Faculty Bibliography

Children with mental health problems are increasingly being evaluated and treated in pediatric clinical settings. This article focuses on the epidemiology, evaluation, and management of the 2 most common pediatric mental health emergencies, suicidal and homicidal/aggressive patients, as well as the equally challenging population of children with autism or other developmental disabilities.

Childhood trauma can have a profound effect on adolescent development, with a lifelong impact on physical and mental health and development. Through a review of current research on the impact of traumatic stress on adolescence, this article provides a framework for adolescent health professionals in pediatrics and primary care to understand and assess the sequelae of traumatic stress, as well as up-to-date recommendations for evidence-based treatment. We first review empirical evidence for critical windows of neurobiological impact of traumatic stress, and then we discuss the connection between these neurobiological effects and posttraumatic syndromes, including posttraumatic stress disorder, depression, aggressive behavior, and psychosis. This article concludes by considering the implications of this current research for clinical assessment and treatment in pediatric and primary care settings.

AIM: Coping by families of patients with schizophrenia include 'approach' strategies considered to be adaptive (e.g. reinterpretation) and potentially maladaptive 'avoidant' strategies (denial/disengagement, use of alcohol and drugs). Little is known about coping strategies used by families of individuals with incipient or emergent psychosis. METHODS: Self-reported coping styles were assessed in family members of 11 ultra high risk and 12 recent-onset psychosis patients, using a modified version of Carver's Coping Orientations to Problems Experienced questionnaire. RESULTS: Families reported moderate use of 'approach' coping (e.g. planning, seeking social support, positive reinterpretation, acceptance and turning to religion) and rare use of 'avoidant' coping strategies (denial/disengagement and use of alcohol and drugs). CONCLUSIONS: The greater endorsement of 'approach' coping by these families is consistent with findings for families of first episode psychosis patients, and it is in contrast to more prevalent 'avoidant' coping by families of patients with more chronic psychotic illness. Early intervention could plausibly help families maintain the use of potentially more adaptive 'approach' coping strategies over time

Vagus nerve stimulation (VNS) is an increasingly used therapy for patients with treatment-refractory epilepsy and depression. Hypomanic and manic symptoms are a rare but recognized adverse effect of VNS treatment. Here we describe a case in which VNS treatment in a patient with epilepsy and unipolar depression was associated with the rapid development of manic symptoms. The patient's manic symptoms resolved with temporary discontinuation of the VNS current, and the patient was eventually able to resume VNS treatment with good effect and without further manic symptoms. Mania is a rare but serious side effect of VNS; however, in this case and in the majority of reported cases of VNS-associated mania, symptoms resolve and VNS can be safely administered

OBJECTIVE: Qualitative research methods were used to understand the experiences of families seeking treatment for young people with recent-onset psychosis; such knowledge can inform services design. METHODS: The authors conducted open-ended interviews in 1999 through 2002 with family members of 13 patients with recent-onset nonaffective psychotic disorders in the New York metropolitan area, focusing on their experience in seeking treatment and engaging with mental health services. RESULTS: Family members described early lack of clarity of diagnosis and obstacles to obtaining treatment. Entry into the mental health system frequently occurred in the context of crisis, with African-American families specifically reporting police involvement. Inpatient hospitalization was depicted as traumatic yet offering relief. Aftercare was described as fragmented, and issues with third-party payers were paramount. Families expressed a desire for more education, information, and support and described their struggles with stigma. These data from families are presented in the context of more recent literature as to the efficacy of specialized treatment programs for early stages of psychotic disorder and their involvement of families. CONCLUSIONS: These qualitative research data support the importance of involving and educating families about psychosis: its recognition, its treatment, and access to services. They also highlight the need to address stigma and implement structural changes in treatment that ensure continuity and coverage of care. Specialized first-episode psychosis services may address these issues, and they may minimize the traumatic experiences of involuntary hospitalization and police involvement early in treatment