RESUMO
The practice of child and adolescent psychiatry is evolving during an unprecedented global health catastrophe, the coronavirus disease 2019 (COVID-19) pandemic. As child and adolescent psychiatrists grapple with COVID-19's enormous medical, educational, social, and economic toll, a mental health crisis is co-occurring. Pre-existing disparities are recognized as contributors to the disproportionate impact of the COVID-19 pandemic on racial and ethnic minorities.1 The magnitude of COVID-19's effects on child and family mental health has yet to be fully revealed. child and adolescent psychiatrists are in a unique position to address this mental health crisis. Child and adolescent psychiatrists must stay up-to-date regarding federal, state, local, and institutional mandates, regulations, and policies informed by the Centers for Disease Control and Prevention2 and other public health institutions, while also navigating the ethical dilemmas unique to child and adolescent psychiatry during the coronavirus era.
Assuntos
Psiquiatria do Adolescente/ética , COVID-19/psicologia , Psiquiatria Infantil/ética , Saúde Mental , Pandemias , Adolescente , Criança , Saúde da Família , Disparidades nos Níveis de Saúde , HumanosRESUMO
COVID-19 is a multi-organ disease due to an infection with the SARS-CoV2 virus. It has become a pandemic in early 2020. The disease appears less devastating in children and adolescents. However, stress, quarantine and eventually mourning have major impacts on development. It is difficult to describe what this pandemic implies for a child psychiatrist, other than by giving a first-hand account. I propose to go through the main ethical questions that have arisen; to describe how my hospital team has reorganized itself to meet the new demands and questions, in particular by opening a unit dedicated to people with autism and challenging behaviors affected by COVID-19; and to address, in a context of national discussion, how the discipline has sought to understand the conditions of a certain well-being during quarantine. Finally, I will try to conclude with more speculative reflections on re-opening.
Assuntos
Psiquiatria do Adolescente , Atitude do Pessoal de Saúde , Transtorno Autístico/terapia , Betacoronavirus , Psiquiatria Infantil , Infecções por Coronavirus , Pandemias , Pneumonia Viral , Psiquiatria , Adolescente , Comportamento do Adolescente , Psiquiatria do Adolescente/ética , Transtorno Autístico/complicações , Transtorno Autístico/psicologia , COVID-19 , Criança , Comportamento Infantil , Psiquiatria Infantil/ética , Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Infecções por Coronavirus/transmissão , Infecção Hospitalar/complicações , Infecção Hospitalar/psicologia , Infecção Hospitalar/terapia , Exposição Ambiental , França , Acessibilidade aos Serviços de Saúde , Reestruturação Hospitalar , Unidades Hospitalares/organização & administração , Humanos , Controle de Infecções/métodos , Serviços de Saúde Mental/ética , Serviços de Saúde Mental/organização & administração , Transtornos do Olfato/etiologia , Transtornos do Olfato/psicologia , Pandemias/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde , Equipe de Assistência ao Paciente , Isolamento de Pacientes/psicologia , Ludoterapia , Pneumonia Viral/complicações , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Pneumonia Viral/transmissão , Prática Profissional/ética , Equipamentos de Proteção , Fatores de Risco , SARS-CoV-2 , Estresse Psicológico/etiologiaAssuntos
Psiquiatria do Adolescente/ética , Psiquiatria do Adolescente/legislação & jurisprudência , Psiquiatria Infantil/ética , Psiquiatria Infantil/legislação & jurisprudência , Conflito Psicológico , Ética Médica , Transtornos Mentais/tratamento farmacológico , Uso Off-Label/ética , Uso Off-Label/legislação & jurisprudência , Psicotrópicos/efeitos adversos , Psicotrópicos/uso terapêutico , Políticas de Controle Social , Adolescente , Antipsicóticos/efeitos adversos , Antipsicóticos/uso terapêutico , Criança , Aprovação de Drogas/legislação & jurisprudência , Alemanha , Humanos , Fatores de Risco , Esquizofrenia/tratamento farmacológicoRESUMO
Physical deformities may cause psychological stress and lead to psychological disorders in children and adolescents. On the other hand, the correction of non-pathological conditions is a legal issue in patients unable to consent, a group that is partly made up of minors. This article provides an overview on available evidence on the psychological consequences of physical deformities, psychiatric contraindications for plastic surgery due to psychological disorders, and on the issue of minors' ability to consent.
