Pedopsychiatry

Pedopsychiatry

Introduction:

Psychiatric disorders have Children are different from those of adults, since they arise in complex and intimate family relationships, and are influenced by the degree of child development. Children are also present special problems for assessment and treatment. Psychiatric disorders present in childhood or adolescents are shown in Table 1.

• Pervasive Developmental Disorders
• Specific Developmental Disabilities
• hyperkinetic disorders
• Conduct disorders
• Affective disorders
• Psychiatric aspects Child Abuse
• Elimination Disorders

  Table 1 Classification psychiatric disorders of childhood and adolescence

Normal development of the first

Some of the characteristics of normal child development are presented in Table 2. Is essential to take into account the developmental stage of the scene the child for a psychiatric evaluation, as it is accepted as a normal step would be abnormal to another.

The first experiments Children play an important role in determining what type of people we are as adults. The role of parents is crucial in this. Child's parents (or parent) who are loving and tolerant, however, able to establish and implement clear and reasonable limits likely to develop high self-esteem and a secure attachment to parents who provide a model for files secure attachments to others in later life. Attachment theory "was first described by John Bowlby in the 1950s. It is derived from his study in children separated from his mother's small hospital. attachment behavior begins about 7 months and is clinging and unwillingness to separate from the primary caregiver, usually the mother. Serves to strengthen the bond between mother and son and has a role in the evolution of the protection of children against predators. A child is secured in able to use the mother as a secure base from which to explore the world was begun, and will also be able to react well to short-term separations. If the attachment is poor because the father does not meet the needs of child care or detention, or is inconsistent, the child will be challenged to explore and separation. This pattern of insecure attachment may persist throughout life, affecting adult relationships.

Assessment of children

How psychiatric history is taken and that the child is considered dependent on age, confidence and language skills of children. Much history will come from parents and children who are willing to leave their parents can be seen alone. It is generally preferable to see one and adolescents before their parents to establish a relationship of trust with them. The interview should take place in a state of rest and friendly, with toys and drawing materials for children under 10 years.

The history should include the following:

• Presentation of the complaints described by the parent and child. It is important to the child to ask about the complaint in a smooth, after winning their trust and talking about neutral topics.
• Recent behavioral difficulties or emotional, even general relationships of health, mood, sleep, appetite, elimination, behavior antisocial, life and fantasy gaming and behavior in school.
• Personal history, pregnancy, birth, steps (motor and speech, feeding, sphincter control, social behavior), medical history, parental separations, schools attended and progress in them.
• Family structure and function of the construction of a genogram is often useful. Relations between Family members should be asked about, and interactions observed during the interview.
• Temperature-track characteristics such as the level of activity, the regularity of the functions (sleep, intestines, eating), adaptability to new circumstances, the willingness to approach people or new situations, the quality and intensity of mood, quality of relationships within and outside the family, care and perseverance can be seen from an age very young.

A mental status examination of the child must be completed, although that often rely on behavior and watch them play. It The following must be taken into account:

• Appearance looking for any anomaly, bruises, cuts and scratches and relevance dress.
• "The activity level of behavior, interactions with parents, motor function, attention and task persistence.
• Tell articulation, vocabulary and language use.
• "Happy, happy, sad, depressed, anxious, hostile, resentful mood.
• Thinking and content of the discourse of fantasy life, for example by asking the three magical wishes.

The evaluation must be completed a physical exam and talk with other informants involved with the child or the family as the family doctor, teacher, school psychologist or social services. An investigation can take place, intelligence tests and tests more frequently university level, such as standardized tests of reading.

Pervasive developmental disorder (autism)

Autism is a serious disorder that begins early and out the third anniversary. It is characterized the lack of social relationships, poor language development and resistance to change and restricted and repetitive behaviors and interests. These children do not take into account or respond to emotions of others or social cues. They do not adapt their behavior appropriately to new environments, and are very limited in their game, they rarely participate in "games imagination. In general, do not choose soft toys unusual and can tied to a particular object, and refuses to be separated from it. Some language skills are very limited, and skills that are present are not generally used in social conversation with others. Three-quarters have a severe mental retardation.

Autism has a prevalence of 4 to 10,000 and is three times more common among boys than girls. It is associated with brain damage, in some cases, genetic factors appear play an important role in the etiology. There is no specific treatment available. Families need much support and counseling, and behavioral problems can be behavioral therapy. The result is generally low, with only 15% never get an independent operation.

