Dataset Information

The Path to Child and Adolescent Psychiatry.

ABSTRACT: The United States has a critical shortage of child and adolescent psychiatrists such that 70% of counties in the United States do not have any child and adolescent psychiatrists.¹ Since 2014, the number of US and Canadian medical school applicants to psychiatry residencies has increased by 69%; however, the number of child and adolescent psychiatry fellowship applicants has increased by only 11%.² Up to two-thirds of psychiatry residents report considering a career in child and adolescent psychiatry; however, only one-fourth of residents ultimately apply for a child and adolescent psychiatry subspecialty training.³^,⁴ We surveyed child and adolescent psychiatry fellows across the country to understand the different pathways into child and adolescent psychiatry, with the hope of providing program directors' and faculty mentors' guidance on how to generate interest in child and adolescent psychiatry and to support residents in this pursuit.

SUBMITTER: Benson NM

PROVIDER: S-EPMC8120247 | biostudies-literature | 2021 Apr

REPOSITORIES: biostudies-literature

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Publications

The Path to Child and Adolescent Psychiatry.

Benson Nicole M NM Beresin Eugene V EV Beach Scott R SR

Journal of the American Academy of Child and Adolescent Psychiatry 20201006 4

The United States has a critical shortage of child and adolescent psychiatrists such that 70% of counties in the United States do not have any child and adolescent psychiatrists.<sup>1</sup> Since 2014, the number of US and Canadian medical school applicants to psychiatry residencies has increased by 69%; however, the number of child and adolescent psychiatry fellowship applicants has increased by only 11%.<sup>2</sup> Up to two-thirds of psychiatry residents report considering a career in child ...[more]

PMID: 33035621

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Project description:Antipsychotics are often prescribed to children and adolescents, mostly off-label. We aimed to assess adherence to recommendations of guidelines for antipsychotic prescription. We reviewed 436 medical records from 155 clinicians from 26 clinics within three Dutch child and adolescent psychiatry organizations (n = 398 outpatient, n = 38 inpatient care). We assessed target symptoms, diagnostic process, prior and concomitant treatment, and consideration of contra-indications. Multiple logistic regression assessed the role of age, sex, and psychiatric diagnosis on adherence to three main recommendations: to (1) prescribe antipsychotics only after other treatments proved insufficient, (2) always combine antipsychotics with psychosocial interventions, and (3) not prescribe multiple antipsychotics simultaneously. Most patients received off-label antipsychotics. Main target symptoms were inattention/hyperactivity (25%), aggression (24%), and other disruptive behaviors (41%). Most patients underwent diagnostic evaluation before the first prescription; however, screening of contra-indications was low (0.2-19%). About 84% had previously received psychosocial treatment and 48% other psychoactive medication, but 9% had not received any treatment. Notably, only 37% continuously received concomitant psychosocial treatment. Simultaneous use of multiple antipsychotics occurred in 3.2%. Younger children were at higher risk of non-adherence to guideline recommendations regarding prior and concomitant treatment, children with autism spectrum disorder or attention-deficit/hyperactivity disorder more likely not to receive concomitant psychosocial treatment. Sex did not significantly affect adherence. Our findings implicate insufficient adherence to important recommendations regarding antipsychotic use in children and adolescents. Especially younger children are at higher risk of receiving suboptimal care. There is an urgency to consistently offer psychosocial interventions during antipsychotic treatment.

Project description:BackgroundMental health disorders are a leading cause of medical disabilities across an individual's lifespan. This burden is particularly substantial in children and adolescents because of challenges in diagnosis and the lack of precision medicine approaches. However, the widespread adoption of wearable devices (eg, smart watches) that are conducive for artificial intelligence applications to remotely diagnose and manage psychiatric disorders in children and adolescents is promising.ObjectiveThis study aims to conduct a scoping review to study, characterize, and identify areas of innovations with wearable devices that can augment current in-person physician assessments to individualize diagnosis and management of psychiatric disorders in child and adolescent psychiatry.MethodsThis scoping review used information from the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A comprehensive search of several databases from 2011 to June 25, 2021, limited to the English language and excluding animal studies, was conducted. The databases included Ovid MEDLINE and Epub ahead of print, in-process and other nonindexed citations, and daily; Ovid Embase; Ovid Cochrane Central Register of Controlled Trials; Ovid Cochrane Database of Systematic Reviews; Web of Science; and Scopus.ResultsThe initial search yielded 344 articles, from which 19 (5.5%) articles were left on the final source list for this scoping review. Articles were divided into three main groups as follows: studies with the main focus on autism spectrum disorder, attention-deficit/hyperactivity disorder, and internalizing disorders such as anxiety disorders. Most of the studies used either cardio-fitness chest straps with electrocardiogram sensors or wrist-worn biosensors, such as watches by Fitbit. Both allowed passive data collection of the physiological signals.ConclusionsOur scoping review found a large heterogeneity of methods and findings in artificial intelligence studies in child psychiatry. Overall, the largest gap identified in this scoping review is the lack of randomized controlled trials, as most studies available were pilot studies and feasibility trials.

Dataset Information

The Path to Child and Adolescent Psychiatry.

Publications

The Path to Child and Adolescent Psychiatry.

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