RESUMEN
The Participatory, Cross-Professional and Cross-Departmental Development of an EthicalMission Statement in a Child and Adolescent Psychiatric Clinic: The Ethics Compass of theUPKKJ Basel Employees in child and adolescent psychiatry navigate a complex field of ethical requirements. At the Clinic for Children and Adolescents of the University Psychiatric Clinics Basel (UPKKJ), these areas of tension were examined in a project that spanned across numerous departments and professional groups. Based on a survey study and a narrative literature review, ethical guidelines were developed: the UPKKJ Ethics Compass. The Ethics Compass highlights various areas such as participation, child welfare, justice and developmental health, which are relevant to the relationships between children, adolescents, parents, and the treatment team. To implement these principles in everyday clinical practice, the Ethics Compass is now regularly used in case work and as a communication aid with external partners. Furthermore, a procedural action plan was developed for collaboration with the Department of Clinical Ethics at the University Hospitals in Basel.
Asunto(s)
Psiquiatría del Adolescente , Psiquiatría Infantil , Hospitales Psiquiátricos , Humanos , Adolescente , Niño , Psiquiatría Infantil/ética , Psiquiatría del Adolescente/ética , Hospitales Psiquiátricos/ética , Suiza , Colaboración Intersectorial , Comunicación Interdisciplinaria , Hospitales Universitarios/éticaRESUMEN
The practice of child and adolescent psychiatry is evolving during an unprecedented global health catastrophe, the coronavirus disease 2019 (COVID-19) pandemic. As child and adolescent psychiatrists grapple with COVID-19's enormous medical, educational, social, and economic toll, a mental health crisis is co-occurring. Pre-existing disparities are recognized as contributors to the disproportionate impact of the COVID-19 pandemic on racial and ethnic minorities.1 The magnitude of COVID-19's effects on child and family mental health has yet to be fully revealed. child and adolescent psychiatrists are in a unique position to address this mental health crisis. Child and adolescent psychiatrists must stay up-to-date regarding federal, state, local, and institutional mandates, regulations, and policies informed by the Centers for Disease Control and Prevention2 and other public health institutions, while also navigating the ethical dilemmas unique to child and adolescent psychiatry during the coronavirus era.
Asunto(s)
Psiquiatría del Adolescente/ética , COVID-19/psicología , Psiquiatría Infantil/ética , Salud Mental , Pandemias , Adolescente , Niño , Salud de la Familia , Disparidades en el Estado de Salud , HumanosRESUMEN
En este artículo, se esbozan y discuten algunos temas relacionados con la bioética del cuidado en la Neuropsiquiatría de la Infancia y la Adolescencia (NPIA). Se pone de relieve el concepto de hacerse cargo del niño en edad de desarrollo y las raíces históricas de la bioética infantil. Se abordan las cuestiones relacionadas con la privacidad, el respeto de la confidencialidad y la protección de los menores, así como el concepto de estigma relacionado con la enfermedad y el cuidado de la mente. Se describe la cuestión ética del uso de fármacos psicoactivos en edad de desarrollo. Se destaca el problema del consentimiento informado y de la elección del método de tratamiento para las enfermedades en las que el conocimiento es incompleto y los resultados no están garantizados. Se aborda la cuestión de la comunicación del diagnóstico, de la necesidad de una intervención oportuna, de métodos apropiados y de la elección del camino en los casos de patología grave y diagnóstico temprano. Por último, se habla de la cuestión ética de las psicoterapias en el servicio público y en centros privados reconocidos por el Sistema Nacional de Salud
In this article, some issues related to the bioethics of care in Child and Adolescent Neuropsychiatry (NPIA) are outlined and discussed. We highlight the concept of looking after a child in his/her developmental age and the historical roots of child bioethics. Issues of privacy, respect for confidentiality and protection of minors are addressed, as well as the concept of stigma related to illness and care. The ethical issue of the use of psychoactive drugs at a developmental age is described. The problem of informed consent and choice of treatment method for diseases where knowledge is incomplete and results are not guaranteed is highlighted. The issue of communication of diagnosis, the need for timely intervention, appropriate methods and choice of path in cases of severe pathology and early diagnosis is addressed. Finally, the ethical issue of psychotherapies in the public service and in private centres recognised by the National Health System is discussed
