Chld Pscyiatry

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brief summary for medical personnel about common child psych disorders

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Chld Pscyiatry

  1. 1. DR/KHALID ALHARBY<br />1<br />بسم الله الرحمن الرحيم<br />CHILD PSYCHIATRY<br />Dr. KHALID AL-HARBY<br />MBBS,SBFM,ABFM<br />
  2. 2. DR/KHALID ALHARBY<br />2<br />Main types of childhood psychiatric disorder<br />Disorders of older <br />children.<br /><ul><li>Emotional disorder.
  3. 3. Disorders of</li></ul> sleeping & elimination.<br /><ul><li>Conduct disorder.
  4. 4. Hyper kinetic syndrome.</li></ul>Disorders of <br />pre-school children.<br /><ul><li>Temper tantrums
  5. 5. breath holding.
  6. 6. Sleep problems.
  7. 7. Feeding problems</li></li></ul><li>DR/KHALID ALHARBY<br />3<br />Main types of childhood psychiatric disorder<br />Disorders of development:<br /><ul><li>Childhood autism.
  8. 8. Specific developmental disorders.
  9. 9. Gender identity disorders</li></li></ul><li>DR/KHALID ALHARBY<br />4<br />Causes <br />Family factors.<br /> - Separation.<br /> - Illness of parent.<br /> - Parental relations.<br /> - Personality deviance <br /> of parent.<br /> - Large family size. <br /> - Child abuse and <br /> neglect. <br />Social and cultural<br /> factors.<br /><ul><li>Overcrowded living </li></ul>conditions.<br /><ul><li>Inadequate social</li></ul> amenities.<br /><ul><li>Lack of community</li></ul> involvement.<br /><ul><li>Heredity.
  10. 10. Physical</li></ul> disease<br /><ul><li>Environment</li></li></ul><li>DR/KHALID ALHARBY<br />5<br />Assessment of Psychiatric problems in childhood<br />Interviewing the parents.<br />Interviewing the child.<br />Interviewing other informants.<br />
  11. 11. DR/KHALID ALHARBY<br />6<br />Interviewing parents: THE MAIN ITEMS FOR ASSESSMENT<br />Other current <br />problems.<br /> Mood, activity, <br />concentration.<br /> Physical symptoms.<br /> Eating, sleeping, <br />elimination.<br /><ul><li>Relationships,</li></ul> particularly with <br />parents and siblings.<br /><ul><li>Antisocial behavior.
  12. 12. School </li></ul>performance.<br />Family history:<br /> separations from <br />and illness of parents.<br /> Quality of relations <br />with<br /> parents and siblings.<br />Personal history of<br /> the child.<br /> - Pregnancy - Birth <br /> - Development<br /> - Past illness and injury<br /> - Attendance and <br />attainments at school<br />The presenting <br />problem.<br /> Nature, severity, <br />frequency.<br /> Situations in which<br /> it occurs.<br /> Factors which make it <br />worse or better<br />
  13. 13. DR/KHALID ALHARBY<br />7<br />Principle observations of a child’s behavior & emotional state<br />Appearance.<br />Activity level.<br />Mood.<br />Rapport with the interviewer.<br />Relationship with parents.<br />Habits, mannerisms<br />
  14. 14. DR/KHALID ALHARBY<br />8<br />Interviewing other informants<br />Teachers<br />social workers.<br />
  15. 15. DR/KHALID ALHARBY<br />9<br />Indications for In-patient Care<br />Severe behavioral disorder.<br />For observation.<br />To separate the child.<br />To observe relationship with mother<br />
  16. 16. DR/KHALID ALHARBY<br />10<br />Temper Tantrum<br />Temper tantrums range from whining and crying to screaming, kicking, hitting, and breath-holding. <br />Equal in girls and boys, age: 1-3 y.<br />Even the most good-natured toddlers has an occasional temper tantrum (normal development)<br />Tantrum Tactics:<br />Keep cool ( do not complicate the problem with your own frustrations)<br />Assess the situation<br />Take the child to a quite, secluded place to calm down <br />
  17. 17. DR/KHALID ALHARBY<br />11<br />Breath holding spells (BHS)<br /> a benign, involuntary recurring condition of childhood in which anger or pain produce crying that culminates in noiseless expiration and apnea.<br />5% of all children ageing (6m-6y)<br />Most common in 12-18 months<br />Boys and girls are affected equally<br />+ ve family history is found in 25%<br />One of the nonepileptic paroxysmal disorders of childhood<br />2 types: cyanotic, and pallid<br />DD: epileptic seizures, syncope, benign paroxysmal vertigo, cataplexy, central or obstructive apnea<br />
