Child and Adolescent Psychiatry - Psychiatry - Lecture Slides, Slides of Psychiatry

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Child Psychiatry Docsity.com Child and Adolescent Psychiatry Differences of Child psychiatry from adult psychiatry: • The child’s existence and emotional development depends on the family or care givers - cooperation with family members; sometimes written consent • The developmental stages are very important assessment of the diagnosis • Use of psychopharmacotherapy is less common in comparison to adult psychiatry • Children are less able to express themselves in words • The child who suffers by psychiatric problems in childhood can be an emotionally stable person in adulthood, but some of the psychic disturbances can change a whole life of the child and his family Docsity.com F80.0 Specific Speech Articulation Disorder • A specific developmental disorder in which the child's use of speech sounds is below the appropriate level for its mental age, but in which there is a normal level of language skills. • The articulation abnormalities are not caused by a neurological abnormality and nonverbal intelligence is within normal range. • Developmental: – phonological disorder – speech articulation disorder • Dyslalia • Functional speech articulation disorder • Lalling Docsity.com F80.1 Expressive Language Disorder • A specific developmental disorder in which the child's ability to use expressive spoken language is markedly below the appropriate level for its mental age, but in which language comprehension is within normal limits. • There may or may not be abnormalities in articulation. • Developmental dysphasia or aphasia, expressive type Docsity.com F80.2 Receptive Language Disorder • A specific developmental disorder in which the child's understanding of language is below the appropriate level for its mental age, particularly in more subtle aspects of language - grammatical structures, tone of voice. • The social reciprocity and make- believe play is normal and severe hearing disturbances are not present. • Developmental: – dysphasia or aphasia, receptive type – Wernicke's aphasia • Word deafness Docsity.com F81 Specific Developmental Disorders of Scholastic Skills F81 Specific developmental disorders of scholastic skills F81.0 Specific reading disorder F81.1 Specific spelling disorder F81.2 Specific disorder of arithmetical skills F81.3 Mixed disorder of scholastic skills F81.8 Other developmental disorders of scholastic skills F81.9 Developmental disorder of scholastic skills, unspecified Disorders in which the normal patterns of skill acquisition are disturbed from the early stages of development. Docsity.com F81.0 Specific Reading Disorder • The child’s reading performance is below his level of mental age. Poor schooling, mental or visual impairment is not the cause of the delay. • The child has difficulties in reciting the alphabet, there are omissions of words, distortions of the content of the facts from material read and rate of reading is very slow. • Associated emotional and behavioural disturbances are common during the school age period. – "Backward reading" – Developmental dyslexia – Specific reading retardation Docsity.com F81.1 Specific Spelling Disorder • Specific and significant impairment in the development of spelling skills in the absence of a history of specific reading disorder, which is not solely accounted for by low mental age, visual acuity problems, or inadequate schooling. • The ability to spell orally and to write out words correctly are both affected. – Specific spelling retardation (without reading disorder) Docsity.com F82 Specific Developmental Disorder of Motor Function • Serious impairment in the development of motor coordination that is not solely explicable in terms of general intellectual retardation or of any specific congenital or acquired neurological disorder • The child is generally clumsy in fine and gross movements; there are difficulties in learning to tie shoe laces, to run, to throw the balls. Drawing skills are usually also poor • In most cases - marked neurodevelopmental immaturities – Clumsy child syndrome – Developmental: • coordination disorder • dyspraxia Docsity.com Treatment • The family and the school have to be properly informed about the child’s disorder. • Special educational training is necessary, nootropic drugs are useful. • For children with coordination difficulties special physical education programs may be help to enhance the child’s self- esteem and ability to interact with peers. Docsity.com F84 Pervasive Developmental Disorders F84 Pervasive developmental disorders F84.0 Childhood autism F84.1 Atypical autism F84.2 Rett's syndrome F84.3 Other childhood disintegrative disorder F84.4 Overactive disorder associated with mental retardation and stereotyped movements F84.5 Asperger's syndrome F84.8 Other pervasive developmental disorders F84.9 Pervasive developmental disorder, unspecified Disorders characterized by qualitative abnormalities in reciprocal social interactions and in patterns of communication, and by a restricted, stereotyped, repetitive repertoire of interests and activities. Docsity.com Treatment • Specific treatment is unknown. • Autistic children usually require special schooling or residential schooling although attempts of integrations are also started. • Special techniques for teaching autistic children and special psychotherapeutic approaches were developed. • Sometimes antipsychotic drugs and antidepressants are used to cope with aggressive behaviour and depression. Docsity.com F84.1 Atypical Autism • A type of pervasive developmental disorder that differs from childhood autism either in age of onset or in failing to fulfill all diagnostic criteria • Abnormal and impaired development manifests after age 3 years or there are impairments in communication and stereotyped behaviour is present, but emotional response to caregivers is not affected. • Atypical autism is diagnosed often in