Understanding Child And Adolescent Psychiatry

The psychology and mindset of the child and the adolescent is becoming increasingly complex, which makes the study of adolescent psychiatry more pertinent and interesting.

As children grow up, they go through a horde of emotion, and changed in their lives which trigger feelings which they might be ill-equipped to handle. It is very important to understand the acute psychology of a child, because the younger years and also the years growing years are very important, as their minds are very malleable.

They are prone to imbibing whatever they see, and they are not used to conflicts and questions which crops up with more and more exposure to the external environment. After extensive study, www.newspsychology.com has found that the sub-practice of child and adolescent psychiatry is more active than most other fields, because of the complexities if the patients, which is ever-increasing. This is our website so you can visit here for any information.

Approaching the Psychology Of Minors

When a psychiatrist is treating a person who is not so mentally developed yet, they have to proceed with caution. It is important to ensure that the patient is free and open with the practitioner, otherwise inhibition, fright or shyness may hamper the process of healing. There are several ways in which treatment is facilitated.

  • Observation is one of the key factors. Children are observed, and their social and personal environment is taken into account.
  • Integrated approach of treatment includes ensuring that the child, along with his friends, peers, teachers and family members are also effectively counseled, for the mental healing and growth of the child.

There are several other ways of treatment, which has to be taken into account, when dealing with kids. Their mental perceptions and ideas are very different from adults, and they have to be handled without being intimidated. 

The Sub Practices In Psychiatry

Psychiatry has changed the way in which people are treated, when they approach specialists with their mental problems and disorders. It is a revolutionary way of treatment, which has ensured that the effects are more long lasting.

Psychiatry is a branch that is becoming more and more relevant, as the problems and stress in people’s lives become more and more potent. Because of such unprecedented stresses, more mental and physical problems are becoming evident which affects the psychology of a person. This has to be treated; otherwise it could affect the standard of life, and may have fatal consequences later on.

Our research that the physical health of a person is also intricately connected with the mental health, and if the latter is not okay, the former is bound to be affected. There are several ways in which the study of psychiatry comes into effect. Our studies have revealed the most common types.

Types, or Sub Practices of Psychiatry

  • Addiction psychiatry which is a treatment method used for those who are suffering from substance abuse and addiction to various narcotics, or even alcohol.
  • Neuropsychiatry which is a study which deals with those patients who are having mental problem which they might have with the nervous system
  • Biological psychiatry which deals with those patients suffering from mental problems because of biological problems
  • Forensic psychiatry which deals with law and psychiatry and deals with criminal psychology mostly.
  • Child psychiatry which is the treatment, of children’s minds and their behavioral patterns
  • Adolescent psychiatry which is a branch which is becoming increasingly popular because of adolescent psychology
  • Emergency psychiatry which is a branch used in case of emergency situations, etc.

It is amply evident that there are several smaller branches and sub-practices under the broader category of psychiatric treatment, which an emerging branch of psychology. 

The Different Psychiatric Treatments

Psychiatry and psychotherapy are the two emerging branches of psychology which seeks to cure psychological problems in the most effective way possible.

Medication and treatment is advancing in all fields of science and medicine, include that of psychology. Currently, psychotherapy and psychiatry go hand in hand in the treatment of complex psychological problems. However, whereas psychology deals with only the mental conditions, psychiatry on the other hand deals with both mental and physical conditions of the patient. It aims to give the most long lasting effects of treatment by means of ensuring that the latest methods are employed. However, there are several types of treatment methods are that used for this type of treatment.

The Types of Treatment

Based on our research work at www.newspsychology.com, there are several kinds of specialized psychiatric treatment the professionals use in order to treat the individual and unique cases of patients. The various kinds of treatment includes-

  • Behavior monitoring and therapy, which mainly consists of communication and counselling
  • Cognitive Behavioral Therapy which deals with the cognitive developments of the brain.
  • Individual psychotherapy which is especially designed to suit each individual patient
  • Cognitive therapy aims to improve the way in which people think and to boost their self esteem
  • Psychiatric Evaluation
  • Group Psychotherapy or counselling, where people with similar conditions can talk and relate and help each other out
  • Electroconclusive therapy which is used for patients who are suffering from severe clinical depression

There are several other new types of treatments which has emerged which treat people on a mental and internal level, without being intrusive, and minimizing the medication and the consequent side effects that may appear. 

