An article in a recent Mayo Clinic e-newsletter cited Child Psychiatrists as being in extremely short supply in the US, and stated that there is little evidence that the shortage will be remedied in the long term either. The May Clinic article mentioned, as one example of the problem, that Wyoming has only 2 child psychiatrists. But the shortage is, in fact, a problem in all fifty states and getting worse. The impact of this shortage has become even more noticeable in recent decades with less stigma attached to seeking help for psychiatric illnesses, as more families seek treatment for children, and as more children become suicidal or dangerous due to lack of psychiatric intervention. With few Child Psychiatrists even taking new patients, long wait times for initial appointments, and the general lack of available practitioners in many areas of the US, many parents have few options other than to bring their children to see doctors without training and experience in tre ating psychiatric disorders or in the proper use of psychiatric drugs.
Several factors likely discourage medical graduates who might otherwise consider this medical specialty from pursuing it. One drawback is the additional two years of training beyond the initial 3 years of Psychiatric residency training that are required to certify as a Child Psychiatrist. The fact that insurance and other reimbursement policies do not adequately reflect the time required for the psychiatrist to obtain a useful history, when the patient, parents, siblings, and even teachers might need to be interviewed to accomplish this also lessens interest in the field. Even assuming a relatively modest incidence of serious mental illness for this age group, this still calculates to a staggering number of patients for each practitioner. The House of Representatives recently passed legislation that provides loan forgiveness to college students studying to work in this area, but given the current and predicted shortfall in producing physicians trained to offer mental c are to children, this is hardly going to solve the problem.
Poll Question:
Given the extreme shortage of child psychiatrists, which of the following do you think would be most likely to help parents more easily find treatment for children with mental problems?
1. Require that the curricula of medical and allied health schools include child psychiatry training
2. Provide certification programs for physicians in other specialties in this area
3. Increase funding for mental health programs in public education
4. Provide certification programs for nurse practitioners and physician assistants to provide psychiatric care to children
5. Fund public health agencies to offer intervention/prevention programs for children's mental health
The correct answer to the question above is: D.
1. Acute disseminated encephalomyelitis (ADEM) typically occurs after a viral infection or an immunization. The symptoms include headache and lethargy. The findings are nonfocal.
2. Central pontine myelinolysis is caused by osmotically mediated damage secondary to rapid correction of electrolyte abnormalities.
3. Multiple sclerosis presents with similar focal neurologic symptoms that cannot be attributed to a single tract or area of the brain. The course would not be so rapid and the mechanism is autoimmune in nature.
4. CORRECT: The etiologic agent of progressive multifocal leukoencephalopathy is JC virus. Most people have evidence of exposure to the virus, however neurologic defects are predominantly seen in the immunosuppressed or immunocompromised. As the name implies, the disease is multifocal and progressive, often leading to coma. Histology demonstrates the characteristic viral inclusion bodies.
5. Although not so common any more, subacute sclerosing panencephalitis can occur in the young often years after a measles infection. There are areas of demyelination and neurofibrillary tangles.
Drug of the Month: Topiramate (Topamax ®)
source: Kaplan edge newsletter
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