Psychiatric disorders in children...........

1. Childhood psychiatric disorders
Presented by
Dr. Pinky Majumdar
Dr. Ashik Kamal Alvee
MD Residents (phase A)
Department of Paediatrics
Dhaka medical college hospital

2. Introduction
Psychiatric disorders are behavioral or mental pattern that causes
significant distress or impairment if personal functioning. Such features
may be persistent, relapsing ,remitting or occur as a single episode.
The causes of mental disorder are often unclear but alarming. But
healthy living is impossible without sound mental health.
Nowadays it is not uncommon in pediatric age group.

3. Epidemiology
Worldwide 10-20% of children and adolescents experience
mental disorders.
In Bangladesh no reliable current data is available regarding
childhood psychiatric illness. Some studies are available which
shows the prevalence of mental health disorders varying
13.4 – 22.9%.
Psychiatric problems are more prevalent in urban areas than rural
areas.

4. Prevalence studies in Bangladesh
Author Sample
size/residence
Age Diagnostic tool Prevalence
rate
Khan et al.
2013
8000/rural &
urban
2-9 TQP/RNDA/MCHAT/DS
M4
29.5%
Khan et al.
2009
4003/rural
data
2-9 TQP-BCL 14.6%
Rabbani et al.
2009
3564/urban/r
ural/semi
urban
5-17 DSM 4 29.5%
Mullik &
goodman et
al.
922/urban/rur
al/semi urban
5-10 SDQ/DAWBA/DSM 4 15.5%

5. Psychiatric disorders are increasing alarmingly in Bangladesh
day by day. Some causes are assumed for this situation
• Complicated urban life.
• Addiction to electronic devices like mobile, video game.
• Increased stress in school
• Busy and working parents.
• Decreased playground.
• Nuclear family.
• Decreased social values and bonding.

6. Classification of psychiatric disorder
 Eating disorder
• Anorexia nervosa, Bulimia nervosa
• Pica, Rumination
 Somatic disorder
• Conversion disorder
• Factitious disorder
• Somatic symptom
 Motor disorder
• Tics
• Stereotype disorders
 Elimination disorder
• Enuresis, encopresis
 Anxiety disorder
• Separation anxiety disorder
• Generalised anxiety disorder
• OCD
• Panic disorder
• PTSD
 Mood disorder
• Major depressive disorder
• Bipolar disorder
 Conduct disorder
 Autism spectral disorder
 Childhood psychosis

7. • Breath holding attack
• Movement disorders
• Sibling rivalry
• Conduct disorder.
• Elimination disorders
(Enuresis, encopresis)
• Tantrums
• Eating disorders (e.g. Pica,
Rumination)
• Anxiety disorders (e.g.
School Phobia, OCD etc)
• ADHD
• Autism spectral disorders
• Somatoform disorders
• Psychosis (e.g. schizophrenia)
Common psychiatric disorders in Bangladesh

8. Sibling Rivalry
• It is one type of maladjustment of children among siblings.
The Child’s emotional need of affection and security may
appear to be threatened with the birth of another child.
• The older children feel deprived and this may initiate hostility in
his behavior.
Management
• Parents have to give their time and attention to both the baby.
• Conscious efforts should be made to involve the older child in
care of younger one.

9. Breath holding spells
• Following trauma or stress, children cries briefly and holds
breath in expiration.
• Types: two types 1) Pallied and 2) cyanotic
• Pallied spell : it occurs due to excessive vagal tone leading to
cerebral hypoperfusion, convulsion , limpness.
• Cyanotic spells : 3 times more common than Pallied spells.
Patient develops cyanosis and hypoxemia during spells
• No specific treatment is necessary or effective.
Parents should be reassured.

10. Temper tantrums
• It is an expression of anger and frustration. In this condition
child is lying or throwing himself down, kicking, screaming,
throwing things or hitting.
• This is very common in one to four year age group.
• At home these behavior can be annoying for parents but in
public they serve as an embracement.
• This condition can be managed. Parents are advised to use
distraction, not to use negative terms but child’s
demand leading to tantrum should not be granted.