0-1 years

• Totally dependent
• fast motor development – walking one years
• 7 months attachment behavior

1-2 years

• Start talking
• Dry days
• Temper tantrums
• Separation Anxiety

2-5 years old

• Complex language skills
• Sociable
• Sexual identity development
• Identification with parents
• Since the formation of consciences
• Vivid fantasy life
• themselves as the center of your world

5-10 years

• clear identity as a girl or boy
• Able to separate the mother and
• Personality attributes acquired by the end of this period remain in adulthood

Adolescence

• Puberty – 1911-1913 years in girls and 13-17 years for children
• Establishment of personal identity
• The establishment of parental autonomy
• Learning to work and develop the skills necessary to become self-sufficient
• Peer relationships are very important group

Table 2 The normal development of the first

Specific development Riots

In these conditions, skills specific, such as reading, spelling, knowledge of arithmetic and language are affected. The problems are present from early childhood. To a diagnosis of pervasive developmental disorder-specific, acquired brain injury or disease must be excluded and that the child must have a reasonable opportunity to acquire these skills at home or at school. The causes of specific developmental disorders are not known with certainty but is believed to arise from abnormalities in the processing cognitive. They are more common among boys than girls.

specific reading disorder is particularly frequent, with a prevalence of 5-10%. The most common problems include reading distortions or additions of words or parts of words, slow reading rate and loss of place in the text. Although the specific reading disorder is not due to insufficient enrollment, absenteeism is a common consequence of academic difficulties. conduct disorder and dyslexia often co-exist.

Hyperkinetic disorder

In the United States this is called deficit hyperactivity disorder (ADHD). Key features of disease are hyperactivity, restlessness, attention, distraction and behavior impulsive. These children are often clumsy and accident subjects in trouble with parents and teachers, because they act without thinking. Other children are often avoided and may become socially isolated.

Symptoms usually occur at an early age but is most frequently diagnosed 6-9 years where there is a prevalence of about 8%. It is three times more common in boys than in girls. Several causes have been proposed for genetic factors and parental allergies. This is a very few children's psychiatric disorders are treated with drugs. stimulates amphetamines are used, such as methylphenidate, which has the paradoxical effect of reducing activity levels and improving care. This translates into better academic results and developing friendship. Behavioral therapy, using a reward system for good behavior, it is also useful for these children.

hyperactivity disorder tends to improve with age, quarter only to have persistent problems in adolescence. About half of them still have some features of hyperactivity into adulthood, and this is often expressed as a behavior conduct.

Conduct Disorder

Main features of behavior are persistent antisocial behavior such as anti-bullying, severe temper tantrums, property damage, fire, theft, absenteeism and persistent disobedience and defiance. The age of the child should be taken into account, and level malice should not be regarded as a sign of conduct disorder. One third of the cases have a specific reading disorder, and there is considerable overlap with hyperactivity. Behavior problems are common, present in at least 4% of children with a peak between 12-16 years of age, and are three times more common in boys than in girls.

There are two types of conduct disorder:

• socialized behavior. These children are able to make friends that usually also behave in antisocial work. Bad behavior is usually more evident outside the home. Relationships with adults can be good, but there are often difficulties with authority figures.
• Unsocialised pipes disorder. These children have no friends, either because they were rejected by their peers, either because deliberately chosen to isolate itself. Antisocial behavior only occurs. A certain degree of emotional disorder is often also present in these children.

The causes of behavior disorders are a complex interaction between the biological structure of the child, family influences and environmental factors such as summersied Figure 1. The style of parenting is thought to be important. behavioral disorders are likely to develop if parents do not give clear limits, control and manage development ineffective or inconsistent discipline. Improved parenting skills is likely to improve performance, even if other etiological factors are present. Other treatment approaches include family therapy, behavioral therapy, remedial courses and providing alternative activities, peer groups. The results are better for the group socialized. Two thirds of the group unsocialised persistent behavior will conduct adulthood.

Emotional Disturbance

Emotional disorders of childhood are characterized by anxiety and depression. They are present in 2-3% of children, especially children are most common psychiatric disorders in girls. In general, have a good prognosis.

Separation Anxiety Disorder

It is normal for young children and preschoolers to feel some separation anxiety over real or threat to their parents. In anxiety disorder Separation anxiety is particularly severe or occurs in older children, and causes some problems in social functioning as the fight against child attends school. Symptoms include persistent anxiety about separation of the attachment figure (usually the mother) and great distress if forced to do so. Some refuse to go to sleep without his mother and nightmares about separation. overprotection custody is often present and other causes include child temperament and stressful events, especially those involving separation, such as family breakdown, loss or illness

Anxiety disorders of childhood

Specific phobias about animals, black or foreign normal in young children and rarely require treatment. GAD can occur and the frequency charactersied psychosomatic symptoms, abdominal pain, in particular.

Family influences

• martial disharmony
• absent parent
• parental violence, alcoholism, personality disorder
• parenting

Child

• genetic factors
• brain damage
• low IQ
• temperament

  

Environmental influences

• center of attention
• school disciplinary code
• influence of bandmates
• social deprivation

Behavior

Figure 1 The etiology of conduct disorder

Depressive illness

Symptoms of depression are very similar in children than in adults – low-power mode, anhedonia, sleep and appetite and depressive thoughts. Fleeting suicidal thoughts are fairly common, but suicide is rare. Moderate to severe depressive illness is rare in prepubertal children, with a steady increase in the impact on adolescents. The causes of depression and its treatment similar to those of adults, although young children seem to be less sensitive to antidepressants than adults, treatment methods better psychological support.

