Child and adolescent psychiatry is the branch of psychiatry that specializes in the study, diagnosis, treatment and prevention of psychopathological disorders in children, adolescents and their families. It involves clinical investigation of the phenomenology, biologic factors, psychosocial factors and response to interventions of child and adolescent psychiatric disorders. The first academic child psychiatry department in the world was founded by Leo Kanner in Baltimore in 1933.

2.  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)

3.  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

4.  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

6. 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

8.  Panic disorder
 Specific & Social Phobias
 GAD
 PTSD/Acute Stress d/o
 Obsessive Compulsive Disorder

9.  What is the phobia of needles/injections
called
 What is the fear of night/darkness
 What is Triskaidekaphobia

10.  Trypanophobia
 Nyctophobia

11.  Substance abuse
 Substance dependence

12.  Major depressive disorder
 Bipolar disorder
 Substance induced mood disorder
 Mood disorder NOS

13. Catatonic
Paranoid
Disorganized
Undifferentiated
Residual

14.  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

15. 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

17.  ADHD
 Opositional defiant disorder
 Conduct disorder

18.  Mental Retardation
 Learning Disorders
 Pervasive developmental disorders
- Autism
- Aspergers Syndrome
- Retts Syndrome
- Childhood disintegrative disorder
- PDD NOS
 Stuttering

19. • IQ < 70
• Onset before age 18
Mild • At least 2 areas of deficit
in adaptive functioning
(communication, self-care, home
Moderate
living, social skills, use of community
resources, self-
direction, academics,work, leisure, he
alth, safety)
Severe • Epidemiology
prevalence of 1-3%
M/F ~2:1
Profound • Comorbidity: 30-70%
psych disorders

20. 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?

21.  Genetic: Down’s Syndrome
 Heritable: Fragile X
 Preventable: Fetal Alcohol Syndrome

22.  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

23.  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.

24. 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

25.  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

26. 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 et.al.* ) hmic, stereotyped motor
movement or vocalization-occur
Transient 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 3:1
Chronic 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. Treatment
Tourete’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

27. Oral
- 0-18 months
- focus of gratification is on the mouth
Anal
- 18-36 months
- child learns to toilet train
Phallic
- 3-6 years
- Oedipal conflict
Latency
- 6 years-puberty
- drives of id are suppressed
Genital
- puberty and beyond
- detachment from parents
- adult sexuality

28. Sensorimotor
- birth-2 years
- child explores objects & their spatial relationships
- object permanence
Preoperational 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 view
Concrete operations
- 7 years-adolescence
- child develops understanding of conservation & reversibility
- can apply basic logical principles without being bound by his/her
own perceptions
Formal operations
- adolescence
- child can manipulate ideas & theorize
- abstract thinking

29. 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. despair
Industry vs. inferiority - 60-death
- 6-teens