Adrian Sondheimer

CASE STUDY Clomipramine Treatment of Delusional Disorder-Somatic Type

Abstract Clomipramine was used to successfully treat a 17-year-old adolescent male who had developed, 2 years earlier, an ego-dystonic, circumscribed, somatic delusion presenting with distinct obsessional features. The development of Delusional Disorders among adolescents is described, along with problems raised for accurate diagnosis when attempting to determine precise positions on the continua of belief-obsession-delusion, nonpsy-chosis-psychosis, and syntonicity-dystonicity. A relationship between childhood Obsessive-compulsive Disorder and Delusional Disorder is posited, with consequent implications for further research in the treatment of the latter disorder with Clomipramine. J. Am. Acad Child Adolesc. Psychiatry , 1988, 27. 2:188–192.

An Approach to Teaching Ethics in Child and Adolescent Psychiatry

Examples of ethical dilemmas, emerging in the context of a resident case-centered seminar, are used to illustrate a proposed approach to instruction in ethics for child and adolescent psychiatry residents. In addition to a rudimentary formal didactic curriculum, a teaching methodology is outlined that intentionally focuses on ethical problems, approaches to analyses, proposed courses of action, and attempts at resolution. Four representative issues are utilized: confidentiality, treatment refusal, treatment termination, and the interface of individual and family therapies. Educational objectives include the increased recognition by child and adolescent psychiatry trainees of potential ethical conflicts, of the utility of ethical analyses to inform choices of clinical interventions, and of the desirability of forestalling premature action before attempts at thoughtful resolution.

Ethics and Child and Adolescent Psychiatry

This article describes the development and experience of one child and adolescent psychiatry training program’s approach to the creation and content of an ethics curriculum. Currently, a series of lecture-discussions covering ethics and forensic subjects are presented during the first year. Ethical principles, models, and reasoning are introduced, and their knowledge is deemed important to arrive at sensible resolutions of clinical dilemmas. Simultaneously, an emphasis on discussion of ethical dimensions of cases is expected during conferences, clinical experiences, and supervision throughout the 2 years of training. This article presents an analysis of one case for illustration. In addition, questions educators should consider prior to curriculum construction, related to the goals of instruction in ethics, are reviewed.

Teaching ethics and forensic psychiatry: a national survey of child and adolescent psychiatry training programs.

Though instruction in ethics and forensic psychiatry is required of child and adolescent psychiatry training programs, the nature of the education commonly provided is not known. The 1992 American Association of Directors of Psychiatric Residency Training Child and Adolescent Psychiatry Caucus survey sought to obtain this information by sending pertinent questionnaires to the 120 national member programs. Ninety-four programs responded, and the vast majority reported formal training in both subject areas. The specific topics covered, professions of the instructors, time devoted to instruction, and nature of clinical experiences offered are described. Furthermore, comparisons between time devoted to instruction and various demographic variables are presented. The results suggest that, while current teaching of ethics and forensic psychiatry in the responding training programs generally seems robust, it would be desirable to develop relevant core curricula and evaluation mechanisms, and to use the expertise of pertinent nonmental health professionals in instruction.

The Literature and Medicine Seminar for Medical Students

Literature and medicine (L-M) seminars have been used occasionally in psychiatric training programs, and their use has been sparingly described in the literature. A similar seminar designed for preclinical medical students, employing short stories focused on medically related themes, was offered as an elective in 1991. By asking enrollees about their future specialty choices, the author found that the L-M seminar predominantly attracted those students who were drawn to the “patient-oriented” specialties. In addition, both psychiatric expertise and sensitivity to student concerns and interests were necessary for the seminar to succeed. It is proposed, therefore, that the L-M seminar provides a novel opportunity for psychiatric educators to attract and encourage patient-oriented students to consider psychiatry as a future specialty choice early in their training.