CHILD PSYCHIATRY
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Transcript CHILD PSYCHIATRY
CHILD
PSYCHIATRY
Dr.sadeghiyeh
CHILD &ADOLESCENT PSYCHIATRIST
ASSISTANT PROFESSOR OF MEDICAL UNIVERSITY
ADHD
( Attention Deficit Hyperactivity Disorder)
%3-5 school age children
M/F ratio 2 to 9/1
Onset: Up to 3 years old BUT Diagnosis in
time of entrance to school
ADHD
ETIOLOGY
Unclear
Genetic
Minimal brain trauma in neonate
Delivery Injuries
Malnutrition
Impair of CNS Development (Esp.Frontal)
Prematurity
ADHD
Clinical Manifestations
IN NEONATE
Hypersensitive to environmental stimulus
(agitation)
IN PRESHOOL
Uncontrollable, long awakening, severe
hyperactivity, risky behavior
ADHD
IN SCHOOL AGE
Restlessness
Inattention
Academic Problems
Forgetfulness, loss of objects
Impulsivity
Disorganized writing
ADHD
Diagnosis:
3 Category of symptoms including:
Hyperactivity, Inattention, Impulsivity in
TWO Situations Before 7 years old
ADHD
Course & Prognosis:
Variable
In %50-80 of child continue toAdolescence
Remission of Symptoms:
FIRST Hyperactivity & Least Inattention
ADHD
Treatment:
DRUG Therapy
First choice is MPH(Ritalin)….
Antidepressants
Antipsychotics
Clonidine (comorbid with Tic)
BEHAVIOR Therapy
ODD (Oppositional Defiant Disorder)
An enduring pattern of negativistic,
hostile & defiant behavior
Behavior is toward authority
figure/without responsibility &
shame/blaming on others
Difficulty in peer relationship
Not resort Physical Aggression or
Destructive Behavior
ODD
%2-16
Typically noted by 8 years/Not later
than Adolescence
Pre puberty :M>F Post puberty:
M=F
ODD
Clinical Manifestations:
Argue with Adults; angry, resentful,
annoyed by others
Presentation in Home, with well
known others, more distress for
around child
Normal IQ
Vulnerable to: Substance Abuse,
Conduct Disorder
ODD
Prognostic Factors:
Family Function / Psychiatric
Comorbidity
Treatment:
Family Intervention
Behavior Therapy
Individual Psychotherapy (Adaptive
Response)
CD ( CONDUCT DISORDER )
ONSET : Late Childhood & Early
Adolescence
M>F (4-12/1 )
Low SES
CD
Clinical Manifestation :
Disobedience from parents
Threatening / Physical Aggression /
Bullying
Use Of Weapons / Animal hurt
Destruction of Property / Stealing / Lying
Escape From Home & School
Lack of remorse & guilt feeling
Irritability , Impulsivity , unresponsibility
CD
Etiology :
Genetic Backgrounds
Psychological Factors :
Divorce Or Separation Of parents
Substance Abuse
Disorganized Family
Poverty/ unemployment / Harsh
Discipline
CD
Course & Prognosis :
Remission of symptoms with time &
Adulthood
%25 – 40 of CD convert to
Antisocial PD
Academic Problem , Subst.abuse ,
unwanted pregnancy, Somatic
injury (due to aggression & accident
)
CD
Treatment:
Individual & Group Psychotherapy
Supportive Psychotherapy
PMT ( Limit Setting , Responsibility
,…)
Family and behavior therapy
Drug therapy ( LI , CBZ , Clonidine
,…)
PDD ( Pervasive Developmental
Disorder )
Autistic Disorder is the most
common type of PDD
Diagnosis :
Onset < 3 years old
Impairment in social interaction ,
communications &stereotypic
behavior
PDD
Clinical Manifestations :
First symptom: impair in social
interaction /Mark Delay in Language
development
Loss Of : Communication with parents /
Social Smile / Eye contact / Stranger
anxiety
PDD
Echolalia / Impairment in Tone &
