Joshua Feder, MD
Editor-in-Chief, The Carlat Child Psychiatry Report
Anxiety is a broad concept that permeates pretty much all of our work. In particular, anxiety often compromises cognitive ability and drives acting-out behavior. So, for our 2018 run at the topic, we speak with Dr. Ira Glovinsky about how anxiety manifests as behavioral dysregulation and is often misconstrued as misbehavior. How do we learn to pick up the cues that this may be going on? How do we help parents to step back from mere punishment and understand this process?
We also hear from Paula Jurczak, BSW, who helps us to parse the usual kinds of internal arousal, ranging from calm reflective states to productive alert states, then to the less adaptive states of alarm, fear, and terror. She reviews aspects of these states to help us recognize the level of arousal and its impact on thinking, then how to manage it and help other caregivers to do the same.
Also in this issue, we take on the benzodiazepine controversy. Perhaps no other subject in pediatric psychopharmacology raises such strong feelings. What are the rational indications? What are the risks? How does one approach the psychopharmacology of anxiety in a safe and measured manner? We provide a handy table to help you consider the often off-label but milder approaches if you have concerns about going right to SSRIs, much less benzodiazepines.
We know that this issue will give you a lot to think about, and we hope that it also gives you practical information and ideas to help you in day-to-day practice.