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Child
PsyChiatry
MADE BY :
Dr Mahmoud Hamdy Ahmed
Associate consultant by the Saudi German
hospital Jeddah
Egyptian fellowship of psychiatry
Diploma in management of NGO’s
Master of Hospital management
‫المحاضرة‬ ‫أهداف‬
•‫من‬ ‫غيرها‬ ‫عن‬ ‫بالفطفال‬ ‫الخاصة‬ ‫النفسية‬ ‫الضطرابات‬ ‫اختلف‬ ‫فلسفة‬ ‫علي‬ ‫المتدرب‬ ‫يتعرف‬ ‫أن‬
.‫النفسية‬ ‫الضطرابات‬
•‫و‬ ‫المختلفة‬ ‫العل ج‬ ‫فطرق‬ ‫و‬ ‫واعراضها‬ ‫انواعها‬ ‫و‬ ‫العقلي‬ ‫التأخر‬ ‫أمراض‬ ‫علي‬ ‫المتدرب‬ ‫يتعرف‬ ‫ان‬
. ‫العل ج‬ ‫و‬ ‫التشخيص‬ ‫في‬ ‫المستخدمة‬ ‫النفسية‬ ‫القياسات‬
•‫النفسية‬ ‫القياسات‬ ‫و‬ ‫المختلفة‬ ‫العل ج‬ ‫فطرق‬ ‫و‬ ‫اعراضة‬ ‫و‬ ‫التوحد‬ ‫مرض‬ ‫علي‬ ‫المتدرب‬ ‫يتعرف‬ ‫ان‬
. ‫العل ج‬ ‫و‬ ‫التشخيص‬ ‫في‬ ‫المستخدمة‬
•‫المختلفة‬ ‫العل ج‬ ‫فطرق‬ ‫و‬ ‫اعراضة‬ ‫و‬ ‫النتباة‬ ‫نقص‬ ‫و‬ ‫الحركة‬ ‫فرط‬ ‫مرض‬ ‫علي‬ ‫المتدرب‬ ‫يتعرف‬ ‫ان‬
. ‫العل ج‬ ‫و‬ ‫التشخيص‬ ‫في‬ ‫المستخدمة‬ ‫النفسية‬ ‫القياسات‬ ‫و‬
‫مختلف‬ ‫الفطفال‬ ‫نفسي‬ ‫فطب‬ ‫لماذا‬ ‫و‬ ‫مقدمة‬
• Apart from dementias, there
are no “adult” disorder from
which children are exempt. In
other words, can occur in this
developmental period.
• There is a group of disorders
that are relatively specific to
children and adolescents. In
other words, arise in this
developmental period.
•‫النفسية‬ ‫الضطرابات‬ ‫جميع‬
‫حدوثها‬ ‫يمكن‬ ‫الزهايمر‬ ‫بخلف‬
. ‫الفطفال‬ ‫في‬
•‫الضطرابات‬ ‫بعض‬ ‫توجد‬
‫و‬ ‫ظهورها‬ ‫بداية‬ ‫في‬ ‫المرتبطة‬
‫ويمكن‬ ‫الطفولة‬ ‫بمرحلة‬ ‫تطورها‬
‫الشديد‬ ‫تاثيرها‬ ‫في‬ ‫خصوصيتها‬
. ‫التعليم‬ ‫و‬ ‫النمو‬ ‫علي‬
‫بالطفولة‬ ‫المتعلقة‬ ‫النفسية‬ ‫المراض‬
• Mental retardation
• Learning disorders
– Reading, mathematical, written expression, NOS
• Motor skills disorder
• disorderCommunication
disorders:
– Expressive, mixed receptive-expressive, phonological,
stuttering,NOS.
• Pervasive developmental
disorder:
– Autistic, Rett’s, childhood disintegrative, Asperger’s,
NOS.