En aquest article, s'esbossen I discuteixen alguns temes relacionats amb la bioètica de la cura en la Neuropsiquiatria de la Infància I l'Adolescència (NPIA). Es posa en relleu el concepte de fer-se càrrec de l'infant en edat de desenvolupament I les arrels històriques de la bioètica infantil. S'aborden les qüestions relacionades amb la privacitat, el respecte de la confidencialitat I la protecció dels menors, així com el concepte d'estigma relacionat amb la malaltia I la cura de la ment. Es descriu la qüestió ètica de l'ús de fàrmacs psicoactius en edat de desenvolupament. Es destaca el problema del consentiment informat I de l'elecció del mètode de tractament per a les malalties en les quals el coneixement és incomplet I els resultats no estan garantits. S'aborda la qüestió de la comunicació de la diagnosi, de la necessitat d'una intervenció oportuna, de mètodes apropiats I de l'elecció del camí en els casos de patologia greu I diagnòstic precoç. Finalment, es parla de la qüestió ètica de les psicoteràpies en el servei públic I en centres privats reconeguts pel Sistema Nacional de Salut
Asunto(s)
Humanos , Niño , Adolescente , Psiquiatría del Adolescente/ética , Psiquiatría Infantil/ética , Discusiones Bioéticas , Consentimiento Informado de Menores/psicología , Trastornos Mentales/terapia , Bioética , Psicotrópicos/uso terapéuticoRESUMEN
COVID-19 is a multi-organ disease due to an infection with the SARS-CoV2 virus. It has become a pandemic in early 2020. The disease appears less devastating in children and adolescents. However, stress, quarantine and eventually mourning have major impacts on development. It is difficult to describe what this pandemic implies for a child psychiatrist, other than by giving a first-hand account. I propose to go through the main ethical questions that have arisen; to describe how my hospital team has reorganized itself to meet the new demands and questions, in particular by opening a unit dedicated to people with autism and challenging behaviors affected by COVID-19; and to address, in a context of national discussion, how the discipline has sought to understand the conditions of a certain well-being during quarantine. Finally, I will try to conclude with more speculative reflections on re-opening.
Asunto(s)
Psiquiatría del Adolescente , Actitud del Personal de Salud , Trastorno Autístico/terapia , Betacoronavirus , Psiquiatría Infantil , Infecciones por Coronavirus , Pandemias , Neumonía Viral , Psiquiatría , Adolescente , Conducta del Adolescente , Psiquiatría del Adolescente/ética , Trastorno Autístico/complicaciones , Trastorno Autístico/psicología , COVID-19 , Niño , Conducta Infantil , Psiquiatría Infantil/ética , Control de Enfermedades Transmisibles/métodos , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/psicología , Infecciones por Coronavirus/transmisión , Infección Hospitalaria/complicaciones , Infección Hospitalaria/psicología , Infección Hospitalaria/terapia , Exposición a Riesgos Ambientales , Francia , Accesibilidad a los Servicios de Salud , Reestructuración Hospitalaria , Unidades Hospitalarias/organización & administración , Humanos , Control de Infecciones/métodos , Servicios de Salud Mental/ética , Servicios de Salud Mental/organización & administración , Trastornos del Olfato/etiología , Trastornos del Olfato/psicología , Pandemias/prevención & control , Aceptación de la Atención de Salud , Grupo de Atención al Paciente , Aislamiento de Pacientes/psicología , Ludoterapia , Neumonía Viral/complicaciones , Neumonía Viral/prevención & control , Neumonía Viral/psicología , Neumonía Viral/transmisión , Práctica Profesional/ética , Equipos de Seguridad , Factores de Riesgo , SARS-CoV-2 , Estrés Psicológico/etiologíaAsunto(s)
Psiquiatría del Adolescente/ética , Psiquiatría del Adolescente/legislación & jurisprudencia , Psiquiatría Infantil/ética , Psiquiatría Infantil/legislación & jurisprudencia , Conflicto Psicológico , Ética Médica , Trastornos Mentales/tratamiento farmacológico , Uso Fuera de lo Indicado/ética , Uso Fuera de lo Indicado/legislación & jurisprudencia , Psicotrópicos/efectos adversos , Psicotrópicos/uso terapéutico , Políticas de Control Social , Adolescente , Antipsicóticos/efectos adversos , Antipsicóticos/uso terapéutico , Niño , Aprobación de Drogas/legislación & jurisprudencia , Alemania , Humanos , Factores de Riesgo , Esquizofrenia/tratamiento farmacológicoRESUMEN
Physical deformities may cause psychological stress and lead to psychological disorders in children and adolescents. On the other hand, the correction of non-pathological conditions is a legal issue in patients unable to consent, a group that is partly made up of minors. This article provides an overview on available evidence on the psychological consequences of physical deformities, psychiatric contraindications for plastic surgery due to psychological disorders, and on the issue of minors' ability to consent.
