Child psychiatric problems PPT

COMMON PSYCHIATRIC
DISORDERS IN CHILDREN
Presented By:
RITIKA SONI

DEFINITION
• These are the disorders
of psychological,
behavioural and
emotional development
disorders with onset
usually occurring in
childhood and
adolescence.

Historical Developments in Child
Psychiatry

CLASSIFICATION OF CHILD PSYCHIATRY
•Mental retardation
•Specific developmental
disorders
•Pervasive developmental
disorders
•Hyperkinetic disorders
•Behavioral disorders

MENTAL SUBNORMALITY
• Acc. to WHO, incomplete or insufficient
general development of the mental
capacities.
• It has two components:
 Metal deficiency and mental retardation
(intellectual disability).
• Mental deficiency / MR. : is failure in
intellectual development that is marked by
low intelligence or mental retardation and
that may result in an inability to function
competently in society.

• Mental retardation begins in childhood
or adolescence before the age of 18.
• In most cases, it persists throughout adulthood.
• MR is preferred term in both ICD-10 and DSM-1V.
• Generalized neurodevelopmental
disorder characterized by significantly
impaired intellectual and adaptive functioning.
• A diagnosis of mental retardation is made if an
individual has an intellectual functioning level well
below average and significant limitations in two or
more adaptive skill areas.

MENTAL RETARDATION
• Mental retardation is defined as
significantly sub average general
intellectual functioning, associated with
significant deficit or impairment in
adaptive functioning, which manifests
during the developmental period (before
18 yrs of age).
APA, 2000

MR:
• It is defined by an IQ score under 70 in
addition to deficits in two or more adaptive
behaviors that affect everyday, general
living.
A historical image of a person with
intellectual disability

Classification of mental retardation
by IQ:
MILD - 50-70*- educable
MODERATE- 35-50*-
trainable
SEVERE – 20-35*-
dependable
PROFOUND - <20- life
support

DEVELOPMENTAL
CHARACTERSTICS OF MR
• Ability to perform self-care activities Mild
• Cognitive/educational capabilities Moderate
• Social or communication capabilities Severe
• Psychomotor capabilities Profound

SIGNS AND SYMPTOMS
• Intellectual disability (ID) begins during childhood and
involves deficits in :
– mental abilities, social skills, and core activities of daily living (ADLs)
when compared to same-aged peers.
– There often are no physical signs of mild forms of ID, although there
may be characteristic physical traits when it is associated with a
genetic disorder (e.g., Down syndrome).
• The level of impairment ranges in severity for each person.
Some of the early signs can include:
– Delays in reaching or failure to achieve milestones in motor skills
development (sitting, crawling, walking)
– Slowness in learning to talk or continued difficulties with speech and
language skills after starting to talk

– Difficulty with self-help and self-care skills (e.g., getting
dressed, washing, and feeding themselves)
– Poor planning or problem solving abilities
– Behavioral and social problems
– Failure to grow intellectually or continued infant-like behavior
– Problems keeping up in school
– Failure to adapt or adjust to new situations
– Difficulty in understanding and following social rules

Oblique Palpebral Fissure Epicanthic Fold
Furrowed Tounge

ETIOLOGY
1. GENETIC: (5%)
a) CHROMOSOMAL ABNORMALITIES
• Disability is caused by
abnormal genes inherited from parents,
errors when genes combine, or other
reasons. The most prevalent genetic
conditions include :
– Down syndrome, (1 out of 700 births)
– Klinefelter syndrome,
– Fragile X syndrome (common among boys, 1out of
1000 births)
– & Turners syndrome

 INBORN ERRORS OF METABOLISM- involving amino
acids, lipids, carbohydrates .
 Phenylketonuria (.5-1% of all cases of MR)
 Niemann- Pick disease- sphingolipidoses (harmful quantities of fatty
substances or lipids , accumulate in spleen, liver,. Lungs, bone
marrow and brain).
 Glycogen storage disease
 SINGLE-GENE DISORDERS
 Tuberous sclerosis(autosomal dominant disorder)/Epiloia)- 1: 15,000
 Dystrophia myotonica
 CRANIAL ANOMALIES
 Microcephaly