What is a panic attack and how to stop it?

 Patients usually cannot name the source of their fear; they may feel confused and have trouble concentrating. The physical signs often include tachycardia, palpitations, dyspnea, and sweating. Patients often try to leave whatever situation they are in to seek help. The attack generally lasts 20 to 30 minutes and rarely more than 1 hour.

The goal of treatment is to eliminate all of your panic attack symptoms. With effective treatment, most people are eventually able to resume everyday activities. The main treatment options for panic attacks are psychotherapy and medications.

Cognitive behavioral therapy is generally viewed as the most effective form of treatment for panic attacks, panic disorder, and agoraphobia. Cognitive behavioral therapy focuses on the thinking patterns and behaviors that are sustaining or triggering the panic attacks. It helps you look at your fears in a more realistic light. For example, if you had a panic attack while driving, what is the worst thing that would really happen? While you might have to pull over to the side of the road, you are not likely to crash your car or have a heart attack. Once you learn that nothing truly disastrous is going to happen, the experience of panic becomes less terrifying.

In exposure therapy for panic disorder, you are exposed to the physical sensations of panic in a safe and controlled environment, giving you the opportunity to learn healthier ways of coping. With each exposure, you become less afraid of these internal bodily sensations and feel a greater sense of control over your panic.

Medication can be used to temporarily control or reduce some of the symptoms of panic disorder.

The SSRIs fluoxetine , paroxetine , sertraline , fluvoxamine , citalopram , and escitalopram have shown effectiveness. For patients with severe panic disorder and associated disability that has either not responded to an SSRI, we suggest treatment with a benzodiazepine (eg, clonazepam or alprazolam). Patients who do not achieve optimal outcomes at completion of either Cognitive behavioral therapy or pharmacotherapy can be considered for a trial of the other modality.

CART is a new breathing therapy that reduces panic and anxiety by reversing hyperventilation. During the treatment, patients undergo simple breathing exercises twice a day. A portable capnometer device supplies feedback during the exercises on a patient's CO2 levels. The goal of these exercises is to reduce chronic and acute hyperventilation and associated physical symptoms. This is achieved by breathing slower but most importantly more shallowly.


Scientists find potential drug targets in deadly pediatric brain tumors

Researchers studying a rare, always fatal brain tumor in children have found several molecular alterations that drive the cancer, according to a new study from scientists at Dana-Farber/Boston Children’s Cancer and Blood Disorders Center and McGill University. The findings identify potential new targets for drug treatments.

The new research could help physicians choose targeted agents with a better chance of combating pediatric high-grade astrocytomas, which are extremely difficult to treat with radiation and surgery. The tumors have resisted treatment attempts with an estimated 250 chemotherapy drugs and combinations over the past 30 years, according to the investigators. Their study was published April 6 in Nature Genetics.

The scientists sequenced tumor biopsy samples and identified a number of mutations or errors in the DNA code. They also found epigenetic changes, which alter how genes are expressed. At least two of the new mutations might be susceptible to blocking by existing drugs, said the investigators. Other molecular targets that they uncovered currently lack specific drugs to attack them but provide new opportunities for future drug development.

These results begin to crack open the genetic "black box" of these tumors, which only now are yielding clues to the abnormal molecular changes that drive them.

"For the most malignant tumor in pediatrics, we finally are beginning to gain a handle on the development of this disease, which is critical to devising effective therapies," says Mark Kieran, MD, PhD, a neuro-oncologist and clinical director of the Brain Tumor Center at Dana-Farber/Boston Children’s. Kieran and neuropathologist Keith Ligon, MD, PhD, of Dana-Farber/Boston Children’s, are co-senior authors along with two researchers from McGill.

The findings are due in part to a project that began more than 10 years ago when clinicians came together to create a collaborative "precision medicine" clinical trial based at Dana-Farber/Boston Children’s. This trial was specifically designed to make discoveries that would change the treatment for children with a type of high grade astrocytoma called diffuse intrinsic pontine glioma (DIPG), the most aggressive brain tumor in children. DIPGs develop in the brainstem — the seat of crucial, basic body functions that keep people alive—and are therefore impossible to remove safely with surgery.

