The medical history in child and adolescent psychiatry

Abstract

Introduction: The training of future specialists in child and adolescent psychiatry involves the acquisition of the skills required for interacting with the patient, their parents and teachers. These techniques help to direct the anamnesis within in structured manner which focuses on achieving, as early as possible, a proper diagnosis and treatment.

Objetives: 1) To describe the medical history model we have used in our clinical practice during initial consultations with children and adolescents, and to contribute to the design of a common framework to be used by specialists of child and adolescent psychiatry. 2) To analyze the diagnostic and therapeutic results obtained by retrospectively reviewing clinical histories taken using the same medical history model presented.

Materials And Methods: In relation to the materials used, our medical history model and a school report form are described in detail. With regards to the methodology, we reviewed the medical histories of 147 patients who were attended to over a period of time spanning from November 2007 and April 2008 by the child and adolescent mental health team at the Arganzuela Mental Health Center in Madrid. To evaluate the systematic model of questions and answers that we present, we have compared the results obtained for variables related to the psychiatric diagnosis, treatment and coordination with the patients’ schools with those reported in recent literature.

Results: In 80 patients (54.4%) we observed difficulties in adapting to stressful situations, where 66 individuals (44.8%) were diagnosed with Adjustment disorder and the other 14 with Post-traumatic stress disorder (9.5%). Attention deficit disorder with hyperactivity (ADDH) was diagnosed in 36 patients (24.4%) and Conduct disorder in another 14 (9.5%). Depression was recognized in 31 cases (21%) and Anxiety disorder in 23 (15.6%). Treatment was psychological in 144 cases (97.9%), pharmacological in 68 (46.2%), social in 25 (17%) and educative in 144 children and adolescents (97.9%). A request for a school report was made for all of the patients included in the sample. As each school report was sent back, a coordination meeting was set up with the teachers associated with 113 cases (76.8%).

Conclusions: 1) The protocols referred to in this work have proven to be effective at facilitating diagnose, treatment and prevention in childhood and adolescent mental health. Coordination with schools helps to teach the essential skills needed for child psychiatric work within a community.