 INFECTIONS : Rubella, syphilis,
toxoplasmosis etc.
 Prematurity
 Birth trauma
 Hypoxia
 IUGR
 Kernicterus
 Placental abnormalities
 Drugs during first trimester
c) ACQUIRED PHYSICAL DISORDERS
IN CHILDHOOD
(2-5%)
- Infections, encephalitis
- Cretinism( severe iodine
deficiency) , cerebral palsy
- Trauma, lead poisoning,
- Malnutrition

d) SOCIOCULTURE CAUSES:
(15%)
- Deprivation of sociocultural
stimulation
e) PSYCHIATRIC DISORDERS
(1-2%)
- Pervasive developmental disorders – infantile Autism
- Childhood onset schizophrenia

• HISTORY
• PHYSICAL EXAMINATION
• DETAILED NEUROLOGICAL
EXAMINATION
• MSE- ASSESSMENT OF ASSOCIATED
PSYCHIATRIC DISORDER

• PSYCHOLOGICAL TESTS: MEASURMENT OF
INTELLIGENCE
– STANFORD – BINET OR BINET KAMATH TEST
– WECHSLER INTELLIGENCE SCALE FOR CHILDREN FOR 6-16
YEARS OF AGE.
– BHATI’S BATTERY OF PERFORMANCE TEST FOR ADAPTIVE
FUNCTIONING:
– VINELAND SOCIAL MATURITY SCALE(VSMS)
– DENVER DEVELOPMENT SCREENING TEST(DDST)
• INVESTIGATIONS
– ROUTINE INVESTIGATIONS
– URINE TEST- PHENYLKETONURIA
– EEG-PRESENCE OF SEIZURES
– BLOOD LEVELS: INBORN ERROR
OF METABOLISM

-CHROSOMAL STUDIES:
AMNIOCENTESIS OR CHORIONIC
VILLUS BIOPSY
- CT, MRI SCAN OF BRAIN
•TFT & LFT - THYROID FUNCTION TEST,
LIVER FUNCTION TEST.

 Health promotion:
Improvement In Socio-economic
Condition
Good Perinatal Medical Care
Education regarding Misconception
about M.R.
Universal Immunization
Facilitating Research
Activities
Genetic counselling
PRIMARY PREVENTION

• Good antenatal care and encouraging
deliveries in hospitals under proper
supervision and care.
 SPECIFIC PROTECTION:
 Good parental, natal, postnatal care to the
pregnant mother at risk.
 Genetic counseling to at risk patients.
 Avoid childbirths in late stage of the
mother.
 Avoiding consanguine marriages.
 Avoiding marriages of mentally retarded.

SECONDARY PREVENTION
o Early detection and
treatment of preventable
disorders.
o Early detection of handicaps
o Early treatment of infections
(antibiotics) anomalies
(surgical correction).
o Early recognition of mental
retardation.

o Mental retardation should
be integrated with normal individuals in
society.
o Amniocentesis and medical termination
of pregnancy on medical grounds.
o Early detection of correctable disorder
o Prevent against abuse.

TERTIARY PREVENTION
1.Disability limitation:
oTreatment of physical and psychological
problems.
oInstitutionalization of severe mentally
retarded or those with psychological
problems.
oEducation (if educable)and training to
avoid handicap.
oPhysiotherapy to treat the associated
deficits.

o Behaviour modification using
• Positive and negative re-
Enforcement, institutionalization care,
Rehabilitation, legislation
o Parental counselling
Rehabilitation:

NURSING MANAGEMENT
1. Risk for injury related to altered physical mobility
or aggressive behavior.
Interventions:
1) Create a safe environment for the client
2) Ensure that small items are removed from
area where client will be ambulating and that
sharp items are out of reach.
3) Store items that client uses frequently with in
easy reach.
4) Pad side rails with the h/o seizures.
5) Prevent physical aggression & acting out
behavior by learning to recognize signs.

2. Self- care deficit related to altered physical
mobility or lack of maturity as evidenced
by not capable to complete the activities of
daily living, poor physical appearance.
Interventions:
a) Identify aspects of self care that may
be with in the clients capabilities.
b) Work on one aspect of self care at a
time.
c) Provide simple, concrete explanations.
d) Offer positive feedback for efforts.
e) When one aspect of self care has been
mastered to the best of the clients
ability, move on to another.
f) Encourage independence

3. Impaired verbal communication
related to developmental
alterations as evidenced by lack
of communication with others.
Interventions:
a) Maintain consistency of staff assignments
over time
b) Anticipate and fulfill client’s needs until
satisfactory communication patterns are
established.
c) Practice these communication skills
repeatedly.