11. Somatic symptom and related disorder
• Soma means body
• Somatoform disorders involves patterns in which individuals
complaints of bodily symptoms that suggest the presence of
medical problems
• But for which no organic basis can be found that satisfactorily
explains the symptoms.
• Such individuals are typically preoccupied with their state of
health and with various presumed disorders or
diseases of bodily organs.

13. Clinical clues on history of conversion disorder
• Predominantly in pubertal and post pubertal age
• Higher incidence in girls.
• Half of the patients complaints concomitant chronic pain.
• Having mental disorder previously.
• History of previous medically unexplained symptoms
• Sudden onset of symptoms at maximum intensity
• Paroxysmal symptoms in presence of family members or
friends
• Out of proportion of severity of neurological symptoms

14. Clinical symptoms
• Motor symptoms
Weakness, paralysis, seizures, apnea and abnormal
movements, tremor
• Sensory deficits
Anesthesia, blindness, deafness, peripheral nerve sensory
loss, hallucinations
• Visceral symptoms
Vomiting , Diarrhea, urinary retention, pseudocyesis, globus
hystericus

15. Contd..
Non epileptic seizures. Characterized by
• More gradual onset
• Truncal muscles involvement more
• Lateral rolling of head and body
• Movements increased if restraint applied
• Closed eyelids-manually opening the eyes produce more
forceful closure
• Rapid post ictal re-orientation

16. Treatment
• Psychotherapy
Cognitive behavior therapy
• Psychopharmacology
V- Validate
E- Educate
E- Empathize
R- Rehabilitate

17. Anxiety disorder
Anxiety disorders are characterized by pathological anxiety in which
• Anxiety becomes disabling, interferes with social interaction,
achievements of goals or hampers quality of life.
• Can lead to low self esteem, social withdrawal and academic
underachievement.
Types
• Separation anxiety disorder.
• Generalized anxiety disorder.
• Post traumatic stress disorder.
• Obsessive compulsive disorder.
• Panic disorder.

18. Separation anxiety disorder
Most commonly experienced one is School refusal.
School refusal
Characteristics
• Peaks at 3 years age and in early teen-age.
• Frightened to leave home.
• Headache, tachycardia before leaving to school.
• Difficulty in returning to school from holidays.
• Forced to attend school met with tears .
• Child stays in or near home.

19. Management of school refusal
• Management of school refusal often requires parent’s
management training and family therapy.
• Working with school personnel is always needed.
• Anxiety often requires special attention from teachers,
counselors and school nurses physiologist and psychiatrist.
Some needs drug therapy. SSRI is group of choice.

20. Some other forms of Separation anxiety disorder
• Childhood onset social phobia
Excessive anxiety in social setting leading to social isolation
• Selective mutism
Children are extremely talkative at home but become silent
outside

21. Generalised anxiety disorder
Occurs in children who often experiences unrealistic worries about
different events or activities for at least 6 months with at least 1
somatic complaint.
When history and physical findings are suggestive pediatricians
should rule out hyperthyroidism, hypoglycemia, pheochromocytoma.
Post traumatic stress disorder
It is typically precipitated by an extreme stressor. PTSD is an
anxiety disorder resulting from a long term and short term effects
of trauma and cause behavioral and psychotic sequels in toddlers,
children and adolescent.
It may be acute (<3 months) or chronic (>3months)

22. Obsessive compulsive disorders
• One of the most common psychiatric disorders with life time
prevalence of 1-3% worldwide with 80% having onset in
childhood.
• It is characterized by specific repetitive thoughts that invade
consciousness (obsessions) or repetitive rituals or movements
that are driven by anxiety (compulsions)
• Most common obsessions are concerned with bodily
wastes and secretions. Most common compulsions
are hand washing, continuous checking of locks
or touching of same objects.

23. Management of anxiety disorder
• Mainly done by cognitive behavioral therapy
• Sometimes combination with drug therapy is needed. In most
cases selective serotonin reuptake inhibitors (SSIRs) are used.
In severe cases beta blockers are used.