Assuntos
Psiquiatria do Adolescente , Atitude do Pessoal de Saúde , Psiquiatria Infantil , Anormalidades Congênitas/psicologia , Anormalidades Congênitas/cirurgia , Procedimentos de Cirurgia Plástica , Psicoterapia , Adolescente , Psiquiatria do Adolescente/legislação & jurisprudência , Transtornos Dismórficos Corporais/diagnóstico , Transtornos Dismórficos Corporais/psicologia , Criança , Psiquiatria Infantil/ética , Psiquiatria Infantil/legislação & jurisprudência , Alemanha , Humanos , Consentimento Livre e Esclarecido/ética , Consentimento Livre e Esclarecido/legislação & jurisprudência , Consentimento Livre e Esclarecido/psicologia , Menores de Idade/psicologia , Consentimento dos Pais/ética , Consentimento dos Pais/legislação & jurisprudência , Consentimento dos Pais/psicologia , Psicoterapia/ética , Procedimentos de Cirurgia Plástica/éticaRESUMO
Epigenetics has the potential to revolutionize diagnosis and treatment in psychiatry, especially child psychiatry, as it may offer the opportunity for early detection and prevention, as well as development of new treatments. As with the previous introduction of genetic research in psychiatry, there is also the problem of unrealistic expectations and new legal and ethical problems. This article reviews the potential contributions and problems of epigenetic research in child psychiatry. Previous legal and ethical issues in genetic research serve as a guide to those in epigenetic research. Recommendations for safeguards and guidelines on the use of epigenetics with children and adolescents are outlined based on the identified issues.
Assuntos
Psiquiatria Infantil/ética , Psiquiatria Infantil/legislação & jurisprudência , Epigenômica/ética , Epigenômica/legislação & jurisprudência , Adolescente , Criança , Ética em Pesquisa , Humanos , Princípios Morais , Pesquisa/legislação & jurisprudênciaAssuntos
Psiquiatria do Adolescente , Psiquiatria Infantil , Guias de Prática Clínica como Assunto , Psicologia do Adolescente , Psicologia da Criança , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa/normas , Adolescente , Psiquiatria do Adolescente/ética , Criança , Psiquiatria Infantil/ética , Consenso , Difusão de Inovações , Ética em Pesquisa , Medicina Baseada em Evidências/ética , Fidelidade a Diretrizes , Humanos , Psicologia do Adolescente/ética , Psicologia da Criança/ética , Ensaios Clínicos Controlados Aleatórios como Assunto/ética , Reino UnidoAssuntos
Psiquiatria Infantil/ética , Ética Médica , Transtornos Mentais/terapia , Relações Médico-Paciente/ética , Psicoterapia/ética , Adolescente , Criança , Fidelidade a Diretrizes , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/psicologia , Relações Profissional-Família , Comportamento Social , Meio Social , Transferência Psicológica , Estados UnidosRESUMO
Depression is a common, recurring disorder affecting millions of youth at some point before they reach mature adulthood. Given the shortage of and uneven distribution of psychiatrists who have completed specialized fellowships in child and adolescent psychiatry, a significant number of depressed youth will receive their pharmacotherapy from general psychiatrists and other prescribers with varying degrees of interest, training, and even willingness to treat children and adolescents. For general psychiatrists who will prescribe antidepressants for minors, knowledge of the training and expertise of nonphysician mental health professionals, the psychotherapies they may employ, and familiarity with school services are essential. Physicians who typically work only with adults will also need familiarity with differing ethical, legal, and regulatory issues and standards applicable to pediatric psychopharmacology. General psychiatrists, pediatricians, family physicians, nurse practitioners, and others contribute greatly to the care of depressed children, adolescents, and their families, and many find this work to be a very rewarding part of their professional practices.