4. Impaired social interaction related to
speech deficiencies or difficulty in
adhering to conventional social behavior
as evidenced by lack of contact with
others.
Intervention:
1. Remain with client during initial interactions with
others on the unit.
2. Explain to other clients the meaning behind some of
the client ‘s non-verbal gestures and signals.
3. Use simple language to explain to client which
behaviors are acceptable and which are not.
4. Reward for appropriate behavior
5. Aversive reinforcement for inappropriate behavior.

SPECIFIC DEVELOPMENTAL DISORDERS

SPECIFIC DEVELOPMENTAL
DISORDERS
• DEFINITION:
• SDD are characterised
by an inadequate
development in usually
one specific area of
functioning.

TYPES OF SPECIFIC
DEVELOPMENTAL DISORDERS
SPECIFIC READING
DISORDERS

SPECIFIC
DEVELOPMENTAL
DISORDER OF
SPEECH AND
LANGUAGE

SPECIFIC
DEVELOPMENTAL
DISORDER OF
MOTOR
FUNCTION

PERVASIVE DEVELOPMENTAL
DISORDER
• Pervasive developmental disorders (PDD) refers to a
group of disorders characterized by delays in the
development of socialization and communication
skills. Parents may note symptoms as early as infancy,
although the typical age of onset is before 3 years of age.

PERVASIVE DEVELOPMENTAL
DISORDER
INFANTILE AUTISM:

DEFINITION
• ASD: A group of disorders that are characterized
by impairment in several areas of development,
including social interaction skills and
interpersonal communication .
• Included in this category are autistic disorder,
Rett’s disorder, childhood disintegrative disorder,
Asperger’s disorder.

1. Rett syndrome
Also called: RTS, cerebroatrophic
hyperammonemia
• A rare genetic mutation affecting brain
development in girls.
• Despite being caused by a gene mutation, Rett syndrome is
rarely inherited.
• Infants seem healthy during their first six months, but over
time, rapidly lose coordination, speech and use of the
hands. Symptoms may then stabilize for years.
• There's no cure, but medication, physio- and speech
therapy and nutritional support help manage symptoms,
prevent complications and improve quality of life.

• Extremely rare
• Fewer than 5 thousand cases per year (India)
• Treatment can help, but this condition can't be
cured
• Requires a medical diagnosis
• Lab tests or imaging always required
•

2. Asperger syndrome
• A Neurodevelopment disorder affecting
ability to effectively socialize and
communicate.
• Asperger's syndrome is a condition on the
autism spectrum, with generally higher
functioning.
• People with this condition may be socially
awkward and have an all-absorbing
interest in specific topics.
• Communication training and behavioural
therapy can help people with the
syndrome learn to socialise more
successfully.

• Rare
• Fewer than 1 million cases per year (India)
• Chronic: can last for years or be lifelong
• Requires a medical diagnosis
• Lab tests or imaging rarely required

3. Childhood disintegrative disorder
• Childhood disintegrative disorder (CDD), also known
as Heller's syndrome and disintegrative psychosis,
dementia infantilis, is a rare condition characterized by
late onset of developmental delays—or severe and
sudden reversals—in language, social function, and motor
skills. Researchers have not been successful in finding a
cause for the disorder. CDD has some similarity to autism,
and is sometimes considered a low-functioning form of it.
• CDD is a rare condition, with only 1.7 cases per 100,000

4.AUTISTIC DISORDER
• Autistic disorder is characterized by a
withdrawal of the child in to the self and in
to a fantasy world of his or her own
creation.
• The child has markedly abnormal or
impaired development in social interaction
and communication.
• Activities and interests may be considered
somewhat bizarre.

Epidemiology
• According to autism and developmental
disabilities monitoring ( ADDM) network
determined the Prevalence of autism
spectrum disorders(ASDs) in the united
states to be about 9 per 1,000.
• Autistic disorder occur about four times
more often in boys than in girls.
• Onset of the disorder occurs before 3
years.
• Most of the cases it runs a chronic course,
with symptoms persisting in to adulthood.

FEATURES
Absent social smile
Lack of eye-to-eye contact
Lack of awareness of other’s
existence or feelings; treats
people as furniture.
Lack of attachment to parents
and absence of separation
anxiety.

