Child and adolescent psychiatric clinics of North America
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Child Adolesc Psychiatr Clin N Am · Oct 2003
ReviewThe traumatized child at the emergency department.
The emergency department child and adolescent psychiatrist is in the unique position of informing and helping emergency department providers address the traumatic impact of the cause of a child's emergency presentation and the potential iatrogenic exacerbation of the acute traumatic response. The child and adolescent psychiatrist must become a clinical traumatologist who provides the necessary consultation and education that lead to practice change in emergency department awareness and procedures and performs the optimal evaluation and interventions for children who present in psychiatric crisis.
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Child Adolesc Psychiatr Clin N Am · Jul 2003
ReviewPsychological aspects of traumatic injury in children and adolescents.
Each year millions of children are exposed to some form of extreme traumatic stressor. These traumatic events include natural disasters (e.g., tornadoes, floods, hurricanes), motor vehicle accidents, life-threatening illnesses and associated painful medical procedures (e.g., severe burns, cancer, limb amputations), physical abuse, sexual assault, witnessing domestic or community violence, kidnapping, and sudden death of a parent. During times of war, violent and nonviolent trauma (e.g., lack of fuel and food) may have terrible effects on children's adjustment. ⋯ This finding has produced a fundamental change in the framework for understanding and helping children at high risk or already in trouble. This shift is evident in a changing conceptualization of the goals of prevention and intervention that currently address competence and problems. Strategies for fostering resilience described in this article should be tested in future controlled psychotherapy trials to verify their efficacy on children's protective factors.
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Child Adolesc Psychiatr Clin N Am · Apr 2003
ReviewDissociative symptoms in posttraumatic stress disorder: diagnosis and treatment.
This article explores the complex relationship between dissociation and psychiatric trauma. Dissociation is described as a defense reaction, a risk factor for the development of posttraumatic stress disorder, and as a set of syndromal disturbances. The authors discuss various models proposed for the relationship between these. They outline developmental considerations in diagnosis and treatment and end by discussing further needed research.
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Child Adolesc Psychiatr Clin N Am · Apr 2003
ReviewPharmacologic treatment approaches for children and adolescents with posttraumatic stress disorder.
Posttraumatic stress disorder is a common cause of morbidity in children and adolescents. The disorder in youth is similar to that in adults, with high rates of psychiatric comorbidity. Children seem to be more sensitive to the effects of trauma, and early life trauma exposure may induce a complex sequence of events that leads to the development of multiple psychiatric disorders in adulthood. ⋯ Despite the lack of well-designed, randomized, controlled trials that support efficacy, medication can be used in a rational and safe manner. Reduction in even one disabling symptom, such as insomnia or hyperarousal, may have a positive ripple effect on a child's overall functioning. Pharmacotherapy is typically used as one component of a more comprehensive multiple modality treatment package, including psychoeducation of the parent and child, focused exposure-based psychotherapy with adjunctive family therapy when indicated, and long-term booster interventions that use an admixture of psychodynamic, cognitive-behavioral, and pharmacologic interventions.
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Child Adolesc Psychiatr Clin N Am · Oct 2002
Forensic aspects of everyday practice: legal issues that every practitioner must know.
In their education and training, mental health care professionals are taught the intricacies and nuances of providing medical care to individuals with any and all psychological or psychiatric problems. This training, however, as comprehensive as it is from a medical perspective, does not and cannot prepare psychiatrists for the complex legal world that effectively has changed the manner and method in which mental health care is provided. As a result of the invasive meddling of the legal process into the mental health field, every patient is potentially a plaintiff in a lawsuit or a complainant in a licensure matter. ⋯ Being in Dr. Peters' position and being accused of medical malpractice in which a patient has suffered emotional or physical damage or has committed suicide is also not a recommended activity for a psychiatrist. Although avoidance of attorneys and the legal process is not possible for the practitioner, with the proper information and legal resources, the child and adolescent psychiatrist can navigate around the legal potholes.