• Attention deficit and disruptive
behavior disorders
– ADHD, ADHD NOS, Conduct disorder, Oppositional
defiant disorder, Disruptive behavior NOS
•‫المتعددة‬ ‫بدرجاتة‬ ‫العقلي‬ ‫التأخر‬
•‫التعلم‬ ‫صعوبات‬
•‫الحركي‬ ‫الجهاز‬ ‫امراض‬
•‫التواصل‬ ‫صعوبات‬ ‫امراض‬
•‫نمو‬ ‫و‬ ‫تطور‬ ‫علي‬ ‫تأثر‬ ‫امراض‬
‫التجاهات‬ ‫جميع‬ ‫في‬ ‫الفطفال‬
•‫النتباة‬ ‫نقص‬ ‫و‬ ‫الحركة‬ ‫فرط‬ ‫مرض‬
Other child disorder
• Feeding and eating disorders of infancy or early childhood:
Pica, Rumination, NOS
• Tic disorder:
Tourette’s disorder, Chronic motor or vocal tic, transient tic, tic NOS
• Elimination disorders
Encopresis, enuresis
• Separation anxiety disorder,
• Selective mutism,
• Reactive attachment disorder,
• Stereotypic movement disorder,
• Disorders of infancy, childhood or adolescence NOS
‫للفطفال‬ ‫اللكلينيكية‬ ‫المقابلة‬ ‫خلل‬
Special aspects in assessment:
• Who is the patient?
• Application of norms
• Involvement of family and
significant others.
• Involvement of nonphysicians
in Health Care Team
• Comorbidity is the rule.
• Interviewing:
Use concrete level of talk,
Playing: games, imaginative play,
Turn taking in telling stories,
Direct observation.
•: ‫اليتي‬ ‫مراعاة‬ ‫يجب‬
1.. ‫عمرية‬ ‫مرحلة‬ ‫اي‬ ‫وفي‬ ‫الطفل‬ ‫من‬
2.‫السن‬ ‫ظل‬ ‫في‬ ‫الطفل‬ ‫هذا‬ ‫من‬ ‫المتوقع‬ ‫ماهو‬
. ‫خلفة‬ ‫و‬ ‫التعليم‬ ‫مستوي‬ ‫و‬
3.‫دور‬ ‫لهم‬ ‫الذين‬ ‫الخرين‬ ‫و‬ ‫الرسرة‬ ‫مقابلة‬
. ‫المدررسين‬ ‫مثل‬ ‫الطفل‬ ‫يتربية‬ ‫في‬
4.‫للطفل‬ ‫العليجي‬ ‫الفريق‬ ‫افراد‬ ‫بين‬ ‫يتكامل‬.
5.‫واضح‬ ‫لكل م‬ ‫ارستخدا م‬ ‫يتم‬ ‫المقابلة‬ ‫خلل‬
‫و‬ ‫اللعاب‬ ‫ارستخدا م‬ ‫و‬ ‫لكنايات‬ ‫بدون‬
‫الررسائل‬ ‫يتوصيل‬ ‫و‬ ‫لرستخل ص‬ ‫الحكايات‬
‫العليجية‬
‫الفطفال‬ ‫نفسي‬ ‫فطب‬ ‫في‬ ‫اختبارات‬ ‫و‬ ‫أدوات‬
• Testing:
Intelligence
Education & achievement
Adaptive behavior
Perceptual-motor abilities
Personality.
Other lab. or imaging tests
• Physical examination
•. ‫للطفل‬ ‫الجسدي‬ ‫الفحص‬
•. ‫يتتضمن‬ ‫و‬ ‫نفسية‬ ‫اختبارات‬
–‫الذلكاء‬ ‫أختبارات‬
–‫للفطفال‬ ‫الشخصية‬ ‫اختبارات‬
–‫الدرارسي‬ ‫التأخر‬ ‫اختبارات‬
–‫النتباة‬ ‫نقص‬ ‫و‬ ‫الحرلكة‬ ‫فرط‬ ‫اختبار‬
–‫التوحد‬ ‫مقياس‬ ‫اختبار‬
•‫العشعات‬ ‫و‬ ‫التحاليل‬ ‫و‬ ‫الفحوصات‬
• Subnormal intelligence, as
measured by IQ tests,
accompanied by deficits in
adaptive functioning (at least 2
domains).
Mild: 50-55 to 70
Moderate: 35-40 to 50-55
Severe: 20-25 to 35-40
Profound: <20
• Diagnosed before 18years.
