Shashank V. Joshi

Psychiatric medications for the treatment of pruritus.

Objectives: To review the use of psychiatric medications in the treatment of pruritus. Methods: A literature review was conducted using the key words pruritus, psychiatric, and treatment. Results: Three categories of pruritus are described: dermatologic, systemic, and psychogenic. Peripheral and central nervous system mechanisms of pruritus are reviewed. Conventional dermatologic treatments for pruritus are contrasted with some of the common psychopharmacologic treatment modalities that include anxiolytic, antidepressant, and antipsychotic agents. A treatment algorithm is offered to help guide the treatment of patients with pruritus. Conclusions: Psychiatric medications have been used successfully in the treatment of pruritus that is associated with both psychocutaneous and systemic disorders, which are resistant to conventional treatment. 5HT = hydroxytryptamine; PGE2 = prostaglandin E2; SSRI = selective serotonin reuptake inhibitor; TCA = tricyclic antidepressant.

Culture and development in children and youth.

Although culture has long been recognized as having a significant impact on human development and its variations, many child and adolescent psychiatrists and mental health clinicians assume a universal nonvariance to normal development, with the risk of identifying variations as pathologic. This article reviews the conceptual basis for the role of culture in human development, particularly psychosocial and cognitive development, presents evidence and support from field observations of children in diverse cultures, and discusses the emerging evidence from the field of cultural neuroscience. Implications for these different perspectives on future research, childhood education, and even intercultural relations are presented.

Culturally Adapted Pharmacotherapy and the Integrative Formulation

There are important ethnic variations in metabolism, response, and tolerability of psychotropic medications. There has been a dramatic expansion of use of psychotropic medications in children in recent years. This article reviews the literature on the role of race and ethnicity in psychopharmacology as it relates to children and adolescents, examines what is known thus far about complementary and alternative medicine approaches in pediatric psychopharmacology, and presents a method to engage patients and families of varying educational and cultural backgrounds in pharmacotherapeutic treatment.

Does Early Mentorship in Child and Adolescent Psychiatry Make a Difference? The Klingenstein Third-Generation Foundation Medical Student Fellowship Program

ObjectiveThere is a critical shortage of child and adolescent psychiatrists in the United States. Increased exposure, through mentorship, clinical experiences, and research opportunities, may increase the number of medical students selecting child and adolescent psychiatry (CAP) as a career choice.MethodBetween 2008 and 2011, 241 first-year participants of a program to increase exposure to CAP, funded by the Klingenstein Third-Generation Foundation (KTGF) at 10 medical schools completed baseline surveys assessing their opinions of and experiences in CAP, and 115 second-year participants completed follow-up surveys to reflect 1 year of experience in the KTGF Program.ResultsStudents reported significantly increased positive perception of mentorship for career and research guidance, along with perceived increased knowledge and understanding of CAP.ConclusionsResults suggest that the KTGF Program positively influenced participating medical students, although future studies are needed to determine whether these changes will translate into more medical students entering the field of CAP.

Recognizing and Referring Children with Posttraumatic Stress Disorder: Guidelines for Pediatric Providers

