The function of assessor: challenge and/or dilemma?
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Biomedical subjects
Publications and source records attributed to D Bürgin.
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Child and adolescent psychiatry of today is closely connected with adult psychiatry, pediatrics, developmental psychology and education. It finds itself in multipolar tension-fields and is in need of a constant bridging towards the allied professions, especially child care. Besides biological and psychological factors, historical, social and cultural influences deeply affect diagnostic and therapeutic procedures concerning disturbed children and adolescents. In the field of research there is a lack of structures and means.
Adolescence is a phase of human development characterized by major psychophysiological transformations and a high vulnerability and/or potential for disturbance. It can be divided into 5 subphases. For the assessment of the psychopathology and the resources it is important not only to evaluate the individual structure and psychodynamics but also to include the interpersonal relationships (family, peer group) in the diagnostic process.
Current research is centered mainly on the age group between 6-12 years. The assessment in preschool age and in adolescence seems to present additional difficulties. DSM III criteria for major depression in childhood are slowly recognized internationally. Newly developed rating scales help to standardize clinical and research assessment methods. Biologic markers show deviations similar to those in depressed adults. Epidemiologic data are still not sufficient. The bridging to the development and disturbances of affect attunement between caretaker and child, to family interactions and to environmental stresses has not yet been established in a satisfactory manner.
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The psychotherapeutic and sociotherapeutic work with the child and his environment is in the field of child and adolescent psychiatry of main importance. During the years of development the psychopharmacological treatment has to include psychotherapeutic work with the parents. Psychotherapy without pharmacotherapy is often indicated, but not the contrary. A treatment with psychotropic drugs seems not to be indicated in cases of light disturbances of a child or adolescent or when they can be influenced by changes in the social environment. Psychopharmacology is a useful supply in the treatment of children with psychic disturbances of medium or high degree. Besides the development of a capacity for identification with the patient the child psychiatrist has to develop a capacity for delimitation, especially than, when there is a tendency of overidentification, which is connected with his choice of the profession. Psychopharmacology will in child psychiatry remain on a empirical level until the clinical entities will be clearer defined, whether in a psychodynamic or in a biologic way. The utility of using psychotropic drugs has always to be compared to the advantages, which may arise in not using these products.
The terms "authoritarian" and "authority" are defined in the context of the process of education. Certain historic, cultural and anthropological aspects of father's role, some newer empirical results concerning the importance of the father for the psychic development of the child and the connection of father and authority are discussed under sociocultural and psychoanalytic viewpoints. Especially the relation between the father and the child in the preoedipal and oedipal phase is treated. This on the back-ground of the dialectic triangle of having a father, becoming father and being father.
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The highly specialized treatment of the child with a fatal illness confronts the patient, his relatives and the staff with continuous psychological stress. Knowledge of how a child feels about illness, life and death is a prerequisite for the understanding and help of these patients. The participation of a child psychiatrist seems to be essential in providing optimal psychological support. In the present study, all children were aware of the life-threatening nature of their disease. The maintenance of a meaningful dialogue till the end is of great importance for the patients and their families. The therapist engaged in such a dialogue is forced to face loss and grief.
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