Child and adolescent psychiatric clinics of North America
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Psychopharmacologic treatment in pediatric critical care requires a careful child or adolescent psychiatric evaluation, including a thorough review of the history of present illness or injury, any current or pre-existing psychiatric disorder, past history, and laboratory studies. Although there is limited evidence to guide psychopharmacologic practice in this setting, psychopharmacologic treatment is increasing in critical care, with known indications for treatment, benefits, and risks; initial dosing guidelines; and best practices. Treatment is guided by the knowledge bases in pediatric physiology, psycho-pharmacology, and treatment of critically ill adults. ⋯ Treating children who are critically ill with psychotropic drugs is an integral component of comprehensive pediatric critical care in relieving pain and delirium; reducing inattention or agitation or aggressive behavior;relieving acute stress, anxiety, or depression; and improving sleep and nutrition. In palliative care, psychopharmacology is integrated with psychologicapproaches to enhance children's comfort at the end of life. Defining how best to prevent the adverse consequences of suffering and stress in pediatric critical care is a goal for protocols and for new psychopharmacologic research [23,153].
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The adolescent at the end of life poses a unique combination of challenges resulting from the collision of failing health with a developmental trajectory meant to lead to attainment of personal independence. Because virtually all spheres of the dying adolescent's life are affected, optimal palliative care for these young persons requires a multidisciplinary team whose members have a good understanding of their complementary roles and a shared commitment to providing well-coordinated care. ⋯ A crucial area for dying adolescents is medical decision making, where the full range of combined support is needed. By helping the young person continue to develop personal autonomy, the multidisciplinary team will enable even the dying adolescent to experience dignity and personal fulfillment.
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Child Adolesc Psychiatr Clin N Am · Apr 2006
ReviewTreatment and postrelease rehabilitative programs for juvenile offenders.
The juvenile justice system has become notably aware of the increasing use of postrelease rehabilitative treatment interventions for offenders. In many instances, juvenile justice systems are required to ensure that core treatment needs of youth are met. ⋯ It reviews cognitive-behavioral theoretical models and core postrelease treatment strategies. It presents a review of youth who have specialized needs in light of postrelease practices, describes several model postrelease rehabilitation programs, and reviews outcomes of these programs.
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Child Adolesc Psychiatr Clin N Am · Jan 2006
ReviewTeamwork: the therapeutic alliance in pediatric pharmacotherapy.
All child psychiatrists' interactions with patients and families have important potential meanings, and the act of prescribing medication is no exception. As psychopharmacologic practice has increased in child psychiatry, facility with psychotherapeutic skills, such as establishing an alliance, identifying and treating symptoms, and promoting adherence must follow to enhance clinical outcomes. This article addresses the role of the therapeutic alliance in pediatric work, the psychologic implications of administering medications, developmental issues altering psychopharmacologic efforts, the role of the dual alliance (allying both patients and parents), and recommendations for clinical practice and further research.
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Child Adolesc Psychiatr Clin N Am · Jul 2005
ReviewThe internet and children: advantages and disadvantages.
This article examines how the Internet has entered children's lives and notes some of its potential positive and negative influences on children. Although the Internet's effects on a given child vary based on each child's characteristics and how the child uses the Internet, adults still must have a fundamental understanding of these general potentials. ⋯ Whether a child uses the Internet and how a child uses the Internet significantly impact the Internet's influence on him or her. A child's personality and developmental needs also inevitably modify the Internet's influence on him or her.