1. Helen W. Wilson, PhD* 2. Shashank V. Joshi, MD* 1. *Division of Child and Adolescent Psychiatry and Child Development, Stanford University School of Medicine, Stanford, CA * Abbreviations: DSM-V : : Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition PTSD: : posttraumatic stress disorder SSRI: : selective serotonin reuptake inhibitors Posttraumatic stress disorder (PTSD) affects approximately 4% of US children and teens and can severely impact the quality of social, academic, and personal welfare aspects of a child or adolescent and can persist into adulthood. Yet, 1 study indicated that only 18% of pediatricians surveyed felt that they had adequate knowledge of pediatric PTSD, and most (72%) reported that greater collaboration with mental health providers would improve their assessment of PTSD. (1) Health-care providers who treat pediatric populations should be aware of the magnitude of this problem and be able to screen for and refer children and teens with PTSD for specific treatments. (1) 1. Banh MK, Saxe G, Mangione T, Horton NJ. Physician-reported practice of managing childhood posttraumatic stress in pediatric primary care. Gen Hosp Psychiatry . 2008;30(6):536–545 After completing this article, readers should be able to: 1. Identify and refer children affected by trauma for appropriate evaluation and evidence-based treatment. 2. Summarize the evidence for treatment approaches, including psychotherapies. 3. Understand the importance of pediatric providers knowing about what treatments have been supported for treating pediatric posttraumatic stress disorder. At a routine health supervision visit, a mother expresses concern that her 3-year-old daughter has “gone back to the terrible twos.” The mother says that her daughter is having intense tantrums that can last hours, is having increased difficulty separating from her, is taking much longer than usual to get to sleep at night, is often coming into her mother’s room in the middle of the night, and has wet her pants on several occasions although she was previously toilet trained. The mother says that these behaviors began shortly after an …

Statement Regarding the National Resident Matching Program Child and Adolescent Psychiatry Match: A Call to Uphold the Gentlepersons’ Agreement

Previous authors [1] have described the decision and process of choosing a psychiatry residency as a “seminal event” (p. 436). The Child and Adolescent Psychiatry (CAP) Caucus of the American Association of Directors of Psychiatric Residency Training (AADPRT) has highlighted that the process for CAP fellowship is no less important and can seem, at times, daunting. Thus, the CAP Caucus of AADPRT, which represents CAP program directors nationally, has had a series of discussions at the AADPRT annual meeting in order to selfgovern the process as it relates to recruitment of applicants from general residency into CAP training programs. The process has resulted in a gentleperson’s agreement that, though not legally binding, highlights the mutually agreed upon “rules of the game”. (Gentleperson’s Agreement is a more inclusive version of the term Gentlemen’s Agreement, which originated from President Theodore Roosevelt’s efforts to calm tensions between Japan and the USA in the early 1900s.) As of the date of this publication, there are 125 accredited CAP training programs in the U.S. In 2013, the specialty joined the Association of American Medical Colleges’ Electronic Residency Application Service (ERAS) process. In doing so, CAP programs agreed to follow the spirit of the “All In” process, whereby programs that participated in the National Resident Matching Program (NRMP) and ERAS were to take all their positions (at least those posted after July 1), exclusively through the Match. The NRMP oversees the Match for CAP fellowships. The NRMP match participation agreement [2] governs the process; however, a few issues have developed and are still considered to be sources of difficulty in child and adolescent training programs. A gentlepersons’ agreement was agreed upon by a near-unanimous voice vote at the AADPRT annual meeting in Tucson, Arizona, March 2014. The terms of this gentlepersons’ agreement include the following:

Shared Learning in Community-Academic Partnerships: Addressing the Needs of Schools

The educational mission of schools extends far beyond coursework and includes supporting students’ social and emotional development. Resources in a school for strengthening this social-emotional growth can stem from a combination of district resources and those available in the local community. Community-academic partnerships can help bridge educational needs at a school and provide mental health services when needed within the school environment. This relationship provides an opportunity for two-way knowledge exchange between partners: to improve the quality of services delivered in schools and to ensure that research and academic activities at the university remain relevant and informed by the needs of communities and schools. This narrative provides two examples of school community-academic partnerships and explores how these collaborative relationships first developed, what interventions were jointly delivered, and shared outcomes as a result of these partnerships. Finally, future directions for these school community and academic relationships are described.

Multicultural and Ethical Considerations in American Medicine

The authors describe and examine models of culturally informed care, giving attention to the culture of the patient and of the provider and the context of care. Ethical issues in multicultural medical environments are discussed and articulated through the use of case studies with narrative explanation. Culturally astute communication skills are explored. The authors recommend effective methods to address ethical issues in multicultural environments.