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To evaluate the diagnostic and therapeutic applications of playrooms implemented in care services of children's health, while waiting for a consultation appointment.
A playroom was developed in a child psychiatry outpatient service in a University Hospital, where spontaneous approaches, without educational or psycho-specific directing, were conducted by members of a multidisciplinary team of this service. The children had their attitudes and behaviors observed by these professionals during the playful waiting time in the playroom. Therefore, all observations have been used in subsequent discussions with the professional directly responsible for the child's care, in order to enrich and supplement the case's supervision.
In spite of the spread of the playrooms, there are few studies about them, their objectives and key aspects for their creation and maintenance. It not only adds new elements to those given by family, teachers and patients, but also allows a free observation of the latent unspoken aspects that emerge during play and complement or even change the caregiver first impressions.
The experience of a playroom implemented in a child psychiatry outpatient service in a University Hospital agrees with the studies that indicate that through playful-creative activities children can make discoveries their own way, develop relationships and elaborate affective aspects of their psychic space. Rescue strategies in spontaneous play are essential elements for the children's integral development, creativity, learning and socialization. Above all, playrooms also have a therapeutic and diagnostic role in children's care.
To access the Intelligence Wechsler Scale for Children (WISC-III) as an auxiliary resource in the diagnosis of patients with suspected mental retardation.
Thirty patients were evaluated in a university psychiatric service for children and adolescents, consulted during 2008. Those patients underwent a psychiatric evaluation and, after, subsequently the WISC III scale was administered. Patients were classified, according to their intellectual coefficients, as with or without a mental retardation score, following ICD-10 criteria. The results were transferred to a SPSS (Statistical Package for Social Sciences) spreadsheet and then analyzed in its socio-demographic and clinic variables.
Of the thirty patients, 18 (60%) were children and 12 (40%) adolescents; 22 (73,33%) were male and 8 (26,67%) female. Furthermore, the sample revealed that 20 (68,97%) patients had had an axis I diagnosis. For the participants, 7 (23,3%) had an IQ below the cutoff of 70, consistent with the mental retardation diagnosis, and agreeing with the psychiatric evaluation. The other 23 (76,7%) patients had an IQ within the normal range. From those considered intellectually deficient, 5 (71,43%) had a score for mild and 2 (28,57%) for moderate mental retardation.
This study showed that clinical diagnosis of mental retardation is difficult, especially for mild cases, when the characteristics are not very clear. The error probability is increased if an instrument such as WISC III is not administered. Therefore, WISC III is an important instrument in the diagnostic process for mental retardation, in many instances changing a first clinic impression.
To analyze the use of Clozapine in six children and adolescents with Serious Conduct Disorder, whose symptoms had been refractory to other pharmacology treatment. Scalar analysis is supplied for the more important psychopathology aspects and the changes with therapeutic one.
Six patients diagnosed with Serious Conduct Disorder are described who had begun the use of Clozapine. They had been widely studied and received application of standardized instruments of infantile psychiatry (CBCL - Child Behavior Check List) before and after the use of this medication.
The patients had mainly significant improvement in relation to the level of aggressiveness and social behavior.
Although ample studies on the use of this medication in children and adolescents do not yet exist, more precisely for cases of Serious Conduct Disorder, the preliminary results are very positive and indicate that Clozapine could be an important tool in the handling of the aggressiveness in those refractory patients with Serious Conduct Disorder.
To analyze the clinical and demographic profile of psychiatric interconsultations in a pediatric ward of a Brazilian university hospital in 2008.
Review and statistical analysis, using SPSS, of the medical records of the 31 children/adolescents admitted to the Hospital from the University of Campinas-Brazil who required psychiatric assessment.
1,072 children/adolescents were hospitalized, with a total of 1,933 admissions. Psychiatric consultation was requested for 31(16 girls and 15 boys), 4(12.9%) were hospitalized more than once in 2008. Ages: 2 months-18 years old (mean: 9.9 ± 4.5). 19(61.3%) were white, 5(16.1%) mixed and 3(9.7%) black. Mothers were responsible for the children/adolescents in 23(74.5%) cases. 2(6.5%) children attended kindergarten and 19(61.3%), primary school. The permanence time varied between 1-199 days (mean: 24 ± 38.1). 8(25.8%) patients had psychiatric diagnoses at admission and were taking psychotropic drugs. 26(83.9%) had a positive clinical pediatric history. In 25(80.6%) patients the psychiatry diagnosed at least one mental disorder (more than one in 15-48.4% patients). Depressive mood disorders were the most prevalent. Psychiatric pharmacotherapy was used for 20(64.5%) patients and 17(54.8%) continued taking medication after discharge. Only 1 patient did not need referral after discharge. 1 patient died 7 months after the assessment.
