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Summary Advanced Child and Adolescent Psychiatry - Leiden University (Part 1)

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6464CA06Y

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Universiteit Leiden (UL)

Advanced Child & Adolescent Psychiatry (Part 1) Lectures, Literature and Case studies Lecture 1: Introduction Lecture 2: Autism Spectrum Disorder Lecture 3: Anxiety and Compulsions Lecture 4: Psychotic Disorders Week 2: Literature - The peer relationships of girls with ASD at school: ...

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leiden university
clinical psychology
master
advanced child and adolescent psychiatry

Institution
Universiteit Leiden (UL)
Education
Advanced Child and Adolescent Psychiatry
Course
6464CA06Y

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‭ADVANCED CHILD AND ADOLESCENT PSYCHIATRY‬

‭Week 1‬ ‭Lecture 1: Introduction‬

‭Week 2‬ ‭Lecture 2: Autism Spectrum Disorder‬ ‭Literature‬
‭●‬ ‭The‬ ‭peer‬ ‭relationships‬ ‭of‬ ‭girls‬‭with‬‭ASD‬‭at‬‭school:‬‭comparison‬
‭to‬‭boys‬‭and‬‭girls‬‭with‬‭and‬‭without‬‭ASD.‬‭Dean‬‭M,‬‭Kasari‬‭C,‬‭Shih‬
‭W,‬ ‭Frankel‬ ‭F,‬ ‭Whitney‬ ‭R,‬ ‭Landa‬ ‭R,‬ ‭Lord‬ ‭C,‬ ‭Orlich‬ ‭F,‬ ‭King‬ ‭B,‬
‭Harwood R.‬
‭●‬ ‭Social‬ ‭attention‬ ‭and‬ ‭autism‬ ‭symptoms‬ ‭in‬ ‭high‬ ‭functioning‬
‭women‬‭with‬‭autism‬‭spectrum‬‭disorder.‬‭Ketelaars‬‭MP,‬‭In‬‭‘t‬‭Veld‬
‭A, Mol A, Swaab H, Bodrij F, van Rijn S.‬
‭●‬ ‭Diagnosis‬ ‭of‬ ‭autism‬ ‭spectrum‬ ‭disorder:‬ ‭reconciling‬ ‭the‬
‭syndrome,‬ ‭its‬ ‭diverse‬ ‭origins,‬ ‭and‬ ‭variation‬ ‭in‬ ‭expression.‬
‭Constantino JN, Charman T‬

‭Week 3‬ ‭Lecture 3: Anxiety and Compulsions‬ ‭Literature‬
‭●‬ ‭Obsessive-compulsive‬ ‭disorder‬ ‭in‬ ‭children‬ ‭and‬ ‭adolescents‬
‭Barton, R., & Heyman, I. (2016).‬
‭●‬ ‭Optimizing‬ ‭exposure‬ ‭therapy‬ ‭with‬ ‭an‬ ‭inhibitory‬ ‭retrieval‬
‭approach‬ ‭and‬ ‭the‬ ‭OptEx‬ ‭Nexus‬ ‭Craske,‬ ‭M.‬ ‭G.,‬ ‭Treanor,‬ ‭M.,‬
‭Zbozinek, T. D., & Vervliet, B. (2022).‬
‭●‬ ‭Factsheet VGCT: Exposure: new insights‬

‭Week 4‬ ‭Lecture 4: Psychotic Disorders‬ ‭Literature‬
‭●‬ ‭Perceived‬ ‭social‬ ‭stress‬ ‭and‬ ‭symptom‬ ‭severity‬ ‭among‬
‭help-seeking‬ ‭adolescents‬ ‭with‬ ‭versus‬ ‭without‬ ‭clinical‬ ‭high‬‭risk‬
‭for psychosis‬‭Millman, Z. B. et al. (2018).‬
‭●‬ ‭Psychosis in children and adolescents.‬‭McClellan,‬‭J. (2018).‬
‭●‬ ‭Changes‬ ‭in‬ ‭the‬ ‭adolescent‬ ‭brain‬ ‭and‬ ‭the‬ ‭pathophysiology‬ ‭of‬
‭psychotic‬‭disorders‬‭Matcheri‬‭S‬‭Keshavan,‬‭Jay‬‭Giedd,‬‭Jennifer‬‭Y‬‭F‬
‭Lau, David A Lewis, Tomáš Paus‬

