CHILDHOOD MENTAL DISORDERS

8/7/2019 CHILDHOOD MENTAL DISORDERS

1/30

CHILDHOOD

MENTALDISORDERS


2/30

Types of childhood mental disorder

Mental Retardation

Learning disorder

Motor skill disorder

Communication disorder

Disruptive behavior disorder

Feeding and eating disorder

Elimination disorder


3/30

Contd.

Tic disorder

Pervasive developmental disorder

Attention- deficit hyperactive disorder(ADHD)

Schizophrenia

BPAD

Anxiety disorder


4/30

Pervasive developmental disorder

Delay and deviance in the development of

social skills, language and communication

and behaviour repertoire. Idiosyncratic interests

Resist change

Inappropriate response to socialenvironment


5/30

Classification

Autistic disorder

Retts disorder

Aspergers disorder

Pervasive developmental disorder NOS


6/30

Autistic Disorder

Also known as early infantile autism, childhoodautism or Kanners autism

Characterised by marked abnormal developmentin social interaction & communication, andrestricted repertoire of activities & interests

First noticed by Henry Maudsley in 1867

Leo Kanner coined the term infantile autism in1943


7/30

Prevalence:

5 per 10,000 children (0.05%) 4-5 times more common in boys than in girls

High socioecnomic status

Etiology:

Not known

Emotionally unresponsive refrigeratormother


8/30

1. Psychodynamic & family factors:

Less affectionate family members

Parental rage and rejection

2. Biological factors:

Associated with conditions with neurologicallesions

h/o perinatal complications

Evidence of minor congenital physical anomalies

About 75% associated with mental retardation 4-32% have associated seizure

Abnormal CT and MRI findings and EEG records


9/30

3. Genetic factors:

2-4% of siblings of autistic children also affected

High concordance rate in monozygotic twins

4. Immunological factors:

Incompatibility between mother and fetus

5. Perinatal factors:

High incidence of various perinatal complications

6. Neuroanatomical factors:

MRI showing total brain volume


10/30

7. Biochemical factors:

plasma serotonin CSF HVA

5HIAA:HVA ratio leading to symtom

improvement


11/30

Diagnosis:

ICD-10: Childhood Autism

Abnormal and/or impaired development

evident before the age of 3yrs

Characteristic abnormal functioning in allthree area of social interaction,communication, and restricted, repetitivebehaviour


12/30

Clinical Features:

Physical Characters: Often attractive at 1st glance

Do not show lateralization

Abnormal dermatoglyphics (finger prints)

Behavioural Characteristics:

1. Qualitative impairment in social interaction- lack

of attachment towards parents, poor eye contact,extreme anxiety when routine is disrupted,

inability to make friends, lack of empathy


13/30

2. Disturbance of communication and language-difficulty in using language to communicate, non

verbal communication may also be impaired,pronoun reversal

3. Stereotyped behaviour- spontaneous exploratoryplay absent, activities of play often repetitive andmonotonous, stereotypies, mannerisms andgrimacing often present when alone

4. Instability of mood and affect

5. Impaired response to sensory stimuli


14/30

6. Associated behavioural symptoms- hyperkinesis,

aggression, temper tantrums, self injurious

behaviour, short attention span, insomnia,

feeding and eating problems, enuresis

7. Associated physical illness- URTI, GI problems,febrile seizures

8. Intellectual functioning- 75% have MR, excellent

rote memory and calculating abilities, hyperlexia


15/30

Differential Diagnosis:

Schizophrenia with childhood onset

MR with behavioural problem

Congenital deafness and severe hearing disorder

Mixed receptive- expressive language disorder

Course and Prognosis:

Generally a lifelong disorder with guardedprognosis

Best prognosis in those with IQ >70, usecommunicative language by age 5-7yrs

Better in supportive home


16/30

Treatment:

Goal:

