This document discusses several psychiatric disorders including conduct disorder, attention deficit hyperactivity disorder, autism, enuresis, encopresis, learning disabilities, and intellectual disability. It provides information on the epidemiology, diagnostic criteria, etiology, classification, symptoms and management of each disorder. Common treatment approaches mentioned include behavioral therapy, medication, family therapy, and special education programs.

1. Psychiatry department
Beni Suef University

2. ⦿cdepression,
⦿phobia,
⦿anxiety and
⦿psychoses
⦿pervasive developmental disorders
⦿ attention deficit/hyperactivity disorder,
⦿conduct disorder and
⦿ mental retardation.
⦿ functional enuresis,
⦿functional encopresis, and
⦿separation anxiety.

3. ⦿ This is a form of disruptive behavior in which
the basic rights of others and age appropriate
societal norms or rules are violated.
⦿Epidemiology
⦿It usually starts before the age of 18 years
⦿male: female ratio 10:1.
⦿ 6-16 % of boys and 2-9 % of girls below 18y have
conduct disorder.

4. ⦿The disorder is either conducted solitary or
in a group (gang).
⦿Aggression may be either direct (overt) or
indirect.
⦿A- Overt aggression is directed to people,
animals or property with the aim of
deliberate injury or destruction.
⦿B- Indirect aggression as shoplifting, lying,
and staying out late at night despite of
parental prohibition.

5. ⦿It is a multifactorial disorder:
⦿1. Genetic factors
⦿2. Organic factors
⦿3. Environmental factors
⦿4. Family factors
⦿5. Social Modeling

6. Family factors
⦿• Neglecting unavailable mother with absence of
support
⦿ • drug abuse or antisocial father
⦿ • Higher psychiatric morbidity among parents
with personality deviation
•Frequent inconsistent punishment
• Increased marital discord
⦿
⦿
⦿ • Disturbed family structure, increased marital
conflicts, divorce and parental violence.

7. 1 For the Child
⦿• Behavioral therapy
⦿• Group therapy
⦿• Pharmacotherapy (to control aggression &
impulsivity)
⦿a. Lithium carbonate
⦿b. Clonidine
⦿c. Anticonvulsants
2 Family therapy
3 Parental training
4 Institutionalization

8. ⦿Epidemiology
⦿This disorder is more common in males than
in females in the ratio 3-5 : l.
⦿ In the United States, its incidence is 3-5 % of
primary school children.
⦿ In Britain, it is less than 1 %.

9. It includes three main criteria:
⦿1- Disturbed attention or concentration:
⦿2- Hyperactivity
⦿3- Impulsivity

10. ⦿1. Genetic factors
⦿2. Organic factors (frontal lobe)
⦿3. Environmental factors (food additives,
preservatives, toxins)

11. 1. Pharmacotherapy:
⦿a. Psychostimulants, e.g.,
dextroamphetamine, methylphenidate
(Ritalin)
⦿b. Antidepressants
⦿c. Antipsychotics
⦿d. Lithium carbonate
2. Special education programs
3. Family therapy

12. ⦿This is a group of psychiatric conditions in
which the expected social skills, language
behavior and behavioral repertoire are
either not developed or are lost in early
childhood before the age of 3 years.
⦿The most common type is Autistic Disorder.

13. ⦿Epidemiology
⦿Autistic Disorder occurs at the rate of 2-5 per
10,000 children under the age of 12. Male to
female ratio is 3-5 to 1.

14. ⦿1. Inability to develop relationship with
people.
⦿2. Delayed development of language skill,
⦿3. Repetitive or stereotyped movements,

15. It is multifactorial including
⦿1. Psychogenic factors
⦿2. Genetic factors
⦿3. Perinatal complications, especially during
the first trimester.
⦿4. Biochemical factors
⦿5. Neurologphysiology: EEG changes in 10-85
% of autistic children

16. ⦿The goal is to decrease the behavioral
symptoms and to help the development of
the delayed functions.
⦿1. Supportive home environment
⦿2. Special educational programs
⦿3. Pharmacotherapy: useful in modifying and
controlling behavior
high potency neuroleptics
Selective Serotonin Reuptake Inhibitors
(SSRI)

18. ⦿ Functional Enuresis
⦿ Enuresis is the repeated voiding of urine into
the child's clothes or bed.
⦿ It may be involuntary or intentional.
Nocturnal bed wetting is the most common
form.
⦿ Daytime control usually precedes nocturnal
control by 1-2 years.

19. ⦿Prevalence of enuresis varies greatly in
different groups, in the States 7 % of 5 year
olds are enuretic.

20. ⦿T
o diagnose functional enuresis:
⦿1. The child must be at least 5 years old
⦿2. Wetting is repetitive
⦿3. Medical causes should be ruled out
particularly in secondary enuresis.
⦿Most common medical causes are urinary
tract infection, diabetes, seizure disorders
and congenital abnormalities.

21. ⦿• Primary: if bladder control has never been
achieved
⦿• Secondary: if urinary incontinence
reappearance after maintainmg competent
functions for 1 year.

22. ⦿1.Restricting fluids before bedtime
⦿2.Waking the child during the night.
⦿3. Rewarding successful dry nights.
⦿4. Bladder training during the day
, i.e.,
delaying bladder emptying
⦿5. Medications: given before going to bed,
such as:
imipramine (Tofranil),
desmopressin (synthetic ADH)
anticholinergic drugs.

23. ⦿It is characterized by fecal soiling of clothes.
Medical evaluation is necessary before
labeling the disorder as functional.
⦿Epidemiology
After the age of four years, encopresis occurs
3-4 times more in boys than in girls. There is
a significant relation between encopresis and
enuresis.