Assuntos
Psiquiatria do Adolescente/ética , Antidepressivos/uso terapêutico , Psiquiatria Infantil/ética , Transtorno Depressivo/terapia , Serviços de Saúde Mental/organização & administração , Encaminhamento e Consulta , Adolescente , Psiquiatria do Adolescente/educação , Psiquiatria do Adolescente/métodos , Adulto , Criança , Psiquiatria Infantil/educação , Psiquiatria Infantil/métodos , Terapia Cognitivo-Comportamental , Transtorno Depressivo/epidemiologia , Prescrições de Medicamentos/estatística & dados numéricos , Terapia Familiar , Feminino , Acessibilidade aos Serviços de Saúde , Humanos , Consentimento Informado por Menores/ética , Masculino , Serviços de Saúde Mental/provisão & distribuição , Uso Off-Label/ética , Assistência Religiosa , Áreas de Pobreza , Psicoterapia , População Rural , Serviços de Saúde Escolar/organização & administração , Instituições Acadêmicas , Serviço Social , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Genetic and neurobiological research into the causes of antisocial behaviour is playing an increasingly important role in forensic psychiatry. AIM: To contribute some ethical and societal reflections on the possible consequences of this kind of research for the prevention of antisocial behaviour. METHOD: In this ethical analysis, which gives attention to the concepts of 'informed consent' and 'best interests', we investigate which persons and which interests need to be taken into account when new preventive measures are implemented. RESULTS: It is important to differentiate between distinct target groups. From an ethical point of view it makes a difference whether measures are related to the early identification of a-symptomatic high-risk children and appropriate preventive interventions, or whether they are directed towards the (sub)typing and preventive treatment of children who already have behavioural problems or whether they are concerned with the treatment of children with conduct disorders whose parents have asked the child psychiatrist for assistance. CONCLUSION: From an ethical point of view it is not really important whether prevention measures are based on genetic and neurobiological research or on societal and psychological research. What is more important is that these measures target particular groups of children and that prevention is implemented in an appropriate manner.
Assuntos
Transtorno da Personalidade Antissocial/prevenção & controle , Comportamento Infantil , Psiquiatria Infantil/ética , Psiquiatria Infantil/métodos , Transtorno da Personalidade Antissocial/genética , Transtorno da Personalidade Antissocial/psicologia , Criança , HumanosRESUMO
OBJECTIVE: To determine whether there is evidence of a time-lag bias in the publication of pediatric antidepressant trials. METHOD: We conducted a meta-analysis of published and unpublished randomized placebo-controlled trials of serotonin reuptake inhibitors (SRIs) in subjects less than 18 years of age with major depressive disorder. Our main outcomes were (1) time to publication of positive versus negative trials, and (2) proportion of treatment responders in trials with standard (<3 years after study completion) versus delayed publication. RESULTS: We identified 15 randomized, placebo-controlled trials of SRIs for pediatric depression. Trials with negative findings had a significantly longer time to publication (median years ± standard deviation = 4.2 ± 1.9) than trials with positive findings (2.2 ± 0.9; log-rank χ(2) = 4.35, p = .037). The estimated efficacy in trials with standard publication time (number needed to treat = 7, 95% CI = 5-11) was significantly greater than those with delayed publication (17, 95% CI = 9-∞; χ(2) = 4.98, p = .025). The inflation-adjusted impact factor of journals for published trials with positive (15.33 ± 11.01) and negative results (7.54 ± 7.90) did not statistically differ (t = 1.4, df = 10, p = .17). CONCLUSIONS: Despite a small number of trials of SRIs for pediatric antidepressants, we found a significant evidence of time-lag bias in the publication of findings. This time-lag bias altered the perceived efficacy of pediatric antidepressants in the medical literature. Time-lag bias is not unique to child psychiatry and reflects a larger problem in scientific publishing.
