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Child Psychiatry

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Child psychiatry

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Child Psychiatry

  1. 1. CHILDCHILD PSYCHIATRYPSYCHIATRY
  2. 2. IntroductionIntroduction A.A. 1 Child is a developing being1 Child is a developing being 2. Child is a dependent being2. Child is a dependent being
  3. 3. B.B. Child as a symbol of relationshipChild as a symbol of relationship problemsproblems i. Child-parent relationshipi. Child-parent relationship ii. Relationship between theii. Relationship between the parentsparents C. Source of historyC. Source of history i. Childi. Child ii. Parentii. Parent iii. Teachersiii. Teachers
  4. 4. Behavioral & EmotionalBehavioral & Emotional Disorders With OnsetDisorders With Onset Usually OccurringUsually Occurring Childhood & AdolescenceChildhood & Adolescence 1.1. Hyperkinetic DisordersHyperkinetic Disorders 2. Conduct Disorders2. Conduct Disorders 3. Mixed Disorders of Conduct and3. Mixed Disorders of Conduct and EmotionsEmotions 4. Emotional Disorders with onset4. Emotional Disorders with onset specific to Childhoodspecific to Childhood
  5. 5. 5. Disorders of Social Functioning5. Disorders of Social Functioning with onset specific to Childhood andwith onset specific to Childhood and AdolescenceAdolescence 6. Tic Disorders6. Tic Disorders 7. Other Behavioral and Emotional7. Other Behavioral and Emotional DisordersDisorders 8. Unspecified Mental Disorders8. Unspecified Mental Disorders
  6. 6. Nocturnal EnuresisNocturnal Enuresis  DefinitionDefinition  Causes/PsychopathologyCauses/Psychopathology  SymptomatologySymptomatology  InvestigationsInvestigations  Management:Management: i. Drugsi. Drugs ii. Behavior Therapyii. Behavior Therapy
  7. 7. Nocturnal EncopresisNocturnal Encopresis  DefinitionDefinition  Causes/PsychopathologyCauses/Psychopathology  SymptomatologySymptomatology  InvestigationsInvestigations  ManagementManagement i.i. DrugsDrugs ii.ii. Behavior TherapyBehavior Therapy
  8. 8. ATTENTION DEFICITATTENTION DEFICIT HYPERACTIVITY DISORDERHYPERACTIVITY DISORDER (ADHD)(ADHD) (HYPERKINETIC DISORDERS)(HYPERKINETIC DISORDERS)
  9. 9. EPIDEMIOLOGYEPIDEMIOLOGY  Early onset usually before age of 6Early onset usually before age of 6 but more noticeable once thebut more noticeable once the child starts schoolchild starts school  Several times more frequent inSeveral times more frequent in boys than girls 3 – 5 x moreboys than girls 3 – 5 x more  More in first born boysMore in first born boys
  10. 10.  Incidence reported 2 – 20% ofIncidence reported 2 – 20% of grade school children ,grade school children , conservative figure 3-5 % ofconservative figure 3-5 % of prepubertal elementary schoolprepubertal elementary school children.children.
  11. 11. ETIOLOGYETIOLOGY
  12. 12.  GENETIC FACTORSGENETIC FACTORS
  13. 13.  DEVELOPMENTALDEVELOPMENTAL FACTORSFACTORS
  14. 14.  NEUROCHEMICALNEUROCHEMICAL FACTORSFACTORS
  15. 15. CARDINAL FEATURESCARDINAL FEATURES  Impaired attentionImpaired attention
  16. 16.  OVEROVER ACTIVITYACTIVITY
  17. 17. Associated FeaturesAssociated Features  DisinhibitionDisinhibition  RecklessnessRecklessness  Impulsive flouting of social rulesImpulsive flouting of social rules  Prone to accidentProne to accident  Secondary:Secondary: dissocial behaviordissocial behavior low self esteemlow self esteem
  18. 18.  Pervasive over situationsPervasive over situations (at least 2 situations)(at least 2 situations)  Persistence over timePersistence over time  Interference with social activitiesInterference with social activities
  19. 19. DiagnosisDiagnosis  Rate and deviation inRate and deviation in developmentdevelopment  School history and teacher’sSchool history and teacher’s reportreport
  20. 20.  relations with siblingsrelations with siblings  mental state:mental state: distractibilitydistractibility perseverationperseveration
  21. 21. Differential DiagnosisDifferential Diagnosis  NormalityNormality  AnxietyAnxiety  DepressionDepression  Bipolar affective disorder (mania)Bipolar affective disorder (mania)
  22. 22.  Conduct disorderConduct disorder  Pervasive developmental disorderPervasive developmental disorder  Learning disordersLearning disorders  EpilepsyEpilepsy
  23. 23. MANAGEMENTMANAGEMENT
  24. 24. PharmacologicalPharmacological  CNS StimulantsCNS Stimulants  TricyclicTricyclic AntidepressantsAntidepressants  AntipsychoticsAntipsychotics  Selective Serotonin ReuptakeSelective Serotonin Reuptake Inhibitors (SSRI)Inhibitors (SSRI)
  25. 25. PSYCHOLOGICALPSYCHOLOGICAL  IndividualIndividual PsychotherapyPsychotherapy  Behavior ModificationBehavior Modification  Reward & PunishmentReward & Punishment
  26. 26. Parental Counseling- To UseParental Counseling- To Use Behavioral InterventionsBehavioral Interventions Group Therapy:Group Therapy:
