Child and adolescent psychiatric clinics of North America
-
Child Adolesc Psychiatr Clin N Am · Jan 2006
ReviewTeamwork: the therapeutic alliance in pediatric pharmacotherapy.
All child psychiatrists' interactions with patients and families have important potential meanings, and the act of prescribing medication is no exception. As psychopharmacologic practice has increased in child psychiatry, facility with psychotherapeutic skills, such as establishing an alliance, identifying and treating symptoms, and promoting adherence must follow to enhance clinical outcomes. This article addresses the role of the therapeutic alliance in pediatric work, the psychologic implications of administering medications, developmental issues altering psychopharmacologic efforts, the role of the dual alliance (allying both patients and parents), and recommendations for clinical practice and further research.
-
Child Adolesc Psychiatr Clin N Am · Jul 2005
ReviewThe internet and children: advantages and disadvantages.
This article examines how the Internet has entered children's lives and notes some of its potential positive and negative influences on children. Although the Internet's effects on a given child vary based on each child's characteristics and how the child uses the Internet, adults still must have a fundamental understanding of these general potentials. ⋯ Whether a child uses the Internet and how a child uses the Internet significantly impact the Internet's influence on him or her. A child's personality and developmental needs also inevitably modify the Internet's influence on him or her.
-
Child Adolesc Psychiatr Clin N Am · Jan 2005
Review Case ReportsElectroconvulsive therapy and repetitive transcranial magnetic stimulation in children and adolescents: a review and report of two cases of epilepsia partialis continua.
Brain stimulation for the treatment of psychiatric disorders has received increasing attention over the past decade. The introduction of experimental means to stimulate the brain noninvasively with magnetic fields not only has raised interest in these novel means of modulating brain activity but also has refocused attention on a mainstay in the treatment of severe major depression and other disorders (electroconvulsive therapy). This article reviews the current state of knowledge concerning the use electroconvulsive therapy, repetitive transcranial magnetic stimulation, and magnetic seizure therapy in children and adolescents. Two cases of medically intractable epilepsia partialis continua are presented to add to the limited literature on the use of repetitive transcranial magnetic stimulation in children and adolescents and illustrate the concept of using functional neuroimaging results to target the application of a focal intervention in an attempt to dampen hyperactive regions of the cortex.
-
Child Adolesc Psychiatr Clin N Am · Apr 2004
Historical ArticlePsychoanalysis and the early beginnings of residential treatment for troubled youth.
One of the intentions of Aichhom, Redl, Wineman, Bettelheim, and Anna Freud in their writings about group care was to advocate for the need to simplify the lives of youths who had known only chaos, to create an atmosphere in which everything has a purpose and predictable positive responses were given unconditionally. Recent efforts, such as those by Greenberg et at, have focused on building community-wide early interventions to forestall later emergence of emotional or behavioral disorders. The efforts also mark a shift away from punishment and exclusion for troubled children at school to more inclusive systems of positive behavioral interventions and support by providing a place to achieve academic and social behavioral success. ⋯ This enhanced awareness of a child's impact on others through the marginal life-space interview, together with enhanced awareness of one's own wishes and thoughts as provided by the milieu and individual therapy, may offer the best means for helping a young person return successfully to the community. Although it is increasingly difficult to support young people in long-term milieu therapy, the concerns initially expressed by Anna Freud and her Viennese colleagues, continued in the work of Bettelheim, Ekstein, and Redl, suggest that attention to a child's understanding of self and experience and focus on the interplay of dynamics between the child and the social milieu continues to offer an important means for therapeutic change. This remains true, even at a time when pressure for "mainstreaming" children with special needs together with financial constraints and reliance on psychopharmacology have altered more traditional understanding of the provision of residential psychodynamic treatment for troubled young people.
-
Child Adolesc Psychiatr Clin N Am · Apr 2004
Review Case ReportsContemporary issues in the psychiatric residential treatment of disturbed adolescents.
This article reviewed the current challenges to the provision of residential treatment for disturbed adolescents, described the Menninger Clinic's model for short-term residential treatment that has been developed over the last 10 years to meet these challenges, and provided a case example to exemplify the role of such newly developed concepts as "mentalizing" in the provision of psychiatric treatment. Stimulated by the alarm of the costs of health care in general, residential treatment is highly scrutinized by private third-party payers and public funding sources. ⋯ The essential ingredients needed to ensure that treatment is effective and that treatment gains are sustained were described. Finally, a case was used to illustrate current views of understanding some of the processes that engage patients and stimulate changes in several variables.