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1.
Child Adolesc Psychiatr Clin N Am ; 33(3): 447-456, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38823816

RESUMO

This article reviews the existing literature related to medical training in public advocacy and provides the reader with several training examples to consider in a child and adolescent psychiatry fellowship or in combined training programs. Advocacy training embedded within community, forensic, integrated care, school, and many other experiences throughout training provides the skills and tools that the trainee will use in the future when they practice in any setting. This comprehensive training approach aligns with the evolving landscape of child and adolescent mental health where a deep commitment to public health and advocacy is increasingly essential.


Assuntos
Psiquiatria Infantil , Humanos , Psiquiatria Infantil/educação , Psiquiatria do Adolescente/educação , Saúde Pública/educação , Criança , Adolescente , Bolsas de Estudo , Defesa do Paciente/educação
2.
Child Adolesc Psychiatr Clin N Am ; 33(3): 397-409, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38823812

RESUMO

Child and adolescent psychiatrists (CAPs) play a crucial role beyond the provision of clinical care. CAPs are uniquely placed to understand and help patients navigate the fine line among psychiatric care, health and well-being, and the laws and policies supporting or impairing these processes. Focusing on vulnerable populations, such as legal system impacted youth and families, CAPs can contribute to the ongoing development of a more just and equitable world for the children of today and of tomorrow.


Assuntos
Psiquiatria do Adolescente , Psiquiatria Infantil , Papel do Médico , Humanos , Adolescente , Psiquiatria do Adolescente/legislação & jurisprudência , Psiquiatria Infantil/legislação & jurisprudência , Criança , Psiquiatras
3.
Child Adolesc Psychiatr Clin N Am ; 33(3): 293-306, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38823804

RESUMO

The majority of a psychiatrist's training and clinical attention is devoted to mental illness rather than mental health. This article suggests a broader understanding and application of mental well-being that can benefit both those already struggling with mental health challenges and those trying to stay well. Recommendations for being a well-being-oriented psychiatrist include increasing one's knowledge about well-being and health promotion and adjusting one's practice to incorporate these principles. Recommendations at the level of the field of psychiatry include revising the definition of a psychiatrist, increasing research on well-being and health promotion, improving financial incentives, expanding efforts in schools and community settings, and providing additional training.


Assuntos
Psiquiatria do Adolescente , Psiquiatria Infantil , Transtornos Mentais , Humanos , Criança , Adolescente , Transtornos Mentais/terapia , Saúde Mental , Promoção da Saúde , Psiquiatras
4.
Child Adolesc Psychiatr Clin N Am ; 33(3): 319-330, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38823806

RESUMO

Children and youth in the United States are experiencing a mental health crisis that predates the COVID-19 pandemic. Child and adolescent psychiatrists have the knowledge and skillset to advocate for improving the pediatric mental health care system at the local, state, and federal levels. Child psychiatrists can use their knowledge and expertise to advocate legislatively or through regulatory advocacy to improve access to mental health care for youth. Further, including advocacy education in psychiatry and child psychiatry graduate medical education would help empower child psychiatrists to make an impact through their advocacy efforts.


Assuntos
Psiquiatria Infantil , Serviços de Saúde Mental , Humanos , Criança , Adolescente , Estados Unidos , COVID-19/prevenção & controle , Psiquiatria do Adolescente , Saúde Mental , Defesa da Criança e do Adolescente , Defesa do Paciente , Transtornos Mentais/terapia
6.
Child Adolesc Psychiatr Clin N Am ; 33(3): 381-395, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38823811

RESUMO

This article highlights the key role of schools in addressing rising mental health disorders among youth. It champions collaboration between health and educational sectors, emphasizing child and adolescent psychiatrists' significant contribution to school-based mental health literacy and interventions. This article encourages for child and adolescent psychiatrists' involvement in policy advocacy for accessible and inclusive mental health care, championing sustainable mental health services through advocating for funding, training, and policy support.


