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Childhood psychiatric disorders

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Childhood psychiatric disorders Dr. Y R Bhattarai TMU Normal child development What is growth and development ? -Process of growing to maturity. -Refers to process of ... – PowerPoint PPT presentation

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Title: Childhood psychiatric disorders


1
Childhood psychiatric disorders
  • Dr. Y R Bhattarai
  • TMU

2
Normal child development
  • What is growth and development ?
  • -Process of growing to maturity.
  • -Refers to process of biological and
    psychological changes in human being between
    birth and end of adolescence as the individual
    progresses from dependency to increasing autonomy.

3
What is the rationale behind the knowledge of
normal developmental process ?
  • For the practice of childhood psychiatry.
  • To identify whether the observed emotional,
    social, or intellectual functioning is abnormal
    as it has to be compared with the corresponding
    normal range for the age group.

4
Distinct areas of development
  • Physical
  • Cognitive
  • Social
  • Emotional
  • Moral
  • psychosexual

5
Age related developmental periods
  • newborn (ages 01 month)
  • infant (ages 1 month 1 year)
  • toddler (ages 13 years)
  • preschooler (ages 46years)
  • school-aged child (ages 610 years)
  • adolescent (ages 1119)

6
AGE PHYSICAL SOCIAL MOTOR LANGUAGE
1ST yr Sits with support(4) Crawls(9) Stranger anxiety(6) Separation anxiety(12) Feet in mouth(5) Changes hands with toy Laughs aloud(4) Ma ma, da da (10)
2nd yr Walk alone(13) Climbs stairs(18) Onlooker and parallel play Kicks ball Stacks 3cubes Uses 10 words
3rd yr Walks backwards Turn door knob Selfish self esteemed No is favorite word Stand on tiptoes(30) Stacks 6 cubes Use pronouns Two word sentences
4th yr Rides tricycles Bowel bladder control Sex specific play Knows sex full name Unbutton buttons, Stacks 9cubes Complete sentences Recognizes common objects on picture
5th yr Alternate feet going downstairs Imitation of adult roles Nightmares monster fears Brushes teeth Can tell stories Uses pronouns prepositions

7
Cognitive development
  • Includes capacity to learn, remember, recognise,
    solve problems and organize the environment.
  • Newborn-learns to suck
  • 8-12 mths-plays peek-a-boo
  • 2yrs-knows animal sounds, names objects
  • 3yrs knows colors
  • 5-6yrs- understands humor
  • 7-11yrs- think logically, personal sense of right
    and wrong

8
Social development
  • Learn to develop sense of themselves so that they
    can think and relate their experiences in other
    situation.
  • Infant- recognizes care giver, shows stranger
    anxiety
  • 2yrs- may separate from care giver
  • 3-6 yrs curiosity about sex
  • 6-12 yrs rules of the games are key, separation
    of the sexes, demonstrating competence is key.

9
Emotional development
  • Recognition and use of their emotions
    appropriately.
  • 2mths- social smile
  • 1-2yrs- likes attention
  • 5yrs- shows sensitivity to criticism
  • gt7 yrs can react to feelings of others and are
    more aware of others feeling

10
Moral development
  • Learning concept of right and wrong
  • 4-7yrs-self control develops, guilt appears
  • 7-11 yrs feels empathy
  • Early teens- peers considered in principles

11
Psychosexual development
  • Process of learning to view themselves and others
    in terms of gender.
  • 12-18 months can differentiate play girls like
    dolls
  • 2-3 yrs child can label self, picture, other
    childrens sex using clothes, toys, hair etc.
  • 3-6 yr same sex peers favored
  • 6-11 yrs heterosexual play
  • gt12 yrs sexual activity begins

12
What leads to developmenat process?
  • The basic mechanisms or causes of developmental
    change are genetic factors and environmental
    factors.
  • Genetic factors - responsible for cellular
    changes like overall growth, changes in
    proportion of body and brain parts, and the
    maturation of aspects of function such as vision
    and dietary needs.
  • Environmental factors affecting development may
    include both diet and disease exposure, as well
    as social, emotional, and cognitive experiences.
  • Rather than acting as independent mechanisms,
    genetic and environmental factors often interact
    to cause developmental change.