Asunto(s)
Psiquiatría del Adolescente , Actitud del Personal de Salud , Psiquiatría Infantil , Anomalías Congénitas/psicología , Anomalías Congénitas/cirugía , Procedimientos de Cirugía Plástica , Psicoterapia , Adolescente , Psiquiatría del Adolescente/legislación & jurisprudencia , Trastorno Dismórfico Corporal/diagnóstico , Trastorno Dismórfico Corporal/psicología , Niño , Psiquiatría Infantil/ética , Psiquiatría Infantil/legislación & jurisprudencia , Alemania , Humanos , Consentimiento Informado/ética , Consentimiento Informado/legislación & jurisprudencia , Consentimiento Informado/psicología , Menores/psicología , Consentimiento Paterno/ética , Consentimiento Paterno/legislación & jurisprudencia , Consentimiento Paterno/psicología , Psicoterapia/ética , Procedimientos de Cirugía Plástica/éticaRESUMEN
Epigenetics has the potential to revolutionize diagnosis and treatment in psychiatry, especially child psychiatry, as it may offer the opportunity for early detection and prevention, as well as development of new treatments. As with the previous introduction of genetic research in psychiatry, there is also the problem of unrealistic expectations and new legal and ethical problems. This article reviews the potential contributions and problems of epigenetic research in child psychiatry. Previous legal and ethical issues in genetic research serve as a guide to those in epigenetic research. Recommendations for safeguards and guidelines on the use of epigenetics with children and adolescents are outlined based on the identified issues.
Asunto(s)
Psiquiatría Infantil/ética , Psiquiatría Infantil/legislación & jurisprudencia , Epigenómica/ética , Epigenómica/legislación & jurisprudencia , Adolescente , Niño , Ética en Investigación , Humanos , Principios Morales , Investigación/legislación & jurisprudenciaAsunto(s)
Humanos , Preescolar , Niño , Adolescente , Psiquiatría Infantil/educación , Psiquiatría Infantil/ética , Psiquiatría Infantil/legislación & jurisprudencia , Psiquiatría del Adolescente/educación , Psiquiatría del Adolescente/ética , Psiquiatría del Adolescente/legislación & jurisprudencia , Salud Mental/ética , Salud Mental/legislación & jurisprudencia , Atención Integral de Salud/legislación & jurisprudencia , Atención Integral de Salud/métodos , Psiquiatría Infantil/organización & administración , Psiquiatría del Adolescente/organización & administración , Análisis Multivariante , Salud Mental , Salud Mental/normas , Atención Integral de Salud/organización & administraciónAsunto(s)
Psiquiatría del Adolescente , Psiquiatría Infantil , Guías de Práctica Clínica como Asunto , Psicología del Adolescente , Psicología Infantil , Ensayos Clínicos Controlados Aleatorios como Asunto , Proyectos de Investigación/normas , Adolescente , Psiquiatría del Adolescente/ética , Niño , Psiquiatría Infantil/ética , Consenso , Difusión de Innovaciones , Ética en Investigación , Medicina Basada en la Evidencia/ética , Adhesión a Directriz , Humanos , Psicología del Adolescente/ética , Psicología Infantil/ética , Ensayos Clínicos Controlados Aleatorios como Asunto/ética , Reino UnidoAsunto(s)
Psiquiatría Infantil/ética , Ética Médica , Trastornos Mentales/terapia , Relaciones Médico-Paciente/ética , Psicoterapia/ética , Adolescente , Niño , Adhesión a Directriz , Humanos , Trastornos Mentales/diagnóstico , Trastornos Mentales/psicología , Relaciones Profesional-Familia , Conducta Social , Medio Social , Transferencia Psicológica , Estados UnidosAsunto(s)
Trastorno Autístico/terapia , Catatonia/terapia , Psiquiatría Infantil/ética , Ética Clínica , Adolescente , Niño , HumanosRESUMEN
Depression is a common, recurring disorder affecting millions of youth at some point before they reach mature adulthood. Given the shortage of and uneven distribution of psychiatrists who have completed specialized fellowships in child and adolescent psychiatry, a significant number of depressed youth will receive their pharmacotherapy from general psychiatrists and other prescribers with varying degrees of interest, training, and even willingness to treat children and adolescents. For general psychiatrists who will prescribe antidepressants for minors, knowledge of the training and expertise of nonphysician mental health professionals, the psychotherapies they may employ, and familiarity with school services are essential. Physicians who typically work only with adults will also need familiarity with differing ethical, legal, and regulatory issues and standards applicable to pediatric psychopharmacology. General psychiatrists, pediatricians, family physicians, nurse practitioners, and others contribute greatly to the care of depressed children, adolescents, and their families, and many find this work to be a very rewarding part of their professional practices.