  18. 18. DR/KHALID ALHARBY<br />12<br />Breath holding spells (BHS)<br />Rx.<br /> - parents respond calmly.<br /> - it disappears with time.<br /><ul><li>No drug is needed: although atropine sulfate may be considered in the management of children with frequent pallid BHS ( because of its anticholinergic action)
  19. 19. Spontaneous resolution in the vast majority of children by the age of 5-6 years
  20. 20. About 50% of cases resolve by the age of 4 years</li></li></ul><li>DR/KHALID ALHARBY<br />13<br />Awake fullness<br />1/5 of aged 1 - 2 y.<br />Rx.: <br /> - reassure parents.<br />- Advice:<br /> * don&apos;t: 1. Respond as soon as he cries.<br /> 2. Spend long periods on his bed side.<br /> 3. Take the child to their own bed.<br /> * do: 1. Establish a consistent bed time routine.<br /> 2. Avoid reinforcement of the behavior.<br /> 3. Improve the appearance of the child’s bed.<br />
  21. 21. DR/KHALID ALHARBY<br />14<br />NIGHTMARES AND NIGHT TERRORS<br />
  22. 22. DR/KHALID ALHARBY<br />15<br />Nightmares<br />Awakening from REM sleep (which constitute &lt;25 % in children above age of 6 years and adults) to full consciousness with recall of unpleasant dreams.<br />Common in children 5 - 6 yrs. of age.<br />Stimulated by frightening experience during the day.(If frequent:  day time anxiety).<br />Rx.<br /> - causes of anxiety. - Re assurance .<br />
  23. 23. DR/KHALID ALHARBY<br />16<br />Night terrors<br />Awakening from stage 3 or 4 of NREM sleep (usually 90 min. after going to sleep).<br />Terrified, confused, and cry for 5-30min.<br />No recall of dream.(and at morning no recall of the episode)<br />Settle slowly in few minutes & return to normal calm sleep.<br />Not persisting to adult life.<br />Occur in 5-15% of children 4-6 y. (though they can appear in babies as young as 9 m)<br />Rx: Not specific <br />(? Awake him shortly before the usual time of terror).<br />
  24. 24. DR/KHALID ALHARBY<br />17<br />Sleep walking(somnambulism)<br />Walk as if he is awake.(for few minutes).<br />? Anxious, not answering questions.<br />Difficult to awaken him, but easy to “drive”<br />Occurs usually during deep NREM sleep &lt;stage 3 or stage 4 sleep&gt; (early part of the night).<br />Age 5 - 12 yrs. (at least once in 15% of them).<br />Rx:<br />- Non specific - Reassurance <br /> Mild: parents should maintain a consistent approach & set color limits to the child’s behavior.<br /> - Close doors and windows - Avoid dangerous objects – hypnosis may be helpful - benzodiazepines <br />
  25. 25. DR/KHALID ALHARBY<br />18<br />
  26. 26. DR/KHALID ALHARBY<br />19<br />Food Refusal<br />Brief periods are common in pre-school.<br />Rx:<br /> - ignorance.<br /> - don’t offer the child special food.<br /> - don’t force him to eat.<br />
  27. 27. DR/KHALID ALHARBY<br />20<br />Pica (geophagy) <br />PIE-KAH, magpie<br />The craving or eating of items that are not food (for at least one month)<br />No specific test, no specific prevention<br />Age: 2-6 years (in 10-32% of this age group) , ? Family pet<br />Substances commonly ingested:<br /><ul><li>Dirt
  28. 28. Clay
  29. 29. Chalk
  30. 30. Cigarette ashes
  31. 31. Sand
  32. 32. Paint
  33. 33. Plaster
  34. 34. Gravel
  35. 35. Rocks
  36. 36. Starch </li></li></ul><li>DR/KHALID ALHARBY<br />21<br />Pica<br />At risk people:<br />Malnutrition or vitamin deficiency<br />Poor people<br /> family history of pica<br />Mental retardation<br />Ethnic or cultural reasons<br />Complications:<br /> malabsorption<br />Lead poisoning<br />Intestinal obstruction<br /> intestinal infection <br />Anemia <br />Mercury poisoning<br />Dental injury <br />
  37. 37. DR/KHALID ALHARBY<br />22<br />Pica<br />Not an eating disorder <br />Physiological theory: eating clay or dirt helps relieve nausea, control diarrhea, increase salivation, remove toxins, and alter odor or taste perception.<br />Psychological theory: a behavioral response to stress, a habit disorder, or a manifestation of oral fixation<br /> Rx: <br /> - Modify stress <br /> - keep away<br /> - reassure: with aging.<br />
