Child and adolescent psychiatry continues to be a severely underserved medical specialty. The shortage of child and adolescent psychiatrists disproportionately affects certain populations. In particular, children of ethnic minorities and those living in rural communities and inner cities experience shortages that are now considered to have reached a crisis level. There are approximately 7500 child psychiatrists practicing in a country with more than 74 million children. Child and adolescent psychiatry is the only medical specialty that comprehensively trains physicians to treat youth with complex mental disorders. Yet only approximately 300 child and adolescent psychiatrists graduate annually from training programs. Thus, there is little hope that this disparity in access to specialty mental health services will be remedied through child and adolescent psychiatry alone.
Primary care clinicians continue to provide the majority of psychiatric treatment for pediatric populations. Pediatricians estimate that 20% of their patients have behavioral and emotional disorders in need of psychiatric treatment. There has been an increasing emphasis from families, insurers, professional organizations, and other stakeholders for children's mental disorders to be treated in primary care. Indeed, the American Academy of Pediatrics has developed guidelines to improve the delivery of evidence-based care to children with common psychiatric disorders, such as attention-deficit hyperactivity disorder (ADHD) and depression.
Noting these changes in the direction of mental health care of children since the first edition was published in 2005, this second edition emphasizes timely research findings in the evaluation and treatment of childhood psychiatric disorders that will help to guide the medical and nonmedical professionals treating children with mental health problems.
Recent studies have given new emphasis on the primary role of pharmacologic treatments for various childhood disorders, including ADHD, depressive disorders, and anxiety disorders. The use of antidepressants continues to be controversial. The Food and Drug Administration (FDA) still maintains a black box warning regarding the risk of suicidality in youth prescribed antidepressants, but some research over the past 5 years has concluded that curtailing prescriptions of antidepressants actually has led to an increased rate of youth suicide. In these 5 years since the first edition, research with youth suffering from schizophrenia, bipolar disorder, and autism have led to the FDA approval of three second-generation antipsychotics for use in pediatric populations. Research in psychotherapy has also increased the evidence base for selected psychotherapies for depression, anxiety, and disruptive disorders. Trauma-focused cognitive—behavioral therapy (CBT) has been shown in several randomized trials to be effective in the treatment of trauma-related symptoms. Exposure and response prevention has been shown effective in the treatment of obsessive—compulsive disorder (OCD).
Perhaps the most interesting findings during the past 5 years are for mood and anxiety disorders. The combination of psychotropic medication and psychotherapy is superior to medication or psychotherapy alone. The Treatment of Adolescent Depression Study (TADS) has shown that combination treatment is significantly superior to antidepressants alone or CBT alone in the treatment of depression and that psychotherapy protects against suicidality in those youth also treated with antidepressants. The Child/Adolescent Anxiety Multimodal Study (CAMS) also showed that combination therapy is superior to treatment with either medication or psychotherapy alone. These developments point to the need for clinicians to be aware that collaboration among clinicians with specific areas of expertise is necessary to provide a comprehensive treatment for youth who suffer from serious psychiatric illness.
Thus, the major audiences for this textbook are pediatricians, family physicians, and nurse practitioners who increasingly encounter children with diverse mental health needs in their practices. General psychiatrists who are often recruited to treat childhood mental disorders particularly in rural areas, and trainees interested in children's mental health, are also a target audience. These medical professionals should find valuable information on diagnosis and treatment to guide their practices. The emphasis is on basic information that will guide clinical practice. We avoid emphasis on esoteric information that, while interesting and cutting edge, can cloud clinical practice. Other mental health clinicians such as psychiatric social workers, special education teachers, and psychologists should appreciate learning of the status of child and adolescent psychiatry and what transpires in clinical treatment.
The second edition of Child and Adolescent Psychiatry: The Essentials continues to strive to meet the needs of clinicians wanting a concise but detailed source for practical information to guide treatment planning for youth with psychiatric illness. The second edition has retained many chapters and authors from the first edition. We have retained chapters on all of the disorders covered in the first edition and added a chapter on elimination disorders as this is a disorder often encountered in primary care. In Section III (Special Issues), we now add a chapter on the treatment of mental health problems in the general health setting, such as primary care. Two chapters address young children, early childhood mental health, and fetal alcohol spectrum disorders. Finally, given the increasing emphasis on nutrition for our nation's youth as well as a growing interest in complementary, alternative, and integrative medicine, we have included a chapter on nutritional aspects of psychiatric disorders. The “Treatment” section has been consolidated into three chapters. The psychopharmacology and systems of care chapters have been retained. A new chapter on evidencebased psychotherapies provides medical specialists and nonpsychiatric mental health professionals updated information on the evidence base supporting various psychotherapies for youth.
Finally, this second edition also includes updated bibliographies, tables, case vignettes, and suggested readings. Many clinicians are now using the Internet as a reference for clinical information. To keep up with this trend, the second edition now includes suggested useful websites for each chapter. Review questions for each chapter provide a quick check on material learned. These questions should help those using the textbook as a review before board examination or residency or fellowship in-service examinations.
Contents
Section I: EVALUATION
- Chapter 1: Psychiatric Assessment of Children and Adolescents
- Chapter 2: Psychological Assessment
- Chapter 3: Rating Scales
- Chapter 4: Attention Deficit/Hyperactivity Disorder
- Chapter 5: Oppositional Defiant Disorder and Conduct Disorder
- Chapter 6: Adolescent Substance-Use Disorders
- Chapter 7: Pediatric Anxiety Disorders
- Chapter 8: Trauma and Associated Disorders
- Chapter 9: Obsessive Compulsive Disorder
- Chapter 10: Tourette's Syndrome
- Chapter 11: Child and Adolescent Depressive Disorders
- Chapter 12: Early Onset Bipolar Disorder
- Chapter 13: Eating Disorders
- Chapter 14: Elimination Disorders: Enuresis and Encopresis
- Chapter 15: Early Onset Schizophrenia and Related Psychotic Disorders
- Chapter 16: Autism Spectrum Disorders
- Chapter 17: Learning Disabilities
- Chapter 18: Early Childhood Mental Health in Clinical Practice
- Chapter 19: Fetal Alcohol Spectrum Disorders
- Chapter 20: Pediatric Sleep Problems
- Chapter 21: Suicidality and Youth: Identification, Treatment and Prevention
- Chapter 22: Aggression by Children and Adolescents
- Chapter 23: Nutritional Aspects of Psychiatric Disorders
- Chapter 24: Caring for Children and Adolescents with Mental Health Problems in the General Health Setting
- Chapter 25: Psychopharmacology
- Chapter 26: Evidence-Based Psychotherapies
- Chapter 27: Community-Based Systems of Care
Book Details
- Hardcover: 560 pages
- Publisher: Lippincott Williams & Wilkins; Second edition (2011)
- Language: English
- ISBN-10: 1605474436
- ISBN-13: 978-1605474434
- Product Dimensions: 10.1 x 7.3 x 1.4 inches