Child and adolescent psychiatric clinics of North America
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There is solid evidence that active and goal-oriented cognitive-behavioral or relationship-focused therapies are generally superior to more generic therapies or to no treatment for clinically diagnosed and for undiagnosed but symptomatic youths. Between 50% to 87% of diagnosed youths who received a targeted treatment had recovered from their depressive episodes, in comparison to 21% to 75% of those who received some other generic therapy and 5% to 48% of wait-listed youths. The cognitive behavioral and relationship-oriented interventions that were tested tended to be even more successful in reducing depressive symptoms in school-based samples, possibly because the participants in the school-based studies may have been less disturbed than the clinically diagnosed cases. ⋯ It also appears that group interventions may be used as profitably as the more traditional individual therapy formats. And although parental participation in empiric treatment trials of pediatric depression has been limited to either separate parent groups as an adjunct [20,21 or family therapy [7], it can be argued that for various practical and clinical reasons [30] direct involvement of parents may be a wise choice. Parents may be critical to the success of interventions with depressed children and should be regarded as potential important agents of change.
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Child Adolesc Psychiatr Clin N Am · Jul 2002
Depression among youth in primary care models for delivering mental health services.
This article emphasizes the promise of efforts to improve care for depression within the primary care setting. These efforts, however face a number of potential obstacles. We have reviewed the literature on the detection and treatment of depression among youth in primary care settings and argue that primary care offers underutilized potential for reaching out to youth and improving access to high-quality care for depression. ⋯ These models build on the strengths of primary care settings and relationships and suport primary care providers with resources that enables them to expand with diagnostic and treatment targets to include depression and other mental health problems. The recent and ongoing studies reviewed in this articles provide some examples of these models. Future research is needed to clarify the effectiveness, costs,and benefits of this approach.
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Child Adolesc Psychiatr Clin N Am · Apr 2002
ReviewThe human genetics of eating disorders lessons from the leptin/melanocortin system.
Genetic analysis of eating disorders is complex phenotypically and genotypically. As seen in the leptin/melanocortin system, however, the results can lead to a deeper understanding and to new therapies. Benefits are expected for eating disorders that stem from genetic and psychologic causes. Finally, an awareness of possible genetic causes of eating disorders will help determine the causes--and thus the treatments--in children and adolescents with eating disorders, as exemplified by obese patients with mutations in the POMC, PC1, leptin, and MC4R loci.
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Child Adolesc Psychiatr Clin N Am · Apr 2000
ReviewNational and state policies influencing the care of children affected by AIDS.
The portrait of HIV-affected children and youth that emerges from this policy overview is still one of children obscured from view by the shadow of their parents' and siblings' illness and policies that only address the needs of HIV-infected individuals. In addition, the secrecy and stigma that still surround HIV and AIDS make it difficult for HIV-affected children and youth to benefit as fully as they might from policies and programs that provide more generic types of care and assistance. Our failure as a nation to better illuminate the plight of HIV-affected children and youth can only leave us with a generation of children who are at greater risk of psychiatric illness, involvement with the criminal justice system, substance abuse, and contracting HIV. ⋯ To support legislative, educational, and advocacy efforts to make managed care and welfare reform more responsive to the needs of HIV-affected children, youth, and their families. To encourage states to provide additional funding for mental health services specifically targeted to HIV-affected children and youth that are sufficiently flexible and of a long enough duration to adequately meet their needs. Surely, as we move into a new millennium with the capacity to map the human genome and clearly view distant galaxies, we should be able to marshal the will and resources necessary to formulate a sufficiently focused effort to respond compassionately and effectively to the needs of a generation of AIDS-affected children and youth.
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Child Adolesc Psychiatr Clin N Am · Jan 2000
ReviewPractical clinical issues regarding child and adolescent psychopharmacology.
The psychotropic treatment of child and adolescent psychiatric disorders is becoming increasingly common. In many cases, its clinical use outstrips its demonstrated scientific validity. Pharmacologic compounds need to be properly utilized, effectively prescribed, and appropriately monitored. This entails a detailed knowledge of various psychotropic agents, their pharmacokinetics and pharmacodynamics, and a high degree of psychotherapeutic sophistication in terms of the patient-family-physician relationship.