  38. 38. DR/KHALID ALHARBY<br />23<br />School Refusal<br />The child may be Psychologically unable to attend school even though he wishes to do so.<br />C/P: - sudden refusal to attend school (complete)<br /> - gradually increasing reluctant to leave home.<br /> - somatic complaint. (Only on School days).<br />Causes:<br /> - separation anxiety (normally at age 18-24 months when separated from caregiver but may persists).<br /> - bullying by other children or failure in class.<br /> - marital problems between parents, or illness of <br /> a family member<br />
  39. 39. DR/KHALID ALHARBY<br />24<br />School Refusal<br />Prevention:<br />Toddlers and preschoolers can benefit from structured experiences with other adults.<br />Inform the child calmly that the parent will return and the child is to stay. Then leave quickly.<br />A firm, caring and quick separation is better.<br />Prognosis: most of them eventually return to school.<br />Rx: <br /> Modify stress circumstances: helping the child to relax, develop better coping skills, using a contract,…..<br />Treat the underlying cause <br />.<br />
  40. 40. DR/KHALID ALHARBY<br />25<br />Hyper kinetic Syndrome (ADHD)<br />1/3 of children are described as overactive by their parents and 1/5 of school children by their teachers.<br />Incidence in USA is 3-7%<br />A developmental condition of inattention and distractibility with or without hyperactivity.<br />C/P: ( it should start before the age of 7 years).<br />- Extreme restlessness - Impulsiveness<br /> - Sustained motor activity - Poor attention<br />- Learning difficulties - Temper and aggressive.<br />Etiology: not related to food (e.g. sugar) <br /> - Genetic - Social - Lead intoxication - intrauterine exposure to Food additives<br />
  41. 41. DR/KHALID ALHARBY<br />26<br /> Hyper kinetic Syndrome (ADHD)<br />Prognosis: <br />   ê age.<br /> usually ceases by puberty<br />  associated learning difficulties are less likely to improve.<br />  antisocial behavior has the worst prognosis.<br />Rx: <br /> Stimulant drugs e.g. Methylphenidate<br /> ? Paradoxical effect.<br />No addiction by those children !!  Family and social support.<br />
  42. 42. DR/KHALID ALHARBY<br />27<br />CONDUCT DISORDER<br />
  43. 43. DR/KHALID ALHARBY<br />28<br />CONDUCT DISORDER<br />Severe and persistent antisocial behavior.<br />The most common type of Psychiatric disorders among adolescents.<br />C/P: Disobedience, lying, aggressiveness, school problems, taunting, stealing, vandalism & fire setting, disapproved sexual behavior, alcohol & drug abuse.<br />Etiology:<br /> environmental factors (important):<br /> unstable, insecure, & rejecting families living in deprived areas.<br /><ul><li>Constitutional factors
  44. 44.  speech & reading difficulties</li></li></ul><li>DR/KHALID ALHARBY<br />29<br />CONDUCT DISORDER<br />Prognosis: <br /> if mild  often improve<br /> if severe  could persist.<br />Rx: <br /> Severe: 1).  stressful circumstances.<br /> 2). Behavioral approach:<br /> - Rewarding desirable behavior<br /> - Ignoring undesirable behavior<br />NB/: No effective Medications<br />
  45. 45. DR/KHALID ALHARBY<br />30<br />JUVENILE DELINQUENCY<br />It is considered because some have conduct disorder.<br />Most common about 15-16 yrs. of age,<br /> male &gt; female.<br />Causes: <br /> 1. Low social class, poverty,poor housing and<br /> poor education.<br /> 2. Poor parenting and shared attitudes to the law<br />Rx:<br /> - improve family environment<br /> - educate the child:<br /> - improve skills<br /> -  harmful peer group influences<br />
  46. 46. DR/KHALID ALHARBY<br />31<br />AUTISM<br />Rare.<br />C/P:<br /> inability to relate<br /> speech and language disorder.<br />  resistant to change.<br />  odd behavior and mannerism.<br />  seizures (in adolescence)<br />Etiology:<br /> unknown<br /> ? Genetic  cognitive abnormalities   thinking and language.<br /> no rule for abnormal parenting<br />
  47. 47. DR/KHALID ALHARBY<br />32<br />AUTISM<br />Prognosis:<br />about 50% acquire some useful speech but may continue to show emotional coldness and odd behavior.<br />10 - 20% can attend ordinary school and later obtain work.<br />10 - 20% need specialschool.<br />60 - 80% are unable to lead an independent life.<br />
  48. 48. DR/KHALID ALHARBY<br />33<br />شكرا لحضوركم<br />

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