Clinical Interview Techniques in Children and Adolescents: Challenges and Solutions (EN) – Transcript

00:00dear colleagues congresses especially for the last five six to 10 years this also was the case in the past but after having easy access to knowledge for all of us as you know quite rapidly if you're a member to pmat or to different journals and uh as you know at

00:24universities you can have access to so many uh Journal same for children and adolesent and adult psychiatrist it's the same thing you actually should have a certain level of knowledge uh but in practice in particular it's also very valuable that

00:49you work with as Mentor just like the surgery the surgeons at the same time uh need a mentor but un unfortunately if it is something that we're doing in our routine unfortunately not why I think it is something to the

01:12flexibility of our field because we all have our own style of doing treatment and people all have their own systems and uh they somehow continue as a settled established practice whether this should be the case yes why not because we're actually practicing art as a medical doctor and

01:37as a psychiatrist I would say it's an extra art performance to us we're using our skill of relationship and Communications possible for example that you can check from the internet while interviewing with the patient to understand whether there's an a cardiotoxic effect of a drug or drug to drug interaction even before press describing it in front of the patient you can actually check it on the

02:03internet so it's all about how we manage the skills communication and it's pretty obvious that there are some issues and that's the reason why I would like to make this talk I mean there are of course certain experiences that you make throughout your life in your career and they're very valuable

02:30and that's the reason why I actually when my colleagues asked me what actually would you would like to present I said not deling a presentation but some challenges and Solutions in the clinical interviews if you have a Child and Adolescent or an a parent uh we all are together during clinical interviews and I think it is important to underline a few points and I will actually go

02:58through them with you you without boring you because I know you're all tired but just a couple of main topics that I'd like to go through let's assume a child or an adolesent wrote to us with a specific problem of course uh I will speak about

03:25the ideal conditions but at the same time forced uh also conditions and the more tight processes that we go through of course first you have to know the ideal uh but uh before the ideal there are also some Force conditions and we have to manage the interviews under Force conditions we do not have the

03:50luxury to say we're not working in the ideal conditions so let's skip those we cannot say that why because eventually usually as a health care provider if someone asks for our help we actually have to help them as long as they ask for it we're not actually taking people and from the streets and

04:17trying to treat them they are knocking on our doors maybe the conditions are not ideal maybe problematic and challenging it is not like we have so much patient load we have have limited time and so on you know it was in in 1998 that I became a specialist at V Gaba hospital and I was uh actually

04:42taking care of six or five patients on a daily basis at the clinic as you would assume mother needs a task but still while examining six five patients you still can build upon uh the patient and put a diagnosis and make the treatment even under challenging conditions we should not forget who we

05:08are let's assum a child uh as I'm telling you no one will bring your child to you just for nothing for a psychiatrist in particular there must be a problem and of course in taking the child uh to the psychiatrist even with the first step on the door you start the treatment and clinical

05:34examination and it continues until they leave the room so have you manage it have you approach your patient during this period of time managing it from the perspective of the child the parent would make you successful it is not actually the medical therapy that you prescribe the migr the combination of drugs and so on

05:59they would not change a lot I can speak it so clearly because eventually if it doesn't work of course you shift to another drug there Alternatives guidelines you can always actually find an alternative to the drugs that you prescribe but what is important is you have to ensure for compliance to treatment including the family the parents it's something ethical of course

06:26because what we actually mean by compliance for the treatment always starts with the relations you built with the family with the parents a parent may leave the room crying or a parent might leave your room laughing if they are leaving your room crying it doesn't matter which diagnosis you put there is actually a style also

06:50in declaring the diagnosis that you put of course you're not giving false hopes I remember a disas from officer and because of uh his own anxiety and a neuros psychiatrist and good knowledge uh about his profession but because of his own

07:20anxiety for example for a 16 year old adolescent to mild to severe mental retardation don't worry he'll be okay he even will become an army member in the future it is not like giving false offs of course he wasn't doing it with bad intentions probably that was actually a way of coping with the patient and handling his own anxiety that's not what

07:45I'm saying whatever it is but your style of expression is important and the second of four you know um we're dealing with children and it's ongoing process clinically you can have huge experience you can have good clinical experience and understand everything immediately for example like the other

08:12uh Physicians our for example we do not have for example blast test and so on it's maybe a pro and com on both sides but from the other perspective what I can tell you is that we're just dealing with an uncertainty if a parent is asking you a question about a clinical diagnosis or

08:38about the prognosis of the disease you cannot be crystal clear as this is the case how would you will explain so many things to the parents and the child it's all about the communicative skills of the psychiatrist of course for being a good psychiatrist you should have great communication skills but uh for a child

09:05an adolescent psychiatrist it must be more because it is not only the child but also with the parents and the circle of the parents the school uh you actually should develop very good communication skills therefore we assume a huge responsibility here and we should not make any mistake so what you see when

09:30they are leaving the room even if you actually have a diagnosis to make and even if it is going to be a severe one to the family uh or the parents of the child you have to build empathy during my residency I heard this guy for example this child is a failure and do not

09:57handle you cannot handle him there's nothing you can do about him her even there are clinici clinicians still having the same attitude we as a medical doctors once you are a parent and if you are a child psychiatrist you should always keep in mind that you're a parent think about a child with

10:24autism I mean if you sent that child saying there's nothing we can do about and her then it would be applicable for the parents as well but you can say for example it is a huge task if can possibly urinate on his her own if can speak 10 words even showing the origin of the pain is a something an advantage I mean you should not actually say

10:51there's nothing we can do about the patient then you will no more uh build empathy you probably would very upset and angry if someone said this for your own child and you probably will never comply with treatment so this is one mistake not only for autism of course for mental retardation for personality behavioral disorders and all therefore especially we have to be very

11:19sensitive about the way that we use language it must not be an offending one of course we should be speaking the truth but we have to use a good language instead saying that and on the other hand we somehow should give some hope I mean of course there are hopeless cases of course there's no doubt about it but there's actually a

11:44relativity for example a child with severe mental retardation even if you provide toilet training or if for example make sure that they can make actually self-care it's something good by 50 60% of the workload of the parents will be lifted if you handle the self-care therefore in your diagnostic

12:09approach in your uh in particular relationship to uh the parents please uh be kind second of all we live and we work under challenging conditions majority of our patients are not aware of the reason why for example they're BR to even for example taking them to the child

12:34psychiatrist saying that for example we will have a physical exam or for example taking the child to the hospital saying that this is my friend especially for the adolesence they actually immediately will understand it so they start to interview in a negative manner because they've been cheated in bringing them to the hospital and therefore uh you do not have a