1
|
- Department of Psychiatry
- 1st Faculty of Medicine
- Charles University, Prague
- Head: Prof. MUDr. Jiří Raboch, DrSc.
|
2
|
- Differences of Child psychiatry from adult psychiatry:
- The child’s existence and emotional development depends on the
family or care givers - cooperation with family members; sometimes
written consent
- The developmental stages are very important assessment of the diagn=
osis
- Use of psychopharmacotherapy is less common in comparison to adult
psychiatry
- Children are less able to express themselves in words
- The child who suffers by psychiatric problems in childhood can be an
emotionally stable person in adulthood, but some of the psychic
disturbances can change a whole life of the child and his family
|
3
|
- F80 Specific developmental disorders of speech and language
- F81 Specific developmental disorders of scholastic skills
- F82 Specific developmental disorder of motor function
- F83 Mixed specific developmental disorders
- F84 Pervasive developmental disorders
- F88 Other disorders of psychological development
- F89 Unspecified disorder of psychological development
|
4
|
- F80 Specific developmental disorders of speech and language
- F80.0 Specific speech articulation disorder
- F80.1 Expressive language disorder
- F80.2 Receptive language disorder
- F80.3 Acquired aphasia with epilepsy (Landau-Kleffner)
- F80.8 Other developmental disorders of speech and language
- F80.9 Developmental disorder of speech and language, unspecified
|
5
|
- A specific developmental disorder in which the child's use of speech
sounds is below the appropriate level for its mental age, but in wh=
ich
there is a normal level of language skills.
- The articulation abnormalities are not caused by a neurological
abnormality and nonverbal intelligence is within normal range.
- Developmental:
- phonological disorder
- speech articulation disorder
- Dyslalia
- Functional speech articulation disorder
- Lalling
|
6
|
- A specific developmental disorder in which the child's ability to u=
se
expressive spoken language is markedly below the appropriate level =
for
its mental age, but in which language comprehension is within normal
limits.
- There may or may not be abnormalities in articulation.
- Developmental dysphasia or aphasia, expressive type
|
7
|
- A specific developmental disorder in which the child's understandin=
g of
language is below the appropriate level for its mental age, particu=
larly
in more subtle aspects of language - grammatical structures, tone of
voice.
- The social reciprocity and make- believe play is normal and severe
hearing disturbances are not present.
- Developmental:
- dysphasia or aphasia, receptive type
- Wernicke's aphasia
- Word deafness
|
8
|
- The child loses receptive and expressive language skills after prev=
ious
period of normal language development. The paroxysmal abnormalities=
on
the EEG are present and in the majority of cases epileptic seizures
occur as well.
- Some children become mute in a period of few months.
- Usually the onset is between the ages of three and seven years, with
skills being lost over days or weeks.
- An inflammatory encephalitic process has been suggested as a possib=
le
cause of this disorder.
- About two-thirds of patients are left with a more or less severe
receptive language deficit.
|
9
|
- Cooperation of neurologist and speech therapist is very important.<=
/li>
- Psychiatric treatment is necessary if the child has secondary psych=
ic
problems, for example in relationship with other children or family=
.
- Nootropic drugs, psychotherapy and special education are useful.
|
10
|
- F81 Specific developmental disorders of scholastic skills
- F81.0 Specific reading disorder
- F81.1 Specific spelling disorder
- F81.2 Specific disorder of arithmetical skills
- F81.3 Mixed disorder of scholastic skills
- F81.8 Other developmental disorders of scholastic skills
- F81.9 Developmental disorder of scholastic skills, unspecified
|
11
|
- The child’s reading performance is below his level of mental =
age.
Poor schooling, mental or visual impairment is not the cause of the
delay.
- The child has difficulties in reciting the alphabet, there are omis=
sions
of words, distortions of the content of the facts from material rea=
d and
rate of reading is very slow.
- Associated emotional and behavioural disturbances are common during=
the
school age period.
- "Backward reading"
- Developmental dyslexia
- Specific reading retardation
|
12
|
- Specific and significant impairment in the development of spelling
skills in the absence of a history of specific reading disorder, wh=
ich
is not solely accounted for by low mental age, visual acuity proble=
ms,
or inadequate schooling.
- The ability to spell orally and to write out words correctly are bo=
th
affected.
- Specific spelling retardation (without reading disorder)
|
13
|
- The arithmetical performance is significantly below the level of the
general intelligence, reading and spelling skills are within normal
rage.
- The deficit concerns mastery of basic computational skills of addit=
ion,
subtraction, multiplication, and division rather than of the more
abstract mathematical skills involved in algebra, trigonometry,
geometry, or calculus.
