La atención a la salud mental de la infancia y adolescencia en España. Un camino recorrido y un largo camino aún por recorrer / Mental health care for children and adolescents in Spain. Past and present status and future perspectives

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Historia clínica en psiquiatría infanto-juvenil / The medical history in child and adolescent psychiatry

INTRODUCCIÓN: La formación de los futuros especialistas en psiquiatría infanto-juvenil necesita el aprendizaje de técnicas específicas de interacción con el paciente, sus padres y profesores que ayuden a focalizar la anamnesis dentro de un marco homogéneo encaminado a conseguir, cuanto antes, un diagnóstico y un tratamiento adecuados. OBJETIVOS: 1º Mostrar el modelo de anamnesis que hemos usado habitualmente en primeras consultas de niños y adolescentes, a lo largo de nuestra práctica clínica, para colaborar en un diseño curricular común de la especialidad. 2º Analizar los resultados diagnósticos y terapéuticos obtenidos al revisar, retrospectivamente, historias clínicas realizadas con el mismo modelo de anamnesis que se presenta. MATERIAL Y MÉTODO: En relación al material utilizado, se describe, pormenorizadamente, nuestro modelo de anamnesis y de coordinación escolar. En relación a la metodología, hemos revisado 147 historias clínicas de pacientes atendidos, previa-mente, con el mismo modelo de anamnesis, durante el periodo de noviembre del 2007 a abril del 2008, por el equipo de salud mental infanto-juvenil del CSM Arganzuela de Madrid. Para valorar el modelo sistemático de preguntas y respuestas que presentamos, hemos comparado, con la bibliografía reciente, los resultados de las variables de diagnóstico psiquiátrico, tratamiento y coordinación escolar de la muestra. RESULTADOS: Respecto al diagnóstico, en 80 historias clínicas (54,4 %) se observaban dificultades de adaptación a situaciones estresantes del entorno, coincidiendo 66 casos con trastorno adaptativo (44,8 %) y otros 14 con trastorno por estrés postraumático (9,5 %). El trastorno por déficit de atención e hiperactividad (TDAH) se daba en 36 pacientes (24,4 %) y el trastorno de comportamiento (TC) en 14 (9,5 %). El trastorno depresivo se confirmaba en 31 casos (21 %) y el trastorno de ansiedad en 23 (15,6 %). Respecto al tratamiento, la intervención había sido psico-terapéutica en 144 casos (97,9 %), farmacológica en 68 (46,2 %), social en 25 (17 %) y educativa en 144 niños y adolescentes (97,9 %). Respecto a la coordinación escolar se realizaron entrevistas en el centro académico, con los tutores de los pacientes, en 113 casos (76,8 % del total). CONCLUSIONES: 1ª Los modelos de anamnesis referidos en este artículo muestran su utilidad para precisar el diagnóstico, el tratamiento y la prevención en salud mental infanto-juvenil. 2ª Nuestras actividades de coordinación escolar enseñan habilidades imprescindibles para el trabajo psiquiátrico comunitario

INTRODUCTION: The training of future specialists in child and adolescent psychiatry involves the acquisition of the skills required for interacting with the patient, their parents and teachers. These techniques help to direct the anamnesis within in structured manner which focuses on achieving, as early as possible, a proper diagnosis and treatment. Objetives: 1) To describe the medical history model we have used in our clinical practice during initial consultations with children and adolescents, and to contribute to the design of a com mon framework to be used by specialists of child and adolescent psychiatry. 2) To analyze the diagnostic and therapeutic results obtained by retrospectively reviewing clinical histories taken using the same medical history model presented. Materials And METHODS: In relation to the materials used, our medical history model and a school report form are described in detail. With regards to the methodology, were viewed the medical histories of 147 patients who were attend ed to over a period of time spanning from November 2007 and April 2008 by the child and adolescent mental health team at the Arganzuela Mental Health Center in Madrid. To evaluate the systematic model of questions and answers that we present, we have compared the results obtained for variables related to the psychiatric diagnosis, treatment and coordination with the patients' schools with those reported in recent literature. RESULTS: In 80 patients (54.4%) we observed difficulties in adapting to stressful situations, where 66 individuals (44.8%) were diagnosed with Adjustment disorder and the other 14 with Post-traumatic stress disorder (9.5%). Attention deficit disorder with hyperactivity (ADDH) was diagnosed in 36 patients (24.4%) and Conduct disorder in another 14 (9.5%). Depression was recognized in 31 cases (21%) and Anxiety disorder in 23 (15.6%). Treatment was psychological in 144 cases (97.9%), pharmacological in 68 (46.2%), social in 25 (17%) and educative in 144 children and adolescents (97.9%). A request for a school report was made for all of the patients included in the sample. As each school report was sent back, a coordination meeting was set up with the teachers associated with 113 cases (76.8%). CONCLUSIONS: 1) The protocols referred to in this work have proven to be effective at facilitating diagnose, treatment and prevention in childhood and adolescent mental health. Coordination with schools helps to teach the essential skills needed for child psychiatric work within a community

Child Psychiatry in Bosnia and Herzegovina: History of Development - Review.

