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The branch of psychiatry that specializes in the study, diagnosis, treatment, a nd prevention of psychopathological disorders of children, adolescents, & their families (Kaplan & Saddock) Clinical investigation of phenomenology, biologic factors, psychosocial factors…. & response to interventions of child and adolescent psychiatric disorders (Kaplan & Saddock)
1883: Emil Kreapelin: Ignored 1933: Moritz Tramer: Swiss psychiatrist 1st Journal: Zeitschrift für Kinderpsychiatrie = Acta Paedopsychiatria 1st academic child psychiatry department in the world was founded by Leo Kanner in Baltimore 1953: AACP 1959: Board certified speciality
Where does the medical term “rounds” originate from? Who stated “Listen to your patient, he is telling you the diagnosis,“ Who 1st developed the concept of Medical residency ? Hint: Rendu-Osler-Weber disease
Dyssomnias: disturbance in initiation or maintenance of Parasomnias: involve abnormal and sleep unnatural - Insomnia movements, behaviors, emotions, per - Hypersomnia ceptions, and dreams that occur - Narcolepsy while falling asleep, sleeping, between sleep - Sleep apnea, stages, or during arousal from sleep - ASPS, DSPS - Nightmares - Jetlag, - Sleep Terror - Shift sleep disorder. - Bruxism - Somnambulism
Anorexia• Refusal to maintain body weight• Intense fear of gaining weight• Preoccupation: body shape• Amenorrhea (at least 3 consecutive menstrual cycles)• 0.5-1% of adolescent girls• Restricting type vs. binge eating/purging type Bulimia• Binge eating 2/week for 3 mo• Binges accompanied by a sense of lack of control• Inappropriate compensatory behavior (purging, laxatives, exercise, ene mas)• Self-evaluation is unduly based on body shape and weight• 1-3% of young women
• IQ < 70 • Onset before age 18 Mild • At least 2 areas of deficit in adaptive functioning (communication, self-care, homeModerate living, social skills, use of community resources, self- direction, academics,work, leisure, he alth, safety) Severe • Epidemiology prevalence of 1-3% M/F ~2:1Profound • Comorbidity: 30-70% psych disorders
What is the most common genetic cause of ID/MR?What is the most common heritable cause of ID/MR?What is the most common preventable cause of ID/MR?
Eneuresis- voiding of urine in inappropriate places- > 2 times per week for 3 months- 5 years of age or older- seen in 7% 5 year old boys & 3% 5 year old girls- can run in families- first line treatment: Reward/Behavioral therapy, Imipramine or ddAVP (vasopressin) are also used Encopresis -lack of bowel control & passage of feces in inappropriate places - > 1 time per month for 3 months - 4 years of age or older - seen in 1% of 5 year olds - higher in males - treat with supportive and behavioral therapy
Markedly disturbed and developmentally inappropriate social relatedness in most contexts The disturbance is not accounted for solely by developmental delay and does not meet the criteria for pervasive developmental disorder Onset before five years of age A history of significant neglect An implicit lack of identifiable, preferred attachment figure.
Symptoms of Separation Anxiety- Distress : separated from caregiver/home- Persistent worry : losing caregiver- Persistent worry about separation due to untoward event- Refusing to go to school- Frequent physical complaints- Fear of being alone- Fear of sleeping away from caregiver- Panic/tantrums at times of separation- Nightmares about separation Developmentally inappropriate anxiety Normal 8 mo to pre-school >3 symptoms for > 4 weeks Common ages 5-7 and 11-14, when kids deal with change at school up to 4% prevalence in children & young adolescents Treatment: Keep in school , CBT, SSRI’s
Do not speak in 1 or > important settings despite ability to comprehend <1% b/w 3-8 yrs F:M 2:1 Etiology: trauma vs. anxiety vs. temperament Rx: CBT Behavioral Parental-Training Speech-lang
A large, community-based study Tourette’s: Motor and/or vocal tics suggested that over 19% of - school-age children have tic sudden, rapid, recurrent, nonrhyt disorders (Kurlan et.al.* ) hmic, stereotyped motor movement or vocalization-occurTransient tic disorder consists of at least 1 year with no tic free multiple motor and/or phonic period for greater than 3 months tics with duration of at least 4 -onset before 18 yrs weeks, but less than 12 Epidemiology months. -0.04% M:F 3:1Chronic tic disorder is either single Associations: genetic or multiple motor or phonic basis, ADHD, OCD, & PANDAS tics, but not both, which are present for more than a year. TreatmentTourete’s (see right side for -behavioral therapy:CBIT description) -antipsychotics, alpha agonists:Tic d/o NOS *Kurlan R, McDermott MP, Deeley C, et al. "Prevalence of tics in schoolchildren and association with placement in special education". Neurology Oct- 2001
Oral - 0-18 months - focus of gratification is on the mouthAnal- 18-36 months- child learns to toilet trainPhallic- 3-6 years- Oedipal conflictLatency- 6 years-puberty- drives of id are suppressedGenital - puberty and beyond - detachment from parents - adult sexuality
Sensorimotor - birth-2 years - child explores objects & their spatial relationships - object permanencePreoperational thought - 2-7 years - symbolic activity & play - “animistic thinking” -- assigns living attributes to inanimate objects, - between ages 4-7 “decentration “ -- child starts to recognize other points of viewConcrete operations- 7 years-adolescence- child develops understanding of conservation & reversibility- can apply basic logical principles without being bound by his/her own perceptionsFormal operations- adolescence- child can manipulate ideas & theorize- abstract thinking
Trust/mistrust Identity vs. role confusion - birth-18 months - teens-20s Autonomy vs. shame Intimacy vs. isolation and doubt - 20s-40s -18 months-3 years Generativity vs. stagnation Initiative vs. guilt - 40-60 - 3-5 years Ego integrity vs. despairIndustry vs. inferiority - 60-death - 6-teens