AM I MISSING THE SYMPTOMS OF SEXUAL ABUSE WITH MY CHILD?

October 31st, 2014

For starters, I will tell you that sexual abuse is hard to diagnose in children while it is happening because fully 25 to 35 percent of victimized children show no symptoms of the abuse. However, two-thirds do develop symptoms, which may range from anxiety, dissociation, depression, sexualized behaviors, bedwetting or expressions of anger to a general decline in social, academic, and overall functioning. Studies of children who have been sexually abused indicate that 60 to 70 percent develop a psychiatric disorder – most commonly PTSD (Post Traumatic Stress Disorder), but also various behavior, anxiety, depressive and dissociative disorders.

Dissociative disorders may include avoiding people, numbness, daydreaming, obsessive fantasizing, depersonalization (objectifying oneself to others), and such somatic complaints as fainting and feelings of physical helplessness.

PTSD from sexual abuse leads to high anxiety. The victim often relives the experience in flashbacks and sometimes reenacts the trauma through sexual acting out. These children often battle depression. Sometimes this depression can become suicidal; the child’s core identity is so fundamentally disturbed that he or she feels hurt beyond repair. Such children also become enraged and quick to act out with other people, whether adults or friends and classmates their age.

Children who are sexually abused may also act out sexually in highly inappropriate ways with other adults they meet. They often have confused ideas about sexuality, closeness and intimacy.

Not every child experiences these severe reactions; it depends on the nature of the abuse the temperament and age of the child. However, clearly some very serious psychic consequences can develop from sexual abuse, and parents need to take seriously any indications that it may be occurring now or has occurred in the past.

If you as a parent suspect that your child has been sexually abused and your child has, in fact, disclosed this, you should listen and be understanding. Reassure your child that he or she should not feel guilty and that they did the right thing by disclosing the abuse. Children should not be blamed for being victims of sexual abuse even though we are anxious and often angry at the time of disclosure. Parents have to offer protection.

Parents should report any suspicion of child abuse to Child Protective Services if it happens inside the family, or to the police or the district attorney’s office if it occurs outside the family.

DISCLAIMER

Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

MENTAL HEALTH – AFTER TRAGEDY VIRGINIA TAKES THE LEAD!

July 24th, 2014

“At the end of the day, I want Virginia to come up with a model for treatment of mental illness,” Sen. R. Creigh Deeds, D-Bath.

By now many of you have heard the tragic story of Virginia Senator Creigh Deeds, who last fall was stabbed by his son, that same son who then took his own life. Gus Deeds, 24, had been released 13 hours earlier from an emergency custody order after local mental health workers failed to find a hospital psychiatric bed before the involuntary detention order expired.

In a statement to newsadvance.com, “His tragedy really gives voice to all of the families we hear from,” said John Snook, deputy director for governmental affairs at the Treatment Advocacy Center, a national organization based in Arlington.

“Those are families that struggle repeatedly to get help for people they love who are deteriorating in front of them — refusing to bathe and hearing voices. They say, ‘I know what is going to happen, but no one will listen,'” Snook said.

As a psychiatrist here in New York City, I see this same situation. I have met many family members throughout my career who have struggled with the same situation. Where do you go when you need mental health support for a loved one? Who will help the mentally ill if they don’t want to (or can’t) help themselves?

It’s evident that not just the state of Virginia has a fragmented and failing mental health system. Just one example is the clarion call from parents, victims and survivors of mass shootings across this country to make mental health a priority. Something I agree we desperately need to do. Let’s hope that the Joint Subcommittee to Study Mental Health Services in the Commonwealth in the 21st Century will be a leader in finding solutions that other states across the nation can model.

In the meantime, it is important that you let your elected officials know that you too want to see mental health changes in your state. The last thing we want to be doing is cutting services!

Here are some other things you can do if you’re worried about your loved one:

Seek out resources – doctors, support groups, mental health clinics, mental health hotlines, etc. The National Alliance on Mental Illness (NAMI) is a great resource in helping to support families and educate them on mental illness.
If your loved one has a diagnosis – educate yourself about their illness.
If you already have a treatment team in place, work close with them.
Make sure to take care of yourself. Find a support group or friends to talk to.
Click here to read more on the mental health panel in Virginia that began work this week.

