Download CHILD PSYCHIATRY

CHILD
PSYCHIATRY
Dr.sadeghiyeh
CHILD &ADOLESCENT PSYCHIATRIST
ASSISTANT PROFESSOR OF MEDICAL UNIVERSITY
ADHD
( Attention Deficit Hyperactivity Disorder)
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%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:
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3 Category of symptoms including:
Hyperactivity, Inattention, Impulsivity in
TWO Situations Before 7 years old
ADHD
Course & Prognosis:
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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
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ODD (Oppositional Defiant Disorder)
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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
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%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 )
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ONSET : Late Childhood & Early
Adolescence
M>F (4-12/1 )
Low SES
CD
Clinical Manifestation :
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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 :
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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:
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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 :
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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
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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
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Early onset / chronic course / poor
prognosis
Specific Abilities
PDD
Treatment :
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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:
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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
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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:
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Psychotherapy
.Drug Therapy
ENURESIS
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%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
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ENURESIS
Diagnosis:
Urination : Voluntary/Involuntary;
in Bed/Clothes; After 5Yrs old
2 time/week for 3 consecutive
monthes
ENURESIS
DDX
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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
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Toilet Training2-3 Yrs)
NOT:Harsh
Discipline/Punishment/Stress&
Discord
ENURESIS
Treatment:
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Family Consultation
Behavior Therapy (Star Chart,….)
Drug Therapy (Imipramine
,DDAVP,….)
MENTAL RETARDATION(MR)
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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)
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MILD MR
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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
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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
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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
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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
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BEHAVIORAL PATTERN
Cognitive Deficit
Egocentricity, Concrete Thinking
 Neurological Deficit
Hyperactivity, Short Attention Span,
Aggressivity
 Self perceptions
Insufficiency, Dependency, Frustration, Low
Selfesteem
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TREATMENT
Prevention (Primary ,Secondary, Tertiary)
 Psychiatric Problems
Drug Therapy
Individual Psycho&Behavioral Therapy
Family Consultation
Cognitive Behavioral Therapy (CBT)
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