- Developmental:
- acalculia
- arithmetical disorder
- Gerstmann's syndrome
|
14
|
- The child can suffer from all previously described specific
developmental disorder of scholastic skills (both arithmetical and
reading or spelling skills are significantly impaired)
- Disorder is not solely explicable in terms of general mental retard=
ation
or of inadequate schooling
|
15
|
- Serious impairment in the development of motor coordination that is=
not
solely explicable in terms of general intellectual retardation or o=
f any
specific congenital or acquired neurological disorder
- The child is generally clumsy in fine and gross movements; there are
difficulties in learning to tie shoe laces, to run, to throw the ba=
lls.
Drawing skills are usually also poor
- In most cases - marked neurodevelopmental immaturities
- Clumsy child syndrome
- Developmental:
- coordination disorder
- dyspraxia
|
16
|
- The family and the school have to be properly informed about the
child’s disorder.
- Special educational training is necessary, nootropic drugs are usef=
ul.
- For children with coordination difficulties special physical educat=
ion
programs may be help to enhance the child’s self-esteem and
ability to interact with peers.
|
17
|
- F84 Pervasive developmental disorders
- F84.0 Childhood autism
- F84.1 Atypical autism
- F84.2 Rett's syndrome
- F84.3 Other childhood disintegrative disorder
- F84.4 Overactive disorder associated with mental retardation and
stereotyped movements
- F84.5 Asperger's syndrome
- F84.8 Other pervasive developmental disorders
- F84.9 Pervasive developmental disorder, unspecified
|
18
|
- Described by Kanner 1943 as infantile autisms
- Autisms are severe impairment of developmental disorder which prese=
nts
before age of 3 years. The abnormal functioning manifest in the are=
a of
social interaction, communication and repetitive behaviour
- There are typical features of clinical picture:
- Inability to relate
- Disorders in development of speech
- Cognitive abnormalities
- Stereotyped behaviour
|
19
|
- The cause of childhood autism is unknown, studies of twins suggest
genetic etiology
- The deficits continue through whole life; great impact on his abili=
ties
to socialize and communicate with other people
- 60-80% of autistic children are unable to lead independent life
- IQ level can be normal
- 30-40 cases per 100 000 children; more common in boys than in girls=
- Autistic disorder
- Infantile:
- autism
- psychosis
- Kanner's syndrome
|
20
|
- Specific treatment is unknown.
- Autistic children usually require special schooling or residential
schooling although attempts of integrations are also started.
- Special techniques for teaching autistic children and special
psychotherapeutic approaches were developed.
- Sometimes antipsychotic drugs and antidepressants are used to cope =
with
aggressive behaviour and depression.
|
21
|
- A type of pervasive developmental disorder that differs from childh=
ood
autism either in age of onset or in failing to fulfill all diagnost=
ic
criteria
- Abnormal and impaired development manifests after age 3 years or th=
ere
are impairments in communication and stereotyped behaviour is prese=
nt,
but emotional response to caregivers is not affected.
- Atypical autism is diagnosed often in profoundly retarded individua=
ls.
- Atypical childhood psychosis
- Mental retardation with autistic features
|
22
|
- The syndrome was described only in girls
- Normal early development is followed by partial or complete loss of
speech and of skills in locomotion and use of hands, together with
deceleration in head growth
- In most cases onset is between 7 and 24 months of age.
- Loss of purposive hand movements, hand-wringing stereotypies, and
hyperventilation
- Social interaction is poor in early childhood, but can develop late=
r
- Motor functioning is more affected in middle childhood, muscles are
hypotonic, kyphoscoliosis and rigid spasticity in the lower limbs o=
ccurs
in majority of cases
- Aggressive behaviour and self injury are rather rare, the antipsych=
otic
drugs for the control of challenging behaviour is not often needed.=
|
23
|
- Described by Asperger as autistic psychopathy in 1944.
- Characterized by the same kind of impairment of social activities a=
nd
stereotyped features of behaviour as is described in autistic child=
ren.
There is no delay of speech and cognitive development. The condition
occurs predominantly in boys (8:1)
- Often associated with marked clumsiness.
- There is a strong tendency for the abnormalities to persist into
adolescence and adult life.
- Psychotic episodes occasionally occur in early adult life.
- Autistic psychopathy
- Schizoid disorder of childhood
|
24
|
- These are very rare developmental disorders with a short period of
normal development before onset. The child looses his acquired skil=
ls
within few months.
- General loss of interest in the environment, stereotyped, repetitive
motor mannerisms, and autistic-like abnormalities in social interac=
tion
and communication.