Assuntos
Acessibilidade aos Serviços de Saúde , Transtornos Mentais , Adolescente , Criança , Humanos , Psiquiatria do Adolescente , Transtornos Mentais/terapia , Transtornos Mentais/prevenção & controle , Serviços de Saúde Mental , Serviços de Saúde Escolar , Serviços de Saúde Mental Escolar
7.
Child Adolesc Psychiatr Clin N Am ; 33(3): 437-445, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38823815

RESUMO

The persistence of health inequity and the need for workforce diverse representation within child and adolescent psychiatry require systemic solutions. There are recommendations and strategies particularly for the training programs with "all of the above" approach to tackle these complex systemic issues. One of the ways is to think through existing and innovative training pipelines by making them less leaky, enhancing quality, expanding the type and size, and connecting them to reach children and adolescents in need.


Assuntos
Psiquiatria do Adolescente , Psiquiatria Infantil , Equidade em Saúde , Adolescente , Criança , Humanos , Psiquiatria do Adolescente/educação , Psiquiatria Infantil/educação , Diversidade Cultural
8.
Perspect Med Educ ; 13(1): 300-306, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38764877

RESUMO

Background: Developing theoretical courses for post-graduate medical training that are aligned to current workplace-based learning practices and adaptive to change in the field is challenging, especially in (sub) specialties where time for re-design is limited and needs to be performed while education continues. Approach: An instructional design method was applied based on flexible co-design to improve post-graduate theoretical courses in child and adolescent psychiatry (CAP) in the Netherlands. In four phases over a period of three years, courses were re-designed at a national level. Evaluation: Once common vision and learning goals were agreed upon and the prototype was developed (phases 1 and 2), the first courses could be tested in daily practice (phase 3). Phase 4 refined these courses in brief iterative cycles and allowed for designing additional courses building on and adding to previous experiences in brief iterative cycles. The resulting national theoretical courses re-allocated resources previously spent on a local level using easily accessible online tools. This allowed trainees to align content with their clinical rotations, personal preferences and training schedules. Reflection: The development of theoretical courses for post-graduate medical training in smaller medical (sub-)specialties with limited resources may profit from a flexible instructional design method. We consider the potential merit of such a method to other medical specialties and other (inter-)national efforts to develop theoretical teaching courses. A longer-term implementation evaluation is needed to show to what extent the investment made in the re-design proves to be future-proof and enables rapid adaptation to changes in the field.


Assuntos
Educação de Pós-Graduação em Medicina , Humanos , Educação de Pós-Graduação em Medicina/métodos , Países Baixos , Currículo/tendências , Psiquiatria do Adolescente/educação , Psiquiatria do Adolescente/métodos , Psiquiatria Infantil/educação , Psiquiatria Infantil/métodos
9.
Acad Psychiatry ; 48(3): 238-243, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38619806

RESUMO

OBJECTIVE: This study examined the current state of forensic education among child and adolescent psychiatry (CAP) fellowship programs, regarding specific forensic topics, teaching resources, methods, and experiences. The authors aimed to gather and analyze this data to assess the need for additional standardization of forensic psychiatry education in CAP fellowship, such as broader access to resources, and/or inform the development of a standardized curriculum, including milestones, in child and adolescent forensic psychiatry. METHODS: The authors collaboratively developed a survey instrument on child and adolescent forensic psychiatry education, which was then sent to 135 accredited CAP fellowship programs. The items included in the survey instrument were designed based on literature review, expert consensus, and a 1992 American Association of Directors of Psychiatric Residency Training survey on teaching ethics and forensic psychiatry. RESULTS: Completed response data was returned by 25 of the 135 programs surveyed. Complete responses came primarily from academic institutions (52% public, 36% private) with small- or medium-sized programs (1-12 total fellows, 88%; 11-29 faculty members, 56%). Programs reported on CAP forensic rotation sites, faculty members' level of expertise and involvement in forensic CAP, common forensic topics and experiences offered, and programs' attitudes towards specific topics and experiences. CONCLUSIONS: Child and adolescent psychiatrists must gain a clear understanding of the essential components of CAP forensic psychiatry during CAP fellowship, to mitigate discomfort when interacting with the legal system and meet the rising need for forensic CAP expertise across systems and structures impacting youth populations.


