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Child psychiatry (Childhood illnesses (Conduct disorder (Management…
Child psychiatry
Childhood
illnesses
Anxiety disorders
Management
Psychological
Behavioural therapy (phobias)
CBT
Medication
Indication: severe
E.g. low dose SSRI
Conservative
Address stressors
Pathophysiology
Negative experiences
Overprotective/anxious parents
Types
Separation anxiety
Generalised anxiety
Specific phobias
Epidemiology
7%
Conduct
disorder
Pathophysiology
Environmental: deprivation, parental PD,
parental substance abuse, social instability
Biological: brain damage in utero
Clinical presentation
Temper tantrums
Defiant behaviour
Epidemiology
M>F
10% overall
Common in young offenders
Management
Psychological
CBT, behavioural therapy
Group therapy, family therapy
Conservative
Social/family support
Definition
Repetitive, persistent pattern of dis-social, aggressive or defiant conduct violating age and social expectations
Prognosis
Many go on to develop
antisocial PD in adulthood
Depression
Pathophysiology
Parental mental illness, social difficulties,
other mental disorder, genetics
Clinical presentation
Somatic complaints
Less guilt, hopelessness and appetite issues vs adults
Epidemiology
M=F
Management
Conservative
Address stressors
Psychological
CBT
Medical
Low dose SSRI
Hyperkinetic
disorders
Epidemiology
M>F
Pathophysiology
Genetics (major factor)
social, ?food allergy/additives,
brain damage in utero
Definition
Hyperactivity and inattention
Clinical presentation
Impaired attention
Impulsive behaviour
Hyperactivity
Fidgety/restless/overactive
Diagnosis
Symptoms start <6y, persist >6m,
with occurrence in >1 social situation
Management
Psychological
Behavioural therapy
Medical
E.g. dexamphetamine, methylphenidate
MOA: stimulants
Pervasive
developmental
disorders
Autism
Epidemiology
M>F
Pathophysiology
Unclear, strong genetics
Clinical
presentation
Abnormal social interaction
Minimal eye contact, facial expression, gestures,
lack of peer relationships, lack of sharing interests,
inappropriate responses to others emotions,
difficulty reading emotions of others,
lack of interest to share hobbies
Abnormal communication
Language delay, difficulty initiating/sustaining convo, idiosyncratic use of words/phrases, lack of imaginary play, difficulty imitating
Restricted/stereotyped interests
Preoccupation with restricted interest,
compulsive rituals/routines, motor mannerisms,
interest in small aspect of object rather than whole
Diagnosis
Abnormalities of:
social interaction
social communication
Restrictive/stereotyped behaviour
Management
Conservative
Social/educational services
Family support
Psychological
Behavioural therapy
Asperger's
syndrome
Pathophysiology
Social and communication difficulties
but no impact on cognition or language
(often high IQ)
Definition
ASDs (autism, Asperger's) are characterised
by abnormalities in social interaction/communication
with restricted, stereotyped interests/activities
Psychosis and
schizophrenia
Pathophysiology
Genetics (strong)
HEE household
Clinical presentation
Hebephrenic (affective change)
Less common to have delusions or perceptions
Epidemiology
Uncommon in children
Common cause of childhood psych admissions
Diagnosis
Must have 1+ of:
Thought disorder (insertion, withdrawal, broadcast)
Delusions (control, passivity)
Hallucinations (voices)
Negative symptoms (catatonia, neologisms)
Management
Psychological
CBT
Family therapy
Medications
Antipsychotic e.g. risperidone
Conservative
Advice and support
School refusal
Pathophysiology
Separation anxiety in young children
True refusal in older children
Epidemiology
Peaks 5y, 11y, and 14-16y
Management
Conservative
Address cause e.g. social phobia
Psychological
Graded return to school
Definition
Refusal to attend/stay in school due to anxiety
Functional
enuresis
Epidemiology
10% 5y, 1% teens
Pathophysiology
Genetics, small bladder capacity
Definition
Repeated, involuntary voiding of urine
after an age when continuence is usual, no functional issue
Clinical presentation
Nocturnal, diurnal, both
Primary (always) or secondary (after period of continence)
Management
Conswrvative
Identify cause
Restrict fluids before bedtime
Wake in night to urinate
Reward charts
Enuresis alarms
Medical
Low dose TCA nocte
Pathophysiology
Biological
Physical illness, birth injuries
Environmental
Family separation, parental loss, poor relationships, mental illness, criminality, low SEC
Genetics
Polygenic affecting temperament and intelligence
Management
Psychological
Family therapy
Individual psychotherapy
Behaviour therapy
Group therapy
Medical
Per condition (depression, Tourette's,
ADHD, epilepsy etc.)
Dose per age/weight
Conservative
Information, reassurance, support
Social services
Special education (writing/arithmetic problems)
Clinical
presentation
Varied
Often reports from family, teachers,
educational psychologists
Diagnosis
History
From child and parent
Examination
Psychiatric assessment
Behaviour and interaction, drawing and toys
If older, can use methods per adults
Definition
Medical discipline dealing with
child and adolescents with emotional,
behavioural and developmental disorders