Comfort Level of Pediatricians and Family Medicine Physicians Diagnosing and Treating Child and Adolescent Psychiatric Disorders
Twelve to twenty-one percent of children and adolescents have psychiatric disorders with at least mild functional impairment. Pediatricians and family medicine physicians prescribe 85% of psychotropic medications taken by children. However, little is known about the comfort level of these physicians with the diagnosis and treatment of psychiatric disorders in children.
To determine the comfort level of physicians in diagnosing and treating psychiatric disorders in children.
An anonymous survey was sent to pediatricians and family medicine physicians in upstate New York. Of 483 surveys, 200 surveys were returned.
To compare differences between pediatricians and family medicine physicians in comfort in diagnosing and prescribing medications for psychiatric disorders.
After controlling for age, race, and years since residency, pediatricians were more comfortable in diagnosing (O.R. = 3.05, C.I. = 1.40-6.63) and prescribing stimulants for (O.R. = 4.16, C.I. = 1.96-8.84) Attention Deficit Disorder. Family medicine physicians were more comfortable in diagnosing (O.R. = .28, C.I. = .14-.57) and prescribing medication for (O.R. = .44, C.I. = .22-.87) anxiety and depression. Despite the differences in comfort, there were no differences in the percentage of each group prescribing the different medications. Of those who were comfortable in making the diagnoses, 13%-64% were not comfortable in prescribing medications, although they did prescribe.
Pediatricians and family medicine physicians who prescribe the majority of psychotropic medications for children report disconcerting degrees of discomfort with the diagnosis and treatment of children's psychiatric disorders. The authors discuss the multiple factors that may impact primary care physician's comfort in diagnosing and treating children and adolescents with psychiatric disorders.
Available from: Gerd Schulte-Körne
- "Hence, they can play a key role in the course of the illness  . However, general practitioners and pediatricians frequently report low confidence in their ability to diagnose depression   and indeed fail to recognize many cases  . "
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ABSTRACT: This study investigated the criterion validity of the WHO-Five Well-Being Index (WHO-5) in screening for depression in pediatric care.
A total of 446 children aged 9 to 12 and 324 adolescents aged 13 to 16, recruited from pediatric hospitals, completed the WHO-5 and a structured diagnostic interview serving as the gold standard. Diagnoses of depressive disorder included major depression and minor depression. Criterion validity was analyzed using the area under the receiver operating curve (AUC). Sensitivity and specificity were computed for optimal cutoffs. Additionally, unaided clinical diagnoses of depression made by the attending pediatricians were assessed.
Diagnoses of depressive disorder were established for 3.6% of children and 11.7% of adolescents. AUCs were .88 for the child and .87 for the adolescent sample. A cutoff score of 10 for children maximized sensitivity (.75) and specificity (.92). For the adolescent sample, decreasing the cutoff score to 9 yielded optimal sensitivity (.74) and specificity (.89). Sensitivity of the unaided clinical diagnosis of depression was .09, while specificity was .96.
The WHO-5 demonstrated good diagnostic accuracy for both age groups. Further evidence is needed to support the feasibility of the WHO-5 as a depression screening instrument used in pediatric care.
General hospital psychiatry 02/2012; 34(3):234-41. DOI:10.1016/j.genhosppsych.2012.01.007 · 2.61 Impact Factor
Available from: Daphne Korczak
- "Alternately, the diagnoses may reflect patient/family disclosed diagnoses recorded by PEM physicians for a variety of reasons which may include decreased assessment time available (Breslow et al, 2003), exhausted patients and/or family members due to assessment time of day (Nadkarni et al, 2000), lack of key collateral informant availability (Breslow et al, 2003; Nadkarni et al, 2000), environmental barriers to history-taking within the ED (Breslow et al, 2003; Nadkarni et al, 2000), or lack of specialty expertise (Fremont et al, 2008). Our findings may be a reflection of the increased time available for psychiatric assessment as compared with ED assessment, however, duration of assessment for PEM physicians or child psychiatrists was not measured in this study. "
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ABSTRACT: To describe the patient population, diagnoses, and disposition of children and adolescents referred by Pediatric Emergency Medicine (PEM) physicians to a Pediatric Psychiatric Crisis Clinic (PCC) for urgent consultation; to describe the percent agreement between PEM physician discharge diagnosis and subsequent child psychiatrist diagnoses.
Data were obtained prospectively over a one-year period for consecutive patients referred to the PCC (n=174). Patients and families were contacted for information regarding subsequent emergency department (ED) visitation following PCC consultation.
Referred patients were commonly male (63%) with a mean age of 12.2 ± 3.2 years diagnosed with adjustment disorder (29%), mood disorder (17%) and anxiety disorder (17%) and significant psychosocial stressors. Five percent of patients required hospitalization. PEM physician discharge diagnosis and child psychiatrist diagnosis were in agreement in 21% of cases.
Patients referred by PEM physicians for urgent outpatient psychiatric assessment were most commonly early adolescent males. The majority of patients did not require ongoing psychiatric care. Further investigation into the differences between PEM physician and child psychiatrist diagnoses is needed to ensure patients and families receive accurate and consistent mental health information and recommendations from all members of their health care team.
Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l'Academie canadienne de psychiatrie de l'enfant et de l'adolescent 11/2010; 19(4):297-302.
Available from: Christopher P. Morley
- "In fact, as much as 65% - 85% of initial ADHD diagnosis and treatment occurs in primary care settings (e.g. Pediatric or Family Medicine practices) [11,12]. Once a child has been determined to meet the basic criteria for ADHD, the next step recommended by a number of authoritative sources is referral to an ADHD specialist, such as a mental health professional, ADHD subspecialty clinic, or Neurodevelopmental Pediatrician [13,14]. "
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ABSTRACT: Attention Deficit Hyperactivity Disorder (ADHD) is a costly and prevalent disorder in the U.S., especially among youth. However, significant disparities in diagnosis and treatment appear to be predicted by the race and insurance status of patients.
This study employed a web-based factorial survey with four ADHD cases derived from an ADHD clinic, two diagnosed with ADHD in actual evaluation, and two not. Randomized measures included race and insurance status of the patients. Participants N = (187) included clinician members of regional and national practice-based research networks and the U.S. clinical membership of the Society of Teachers of Family Medicine. The main outcomes were decisions to 1) diagnose and 2) treat the cases, based upon the information presented, analyzed via binary logistic regression of the randomized factors and case indicators on diagnosis and treatment.
ADHD-positive cases were 8 times more likely to be diagnosed and 12 times more likely to be treated, and the male ADHD positive case was more likely to be diagnosed and treated than the female ADHD positive case. Uninsured cases were significantly more likely to be treated overall, but male cases that were uninsured were about half as likely to be diagnosed and treated with ADHD. Additionally, African-American race appears to increase the likelihood of medicinal treatment for ADHD and being both African-American and uninsured appears to cut the odds of medicinal treatment in half, but not significantly.
Family physicians were competent at discerning between near-threshold ADHD-negative and ADHD positive cases. However, insurance status and race, as well as gender, appear to affect the likelihood of diagnosis and treatment for ADHD in Family Medicine settings.
BMC Family Practice 02/2010; 11(1):11. DOI:10.1186/1471-2296-11-11 · 1.67 Impact Factor
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