Psychiatrists increasingly able to assess, treat mental health problems of the very young

Article Abstract:

By the time children have reached the age of three, as many as 15 percent will have a behavior problem, according to one expert. Progress has been made in recent years in diagnosing and treating psychiatric disorders of infancy. Autism, a true psychiatric disorder, develops before the age of three. Autistic children are impaired in their social relationships and communication, and are usually retarded. Even at very early ages, their failure to make eye contact or develop attachment to their parents is noted. Physiological studies of autistic children have shown several abnormalities, and autistic children often develop seizures. Treatment involves teaching basic skills and usually relies upon behavior modification, not psychotherapy or (usually) medication. Attachment disorders reflect problems in the parent-child relationship; as such, they are not examples of typical psychiatric disorders. Insecurely attached children appear to fare worse in later life than children who are securely attached to both parents. Sleep disorders arise from a variety of factors, such as genetic predisposition, problems in the maternal-infant relationship, stress or depression in the mother, or more serious problems. Little is known concerning eating disorders in infants; many develop after the baby has undergone an invasive medical procedure. Hospitalization can impair development in several ways, since it exposes the baby to restraints, changing caretakers, the absence of parents, and environments that can stunt normal development. Even in extreme medical cases, however, such as when a child must be isolated for immune deficiencies, effective stimulation can be provided by creative staff members. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Care and treatment, Methods, Evaluation, Infants, Autistic children, Infant psychiatry

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Potentially ineffective care: a new outcome to assess the limits of critical care

Article Abstract:

A newly proposed outcome measurement called potentially ineffective care (PIC) may help doctors identify critical care patients who are unlikely to benefit from treatment. Researchers studied mortality rates and hospital expenditures for 402 patients who had been admitted to an intensive care unit between Jun 1988 and Jan 1989. These patients incurred $22 million in hospital charges during their stay in the ICU. PIC was defined as resource use in the upper 25th percentile by patients who died within 100 days of discharge from the ICU. Thirteen percent of the patients fell into this category and used 32% of the total resources. The most appropriate determination of PIC involved multiplying the APACHE-predicted mortality (APM) on the first day of admission by the APM on the 5th day. A PIC value of 0.35 or more was 98% effective in identifying patients who could benefit from treatment.

Innovations, Critical care medicine

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Mini-Mental State Examination: norms, normals, and numbers

Article Abstract:

The Mini-Mental State Examination (MMSE) is used to assess cognitive function. It is useful not only in identifying cognitive dysfunction but also in monitoring patient response to treatment. It consists of 30 questions testing orientation, registration of new information, attention and calculation, recall and language skills. Low MMSE scores are not diagnostic of any particular disorder such as dementia, but they do serve to flag the clinician's attention. A large population-based study of cognitively normal and abnormal people found that age and level of education influence MMSE scores. MMSE scores increased with level of education and declined with age. Knowledge of what is considered a normal score for a person's age and educational level makes the test more useful and accurate.

Editorial, Testing, Mental health, Cognition, Cognitive tests

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