Structured cooperation of neuropediatrics and pediatric psychiatry – why?

1800 patients of a community hospital were compared with 150 patients of a neuropediatric centre with respect to their neurological/psychiatric comorbidity. In the psychiatric sample, we identified 130 patients with a neurological disorder: 41% of the patients had an epileptic disorder, 20% a motor dysfunction, 11% a microcephaly, 10% migraine and 8% sleep disorders. Patients with an epileptic disorder had an adjustment disorder (23%), an attention deficit hyperactivity disorder (21%), an emotional disorder (15%) or an autistic spectrum disorder (11%). 4% of these patients were mentally retarded. The most common psychiatric diagnosis in the neuropediatric sample was an attention deficit hyperactivity disorder (38%), followed by somatoform disorders (30%), mental disorders due to brain damage (20%) and autistic spectrum disorder (10%). The evaluation and the treatment of complex developmental disorders requires a competent multiprofessional team with neuropediatric and psychiatric expertise. In our experience, the challenge lies in providing an integrated and well coordinated therapeutic approach, as speech and language disorders, mental retardation and abnormal psychosocial circumstances all have to be taken into account to provide an optimal setting for the development of the child. Optimisation of the medication is but one aspect of the approach.