759
ANZJP Correspondence important as it results in clearer diagnostic criteria that better reflect the nature of the symptom as well as schizophrenia itself. This in turn will help better inform treatment and rehabilitation options for individuals with FTD. While we acknowledge that these top-level changes unfortunately do not happen quickly, there are some measures that can be adopted in the interim. First, it would be beneficial to avoid use of the term ‘disorganised thoughts’ in positive symptom classifications of schizophrenia to avoid confusion with ‘thought disorder’. This would better facilitate
the identification of FTD as being of a different nature. Second, distinctions between positive and negative FTD should continue to be recognised and adopted. Finally, continued examination of the cognitive mechanisms underlying individual FTD symptoms, particularly longitudinal work, would help in further fine-tuning the growing understanding of the disorder and strengthen the case for nosological change.
Piaget and electronic medical record Florence Levy1 and Alison Crawford2
about alcohol use, the most important from a child psychiatric perspective is the Mental Status examination. The developmental insights provided by Piaget (1926) could form the basis of a more useful approach, which reflect a child’s intellectual capacity at particular stages of development. Most important are two crucial developments. The first is the development of spoken language, which allows the transition from sensori-motor intelligence to representational thought, freeing the child from the limitations of direct action. According to Wadsworth (1984), Piaget believed that affective development is also based on capacity for representation and reciprocity of attitudes and values between the young child and others. This development is thought to occur during the stage of preoperational thought from the age of 2 to 7 years. A further major and significant change occurs around the age of 11– 15 years with the development of formal operations, where there is a further ‘freeing’ of thought from direct experience. Formal operations differ from concrete operations in that they allow the child or early adolescent to think about thoughts, namely, to reflect. Thus, formal operations are characterised by ‘scientific reasoning and hypothesis building’ (Wadsworth, 1984). Importantly, there are major changes in moral development during this stage, where there
1Child
and Family East, Prince of Wales Hospital, University of New South Wales, Sydney, NSW, Australia 2Psychiatry Registrar, Prince of Wales Hospital, Sydney, NSW, Australia Corresponding author: Florence Levy, Child and Family East, Prince of Wales Hospital, University of New South Wales, Sydney, NSW 2031, Australia. Email: [email protected] DOI: 10.1177/0004867415578934
To the Editor The advent of electronic medical record (EMR) in the New South Wales Health Department has highlighted long-standing issues in relation to the assessment and recording of child psychiatric information. In particular, the use of universal EMR protocols makes the incorrect assumption that prepubertal children are small adults and can be assessed with the same set of data files. This reflects common misunderstanding of child development, but could present an opportunity to incorporate a more accurate and useful developmental approach into the assessment of children and early adolescents. While changes might be made in a number of areas such as questions
Declaration of interest The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
References American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Arlington, VA: American Psychiatric Publishing. Leeson VC, McKenna PJ, Murray G, et al. (2005) What happens to semantic memory when formal thought disorder remits? Cognitive Neuropsychiatry 10: 57–71. Wood SJ, Tarnawski AU, Proffitt TM, et al. (2007) Fractionation of verbal memory impairment in schizophrenia and schizophreniform psychosis. Australian and New Zealand Journal of Psychiatry 41: 732–739.
is an evolution from asocial judgement (expiatory punishment) to social judgements (reciprocity), where intent and circumstances can be considered. This is an intensely idealistic stage of development and perhaps accounts for positive and negative influences on idealism and philosophical adolescent thinking. Classical Piagetian teaching could be considered specialised, but it provides a body developmental understandings that are in danger of being forgotten, as well as potential for further updated investigation. A more recent set of child Mental Status examinations is provided in Kaplan et al. (2014) textbook, which also indicates childhood differences. Declaration of interest The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
References Kaplan BJ, Sadock VA and Ruiz P (2014) Assessment, examination, and psychological testing. In: Sadock BJ, Sadock VA and Ruiz P (eds) Kaplan and Sadock’s Synopsis of Psychiatry: Behavioral Sciences/ Clinical Psychology, 11th Edition. Philadelphia, PA: Wolters Kluwer, pp. 1107–1117. Piaget J (1926) The Language and Thought of the Child. New York: Harcourt Brace Jovanovich. Wadsworth BJ (1984) Piaget’s Theory of Affective Development. White Plains, NY: Longman Inc.
