CHILD PSYCHIATRY M SADRAMELY CHILD ADOLESCENT PSYCHIATRIST ASSISTANT

CHILD PSYCHIATRY M. SADRAMELY CHILD &ADOLESCENT PSYCHIATRIST ASSISTANT PROFESSOR OF MEDICAL UNIVERSITY

ADHD ( Attention Deficit Hyperactivity Disorder) %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: ¡ 3 Category of symptoms including: Hyperactivity, Inattention, Impulsivity in TWO Situations Before 7 years old

ADHD Course & Prognosis: Variable ¡ In %50 -80 of child continue to. Adolescence ¡ Remission of Symptoms: FIRST Hyperactivity & Least Inattention ¡

ADHD Treatment: DRUG Therapy First choice is MPH(Ritalin)…. Antidepressants Antipsychotics Clonidine (comorbid with Tic) ¡ BEHAVIOR Therapy ¡

ODD (Oppositional Defiant Disorder) 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 %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 ) ONSET : Late Childhood & Early Adolescence ¡ M>F (4 -12/1 ) ¡ Low SES ¡

CD Clinical Manifestation : ¡ ¡ ¡ ¡ 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 Low IQ Poverty/ unemployment / Harsh Discipline ¡

CD Course & Prognosis : 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: 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 : ¡ 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 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 Early onset / chronic course / poor prognosis ¡ Specific Abilities ¡

PDD Treatment : 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: ¡ 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 ¡

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: ¡ Psychotherapy . Drug Therapy

ENURESIS ¡ ¡ %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

ENURESIS Diagnosis: Urination : Voluntary/Involuntary; in Bed/Clothes; After 5 Yrs old 2 time/week for 3 consecutive monthes

ENURESIS DDX ¡ ¡ ¡ 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 ¡ Toilet Training(1 -3 Yrs) ¡ NOT: Harsh Discipline/Punishment/Stress& Discord ¡

ENURESIS Treatment: Family Consultation ¡ Behavior Therapy (Star Chart, …. ) ¡ Drug Therapy (Imipramine , DDAVP, …. ) ¡

MENTAL RETARDATION(MR) 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) ¡

MILD MR 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 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 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 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 ¡

BEHAVIORAL PATTERN Cognitive Deficit Egocentricity, Concrete Thinking ¡ Neurological Deficit Hyperactivity, Short Attention Span, Aggressivity ¡ Self perceptions Insufficiency, Dependency, Frustration, Low Selfesteem ¡

TREATMENT Prevention (Primary , Secondary, Tertiary) ¡ Psychiatric Problems Drug Therapy Individual Psycho&Behavioral Therapy Family Consultation Cognitive Behavioral Therapy (CBT) ¡