24. Attention Deficit Hyperactivity Disorder (ADHD)
• This is a neuro-developmental disorder. But it is discussed with
psychiatric disorders because it has psychiatric components
also.
• Approximately 6.4 million children in the world is suffering from
this disorder.
Pathogenesis
• 5-10% reduction in prefrontal cortex and basal ganglia volume.
• Prefrontal cortex and basal ganglia are rich in dopamine
receptors
• Dopaminergic medication in ADHD patient and
fluorodopa positron emission tomography scan support
dopamine hypothesis.

25. Symptoms
According to DSM 5
symptoms of inattention are
• Has trouble holding attention on tasks
• Does not seem to listen
• Does not follow instructions
• Has trouble organizing tasks and activities.
• Reluctant to do tasks that require mental effort over a long
period of time.
• Easily distracted.
• Forgetful in daily activities.

26. Contd..
symptoms of hyperactivity are
• Fidgets with or taps hands or feet, or squirms in seat.
• Unable to play quietly.
• Is often “on the go”
• Talks excessively.
• Blurts out an answer before a question has been completed.
• Has trouble waiting his/her turn.
• Interrupts or intrudes on others

27. ADHD key points
• Must have symptoms for at least 6 months.
• Symptoms must be present prior to age 7.
• Evidence of significant functional impairment.
• Symptoms are extreme of normal behavior.

28. Treatment
Behavioral therapy
Aims at identifying behaviors that impairs a child’s life and
ultimately improving behavior.
Pharmacological Treatment
• Stimulants : Amphetamine, Dextroamphetamine
• Serotonin and nor epinephrine reuptake inhibitor : Atomoxetine
• α-agonist : Clonidine
• Tricyclic anti Depressant : Imipramine, Clomipramine
• SSRI
• MAOI

29. Autism spectral disorders
Autism spectrum disorder (ASD) commonly referred to as autism,
is a complex developmental brain disorder caused by a
combination of genetic and environmental influences,
Characterized in varying degrees, by communication difficulties,
social and behavioral challenges and repetitive behaviors,
considered to be a life span disorder.
• Auto – Childs are locked within themselves
• Spectrum – wide range of symptoms and severity.

31. Epidemiology
• Over 10 million patients worldwide.
• 1 in 58 children have ASD.
• 4 to 5 times more common among boys than girls.
• Rates of ASD related to differences in diagnostic criteria,
practices, inclusions of sub threshold cases, age, location of the
study.
• Bangladesh – 0.075% of all rural children.
3% prevalence in urban area.

32. Etiology/risk factors
• Mostly unknown
• Genetic
• Risk factors include
Prenatal rubella, CMV infection of mother
GDM
Advanced paternal or maternal age
Use of psychiatric drug of mother during pregnancy

34. 2 core symptoms interaction
Defects in social
interaction and
communication
Restricted and
repetitive Pattern
of behavior
Early signs of Autism
Before 12 months After 12 months
No words
(16 months)
No joyful
expressions
No sharing of
sounds or facial
expressions
No meaningful
two-word phrases
(24 months)
No babbling Lack of social
interaction
No gestures such as
waving or pointing
Prevalence of
behavioral issues
Warning !
What are the symptoms?

35. • Fails to respond to name
• Resists cuddling and holding
• Unaware of others feelings
• Seems to prefer playing alone, living in his/her own life
• Starts talking later than of 2 years of age
• Loses previously acquired ability to say words or sentences
• Does not make eye contact upon request
• May use a singsong voice or robot like speech
• Cant initiate a conversation or keep on going
• May repeat words or phrases
• Performs repetitive movements
• Develops specific routines or rituals
• Disturbed at slightest change in routine
• Moves constantly
• Fascinated by parts of an object, such as spinning wheels
• Sensitive to light, sound, and touch and yet oblivious to pain
Defects in
social
interaction
and
communication
Restricted
and repetitive
Pattern of
behavior
Clinical characteristics