profoundly retarded individuals. – Atypical childhood psychosis – Mental retardation with autistic features Docsity.com F84.2 Rett's Syndrome (Described by Rett 1964) • The syndrome was described only in girls • Normal early development is followed by partial or complete loss of speech and of skills in locomotion and use of hands, together with deceleration in head growth • In most cases onset is between 7 and 24 months of age. • Loss of purposive hand movements, hand-wringing stereotypies, and hyperventilation • Social interaction is poor in early childhood, but can develop later • Motor functioning is more affected in middle childhood, muscles are hypotonic, kyphoscoliosis and rigid spasticity in the lower limbs occurs in majority of cases • Aggressive behaviour and self injury are rather rare, the antipsychotic drugs for the control of challenging behaviour is not often needed. Docsity.com Behavioural and Emotional Disorders with Onset Usually Occurring in Childhood and Adolescence (F90-F98) F90 Hyperkinetic disorders F91 Conduct disorders F92 Mixed disorders of conduct and emotions F93 Emotional disorders with onset specific to childhood F94 Disorders of social functioning with onset specific to childhood and adolescence F95 Tic disorders F98 Other behavioural and emotional disorders with onset usually occurring in childhood and adolescence Docsity.com F90 Hyperkinetic Disorders F90 Hyperkinetic disorders F90.0 Disturbance of activity and attention F90.1 Hyperkinetic conduct disorder F90.8 Other hyperkinetic disorders F90.9 Hyperkinetic disorder, unspecified Docsity.com F90 Hyperkinetic Disorders • Hyperkinetic disorders occur mostly in first five years of life, and they are several times more frequent in boys than in girls • The main marks of the syndrome are: – inattention – impulsivity – hyperactivity • ADHD: Attention-Deficit Hyperactivity Disorder (formerly MBD: minimal brain dysfunction) • Prevalence is from 3% to 10% of elementary-school children Docsity.com F91 Conduct Disorders F91 Conduct disorders F91.0 Conduct disorder confined to the family context F91.1 Unsocialized conduct disorder F91.2 Socialized conduct disorder F91.3 Oppositional defiant disorder F91.8 Other conduct disorders F91.9 Conduct disorder, unspecified Conduct disorders are diagnosed when the child is showing persistent and serious dissocial or aggressive behaviour patterns, such as excessive fighting or bullying, cruelty to animals or other people, destructiveness to property, stealing, lying, and truancy from school and running away from home. Docsity.com F91.0 Conduct Disorder Confined to the Family Context • The dissocial or aggressive behaviour is intent on family members and occurs mostly at home or immediate household. Stealing from home and destruction of beloved property of particular family members is typical. Social relationships outside the family are within the normal range. Docsity.com F91.1 Unsocialized Conduct Disorder • Aggressive and dissocial behaviour is connected with the child’s poor relationships with other children and peers groups. • There is a lack of close friends, rejection by other children, unpopularity in the school and hostile feelings toward adults. Docsity.com Treatment • Family situation should be consider and its relation to the child’s disorder. The family therapy is necessary to enhance emotional support and understanding. • In the cases of dysfunctional families, abused or neglected children, an adoptive homes, foster care or supervised residence is recommended. • Court intervention is required for the placement. Docsity.com F92 Mixed Disorders of Conduct and Emotions • A group of disorders characterized by the combination of persistently aggressive, dissocial or defiant behaviour with overt and marked symptoms of depression, anxiety or other emotional upsets • Mood disorders in children are often expressed by a challenging behaviour or somatic symptoms F92 Mixed disorders of conduct and emotions F92.0 Depressive conduct disorder F92.8 Other mixed disorders of conduct and emotions F92.9 Mixed disorder of conduct and emotions, unspecified Docsity.com F93 Emotional Disorders with Onset Specific to Childhood F93 Emotional disorders with onset specific to childhood F93.0 Separation anxiety disorder of childhood F93.1 Phobic anxiety disorder of childhood F93.2 Social anxiety disorder of childhood F93.3 Sibling rivalry disorder F93.8 Other childhood emotional disorders F93.9 Childhood emotional disorder, unspecified Docsity.com F93.2 Social Anxiety Disorder of Childhood • There is a wariness of strangers and social apprehension or anxiety when encountering new, strange, or socially threatening situations. This category should be used only where such fears arise during the early years, and are both unusual in degree and accompanied by problems in social functioning. • A fear of social encounters is associated with avoidance behaviour, which produces problems in functioning in a peers group and in the school performance as well. • The social acceptance of the child can be very difficult and can have impact on his or hers further personal development. • Treatment: – psychotherapy – anxiolytic drugs Docsity.com F93.3 Sibling Rivalry Disorder • Some degree of emotional disturbance usually following the birth of an immediately younger sibling is shown by a majority of young children. • Sibling rivalry disorder should be diagnosed only if the degree or persistence of the disturbance is both statistically unusual and associated with abnormalities of social interaction. • The children with sibling rivalry disorder are acting with serious hatred to the new born, in severe cases they are showing physical harming behaviour and persistent competition to gain parents attention. • Treatment: – psychotherapy dealing with family structure – prevention Docsity.com F94 Disorders of Social Functioning with Onset Specific to Childhood and Adolescence F94 Disorders of social functioning with onset specific to