Transcript Child psychiatry

Child Psychiatry
Prof. MUDr. Ivana Drtílková, CSc.
Dept. of Psychiatry,
Masaryk University , Brno
Child Psychiatry
Conduct Disorder
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genetic and environmental components
more common among boys(6-16%)
than girls (2-9%)
Child Psychiatry
Diagnosis : repetitive and persistent pattern of
behavior in which the rights of others or basic
social rules are violated.
 Aggressive behavior that causes or threatens
harm to other people or animals,
( bullying or intimidating others, initiating
physical fights..),
 Non-aggressive conduct ( property loss or
damage, fire-setting ..)
 Deceitfulness or theft
 Serious rule violations, ( running away from
home overnight, often being truant from school.)
Child Psychiatry
Treatment: family therapy, and cognitive
behavioral approaches which focus on
building skills such as anger management.
Pharmacological intervention alone is not
sufficient..
Bed-Wetting
(Primary Nocturnal Enuresis)
Bed-wetting is accidental urination during
sleep.
 children over age 5 or 6 ( age at which
continence could definitely be expected)
 Bed-wetting that develops after a child has
been dry for a period of time (secondary
nocturnal enuresis)
Bed-Wetting
(Primary Nocturnal Enuresis)
Cause for bed-wetting:
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Delayed growth and development.
Small bladder capacity.
Lack of enough antidiuretic hormone (ADH).
Sound sleeping.
Psychological and social factors.
Bed-Wetting
(Primary Nocturnal Enuresis)
Medications :
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that either increase the amount of urine
that the bladder can hold bladder
capacity- (imipramine)
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or decrease the amount of urine released
by the kidneys ( desmopressin).
TIC DISORDERS
Tics are : abrupt, purposeless, and involuntary
vocal sounds or muscular jerks.
They are sudden, rapid, and recurrent.
1. Transient tic disorder - the most common
type , with symptoms lasting at least four
months, but no longer than one year.
Onset - nearly 10 percent of school childrenmore prevalent in periods of stress, fatigue, or
as a result of certain types of medications
( stimulants)
TIC DISORDERS
2. Chronic tics- lasting more than one year
3. Tourette's disorder (TD)
Tourette's disorder is an autosomal dominant
disorder with incomplete penetrance.
Non-genetic cause in 10 to 15 percent of
children (complications of pregnancy, low
birthweight, head trauma, carbon monoxide
poisoning, and encephalitis..).
TIC DISORDERS
3. Tourette's disorder (TD)
Tourette's disorder (TD multiple repeated tics
(abrupt, purposeless, and involuntary vocal
sounds or muscular jerks.)
Begin : between the ages of 5 and 10 years of
age
TIC DISORDERS
Tourette a disorder - symptoms may include:
involuntary, purposeless, motor movements
(the face, neck, shoulders, trunk, or hands)
 head jerking
 squinting
 blinking
 shrugging
 grimacing
 nose-twitching
TIC DISORDERS
Tourette a disorder - symptoms may include:
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any excessively repeated movements
(i.e., foot tapping, leg jerking, scratching)
kissing
pinching
sticking out the tongue or lip-smacking
making obscene gestures
TIC DISORDERS
Tourette a disorder is also characterized by
one or more vocal tics :
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grunting or moaning sounds
barks
tongue clicking
sniffs
hooting
obscenities
throat clearing, snorts, or coughs
TIC DISORDERS
Tourette a disorder is also characterized by
one or more vocal tics :
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squeaking noises
hissing
spitting
whistling
gurgling
echoing sounds or phrases repeatedly
CHILDHOOD
SCHIZOPHRENIA
Definition:
Same diagnostic criteria apply to children,
adolescents, and adults
Based symptoms : deficits in adaptive functioning,
and duration of six months
Incidence :
less than 1/10,000 births
CHILDHOOD
SCHIZOPHRENIA
General Characteristics:
1. Slight male predominance
2. Less educated and professionally successful
families
3. Patients have low-average to average range
of intelligence
4. Patterns of behavior before a formal diagnosis:
attention/conduct problems, earlier patterns of
inhibition, withdrawal and sensitivity
CHILDHOOD
SCHIZOPHRENIA
General Characteristics:
5. Disease is rarely observed before age 5
6. 80% of children have auditory hallucinations;
50% have delusional beliefs
7. Can be observed with additional conditions such
as: conduct disorder, learning disabilities,
mental retardation, and autism
8. Poor prognosis if onset before age 10 with
above personality difficulties
CHILDHOOD
SCHIZOPHRENIA
CHARACTERISTIC SYMPTOMS :
Positive symptoms ( productive ) :
Delusions
Hallutiations
Disorganised speech (often incoherence )
Grossly disorganized or catatonic behavior
CHILDHOOD
SCHIZOPHRENIA
CHARACTERISTIC SYMPTOMS :
Negative symptoms ( nonproductive ) :
affective flattening
social dysfunction
Problematic in children - fantasy figures,
which would not of themselves
suggest psychosis.