36. Psycho-education and behavioral interventions
• Teach-treatment and education of autistic and related
handicapped children
• Applied behavioral analysis communication
• Alternative communication
• Social skill techniques
• Parental involvement
Psychopharmacology
• Antidepressants, SSRIs, Beta blockers, mood stabilizers etc.
Others
• Sensory and auditory integration, megavitamin therapy, gluten and
casein free diet etc
Referral to an expert on autism and related problems.
Management of ASD

37. Disruptive ,impulse control, conduct disorder
These are an interrelated set of syndromes characterized by a core
deficit of self regulation in anger, aggression and specific behavioral
problems.
Oppositional defiant disorder : Characterized by persistent pattern
of outbursts, arguing, disobedience generally against authority
figure.
Intermittent explosive disorder : Characterized by recurrent verbal
or physical aggression that is grossly inappropriate to provocation.
Some age specific behavioral disorders
Stealing, Lying, Aggression
Cutting and other self injury behavior etc.

38. Childhood psychosis
Childhood schizophrenia
This is not very much common in pediatric age group, but in
adolescent period.
Characterised by active (positive) symptoms like hallucination,
delusion, disorganized speech, disorganized behavior and some
negative symptoms like social withdrawal, loss of motivation and
cognitive impairment
Symptoms last at least for 6 months.
Treatment
• Antipsychotic drugs.
• Cognitive behavior therapy.

39. Eating disorders
Eating disorders are any psychological disorders
characterized by abnormal or disturbed eating habits.
Types
• Pica
• Rumination disorder
• Anorexia nervosa
• Bulimia nervosa

40. Rumination disorder
Rumination disorder is the repeated regurgitation of food, where the
regurgitated food may be rechewed, reswallowed or spit out, for a
period of at least 1 month following a period of normal functioning.
Age of appearance: 1st year of life (Between 3 and 12 months).
Features
• Weight loss
• Malnutrition (Can lead to growth delay
and negative effect on development)

41. • Behavioral treatment: Aims at reinforcing correct eating behavior.
• Aversive conditioning techniques (withdrawal of positive attention):
Considered when a child’s health is at risk.
• In severe dehydration and malnutrition : An intensive integrated
medical-behavioral treatment is needed.
Treatment

42. Pica
DSM-5 criteria, for diagnosing Pica are:
• Persistent eating of non-nutritive substances (e.g., paper, soap,
charcoal, clay, wool, ashes, paint, earth) for at least 1 month.
• Eating is inappropriate to the developmental level of the individual.
• This behavior is not part of the culture or social practice.
• If occurring in the presence of other mental disorders it is severe
enough to warrant independent clinical attention.
EPIDEMIOLOGY
• Most common in childhood (After 2 years of age).
• More common in those with intellectual disability and
autism spectrum disorders.

43. Etiology
• Nutritional deficiencies
(e.g., iron, zinc, and calcium).
• Child abuse and neglect.
• Poor supervision from family.
• Mental disorder
(e.g. autism spectrum disorders).
• Cultural and familial factors.
Treatment
• Proper supervision and play opportunities : To stimulate child
psychology.
• Parental counselling: In case of parental negligence.
• Management of any other concurrent mental disorder.
• Specific treatment: Management of the sequelae related to an
ingested item (e.g. lead poisoning, parasitic Infestation).

44. Anorexia nervosa
It involves overestimation of body size and
shape. It has 2 subtypes
Restrictive subtype: Excessive dieting and
compulsive exercising
Binge-purge subtype: Patients might
intermittently overeat and then attempt to rid
themselves of calories by vomiting or taking
laxatives, still with a strong drive for thinness.

45. Bulimia nervosa
Episodes of eating large
amounts of food in a brief
period, followed by
compensatory vomiting,
laxative use, and exercise
or fasting to rid the body of
the effects of overeating in
an effort to avoid obesity
Fig: cycle of bulimia nervosa

46. Treatment
Prescribing proper nutrition
• Should work to increase weight 0.5-1 lb/week up to 90% of average
weight for age, sex and height (for anorexia nervosa patients).
• Stabilizing intake (for bulimia nervosa patients).
Behavior therapies
Cognitive behavior therapy, dialectical behavior therapy, group therapy.
Drug therapy
Given specially in cases of depression(e.g. SSRIs)

47. Mood disorders
Definition
Mood disorders are sets of psychiatric symptoms characterized
by a core deficit in emotional self-regulation.
Epidemiology
Approximately 1% children in prepubertal phase and 3% children
in pubertal phase.
Types
1. Depressive disorders.
2. Bipolar disorders.

