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