Paramjit T. Joshi

Depression and Bipolar Support Alliance Consensus Statement on the Unmet Needs in Diagnosis and Treatment of Mood Disorders in Children and Adolescents

OBJECTIVEnTo focus attention on the critical unmet needs of children and adolescents with mood disorders and to make recommendations for future research and allocation of healthcare resources.nnnMETHODnThe 36-member Consensus Development Panel consisted of experts in child/adolescent or adult psychiatry and psychology, pediatrics, and mental health advocacy. Reviews of the literature concerning youth mood disorders were performed on the subjects of risk factors, prevention, diagnosis, treatment, and services delivery, and opinions and experiences of mental health advocates were obtained.nnnRESULTSnThe Consensus Development Panel listened to presentations and participated in discussions. Independent workgroups of clinicians, scientists, and mental health advocates considered the evidence and prepared preliminary statements. Workgroup leaders presented drafts for discussion by the Consensus Development Panel. The final document was reviewed by the entire group and edited to incorporate input from all participants.nnnCONCLUSIONSnEvidence suggests high rates of unmet needs for children and adolescents with depression or bipolar disorder. Training is largely limited to child mental health specialists; general psychiatrists, pediatricians, and other primary care physicians receive little or no training. As a result, treatment patterns may reflect adult treatment plans that are not validated for youths. Effective treatments have been identified and some preliminary prevention models have been developed, but they are not yet widely applied. Patients experience limited exposure to clinicians adequately trained to address their problems and little information to guide care decisions, particularly concerning bipolar disorder. National efforts are required to restructure healthcare delivery and provider training and to immediately develop more advanced research on pathophysiology, prevention, and services delivery effectiveness.

The Children's Affective Lability Scale: A psychometric evaluation of reliability

The Childrens Affective Lability Scale (CALS) is a 20-item parent report measure developed to assess affect regulation in children aged 6-16. It was normed with school children in regular education classrooms and with children hospitalized in a psychiatric facility. Internal-consistency reliability, split-half reliability, and two-week test-retest reliability were excellent. Staff interrater reliability in the psychiatric sample was acceptable. Higher CALS scores were observed in an in-patient psychiatric sample than in either an out-patient or a normative sample. A principal components factor analysis yielded two components for the normative sample.

Use of a Quiet Room on an Inpatient Unit

Abstract Removal to a quiet room is a commonly used behavioral technique to reduce aggressive and disruptive behaviors and decrease sensory stimuli in the management of children on inpatient psychiatric units. The use of the quiet room by nursing staff was systematically examined in a series of psychiatrically disturbed preadolescent children on an inpatient unit. The results indicate that the frequency and time spent in the quiet room decrease significantly over time during hospitalization and that the majority of the episodes involve voluntary self-seclusion. Furthermore, in the majority of the episodes the patients were quiet, and in half of the episodes they were able to explain the reason for quiet room usage. Results suggest that the quiet room may be a useful, therapeutic management tool that enhances self-control in children with serious psychiatric disturbances.

Exposure to violence and trauma: questionnaire for adolescents

Violence has become a major part of life in many schools, homes and communities in the USA. It is especially devastating to children and adolescents who are vulnerable because of emotional, social ...

Effective management with lithium of a persistent, post-traumatic hypomania in a 10-year-old child.

A 10-year-old child who suffered closed head trauma resulting in a coma of 1 weeks duration at the age of 4, developed a persistent, severe behavioral disorder characterized by hyperactivity, impulsivity, distractability, irritability, and grandiosity. Prior attempts at treatment with stimulants and behavioral modification were unsuccessful. Treatment with lithium carbonate resulted in a marked reduction in symptoms and attenuation in her emotional lability.

Psychometric characteristics of the Children's Motivation Scale.

A 16-item Childrens Motivation Scale (CMS) was developed to evaluate level of motivation in children and adolescents. The study population consisted of a normative sample of 290 school children and a clinical sample of 165 child and adolescent psychiatric patients. Test-retest, internal consistency, and interrater reliability were fair to good for both samples. Validity of the CMS was demonstrated by its ability to differentiate clinical from normative samples according to the level of motivation, by a significant correlation of the CMS with an independent measure of withdrawal, and by its lack of correlation with an independent measure of depression. Principal components analysis identified a three-component structure. These findings support the conclusion that the CMS accesses a clinically important but often overlooked psychiatric construct.

The Johns Hopkins Depression Scale: normative data and validation in child psychiatry patients.

With a newly devised 38-item symptom checklist based upon DSM-III criteria for major affective disorder, normative data were obtained on 1,004 school children, aged 5 to 13 years. The items on the checklist were scored on a severity scale of 0 to 4 with a maximum score of 152. The average raw scores in this population was 31.2, SD +/- 2.4. Of 57 inpatients, 27 met DSM-III criteria for a major affective disorder and obtained mean raw scores of 66.8, SD +/- 13.4. The 30 nondepressed inpatients had scores of 36.4, SD +/- 5.3. The differences in the raw scores between the depressed inpatients and normal controls, and depressed and nondepressed inpatients were found to be statistically significant (p less than 0.01). The new checklist can serve as a potential screening instrument, is not time consuming, and has been standardized on a large normal control population for age and sex.

Guidelines for international trauma work

The trend to make children targets of atrocities secondary to war is one of the biggest human tragedies which stirs outrage, while simultaneously mobilizing spontaneous humanitarian impulses of wanting to help, perpetuated by the images in the media of children in anguish and pain. The issue of psychological trauma caused by violence has become a global epidemic, and the worlds most pressing social and public health dilemma. Such traumatization has been shown to have long-lasting devastating consequences on normal growth and development. This results in much sympathy and concern on the part of adults who are deeply troubled seeing children suffer during war and the increasing epidemics of global violence. However, one quickly learns that such sympathetic impulses need to be harnessed in a productive manner. Knowledge and training in the psychopathology and phenomenology of mental illness is not enough. Alas, the most recent lessons learned in Croatia and Bosnia-Herzegovina were many and the experiences h...