The paper gives an overview of the spatial conditions, human resources and development course of child and adolescent psychiatry as an independent profession. The beginnings of the development date back to 1959, when the Department of children and youth is opened in Sarajevo at the Neuropsychiatric Clinic, which continues without interruption even today. After that was opened same department in Banja Luka and after a certain period of outpatient work, and stationary departments in Tuzla and Mostar. Over time, as the world's developed and improved understanding of the needs of treatment of mental disorders, and as the trends of professional approaches changed from time to time, the same set of guidelines were followed by the professional work of staff members in the departments. As the material opportunities allowed, in all localities there is a clear tendency to improve spatial conditions. However, personnel capability has improved at a slightly faster pace, so by the war time in Bosnia-Herzegovina (BH) between 1992 and 1995, in BH were mostly trained professional teams. In meanwhile, the need for psychiatric assistance has largely exceeded the human resource capabilities. The situation of war has changed dramatically in the present situation, departments are empty, and there is a paradoxical situation that the patient in the hospitals does not exist, but the reason is bizarre, since because of the war, physically, patients are not able to access to hospitals. This situation also contributes to the departure a large number of staff, which is in the child psychiatry, and so was insufficient. Despite this, during the war in Sarajevo, the Psychiatric Clinic conducts research on psychiatric morbidity and evaluation of population trauma due to war stress in the city of Sarajevo, and included the population of children and adolescents who remained in the city. The project is implemented only in the city area, because Sarajevo was city, three and half years under the total military siege. Further on, the paper elaborates the status of spatial and human resources capacity in the post-war period up to the present day. There is an evident expansion of the psychological assistance service throughout the territory of BH, which has been largely on the initiative and all the necessary assistance of the international community through non-governmental organizations, but with the involvement of the remaining domestic staffs. They were also stated the government projects, in the last two decades, on the professional training of staff working in Mental Health Centers across the country. In the latest age of the last ten years, a number of private psychological counselling centers have been opened that, beside the psychiatrists, are led by certified psychotherapists, psychologists, pedagogues, and teachers. This fact is very important for the future, because this is a good part solving the current lack of professionalism to provide psychological assistance to the population in developmental age. All professionals involved in the human psyche were aware of how important the timely recognition and provided expert assistance, when it comes to developmental age. In the post-war period, certain scientific researches on the psychological trauma severity of the population are being carried out, and the results of some of these researches are mentioned in this paper. The paper concludes with the statement that the current state of development of child psychiatry in the country is satisfactory in relation to the conditions that we had the past decade, but with the suggestion that a long way to furthering this profession and its affirmation at the global level is in the future.

The ambivalent role of the institution in the history of child and adolescent psychiatry: a case study of the Hawthorn Centre in Michigan, USA.

Historians have examined the role of psychiatric institutions in the USA and addressed whether this form of care helped or harmed patients (depending on the perspective of the time period, historical actors, and historians). But the story for children's mental institutions was different. At the time when adult institutions were in decline, children's mental hospitals were expanding. Parents and advocates clamoured for more beds and more services. The decrease in facilities for children was more due to economic factors than ideological opposition. This paper explores a case study of a hospital in Michigan as a window into the different characteristics of the discussion of psychiatric care for children.