Doctors and patients from more than 20 institutions have now joined this study, which requires taking a biopsy from 100 children, analyzing their tumor tissue using pathology and molecular testing, and planning treatment specifically for each patient based on the results. A goal of the study is to determine whether advanced DNA sequencing and other tools that search for abnormalities and biomarkers can be used to guide potential treatments.

"Instead of treating all the patients the same, this trial obtains a biopsy at the time of diagnosis and the treatment is determined by the expression pattern of the tumor," says Kieran.

Findings in the Nature Genetics study include analysis of biopsy samples from the first group of children enrolled in the trial. In all, 40 tumor specimens underwent sequencing; 25 were from patients with DIPG tumors, some of whom were on the trial.

Most of the tumors were found to harbor a mutation called K27M in the H3F3A protein that is a basic building block of the "epigenome." The effects of this mutation are termed epigenetic because they can change the level of gene activity without changing the structure of a gene’s DNA. Mutations in H3F3A have recently been detected in a large percentage of pediatric high-grade astrocytomas, but effective drugs for this mutation have not yet been found.

However, the scientists found that H3F3A mutations always occurred with other mutations that could in theory be targeted by existing drugs. One such new mutation, in the gene ACVR1, was found in five of the diffuse intrinsic pontine gliomas. Interestingly, notes Ligon, this was the first time this gene had been involved in cancer, but the mutation has been identified before as the cause of a rare disorder, "stone man syndrome," where the body’s tissues gradually turn to bone.

The researchers discovered additional mutations in the FGFR1 and PI3K cell growth signaling pathways. Drugs exist that can block these overactive pathways and are being tested in other cancers. "These alterations in growth factor receptors and in members of the PI3K pathway offer previously unforeseen therapeutic possibilities in a deadly cancer," the authors commented in their study.

The researchers expect to learn more about these and other mutations as the collaborative effort continues to study more samples of the pediatric tumors.

The other co-senior authors are Jacek Majewski, PhD, and Nada Jabado, MD, PhD, of McGill University. Co-first authors are Adam Fontebasso, MD, PhD, and Simon Papillon-Cavanagh of McGill; and Jeremy Schwartzentruber, MSc, of the Wellcome Trust Sanger Institute in Cambridge, England. Additional Dana-Farber faculty collaborating on the project and clinical trial are Liliana Goumnerova, MD of Dana-Farber/Boston Children’s and Azra Ligon, PhD, of Dana-Farber/Brigham and Women’s Cancer Center.

Research funding was provided in part by the National Institutes of Health grant P01CA142536.

Heritability of avoidant and dependent personality disorder traits

 A new twin study from the Norwegian Institute of Public Health shows that the heritability of avoidant and dependent personality disorder traits might be higher than previously reported. People with avoidant personality disorder are often anxious in the company of others, while people with dependent personality disorder feel more secure.

Results from previous studies indicate that genetic factors explain about one third of the individual differences in these personality disorder traits, while the remaining variation is best explained by environmental influences. These studies used single-occasion interviews only.

In contrast, the current study used two different measures of assessment at two different time-points in order to measure personality disorders traits, and is therefore considered more methodologically sound. In 1998, 8,045 young adult twins answered a questionnaire that included questions about personality disorder traits. Some years later, 2794 of these twins took part in a structured diagnostic interview. Both identical (monozygotic) and fraternal (dizygotic) twins participated.

Identical twins share 100% of the genetic material, while fraternal twins share on average 50% — meaning that they are genetically similar to other siblings. By comparing how similar the two types of twin pairs are on a particular trait, researchers can determine how much of the variation between individuals can be explained by genes and environment, respectively.

Higher heritability when controlling for random effects

The researchers found that two thirds of the variation in avoidant and dependent personality disorder traits could be explained by genes, and that the most important environmental influences were those unique to each twin. Such environmental influences can be any that contribute to the twins in a pair being different, e.g. the influence of different friends, teachers, activities, or various life events.

"It is important to emphasize that the term heritability does not refer to individuals per se. Heritability is a statistic that relates to the population as a whole, and is expressed as a proportion of how much the total variation in a trait, such as personality disorders, is influenced by genes," says PhD student and first author of the study Line C. Gjerde.

