Child and adolescent psychiatric clinics of North America
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This article provides a summary of the history of the development of the subspecialty of child and adolescent psychiatry and the concomitant development of training in the field. The historical perspective provides a context for the discussion of an overview of child and adolescent psychiatry training in the twenty-first century. Four challenges are identified: recruitment, funding, curriculum, and assessment and remediation, each of which is discussed in some depth. The article concludes with a perspective that focuses efforts in training more on basic core competencies rather than the rapidly expanding and changing medical knowledge and specific clinical interventions relevant to the field.
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This article briefly describes the background and development of the core competencies in medicine and their relevance to various levels of medical education: undergraduate, graduate, and post-graduate. The current status and issues of the competencies for each state of training--medical schools, residencies, and continuing medical education--are reviewed. Strategies for developing and implementing the core competencies into child and adolescent psychiatry training are discussed.
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The adolescent at the end of life poses a unique combination of challenges resulting from the collision of failing health with a developmental trajectory meant to lead to attainment of personal independence. Because virtually all spheres of the dying adolescent's life are affected, optimal palliative care for these young persons requires a multidisciplinary team whose members have a good understanding of their complementary roles and a shared commitment to providing well-coordinated care. ⋯ A crucial area for dying adolescents is medical decision making, where the full range of combined support is needed. By helping the young person continue to develop personal autonomy, the multidisciplinary team will enable even the dying adolescent to experience dignity and personal fulfillment.
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Psychopharmacologic treatment in pediatric critical care requires a careful child or adolescent psychiatric evaluation, including a thorough review of the history of present illness or injury, any current or pre-existing psychiatric disorder, past history, and laboratory studies. Although there is limited evidence to guide psychopharmacologic practice in this setting, psychopharmacologic treatment is increasing in critical care, with known indications for treatment, benefits, and risks; initial dosing guidelines; and best practices. Treatment is guided by the knowledge bases in pediatric physiology, psycho-pharmacology, and treatment of critically ill adults. ⋯ Treating children who are critically ill with psychotropic drugs is an integral component of comprehensive pediatric critical care in relieving pain and delirium; reducing inattention or agitation or aggressive behavior;relieving acute stress, anxiety, or depression; and improving sleep and nutrition. In palliative care, psychopharmacology is integrated with psychologicapproaches to enhance children's comfort at the end of life. Defining how best to prevent the adverse consequences of suffering and stress in pediatric critical care is a goal for protocols and for new psychopharmacologic research [23,153].
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Child Adolesc Psychiatr Clin N Am · Apr 2006
ReviewTreatment and postrelease rehabilitative programs for juvenile offenders.
The juvenile justice system has become notably aware of the increasing use of postrelease rehabilitative treatment interventions for offenders. In many instances, juvenile justice systems are required to ensure that core treatment needs of youth are met. ⋯ It reviews cognitive-behavioral theoretical models and core postrelease treatment strategies. It presents a review of youth who have specialized needs in light of postrelease practices, describes several model postrelease rehabilitation programs, and reviews outcomes of these programs.