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Biomedical subjects

A P Froese

Publications and source records attributed to A P Froese.

16 recordsLinked to original sources
PubMed1999

Relational V-code conditions in a child and adolescent population do warrant treatment.

It is often argued that relational V-code conditions are less serious than classical psychiatric disorders, and that they should therefore receive lower clinical priority or diminished levels of treatment funding. Despite these common assertions, there have been virtually no studies that have used actual case data to evaluate whether such problems are in fact less serious and less worthy of treatment funding. We used actual case data from a universally funded child and family clinic to evaluate these questions. Results showed that both classical diagnoses and relational problems were significantly related to markers of clinical severity. As with previous research, family therapy was not differentially associated with a larger number of treatment sessions.

Adolescent↗
PubMed1992

Waiting list information strategies for child psychiatry: an intervention and measurement approach.

This paper describes a number of steps we have initiated to study our chronic waiting list problems. We describe a program involving monthly data collection which has enabled us to document the effectiveness of some strategies and predictive variables. During 1989 the data were supplemented with information collected by a questionnaire mailed to every other referral. We found that an initial response to the questionnaire was a powerful predictor of successfully kept first appointments six to 12 months later. The significance of these differences, the impact of our tracking procedures and the issues and causes, along with some strategies, are discussed.

Adolescent↗
PubMed1991

Minors' right to psychiatric treatment.

This article provides a selected overview of the rights of minors under the Mental Health Act (Ministry of Health) and the Child and Family Services Act (Ministry of Community and Social Services) in the province of Ontario. Although the paper addresses specific issues related to mental health regulations as they apply to children and adolescents in Ontario, similar arguments apply to the regulations in most provinces. Specifically the paper raises some legal and ethical questions regarding minors' right to treatment. It is suggested that the legislation may impede access to treatment in some instances.

Adolescent↗
PubMed1987

Functional dysphonia in adolescence: two case reports.

Reports of functional dysphonia in children and adolescents under 16 years of age are few. Approximately a dozen cases have been reported in the English literature over the past 35 years. Most of the articles appear in journals related to the fields of speech, hearing and communication with a few in the Otorhinolaryngologic journals. Published papers in psychiatric journals dealing with voice or speech disorders are virtually nonexistent. In children and adolescents the two most common varieties are the Whispering Syndrome, which occurs predominantly in girls, and the Hysterical High Pitched Voice seen mostly in boys. This paper discusses these two varieties of functional dysphonia and presents a case example of each.

Adolescent↗
PubMed1986

Impact of removing the waiting list upon clinic intakes.

This study reports the results of eliminating the waiting list for a one month period in 1985 upon the referrals made to an out-patient Child and Family Clinic. The Clinic receives most of it's referrals from community physicians and agencies. The study was carried out amidst a background of an increasing number of referrals. Fifty-nine referrals, mainly families, were received. Among those who were referred and seen, most (58 percent) accepted the offer of a no wait appointment and completed the referral within about one week. A smaller number (17 percent) did not respond to such an offer but later completed the referral. Thus, 76 percent of the referrals overall were completed within 6 months. This was essentially the same as the completion rate for a comparison sample in 1984 (77 percent). The kinds of problems found among these two groups, as well as among the "non-completers" was analysed. One trend was that cases involving family dysfunction tend to show early or not at all. Overall, the large percentage (60 percent) of families with histories of separation problems as an associated variable, suggested this as a possible explanation for the increasing number of referrals in recent years.

Ambulatory Care↗
PubMed1980

Emotional implications of primary familial hyperlipoproteinemia in childhood and adolescence.

To determine whether 43 patients and their 23 unaffected siblings were at increased risk for psychologic upset, 28 families of children being treated for primary familial hyperlipoproteinemia were studied. Nine fathers but no mothers had died of the disease. The families were interviewed for psychiatric assessment, and the parent(s) scored a questionnaire concerning eight behavioral factors. Male patients had significantly higher scores for impulsive hyperactive behavior than their male siblings. Fatherless female patients had the highest scores for perfectionism and the lowest scores for conduct problems and impulsive hyperactive behavior. Fatherless children scored lower for impulsive hyperactive behavior than children with fathers; fatherless male children were more anxious than fatherless female children. There were more significant differences in scores for children whose father was still alive vs those whose father had died than in scores for affected children vs unaffected siblings. Thus, the emotional impact of the premature death of an affected parent appears greater than that of having the disease. Therefore, one should be alert for changes in behavior in children with primary familial hyperlipoproteinemia when a parent dies of the disease and as the patients approach the age at which the parent died.

