Introduction to Child Psychiatry

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  • 1.  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)
  • 2.  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
  • 3.  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
  • 4. ADULT D/O seen in kids Starting in childhood Anxiety Disorders  Disruptive Behavior d/o Mood Disorders  Pervasive Substance Abuse developmental d/o Sleep disorders  Elimination disorders Eating disorders  Feeding disorders Schizophrenia  Tourette’s/Tics Adjustment disorder  Selective Mutism  Seperatation Anxiety d/o  RAD
  • 5.  Panic disorder Specific & Social Phobias GAD PTSD/Acute Stress d/o Obsessive Compulsive Disorder
  • 6.  What is the phobia of needles/injections called What is the fear of night/darkness What is Triskaidekaphobia
  • 7.  Trypanophobia Nyctophobia
  • 8.  Substance abuse Substance dependence
  • 9.  Major depressive disorder Bipolar disorder Substance induced mood disorder Mood disorder NOS
  • 10. CatatonicParanoidDisorganizedUndifferentiatedResidual
  • 11.  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
  • 12. 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
  • 13.  ADHD Opositional defiant disorder Conduct disorder
  • 14.  Mental Retardation Learning Disorders Pervasive developmental disorders- Autism- Aspergers Syndrome- Retts Syndrome- Childhood disintegrative disorder- PDD NOS Stuttering
  • 15. • 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
  • 16. 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?
  • 17.  Genetic: Down’s Syndrome Heritable: Fragile X Preventable: Fetal Alcohol Syndrome
  • 18.  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
  • 19.  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.
  • 20. 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
  • 21.  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
  • 22. 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* ) 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
  • 23. 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
  • 24. 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
  • 25. 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