The content of hallutiations and delusions varies
with age.
CHILDHOOD
SCHIZOPHRENIA
TREATMENT :
Antipsychotics are the drugs of first choice in
chilhood for schizofrenia
Imortance : minimizing any cognitive dulling in
school children , atypical antipsychotics are
preferred (risperidone, olanzapine).
DEPRESSION IN CHILDERN
Risk factors in their lives which could predispose:
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family history of mental illness or suicide,
abuse (physical, emotional or sexual),
chronic illness and the loss of a parent at an
early age to death,
divorce or abandonment.
The depression could be wholly chemical, wholly
due to psychological factors, or combination of the
two.
DEPRESSION IN CHILDERN
Symptoms of Depression in Children
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Persistent sadness and/or irritability.
Low self-esteem or feelings or worthlessness.
A child may make such statements as, "I'm
bad. I'm stupid. No one likes me."
Loss of interest in previously enjoyed
activities.
Change in appetite (either increase or
decrease).
Change in sleep patterns (either increase or
decrease).
DEPRESSION IN CHILDERN
Symptoms of Depression in Children
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Difficulty concentrating.
Anger and rage
Headaches, stomachaches or other physical
pains that seem to have no cause.
Changes in activity level( more lethargic or
more hyperactive. )
Recurring thoughts of death or suicide.
DEPRESSION IN CHILDERN
If the child has bipolar disorder, also known
as manic depression, these symptoms could
be present:
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abrupt, rapid mood swings
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periods of extreme hyperactivity
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prolonged, explosive temper tantrums or rages
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exaggerated ideas about self or abilities
Bipolar disorder is often mis-diagnosed as
attention-deficit disorder with hyperactivity
(ADHD), obsessive-compulsive disorder (OCD),
oppositional defiant disorder or conduct disorder.
AUTISM IN CHILDREN
First described : Leo Kanner in 1943
as a disturbance of affective contact
Prevalence: 4-5 cases per 10000
The basic criteria :
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early onset (before 3-5 years of age),
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severe abnormality of reciprocal social
relatedness,
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severe abnormality of communication
development,
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restricted, repetitive and stereotyped patterns
of behavior, interests, activities, and
imagination;
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abnormal responses to sensory stimuli.
AUTISM IN CHILDREN
SOCIAL DISTURBANCE
The human face holds little interest for the autistic
infant
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lack of eye contact, poor or absent
attachments
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general lack of social interest
COMMUNACATIVE DISTURBANCE
echolalia, pronoun reversal, inappropriate
cadence and intonation, impaired semantic
development
AUTISM IN CHILDREN
COGNITIVE DEVELOPMENT
Most ( approximately three-fourths ) autistic
children scored in the mentally retarded range
A few autistic individuals exhibit truly remarkable
abilities( musical or drawing ability . memory
BEHAVIOR FEATURES
Restricted repetitive and stereotyped patterns of
behavior, interests and activities.
Interest in nonfunctional aspects of objects
( taste or feel )
AUTISM IN CHILDREN
Stereotyped movements ( hand flapping, toe
walking, spinning objcts and the like).
Bizare affective responses - panicked in
response to new situations.
