Child and adolescent psychiatric clinics of North America
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Child Adolesc Psychiatr Clin N Am · Jan 2005
Review Case ReportsElectroconvulsive therapy and repetitive transcranial magnetic stimulation in children and adolescents: a review and report of two cases of epilepsia partialis continua.
Brain stimulation for the treatment of psychiatric disorders has received increasing attention over the past decade. The introduction of experimental means to stimulate the brain noninvasively with magnetic fields not only has raised interest in these novel means of modulating brain activity but also has refocused attention on a mainstay in the treatment of severe major depression and other disorders (electroconvulsive therapy). This article reviews the current state of knowledge concerning the use electroconvulsive therapy, repetitive transcranial magnetic stimulation, and magnetic seizure therapy in children and adolescents. Two cases of medically intractable epilepsia partialis continua are presented to add to the limited literature on the use of repetitive transcranial magnetic stimulation in children and adolescents and illustrate the concept of using functional neuroimaging results to target the application of a focal intervention in an attempt to dampen hyperactive regions of the cortex.
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Child Adolesc Psychiatr Clin N Am · Apr 2004
Review Case ReportsContemporary issues in the psychiatric residential treatment of disturbed adolescents.
This article reviewed the current challenges to the provision of residential treatment for disturbed adolescents, described the Menninger Clinic's model for short-term residential treatment that has been developed over the last 10 years to meet these challenges, and provided a case example to exemplify the role of such newly developed concepts as "mentalizing" in the provision of psychiatric treatment. Stimulated by the alarm of the costs of health care in general, residential treatment is highly scrutinized by private third-party payers and public funding sources. ⋯ The essential ingredients needed to ensure that treatment is effective and that treatment gains are sustained were described. Finally, a case was used to illustrate current views of understanding some of the processes that engage patients and stimulate changes in several variables.
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Child Adolesc Psychiatr Clin N Am · Oct 2003
ReviewThe traumatized child at the emergency department.
The emergency department child and adolescent psychiatrist is in the unique position of informing and helping emergency department providers address the traumatic impact of the cause of a child's emergency presentation and the potential iatrogenic exacerbation of the acute traumatic response. The child and adolescent psychiatrist must become a clinical traumatologist who provides the necessary consultation and education that lead to practice change in emergency department awareness and procedures and performs the optimal evaluation and interventions for children who present in psychiatric crisis.
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Child Adolesc Psychiatr Clin N Am · Jul 2003
ReviewPsychological aspects of traumatic injury in children and adolescents.
Each year millions of children are exposed to some form of extreme traumatic stressor. These traumatic events include natural disasters (e.g., tornadoes, floods, hurricanes), motor vehicle accidents, life-threatening illnesses and associated painful medical procedures (e.g., severe burns, cancer, limb amputations), physical abuse, sexual assault, witnessing domestic or community violence, kidnapping, and sudden death of a parent. During times of war, violent and nonviolent trauma (e.g., lack of fuel and food) may have terrible effects on children's adjustment. ⋯ This finding has produced a fundamental change in the framework for understanding and helping children at high risk or already in trouble. This shift is evident in a changing conceptualization of the goals of prevention and intervention that currently address competence and problems. Strategies for fostering resilience described in this article should be tested in future controlled psychotherapy trials to verify their efficacy on children's protective factors.
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Child Adolesc Psychiatr Clin N Am · Apr 2003
ReviewDissociative symptoms in posttraumatic stress disorder: diagnosis and treatment.
This article explores the complex relationship between dissociation and psychiatric trauma. Dissociation is described as a defense reaction, a risk factor for the development of posttraumatic stress disorder, and as a set of syndromal disturbances. The authors discuss various models proposed for the relationship between these. They outline developmental considerations in diagnosis and treatment and end by discussing further needed research.