Education on the Social Determinants of Mental Health in Child and Adolescent Psychiatry Fellowships.

OBJECTIVE: This article describes survey results from child and adolescent psychiatry (CAP) fellowship program directors regarding attitudes of their programs' capacity to effectively educate fellows on the social determinants of mental health and program directors' perceived importance of doing so. METHODS: A survey asking about six topics within the social determinants of mental health was disseminated to all CAP program directors with email addresses found in the Fellowship and Residency Electronic Interactive Database (FREIDA) (n = 134). Data were exported using the Qualtrics survey platform. RESULTS: Fifty-three program directors (40%) responded to the survey. Overall, 98% of program directors felt education on the social determinants of mental health was "essential" for fellowship training, but there were significant differences in perceived relative importance and effectiveness of education provided across topics. Familial factors were rated as significantly more important than structural, historical, and economic factors. Structural and historical factors were viewed as being taught less effectively than other factors. Educational, structural, and historical factors and neighborhood factors were allotted significantly less instructional time than familial factors. CONCLUSIONS: While there is near-universal consensus that social determinants of mental health education are critical for fellowship training, program directors feel that social determinants of mental health topics differ in importance and are taught at varying levels of effectiveness. These findings highlight the need for intra-institutional and or inter-institutional collaboration for social determinants of mental health educational content development if CAP programs are to prepare trainees to best serve their most vulnerable patients.

Psychopharmacologic Treatment of Schizophrenia in Adolescents and Children.

An increasing number of antipsychotic medications have demonstrated efficacy in randomized placebo-controlled trials in the treatment of children and adolescents with schizophrenia. This review summarizes and synthesizes relevant antipsychotic medication studies, with particular emphasis on second-generation agents, and discusses other clinical considerations that may influence medication selection. With the exception of clozapine demonstrating superior efficacy in the improvement of psychotic symptoms in treatment-resistant patients, many antipsychotic agents have been shown to be similarly efficacious, including first-generation medications. Consideration of the side-effect profile, which can differ substantially from medication to medication, is essential when choosing treatment options.