include avoidance behaviors, somatic complaints, social difficulties, and sleep disturbances, consideration of a differential diagnosis is important. Among the available psychosocial interventions, cognitive-behavioral therapy (CBT) and exposure-based therapies have emerged as the most well-established treatment approaches for addressing anxiety disorders among children and adolescents. Pharmacologically, selective serotonin reuptake inhibitors (SSRIs) have been established to be safe and efficacious for the treatment of pediatric anxiety and are considered the medications of choice for this population. Research indicates that CBT plus SSRI medication is the most effective treatment of anxiety for youths ages seven to 17, compared with either CBT or medication alone. Medication monotherapy and CBT monotherapy have also been demonstrated to be effective treatments.

Development and Mental Health of Lesbian, Gay, Bisexual, or Transgender Youth in Pediatric Practice.

Assessing, monitoring, and supporting children and adolescents' mental health are integral parts of comprehensive pediatric primary care. These are especially relevant for LGBT youth, who frequently experience unique stressors, often including having an identity different from family and peer expectations, whether to reveal it, and stigma like peer bullying, family rejection, social intolerance, and self nonacceptance. Pediatricians should know key mental health practice principles for LGBT youth, how to adapt these to various pediatric settings, the continuum of mental health interventions, and their local resources. Practice principles in pediatric care for LGBT youth and examples of their implementation are discussed.

Appropriate and judicious use of psychotropic medications in youth.

The issue of prescribing psychotropic medications is one that stirs much emotion and debate among parents and providers alike. This article is presented as a primer on the appropriate and judicious use of psychotropic medications in youth. Rather than focusing on any specific class of medications or on any clinical condition, the article presents best practices as well as key clinical pearls regarding the art and science of psychopharmacology in youth.