#drpaul #drhenrypaul #henrypaulmd #whenkidsneedmeds #mentalhealthteens

DISCLAIMER
Information contained in this blog is intended for educational purposes only. It is not intended as medical or psychiatric advice for individual conditions or treatment and does not substitute for a medical or psychiatric examination. A psychiatrist must make a determination about any treatment or prescription. Dr. Paul does not assume any responsibility or risk for the use of any information contained within this blog.

WHAT ARE THE LONG-TERM EFFECTS OF THE MEDICATIONS MY CHILD IS TAKING?

January 30th, 2014

Naturally, parents worry about long-term negative effects of psychotropic medication on children. We have very little data since most of the psychotropic drug explosion has been relatively recent, and not enough time has passed to see any long-term effects on the brain or development in general, but even for very common psychotropic drugs like Ritalin, which has been used for fifty years, there has been no evidence that there are long-term dangers. At this time, there is no documented reason to worry about psychotropic drugs causing death or long-term damage to our children. While some of the side effects like drowsiness, mood changes, or other symptoms can affect our children, these are easily recognized and treated if the medication is being monitored correctly. Even for drugs that have been used for fifty years there is no evidence of long-term damage to children except for relatively minor issues like a very small height diminution in children who have taken some of the ADHD medications and even in this case it is not known if the decrease lasts into adulthood.

Lastly, there are always the newspaper headlines about famous or not so famous people dying from psychotropic drugs. This is very different from dying from proper prescribing. In these cases, there is usually an overdose of the drug, either intentionally or otherwise, a combination of drugs, or an interaction with illicit drugs or alcohol.

CAN MY PEDIATRICIAN PRESCRIBE PSYCHIATRIC MEDICATION?

January 28th, 2014

In the United States, doctors without special psychiatric training write the great majority of prescriptions for psychotropic medications. Although it is difficult to quantify, it appears that psychiatrists write only about 20 to 25 percent. It would be preferable to have all of these prescriptions written by a psychiatrist and particularly with children and teenagers it be done by a child and adolescent psychiatrist. Why? Because the practice of prescribing these specialized medications requires specific knowledge of children and teenagers that is only gained by those who have completed special training in child and adolescent psychiatry in approved residency programs.

A general (adult) psychiatrist goes to medical school and then completes postgraduate specialty training of four years of general psychiatry. A child and adolescent psychiatrist goes on for an additional two years receiving additional training in child and adolescent psychiatry.

In a child and adolescent residency, one learns about the details of child/teenage/family development in all areas: biological, neurological, educational, psychological, emotional, and physical realms. One learns about the field of pediatrics and is able to integrate physical illness and its effects into diagnostic and treatment expertise. There is detailed exposure to the diagnosis of all the mental disorders that occur in the formative years, both in outpatient and hospital settings. One studies feelings, behaviors, and thinking patterns. In addition, there is exposure to all the various modes of therapeutic intervention including individual, family, and group talk therapy.

In a child and adolescent psychiatry residency, one scrutinizes the use of psychotropic drugs for the many disorders of childhood and teenagers; not only the helping effects of medications but the side effects, the use of multiple medications, the emotional repercussions of taking medication on the child and family, and the introduction of medication to school personnel when necessary. Most importantly, one learns about the unique metabolism of medication by young people.

Only about eight thousand doctors are trained in child and adolescent psychiatry in the United States. This is a small amount, and the field is considered very understaffed. Because of this, it will not always be possible to see a trained child and adolescent psychiatrist, especially if you live in a rural area. Pediatricians, clinic nurse practitioners, and general psychiatrists are the other major prescribing groups for the child and adolescent psychotropics and, although the great majority has the skill in this area, it is best to find out how much experience in prescribing to young people in particular they have. You can simply ask your doctor directly about their education, continuing education, and of course, direct patient care experience. Additionally you can search the Internet, consult with local mental health associations, and with the referring person (pediatrician) to learn more about the doctor in question.

Dr. Henry Paul, MD

Psychiatrist, Author and Educator