• Not due to brain insult in late
childhood (dementia)
•. ‫العشياء‬ ‫ربط‬ ‫علي‬ ‫القدرة‬ ‫:هو‬ ‫الذلكاء‬ ‫يتعريف‬
Epidemiology:
• 1-2%
• More in males 2:1
• Mild is more common and more
prevalent in lower social classes.
moderate and severe and
profound are equally common in
low and high social classes.
Etiology:
• Heridity, perinatal and
environmental events during
infancy or early childhood.
Course and outcome:
• Reduced life expectancy.
• Progress at a slower rate.
• Maturational spurts.
Clinical management:
• Thorough investigations.
• Comprehensive program
• Management of medical comorbidities
• Inability to achieve at a level consistent with the person’s overall IQ, in a
specific area of learning.
Epidemiology:
• Relatively common (reading disability:2-8% of school aged children).
• More in males.
• High comorbidity with ADHD
Etiology:
• neurodevelopmental defect
Complications:
• psychological
Management:
• Educational interventions (remedial and compensatory).
• Treatment of comorbidities.
Autistic disorder is the most important
among them. Characterised by:
• Impaired social interactions.
• Impaired ability to communicate.
• Restricted repertoire of activities and
interests.
Epidemiology:
• 10-15 per 10,000
• More in males (4:1)
Etiology: neurodevelopmental.
• Large brain size, wide ventricles, failure to
achieve normal cerebral asymmetry (defective
pruning)
• cerebellum (vermis), temporal lobes
(hypoperfusion),Anterior cingulategyrus
(decreased metabolic activity) hippocampal
complex.
• Immature cells in limbic structures in the
cerebellum.
DSM-IV-TR ( at least 6 of 12) onset before 3 years
• Impaired social interactions. (at least 2)
1. Nonverbal behaviors to regulate social interactions
2. Peer relations
3. Spontaneous sharing of interest, enjoyment.
4. Emotional reciprocity
• Impaired ability to communicate. (at least 1)
1. Develop language
2. Initiate or sustain speech
3. Stereotypic or idiosyncratic language.
4. Make-belief play
• Restricted repertoire of activities and interests (at least 1)
1. Stereotyped preoccupation with interests or activities
2. Adherence to non functional routine.
3. Stereotyped motor mannerisms
4. persistent preoccupation with parts of objects.
Investigations:
• Audiometry & visual
examination: rule out sensory
defects as a cause.
• IQ: co-morbid MR (70%).
• EEG: co-morbid changes in
(50%)
• Kariotyping, metabolic
disorders screening, heavy
metal toxicity screening.
• Psychmetry (cars).
Course:
• chronic, lifelong disorder,
• severe morbidity. Only (2-3%) may
be able to progress normally in
school and live independently.
• Good prognostic factors include
higher IQ and milder forms.
Differential diagnosis:
MR, severe sensory defects,
language disorders, childhood
schizophrenia.
Clinical management:
• Parent education
• Parent support
• Special education
• Speech therapy
• Behavioral modification
• Medical treatment: adjuvent to
behavioral approaches. They
include: antiepileptics,
antipsychotics, fluoxetine,
naltrexone, clomipramine.
• Rett’s syndrome:
Severe form of autism strictly in
females, characterized by:
epilepsy, microcephaly, cerebellar
involvement symptoms.
• Asperger’s syndrome:
Milder form of autism??,
characterized by normal language
and normal intelligence.
• DSM-IV-TR: (at least 12 from
18)persisting for at least 6 months
and are maladaptive.
A) Inattention:
– Fails to pay close attention to details and
makes careless mistakes.
– Difficult to sustain attention in tasks or play.
– Easily distracted by external stimuli
– Dislikes tasks that require sustained mental
effort.
– Does not seem to listen when spoken to
directly.
– Does not follow instructions and fails to finish
tasks
– Difficulty organising tasks or activities
– Forgetful in daily activities.
B) Hyperactivity-
– Often fidgets
– Leaves seat
– Runs and climbs
– Difficult to play quietly
– On the go
– Excessive talking
c) Impulsivity:.
