Childpsychiatry 2 12/3/2014 Prof. Elham Aljammas

Development of Drawing 3 years old 4 years old 5 years old 6 years old Test of maturity: Eva is here.    

  Emotional disorders Important differences between the disorders in adult & children: 1.Some subtypes are different (separation anxiety) 2.Medications is rarely used 3.Equal male &female ratio(1/2in adult) 4.Most affected children do not become affected adults

  SEPERATION AXIETY DISORDERS Among 5-11 yr olds 3-4%have excessive, prolonged anxiety when faced with separation Older children may describe being harmful that the person will be harmed & not return can begin at the time of stress ,such as after a death or tragedy Some parents are noted to be very protective

Early detection of mental illness may decrease the life long burden on the family or community

Symptoms of anxiety in children: Behavioral Clinging to parent Unwilling to leave house Unwilling to go to bed Actions designed to avoid feared events(hiding) Psychological Feeling worried Nightmares Physical Abdominal pans Headaches

Organizing policy in mental health services

Managements: 1.explanation& reassurance 2.Identifications& resolution of stressors 3. ensuring that the parents are not reinforcing the problem 4. use specific interventions for secondary problems such as school refusal 5. applying behavioral techniques

Trends of care for children

Somatoform disorder Obsessive compulsive disorder Mood disorders   School refusal School refusal is not a psychiatric disorder, but is a common cause of child psychiatrist & frequently attributable to an emotional disorders

Not attending school child remaining at home Child not at home Child kept at home (truant) separation anxiety child reluctant to go to school(school refusal fear of school- social travel phobia social withdrawal

underlying conduct dis. Underlying emotional disorders   Truancy School refusal older than 11yr Younger<11yr old underlying conduct dis. Underlying emotional disorders poor sch. Records Good academic & behavioral record poor prognosis Good prognosis broken home Parents overprotective &anxious

Management Rapid return to school before avoidance is too ingrained Address any specific fears or stresses Treat any associated psychiatric disorders. Prognosis: Younger children –good Slightly increased risk of anxiety disorder in adulthood.  

Conduct disorder Conduct disorder is the commonest psychiatric disorder of childhood adolescence Sex ratio=5/1(B/G) diagnosis usually made after age of 7yr Conduct is disturbed & antisocial well beyond the range misbehavior normally observed. Clinical features of conduct disorders: 1.prschool children Aggressive behaviour Poor concentration 2.in mid childhood Lying Stealing Disturbed & oppositional behavior bullying

Conduct disorders

3.In adolescence Stealing Truancy Promiscuity Substance misuse Vandalism Reckless behavior Conduct disorder is associated with social deprivation,& poor parenting., individual factors Brain damage,epilepsy,specific reading disorder. Long term prognosis is poor Management is a mixture of punishment & treatment

Attention deficit hyperactivity disorder .prevalence =2% in UK (3/4boys) Etiology : genetic contribution, increased rate of depressive disorders ,learning difficulties, alcoholism, antisocial personality disorder,neurodevelopmental disorder . (Rare ) social deprivation ,food allergy Features : hyperactive ,poor attention & concentration,distractable & impulsive, poor planning & organization. Associated with: learning difficulties clumsiness low self esteem, socially disinhibited,no localizing neurological signs ,50% coexist with conduct disorder. Management: Support for the child & the family Specific educational approaches (attention& learning difficulties) Behavior modification Stimulant(methylphenidate ),careful about addiction & growth retardation Prognosis variable---1/3 resolve completely.

Pervasive Developmental Disorders Group of disorders characterized by abnormalities in communication and social interaction and by restricted repetitive activities and interest. Most cases manifest before 5 years.

Autistic Disorder Childhood autism (ICD-10) Autistic Disorder ( DSM-IV) Abnormal development apparent before the age of 3 years. 3 kinds of social development: Abnormality of social development. Abnormality of communication Restriction of interest and behavior.

Pervasive developmental disorders(AUTISM) Is characterized by failure to develop normal communication(social emotional).They have restricted use of language ,seems oblivious to non verbal communication& emotional expression Have limited solitary ,repetitive behavior& resist attempts to change their routine 80% boys 1 in 2500 children age of onset <3 years autistic triad Autistic aloneness Impaired language & communication Solitary repetitive behavior Failure to develop Associated with: mannerism& rituals ,epilepsy in 25%,MR In75% Etiology ;genetic ,no environmental risk factor Neuropath logical involvement of the cerebellum& 0liveary nuclei has been reported Prognosis: poor Needs special school & residential care.

PTSD

Epidemiology The lifetime prevalence ~ 8% Among high-risk groups ~ 5 to 75% Significantly higher in women

Comorbidity About 2/3 have at least two other disorders like: depressive disorders, substance-related disorders, other anxiety disorders, and bipolar disorders.

Etiology Biological Factors HPA axis

Etiology biological factors (brain imaging) Faced with scores of traumatized veterans of the Viet Nam war, researchers have been studying the underlying physiology of PTSD since the late 1960s. Animal studies have shown repeatedly that prolonged stress releases hormones that can damage the hippocampus, a region of the brain associated with memory. In a series of brain imaging studies conducted with humans in the mid-1990s, researchers found that the hippocampi of PTSD sufferers were smaller than average. These findings lead some to hypothesize that the damage extreme stress does to the hippocampus causes PTSD; however, a study published in the October 2002 issue of Nature Neuroscience suggests otherwise. The hippocampus, a region of the brain associated with memory, can be damaged by the prolonged release of stress hormones

Diagnosis Clinical features divided into 3 groups: Hyperarousal (persistent anxiety, irritability, insomnia, and poor concentration) Intrusions (intense intrusive imagery, flashbacks, and recurrent distressing dreams) Avoidance (difficulty in recalling stressful events at will, avoidance of reminders of the events, detachment, inability to feel emotion “numbness”, and diminished interest in activities)

Course and Prognosis PTSD usually develops some time after the trauma. The delay can be as short as I week and as long as 30 years. Untreated, ~30% recover completely, 40% continue to have mild symptoms, 20% moderate, and 10% remain unchanged or become worst. After 1 year 50% recover.

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