- These children usually remain without speech and unable to lead
independent lives.
- Dementia infantilis
- Disintegrative psychosis
- Heller's syndrome
- Symbiotic psychosis
|
25
|
- F90 Hyperkinetic disorders
- F91 Conduct disorders
- F92 Mixed disorders of conduct and emotions
- F93 Emotional disorders with onset specific to childhood
- F94 Disorders of social functioning with onset specific to childhoo=
d and
adolescence
- F95 Tic disorders
- F98 Other behavioural and emotional disorders with onset usually
occurring in childhood and adolescence
|
26
|
- F90 Hyperkinetic disorders
- F90.0 Disturbance of activity and attention
- F90.1 Hyperkinetic conduct disorder
- F90.8 Other hyperkinetic disorders
- F90.9 Hyperkinetic disorder, unspecified
|
27
|
- Hyperkinetic disorders occur
mostly in first five years of life, and they are several times more
frequent in boys than in girls
- The main marks of the syndrome are:
- inattention
- impulsivity
- hyperactivity
- ADHD: Attention-Deficit Hyperactivity Disorder (formerly MBD: minim=
al
brain dysfunction)
- Prevalence is from 3% to 10% of elementary-school children
|
28
|
- Etiology: genetic predisposition, maternal deprivation, environment=
al
toxins or intrauterine or postnatal brain damage
- About 50% of children with hyperkinetic syndrome have so called
„soft signs” and minor abnormalities in EEG
- IQ: from subnormal to high intelligence
- Specific learning disabilities often coexist with hyperkinetic synd=
rome
- Types of hyperactivity syndrome:
- disturbance of activity and attention
- hyperkinetic conduct disorder
|
29
|
- Parents and teachers have to be advised how to cope with hyperactive
children
- Nootropic drugs and mild doses of antipsychotics are sometimes
prescribed.
- Stimulant drugs as methylphenidate sometimes have the paradoxical
effect, according to theory, that stimulants act by reducing the
excessive, poorly synchronized variability in the various dimension=
s of
arousal and reactivity seen in ADHD.
- Stimulants are the drugs of first choice
|
30
|
- F91 Conduct disorders
- F91.0 Conduct disorder confined to the family context
- F91.1 Unsocialized conduct disorder
- F91.2 Socialized conduct disorder
- F91.3 Oppositional defiant disorder
- F91.8 Other conduct disorders
- F91.9 Conduct disorder, unspecified
|
31
|
- The dissocial or aggressive behaviour is intent on family members a=
nd
occurs mostly at home or immediate household. Stealing from home and
destruction of beloved property of particular family members is typ=
ical.
Social relationships outside the family are within the normal range=
.
|
32
|
- Aggressive and dissocial behaviour is connected with the child̵=
7;s
poor relationships with other children and peers groups.
- There is a lack of close friends, rejection by other children,
unpopularity in the school and hostile feelings toward adults.
|
33
|
- The diagnosis is applied when the child is showing aggressive and
dissocial behaviour, but relationship with children of the same age=
is
adequate.
|
34
|
- Children under age of 9 to 10 years, showing persistently negativis=
tic,
provocative and disruptive behaviour.
- The more aggressive conduct disorders are not present, general law =
and
rights of other people are respected.
- This type of behaviour is often directed towards a new member of the
family - i.e. step father.
|
35
|
- Family situation should be consider and its relation to the
child’s disorder. The family therapy is necessary to enhance
emotional support and understanding.
- In the cases of dysfunctional families, abused or neglected childre=
n, an
adoptive homes, foster care or supervised residence is recommended.=
- Court intervention is required for the placement.
|
36
|
- A group of disorders characterized by the combination of persistent=
ly
aggressive, dissocial or defiant behaviour with overt and marked
symptoms of depression, anxiety or other emotional upsets
- Mood disorders in children are often expressed by a challenging
behaviour or somatic symptoms
- F92 Mixed disorders of co=
nduct
and emotions
- F92.0 Depressive cond=
uct
disorder
- F92.8 Other mixed dis=
orders
of conduct and emotions
- F92.9 Mixed disorder =
of
conduct and emotions, unspecified
|
37
|
- F93 Emotional disorders with onset specific to childhood
- F93.0 Separation anxiety disorder of childhood
- F93.1 Phobic anxiety disorder of childhood
- F93.2 Social anxiety disorder of childhood
- F93.3 Sibling rivalry disorder
- F93.8 Other childhood emotional disorders
- F93.9 Childhood emotional disorder, unspecified
|
38
|
- The child is showing anxiety when being separated from persons who =
are
for him emotionally important - parents, family members. Developmen=
tal
stage should be considered
- School refusal is often a symptom of separation anxiety disorders=
li>
- Treatment:
- in the case of school refusal the child should be returned to scho=
ol
immediately and strict limits should be established
- the treatment is focused on family structure and recommendation in=
the
ways of upbringing.
