Addressing the Nationwide Shortage of Child and Adolescent Psychiatrists: Determining Factors that Influence the Decision for Psychiatry Residents to Pursue Child and Adolescent Psychiatry Training.

OBJECTIVE: This study aimed to identify factors that influence whether adult psychiatry residents choose to pursue fellowship training, particularly in child psychiatry. The study also assessed how child psychiatry is perceived among adult psychiatry residents as a subspecialty. METHODS: Electronic surveys were administered to all adult psychiatry residents at the University of Michigan, Henry Ford Health System, and Authority Health. These three programs were selected for geographic convenience. The survey included demographic questions as well as Likert-scale statements that assessed the importance of various factors in determining future career choice. The survey also assessed the agreeability of various statements pertaining to the field of child psychiatry. RESULTS: The most important factor for residents in deciding their specialty choice was personal interest, followed by work-life balance, the ability to work directly with patients, and the location of their future job. Over half of residents rated length of training as being "extremely important" or "very important," and fewer than 30% of residents surveyed felt that child psychiatry fellowship was too long. Child psychiatry is widely recognized by residents as having ample job opportunities. However, fewer than 30% of psychiatry residents surveyed rated a high level of interest in child psychiatry. CONCLUSION: The knowledge of psychiatry residents' views on specialty selection could inform decision making around recruitment efforts. It may also gauge the efficacy and impact of different propositions made to increase child psychiatry recruitment, such as shortening fellowship training in child psychiatry and sponsoring mentorships and interest groups.

Consanguinity and Autism.

PURPOSE OF REVIEW: Consanguinity can increase the risk for autosomal recessive conditions, along with autism spectrum disorder (ASD). Rarely outside of the genetics community is this discussed. Understanding its impact on the development of ASD and increasing awareness for physicians is important. RECENT FINDINGS: ASD is a polygenic multifactorial disorder associated with morbidity and burden of care. Studies have confirmed its heritability, suspecting to an autosomal recessive transmission. Consanguinity increases the risk for uncovering recessive disorder and its role as an independent contributor for the development of ASD should be examined. With consanguinity being a known risk factor for autosomal recessive conditions, clinicians should routinely screen for it when evaluating for ASD, as this is inconsistently done. If suspected, genetic testing should be also recommended. Understanding current risk as well as future risk and providing families with the education to make the most informed decisions is necessary.

Building Child and Adolescent Psychiatry Expertise in Ghana Through Training and Knowledge Dissemination: a Review of the Initial Collaboration Stages, Opportunities, and Challenges.

PURPOSE OF REVIEW: Improving child and adolescent mental health (CAMH) is a priority worldwide. The majority of children with psychiatric conditions in low-middle-income countries (LMIC), like Ghana, receive no treatment due largely to limited resources and few CAMH training opportunities. The Komfo Anokye Teaching Hospital (KATH) and University of Michigan (UM) established a partnership to expand CAMH training for general psychiatrists in Ghana. Lessons learned from the early stages of the collaboration can serve as an adaptable roadmap for similar efforts to expand CAMH training in LMIC. RECENT FINDINGS: Previous articles have discussed global academic partnership, training, and capacity building programs; however, early challenges, opportunities, and preparatory stages involved in creating a mutually beneficial collaboration aimed at improving child psychiatry expertise in a LMIC are under explored in the global mental health literature. This article seeks to fill that gap by using examples to highlight unique considerations for institutions in the initial stages of establishing their global partnership. The early stages of a global partnership can impact the success of the collaboration. Collaborations should be bi-directional, sensitive to local culture, and flexible and establish achievable sustainable goals.

Problems with "problem behavior": A secondary systematic review of intervention research on transition-age autistic youth.

LAY ABSTRACT: In a previous study, we looked at research done on strategies to support autistic people who were between 14 and 22 years old. For this study, we looked at all of the studies in our previous study that tried to decrease or stop autistic people from doing certain things-many researchers call these things "problem behavior." There were 48 studies that tried to reduce problem behavior, and most of them used strategies like prompting and reinforcement to try get autistic people to change their behavior. We found many things wrong with these studies. Most of them did not define the group of behaviors they were trying to stop autistic people from doing. None of the studies looked at whether any side effects happened when they tried the strategy they were studying. Also, most of the studies tried to stop autistic people from doing behaviors that probably were not harmful, like stereotypic behavior. Most of the studies did not say how they decided that the behaviors they tried to stop were a problem for the autistic people in the study, and most studies did not try to figure out why the autistic people in the study did the behaviors the researchers were trying to stop them from doing.

An evaluation of intervention research for transition-age autistic youth.

LAY ABSTRACT: In this study, we assess the quality of intervention research that focuses on autistic youth who are 14-22 years old. We found 193 different studies on this topic, and carefully reviewed them. Most of these studies tested strategies that were behavioral. This means that they used procedures like prompting and rewards to change participants' behavior. We found that the majority of studies had problems that make it hard to determine whether or not the intervention worked. The problems related to how researchers designed their studies, and how they measured the study outcomes. We also found that researchers rarely tried to find out if the strategies they studied had unintended negative effects for participants. Because of these issues, we make suggestions for how researchers might design better studies that will let people know how well the strategies worked.

Sinus Bradycardia in an Adolescent Taking Lamotrigine.

Lamotrigine is commonly prescribed for the treatment of neurological conditions and is increasingly being prescribed for psychiatric conditions as well. Although largely well tolerated, it is known to have a number of potential side effects, and in March 2021, the FDA issued its most recent warning for the medication due to its increased risk of cardiac arrhythmias. In this report, we describe a case in which an adolescent patient was found to be bradycardic after starting lamotrigine for antidepressant augmentation, with a gradual return to normal heart rate as the medication was subsequently tapered and discontinued. Further research is needed to more accurately estimate the risk of cardiac side effects and to establish appropriate monitoring guidelines for cardiac arrhythmias in those taking lamotrigine.

Integrating Measurement-Based Care into Trainee Education.

Although there is no published literature on the use of rating scales in child and adolescent psychiatry fellowships, there is evidence of use of rating scales in other residency programs including general psychiatry, pediatrics, and family medicine. The authors surveyed the American Association of Directors of Psychiatric Residency Training listserv inquiring how rating scales are used in child and adolescent psychiatry training programs. Results included the use of specific rating scales, if they are optional or required, presence or absence of didactics, perception of rating instruments by fellows and faculty, integration with quality improvement projects, and use in practice after graduation.

Valproate Induced Hypertensive Urgency.

Valproate is a medication used in the treatment of seizures, bipolar disorder, migraines, and behavioral problems. Here we present a case of an 8-year-old boy who presented with hypertensive urgency after initiation of valproate. Primary treatment of his hypertension was ineffective. Blood pressure stabilization was achieved following discontinuation of valproate. Clinicians should be aware of the risk of developing hypertensive urgency with administration of valproate.

Psychopharmacology of autism spectrum disorders: a selective review.

While there is no cure for autism spectrum disorder, psychopharmacologic agents are often used with behavioral and educational approaches to treat its comorbid symptoms of hyperactivity, irritability, and aggression. Studies suggest that at least 50% of persons with autism spectrum disorder receive psychotropic medications during their life span. This selective review examines recent studies about the use of psychotropic medications in persons with autism spectrum disorder. The aim was to focus on randomized controlled trials conducted from 1990 to 2010 on this topic. A comprehensive literature search was performed using PubMed and Cochrane databases. Out of 105 studies identified for the review, only 24 were randomized controlled trials. Thus, despite the common use of these medications in autism spectrum disorder, more controlled studies are needed to determine their long-term efficacy and safety.