The experience of being ill can have great emotional significance for children/adolescents and their families. The presence of a psychiatrist on staff can help the pediatrician in dealing with these situations, influencing therapy and prognosis.
To review the literature on child sexual abuse with emphasis on psychosocial/psychodynamic aspects.
Systematic literature review from the articles indexed in Medline, PSYinfo, Pepsic, Lilacs and Scielo in the last ten years. Terms researched were: child sexual abuse, psychosocial, psychodynamic and psychoanalysis.
Child sexual abuse can have devastating consequences for the psychological functioning of children, possibly interfering with their proper process of development. It can contribute to violent behavior, acts of delinquency and mental disorders in adolescence and adulthood, as well as the development of comorbid post-traumatic stress and self-aggressive behaviors, risk behaviors and teenage pregnancy. Gravity of psychic consequences increase in relation to the frequency of abuse. Aspects of power, seduction and coercion are involved. Inequalities of age and gender are highlighted. Often practiced without the use of physical force, it may be difficult to be proven. A frequent abuser of familiarity with the child creates conditions that foster abuse. The revelation of the abuse may not occur, perpetuating the suffering and helplessness of the child. Sexually abused children may develop identification with the abuser and even become sexual offenders in adulthood. There are difficulties in the conceptual definition of abuse, the establishment of protocols for investigative and therapeutic management of cases and in predicting the immediate consequences along with the medium and long-term consequences.
Studies on the therapeutic practices used for the treatment of abused children and their families can help to construct therapeutic models, minimizing suffering in this terrible situation of violence.
To investigate socio-demographic and clinical trials of 19 sexually abused children.
Statistical analysis with SPSS of data on psychiatric and pediatric care of sexually abused children, aged 2-12 years old, treated at the Pediatric Service of University of Campinas-Brazil Clinical Hospital in 2007.
From a total of 19 children, 2 (10.5%) were boys and 17 (89.5%) girls. The average age group was 7.4 years. Eleven (57.9%) attended regular school, one (5.3%) attended special school, one (5.3%) pre-school and six (31.5%) did not attend any school. Regarding ethnicity, 11 (57.9%) children were white and eight (42.1%) non-white. The abuse was committed with physical threats in nine (47.4%) cases, without threats in two (10.5%). Eight children were unable to define physical threat. The abuse occurred only once in 10 (52.6%) cases and several times in nine (47.4%). Prior psychiatric treatment occurred in two (5.3%) children and psychological treatment in six (31.6%). Twelve (63.2%) children had never attended psychological or psychiatric consultations. Eleven (57.9%) children received a psychiatric diagnosis and referral for treatment. In 13 (68.4%) attendance was diagnosed in the Z-code of the International Classification of Diseases-10. Family and people close to children appear as abusers in 15 cases (78.9%).
Despite the small sample, this study supports the literature in which child sexual abuse appears as a phenomenon more frequent in girls, dysfunctional families, and practiced mainly by family members or close friends of children. The relationship with psychiatric disorders was also highlighted.
To analyze, for all the pediatric consultations in 2008 in the emergency ward of the Pediatric Hospital of the University of Campinas, the clinical and demographic profile of the consultations in which there was a possible psychiatric diagnosis.
Review of all forms of consultations for children enrolled in the unit during 2008, selecting those with the possibility of a psychiatric diagnosis.
Of 21,811 consultations in 2008, 95(0.43%) included psychiatric complaints - 60(63.2%) girls and 35(36.8%) boys, aged 1-13 years(9±0.4). 70(73.7%) were white, 18(18.9%) mixed and 7(7.4%) black. A psychiatric evaluation was called for in 39(41.0%) cases. In 35(36.8%) sexual abuse was suspected. Other forms of violence were reported in 8(8.4%) cases. There were 6(6.31%) suicide attempts, 10(10.5%) cases of extreme agitation, 14(14.7%) consultations for extreme anxiety/dissociative symptoms, 5(5.3%) for depressive symptoms and 4(4.2%) for a psychotic condition. Twenty(21.1%) children were already using psychotropic drugs at the time of evaluation and in 29(30.5%) evaluations there were subsequent psychiatric interventions, with drug prescriptions in 11(37.9%). Nine(9.5%) children had clinical/pediatric conditions.
Children may need psychiatric care in emergency situations for various conditions. Despite the small percentage among the total number of pediatric emergency consultations, psychiatric evaluation, when necessary, can be useful and have an impact on diagnostic and therapeutic procedures. The plight of these children can be intense, demanding prompt and effective action. A psychiatrist can provide assistance that may help the pediatrician in the management of severe pathological conditions that affect the mental lives of children.
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