Service delivery in child psychiatry: provider shortage isn't the only problem.

Although the shortage of pediatric mental health practitioners in the United States is often cited as the major stumbling block to good care, several deficiencies and problems related to service delivery may be just as great a threat to the delivery of child and adolescent psychological and psychiatric clinical care. Problems and suggestions for change related to research, training, insurance, hospitalization, practitioner collaboration and role definition are discussed.

Targeting the dopamine system in the treatment of attention-deficit/hyperactivity disorder.

Attention-deficit/hyperactivity disorder (ADHD) is a highly heritable condition that affects a significant number of children and adults worldwide. During the past 30 years, the diagnosis and treatment of ADHD has relied on clinical assessment and empirical experience with stimulant medications. More recently, advances in family genetic studies, molecular genetic studies, preclinical research, radiographic imaging techniques and neuropsychological evaluation have significantly enhanced our understanding of the neurobiology of ADHD.

Psychopharmacologic treatment of aggressive preschoolers: a chart review.

Very young children with severe aggression are a growing focus of care in child psychiatry. Notwithstanding diagnostic uncertainties in this age group, medication, not usually considered a first-line intervention, is becoming a treatment option for a growing number of clinicians in spite of a dearth of research in this area. This chart review assessed the patient characteristics, diagnoses and treatment responses of aggressive preschoolers who were treated in a university child psychiatry outpatient clinic from 2001-2004.

Diagnostic profiles in outpatient child psychiatry.

Outpatient child psychiatrists appear to be treating a broadening array of complex, highly comorbid, and difficult-to-treat youths. In this study, designed to evaluate the current demographic and diagnostic profile of outpatient child psychiatric patients 1,292 outpatient records from 8 treatment settings were reviewed. Patient age, race, gender, and diagnoses were recorded and analyzed.

Oxcarbazepine in the treatment of child psychiatric disorders: a retrospective chart review.

Though not considered a first-line treatment, oxcarbazepine has become an option in the expanding effort to ameliorate severely dysregulated mood and behavioral symptoms in youth. Like most pharmaceuticals in child and adolescent psychiatry, oxcarbazepine is not U.S.

Current prescribing patterns in outpatient child and adolescent psychiatric practice in central New York.

Objective: The aim of this study was to evaluate current prescribing patterns of outpatient child psychiatrists in central New York.

Methods: Data were drawn from all active files of 1- to 18-year-olds (n = 1292) at eight outpatient treatment locations in central New York on one day in 2002. Age, race, gender, diagnoses, current medications, and doses were recorded.

Intramuscular ziprasidone in youth: a retrospective chart review.

Objective: The aim of this study was to assess the tolerability and effectiveness of intramuscular ziprasidone in inpatient children and adolescents.

Method: A retrospective chart review was conducted of child and adolescent inpatients at a private psychiatric hospital in central New York between January 1, 2003 and August 30, 2003. Subjects who had received intramuscular ziprasidone were identified, and their age, gender, and dosage were recorded.

Aripiprazole in an adult with Asperger disorder.

Objective: To report a case of aripiprazole-responsive adult Asperger disorder.

Case Summary: A 34-year-old white man with lifelong, disabling Asperger disorder and a 20-year history of failed psychotherapeutic and pharmacologic interventions was prescribed aripiprazole, with dramatic symptomatic improvement.

Discussion: Multiple prior pharmacologic efforts over several years aimed predominantly at altering serotonin and dopamine neurotransmission resulted in treatment failure due to intolerable adverse effects, exacerbation of underlying symptoms, or nonresponse.