– Blurts out answers
– Difficulty waiting turns
– interrupts or intrudes
Epidemiology:
• 3-10% in school aged children. More in
males (3:1)
Etiology:
• Genetics (gene for D4 receptor or
dopamine transporter gene)
• Perinatal problems.
• Neuroimaging studies showed reduced
size of the prefrontal cortex (executive
functions and response inhibition),
basal ganglia and cerebellum (timing)
• Psychosocial: parental anxiety,
inexperience
Course:
• 50% remit
• 25% antisocial, substance abuse,
• depression
Differential Diagnosis:
1. Normal
2. Conduct disorder
3. Learning disorders
4. Mood disorders
5. Adjustment disorder
6. Thyroid disorder
Clinical management:
• Combination of somatic and
behavioral management
1) Psychostimulants (1st
. Line):
• DA reuptake inhibitors
Short acting: methylphenidate: 0.5-
1mgmg/d
Long acting: methylphenidate, concerta
• NA reuptake inhibitor: atomoxetine
(strattera): 1.2mg/kg/d.
2) antidepressant: clomipramin, bupropion
Conduct Disorder
DSM-IV-TR: (3 or more for 12 months).
Aggression to people and animals:
1. Bullies, threats or intimidates.
2. Initiates fights
3. Used weapon
4. Physically cruel to people
5. Physically cruel to animals
6. Stolen while confronting victim
7. Forced someone into sexual act
Destruction of property:
1. Fire setting intending serious damage
2. Deliberate destruction of other’s property
Deceitfulness:
1. Broken into someoneelse’s house, car
2. Lies to obtain good or favors
3. Theft without confrontation
Serious violation of rules:
1. Stays out at nightdespite prohibition before 13
2. Run away from home at least twice
3. Truancy from school before 13
Conduct Disorder
Epidemiology:
• 10% of males, 2% females
Etiology:
• Genetics
• Psychosocial
Course:
• 40% antisocial
Differential diagnosis:
• ADHD, Learning disability, mood disorder, oppositional defiant disorder.
Clinical management:
• Parental training
• Anti epileptic drugs
• SSRIs
• Treatment of comorbidies
طب نفسي الأطفال للأخصائيين النفسيين

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طب نفسي الأطفال للأخصائيين النفسيين

  • 1. Child PsyChiatry MADE BY : Dr Mahmoud Hamdy Ahmed Associate consultant by the Saudi German hospital Jeddah Egyptian fellowship of psychiatry Diploma in management of NGO’s Master of Hospital management
  • 2. ‫المحاضرة‬ ‫أهداف‬ •‫من‬ ‫غيرها‬ ‫عن‬ ‫بالفطفال‬ ‫الخاصة‬ ‫النفسية‬ ‫الضطرابات‬ ‫اختلف‬ ‫فلسفة‬ ‫علي‬ ‫المتدرب‬ ‫يتعرف‬ ‫أن‬ .‫النفسية‬ ‫الضطرابات‬ •‫و‬ ‫المختلفة‬ ‫العل ج‬ ‫فطرق‬ ‫و‬ ‫واعراضها‬ ‫انواعها‬ ‫و‬ ‫العقلي‬ ‫التأخر‬ ‫أمراض‬ ‫علي‬ ‫المتدرب‬ ‫يتعرف‬ ‫ان‬ . ‫العل ج‬ ‫و‬ ‫التشخيص‬ ‫في‬ ‫المستخدمة‬ ‫النفسية‬ ‫القياسات‬ •‫النفسية‬ ‫القياسات‬ ‫و‬ ‫المختلفة‬ ‫العل ج‬ ‫فطرق‬ ‫و‬ ‫اعراضة‬ ‫و‬ ‫التوحد‬ ‫مرض‬ ‫علي‬ ‫المتدرب‬ ‫يتعرف‬ ‫ان‬ . ‫العل ج‬ ‫و‬ ‫التشخيص‬ ‫في‬ ‫المستخدمة‬ •‫المختلفة‬ ‫العل ج‬ ‫فطرق‬ ‫و‬ ‫اعراضة‬ ‫و‬ ‫النتباة‬ ‫نقص‬ ‫و‬ ‫الحركة‬ ‫فرط‬ ‫مرض‬ ‫علي‬ ‫المتدرب‬ ‫يتعرف‬ ‫ان‬ . ‫العل ج‬ ‫و‬ ‫التشخيص‬ ‫في‬ ‫المستخدمة‬ ‫النفسية‬ ‫القياسات‬ ‫و‬
