Child

1
Child Adolescent Psychiatry in Primary Care

• A symptom-based overview

2
Epidemiology of Mental Health
3
Symptomatology

• 4 patterns
• Conduct Disorder
• Emotional Disorder
• Relationship Disorder
• Developmental Disorder
• plus specific illnesses which occupy one or more
  of these domains

4
Conduct Disorder

• Disorders characterised by a repetitive and
  persistent pattern of dissocial, aggressive or
  defiant conduct
• ICD-10

5
Conduct Disorder

• Often confined to family
• May be
• unsocialised (abnormal relationship with others)
• socialised (normal relationships e.g. with peers)
• Oppositional defiant
• Commonly mixed with Emotional Disorder

6
Conduct Disorder

• Management
• Family Therapy
• Social Support

7
Emotional Disorder

• Depression
• 10 of 10-yr-olds miserable (parents report)
• 40 of 14-yr-olds miserable (self-report)
• Anxiety
• Mania

8
Depression

• Childhood boys girls
• Adolescence boys ltlt girls
• Management
• Drug Rx?
• Therapy
• Family
• Cognitive (individual)
• School liaison

9
Anxiety

• Separation
• Phobic
• Generalised
• School Refusal

10
Phobias and all that.

• Agoraphobia F40.0
• Social phobias F40.1
• Simple phobia F40.2
• Obsessive-Compulsive Disorder F42
• Panic Disorder F41.0
• PTSD F43.1

11
OCD

• Obsessive Compulsive Disorder
• intrusive, repetitive thoughts
• anxiety-provoking
• ?abnormal 5HT transmission

12
Mania

• Very rare
• Commonly misdiagnosed
• hyperkinetic disorder (childhood)
• schizophrenia (adolescence)
• First Rank symptoms may be prominent

13
Relationship Disorder

• Sibling rivalry
• Elective mutism
• Attachment Disorders
• Reactive
• Disinhibited

14
Developmental Disorder

• Pervasive Developmental disorders
• Childhood Autism
• Retts Syndrome
• Aspergers Syndrome

15
Autism

• Genetically-influenced
• Neurodevelopmental impairment
• onset before 3 years
• Atypical variants
• later onset
• limited effect

16
Autism

• 3 Domains
• Communication
• Social interaction
• Repetitive behaviour

17
Aspergers Syndrome

• Problem areas
• Social interaction
• Restricted/Stereotyped interests
• Differs from Autism
• Normal cognitive language development
• Clumsiness
• tends to lead to depression later

18
Hyperkinetic Disorders (ADHD)

• Neurodevelopmental cause
• Early onset
• Boys gt Girls
• Show lack of persistence in activities requiring
  attention
• Move from one activity to another without
  completing

19
Attention Deficit Hyperactivity Disorder

• Common Presentations
• accident prone
• socially-dissociated relationships with adults
• aggressive
• disciplinary problems
• Associations
• below-average intelligence or mild handicap
• epilepsy
• minor motor difficulties

20
ADHD

• Management
• Behaviour modification
• Cerebral stimulants
• Methylphenidate (Ritalin)
• Tranylcypromine

21
Ritalin

• Amphetamine CNS stimulant
• Must be used under Specialist supervision
• Must be periodically withdrawn to verify still
  working
• Controlled (Sched 2 MDA) drug
• ADR weight loss etc

22
Substance Misuse

• Glue/Solvents
• Tobacco
• Alcohol
• Drug

23
Eating Disorders

• Anorexia Nervosa F50.0
• Deliberate weight loss resulting in a bodyweight
  more than 15 below the norm
• Bulimia Nervosa F50.2
• Repeated bouts of overeating and an excessive
  preoccupation with the control of bodyweight

24
Anorexia Nervosa

• Weight reduced by
• avoidance of food
• overactivity
• excessive exercise
• appetite suppressants
• laxatives/diuretics

25
Anorexia Nervosa complications
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Anorexia Nervosa management

• Aim to restore healthy weight and diet
• Gradual work towards patient accepting need
  responsibility for healthy weight
• Hospital admission?
• Behavioural therapy

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Bulimia Nervosa

• Differs from Anorexia
• Binge Eating
• Purging
• vomiting
• laxatives, diuretics
• Prevalence 0.5-1, peak age in 20s

28
Bulimia Nervosa

• Physical features
• salivary gland enlargement
• erosion of dental enamel
• calluses dorsum of hand (Russells sign)
• metabolic disturbances
• Management
• Behavioural therapy
• ?SSRI

29
Other specific disorders

• Obsessive Compulsive Disorder F42
• Sleep Disorders
• Trichotillomania
• Tic
• Enuresis
• Encopresis

30
Sleep Disorders

• Sleepwalking
• first ? of sleep
• low levels of awareness, reactivity, recall
• Sleep (Night) Terrors
• first ? of sleep
• terror, vocalisation, motility
• limited recall
• Nightmares
• Hypersomnia

31
Tic disorders

• Involuntary rapid, recurrent, non-rhythmic motor
  movements or vocal production
• Gilles de la Tourettes Syndrome
• multiple tics
• facial, limb
• compulsive utterances
• coprolalia
• Treatment

32
Enuresis

• What is normal?
• What investigations?
• What therapy
• Behavioural
• Drug

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Summary

• Most Childhood Mental Health problems are
  disorders of conduct or emotion
• Many represent wider problems within the family
• Family Therapy or Cognitive Behavioural Therapy
  more often successful, but take a great deal more
  time, than drug therapy