What is special about a Paediatric Liaison Child and Adolescent Mental Health service?

Abstract

Background The paediatric population is known to be at high risk for psychiatric problems. Paediatric liaison child/adolescent mental health services (PL‐CAMHS) have been developed to help increase recognition and management of psychiatric morbidity in the paediatric setting. This report describes clinical activity by a psychological medicine PL‐CAMHS and considers specificity by comparing this with community/general CAMHS activity. Method Clinical information was obtained on consecutive patients seen by a PL‐CAMHS in a UK tertiary specialist hospital. Where feasible this was compared with published data on national/community CAMHS work. Results Data was obtained on 800 patients (mean age 11.9, SD 3.8). Most referrals came from a variety of paediatric teams, nearly two‐thirds were for psychosomatic problems or difficulties adjusting to physical illness. The majority had an ICD‐10 psychiatric diagnosis (mostly adjustment, mood and anxiety, and somatoform disorders); problems were often complex and in about half, family difficulties were also noted; one‐third had received prior mental health treatment. Virtually all children were seen by the PL service within a month of referral and only 2% of families failed to attend for assessment. Some level of clinical improvement was noted for the majority. There were indications of differences from national/community CAMHS work in referral source, take up rates and psychiatric diagnoses. Conclusions Paediatric liaison child and adolescent mental health services users commonly have characteristic psychiatric problems, interventions appear potentially effective and the work is specific and complementary of community CAMHS. Thus PL‐CAMHS make a distinct contribution to the provision of truly comprehensive CAMHS.

Assessing feasibility of routine identification tools for mental health disorder in neurology clinics

“…Only the parent report version was used in this study. The SDQ has been validated across the wide age range of children and young people seen within neurology clinics,3–18 22 and used in those with autism spectrum disorder23 and intellectual disabilities,24 known to be highly prevalent in young people with neurological conditions 25…”

“…One solution to the challenges in identifying mental health disorders is to embed mental health specialists within paediatric teams 14 15. However, many paediatric centres do not have access to embedded psychiatric liaison services, despite guidance to the contrary16 and provision is variable where such services do exist 17. Given the already stretched capacity of child and adolescent mental health services, it may be unfeasible for a qualified mental health professional to be colocated within all paediatric clinics with the sole purpose of identifying and treating mental health difficulties.…”

Hospital management of paediatric functional somatic symptoms

“…It would certainly be of interest to conduct prospective studies of paediatric admissions to ascertain actual prevalence. Nevertheless, the number of children with definite FSS referred to PL CAMHS is comparable to reported by a PL CAMHS service in a tertiary, specialised hospital in the UK indicating similar referral practices in departments with available PL CAMHS. On the face of it, this would place FSS in the category of rare disorders within current paediatric hospital practice and therefore likely to require specialist help.…”

64 congreso Nacional de la Asociación Española de Psiquiatría del Niño y del Adolescente

“…El trastorno por déficit de atención/hiperactividad (TDAH) es un trastorno del neurodesarrollo caracterizado por falta de atención, hiperactividad e impulsividad persistentes (1,2). Los tratamientos farmacológicos y no farmacológicos mejoran la sintomatología (3).…”

“…El trastorno por déficit de atención con hiperactividad (TDAH) es uno de los trastornos neurobiológicos más comunes en la infancia (1). Aunque hay disponibles varias opciones terapéuticas, no está claro cuál sería la más adecuada según los perfiles de comorbilidades (2). Nuestro objetivo es comparar la eficacia de los tratamientos metilfenidato (MPH) y lisdexanfetamina (LDX) en primera línea en niños/adolescentes, aportando nuevas y sólidas evidencias, con una metodología novedosa (3,4).…”