No or abnormal social play; prefers
solitary games
Marked impairment in making
friends
Lack of imitative behaviour
Absence of fear in presence of danger

1. BIOLOGICAL FACTORS:
*GENETIC-
-parents who have more than one child
with autistic disorder
- both monozygotic and dizygotic twins
- several chromosomes-2,7,15,16,17.
2. PHYSIOLOGICAL FACTORS:
*MATERNAL RUBELLA(WHEN
ASSOCIATED WITH INFANTILE DEAFNESS
OR BLINDNESS)
ETIOLOGY

-women with asthma and
allergies
- ENCEPHALITIS
- MENINGITIS

3. NEUROLOGICAL FACTORS:
- Abnormalities in brain structure or function
Cerebellum, cerebral cortex, limbic system,
corpus callosum, basal ganglia, and brain
stem.
4.The role of neurotransmitters, such as
serotonin, dopamine, and epinephrine.

CLINICAL MANIFESTATION:
Lack of involvement with others
 Lack of verbal communication-non-verbal
communication like facial expression, or
gestures is often absent, socially
inappropriate.
Preoccupation with inanimate objects-
Tape, lamp,desk,building
Restricted activities and interests
(excessive fascination with objects-fan)

 Routine may become an obsession
,with minor alterations in routine
leading to marked distress.
 Stereotyped body movements ( hand
clapping, rocking) and verbalizations
(repetition of words or phrases) are
typical.
 Diet abnormalities includes eating only
a few specific foods or consuming an
excessive amount of fluids
 Behaviors that are self-injurious, such
as head banging or biting the hands or
arms, may be evident.

TREATMENT
- BEHAVIOR THERAPY
- PSYCHOTHERAPY:
- PHARMACOTHERAPY:
1. Resperidone
2. Aripiprazole
3. Haloperidol

NURSING MANAGEMENT
1.Risk for self -mutilation r/t Neurological
alterations.
Interventions:
a) Work with the child on one to one basis
b) Try to determine if the self- mutilative
behavior occurs in response to increasing
anxiety.
c) Try to intervene with diversion or
replacement activities.
d) Protect the child when self mutilative
behavior occurs. Devices such as-
helmet, padded hand mitts, or arm
covers.

2. Impaired social interaction r/to
inability to trust, neurological
alterations.
a) Assign a limited number of caregivers to
the child
b) Provide child with familiar objects, such
as familiar toys or a blanket.
c) Support child’s attempt to interact with
child
d) Give positive reinforcement for eye
contact with something acceptable to the
child(food, familiar objects)
e) Gradually replace with social
reinforcement (e.g. touch, smiling,
hugging).

3. Impaired verbal communication r/t
withdrawal in to self, inadequate sensory
stimulation , neurological alterations
• Maintain consistency in assignment of
caregivers.
• Anticipate and fulfill the child’s needs until
communication can be established.
• Seek clarification and validation
• Give positive reinforcement when eye
contact is used to convey non-verbal
expressions.

4. Disturbed personal identity r/t
inadequate sensory stimulation
,neurological alterations.
A) Assist child to recognize separateness
during self care activities, such as
dressing and feeding
B) Assist the child in learning to name own
body parts.
C) This can be facilitated by the use of
mirrors, drawing, and picture of the child.

CHILDHOOD SCHIZOPHRENIA
In childhood schizophrenia , children must evidence a
deterioration from a previous level of functioning ;a
blunt,flat,or inappropriate affect; a disturbance in
perception , a loss of ego boundaries or sense of self;
and a pronounced ambivalence and lack of goal-
directed activity, such as posturing or marked decrease
in reactivity.

• Child begin to
withdraw from the
external world.
• Disturbance in affect,
they display panic
reactions, temper
tantrum

- Demonstrates delusional behaviour or
false belief with no basis in fact.
- They may express fear that someone
will eat them.
- Child may report auditory illusions such
as” voices inside my head”.

- Bizarreness in
verbalizations.
- loose association
- Repetitive speech
- Inappropriate affect.