Adolescent↗
PubMed1978

The superior-mesenteric-artery syndrome: cause or complication of anorexia nervosa?

The so-called superior-mesenteric-artery syndrome is not mentioned in psychiatric journals or books. Yet two variations of the condition have been described. In its acute form, it can be mistaken for psychogenic vomiting in anorexic patients, while its chronic intermittent form is readily misdiagnosed as anorexia nervosa. The case report is of a 16 year old boy admitted for investigation and treatment of severe weight loss. He initially responded to a modified behaviour program, but within days developed an acute small-bowel obstruction. Superior-mesenteric-artery syndrome was diagnosed and he improved with appropriate medical management. This condition needs to be considered by the psychiatrist who otherwise might not differentiate it from the symptoms of anorexia nervosa.

Adolescent↗
PubMedDate not supplied

Pediatric referrals to psychiatry: III. Is the psychiatrist's opinion heard?

At least one psychiatric diagnosis was made for 205 of 220 children whose psychiatric evaluation had been requested by the medical service. Only 78 of 242 psychiatric diagnoses given the 205 patients were reflected correctly in the medical discharge diagnoses. In addition, seven of fifteen patients considered to be "normal" by the consulting psychiatrist had a psychiatric or mixed medical-psychiatric diagnoses included in the discharge diagnoses. Psychophysiological disorders, psychoses and special symptom diagnoses were likely to be correctly reflected in the discharge diagnoses, while depression and adjustment reaction were not. Possible reasons why the psychiatrist's diagnostic opinion is not correctly reflected in the discharge diagnosis in over one-half of the referrals are discussed. Pediatricians may be reluctant to label their patients "neurotic" for life, or may consider the problem transient-that is, only a "passing phase". But these theories are discounted by the fact that seven patients considered to be emotionally normal when assessed by the psychiatrist were discharged with a psychiatric or mixed medical-psychiatric diagnosis.

Adolescent↗
PubMedDate not supplied

Pediatric referrals to psychiatry: II. Factors relating to delays in referral.

Delays in requesting psychiatric consultation were examined, in relation to 220 referrals from a medical ward in a pediatric hospital, to determine why children referred for psychiatric evaluation remained in hospital longer than the non-referred. Request delays did not correlate with age, sex, or length of hospitalization, but were likely to be shorter for acutely ill patients and those whose admission diagnosis evidenced the pediatrician's awareness of the possibility of significant emotional factors. The onus may be on the psychiatrist to increase the medical staff's awareness of the possibility that emotional factors often contribute to their patient's ills. This increased awareness may result in prompt referrals to psychiatry, and shorter, less costly hospitalization.

Adolescent↗
PubMedDate not supplied

Pediatric referrals to psychiatry: I. Comparison of referrals and nonreferrals.

Age, sex and duration of hospital stay of 220 patients consecutively referred to psychiatry (Group I) and of their fellow 2065 nonreferred patients (Group II) were compared. Overall, Group I was significantly older, remained in hospital longer, and included more girls than boys, whereas Group II included slightly more boys than girls. Separation of Group II into those whose primary discharge diagnosis was psychiatric or nonpsychiatric revealed that mean age and duration of hospital stay of the former were almost identical, and the sex distribution was similar, to those of Group I. These findings suggest that children referred for psychiatric evaluation differ from their nonreferred fellows discharged with a nonpsychiatric diagnosis but not from nonreferred fellows discharged with a psychiatric diagnosis.

Adolescent↗
PubMedDate not supplied

Teamwork: a multidisciplinary pediatric-liaison service.

Psychiatrists, psychologists and social workers are often consulted about the same hospitalized patient. Since each may differ in their training, orientation and experience, the opinions expressed by them to the consultee may differ. The authors have described a multidisciplinary liaison team operating within a pediatric teaching hospital. The consultants work as a team in close collaboration with each other and with the psychiatric nurse clinician and an occupational therapist. The team approach has specific advantages. It allows for a concise and unified approach to the emotional and social needs of the patients. It presents a forum for informal consultations and interdisciplinary meetings. In addition, teaching opportunities are many as each discipline learns from the other.

Adolescent↗