24. ⦿Diagnosis
⦿1. The child is at least 4 years old.
⦿2. Encopresis occurs at least once a month
for at least 3 months.
⦿3. Medical causes should be excluded.

25. ⦿a. Primary or secondary: primary if no bowel
control has been achieved, and secondary if the
child has learned control for one year.
⦿b. With constipation and overflow, or without
constipation:
⦿75 % of encopretic children have constipation.
⦿There is fecal concretion with overflow of fluid
fecal matter.
⦿Incontinence without constipation results in
intermittent production of formed stools.

26. ⦿1. For encopresis without constipation, a
behavioral program gives rewards for just
sitting on the toilet then later for moving
bowels appropriately.
⦿2. For children with severe retention or
impaction cleaning out the bowel initially (
enemas), followed by retraining the bowel
(high roughage diet, developing of a toilet
routine) are used in addition to behavioral
program
⦿3. In resistant cases individual and family
psychotherapeutic interventions are needed.

27. ⦿These disorders are termed academic skills
disorders.
⦿These children usually present with one of
the basic psychological problems involved in
understanding or in using spoken or written
language.
⦿ They usually present with poor scholastic
achievement despite their average
intelligence as assessed by the individually
administered standardized intelligence tests.

28. ⦿Impairment in the academic areas includes
disorders in:
⦿• Reading
⦿• Mathematics
⦿• Written expression.
⦿It might be associated with:
⦿1. Delayed speech
⦿2. Anxiety and other emotional problems.
⦿3. They may as well present behavioral
problems such as alienation or rebellion.

29. ⦿Etiology
⦿It includes a variety of neurocortical deficits
resulting in various
⦿disruptions of cognitive processing, e.g.
difficulty in visual spatial or linguistic
processing.

31. ⦿Management
⦿1. Special assessment including 1Q, EEG,
plain X ray skull, and CT scan brain
⦿2. Special educational programs with special
scholastic placements.
⦿3. Family counseling and training programs to
help in the education.
⦿4. T
eacher's education to help in the
education progress
⦿5. Psychotherapy for the patient and family
.

32. ⦿The diagnosis of Mental Retardation MR
requires both low intelligence (IQ less than
70) and
⦿deficits in adaptive functions i.e. impairment
of skills manifested during the
developmental period (before the age of 18
years)
⦿including cognitive, language, motor and
social abilities.

33. ⦿Classification
⦿The intelligence quotient was calculated
from the following formula:
⦿IQ= mental age/ chronological age x 100
⦿On basis of IQ : mental retardation is
classified into:
⦿Mild:
⦿Moderate:
⦿Severe:
⦿Profound:
IQ 50-69
IQ 35-49
IQ 20-34
IQ below 20

34. a. Biological Causes:
⦿Genetic Factors
⦿Prenatal Factors
⦿Perinatal Factors
⦿Causes during Infancy or childhood
b. Psychosocial Causes

35. ⦿Majority (85%) of those with M.R.
• Self care and living skills:
⦿Most have no difficulty in achieving full
independence in self-care (eating, washing,
dressing, and sphincteric control).
⦿They may need help with planning a budget.
• Language and communication skills:
⦿Most achieve the ability to use speech for
everyday purposes and can hold conversations
in normal circumstances.
• Education and occupation:
⦿ Educable, many have difficulties reading and
writing, but can achieve an academic level of
grade 6.
⦿They can hold a job.

36. ⦿ 10% of those with M.R.
• Self care and living skills:
⦿Achievement of self care and motor skills is retarded, yet
they can be trained to attain considerable independence in
daily living but they need supervision.
⦿ They are usually capable of managing pocket money but
find difficulty in calculating the change due.
• Language and communication skills:
⦿Slow in developing comprehension and use of language,
however they are usually able to communicate adequately.
• Education and occupation:
⦿Limited progress with school work, usually not beyond the
academic level of grade 2,
⦿ They are trainable.
⦿ Some adults can carry out simple manual work.

37. ⦿4% of those with M.R.
⦿ • Self care and living skills: They need a
great deal of supervision as their self-care
and motor skills are markedly impaired.
⦿They are dependent on others for money
arrangement
⦿• Language and communication skills: The
development of comprehension and use of
language is very limited and communication
is often not by speech.
⦿• Education: Below first grade. They are not
trainable.

38. Profound M.R. (IQ below 20):
1% of MR
•Self care and living skills: Constant help
and supervision is needed for basic needs.
• Language and communication skills:
Severely limited in ability to understand
language.
They communicate in a very limited non-
verbal way.
• Education: Extremely limited

39. ⦿For mental retardation at all levels of
severity, the developmental course is
SLOW but not deviant.
⦿ Although the normal sequence of
developmental stages occurs, the speed of
developmental change is slow and there is
a ceiling on ultimate achievement.

40. ⦿Mentally retarded children are four to five times
at a higher risk to have a psychiatric disorder
than children with normal intelligence.
⦿The most common constellation of symptoms
includes:
⦿ irritability,
⦿hyperactivity,
⦿ impulsivity,
⦿short attention span and
⦿language delay.
⦿aggressive temper outbursts.

41. ⦿1. Early detection of treatable causes as
hypothyroidism and malnutrition.
⦿2. Proper comprehensive evaluation to address the
multiple disabilities and complications associated
with MR whether medical or psychiatric.
⦿3. Parental guidance: support, education, genetic.
⦿4. Detecting strengths and weaknesses
⦿5. Specialists for speech therapy.
⦿6. Behavior modification
⦿7. Psychotherapy (mild MR) to enhance self-esteem,
social and emotional development and behavioral
control.
⦿8. Treatment of co-morbid conditions e.g. depression
or ADHD.