- in severe cases use of antidepressants is necessary
|
39
|
- The phobic states most commonly encountered in children involve fea=
r of
animals, insects, dark and school. Animal and insect phobias usually
start at the age of 5 years and almost none start in adult life. So=
me
phobias start in the late adolescence - i.e. agoraphobia
- Treatment:
- psychotherapy and a sensible parental handling is recommended
- the anxiety reducing techniques are useful, i.e. desensitization=
li>
|
40
|
- There is a wariness of strangers and social apprehension or anxiety=
when
encountering new, strange, or socially threatening situations. This
category should be used only where such fears arise during the early
years, and are both unusual in degree and accompanied by problems in
social functioning.
- A fear of social encounters is associated with avoidance behaviour,
which produces problems in functioning in a peers group and in the
school performance as well.
- The social acceptance of the child can be very difficult and can ha=
ve
impact on his or hers further personal development.
- Treatment:
- psychotherapy
- anxiolytic drugs
|
41
|
- Some degree of emotional disturbance usually following the birth of=
an
immediately younger sibling is shown by a majority of young childre=
n.
- Sibling rivalry disorder should be diagnosed only if the degree or
persistence of the disturbance is both statistically unusual and
associated with abnormalities of social interaction.
- The children with sibling rivalry disorder are acting with serious
hatred to the new born, in severe cases they are showing physical
harming behaviour and persistent competition to gain parents attent=
ion.
- Treatment:
- psychotherapy dealing with family structure
- prevention
|
42
|
|
43
|
- Characterized by a marked, emotionally determined selectivity in
speaking, such that the child demonstrates a language competence in=
some
situations but fails to speak in other (definable) situations
- These children show specific personality features as social anxiety=
and
oversensitivity.
- Treatment:
- psychotherapy
- in severe cases anxiolytic drugs
|
44
|
- Characterized by abnormal social responses of the child to the care
givers that develop before age of 5 years.
- The disorder is often an outcome of a parental neglect, abuse or
mishandling and deprivation in institutional care.
- The child shows fearfulness, poor social interaction with peers,
aggressive responses and self injurious behaviour.
- The language development could also be delayed and impaired physical
growth can occur.
- Treatment:
- avoidance of mishandling in institutional care
- good foster homes and adoption policy
- social vigilance to inept parenting
|
45
|
- Abnormal social functioning develops during first 5 years in childr=
en
who have no opportunity of emotionally stable relationship with care
givers. The disturbance can be recognized in children growing from
infancy in institutions or experiencing extremely frequent changes =
in
care givers.
- To avoid this developmental disturbance good adoption policy is
necessary. Non - attachment institutional care should be excluded f=
rom
praxis.
|
46
|
- A tic is an involuntary, rapid, recurrent, nonrhythmic motor moveme=
nt
(usually involving circumscribed muscle groups) or vocal production=
that
is of sudden onset and that serves no apparent purpose
- Tics are experienced as irresistible, but can be suppressed for sho=
rter
periods of time
- Conditions of diagnosis are also a lack of neurological disorder,
repetitiveness, disappearance during sleep, lack of rhythmicity, and
lack of purpose
|
47
|
- Simple motor tics: eye-blinking, neck-jerking, shoulder-shrugging,
facial grimacing
- Simple vocal tics: throat clearing, barking, sniffing, hissing
- Complex motor tics: jumping and hopping
- Complex vocal tics: repetition of particular words or sentences, and
sometimes the use of socially unacceptable (often obscene) words
(coprolalia), and the repetition of one's own sounds or words
(palilalia)
|
48
|
- F95 Tic disorders
- F95.0 Transient tic disorder
- F95.2 Combined vocal and multiple motor tic disorder (de la Tourett=
e)
- F95.8 Other tic disorders
- F95.9 Tic disorder, unspecified
|
49
|
- Sleep therapy
- Hypnotherapy
- Hydrotherapy
- Neurosurgery
- Shock therapy
- Antipsychotic drugs
- Antidepressants
- Nootropic drugs
- Behavioural and cognitive therapy
- Cooperation with the family is important.