‭Week 5‬ L‭ ecture 5: Borderline Personality‬ ‭Literature‬
‭Disorder‬

‭Week 6‬ ‭Lecture 6: Attachment Disorders‬ ‭Literature‬

‭Week 7‬ ‭Lecture 7: Eating Disorders‬ ‭Literature‬

,‭Lecture 1: INTRODUCTION‬

‭DIFFERENCES BETWEEN SPECIALISTS‬‭(in hierarchy, education, and professional - at the same level but -)‬
‭●‬ ‭Psychiatrist‬‭(as‬‭a‬‭medical‬‭specialist):‬‭controls‬‭and‬‭treats‬‭somatic‬‭symptoms‬‭,‬‭prescribes‬‭medication‬‭,‬‭duties‬‭at‬‭night‬‭and‬‭during‬
‭the‬‭weekend‬
‭●‬ ‭Clinical psychologist‬‭: specialist in (neuro-)‬‭psychological assessment‬‭and‬‭psychotherapy treatment‬
‭●‬ ‭At LUMC Curium - Psychologist-specialist vs Psychaitrist:‬
‭○‬ ‭Similarities: same responsibilities as the psychiatrist‬
‭○‬ ‭Difference: except for medical duties‬

‭CHILD AND ADOLESCENT DEVELOPMENT AND DISORDERS‬
‭●‬ ‭Normal development‬‭(cognitive, social, emotional)‬
‭●‬ ‭Atypical development‬‭–‬‭most common disorders‬‭:‬
‭○‬ ‭Learning disabilities (such as dyslexia)‬
‭○‬ ‭Speech-language disorders‬
‭○‬ ‭Intellectual disabilities‬
‭○‬ ‭Neurodevelopmental disorders, such as ADHD and autism‬
‭●‬ ‭Complex disorders‬‭– and comorbidity‬
‭○‬ ‭Anxiety‬
‭○‬ ‭Depression‬
‭○‬ ‭Eating disorders‬
‭○‬ ‭Attachment disorders/trauma‬
‭○‬ ‭Stressor-related disorders‬
‭○‬ ‭Personality disorders‬
‭○‬ ‭Psychotic disorders‬

‭ORGANIZATION OF PSYCHOLOGICAL SERVICES IN‬‭THE NETHERLANDS‬
‭●‬ ‭Child Healthcare / Youth and Family Centre‬
‭○‬ ‭0-18 yrs: 0-4 child consultation clinic; 4-18 youth and family center‬
‭○‬ ‭No referral of a general practitioner is needed‬
‭●‬ ‭Basic mental healthcare‬‭(Basic GGZ)‬
‭●‬ ‭Specialized mental healthcare‬‭(Specialistische GGZ):‬‭LUMC Curium‬
‭○‬ ‭All ages‬
‭○‬ ‭Referral‬‭of a general practitioner or Youth and family center is needed‬
‭○‬ ‭Most complex cases‬
‭○‬ ‭0-18 yrs:‬‭local authorities pay‬‭(they receive funds from the central government) (16 => parents don’t need to know)‬
‭○‬ ‭18+ years:‬‭health insurance that pays‬

‭TREATMENT‬‭OUTCOME‬
‭●‬ ‭Factors that influence client outcomes can be‬‭divided into four areas‬
‭○‬ ‭Extra-therapeutic factors‬
‭○‬ ‭Expectancy effects‬
‭○‬ ‭Specific therapy techniques‬
‭○‬ ‭Common‬‭factors:‬‭empathy‬‭,‬‭warmth‬‭,‬‭and‬‭the‬‭therapeutic‬‭relationship‬‭have‬‭been‬‭shown‬‭to‬‭correlate‬‭more‬‭highly‬‭with‬
‭client outcomes than specialized treatment interventions‬‭.‬
‭●‬ ‭Alliance and expectancy are active ingredients of treatment.‬