Asunto(s)
Psiquiatría del Adolescente/ética , Antidepresivos/uso terapéutico , Psiquiatría Infantil/ética , Trastorno Depresivo/terapia , Servicios de Salud Mental/organización & administración , Derivación y Consulta , Adolescente , Psiquiatría del Adolescente/educación , Psiquiatría del Adolescente/métodos , Adulto , Niño , Psiquiatría Infantil/educación , Psiquiatría Infantil/métodos , Terapia Cognitivo-Conductual , Trastorno Depresivo/epidemiología , Prescripciones de Medicamentos/estadística & datos numéricos , Terapia Familiar , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Consentimiento Informado de Menores/ética , Masculino , Servicios de Salud Mental/provisión & distribución , Uso Fuera de lo Indicado/ética , Cuidado Pastoral , Áreas de Pobreza , Psicoterapia , Población Rural , Servicios de Salud Escolar/organización & administración , Instituciones Académicas , Servicio Social , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: Genetic and neurobiological research into the causes of antisocial behaviour is playing an increasingly important role in forensic psychiatry. AIM: To contribute some ethical and societal reflections on the possible consequences of this kind of research for the prevention of antisocial behaviour. METHOD: In this ethical analysis, which gives attention to the concepts of 'informed consent' and 'best interests', we investigate which persons and which interests need to be taken into account when new preventive measures are implemented. RESULTS: It is important to differentiate between distinct target groups. From an ethical point of view it makes a difference whether measures are related to the early identification of a-symptomatic high-risk children and appropriate preventive interventions, or whether they are directed towards the (sub)typing and preventive treatment of children who already have behavioural problems or whether they are concerned with the treatment of children with conduct disorders whose parents have asked the child psychiatrist for assistance. CONCLUSION: From an ethical point of view it is not really important whether prevention measures are based on genetic and neurobiological research or on societal and psychological research. What is more important is that these measures target particular groups of children and that prevention is implemented in an appropriate manner.
Asunto(s)
Trastorno de Personalidad Antisocial/prevención & control , Conducta Infantil , Psiquiatría Infantil/ética , Psiquiatría Infantil/métodos , Trastorno de Personalidad Antisocial/genética , Trastorno de Personalidad Antisocial/psicología , Niño , HumanosRESUMEN
OBJECTIVE: To determine whether there is evidence of a time-lag bias in the publication of pediatric antidepressant trials. METHOD: We conducted a meta-analysis of published and unpublished randomized placebo-controlled trials of serotonin reuptake inhibitors (SRIs) in subjects less than 18 years of age with major depressive disorder. Our main outcomes were (1) time to publication of positive versus negative trials, and (2) proportion of treatment responders in trials with standard (<3 years after study completion) versus delayed publication. RESULTS: We identified 15 randomized, placebo-controlled trials of SRIs for pediatric depression. Trials with negative findings had a significantly longer time to publication (median years ± standard deviation = 4.2 ± 1.9) than trials with positive findings (2.2 ± 0.9; log-rank χ(2) = 4.35, p = .037). The estimated efficacy in trials with standard publication time (number needed to treat = 7, 95% CI = 5-11) was significantly greater than those with delayed publication (17, 95% CI = 9-∞; χ(2) = 4.98, p = .025). The inflation-adjusted impact factor of journals for published trials with positive (15.33 ± 11.01) and negative results (7.54 ± 7.90) did not statistically differ (t = 1.4, df = 10, p = .17). CONCLUSIONS: Despite a small number of trials of SRIs for pediatric antidepressants, we found a significant evidence of time-lag bias in the publication of findings. This time-lag bias altered the perceived efficacy of pediatric antidepressants in the medical literature. Time-lag bias is not unique to child psychiatry and reflects a larger problem in scientific publishing.
Asunto(s)
Trastorno Depresivo Mayor/tratamiento farmacológico , Sesgo de Publicación , Edición , Ensayos Clínicos Controlados Aleatorios como Asunto/economía , Inhibidores Selectivos de la Recaptación de Serotonina/uso terapéutico , Adolescente , Niño , Psiquiatría Infantil/ética , Costos de los Medicamentos , Humanos , Factor de Impacto de la Revista , Evaluación de Resultado en la Atención de Salud , Edición/economía , Edición/ética , Proyectos de Investigación , Factores de Tiempo , Resultado del TratamientoRESUMEN
The details of the implementation of early prevention in child mental health in France have been at the heart of a debate between the defenders of a universal approach and the proponents of an approach targeting specific populations. The universal approach draws on various aspects of mother and child care and early childhood care offering considerate and expressive prevention based on a relationship of trust developed over time between professionals, parents and children. The targeted approach is based on the development of programs aimed at identifying vulnerable or at-risk populations. The ethical issues raised by targeted strategies are presented and discussed. The study highlights the difficulty of distinguishing between the social, educational, medical and psychological issues raised by early prevention.