childhood and adolescence F94.0 Elective mutism F94.1 Reactive attachment disorder of childhood F94.2 Disinhibited attachment disorder of childhood F94.8 Other childhood disorders of social functioning F94.9 Childhood disorder of social functioning, unspecified This group of disorders is characterized by abnormalities in social functioning which are not associated with severe deficit and social incapacity found in pervasive developmental disorders. Docsity.com F94.2 Disinhibited Attachment Disorder of Childhood • Abnormal social functioning develops during first 5 years in children who have no opportunity of emotionally stable relationship with care givers. The disturbance can be recognized in children growing from infancy in institutions or experiencing extremely frequent changes in care givers. • To avoid this developmental disturbance good adoption policy is necessary. Non - attachment institutional care should be excluded from praxis. Docsity.com F95 Tic Disorders • A tic is an involuntary, rapid, recurrent, nonrhythmic motor movement (usually involving circumscribed muscle groups) or vocal production that is of sudden onset and that serves no apparent purpose • Tics are experienced as irresistible, but can be suppressed for shorter periods of time • Conditions of diagnosis are also a lack of neurological disorder, repetitiveness, disappearance during sleep, lack of rhythmicity, and lack of purpose Docsity.com F95 Tic Disorders • Simple motor tics: eye-blinking, neck-jerking, shoulder- shrugging, facial grimacing • Simple vocal tics: throat clearing, barking, sniffing, hissing • Complex motor tics: jumping and hopping • Complex vocal tics: repetition of particular words or sentences, and sometimes the use of socially unacceptable (often obscene) words (coprolalia), and the repetition of one's own sounds or words (palilalia) Docsity.com F98 Other Behavioural and Emotional Disorders with Onset Usually Occurring in Childhood and Adolescence F98 Other behavioural and emotional disorders with onset usually occurring in childhood and adolescence F98.0 Nonorganic enuresis F98.1 Nonorganic encopresis F98.2 Feeding disorder of infancy and childhood F98.3 Pica of infancy and childhood F98.4 Stereotyped movement disorders F98.5 Stuttering (stammering) F98.6 Cluttering F98.8 Other specified behavioural and emotional disorders with onset usually occurring in F98.9 Unspecified behavioural and emotional disorders with onset usually occurring in childhood and adolescence Docsity.com F98.0 Nonorganic Enuresis • The child is not able of voluntary bladder control during the day (enuresis diurnal) or during the night (enuresis nocturnal) • The enuresis may be present from birth (enuresis primaria), or it may occur after a period of time of acquired bladder control (enuresis secundaria) • There is no neurological disorder or structural abnormality of urinary system, or lack of bladder control is not due to epileptic attacks or cystitis or diabetic polyuria • Enuresis is not diagnosed in a child less than 4 years of mental age • Emotional problems may arise as a secondary consequence of enuresis Docsity.com Treatment • Mild restriction of fluids before bedtime • Waking for the toilet during the night • Rewarding success and not to focus attention on failure • Antidepressants Docsity.com F98.2 Feeding Disorder of Infancy and Childhood • Feeding disorder generally involves food refusal and extreme faddiness in the presence of an adequate food supply, a reasonably competent caregiver, and the absence of organic disease. • Can be associated with rumination (repeated regurgitation without nausea) • Occurs often in children in institutional care or mentally retarded Docsity.com F98.3 Pica of Infancy and Childhood • Persistent eating of non - nutritive substances (soil, wall paint) • Common in mentally retarded children or very young children with normal intelligence level Docsity.com F98.4 Stereotyped Movement Disorders • Voluntary, repetitive, stereotyped, nonfunctional (and often rhythmic) movements that do not form part of any recognized psychiatric or neurological condition. • The non self-injurious movements: – body-rocking – head-rocking – hair-plucking – hair-twisting – finger-flicking mannerisms – hand-flapping • Stereotyped self-injurious behaviour: – repetitive head-banging – face-slapping – eye-poking – biting of hands, lips or other body parts • In mentally retarded children, or in some children with visual impairment. Docsity.com F98.8 Other Specified Behavioural and Emotional Disorders with Onset Usually Occurring in Childhood and Adolescence • Attention deficit disorder without hyperactivity • Excessive masturbation • Nail — biting • Nose — picking • Thumb — sucking Docsity.com Psychic Disorders that Usually Occur in Adulthood but Can Have Early Onset in Childhood or Adolescence • Schizophrenic disorders with early onset in childhood occur, but they are very rare and the prognosis is poor, because of influence on psychic development. Treatment quite often includes antipsychotic drugs and residential care • Manic-depressive disorder is rare before puberty, but increases in incidence during adolescence • Treatment resembles that of adults, only electroconvulsive therapy is not applied before adolescence Docsity.com Child Abuse • The term child abuse is used to indicate physical abuse, sexual abuse, or emotional abuse and child neglect. • Child care after divorce: – some parents are not able to reach consent about child care after divorce period, so child psychiatrist is asked by the court to give an advice on the best solution for the children – after divorce disagreements are traumatic for the children and the child psychiatrist’s statements should be very carefully expressed, to protect the well being and future development of the child – the parental rights of both parents - mother and father should be respected and protected – cooperation with child psychologist and social workers is necessary Docsity.com