MANAGEMENT
 Frequent hospitalization.
 Counseling to the family
members
 safe environment
 Anticipate a routine for basic care.
 Antipsychotics-
:chlorpromazine(CPZ) can be used.
 Place in residential or day schools for individual
and group play therapy
 Behavior treatment

INTRODUCTION
• This is a syndrome first described by
Heinrich Hoff in 1854.
• It has been known by a variety of names
like
– Minimal brain dysfunction(MBD),
– Hyperkinetic syndrome,
– Strauss syndrome,
– Organic driveness and
– Minimal brain damage.
• .

This occur in about 3%of school age children
Males are more often affected
The onset occurs before the age of 7 years and a large variety of patients
exhibits symptoms by the 4th year of age.
(Acc to DSM-5: at least six symptoms of inattention and/or at least six
symptoms of hyperactivity and impulsivity. Symptoms must be severe enough
to interfere with functioning, must occur in at least two settings (ie, school and
home), and must have an age of onset before 12 years of age.)
When the symptoms continue for at least six months and
Symptoms must also create a real handicap in at least two areas of the
child’s life:
 in the classroom,
 the playground,
 at home,
 in the community, or
 in social settings.
- Diagnose the child with ADHD.

Epidemiology
• ADHD has a prevalence rate of ~7%–9%
of children and 2.5%–4% of adults, ADHD
is more common in males than females.
• and females with ADHD are more likely to
have problems primarily with inattention.
• Associated disorder:
Other conditions, such as learning
disabilities, anxiety disorder, conduct
disorder, depression, and substance
abuse, are common in people with ADHD.

HYPERACTIVITY
• Excessive psychomotor activity that may
be purposeful or aimless, accompanied by
physical movements and verbal utterances
that are usually more rapid than normal.
• Inattention and distractibility are common
with hyperactive behavior.

INATTENTION
• Means a person wanders off task, lacks
persistence, has difficulty sustaining focus,
and is disorganized.

IMPULSIVITY
• The trait of acting without reflection and
without thought to the consequences of
the behavior.
• An abrupt inclination to act on certain
behavioral urges.
• An impulsive person may be socially
intrusive(where one is not welcome) and
excessively interrupt others or make
important decisions without considering
the long-term consequences.

CLINICAL TYPES
• With hyperactivity, without hyperactivity, residual
types, with conduct disorder
1. ATTENTION DEFICIT DISORDER WITH
HYPERACTIVITY:
The characteristic features are:
A. Poor attention span with distractibility:
a) Fails to finish the things started
b) Shift from one uncompleted activity to another
c) Doesn't seem to listen
d) Easily distracted by external stimuli
e) Overlook or miss details, make careless mistakes
in schoolwork, at work, or during other activities
f) Avoid or dislike tasks that require sustained
mental effort, such as schoolwork or homework,
for teens and older adults, preparing reports,
completing forms or reviewing lengthy papers

B. HYPERACTIVITY:
a) Difficulty in sitting still at one place for long
b) Leave their seats in situations when staying seated is
expected, such as in the classroom or in the office
c) Moving about here and there
d) Talks excessively
e) Interference in others activity
f) Interrupt or intrude on others, for example in
conversations, games, or activities
C. IMPULSIVITY:
a) Acts before thinking, on the spur of the moment
b) Difficulty in waiting for turn at work or play

2. ATTENTION DEFICIT DISORDER
WITHOUT HYPERACTIVITY:
3. RESIDUAL TYPE
It is usually diagnosed in a patient in
adulthood, with a past history of ADD and
presence of a few residual features in
adult life
4. HYPERKINETIC DISORDER WITH
CONDUCT DISORDER (HYPERKINETIC
CONDUCT DISORDER)

ETIOLOGY
-MINIMAL BRAIN DAMAGE
-MATURATIONAL LAG
-GENETICS- CHROMOSOME -16
- NEUROTRANSMITTERS- ADHD patients have
variations on the transporter genes for these
neurotransmitters. (DOPAMINE,
NOREPINEPHRINE, SEROTONIN)
-ANATOMICAL INFLUENCES- PREFRONTAL
LOBES, BASAL GANGLIA , CEREBELLUM
ETC.
-EARLY DEVELOPMENTAL PSYCHODYNAMIC
FACTORS

• PRENATAL, PERINATAL, POSTNATAL
FACTORS:
- MATERNAL SMOKING, INTRAUTERINE
EXPOSURE TO TOXIC SUBSTANCES
LIKE ALCOHAL
- PERINATAL FACTORS LIKE
PREMATURITY, LBW BABY, SIGNS OF
FETAL DISTRESS, PRECIPITATED
LABOUR/PROLONGED ETC.
- POSTNATAL FACTORS LIKE
CEREBRAL PALSY, SEIZURES, AND
OTHER CNS ABNORMALITIES BY
TRAUMA INFECTIONS ETC.