48. Major depressive disorder
Here, a period of at least 2 weeks in which there is a depressed mood
and loss of interest in all activities for most of the day.
Persistent depressive disorder
Characterized by depressed mood for more days (at least 1 year).
Symptoms are less severe than major depressive disorder.
Disruptive mood dysregulation disorder
A severe, persistent irritability evident for at least 1 year, characterized
by frequent temper outbursts and a persistently irritable mood that is
present for most of the day.
Depressive disorders

49. CLINICAL COURSE
• Time of onset: May appear at any age, commonly in puberty.
• Median duration: 5-8 months. The course is quite variable.
• Depressed children appear to be more likely to develop non-
depressive psychiatric disorders in adulthood.(Bipolar disorder in 20%)
• Recurrence : 50%-70% after 5 years.
• Negative prognostic factors
More severe symptoms.
Longer time to remission.
History of maltreatment.
Co-morbid psychiatric disorders.

50. Comorbidity
• Present in 40-90% cases
• Anxiety disorder, ADHD, Eating disorder, Substance use
disorders.
Etiology/ Risk factors
• Twins
• Positive family history
• Physical/sexual abuse.
• Chronic illness.
• School difficulties (bullying,
academic failure).
• Family disharmony.
• Parental psychopathology.
• Domestic violence.

51. Treatment
Guided self-help
This include provision of educational materials (e.g., pamphlets, books,
workbooks, internet sites) that provide information to the youth about dealing
with stressful situations.
Supportive psychotherapy
Focuses on teaching thoughts (e.g., positive self-talk) and behaviors (e.g., pleasurable
activities, problem-solving, effective communication)
Moderate/ severe depression
Cognitive behavior therapy/antidepressant drugs or both
Fig: flow chart of treatment in depressive disorder

52. Bipolar disorders
• More common in teenagers
• It includes manic and depressive episodes.
• Features of manic episodes are
Euphoria.
Excessively cheerfulness
Inflated self-esteem
Feeling of having full energy despite little sleep.
Speech can be rapid, pressured, and loud.
• There are also features of depression.

53. Treatment
Medication
It is the primary treatment
• Atypical antipsychotics are first choice (risperidone, quetiapine)
• Mood stabilizers (lithium carbonate) are also used.
• Antidepressant medication
Psychotherapy : An adjunctive treatment for the bipolar disorders.
Risk of suicide
15 times more than a healthy child.

54. Motor disorders
Motor disorders are interrelated sets of psychiatric symptoms
characterized by abnormal motor movements and associated
phenomena.
Motors disorders include
Tic disorders.
Stereotypic (same type) movement.
Developmental coordination disorders.

55. Tic disorders
A tic is a sudden, rapid, recurrent, nonrhythmic motor movement
or vocalization.
Types
Tourette’s disorder : Both motor and vocal tics have been present
at some time during the illness, although not necessarily
concurrently. (Persists >1 year)
Persistent tic disorders : Motor or vocal tics have been present
during the illness, but not both. (Persists >1 year)
Provisional tic disorders: Single or multiple motor and/or vocal
tics. The tics have been present for less than 1 year.

56. Movements in tic disorder
• Simple motor tics (e.g., eye blinking, neck jerking, shoulder shrugging)
• Complex motor tics (e.g., tapping the foot, imitating someone else’s
movement)
• Simple vocal tics (e.g., throat clearing, sniffing, coughing)
• Complex vocal tics (e.g., partial words ,words out of context)
• Tics are worsened by anxiety,
excitement, or exhaustion.

