Managed care organizations and academic medicine: establishing a more effective working alliance.

Instead of focusing solely on the demonization of "managed care" as an abstract concept, we suggest that institutions of medical education recognize that managed care in some form is here to stay. We believe it is critical that both academic institutions and managed care organizations work together to optimize health care delivery. In order to achieve this, we suggest that responsible physicians work toward the development of a more effective "working alliance" between managed care organizations and academic medical centers. This working alliance would involve the exchange of ideas and focused efforts by both parties to educate the other. Specific interventions are described.

The diagnosis of infant psychopathology: current challenges and recent contributions.

In this paper we describe current difficulties in the diagnosis of infant psychopathology and two recent contributions to the assessment of infant psychopathology, "KIDDIES," and "Zero to Three." In order to accomplish this a literature review was completed regarding infant psychopathology and current diagnostic instruments. The literature supports the notion that there is a need for more empirical research in the area of infant psychopathologies and for more reliable and valid scales of infant psychopathology. Zero to Three and KIDDIES are useful tools in the assessment of psychopathology, and have complementary strengths.

The management of patients with attention-deficit hyperactivity disorder by family practitioners.

BACKGROUND: The objective of this study was to describe the practices of family practitioners in Missouri in the treatment of patients with ADHD. METHOD: The 634 Diplomats of the American Board of Family Practice of Missouri were surveyed. RESULTS: Respondents considered stimulant medication to be effective treatment for ADHD; methylphenidate was the drug of choice. Most respondents (79%) reported recommending behavioral management to parents. Reported efficacy of stimulants (item 2) and use of behavior management (item 8) were related in the negative direction, while reported efficacy of stimulants and using stimulants alone (item 13) were related in the positive direction. CONCLUSIONS: Family practitioners in Missouri used accepted treatments for ADHD, but in general, practices were not entirely consistent with the current standard of care. Physicians' belief in the efficacy of stimulants may have prejudiced them against multimodal treatment.

Results of blood lead screening in children referred for behavioral disorders.

This study reviews findings from blood lead level screening in children referred to an Attention Deficit Hyperactivity Disorder clinic. Results obtained from 102 children revealed a sample mean blood lead level of 2.29 micrograms/dL and one patient with a mildly elevated blood lead level. Comparing these findings to results of national studies suggests that these children are not at higher risk for elevated lead levels than is the average child living in a similar setting.

Sport psychiatry in childhood and adolescence: an overview.

This review explores the importance and relevance of sport during childhood and adolescence, utilizing traditional stage theories of development. The literature supports the notion that sport is a necessary study as a health issue and a preventative tool in the field of psychiatry. Play and sport in childhood and adolescence enhance development physically, mentally, and socially. Participating in athletics encourages the development of leadership skills, self-esteem, muscle development and overall physical health. There is a lack of literature in the important area of sport psychiatry especially when considering beneficial, not deficit oriented youth athletic development. Child psychiatrists need to begin researching sport in order to develop a comprehensive understanding of how athletics can enhance the mental and physical health of youth.

Assessment and diagnosis of attention deficit/hyperactivity disorder in pediatric general practice.

Thorough assessment is a critical first step in the treatment of any psychiatric disorder. The need for rigorous assessment procedures is underscored for those disorders, such as Attention Deficit/Hyperactivity Disorder (ADHD) of childhood, that have a high comorbidity with other common psychiatric disorders, including childhood depression and anxiety. Extensive research regarding diagnostic procedures for ADHD has demonstrated the importance of obtaining assessment data from multiple informants and in multiple modalities as a way of confirming ADHD diagnoses. This article describes how a physician in general pediatric practice might execute a thorough initial and follow-up assessment of a child's ADHD symptomology.

Attention deficit hyperactivity disorder, infantile autism, and elevated blood-lead: a possible relationship.

This case involves a 4 1/2-year-old boy diagnosed with autism, attention deficit hyperactivity disorder (ADHD), and an elevated blood-lead level of 42 mcg/dl. The child was treated for the elevated blood-lead with the chelating agent succimer. The parents reported a decrease in repetitive behaviors while on succimer with a regression to previous symptoms when medication was discontinued. Also seen was a decrease of hyperactive behavior while being treated with succimer. This article explores the interaction and possible casual relationship of an elevated blood-lead, autism, and ADHD as well as treatment of the behavioral symptoms.

Comorbidity of conduct disorder and personality disorders in an incarcerated juvenile population.

OBJECTIVE: Youths with conduct disorder extract an inordinate amount of time and money from the U.S. judicial system and taxpayers, yet studies pertaining to this population have been few. This study was undertaken to examine the co-occurrence of personality disorders and conduct disorder in a group of incarcerated children and adolescents and to raise the issue of the possibility of antisocial personality disorder in persons under the age of 18 years. METHOD: One hundred incarcerated juvenile offenders aged 11-17 years were randomly selected and then interviewed with the Diagnostic Interview for Children and Adolescents--Revised and the Structured Clinical Interview for DSM-III-R Personality Disorders to establish their psychiatric diagnoses. RESULTS: Eighty-seven percent of the group met the criteria for conduct disorder. Among those diagnosed as having conduct disorder, the only comorbid personality disorder that was present with significant frequency was antisocial personality disorder. The other comorbid personality disorder diagnoses that appeared most frequently were the borderline, narcissistic, paranoid, passive-aggressive, and dependent types. Borderline personality disorder was observed more frequently in the females than in the males with conduct disorder. CONCLUSIONS: The findings suggest that by using DSM-III-R criteria for adult personality disorders, one finds a considerable number of personality disorders in a young population with conduct disorder. The findings also show that youths manifest signs of antisocial personality disorder before they are 18 years of age, raising the question of how age should be incorporated into the diagnosis of personality disorder as DSM-IV is being prepared.