rate of voice
Stereotyped & repetitive : Activities
/ Interest / Behaviors
Hyper or hyposensitivity to sensory
stimulus /Untolerable to Changes
Lack of curiosity & initiatory in play
Enjoy Music
PDD
Course & prognosis
Early onset / chronic course / poor
prognosis
Specific Abilities
PDD
Treatment :
Refer to Specialist
Inform Parents : Cause /
destigmatization / Education of
some skills / Family Consultation
Specific Education & Program
Drug : AP , Mood Stabilizer ,
Antidepressants
MAJOR DEPRESSIVE
DISORDER(MDD)
%2 of School Age Children
ETIOLOGY:
Familial (Genetic Factors)
Biologic Factors
Social Factors
MAJOR DEPRESSIVE
DISORDER(MDD)
Clinical Manifestations:
Dx is As Adults
In Preadolescents:
Tempertantrumes, Psychomotor
Agitation ,Restlessness, Anhedonia,
Somatic Complaints, Hallucination
MAJOR DEPRESSIVE
DISORDER(MDD)
In Adolescents:
Hopelessness, PMR, Oppositional Behavior
,CD,SUD
Restlessness,Aggression,Isolation,Academic
Problems
PROGNOSIS :
Early onset: Most Severe & Chronic Course
TREATMENT:
Psychotherapy
.Drug Therapy
ENURESIS
%7 Males,%3 Female in 5 Yrs old
Etiology
Genetic(%75)
Low volume Bladder
Delay Development (in sphincter
control)
Lack of Toilet Training
Family Stress &Discord
School entrance
a
l
e
s
ENURESIS
Diagnosis:
Urination : Voluntary/Involuntary;
in Bed/Clothes; After 5Yrs old
2 time/week for 3 consecutive
monthes
ENURESIS
DDX
UTI
.UT Anomalies
Diabetes
.Epilepsy
Neurogenic Bladder
Sickle cell Anemia
Drugs: Phenothiazines
Based on HX, Ph Exam, CBC, U/A U/C
ENURESIS
Course & Prognosis
Remission up to Puberty (often)
Persistent Family Stress: Poor
Prognosis
Prevention
Toilet Training2-3 Yrs)
NOT:Harsh
Discipline/Punishment/Stress&
Discord
ENURESIS
Treatment:
Family Consultation
Behavior Therapy (Star Chart,….)
Drug Therapy (Imipramine
,DDAVP,….)
MENTAL RETARDATION(MR)
Is defined significantly Subaverage
Intellectual Functioning(<70) WITH
Impairment in Adaptive Behavior before
Age 18
Prevalance:%1-3
Highest Incidence: School Age Children with
PEAK 10-14 Yrs old
M:1/5 F
Classified in 4 Category:
Mild MR(%85)
Moderate MR(%10)
Severe MR(%4)
Profound MR(1-2)
MILD MR
IQ:50-55 TO 70
Diagnosable: Entrance to School (Grade 1-2)
Educable
Specific Causes NOT Detectable
Can live Independently with Appropriate
Support
MODERATE MR
IQ:35-40 TO 50-55
Diagnosis: Pre School Age
Most, Acquire Language &can Communicate
during Early Adulthood
Academic Achievement: Max: Grade 2-3
SEVERE MR
IQ:20-25 TO 35-40
Diagnosis: Up to 2 Yrs
May develop Communication Skills,Can
Learn Counts & Words that critical for
functioning
Causes of MR is More Identifiable
PROFOUND MR
IQ <20
Most Identifiable Causes
May taught Self-care Skills &Learn to
Communicate their needs with Appropriate
Training
ETIOLOGY
Non Organic(%75)
Mild, Familial Pattern, Role of SES
Depreviation
Organic(%25)
Prenatal :Chromosomal, Infection, …
Natal: Cardiovascular Shock, Prematurity
Postnatal: Trauma, Infection, Endocrine
BEHAVIORAL PATTERN
Cognitive Deficit
Egocentricity, Concrete Thinking
Neurological Deficit
Hyperactivity, Short Attention Span,
Aggressivity
Self perceptions
Insufficiency, Dependency, Frustration, Low
Selfesteem
TREATMENT
Prevention (Primary ,Secondary, Tertiary)
Psychiatric Problems
Drug Therapy
Individual Psycho&Behavioral Therapy
Family Consultation
Cognitive Behavioral Therapy (CBT)