|
50
|
- F98 Other behavioural and emotional disorders with onset usually
occurring in childhood and adolescence
- F98.0 Nonorganic enuresis
- F98.1 Nonorganic encopresis
- F98.2 Feeding disorder of infancy and childhood
- F98.3 Pica of infancy and childhood
- F98.4 Stereotyped movement disorders
- F98.5 Stuttering (stammering)
- F98.6 Cluttering
- F98.8 Other specified behavioural and emotional disorders with onset
usually occurring in
- F98.9 Unspecified behavioural and emotional disorders with onset us=
ually
occurring in childhood and adolescence
|
51
|
- The child is not able of voluntary bladder control during the day
(enuresis diurnal) or during the night (enuresis nocturnal)
- The enuresis may be present from birth (enuresis primaria), or it m=
ay
occur after a period of time of acquired bladder control (enuresis
secundaria)
- There is no neurological disorder or structural abnormality of urin=
ary
system, or lack of bladder control is not due to epileptic attacks =
or
cystitis or diabetic polyuria
- Enuresis is not diagnosed in a child less than 4 years of mental ag=
e
- Emotional problems may arise as a secondary consequence of enuresis=
|
52
|
- Mild restriction of fluids before bedtime
- Waking for the toilet during the night
- Rewarding success and not to focus attention on failure
- Antidepressants
|
53
|
- The diagnosis involves repeated intended or unintended passage of f=
aeces
in places not appropriate for that purpose.
- The etiology:
- result of inappropriate toilet training
- the child is able of bowel control, but because of different reaso=
ns is
refusing to defecate in appropriate places
- physiological problems or emotional problems
- Encopresis can be accompanied by smearing of faeces over the body or
environment or is a part of anal masturbation. It occurs in children
with emotional or behavioural disturbances or mentally retarded per=
sons.
|
54
|
- Psychotherapy
- to reward success
- the child is taught to establish more normal bowel habit, for exam=
ple
by sitting on the toilet regularly after the meals
- Anxiolytics or antidepressants
|
55
|
- Feeding disorder generally involves food refusal and extreme faddin=
ess
in the presence of an adequate food supply, a reasonably competent
caregiver, and the absence of organic disease.
- Can be associated with rumination (repeated regurgitation without
nausea)
- Occurs often in children in institutional care or mentally retarded=
|
56
|
- Persistent eating of non - nutritive substances (soil, wall paint)<=
/li>
- Common in mentally retarded children or very young children with no=
rmal
intelligence level
|
57
|
- Voluntary, repetitive, stereotyped, nonfunctional (and often rhythm=
ic)
movements that do not form part of any recognized psychiatric or
neurological condition.
- The non self-injurious movements:
- body-rocking
- head-rocking
- hair-plucking
- hair-twisting
- finger-flicking mannerisms
- hand-flapping
- Stereotyped self-injurious behaviour:
- repetitive head-banging
- face-slapping
- eye-poking
- biting of hands, lips or other body parts
- In mentally retarded children, or in some children with visual
impairment.
|
58
|
- Frequent repetition of prolongation of sounds or syllables or words=
- Could be transient phase in early childhood or persistent speech fa=
ilure
until adult life
|
59
|
- A rapid rate of speech with breakdown in fluency, but no repetition=
s or
hesitations, of a severity to give rise to diminished speech
intelligibility.
- Speech is erratic and dysrhythmic, with rapid jerky spurts that usu=
ally
involve faulty phrasing patterns
|
60
|
- Attention deficit disorder without hyperactivity
- Excessive masturbation
- Nail — biting
- Nose — picking
- Thumb — sucking
|
61
|
- Schizophrenic disorders with early onset in childhood occur, but th=
ey
are very rare and the prognosis is poor, because of influence on ps=
ychic
development. Treatment quite often includes antipsychotic drugs and
residential care
- Manic-depressive disorder is rare before puberty, but increases in
incidence during adolescence
- Treatment resembles that of adults, only electroconvulsive therapy =
is
not applied before adolescence
|
62
|
- The term child abuse is used to indicate physical abuse, sexual abu=
se,
or emotional abuse and child neglect.
- Child care after divorce:
- some parents are not able to reach consent about child care after
divorce period, so child psychiatrist is asked by the court to giv=
e an
advice on the best solution for the children
- after divorce disagreements are traumatic for the children and the
child psychiatrist’s statements should be very carefully
expressed, to protect the well being and future development of the
child
- the parental rights of both parents - mother and father should be
respected and protected
- cooperation with child psychologist and social workers is necessar=
y
|
63
|
|
64
|
|
65
|
|
66
|
|
67
|
|
68
|
|
69
|
|
70
|
|
71
|
|
72
|
|
73
|
|