57. Clinical course
Onset : Typically between ages 4 - 6 years
Peak severity : Between ages 10 - 12 years.
Attenuation of tic severity : By age 18-20 years.
Differential diagnoses
Repetitive movements
• Dystonia
• Chorea
• Compulsions
• Myoclonus
• Akathisia
• Stereotypies
Various neurological diseases
• Wilson’s disease
• Huntington’s syndrome
• Various frontal/subcortical
lesions

58. Epidemiology
Risk factors
• Frontal/ sub frontal lesions.
• Male sex.
• In 1st degree relatives.
• Twins ( 80% in monozygotic and 20% in dizygotic).
As many as 1 in 100 people experience some form of tic
disorder, usually before the onset of puberty

60. Treatment
Options are
• Psychoeducation: Open discussion about patient’s typical
exacerbating and alleviating factors, course of the disease and
treatment options (including no treatment).
• Behavioral therapy : When tics are distressing or functionally
impairing.
• Medications: Should be considered when the tics are causing
severe impairment in the quality of life (Haloperidol, Pimozide
Risperidone etc).

61. Stereotypic Movement Disorder
A psychiatric disorder characterized by repetitive, seemingly
driven, and apparently purposeless motor behavior (stereotypic)
that interferes with social, academic, or other activities that may
result in self-injury.
Examples
Hand shaking or waving, body rocking, head banging, self-biting,
and hitting one’s own body etc.
• Typically begin within the first 3 years of life
• These movements resolve over time.

62. Enuresis
Involuntary passage of urine beyond the age when bladder
control should have been achieved.
Age of onset : usually between 3-8 years.
Types
• Nocturnal only
• Daytime only
• Nocturnal and daytime enuresis
Psychiatric conditions connected to enuresis
Stress, ADHD.

63. Key points about enuresis in psychiatric illness
• Repeated voiding of urine into bed or clothes (involuntary or
intentional)
• Behavior is manifested by a frequency of twice a week for at
least 3 consecutive months.
• Age is at least 5 years.
• The behavior is not due to the direct physiological effect of a
substance (such as a diuretic) or a general medical
condition (e.g, diabetes, spina bifida,seizure disorder etc).

64. Treatment
• Reward the child for dry night.
• UTI, Diabetes mellitus, diabetes insipidus, any other medical
condition should be ruled out.
• Fluid restriction and night lifting to toilet causes temporary
improvement, eventually relapses.
• Bladder training (practicing to hold urine for longer period of
time)
• Conditioning with a alarm when there is bed wetting. It generally
works within weeks.
• Drug therapy : tricyclic anti depressant (imipramine)

65. Encopresis
Involuntary passage of feces beyond the age when bowel control
should have been achieved.
Causes of encopresis
Encopresis is commonly caused by constipation, by
psychological disorders (e.g. anxiety, fear, anger) or
neurological disorders.

66. Key points about encopresis in psychiatric illness
• Age must be at least 4 years.
• A repeated passage of feces into inappropriate places, e.g.,
clothing or floor. (Intentional or involuntary)
• At least 1 event month for at least 3 consecutive months.
• The behavior is not attributable to the effects of a substance,
e.g., laxative, or another medical condition, with the exception
of a mechanism involving constipation.

67. Treatment
• A combination of laxative and sitting on toilet for timed intervals
daily. If no constipation then laxative use not needed.
• Supportive psychotherapy and relaxation techniques useful in
anxiety.

68. Approach at detecting psychiatric disorder
Psychosocial interviewing in a routine pediatric visit is the primary
approach towards assessing a psychiatric disorder.
• Domains which are included in the interview are named HEADSS
(home, education, activities, drugs, sexuality, suicide/depression).
Interview of both children and parents are taken.
• During interview we have to look for signs of psychiatric
disorders which gives clinicians the tools needed to recognize
early symptoms.

69. Mental health action signs
• Feeling very sad or withdrawn for more than 2 weeks.
• Seriously trying to harm or kill thyrself, or making plans to do so.
• Sudden overwhelming fear, sometimes with a racing heart or fast breathing.
• Involvement in many fights or wanting to badly hurt others.
• Severe out-of-control behavior that can hurt thyself or others.
• Not eating, throwing up or using laxatives to lose weight.
• Intense worries or fears that get in the way of daily activities.
• Extreme difficulty in concentrating or staying still.
• Severe mood swings that cause problems in relationships.
• Drastic changes in behavior or personality.