13
Classification of childhood psychiatric
disorders-DSM-IV TR
  • Mental retardation
  • Learning disorders
  • Motor skill disorders
  • Communication disorders
  • Pervasive developmental disorders- Autism
  • Attention-Deficit/ Hyperactivity Disorders
  • Tic disorders
  • Feeding and eating disorders of infancy
    childhood
  • Elimination disorders- Enuresis
  • Other disorders of infancy, childhood
    adolescence

14
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15
Enuresis
  • Term derived from Greek word enourein-to void
    urine
  • Definition
  • Enuresis is defined as the involuntary or
    intentional voiding of urine.

16
Normal continence development
  • normal process of continence
  • -achievement of night time bowel continence
  • -achievement of day time bowel continence
  • -achievement of day time bladder continence
  • -At last achievement of night time bladder
    continence
  • By three years 98 are dry in day and 78 dry at
    night. However other children may take as much as
    13 to 14 years or more to acquire complete
    control.

17
Types
  • According to achievement of continence
  • Continence is said to be achieved if child is dry
    for 6mths to 1year
  • primary- child has never maintained urinary
    continence for more than 1 year
  • Secondary- child achieved continence for 1 year
    or more but lost it again

18
  • According to timing of the episodes
  • Nocturnal
  • Diurnal
  • Nocturnal and diurnal

19
etiology
  • Genetic factor-
  • 75 of enuretic child had affected 1st degree
    biological relative
  • Child risk- 5.2 times if mother had disorder,7.1
    times if father had disorder
  • Psychological factor-
  • Low socio-economic
  • Onset after loss of parents
  • Sleep physiology- dream, deep sleep
  • Urine osmolality - enuretic child have decreased
    ability to concentrate urine at night thus
    leading to increased volume of urine

20
diagnosis
  • Repeated voiding of urine into beds or clothes
    involuntarily or intentional.
  • Frequency-2/week for 3 consecutive months, if
    less frequent must produce significant distress
    or functional impairment
  • Age- chronological age of at least 5yrs(or
    equivalent developmental age)
  • Not due to other know causes

21
Differential diagnosis
  • UTI
  • Urinary tract malformations
  • Seizures
  • Diabetes
  • Substance- diuretics

22
Treatment
  • Behavior therapy
  • bell and pad method of conditioning
  • external ultrasonic monitor attached to waist

23
Pharmacotherapy
  • Other
  • -Limit fluids before bedtime.
  • -Have your child go to the bathroom at the
    beginning of the bedtime routine and then again
    right before going to sleep.
  • -A reward system for dry nights.
  • -Asking your child to change the bed sheets when
    he or she wets.
  • -Bladder training having your child practice
    holding his or her urine for longer and longer
    times during the day, in effort to stretch the
    bladder so it can hold more urine.
  • -Do not punish or ridicule the child for
    bedwetting as it may worsen the problem.
  • Imipramine
  • Desmopressin acetate (synthetic vasopressin)

24
ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD)
25
  • ADHD is characterized by inattention,
    hyperactivity and impulsivity with social or
    academic functions.
  • Symptoms last for at least 6 months and the
    onset occurs before 7 yrs of age.
  • Symptoms are present in multiple settings e.g. in
    home and school

26
Prevalence and etiology
  • 5 of school age children
  • Occurs at a 91 male to female ratio
  • No specific etiologies have been identified.
  • Some associated conditions are perinatal
    injuries, malnutrition and substance exposure

27
Onset and symptoms
  • Usually first recognized when a child enters
    school and symptoms usually persist throughout
    childhood.
  • Symptoms short attention span, inability to
    wait in lines, failure to stay quiet or sit still
    in class, disobedience, fighting, poor academic
    performance, carelessness and poor relationship
    with siblings.

28
Associated problems
  • Conduct disorder
  • Learning disorders
  • Motor skills disorders
  • Communication disorders
  • Drug abuse
  • School failure
  • And physical trauma due to impulsivity

29
Evaluation
  • Careful history from parents and teachers
  • Given a simple puzzle to solve
  • Recognize letters traced on palms
  • IQ tests
  • Physical and neurological examination are normal.

30
Differential diagnosis
  • Mental retardation
  • Autistic disorders
  • Mood disorders
  • Oppositional defiant disorders
  • Rule out
  • -Age appropriate behaviors
  • -Response to environmental problems

31
Management
  • Combination of somatic and behavioral treatments.
  • Psychostimulants such as methylphenidate and
    other amphetamines are effective in decreasing
    hyperactivity, inattention and impulsivity. Given
    only during school days.
  • Behavioral management techniques include
    minimization of classroom distractions, reducing
    stimulation e.g. 1 playmate at a time, short and
    focused tasks.

32
THANKYOU
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