"The strength of this study is that we have measured personality disorder traits with both a questionnaire and, at a later time-point, an interview. This provides a better estimate of heritability than studies that measure personality disorder once and with one instrument only. The method applied in the current study allows us to capture the core of these personality disorder traits and not random effects, or effects specific to a certain time point or method of assessment," Gjerde explains.

Implications for clinicians

The key finding that genes are so influential in the development of personality disorders emphasizes the importance of obtaining a thorough family history from patients with symptoms of such disorders. However, this does not mean that personality disorders are not treatable. Gjerde emphasizes that the strong genetic influence found in the study does not imply any form of determinism:

"If a person has a family history of personality disorders, this does not necessarily mean that he or she will develop a personality disorder. Whether or not a genetic vulnerability leads to the expression of a certain trait or disorder depends on a complex interplay of both genetic and environmental factors."

The study was carried out in collaboration with the Virginia Institute for Psychiatric and Behavioral Genetics at the Virginia Commonwealth University, USA.

What is a personality disorder?

According to the diagnostic manual DSM-IV, a personality disorder is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture, is pervasive and inflexible, has an onset in early adolescence or early adulthood, is stable over time, and leads to distress or impairment.

Journal Reference:

  1. L. C. Gjerde, N. Czajkowski, E. Røysamb, R. E. Ørstavik, G. P. Knudsen, K. Østby, S. Torgersen, J. Myers, K. S. Kendler, T. Reichborn-Kjennerud. The heritability of avoidant and dependent personality disorder assessed by personal interview and questionnaire. Acta Psychiatrica Scandinavica, 2012; DOI: 10.1111/j.1600-0447.2012.01862.x

Possible link between infants' regulatory behaviors and maternal mental health

Functional somatic symptoms (FSS) are physical complaints, such as headaches, pain, fatigue, and dizziness, that cannot be explained medically. These symptoms affect 10-30% of children and adolescents and account for 2-4% of all pediatric doctor visits. A new study scheduled for publication in The Journal of Pediatrics finds that infants with regulatory problems (i.e., feeding, sleeping, and tactile reactivity) and/or maternal psychiatric problems may have an increased risk of FSS in later childhood.

It is believed that maternal anxiety and depression can influence the child's capacity to self-regulate, but infant problems can also exaggerate parental problems. Charlotte Ulrikka Rask, MD, PhD, Child and Adolescent Psychiatrist at Aarhus University Hospital in Denmark, states, "Parents of infants with regulatory problems could be taught to help their infants regulate their behavioral and physiological state, which potentially could reduce the risk of later development of impairing FSS."

Dr. Rask and colleagues from Aarhus University Hospital and Copenhagen University Hospital in Denmark prospectively assessed 1,327 5-7-year-old children who are part of the Copenhagen Child Cohort (6,090 children born around Copenhagen in 2000). Home health nurses assessed infants 4 times before they were 10 months of age. Maternal mental health was assessed by self-report 1-5 weeks after child birth, and researchers checked whether mothers had been diagnosed with a mental disorder during the infant's first year of life. Three overall factors were assessed: (1) infant regulatory factor; (2) maternal postnatal psychiatric illness; and (3) annual household income.

At 5-7 years of age, 23.2% of the children had FSS, with an increased prevalence in girls (27.6% versus 18.8%). Impairing, or severe, FSS was seen in 4.4% of the children. Limb pain, headaches, and stomach aches were the most frequent FSS reported. Thirteen mothers were diagnosed with depression, bipolar disorder, or anxiety during their infants' first year of life; the infants of these mothers were 7 times more likely to develop FSS at 5-7 years of age. Infants with 2 or more regulating issues had a nearly 3-fold increased risk of FSS at 5-7 years of age. There was no association between impairing FSS and household income early in life.

Because recent studies have suggested that eating and sleeping problems during early childhood may be risk factors for mood and anxiety disorders and FSS (e.g., recurrent abdominal pain) later in life, early intervention is important for both parents and infants. Dr. Rask suggests, "Interventions should include strategies to improve maternal mental health and parents' ability to handle the infant's regulatory problems, as well as strategies that focus on infants who have multiple regulatory problems."