Australian & New Zealand Journal of Psychiatry, 49(8)
Downloaded from anp.sagepub.com at UNIV OF LETHBRIDGE on November 14, 2015
ANZJP Correspondence important as it results in clearer diagnostic criteria that better reflect the nature of the symptom as well as schizophrenia itself. This in turn will help better inform treatment and rehabilitation options for individuals with FTD. While we acknowledge that these top-level changes unfortunately do not happen quickly, there are some measures that can be adopted in the interim. First, it would be beneficial to avoid use of the term ‘disorganised thoughts’ in positive symptom classifications of schizophrenia to avoid confusion with ‘thought disorder’. This would better facilitate
the identification of FTD as being of a different nature. Second, distinctions between positive and negative FTD should continue to be recognised and adopted. Finally, continued examination of the cognitive mechanisms underlying individual FTD symptoms, particularly longitudinal work, would help in further fine-tuning the growing understanding of the disorder and strengthen the case for nosological change.
Piaget and electronic medical record Florence Levy1 and Alison Crawford2
about alcohol use, the most important from a child psychiatric perspective is the Mental Status examination. The developmental insights provided by Piaget (1926) could form the basis of a more useful approach, which reflect a child’s intellectual capacity at particular stages of development. Most important are two crucial developments. The first is the development of spoken language, which allows the transition from sensori-motor intelligence to representational thought, freeing the child from the limitations of direct action. According to Wadsworth (1984), Piaget believed that affective development is also based on capacity for representation and reciprocity of attitudes and values between the young child and others. This development is thought to occur during the stage of preoperational thought from the age of 2 to 7 years. A further major and significant change occurs around the age of 11– 15 years with the development of formal operations, where there is a further ‘freeing’ of thought from direct experience. Formal operations differ from concrete operations in that they allow the child or early adolescent to think about thoughts, namely, to reflect. Thus, formal operations are characterised by ‘scientific reasoning and hypothesis building’ (Wadsworth, 1984). Importantly, there are major changes in moral development during this stage, where there
1Child
and Family East, Prince of Wales Hospital, University of New South Wales, Sydney, NSW, Australia 2Psychiatry Registrar, Prince of Wales Hospital, Sydney, NSW, Australia Corresponding author: Florence Levy, Child and Family East, Prince of Wales Hospital, University of New South Wales, Sydney, NSW 2031, Australia. Email: [email protected] DOI: 10.1177/0004867415578934
To the Editor The advent of electronic medical record (EMR) in the New South Wales Health Department has highlighted long-standing issues in relation to the assessment and recording of child psychiatric information. In particular, the use of universal EMR protocols makes the incorrect assumption that prepubertal children are small adults and can be assessed with the same set of data files. This reflects common misunderstanding of child development, but could present an opportunity to incorporate a more accurate and useful developmental approach into the assessment of children and early adolescents. While changes might be made in a number of areas such as questions
Declaration of interest The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
References American Psychiatric Association (2013) Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. Arlington, VA: American Psychiatric Publishing. Leeson VC, McKenna PJ, Murray G, et al. (2005) What happens to semantic memory when formal thought disorder remits? Cognitive Neuropsychiatry 10: 57–71. Wood SJ, Tarnawski AU, Proffitt TM, et al. (2007) Fractionation of verbal memory impairment in schizophrenia and schizophreniform psychosis. Australian and New Zealand Journal of Psychiatry 41: 732–739.
is an evolution from asocial judgement (expiatory punishment) to social judgements (reciprocity), where intent and circumstances can be considered. This is an intensely idealistic stage of development and perhaps accounts for positive and negative influences on idealism and philosophical adolescent thinking. Classical Piagetian teaching could be considered specialised, but it provides a body developmental understandings that are in danger of being forgotten, as well as potential for further updated investigation. A more recent set of child Mental Status examinations is provided in Kaplan et al. (2014) textbook, which also indicates childhood differences. Declaration of interest The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.
Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.
References Kaplan BJ, Sadock VA and Ruiz P (2014) Assessment, examination, and psychological testing. In: Sadock BJ, Sadock VA and Ruiz P (eds) Kaplan and Sadock’s Synopsis of Psychiatry: Behavioral Sciences/ Clinical Psychology, 11th Edition. Philadelphia, PA: Wolters Kluwer, pp. 1107–1117. Piaget J (1926) The Language and Thought of the Child. New York: Harcourt Brace Jovanovich. Wadsworth BJ (1984) Piaget’s Theory of Affective Development. White Plains, NY: Longman Inc.
Australian & New Zealand Journal of Psychiatry, 49(8)
Downloaded from anp.sagepub.com at UNIV OF LETHBRIDGE on November 14, 2015
