Neurodevelopmental Perspectives on Chronic Illness Across the Lifespan: Child Psychiatry for the General Psychiatrist. Sponsored by ACLP’s Pediatric SIG.

Virtual

Lead Speaker(s)

Aishwarya Rajagopalan, D.O.

Pediatric Consultation Liaison Psychiatrist
Duke University School of Medicine
Durham, North Carolina

Moderator/Discussant(s)

Katherine Ort, MD

Chief of Service, Child and Adolescent Psychiatry, Hassenfeld Children's Hospital at NYU Langone
NYU Langone
New York, New York

Speaker(s)

Priya Gearin, MD

Assistant Professor
University of Nebraska Medical Center
omaha, Nebraska
Laura Campbell, MD (she/her/hers)

Clinical Assistant Professor, Child & Adolescent Consultation-Liaison Psychiatrist
New York University (NYU)
New York, New York

Abstract: Consultation-liaison psychiatrists are often called on to address concerns related to health literacy and treatment non-adherence in patients with chronic health conditions across the lifespan. These patients experience recurrent Emergency Department presentations and medical admissions, which are challenging for both patients and providers. Child and adolescent psychiatrists are trained to conceptualize care through developmental and dynamic lenses, which include assessment of familial, educational, legal, and public health supports, as well as racial, socioeconomic, and gender inequalities. Recognizing that many chronically medically ill patients present to the psychiatrist only after treatment concerns arise, this presentation aims to review how developmental theories apply across the lifespan and across care settings.

Dr. Rajagopalan (15 minutes) will introduce the chronically ill patient in the hospital setting. She will review concepts of Piaget and Eriksonian development, and how the development of a chronic health condition in the early years of one’s life can impact subsequent stages of development to manifest across the lifespan.

Dr. Gearin (15 minutes) will review psychodynamic principles and perspectives on the healthcare provider-patient relationship particularly with regards to the development of chronic health conditions. She will discuss the bilateral relationship between chronic illness and ego identity. She will also review the relevance of transference and countertransference which may be experienced by both psychiatry and non-psychiatry team members.

Dr. Campbell (15 minutes) will review common consult questions for consultation-liaison psychiatrists treating patients with chronic health conditions: 1. Patients who do not understand the treatment plan, despite extensive education (raising questions of capacity, intellectual disability, and neuropsychiatric sequelae of illness). 2. Patients who are not cooperative and may demonstrate extreme treatment-interfering behaviors, including non-adherence as a form of self-injury. 3. Patients who are broadly emotionally or behaviorally dysregulated. 4. Patients who are well-known to medical providers, but demonstrate new psychiatric symptoms. Dr. Campbell will discuss interdisciplinary collaboration and innovative approaches to expanding continuity of care across inpatient and outpatient settings.

Dr. Ort (20 minutes) will highlight themes that can emerge for consultation-liaison psychiatrists, including the experience of adults who receive care in a children’s hospital, the importance of recognizing discrepancies between chronological and developmental age, and the impact early development of chronic health conditions can have on identity, sense of self, and engagement in healthcare. Dr. Ort will also explore themes related to the impact of chronic illness on family system dynamics and offer tools utilized in family centered care that can be implemented in adult care settings.

The session will end with 10 minutes of question and answer with our speakers. This presentation is sponsored by the Pediatric SIG.

Sources:

Pinquart, M. (2014). Achievement of developmental milestones in emerging and young adults with and without pediatric chronic illness—a meta-analysis. Journal of Pediatric Psychology, 39(6), 577-587.

Vogel-Scibilia, S. E., McNulty, K. C., Baxter, B., Miller, S., Dine, M., & Frese, F. J. (2009). The recovery process utilizing Erikson’s stages of human development. Community Mental Health Journal, 45, 405-414.

Content Contributors: Ewa Bieber, MD

Diversity, Equity, and Inclusion: Our presentation explores neurodevelopmental frameworks for understanding people who develop chronic health conditions in early life. This topic is intersectional and includes discussion of structural factors impacting diagnosis and management (e.g., healthcare redlining), as well as explorations of discrimination within the healthcare system including racism, sexism, homophobia, and ableism. We discuss how early exposure to chronic health challenges can fundamentally alter individual development, often in ways which compound healthcare disparities. Our speaker panel represents psychiatrists from diverse geographic backgrounds, at various career stages, and practicing in a wide range of clinical settings.
Learning Objectives:
Recognize common challenges for patients experiencing chronic health conditions in relation to stages of psychosocial development
Describe developmentally-informed approaches to common consult questions
Discuss innovative strategies to support primary medical teams, improve patient experiences, and decrease healthcare disparities when treating patients with chronic health conditions