  • 3. ‫مختلف‬ ‫الفطفال‬ ‫نفسي‬ ‫فطب‬ ‫لماذا‬ ‫و‬ ‫مقدمة‬ • Apart from dementias, there are no “adult” disorder from which children are exempt. In other words, can occur in this developmental period. • There is a group of disorders that are relatively specific to children and adolescents. In other words, arise in this developmental period. •‫النفسية‬ ‫الضطرابات‬ ‫جميع‬ ‫حدوثها‬ ‫يمكن‬ ‫الزهايمر‬ ‫بخلف‬ . ‫الفطفال‬ ‫في‬ •‫الضطرابات‬ ‫بعض‬ ‫توجد‬ ‫و‬ ‫ظهورها‬ ‫بداية‬ ‫في‬ ‫المرتبطة‬ ‫ويمكن‬ ‫الطفولة‬ ‫بمرحلة‬ ‫تطورها‬ ‫الشديد‬ ‫تاثيرها‬ ‫في‬ ‫خصوصيتها‬ . ‫التعليم‬ ‫و‬ ‫النمو‬ ‫علي‬
  • 4. ‫بالطفولة‬ ‫المتعلقة‬ ‫النفسية‬ ‫المراض‬ • Mental retardation • Learning disorders – Reading, mathematical, written expression, NOS • Motor skills disorder • disorderCommunication disorders: – Expressive, mixed receptive-expressive, phonological, stuttering,NOS. • Pervasive developmental disorder: – Autistic, Rett’s, childhood disintegrative, Asperger’s, NOS. • Attention deficit and disruptive behavior disorders – ADHD, ADHD NOS, Conduct disorder, Oppositional defiant disorder, Disruptive behavior NOS •‫المتعددة‬ ‫بدرجاتة‬ ‫العقلي‬ ‫التأخر‬ •‫التعلم‬ ‫صعوبات‬ •‫الحركي‬ ‫الجهاز‬ ‫امراض‬ •‫التواصل‬ ‫صعوبات‬ ‫امراض‬ •‫نمو‬ ‫و‬ ‫تطور‬ ‫علي‬ ‫تأثر‬ ‫امراض‬ ‫التجاهات‬ ‫جميع‬ ‫في‬ ‫الفطفال‬ •‫النتباة‬ ‫نقص‬ ‫و‬ ‫الحركة‬ ‫فرط‬ ‫مرض‬
  • 5. Other child disorder • Feeding and eating disorders of infancy or early childhood: Pica, Rumination, NOS • Tic disorder: Tourette’s disorder, Chronic motor or vocal tic, transient tic, tic NOS • Elimination disorders Encopresis, enuresis • Separation anxiety disorder, • Selective mutism, • Reactive attachment disorder, • Stereotypic movement disorder, • Disorders of infancy, childhood or adolescence NOS
  • 6. ‫للفطفال‬ ‫اللكلينيكية‬ ‫المقابلة‬ ‫خلل‬ Special aspects in assessment: • Who is the patient? • Application of norms • Involvement of family and significant others. • Involvement of nonphysicians in Health Care Team • Comorbidity is the rule. • Interviewing: Use concrete level of talk, Playing: games, imaginative play, Turn taking in telling stories, Direct observation. •: ‫اليتي‬ ‫مراعاة‬ ‫يجب‬ 1.. ‫عمرية‬ ‫مرحلة‬ ‫اي‬ ‫وفي‬ ‫الطفل‬ ‫من‬ 2.‫السن‬ ‫ظل‬ ‫في‬ ‫الطفل‬ ‫هذا‬ ‫من‬ ‫المتوقع‬ ‫ماهو‬ . ‫خلفة‬ ‫و‬ ‫التعليم‬ ‫مستوي‬ ‫و‬ 3.‫دور‬ ‫لهم‬ ‫الذين‬ ‫الخرين‬ ‫و‬ ‫الرسرة‬ ‫مقابلة‬ . ‫المدررسين‬ ‫مثل‬ ‫الطفل‬ ‫يتربية‬ ‫في‬ 4.‫للطفل‬ ‫العليجي‬ ‫الفريق‬ ‫افراد‬ ‫بين‬ ‫يتكامل‬. 5.‫واضح‬ ‫لكل م‬ ‫ارستخدا م‬ ‫يتم‬ ‫المقابلة‬ ‫خلل‬ ‫و‬ ‫اللعاب‬ ‫ارستخدا م‬ ‫و‬ ‫لكنايات‬ ‫بدون‬ ‫الررسائل‬ ‫يتوصيل‬ ‫و‬ ‫لرستخل ص‬ ‫الحكايات‬ ‫العليجية‬