‭TREATMENT‬‭RELATIONSHIP‬
‭●‬ ‭Interpersonal skills‬‭:‬
‭○‬ ‭Verbal fluency‬
‭○‬ ‭Interpersonal perception (what is happening between you and the client - knowledge on our regulation)‬
‭○‬ ‭Affective modulation and expressiveness‬
‭○‬ ‭Warmth and acceptance‬
‭○‬ ‭Empathy‬
‭○‬ ‭Focus on other‬
‭●‬ ‭Therapist‬‭:‬

, ‭ ‬ I‭s someone you can‬‭trust‬‭, who can help you and understand you‬
○
‭○‬ ‭Aware of the client’s age,‬‭characteristics‬‭,‬‭cultural‬‭background‬‭, and‬‭context‬
‭○‬ ‭Flexible‬ ‭and‬ ‭will‬ ‭adjust‬ ‭therapy‬ ‭if‬ ‭resistance‬ ‭to‬ ‭the‬ ‭treatment‬ ‭is‬ ‭apparent‬ ‭or‬ ‭the‬ ‭client‬ ‭is‬ ‭not‬ ‭making‬ ‭adequate‬
‭progress‬
‭○‬ ‭Communicates‬‭hope and optimism‬
‭○‬ ‭Aware‬‭of‬‭their‬‭own‬‭psychological‬‭process‬‭and‬‭do‬‭not‬‭inject‬‭their‬‭own‬‭material‬‭into‬‭the‬‭therapy‬‭process‬‭unless‬‭such‬
‭actions are deliberate and therapeutic‬

L‭ UMC CURIUM‬
‭ORGANIZATION‬
‭●‬ ‭LUMC – is divided into 4 divisions‬
‭●‬ ‭Division 3 – department Psychiatry‬
‭●‬ ‭Sub-department Child and Adolescent Psychiatry‬
‭●‬ ‭Head of Curium: Prof dr Robert Vermeiren and Manager: Willeke van den Oudenrijn‬
‭●‬ ‭3 care programs - partly based on diagnostic classification‬
‭○‬ ‭Neurodevelopmental disorders: Mirjam Rinne‬
‭○‬ ‭Emotional disorders (anxiety, psychotic): Tes Mijnders, Eva van Well‬
‭○‬ ‭Complex disorders and family problems: Lian Nijland, Lucas Korthals Altes + Janine Baartmans (De Viersprong)‬

‭AT LUMC CURIUM COMBINATION OF‬
‭●‬ ‭Patient care‬
‭●‬ ‭Research - in clinical practice, with the most complex group (severe and enduring problems)‬
‭●‬ ‭Education/training of professionals - all levels from MSc to specialist‬
‭●‬ ‭Management‬

‭PATIENT CARE‬
‭●‬ ‭Within a program‬
‭○‬ ‭Inpatient and outpatient treatment‬
‭○‬ ‭Guidelines for the diagnostic process (mainly outpatient) and treatment process‬
‭●‬ ‭In outpatient and inpatient teams‬
‭○‬ ‭Different levels of education of professionals‬
‭○‬ ‭Diagnostic process and treatment process are done by the same persons/in the same team, supervised by a specialist‬
‭○‬ ‭Specific‬ ‭treatment‬ ‭programs/therapies‬‭(CBT,‬‭DBT,‬‭psychotherapy,‬‭nonverbal‬‭therapy,‬‭farmaceutical‬‭treatment,‬‭family‬
‭therapy)‬

