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Summary Crisis and Forensic Psychiatry Literature
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Hot Topics in Psychiatry – Course 1 Crisis and Forensic PsychiatryIACAPAP Textbook of Child and Adolescent Mental Health
Week 1: Psychosomatic problems
J.1 Child and Adolescent Psychiatric Emergencies
Children and adolescents who present with acute mental health complaints require a systematic
assessment to determine if they are suffering from an acute psychiatric disorder vs. a mental health
problem which presents with a crisis.
Goals of emergency assessment:
- Determine if the patient is at imminent risk of harm to self/others
- Establish the presence of one of more psychiatric disorder(s)
- Elicit the factors that may have caused/contributed to the initiation of these problems and
to their persistence (genetic, developmental, familial, social, medical)
- Identify areas of strength as well as potential supports within the family and the wider social
environment
- Identify target problems for treatment
- Determine if in-patient psychiatric hospitalisation is needed
Assessment of a child/adolescents differs from that of an adult:
- Most adults seek help on their own behalf; children rarely will.
- For adolescents, first them and then with their parents, or vice versa. For children, see the
child together with parents or parents alone first, then the child alone.
- Children <12 are less likely to reliably answer questions about mood, onset and duration of
symptoms, be able to compare themselves to their peers and questions that require them to
use judgement.
- Adolescents value privacy and independence; more likely to share information if they know
it’ll be kept confidential. Outline under which conditions information will be shared with
parents – i.e. suicidal and homicidal thoughts.
- Depending on age and development, some children are not able to provide certain historical
and clinically necessary information parents and caregivers become the primary source of
information. Be careful not to exclude children from the process. Multiple informants are
crucial.
- To accurately assess the child’s behaviour, one needs to know what is developmentally
appropriate concerning their behaviour and functioning.
Clinical evaluation: a detailed history, a mental status examination (and evidence of a recent physical
examination), a formulation, diagnosis, co-occurring disorders and differential diagnosis.
- Treatment history – inventory and assessment of prior treatments, incl. pharmacotherapy
and psychotherapy
- Family assessment – mental health problems, i.e. suicide, substance abuse, mood disorders
and psychosis
Most Common Psychiatric Disorders in ED
Psychosis: disorder of thinking (delusions) and perception (hallucinations) in which there is a gross
impairment in reality testing; youth might experience a decline in social and cognitive functioning
prior to presenting with psychotic symptoms
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