Comfort Level of Pediatricians and Family Medicine Physicians Diagnosing and Treating Child and Adolescent Psychiatric Disorders

Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY 12310, USA.
The International Journal of Psychiatry in Medicine (Impact Factor: 0.89). 02/2008; 38(2):153-68. DOI: 10.2190/PM.38.2.c
Source: PubMed


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.

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    • "Hence, they can play a key role in the course of the illness [8] [9]. However, general practitioners and pediatricians frequently report low confidence in their ability to diagnose depression [10] [11] and indeed fail to recognize many cases [12] [13]. "
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    General hospital psychiatry 02/2012; 34(3):234-41. DOI:10.1016/j.genhosppsych.2012.01.007 · 2.61 Impact Factor
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    • "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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    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.
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    • "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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