Historia de la Asociación Española de Psiquiatría del Niño y del Adolescente (AEPNyA) en su setenta aniversario / History of the Spanish Association of Child and Adolescent Psychiatry on its 70th Anniversary

La Asociación española de psiquiatría del niño y del adolescente (AEPNyA) se fundó en Barcelona en el año 1950 como una sociedad médica que tenía como objetivo el estudio de los trastornos psiquiátricos de niños y adolescentes. Su desarrollo corre en paralelo con la de la psiquiatría infantil europea. Los fundadores fueron hombres y mujeres ilustrados, comprometidos con su tiempo y con la salud mental, la educación y los derechos de la infancia. Este artículo aborda los hitos principales de la historia de AEPNyA y distingue tres periodos: los comienzos, la fase de afianzamiento y el tiempo de la madurez. Los autores desean rendir un homenaje a los miembros fundadores y a todos aquellos que han contribuido al desarrollo de la Asociación

The Spanish Association of Child and Adolescent Psychiatry (AEPNyA) was founded in 1950 in Barcelona as a medical society, and was one of the first Societies for Child Psychiatry in Europe. Its founders were learned men and women who were concerned not only with children's psychiatric disorders, but also with their education and rights. The history of child psychiatry in Spain is intertwined with the development of this field throughout Europe. Over the course of its history, the AEPNyA has gone through several stages: its beginnings, its development, and its more established stage. This article pays tribute to the founders of the AEPNyA and to all those that have made a contribution to its development

[The history and development of the Zeitschrift für Kinder- und Jugendpsychiatrie - Review and outlook on the occasion of its 45th anniversary]. / Die Gründungsgeschichte und Entwicklung der Zeitschrift für Kinder- und Jugendpsychiatrie und Psychiatrie ­ Rückblick und Ausblick aus Anlass ihres 45-jährigen Bestehens.

The history and development of the Zeitschrift für Kinder- und Jugendpsychiatrie - Review and outlook on the occasion of its 45th anniversary Abstract. This article is based on archived documents and provides an overview of the founding of the Journal of Child and Adolescent Psychiatry and Psychotherapy and its precursor, the Yearbook of Adolescent Psychiatry and Allied Professions. The first volume of this journal appeared in 1973, 5 years after child and adolescent psychiatry had become an independent specialty in the Federal Republic of Germany. The founders of the journal and its first Editors-in-Chief were Hermann Stutte (1909-1982) and Hubert Harbauer (1019-1980). The Co-Editors and later Editors-in-Chief were Helmut Remschmidt and Martin Schmidt, who continued to edit the journal for the next 30 years. The Director of the publishing company at that time (Hans Huber, Bern), Walter Jäger (1916-2001), was a major factor in nurturing the journal. In 1975, he received an honorary doctorate from the Medical Faculty of the Philipps University of Marburg. Since the beginning, the journal has incorporated progressive developments and can be considered the leading organ in German-language child and adolescent psychiatry. With a current impact factor of 1.206, it holds rank 100 on the list of 142 international psychiatric journals.

[50 years specialty for child and adolescent psychiatry in Germany. History, current situation, and future perspectives]. / 50 Jahre Facharzt für Kinder- und Jugendpsychiatrie in DeutschlandGeschichte, Gegenwart und Zukunftsperspektiven 1.

50 years specialty for child and adolescent psychiatry in Germany. History, current situation, and future perspectives Abstract. Abstracts: Method: Review of the historical background and implementation of an independent medical specialty "child and adolescent psychiatry" (CAP) in Germany. Results: The implementation of an independent specialty for CAP in 1968 was crucial for the progressive further development of the discipline. The Enquête Commission "Psychiatry" of the Federal Government, followed by the Model Program "Psychiatry", the Staff Regulations for Psychiatry, the Agreement on the Social Psychiatry and the Psychotherapy Act have had significant impact on the care for psychiatrically ill children and adolescents and their families. This led to an institutional anchoring of new structures, covering three of the four leading principles of the Model Program, namely integration into medicine, community-based and appropriate care. Equality of psychiatric patients with other patient groups has, nevertheless, not yet been achieved and is still to be claimed. Current and future challenges are: (1) The realistic evaluation of new research methods and epochal trends and elimination of opposites, (2) the establishment of future-oriented research initiatives, (3) the intensive promotion of clinical and scientific staff members, and (4) a renewed attention for the subjective perspective of the illness. Conclusions: The implementation of an independent specialty "child and adolescent psychiatry" was an important stimulus for the further development of the discipline. Essential demands for the future will be: the integration of CAP into the curriculum for medical students and the promotion of young researchers within the scope of regional and supra-regional projects.

[The history of child and adolescent psychiatry in Austria : Essay about a long development]. / Die Geschichte der Kinder- und Jugendpsychiatrie in Österreich : Der Versuch der Zusammenschau einer langen Entwicklung.

The history of child and adolescent psychiatry in Austria is very short - it was established first in 1975, finally it achieved the status of a seperate specialisation in 2007. In earlier years the name of this specialty was used under the guise of scientific interest for malpractice and child abuse or child murder during the times of the 2nd World War.But also, the development after 1945 showed how long abviant ideas could survive. During the last decade CAP showed a formidable development, quality and support of patient care improved significantly. Also the scientific development and education in CAP improved. The Austrian Society for CAP developed - although exclusively privately run - into a professional and scientific society, which ist respected by politicians and society.