‭INDIVIDUALLY PLANNED TREATMENT PROGRAM‬
‭●‬ ‭As short as possible, as intensive as necessary:‬
‭○‬ ‭Outpatient treatment, individually and/or family‬
‭○‬ ‭Home treatment, individually and/or family‬
‭○‬ ‭Day clinic (chair)‬
‭○‬ ‭Clinic Inpatient (bed)‬
‭○‬ ‭“Flexbed”‬
‭○‬ ‭Bed on prescription (BOR)‬
‭○‬ ‭Chair on prescription (SOR)‬
‭○‬ ‭Consultation by telephone (TOR)‬

‭(DAY) CLINICAL TREATMENT CURIUM LUMC‬
‭1.‬ ‭Focused individualized treatment‬‭: concrete treatment goals‬
‭2.‬ ‭Treatment climate‬‭: working from competencies, skills training‬
‭3.‬ ‭Short inpatient treatment in strong cooperation with outpatient treatment and home training‬
‭4.‬ ‭Families in control‬
‭5.‬ ‭Empowerment of the family‬
‭6.‬ ‭Outpatient pre- and post-clinical treatment programs‬

‭BASIC ATTITUDE TOWARDS FAMILIES‬

, ‭●‬ P ‭ arents‬‭are‬‭competent‬‭and‬‭experts‬‭about‬‭their‬‭child‬‭,‬‭and‬‭the‬‭treatment‬‭team‬‭are‬‭experts‬‭on‬‭theoretical‬‭knowledge‬‭about‬‭the‬
‭disorder and treatment‬
‭●‬ ‭Parents go on together with their children, the team passes by‬
‭●‬ ‭Building on the competencies‬‭of the child and the family‬
‭●‬ ‭Goal is not to cure but to‬‭foster functioning and find a new balance for the child and the family‬
‭●‬ ‭Non-Violent‬ ‭Resistance‬ ‭(Chaim‬ ‭Omer)‬ ‭–‬ ‭parental‬ ‭(or‬ ‭adult)‬ ‭presence‬ ‭in‬ ‭the‬ ‭child’s‬ ‭mind,‬ ‭to‬ ‭reduce‬ ‭helplessness‬ ‭and‬ ‭gain‬
‭authority by supporting parents.‬

‭INDIVIDUAL PAPER ASSIGNMENT REFERRAL AND INTAKE AT LUMC CURIUM‬
‭●‬ ‭Referral‬‭:‬
‭○‬ ‭First by telephone (referrer and parent) => teams‬
‭○‬ ‭Referral letter‬
‭○‬ ‭DAWBA (development and well-being assessment questionnaire), interview and rating‬
‭●‬ ‭Intake‬‭:‬
‭○‬ ‭Interview with parents and child‬
‭○‬ ‭Child psychiatric examination‬
‭○‬ ‭Importance of the differential diagnosis for hypotheses generation‬

‭INTAKE AND TREATMENT AT LUMC CURIUM‬
‭●‬ ‭Diagnostic‬ ‭process:‬ ‭assessing‬ ‭child’s‬ ‭developmental‬ ‭history,‬‭psychological‬‭assessment‬‭(IQ,‬‭questionnaires),‬‭information‬‭from‬
‭school‬
‭●‬ ‭Multidisciplinary‬‭meeting‬‭with‬‭a‬‭specialist,‬‭social‬‭worker/family‬‭therapist,‬‭and‬‭student,‬‭when‬‭indicated‬‭with‬‭a‬‭psychologist‬‭for‬
‭results from psychological assessment =>‬‭descriptive diagnosis‬‭(not DSMV-classification per se)‬‭+ treatment plan‬
‭●‬ ‭Meeting with parents and children for advice‬
‭●‬ ‭Treatment => 3 monthly multidisciplinary evaluation‬

‭WORKING WITH CHILDREN AND YOUNG PEOPLE VS ADULT MENTAL HEALTH CARE‬
‭●‬ ‭Working with different developmental phases‬
‭●‬ ‭Always‬‭working with families/caretakers‬
‭●‬ ‭Working with schools, community, legal system, etc.‬
‭●‬ ‭C&A psychiatry is a relatively young specialism still in development‬
‭○‬ ‭More complex, more differentiated, more co-operation => more difficult?‬

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