Deficits in imaginative play.
AUTISM IN CHILDREN
ETIOLOGY AND PATHOGENESIS
There may be a genetic basis to the disorderfamily members with other related disabilities
Autistic children exhibited :
an increased frequency of physical anomalies,
persistent primitive reflexes,
various neurological soft sings and
increased abnormalities on EEG.
Treatment
Drug treatments ( risperidone )
Other therapies : behavioral treatments (teaching
autistic "appropriate" behaviors).
Attention deficit hyperactivity
disorder ( ADHD)
CHARACTERISTIC :
1). INAPPROPRIATE OR EXCESSIVE ACTIVITY
2). POOR SUSTAINED ATTENTION
3). DIFFICULTIES IN INHIBITING IMPULSES IN
SOCIAL BEHAVIOR AND ON COGNITIVE
TASKS.
4). DIFFICULTIES GETTING ALONG WITH OTHERS
5). SCHOOL UNDERACHIEVEMENT
PREVALENCE :
8 % OCCURS BETWEEN 6 - 8 YEARS
IN BOYS - 9 % IN GIRLS - 3 %
Attention deficit hyperactivity
disorder ( ADHD)
Type of disorder
ADHD combined type
ADHD predominantly inattentive type
ADHD predominantly hyperactive-impulsive type
Attention deficit hyperactivity
disorder ( ADHD)
Cause of ADHD
suspected contributing factors may include:
Neurophysiology - differences in brain
anatomy, electrical activity and metabolism.
Catecholamine function are very probably
involved in the pathogenesis of hyperactivity.
Genetics - possible gene mutations may be
present.
Attention deficit hyperactivity
disorder ( ADHD)
Cause of ADHD
suspected contributing factors may include:
Drugs - drug use (nicotine and cocaine) by the
mother during pregnancy .
Lead - chronic exposure - influence behaviour
and brain chemistry.
Lack of early attachment - traumatic
experiences related to the attachment
Attention deficit hyperactivity
disorder ( ADHD)
Therapy of ADHD
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behavioural management, psychological
counselling
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drugs target the brain's neurotransmitters (
stimulants, antidepressants..)
Stimulant drugs
Dexamphetamine and methylphenidate (Ritalin)
work by acting on the neurotransmitters that
release the chemical dopamine.
About 7O % of children with hyperactivity
improve on a stimulant regimen.
Attention deficit hyperactivity
disorder ( ADHD)
Inattention criteria
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Fail to give close attention to details or make
careless mistakes in school work.
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Have difficulty sustaining attention in tasks or
play activities.
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Not seem to listen when spoken to directly.
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Not follow through on instructions and fail to
finish school work, chores or duties in the
workplace
Attention deficit hyperactivity
disorder ( ADHD)
Inattention criteria
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Have difficulty organising tasks and activities.
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Avoid, dislike or be reluctant to engage in
tasks that require sustained mental effort
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Lose things necessary for tasks or activities
(for example: toys, school assignments,
pencils, books or tools).
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Be easily distracted.
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Be forgetful in daily activities.
Attention deficit hyperactivity
disorder ( ADHD)
Hyperactivity-impulsivity criteria
Hyperactivity
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Often fidgets with hands or feet or squirms in
seat.
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Often leaves seat in classroom or in other
situations in which remaining seated is
expected.
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Often runs about or climbs excessively in
situations in which it is inappropriate
Attention deficit hyperactivity
disorder ( ADHD)
Hyperactivity-impulsivity criteria
Hyperactivity
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Often has difficulty playing or engaging in
leisure activities quietly.
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Is often 'on the go' or often acts as if 'driven
by a motor'.
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Often talks excessively
Attention deficit hyperactivity
disorder ( ADHD)
Hyperactivity-impulsivity criteria
Impulsivity
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Often blurts out answers before questions
have been completed.
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Often has difficulty waiting in turn.
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Often interrupts or intrudes on others (for
example, 'butts into' conversations or games).
Child Psychiatry
References :
Child and Adolescent Psychiatry, edited
by Melvin Lewis, Wiliams and Wilkins,
1996, 1260 pp.