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Rates of psychiatric illness among the child and adolescent population have increased over the past several decades. As social and government agencies work to expand access to mental health treatment, more and more children and adolescents are receiving medications for their symptoms. However, many drugs used in this population are not approved for people under the age of 18, and have not been studied in terms of long-term impact on the developing brain. A significant proportion of these patients receive psychiatric polypharmacy, or the prescription of 2 or more psychotropic agents. This rate has increased from about 8% in 1996 to over 40% in 2005. Factors correlated with polypharmacy include older age, male gender, White race, and low socioeconomic status. Polypharmacy can increase the risk of drug-drug interactions, increase morbidity/mortality through cumulative toxicity, and cause decreased medication adherence.
Study Aims: This study aimed to examine psychiatric polypharmacy specifically among psychiatrically hospitalized patients in a New York City hospital, and to determine the impact of the COVID-19 pandemic.
Methods
This IRB-approved study reviewed the medical records of 1101 child and adolescent patients that were psychiatrically hospitalized between June 1 2018 and November 30 2021 at Mount Sinai Morningside. Sociodemographic and clinical information was collected and analyzed using SPSS.
Results
In this sample, 29.4% of patients received psychotropic polypharmacy. The polypharmacy group contained a higher percentage of males, White patients, and fewer Asian/South Asian patients. They had on average more hospitalizations, a longer hospitalization period, and were more likely to be diagnosed with an impulsive/behavioral disorder, developmental disorder, or bipolar spectrum disorder. The polypharmacy group were twice as likely to receive medication for agitation while hospitalized. A regression model identified positive predictors of polypharmacy as having a history of violence and a higher number of psychiatric hospitalizations. Negative predictors included non-White race. White patients had the highest average number of medications and Asian/South Asian patients had the lowest. No impact of the COVID-19 pandemic was found.
Conclusion
Psychiatric polypharmacy is extremely common in the child and adolescent population that requires psychiatric hospitalization. Increased behavioral needs, such as episodes of violence, as well as greater illness severity, as indicated by greater number of hospitalizations, may be the driving factors behind polypharmacy. Further investigation is indicated to determine other contributing causal factors and to track long-term consequences of psychiatric polypharmacy.
The purpose of this chapter is to connect human movement theory with practice. Thus, the chapter answers the questions: What does human movement theory look like in practice? How can it be optimised for all children? Why is it vital for the advancement of health and wellbeing in childhood? The physical dimension is significant within children’s learning because it offers powerful and meaningful connections across all learning and development areas (Lynch, 2019). The socio-cultural perspective suggests that the curriculum ought to be connected to the child’s world and everyday interests (Arthur et al., 2020). Since children have a natural play structure, learning through movement heightens their interest.
The purpose of this chapter is to connect ‘human movement’ theory with practice. Thus, the chapter answers the questions: What does human movement theory look like in practice? How can it be optimised for all children? Why is it vital for the advancement of ‘health and wellbeing in childhood’?
The purpose of this chapter is to connect ‘human movement’ theory with practice. Thus, the chapter answers the questions: What does human movement theory look like in practice? How can it be optimised for all children? Why is it vital for the advancement of ‘health and wellbeing in childhood’?
Examines George H. W. Bush’s efforts to establish a new world order and reliance on traditional Cold War strategies and alliances. Assesses Bush Sr.’s successes (e.g. German reunification) and failures (in Yugoslavia and Iraq). Documents beginning of post-Cold War US wars of Muslim liberation, a pattern continued by the presdients that followed him.
Argues that Obama was a Cold War–style foreign policy realist. Despite hopes and fears that he would transform American interests, he continued with approaches to Muslims and to counterterrorism, for example, that echoed those of his predecessors. Coming to power decrying the “dumb” Iraq War, Obama was complicit in regime change in Libya. He thus continued the pattern of waging wars to liberate Muslims.
Examines September 11 attacks and the Cold War–style response of George W. Bush. Assesses competing interpretations of 9/11. Outlines Bush Doctrine and argues for its continuity with Cold War strategies. Considers case for and performance in wars in Afghanistan and Iraq. Details first phase of the War on Terror and the traditional alliances that it relied on.
Argues that Trump did not transcend the Cold War or the approaches of his post–Cold War predecessors. While stylistically very different, the substance of Trump’s foreign policy was more similar to than different from that of Bush Jr. and Obama. Examines his trade war with China and the consistency of approach that underpinned it. Concludes by arguing why and how the US remained dominant after the Cold War, and the enduring advantages it enjoys over it competitors like China.
Considers the strong realism of Obama and how his efforts to avoid the Syrian Civil War were like those of George H. W. Bush in Yugoslavia. Examines pros and cons of his nuclear deal with Iran and his failure to contain Russian power in Ukraine and Syria, an impotence he shares with several of his Cold War and post–Cold War predecessors. Assesses the Obama foreign policy legacy and how far it explains the rise of Donald Trump.
Argues for continuity (with the Cold War) and success (in the post–Cold War era) of American foreign policy. Assesses major interpretations and historiography of the Cold War and post–Cold War eras.
Argues for Clinton's reversion to Cold War diplomacy in his second term. Containment of Russia and Iraq became central concerns. Chronicles Clinton battles with Congress, his impeachment, and his expansive foreign policy of apparent humanitarian interventions (in Kosovo especially), but waged as much to contain Russian power as to advance human rights.
Considers how George W. Bush rescued the catastrophe of post-invasion Iraq with his Surge. Analyzes key events of second Bush term, his freedom agenda, and wider counterterrorism efforts. Argues that Bush continued with a foreign policy approach made in the Cold War, in which Russian power remained a central concern. Details how Bush resembled his Cold War predecessors in his Russia policy, especially during the Russo-Georgia War. Examines successes and failures of Bush Jr.’s foreign policy, with a special focus on his approach to China. Argues that Bush’s foreign toward India was a considerable success.
Argues that despite hopes of sweeping change, Clinton ended up running a traditional, Cold War–style foreign policy. He used Cold War institutions like NATO, and acted to contain Russian power in the Balkans. Examines attempts to apply a Clinton Doctrine and its successes and failures. Argues that Clinton's interventions advanced a trend of wars of Muslim liberation.
This book offers a bold re-interpretation of the prevailing narrative that US foreign policy after the Cold War was a failure. In chapters that retell and re-argue the key episodes of the post-Cold War years, Lynch argues that the Cold War cast a shadow on the presidents that came after it and that success came more from adapting to that shadow than in attempts to escape it. When strategic lessons of the Cold War were applied, presidents fared better; when they were forgotten, they fared worse. This book tells the story not of a revolution in American foreign policy but of its essentially continuous character from one era to the next. While there were many setbacks between the fall of Soviet communism and the opening years of the Trump administration, from Rwanda to 9/11 and Iraq to Syria, Lynch demonstrates that the US remained the world's dominant power.