• ENVIORNMENTAL FACTORS:
- ENVIORNMENTAL LEAD- ELEVATED
BODY LEAD (>10 ug /dl) MAY LEAD TO
COGNITIVE AND BEHAVIORAL
PROBLEMS DURING DEVELOPMENT IN
CHILDREN
- EXCESSIVE PAMPERING
• DIET FACTORS:
- FOOD DYES AND ADDITIVES LIKE
ARTIFICIAL FLAVOURING,
PRESEVATIVES.

DIAGNOSIS
• THE DIAGNOSIS CAN BE MADE ON
THE BASIS OF:
- TEACHER’S SCHOOL REPORT(OFTEN
MOST RELIABLE)
- PARENT’S REPORT
- CLINICAL EXAMINATION

• BEHAVIOUR MODIFICATION - involve practical
assistance, such as help organizing tasks or completing schoolwork, or
working through emotionally difficult events. Behavioral therapy also
teaches a person how to:
– monitor his or her own behavior
– give oneself praise or rewards for acting in a desired way, such as
controlling anger or thinking before acting
- Positive or negative feedback for certain behaviors
- Therapists may also teach children social skills, such as how to wait
their turn, share toys, ask for help, or respond to teasing.
- Learning to read facial expressions and the tone of voice in others, and
how to respond appropriately
- Cognitive behavioral therapy can also teach a person mindfulness
techniques, or meditation.
TREATMENT

• FAMILY AND MARITAL THERAPY-
can help family members and spouses find
better ways to handle disruptive behaviors,
to encourage behavior changes, and
improve interactions with the patient.
• COUNSELLING AND SUPPORTIVE
PSYCHOTHERAPY

Education and Training
• Parenting skills training (behavioral
parent management training)- rewards
and consequences to change a child’s
behavior
• Stress management techniques- ability
to deal with frustration
• Support groups - can help parents and
families connect with others who have
similar problems and concerns.

PHARMACOTHERAPY
a) STIMULANT MEDICATION:
- Dextro-amphetamine (10-40
mg/day) and methylphenidate (10-
60 mg/day)
- ATOMOXETINE
(PATIENTS NOT RESPONDING
TO STIMULANTS)

Non-stimulants
• These medications take longer to start
working than stimulants, but can also
improve focus, attention, and impulsivity in
a person with ADHD.
• Doctors may prescribe a non-stimulant:
when a person has bothersome side
effects from stimulants;
• when a stimulant was not effective;
• Acc to FDA: some antidepressants are
sometimes used alone or in combination
with a stimulant to treat ADHD.
• OTHERS:
• Buspiron /Buspur

DISRUPTIVE BEHAVIOR
DISORDER (DBD)
• A disturbance of conduct severe
enough to produce significant
impairment in social, occupational, or
academic functioning because of
symptoms that range from oppositional
defiant to moderate and severe
conduct disturbances

CONDUCT DISORDER
• With conduct disorder, there is a
repetitive and persistent pattern of
behavior in which the basic rights of
others or major age-appropriate
societal norms or rules are violated/not
followed by individuals.

Characteristic features:
• Frequent lying
• Stealing or robbery
• Running away from home and school
• Physical violence like rape, fire setting,
assault or breaking-in, use of weapons.
• Cruelty towards other people and animals.
• Physical aggression is common.
• Low self esteem
• Poor frustration tolerance, irritability,
frequent temper out bursts
• Poor academic performance
• Symptoms of ADHD

According to DSM-IV
• DIVIDES THIS DISORDER IN TO TWO
SUBTYPES:
1. Childhood onset type: this subtype is
defined by the onset of at least one
criterion characteristic of conduct disorder
prior to age 10.
• Usually boys
• Physical aggression, disturbed peer
relationships
• In childhood they have ODD and in
adulthood develops antisocial
personality disorder.

2. Adolescent- onset type:
Less likely to display aggressive behavior,
may show behavioral changes, antisocial
personality disorder.

