CHILDREN AND PREVENTIVE PSYCHIATRY
Many years ago Leon Eisenberg (Pediatrics (1962), 30, 815-828) commented on the paradox that paediatricians more commonly seek the advice of psychiatrists than vice-versa, despite the tremendous contribution that paediatrics has made to our understanding of mental illness. This imbalance in consultation could not be justified, Eisenberg commented, ‘unless one were to assume that the psychiatrist knows all that the pediatrician does, plus something more - or that what the pediatrician knows is of no consequence for the psychiatrist. No one would seriously maintain the former statement, and the latter is no less patently absurd’.
This issue illustrates the significant inter-relationship between child psychiatry, obstetrics, paediatrics and adult psychiatry, and their need to continue talking. Joyce (
pp. 93-95
) points out that the precursors of adult schizophrenia may be set at a very early stage, with genetic factors interacting with environmental ones, such as foetal hypoxia, to create anatomical and functional vulnerability to the disorder, and that memory impairment may be a risk factor rather than a consequence of schizophrenia. Niemi et al (
pp. 108-114
) also show the strong relationship between neurological soft signs in childhood and schizophrenia-spectrum disorder; Baker & Skuse (
pp. 115-120
) show identical features in childhood in those with chromosome 22q11 deletion syndrome. Bipolar disorder, often considered to be a consequence of genetic vulnerability with the episodes precipitated by life events, is shown by Garno et al (
pp. 121-125
) to have a strong association with severe childhood abuse and earlier age of onset. All these findings are making the chronological division of child, adolescent and adult psychiatry increasingly difficult to maintain.
Eating disorders have also been traditionally linked to childhood and have fascinated paediatricians and psychiatrists since the time of Gull. Currin et al (
pp. 132-135
) show that in primary care these disorders are commoner in adult life than in adolescence...
