Search

Background: Children and adolescents are especially vulnerable to mental, neurological and substance use disorders during various stages of their growth and development. They often require specialised personnel whose training is time consuming and costly. Consequently many children and adolescents remain untreated in developing countries. This paper describes steps Uganda is taking to develop local capacity for child and adolescent mental health services through training of multi-disciplinary teams. Methods: A two year training programme was introduced in accordance with the Ugandan Ministry of Health Child and Adolescent Mental Health Strategy. This had been jointly developed in 2008 by Mbarara University of Science and Technology, Makerere University, the Uganda Ministry of Health and East London Foundation NHS Trust, United Kingdom (UK). The initial funding for the programme focused on monitoring and evaluation of the training, quality of clinical practice and clinical activity data. Results: Fifty health workers have been trained and are now working at regional referral hospitals and non-governmental organisations. Monitoring and evaluation demonstrated major increases in the range of disorders and client numbers (2,184 to 31,034) over six years. There was increased confidence, knowledge and skills in assessment. Learning Multidisciplinary environment learning was interesting and helpful. Assessments were more thorough and child centred and more psychological treatments were being used. Programme graduates are now contributing as trainers. Conclusion: The clinically focussed multidisciplinary training has yielded rewarding outcomes across Uganda. Ongoing support and collaborative work can expand service capacity in child and adolescent mental health for Uganda and other developing countries.

Specific learning difficulties (SLDs), of which dyslexia is the most widely recognized, may not be identified early and specialist resources for remediation are not always available in mainstream education in the UK. The prevalence, causes and cognitive mechanisms of different types of SLD are described in this article, together with their inter-relationships and association with other developmental disorders such as language disorders, autism and attention deficit hyperactivity disorder (ADHD). Especially when unrecognized, SLDs can contribute to the development of emotional and behavioural difficulties and can complicate the management of ADHD. SLDs are common, especially in boys referred to child and adolescent mental health services, and professionals must be alert to the possible contribution of an SLD to emotional and/or behavioural problems and understand the impact on the individual child’s functioning, especially at school. The assessment and management of SLDs are discussed, together with respective roles of health and education professionals to facilitate liaison. Health professionals can, when necessary, support families in making the case for a psychometric assessment, a full assessment of special educational needs and for additional resources in school. Phonological impairment causes persistent literacy, mathematical and subtle language difficulties that, even in highly intelligent children, affect educational progress and contribute to emotional difficulties. Disadvantaged children and those who also have ADHD, dyspraxia or a history of language disorder are particularly at risk of antisocial behaviour and school exclusion. For complex or comorbid SLD, treatment of ADHD with methylphenidate and therapeutic work with the child and his family are vital as early as possible to prevent the development of academic failure, low self-esteem or serious behaviour problems.

The Social Competence Interview (SCI), an interview to induce cardiovascular reactivity through recounting a stressful life experience, was used with a sample of 120 working women employed as childcare providers. Women recounted their most stressful work factor while cardiovascular reactions were monitored at 2-minute intervals (data points included 4 baseline, 6 SCI, and 3 recovery). Increases were found when comparing mean baseline and SCI measures: systolic blood pressure (SBP) increased 10.00 mmHg; diastolic blood pressure (DBP)increased 10.63 mmHg; and heart rate increased 4.57 beats per minute. Consistent with the literature SBP and DBP were higher for some subgroups of women (those who were 50 years or older, were obese, or had 4 or more risk factors) across all data points. There were no time by individual difference interactions, indicating that the patterns of change over time were the same across groups. In a logistic regression, comparing women who reached SBPor = 140 mmHg and/or DBPor = 90 mmHg during the SCI versus those who did not, higher BP was associated with being older and obese, having a higher level of acceptance coping, and a lower level of suppression of competing activities coping.

This chapter explains how mental illness affects parenting and influences the development of children. It talks about abuse and neglect, the effects of separation and the risk of mental health problems in children. Large numbers of children grow up with a mentally ill parent. A study of parental psychiatric histories of 850 twin pairs in Virginia found that only 26% of families had no lifetime history of psychiatric disorder in either parent. The chapter outlines a developmental framework to help understand the interrelationship of risk variables in the development of the child, the emergence of disturbance and its modification. Clinically, this framework may assist with the developmental assessment of children. The effects of social disadvantage are discussed. The catalogue of risks for children of mentally ill parents described in the chapter emphasizes the need for skilful coordination of professionals involved with both the parents and the children.

Thirty out-patients with severe anorexia nervosa were randomly allocated to either 12 sessions of dietary advice or 12 sessions of combined individual and family psychotherapy. At one-year follow-up both groups showed significant overall improvement, and the dietary advice group showed significant weight gain. A similar mean weight gain for the psychotherapy patients did not reach statistical significance, but this group made significant improvements in sexual and social adjustment.

This paper reports observations following on a study of anorexia nervosa in 34 twins and one set of triplets, and within which approximately half the monozygotic (MZ) twins displayed concordance, compared with 7% of the dizygotic (DZ) twins. One additional case, involving childhood adoptions, is described, wherein neither genetic nor specifically assortative selection factors seem to have been at work. The findings suggest that genetic and environmental factors can interact to contribute to the development of this apparently culture-based and multifactorially derived condition. A number of possible genetic strands to the condition are proposed; probably not all of them are specifically necessary for its development. The same may apply to experiential influences. Elsewhere it has been argued that the one essential charactistic of anorexia nervosa is avoidance behavior and the factors permitting and facilitating it (Crisp, 1980). Experiential influences, in the form of psychological maturational challenges in adolescence impinging on constitutional propensities to the point of precipitating the disorder out, would seem often themselves to have been influenced by constitutional psychological characteristics and earlier childhood experiences. A further pooling and study of all known twin and adoptive cases might now advance our knowledge of this condition further.

The literature concerning medical marriages is reviewed and, where relevant to potential stress in marriage, the differences between British and North American medical careers are discussed. After a general review of psychiatric morbidity, suicide rates and substance abuse amongst doctors, the major difficulties for married doctors during training are contrasted with the increased stability of mature medical marriages, which nevertheless are relatively unsatisfying for both partners. Little is known about recent medical marriages, particularly in Britain. The likely difficulties for the woman doctor with a non-medical spouse and for dual doctor marriages are discussed, together with the implications for childcare. Problems in marriage are not necessarily associated with the actual number of hours spent working, but satisfaction seems to be associated with communuication and intimacy between the partners.