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Child & Adolescent Psychiatry - Coggle Diagram
Child & Adolescent Psychiatry
Enuresis
DSM V Criteria
Repeated voiding of urine into bed or clothes voluntary or involuntary
Behaviour clinically significant (2x weekly for 3 consecutive months OR social/academic fx impiarment)
At least 5 years old
Not due to substance (diuretic) or medical condition (diabetes)
Types: nocturnal, diurnal, nocturnal & diurnal
Primary: Never achieved dryness
Secondary: Previously toilet trained for 6-12 consecutive months
Aetiology
Organic
Family hx of voiding abnormalities
Developmental delay
Deficient learning
Parenting practices (unrealistic, punishment)
Family circumstances (stress, conflict, sibling teasing)
Societal/environmental
Emotional (trauma, family changes, life changes)
Associated psych conditions
ADHD
Conduct d/o
Sleep d/o
Early mother-child attachemtn difficulties
Assessment/Approach
Exclude organic cause
History:
Differentiate between primary & secondary
Explore anxieties, fears & stressors
Developmental hx - pregnancy, birth, mile stones
Family hx
Family response to enuresis
Factors
Precipitating factors
UTI, GIT illness, coercive/intrusive bladder training
Acute life stressors, child sexual abuse
Maintaining
Personal biological (UTI, physical abnormalitiy)
Personal psychological (aggression, anxiety)
Contextual/social (family denies problem)
Predisposing factors
Personal biological (genes, UTI)
Personal psychological (developmental delay)
Contextual/social (toilet training, family disorganisation)
Protective
Personal biological (good health)
Personal psychological (IQ, temperament, self-esteem)
Contextual/social (family accepts problem, commits to resolving it)
Intervention
Psycho
Acknowledge childs emotions related to enuresis (frustration, shame, poor self-esteem)
Child must play active role in treatment (increases sense of personal agency & control over problem)
Encourage responsibility for behaviour (help clean up)
Positive reinforcement
Social
Parental involvement
Psychoeducation
reflect & acknowledge parent's frustration
Discourage teasing by siblings
Address related family problems
Modify environment (e.g. night light to help with fear of dark when getting up)
Bio
Increase bladder capacity + strengthen bladder sphincter muscle
Limiting fluids in evening
Routine of voiding before bedtime
Waking during sleep to void
Urine alarm
Medication
Disruptive behaviour D/O
Conduct D/O
Repetitive & persistent pattern of behaviours in which basic rights of others or major age-appropriate norms or rules of society are violated
4 main groupings
Deceitfullness or theft
Broken into someone's house, building, car, etc.
Lies to obtain goods or favours or to avoid obligations
Stolen items of nontrivial value without confronting victim
Non-aggressive conduct that causes property loss or damage
Deliberate fire setting with intention of causing serious damage
Deliberately destroyed others property
Aggressive conduct that causes or threatens physical harm to other people/animals
Bullies, threatens, intimidates
Initiates physical fights
Has used weapon to cause harm to others
Physically cruel to people or animals
Stolen while confronting a victim
Forced someone into sexual activity
Serious violations of rules
Stays out at night despite parental prohibitions, beginning before 13 years
Has run away from home overnight at least twice while living in parental home
Often truant from school, beginning before 13 years
Oppositional Defiant D/O
Recurrent pattern of
negative, defiant, disobedient and hostile
behaviour towards authority figures lasting at least
six months
Diagnosis
Symptoms:
Angry irritable mood (loses temper, touchy/easily annoyed, angry, resentful)
Argumentative/defiant behaviour (argues w authority/adults, actively defies rules & requests, deliberately annoys others, blames others for own mistakes)
Vindictiveness
Significant clinical impact on education, social functioning or other areas
Symptoms do not occur only during course of other psychiatric illness
Attention Deficit Hyperactivity D/O
Management
Bio
Antipsychotics:
Aripiprazole - 13yrs & older for SZP, 6-17yrs for irritability with autism
Risperidone - 13yrs & older for SZP, 5-16yrs for irritability with autism
Quetiapine - 13yrs & older for SZP
Olanzapine - 13-17yrs for SZP & Bipolar
Stimulants:
Methylphenidate
Concerta = long acting
Ritalin = short acting
Side effects: appetite suppression, nausea, stomach ache, insomnia, mood changes (sadness, dampening, agitation, irritability, emotionaltiy), jitteriness, headache, growth delay
SSRIs:
Fluoxetine - 8yr & older for MDD, 6yrs & older for OCD
Sertraline - 6yr &older for OCD
Escitalopram - 12yr &older for MDD
Psycho
Family intervetnion that provides behaviour management
Parent management training (PMT)
Individual therapy (CBT)
Parent-child interaction therapy (PCIT)
Group therapy
Social
Social activities with exercise/outdoor element
Encopresis
Repeated passage of faeces into inappropriate places (clothing/floor) - voluntary or involuntary
At least 1 incident monthly for at least 3 months
At least 4 years old
Not due to direct effect of substance of medical condition
Classification:
With constipation
Without constipation
Overflow incontinence
Soiling
(different from encopresis) - Involuntary passage of fluid or semi-solid stool into clothing