  • 7. ‫الفطفال‬ ‫نفسي‬ ‫فطب‬ ‫في‬ ‫اختبارات‬ ‫و‬ ‫أدوات‬ • Testing: Intelligence Education & achievement Adaptive behavior Perceptual-motor abilities Personality. Other lab. or imaging tests • Physical examination •. ‫للطفل‬ ‫الجسدي‬ ‫الفحص‬ •. ‫يتتضمن‬ ‫و‬ ‫نفسية‬ ‫اختبارات‬ –‫الذلكاء‬ ‫أختبارات‬ –‫للفطفال‬ ‫الشخصية‬ ‫اختبارات‬ –‫الدرارسي‬ ‫التأخر‬ ‫اختبارات‬ –‫النتباة‬ ‫نقص‬ ‫و‬ ‫الحرلكة‬ ‫فرط‬ ‫اختبار‬ –‫التوحد‬ ‫مقياس‬ ‫اختبار‬ •‫العشعات‬ ‫و‬ ‫التحاليل‬ ‫و‬ ‫الفحوصات‬
  • 8. • Subnormal intelligence, as measured by IQ tests, accompanied by deficits in adaptive functioning (at least 2 domains). Mild: 50-55 to 70 Moderate: 35-40 to 50-55 Severe: 20-25 to 35-40 Profound: <20 • Diagnosed before 18years. • Not due to brain insult in late childhood (dementia) •. ‫العشياء‬ ‫ربط‬ ‫علي‬ ‫القدرة‬ ‫:هو‬ ‫الذلكاء‬ ‫يتعريف‬ Epidemiology: • 1-2% • More in males 2:1 • Mild is more common and more prevalent in lower social classes. moderate and severe and profound are equally common in low and high social classes. Etiology: • Heridity, perinatal and environmental events during infancy or early childhood.
  • 9. Course and outcome: • Reduced life expectancy. • Progress at a slower rate. • Maturational spurts. Clinical management: • Thorough investigations. • Comprehensive program • Management of medical comorbidities
  • 10. • Inability to achieve at a level consistent with the person’s overall IQ, in a specific area of learning. Epidemiology: • Relatively common (reading disability:2-8% of school aged children). • More in males. • High comorbidity with ADHD Etiology: • neurodevelopmental defect Complications: • psychological Management: • Educational interventions (remedial and compensatory). • Treatment of comorbidities.
  • 11. Autistic disorder is the most important among them. Characterised by: • Impaired social interactions. • Impaired ability to communicate. • Restricted repertoire of activities and interests. Epidemiology: • 10-15 per 10,000 • More in males (4:1) Etiology: neurodevelopmental. • Large brain size, wide ventricles, failure to achieve normal cerebral asymmetry (defective pruning) • cerebellum (vermis), temporal lobes (hypoperfusion),Anterior cingulategyrus (decreased metabolic activity) hippocampal complex. • Immature cells in limbic structures in the cerebellum.