Shared genetic link in psychiatric and movement disorders

 — Fewer than 100 people in the world are known to be affected by a movement disorder called rapid-onset dystonia-parkinsonism (RDP), but its symptoms are life-changing. Seemingly normal young people are suddenly and dramatically unable to control movement of their arms or legs and have trouble speaking or swallowing. A normal life is nearly impossible.

RDP is caused by a genetic mutation (ATP1A3) that often runs in families. Now Wake Forest Baptist Medical Center researchers believe that same genetic predisposition might also be associated with psychiatric problems, such as anxiety, mood disorders and substance abuse/dependence.

Allison Brashear, M.D., chair of neurology at Wake Forest Baptist, and the lead investigator in this four-year, $2.5 million study funded by the National Institute of Neurological Disorders and Stroke (NINDS), said this is one of the few studies to look at this rare condition that has no known treatment. "RDP often occurs suddenly after a stressful episode, such as running a marathon or childbirth," said Brashear. "Patients become severely disabled over hours to days and do not recover."

Brashear and nine other Wake Forest Baptist scientists, as well as colleagues from Harvard Medical School and Mount Sinai School of Medicine, enrolled 56 individuals for this study. Twenty-three of the RDP patients were related, three RDP patients were unrelated.

Of the 29 participants with the genetic mutation, 26 had dystonia symptoms and three were carriers, but without the motor symptoms; the remaining 27 participants without the mutation, were enrolled as the control group.

Following standard physical examination and behavioral assessment, Brashear's team found that individuals with the mutation but without the motor symptoms did not report any history of psychiatric disorder, while those with dystonia symptoms reported anxiety (48 percent; control 41 percent), mood (50 percent; control 22 percent), psychotic (19 percent; control 0 percent) and substance abuse/dependence (38 percent; control 27 percent).

Researchers concluded that ATP1A3 mutations cause a wide spectrum of motor and nonmotor symptoms and that psychotic symptoms tended to develop before or simultaneous to the beginning of motor dysfunction. Further, the team believes the findings suggest psychiatric disorders may be another expression of the genetic mutation. Brashear said there are also clinical implications as a result of this study and suggested that those who deal with patients with psychosis, particularly in families with a history of dystonia-parkinsonism, consider the genetic mutation as a possible contributor to the mental illness.

Co-authors in this study, published in the journal Neurology, were: Jared F. Cook, M.A., Deborah F. Hill, M.A, Alethea Amponsah, B.A., Beverly M. Snively, Ph.D., Laney Light, M.S., Cynthia K. Suerken, M.S., W. Vaughn McCall, M.D., and Niki Boggs, B.A., of Wake Forest Baptist; Laurie Ozelius, Ph.D., Mount Sinai School of Medicine; and Kathleen J. Sweadner, Ph.D., Harvard Medical School.

Funding for this study was provided by the National Institute for Neurological Disorders and Stroke through Grant # NINDS 5R01-NS058949-04.

Journal Reference:

  1. A. Brashear, J. F. Cook, D. F. Hill, A. Amponsah, B. M. Snively, L. Light, N. Boggs, C. K. Suerken, M. Stacy, L. Ozelius, K. J. Sweadner, W. V. McCall. Psychiatric disorders in rapid-onset dystonia-parkinsonism. Neurology, 2012; 79 (11): 1168 DOI: 10.1212/WNL.0b013e3182698d6c

Genetic mutation linked to psychiatric disease and obesity

McGill researchers have identified a small region in the genome that conclusively plays a role in the development of psychiatric disease and obesity. The key lies in the genomic deletion of brain-derived neurotrophic factor, or BDNF, a nervous system growth factor that plays a critical role in brain development.

To determine the role of BDNF in humans, Prof. Carl Ernst, from McGill's Department of Psychiatry, Faculty of Medicine, screened over 35,000 people referred for genetic screening at clinics and over 30,000 control subjects in Canada, the U.S., and Europe. Overall, five individuals were identified with BDNF deletions, all of whom were obese, had a mild-moderate intellectual impairment, and had a mood disorder. Children had anxiety disorders, aggressive disorders, or attention deficit-hyperactivity disorder (ADHD), while post-pubescent subjects had anxiety and major depressive disorders. Subjects gradually gained weight as they aged, suggesting that obesity is a long-term process when BDNF is deleted.