[Coercive Measures in Child and Adolescent Psychiatry in Post-war Germany, Using the Example of the "Pflege- und Beobachtungsstation" in the State Psychiatric Hospital Weissenau (1951-1966)]. / Zwangsmaßnahmen in der Kinder- und Jugendpsychiatrie in der Nachkriegszeit am Beispiel der Pflege- und Beobachtungsstation des Psychiatrischen Landeskrankenhauses Weissenau (1951-1966).

Coercive Measures in Child and Adolescent Psychiatry in Post-war Germany, Using the Example of the "Pflege- und Beobachtungsstation" in the State Psychiatric Hospital Weissenau (1951-1966) The patient admissions at the children's ward of the State Psychiatric Hospital Weissenau in the years 1951, 1956, 1961 and 1966 were analyzed regarding documented coercive measures. Shortage of staff, mainly inadequately skilled personnel, a mixing of age groups in the patient cohort, neurological and psychiatric disorders and of patients who were in need of nursing and of those who needed treatment constituted the general work environment. Coercive measures against patients, mostly disproportionate isolations, were a constant part of daily life on the ward. This affected in particular patients who had to stay longer at the hospital and whose stay was financed by public authority. The uselessness of such measures was known, which can be seen e. g. in the Caretaker's Handbook of that time and the comments in the patient files. The situation still escalated in some cases (for example by transfer to an adult ward). For a long time, coercive measures against patients were part of everyday life at the children's ward of the Weissenau; the actual figures are suspected to be much higher.

[Hans Heinze and the Research Programme of the German Association of Child Psychiatry and Therapeutic Education 1942-1945]. / Hans Heinze und das Forschungsprogramm der Deutschen Gesellschaft für Kinderpsychiatrie und Heilpädagogik.

Hans Heinze and the Research Programme of the German Association of Child Psychiatry and Therapeutic Education 1942-1945 Upon its foundation in 1940, Paul Schröder, full professor for psychiatry in Leipzig, was the first president of the German Society for Child Psychiatry and Therapeutic Education (DGKH). Following his death in 1941, his student Hans Heinze (Brandenburg/H.) succeeded him, prevailing over Werner Villinger (Breslau). The principal task of the DGKH was considered to be the exploration of the genetic origins of intellectual disabilities and behavioural disorders among children and adolescents. Based on their research since the 1920s, Schröder and Heinze believed that genetically predisposed, i. e. hereditary, character structures were aetiological for behavioural deviations among minors. It was their opinion that, based on the characterology they had established, development capabilities of children, as well as their "value" for the community, could be reliably predicted. In order to spare the community fruitless expenditures, they suggested that pedagogical stimulation was to be diminished in cases that reached the "hereditary boundaries of education". This assessment of a hereditary and hence unswayable inferiority was contested by the "Berlin School", represented by psychiatrist Franz Kramer and social pedagogue Ruth von der Leyen. They argued that while the possibility of "brutal-egoistical behaviour" existed, given the hereditary predisposition, it could however be successfully counteracted by pedagogic-therapeutic measures. After 1933, this faction controversy within the institutionally emerging child and adolescent psychiatry was decided in favour of the "Leipzig School", which was conform to the system and ideology of the time.

[Milestones of Child Neuropsychiatry]. / Meilensteine der Kinderneuropsychiatrie.

The development of child and adolescent psychiatry took different pathways in East and West Germany after World War II. In East Germany, child and adolescent psychiatry put more emphasis on neurology as it was influenced by the foundation of the first chair and care unit in Rostock. Prof. Göllnitz, who held the chair for many years, established child and adolescent neuropsychiatry as a subject in its own right in research and health care and helped promoting it at other universities and medical academies.

[Care Provided to Psychopaths in Rostock]. / Psychopathenfürsorge in Rostock.

In the first decades of the 20th century stations for observing "psychopathological" children and adolescents were established at a number of psychiatric facilities in the German Reich. Often they functioned as the nucleus for future psychiatric clinics for children and adolescents. Using primary sources of the Landeshauptarchiv Schwerin (main land archive in Schwerin), the local development of the neuropsychiatric clinic in Rostock-Gehlsheim is illustrated in this paper, exploring the question to what degree it caused the specific development of psychiatry in the child and adolescent age group.