A Comprehensive Child Psychiatry Approach for Managing Patients with Differences of Sexual Development in a Multidisciplinary Setting: An Alternative Follow-up Model.

OBJECTIVE

To examine the implementation of a new psychiatric follow-up model for patients with differences of sexual development (DSD), a group of conditions affecting gender determination and differentiation, focusing on the model’s impact on patient care and residents’ training.

METHODS

Data from patients monitored between March 2000 and November 2023 and 28 child and adolescent psychiatry residents in a tertiary-care center were analyzed. Data was collected before and after implementing the new model using psychiatric assessment and the Clinical Global Impression (CGI) and Global Assessment Scale (GAS).

RESULTS

The patient cohort consisted of 129 patients with DSD, of whom 10 (7.75%) were lost to follow up. Of the remaining 119 patients, 89 (74.8%) were monitored by two expert specialists prior to the model’s implementation, while 30 (25.2%) were cared for by junior child and adolescent psychiatry residents under supervision following the implementation of the new model. The mean age of the patients was 10.86±6.32 years. No significant differences in the prevalence of psychiatric disorders or in CGI or GAS scores before and after implementing the new education model were found (p>0.05). The most common psychiatric diagnosis in our sample was attention-deficit/hyperactivity disorder (19.4%), followed by intellectual disability and major depressive disorder, each accounting for 14.0%. Residents reported enhanced competence in managing patients with DSD (14.3%), improved communication skills, and better identification of subthreshold psychiatric symptoms (25%), as well as a greater understanding of the multidisciplinary approach (14.3%).

CONCLUSION

This study highlighted the importance of structured psychiatric support in the management of DSD. Furthermore, the education of future psychiatrists was subjectively improved.