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

Introduction: Training in family therapy for general psychiatry residents during their child rotation is either not taught or the objectives not well described in psychiatric curricula.

Method: Based on the combined experience of 4 family therapists over a 6 year period with 56 students (psychiatry, social work, psychology), we describe our experience with training general psychiatry residents in an introduction to an interdisciplinary family therapy, systemic-reflective course during their child psychiatry rotation. The model was based on experiential training, where both trainees and supervisors could build skills as they reflect on their process as learners and teachers.

Results: Residents' ratings at the end of rotation indicated extremely high satisfaction with the course.

Conclusion: We advocate that an experiential interdisciplinary course serving as an introduction to family assessment and systemic/reflective principles are valuable skills that have lasting value to general psychiatry residents.

Introduction: Although the term borderline personality disorder (BPD) is used to describe adolescents in clinical settings, there is confusion as to what it comprises. To further elucidate that diagnosis, this article reviews its construct validity.

Method: Relevant publications appearing in PsychInfo (1872 to present) were reviewed for the purposes of this article.

Results: Thirty-six of the approximately sixty-five publications selected for consideration were included in this review.

Conclusion: The construct validity of adolescent BPD is supported by internal consistency (comparable to that of adults), group differences (ie this diagnosis segregates BPD from non-BPD adolescents), convergent validity (ie multiple measures of this disorder measure the same pathology) and concurrent validity, whereby these youth manifest functional impairment and distress. By contrast, the adolescent BPD criteria manifest less construct validity than the adult diagnosis in that its criteria did not uniformly predict the overall diagnosis, and showed more criterion overlap with other personality disorders and a broader pattern of axis II comorbidity. Further diminishing its construct validity, factor analysis suggested that adolescent BPD was not a single entity, and its low predictive validity was demonstrated by little diagnostic stability through adolescence into adulthood.

Introduction: Self injurious behaviour is not uncommon in depressed adolescents while little is known about effective treatments for this behaviour in this age group. The objective of this article is to illustrate the development and initial pilot of groups for adolescents who self injure and their parents.

Method: Articles and texts derived from a literature search of group treatments for self injuring adolescents were used to develop a pilot group for self injuring adolescents and a separate group for parents. The groups were piloted over the spring of 2004, at a community child and youth mental health clinic.

Results: Eight weekly sessions for adolescents and 4 biweekly sessions for parents occurred. The adolescent group was a back to back dialectical behaviour therapy (DBT) skills group followed by a therapeutic support group. Two thirds of both the adolescents and parents completed their groups. Overall, adolescents found both theirs and the parent group helpful. Parents reported that their group enabled more balanced and less reactive communication as well as benefit in meeting and talking with other parents facing similar difficulties.

Conclusion: Further refinement and formal evaluation of such group therapy approaches to the treatment of self injurious behaviour in adolescents is warranted.

Introduction: The ability to accurately infer the thoughts, intentions and emotional states of others has often been associated with the concept of empathy. De.cits in this ability are common in those with personality disorders.

Method: Current neurocognitive models of empathy-related abilities and the biological research to support them are discussed.

Results: There is evidence that observing the actions of others activates regions of the observer's brain involved in executing the analogous action. It is proposed this motor resonance is used to cortically simulate observed movements. Simulation may permit access to the thoughts and emotions of the observer when they make a similar action. This information could then be used to infer the intentions of the observed person.

Conclusion: The relevance of these models to clinical aspects of personality disorders is discussed.

Introduction: the Diagnostic Interview for Narcissism, an instrument developed by Gunderson and associates to assess pathological narcissistic traits in adults, has been adapted for use with parents of preadolescents as a semi-structured interview. A sixth section has been added to assess the parental narcissistic investment of the child.

Methods: the sample consists of 21 parents of children (aged 8-13 years) at risk for narcissistic personality disorder. An interviewer-observer design, with independent interview evaluation, was used to assess inter-rater reliabilities. Both raters were blind to diagnostic information.

Results: Very good inter-rater reliabilities (ranging from .85 to 1.00) were obtained for all 35 statements of this Parent version of the DIN (P-DIN). Good internal consistencies a=0.82, a=0.88, a=0.69, respectively) were obtained for the first three Sections of the P-DIN, which include all the DSM-IV criteria for Narcissistic Personality Disorder. Section V, Social/Moral Adaptation (a=0.54), and Section VI, Parental Narcissistic Investment of the Child (a=0.62), had weaker internal consistencies. Section IV, Mood States, had the lowest internal consistency (a=0.50). Finally, a high reliability coefficient was obtained for the total scale (a=0.92, 32 statements for Sections I to V).

Conclusion: present results of this pilot study justify further research into the P-DIN psychometric properties.

Introduction: A personality pathology framework may be useful in the diagnosis and treatment of children with chronic psychopathology and impairment in many domains of functioning. This paper presents the utility of such an approach through a description of research investigating borderline pathology of childhood (BPC).

Methods: Literature regarding the phenomenology, risk factors, and outcomes of BPC and similar disorders is reviewed.

Results: Research conducted at the SMBD-Jewish General Hospital in Montreal has shown that children with BPC can be reliably identified via chart review, and that they exhibit a pattern of risk factors similar to that of adults with borderline personality disorder, such as psychological trauma and deficits in executive function. Preliminary results of a follow-up study in adolescence suggests that these children remain more functionally impaired than a comparison group. Our current research investigates neuropsychological deficits and their relationship to trauma in children with BPC. We are also exploring whether a similar pattern can be observed in their parents.

Conclusion: We conclude that BPC symptom patterns may diagnostically define a group of high risk children and may eventually guide our approach to early intervention.