Child and adolescent psychiatric clinics of North America
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Child Adolesc Psychiatr Clin N Am · Oct 2011
Guidelines for pubertal suspension and gender reassignment for transgender adolescents.
Pubertal suppression at Tanner stage 2 should be considered in adolescents with persistent gender identity disorder (GID). Issues related to achievement of adult height, timing of initiating sex steroid treatment, future fertility options, preventing uterine bleeding, and required modifications of genital surgery remain concerns. Concerns have been raised about altering neuropsychological development during cessation of puberty and reinitiation of puberty by the sex steroid opposite those determined by genetic sex. Collaborative assessment and treatment of dysphoric adolescents with persistent GID resolves these concerns and deepens our understanding of gender development.
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This article focuses on considerations for natal females who present in the adolescent years with concerns related to their gender. They maybe individuals previously evaluated in their childhood years who have persisted with gender variance or gender identity disorder (GID) in DSM-IV, or they may be presenting for the first time in their adolescent years. The article discusses how to assess adolescents who come for evaluation and what treatments and other resources are available for them and their families. Where there seem to be differences between boys and girls with gender identity issues, they will be noted.
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Child Adolesc Psychiatr Clin N Am · Apr 2010
ReviewPartnerships between pediatric palliative care and psychiatry.
Children with life-threatening illnesses and their families may face physical, emotional, psychosocial, and spiritual challenges throughout the children's course of illness. Pediatric palliative care is designed to meet such challenges. Given the psychosocial and emotional needs of children and their families it is clear that psychiatrists can, and do, play a role in delivering pediatric palliative care. ⋯ The authors present an overview of pediatric palliative care followed by a summary of some of the roles for psychiatry. Two innovative pediatric palliative care programs that psychiatrists may or may not be aware of are described. Finally, some challenges that are faced in further developing this partnership and suggestions for future research are discussed.
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Child Adolesc Psychiatr Clin N Am · Jan 2010
ReviewPhysician leadership and quality improvement in the acute child and adolescent psychiatric care setting.
Inpatient child and adolescent psychiatry leadership roles are often multifaceted, necessitating strong clinical knowledge and skills, organizational and leadership abilities, and in the academic setting the desire and skill in teaching and research. Early career psychiatrists who do possess these attributes may find themselves unprepared for such challenges as dealing with complex administrative and economic issues, accreditation, legal matters, and multitasking. This article offers a primer addressing these basic issues and in managing change through quality improvement processes.
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Child Adolesc Psychiatr Clin N Am · Jan 2010
ReviewDirecting child and adolescent psychiatry training for residents.
Directing child and adolescent psychiatry (CAP) training for residents is a complex and challenging administrative task that encompasses the broad creativity of the orchestral conductor, the social and interpersonal effectiveness of the best politician, and the orientation to details of the finest accountant. This article examines these roles in detail, recognizing the leadership, administrative, and managerial achievements of the successful child and adolescent program director. ⋯ The article concludes with suggestions for CAP training directors to influence medical student education. Although challenging and sometimes frustrating, the role of the program director in CAP training is almost always exciting and rewarding.