Unit13 child and adolescent psychiatryonline
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Unit13 child and adolescent psychiatryonline Presentation Transcript

  • 1. Child and Adolescent Psychiatry
  • 2. Standard Autistic Disorder DSMIV-TR (A, B, or C) A. Six or more items from 1,2, or 3.  1. Qualitative impairment in social interaction  Multiple non-verbal behaviors and gestures  Failure to develop peer relationships  Lack of sharing social enjoyment  Lack of social reciprocity 
  • 3.  2. Qualitative impairment in communication  Delay in spoken language  Marked impairment in sustaining conversations Repetitive use of language or idiosyncratic language Lack of make believe play 3. Stereotyped behavior  Abnormal preoccupation with a pattern of interest  Inflexible routines or rituals  Repetitive motor mannerisms  Persistent pre-occupation with parts of objects
  • 4.  B. Delays in at least one of the following  Social interaction  Social communication  Symbolic or imaginative play C. Not accounted for by Rett’s or another disintegrative disorder
  • 5. Asperger’ Syndrome Usually first observed after age 2 Oddity of social interaction No language impairment Mild mental retardation to normal IQ Seizure disorder common Social interactions can be mastered
  • 6. Rett’s Disorder Observed only in females Cause unknown Normal prenatal and peri-natal development Loss of previously acquired hand skills, social engagement, gait and language between 5 and 30 months Onset before age 4 Severe mental retardation Seizure disorder Poor prognosis
  • 7. Childhood Disintegrative Disorder More common in males Normal development for 2 years Loss of previously acquired language, social, bowel and bladder, play and motor skills before age 10 Outcome very poor
  • 8. Differential diagnosis Schizophrenia with childhood onset Mental retardation with behavioral symptoms Mixed receptive-expressive language Acquired aphasia
  • 9. Schizophrenia with Childhood Onset Pre-pubertal onset extremely rare Neuro-developmental abnormalities No onset before the age of 5 Normal intelligence Command hallucinations Bizarre delusions Loose associations Thought blocking
  • 10. Mental Retardation with Behavioral Symptoms Chromosomal problems Metabolic disorders Over 1000 genetic or metabolic causes
  • 11. Mixed Receptive-expressive Language Impaired skills in language comprehension and understanding May also have auditory impairment; i.e. sound discrimination, memory of sound sequences Difficulty processing visual symbols Developmental lags Long term social problems
  • 12. Mixed Receptive-expressive Language Selective deficit in language skills Poor ability to express self Immature articulation
  • 13. Acquired Aphasia Difficulty remembering words Secondary to brain trauma, tumors, or seizure disorder Preceded by normal language development May start to talk again Prognosis unsure
  • 14. Attention Deficit Hyperactivity Disorder Inattention Hyperactivity Impulsivity Low tolerance for frustration Temper outbursts
  • 15. Oppositional Defiant Disorder Evident before age 8 Stubborn Argumentative Limit testers Refusal to accept blame Deviant behavior with authority figures No serious violations of rights of others Symptoms most evident at home Severe power struggles
  • 16. Conduct Disorder Evident by age 10 Behavior outside of societal norms Aggression towards people and animals Destruction of property Deceitfulness and/or theft Serious violations of rules Violation of rights of others More common in males
  • 17. Conduct Disorder cont’d Poor peer relationships Lack of feelings of guilt or remorse Low self-esteem School discipline problems Boys: Fighting, stealing, vandalizing Girls: Truancy, substance abuse, run aways, prostitution
  • 18. Tourette’s Disorder Genetic transmission 70% of female offspring inheriting the gene develop the illness 99% of males inheriting the gene develop the illness Permanent progressive illness Possible periods of remission
  • 19. Tourette’s Disorder, cont’d Onset age 2-10 Motor tics  Eye blinking  Tongue protrusion  Touching  Squatting  Skipping Verbal tics  Barking  Grunts  Clicks  Yelps
  • 20. Tourette’s Disorder, cont’d Obsessions and compulsions Hyperactivity Distractibility Impulsivity Low self-esteem
  • 21. Adjustment Disorder Emotional response to an identifiable stressor Inception within 3 months of stressor Decreased school performance Temporary changes in social relationships Ceases after 6 months Subtypes  Anxiety  Mixed anxiety and depression  Conduct disturbance  Mixed conduct and emotion disturbance
  • 22. Childhood Eating Disorders Pica Rumination Disorder Feeding and Eating Disorder
  • 23. Pica Persistence in eating non-nutritive substances  Paint –plaster-dirt- animal feces No aversion to eating food Frequently associated with mental retardation
  • 24. Rumination Disorder Repeated regurgitation and re-chewing food Lack of nausea, retching, or GI problems May occur with developmental delays
  • 25. Feeding and Eating Disorder Infant or child does not eat adequate amounts of food No medical disorder or mental retardation Food is available Failure to gain weight Experiences developmental delays