Assuntos
Psiquiatria do Adolescente , Psiquiatria Infantil , Currículo , Bolsas de Estudo , Psiquiatria Legal , Humanos , Psiquiatria do Adolescente/educação , Psiquiatria Legal/educação , Psiquiatria Infantil/educação , Adolescente , Inquéritos e Questionários , Criança , Estados Unidos
11.
Child Adolesc Ment Health ; 29(2): 192-193, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38634296

RESUMO

Advancing diversity, equity and inclusion (DEI) are key priorities for the American Academy of Child and Adolescent Psychiatry (AACAP). AACAP was founded in 1953. The mission of the AACAP includes promoting the healthy development of all children, adolescents, and families through advocacy, education, and research. AACAP's Presidential Initiative of CAPture Belonging's goal was to prioritize diversity, equity, inclusion and belonging to create transformational and sustainable changes in the organization and child and adolescent psychiatry. The presidential initiative's strategy had three pillars: advancing diversity, equity, inclusion, and belonging (DEIB) in all program and services, creating a pipeline for diverse child and adolescent psychiatrists, and monitoring DEIB activities and progress. A presidential task force was created and charged with implementing a 2-year action plan and strategy. A 5-point action plan prioritized: awareness, advocacy, workforce and professional development, national partnerships, and sustainability. Focusing on DEIB for any organization enriches the work, community and success that can be achieved. AACAP is proud to have committed to this DEIB path and has already experienced success through continuous membership growth, membership engagement, and record attendance at annual meetings and volunteer involvement. These accomplishments can only enhance AACAP's ability to serve the mission of promoting the healthy development of all children, adolescents, and families through advocacy, education, and research.


Assuntos
Benzamidas , Diversidade, Equidade, Inclusão , Saúde Mental , Criança , Humanos , Adolescente , Estados Unidos , Psiquiatria do Adolescente/educação , Saúde do Adolescente
13.
J Am Acad Child Adolesc Psychiatry ; 63(6): 581-582, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38452812

RESUMO

The article by Lock et al.1 in this month's issue of the Journal highlights 3 features that are of interest to child and adolescent psychiatrists. First, it provides further evidence for an effective therapy for an extremely debilitating condition, with additional means for improving prognosis. Second, it underscores how families can be helpful in supporting therapy for their children, thus avoiding unnecessary scapegoating of parents. Finally, it is a fine example of a clinical trial performed in accordance with all the principles of modern methodology.


Assuntos
Medicina de Precisão , Humanos , Criança , Psiquiatria Infantil , Adolescente , Psiquiatria do Adolescente
16.
Medwave ; 24(2): e2777, 2024 Mar 21.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-38513231

RESUMO

Background: The COVID-19 pandemic led to a prompt implementation of remote care, especially in mental health care. The evidence supporting this modality of care is still emerging, with few qualitative studies describing its implementation in Latin American countries. This study aims to understand the perspectives of therapists and patients regarding the use of telehealth in a child and adolescent mental health unit of a Chilean public service. Methods: This is a qualitative study. Two focus groups were defined with 14 professionals, and 16 in-depth interviews were conducted with users of an outpatient child and adolescent psychiatry unit. The data were analyzed using the grounded theory model. Results: In the group of therapists, four main categories emerged: background of mental telehealth, implementation, mental telehealth from the therapist's position, and projections. Three main categories emerged in the patient's group: implementation, evaluation of mental telehealth users, and projections. Conclusions: There are elements in common between the opinions of patients and therapists. Something to note within the patient's group is that, despite accepting remote care and recognizing its positive aspects, aside from the pandemic context, they prefer face-to-face or mixed care.