Socially acceptable behaviour

odd behavioural symptoms

verbal and nonverbal communication

1. Behavioural Therapy

2. Language remediation and facilitatedcommunication

3. Parental counselling4. Psychopharmacology- valuable adjunctive

treatment to behavioural symptoms

Antipsychotics, SSRI, Lithium


17/30

Retts Disorder

Described by Andreas Rett in1965

Occurs in girls only

Development of several specific deficit following a

period of normal functioning during 1

st

5 monthsafter birth

At 6 months to 2yrs- develop progressive

encephalopathy

1) head growth between 5 & 48 months2) loss of previously acquired purposeful hand skill &

subsequent stereotypical hand movement


18/30

3) loss of social engagement early in the course

4) appearance of poorly coordinated gait or trunkmovement

5) expressive & receptive language deficits with

psychomotor retardation

Treatment:

Symptomatic

Anticonvulsant Behavior therapy

Physiotherapy for muscular dysfunction


19/30

Attention Deficit Hyperactivity

Disorder Consists of a persistent pattern of inattention

and/or hyperactive and impulsive behaviour that is

more severe than expected in children of that age

and level of development

Epidemiology:

Vary from 2-20%

Boys:Girls- 2-9:1


20/30

Etiology:

1. Genetic factors-

High concordance rate among monozygotic thandizygotic twins

High risk of siblings being affected

2. Developmental factors-

Born during September

Infection in the 1st trimester

Fetal and perinatal subtle CNS damage Soft neurological signs


21/30

3. Neurochemical factors-

Noradrenaline

adrenaline, dopamine

4. Neurophysiological factors-

Delay in sequence of brain development

Abnormal EEG and PET scan

5. Psychosocial factors-

Prolonged emotional deprivation

Stressful psychic events, disruption of familyequilibrium


22/30

Diagnosis:

Presence of impaired attention and overactivity

Evident in more than one situation

Should be of early onset (before 6yrs age) andlong duration

Clinical Features:

Impared attention- prematurely breaking off fromtask, leaving activities unfinished, change activities

frequently, doesnot seem to listen, avoids ordislikes tasks requiring sustained mental effort,forgetful and loses things frequently, easilydistracted


23/30

Overactivity- restlessness, running and jumpingaround, excessive talkativeness, noisiness,

fidgeting and wriggling

Impulsivity- blurts out answer before question iscompleted, difficulty awaiting turn, interrupts or

intrudes on others


Temperamental characteristic

Mania

Anxiety

Conduct disorder


24/30


Course is variable

Overactivity is usually the 1st symptom to remitand distractibility is the last

Remission usually occurs between 12-20 yrs

In 15-20% symptoms persist into adulthood

Persistance of symptoms may be predicted by-

Family hx of ADHD

Negative life eventsComorbidity


25/30

Treatment:

1. Pharmacotherapy- Stimulants- methyphenydate,

dextroamphetamine

Antidepressants- bupropion, venlafaxine

Atomoxetine Clonidine, guanfacine

2. Psychological intervention-

Behaviour therapy

Parental counselling and training


26/30

Enuresis

A disorder characterised by involuntary voiding of

urine by day and/or by night, which is abnormal in

relation to individuals mental age

Prevalence decreases with increasing age

Mental disorders present in about 20% of enureticchildren


27/30

Etiology:1. Physiological factors- major role in most cases

Difficulty in bladder control influenced byneuromuscular and cognitive development

2. Genetic factors-

75% have affected 1

st

degree relative Risk increases 7 times if father is enuretic

High cconcordance rate among monozygotictwins than dizygotic twins

3. Biological factors-

Anatomically normal but functionally smallbladder

ADH


28/30

4. Psychosocial factors-

Birth of sibling

Hospitalisation between 2-4yrs Start of school

Break up in family

Diagnosis: Atleast 5yrs age

Involuntary voiding of urine by day and/or bynight

not a consequence of a lack of bladder controldue to any neurological disorder, epilepticattacks, or any structural abnormality of theurinary tract


29/30


Genitourinary pathology- spina bifidaocculta, obstructive uropathy, cystitis

Diabetes mellitus, diabetes insipidus,seizure, drug intoxication


Usually self limited

Late onset usually associated with comorbidpsychiatric conditions


30/30

Treatment:

Rule out organic condition

Review appropriate toilet training

Star chart

Restricting fluid before bed and night liftingto toilet train the child

Behavioural therapy

PharmacotherapyImipramine

desmopressin

CHILDHOOD MENTAL DISORDERS

Documents

Transcript of CHILDHOOD MENTAL DISORDERS