Assuntos
Transtorno Depressivo Maior/tratamento farmacológico , Viés de Publicação , Editoração , Ensaios Clínicos Controlados Aleatórios como Assunto/economia , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , Adolescente , Criança , Psiquiatria Infantil/ética , Custos de Medicamentos , Humanos , Fator de Impacto de Revistas , Avaliação de Resultados em Cuidados de Saúde , Editoração/economia , Editoração/ética , Projetos de Pesquisa , Fatores de Tempo , Resultado do TratamentoRESUMO
The details of the implementation of early prevention in child mental health in France have been at the heart of a debate between the defenders of a universal approach and the proponents of an approach targeting specific populations. The universal approach draws on various aspects of mother and child care and early childhood care offering considerate and expressive prevention based on a relationship of trust developed over time between professionals, parents and children. The targeted approach is based on the development of programs aimed at identifying vulnerable or at-risk populations. The ethical issues raised by targeted strategies are presented and discussed. The study highlights the difficulty of distinguishing between the social, educational, medical and psychological issues raised by early prevention.
Assuntos
Transtornos do Comportamento Infantil/prevenção & controle , Serviços de Saúde da Criança , Psiquiatria Infantil/ética , Delinquência Juvenil/prevenção & controle , Criança , Transtornos do Comportamento Infantil/psicologia , Orientação Infantil , França , Humanos , Serviços de Saúde MentalRESUMO
What is the right and good action in dealing with young patients in child and adolescent psychiatry? To answer this question, we have to consider professional standards, legal rules, and ethical reflections. With reference to the latter, four bioethical principles were proposed by Beauchamp and Childress to identify and to deal with ethical problems and conflicts. On the basis of this scheme we reflect on the legal aspects and discuss the following topics: (1) self-determination of adolescents concerning their own psychiatric treatment, (2) conflicts between autonomy and care, which occur relatively often, whenever restrictions to personal liberty are indicated, and (3) admission of adolescents in adult psychiatric wards. The bioethical principles facilitate a reliable decision-making process in individual cases. The standards of right and good action have to be implemented in the field of distributive justice. We find evidence that prioritization decisions for inpatient admission are already established in German child and adolescent psychiatry.
Assuntos
Psiquiatria do Adolescente/ética , Psiquiatria Infantil/ética , Ética Médica , Transtornos Mentais/terapia , Direitos do Paciente/ética , Autonomia Pessoal , Adolescente , Psiquiatria do Adolescente/legislação & jurisprudência , Adulto , Fatores Etários , Criança , Psiquiatria Infantil/legislação & jurisprudência , Internação Compulsória de Doente Mental/legislação & jurisprudência , Confidencialidade/ética , Confidencialidade/legislação & jurisprudência , Alemanha , Número de Leitos em Hospital , Humanos , Tempo de Internação/legislação & jurisprudência , Transtornos Mentais/diagnóstico , Transtornos Mentais/psicologia , Notificação aos Pais/ética , Notificação aos Pais/legislação & jurisprudência , Admissão do Paciente/legislação & jurisprudência , Direitos do Paciente/legislação & jurisprudência , Unidade Hospitalar de Psiquiatria/ética , Unidade Hospitalar de Psiquiatria/legislação & jurisprudênciaRESUMO
Although culture has long been recognized as having a significant impact on human development and its variations, many child and adolescent psychiatrists and mental health clinicians assume a universal nonvariance to normal development, with the risk of identifying variations as pathologic. This article reviews the conceptual basis for the role of culture in human development, particularly psychosocial and cognitive development, presents evidence and support from field observations of children in diverse cultures, and discusses the emerging evidence from the field of cultural neuroscience. Implications for these different perspectives on future research, childhood education, and even intercultural relations are presented.