Antecedentes: La pandemia por COVID-19 generó una implementación súbita de las atenciones a distancia, especialmente en atenciones de salud mental. La evidencia que sustenta esta modalidad de atención es aún emergente, con escasos estudios cualitativos que representen su implementación en países latinoamericanos. El objetivo de este trabajo es conocer la perspectiva de terapeutas y de usuarios, respecto del uso de la telesalud en una unidad de salud mental infantil y de la adolescencia de un servicio público chileno. Métodos: Estudio cualitativo. Se establecieron dos grupos focales con 14 profesionales en total, y 16 entrevistas en profundidad con usuarios de una unidad ambulatoria de psiquiatría infanto juvenil.. Los datos se analizaron utilizando el modelo de teoría fundamentada. Resultados: En el grupo de terapeutas surgen cuatro categorías fundamentales; antecedentes de la telesalud mental, implementación, telesalud mental desde la posición del terapeuta y proyecciones. En el grupo de usuarios surgieron tres categorías principales: implementación, evaluación de los usuarios de la telesalud mental y proyecciones. Conclusiones: Existen elementos en común entre la opinión de los usuarios y terapeutas. Un elemento importante dentro del grupo de los usuarios es que, a pesar de aceptar la atención remota y reconocer aspectos positivos en esta, fuera del contexto de pandemia prefieren atenciones presenciales o mixtas.


Assuntos
Pandemias , Telemedicina , Adolescente , Criança , Humanos , Psiquiatria do Adolescente , Pesquisa Qualitativa , Saúde Mental
17.
Eur. j. psychiatry ; 38(1): [100228], Jan.-Mar. 2024. tab, graf
Artigo em Inglês | IBECS | ID: ibc-229234

RESUMO

Background and objectives The relationship between pain and psychiatric conditions in children and adolescents has been understudied. This study aimed to investigate the influence of gender on the association between pain and psychiatric diagnoses, as well as the specific relationship between pain and attention deficit/hyperactivity disorder (ADHD), in a sample of adolescents from the general population. Additionally, the study explored whether pain frequency or intensity in individuals with ADHD was influenced by coexisting psychiatric disorders and ADHD medications. Methods This cross-sectional study included 1608 conveniently sampled Swedish upper secondary school students aged 15–19 years. Data were collected at the end of 2020 using the electronic "Mental and Somatic Health without borders" survey. Results A significant positive association (p < 0.001) was observed between pain frequency, intensity, and the presence of any psychiatric diagnosis. Female adolescents reported more frequent and intensive pain in the groups with or without any psychiatric diagnosis and in those with ADHD, however the presence of a psychiatric diagnosis had a comparatively lesser impact on pain frequency in females when compared to males. In adolescents with ADHD, pain frequency, but not intensity, showed a significant further increase. Moreover, the presence of coexisting depression and/or anxiety further heightened the association between pain frequency and ADHD. Notably, common ADHD medications did not have a significant impact on pain experiences. Headache emerged as the most prevalent type of pain across all groups of adolescents. Back pain specifically appeared as the next most common type of pain among adolescents with ADHD. Conclusion The findings suggest a positive association between pain and the presence of psychiatric diagnoses, including ADHD, in adolescents. Gender modified this association. Back pain arised specifically coupled to ADHD. ... (AU)


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Dor , Psiquiatria do Adolescente , Transtorno do Deficit de Atenção com Hiperatividade , Estudos de Gênero , Disfunção Cognitiva , Conduta do Tratamento Medicamentoso
18.
Psiquiatr. biol. (Internet) ; 31(1): [100445], ene.-mar 2024.
Artigo em Espanhol | IBECS | ID: ibc-231639

RESUMO

Los trastornos psiquiátricos en la infancia y adolescencia pueden persistir, cambiar, remitir o aumentar en la edad adulta. Este estudio explora la estabilidad y las trayectorias diagnósticas de 311 niños y adolescentes entre 3 y 17 años hasta la edad adulta. Se encuentra que la estabilidad diagnóstica varía en función de la enfermedad. Los cambios de diagnóstico son más frecuentes en el trastorno de conducta y los trastornos afectivos, mientras que la mayor estabilidad diagnóstica se da en las dificultades del aprendizaje, trastorno de déficit de atención con hiperactividad y trastornos del espectro autista. La remisión completa es más frecuente en los trastornos de ansiedad. Los diagnósticos psiquiátricos tienen implicaciones sociales, emocionales y prácticas. Es necesario adaptar los recursos de salud mental a las necesidades de cada grupo de edad. (AU)


