Showing posts with label mental health. Show all posts
Showing posts with label mental health. Show all posts

Monday, October 19, 2015

Who Is Seeing the Children and Teens with Mental Health Issues—and Who Is Doing the Prescribing of Psychotropic Medications?

By: Lewis First, MD, MS; Editor-in-Chief     

          We know that there is a critical shortage of mental health services for children and teens in this country, such that primary care providers (PCPs) are called upon to often diagnose and in turn treat and follow these patients because of lack of access to psychiatrists and even psychologists and social workers.  
         So just how often are these children being managed by a PCP?  Anderson et al. (doi: 10.1542/peds.2015-0807), in a study being released this week, used a nationally representative data set to determine if children and teens from 2 to 21 years are seen in the outpatient setting for their mental health issues by PCPs, psychiatrists or psychologists and social workers and who is prescribing psychotropic medications for these patients.  More than a third of children in this database were being seen by PCPs only which may or may not surprise you.  What won’t surprise you is that more than 40% of children with attention-deficit hyperactivity disorder (ADHD) were only seen by a PCP.  These numbers may be increasing rather than decreasing as the mental health issues we uncover in our patients rise, and the mental health work force stays about the same or even decreases in the years ahead. 
How does your practice compare to the results shared in this provocative study?  What do you suggest the AAP might do to help remedy the situation? Should pediatricians be trained to prescribe psychotropic medications that go beyond an ADHD regimen more than they are currently learning how to do?  We want to know how you are dealing with the mental health problems in your practice through your response to this blog, sending us an e-letter or posting your comments on our Facebook or Twitter pages.

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Monday, April 20, 2015

A Guiding Hand in Pediatric Psychiatry: The Massachusetts Child Psychiatry Project in Action

By: Joann Schulte  DO, MPH; Editorial Board Member
      It should come as no surprise that the mental health care needs of children and adolescents has increased more than that of adults during the period 1995-20101.  The responsibility for dealing with that increase seems to fall more and more  on primary care pediatricians.. The reasons are multiple: a shortage of child mental health specialists; mental health problems are more complex; and the use of psychotropic medications by primary care pediatricians due to the lack of child psychiatrist availability is increasing.
      So what’s a pediatrician to do when you want to consult a psychiatrist or other mental health specialist and they are not readily available? You create a program that enables primary care providers to consult with mental health practitioners in their region about diagnostic issues and use of psychotropic medication.  One such program, the Massachusetts Child Psychiatry Access Project is described in a new study being published this month by Van Cleave et al. (doi:10.1542/peds.2014-0720) in Pediatrics.
      The Massachusetts program (between 2005 and 2011) enrolled 285 practices whose providers called for advice a mean of 5.2 times per 1000 patients per year and saw calls steadily increase as seen in the figure below from the article.
Calls per month to all MCPAP sites by PCPs, May 2005-July 2011
       Calls most frequently concerned medication/evaluation questions and most commonly referred to  patients with diagnoses of ADHD and anxiety.  The researchers found that 46% of the time the call resulted in a referral back to the primary care provider and another 42% of calls led to an evaluation by a psychiatrist or to a care coordinator to identify appropriate resources for the patient.
      The demand for mental health services by pediatric patients is increasing and the evaluation of this project in Massachusetts suggests the use of a consulting service was of help to practicing pediatricians. Having somebody in the mental health world who is accessible by phone and can listen and provide appropriate advice to a practicing pediatrician is important if we are going to help our patients with their mental health needs.

1.  Olfson M et al. National trends in the mental health care of children, adolescents and adults by office-based physicians. JAMA Psychiatry 2014; 7(1):81-90

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Tuesday, February 10, 2015

Extremely Low Birth Weight Infants Now in Their 30s: How’s Their Mental Health?

By: Lewis First, MD, MS; Editor-in-Chief

@singingbeagle Flickr

          It is amazing how much we learn from longitudinal follow-ups of our patients. What was once only a follow-up of a few years tracking a cohort (if we were lucky to keep collecting data on them) has evolved into decades of tracking patients since infancy—and preterm infants are a great example. 
This week Van Lishout et al. (doi: 10.1542/peds.2014-3143) report on a prospective longitudinal population-based cohort of extremely low birth weight (ELBW) infants followed for over three decades in Ontario Canada. This cohort was mixed with an equal number of non-ELBW infants in their 30s and were interviewed in regard to their mental health as adults with interviewers unaware of early birth history. 
The results are interesting and reflect that ELBW adults are less likely to have alcohol or substance abuse problems but a greater risk of non-substance related mental health issue including generalized anxiety, and attention-deficit/hyperactivity disorder. Risks increased for both substance and non-substance related psychiatric disorders if antenatal corticosteroids had been administered. 
          While we realize we don’t usually follow our patients into their 30s, the information in this study is useful for educating both parents and adolescent patients to perhaps be better aware of problems that might occur more frequently as they move into adulthood, and at the same time take preventive steps to reduce the occurrence of such problems knowing what this study tells us.  Kudos to the investigators for being able to follow this ELBW cohort for so long and in turn for sharing with us information that can influence how we counsel these patients while they are still in our practice.

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