Secondary complications are:
• Drug abuse and dependence
• Syphilis
• AIDS
• Criminal record
• Suicidal behavior

Predisposing factors
• Biological influences:
a) Genetics –chromosome-2
b) Temperament
• Biochemical factor: nor epinephrine,
serotonin
a) One study revealed that elevated
testosterone in pubertal boys with deviant
peers
• Psychosocial factors: poor peer relation,
aggression may cause peer rejection
• Family influences: parental rejection,
harsh discipline, large family size,
frequent shifting of parents, parents with
antisocial personality disorder, marital
conflict, inadequate communication

MANAGEMENT
• Treatment is usually difficult.
• Most frequent mode of management is
placement in a corrective institution.
• Behavioral, educational, and
psychotherapeutic measures are usually
employed for behavior modification.
• Hyperactivity/ Inattention -stimulants
• Impulse control disorder, episodic
aggressive behavior- lithium,
carbamazepines and psychotic symptoms-
antipsychotics.

NSG CARE PLAN
• Risk for other directed violence related to
characteristic of temprament,peer
rejection, -ve parental role models,
dysfxnal family dynamics
• Impaired social interaction related to -ve
parental role models, impaired peer
relations as evidenced by inappropriate
social behavior
• Low self-esteem related to lack of positive
feedback and unsatisfactory parent/child
relationship.

OPPOSITIONAL DEFIANT
DISORDER(ODD)
• It is characterized by a pattern of
negativistic, defiant, disobedient, and
hostile behavior toward authority figures
that occurs more frequently and interferes
with social, academic or occupational
functioning .
• More prevalent in boys than in girls before
puberty.

Predisposing factors
• Biological influences
- Genetics
- Temperament
- Or biochemical alterations :–dopamine,
serotonin, nor epinephrine.
• Family influences: Parental problems in
discipline, structuring and limit setting.
• Identification by the child with an impulse
disordered parent who sets a role model
for oppositional defiant interactions
• Parental unavailability (e.g. : separation,
evening work hours)

• Management:
• Assessment:
- Passive aggressive behavior such as
stubborn, procrastination(action of
delaying or postpone something),
disobedience, , carelessness, negativism,
deliberately ignoring the communication of
others and unwillingness to compromise.
- Other symptoms that may be evident are
running away, school avoidance, school
underachievement, temper tantrums,
fighting, argumentativeness.

SEPARATION ANXIETY
DISORDER
• The essential feature of separation anxiety
disorder is excessive anxiety concerning
separation from the home those to whom
the person is attached.
• interferes with social, academic,
occupational or other areas of functioning.
• Onset may occur anytime before age 18
years, most commonly diagnosed around
age 5 or 6, when the child goes to school.

Predisposing factors:
• Biological influences:
- Genetics
• Temperament: -irritable as infant,
unusually shy, and fearful as a toddler,
and quite, & withdrawal in the preschool
and early school age years with marked
behavioral restraint and physiological
arousal in unfamiliar situations.
• Environmental influences:
- Stressful life events
- Family influences : over attachment to
mother, overprotection , transfer of anxiety
through role modeling.

General management
• Behavior therapy
• Family therapy
• Group therapy
• Play therapy
• Psychopharmacology- Antianxiety drugs.

NSG CARE PLAN
• Anxiety related to family history,
temperament, over attachment to parents,
negative role modeling.
• Ineffective coping related to unresolved
separation conflicts &inadequate coping
skills.
• Impaired social interaction related to
reluctance to be away from attachment
figures.

Treatment
• Psychotherapy and training
• Bladder-strengthening
exercises
• Using an electric alarm
(buzzer) device
• Drugs
Imipramine hydrochloride,
0.9-1.5mg/kg/ day
Anticholinergic agent,
oxybutinin,10-20 mg/ day

– It is a chronic type of tics
disorder typically characterized
by :
Multiple motor tics
Multiple vocal tics
Duration more than 1 year
Onset usually before 11 year of
age and almost always
– before 21 years

MULTIPLE MOTOR TICS
Simple
It may include eye-blinking, grimacing,
shrugging of shoulders, tongue
protrusion
Complex:
These are facial gestures
jumping ,hitting self,
squatting etc

MULTIPLE VOCAL TICS
Simple:
It includes barking, throat
clearing, sniffing etc
Complex:
Obsessions and compulsions are often
the associated symtoms.

Child psychiatric problems PPT

Child psychiatric problems PPT

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Child psychiatric problems PPT