Psychiatric disorders in childhood and adolescence may persist, change, remit or increase in adulthood. This study explores the diagnostic stability and trajectories of 311 children and adolescents aged 3-17 years into adulthood. Diagnostic stability is found to vary according to pathology. Diagnostic changes are more frequent in conduct disorder and affective disorders, while the highest diagnostic stability was found in learning difficulties, attention deficit learning disabilities, attention deficit hyperactivity disorder and autism spectrum disorders. Complete remission is more frequent in anxiety disorders. Psychiatric diagnoses have social, emotional and practical implications. Mental health resources need to be adapted to the needs of each age group. (AU)


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Transtornos Mentais/diagnóstico , Psiquiatria Infantil/métodos , Psiquiatria do Adolescente/métodos , Seguimentos , Estudos de Coortes
19.
J Child Adolesc Psychopharmacol ; 34(1): 4-20, 2024 02.
Artigo em Inglês | MEDLINE | ID: mdl-38377525

RESUMO

The efficacy and tolerability of psychotropic medications can vary significantly among children and adolescents, and some of this variability relates to pharmacogenetic factors. Pharmacogenetics (PGx) in child and adolescent psychiatry can potentially improve treatment outcomes and minimize adverse drug reactions. This article reviews key pharmacokinetic and pharmacodynamic genes and principles of pharmacogenetic testing and discusses the evidence base for clinical decision-making concerning PGx testing. This article reviews current guidelines from the United States Food and Drug Administration (FDA), the Clinical Pharmacogenetics Implementation Consortium (CPIC), and the Dutch Pharmacogenetics Working Group (DPWG) and explores potential future directions. This review discusses key clinical considerations for clinicians prescribing psychotropic medications in children and adolescents, focusing on antidepressants, antipsychotics, stimulants, norepinephrine reuptake inhibitors, and alpha-2 agonists. Finally, this review synthesizes the practical use of pharmacogenetic testing and clinical decision support systems.


Assuntos
Psiquiatria do Adolescente , Farmacogenética , Estados Unidos , Criança , Humanos , Adolescente , Psicotrópicos/uso terapêutico , Antidepressivos/uso terapêutico , Testes Farmacogenômicos
20.
Acad Psychiatry ; 48(3): 254-257, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38321353

RESUMO

OBJECTIVES: This study aimed to identify factors affecting current general psychiatry residents' interest in child and adolescent psychiatry (CAP) at Lehigh Valley Health Network (LVHN). Furthermore, it aimed to identify areas for improvement in clinical education to address the shortage of child psychiatrists at the institution at the time of this study. METHODS: An electronic anonymous pre-implementation survey was sent to all the current general psychiatry residents at LVHN. It assessed the most important factors for trainees in deciding their career paths into CAP, their comfort level with children and families, and overall CAP and related systems-based knowledge. Interventions based on the survey results were implemented in the LVHN psychiatry residency program. The residents then completed a post-intervention survey to assess the impact of these interventions on their perspectives toward CAP. RESULTS: CAP rotation experience and work with families were strong influencers for general psychiatry residents at LVHN in pursing CAP. Systems-based knowledge was particularly lacking compared to overall CAP knowledge. Educational interventions that were implemented at LVHN led to improvements in residents' sense of competence working with children and families with no net loss of interest in CAP. CONCLUSIONS: Educational modifications enhanced attitudes toward CAP among LVHN general psychiatry residents. Implementing such modifications at other residency programs may be likewise effective in retaining interest in CAP among their general psychiatry residents.


Assuntos
Psiquiatria do Adolescente , Escolha da Profissão , Psiquiatria Infantil , Internato e Residência , Humanos , Psiquiatria Infantil/educação , Psiquiatria do Adolescente/educação , Feminino , Inquéritos e Questionários , Masculino , Adulto , Atitude do Pessoal de Saúde , Psiquiatria/educação
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