  27. 27. COURSE ANDCOURSE AND PROGNOSISPROGNOSIS
  28. 28. AUTISMAUTISM
  29. 29. AUTISMAUTISM  Abnormal and/or impairedAbnormal and/or impaired development.development.  Manifest before the age of 3Manifest before the age of 3 years.years.  Abnormal functioning in allAbnormal functioning in all three areas.three areas.
  30. 30.  Social Interaction.Social Interaction.  Communication.Communication.  Restricted, RepetitiveRestricted, Repetitive Behavior.Behavior.
  31. 31. EPIDEMIOLOGYEPIDEMIOLOGY  Prevalence:- 2-5 cases perPrevalence:- 2-5 cases per 10,000 children under age of10,000 children under age of 12.12.  Before age of 36 months.Before age of 36 months.  3 – 5 x more common in boys.3 – 5 x more common in boys.  Equally prevalent in all socialEqually prevalent in all social strata.strata.
  32. 32. ETIOLOGYETIOLOGY
  33. 33. NEUROLOGICAL &NEUROLOGICAL & BIOLOGICALBIOLOGICAL FACTORS:FACTORS:  Complication ofComplication of pregnancy in firstpregnancy in first trimester.trimester.  4 – 32% have increase4 – 32% have increase brain volume,brain volume, temporal lobe damage.temporal lobe damage.
  34. 34. GENETICGENETIC FACTORSFACTORS::  2 – 4% of siblings2 – 4% of siblings of children withof children with autism also haveautism also have autism.autism.  50 x higher rate50 x higher rate than in generalthan in general population.population.
  35. 35. BIOCHEMICAL FACTORSBIOCHEMICAL FACTORS :: Increase plasma serotoninIncrease plasma serotonin
  36. 36. CLINICAL FEATURESCLINICAL FEATURES
  37. 37. Qualitative Impairment InQualitative Impairment In Social InteractionSocial Interaction
  38. 38. Disturbances OfDisturbances Of Communication &Communication & LanguageLanguage
  39. 39. Restricted, Repetitive &Restricted, Repetitive & Stereotyped, Pattern OfStereotyped, Pattern Of Behavior, Interests &Behavior, Interests & ActivitiesActivities
  40. 40. ASSOCIATED FEATURES:ASSOCIATED FEATURES:  Hyper KinesisHyper Kinesis  Aggressiveness & TemperAggressiveness & Temper TantrumsTantrums  Self Injurious BehaviorSelf Injurious Behavior  Sleeping & EatingSleeping & Eating DisturbancesDisturbances  Intellectual FunctioningIntellectual Functioning 40% - IQ < 5040% - IQ < 50
  41. 41. DIFFERENTIAL DIAGNOSISDIFFERENTIAL DIAGNOSIS  SchizophreniaSchizophrenia  Mental Retardation &Mental Retardation & Behavioral SymptomsBehavioral Symptoms  Developmental Disorders ofDevelopmental Disorders of Receptive LanguageReceptive Language
  42. 42. MANAGEMENTMANAGEMENT
  43. 43. TREATMENT GOALSTREATMENT GOALS  Increase socially acceptableIncrease socially acceptable behavior.behavior.  Reduce odd behavior.Reduce odd behavior.  Develop verbal & non verbalDevelop verbal & non verbal communication.communication.
  44. 44.  Behavior reinforcementBehavior reinforcement  Family counseling & supportFamily counseling & support  Educational & behavioralEducational & behavioral methodsmethods
  45. 45. PHARMACOLOGICALPHARMACOLOGICAL TREATMENTTREATMENT for associatedfor associated symptoms e.g.symptoms e.g.  aggression,aggression,  severe tempersevere temper tantrums,tantrums,  hyperactivity.hyperactivity.
  46. 46. COURSE & PROGNOSISCOURSE & PROGNOSIS
  47. 47. STAMMERINGSTAMMERING (STUTTERING)(STUTTERING)
  48. 48. Speech characterized bySpeech characterized by frequent repetition orfrequent repetition or prolongation of sounds orprolongation of sounds or syllables or words or by frequentsyllables or words or by frequent hesitation or pauses that disrupthesitation or pauses that disrupt the rhythmic flow of speech.the rhythmic flow of speech.
  49. 49. EPIDEMIOLOGYEPIDEMIOLOGY ::  1% in general population.1% in general population.  Most common in young children.Most common in young children.  3 – 4 times more common in males.3 – 4 times more common in males.  More in families with historyMore in families with history of stuttering.of stuttering.  Appears mostly between 18Appears mostly between 18 months – 9 years.months – 9 years.
  50. 50. ETIOLOGYETIOLOGY::  UnknownUnknown  Psychological FactorsPsychological Factors  Organic CauseOrganic Cause  Learned BehaviorLearned Behavior
  51. 51. CLINICAL FEATURESCLINICAL FEATURES ::  Vivid fearful anticipation ofVivid fearful anticipation of stuttering.stuttering.  Avoid situations requiringAvoid situations requiring speech.speech.  Word substitution.Word substitution.  Frustration, anxiety, depression.Frustration, anxiety, depression.
  52. 52. DIFFERENTIALDIFFERENTIAL DIAGNOSISDIAGNOSIS::  Normal Speech DysfluencyNormal Speech Dysfluency  ClutteringCluttering
  53. 53. TREATMENTTREATMENT::  Breathing Exercise,Breathing Exercise, Relaxation TechniqueRelaxation Technique  Speech Therapy.Speech Therapy.  PsychotherapyPsychotherapy  Family Therapy If Needed.Family Therapy If Needed.
  54. 54. COURSE AND PROGNOSISCOURSE AND PROGNOSIS

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