"Scientists have been trying to find a region of the genome which plays a role in human psychopathology, searching for answers anywhere in our DNA that may give us a clue to the genetic causes of these types of disorders," says Prof. Ernst, who is also a researcher at the Douglas Mental Health University Institute. "Our study conclusively links a single region of the genome to mood and anxiety."

The findings, published in the Archives of General Psychiatry, reveal for the first time the link between BDNF deletion, cognition, and weight gain in humans. BDNF has been suspected to have many functions in the brain based on animal studies, but no study had shown what happens when BDNF is missing from the human genome. This research provides a step toward better understanding human behaviour and mood by clearly identifying genes that may be involved in mental disorders.

"Mood and anxiety can be seen like a house of cards. In this case, the walls of the house represent the myriad of biological interactions that maintain the structure," says Ernst, "Studying these moving parts can be tricky, so teasing apart even a single event is important. Linking a deletion in BDNF conclusively to mood and anxiety really tells us that it is possible to dissect the biological pathways involved in determining how we feel and act.

We now have a molecular pathway we are confident is involved in psychopathology," adds Ernst, "Because thousands of genes are involved in mood, anxiety, or obesity, it allows us to root our studies on a solid foundation. All of the participants in our study had mild-moderate intellectual disability, but most people with these cognitive problems do not have psychiatric problems — so what is it about deletion of BDNF that affects mood? My hope now is to test the hypothesis that boosting BDNF in people with anxiety or depression might improve brain health."

Journal Reference:

  1. Ernst C, Marshall CR, Shen Y, et al. Highly Penetrant Alterations of a Critical Region Including BDNF in Human Psychopathology and Obesity. Archives of General Psychiatry, 2012; DOI: 10.1001/archgenpsychiatry.2012.660

Study finds faults in proposed mental disorder diagnosis

— A much anticipated addition to the revised Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5) is questionable according to research findings. The newly revised DSM-5, the first alterations since it was last revised in 1994, includes attenuated psychosis syndrome (APS), a new diagnosis that would identify those impaired by preliminary psychotic symptoms that do not meet the threshold for an existing diagnosis as having a psychotic disorder. In an effort to understand the impact this new diagnosis would have in a real clinical setting, researchers at Butler Hospital, Brown University and Rhode Island Hospital studied how APS applied in an outpatient clinic, and found reasons for concern.

The findings are published in the October issue of Journal of Clinical Psychology.

Published by the American Psychiatric Association, the DSM provides standard criteria for the diagnosis of mental disorders and is used by clinicians and other key mental healthcare professionals across the U.S. "Including APS as a new diagnosis in the DSM-5 has been an issue of debate since its first consideration because of the negative impact it could have on patients and their families," said Brandon Gaudiano, PhD, a research psychologist at Butler Hospital and an Assistant Professor of Psychiatry & Human Behavior at the Alpert Medical School of Brown University. One of the original rationales for APS was to help identify patients who are at high risk for transition to a psychotic disorder in the near future but do not currently meet the criteria for one of the existing DSM-4 psychotic disorder diagnoses. In the study of over 1,200 patients, the researchers did not identify a single patient who met the criteria for APS who did not already meet the criteria for another existing DSM disorder, thus calling into question the true need for the new diagnosis.

The study also found that 28 percent of clinic patients reported these attenuated psychotic symptoms in addition to their other common psychiatric symptoms. The researchers believe that these attenuated symptoms are better explained by the patients' existing conditions, such as depression and anxiety in most cases, and are unlikely to represent true psychotic symptoms. However, if included in the new DSM-5, the fear is that many clinicians could simply give APS as an additional diagnosis, thus causing many more patients to be inappropriately labeled as potentially "psychotic."

"APS has been a controversial topic because the introduction of this diagnosis would basically lower the threshold for diagnosing someone with a psychotic-type disorder. Making such a diagnosis has serious implications because it could lead to inappropriate treatments such as antipsychotic medications that could pose more risks than benefits for these patients or increased stigma," said Gaudiano.

Researchers and clinicians anticipate APS to be included in the appendix of the revised DSM-5 coming out in 2013, not the main text. As Gaudiano explains, this would not officially recognize the syndrome as an accepted diagnosis, but rather open the door for discussion of its utility and allow for further studies of if and how APS may be made more useful and less problematic.