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Child Psychiatry
Conduct Disorder
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..
Delayed growth and development. Small bladder capacity. Lack of enough antidiuretic hormone (ADH). Sound sleeping. Psychological and social factors.
that either increase the amount of urine that the bladder can hold bladder capacity- (imipramine) 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:
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 :
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 :
squeaking noises hissing spitting whistling gurgling echoing sounds or phrases repeatedly
CHILDHOOD SCHIZOPHRENIA
Definition:
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
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:
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
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
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: abrupt, rapid mood swings periods of extreme hyperactivity prolonged, explosive temper tantrums or rages 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 : 1) early onset (before 3-5 years of age), 2) severe abnormality of reciprocal social relatedness, 3) severe abnormality of communication development, 4) restricted, repetitive and stereotyped patterns of behavior, interests, activities, and imagination; 5) abnormal responses to sensory stimuli.
AUTISM IN CHILDREN
SOCIAL DISTURBANCE The human face holds little interest for the autistic infant lack of eye contact, poor or absent attachments 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).
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
Fail to give close attention to details or make careless mistakes in school work. Have difficulty sustaining attention in tasks or play activities. Not seem to listen when spoken to directly. Not follow through on instructions and fail to finish school work, chores or duties in the workplace
Have difficulty organising tasks and activities. Avoid, dislike or be reluctant to engage in tasks that require sustained mental effort Lose things necessary for tasks or activities (for example: toys, school assignments, pencils, books or tools). Be easily distracted. Be forgetful in daily activities.
Hyperactivity
Often fidgets with hands or feet or squirms in seat. Often leaves seat in classroom or in other situations in which remaining seated is expected.
Hyperactivity
Impulsivity
Often blurts out answers before questions have been completed. Often has difficulty waiting in turn. 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.