The Canadian child and adolescent psychiatry review = La revue canadienne de psychiatrie de l'enfant et de l'adolescent最新文献

Introduction: Mental health research has consistently focused on high rates of treatment non-adherence, and how inpatient programs and health professionals can effectively confront this reality. The literature has centred almost exclusively on adult populations. Unfortunately, psychotic and major mood disorders are serious and persistent mental health problems that are increasingly recognized as having an early onset, affecting children and adolescents.

Method: This article draws on a review of the literature and Habermas's three domains of knowledge: technical, practical, and emancipatory. This article has incorporated current research, adherence theories, and the facilitation of the unique local expertise of health professionals to generate a framework. This framework is designed to teach health professionals working in child and adolescent psychiatric inpatient units how they and the larger unit can practice to enhance patient treatment adherence during and after admission.

Results: A five-step approach to teach health professionals to enhance treatment adherence has been developed based on current research and educational theories and principles.

Conclusion: Health professionals working in child and adolescent psychiatry can practice to enhance patient treatment adherence, and improve patient and family outcomes.

Introduction: Mental health clinicians make their careers working with patients and families who have experienced extremes of stress and trauma.

Methods: The psychological effects on the caregiver of prolonged therapeutic work with traumatized patients have previously been studied within the theoretical frameworks of Burnout, Secondary Post Traumatic Stress and Vicarious Traumatization.

Results: We report a qualitative study of experienced clinicians' responses to the stressors inherent in such therapeutic work, and the coping strategies they developed.

Conclusion: We found that some degree of vicarious traumatization was the main result of engaging in such work.

Introduction: To compare results of clinical diagnosis, NIMH DISC-IV diagnoses and the Global Severity Index of the Symptom Check List- Revised (SCL-90-R) in an adolescent inpatient population.

Method: NIMH DISC-IV and SCL-90-R were administered to consecutive admissions to the inpatient adolescent unit of a teaching hospital as a regular admission procedure.

Results: There was better agreement between clinical diagnosis and the NIMH-DISC-IV diagnosis as compared to previous studies for NIMH DISC-IV. The presence of an NIMH DISC-IV diagnosis was associated with elevated SCL-90-R scores.

Conclusion: Structured diagnostic interviews and Self rated symptom scales are useful adjuncts in clinical diagnostics, enhancing valuable clinical expertise.

Introduction: There have been various strategies employed to improve the ability of primary care physicians to identify and intervene in the mental health concerns of young children. In this study we assessed community physician needs and ability to identify mental health problems in children less than 6 years of age.

Methods: Two surveys were conducted. The purpose of the surveys was to identify the learning needs among primary care physicians and their capacity to serve very young children.

Results: Most physicians reported that they did not have enough knowledge and support to detect and manage mental health problems in young children and that they received minimal undergraduate training.

Conclusions: Community physicians require primary mental health care support to serve the mental health concerns of young children age 0-6.

Introduction: To provide a historical review of transcultural child psychiatry in Canada and discuss its future mandate within traditional mental health services.

Method: To present a summary of some key papers and chapters in the literature which describe the history and present status of transcultural child psychiatry since its inception 30 years ago.

Results: There is a virtual absence of transcultural material in the early editions of the most valued textbooks of child and adolescent psychiatry. This has only begun to change during the past 5 years. In Canada, work has centered around recently arrived immigrant and refugee children with comparatively little work being done with other minority groups.

Conclusion: Transcultural child psychiatry remains a profoundly understaffed subspecialty. To change this, university departments of child psychiatry should initiate the formation of groups of transculturally aware clinicians and researchers.

Introduction: Over 30% of children with ADHD treated with a rigorous multimodal intervention in the MTA study did not reach full functional remission. New long-acting drugs have been developed with this treatment goal in mind.

Methods: Presentations at the 2004 Annual Meeting of the Canadian Academy of Child and Adolescent Psychiatry discussed the development of long-acting drugs for ADHD and clinical studies of their efficacy; these presentations are summarized below.

Results: Concerta(R) OROS-MPH releases methylphenidate (MPH) in an initial bolus, followed by increasing concentrations throughout the day. This pattern of drug delivery overcomes the development of acute tolerance; classroom analog studies have shown that ADHD symptoms and academic productivity are thereby maintained for 12 hours. A larger open-label study showed that efficacy was maintained through the 12-month study period. An 8-week open-label trial found that OROS-MPH produced significantly higher remission rates than immediate-release MPH (44% vs 16%; p = 0.0002), as well as significantly higher Clinical Global Impression and parent satisfaction scores. Adderall XR(R), an extended-release formulation of mixed amphetamine salts, has recently been withdrawn from the market.

Conclusions: Long-acting stimulant formulations have dramatically changed the landscape of ADHD practice.