School refusal

The rejection of the child's school refuses to go to school because of concerns specific about the school, the journey of the same or separation anxiety. This represents approximately 1% of all absences from school and is much less common than truancy in which the child hides his absence from school and their parents. Characteristics of children with school refusal are compared with those who are accustomed steers in Table 1. School of rejection must be processed by the child's return to school as soon as possible that avoidance is likely to increase anxiety. A re-introduction quality necessary, with support for the child and parents.

Child Abuse

Child abuse can take the form of neglect, emotional abuse, physical or sexual. It plays a role in the development of psychiatric disorders in children can continue into adulthood. It is essential that all professionals who come into contact with children should be aware of potential abuse play a role in the problems posed by a child and his family.

Table 3 Comparison of characteristics of children with repeated absences, and school refusal

School rejection

Absenteeism

The absence of school meets parents

The absence of parents from school hidden

Spend days at home alone or with parents

May day to spend away from home with peers

the peak incidence 11 years

Increase with age

The fear of school or separation anxiety

There is an emotional disorder

All social classes

The increase in lower social classes

No increase in the parents' marital discord

dysfunctional family

parental overprotection

harsh parenting

  

Incidence abuse is difficult to measure than most cases are not reported, and a definition of what constitutes abuse varies. The official figures reported abuse cases have increased in recent years, although This is probably due to increased reporting rather than actual increase in abuse. A British study found that 12% of women and 8% of men have some type of sexual abuse before the age of 16.

There are many factors that contribute to child abuse. Some children are more vulnerable than others, for example, reactions have early separation from the mother, mentally or physically disabled or have features that make driving difficult temperament. Some parents are more likely to be violent, especially those who have been abused as children, live in poor socio-economic and have a realistic style of disciplining their children.

The form most common sexual abuse is father-daughter incest. Sexually abused children may have a sudden change in their social behavior or academic performance or problems behavior. Some sexual play involved repetitive and sexually precocious. It is important to give these children an opportunity to reveal their abuse, but great care must be taken not to increase their trauma. Social services should be informed of any disclosure of sexual abuse committed by a child and child care procedures. The emotional effects of abuse child sex can be addressed in individual psychotherapy with the child. Teens and adults can also be offered group therapy, which has the advantage of reducing feelings insulation and allow the development of confidence and self esteem. A third of sexually abused children are not long-term negative effects, others are prone to depression, low self-esteem, sexual problems and tend to re-victimization in adulthood.

Elimination Disorders

Enuresis

Enuresis is the involuntary emptying of the bladder occur after the age of 5 years in the absence of an organic cause. Bedwetting (enuresis night) is common, occurring in 10% over 5 years, 5% of persons 10 years and 1% of youth 15. The diurnal enuresis is less common. Enuresis is considered primary, if there was a prior period of bladder control, and secondary if it follows a period of abstinence. It is twice as common among children girls, and most cases occur due to delayed neurological maturation that simply is corrected over time. There is often a positive family history a problem. Secondary enuresis can occur as a regression characteristic behavior when under stress. The Council is made to exclude a physical cause, especially urinary tract infections, to reassure parents and encourage them to solve the problem calmly and quietly. Establish a program of behavior as a simple table or the wheel and the hood can be used.

  

Encopresis

Encopresis is the defecation in inappropriate places, despite routine monitoring of the intestine. Most children, fecal continent substances at the age of 3 years. At age 8, 2% of males and 1% of girls suffer from encopresis. This may be due to inadequate toilet training or have a psychological cause of behavior representing child's feelings of anger or regression to a time of stress. Constipation with overflow incontinence is the main differential diagnosis exclude.

Adolescence

Teenagers have social problems difficult and emotional process. For example, there are often disputes over the degree of independence they want and are allowed to have parents. The peer group is very important and influential, and can provide valuable support to people to try new things away from family. They can also raise serious concerns about the rejection of the group, and may encourage criminal behavior. The development of sexual relations is another source potential confusion, anxiety and conflict.

The reason for psychiatric changes such as children become teenagers. There is a marked increase in disorders depression, especially among girls, and schizophrenia is much more common in late adolescence. Problems with alcohol abuse and eating disorders drug also tend to appear at this time. developmental disorders in general have been resolved.

Reference:

1. Stepler D. Oxford Handbook of Psychiatry, Oxford University Press, 2006

2. G Smith et al. Key issues in psychiatry. Bios Scientific Publisher Limited, 1996.

3. Boyle D, S Davies. Psychiatry, 2002 Mosby's Crash Course

About the Author

Prof. Saoud Al Mualla (M.B, MSC, M.D, Dip, MRCPsych)

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