  • 12. DSM-IV-TR ( at least 6 of 12) onset before 3 years • Impaired social interactions. (at least 2) 1. Nonverbal behaviors to regulate social interactions 2. Peer relations 3. Spontaneous sharing of interest, enjoyment. 4. Emotional reciprocity • Impaired ability to communicate. (at least 1) 1. Develop language 2. Initiate or sustain speech 3. Stereotypic or idiosyncratic language. 4. Make-belief play • Restricted repertoire of activities and interests (at least 1) 1. Stereotyped preoccupation with interests or activities 2. Adherence to non functional routine. 3. Stereotyped motor mannerisms 4. persistent preoccupation with parts of objects.
  • 13. Investigations: • Audiometry & visual examination: rule out sensory defects as a cause. • IQ: co-morbid MR (70%). • EEG: co-morbid changes in (50%) • Kariotyping, metabolic disorders screening, heavy metal toxicity screening. • Psychmetry (cars). Course: • chronic, lifelong disorder, • severe morbidity. Only (2-3%) may be able to progress normally in school and live independently. • Good prognostic factors include higher IQ and milder forms. Differential diagnosis: MR, severe sensory defects, language disorders, childhood schizophrenia.
  • 14. Clinical management: • Parent education • Parent support • Special education • Speech therapy • Behavioral modification • Medical treatment: adjuvent to behavioral approaches. They include: antiepileptics, antipsychotics, fluoxetine, naltrexone, clomipramine. • Rett’s syndrome: Severe form of autism strictly in females, characterized by: epilepsy, microcephaly, cerebellar involvement symptoms. • Asperger’s syndrome: Milder form of autism??, characterized by normal language and normal intelligence.
  • 15.
  • 16. • DSM-IV-TR: (at least 12 from 18)persisting for at least 6 months and are maladaptive. A) Inattention: – Fails to pay close attention to details and makes careless mistakes. – Difficult to sustain attention in tasks or play. – Easily distracted by external stimuli – Dislikes tasks that require sustained mental effort. – Does not seem to listen when spoken to directly. – Does not follow instructions and fails to finish tasks – Difficulty organising tasks or activities – Forgetful in daily activities. B) Hyperactivity- – Often fidgets – Leaves seat – Runs and climbs – Difficult to play quietly – On the go – Excessive talking c) Impulsivity:. – Blurts out answers – Difficulty waiting turns – interrupts or intrudes
  • 17. Epidemiology: • 3-10% in school aged children. More in males (3:1) Etiology: • Genetics (gene for D4 receptor or dopamine transporter gene) • Perinatal problems. • Neuroimaging studies showed reduced size of the prefrontal cortex (executive functions and response inhibition), basal ganglia and cerebellum (timing) • Psychosocial: parental anxiety, inexperience Course: • 50% remit • 25% antisocial, substance abuse, • depression Differential Diagnosis: 1. Normal 2. Conduct disorder 3. Learning disorders 4. Mood disorders 5. Adjustment disorder 6. Thyroid disorder Clinical management: • Combination of somatic and behavioral management 1) Psychostimulants (1st . Line): • DA reuptake inhibitors Short acting: methylphenidate: 0.5- 1mgmg/d Long acting: methylphenidate, concerta • NA reuptake inhibitor: atomoxetine (strattera): 1.2mg/kg/d. 2) antidepressant: clomipramin, bupropion
  • 18. Conduct Disorder DSM-IV-TR: (3 or more for 12 months). Aggression to people and animals: 1. Bullies, threats or intimidates. 2. Initiates fights 3. Used weapon 4. Physically cruel to people 5. Physically cruel to animals 6. Stolen while confronting victim 7. Forced someone into sexual act Destruction of property: 1. Fire setting intending serious damage 2. Deliberate destruction of other’s property Deceitfulness: 1. Broken into someoneelse’s house, car 2. Lies to obtain good or favors 3. Theft without confrontation Serious violation of rules: 1. Stays out at nightdespite prohibition before 13 2. Run away from home at least twice 3. Truancy from school before 13
  • 19. Conduct Disorder Epidemiology: • 10% of males, 2% females Etiology: • Genetics • Psychosocial Course: • 40% antisocial Differential diagnosis: • ADHD, Learning disability, mood disorder, oppositional defiant disorder. Clinical management: • Parental training • Anti epileptic drugs • SSRIs • Treatment of comorbidies