70. Fig : Psychological assessment tools

71. Medical conditions having association with various
psychiatric diseases
• Rumination : Pyloric stenosis, Gastroparesis etc.
• Pica : Iron, Zinc, Calcium deficiency etc.
• Tics : Wilson’s disease, Huntington's disease,
Frontal-subcortical circuit defect etc.
• Anxiety : Hyperthyroidism, Hypoglycemia, pheochromocytoma etc.
• Depression : chronic diseases, hypothyroidism etc.

72. Investigations
Investigations Significance
CBC with PBF Diagnosis of chronic diseases, malignancy
(depression)
Iron deficiency anemia (Pica)
S. Iron profile Iron deficiency (Pica)
S. calcium Calcium deficiency (Pica)
S. T3, T4, TSH Hypothyroidism (can mimic depression)
Hyperthyroidism (can mimic anxiety)
Random blood sugar Hypoglycemia (can mimic anxiety)
SGPT, S. bilirubin, PT Increased (Wilson’s disease)
S. Ceruloplasmin level Decreased (Wilson’s disease)

73. Investigations Significance
24 hour urinary copper Increased (Wilson’s disease)
Urine VMA, catecholamines Increased (pheochromocytoma)
MRI of brain To see if any structural defect
EEG (electroencephalogram) Helpful in diagnosis
Barium meal X-ray, USG of Whole
abdomen
Helpful in diagnosis of Pyloric
stenosis, gastroparesis
Liver biopsy Diagnosis of Wilson’s disease

74. Psychopharmacology
Target symptoms Drugs
Agitation Atypical/typical antipsychotic
Anxiolytic
Aggression Stimulant
Atypical antipsychotic
Anxiety Antidepressant
Anxiolytic
Depression Antidepressant
Hyperactivity, inattention,
impulsivity
Stimulant
Alpha-agonist
Mania Atypical antipsychotic
Psychosis Atypical antipsychotic
Target Symptom Approach to Psychopharmacologic Management

75. Anti psychotics
Atypical antipsychotics
• Aripiprazole
• Olanzapine
• Quetapine
• Risperidone
Typical antipsychotics
• Haloperidol
Antidepressants
Selective serotonin reuptake inhibitors
• Citalopam, Escitalopam, Fluoxetine
Sertraline
Tricyclic antidepressant
• Clomipramine
Atypical antidepressant
• Bupropione
Anxiolytics
• Lorazepam,Clonazepam,Buspirone

76. Stimulants
• Methylphenidate
• Amphetamine
• Dextroamphetamine
• Dexmethylphenidate
Alpha agonists
• Clonidine
• Guanfacine
Mood stabilizers
• Lithium carbonate
• divalproex
Contd..

77. Psychotherapy
The use of psychotherapy involves a series of interconnected
steps including performing an assessment, deciding upon
treatment and monitoring plan, obtaining consent, and
implementing treatment.
Types
• Behavior therapy.
• Cognitive behavior therapy.
• Family therapy.
• Supportive psychotherapy.

78. Behavior therapy
The treatment begins with a behavioral assessment with interview,
observation, diary or rating scale components, along with a
functional analysis immediately preceding external events, and real-
world consequences of the behavior.
A treatment plan is then developed to modify the maladaptive
functions of the behavior, using tools such as positive and negative
reinforcement, punishment, response cost, systematic
desensitization etc.

79. Cognitive behavior therapy
Cognitive behavioral therapy (CBT) is a type of
psychotherapeutic treatment that helps patients understand the
thoughts and feelings that influence behaviors.
Cognitive behavior therapy is focused on helping patients deal
with specific problem. Here the therapist has major role.
During the course of treatment, patient learn how to IDENTIFY
and CHANGE destructive or disturbing thought
by themselves.

80. Conclusion
Mental health is an important component of healthy living and
early diagnosis and management of child psychiatric disorders
can ensure the child a healthy life and a sound adulthood.
10th October is observed as world mental health day worldwide
every year.