Child is father of the man: child abuse and development of future psychopathology

Available epidemiological data indicate that the abuse of children within families is a very common phenomenon, and is still on the rise. Among others, abuse includes direct physical and emotional violence to the child, as well as the indirect emotional trauma of witnessing interparental violence. These early trauma experienced within the context of the family can influence the development of the child's personality as well as predispose towards the development of mental disorders in adulthood. There are some important factors influencing the occurrence of abuse, or the conditions predisposing it: certain parental personality traits appear to be instrumental, and the presence of individual psychopathology of parents is also connected with different forms of family dysfunction as a system, representing a variable which is interpolated in the quality of parenthood as the most important factor that determines long-term consequences on children and possible future psychopathology. The complex but tangible effects of parents' personality traits on the psychological development of children may contribute to the transgenerational transmission of abuse and violence. The phenomenon of domestic violence and abuse can be described from the perspective of the psychological and systemic theoretical postulates. According to systemic theory and practice, dysfunctional communication in the family is a significant predictor for domestic violence. Characteristics of dysfunctional communication include low levels of verbal expressiveness and emotional responsiveness, low tolerance to criticism and its interpretation as a threat or intimidation, and consequently increased anxiety and subsequent escalation of an argument into violence. Overall it seems that there may be a complex connection between parental personality and family interaction patterns, leading to dysfunctional communication which further amplifies the detrimental characteristics of family dynamics, and eventually escalates to violence. According to one theory, there may be a degree of transgenerational transmission of these communication patterns in children who have been victims of violence, thus propagating the conditions for violence, this time perpetrated by the victims themselves. Therefore there is a pressing need for prevention, perhaps through psychoeducation for parents or through early detection and treatment of traumatized children and adolescents, in the hope that the transgenerational vicious cycle of violence may be broken.

Psychotropic medication use in children and adolescents in an inpatient setting

Medication can be an effective part of treatment for several psychiatric disorders of childhood and adolescence but its use should be based on a comprehensive psychiatric evaluation and treatment plan. The aim of this study was to evaluate psychotropic medication use for children and adolescents treated as inpatients and to compare it with principles of rational pharmacotherapy, thus identifying possible downsides of current practices and pointing a way towards safer and more efficient practices. This is a descriptive study of prescribing trends at the Clinical Department for Children and Adolescents of the Institute of Mental Health in Belgrade, during the period from September 2009 to September 2010. Analyzed demographic data (age, gender) and the number of hospitalizations were obtained from medical histories, while diagnoses were obtained from discharge notes. Prescribed therapy was copied from medication charts. Drug dosages were analyzed as average daily doses prescribed during the hospitalization. Psychiatric diagnoses were classified according to The International Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). During the examined time period, 264 patients were hospitalized (61.4% males), with an average age of 11.4±5.1 years. We have found that 66.3% of admitted patients were treated with pharmacotherapy in addition to other treatment modalities. There was a highly significant correlation between the age of patients and the prescribed dosage (Spearman's rho=0.360, p<0.001) as well as the number of prescribed drugs (Spearman's rho=0.405, p<0.001). The most commonly diagnosed psychiatric disorders were: autism spectrum disorders (20.8%), conduct disorders(19.7%), mixed developmental disorder (14.8%), adjustment disorder (7.2%), mental retardation (7.2%),acute psychosis (4.5%), and ADHD (2.3%). The most commonly prescribed medications were antipsychotics(45.9%), followed by antidepressants (17.2%), mood stabilizers (16.1%), benzodiazepines (14.4%), and other psychotropic drugs (6.4%). The most commonly prescribed antipsychotic was risperidone, used for more than 50% of the patients treated with antipsychotics. Taken together risperidone and chlorpromazine were more than 75% of all prescribed antipsychotics. 98.4% of prescribed antidepressants belonged to the SSRIs,with sertraline and fluoxetine accounting for almost 90% of them. All prescribed dosages were in accordance with the official guidelines. This is the first survey in Serbia to document the practice of prescribing psychotropic medication in the field of child and adolescent psychiatry. Current drug-prescribing practices at the Clinical Department for Children and Adolescents of the Institute of Mental Health in Belgrade are in accordance with current practices in the United States and Europe. Not every child with symptoms of mental health problems needs pharmacological treatment; when they do, the general rule of thumb should be "start low, go slow, and taper slowly". Follow-up studies are necessary to assess the change of trends, as well as studies in different patient populations and health centers, in order to globally evaluate psychotropic medication use in children and adolescents in Serbia.